From Adequate Nutrition to Optimum Nutrition

Research in human nutrition over the past four decades has led to many discoveries as well as a comprehensive understanding of the exact mechanisms behind how food nutrients affect our bodies. As I discuss in my video Reductionism and the Deficiency Mentality, however, the “prevalence of epidemics of diet-related chronic diseases, especially obesity, type 2 diabetes, osteoporosis, cardiovascular diseases, and cancers, dramatically increases worldwide each year.” Why hasn’t all this intricate knowledge translated into improvements in public health? Perhaps it has to do with our entire philosophy of nutrition called reductionism, where everything is broken down into its constituent parts; food is reduced to a collection of single compounds with supposed single effects. “The reductionist approach has traditionally been and continues today as the dominant approach in nutrition research.” For example, did you know that mechanistically, there’s a chemical in ginger root that down-regulates phorbol myristate acetate-induced phosphorylation of ERK1/2 and JNK MAP kinases? That’s actually pretty cool, but not while millions of people continue to die of diet-related disease.

We already know that three quarters of chronic disease risk––diabetes, heart attacks, stroke, and cancer—can be eliminated if everyone followed four simple practices: not smoking, not being obese, getting a half hour of exercise a day, and eating a healthier diet, defined as more fruits, veggies, and whole grains, and less meat. Think what that could mean in terms of the human costs. We already know enough to save millions of lives. So, shouldn’t our efforts be spent implementing these changes before another dollar is spent on research such as figuring out whether there is some grape skin extract that can lower cholesterol in zebra fish or even trying to find out whether there are whole foods that can do the same? Why spend taxpayer dollars clogging the arteries of striped minnows by feeding them a high cholesterol diet to see whether hawthorn leaves and flowers have the potential to help? Even if they did and even if it worked in people, too, wouldn’t it be better to simply not clog our arteries in the first place? This dramatic drop in risk and increase in healthy life years through preventive nutrition need not involve superfoods or herbal extracts or fancy nutritional supplements—just healthier eating. When Hippocrates supposedly said, “Let food be your medicine and medicine be your food,” he “did not mean that foods are drugs, but rather, that the best way to remain in good health is to maintain a healthy diet.” (Note: Hippocrates probably never actually said that—but it’s a great sentiment anyways!)

The historical attitude of the field of nutrition, however, may be best summed up by the phrase, “Eat what you want after you eat what you should.” In other words, eat whatever you want as long as you get your vitamins and minerals. This mindset is epitomized by breakfast cereals, which often provide double-digit vitamins and minerals. But the road to health is not paved with Coke plus vitamins and minerals. This reductionistic attitude “is good for the food industry but not actually good for human health.” Why not? Well, if food is good only for a few nutrients, then you can get away with selling vitamin-fortified Twinkies.

We need to shift from the concept of merely getting adequate nutrition to getting optimal nutrition. That is, we shouldn’t just aim to avoid scurvy, but we should promote health and minimize our risk of developing degenerative diseases.

Bringing things down to their molecular components works for drug development, for example, discovering all the vitamins and curing deficiency diseases. In the field of nutrition, “[h]owever, the reductionist approach is beginning to reach its limits.” We discovered all the vitamins more than a half-century ago. When is the last time you heard of someone coming down with scurvy, pellagra, or kwashiorkor, the classic deficiency syndromes? What about the diseases of dietary excess: heart disease, diabetes, obesity, and hypertension? Ever heard of anyone with any of those? Of course we have. Yet we continue to have this deficiency mindset when it comes to nutrition.

When someone tries to reduce their consumption of meat, why is “where are you going to get your protein?” the first question they get asked, rather than “if you start eating like that, where are you going to get your heart disease?” The same deficiency mindset led to the emergence of a multibillion-dollar supplement industry. What about a daily multivitamin just “as ‘insurance’ against nutrient deficiency?” Better insurance would be just to eat healthy food.

Professor Emeritus T. Colin Campbell wrote a Whole book about this issue, and I’m looking forward to doing many more videos on the topic.

So, where do plant-eaters get protein? Check out Do Vegetarians Get Enough Protein? to learn more.

The concept of optimal, rather than merely adequate, nutrition is illustrated well in this video about fiber: Lose Two Pounds in One Sitting: Taking the Mioscenic Route.

Other videos on reductionism include

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:

The Eskimo Myth

As I reviewed in my video Is Fish Oil Just Snake Oil?, the revelation that fish oil appears useless in preventing heart disease—in both heart patients and those trying to prevent heart disease in the first place—leads one to wonder how this whole fish tale began.

The common mythology is that in response to anecdotal reports of a low prevalence of coronary heart disease among the Eskimo, Danish researchers Bang and Dyerberg went there and confirmed a very low incidence of heart attack. The absence of coronary artery disease would be strange in a meat-based diet with hardly any fruits and vegetables—“in other words, a diet that violates all principles of balanced and heart-healthy nutrition.” This paradox was attributed to all the seal and whale blubber, which is extremely rich in omega-3 fish fat, and the rest is history.

There’s a problem, though. It isn’t true.

As I discuss in my video Omega-3s and the Eskimo Fish Tale, the fact is Bang and Dyerberg never examined the cardiovascular status of the Eskimo; they just accepted at face value this notion that coronary atherosclerosis is almost unknown among the Eskimo, a concept that has been disproven over and over starting back in the 1930s. In fact, going back more than a thousand years, we have frozen Eskimo mummies with atherosclerosis. From 500 years ago, a woman in her early 40s had atherosclerosis in her aorta and coronary arteries. And these aren’t just isolated cases. The totality of evidence from actual clinical investigations, autopsies, and imaging techniques is that they have the same plague of coronary artery disease that non-Eskimo populations have, and the Eskimo actually have twice the fatal stroke rate and don’t live particularly long.

“Considering the dismal health status of Eskimos, it is remarkable that instead of labelling their diet as dangerous to health,” they just accepted and echoed the myth, and tried to come up with a reason to explain the false premise. The Eskimo had such dismal health that the Westernization of their diets actually lowered their rates of ischemic heart disease. You know your diet’s bad when the arrival of Twinkies improves your health.

So, why do so many researchers to this day unquestioningly parrot the myth? “Publications still referring to Bang and Dyerberg’s nutritional studies as proof that Eskimos have low prevalence of [heart disease] represent either misinterpretation of the original findings or an example of confirmation bias,” which is when people cherry-pick or slant information to confirm their preconceived notions. As the great scientist Francis Bacon put it: “Man prefers to believe what he prefers to be true.” So, we get literally thousands of articles on the alleged benefits of omega-3 fatty acids, a billion-dollar industry selling fish oil capsules, and millions of Americans taking the stuff—all based on a hypothesis that was questionable from the very beginning.

What’s this about no benefit for fish oil consumption and heart disease? See my video Is Fish Oil Just Snake Oil?.

What about fish oil for mood disorders? See Fish Consumption and Suicide. Is Fish “Brain Food” for Older Adults? Should Vegans Take DHA to Preserve Brain Function? Consumption of long-chain omega-3s (EPA and DHA) may be useful for forming and maintaining brain health, but there’s a struggle between Mercury vs. Omega-3s for Brain Development when coming from fish or fish oil, thanks to how polluted our oceans have become. In fact, this is the case even in “distilled” fish oil; see Fish Oil in Troubled Waters for more. The marine pollutants may explain the relationship between Fish and Diabetes and ALS (Lou Gehrig’s Disease): Fishing for Answers. Thankfully, there are now pollutant-free (yeast- and microalgae-derived) sources.

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:

How Doctors Responded to Being Named a Leading Killer

In my video Why Prevention Is Worth a Ton of Cure, I profiled a paper that added up all the deaths caused by medical care in this country, including the hundred thousand deaths from medication side effects, all the deaths caused by errors, and so on. The author of the paper concluded that the third leading cause of death in America is the American medical system.

What was the medical community’s reaction to this revelation? After all, the paper was published in one of the most prestigious medical journals, the Journal of the American Medical Association, and was authored by one of our most prestigious physicians, Barbara Starfield, who literally wrote the book on primary care. When she was asked in an interview what the response was, Starfield replied that her primary care work had been widely embraced, but her findings on how harmful and ineffective healthcare could be received almost no attention.

This inspires the recollection of “the dark dystopia of George Orwell’s 1984, where awkward facts are swallowed up by the ‘memory hole’ as if they had never existed at all.” Report after report has come out, and the response has been a deafening silence both in deed and in word, failing to even openly discuss the problem, leading to thousands of additional deaths. We can’t just keep putting out reports, we have to actually do something.

As I discuss in my video How Doctors Responded to Being Named a Leading Killer, the first report was published in 1978, suggesting about 120,000 preventable hospital deaths a year. The response? Silence for another 16 years until another scathing reminder was published. If we multiply 120,000 by those 16 years, we get 1.9 million preventable deaths, about which there was near total doctor silence. There was no substantial effort to reduce the number of those deaths. The Institute of Medicine (IOM) then released its landmark study in 1999, asserting that yet another 600,000 patients died during that time when providers could have acted.

Some things have finally changed. Work hour limits were instituted for medical trainees. Interns and residents could no longer be worked more than 80 hours a week, at least on paper, and the shifts couldn’t be more than 30 hours long. That may not sound like a big step, but when I started out my internship, I worked 36 hour shifts every three days, 117-hour work weeks.

When interns and residents are forced to pull all-nighters, they make 36% more serious medical errors, five times more diagnostic errors, and have twice as many “attentional failures.” That doesn’t sound so bad, until you realize that means things like nodding off during surgery.

The patient is supposed to be asleep during surgery, not the surgeon.

Performance is impaired as much as a blood alcohol level that would make it illegal to drive a car—but these overworked interns and residents can still do surgery. No surprise there were 300% more patient deaths. Residents consider themselves lucky if they get through training without killing anyone. Not that the family would ever find out. With rare exceptions, doctors are unaccountable for their actions.

The IOM report did break the silence and prompted widespread promises of change, but what they did not do is act as if they really believed their own findings. If we truly believed that a minimum of 120 people every day were dying preventable deaths in hospitals, we would draw a line in the sand. If an airliner was crashing every day, we’d expect that the FAA would step in and do something. The Institute of Medicine could insistently demand that doctors and hospitals immediately adopt at least a minimum set of preventive practices—for example, bar-coding drugs so there aren’t any mix-ups, like they do for even a pack of Tic Tacs at the grocery store. Rather than just going on to write yet another report, they could bluntly warn colleagues they would publicly censure those who resisted implementing these minimum practices, calling for some kind of stringent sanctions.

Instead, we get silence. But not for Barbara Starfield, who is unfortunately no longer with us. Ironically, she may have died from one of the adverse drug reactions she so vociferously warned us about. She was placed on aspirin and the blood-thinner Plavix to keep a stent she had to have placed in her coronary artery from clogging up. She told her cardiologist she was bruising more, bleeding longer, but those side effects are the risks you hope don’t outweigh the benefits. Starfield apparently hit her head while swimming and bled into her brain.

The question for me is not whether she should have been on two blood-thinners for that long or even whether she should have had the stent inserted. Instead, I question whether or not she could have outright avoided the heart disease, which is 96% avoidable in women.

The number-one killer of women need almost never happen.

For those curious about my time in medical training, you can read my memoir of sorts, Heart Failure: Diary of a Third Year Medical Student.

It isn’t just medical treatment that can be harmful. Even medical diagnosis can be dangerous, as I discuss in my video Cancer Risk From CT Scan Radiation.

And, just as we’re (finally) seeing some changes in training protocols, the times, they are a-changin’ with the emergence of the field of lifestyle medicine, as I present in several videos, including:

 I recently made some videos to give people a closer look at why I believe it’s so important for us to take responsibility for our own health. You can see all of them on our new Introductory Videos page.

I’m excited to be part of this revolution in medicine. Please consider joining me by supporting the 501c3 nonprofit organization that keeps alive by making a tax-deductible donation. Thank you so much for helping me help so many others.

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: