A highly effective, cheap, easy-to-use, safer treatment for heavy periods

Ginger is most famous for its role in preventing and alleviating nausea and vomiting. There are now so many studies that there are reviews of reviews. Just a half teaspoon of powdered ginger “is associated with a 5-fold likelihood of improvement” in morning sickness in early pregnancy. (See my video Natural Treatments for Morning Sickness for more on this.) Ginger has also been shown to help with motion sickness, improve postoperative nausea and vomiting, prevent antiretroviral-induced nausea and vomiting during HIV treatment, and was said to be a “miracle” against chemotherapy-induced vomiting.

In a randomized, double-blind, placebo-controlled clinical trial of ginger for breast cancer chemotherapy, chemo-induced vomiting was relieved in all phases—the acute phase within 24 hours of the chemo, two to three days after, and even before chemo sessions with what’s known as anticipatory vomiting. (After a few chemo treatments, the body knows what’s coming and starts throwing up at just the thought of the next session.) Anticipatory nausea can’t seem to be controlled by drugs, even the fancy new ones that can cost 10,000 times more than ginger, which comes in at about two pennies per dose and may work even better in some ways.

Ginger can also help with pain. One-eighth of a teaspoon of powdered ginger, which costs just one penny, was found to work as well as the migraine headache drug Imitrex, without the side effects. (See my video Ginger for Migraines for more.)

Speaking of pain, my video Ginger for Nausea, Menstrual Cramps, and Irritable Bowel Syndrome discusses that it may also be as effective as ibuprofen for alleviating menstrual cramps. Painful periods are exceedingly common and can sometimes cause severe suffering yet have been “virtually ignored” by pain management researchers and practitioners. Four randomized controlled trials, however, have been published on ginger for menstrual pain, and all four showed significant benefit when ginger was taken during the first few days of periods. Effective doses ranged from about a third of a teaspoon a day to a full teaspoon a day, but because they all seemed to work, one might as well start out with the penny-a-day dose.

As a side benefit, ginger can dramatically reduce heavy flow, which is one of the most common gynecological problems for young women. We know there are pro-inflammatory foods that may contribute to heavy menstrual bleeding, so how about trying an anti-inflammatory food like ginger? Heavy menstrual bleeding is defined as more than a third of a cup (80 milliliters), but all the study subjects started out much higher than that. Just an eighth teaspoon of powdered ginger three times a day starting the day before their period cut their flow in half, and it seemed to work better each month they tried it, providing a highly effective, cheap, easy-to-use, safer treatment for menstrual blood loss and pain.

So, ginger works for migraines and menstrual cramps, but just because it may be effective for many types of pain doesn’t mean it’s necessarily efficacious for all pain. For example, what about intestinal cramps? Is ginger effective for the treatment of irritable bowel syndrome (IBS)? The answer is yes, dropping IBS severity by more than 25 percent. But, so did the placebo. So, the real answer is no—it is not effective for the treatment of IBS, yet “[g]inger is one of the most commonly used herbal medicines for irritable bowel syndrome (IBS).” Silly people, don’t they know it doesn’t work any better than a sugar pill? Or, from another perspective, are they smart for using something that offers relief 53 percent of the time and doesn’t risk the adverse effects of some of the drugs with which doctors may harm one person for every three they help?


If placebos are so safe and effective, should doctors prescribe them? I discuss the pros and cons in The Lie That Heals: Should Doctors Give Placebos?.

What does work for IBS? See my videos:

What else can women do to make their periods more tolerable? See:

For more on ginger, 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, year-in-review presentations:

Sip Smoothies Slowly

A famous study in 2000 compared the impact of soda versus jelly beans. Researchers had people add 28 extra spoonfuls of sugar to their daily diet in the form of jelly beans or soda. Then, they measured how many calories participants ate over the rest of the day to see if their bodies would compensate for all that extra sugar. For the jelly bean group, their bodies registered all the extra calories from the handfuls of jelly beans and they ended up eating less of everything else throughout the day. So, they ate pretty much the same number of calories before and after adding the jelly beans to their diet. But, for the soda group, despite all the added calories from the cans of pop they were drinking every day, they kept eating about the same amount. No wonder they gained weight after a month of drinking soda. Their bodies didn’t seem to recognize the extra calories when they were in liquid form and therefore didn’t compensate by reducing their appetite for the rest of the day.

What if we drink a smoothie for breakfast instead of eating a solid meal? Will our body think we skipped breakfast and make us so ravenous at lunch we’d eat more than we normally would and end up gaining weight? To answer this, we first have to determine if this solid versus liquid calorie effect is real. Soda and jelly beans don’t just differ by physical form; they have different ingredients. That’s a problem with a lot of these kinds of studies: They use dissimilar foods.

Take, for example, the study comparing liquid to solid breakfasts in my video Liquid Calories: Do Smoothies Lead to Weight Gain?. Researchers gave participants breakfasts of either fruit juices and skim milk or oatmeal with blueberries and apples. Not so surprisingly, study subjects were less hungry after the oatmeal. But, that may not be a solid versus liquid effect, as the breakfasts were comprised of completely different foods.

To test for a solid versus liquid effect, you’d have to use the exact same foods in two different forms. Finally, a study did just that. Researchers looked at what happens if you have a fruit salad with raw apples, apricots, and bananas with three cups of water to drink versus blending the fruit with two of the cups of water to make a smoothie and then just drinking the third cup of water. It’s the identical meal—one in solid form and one in smoothie form. What happened? People felt significantly less full after the smoothie, although it was the same amount of food and fiber. In smoothie form, it didn’t fill people up as much as eating fruit au natural.

Originally, we thought it was due to the lack of chewing. The act of chewing itself may be an I’ve-eaten-enough signal that you don’t get just by drinking. Researchers had people chew either 10 or 35 times per mouthful and eat pasta until they felt comfortably full. Those forced to chew 35 times per bite ended up eating about a third of a cup less pasta than those who only chewed 10 times per bite. So there we have it: We had the proof of solid versus liquid effect and the mechanism. But, as so often happens in science, just when we have everything neatly wrapped up with a bow, a paradox arises.

In this case, the great soup paradox.

Pureed, blended soup—essentially a hot, green smoothie of blended vegetables—is more satiating than the same veggies in solid form. The same meal in liquid form was more filling than in solid form. So, it can’t be the chewing that has the satiating effect. In fact, there doesn’t appear to be a solid versus liquid effect at all since cold smoothies appear to be less filling, but hot smoothies appear to be more filling. They are so filling that when people have soup as a first course, they eat so much less of the main course, that they eat fewer calories overall, even when you add in the soup calories.

How can we explain this paradox? Maybe pureed fruit is less filling than solid, but pureed vegetables are more filling? To test this, Purdue University researchers used apple soup. They mixed about a cup of apple juice with two cups of applesauce, liquefied it in a blender, and heated it up. If you have people eat three actual apples, they started out pretty hungry, but, within 15 minutes of eating the apples, they were hardly hungry at all. Drinking three cups of apple juice didn’t cut hunger much, but what about the apple soup, which was pretty much just hot apple juice with applesauce mixed in? The apple soup cut hunger almost as much as the whole apples, even more than an hour later. It even beat out whole apples for decreasing overall calorie intake for the day.

What’s so special about soup? What does eating soup have in common with prolonged chewing that differentiates it from smoothie drinking? Time. It took about twice as long to chew 35 times. And think about how long it takes to eat a bowl of soup compared to drinking a smoothie. Eating slower reduces calorie intake.

Alternatively, maybe we just imagine soup to be filling, so it’s like a placebo effect. Feelings like hunger and fullness are subjective. People tend to report hunger more in accordance with how many calories they think something has rather than the actual caloric content. If you study people with no short-term memory, like the character in the movie Memento who couldn’t remember what happened more than a minute ago, they can overdose on food because they forgot they just ate, which shows what poor judges we are of our own hunger. It’s not just subjective effects, either. In a famous study called Mind Over Milkshakes, people were offered two different milkshakes, one described as indulgent, “decadence you deserve,” and the other a sensible, “guilt-free satisfaction.” People have different hormonal responses to them even though they were being fooled and given the exact same milkshake.

Finally, maybe it was just because the soup was hot, and warmer foods may be more satiating? How do we figure out if the solution to the soup mystery was time, thought, or temperature? If only the study we discussed earlier that had subjects eat either a fruit salad with three cups of water or drink the same exact foods in smoothie form had a third group—a liquid eating group, too. Well, it did!

Researchers also offered the fruit smoothie in a bowl to be eaten cold with a spoon. (Very un-soup-like.) So, if it were thought or temperature, the fullness rating would be down by the liquid drinking. However, if it was just the slowed eating rate that made soup as filling as solid food, then the fullness rating would be up closer to the solid eating rating—and it was exactly as high. The only real reason smoothies aren’t as filling is because we gulp them down, but if we sip them slowly over time, they can be just as filling as if we ate the fruits and veggies solid.

Wow, that study thought of everything. You don’t know the half of it! They also wanted to see if it would work with high-fat smoothies too. So, what, almond butter or walnuts? No, they used a liquefied fat smoothie of steamed pork belly.

I guess maybe  sometimes smoothies can suppress your appetite 🙂

I have a whole series of videos on smoothies: Are Green Smoothies Good for You?, Are Green Smoothies Bad for You?, Green Smoothies: What Does the Science Say?, and The Downside of Green Smoothies.

For videos on weight gain, see Do Fruit & Nut Bars Cause Weight Gain?, Does Chocolate Cause Weight Gain?, Nuts and Obesity: The Weight of Evidence, and How Diet Soda Can Make Us Gain Weight. 

For weight loss, check out How Much Exercise to Sustain Weight Loss, Brown Fat: Losing Weight Through Thermogenesis, Boosting Brown Fat Through Diet, Eating More to Weigh Less, and Can Morbid Obesity Be Reversed Through Diet?

In health,

Michael Greger, M.D.

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

A Dietary Treatment for Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a chronic, episodic intestinal disorder characterized by abdominal pain and altered bowel habits. It affects 1 in 7 Americans, although most go undiagnosed. IBS can have a substantial impact on well-being and health, but doctors underestimate the impact the disease can have, particularly the pain and discomfort. Using some measures, the health-related quality of life of irritable bowel sufferers can rival that of sufferers of much more serious disorders, such as diabetes, kidney failure, and inflammatory bowel diseases. The first step toward successful treatment is for doctors to acknowledge the condition and not just dismiss the patient as just hysterical or something.

Another reason sufferers often don’t seek medical care may be the lack of effectiveness of the available treatments. There is a huge unmet therapeutic need. Since IBS has no cure, treatment is targeted to alleviate the symptoms. Typical antispasmodic drugs can cause side effects, including dry mouth, dizziness, blurred vision, confusion, and fall risk. New drugs now on the market, like Lubiprostone and Linaclotide, can cost up to $3,000 a year and can cause as side effects many of symptoms we’re trying to treat.

Antidepressants are commonly given but may take weeks or even months to start helping. Prozac or Celexa take 4 to 6 weeks to help, and Paxil can take up to 12 weeks. They also have their own array of side effects, including sexual dysfunction in over 70% of the people who take these drugs.

There’s got to be a better way.

Acupuncture works, but not better than placebo. Placebo acupuncture? That’s where you poke people with a fake needle away from any known acupuncture points. Yet that worked just as well as real acupuncture, showing the power of the placebo effect.

I’ve talked about the ethics of so many doctors who effectively pass off sugar pills as effective drugs, arguing that the ends justify their means. There’s actually a way to harness the placebo effect without lying to patients, though. We tell them it’s a sugar pill. Patients with irritable bowel syndrome were randomized to either get nothing or a prescription medicine bottle of placebo pills with a label clearly marked “placebo pills” “take 2 pills twice daily.” I kid you not.

Lo and behold, it worked! That’s how powerful the placebo effect can be for irritable bowel. They conclude that for some disorders it may be appropriate for clinicians to recommend that patients try an inexpensive and safe placebo. Indeed, sugar pills probably won’t cost $3,000 a year. But is there a safe alternative that actually works?

As you can see in my video, Peppermint Oil for Irritable Bowel Syndrome, nine randomized placebo-controlled studies have indeed found peppermint oil to be a safe and effective treatment for irritable bowel syndrome. A few adverse events were reported, but were mild and transient in nature, such as a peppermint taste, peppermint smell, and a cooling sensation around one’s bottom on the way out. In contrast, in some of the head-to-head peppermint versus drug studies, some of the drug side effects were so unbearable that patients had to drop out of the study. This suggests it might be a reasonable approach for clinicians to treat IBS patients with peppermint oil as a first-line therapy, before trying anything else.

The longest trial only lasted 12 weeks, so we don’t yet know about long-term efficacy. The benefits may last at least a month after stopping, though, perhaps due to lasting changes in our gut flora.

The studies used peppermint oil capsules so researchers could match them with placebo pills. What about peppermint tea? It’s never been tested, but one might assume it wouldn’t be concentrated enough. However, a quarter cup of fresh peppermint leaves has as much peppermint oil as some of the capsule doses used in the studies. One could easily blend it into a smoothie or with frozen berries to make something like my pink juice recipe. You can grow mint right on your window sill.

We doctors need effective treatments that “are cheap, safe, and readily available. This is particularly relevant at the present time as newer and more expensive drugs have either failed to show efficacy or been withdrawn from the market owing to concerns about serious adverse events.” Just like it may be a good idea to only eat foods with ingredients you can pronounce, it may be better to try some mint before novel pharmacological approaches, such the new dual mu-opioid agonist delta-antagonist drug with a name like JNJ-27018966.

I have some other mint videos: Enhancing Athletic Performance With Peppermint and Peppermint Aromatherapy for Nausea. Lemon balm is also in the mint family, so check out Reducing Radiation Damage With Ginger & Lemon Balm and Best Aromatherapy Herb for Alzheimer’s.

You can also sprinkle dried mint on various dishes. See Antioxidants in a Pinch.

What else might work for IBS? See Kiwifruit for Irritable Bowel Syndrome and Cayenne Pepper for Irritable Bowel Syndrome and Chronic Indigestion.

Irritable bowel symptoms can overlap with problems with gluten, so make sure your physician rules out celiac disease. These may be helpful:

In health,

Michael Greger, M.D.

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