Should You Get an Annual Health Check-Up?

What are the risks and benefits of getting an annual check-up from your doctor?

Physicians and patients have come to expect the annual check-up as a routine part of care. “However, considerable research has not demonstrated a substantial benefit,” so a “revolt is brewing against the tradition of periodic” check-ups. “Even the Society for General Internal Medicine advised primary care physicians to avoid ‘routine general health checks for asymptomatic adults.’”

As I discuss in my video Is It Worth Getting Annual Health Check-Ups?, routine check-ups do seem to make sense. But, historically, medical practice has included all sorts of interventions that seemed to make sense, such as hormone replacement therapy for menopause—that is, until it was put to the test and found to increase risks of breast cancer, blood clots, heart disease, and stroke. “History repeatedly shows that good intentions and ‘common sense’ kill in the name of prevention (for example, prone sleeping recommendation for infants).” Indeed, doctors killed babies by making the so-called common sense recommendation that infants sleep on their tummies, whereas we now know “Face Up to Wake Up.” “We should always demand evidence rather than succumb to delusion.”

“We check our cars regularly, so why shouldn’t we also check our bodies…?” Well, unlike cars, our bodies have self-healing properties. To see if the benefits outweigh the harms, researchers decided to put it to the test.

“What are the benefits and harms of general health checks for adult populations?” The bottom line is that check-ups were “not associated with lower rates of all-cause mortality, mortality from cardiovascular disease, or mortality from cancer,” meaning they weren’t associated with living longer or a lower risk of dying from heart disease, stroke, or cancer. So, general check-ups may not reduce disease rates or death rates, but they do increase the number of new diagnoses. And, the “[h]armful effects of some tests and subsequent treatment could have balanced out possible beneficial effects of others.”

Possible harms from check-ups include “overdiagnosis, overtreatment, distress or injury from invasive follow-up tests, distress due to false positive test results, false reassurance due to false negative test results, possible continuation of adverse health behaviours due to negative test results, adverse psychosocial effects due to labelling, and difficulties with getting insurance” (now that you have a pre-existing condition), not to mention all of the associated costs. 

Take diabetes, for example. Wouldn’t it be great if we detected cases of diabetes earlier? Perhaps not, if you were one of the people given Avandia, the number one diabetes drug that was then pulled off the market because instead of helping people, it appeared to be killing them. Adverse drug events are now one of our leading causes of death. When it comes to lifestyle diseases like type 2 diabetes, maybe we should focus instead on creating healthier food environments. This is what one of my favorite organizations, Balanced, does to help prevent the diabetes epidemic in the first place.

How many times have you tried to inform someone about healthy eating and evidence-based nutrition, only to have them say, “No, I don’t have to worry. My doctor reassured me I’m fine. I just had a check-up, and everything’s normal.” As if having a normal cholesterol is okay in a society where it’s normal to drop dead of a heart attack, the number one killer of men and women. It would be one thing if you went to see a lifestyle medicine doctor who spent the check-up giving you the tools to prevent 80 percent of chronic disease, but given the way medicine is currently practiced, it’s no wonder why the history of routine check-ups “has been one of glorious failure, but generations of well meaning clinicians and public health physicians struggle to allow themselves to believe it.” But, “policy should be based on evidence…” 

Poor diet may be “on par with tobacco smoking as the most common actual causes of death,” yet the medical profession is inadequately trained in nutrition. Worse, nutrition education in medical school appears to be declining. If you can believe it, there is actually a “shrinking of formalized nutrition education” among health professionals, so the advice you get during your annual check-up may just be from the last tabloid your doctor skimmed while in the supermarket check-out line.

“And screening appointments should not be regarded as a form of ‘health education,’” read one medical journal editorial. “People who are obese know very well that they are, and if we have no means of helping them…then we should shut up.” Well, if you really have nothing to say that will help them, maybe you should shut up, especially those doctors who say they “have no idea what constitutes a ‘healthy’ diet”—although we do know that veggies and nuts are a good start.

Won’t a check-up allow your physician to do a comprehensive physical exam and routine blood testing? I discuss that, as well as the pros and cons, in my vide Is it Worth Getting an Annual Physical Exam?.

Did I say lifestyle medicine? Yes! Learn more about this exciting growing field in Lifestyle Medicine: Treating the Causes of Disease and Convincing Doctors to Embrace Lifestyle Medicine. Make sure your doctor is a member of the American College of Lifestyle Medicine (and even better certified by the American Board of Lifestyle Medicine).

Still don’t understand how there can be risks? See Why Prevention Is Worth a Ton of Cure. Unfortunately, physicians and patients alike wildly overestimate the benefits of pills and procedures. See, for example, The Actual Benefit of Diet vs. Drugs.

The fact is Physicians May Be Missing Their Most Important Tool.


And what about mammograms? See my video series:

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:

Dr. Gundry’s The Plant Paradox Is Wrong

A book purported to expose “hidden dangers” in healthy foods doesn’t even pass the whiff test.

I started getting emails about The Plant Paradox, a book purporting to expose “the hidden dangers in ‘healthy’ foods that cause disease and weight gain”—foods like beans, whole grains, and tomatoes. Hidden dangers? The author’s talking about lectins in a rehashing of the discredited Blood Type Diet from decades ago. I reviewed it a while ago in my video Blood Type Diet Debunked, but it just keeps coming back. The Plant Paradox was written by an MD, but if you’ve seen my medical school videos including Physicians May Be Missing Their Most Important Tool, you’ll know that is effectively an anti-credential when it comes to writing diet books, basically advertising to the world that they’ve likely received little or no formal training in nutrition. Dr. Atkins was, after all, a cardiologist. Even when we give the benefit of the doubt, the problem is it doesn’t even seem to pass the sniff test, as I discuss in my video Dr. Gundry’s The Plant Paradox Is Wrong.

If lectins are bad, then beans would be the worst, so bean counters would presumably find that bean eaters cut their lives short. But, the exact opposite may be true, with legumes—beans, split peas, chickpeas, and lentils—found to be perhaps “the most important dietary predictor of survival in older people” in countries around the world. As Dan Buettner pointed out in his Blue Zones work, lectin-packed foods are the “cornerstones” of the diets of all the healthiest, longest-lived populations on the planet. Plant-based diets in general and legumes, the most lectin-lush of foods, in particular are a common thread among longevity Blue Zones around the world, as you can see at 1:30 in my video.

If lectins are bad, then whole-grain consumers should be riddled with disease when in fact “whole grain intake is associated with a reduced risk of coronary heart disease,” the number one killer of men and women, “cardiovascular disease, and total cancer, and mortality from all causes” put together. This means that people who eat whole grains tend to live longer and suffer from fewer “respiratory diseases, infectious diseases, diabetes, and all non-cardiovascular, non-cancer causes” to boot. And, this is not only the case in population studies. As I showed in my video Can Oatmeal Help Fatty Liver Disease?, you can randomize people into whole grain interventions and prove cause-and-effect benefits. It’s the same with tomatoes. When you randomize women to a cup and a half of tomato juice or water every day, all that nightshade tomato lectin “reduces systemic inflammation” or has waist-slimming effects, reducing cholesterol as well as inflammatory mediators.

So, when people told me about The Plant Paradox, I thought to myself: Let me guess. He sells a line of lectin-blocking supplements. And, what do you know? His Lectin Shield capsules “assist your body in the fight against lectins” for only $79.95 a month. That’s only about a thousand dollars a year—a bargain for “pleasant bathroom visits.” Then, of course, there are ten other supplements for sale, so for only $8,000 or $9,000 a year, you can lick those lectins. Let’s not forget his skincare line. “Firm + Sculpt” for an extra $120 a month, which is all so much more affordable when you subscribe to his VIP club.

Look, people ask me all the time to comment on a new blog, book, or YouTube video, and I remind them that a hundred thousand peer-reviewed scientific papers on nutrition are published in the medical literature every year and we can barely keep up with those. But because people continually emailed me about this book, I decided I’d give it a chance.  He tells us to “forget everything you thought you knew was true.” (Diet books love saying that.) Okay. Ready? Chapter 1, citation 1: “Eating shellfish and egg yolks dramatically reduces total cholesterol.” What?! Egg yolks reduce cholesterol? What is this citation? I’ve linked the paper he cites on shellfish consumption so you can see it for yourself. By now, you know how these studies go. How do you show a food decreases cholesterol? Remove so much meat, cheese, and eggs that, overall, saturated fat falls—in this case, about 50 percent, as you can see at 4:15 in my video. If you cut saturated fat in half, of course cholesterol levels are going to drop. So, the researchers got a drop in cholesterol after removing meat, cheese, and egg yolks, yet that’s the paper he uses to support his statement that “egg yolks dramatically reduce[d] cholesterol.” That’s unbelievable! That’s the opposite of the truth. As you can see at 4:36 in my video, the truth is if you add egg yolks to people’s diets, their cholesterol goes up. How dare he say otherwise? What’s more, it’s not like he’s spewing some harmless foolishness, like saying the Earth is flat. Heart disease is the number one killer of men and women. His claims could actually hurt people.

So much for my giving him the benefit of the doubt.

This is an unusual article for me. I normally try to stay out of the so-called diet wars and just stick to bringing you the latest science. Roughly 100,000 papers are published on nutrition in the peer-reviewed medical literature every year, and we have a hard enough time keeping up with them, but let me know what you think: Would you like me to allocate time to more of these types of reactive discussions?

You’ll note I never really addressed Dr. Gundry’s thesis about lectins, but I do exactly that in these two videos: How to Avoid Lectin Poisoning and Are Lectins in Food Good or Bad for You?.


Here are links to the videos I alluded to in this article, if you want to learn more:

What else can tomatoes do? See Inhibiting Platelet Activation with Tomato Seeds.

One of the key reasons whole grains may be so beneficial is their effect on our good bacteria. Check out Gut Microbiome: Strike It Rich with Whole Grains and Microbiome: We Are What They Eat to learn 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:

How to Reduce Your TMAO Levels

Should we be concerned about high-choline plant foods such as broccoli producing the same toxic TMAO that results from eating high-choline animal foods such as eggs?

Choline- and carnitine-rich foods—meat, eggs, and dairy—can be converted by our gut flora into trimethylamine, which in our livers is then turned into TMAO, a toxic compound that may increase our risk of heart failure, kidney failure, and atherosclerosis, or heart attacks and strokes. The good news, though, is that this “opens up exciting new nutritional and interventional prospects” for prevention, as I discuss this in my video How to Reduce Your TMAO Levels.

Okay, so how do we do it? Well, if our gut bacteria can take meat, dairy, and eggs and turn them into TMAO, all we have to do is…destroy our gut flora! We could give people antibiotics to eliminate the production of TMAO. However, that could also kill our good bacteria and “facilitate the emergence of antibiotic-resistant bacterial strains.”

What about probiotic supplements? Maybe if we add good bacteria, they will crowd out the ones that take the meat, egg, and dairy compounds and turn them into the TMA that our liver turns into TMAO. But, that doesn’t work. Adding good bacteria doesn’t seem to get rid of the bad. What if we added new bacteria that could somehow siphon off the TMA made by the bad bacteria? Well, there’s a bacterium inside the guts of cows and sheep that turns trimethylamine into methane. Could we use that bacterium to get rid of some of the trimethylamine from our gut, like a cow fecal transplant? There’s a problem with that. If it didn’t take, you’d have to keep giving it to people: “Continuous administrations may be necessary if subjects do not become colonized.” So, might the fact that Consumer Reports found fecal contamination in every sample of beef it tested be a good thing? No. Methane-producing bacteria may be able to eat up our TMAO, but, unfortunately, these bacteria may be associated with a variety of diseases, from gum disease down to colorectal cancer, as you can see at 2:15 in my video.

If antibiotics and probiotics aren’t going to work to prevent gut bacteria from taking meat, dairy, and eggs and turning them into the trimethylamine, which our liver makes TMAO out of, I guess we have no choice but to cut down on…our liver function!

That was the billion-dollar answer to cholesterol. The same foods—meat, dairy, and eggs—raise our cholesterol, but dietary change isn’t very profitable. So, the drug industry developed statin drugs that cripple the liver’s enzyme that makes cholesterol. Could “pharmacologic inhibition” of the enzymes in our liver that make TMAO “potentially serve as a therapy for CVD [cardiovascular disease] risk reduction”? Trimethylaminuria is a genetic condition in which this enzyme is naturally impaired, in which there is a build-up of trimethylamine in the bloodstream. The problem is that trimethylamine is so stinky it makes you smell like “dead fish.” So, “given the known adverse effects…from sufferers of fish odor syndrome, the untoward odorous side effects of inhibiting this enzyme make it a less attractive [drug] target.”

Do we have to choose between smelling like dead fish or suffering from heart and kidney disease? If only there were some other way we could stop this process from happening. Well, what do those with trimethylaminuria often do to cut down trimethylamine levels? They stop eating animal products.

About a third of those who complain of bad body odor despite good personal hygiene test positive for the condition, but reducing or eliminating meat, egg, and dairy intake can be a real lifesaver. But, given what we now know about how toxic the end product TMAO can be for normal people, cutting down on animal products may not just save the social lives of people with a rare genetic disorder, but help save everyone else’s actual lives.

The “simplest point of intervention” is to simply limit the consumption of foods rich in choline and L-carnitine, which “can be an effective strategy to limit circulating TMAO.” But, wait! We could always try to genetically engineer a bacterium that eats up trimethylamine, but “the simplest and safest recommendation” may just be to eat more healthfully. You can completely eliminate carnitine from the diet, since our body makes all we need, but choline is an essential nutrient so we do need some. Thankfully, we can get all we need in fruits, vegetables, beans, and nuts. “However excess choline, such as that found in eggs, may be worth avoiding.”

Need we worry about high-choline plant foods, like broccoli? Consumption of cruciferous vegetables is associated with a significantly longer life and less cardiovascular disease mortality, as you can see at 5:34 in my video. To see what was going on, researchers took the vegetable highest in choline, brussels sprouts, and had people eat two cups a day for three weeks. What happened? Their TMAO levels actually went down. It turns out that brussels sprouts appear to naturally downregulate that TMAO liver enzyme—not enough to make you stinky, but just enough to drop TMAO.

And, people who eat completely plant-based may not make any TMAO at all—even if you try. You can give a vegan a steak, which contains both choline and carnitine, and there will not even be a bump in TMAO because vegetarians and vegans have different gut microbial communities. If we don’t eat steak, then we don’t foster the growth of steak-eating bacteria in our gut. So forget the cow—how about getting a fecal transplant from a vegan? From a TMAO standpoint, we may not have to eat like a vegan as long as we poop like one.


Can you sense my frustration as I read paper after paper proposing those ridiculous (but profitable!) answers when the safe, simple, side-effect-free solution was staring them in the face the whole time? It makes me think of so many parallels, not the least of which are:

For more on TMAO, the “smoking gun” of diet-microbiome-disease interactions, 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: