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:

Black Women Find Healing (But Sometimes Racism, Too) in the Outdoors

It would be the last hike of the season, Jessica Newton had excitedly posted on her social media platforms. With mild weather forecast and Colorado’s breathtaking fall foliage as a backdrop, she was convinced an excursion at Beaver Ranch Park would be the quintessential way to close out months of warm-weather hikes with her “sister friends.”


This story also ran on NPR. It can be republished for free.

Still, when that Sunday morning in 2018 arrived, she was shocked when her usual crew of about 15 had mushroomed into about 70 Black women. There’s a first time for everything, she thought as they broke into smaller groups and headed toward the nature trail. What a sight they were, she recalled, as the women — in sneakers and hiking boots, a virtual sea of colorful headwraps, flowy braids and dreadlocks, poufy twists and long, flowy locks — trekked peacefully across the craggy terrain in the crisp mountain air.

It. Was. Perfect. Exactly what Newton had envisioned when in 2017 she founded Black Girls Hike to connect with other Black women who share her affinity for outdoor activities. She also wanted to recruit others who had yet to experience the serenity of nature, a pastime she fell for as a child attending an affluent, predominately white private school.

But their peaceful exploration of nature and casual chatter — about everything from food and family to hair care and child care — was abruptly interrupted, she said, by the ugly face of racism.

“We had the sheriff called on us, park rangers called on us,” recalled Newton, now 37, who owns a construction industry project development firm in Denver.

“This lady who was horseback riding was upset that we were hiking on her trail. She said that we’d spooked her horse,” she said of a woman in a group of white horseback riders they encountered. “It just didn’t make any sense. I felt like, it’s a horse and you have an entire mountain that you can trot through, run through, gallop through or whatever. She was just upset that we were in her space.”

Eventually, two Jefferson County sheriff’s deputies, with guns on their hips, approached, asking, “What’s going on here?” They had been contacted by rangers who’d received complaints about a large group of Black women being followed by camera drones in the park; the drones belonged to a national television news crew shooting a feature on the group. (The segment aired weeks later, but footage of the confrontation wasn’t included.)

“‘Move that mob!’” attendee Portia Prescott recalled one of the horseback riders barking.

“Why is it that a group of Black women hiking on a trail on a Sunday afternoon in Colorado is considered a ‘mob?’” Prescott asked.

A man soon arrived who identified himself as the husband of one of the white women on horseback and the manager of the park, according to the Jefferson County Sheriff’s Office incident report, and began arguing with the television producers in what one deputy described in the report as a “hostile” manner.

The leader of the horseback tour told the deputies that noise from the large group and the drones startled the horses and that when she complained to the news crew, they told her to deal with it herself, the report said. The news crew told deputies that the group members felt insulted by the horseback riders use of the term “mob.” The woman leading the horseback riders, identified in the incident report as Marie Elliott, said that she did not remember calling the group a mob, but she told the officers she “would have said the same thing if the group had been a large group of Girl Scouts.”

In the end, Newton and her fellow hikers were warned for failing to secure a permit for the group. Newton said she regrets putting members in a distressing — and potentially life-threatening — situation by unknowingly breaking a park rule. However, she suspects that a similarly sized hiking group of white women would not have been confronted so aggressively.

“You should be excited that we are bringing more people to use your parks,” added Newton. “Instead, we got slammed with [threats of] violations and ‘Who are you?’ and ‘Please, get your people and get out of here.’ It’s just crazy.”

Mike Taplin, spokesperson for the Jefferson County Sheriff’s Office, confirmed that no citations were issued. The deputies “positively engaged with everyone, with the goal of preserving the peace,” he said.

Newton said the “frustrating” incident has reminded her why her group, which she has revamped and renamed Vibe Tribe Adventures, is so needed in the white-dominated outdoor enthusiasts’ arena.

With the tagline “Find your tribe,” the group aims to create a sisterhood for Black women “on the trails, on waterways and in our local communities across the globe.” Last summer, she secured nonprofit status and expanded Vibe Tribe’s focus, adding snowshoeing, fly-fishing, zip lining and kayaking to its roster. Today, the Denver-based group has 11 chapters across the U.S. (even Guam) and Canada, with about 2,100 members.

Research suggests her work is needed. The most recent National Park Service survey found that 6% of visitors are Black, compared with 77% white. Newton said that must change — especially given the opportunities parks provide and the health challenges that disproportionately plague Black women. Research shows they experience higher rates of chronic preventable health conditions, including diabetes, hypertension and cardiovascular disease. A 2020 study found that racial discrimination also may increase stress, lead to health problems and reduce cognitive functioning in Black women. Newton said it underscores the need for stress-relieving activities.

“It’s been studied at several colleges that if you are outdoors for at least five minutes, it literally brings your stress level down significantly,” said Newton. “Being around nature, it’s like grounding yourself. That is vital.”

Newton said participation in the group generally tapers off in winter. She is hopeful, though, that cabin fever from the pandemic will inspire more Black women to try winter activities.

Atlanta member Stormy Bradley, 49, said the group has added value to her life. “I am a happier and healthier person because I get to do what I love,” said the sixth grade teacher. “The most surprising thing is the sisterhood we experience on and off the trails.”

Patricia Cameron, a Black woman living in Colorado Springs, drew headlines this summer when she hiked 486 miles — from Denver to Durango — and blogged about her experience to draw attention to diversity in the outdoors. She founded the Colorado nonprofit Blackpackers in 2019.

“One thing I caught people saying a lot of is ‘Well, nature is free’ and ‘Nature isn’t racist’ — and there’s two things wrong with that,” said Cameron, a 37-year-old single mother of a preteen.

“Nature and outside can be free, yes, but what about transportation? How do you get to certain outdoor environments? Do you have the gear to enjoy the outdoors, especially in Colorado, where we’re very gear-conscious and very label-conscious?” she asked. “Nature isn’t going to call me the N-word, but the people outside might.”

Cameron applauds Newton’s efforts and those of other groups nationwide, like Nature Gurlz, Outdoor Afro, Diversify Outdoors, Black Outdoors, Soul Trak Outdoors, Melanin Base Camp and Black Girls Run, that have a similar mission. Cameron said it also was encouraging that the Outdoor Industry Association, a trade group, pledged in the wake of the racial unrest sparked by George Floyd’s death to help address a “long history of systemic racism and injustice” in the outdoors.

Efforts to draw more Black people, especially women, outdoors, Cameron said, must include addressing barriers, like cost. For example, Blackpackers provides a “gear locker” to help members use pricey outdoor gear free or at discounted rates. She has also partnered with businesses and organizations that subsidize and sponsor outdoor excursions. During the pandemic, Vibe Tribe has waived all membership fees through this month.

Cameron said she dreams of a day when Black people are free from the pressures of carrying the nation’s racial baggage when participating in outdoor activities.

Vibe Tribe member and longtime outdoor enthusiast Jan Garduno, 52, of Aurora, Colorado, agreed that fear and safety are pressing concerns. For example, leading up to the presidential election she changed out of her “Let My People Vote” T-shirt before heading out on a solo walk for fear of how other hikers might react.

Groups like Vibe Tribe, she said, provide camaraderie and an increased sense of safety. And another plus? The health benefits can also be transformative.

“I’ve been able to lose about 40 pounds and I’ve kept it off,” explained Garduno.

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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This story can be republished for free (details).

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:

Retiree Living the RV Dream Fights $12,387 Nightmare Lab Fee

Lorraine Rogge and her husband, Michael Rogge, travel the country in a recreational vehicle, a well-earned adventure in retirement. This spring found them parked in Artesia, New Mexico, for several months.


This story also ran on NPR. It can be republished for free.

In May, Rogge, 60, began to feel pelvic pain and cramping. But she had had a total hysterectomy in 2006, so the pain seemed unusual, especially because it lasted for days. She looked for a local gynecologist and found one who took her insurance at the Carlsbad Medical Center in Carlsbad, New Mexico, about a 20-mile drive from the RV lot.

The doctor asked if Rogge was sexually active, and she responded yes and that she had been married to Michael for 26 years. Rogge felt she made it clear that she is in a monogamous relationship. The doctor then did a gynecological examination and took a vaginal swab sample for laboratory testing.

The only lab test Rogge remembered discussing with the doctor was to see whether she had a yeast infection. She wasn’t given any medication to treat the pelvic pain and eventually it disappeared after a few days.

Then the bill came.

The Patient: Lorraine Rogge, 60. Her insurance coverage was an Anthem Blue Cross retiree plan through her husband’s former employer, with a deductible of $2,000 and out-of-pocket maximum of $6,750 for in-network providers.

Total Bill: Carlsbad Medical Center billed $12,386.93 to Anthem Blue Cross for a vaginosis, vaginitis and sexually transmitted infections (STI) testing panel. The insurer paid $4,161.58 on a negotiated rate of $7,172.05. That left Rogge responsible for $1,970 of her deductible and $1,040.36 coinsurance. Her total owed for the lab bill was $3,010.47. Rogge also paid $93.85 for the visit to the doctor.

Service Provider: Carlsbad Medical Center in Carlsbad, New Mexico. It is owned by Community Health Systems, a large for-profit chain of hospital systems based in Franklin, Tennessee, outside Nashville. The doctor Rogge saw works for Carlsbad Medical Center and its lab processed her test.

Medical Service: A bundled testing panel that looked for bacterial and yeast infections as well as common STIs, including chlamydia, gonorrhea and trichomoniasis.

What Gives: There were two things Rogge didn’t know as she sought care. First, Carlsbad Medical Center is notorious for its high prices and aggressive billing practices and, second, she wasn’t aware she would be tested for a wide range of sexually transmitted infections.

The latter bothered her a lot since she has been sexually active only with her husband. She doesn’t remember being advised about the STI testing at all. Nor was she questioned about whether she or her husband might have been sexually active with other people, which could have justified broader testing. They have been on the road together for five years.

“I was incensed that they ran these tests, when they just said they were going to run a yeast infection test,” said Rogge. “They ran all these tests that one would run on a very young person who had a lot of boyfriends, not a 60-year-old grandmother that’s been married for 26 years.”

Although a doctor doesn’t need a patient’s authorization to run tests, it’s not good practice to do so without informing the patient, said Dr. Ina Park, an associate professor of family community medicine at the University of California-San Francisco School of Medicine. That is particularly true with tests of a sensitive nature, like STIs. It is doubly true when the tests are going to costs thousands of dollars.

Park, an expert in sexually transmitted infections, also questioned the necessity of the full panel of tests for a patient who had a hysterectomy.

Beyond that, the pricing for these tests was extremely high. “It should not cost $12,000 to get an evaluation for vaginitis,” said Park.

Charles Root, an expert in lab billing, agreed.

“Quite frankly, the retail prices on [the bill] are ridiculous, they make no sense at all,” said Root. “Those are tests that cost about $10 to run.”

In fall 2019, The New York Times and CNN investigated Carlsbad Medical Center and found the facility had taken thousands of patients to court for unpaid hospital bills. Carlsbad Medical Center also has higher prices than many other facilities — a 2019 Rand Corp. study found that private insurance companies paid Carlsbad Medical Center 505% of what Medicare would pay for the same procedures.

The bundled testing panel run on Rogge’s sample was a Quest Diagnostics SureSwab Vaginosis Panel Plus. It included six types of tests. Quest Diagnostics didn’t provide the cost for the bundled tests, but Kim Gorode, a company spokesperson, said if the tests had been ordered directly through Quest rather than through the hospital, it was likely “the patient responsibility would have been substantially less.”

According to Medicare’s Clinical Laboratory Fee Schedule, Medicare would have reimbursed labs only about $40 for each test run on Rogge’s sample. And Medicaid would reimburse hospitals in New Mexico similarly, according to figures provided by Russell Toal, superintendent of New Mexico’s insurance department.

But hospitals and clinics can — and do — add substantial markups to clinical tests sent out to commercial labs.

Although private health insurance doesn’t typically reimburse hospitals at Medicare or Medicaid rates, Root said, private insurance reimbursement rates are rarely much more than 200% to 300% of Medicare’s rates. Assuming a 300% reimbursement rate, the total private insurance would have reimbursed for the six tests would have been $720.

That $720 is less than what Carlsbad Medical Center charged Rogge for her chlamydia test alone: $1,045. And for several of the tests, the medical center charged multiple quantities — presumably corresponding to how many species were tested for — elevating the cost of the yeast infection test to over $4,000.

Toal, who reviewed Rogge’s bill, called the prices “outrageous.”

Resolution: Rogge contacted Anthem Blue Cross and talked to a customer service representative, who submitted a fraud-and-waste claim and an appeal contending the charges were excessive.

The appeal was denied. Anthem Blue Cross told Rogge that under her plan the insurance company had paid the amount it was responsible for, and that based on her deductible and coinsurance amounts, she was responsible for the remainder.

Anthem Blue Cross said in a statement to KHN all the tests run on Rogge were approved and “paid for in accordance with Anthem’s pre-determined contracted rate with Carlsbad Medical Center.”

By the time Rogge’s appeal was denied, she had researched Carlsbad Medical Center and read the stories of patients being brought to court for medical bills they couldn’t pay. She had also gotten a notice from the hospital that her account would be sent to a collection agency if she didn’t pay the $3,000 balance.

Fearing the possibility of getting sued or ruining her credit, Rogge agreed to a plan to pay the bill over three years. She made three payments of $83.63 each in September, October and November, totaling $250.89.

After a Nov. 18 call and email from KHN, Carlsbad Medical Center called Rogge on Nov. 20 and said the remainder of her account balance would be waived.

Rogge was thrilled. We “aren’t the kind of people who have payment plans hanging over our heads,” she said, adding: “This is a relief.”

“I’m going to go on a bike ride now” to celebrate, she said.

The Takeaway: Particularly when visiting a doctor with whom you don’t have a long-standing trusted relationship, don’t be afraid to ask: How much is this test going to cost? Also ask for what, exactly, are you being tested? Do not be comforted by the facility’s in-network status. With coinsurance and deductibles, you can still be out a lot.

If it’s a blood test that will be sent out to a commercial lab like Quest Diagnostics anyway, ask the physician to just give you a requisition to have the blood drawn at the commercial lab. That way you avoid the markup. This advice is obviously not possible for a vaginal swab gathered in a doctor’s office.

Patients should always fight bills they believe are excessively high and escalate the matter if necessary.

Rogge started with her insurer and the provider, as should most patients with a billing question. But, as she learned: In American medicine, what’s legal and in accordance with an insurance contract can seem logically absurd. Still, if you get no satisfaction from your initial inquiries, be aware of options for taking your complaints further.

Every state and U.S. territory has a department that regulates the insurance industry. In New Mexico, that’s the Office of the Superintendent of Insurance. Consumers can look up their state’s department on the National Association of Insurance Commissioners website.

Toal, the insurance superintendent in New Mexico, said his office doesn’t (and no office in the state does that he’s aware of) have the authority to tell a hospital its prices are too high. But he can look into a bill like Rogge’s if a complaint is filed with his office.

“If the patient wants, they can request an independent review, so the bill would go to an independent organization that could see if it was medically necessary,” Toal said.

That wasn’t needed in this case because Rogge’s bill was waived. And after being contacted by KHN, Melissa Suggs, a spokesperson with Carlsbad Medical Center, said the facility is revising their lab charges.

“Pricing for these services will be lower in the future,” Suggs said in a statement.

Bill of the Month is a crowdsourced investigation by KHN and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

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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Readers and Tweeters Defend Front-Line Nurses and Blind Us With Science

Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.

The demand for skilled nurses during the pandemic is through the roof! Travel nurses command a hefty salary and they are worth every penny… #COVID19 #pandemic #RN https://t.co/gYQpkHqaoX

— Talmage Egan, MD (@UofU_Anes_Chair) November 26, 2020

— Dr. Talmage Egan, Salt Lake City

Nurses Deserve to Be Paid Handsomely

I read your article “Need a COVID-19 Nurse? That’ll Be $8,000 a Week” (Nov. 24) in the Springfield Journal-Register. It was an interesting article as I have a daughter who is a nurse. Nurses have been underpaid and unappreciated for years. It made me angry that the article characterized the wages some hospitals are willing to pay for nurses as exorbitant. Hogwash if you think someone should risk their life every hour of the day to care for COVID patients without proper compensation. How many doctors make over a million a year? You don’t cite that as unusual. I feel that nurses should go for the gold as they have been taken advantage of for years and, too bad, but good for them. Choose your words more carefully in the future. Nurses ROCK!!!!

— Mike Booher, Lincoln, Illinois

Hospitals go out of their way to avoid competing for nursing labor by raising wages. Now hospital executives and public health advocates act like it’s a travesty that COVID nurses are finally getting paid market rates to take on risky jobs. https://t.co/6z0idToVn6

— Devon M. Herrick (@DevonHerrick) November 24, 2020

— Devon M. Herrick, Dallas

Missing in the Mix of Vaccine Coverage

I must note two important omissions in the article “Time to Discuss Potentially Unpleasant Side Effects of COVID Shots? Scientists Say Yes” (Nov. 12). First, although these were interim trial results, the placebo arm should also have been reported out. What was the placebo infection rate? Reporting 90% effectiveness is irrelevant without reporting the placebo rate simultaneously. And one needs to align the infection rate in trial subjects with the incidence of disease in the U.S. population. They should be similar, but if not, any discrepancy must be explained (such as, no elderly people or children participating in the trial). Secondly, and perhaps more important: What other mitigating measures were volunteers in this trial required/advised to take? For example, physical distancing, masks, etc. I could find no mention of this, positively or negatively, when reading the protocol on clinicaltrials.gov. Any vaccine alone could not provide 94.5% efficacy. To determine the relative contributions of other measures, you’d need, say, a four-arm study — placebo with mask, placebo without mask, vaccine with mask, vaccine without mask. Statistically and clinically, one must account for other variables that may confound an apparent result.

This is a crucial point as the lay public is thinking that, by getting the vaccine, masks might no longer be necessary and they’ll have a 95% chance of not being infected. This is rubbish. The media and the public “experts” need to address this as they are setting themselves up for an immense PR failure and still greater skepticism. People may need to wear masks for many more months, maybe years, even with an effective vaccine.

— Stephen Zaruby, Truckee, California

I’m already confused 😕 https://t.co/UlJPh2EEvK

— hameen tariq (@hameentariq) November 23, 2020

— Hameen Tariq, Wilmington, Delaware

Exploring Cancer Drug’s Effects on COVID

Your story “Clots, Strokes and Rashes: Is COVID a Disease of the Blood Vessels?” (Nov. 13) was reprinted in my local newspaper. My brother, James L. Kinsella Ph.D., led the original work at the National Institutes of Health researching how the chemotherapy drug Taxol could reduce inflammation in coronary articles following the placement of coronary stents. This led to the very effective use of drug-eluting coronary stents. My unprofessional musing causes me to wonder if this anti-inflammatory response to Taxol might have some application as an early therapeutic intervention to reduce the inflammatory response of COVID-19 being studied by Dr. William Li. I can’t ask my brother; he passed away.

— Rick Kinsella, Oneida, New York

He wouldn’t be dead without covid. We’ve learned that things that aren’t life threatening are made life threatening by this disease. It attacks your blood vessels so it can exacerbate anything anywhere in your body that uses blood vessels. Stay safe indeed https://t.co/BFsqrKSFmH

— James McPicnic (@WhiteRatbit) December 3, 2020

— James “J.P.” McPicnic, Los Angeles

Women’s Health Should Not Be Up for Debate

Birth control medication is so much more than a pawn in politics (“Coming Abortion Fight Could Threaten Birth Control, Too,” Nov. 5). It changes the lives of so many women for the better. Birth control access has been proven to lead to higher rates of education for women, lower levels of child poverty, lower Medicaid costs for women’s health and higher productivity of society as a whole. It also treats a large number of medical conditions associated with women’s health. It effectively treats severe menstrual migraines, hormonal acne, endometriosis, severe menstrual pain, uterine abnormalities, anemia and heavy menstrual bleeding, among other health conditions. This medication is involved in treating so many women’s health concerns, improves infant and child health outcomes, and reduces child poverty, and yet almost 20 million women in the U.S. currently have no access to birth control medication. American politicians need to consider, if nothing else, the spillover costs to society when birth control access is reduced.

Women’s reproductive health should not be up for debate and yet it is at the center of so many political agendas. As a 24-year-old woman pursuing dual master’s degrees in public health and physician assistant studies, my focus should be on learning to become an exceptional health care provider, not whether my health will be up for debate in court. If politicians truly have the best interests of Americans at heart, they should be looking to expand birth control access, not restrict it.  Evidence needs to be incorporated into political agendas, and the evidence shows that when women succeed, society succeeds. Women’s education, health and reproductive rights should be at the forefront of every discussion on what constitutes a thriving population — the evidence has proven that women’s autonomy holds the answer and access to birth control is a vital piece of that.

— Gabby Henshue, Madison, Wisconsin

Scary times for women’s bodies.

“States could effectively ban contraception by arguing that some contraceptives act as abortifacients.” Threat is real. I’ve worked in states where this argument has been made.https://t.co/LmdWFRUNOZ

— Elizabeth M. Baskett (@EMBaskett) November 11, 2020

— Elizabeth M. Baskett, Denver

Injustice in High Gear

I was appalled at the charges on the medical bill from the Carson City emergency department for that child who fell off his bike (“Bill of the Month: After Kid’s Minor Bike Accident, Major Bill Sets Legal Wheels in Motion,” Nov. 25) — $18,000 for an exam and stitches? What would it take to sort out such problems in our health system? Lower prices from providers could only result in lower insurance premiums.

— Karen Johnson, San Rafael, California

Attempted subrogation, man, I tell yah https://t.co/spxcMlSiCk

— Annie M. Davidson (@attyannie) November 25, 2020

— Annie M. Davidson, St. Paul, Minnesota

KHN Morning Briefing: A Wealth of Information in One Spot!

I just wanted to say it is awesome to have portions of articles from many major news outlets because never does one tell the whole story. Case in point: I was trying to research what exactly President Donald Trump had done that “allowed doctors to discriminate against LGBT people,” and it was very helpful having a wide array of media sources on a single page to help get the bigger picture and try and weed through the bias of all of them (“Trump Administration’s Expanded Conscience Rule Will Allow Medical Professionals To Refuse To Provide Health Care Services,” May 3). Just sending my compliments. Keep up the great work.

— Nolan Steeley, Greensburg, Pennsylvania

💥Racism in #healthcare undermines #quality of care and patient safety. There’s hard work to be done to weed it out of all parts of society, especially clinical care. https://t.co/TbK0yIuraB

— Natalie S. Burke (@natalie4health) November 28, 2020

— Natalie S. Burke, Washington, D.C.

Education and Coverage Gaps Lead to Avoidable Amputations 

Coming to terms with systemic racism in health care is long overdue (“What Doctors Aren’t Always Taught: How to Spot Racism in Health Care,” Nov. 17). The way medicine is taught and the payment policies that shape the system have created persistent disparities in patient outcomes across racial and ethnic groups.

As a result, Black Americans are 80% more likely than whites to be diagnosed with diabetes and are twice as likely to die from the disease. Furthermore, Black American patients are up to four times more likely to experience an amputation than their white counterparts due to advanced peripheral artery disease (PAD), a common complication for people with diabetes and other chronic conditions. Similarly, Latinos are up to 75% more likely to experience an amputation than whites, while Native Americans are twice as likely to lose a limb.

As many as 85% of the nation’s 200,000 non-traumatic amputations could be prevented with access to screening and early detection. By screening for PAD through non-invasive arterial testing, the likelihood of an individual needing a PAD-related amputation can be reduced by up to 90%. Unfortunately, too few Americans — particularly racial and ethnic minorities — are even offered routine screening for PAD due to a widespread lack of understanding about the disease, as well as structural coverage barriers to simple, painless tests. As a result, many do not even know they have the disease until it is too late to save their limbs.

Communities of color deserve better. Members of the Congressional PAD Caucus — led by Rep. Donald Payne Jr. (D-N.J.) — recently introduced the Amputation Reduction and Compassion (ARC) Act to establish an education program about the disease — particularly for high-risk populations — and update reimbursement policy to disallow payment for non-emergent amputations unless arterial testing has been done in the three months before amputation. These simple solutions have the power to prevent thousands of avoidable amputations, and begin to correct health disparities in minority communities.

While we still have a long way to go as our country continues to grapple with systemic racism in health care, the ARC Act represents an important step toward ending disparities in PAD care.

— Dr. Foluso Fakorede, CEO of Cardiovascular Solutions of Central Mississippi, Cleveland, Mississippi

Racism in Health Care? Another example of injecting Politics. Inarguably, racism exists everywhere, but to make this a big issue is a disservice. Diff DX requires inclusion of Race/Ethnicity, to wit: Sickle Cell in Blacks,Alpha & Beta Thalassemia in Asians https://t.co/xyP54dPjH8

— Alexander R. Lim, MD (@AlexanderLim13) November 25, 2020

— Dr. Alexander R. Lim, Corpus Christi, Texas

‘Obamacare’ Unfairly Politicizes Health Law

I found this article interesting (“Biden Plan to Lower Medicare Eligibility Age to 60 Faces Hostility From Hospitals,” Nov. 11) but was surprised that the Affordable Care Act was referred to as “Obamacare.” Please don’t politicize the ACA — we really need it to continue allowing people to access health care. Many people do not have health care through their workplace and are unable to afford private insurance premiums. I was once one of those people before I was hired at our local library. It was really tough. Thank you for your reporting.

— Pamela Elicker, Port Townsend, Washington

Putting People First on the Podcast

When you were talking about drug policy and the ballot in a recent podcast (“KHN’s ‘What the Health?’: Change Is in the Air,” Nov. 6), you used terms that are considered incorrect or stigmatizing. For example, saying “opioid epidemic” when it’s really a crisis and referring to substance use as “abuse.” The Associated Press and NPR, among others, have pledged to use people-first language, as also supported by the American Psychological Association.

— Deirdre Dingman, Philadelphia

The Backbone of the Insurance Industry

It’s disingenuous to assert that people “can’t always rely on insurance brokers to give them accurate information or steer them to comprehensive coverage” based on the unfortunate experience of one consumer with a short-term health plan, as Michelle Andrews did in the article “Think Your Health Care Is Covered? Beware of the ‘Junk’ Insurance Plan” (Dec. 4).

Agents and brokers are crucial to our nation’s efforts to get people covered. This year, they assisted almost half of all healthcare.gov enrollees — and brought 1.12 million new enrollees into the marketplace. It’s no wonder that a new report from the Centers for Medicare & Medicaid Services has called agents and brokers “instrumental in driving greater participation in the individual health insurance market.”

Further, agents and brokers have long maintained that short-term plans are not appropriate substitutes for comprehensive exchange coverage. We at the National Association of Health Underwriters stated as much in official comments filed with the Trump administration before it finalized a rule extending the duration of short-term plans to 12 months.

— Janet Trautwein, CEO of the National Association of Health Underwriters, Washington, D.C.

 


Not Tickling My Funny Bone

You ought to find some cartoonists who are not so flagrantly left-leaning — continuing to provide left-sided commentary is not right. It’s like all of the news stations pushing for socialism.

— Harry Gousha, Upland, California

Editor’s note: It is the tradition and mission among editorial cartoonists to satirize those in power. As with the nation’s leadership, the targets of political cartoons toggle from right to left. Balance is not these artists’ goal, but over time their commentary balances out. Stick with us, and we hope to amuse you in the future.

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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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:

 

 

 

Zoloft enters list of 10 most commonly prescribed drugs in Australia

Increase in women being diagnosed with depression partly behind rise in use

An increase in women being diagnosed with depression is partly behind a significant rise in prescriptions of the antidepressant sertraline – sold under the brand name Zoloft – which is in the list of Australia’s most commonly prescribed drugs for the first time.

On Tuesday Australian Prescriber published its annual list of the 10 most commonly taken drugs – based on standard daily doses for every 1,000 people in the population each day – along with a list of the 10 most costly drugs to government, and the 10 most common drugs by prescription counts.

Related: Why mental health is the legacy-defining fight Scott Morrison can’t afford to lose | Katharine Murphy

Continue reading…

For Nurses Feeling the Strain of the Pandemic, Virus Resurgence Is ‘Paralyzing’

For Christina Nester, the pandemic lull in Massachusetts lasted about three months through summer into early fall. In late June, St. Vincent Hospital had resumed elective surgeries, and the unit the 48-year-old nurse works on switched back from taking care of only COVID-19 patients to its pre-pandemic roster of patients recovering from gallbladder operations, mastectomies and other surgeries.

That is, until October, when patients with coronavirus infections began to reappear on the unit and, with them, the fear of many more to come. “It’s paralyzing, I’m not going to lie,” said Nester, who’s worked at the Worcester hospital for nearly two decades. “My little clan of nurses that I work with, we panicked when it started to uptick here.”

Adding to that stress is that nurses are caught betwixt caring for the bedside needs of their patients and implementing policies set by others, such as physician-ordered treatment plans and strict hospital rules to ward off the coronavirus. The push-pull of those forces, amid a fight against a deadly disease, is straining this vital backbone of health providers nationwide, and that could accumulate to unstainable levels if the virus’s surge is not contained this winter, advocates and researchers warn.

Nurses spend the most sustained time with a patient of any clinician, and these days patients are often incredibly fearful and isolated, said Cynda Rushton, a registered nurse and bioethicist at Johns Hopkins University in Baltimore.

“They have become, in some ways, a kind of emotional surrogate for family members who can’t be there, to support and advise and offer a human touch,” Rushton said. “They have witnessed incredible amounts of suffering and death. That, I think, also weighs really heavily on nurses.”

A study published this fall in the journal General Hospital Psychiatry found that 64% of clinicians working as nurses, nurse practitioners or physician assistants at a New York City hospital screened positively for acute distress, 53% for depressive symptoms and 40% for anxiety — all higher rates than found among physicians screened.

Researchers are concerned that nurses working in a rapidly changing crisis like the pandemic — with problems ranging from staff shortages that curtail their time with patients to enforcing visitation policies that upset families — can develop a psychological response called “moral injury.” That injury occurs, they say, when nurses feel stymied by their inability to provide the level of care they believe patients require.

Dr. Wendy Dean, co-founder of Moral Injury of Healthcare, a nonprofit organization based in Carlisle, Pennsylvania, said, “Probably the biggest driver of burnout is unrecognized unattended moral injury.”

In parts of the country over the summer, nurses got some mental health respite when cases declined, Dean said.

“Not enough to really process it all,” she said. “I think that’s a process that will take several years. And it’s probably going to be extended because the pandemic itself is extended.”

Sense of Powerlessness

Before the pandemic hit her Massachusetts hospital “like a forest fire” in March, Nester had rarely seen a patient die, other than someone in the final days of a disease like cancer.

Suddenly she was involved with frequent transfers of patients to the intensive care unit when they couldn’t breathe. She recounts stories, imprinted on her memory: The woman in her 80s who didn’t even seem ill on the day she was hospitalized, who Nester helped transport to the morgue less than a week later. The husband and wife who were sick in the intensive care unit, while the adult daughter fought the virus on Nester’s unit.

“Then both parents died, and the daughter died,” Nester said. “There’s not really words for it.”

During these gut-wrenching shifts, nurses can sometimes become separated from their emotional support system — one another, said Rushton, who has written a book about preventing moral injury among health care providers. To better handle the influx, some nurses who typically work in noncritical care areas have been moved to care for seriously ill patients. That forces them to not only adjust to a new type of nursing, but also disrupts an often-well-honed working rhythm and camaraderie with their regular nursing co-workers, she said.

At St. Vincent Hospital, the nurses on Nester’s unit were told one March day that the primarily postsurgical unit was being converted to a COVID unit. Nester tried to squelch fears for her own safety while comforting her COVID-19 patients, who were often elderly, terrified and sometimes hard of hearing, making it difficult to communicate through layers of masks.

“You’re trying to yell through all of these barriers and try to show them with your eyes that you’re here and you’re not going to leave them and will take care of them,” she said. “But yet you’re panicking inside completely that you’re going to get this disease and you’re going to be the one in the bed or a family member that you love, take it home to them.”

When asked if hospital leaders had seen signs of strain among the nursing staff or were concerned about their resilience headed into the winter months, a St. Vincent spokesperson wrote in a brief statement that during the pandemic “we have prioritized the safety and well-being of our staff, and we remain focused on that.”

Nationally, the viral risk to clinicians has been well documented. From March 1 through May 31, 6% of adults hospitalized were health care workers, one-third of them in nursing-related occupations, according to data published last month by the Centers for Disease Control and Prevention.

As cases mount in the winter months, moral injury researcher Dean said, “nurses are going to do the calculation and say, ‘This risk isn’t worth it.’”

Juliano Innocenti, a traveling nurse working in the San Francisco area, decided to take off for a few months and will focus on wrapping up his nurse practitioner degree instead. Since April, he’s been seeing a therapist “to navigate my powerlessness in all of this.”

Innocenti, 41, has not been on the front lines in a hospital battling COVID-19, but he still feels the stress because he has been treating the public at an outpatient dialysis clinic and a psychiatric hospital and seen administrative problems generated by the crisis. He pointed to issues such as inadequate personal protective equipment.

Innocenti said he was concerned about “the lack of planning and just blatant disregard for the basic safety of patients and staff.” Profit motives too often drive decisions, he suggested. “That’s what I’m taking a break from.”

Building Resiliency

As cases surge again, hospital leaders need to think bigger than employee assistance programs to backstop their already depleted ranks of nurses, Dean said. Along with plenty of protective equipment, that includes helping them with everything from groceries to transportation, she said. Overstaff a bit, she suggested, so nurses can take a day off when they hit an emotional cliff.

The American Nurses Association, the American Association of Critical-Care Nurses (AACN) and several other nursing groups have compiled online resources with links to mental health programs as well as tips for getting through each pandemic workday.

Kiersten Henry, an AACN board member and nurse practitioner in the intensive care unit at MedStar Montgomery Medical Center in Olney, Maryland, said that the nurses and other clinicians there have started to gather for a quick huddle at the end of difficult shifts. Along with talking about what happened, they share several good things that also occurred that day.

“It doesn’t mean that you’re not taking it home with you,” Henry said, “but you’re actually verbally processing it to your peers.”

When cases reached their highest point of the spring in Massachusetts, Nester said there were some days she didn’t want to return.

“But you know that your friends are there,” she said. “And the only ones that really truly understand what’s going on are your co-workers. How can you leave them?”

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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The Antioxidant Power of Açaí vs. Apples

There are so many açaí products on the market now, from frozen pulp in smoothie packs to freeze-dried powder and supplements. How is it eaten traditionally? “In the Brazilian Amazon, the Indian tribes of the forest cut down the tree and eat the palm heart…then urinate on the rest of the tree to attract a species of palm beetle to lay its eggs inside the tree. Several weeks later, they return to harvest 3–4 pounds of beetle grub larvae….” I think I’ll just stick to my smoothie pack.

“Despite being used for a long time as food and beverage” in the Amazon, açaí berries have only been researched scientifically since the beginning of this century. A number of years ago, I reviewed that research in my video Clinical Studies on Açaí Berries, starting with in vitro studies showing that açaí could kill leukemia cells in a petri dish at levels you might expect to find in the bloodstream after eating one or two cups of açaí pulp and could also cut the growth of colon cancer cells in half.

Unfortunately, as I discuss in my video The Antioxidant Effects of Açaí vs. Apples, subsequent published studies have failed to find such benefits for that particular type of colon cancer, a different type of colon cancer, or an estrogen-receptor negative form of breast cancer. An açaí extract did appear to kill off a line of estrogen-receptor positive breast cancer cells, but to achieve that level of açaí nutrients in your breast, you’d have to eat about 400 cups of açaí pulp.

The problem with many of these petri dish studies is that they use concentrations that you could never realistically achieve in your bloodstream. For example, as you can see at 1:48 in my video, açaí berries may exert a neuroprotective effect, blocking the buildup of amyloid fibers implicated in Alzheimer’s—but only at a dose reached by drinking about 2,000 cups at one time. They may also have an anti-allergy effect or decrease bone loss—at a mere 1,000 cups a day.

In my previous video Clinical Studies on Açaí Berries, I also talked about a clinical study in which subjects were asked to drink less than a cup a day of açaí in a smoothie. They appeared to get significant improvements in blood sugar, insulin levels, and cholesterol. Now, there was no control group and it was a small study, but there’d never been a bigger study trying to replicate it until a study published in 2016.

As you can see at 2:37 in my video, researchers gave subjects the same amount of açaí for the same duration as the previous study, but they found no significant improvements in blood sugars, insulin, or cholesterol. Why did this study fail to show the benefits seen in the first study? Well, this study was publicly funded with “no conflicts of interest,” while the first study was funded by an açaí company, which always makes you suspect that perhaps it was somehow designed to get the desired result. And, indeed, the participants in that first study were not just given açaí smoothies, but they were explicitly told to avoid processed meat, “for example bacon and hot dogs.” No wonder their numbers looked better at the end of the month. Now, the new study did find a decrease in markers of oxidative stress in the participants’ bloodstreams, a sign of how rich in antioxidants açaí berries can be.

Those who hock supplements love to talk about how açaí consumption can “triple antioxidant capacity” of your blood. And, if you look at the study they cite, you’ll find that the antioxidant capacity of participants’ blood did actually triple after eating açaí—but the same or even better tripling was achieved after consuming just plain applesauce, which the researchers used as a control that happens to be significantly cheaper than açaí berries or supplements. You can see the graph at 3:42 in my video.

A new study has shown significant improvements in artery function after eating açaí berries, but are they any more effective than other common fruits and vegetables? You can learn more about that in my video The Benefits of Açaí vs. Blueberries for Artery Function.


What’s so great about antioxidants? Check out:

Where else can you get them? See Flashback Friday: Antioxidants in a Pinch and Antioxidant Power of Plants vs. Animal Foods.

What are the nutritional aspects of those grub-kabobs? See Bug Appétit: Barriers to Entomophagy and Good Grub: The Healthiest Meat.

In health,

Michael Greger, M.D.

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Black Hair Matters: How Going Natural Made Me Visible

The night before I chopped off my hair, I got nervous.

This decision felt bigger than me, given all the weight that Black women’s hair carries. But after three months of wearing hats and scarves in a pandemic when trips to the hairdresser felt unsafe, I walked into a salon emotionally exhausted but ready to finally see my natural hair.

I thought a few tears would fall, but, as the last of my chemically straightened hair floated to the floor like rain, I felt cleansed. Free. I laughed hysterically as I drove away from the salon.

Friends and family cheered me on virtually, but my father quietly worried about my decision. My dad grew up in the Jim Crow South, where many women straightened their hair to land jobs, husbands and respect. Before my big chop, he never said much about my hair beyond the occasional compliment, which is why I was surprised when he issued a warning.

“Watch it out there. Your hair is cut now,” he blurted when he saw me walking out of the house.

My mother heard him but remained silent. She had her own set of concerns. She was worried about me looking less professional.

I also had to help my now 4-year-old daughter understand why I decided to go natural. We’ve watched the animated “Hair Love” a million times. We’ve read books like “Happy Hair” by Mechal Renee Roe, “I Love My Hair!” by Natasha Anastasia Tarpley and my personal favorite, “Don’t Touch My Hair!” by Sharee Miller.

Still, my daughter had a hard time adjusting to my new haircut, often asking when I planned to get my hair styled again. She preferred my extensions, saying she thought I looked more like a princess that way. I gently explained that my hair is a style — and the one I choose — even if it’s not long and straight.

My family’s emotions about my hair left me tangled.

Of course, the styling of Black hair has been fraught for centuries. The CROWN Act, which passed the U.S. House in September and is now pending in the Senate, is intended to protect Black people from discrimination in schools, housing and employment based on their hairstyle. But such a law, even if passed, cannot stop bigotry, bullets and the emotional battle that comes with being a Black woman in America as seen through something as simple as our hair.

I hadn’t considered talking to my daughter about how hair could affect her personal safety until my father broke his silence. A haircut shouldn’t influence your life expectancy.

On the night of my haircut, I drove to the store more aware of how others would perceive my new look. My father, however, was more worried about my safety because my silhouette could possibly be mistaken for a Black man’s frame.

We live in the Midwest, just outside St. Louis, where natural hair still makes a statement for Black women. If my buzz cut made me look more like a Black man, would the cops in our town treat me differently? In my dad’s eyes, my femininity increased my chances of making it home safely.

His comments also led to a conversation about the intersection between racism and sexism. Without reading the crucial work of scholar Kimberlé Crenshaw and other activists, my father intuitively understood that society has placed Black women in a blind spot, where our gender and our race make us invisible in many ways.

But that space isn’t safe, is it? A Eurocentric feminine hairstyle can’t protect Black women from the many deadly forms of racism.

Police officers can see us. Since 2015, at least 48 Black women have been killed by the police. I’m guessing the style of their hair didn’t matter to the officers pulling the triggers. In the past few years, the #SayHerName campaign has put a spotlight on their killings, but society still pays less attention to the police killings of Black women. While most people have heard of George Floyd, Michael Brown and Breonna Taylor, fewer know about Kathryn Johnston, Korryn Gaines and India Kager.

In death and life, our rights and our achievements don’t seem to hold as much weight compared with those of our male counterparts or our white ones. Yet, many Black women go to great lengths to be accepted in this country.

In the past few weeks, I’ve listened to other Black women in my life vent about their hair and navigating racism. We’ve shared our fears, hair horror stories and moments of victory. I’ve come to realize that my haircut wasn’t just about changing my style. It was also about reclaiming my crown after years of letting society control it.

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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‘Breakthrough Finding’ Reveals Why Certain COVID Patients Die

Dr. Megan Ranney has learned a lot about COVID-19 since she began treating patients with the disease in the emergency department in February.

But there’s one question she still can’t answer: What makes some patients so much sicker than others?

Advancing age and underlying medical problems explain only part of the phenomenon, said Ranney, who has seen patients of similar age, background and health status follow wildly different trajectories.

“Why does one 40-year-old get really sick and another one not even need to be admitted?” asked Ranney, an associate professor of emergency medicine at Brown University.

In some cases, provocative new research shows, some people — men in particular — succumb because their immune systems are hit by friendly fire. Researchers hope the finding will help them develop targeted therapies for these patients.

In an international study in Science, 10% of nearly 1,000 COVID patients who developed life-threatening pneumonia had antibodies that disable key immune system proteins called interferons. These antibodies — known as autoantibodies because they attack the body itself — were not found at all in 663 people with mild or asymptomatic COVID infections. Only four of 1,227 healthy individuals had the autoantibodies. The study, published on Oct. 23, was led by the COVID Human Genetic Effort, which includes 200 research centers in 40 countries.

“This is one of the most important things we’ve learned about the immune system since the start of the pandemic,” said Dr. Eric Topol, executive vice president for research at Scripps Research in San Diego, who was not involved in the new study. “This is a breakthrough finding.”

In a second Science study by the same team, authors found that an additional 3.5% of critically ill patients had mutations in genes that control the interferons involved in fighting viruses. Given that the body has 500 to 600 of these genes, it’s possible researchers will find more mutations, said Qian Zhang, lead author of the second study.

Interferons serve as the body’s first line of defense against infection, sounding the alarm and activating an army of virus-fighting genes, said virologist Angela Rasmussen, an associate research scientist at the Center of Infection and Immunity at Columbia University’s Mailman School of Public Health.

“Interferons are like a fire alarm and a sprinkler system all in one,” said Rasmussen, who wasn’t involved in the new studies.

Lab studies show interferons are suppressed in some people with COVID-19, perhaps by the virus itself.

Interferons are particularly important for protecting the body against new viruses, such as the coronavirus, which the body has never encountered, said Zhang, a researcher at Rockefeller University’s St. Giles Laboratory of Human Genetics of Infectious Diseases.

When infected with the novel coronavirus, “your body should have alarms ringing everywhere,” said Zhang. “If you don’t get the alarm out, you could have viruses everywhere in large numbers.”

Significantly, patients didn’t make autoantibodies in response to the virus. Instead, they appeared to have had them before the pandemic even began, said Paul Bastard, the antibody study’s lead author, also a researcher at Rockefeller University.

For reasons that researchers don’t understand, the autoantibodies never caused a problem until patients were infected with COVID-19, Bastard said. Somehow, the novel coronavirus, or the immune response it triggered, appears to have set them in motion.

“Before COVID, their condition was silent,” Bastard said. “Most of them hadn’t gotten sick before.”

Bastard said he now wonders whether autoantibodies against interferon also increase the risk from other viruses, such as influenza. Among patients in his study, “some of them had gotten flu in the past, and we’re looking to see if the autoantibodies could have had an effect on flu.”

Scientists have long known that viruses and the immune system compete in a sort of arms race, with viruses evolving ways to evade the immune system and even suppress its response, said Sabra Klein, a professor of molecular microbiology and immunology at the Johns Hopkins Bloomberg School of Public Health.

Antibodies are usually the heroes of the immune system, defending the body against viruses and other threats. But sometimes, in a phenomenon known as autoimmune disease, the immune system appears confused and creates autoantibodies. This occurs in diseases such as rheumatoid arthritis, when antibodies attack the joints, and Type 1 diabetes, in which the immune system attacks insulin-producing cells in the pancreas.

Although doctors don’t know the exact causes of autoimmune disease, they’ve observed that the conditions often occur after a viral infection. Autoimmune diseases are more common as people age.

In yet another unexpected finding, 94% of patients in the study with these autoantibodies were men. About 12.5% of men with life-threatening COVID pneumonia had autoantibodies against interferon, compared with 2.6% of women.

That was unexpected, given that autoimmune disease is far more common in women, Klein said.

“I’ve been studying sex differences in viral infections for 22 years, and I don’t think anybody who studies autoantibodies thought this would be a risk factor for COVID-19,” Klein said.

The study might help explain why men are more likely than women to become critically ill with COVID-19 and die, Klein said.

“You see significantly more men dying in their 30s, not just in their 80s,” she said.

Akiko Iwasaki, a professor of immunobiology at the Yale School of Medicine, noted that several genes involved in the immune system’s response to viruses are on the X chromosome.

Women have two copies of this chromosome — along with two copies of each gene. That gives women a backup in case one copy of a gene becomes defective, Iwasaki said.

Men, however, have only one copy of the X chromosome. So if there is a defect or harmful gene on the X chromosome, they have no other copy of that gene to correct the problem, Iwasaki said.

Bastard noted that one woman in the study who developed autoantibodies has a rare genetic condition in which she has only one X chromosome.

Scientists have struggled to explain why men have a higher risk of hospitalization and death from COVID-19. When the disease first appeared in China, experts speculated that men suffered more from the virus because they are much more likely to smoke than Chinese women.

Researchers quickly noticed that men in Spain were also more likely to die of COVID-19, however, even though men and women there smoke at about the same rate, Klein said.

Experts have hypothesized that men might be put at higher risk by being less likely to wear masks in public than women and more likely to delay seeking medical care, Klein said.

But behavioral differences between men and women provide only part of the answer. Scientists say it’s possible that the hormone estrogen may somehow protect women, while testosterone may put men at greater risk. Interestingly, recent studies have found that obesity poses a much greater risk to men with COVID-19 than to women, Klein said.

Yet women have their own form of suffering from COVID-19.

Studies show women are four times more likely to experience long-term COVID symptoms, lasting weeks or months, including fatigue, weakness and a kind of mental confusion known as “brain fog,” Klein noted.

As women, “maybe we survive it and are less likely to die, but then we have all these long-term complications,” she said.

After reading the studies, Klein said, she would like to learn whether patients who become severely ill from other viruses, such as influenza, also harbor genes or antibodies that disable interferon.

“There’s no evidence for this in flu,” Klein said. “But we haven’t looked. Through COVID-19, we may have uncovered a very novel mechanism of disease, which we could find is present in a number of diseases.”

To be sure, scientists say that the new study solves only part of the mystery of why patient outcomes can vary so greatly.

Researchers say it’s possible that some patients are protected by past exposure to other coronaviruses. Patients who get very sick also may have inhaled higher doses of the virus, such as from repeated exposure to infected co-workers.

Although doctors have looked for links between disease outcomes and blood type, studies have produced conflicting results.

Screening patients for autoantibodies against interferons could help predict which patients are more likely to become very sick, said Bastard, who is also affiliated with the Necker Hospital for Sick Children in Paris. Testing takes about two days. Hospitals in Paris can now screen patients on request from a doctor, he said.

Although only 10% of patients with life-threatening COVID-19 have autoantibodies, “I think we should give the test to everyone who is admitted,” Bastard said. Otherwise, “we wouldn’t know who is at risk for a severe form of the disease.”

Bastard said he hopes his findings will lead to new therapies that save lives. He notes that the body manufactures many types of interferons. Giving these patients a different type of interferon — one not disabled by their genes or autoantibodies — might help them fight off the virus.

In fact, a pilot study of 98 patients published Thursday in the Lancet Respiratory Medicine journal found benefits from an inhaled form of interferon. In the industry-funded British study, hospitalized COVID patients randomly assigned to receive interferon beta-1a were more than twice as likely as others to recover enough to resume their regular activities.

Researchers need to confirm these findings in a much larger study, said Dr. Nathan Peiffer-Smadja, a researcher at Imperial College London who was not involved in the study but wrote an accompanying editorial. Future studies should test patients’ blood for genetic mutations and autoantibodies against interferon, to see if they respond differently than others.

Peiffer-Smadja notes that inhaled interferon may work better than an injected form of the drug because it’s delivered directly to the lungs. While injected versions of interferon have been used for years to treat other diseases, the inhaled version is still experimental and not commercially available.

And doctors should be cautious about interferon for now, because a study led by the World Health Organization found no benefit to an injected form of the drug in COVID patients, Peiffer-Smadja said. In fact, there was a trend toward higher mortality rates in patients given interferon, although this finding could have been due to chance. Giving interferon later in the course of disease could encourage a destructive immune overreaction called a cytokine storm, in which the immune system does more damage than the virus.

Around the world, scientists have launched more than 100 clinical trials of interferons, according to clinicaltrials.gov, a database of research studies from the National Institutes of Health.

Until larger studies are completed, doctors say, Bastard’s findings are unlikely to change how they treat COVID-19.

Dr. Lewis Kaplan, president of the Society of Critical Care Medicine, said he treats patients according to their symptoms, not their risk factors.

“If you are a little sick, you get treated with a little bit of care,” Kaplan said. “You are really sick, you get a lot of care. But if a COVID patient comes in with hypertension, diabetes and obesity, we don’t say, ‘They have risk factors. Let’s put them in the ICU.’”

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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Trump’s Anti-Abortion Zeal Shook Fragile Health Systems Around the World

In Ethiopia, health clinics for teenagers once supported by U.S. foreign aid closed down. In Kenya, a decades-long effort to integrate HIV testing and family planning unraveled. And in Nepal, intrepid government workers who once traversed the Himalayas to spread information about reproductive health were halted.

Around the world, countries that depend on U.S. foreign aid have scrapped or scaled back ambitious public health projects, refashioning their health systems over the past four years to comport with President Donald Trump’s sweeping anti-abortion restrictions that went further than any Republican president before him.

The effects have been profound: As groups scrambled to meet the administration’s strict ideologically driven rules, they severed ties with health care providers that discuss abortion in any way, deleted references to abortion on websites and in sexual education curricula, and stopped discussing modern contraception for fear of forfeiting vital American aid.

President-elect Joe Biden has pledged to reverse the policy when he takes office, and he campaigned on a promise to enshrine abortion rights in federal law. But for many foreign aid groups, the changes may be permanent.

“The U.S. has lost its position as a leader and lost its credibility,” said Terry McGovern, of Columbia University’s Mailman School of Public Health who has overseen research of the Trump policy in multiple countries.

Since Ronald Reagan, Republican presidents have barred foreign aid organizations from using U.S. global health funds to counsel women about abortion or refer them to a safe abortion provider. But the Trump administration vastly expanded those anti-abortion restrictions, known as “the global gag rule” by opponents. Under Trump, the rule applies to some $9 billion of aid touching nearly every facet of global health funding, including groups working on HIV, malaria, tuberculosis and water sanitation. Under President George W. Bush, the policy applied to a fraction of that, $600 million in foreign aid.

The Trump administration proudly touted these efforts to protect “the unborn abroad,” but the rules have left international aid groups deeply skeptical of U.S. promises and deepened the nation’s rift with European countries that have long viewed abortion access as vital to women’s health and safety.

Some major organizations opted out of any U.S. funding rather than comply with the new strictures, including Marie Stopes International and International Planned Parenthood Federation, among the largest providers of reproductive health care in the developing world. Untold numbers of front-line health care workers — in large cities and remote villages alike — have been confused by what seem like sudden swings in American policy.

And that trepidation may not be quick to dissipate even with a Democrat in the White House.

“Biden and Trump may seem radically different to Americans,” said Jennifer Sherwood, a policy manager at Amfar, the Foundation for AIDS Research. “But if you’re a small organization in sub-Saharan Africa, you may not understand what this new [Biden] administration means and if you can trust the United States.”

The restrictions intentionally constrict the activities of foreign aid groups, many of which have worked in close coordination with American counterparts for decades. The rules also have a ripple effect on their funding: U.S. funding to foreign groups is contingent on their not accepting money from other countries, or even private foundations, to underwrite abortion-related services. They are not allowed to subcontract with other organizations that run separate abortion-related projects.

Trump telegraphed the worldwide anti-abortion gains in appeals to evangelical Christians. In early October, Secretary of State Mike Pompeo touted the policy during a speech to the Florida Family Policy Council, a conservative anti-abortion group, calling it an “unprecedented defense of the unborn abroad.”

“Our administration has drawn on our first principles to defend life in our foreign policy like no administration in all of history,” said Pompeo, who is an evangelical Christian.

The hard-right policies of the Trump administration stand in stark contrast to the steady liberalization of abortion laws in countries around the world over the past two decades. Since 2000, more than two dozen countries have eased abortion laws, including Ireland, South Korea, the Democratic Republic of Congo and Ethiopia.

Even in countries where abortion is forbidden, the rules are having an impact on reproductive health care. In Madagascar, where abortion is illegal with no exceptions, the largest provider of contraception, Marie Stopes, turned down U.S. money, endangering its ability to offer unfettered medical care to women, ending support for nearly 200 public and private facilities.

Mamy Jean Jacques Razafimahatratra, a researcher at the Institut National de Santé Publique et Communautaire in Antananarivo, found that led to shortages of contraception, in a poor country where travel to nearby towns is difficult.

“The women asked us, ‘What is the cause of this rupture?’” said Razafimahatratra. “We tried to explain to them the reason, and [they say], ‘But that regulation is for abortion, so we don’t understand why we are also penalized?’”

Researchers at Amfar and Johns Hopkins, in a study published in Health Affairs, found the anti-abortion policies could have deadly consequences, specifically in preventing the spread of HIV/AIDS. Sherwood said young African women face the highest risk of HIV and many clinics had combined HIV testing and treatment with family planning services.

But, fearing they would run afoul of the Trump policy and thus forfeit funding, clinics have curtailed family planning for patients, reducing the number of women seeking care in African countries.

“A lot of the times, they want contraception,” said Sherwood. “That is what’s on their mind, and HIV is the secondary thing, something we can tack on to meet their needs all at once.”

Jennifer Kates, director of global health and HIV policy at KFF said, “I have no doubt some groups are going to say, ‘We are not going to play there anymore.’” (KHN is an editorially independent program of KFF.)

The practical challenges of restarting these programs are steep: rehiring staff, reopening clinics, retraining employees, rewriting curricula.

“You can imagine being a health care worker that was under threat of losing their funding for counseling a patient on abortion,” Sherwood said. “To us, it’s like a light switch that can turn off and on, but to them, this is a very opaque and confusing process. It’s not how health systems work. You can’t just change the way they work overnight.”

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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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.


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In health,

Michael Greger, M.D.

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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 .

Colorado Initiative Would Further Limit Access in Middle America’s ‘Abortion Desert’

Colorado voters are deciding a ballot question that seeks to limit how far into pregnancy an abortion can be legally performed. While the measure would change the law only in Colorado, it would resonate throughout the Rocky Mountain states and Midwest amid an intensifying national fight, fueled by a Supreme Court vacancy, over the future of abortion.

In 1967 — six years before the Supreme Court’s Roe v. Wade decision protected the right to an abortion in the U.S. — Colorado became the first state to pass a law widening access to legal abortion. More than 50 years later, it remains one of just seven states without gestational limits on the procedure, making Colorado one of the few options for people nationwide who need abortions later in pregnancy.

Proposition 115 seeks to change that. It would outlaw abortion in the state after 22 weeks. The proposition makes an exception to save the life of the pregnant person, but none for cases of rape or incest or to protect the health of the pregnant individual or fetus.

But the impact of the measure also would be felt by neighboring states where people have little or no access to abortion. Kelly Baden, vice president of reproductive rights at the left-leaning policy group State Innovation Exchange, called the surrounding region an abortion desert.

“Colorado really plays an important role in the region in being a haven for access for people who live in those highly restrictive states, some of which neighbor us, like Kansas, Nebraska — that whole swath of the Midwest from the Dakotas on down to Texas,” Baden said.

A study published in the Journal of Medical Internet Research in 2018 found the Midwest has fewer abortion clinics per capita than any other U.S. region, with 92 facilities across 10 states.

Colorado providers have stepped in, and approximately 1 in 10 abortions are performed on people from out of state. A billboard on Interstate 70 welcomed visitors from Utah with the message “Welcome to Colorado, where you can get a safe, legal abortion.”

Colorado voters have rejected three abortion-related ballot measures since 2008, which advocates pointed to as evidence that the state’s residents are fine with the status quo.

“Colorado has already voted on ridiculous abortion restrictions multiple times and said, ‘We don’t want them.’ It’s insulting that these extremists keep trying,” said Whitney Woods, speaking on her own behalf while on maternity leave from Planned Parenthood of the Rocky Mountains.

Over the past decade, however, those measures have been rejected by smaller and smaller margins, said Bob Enyart, a spokesperson for Colorado Right to Life — one of several groups pushing for Proposition 115 to pass.

“Coloradoans increasingly voted to recognize each unborn child as a person from 2008 to 2010 to 2014,” said Enyart.

Indeed, 2008’s Amendment 48, which proposed redefining personhood in the state constitution as starting at conception, received support from 27% of voters. Six years later, that support grew to 35% for Amendment 67.

A recent poll by 9News in Denver and Colorado Politics showed that voters are more evenly divided about the new proposition, with 45% saying they’ll vote no, 42% planning to vote yes, and a crucial 13% still undecided.

Randi Davis, a mom in Aurora, is one voter whose own experience illustrates how personal and nuanced the question can be. When she was pregnant, Davis was advised to have an abortion, as her baby’s odds of survival were slim to none. She said she opted against abortion and went on to give birth to a full-term stillborn baby.

“I’m not necessarily for abortion,” Davis said. “However, I do believe every woman should have their own choice to abort for whatever reason.”

She said she’s voting against the proposition.

Dr. Thomas Perille heads the medical advisory team for the Coalition for Women and Children (also known as Due Date Too Late), the group that petitioned to put Proposition 115 on the ballot and calls abortions later in pregnancy “too extreme.” Perille contends the new proposition “bears no relation” to the previous measures, giving it a better chance of passing.

“Those were bans on abortion, and Prop 115 is a reasonable restriction of abortion after fetal viability,” he said.

Abortion-rights activists worry that bans of abortions after the first trimester aim to gradually shift public opinion and gain traction to fully outlaw the procedure.

“They’re hoping that they can slide this under the radar and really cast it as a compromise between anti-abortion and pro-choice voters,” said Fawn Bolak, spokesperson for ProgressNow Colorado. “But that’s not what this is. This is a violation of Roe v. Wade.”

Perille said that, while first-trimester abortions are “relatively safe,” late abortions pose a “substantial risk” to the people having them. Advocates for the initiative said studies show the risk of death to the pregnant person from an abortion increases with each week of gestation.

Opponents point to another study that shows legal abortions overall tend to be safer and pose less of a threat to pregnant people’s lives than childbirth.

Colorado isn’t the only state voting on an abortion initiative this election cycle. Voters in Louisiana are considering a constitutional amendment that says nothing in the state constitution can be interpreted as protecting a right to, or requiring funding of, abortion.

The measure’s advocates say that, if Roe v. Wade is overturned, the legality of abortion in Louisiana would be up to state lawmakers. Opponents say the measure, if it passes, would eliminate legal access to abortion in the state if Roe v. Wade is dismantled.

“Constitutions are supposed to be about preserving and enshrining freedom, but this amendment takes away freedom and rights while allowing the government to tell people what they can and cannot do with their body,” said Michelle Erenberg, executive director for Lift Louisiana, a group that advocates for abortion rights.

Abortion-rights advocates also point out that Louisiana passed its own 22-week abortion ban a decade ago, and worry that Colorado could follow a similar path toward even greater restrictions.

The decisions before voters in Colorado and Louisiana come amid renewed attention nationwide on abortions since Supreme Court Justice Ruth Bader Ginsberg’s death last month. Senate Republicans are now pushing through President Donald Trump’s nominee, Judge Amy Coney Barrett. That has led voters and activists on both sides of the issue to become heavily focused on what Barrett’s appointment could mean for the future of Roe v. Wade.

Abortion opponents contend it’s not clear that Barrett’s confirmation would doom Roe.

“We have seen no evidence that Amy Coney Barrett has ever recognized that the unborn child is a person or has a right to life,” Enyart said. “We are concerned that she may disagree with the Roe opinion merely as a matter of process, not morality.”

But The Guardian recently reported on Barrett’s previous involvement with an anti-abortion organization, noting she signed a newspaper ad that called Roe “barbaric,” which put abortion-rights advocates on edge.

Erika Christensen, who helped pass New York’s Reproductive Health Act, said she is concerned but added that these new threats to abortion rights have become a rallying point for advocates.

Baden agreed, saying the renewed energy is particularly strong locally.

“We need to turn to the state level, and do whatever we can to prepare for what might come one day, be it from the Supreme Court or from another Trump executive order, or something else coming,” she said. “Roe is the floor, not the ceiling, right?”

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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70% Taking Common Antidepressants Suffer Sexual Side Effects

What’s the latest on treating depression with the spice saffron? Years ago, I covered a head-to-head comparison of saffron versus Prozac for the treatment of depression in my video Saffron vs. Prozac, and saffron seemed to work just as well as the drug. In the years since, five other studies have found that saffron beat out placebo or rivaled antidepressant medications.

It may be the spice’s red pigment, crocin, since that alone beat out placebo as an adjunct treatment, significantly decreasing symptoms of depression, symptoms of anxiety, and general psychological distress. Perhaps, its antioxidants played a role in “preventing free radical-induced damage in the brain.” The amount of crocin the researchers used was equivalent to about a half teaspoon of saffron a day.

If the spice works as well as the drugs, one could argue that the spice wins, since it doesn’t cause sexual dysfunction in the majority of men and women like most prescribed antidepressants do. SSRI drugs like Prozac, Paxil, and Zoloft cause “adverse sexual side effects” in around 70 percent of people taking them. What’s more, physicians not only significantly underestimate the occurrence of side effects, but they also tend to underrate how much they impact the lives of their patients.

Not only is this not a problem with saffron, the spice may even be able to treat it, as I explore in my video Best Food for Antidepressant-Induced Sexual Dysfunction. “In folk medicine, there is a widely held belief that saffron might have aphrodisiac effects.” To test this, men with Prozac-induced sexual impairment were randomized to saffron or placebo for a month. By week four, the saffron group “resulted in significantly greater improvement in erectile function…and intercourse satisfaction,” and more than half of the men in the saffron group regained “normal erectile function.” The researchers concluded that saffron is an “efficacious treatment” for Prozac-related erectile dysfunction. It has all been found to be effective for female sexual dysfunction, as well, as you can see at 2:35 in my video. Female sexual function increased by week four, improving some of the Prozac-induced sexual problems but not others. So, it may be better to try saffron in the first place for the depression and avoid developing these sexual dysfunction problems, since they sometimes can persist even after stopping the drugs, potentially worsening one’s long-term depression prognosis.

This includes unusual side effects, such as genital anesthesia, where you literally lose sensation. It can happen in men and women. More rarely, antidepressants can induce a condition called restless genital syndrome. You’ve heard of restless legs syndrome? Well, this is a restless between-the-legs syndrome. These PSSDs, or Post-SSRI Sexual Dysfunctions, meaning dysfunctions that appear or persist after stopping taking these antidepressants, can be so serious that “prescribing physicians should mention the potential danger of the occurrence of genital (e.g., penile or vaginal) anesthesia to every patient prior to any SSRI treatment.” If you’re on one of these drugs, did your doctor warn you about that?

All hope is not lost, though. Evidently, penile anesthesia responds to low-power laser irradiation. After 20 laser treatments to his penis, one man, who had lost his penile sensation thanks to the drug Paxil, partially regained his “penile touch and temperature sensation.” However, he still couldn’t perform to his girlfriend’s satisfaction, and she evidently ended up leaving him over it, which certainly didn’t help his mood. But, before you feel too badly for him, compare a little penile light therapy to clitoridectomy, clitoris removal surgery, or another Paxil-related case where a woman’s symptoms only improved after six courses of electroshock therapy.

Pass the paella!


For more on the spice, check out:

Those drug side effects sound devastating, but depression is no walk in the park. However, when one balances risk and benefit, one assumes that there are actually benefits to taking them. That’s why the shocking science I explored in Do Antidepressant Drugs Really Work? is so important.

What else may boost mood? A healthy diet and exercise:

For more on sexual health generally, see:

What else can spices do? Here’s just a taste:

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 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:

 

 

In Debate, Pence and Harris Offer Conflicting Views of Nation’s Reality

The Trump administration’s pandemic response: decisive action that saved lives, or the greatest failure of any presidential administration? During Wednesday’s vice presidential debate, Vice President Mike Pence and the Democratic challenger, Sen. Kamala Harris of California, offered drastically different takes — from behind  plexiglass screens — on how the president has handled the COVID-19 crisis.

Pence touted problematic claims, such as that President Donald Trump’s ban on travel from China helped the nation respond to the coronavirus (PolitiFact rated a similar claim “False”) and that the country would have a vaccine in less than a year (the director of the Centers for Disease Control and Prevention said a vaccine, yet to be approved, will not be widely available until next year).

Harris said the Trump administration misled the public about how serious the virus is, pointing to briefings Trump and Pence received in January. Trump told journalist Bob Woodward in a recorded interview that he purposely downplayed it.

Our partners at PolitiFact broke down a whole gamut of claims — on fracking, the economic recovery and the Supreme Court. The highlights regarding health care and coronavirus policies follow:

Kamala Harris: “The president said [the coronavirus] was a hoax.”Rating: False

This often-repeated statement falsely attributed to Trump has its roots in a Feb. 28 rally in North Carolina. But it’s a mischaracterization of what he actually said, which was an attack on Democrats’ response to the virus.

Trump cast the Democrats’ criticism of his work as foisting a hoax on the public. “They tried the impeachment hoax,” he said. “That was not a perfect conversation. They tried anything. They tried it over and over. They’d been doing it since you got in. It’s all turning. They lost. It’s all turning. Think of it. Think of it. And this is their new hoax.”

Mike Pence: The Rose Garden event with Judge Amy Coney Barrett “was an outdoor event, which all of our scientists regularly and routinely advised.”Wrong

The event included an indoor component, during which Trump, Barrett and others posed for photos without masks. Public health officials do say outdoor activities are less risky — provided masks are worn — than indoor events, where it might be harder to keep people apart and there’s less ventilation. But attendees of the Sept. 26 White House event for the nomination of Barrett to the Supreme Court did not practice social distancing, and many did not wear masks throughout the event.

Pence: Trump “suspended all travel from China. … Joe Biden opposed that decision. He called it xenophobic and hysterical.”Misleading

There were exemptions in Trump’s travel restrictions on China. On Jan. 21, the CDC confirmed the first U.S. case of the new coronavirus: a patient in Washington state who had traveled from Wuhan, China. On Jan. 31, the Trump administration announced a ban on travelers from China, but it exempted several categories of people, including U.S. citizens and lawful permanent residents. It took effect Feb. 2.

According to The New York Times, about 40,000 people traveled from China to the United States in the two months after Trump announced travel restrictions, and 60% of people on direct flights from China were not U.S. citizens.

As for the “xenophobic and hysterical” comment, Biden has not directly said the travel restrictions were xenophobic. Around the time the Trump administration announced the restrictions, Biden said Trump had a “record of hysteria, xenophobia and fearmongering.” Biden also used the word “xenophobic” in reply to a Trump tweet about limiting entry to travelers from China in which the president described the coronavirus as the “Chinese virus.”

Harris: Obama “created within the White House an office that basically was responsible for monitoring pandemics. They got rid of it. There was a team of disease experts that President Obama and Vice President Biden dispatched to China to monitor what is now predictable and what might happen. They pulled them out.” Largely accurate

Harris described two pieces of Washington’s operation to protect against new viral threats. There was a division within the White House National Security Council. And there was a CDC office in China.

In May 2018, the top White House official in charge of the U.S. response to pandemics left the administration. Then-national security adviser John Bolton reorganized the White House global health team. Homeland security adviser Tom Bossert, who recommended strong defenses against disease and biological warfare, had left in April 2018. Neither Bossert nor the official overseeing the U.S. pandemic response was replaced. Nor were their teams, some of whose responsibilities were farmed out to other corners of the administration.

In China, the CDC program specifically charged with spotting new infectious diseases went from four American staff members in 2017 to none by 2019.

Pence: Biden’s “own chief of staff, Ron Klain, would say last year that it was pure luck, that they did everything possible wrong [with H1N1]. And we learned from that.”Needs context

Klain, Biden’s former chief of staff, spoke about H1N1 during a biosecurity conference in May 2019: “A bunch of really talented, really great people working on it, and we did every possible thing wrong. And it’s, you know, 60 million Americans got H1N1 in that period of time. And it’s just purely a fortuity that this isn’t one of the great mass casualty events in American history. It had nothing to do with us doing anything right. It just had to do with luck.”

Klain has since told Politico and FactCheck.org that his comments were taken out of context, and that they were specifically in reference to the Obama administration’s difficulties meeting the public demand for an H1N1 vaccine. He was not talking about Biden directly.

Pence: The Obama administration “left the strategic national stockpile empty.”Rating: Mostly False

The Obama administration did not leave an “empty” national stockpile. Just months before COVID cases popped up in the U.S., the former director of the stockpile described it as an $8 billion enterprise with extensive holdings of many needed items. But N95 masks, for example, had been depleted after the H1N1 outbreak in 2009.

Pence: On the nation’s COVID response, “the reality is, when you look at the Biden plan, it reads an awful lot like what President Trump and I and our task force have been doing every step of the way.”Misleading

At first glance, the Biden plan does track closely with some of the talking points advanced by the Trump administration: the need to develop and distribute a vaccine, provide COVID tests free, reduce costs for COVID treatments, and produce necessary protective equipment and ventilators. But Biden’s plan proposes many other priorities that the Trump administration has not pursued. Biden also has, throughout the campaign, followed recommendations about mask-wearing and social distancing that the administration has defied — a pattern that’s being blamed for Trump’s own infection with COVID-19 and the outbreak at the White House.

Pence: The Obama administration “left an empty and hollow plan.”Misleading

The Obama administration left a “playbook” that detailed steps to take in the event of an infectious disease outbreak. The 69-page document from 2016 was a National Security Council guidebook created to assist leaders “in coordinating a complex U.S. government response to a high-consequence emerging disease threat anywhere in the world.”

Harris: “Today they still don’t have a plan” to deal with the pandemic.Needs context

Biden said the same thing during the first presidential debate. The Trump administration does have a plan to distribute vaccines once they are produced. But experts say the administration has failed to produce a national testing plan or a national strategy to address the COVID pandemic. The administration maintains its emphasis has been on helping the economy reopen. However, it has fallen short in executing a coordinated response between the federal government and states to combat the coronavirus. More than 210,000 Americans have died of COVID-19, more deaths than in any other country.

Pence (to Harris): “The fact that you continue to undermine public confidence in a vaccine, if a vaccine emerges during the Trump administration, I think is unconscionable.”Needs context

Harris said during the debate that she would not take Trump’s word that a vaccine is effective, insisting she would instead trust the opinion of an expert, such as Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases: “I will be the first in line to take it, absolutely.” Harris recently suggested Trump would push a vaccine before it was ready to help his electoral chances. But Harris is voicing concerns shared by many Americans. Last month, a Pew poll found Americans are divided on whether to get a COVID vaccine, with 78% saying they are worried it will be approved too quickly.

Harris: “The president hasn’t been transparent in terms of health records.” Accurate

After Trump announced his COVID diagnosis and was admitted to Walter Reed National Military Medical Center for treatment, his physician, Dr. Sean Conley, briefed reporters on the president’s health. Conley provided selective information and declined to answer questions, such as when the president first tested positive for the disease or the condition of his lungs. Conley said he couldn’t share this information, citing HIPAA — the Health Insurance Portability and Accountability Act of 1996. Experts told us HIPAA does prohibit Conley from sharing any health information the president hasn’t authorized him to share. However, if Trump wanted his doctor to be transparent, he could waive HIPAA protections. Beyond the recent questions about his COVID infection, Trump has shared less general health information than past presidents. But no law requires presidents to disclose information about their health.

Pence: Biden and Harris support abortion “all the way up to the moment of birth.”Misleading

Biden and Harris have not said they support abortion up to the moment of birth. They say they support Roe v. Wade, the landmark Supreme Court case that legalized abortion while giving states the ability to regulate it after a certain point. Biden and Harris say they want to codify Roe v. Wade into law and are against state laws that they say violate the rulings in the case. Supporting Roe is not the same as supporting abortion up to the moment of birth, experts say.

“Because Roe allows states to prohibit abortion once a fetus is viable, agreement with the case does not indicate support for abortions ‘up to the moment of birth,’” said Darren Hutchinson, a professor at the University of Florida’s Levin College of Law.

KHN reporters Emmarie Huetteman and Victoria Knight and PolitiFact staff writers Daniel Funke, Jon Greenberg, Louis Jacobson, Noah Y. Kim, Bill McCarthy, Samantha Putterman, Amy Sherman and Miriam Valverde contributed to this report.

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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Republican Convention, Day 2: Pomp, the Pandemic and Planned Parenthood

The Republican National Convention offered Americans a picture Tuesday night of a compassionate White House in action. But not a lot was said about the biggest health crisis in a century that has killed more than 170,000 people in this country.

First lady Melania Trump wrapped up the evening with a speech from her redesigned Rose Garden, acknowledging to audience members — almost all without masks — that, “since March, our lives have changed drastically.” She also said her husband’s administration has been relentless in its effort to find a vaccine or treatment for COVID-19. “Donald will not rest until he has done all he can to take care of everyone impacted by this terrible pandemic,” she said.

Before ending her address, she alluded to her husband’s brash reputation. “Total honesty is what we as citizens deserve from our president,” she said. “Whether you like it or not, you always know what he’s thinking.”

Her speech didn’t leave much work for fact checkers, but other remarks from the president’s adult children, as well as the evening’s other speakers, did.

Our PolitiFact partners provided a detailed rundown on statements from Tuesday night. Here are some health care highlights:

The pandemic “was awful. Health and economic impacts were tragic. Hardship and heartbreak were everywhere. But presidential leadership came swiftly and effectively, with an extraordinary rescue for health and safety to successfully fight the coronavirus.” — Larry Kudlow, director of the National Economic Council

To hear chief White House economic adviser Larry Kudlow say it, the pandemic is in the rearview mirror. There are states, such as Texas and Florida, where a deadly surge has eased. Nationally, however, the death toll continues to climb.

Data from the COVID Tracking Project shows deaths topping 170,000. And the recent rise in deaths is only slightly less compared with the early months of the pandemic.

The Institute for Health Metrics and Evaluation at the University of Washington estimates that the number of COVID deaths will exceed 300,000 by Dec. 1. That would be nearly double the deaths so far.

Kudlow offered an optimistic picture of the economic recovery and the growth to come, telling Americans to expect 20% growth in a “V-shaped recovery” in the second half of the year.

But much hinges on the course of the virus. Current trends show an ongoing threat to the prosperity Kudlow described.

“And if you believe in expanding quality and affordable health care, only President Trump, my father, signed Right to Try into law, the favored nations clause, and other actions to lower drug prices and keep Americans from getting ripped off.” — Tiffany Trump

This is somewhat misleading. The Right to Try law that Trump signed in 2018 allows individuals with life-threatening conditions who have tried all approved treatment options and cannot participate in clinical trials to access unapproved treatments. It did not, however, lower drug prices.

Trump also signed an executive order on July 24, which he has referenced as the “favored nations clause,” that has not been put into action. Nor has the text of this executive order been made public, so the details of how it would be executed are unclear. The idea of the “favored nations” proposal is that the U.S. would pay similar prices as European countries do for some Medicare Part B physician-administered drugs. This proposal has been strongly opposed by drugmakers, and experts told us they were skeptical that it would be implemented.

While Trump has long talked about lowering drug prices as one of his top health care goals, he has made little progress in doing so, outside of issuing several executive orders that have yet to be enacted.

“Margaret Sanger was a racist who believed in eugenics. Her goal when founding Planned Parenthood was to eradicate minorities.” — Abby Johnson, former Planned Parenthood worker

This statement is misleading. Sanger has been routinely criticized for supporting eugenics — the belief of improving the population by controlled breeding for desirable characteristics. But historians and scholars who have studied Sanger’s life say her opinions concerned public health and were not specific to race.

The basic concept that humanity could be improved by selective breeding was a firmly held belief by many in the years before World War II. Winston Churchill, Herbert Hoover, Theodore Roosevelt, George Bernard Shaw and H.G. Wells all supported the eugenics movement. The philosophy fell out of favor after Nazis adopted eugenics to support exterminating non-Aryan races.

Still, Planned Parenthood recently announced it would remove Sanger’s name from its Manhattan Health Center because of her eugenics beliefs, and there is some disagreement about her views and whether they should be reevaluated amid protests against systemic racism and a pandemic that has disproportionately affected minorities.

Sanger was a birth control activist, which means she wanted women to be able to avoid unwanted pregnancies. The historical record shows she worked for women of all classes and races to have that choice.

Those who call Sanger a racist often cite her work on what was called the Negro Project, an effort that started in 1939 that brought birth control services (but not abortion) to Black communities in the South. Black leaders such as W.E.B. Du Bois and Mary McLeod Bethune, founder of the National Council of Negro Women, were members of its advisory council.

PolitiFact’s Louis Jacobson, Amy Sherman, Samantha Putterman, Jon Greenberg, Miriam Valverde and KHN reporter Victoria Knight contributed to this report.

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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What Explains the Egg-Cancer Connection

The reason egg consumption is associated with elevated cancer risk may be the TMAO, considered the “smoking gun” of microbiome-disease interactions.

“We are walking communities comprised not only of a Homo sapiens host, but also of trillions of symbiotic commensal microorganisms within the gut and on every other surface of our bodies.” There are more bacterial cells in our gut than there are human cells in our entire body. In fact, only about 10 percent of the DNA in our body is human. The rest is in our microbiome, the microbes with whom we share with the “walking community” we call our body. What do they do?

Our gut bacteria microbiota “serve as a filter for our largest environmental exposure—what we eat”—and, “technically speaking, food is a foreign object that we take into our bodies” by the pound every day. The “microbial community within each of us significantly influences how we experience a meal…Hence, our metabolism and absorption of food occurs through” this filter of bacteria.

However, as you can see at 1:22 in my video How Our Gut Bacteria Can Use Eggs to Accelerate Cancer, if we eat a lot of meat, including poultry and fish, milk, cheese, and eggs, we can foster the growth of bacteria that convert the choline and carnitine in those foods into trimethylamine (TMA), which can be oxidized into TMAO and wreak havoc on our arteries, increasing our risk of heart attack, stroke, and death.

We’ve known about this “troublesome” transformation from choline into trimethylamine for more than 40 years, but that was way before we learned about the heart disease connection. Why were researchers concerned back then? Because these methylamines might form nitrosamines, which have “marked carcinogenic activity”—cancer-causing activity. So where is choline found in our diet? Mostly from meat, eggs, dairy, and refined grains. The link between meat and cancer probably wouldn’t surprise anyone. In fact, just due to the industrial pollutants, like PCBs, children probably shouldn’t eat more than about five servings a month of meats like beef, pork, or chicken combined. But, what about cancer and eggs?

Studies going back to the 1970s hinted at a correlation between eggs and colon cancer, as you can see at 2:45 in my video. That was based just on so-called ecological data, though, showing that countries eating more eggs tended to have higher cancer rates, but that could be due to a million factors. It needed to be put to the test.

This testing started in the 80s, and, by the 1990s, 15 studies had been published, of which 10 suggested “a direct association” between egg consumption and colorectal cancer, “whereas five found no association.” By 2014, dozens more studies had been published, confirming that eggs may indeed be playing a role in the development of colon cancer, though no relationship was discovered between egg consumption and the development of precancerous polyps, which “suggested that egg consumption might be involved in the promotional” stage of cancer growth—accelerating cancer growth—rather than initiating the cancer in the first place.

This brings us to 2015. Perhaps it’s the TMAO made from the choline in meat and eggs that’s promoting cancer growth. Indeed, in the Women’s Health Initiative study, women with the highest TMAO levels in their blood had approximately three times greater risk of rectal cancer, suggesting that TMAO levels “may serve as a potential predictor of increased colorectal cancer risk.”

As you can see at 4:17 in my video, though there may be more evidence for elevated breast cancer risk with egg consumption than prostate cancer risk, the only other study to date on TMAO and cancer looked at prostate cancer and did indeed find a higher risk.

“Diet has long been considered a primary factor in health; however, with the microbiome revolution of the past decade, we have begun to understand how diet can” affect the back and forth between us and the rest of us inside, and the whole TMAO story is “a smoking gun” in gut bacteria-disease interactions.

Since choline and carnitine are the primary sources of TMAO production, the logical intervention strategy might be to reduce meat, dairy, and egg consumption. And, if we eat plant-based for long enough, we can actually change our gut microbial communities such that we may not be able to make TMAO even if we try.

“The theory of ‘you are what you eat’ finally is supported by scientific evidence.” We may not have to eat healthy for long, though. Soon, Big Pharma hopes, “we may yet ‘drug the microbiome’…as a way of promoting cardiovascular health.”

What did the egg industry do in response to this information? Distort the scientific record. See my video Egg Industry Response to Choline and TMAO.


This is not the first time the egg industry has been caught in the act. See, for example:

For background on TMAO see my original coverage in Carnitine, Choline, Cancer, and Cholesterol: The TMAO Connection and then find out How to Reduce Your TMAO Levels. Also, see: Flashback Friday: How to Reduce Your TMAO Levels.

This is all part of the microbiome revolution in medicine, the underappreciated role our gut flora play in our health. For more, 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:

Armpit Shaving and Breast Cancer

Shaving before applying underarm antiperspirants can increase aluminum absorption. Could this explain the greater number of tumors and the disproportionate incidence of breast cancer in the upper outer quadrant of the breast near the armpit?

A famous case report called “The Mortician’s Mystery,” published in the New England Journal of Medicine back in the 1980s, described a man whose testicles started shrinking and breasts started growing. It turns out the mortician failed to wear gloves as he massaged embalming cream onto corpses. It was concluded there must have been an estrogenic compound in the cream that was absorbed through his skin into his body, one of the first such cases described.

This case was cited as inspiration by a group of researchers who came up with a new theory to explain a breast cancer mystery: Why do most breast cancers occur in the upper outer corner of the breast? The standard explanation was simply because that’s where most of the breast tissue is located, as the so-called tail of the breast extends up to the armpit, but that doesn’t explain the fact that it wasn’t always this way. Indeed, there has been a shift toward the appearance of breast cancer in the upper corner of the breast. And, it also doesn’t explain why “greater genomic instability”––chromosome abnormalities––has been “observed…in outer quadrants of the breast,” which may signal precancerous changes. There definitely seems to be something happening to that outer side of the breast, and it’s something relatively new, occurring in the last 50 years or so.

Is it possible that the increasing use of [underarm] antiperspirant which parallels breast cancer incidence could also be an explanation for the greater number of ductal tumours…and disproportionate incidence of breast cancer in the upper outer quadrant” of the breast near the site where stick, spray, or roll-on is applied? I discuss this possibility in my video Antiperspirants and Breast Cancer, where you can see a graph of U.S. breast cancer incidence and antiperspirant/deodorant sales at 1:38.

There is a free flow of lymph fluid back and forth between the breast and the armpit. If you measure aluminum levels in breasts removed during mastectomies, the “aluminum content of breast tissue in the outer regions [near the armpits]…was significantly higher,” presumably due to the “closer proximity to the underarm” area.

This is a concern because, in a petri dish at least, it has been demonstrated that aluminum is a so-called metalloestrogen, having pro-estrogenic effects on breast cancer cells. Long-term exposure of normal breast tissue cells in a test tube to aluminum concentrations in the range of those found in breasts results in precancerous-type changes. Then, as you can see at 2:41 in my video, once the cells have turned, those same concentrations “can increase the migratory and invasive activity of…human breast cancer cells” in a petri dish. This is important because women don’t die from the tumor in the breast itself, “but from the ability of the cancer cells to spread and grow at distant sites,” like the bones, lungs, liver, or brain. But, we don’t care about petri dishes. We care about people.

In 2002, a paper was published in the Journal of the National Cancer Institute in which the underarm antiperspirant habits of 800 breast cancer survivors were compared with those of women who had never gotten breast cancer, the first study of its kind. The finding? No indication of a link between the two.

Based on this study, Harvard Women’s Health Watch assured women that antiperspirants do not cause breast cancer and “women who are worried that antiperspirants might cause breast cancer can finally rest easy.” But two months later, another study was published that found that “frequency and earlier onset of antiperspirant/deodorant usage with underarm shaving was associated with an earlier age of breast cancer diagnosis.” As you can see at 3:56 in my video, it’s as much as 20 years earlier in women using antiperspirant and shaving their armpits more than three times a week. And, the earlier they started before versus after age 16 appeared to move up their breast cancer diagnosis by 10 or 20 years. The researchers concluded that “underarm shaving with antiperspirant/deodorant use may play a role in breast cancer” after all.

But what does shaving have to do with it? Shaving removes more than just armpit hair. It also removes armpit skin; you end up shaving off the top skin layer. And, while there is very little aluminum absorption through intact skin, when you strip off the outer layer with a razor and then rub on an antiperspirant, you get a six-fold increase in aluminum absorption through the skin. Though this is good news for women who don’t shave, the high transdermal, or through-the-skin, aluminum uptake on shaved skin “should compel antiperspirant manufacturers to proceed with the utmost caution.”

Both European safety authorities and the U.S. Food and Drug Administration (FDA) specifically advise against using aluminum antiperspirants on damaged or broken skin. However, shaving before antiperspirant application “can create abrasions in the skin…thereby negating the specific warning by the FDA and EU.” (I’m sure everyone knows about the FDA’s cautionary advice, having read Title 21 Part 350 Subpart C50-5c1 of the Code of Federal Regulations.)

We get so much aluminum in our diet from processed foods—such as anticaking agents in pancake mix, melting agents in American cheese, meat binders, gravy thickeners, baking powder, and candy—that the contribution from underarm antiperspirants would presumably be minimal in comparison. “But everything was turned topsy-turvy in 2004,” when a case was reported of a woman with bone pain and fatigue suffering from aluminum toxicity. Within months of stopping the antiperspirant, which she had been applying daily to her regularly shaved armpits, her aluminum levels came down and her symptoms resolved. Although not everyone absorbs that much aluminum, the case “suggests that caution should be exercised when using aluminum-containing antiperspirants frequently.”

Recently, as you can see at 6:29 in my video, it was shown that women with breast cancer have twice the level of aluminum in their breasts compared with women without breast cancer, though this doesn’t prove cause and effect. Maybe the aluminum contributed to the cancer, or maybe the cancer contributed to the aluminum. Maybe tumors just absorb more aluminum. Subsequent research has suggested this alternative explanation is unlikely. So, where do we stand now?

The latest review on the subject concluded that as a consequence of the new data, given that aluminum can be toxic and we have no need for it, “reducing the concentration of this metal in antiperspirants is a matter of urgency.” Or, at the very least, the label should warn: “Do not use after shaving.” Of course, we could cease usage of aluminum-containing antiperspirants altogether, but then wouldn’t we smell? Ironically, antiperspirants can make us stink worse. They increase the types of bacteria that cause body odor. It’s like the story with antidepressant drugs, which can actually make one more depressed in the long run (as I discuss in my video Do Antidepressant Drugs Really Work?). The more we use antiperspirants, the more we may need them, which is awfully convenient for a billion-dollar industry.

Is there any way to decrease body odor through changes in diet? An early video of mine discusses Body Odor and Diet, and I have some new updated ones coming down the pike!


What else can we do to decrease breast cancer risk? See, for example:

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:

VivoPlex raises funding to develop intra-uterine sensor

VivoPlex, a UK based firm specialising in fertility and women’s health, has raised £3.9m to develop an intra-uterine sensor system and generate clinical data that could be used for European approval.

Oxford-based VivoPlex raised the funds in two tranches, which will be used to complete the first feasibility study of its wireless battery-free uterine sensor system.

If the data support European approval, the sensor would be the company’s first product on the market.

The Future Fund participated in the second tranche of the fundraising alongside other investors, unlocking matched financing and helping to drive the business forward towards commercialisation.

Developed by the government and delivered by the British Business Bank, the Future Fund supports high potential innovative businesses in the UK currently affected by COVID-19.

However VivoPlex said that like many other medical device and pharma companies, it will wait until the capacity becomes available after the COVID-19 lockdown.

VivoPlex said its products represent the first insertable wireless devices for measurement of important uterine parameters of oxygen concentration, pH, and temperature.

The VivoPlex product comprises an insertable monitor no bigger than an intra-uterine device (IUD or coil) plus a wearable in the form of washable, discreet briefs that provides wireless power to the device and transmits data to proprietary software for use by the clinical specialist.

According to VivoPlex the system has produced encouraging results in early studies.

The company, which brings together a multidisciplinary team of clinical fertility experts and world-class biosensor and digital technology engineers, with experienced corporate and business development executives, was established in 2015 as a spin-out from the University of Southampton.

CEO Joanna Smart said: “The close of our clinical stage funding round enables us to continue development of our intra-uterine sensor platform and bring our first product to market, and we would like to thank all our supporters, including the Future Fund.

“The field of women’s health needs better tools to support evidence-based clinical decisions and we at VivoPlex are excited to have developed a technology that can provide valuable insights to doctors.”

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KHN’s ‘What the Health?’: The Trump Administration’s War on Fauci


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Not only does the Trump administration lack a comprehensive plan for addressing the ongoing coronavirus pandemic, it spent much of the past week working to undercut one of the nation’s most trusted scientists, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. Reporters were given “opposition research” noting times when Fauci was allegedly wrong about the course of the pandemic, and Peter Navarro, a trade adviser to President Donald Trump, published an op-ed in USA Today attacking Fauci personally.

Meanwhile, the Supreme Court may not hear the case challenging the constitutionality of the Affordable Care Act before the November elections, although its existence is likely to serve as fodder for Democrats up and down the ballot.

And lower courts have been active on the reproductive health front since the high court declined to fully exercise its anti-abortion majority. Federal judges in Tennessee and Georgia blocked abortion bans, while one in Maryland blocked an administration rule requiring insurance companies that sell plans on the Affordable Care Act exchanges to send customers a separate bill for abortion coverage if it is offered.

This week’s panelists are Julie Rovner of Kaiser Health News, Alice Miranda Ollstein of Politico, Paige Winfield Cunningham of The Washington Post and Erin Mershon of Stat News.

Among the takeaways from this week’s podcast:

  • Despite rosy pronouncements by federal officials that testing efforts in the country are progressing well, many states still report problems getting supplies they need, and delays in getting test results are making contact tracing all but impossible.
  • The testing problems create major hurdles to opening schools on time, as testing and contact tracing have been prerequisites to open schools safely.
  • Researchers are complaining that the Trump administration’s decision to have hospitals report their coronavirus data to HHS, instead of the Centers for Disease Control and Prevention, may make it difficult for them to study aspects of the outbreak.
  • Groups that oppose abortion see efforts by Chief Justice John Roberts to moderate decisions this year as a signal he may not be receptive to their arguments to overturn Roe v. Wade, which legalized abortion nationally. The chance to get one more conservative on the court to replace one of the current liberals could galvanize more support for President Donald Trump’s reelection campaign.
  • On the issue of abortion, House Democrats surprised some people by keeping the Hyde Amendment — which outlaws federal spending for abortions in nearly all cases — in the HHS appropriations bill. That was likely an effort to protect vulnerable Democrats in conservative districts.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too:

Julie Rovner: The New Yorker’s “How Trump Is Helping Tycoons Exploit the Pandemic,” by Jane Mayer

Alice Miranda Ollstein: The New York Times Magazine’s “Why We’re Losing the Battle With Covid-19,” by Jeneen Interlandi

Erin Mershon: The New York Times’ “Bottleneck for U.S. Coronavirus Response: The Fax Machine,” by Sarah Kliff and Margot Sanger-Katz

Paige Winfield Cunningham: Politico’s “Inspector General: Medicare Chief Broke Rules on Her Publicity Contracts,” by Dan Diamond and Adam Cancryn


To hear all our podcasts, click here.

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What Does Drinking Soy Milk Do to Hormone Levels?

The vast majority of breast cancers start out hormone-dependent, where estradiol, the primary human estrogen, “plays a crucial role in their breast cancer development and progression.” That’s one of the reasons why soy food consumption appears so protective against breast cancer: Soy phytoestrogens, like genistein, act as estrogen-blockers and block the binding of estrogens, such as estradiol, to breast cancer cells, as you can see at 0:24 in my video How to Block Breast Cancer’s Estrogen-Producing Enzymes.

Wait a second. The majority of breast cancers occur after menopause when the ovaries have stopped producing estrogen. What’s the point of eating estrogen-blockers if there’s no estrogen to block? It turns out that breast cancer tumors produce their own estrogen from scratch to fuel their own growth.

As you can see at 1:03 in my video, “estrogens may be formed in breast tumors by two pathways, namely the aromatase pathway and sulfatase pathway.” The breast cancer takes cholesterol and produces its own estrogen using either the aromatase enzyme or two hydroxysteroid dehydrogenase enzymes.

So, there are two ways to stop breast cancer. One is to use anti-estrogens—that is, estrogen-blockers—like the soy phytoestrogens or the anti-estrogen drug tamoxifen. “However, another way to block estradiol is by using anti-enzymes” to prevent the breast cancer from making all the estrogen in the first place. And, indeed, there are a variety of anti-aromatase drugs in current use. In fact, inhibiting the estrogen production has been shown to be more effective than just trying to block the effects of the estrogen, “suggesting that the inhibition of estrogen synthesis is clinically very important for the treatment of estrogen-dependent breast cancer.”

It turns out that soy phytoestrogens can do both.

Using ovary cells taken from women undergoing in vitro fertilization, soy phytoestrogens were found to reduce the expression of the aromatase enzyme. What about in breast cancer cells, though? This occurred in breast cancer cells, too, and not only was aromatase activity suppressed, but that of the other estrogen-producing enzyme, as well. But this was in a petri dish. Does soy also suppress estrogen production in people?

Well, as you can see at 2:34 in my video, circulating estrogen levels appear significantly lower in Japanese women than Caucasian American women, and Japan does have the highest per-capita soy food consumption, but you can’t know it’s the soy until you put it to the test. Japanese women were randomized to add soy milk to their diet or not for a few months. Estrogen levels successfully dropped about a quarter in the soy milk supplemented group. Interestingly, as you can see at 3:04 in my video, when the researchers tried the same experiment in men, they got similar results: a significant drop in female hormone levels, with no change in testosterone levels.

These results, though, are in Japanese men and women who were already consuming soy in their baseline diet. So, the study was really just looking at higher versus lower soy intake. What happens if you give soy milk to women in Texas? As you can see at 3:29 in my video, circulating estrogen levels were cut in half. Since increased estrogen levels are “markers for high risk for breast cancer,” the effectiveness of soy in reducing estrogen levels may help explain why Chinese and Japanese women have such low rates of breast cancer. What’s truly remarkable is that estrogen levels stayed down for a month or two even after the subjects stopped drinking soy milk, which suggests you don’t have to consume soy every day to have the cancer protective benefit.

Wait, soy protects against breast cancer? Yes, in study after study after study—and even in women at high risk. Watch my video BRCA Breast Cancer Genes and Soy for the full story.

 What about if you already have breast cancer? In that case, see Is Soy Healthy for Breast Cancer Survivors?

 And what about GMO soy? Get the facts in GMO Soy and Breast Cancer.

 Okay, then, Who Shouldn’t Eat Soy? Watch my video and find out.


What else can we do to decrease breast cancer risk? See:

 You may also be interested in:

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:

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:

Pill-Free Ways to improve Your Sex Life

“Sex is important to health,” according to the Harvard Health Letter. “Frequent sexual intercourse is associated with reduced heart attack risk.” But, as I discuss in my video Do Men Who Have More Sex Live Longer?, that seems to be the perfect case of reverse causation. They’re implying that more sex leads to healthier arteries, but isn’t the opposite more likely—that is, healthier arteries lead to more sex? Blood flow in the penis is so reflective of blood flow elsewhere that penile Doppler ultrasound can predict cardiovascular disease. However, low frequency of sexual activity may predict cardiovascular disease in men independently of erectile dysfunction. This suggests that sex may be more than “just fun” and may also be therapeutic, or at least so says an editor of the Journal of Sexual Medicine and colleagues in discussing whether or not “frequent sexual activity can be prescribed” to improve general health. In men, they suggest it’s because more sex means more testosterone.

When men have sex, they get a big spike in testosterone levels in their blood, but, interestingly, in contrast, they don’t get a testosterone boost when they masturbate, as you can see at 1:21 in my video. This may be because “testosterone increases with competitive success,” like if you win a sports game. While sex “is not usually regarded as a competitive event…one’s mental state following coitus could nevertheless be something like that of a winner,” as opposed to the mental state after masturbation.

As you can see at 2:00 in my video, the spike in sex hormones in the blood is so great that men’s beards actually grow faster on days they have sex. And, since low testosterone levels are associated with increased risk of mortality, this could help explain the health benefits of having sex.

So, do men who have more sex actually live longer? I searched Pubmed for sexual activity and longevity and found a study supported by the U.S. Department of Agriculture, titled “Sexual activity and longevity of the southern green stink bug”—clearly an example of our taxpayer dollars hard at work. I was less interested in whether or not screwworms live up to their namesake and more interested in a study on sex and death, in which the objective was “to examine the relation between frequency of orgasm and mortality.” The researchers found that men with “high orgasmic frequency” appeared to cut their risk of premature death in half and, apparently, the more, the better: There was an associated 36 percent drop in mortality odds for every additional 100 orgasms a year. “Conclusion: Sexual activity seems to have a protective effect on men’s health”—but, apparently, not if you cheat. “Unfaithfulness in men seems to be associated with a higher risk of major cardiovascular events,” like heart attacks and strokes. “Extramarital sex may be hazardous and stressful because the lover is often younger…[and] a secret sexual encounter” may be more stressful.

In a large autopsy series, the majority of cases of sudden death during sex occurred in men during extramarital intercourse. The absolute risk is low—“only one out of 580 men might be expected to suffer a sudden death attributable to sexual intercourse”—but for those at high risk, research shows that “[s]ex in familiar surroundings, in a comfortable room temperature, and with the usual partner adds less stress to the heart” and may be safer.

Speaking of safe sex, you thought drinking and driving was bad? “While it is generally assumed that sexual behavior happens in parked cars, there is little discussion…in the research literature of sexual activity in moving vehicles.” About one in five college students report engaging in sex while driving, nearly half while going more than 60 miles an hour. Researchers suggest maybe this is something students should be warned about in health class.

When done right, though, love may protect your lover’s life. Given the benefits of sexual activity, “intervention programmes could also be considered, perhaps based on the exciting ‘At least five a day’ campaign aimed at increasing fruit and vegetable consumption—although the numerical imperative may have to be adjusted.”

What are some pill-free ways to improve your sex life? Exercising, quitting smoking, not drinking too much alcohol, not weighing too much, and eating a healthy diet. But what does it mean to “eat a healthy diet”? As I discuss in my video Best Foods to Improve Sexual Function, heart-healthy lifestyle changes are sex-healthy lifestyle changes, which have been demonstrated in studies from around the world, including in women (for whom there is sadly a dearth of research about in the biomedical literature). “Sexual function in women is significantly affected” by coronary artery disease, atherosclerotic narrowing of blood flow through our arteries, including the arteries that supply our pelvis. So, high cholesterol may mean “lower arousal, orgasm, lubrication, and satisfaction,” and the same holds for high blood pressure.

Given this, putting women on a more plant-based diet may help with sexual functioning.   Researchers found that improvements in female sexual function index scores were related to an increased intake of fruits, vegetables, nuts, and beans, and a shift from animal to plant sources of fat. The same for men: a significant improvement in international Index of Erectile Function scores. In fact, the largest study on diet and erectile dysfunction found that each additional daily serving of fruits or vegetables may reduce the risk of ED by 10 percent. But why? It may be due to the anti-inflammatory effects. Two years on a healthier diet resulted in a significant reduction in systemic inflammation, as indicated by reduced levels of C-reactive protein. Fiber itself may play an anti-inflammatory role. Those who eat the most fiber tend to have significantly lower levels of inflammation in their bodies, as you can see at 2:06 in my video. The opposite was found for saturated fat, “associated with an increased likelihood of elevated CRP”, C-reactive protein levels.

We’re used to seeing changes in inflammatory markers over weeks, months, or years, but people don’t realize that the level of inflammation in our bodies can change after only a single meal. For example, there’s a pro-inflammatory signaling molecule in our bodies called interleukin 18, thought to play a role in destabilizing atherosclerotic plaque. As such, the level of interleukin 18 in the blood “ is a strong predictor” of cardiovascular death.

What would happen if you fed people one of three different types of meals: sausage-egg-butter-oil sandwiches, cheeseless pizza with white flour crust, or the same cheeseless pizza but with whole-wheat crust? Within hours of eating the sausage sandwich, interleukin 18 levels shot up about 20 percent, an effect not seen after eating the plant-based pizza. In contrast, those eating the whole food, plant-based pizza made with the whole-wheat crust had about a 20 percent drop in interleukin 18 levels within hours of consumption, reinforcing dietary recommendations to eat a diet high in fiber and starches, and low in saturated fat to prevent chronic diseases.

But the billions in profits are in pills, not plants, which is why the pharmacology of the female orgasm has been studied ever since 1972 when a researcher at Tulane University implanted tubes deep within the brain of a woman so he could inject drugs directly into her brain and was able to induce repetitive orgasms. A man who had electrodes placed into similar parts of his brain was given a device for a few hours that allowed him to press the button himself to stimulate the electrode. He pressed the button up to 1,500 times.


For more on male reproductive health, see:

Also check out my other men’s health videos, such as:

What effect might that inflammation directly following an unhealthy meal have on our artery function? Check out my three-part endotoxins series starting with The Leaky Gut Theory of Why Animal Products Cause Inflammation.

And why exactly is fiber anti-inflammatory? Watch my video Prebiotics: Tending Our Inner Garden.

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 to Take for Menstrual Cramps

In my video Ginger for Migraines, I described how ginger works as well as the leading “drug” in the treatment of migraines, “one of the most common causes of pain syndromes,” affecting as much as 12 percent of the population. Twelve percent is “common”?

How about menstrual cramps, which plague up to 90 percent of younger women? You can tell this study was written by a guy because he emphasizes the absenteeism and all the “lost productivity” for our nation. Menstrual cramps also just really hurt.

Can ginger help? As I discuss in my video Benefits of Ginger for Menstrual Cramps, women took a quarter teaspoon of ground ginger powder three times a day during the first three days of menstruation, and pain dropped from seven on a scale of one to ten down to a five, whereas there was no significant change in the placebo group, as you can see at 0:56 in my video. Most women in the placebo group said their symptoms stayed the same, whereas those unknowingly in the ginger group said they felt much better.

A subsequent study found that even just an eighth of a teaspoon three times a day appeared to work just as well, dropping pain from an eight to a six and, in the second month, down to a three. The “alleviation of menstrual pain was more remarkable during the second month of the intervention,” and study participants had only been taking the ginger for four days, not the whole month, suggesting it might work even better if women use ginger every period. 

What about the duration of pain? As you can see at 1:52 in my video, a quarter teaspoon of ground ginger powder three times a day not only dropped the severity of pain from about a seven down to a five but also decreased the duration of total hours in pain from 19 hours down to about 15 hours, indicating that three quarters of a teaspoon of ginger powder a day for three days is a safe and effective way to produce pain relief in college students with painful menstrual cramps, compared to placebo, capsules filled instead with powdered toast. But women don’t take breadcrumbs for their cramps. How does ginger compare with ibuprofen? An eighth of a teaspoon of ginger powder four times a day for three days versus 400 milligrams of Motrin were put to the test, and the ginger worked just as well as the drug of choice, as you can see at 2:40 in my video.

If you do take the drug, though, I was surprised to learn that it may be better to take drugs like ibuprofen and naproxen on an empty stomach because that may speed up the pain relief and help keep people from taking higher doses.


I’ve touched on this effect before in Ginger for Nausea, Menstrual Cramps, and Irritable Bowel Syndrome. What else can this amazing plant do? See, for example:

What else can really help with cramps, PMS, and cyclical breast pain? 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:

Balancing the Risks and Benefits of Vitamin C Supplements

Mainstream medicine has long had a healthy skepticism of dietary supplements, extending to the present day with commentaries like “Enough is enough.” In an essay entitled “Battling quackery,” however, published in the Archives of Internal Medicine, it’s argued that we may have gone too far in our supplement bashing, as evidenced by our “uncritical acceptance” of supposed toxicities; the surprisingly “angry, scornful tone” found in medical texts using words like “careless,” “useless,” “indefensible,” “wasteful,” and “insidious”; and ignoring evidence of possible benefit.

“To illustrate the uncritical acceptance of bad news” about supplements, the authors discussed the “well-known” concept that high-dose vitamin C can cause kidney stones, as I highlight in my video Do Vitamin C Supplements Prevent Colds but Cause Kidney Stones? Just because something is well-known in medicine, however, doesn’t mean it’s necessarily true. In fact, the authors couldn’t find a single, reported case.

We’ve known that vitamin C is turned into oxalates in the body, and, if the level of oxalates in the urine gets too high, stones can form, but, even at 4,000 mg of vitamin C a day, which is like a couple gallons’ worth of orange juice, urinary oxalates may not get very high, as you can see at 1:10 in my video. Of course, there may be the rare individuals who have an increased capacity for this conversion into oxalates, so a theoretical risk of kidney stones with high-dose vitamin C supplements was raised in a letter printed in a medical journal back in 1973.

When the theoretical risk was discussed in the medical literature, however, the researchers made it sound as if it were an established phenomenon: “Excessive intake of vitamin C may also be associated with the formation of oxalate stones.” Sounds less like a theoretical risk and more like an established phenomenon, right? That statement had seven citations supposedly suggesting an association between excessive vitamin-C intake and the formation of oxalate kidney stones. Let’s look at the cited sources, which you can see from 1:47 in my video. One reference is the letter about the theoretical risk, which is legitimate, but another listed citation, titled “Jaundice following the administration of niacin,” has nothing to do with either vitamin C or kidney stones. What’s more, the other five citations are just references to books. That may be acceptable if the books cited primary research themselves, but, instead, there was a kind of circular logic, where the books just cite other books citing that theoretical risk letter again. So, while it looks as if there’s a lot of evidence, they’re all just expressing this opinion with no new data.

By that time, there actually were studies that followed populations of people taking vitamin C supplements and found no increased kidney stone risk among men, then later, the same was shown in women. So, you can understand the frustration of the authors of “Battling quackery” commentary that vitamin-C supplements appeared to be unfairly villainized.

The irony is that we now know that vitamin-C supplements do indeed appear to increase kidney stone risk. The same population of men referenced above was followed further out, and men taking vitamin-C supplements did in fact end up with higher risk. This has since been confirmed in a second study, though also of men. We don’t yet know if women are similarly at risk, though there has now also been a case reported of a child running into problems.

What does doubling of risk mean exactly in this context? Those taking a thousand milligrams or so of vitamin C a day may have a 1-in-300 chance of getting a kidney stone every year, instead of a 1-in-600 chance. One in 300 “is not an insignificant risk,” as kidney stones can be really painful, so researchers concluded that since there are no benefits and some risk, it’s better to stay away.

But there are benefits. Taking vitamin C just when you get a cold doesn’t seem to help, and although regular supplement users don’t seem to get fewer colds, when they do get sick, they don’t get as sick and get better about 10 percent faster. And, those under extreme physical stress may cut their cold risk in half. So, it’s really up to each individual to balance the potential common cold benefit with the potential kidney stone risk.


What about intravenous vitamin C? I’ve got a whole video series on that, including:

If you’re not taking vitamin C supplements for pharmacological effects and just want to know how many vitamin C-rich fruits and vegetables to eat every day, check out my video What Is the Optimal Vitamin C Intake?.

Is there anything we can put into our mouth that really might help prevent colds? These videos will point you in the right direction:

And, if you’re interested in learning about the most important steps you can take to prevent and treat kidney stones, look no further than my videos How to Prevent Kidney Stones with Diet and How to Treat Kidney Stones with Diet.

What about high-oxalate vegetables such as rhubarb, spinach, beet greens and swiss chard? I’d encourage a moderation in intake. If you’re going to take my advice to ideally eat cups of dark green leafy vegetables a day I’d recommend sticking with other greens such as kale or collards.

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 Role of Meat and Dairy in Triggering Type 1 Diabetes

Type 1 diabetes “arises following the autoimmune destruction of the insulin-producing pancreatic β [beta] cells…[and] is most often diagnosed in children and adolescents, usually presenting with a classic trio of symptoms” as their blood sugars spike: excessive thirst, hunger, and urination. They need to go on insulin for the rest of their lives, since their own immune systems attacked and destroyed their ability to produce it. What would cause our body to do such a thing? I examine this in my video, Does Paratuberculosis in Milk Trigger Type 1 Diabetes?

Whatever it is, it has been on the rise around the world, starting after World War 2. “Understanding why and how this produced the current pandemic of childhood diabetes would be an important step toward reversing it.” A plausible guess is “molecular mimicry, whereby a foreign antigen (bacterial or viral) provokes an immune response, which cross-reacts” with a similar-looking protein on our pancreas such that when we attack the bug, our own organ gets caught in the cross-fire. Given this, what pancreatic proteins are type 1 diabetics self-attacking? In the 1980s, a protein was identified that we came to realize in the 1990s looked an awful lot like a certain mycobacterial protein. Mycobacteria are a family of bacteria that cause diseases like tuberculosis and leprosy, and, in one study, all newly diagnosed type 1 diabetic children were found to have immune responses to this mycobacterial protein. This didn’t make any sense as incidence of type 1 diabetes has been going up in the industrialized world, whereas TB and leprosy rates have gone down. However, there is one mycobacterial infection in farm animals that has shot up with the industrialization and globalization of animal agriculture: paratuberculosis (paraTB), which causes Johne’s disease in animals. Paratuberculosis is now recognized as a global problem for the livestock industry.

Weren’t there a dozen or so studies suggesting that “cow’s milk exposure may be an important determinant of subsequent type 1 diabetes” in childhood? Indeed. After putting two and two together, an idea was put forward in 2006: Could mycobacterium paratuberculosis from cattle be a trigger for type 1 diabetes? The idea was compelling enough for researchers put it to the test.

They attempted to test the association of Mycobacterium avium paratuberculosis (MAP), the full name for the bug, with type 1 diabetes by testing diabetics for the presence of the bacteria in their blood. Lo and behold, most of the diabetic patients tested positive for the bug, compared to only a minority of the healthy control subjects. This evidence of MAP bacteria in the blood of patients with type 1 diabetes “might provide an important foundation in establishing an infectious etiology,” or cause, for type 1 diabetes. “These results also might possibly have implications for countries that have the greatest livestock populations and high incidence of MAP concurrent with the highest numbers of patients with” diabetes, like the United States.

Johne’s is the name of the disease when farm animals get infected by MAP. The reason diabetes researchers chose to look at Sardinia, an island off the coast of Italy, is because paratuberculosis is present in more than 50 percent of Sardinian herds. Surpassing that, though, is the U.S. dairy herd. According to a recent national survey, 68 percent of the U.S. dairy herd are infected with MAP, especially those cattle at big, industrial dairies, as you can see at 3:33 in my video. Ninety-five percent of operations with more than 500 cows came up positive. It’s estimated the disease costs the U.S. industry more than a billion dollars a year.

How do people become exposed? “The most important routes of access of MAP to the [human] food chain appear to be contaminated milk, milk products and meat” from infected cattle, sheep, and goats. MAP or MAP DNA has been detected in raw milk, pasteurized milk, infant formula, cheese, ice cream, muscle and organ tissues, and retail meat. We know paraTB bacteria survive pasteurization because Wisconsin researchers bought hundreds of pints of retail milk off store shelves from three of the top U.S. milk-producing states and tested for the presence of viable, meaning living, MAP bacteria. They found that 2.8 percent of the retail milk tested came back positive for live paraTB bacteria, with most brands yielding at least one positive sample. If paraTB does end up being a diabetes trigger, then “these findings indicate that retail milk [in the United States] would need to be considered as a transmission vector.” Why hasn’t the public heard about this research? Perhaps because the industry is not too keen on sharing it. Indeed, according to an article in the Journal of Dairy Science: “Fear of consumer reaction…can impede rational, open discussion of scientific studies.”

Not only is MAP a serious problem for the global livestock industry, but it also may trigger type 1 diabetes, given that paraTB bacteria have been found in the bloodstream of the majority of type 1 diabetics tested who presumably are exposed through the retail milk supply as the bacteria can survive pasteurization. But what about the meat supply? MAP has been found in beef, pork, and chicken. It’s an intestinal bug, and unfortunately, “[f]aecal contamination of the carcass in the abattoir [slaughter plant] is unavoidable…” Then, unless the meat is cooked well-done, it could harbor living MAP.

In terms of meat, “ground beef represents the greatest potential risk for harboring MAP…[as] a significant proportion originates from culled dairy cattle,” who may be culled because they have paratuberculosis. These animals may go straight into the human food chain. There also exists greater prevalence of fecal contamination and lymph nodes in ground meat, and the grinding can force the bacteria deep inside the ground beef burger. As such, “given the weight of evidence and the severity and magnitude of potential human health problems, the precautionary principle suggests that it is time to take actions to limit…human exposure to MAP.” At the very least, we should stop funneling animals known to be infected into the human food supply.

We know that milk exposure is associated with type 1 diabetes, but what about meat? As I discuss in my video Meat Consumption and the Development of Types 1 Diabetes, researchers attempted to tease out the nutritional factors that could help account for the 350-fold variation in type 1 diabetes rates around the world. Why do some parts of the world have rates hundreds of times higher than others? Yes, the more dairy populations ate, the higher their rates of childhood type 1 diabetes, but the same was found for meat, as you can see at 2:07 in my video. This gave “credibility to the speculation that the increasing dietary supply of animal protein after World War II may have contributed to the reported increasing incidence of type 1 diabetes…” Additionally, there was a negative correlation—that is, a protective correlation that you can see at 2:26 in my video—between the intake of grains and type 1 diabetes, which “may fit within the more general context of a lower prevalence of chronic diseases” among those eating more plant-based diets.

What’s more, the increase in meat consumption over time appeared to parallel the increasing incidence of type 1 diabetes. Now, we always need to be cautious about the interpretation of country-by-country comparisons. Just because a country eats a particular way doesn’t mean the individuals who get the disease ate that way. For example, a similar study looking specifically at the diets of children and adolescents between different countries “support[ed] previous research about the importance of cow’s milk and [other] animal products” in causing type 1 diabetes. But, the researchers also found that in countries where they tended to eat the most sugar, kids tended to have lower rates of the disease, as you can see at 3:18 in my video. This finding didn’t reach statistical significance since there were so few countries examined in the study, but, even if it had and even if there were other studies to back it up, there are countless factors that could be going on. Maybe in countries where people ate the least sugar, they also ate the most high fructose corn syrup or something. That’s why you always need to put it to the test. When the diets of people who actually got the disease were analyzed, increased risk of type 1 diabetes was associated with milk, sugar, bread, soda, eggs, and meat consumption.

In Sardinia, where the original link was made between paraTB and type 1 diabetes, a highly “statistically significant dose-response relationship” was found, meaning more meat meant more risk, especially during the first two years of children’s lives. So, “[h]igh meat consumption seems to be an important early in life cofactor for type 1 diabetes development,” although we needed more data.

The latest such study, which followed thousands of mother-child pairs, found that mothers eating meat during breastfeeding was associated with an increased risk of both preclinical and full-blown, clinical type 1 diabetes by the time their children reached age eight. The researchers thought it might be the glycotoxins, the AGEs found in cooked meat, which can be transferred from mother to child through breastfeeding, but they have learned that paratuberculosis bacteria can also be transferred through human breast milk. These bacteria have even been grown from the breast milk of women with Crohn’s disease, another autoimmune disease linked to paraTB bacteria exposure.


For a deeper discussion of other possibilities as to why cow’s milk consumption is linked to this autoimmune destruction of insulin production, see Does Casein in Milk Trigger Type 1 Diabetes? and Does Bovine Insulin in Milk Trigger Type 1 Diabetes?.

If we don’t drink milk, though, what about our bone health? See my videos Long-Term Vegan Bone Health and Is Milk Good for Our Bones?.

The vast majority of cases of diabetes in the United States are type 2, though. Ironically, meat may also play a role there. See my videos Why Is Meat a Risk Factor for Diabetes? and How May Plants Protect Against Diabetes? for more information.

For more on the links between milk and diabetes, see my videos Does Casein in Milk Trigger Type 1 Diabetes? and Does Bovine Insulin in Milk Trigger Diabetes?. What about treating and preventing diabetes through diet? Check out How Not to Die from Diabetes and How to Prevent Prediabetes from Turning Into Diabetes.

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 Endometriosis with Diet

“Endometriosis is a major cause of disability and compromised quality of life in women and teenage girls.” It “is a chronic disease which is under-diagnosed, under-reported, and under-researched…[and for patients, it] can be a nightmare of misinformation, myths, taboos, lack of diagnosis, and problematic hit-and-miss treatments overlaid by a painful, chronic, stubborn disease.”

Pain is what best characterizes the disease: pain, painful intercourse, heavy irregular periods, and infertility. About one in a dozen young women suffer from endometriosis, and it accounts for about half the cases of pelvic pain and infertility. It’s caused by what’s called “retrograde menstruation”—blood, instead of going down, goes up into the abdominal cavity, where tissue of the uterine lining can implant onto other organs. The lesions can be removed surgically, but the recurrence rate within five years is as high as 50 percent.

Endometriosis is an estrogen-dependent disease, so might the anti-estrogenic effects of the phytoestrogens in flaxseeds and soy foods help, as they appear to do in breast cancer? I couldn’t find studies on flax and endometriosis, but soy food consumption may indeed reduce the risk of that disease. What about treating endometriosis with soy? While I couldn’t find any studies on that, there is another food associated with decreased breast cancer risk: seaweed.

Seaweeds have special types of fiber and phytonutrients not found in land plants, so in order to get these unique components, we would need to incorporate sea vegetables into our diet. Seaweeds, may have anti-cancer properties, including anti-estrogen effects. Japanese women have among the lowest rates of breast, endometrial, and ovarian cancers, as well as longer menstrual cycles and lower estrogen levels circulating in their blood, which may help account for their low risk of estrogen-dependent cancers. We assumed this was due to their soy-rich diets, but their high intake of seaweed might also be helping.

When seaweed broth was dripped on human ovary cells that make estrogen, estrogen levels dropped. Why? It either inhibits production or facilitates breakdown of estrogen. It may even block estrogen receptors, lowering the activity of the estrogen that is produced. This is in a petri dish, though. Does it happen in women, too? Yes.

Researchers estimated that an effective estrogen-lowering dose of seaweed for an average American woman might be around five grams a day, but, apparently, no one has tried testing it on cancer patients yet. However, it has been tried on endometriosis, as I discuss in my video How to Treat Endometriosis with Seaweed.

Three women with abnormal menstrual cycles, including two with endometriosis, volunteered to add a tiny amount of dried, powdered bladderwrack, a common seaweed, to their daily diet. This effectively lengthened their cycles and reduced the duration of their periods—and not just by a little. As you can see at 3:14 in my video, subject 1 had a 30-year history of irregular periods, averaging every 16 days. Taking just a quarter-teaspoon of this seaweed powder a day added 10 days onto her cycle, up to 26 days, and adding a daily half-teaspoon increased her cycle to 31 days, nearly doubling its length. Furthermore, as you can see at 3:38 in my video, all three women experienced marked reductions in blood flow and a decreased duration of menstruation. For 30 years, subject 1 had been having her period every 16 days, and it typically lasted 9 days. Can you imagine? Then, by just taking a daily half-teaspoon of seaweed, her period came just once a month and only lasted about four days. Most importantly, in the two women suffering from endometriosis, they reported “substantial alleviation” of their pain. How is that possible? There was a 75 percent drop in estrogen levels after just a quarter-teaspoon of seaweed powder a day and an 85 percent drop after a half-teaspoon. 

Of course, with just a few women and no control group in that study, we need bigger, better studies. But, that study was published more than a decade ago and not a single such study has been published since. Millions of women are suffering with these conditions. Does the research world just not care about women? The more pointed question is: who’s going to fund the work? Less than a teaspoon of seaweed costs less than five cents, so a larger study may never be done. But, without any downsides, I suggest endometriosis sufferers give it a try.


For more on endometriosis, see my video What Diet Best Lowers Phthalate Exposure?, and, to learn about the anti-estrogenic effects of the phytoestrogens in flaxseeds on breast cancer, see Flaxseeds and Breast Cancer Survival: Clinical Evidence.

Interested in more on sea vegetables? See:

I recommend staying away from kelp and hijiki, though. Why? See Too Much Iodine Can Be as Bad as Too Little.

Learn more about other natural remedies for menstrual problems:

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 to Eat and Avoid for Women with BRCA Gene Mutations

Five studies have been performed on breast cancer survival and soy foods involving more than 10,000 breast cancer patients, and together they found that those who eat more soy live longer and have a lower risk of the cancer coming back. What about women who carry breast cancer genes? Fewer than 10 percent of breast cancer cases run in families, but when they do, it tends to be mutations to one of the tumor suppressor genes, BRCA1 or BRCA2. BRCA 1 and BRCA 2 are involved in DNA repair, so if either one of them is damaged, chromosomal abnormalities can result, which can set us up for cancer. I examine this in my video Should Women at High Risk for Breast Cancer Avoid Soy?.

This idea that we have tumor suppressor genes goes back to famous research from the 1960s that showed that if we fuse together a normal cell with a cancer cell, rather than the cancer cell turning the normal cell malignant, the normal cell actually suppresses the cancerous one. Tumor suppressor genes are typically split into two types: gatekeeper genes that keep cancer cells in check and caretaker genes that prevent the cell from becoming cancerous in the first place. BRCA genes appear able to do both, which is why their function is so important.

Until recently, dietary recommendations for those with mutations to BRCA genes focused on reducing DNA damage caused by free radicals by eating lots of antioxidant-packed fruits and vegetables. If our DNA repair capacity is low, we want to be extra careful about damaging our DNA in the first place. But what if we could also boost BRCA function? In my video BRCA Breast Cancer Genes and Soy, I showed how, in vitro, soy phytoestrogens could turn back on BRCA protection suppressed by breast cancer, upregulating BRCA expression as much as 1,000 percent within 48 hours.

Does that translate out of the petri dish and into the person? Apparently so. Soy intake was associated with only a 27 percent breast cancer risk reduction in people with normal BRCA genes, but a 73 percent risk reduction in carriers of BRCA gene mutations. So, a healthy diet may be particularly important for those at high genetic risk. Meat consumption, for example, was linked to twice as much risk in those with BRCA mutations: 97 percent increased risk instead of only 41 percent increased breast cancer risk in those with normal BRCA genes. So, the same dietary advice applies to those with and without BRCA mutations, but it’s more important when there’s more risk.


What about women without breast cancer genes or those who have already been diagnosed? See my video Is Soy Healthy for Breast Cancer Survivors?.

What is in meat that may increase risk? 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: