What About the Sodium in Miso?

According to the second World Cancer Research Fund/American Institute for Cancer Research expert report, “[s]alt is a probable cause of stomach cancer,” one of the world’s leading cancer killers. If the report’s estimate of an 8 percent increase in risk for every extra gram of salt a day is correct, then in a country like the United Kingdom, nearly 1,700 cases of stomach cancer happen every year just because of excess salt intake, as you can see at 0:27 in my video Is Miso Healthy?, and, in a country like the United States, it would be thousands more annually.

The risk of stomach cancer associated with salt intake appears on par with smoking or heavy alcohol use, but may only be half as bad as opium use or increased total meat consumption, as you can see at 0:43 in my video. These findings were based on a study of more than a half million people, which may explain why those eating meatless diets appear to have nearly two-thirds lower risk.

We know dietary salt intake is directly associated with the risk of stomach cancer, and the higher the intake, the higher the risk. A meta-analysis went one step further and looked at specific salt-rich foods: pickled foods, salted fish, processed meat, and miso soup. Habitual consumption of pickled foods, salted fish, and processed meat were each associated with about a 25 percent greater risk of stomach cancer. The pickled foods may explain why Korea, where the pickled cabbage dish kimchi is a staple, appears to have the highest stomach cancer rates in the world, as you can see at 1:39 in my video. But researchers found there was no significant association with the consumption of miso soup. This may be because the carcinogenic effects of the salt in miso soup are counteracted by the anti-carcinogenic effects of the soy, effectively canceling out the risk. And, if we made garlicky soup with some scallions thrown in, our cancer risk may drop even lower, as you can see at 2:06 in my video.

Cancer isn’t the primary reason people are told to avoid salt, though. What about miso soup and high blood pressure? Similar to the relationship between miso and cancer, the salt in miso pushes up our blood pressures, but miso’s soy protein may be relaxing them down. If we compare the effects of soy milk to cow’s milk, for example, and, to make it even more fair, compare soy milk to skim cow’s milk to avoid the saturated butter fat, soy milk can much more dramatically improve blood pressure among women with hypertension, as you can see at 2:43 in my video. But would the effect be dramatic enough to counter all the salt in miso? Japanese researchers decided to put it to the test.

For four years, they followed men and women in their 60s, who, at the start of the study, had normal blood pressure, to see who was more likely to be diagnosed with hypertension in that time: those who had two or more bowls of miso soup a day or those who had one or less. Two bowls a day may add a half teaspoon of salt to one’s daily diet, yet those who had two or more bowls of miso soup every day appeared to have five times lower risk of becoming hypertensive. So, maybe the anti-hypertensive effects of the soy in the miso exceed the hypertensive effects of the salt.


Indeed, miso paste, a whole soy food, can be used as a “green light” source of saltiness when cooking. That’s why I used it in my pesto recipe in How Not to Die and in my How Not to Die Cookbook. It can help you in Shaking the Salt Habit.

Not convinced that salt is bad for you? Check out these videos:

Not convinced that soy is good for you? See:

In health,
Michael Greger, M.D.

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

What Happens When Pregnant Women Eat More Animal Protein

Are high-protein diets during pregnancy healthful or harmful? That question was answered about 40 years ago in the infamous Harlem Trial of 1976: a “randomized controlled trial of nutritional supplementation pregnancy, in a poor black urban population in the United States.” The study, which I discuss in my video The Effect of Animal Protein on Stress Hormones, Testosterone, and Pregnancy, “was begun when protein was commonly assumed to be deficient in the diet of the poor.” Had researchers actually analyzed their diets before they started, they would have realized that this wasn’t true, but why let facts get in the way of assumptions? So, the researchers split poor black pregnant women into three groups, each receiving one of the following treatments: (1) an extra 40 grams of animal protein a day, which is essentially a couple cans of Ensure, (2) an extra 6 grams of animal protein, or (3) no extra protein. Then they sat back and watched what happened. The high-protein group suffered “an excess of very early premature births and associated neonatal [infant] deaths, and there was significant growth retardation” in the babies who survived. More protein meant more prematurity, more deaths, and more growth retardation, which you can see reflected in the chart at 1:00 in my video.

What’s more, animal protein intake during pregnancy has been associated with children becoming overweight later in life and getting high blood pressure. The “offspring of mothers who reported eating more meat and fish had higher systolic blood pressure” in adulthood. This was part of another failed dietary intervention trial in which mothers were advised to eat a pound of meat a day. The increased weight gain and high blood pressure may be due to the obesity-causing chemical pollutants in the meat supply, as I’ve discussed in my video Animal Protein, Pregnancy, and Childhood Obesity, or the animal protein-induced rise in the growth hormone IGF-1. Or, it could be due to a steroid stress hormone called cortisol.

As you can see in the chart at 2:01 in my video, a single meal high in animal protein can nearly double the level of the stress hormone in the blood within a half hour of consumption, much more than a meal closer to the recommended level of protein. When subjects are given a meal of crab, tuna fish, and cottage cheese, the stress hormone level shoots up. If they’re instead given some barley soup and a vegetable stir-fry on rice, the stress hormone level goes down after the meal, as you can see at 2:27 in my video. Imagine eating meat-fish-dairy meals day after day. Doing so “may chronically stimulate” our stress response axis “and increase the release of vasoactive hormones” that could increase our blood pressure. And, all that extra cortisol release has been linked to increased risk for elevated blood levels of insulin, triglycerides, and cholesterol.

When men on a high-protein diet, “such as meat, fish, poultry, egg white,” were switched to a high-carb diet of bread, vegetables, fruit, and sugary junk, their cortisol levels dropped about a quarter within 10 days. At the same time, their testosterone levels shot up by about the same amount, as you can see at 3:09 in my video. High-protein diets suppress testosterone. That is why, if men eating plant-based diets begin to eat meat every day, their testosterone levels go down and some estrogens actually go up, and that’s why bodybuilders can get such low testosterone levels. It’s not the steroids they’re taking. If you look at natural bodybuilders who don’t use steroids, there is a 75 percent drop in testosterone levels in the months leading up to a competition. Testosterone levels were cut by more than half, which is enough to drop a guy into an abnormally low range, as you can see at 3:47 in my video. It’s ironic that they’re eating protein to look manly on the outside, but it can make them less and less manly on the inside. And, from an obesity standpoint, in general, a drop in testosterone levels may increase the risk of gaining weight and body fat. What does cortisol have to do with weight?

There’s actually a disease caused by having too much cortisol, called Cushing’s syndrome, which can increase abdominal obesity. Even in normal women, though, chronic stress and chronic high cortisol levels can contribute to obesity. What’s more, if they’re pregnant, high-meat and low-carb diets may increase cortisol levels in the moms, which can lead to inappropriate fetal exposure to cortisol, which, in turn, can affect the developing fetus, resetting her or his whole stress response thermostat and leading to higher cortisol levels in later adult life. This can have serious, life-long health consequences. Every maternal daily portion of meat and fish was associated with 5 percent higher cortisol levels in their children as much as 30 years later, though green vegetable consumption was found to be protective. Higher meat consumption, such as three servings a day compared to one or two, was associated with significantly higher cortisol levels, but eating greens every day appeared to blunt some of that excess stress response, as you can see at 5:12 in my video.

As well, the adult children of mothers who ate a lot of meat during pregnancy don’t only have higher stress hormone levels, they also appear to react more negatively to whatever life throws at them. Researchers put them through the Trier Test, which involves public speaking in front of a panel of judges, following by a live math exercise. You can see in my video at 5:36 a chart comparing the stress hormone responses in those whose moms ate less than two servings of meat per day, about two servings a day, or about two to three servings a day. Note that before the test started, the cortisol levels of the two groups eating less meat started out about the same, but their exaggerated cortisol response was laid bare when exposed to a stressful situation. The real-world effects of this are that after that sort of test, when people are given their own private snack buffet with fruits and veggies versus fatty, sugary, comfort foods like chocolate cake, guess who may eat less of the fruits and veggies? Those who have high chronic stress levels. “Cortisol has been implicated as a factor in motivating food intake” even when we aren’t really hungry.

It’s no surprise then that a woman’s animal protein intake during pregnancy may lead to larger weight gain for her children later in life—and maybe even for her grandchildren. “Remarkably, recent evidence suggests that the long-term consequences of adverse conditions during early development may not be limited to one generation, but may lead to poor health in the generations to follow, even if these individuals develop in normal conditions themselves.” Indeed, the diet of a pregnant mother may affect the development and disease risk of her children and even her grandchildren. Ultimately, these findings may shed light on our rapidly expanding epidemics of diabetes, obesity, and heart disease.


Whoa, there was a lot to unpack! Rather than break it up, since so much of it was tied together, as you could see, I compiled everything into this one, heftier piece. You may want to read this a second time and watch the video to absorb it all.

For more on how a woman’s diet during pregnancy can affect her children, see Maternal Diet May Affect Stress Responses in Children and Animal Protein, Pregnancy, and Childhood Obesity.

Protein is such a misunderstood nutrient. For more information, 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:

How the Egg Industry Tried to Bury the TMAO Risk

“Metabolomics is a term used to describe the measurement of multiple small-molecule metabolites in biological specimens, including bodily fluids,” with the goal of “[i]dentifying the molecular signatures.” For example, if we compared the metabolic profile of those with severe heart disease to those with clean arteries, we might be able to come up with a cheap, simple, and noninvasive way to screen people. If heart patients happened to have something in their blood that healthy people didn’t, we could test for that. What’s more, perhaps it would even help us understand the mechanisms of disease. “To refer to metabolomics as a new field is injustice to ancient doctors who used ants to diagnose the patients of diabetes” (because the ants could detect the sugar in the diabetics’ urine).

The first modern foray discovered hundreds of substances in a single breath, thanks to the development of computer technology that made it possible to handle large amounts of information—and that was in 1971, when a computer took up nearly an entire room. “[N]ew metabolomics technologies [have] allowed researchers to measure hundreds or even thousands of metabolites at a time,” which is good since more than 25,000 compounds may be entering our body through our diet alone.

Researchers can use computers to turn metabolic data into maps that allow them to try to piece together connections. You can see sample data and a map at 1:28 in my video Egg Industry Response to Choline and TMAO. Metabolomics is where the story of TMAO started. “Everyone knows that a ‘bad diet’ can lead to heart disease. But which dietary components are the most harmful?” Researchers at the Cleveland Clinic “screened blood from patients who had experienced a heart attack or stroke and compared the results with those from blood of people who had not.”

Using an array of different technology, the researchers identified a compound called TMAO, which stands for trimethylamine N-oxide. The more TMAO people had in their blood, the greater the odds they had heart disease and the worse their heart disease was.

Where does TMAO come from? At 2:19 in my video, you can see a graphic showing that our liver turns TMA into TMAO—but where does TMA come from? Certain bacteria in our gut turn the choline in our diet into TMA. Where is the highest concentration of choline found? Eggs, milk, and meats, including poultry and fish. So, when we eat these foods, our gut bacteria may make TMA, which is absorbed into our system and oxidized by our liver into TMAO, which may then increase our risk of heart attack, stroke, and death.

However, simply because people with heart disease tend to have higher TMAO levels at a snapshot in time doesn’t mean having high TMAO levels necessarily leads to bad outcomes. We’d really want to follow people over time, which is what researchers did next. Four thousand people were followed for three years, and, as you can see in the graph at 3:10 in my video, those with the highest TMAO levels went on to have significantly more heart attacks, strokes, or death.

Let’s back up for a moment. If high TMAO levels come from eating lots of meat, dairy, and eggs, then maybe the only reason people with high TMAO levels have lots of heart attacks is that they’re eating lots of meat, dairy, and eggs. Perhaps having high TMAO levels is just a marker of a diet high in “red meat, eggs, milk, and chicken”—a diet that’s killing people by raising cholesterol levels, for example, and has nothing to do with TMAO at all. Conversely, the reason a low TMAO level seems so protective may just be that it’s indicative of a more plant-based diet.

One reason we think TMAO is directly responsible is that TMAO levels predict the risk of heart attacks, strokes, or death “independently of traditional cardiovascular risk factors.” Put another way, regardless of whether or not you had high cholesterol or low cholesterol, or high blood pressure or low blood pressure, having high TMAO levels appeared to be bad news. This has since been replicated in other studies. Participants were found to have up to nine times the odds of heart disease at high TMAO blood levels even after “controll[ing] for meat, fish, and cholesterol (surrogate for egg) intake.”

What about the rest of the sequence, though? How can we be certain that our gut bacteria can take the choline we eat and turn it into trimethylamine in the first place? It’s easy. Just administer a simple dietary choline challenge by giving participants some eggs.

Within about an hour of eating two hard-boiled eggs, there is a bump of TMAO in the blood, as you can see at 4:51 in my video. What if the subjects are then given antibiotics to wipe out their gut flora? After the antibiotics, nothing happens after they eat more eggs. In fact, their TMAO levels are down at zero. This shows that our gut bacteria play a critical role. But, if we wait a month and give their guts some time to recover from the antibiotics, TMAO levels creep back up.

These findings did not thrill the egg industry. Imagine working for the American Egg Board and being tasked with designing a study to show there is no effect of eating nearly an egg a day. How could a study be rigged to show no difference? If we look at the effect of an egg meal (see 5:32 in my video), we see it gives a bump in TMAO levels. However, our kidneys are so good at getting rid of TMAO, by hours four, six, and eight, we’re back to baseline. So, the way to rig the study is just make sure the subjects hadn’t eaten those eggs in the last 12 hours. Then, you can show “no effect,” get your study published in the Journal of the Academy of Nutrition and Dietetics, and collect your paycheck.


Unfortunately, this appears to be part for the course for the egg industry. For more on their suspect activities, see:

For more on the TMAO story, 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: