The increase of vegetables in the diet is one way to reduce inflammation.

Vegetables are an important part of the Mediterranean diet, providing essential nutrients. A diet rich in vegetables that contain antioxidants. As a result, the Med diet reduces the risk of heart disease, cancer, dementia, and anti-inflammatory diseases.

Vegetables are low in calories, but high in nutrient density. In addition to providing high nutrient value, they provide satiety. Thus making vegetables the cornerstone for weight loss and maintenance.

One serving of vegetables is 3 ounces (85 grams) of raw or double that cooked. Three servings of vegetables a day is the daily goal. Without a doubt, the more vegetables, the better.

Breakfast ideas for vegetables include what you might put in an omelet:  tomatoes, spinach, onions, and chives. Even the breakfast bites can have multiple vegetables in them.

While salads are great for lunch, filled with kale, radishes, and carrots, don't forget that you can pile a sandwich with lettuce, cucumbers, sprouts, and tomato.

Need a snack during the middle of the day, plan on carrots for the afternoon and for the drive home. You can't fall asleep while chewing on carrots.

Broccoli might be a great snack before dinner. Raw, even if you have a bit of ranch dressing. Buy packets of dry ranch dry ingredients and add to Greek yogurt.

Don't forget that dinner salad. Make it large and beautiful.

Vegetables contain nutrients that your body needs. They are rich in magnesium, potassium, and folate.

There is no supplement that can replace vegetables.

Every study has shown that an increase in vegetables decreases heart disease, cancer, and inflammation.

People who sell supplements often point out that vegetables have anti-nutrients in them. I have talked about this in a previous podcast and post (here). Of the various supplement salesmen out there, from the self-described Carnivore and his business partner Liver King to Dr. Gundry.

Legumes like beans and lentils are nutrient-rich, protein-, and fiber-rich foods whose benefits outweigh any lectin.  High doses of lectins, when fed to animals, lead to diarrhea, inflammation, and other problems. These problems have never been seen in human studies with normal foods. The main lectins are destroyed by cooking, soaking, sprouting, fermenting, boiling, and canning.

All human trials show that diets rich in legumes, and whole grains, lead to better health.

Oxalates can be absorbed from the gut, bind to calcium, and cause calcium kidney stones. They will also bind other minerals, such as zinc. This has led some to avoid healthy foods like spinach, swiss chard, amaranth, taro, sweet potatoes, beets, rhubarb, and sorrel.

Cooking greatly decreases the oxalate content. In addition, cooking increases the nutrients of the vegetables available for absorption. The higher the vegetable content, the higher the mineral content of the diet, the fewer kidney stones are formed.  People who consume a DASH diet have a 40-50% decreased risk of kidney stones (reference). The DASH diet is the American version of the Mediterranean diet.

Fatty liver disease is the most common reason for liver transplantation. Fatty liver disease replaced alcoholic liver disease a decade ago.

The rise of obesity has contributed to fatty liver disease, and fat, like alcohol, is deadly to your liver.

So can you clean out your liver?  Simple answer - no. But that doesn't stop the world from making dubious claims.

The most famous was Carter's Little Liver pills. They promised to increase the flow of bile in the liver. This would rid the body of toxins.

Even when it was marketed in 1868, it was known as a "patent" medicine. Thus a medicine without merit was sold by quacks.

In 1959, the name was changed to "Carter's Little Pills." The FDA, in 1951, filed suit that the pills had nothing to do with the liver.

The phrase "Someone has more (fill in the blank) than Carter has pills" comes from this product.

Stanley Burroughs, a lumber salesman, invented the "master" liver cleanse. The formula was tea or lemonade with cayenne pepper and maple syrup. There was no clinical data this ever worked. In spite of the lack of evidence, it continues to be recycled in the pseudoscience world.

Burroughs first published the book in 1946, "The Master Cleanse," and re-released it in 1976 under the title "The Master Cleanser".

Burroughs was convicted of manslaughter in California and fined for practicing medicine without a license.

This "juice" or "liver cleanse" or liver detoxification program keeps coming around with different ingredients. Some of the latest include olive oil.

The gallbladder flush is the same formula.  People will defecate small round balls of fecal material. Then they are told that these represent gallbladder stones, but they are not. Thus, the flush is useless.

All the blood from the stomach and small bowel is filtered through the liver. Hence, the liver can be considered a filter.

Once the food you eat is broken down and digested by the gut, those nutrients go to the liver.  Then the liver determines if you need to use the nutrients, store the nutrients, or get rid of the nutrients.

The liver gets the first pass at the medicines you take.  Many medicines require the liver to process them to be effective. Those drugs are called "pro-drugs." Aspirin, for example, is a drug whose active ingredient is salicylic acid.

The liver can also take harmful substances and render them harmless.  In spite of the liver's ability to deactivate harmful products, a person can overcome the liver's ability to detoxify substances. The classic case is alcohol.

Once alcohol is ingested, the liver begins to change it into acetaldehyde. Acetaldehyde is both toxic to the liver and responsible for most hangovers. Acetaldehyde is metabolized into harmless products.

If a person consumes more alcohol than the liver can metabolize, they will become intoxicated. In addition, they will develop both acute fatty liver and chronic fatty liver. A fatty liver can lead to cirrhosis and liver failure.

Since there are multiple complex metabolic pathways in the liver, there is no one agent that will fix the liver.

Supplements touted to help the liver include:

Milk Thistle.  The active ingredient is silymarin. Silymarin has been extensively studied in alcoholic liver disease, fatty liver disease, hepatitis, Tylenol poisoning, and mushroom poisoning. It works as an anti-oxidant and has shown promise, particularly when used early.

There has not been a clinical study showing that one can overcome the sins of a party with any preventive agent. The best preventative against damage to the liver is to avoid the process.

Does the artificial sweetener erythritol increase the risk of heart attacks? In fact, some say that this is just hype.

The article abstract can be found here.

It has been used for years in food as a "non-nutritive sweetener." Erythritol is used in many processed foods, replacing the calories from sugar. The Food and Drug Administration considers erythritol a food additive (GRAS). As a food additive, erythritol has never been tested for its toxicity or long-term use.

While artificial sweeteners decrease calories, do they decrease obesity? They have been shown to decrease obesity among teenagers (ref here). By reducing calories, it seems obvious that obesity would decrease. And yet, this has not been a consistent result

A study showed that increased erythritol led to increased obesity. And that was just the erythritol your body makes.

Since your body makes erythritol. Does that mean it must be safe?

The human body produces many toxic substances. For example, formaldehyde. Humans produce about 1.5 ounces of formaldehyde a day.

Acetaldehyde is a breakdown product of ethanol. Drink too much alcohol, and you will produce enough acetaldehyde to kill you.

There have been a number of peer-reviewed journal articles showing that artificial sweeteners have adverse consequences:

• Weight gain and obesity  (ref)
• Insulin resistance (ref)
• Type 2 Diabetes (ref)
• Stroke, heart disease, and all-cause mortality (ref)
• Increased heart deaths in women (ref)

We have about ten micromoles per liter of blood. That would be the baseline level. Blood levels with 1000 times as much erythritol are found in people who consume it as a sweetener.

One study showed that erythritol led to improved blood vessel function after drinking erythritol for a month (ref). But this was in healthy young adults. What about people with underlying heart disease?

The Erythritol study was done by the highly regarded Cleveland Clinic and published in the journal Nature Medicine. It was peer-reviewed, meaning many other scientists looked at that data and concluded the study was worthy of being included in this prestigious journal.

What this study examined was the correlation of erythritol with people prone to heart disease. They studied people at risk for heart disease. Such as those with high blood cholesterol, diabetes, obesity, or hypertension. They looked at the blood levels of erythritol. Data divided the patients according to how much erythritol was in their blood. What they found was that those with the highest levels of erythritol had the highest incidence of heart disease, strokes, and cardiac deaths of any other group when they followed them for three years.

They found the same results in both a cohort of people from the United States, which had over 1100 participants, and in an identical cohort of over 2000 people from Europe. The higher the level of erythritol in the blood, the more likely they were to have heart attacks, strokes, or die in the next three years.

Some criticized the study for not doing a dietary history of erythritol. This criticism is invalid, as normal levels of erythritol in the blood are 1000 times less than what you get when you use erythritol in food. Blood levels of erythritol are a better validation of what is in the diet than a dietary history. Not only is it hard to remember what products might contain erythritol, but in the US, some products with erythritol are not required to list it in their ingredients.

Another criticism was that they used people already prone to heart disease. That was the point of the article. By taking the highest risk group, those with high cholesterol, are obese, or have diabetes, you can shorten the time to see the effect. You already have disease, and you want to see if the erythritol makes things worse. In this case, those with high levels of erythritol were prone to a heart attack in three years.

If you take a group of young healthy people, erythritol tends to make their blood vessels a little more compliant. In contrast, in older people with stiffer arteries, erythritol has a worse effect.

Overall, the study was well executed and clearly warrants further investigation.

Are you afraid that eating fruit will cause your blood sugar to spike? Let us bust that myth right now.

Only ten percent of adults eat enough whole fruit daily despite the clear benefits of fruit.

 My 98-year-old dad eats fruit with breakfast for as long as I have known him. We would have grapefruit every morning. We even had those cute grapefruit spoons to wrestle the goodness out of the half grapefruit.

Now, dad enjoys a mixed bit of fruit.

In 28 studies with over 1.6 million people, each serving of fruit led to a 5% lower incidence of death (reference).

8% less risk of heart disease

3% lower risk of cancer

200 grams (7 ounces) showed the lowest risk of cancer rates and deaths from cancer.

Thirty years ago, the low-carb community advised against whole fruits. Their rationale was that fruits spiked blood sugar, which caused insulin to rise, which caused fat storage. They even cautioned against eating carrots for the same reason. But now, even the most extreme members of that community proudly eat fruit.

Breakfast with 1/2 cup of blueberries

Morning snack of one medium banana

Lunch with one apple

Afternoon snack of 1/2 cup of grapes (about 16)

Evening snack of 1 clementine

The tomato is a fruit. Yes, the Supreme Court said, for taxation purposes, it is a vegetable, but it isn't.

• promoting long-term weight management
• reducing the risk of heart disease
• reducing the risk of type 2 diabetes
• decreasing the risk of colon and lung cancer
• lowering the risk of depression
• successful aging (like dad)
• higher bone mineral density
• decreasing incidence of seborrheic dermatitis
• less constipation
• less irritable bowel
• less inflammatory bowel
• less diverticular disease
• less hemorrhoids
• less stress

Fruit is not the enemy - but it is one of the easiest of the nine food groups to add to your Mediterranean Diet and one of the easiest and most delicious to add to the DASH diet.

-----

Produced by Simpler Media

For the human body, salt is both an essential metal and toxic at a high dose.  The most common form of sodium comes from sodium chloride, a salt.  However, too much salt and arteries become stiff, and the risk of heart disease and cardiovascular disease increases. The majority of dietary salt comes from processed foods.

Probably the most famous book is The Salt Fix.  A rambling book claiming low salt is responsible for everything from lower sex drive to insulin resistance. The book is logical and simplistic, with abundant citations taken out of context. In summary, the book is almost completely incorrect.

One of the classic studies about salt and hypertension is the DASH sodium study. In these studies, the study participants were fed the diet with varying amounts of salt. These studies are expensive and often not done, but powerful. Additionally, the lower levels of salt, the lower the blood pressure. In fact, a low-sodium DASH diet led to a reduction of blood pressure equivalent to one blood pressure pill.

In contrast, "The Salt Fix" states that decreasing levels of salt led to increasing blood pressure and heart disease. The Salt Fix explanation is that lower salt leads to increased levels of renin, angiotensin, and aldosterone (hormones that would increase blood pressure). His conclusion is the opposite of hundreds of articles and much analysis. Such as here, here, and here.

Another false claim, "The Salt Fix," stated the DASH study showed an increase in LDL, cholesterol, and triglycerides.

The DASH diet showed no significant impact at all.

• Our ancestors ate more salt
• The primitive argument for which there is no proof. Since our ancestors ate mostly plants and no processed foods, this is easily debunked. Meat eaters know that a one-pound chicken contains about 150 mg of salt. A double patty of hamburger has 500 mg. He makes up numbers that don't make sense.
• He states our ancestors ate from salt licks, but there are few in Africa (he makes up stuff)
• Other countries have higher salt intake and lower heart disease
• He cites Korea (which has 50% hypertension or pre-hypertension), Japan (highest incidence of stomach cancer related to salt), and France (hypertension is high, but low levels of heart disease related to the Mediterranean diet practiced by most).
• Salt doesn't lower blood pressure by a significant amount and makes food bland.
• The DASH diet studies show significant reductions in blood pressure, and the food is not bland.
• Lower salt leads to increased death.
• The opposite has been shown. Increased levels of sodium in the diet show increased levels of death.
• Lower salt leads to lower iodine levels.
• Iodized salt was introduced in the US because of the low iodine in Midwest soil. Better sources of iodine include fish and kelp. But the United States also fortifies iodine in bread and dairy products. But too much iodized salt can lead to hypothyroidism.
• Sodium restriction in failing kidneys leads to worse problems
• Ask any kidney doctor, the worst thing for failing kidneys is overload with salt. While salt regulation may be diminished with kidney failure, patients with renal failure need more dialysis with higher salt diets.
• As we age, our kidneys get rid of more salt and need more in our diet.
• We lose some renal function with age, but increasing dietary salt leads to increasing mortality and aging of blood vessels.
• Low salt during pregnancy leads to obesity
• Lower salt in pregnancy yields the opposite
• There are more bits of misinformation in this book. Suffice it to say those who read this book and chose not to read the primary literature might be convinced that we need more salt than less salt.

Salt is salt. It is NaCl. Some have minor amounts of contaminants and other metals in them, which give them color. It is not enough to make a significant impact on your body chemistry or your health.

This salt comes from about 200 miles away from the Himalayas, it is mined in Pakistan. Sounds better to say it is from the Himalayas, but it isn't. Thus, salt is mined much like the salt from Utah. The reason for the pink color is various contaminants. While many tout benefits of this salt, the additional minerals found in Pink salt are insignificant. Thus, the salt is expensive, pink, and mainly decorative.

Celtic salt is from the coast of France, where the salt water is evaporated to get the salt. In contrast, pink and white salt are mined from the old oceans. Celtic salt has more trace minerals than pink salt or white salt. However, the amount of minerals in these salts is not of consequence to humans.

Marathon runners and endurance athletes have died from low salt levels in the blood (hyponatremia). Drinking too much water, or non-salty beverages is one reason for this.

Sweating is not a major loss of salt in athletes.  The average athlete will sweat about 15-65 mEq/Liter, with a maximum of 2 liters per twenty-four hours.

The major problem with those with low blood sodium after endurance athletic events is drinking too much water. Adding salt to the fluids does not improve performance, nor does it.

Some fear the anti-caking agents used in table salt. Sodium and Potassium ferrocyanide sound horrible because of the cyanide. However, ferrocyanide does not break down into toxic cyanide. Still, those who have not taken Chemistry 101 don't understand this. After all, salt itself has "chloride," which kills when it is chlorine gas.

Did you ever wonder what the controversy is about gas stoves? There is no controversy. Gas range tops are responsible for high levels of indoor pollution. But what should we do? The answer, change to an induction cooking top

You can imagine the first time cooking was brought indoors. Probably a fire inside a cave. It turns out that wasn't all that safe. The particulate matter from the wood not only increased the risk of lung disease, but also increased the transmission of respiratory illness.

Community houses, like this one for the Tlingit Nation from Southeast Alaska, had a fire pit in the center of the house. Your status in the community determined how close you would sit by the fire.

While the opening in the roof provided some ventilation, it was not enough.

Particulate Matter and Disease in Native Americans has been well studied. The lung damage from particulate matter predisposed Native Americans to pneumonia, tuberculosis, influenza, and smallpox.

The use of wooden stoves with a chimney, and contained fire, were the most popular stoves in America until after the Great Depression.

America was excited to go electric. But there is something primal about gas and electric cooking.

The phrase cooking with gas was from the gas companies competing with electric companies for the new kitchen. The idea that gas was less expensive, faster, and you could see the flame became the basis for their campaign.

They were trying to compete with "clean electric"

Products from indoor gas ranges are highly toxic to lung tissue. Those products

include:

• Nitrogen dioxide
• Carbon dioxide
• Methane emission
• Benzene

Even with the range off, gas escapes and pollutes the air indoors. Good ventilation decreases the exposure to gas. Most people do not like continuous fans. In addition to the methane, there is also benzene that escapes.

As soon as the United States Consumer Product Safety announced it was considering regulations for indoor gas cooking the vitriole started.

A Wall Street Journal Editorial stated "Don’t believe for a second Consumer Product Safety Commission member Richard Trumka Jr.’s slippery claim that they aren’t coming for your stove."  She also went on to state that the research was paid for.

Jim Jordan, the Republican Congressman from Ohio tweeted, "God, Guns, and Gas Stoves."

Sean Hannity, that famous high school graduate stated that "Biden is coming for your gas stove."

On my tiktok channel I had lots of people parrot this.

I never knew so many old white men knew where the stove was? Let alone what it used for fuel

We have known about the dangers of nitrogen dioxide since the 1960's. (see here, here, here). Experimental data showed it cause lung damage in animal models, then it was associated with human studies. None of these researchers were concerned about climate change.

Even ventilation to the outdoor with a powerful hood may not decrease the nitrogen dioxide enough. And often you won't have the ventilation fan on when the stove is not on.

Converting to induction stovetop might be expensive, although there is currently a government tax incentive to do so.

Even though I just bought my house, and it came with a lovely gas stovetop, I am changing to induction. Until then, I am using my induction hotplates (I have two) for most cooking.

While the low-carb world and its extremists will tell you that grains are evil, they are wrong. There is a significant difference between refined and whole grains.

Whole grains contain the bran, a fiber-rich outer sheath. Further whole gains have the germ cell and the endosperm. But the refined grain is just the endosperm.

Compare whole grain bread, which contains substantially more fiber and vitamins than the white bread. Consuming refined grains increases the risk of heart disease. But consuming whole grains decreases risks of heart disease, diabetes, and cancer.

Bran is rich in fiber.  Additionally, bran is a source of B vitamins, iron, copper, zinc, magnesium, and phytochemicals.

Fiber is an “essential nutrient.” An essential nutrient is defined as a nutrient your body cannot make and must get from your diet.

But carnivore aficionados disagree; they believe fiber is not an essential nutrient. Carnivores note that you really don’t digest fiber. And they opine that people can live without fiber. However, they forget one key, the microbiome.

The microbiome are the trillions of bacteria, yeast, and fungi that live in your gut.  Many scientists consider the gut microbiota another “organ” of our body.

There is a clear difference in the type and number of bacteria that occupy the guts of people with obesity compared to those who are not obese.

Some bacteria will increase hunger hormones. Those same bacteria also decrease satiety hormones, need more food to feel "full." Finally, they increase the ability of fat cells to increase in size, leading to obesity.

• Synthesize vitamins K and B
• Make Conjugated Linoleic Acid (CLA) that reduces obesity
• CLA decreases inflammation
• Ingestion of some fiber promotes the growth of bacteria that decrease the secretion of ghrelin in obese humans.

In the microbiome, what feeds the bacteria that decrease obesity includes the fiber from whole grains. The bran of whole grains contains powerful fibers like oligosaccharides.

What is a serving of whole grains? It seems confusing, especially since some products are a mix of both whole and refined grains. In the Mediterranean Diet, you might notice 9 ounces, but is that grain when it is dry or wet or both?

So it turns out there is a whole grain council that has done the work for you, and they tell you right on the package.

This makes your math simple. You either need three stickers of the 100% whole grain or six of the other stickers.

If you have ever seen Paul Saldino, his famous line is that Kale is BS. He even sells the shirt. But are they? Saldino isn't the only one who proposes this.

Dr. Gundry, a former heart surgeon, has his own take. Gundry claims modern health problems come from eating lectins. Lectins are compounds found in beans that are natural pesticides.  Thus, Gundry claims lectins harm people. Copying destroys lectins.

Plants make compounds to protect them against predators - other plants, pests, and the like. But do they harm humans?

It turns out that some plant defense compounds are beneficial to humans. Take coffee. Yes, coffee - the caffeine is a defense mechanism. Some people will tell you that coffee is bad for you - but they don't get up in the early morning or have kids.

• Gluten
• People who don't have celiac disease or gluten sensitivity do not need gluten-free diets (ref).
• Oxalates
• Potassium-rich vegetables such as Brussels sprouts, broccoli, and kale reduce calcium loss and prevent kidney stones from forming. These vegetables are rich in antioxidants that decrease the risk of bladder, prostate, and kidney cancer. Check with your local dietician for a diet based on the type of kidney stone you have. (ref)
• Caffeine
• If you don't drink coffee, you will lose all joy in life. (reference is me)
• Polyphenols
•  Plant polyphenols have antioxidant, anti-inflammatory, anti-allergic, anti-atherogenic, anti-thrombotic, and anti-mutagenic effects - they are healthy for you (ref)
• Phytates
• Consuming a phytate-rich diet, such as a colorful, plant-based diet, the benefits exceed the impacts on mineral absorption. In addition, phytates are anti-oxidants. (ref)
• Saponins
• These compounds are among the most well-studied compounds to decrease risk and help treat cardiovascular diseases. (ref)
• Isothiocyanates
• Brassica vegetables contain many valuable metabolites that are effective in chemoprevention of cancer (ref)
• salicylates
• These anti-inflammatory compounds are the basis of aspirin
• Phytosterols
• phytoestrogen-containing foods, such as legumes, grains, seeds, nuts, fruits, and vegetables, are rich sources of vitamins, minerals, fiber, and other health-promoting phytochemicals.
• Lectins
• Cooking destroys lectins. Lectin-rich foods, legumes, and whole grains show reduced inflammatory biomarkers in both animals and humans (ref).

What do human trials say about vegetables? They improve health, reduce the risk of heart disease, and reduce the risk of cancer.

Do some of them contain anti-nutrients? Well, some do bind them, but health benefits outweigh any potential harm.

You can believe a shirtless salesman of supplements and scams. Someone who was trained as a psychiatrist, who goes into a grocery store shirtless and yells at kale - or you can believe science.

The most abundant solid ingredient in breast milk is a fiber. That fiber is human milk oligosaccharides. These oligosaccharides are a prebiotic that is carbohydrate based. They meet the definition of fiber. This fiber is important to infants, especially neonates.

When people say fiber is non-essential, they are incorrect. Why? Because the definition of an essential nutrient is:

“A nutrient required for normal body function that either cannot be made by the body or cannot be made in amounts adequate for good health and therefore must be provided by the diet”

Every study looking at increasing fiber has shown an improvement in human health. But what does fiber help with?

Fiber will bulk up your stool and make it easier to have bowel movements. This gives you less constipation, fewer hemorrhoids, and less risk of colon diverticular disease.

If your stool is too loose, you need more fiber. If your stool is too hard, you need more fiber and water.

Your body makes cholesterol, and that cholesterol goes through your gut. When you have increased fiber in your gut, some cholesterol gets bound to it. Thus, increasing fiber means less blood cholesterol.

Fiber decreases spikes in blood sugar. Want an example? Take an apple and a doughnut. A doughnut has less sugar than an apple, but a doughnut will spike your blood sugar more than an apple. Why? Part of the reason is the increased fiber in the apple (and fat, a doughnut has 15 grams of fat) – an apple has 3 grams of fiber, a doughnut has 0.9 grams.

Fiber binds to bile acids (ref). When you eat meat and increase meat in your diet, you increase fat. To digest fat, your body increases the production of bile acids, which are released into the gut. Your gut reabsorbs 95%, but about 5% makes it to the colon, where other bacteria encounter them, and then bad things happen.

Bacteria break down these bile acids into pro-inflammatory and pro-carcinogenic compounds. This is in contrast to a plant-based diet with high fiber. Fiber binds to the bile acids allowing them to pass without causing harm to the colon.

When a person consumes fiber, the fiber is used as food by some bacteria. These bacteria metabolize the fiber and excrete short-chain fatty acids.

Inside your bowels, there are many microorganisms, from bacteria to yeast. What determines which bacteria thrive? There are bad bacteria and bad yeast, and to encourage the growth of the good bacteria, you have to feed them. How do you feed them?

The favorite food of the good bacteria? Fiber.

Bacteria "eat" fiber and produce short-chain fatty acids, which are great because:

They decrease inflammation, improve blood sugar control, and blood lipids.

The term vitamin was coined by the chemist Casimir Funk as he revealed the Thiamine structure to the world. So while you may think – isn’t vitamin A (it is the alphabet) the first vitamin – we take our poetic license here to point out that the first compound to be called a vitamin was Thiamine, now known as vitamin B1. But the story of that vitamin was made possible by two individuals – but the most noteworthy was Takaki Kanehiro.

Our podcast today discusses the education of Kanehiro and how that influenced his view. But let’s work backward a bit.

Vitamin B1 and Beriberi

Beriberi is caused by a lack of vitamin B1 (thiamin) in the diet. This vitamin is essential in the biochemical process of utilizing fats, carbohydrates, and proteins for energy. The nerves are particularly affected because of their metabolic pathways – hence, a wide range of symptoms from difficulty with walking (motor function) then sensory function of the legs, and finally, it affects the conduction in the heart, which leads to death.

White Rice and Beriberi

White polished rice was the fad food not only in the cities of Japan but also in China. To polish the rice, the husk and germ are removed, but this is also where the vitamins are. When people eat just one food item, they are likely to develop a deficiency disease, and this was the case with sailors and white polished rice.

The officers would not only eat rice but were given a variety of foods and thus avoided beriberi. But the crew typically only ate white rice.

Beriberi in Mid-1800’s Japan

In Japan in the mid-1800s, especially in the city, polished white rice was the calorie source of choice. White rice is easy to store, looks clean, is faster to cook, and eating it is less chewy. White rice was considered what the wealthy people ate – it was beautifully displayed, and unlike brown rice, did not go rancid. What they didn’t know was the processing of the rice led to stripping the rice of the vitamin-rich portion. 

In the rural areas of Japan, there was little beriberi as they mostly ate brown rice (barley rice). 

This led to a major problem in their Navy, where beriberi was endemic. White polished rice was the caloric source for the Navy, and often one third of the crew would develop beriberi and be unable to carry out their duties.

There were many thoughts as to the cause of beriberi, but none of them had panned out well.

Eastern Traditional Cures for Beriberi

On occasion, Eastern healers would recommend various teas and herbs. But, some would recommend barley rice. Some of these cures are retrospective, meaning once the traditional Japanese medical folks learned that barley rice was a cure for beriberi, they stated that they had prescribed it for years. Barley rice does have vitamin B1 (1 cup contains a day’s supply). But during the time, the cures from these village doctors were rare and not enough for the Japanese Navy, in spite of losing more people to beriberi than to war – would adopt. Also, note that barley rice is not as transportable as white polished rice and has a shorter shelf life. During this time, Japan was becoming westernized, and they were working on importing medical ideas from Germany, although they had a fair bit of influence from the British method. 

Kanehiro’s training

When Kanehiro was being trained, his initial training was from the Eastern Medicine part of his province. This training was apprentice-like, and he heard someone say that “There are no good doctors in Sustama.” When William Wills opened a medical school in his province, he jumped at the chance – but Wills encouraged him to go to London for further training.

In order to do this, Kanehiro joined the Navy in 1872. He remained in the Japanese Navy for the rest of his life.

In 1875 Kanehiro went to London and began to study at St Thomas Hospital. To this day, St Thomas hospital sits across the Thames River from Westminster, Big Ben, and parliament.

Epidemiology – cholera to beriberi

Just a 30-minute walk from the St Thomas hospital is the Broad Street Pumping station, where 22 years before, John Snow had meticulously shown how cholera had been transmitted through the water. The theory of cholera was not widely accepted at the time, in spite of the guardians removing the pump handle in 1859 and the outbreak stopping. By the time Kanehiro arrived, the methodology of Snow and the field of epidemiology was the most heralded new science of the day.

Besides learning modern surgical methods of the day, Kanehiro also learned epidemiology and the scientific method.

Return to Japan and the Study of Diet as a cause of Beriberi

When Kanehiro returned to Japan, he dedicated himself to finding the cure for beriberi – the disease that killed more Japanese sailors than battle. Using the methods of epidemiology, he developed an experiment to prove that beriberi was secondary to the food they ate and not the other conditions of the ship.

For the rest of the story – please listen to the podcast – subscribe if you like it. Thank you.

Vandenbroucke JP. Adolphe Vorderman’s 1897 study of beriberi among prison inmates in the Dutch East Indies: an example of scrupulous efforts to avoid bias. JLL Bulletin: commentaries on the history of treatment evaluation, www.jameslindlibrary.org (2012, accessed 28 June 2013).

Takaki, K . On the cause and prevention of kak’ke. Trans Sei-I-Kwai 1885; 39(Suppl 4): 29–37.

Takaki, K . On the preservation of health amongst the personnel of the Japanese Navy and Army. Lecture II, delivered on May 9th. Lancet 1906; 1: 1451–1455.

Takaki, K . On the preservation of health amongst the personnel of the Japanese Navy and Army. Lecture III, delivered on May 11th. Lancet 1906; 1: 1520–1523.

Imagine being able to improve the Mediterranean Diet with a few changes. Is the new "Green" Mediterranean Diet the ultimate hack? The Green Mediterranean Diet  (Green-Med) has become the hottest version of the MED diet yet.

There are three advantages to Green-Med

1. Less Fatty Liver
2. Decreased risk of heart disease
3. Less Visceral Fat

Non-alcoholic fatty liver disease is the number one cause of liver failure in the United States. It surpassed alcoholic liver disease as the number one reason for liver transplants. But how do you get fatty liver?

Low-Carb enthusiasts blame fructose, or almost any sugar, as the cause of fatty liver disease. Although the latest boogyman is "seed oils." On the other hand, vegans will blame saturated fats.

But sugars in mice are not the same as sugars in men.

Fatty liver appears to be a byproduct of obesity, excess calories, and genetics.

After weight loss surgery, people rapidly lose weight, including in their liver.

But people on the Green Mediterranean Diet lost more weight in their liver than those with the standard Mediterranean diet.

Belly fat is one of the hardest fats to get rid of. As people age, belly fat increases. So when women go through menopause, they increase belly fat.  And lowering belly fat is best done through weight loss with a high-fiber diet and cardiovascular exercise. But Green-Med appears to lower it even more.

Although MED is known for reducing the risk of heart disease, Green-Med seems superior.

The difference between the green and standard Mediterranean diet

• 28 grams of walnuts a day - about one ounce
• 3-4 cups of green tea per day
• 100 grams per day of frozen Mankai
• Reduction in red meat

Green Tea is Easy

There are more polyphenols in it than in black tea - so it's easier to drink.

Adding walnuts is easy; they are also a great source of omega-3 fatty acids.

Decreasing red meat isn't difficult.

Finding Mankai or duckweed - well, you can't in the United States

No one has reproduced the data about the Green Mediterranean Diet - perhaps because they can't find those frozen cubes of duckweed.