Common Disease Fundamentals

To paraphrase some of the doctors I respect and follow, “heart disease, diabetes, arthritis, obesity, hypothyroidism, acne, kidney disease, even cancer… they are all ONE DISEASE. These are all food-borne illnesses. ALL chronic diseases are caused primarily by eating a bad diet consisting mostly of processed foods and animal products with not enough fruits and vegetables. We give these conditions different names which then allow drug companies to create different, expensive drugs which don’t treat, just manage disease”.

Fix the diet and you will go a long way to fixing your health.

The only diet shown to reverse disease long term is one focused predominantly on


Just a small disclaimer about my credentials. I am a board-certified Otolaryngologist/Head and Neck Surgeon (Ear, Nose and Throat Specialist or ENT for short). I am not an Internal Medicine, Diabetes, Heart Disease…specialist. Although I know a fair bit about these conditions, I do not make any recommendations about changing medications or managing these conditions beyond the benefits of implementing lifestyle interventions. Please go to your own primary care physician or specialist for definitive treatment or recommendations about changing your medicines. If you don’t have a primary care physician, an interesting diagnostic tool if you have symptoms you want to investigate is This online tool is a private, free service which analyzes symptoms and provide some diagnostic possibilities. I think it’s a little more informative than “Dr. Google”. Another site which offer various health measure calculators such as BMI (Body Mass Index) and even Sleep Apnea risk calculators, visit Calculate by QxMD. (

“Modern” western medicine is based on a system of treating symptoms. It evolved to treat acute illnesses and problems but now we are trying to treat chronic disease with an acute care model. If you break a limb, are having a heart attack or need urgent, complex surgery, the US has the best healthcare system to save your life, treat your infection or “manage” your acute condition. If you have a chronic disease however, we do a pretty lousy job. We don’t practice “health care”, we practice “sick care”. The “care” part of the equation is often missing. The healthcare industry is exploding, is expensive and how we care for patients has evolved into a business.

Here is a comparison of present day US healthcare compared with how we practiced in 1970:

  • Number of healthcare jobs: 4 million VS >16 million. It’s the #1 US economy today!
  • Healthcare spending per person: $550/yr. VS >$11,000/yr.
  • Time allotted for office visits: 60 minutes (new patient) and 30 minutes (established) VS 12 minutes and 7 minutes respectively
  • % of GDP of healthcare: 6.9 VS 18% today
  • Average hospital daily room charges: ~$100 VS ~$4,600
  • Although hospital food wasn’t great in the 70’s, it it significantly worse today with most urban hospitals even having fast food establishments in their lobbies like McDonald’s in many children’s hospitals. Some other establishments commonly seen in hospitals are Subway, Wendy’s and Chick-Fil A.

As mentioned on other pages, the US spends the most on healthcare (over $3.5 trillion a year, almost double what the next closest country spends, which has socialized medicine to boot!). Healthcare costs are the most common cause of personal bankruptcy. In 2018, direct costs to treat Alzheimer’s Disease alone were over $260 billion. Adding indirect costs almost doubles that number. Heart disease costs were $120 billion and cancer, $60 billion. Despite that spending, the US ranks only 37th in infant mortality and 50th in life expectancy among developed countries and, after a gradual increase in life expectancy every year since records have been kept, since 2016 when we ranked 42nd, our life span has been continuously decreasing. We rank 48th with respect to rate of chronic disease. The average American spends the last 9 years of their lives physically debilitated and the last 20 struggling with at least 1 significant chronic disease. Also, sadly, 100 million people have to make the daily decision between paying for healthcare vs paying to feed their families. We don’t have a “healthcare” industry, we have a “disease management” industry. We don’t spend money on making people healthy. We encourage disease by putting a band-aid on symptoms with pills.

We are 1st in obesity with 75% of Americans being overweight and 42% being obese! Our kids top the worldwide charts when it comes to many diseases such as diabetes, autism, heart disease, cancer, allergy and autism rates! We spend 86% of our healthcare costs treating chronic, reversible diseases. We increase these costs by 6-8% every year. Some of these chronic conditions include heart disease (#1 cause of death for over 100 years), stroke, cancer, type 2 diabetes, obesity, arthritis and dementia (which is actually a chronic inflammatory disease). The vast majority (85%) of these diseases are directly related to our lifestyle. 70% of deaths worldwide (more than 30 million in 2017) were from a chronic, reversible diseases. According to the CDC in 1990 20% of the deaths in the US were related to chronic disease.  Today, that number has risen to 75% or 1.7 million US lives annually.

We spend 86% of our healthcare costs treating chronic, reversible diseases and each year we increase that spending by 6-8%. Sadly, only 2.6% of US health expenditures go towards prevention and healthy lifestyle education. In fact, 47% of US hospitals have long-term contracts with fast food franchises like McDonalds which are prominently located in their lobbies.

In 1960, the US population overall had a chronic disease rate of only 4%. Today:

    • 60% of Americans have at least 1 chronic condition.
      • 48% have some form of cardiovascular disease.
      • 30% have hypertension and 20% of them don’t know it.
      • 15% have chronic kidney disease and 90% don’t know it.
      • 10% have diabetes and another 30% have pre-diabetes.
      • 30% have elevated cholesterol.
      • 10% have some form of chronic lung disease.
    • 40% of Americans have 2-4 chronic conditions.
    • 10% of Americans are living with 5 or more chronic conditions.
    • 46% of children have a chronic disease.

The only species on the planet suffering with obesity and chronic diseases are humans and the pets and animals we feed and keep warm (and they have the same diseases we do!).

Although getting cancer scares people the most, if all the cancer in the US were to be miraculously cured all of a sudden, life expectancy would only go up by 2.8 years. In 1971, President Richard Nixon announced a “war on cancer”. At that time, the overall cancer rate was 12% (1:8) and cure was less than 28%. In 2017, the cancer rate has risen to 38% (1:3), not even including skin cancers, and survival has only improved to 31%. Proportionally, many more people are dying of cancer today than in 1971. Why cancer rates are rising is a complicated issue but deteriorating lifestyle choices (poor, animal product-centric diet and lack of activity) along an ever-growing toxic environment and food supply are undoubtedly the biggest factors. Treating cancer is important but preventing it is of greater importance. In addition, we must address all the other chronic diseases which have the greatest impact on daily health and longevity. The good news is that all of the healthy lifestyle changes, especially nutrition, impact positively on ALL of the most common chronic conditions, as well as cancer. “The Transformative Power of Lifestyle Medicine”  is a great TEDx lecture on YouTube by Dean Ornish, MD, a pioneer in the now-popular specialty of Integrative Lifestyle Medicine. Dr. Kim Williams, former head of the American College of Cardiology and Chief of the Division of Cardiology at Rush University Medical Center said: “There are two kinds of cardiologists: vegans and those who haven’t read the data”The science is clear. Better nutrition primarily through a plant-based diet along with other lifestyle improvements can prevent and reverse most chronic disease. The ONLY diet scientifically proven in numerous long-term studies to reverse heart disease, along with many other chronic diseases, is a whole foods, plant based. Minimizing fat, salt and sugar add significantly, especially if your disease is advanced. Many researchers, including Dr. Dean Ornish, Dr. John McDougall, Dr. Nathan Pritikin and Dr. Caldwell Esselstyn have reproduced this finding in many studies involving thousands of patients. These are not just scientists but actual doctors treating and curing actual patients.

In the past, people died of under-nutrition. Today, most people die of “over-nutrition”. Below is some information about these chronic diseases along with some references grouped by condition.

That’s not to say that there are not other medical conditions which we should ignore. There are some 7000 estimated “rare” diseases which affect about 30 million (~10%) of Americans. About 95% of those condition have no known treatment not to mention a known cause, other than the obvious genetic ones. Many of these conditions I would argue are still related to our lifestyle, particularly our food choices and other toxic exposures. Most of these people are also suffering additional lifestyle-related conditions so reversing these is still imperative.

“How Not To Die” Michael Greger, MD. The best medical / nutritional reference book hands down. It is based on his very robust website If you only buy one book about health and nutrition, this is the one to buy.


“Your Body in Balance” Dr. Neal Barnard’s book about how lifestyle, especially foods impact our hormones and health.




“Natural forces within us are the true healers of disease”. Hippocrates

Our bodies are constantly in a state of trying to protect, repair and maintain itself. Health is not simply the absence of disease. Health is an active state. According to Dr. William Li, MD, author of a phenomenal recently published book “Eat to Beat Disease, our body has within it five health defense systems responsible for maintaining our health and resisting the regular hazards we all face every day as part of ordinary life. When working properly, they also heal us when incursions from disease inflict damage in our body. Lifestyle factors such as following a plant-based diet and eliminating processed foods and animal products, stress management, improved sleep, love and social support and exercise all play a huge role in how these 5 systems function.

ANGIOGENESIS. 60,000 miles of blood vessels course throughout our bodies and bring oxygen and nutrients to all of our cells and organs. Angiogenesis is the process by which these blood vessels are formed. When there is an acute injury, new vessels form to help heal injuries and then when no longer needed, those vessels disappear. This is a natural process of healthy angiogenesis. When cancers form (and they form continuously in all of our bodies!), they will only grow and spread if new blood vessels are formed in a destructive pattern of angiogenesis. Once a small, stable nest of cancer cells obtains a new blood supply, the rate of cell division and tumor growth explodes, increasing by 16,000 times in only 2 weeks! There is a balance between healthy blood vessel formation and destruction and unhealthy one. Healthy and unhealthy lifestyle choices dictate whether our bodies keep the proper balance between healthy and unhealthy angiogenesis. Foods like soy, green tea, coffee, tomatoes, red wine, beer, and even hard cheese can influence the angiogenesis defense system.

REGENERATION. About 300 million human cells die every minute and, in that same minute, 1.5 billion new cells are formed. Powered by more than 750,000 stem cells distributed throughout our bone marrow, lungs, liver, and almost all of our organs, our body regenerates itself every day. They quietly regenerate most of our organs “behind the scenes” as we age. The process happens at its own pace, different for each organ but it is continuous.

  • Your small intestine regenerates every 2-4 days.
  • Your lungs and stomach, every 8 days.
  • Your skin, every 2 weeks.
  • Your red blood cells, every 4 months.
  • Immune cells – every 7 days
  • Platelets – 20% regenerate daily.
  • Your fat cells, every 8 years. You are born and die with basically the same number of fat cells.
  • Your skeleton, every 10 years.

These stem cells maintain, repair, and regenerate our bodies throughout our lives. Chronic diseases like atherosclerosis and diabetes, damage stem cells. Some foods like dark chocolate, black tea, and beer can mobilize them and help us regenerate. Other foods, like purple potatoes, can kill deadly stem cells that spark cancer growth.

MICROBIOME. Almost 40 trillion bacteria (some estimate as many as 100 trillion) cover the surfaces of our bodies, most of which act to defend our health. They are like a force field. Not only do these bacteria produce health supporting metabolites from the foods that we swallow and deliver to our gut, but they also control our immune system, influence angiogenesis, and even help produce hormones that influence our brain and social function. We can boost our microbiome by eating foods like kimchi, sauerkraut, sourdough bread as well as fiber-rich fruits and vegetables. The single most important factor in creating and maintaining a healthy microbiome is the variety of fruits and vegetables that you eat which helps maintain the diversity of the microbes. An example of the power of the microbiome is one particular microbe, aceromancia, which dramatically improves responses to chemotherapy. It is dependent on proper mucus production by the gut lining which is promoted by such foods as cranberries and pomegranate as well as concord grapes. Another important microbe is ruminococcus. It loves fiber. For every 5 grams of fiber consumed, there is a 30% decrease in mortality. For a lot more about the microbiome, check out this section.

DNA PROTECTION. Our DNA is our genetic blueprint, but it is also designed to be a defense system. It has surprising repair mechanisms that protect us against damage caused by solar radiation, household chemicals, stress, compromised sleep, and poor diet, among other insults. Only 3% of our DNA codes for stuff we actually need. The rest is instructions including how to fix itself. DNA is constantly getting damaged (10,000 genetic mutations a day) and constantly being repaired. Not only can certain foods prompt DNA to fix itself, but some foods turn on helpful genes and turn off harmful ones. For example, 1 kiwi a day neutralizes 60% of the incoming DNA damage. 3 a day actually builds up DNA. This is known as epigenetics (click here for more on this topic). Other foods lengthen our telomeres, which protect DNA and slow aging. Dr. Ornish has shown that within 3 weeks of improved lifestyle, including following a vegan diet, more than 500 gene alterations can be noted. About 450 cancer causing genes were down-regulated and about 50 cancer suppressing genes were up-regulated.

IMMUNITY. Our immune system defends our health in sophisticated ways that are much more complicated than we previously thought. It is influenced by our gut (it is estimated that 70% of our immune system resides in the gut), and it can be manipulated to successfully attack and wipe out cancer, even in the elderly. We are constantly discovering new things about and changing our understanding of the immune system. Foods like blackberries, walnuts, and pomegranate can activate the immune system, while other foods like saturated fat found mostly in animal foods, can dampen its activities and help reduce the symptoms of autoimmune diseases. Jimmy Carter was diagnosed with metastatic melanoma in 2015. It had spread to his brain and his liver. This was traditionally considered a death sentence, and a rapid one. But he received, what at the time was considered an experimental treatment, immunotherapy, which helped his own immune system identify and eliminate his cancer. He has been cancer free since. 




I hear this comment a lot in my office, regardless of the reason the patient is in to see me. The bottom line with every symptom and condition is that they rarely just start. Things have been going on in the background, in most cases for years, before symptoms actually surface.

  • The changes in the brain leading to dementia start 20-30 years before the first symptoms.
  • The first cells mutating leading to cancer probably appeared years, if not decades before a tumor is detected.
  • Elevated blood pressure and atherosclerosis have been going on in the background long before the first heart attack or stroke.
  • Hearing loss has been gradually worsening for decades before people notice difficulty understanding their friends and relatives.
  • Insulin resistance, the precursor to diabetes, has been silently going on in the background until one day a blood test is done or a complication occurs and diabetes is identified.

The body has an amazing way of trying to heal and compensate for things, until it no longer can. The pancreas can only produce so much insulin before the pancreas poops out. the liver can only metabolize so much fat before you develop fatty liver. The time to improve your health and life is before you develop symptoms. Sins of our youth or middle age always come back to haunt us in the future and at that point, too much damage may have been done.

The good news is that given the right environment, most chronic diseases can be reversed or at least better controlled but it takes effort. A better diet. More exercise. Better sleep. Better control over our stress. Improved, positive relationships. It’s a multi-tiered approach.




As reiterated in a few different parts of this site, medications do not treat disease, they manage them. They are band-aids and do not address why a disease is present. Only you can fix your condition, whatever it is. Chronic disease is for the most part lifestyle-related. Only you have the power to reverse that. It takes hard work to change as well as a firm belief that you can change. With meaningful lifestyle improvements, both physical symptoms, physiologic parameters like heart rate and blood pressure and blood work values can improve in only a few short weeks and in some cases, like reducing or eliminating the need to take insulin in Type 2 diabetics, within days. Lifestyle changes, however, can be scary, and significant, but are necessary if you want to get better.

When people first get some kind of diagnosis, they attempt to change, mostly out of fear but this does not last. Lasting, meaningful change takes more motivation than just fear. It takes a true change in how we perceive life and how we approach it. You need to define your “why”. Why do you want to live longer? To feel better? To see you children or grandchildren grow up, graduate and get married? To see a project to it’s conclusion? Whatever it is, you need to identify it and remind yourself of it, constantly.

Studies show that habit change, by way of forming new neural pathways in the brain, takes about 45 days. Only one and half months. Studies also show that adaptation to new tastes, about 3-4 weeks. This is called neuroadaptation. This is seen with our perception of common tastes like sweet, salty and fatty foods. When you eliminate added sugar from your diet, within a few weeks, fruit tastes sweeter. In that same time-frame, by eliminating added salt, you can actually taste the salt in a celery stick which you don’t typically do when you add or consume a lot of salt. The same happens with fatty foods. The point is that how we consciously and unconsciously perceive things has a significant impact on our choices and responses.

In his phenomenal book “Cured: The Life-Changing Science of Spontaneous Healing”, Dr. Jefferey Reddiger, MD, describes how “miraculous” cures and life threatening disease reversal is seen worldwide, but in almost every case, massive change in lifestyle habits was implemented. Some of these changes were nutritional (not all of them eliminated animal products but most of them did, all of them increased organic fruit and vegetable consumption, eliminated sugars and processed foods and kept their animal food sources from clean and ethical sources). Some were related to exercise (not necessarily starting an endurance sport protocol, just adding more movement in their lives). Many to changes in stress management, faith and attitudes about life. The important point is that they took their destinies into their own hands. They accepted the diagnosis, but not the prognosis.

The point is that you have control over your diseases and health. Your doctors can give you advice, but ultimately, you have to do the work and just taking medications is not going to do it most of the time.



“If you don’t know how to say “NO”, your body will eventually say “NO” for you”. Gabor Maté, MD




There are three kinds of lies: lies, damned lies, and statistics.” actual author unknown

It is extremely important to really understand what quoted statistics actually mean for you and your health. This applies to everything from nutrition to risk of disease. For example, a doubling (2x increase) of the risk of getting a disease when you increase the absolute numbers from 1 case of a disease to 2 cases is insignificant when you are looking at 10,000 people. In the context of only 10 people, a doubling IS significant. Such statistics can be used to exaggerate results. It can be complicated and confusing. Click here for a more detailed discussion about this topic.



“INFLAMMATION is like an unnoticed brush fire, where the low flames spread through plants and grasses, never igniting into a full blaze but smoldering along the ground, causing damage to the landscape”

Jeffrey Rediger, MD, author “Cured” documenting the lifestyle changes leading to “miraculous” spontaneous cures.




The fundamental problem with just about ALL diseases is chronic inflammation. As many as 50% of deaths worldwide are attributable in a major degree to some form of inflammation. In short, inflammation is the body’s normal response to external and internal threats like injury, physical and emotional stress, infection or toxic exposures. When the immune system senses any kind of danger, it responds by activating proteins meant to protect cells and tissues. Under normal circumstances, inflammation is protective and helpful, but if immune cells start to overreact or are chronically stimulated, that inflammation can be directed against our own tissues. This type of harmful, chronic or repeated inflammation can have a number of causes, including a virus or bacteria, an autoimmune disorder, sugary and fatty foods, lack of sleep, repeat physical injuries or the way you respond to stress. Here are a few ways inflammation can impact your health.


It’s a normal response to infection. Inflammation is most visible (and most beneficial) when it’s helping to repair a wound or fight off an illness. You see your body’s inflammatory response whenever you have a fever or a sore throat with swollen glands, or an infected cut that’s become red and warm to the touch. The first-century Roman physician Aurelius Cornelius Celsus described the four cardinal signs of inflammation: calor (heat), dolor (pain), rubor (redness), and tumor (swelling). These are signs that your immune system is sending white blood cells, immune cell-stimulating growth factors, and nutrients to the affected areas to heal the area. In this situation, inflammation is a healthy and necessary function for healing. But this type of helpful inflammation is only temporary. When the infection or illness is gone, inflammation should go away as well.

Inflammation prepares you for battles. Another type of inflammation occurs in response to emotional stress. Instead of blood cells rushing to one part of the body however, an inflammatory protein called C-reactive protein (CRP) is released from the liver and travels throughout the body. This protein triggers other inflammatory pathways which is the body’s biological response to impending danger also known as the “flight or fight” response. This response floods you with cortisol and adrenaline and could help you escape a life-threatening situation. But continuous stress over a long period of time, or even dwelling on past stressful events can cause CRP levels to be constantly elevated, which can be a factor in many chronic health conditions.


It can harm your gut. As much as 70% of our body’s immune system is in the intestines. 80% of our antibodies are generated by the Gut Associated Lymphoid Tissue (GALT). Most of the time, those immune cells ignore the trillions of healthy microbes that live in the gut, but for some people, that tolerance malfunctions and their immune cells begin to react to them, creating chronic inflammation. The immune cells can also attack the digestive tract lining itself, an autoimmune condition known as inflammatory bowel disease (IBD) which includes Ulcerative Colitis and Crohn’s Disease. The symptoms include diarrhea, cramps, ulcers, and may even require surgical removal of severely damaged intestines. We don’t know exactly why some people get IBD but diet, genetics, environment, antibiotics and stress all seem to play a role.

It causes dementia. Only 1-3% of dementia cases are attributable purely to genetics. The vast majority are a result of chronic inflammation caused by a variety of factors, almost all related to poor lifestyle choices. The damage is a slow process, taking decades. Some studies even link childhood inflammation to increased dementia risk.

When the brain inflames, it metabolizes tryptophan, creating various toxic by-products that damage the hippocampus. Tryptophan is also needed to make serotonin. Low tryptophan means low serotonin worsening the depression.
An inflamed brain makes excess SERT, the serotonin transporter which is responsible for reabsorbing the serotonin into the secreting neuron, lessening the impact on the connecting neuron. SSRIs work by preventing SERT from doing, or overdoing, its job, allowing more serotonin to remain in the synapse (space between the neurons), and thus increasing the stimulation of the connecting nerve.

It can harm your joints.  One joint-damaging condition is Rheumatoid Arthritis (RA). Although genetics plays a role, RA is also linked to diet, smoking, vitamin D deficiency and other risk factors including yersinia infections from contaminated pork products. A 2013 Yale University study, for example, found that a salty diet may contribute to the development of RA. The inflammation caused by RA can also cause problems in the eyes and other body parts.

Inflammation is linked to heart disease. Any part of your body that’s been injured or damaged can trigger inflammation, even the insides of blood vessels called the endothelium. The formation of fatty plaques in the arteries can trigger chronic inflammation. The plaques attract white blood cells, grow larger, and can form blood clots, which can cause a heart attack or can break off leading to a pulmonary embolism or stroke. Obesity and unhealthy eating increases inflammation, but even otherwise healthy people who experience chronic inflammation because of an autoimmune disorder, like rheumatoid arthritis, psoriasis or Celiac disease, appear to have a higher risk of heart disease, regardless of their weight or eating habits. Even the inflammation from poor dental and gum care adds to cardiovascular risk.

It’s linked to a higher risk of cancer. Chronic inflammation has been linked to a number of cancers including the lung, esophagus, cervix and digestive tract. A 2014 Harvard University study found that obese teenagers with high levels of inflammation had a 63% increased risk of developing colorectal cancer as adults compared to their thinner peers. The inflammation may be due to obesity, a chronic infection, a chemical irritant or chronic condition. Chronic reflux for example causes repeat inflammation of the esophagus and the repeated damage can lead to esophageal cancer, often diagnosed at very advanced stages. When immune cells begin to cause unnecessary inflammation, immune regulation and monitoring deteriorates and it creates an optimal environment for cancer cells to grow. In addition, when you take a medication to reduce inflammation without addressing the cause of the inflammation, your normal immune response is also suppressed. This increases your risks for various infections and again, cancer surveillance decreases. As mentioned above, caners are continuously forming and are being destroyed in our bodies. If the immune system can’t do its job, cancers have a much better chance of taking hold and growing.

Inflammation impacts on your sleep. In a 2009 study from Case Western Reserve University, people who reported sleeping more or less than the recommended 7-8 hours had higher levels of inflammatory proteins. Whether inflammation affects sleep duration or whether sleep duration triggers inflammation is not clear but they are clearly associated. It’s also possible that a different underlying issue, like chronic stress or disease, causes both. Shift work has also been found to increase inflammation in the body. Shift workers have a much higher rate of chronic disease and cancer.

It’s bad for your lungs. When inflammation occurs in the lungs, it can cause fluid accumulation and narrowing of the airways, making it difficult to breathe. Infections, asthma and chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis, are all characterized by inflammation in the lungs. Smoking, exposure to air pollution or household chemicals, being overweight, and even consumption of processed meats have been linked to lung inflammation.

It damages gums and teeth. Inflammation can come from and also wreak havoc on your mouth. Chronic inflammation of the gums caused by bacterial accumulation and bad teeth cause gums to recede and the bones around the teeth to become weakened or damaged. Brushing and flossing regularly can prevent this periodontitis which doesn’t just affect oral health but is also linked to heart disease and dementia as well since imbalance of bacteria in the mouth may also trigger inflammation elsewhere in the body. More aggressive oral hygiene measures such as mouthwashes, tongue scraping or harsh toothpaste actually contribute to heart disease and even type 2 diabetes since they add to the bacterial imbalance and promote the growth of harmful organisms.

It makes weight loss more difficult. Obesity is a major cause of inflammation in the body and losing weight is one of the most effective ways to fight it. That’s sometimes difficult because chronic inflammation can influence hunger signals and slow down metabolism, so you eat more but burn fewer calories. Inflammation can also increase insulin resistance which raises your risk for developing diabetes and makes managing both type 1 and type 2 diabetes more difficult. It has also been linked with future weight gain.

It damages bones. Inflammation interferes with bone growth and promotes increased bone loss. Inflammatory proteins in the blood interrupt bone remodeling which is an ongoing process in which old, damaged pieces of bone are replaced with new ones. This occurs throughout life, even well into old age. Inflammation of the gastrointestinal tract (as with IBD) can be especially detrimental to bone health. It can prevent the absorption of important bone-building nutrients like calcium and vitamin D. Another inflammatory disease like arthritis, can also have a real impact on bone health since it limits peoples physical activity and can keep them from performing weight-bearing, bone-strengthening exercises.

It affects your skin. Psoriasis is an inflammatory condition in which the immune system causes skin cells to grow too quickly. A 2013 study published in JAMA Dermatology suggested that losing weight could help psoriasis patients find relief since obesity contributes to inflammation. Chronic inflammation has also been shown to contribute to faster cell aging and it also plays a role in the formation of wrinkles and other visible signs of aging. Consuming lots of fruits and vegetables, which increases antioxidant consumption, has been shown to delay sun burning and even increase the speed of recovery after a burn.

It’s linked with depression. Inflammation in the brain may be linked to depression according to a 2015 study published in JAMA Psychiatry. Specifically, it may be responsible for depressive symptoms such as low mood, lack of appetite, and poor sleep. Previous research has found that people with depression have higher levels of inflammation in their blood, as well.

DEPRESSION: Serotonin Hypothesis vs the Cytokine Hypothesis

It is well-known that when wild and domesticated animals get sick, they exhibit a cluster of behaviors and symptoms. They will stop moving, socializing, eating and interacting with others.  They will often isolate themselves.  Symptoms all similar to what chronically and pathologically depressed people exhibit. In animals, this was thought to be related to the infection itself but in the 1970’s, what was called at the time “factor X” was identified as a possible causative agent.  When serum from the sick animals was injected into healthy animals, they started to exhibit the same behaviors without any evidence of infection.  It turns out that factor X were the cytokines which are produced during an inflammatory response in these have more recently been linked to depression in humans. The same elevation in cytokines is often seen in depressed humans. Rather than just putting someone on antidepressants to “fix the imbalance of chemicals in the brain”, we should be focusing on identifying the cause of the inflammation and addressing that.

TREATING AND REVERSING INFLAMMATION. Chronic inflammation doesn’t happen overnight. Reversing it doesn’t occur overnight either, especially if you’ve been inflamed for a long time. But by incorporating all (not just one – remember, there’s no easy way out!) of these strategies, you will begin reducing your inflammation and can see results in as little as two weeks.

FOCUS ON YOUR DIET. Taming chronic inflammation starts with what you put in your body. Every time you eat. The best way to shift that balance is to eat fewer inflammatory foods and consume more anti-inflammatory foods. The latter includes lots of different fruits and vegetables, raw nuts and seeds, cultured and fermented foods and even some wild caught fish. Consider that our ancestors ate nearly an equal ratio of omega-3 and omega-6 fatty acids, whereas today we are eating 20 times (sometimes higher) more of the inflammatory omega-6 fatty acids. We’re eating fewer anti-inflammatory foods and the inflammatory ones we consume (sometimes from not-so-obvious sources like almond milk or factory-raised eggs) can crowd out the healthy ones. Take soybean oil, prevalent in practically every restaurant meal you eat, which can decrease the amounts of the anti-inflammatory fatty acids EPA and DHA. Even if you’re avoiding the usual suspects like sugar and gluten, inflammatory foods can be slipping into your diet. Grain-fed meats, vegetable oils, roasted nuts and seeds (not raw or sprouted) and pretty much any processed food in your grocery store, fuels inflammation. Sugar is also pro-inflammatory. Just one can of soda a day has been shown to increase inflammatory markers in the blood.

  • Consume at least 25 grams of FIBER every day. A fiber-rich diet helps reduce inflammation by supplying naturally occurring anti-inflammatory phytonutrients found in fruits, vegetables and other whole foods. Contrary to what most Americans think, there is NO FIBER in any animal products. To get your fill of fiber, seek out whole grains, fruits and vegetables. These include whole grains such as barley and oatmeal and vegetables like okra, eggplant and onions and a variety of fruits like bananas (3 grams of fiber per banana) and blueberries (3.5 grams of fiber per cup).
  • Eat a minimum of nine servings of FRUITS and VEGETABLES every dayOne “serving” is half a cup of a cooked fruit or vegetable or one cup of a raw leafy vegetable. Add anti-inflammatory herbs and spices such as turmeric and ginger to your cooked fruits and vegetables to increase their antioxidant capacity.
  • Include, or better yet in addition, eat at least four servings of both ALLIUMS and CRUCIFERS every week. Alliums include garlic, scallions, onions and leeks while crucifers refer to vegetables such as broccoli, cabbage, cauliflower, mustard greens and Brussels sprouts.
  • Limit SATURATED FAT. Although some plants contain saturated fat (especially coconut oil), the vast majority of saturated fat in our diet comes from animal products, especially meat and cheese. By keeping saturated fat low (that’s about 20 grams per 2,000 calories), you’ll help reduce the risk of heart disease. If you choose to eat meat, limit it to once per week and marinate it with herbs, spices and tart, unsweetened fruit juices to reduce the toxic compounds formed during cooking like TMAO.
  • Consume foods rich in OMEGA-3 FATTY ACIDS. Omega-3 fatty acids reduce inflammation and may help lower risk of conditions that often have a high inflammatory process at their root such as heart disease, cancer and arthritis. Aim to eat lots of foods high in omega-3 fatty acids like flax meal, walnuts and beans such as navy, kidney and soy. Cold-water seafood such as salmon, oysters, herring, mackerel, trout, sardines and anchovies are high in omega 3s but they get it from the algae they eat, which is a cleaner source. Taking a good-quality omega-3 supplement also helps.
  • Avoid PROCESSED FOODS and REFINED SUGARS. This includes any food that contains high-fructose corn syrup or is high in sodium, which contribute to inflammation throughout the body. Avoid refined sugar and artificial sweeteners altogether. They contribute to increased insulin resistance (the fundamental cause of diabetes), raise uric acid levelsraise blood pressure and increase the risk of fatty liver disease, the most common reason for liver transplants today.
  • Cut out TRANS FATS. In 2006, the FDA required food manufacturers to identify trans fats on nutrition labels. Studies show that people who consume trans fats have higher levels of C-reactive protein, a marker of inflammation in the body. A good rule of thumb is to always read labels and avoid products that contain the words “hydrogenated” or “partially hydrogenated” oils. Vegetable shortenings, margarine, crackers and cookies are just a few examples of foods that contain trans fats.
  • Sweeten meals with phytonutrient-rich fruits and flavor foods with spices. Most fruits and vegetables are loaded with fiber and important phytonutrients. In order to naturally sweeten your meals, try adding apples, apricots, dates, berries and even carrots. For flavoring meals, use spices that are known for their anti-inflammatory properties, including cloves, cinnamon, turmeric, rosemary, ginger, sage, cumin and thyme.


HEAL YOUR GUT. When your gut lining is disturbed, it cannot absorb nutrients optimally and inflammation develops. Eventually problems like leaky gut lead to food sensitivities and even autoimmune disease. A downward spiral occurs as gut inflammation leads to systemic (or full-body) inflammation, creating pain, headaches, and other symptoms that you might never suspect originated in your gut. Healing gut inflammation requires time and patience. The right protocol eliminates food sensitivities, incorporates plenty of anti-inflammatory foods, and includes gut-supporting nutrients like probiotics, and prebiotics.

The vagus nerve is the longest and most complex nerve in the body. Vagus means “wanderer”, and this nerve literally wanders from the brainstem through the heart and lungs all the way down to the gut, collecting information along the way and notifying the brain of any unusual activity. It detects increases in inflammation, shifts in stress hormones and even microscopic changes in the diversity of the microbiota of the gut. Although 80% of the messages from the vagus nerve go from the body to the brain, giving rise to the 6th sense, the other 20% go from the brain to the body to neutralize stress. The amygdala reacts first, inducing fear and launching a stress response.

GET THE RIGHT NUTRIENTS. If you’re not eating an anti-inflammatory diet and incorporating other lifestyle strategies delineated here, taking supplements which lower inflammation won’t help much. But combined with the right diet, some supplements can help. A few good ones include:

  • Curcumin: Turmeric is the yellow-orange East Indian spice, but its active ingredient is curcumin, which provides anti-inflammatory, antioxidant, and gut-healing benefits. Sprinkle organic turmeric powder onto all your food, but to get the full anti-inflammatory benefits, consider a concentrated curcumin supplement. Make sure it contains piperine, the active ingredient in pepper, which increases curcumin absorption by 2000%.
  • Omega 3: The two main anti-inflammatory omega-3 fatty acids, EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), are important anti-inflammatory promoters in the body that are often deficient in the American diet. Studies have shown that omega-3s help reduce inflammation in the gut and elsewhere. Make sure you source the right type. Although you can get these from fish oils, cleaner sources include algae, ground flax seeds and walnuts.
  • Probiotics: Although regular use as a “preventive” measure is not a good idea, these healthy microorganisms can support optimal gut-flora balance if you need to be on an antibiotic or have significant gut issues to begin with. They can also reduce inflammation. It’s always best to source a high-potency probiotic from a reputable company that focuses on gut health. What’s more important to keep your gut healthy are the “prebiotics”, those foods which promote a healthy gut like cruciferous vegetables (broccoli, cauliflower, asparagus and Brussels sprouts). Other prebiotics include onions, garlic and whole grains. A great source of good quality prebiotics is a company called Seed.

AVOID TOXINS. Many of the over 80,000 chemicals we are exposed to daily have not been tested for human safety. They are everywhere: in our furniture as fire retardants, in cosmetics as heavy metals, in our household cleaners as emulsifiers and in our food as preservatives. The FDA has already approved more than 10,000 food additives alone. These toxins create all sorts of problems. They disrupt our hormonal balance, keep our immune system revved up and increase our risk for diseases including cancer and autoimmune disease. Chronic inflammation plays a role in all of these problems. Just like we are all inflamed, we are all toxic. To reduce that toxic load, you’ll want to minimize the toxins you’re exposed to daily that are under your control. That might mean becoming more mindful about what cosmetics you use, what household cleaners you keep around and what skin products you spread on your body, as well as drinking clean, filtered water and eating mostly organic foods. If you choose to eat meat, you must consume clean protein sources like pasture-raised meats. Do not eat any farm-raised fish. You’ll also want to eat plenty of detoxifying foods, including leafy and cruciferous greens, along with spices like turmeric. For more on toxins, click here.

MOVE YOUR BODY. Regular exercise protects against chronic low-grade systemic inflammation present in diseases such as type 2 diabetes and cardiovascular disease. Although exercise is great, constant movement is better. We just sit around too much. Research shows high-intensity interval training, which is fast and effective, can reduce the inflammation that contributes to disease like cancer. Moderate exercise reduces inflammation, but extreme exercise (like marathon training and cross fit training) will increase inflammation so fueling yourself properly is crucial. The important thing is that you do something that challenges your body without abusing its limits.

Exercise is anti-inflammatory and reduces the inflammation that can damage the heart and depress the mood. Exercising muscles release specialized cytokines called myokines. Like regular cytokines , myokines sound an alarm, but their message is less alarming and more precautionary. As soon as you stop exercising, the body sends in an anti-inflammatory cleanup crew to clear away the inflamed mess. This cleanup crew is so thorough that they clear up all the inflammation brought on by exercise and then some. With consistent training, practice makes the cleanup crew more efficient and the body becomes less inflamed.

During midlife, the blood flow to the brain decreases at a rate of about 10% per decade. Lactate, which builds up during vigorous exercise, stimulates the production of more blood vessels in the brain to increase blood flow. Exercising above your lactate threshold, a level where you are starting to feel a little pain and burning, gives your brain the lactate it needs to ward off vascular dementia.

Lactate is a bi-product constantly produced in the body during normal metabolism and exercise. It does not increase in concentration until the rate of lactate production exceeds the rate of lactate removal which is governed by a number of factors. The most important ones are the duration and level of exertion of exercise.  Lactate travels from the exercising muscles to the hippocampus, the part of the brain which among other things is responsible for short term memory production, where it increases brain derived neurotrophic factor (BDNF). This compound acts like a fertilizer for brain cells, helping them grow, but it is reduced in the hippocampus of individuals with Alzheimer’s. With advancing age, the hippocampus shrinks at a rate of 1.5% per year in healthy older adults but 4% per year in Alzheimer’s patients. Exercise counteracts the expected decline and may even reverse it. Older adults who walked only three times per week for a year enjoyed a 2% increase in their hippocampal volume. Even after just 3 months of walking or jogging, older adults whose fitness improved also experienced greater increases in their hippocampal size and blood flow.

There is a lot more on exercise here.

MANAGE YOUR STRESS. Stress is a major and underestimated factor that affects inflammation, even when all other lifestyle behaviors (like diet and exercise) are implemented. Stress increases inflammation, regardless of how good your diet is. It activates the sympathetic “fight-or-flight” response that makes you feel like you’re under attack when you’re not. It leads to elevated blood pressure, palpitations and reduced blood flow to the intestines, resulting in poor digestion and assimilation of nutrients. Although we have become desensitized psychologically to the thought of stress, our bodies have not been desensitized to its impact. Essentially, we’ve ceased to notice what a huge impact stress has on our lives. Start by saying “no” and creating more space in your life for rest and relaxation. Click here for more information on stress management.

SLEEP MORE. Forty percent of Americans get less than the 7 hours of recommended sleep per night, 1 hour less per night than Americans got in 1942. That’s surprising considering modern technology should be making our lives easier, not harder. Among other detrimental effects of sleep deprivation, it also exacerbates inflammation. Multiple mechanisms are at work here. Sleep loss adversely alters the body’s inflammatory markers. Fatigue also makes you more prone to make unwise food choices, fuel up on caffeine, and feel more stressed throughout your day. Keeping inflammation under control requires 7-8 hours of solid, uninterrupted sleep every night.

When we sleep less, we are awake more. There is simply more opportunity to eat . Also, a tired person eats more because their hormones are out of whack. Ghrelin, the appetite-stimulating hormone increases. Whereas leptin decreases , which is needed to suppress appetite.

There is much more on sleep here.

“Body on Fire: How Inflammation Triggers Chronic Illness and the Tools We Have to Fight It”. Dr. Monica Aggarwal. Dr. Aggarwal is a Cardiologist who reversed her debilitating rheumatoid arthritis symptoms.




Insulin is a hormone produced by the beta cells of the pancreas. Although well known to be associated with sugar transport in the body, it also is involved in fat storage and also acts as a growth hormone.

Although most cells need insulin to help glucose transfer from the blood into cells where it is used or stored as energy, some tissues and cells do not need insulin for this to occur. In addition, some cells which normally do need insulin, under certain situations, do not. Glucose transporters are a wide group of membrane proteins that facilitate the transport of glucose across the plasma membrane, a process known as facilitated diffusion, independent of insulin. Because glucose is a vital source of energy for all life, these transporters are present in all phyla. The GLUT (or SLC2A) family of proteins is found in most mammalian cells. 14 GLUTS are encoded by the human genome. Organs or cells which do not need insulin to take up glucose using Glut transporters can be remembered with the pneumonic BRICKLE:

B – Brain
R – Red blood cells (RBCs). These carry oxygen to all of our tissues.
I  – Intestine
C – Cornea
K – Kidney
L – Liver. Under times of excess glucose in the blood, otherwise, Insulin is still needed.
E – Exercising skeletal muscle. Under times of rest, Insulin is still required.

The brain consumes the most circulating glucose, almost 25% of it. The liver tries to protect the other organs from excess glucose but takes up much more of it. Most of it can be stored as glycogen but eventually, at consistently high levels, it gets converted into fatty acids, leading to a fatty liver. Very refined sugars, like those found in sugar sweetened beverages, are quickly absorbed and cause rapid rises in sugar levels in the blood. These beverages, which include fruit juices, are the single greatest contributor to fatty liver and weight gain, of all foods and beverages.

Insulin resistance is the condition where your body starts to become resistant to the effects of insulin. As this progresses, more and more insulin is secreted (hyperinsulinemia). It’s not just a diabetic issue. Insulin resistance is felt to affect upwards of 90% of Americans because of the Standard American Diet in addition to other lifestyle factors like lack of exercise and poor sleeping patterns. Regular blood tests (fasting blood sugar or Hemoglobin A1c) won’t identify IR. Low blood sugar does not mean that your insulin is working. Insulin function starts to become impaired as early as 13 years before even pre-diabetes is clinically evident., Seeing how the body responds to glucose (i.e. a glucose tolerance test) is the true indicator of insulin function. In both types of diabetes, insulin resistance is an important issue. IR is associated with numerous health risks. For one thing, it causes hyperinsulinemia, or high circulating insulin levels, which may be directly damaging to blood vessels. Hyperinsulinemia is also associated with high blood pressure, heart disease and heart failure, obesity (particularly abdominal obesity), osteoporosis (thinning bones), and certain types of cancer, such as colon, breast, and prostate cancer. In contrast, having low circulating insulin levels is associated with greater longevity. Most centenarians without diabetes have low circulating insulin levels.

IR in the brain affects central triggers for Nitric Oxide (NO) production. NO is involved in the active relaxation of blood vessels resulting in lowering blood pressure and making arteries more supple. IR also directly blocks the function of NO Synthase, the enzyme crucial for production of NO.

IR ultimately increases insulin levels which has all kinds of other effects like:

  • Increased Fat storage 
  • Increased estrogen production
  • Stimulation of ovarian theca cells resulting in increased testosterone and androgen production leading tom more hair, weight gain and menstrual irregularity
  • Pancreatic cancer higher with IR

Despite having normal standard blood sugar lab values like fasting blood sugar or even Hemoglobin A1c (an 3 month average of blood sugar) many people still have not just insulin resistance, but even pre-diabetes and even frank diabetes. The numbers are sobering.

22% of the estimated 34 million Americans estimated to have DM don’t even know they have it. 88% of the 84 million Americans estimated to have pre-diabetes don’t know they have it.

By the time someone is diagnosed with even pre-diabetes, the pancreas has already been damaged enough that it’s ability to produce hormones, in particular insulin, is reduced by 60%. That may sound quite dire but if caught early enough, the pancreas can bounce back and recover some function. In addition, even if it does not fully recover, or even remains at its 40% functional capacity, as long as insulin sensitivity is maintained, the residual pancreas will continue to function normally for the rest of your life. Improving your diet and lifestyle is always worth pursuing.

The pancreas starts to produce more insulin than normal as early as 20 years before diabetes is diagnosed. It often produces as much as 500% mor insulin than normal.

IR is fundamentally caused by 2 things:

  1. Consuming too much sugar, primarily in the form of added sugars and highly processed and refined foods. These greatly increase blood sugar levels forcing the pancreas to pump out tremendous amounts of insulin, up to 500% more than baseline. But the more important culprit is fat.
  2. Fat in the diet and in the cells or our organs. It gets first deposited in the liver, followed by the pancreas, and then the muscles and arteries. In each of those organs, it impairs their function. This fat also impacts on how insulin functions as well as on insulin signaling in the cells, particularly the muscle and brain cells, which take up most of the glucose circulating in our bodies.

These are both predominant factors in the Standard American Diet (SAD) and is solely responsible for our obesity and chronic disease epidemic.

Saturated fat and Insulin Resistance (IR)

Although fat in general is the major contributor to IR and ultimately diabetes, it is the saturated fat which is the main culprit. Americans consume 3x more saturated fat than unsaturated fat, so keeping the message simple “limit your fat intake” is the best approach. The reality is that unprocessed/unheated unsaturated fats like the essential Omega 3 and 6 fats are an important part of the diet, but keeping it simple is still effective.  

Just 1 fatty breakfast increases fasting BS by 58% the next day. A study where they gave young, healthy college students a 30% saturated fat breakfast for only 4 mornings raised fasting blood sugar to pre-diabetic levels despite there being only a minimal increase in sugar in the breakfast. In addition, it impaired their memory by 16%. 

Insulin also tells the liver to stop making sugar (gluconeogenesis). But when the liver becomes resistant to Insulin, primarily from a fatty liver or generalized IR, then it does not respond properly to signals and continues to make glucose, even though we have plenty, usually too much, circulating.

Under normal circumstances, when BS levels are low in the blood, the pancreatic alpha cells produce glucagon, a hormone which essentially does the opposite of Insulin. It signals the liver to produce more glucose (increases gluconeogenesis) and tells cells to release its stored glucose and to burn more fat as an energy source, preserving the glucose for the brain. Higher insulin resistance impairs glucagon signaling leading to higher fasting glucagon levels, less early glucagon suppression, and greater late glucagon suppression. All of this translates into impaired, meaning increased and unregulated, liver glucose production.

Toll-like receptor 4 (TRL4) is a cell membrane receptor which binds saturated fat. It triggers an inflammatory cascade leading to a significant rise in cytokines. This leads to increased vascular and heart inflammation raising heart attack and stroke risk as well as increasing brain inflammation leading to dementia and Parkinson’s disease.

Ceramides are a class of fatty acids called lipids. They’re naturally found in skin cells and make up about 50 percent of the outer layer of skin (epidermis). They are complex lipids that play a central role in cell membrane integrity, cellular stress response, inflammatory signaling, and apoptosis. More fat intake leads to more ceramide presence. Ceramides inhibit phosphatidylinositol kinase, inducing skeletal muscle IR.

Insulin receptor number is reduced by saturated fat by 100% (reduced in half). By making cell surfaces stiffer, because they lack the flexibility of mono and polyunsaturated fats, they leave less room for the Insulin receptor. Saturated fat also interferes with signaling between the insulin receptor and the glucose transporter 4 (glut4) molecule which helps to move sugar into cells, even independent of insulin signaling. This impairs muscle cell uptake of sugar.

Free fatty acids also damage the cells which make insulin, the beta cells. There can be as much as a 30-50% reduction in the beta cells in the pancreas. Some of these can be reactivated but the longer they are damaged, the less likely they are to start functioning again.

We normally make a small amount of saturated fatty acids from the sugar we consume. If there is too much sugar which can’t be used or stored as glycogen, some of the leftover fatty acids are turned into palmitic acid, one of the most dangerous saturated fatty acids. This increases IR, especially in the liver, so the liver continues to make sugar, despite there being plenty around.

There is a lot more on this topic below in the sections about diabetes.




Dr. Barnard was the first surgeon to successfully transplant a heart.

Dr. Barnard was the first surgeon to successfully transplant a heart.

Vascular disease, primarily atherosclerotic heart disease, is the by far the #1 killer of Americans. It’s been #1 for over 120 years with the exception of 1918 when Spanish Flu killed more people. Before that, infections, mostly pulmonary ones, killed most people. The first recorded “heart attack” was in 1896. By the Korean war (1950-53), 50% of the soldiers who died, the average age of whom was 19, had heart disease. By 1956, the military encountered a major problem with trying to get military recruits since most of the failed the induction physical. In 2019, 48% of Americans were estimated to have heart disease, and this is a very conservative estimate. 1 in 3 Americans will die of cardiovascular disease. That’s about 800,000 people a year. Globally, cardiovascular disease accounts for 31% of all deaths in developed countries. An interesting statistic is that among firefighters, the most common on-the-job cause of death is not fire-related injuries, its heart attacks! There is a lethal heart attack in the US every second. That’s almost half a million people a year! Almost 75% of them are new and the average age for a new heart attack is 65 years for men and 71 for women. There are about 1.5 million known heart attacks a year in the US and 66% of them are the patients first sign of heart disease. It’s estimated that there are about 3 million “silent” heart attacks. Over 50% of American adults have hypertension and your chances of developing it during your lifetime is more than 80%. it is NOT a condition related to aging. It is a condition related to poor lifestyle choices. 

You are as old as your arteries!

Atherosclerotic disease is not just something which occurs when you are older. It starts early. An MRI study from Australia on babies still in the uterus showed plaque in their heart arteries if their mothers ate a poor diet. Many studies of children who dies of other causes revealed heart disease already beginning. 77% of the soldiers who dies in the Korean War showed significant atherosclerosis and their average age was only 22. A study revealed that 65% of over 700 asymptomatic teens and kids already had measurable, in some cases advanced, heart disease.

Vascular disease includes coronary artery disease (the heart), cerebrovascular disease (the brain – stroke and dementia), peripheral vascular disease (blood flow to and from the extremities), hypertension (high blood pressure) and heart failure. They are all linked by one underlying problem, endothelial dysfunction. The endothelium is the tissue that forms an invisible single layer of cells lining various organs and cavities of the body, especially the blood vessels, heart, and lymphatic vessels. It makes the inside of arteries slick and smooth. The vascular endothelium is a complex, highly specialized and metabolically active organ, which performs a number of essential biological functions. These cells form an important barrier but they also secrete various compounds. Some repel toxins that are damaging like those the residues of smoking and others control vascular tone, through the production of vasoconstrictive compounds which contract blood vessel walls, narrowing blood vessels (for instance, endothelin and thromboxane) and vasodilatory compounds which relax vascular tissue, opening up blood vessels (for example, nitric oxide and prostaglandins). The endothelium helps to maintain blood fluidity and it helps to regulate platelet function by preventing platelets and white blood cells from becoming too sticky and forming clots. It also helps to control inflammation. By the way, dark leafy greens and beets are very high in nitrates which are released when you chew. Normal anaerobic bacteria which reside in the grooves of your tongue convert the nitrate into nitrite. This conversion does not occur if you kill those bacteria with mouthwashes or toothpaste with chemicals. Antimicrobial mouthwashes (with alcohol or chlorhexidine) kill off the bacteria on the tongue which make that first conversion, even after 1-2 days of use. The nitrite then gets converted into nitric oxide by the acids in your stomach (which is why antacids are bad for you). See the next section for mor information about this crucial, and possibly the most crucial, molecule responsible for good vascular health.




When the endothelial cells are damaged, their ability to produce these helpful compounds diminishes and arteries become more inflamed, narrow and stiff. In addition, when the cells are damaged, small breaks occur between them allowing cholesterol to deposit which eventually forms plaques which narrow blood vessels further diminishing blood flow leading to organ damage, heart attacks and strokes. A very early sign of this in men is ERECTILE DYSFUNCTION (ED) since this is all about blood flow. The arteries supplying the penis are much smaller than those supplying the heart so ED shows up first but don’t be fooled, heart diseases is not just the next stage, it is already occurring. There is more about ED below. There are other early indicators of generalized atherosclerosis. They can be subtle and include things like:

  • premature thinning or balding in both men and women.
  • early graying of hair.
  • skin wrinkles

The endothelium is damaged by a variety of factors and conditions, most of which are reversible with lifestyle changes. Some of these include:

  • diabetes, pre-diabetes and insulin resistance.
  • hypertension (which is also caused by endothelial damage creating a continuous loop).
  • a poor diet including all animal products, sugars and processed foods. Fruits and vegetables by the way are protective. 1 fatty meal, even in athletes, impairs arterial function for up to 6 hours.
  • elevated cholesterol and triglycerides.
  • smoking.
  • a sedentary lifestyle and lack of exercise.

The matter is quite simple. As blood flow diminishes and arteries stiffen, the tissues those arteries supply start to suffer. They don’t get the proper amounts of oxygen, nutrients and energy for proper function and they start to malfunction and age faster. This means ALL of our organs.

When an artery to heart muscle is compromised, the heart has to pump harder and harder to get the blood and the oxygen it’s carrying to the tissues and organs. With all that extra workload, over time, the walls of the heart thicken and the muscle weakens. Angina refers to the pain experienced when heart muscle itself is deprived of oxygen. Sometime this pain manifests as shoulder, arm or neck pain because of complex cross-innervation of pain fibers. When blood flow to part of the heart stops, it leads to a heart attack which is where heart muscle dies. As cells die, they rupture releasing enzymes which is what is measured in the emergency room and hospitals. If you can get to the area of narrowing fast enough, something can be put into the artery to open it up. Drugs can do this but so can a stent. Stents have made more money for more doctors, hospitals and manufacturers than any one other medical intervention in history. They do save lives however they do not change long-term health outcomes or mortality rates. They only fix the one spot where the narrowing is the worst, not the underlying generalized vascular disease. Unless you are in the midst of a heart attack or are the 1-2% of the most severe heart disease patients, angioplasty, stents and bypass surgery have been shown NOT to extend life, prevent heart attacks or even significantly improve angina (chest pain). We spend over a $100 billion a year on dangerous ineffective procedures when those diseases can be much more effectively reversed with lifestyle changes. Despite only accounting for 4% of the world’s population, Americans undergo 50% of all angioplasties and bypass surgeries and again, our life expectancy is 42nd in the world!

The first cardiac angiogram was actually done by accident in 1959 by Dr. Mason Jones, a radiologist at the Cleveland Clinic. He was imaging the aorta and at that time, it was thought that imaging the coronary arteries could block them and lead to heart attacks and death. By accident, during an aortic angiogram, the catheter slipped into a coronary artery, the heart vasculature was accidentally imaged and the patient did fine. This rapidly led to the world of cardiac angiogram testing as we now it today. It wasn’t until 1980 the stents were first developed by interventional radiologist Dr. Julio Palmaz in his San Antonio Texas garage. He partnered with cardiologist Richard Shatz and they were actually financed by Phil Romano, the burger king of San Antonio and owner of Fudruckers, a well known burger fast food restaurant. They patented the device, the rights were partially purchased by Johnson and Johnson who marketed, produced and sold the devices and over the years, they all made billions of dollars. Stents very quickly became the standard of care and a real financial boon for many other doctors and institutions as well. A full 25% of the income for the Cleveland Clinic came through angiograms and stents. All that despite the fact that stents have not been shown to have any impact on long term disease or longevity when put in electively. Diet and lifestyle changes have the greatest impact on longevity. In a study done where patients with stable angina (chest pain from heart disease) were either given a stent or told they were but didn’t get one, there was no improvement in symptoms r outcomes in the stent group. In fact, the group that was told they got a stent but didn’t fared better! The history of stents and the resistance of hospitals to adopt less expensive and more accurate tests to assess heart disease is highlighted in the movie “The Widow Maker”. The financial gain from stents is just too tempting.

The Cleveland Clinic, by the way, is also where the first cardiac bypass surgery was reportedly performed successfully in 1969 by Dr. Rene Favalaro.

The first actual successful CABG surgery was performed by Robert Goetz at the Albert Einstein College of Medicine-Bronx Municipal Hospital Center in New York. On May 2, 1960, Goetz led then a team of four surgeons in anastomosing the right internal thoracic artery (RITA) to the RCA of a male New York taxi driver using this device.

Today, nearly 500,000 CABG procedures are performed each year in the U.S., making it one of the nation’s most common major operations.

Overall, complications from heart bypass surgery is ~50%. Not good odds. Failure rate of these procedures is about 25% at 1 year and 50% at 5 years. That is assuming that no changes are made in lifestyle.

Many studies have shown that healthy lifestyle changes, especially changing your diet to a whole food, plant based, low oil, low salt and low added sugar diet, reverses plaque in arteries and restores normal blood flow. No drug does that. The main dietary culprit is fat and cholesterol, found mostly in meat and animal products but also in oils and processed foods. Within minutes of even 1 high fat meal, arterial function is affected by inhibiting nitric oxide production in arterial walls resulting in decreased oxygenation and stiffening of arteries. This is why a significant number of heart attacks occur after meals.

SEXUAL DYSFUNCTION. Erectile Dysfunction (often referred to as ED in television commercials) is almost 100% of the time related to impaired blood flow secondary to vascular disease. It should be considered the first sign of more generalized and concerning vascular disease throughout the body. ED is referred to as the “canary in the coal mine” when it comes to atherosclerotic/heart disease. The arteries supplying the penis are 1/5th the diameter of those supplying the heart and ED precedes clinical heart disease by only 3 years. “ED” mean “erectile dysfunction” to urologists but it means “early death” to cardiologists.  It is estimated that 25% of adult men (over 21 years of age) have ED. It affects 40% of 40 year old’s, 50% of 50 year old’s and 60% at 60. If you have issues with ED, see your doctor or cardiologist ASAP. Even without any clinical evidence of heart disease, if you have ED, there is a 4000% increased risk of heart attack or stroke because of the likelihood of underlying generalized vascular disease. Even in smokers, the risk is only 300-400% greater so don’t ignore ED and think that the little blue pill will fix everything. Even one fatty, animal based meal impairs blood flow leading to 5x fewer erections, 1/4 of erection duration as well as less strong erections. In the same way blood flow impairs penile function, it also contributes to female genital issues such as dryness and diminished vaginal sensitivity. The clitoris has more than 8000 nerve endings and they are damaged by animal rich diets.

Getting an erection is a complex event which is impacted by many things. It’s a:

  1. Vascular (blood flow) event. By far the #1 most important aspect.
  2. Psychological event. You need to be in the mood.
  3. Neurological event. 
  4. Endocrine (hormonal) event.

The single layer of cells which line our arteries, the endothelium, secretes a very important compound nitric oxide (NO2) which relaxes arteries and increases blood flow. Blood fills the venous sinuses (tiny capillaries) in the penis which become engorged when blood flow out is impaired by fibrous tissue which also makes up the penis. The penis enlarges and becomes hard.

ED is the “canary in the coal mine” when it comes to being a risk factor for heart disease.

International Index of Erectile Function (IIEF-%) is a measure of erectile function. Below is a link to a risk calculator for ED.

  1. Organic causes
    1. Blood vessel dysfunction is #1 by far.
    2. Hormonal, like low testosterone (actually pretty rare cause) or thyroid function.
    3. Neurological, as can be seen in diabetes (neuropathy)
  2. Psychological causes
    1. Anxiety
    2. Depression
  3. Drug Side effects
    1. Antidepressants and other psychiatric medicines
    2. Antihistamine medicines
    3. Heartburn medications
    4. High blood pressure medicines and diuretics (water pills)
    5. Parkinson disease medicines
    6. Hormonal medicines
    7. Chemotherapy for cancer
    8. Opiate analgesics (painkillers)
    9. Recreational drugs like alcohol and marihuana
    10. Anti-inflammatories like ibuprofen
    11. Other random medications

Similarly, to heart arterial function, after a meal containing fat, there is measurable increase in ED, even in healthy 20-year-old athletes. Smoking will also impair arterial function. Even smoking one cigarette impairs arterial function within minutes and the effect last for hours. Foods high in nitric oxide include greens (arugula, kale, Swiss chard, spinach…), beets, watermelon (especially the white part of the rind), nuts and grains like oats. As mentioned in the section about oral hygiene, using mouthwashes and harsh toothpaste will kill off the beneficial bacteria that create NO from foods so don’t use them! Green tea has also been shown to improve endothelial function within 30 minutes, lasting for 2 hours. Its beneficial effects are negated however by adding dairy/creamers. A John’s Hopkins study showed that even one meat-based meal given to healthy volunteers induces 4 hours of decreased arterial blood flow by 50% because of diminished arterial muscle wall relaxation. What’s more significant is that the artery that was studied was the brachial artery, one of the largest arteries in the arm. If such a large artery can have such diminished function, imagine what is happening at  the micro-arterial level! Even 1 meal makes a difference. A sausage and egg McMuffin was shown to impair endothelial function for up to 7 hours, maximally being affected at 4 hours.

STROKES AND MINI-STROKES. When blood flow to brain tissue is compromised temporarily, this is called a Transient Ischemic Attack (TIA or “mini-stroke”). Ischemia means “diminished blood flow”. This diminished blood flow results in a decreased supply of nutrients like oxygen and glucose. The brain tissue goes into shock and you develop neurological symptoms like numbness, weakness, a droopy face, speech difficulties… If blood flow can be re-established fast enough, the neurological damage can be reversed. If not, brain tissue dies resulting in a stroke leaving you with all kinds of neurological deficits and problems depending on which part of the brain was affected. A hemorrhagic stroke occurs when there is actual bleeding in the brain which has a long list of damaging effects. Hemorrhagic strokes are also at increased risk because of lifestyle choices. 


  1. EAT BETTER Less animal products and more fruits and vegetables. You can’t reverse heart disease with medications but you CAN with a whole food, plant-based diet. A whole food, plant-based diet lowers risk of stroke by 44%, more than ANY drug. The ONLY diet scientifically proven to reverse heart and vascular disease is a whole foods, plant-based, low salt, low fat and low sugar diet. You CAN reverse heart disease and open up narrowed arteries! Patients waiting for heart surgery, even heart transplants were able to avoid those procedures by changing their diets and lifestyle. A 5-year study showed that a standard diet resulted in a 2.5x greater risk of having a cardiovascular event as compared with a plant-based diet.
  2. MOVE MORE. Never stop moving and exercise daily.
  3. STRESS LESS. Socialize, meditate, sleep…all important
  4. TAKE CARE OF YOUR TEETH. Poor dental and gum care are a major source of inflammation. Floss and brush your teeth regularly but don’t use mouthwashes. They get rid of bacteria that promote production of compounds which help to relax blood vessels.

You are never too early to think about or be affected by vascular disease.

  • One study revealed that 65% of over 700 asymptomatic teens and kids had measurable, in some cases advanced, heart disease.
  • Another study showed that 40% of 6-11 year old’s had elevated cholesterol.
  • 7% of U.S. children and adolescents ages 6 to 19 have high total cholesterol.
  • Autopsy studies of otherwise healthy Viet Nam soldiers who died in the field (most of whom were late teens to early 20’s) revealed a 30% rate of significant atherosclerotic heart disease.
  • 19.2% of adolescent-age boys and 12.6% of girls have pre-hypertension or hypertension, an estimated 38% increase since 1994.
  • There is a 4x greater risk of dying of heart disease if you were overweight or obese as a child.


There are 3 cardiac disease prevention categories:

  1. PRIMORDIAL prevention. Prevent even the early stages of disease. Must be started in early childhood.
  2. PRIMARY prevention. Prevent a major event when one or more risk factors are already present.
  3. SECONDARY prevention. A major event has already occurred and you are trying prevent a second or subsequent event.

Despite some of the statistics about the surprisingly high incidence of heart disease, hypertension, diabetes and obesity in childhood, even very early childhood, very few people are even thinking about this stage of prevention. Even at the secondary stage, our reliance on medications and the false notion that they are protecting us results in very little positive change to reverse disease and eliminate risk. Most people start to deal with things once something bad has already happened.

There has been a lot of press recently about the overuse of aspirin (ASA). Aspirin causes more deaths and complications worldwide than any other drug! Even a baby aspirin (81mg).  In those who take aspirin regularly, 1 in 15 (7%) will have a complications and 1 in 556 will die from one of those complications. That having been said, it can be a lifesaver but there are specific indications based on previous events or existing risk. Which risks and how many risk factors is hotly debated and you and your doctor need to make an informed decision about this. If there is a history of bleeding issues, you should be very careful with aspirin use as this could significantly worsen the problem. If you are over 70, without significant risk factors, you should also be careful. The risk factors for vascular disease are as follows:

Main factors (independent of whether these conditions are controlled with medications or not):

  • Hypertension – #1 risk overall factor for premature death, especially from heart/vascular disease.
  • Smoking
  • Diabetes
  • Cholesterol elevation
  • Having a 1st order relative with who had an early cardiac event (<55 for men and <65 for women)

Secondary factors:

  • Metabolic syndrome. These 5 risk factors increase the likelihood of developing heart disease, diabetes, and stroke:
    • increased blood pressure (greater than 130/85 mmHg)
    • high blood sugar levels (insulin resistance)
    • excess fat around the waist
    • high triglyceride levels
    • low levels of good cholesterol, or HDL
  • Chronic Kidney Disease.
  • Premature menopause in women.
  • Blood marker abnormalities beyond the major known ones:
    • Triglycerides >75
    • CRP >2.0 (indicator of inflammation)
    • Lp(a) >50 (an inherited subtype of lipoprotein)
    • APOb (another genetic marker for increased cardiac risk)

We are learning more and more about the role of the lipoprotein a, Lp(a). This variant LDL particle is present in as many as 25-30% of humans and is an independent risk factor for heart disease, beyond other cholesterol markers. It contributes to plaque formation and also has been implicated in damaging collagen which makes up the walls of blood vessels, causing them to be weaker. Unfortunately, as yet, treatments to lower this LDL particle have not been effective with lifestyle changes alone. Standard statins are not effective. There is a lot more about this molecule in the Cholesterol section below. Also, have a look at this article: COLLAGEN, Lp(a) AND HEART DISEASE

These are some online tools to help you calculate your 10-year risk estimate:

Some people argue that regular aspirin use can lower the risk of colon cancer. Although there are studies that do support this, you get as much, if not greater risk reduction by eliminating the processed foods and animal products from your diet! Eat more fruits and vegetables and you’ll avoid colon cancer without the added risks from the aspirin!

One last though on the heart. It is not just an isolated organ acting as a pump. It is an organ which interacts with other organs, especially the brain. It generates an electromagnetic energy field 60x greater than the brain and a biomagnetic field 5x greater than the brain. It contains 40,000 neurons which make up the “heart brain” and its electromagnetic fields can can be measured 5 feet around our bodies and thus can influence others.


Dr. Caldwell Esselstyn is a Cleveland Clinic physician, lifestyle medicine pioneer and author of the best-selling book  Prevent and Reverse Heart Disease. In one of his clinical studies, in a group of patients who collectively had 48 cardiac events, in those who followed his program, there was not a single cardiac event in the subsequent 12 years. Among these patients was one woman who had 2 heart attacks and was told by her previous cardiologist to “go home and prepare to die”! In a nutshell, below is his take on heart disease and how to reverse an prevent it.

Heart and vascular disease is a food-borne illness. It need never occur and if it occurs, it need not progress. Vascular disease starts with damage to the ENDOTHELIUM which produces NITRIC OXIDE. This crucial gaseous compound will halt and even reverse vascular disease progression and is responsible for:

  1. Keeping the blood vessel walls very lubricated allowing nutrients to flow easily to all your organs and cells.
  2. It’s the strongest blood vessel dilator in the body.
  3. Protects the arterial walls from thickening, stiffening, narrowing and developing plaque.

He has a very strict, proven approach to the diet he recommends to his patients. First of all, he says that “If you want moderate disease, follow moderation in your diet”. He is strict! His protocol works and is one which eliminates the foods which cause endothelial and arterial damage and encourage the ones which lead to repair and reversal of established disease and maintenance of a healthy vasculature.

These foods injure the endothelium and should be eliminated:

  1. OILS. All of them. Even olive oil. Not a drop. Read labels because a lot of processed foods contain oils.
  2. ANIMAL PRODUCTS. Anything with a mother or a face.
  3. DAIRY. Milk, cheese, yogurt, kefir as well as milk components like casein and whey, its main proteins and lactose, its main sugar.
  4. SUGAR. White sugar, cane sugar, agave, honey, stevia…
    1. Drinks. All sugar sweetened beverages, including fruit juices.
    2. Cakes, pies… processed foods.
  5. AVOCADO and NUTS. Although they contain healthier fats, they still contain saturated fat.
  6. CAFFEINE. It adds to palpitations and blood pressure elevation. It also has been shown to affect NO production in your arteries.

Foods which support the endothelium and are strongly encouraged without limit:

  1. GREEN LEAFY VEGETABLES. The best way to consume them is to chew them 5-6x a day after boiling them for ~ 5 minutes, making them a little less bitter and more palatable, and adding some balsamic vinegar, which restores the nitric oxide synthase enzyme contained within the endothelial cell, responsible for making nitric oxide. NO also stimulates the bone marrow to produce more endothelial progenitor cells which replace the old, less efficient ones. Chewing, rather than blending or juicing, releases the nitrate which mix with the bacteria in the grooves of the tongue which converts the nitrate into nitrite. The gastric acid reduces the nitrite into nitric acid. That’s why acid reducers are unhealthy. They impact on digestion and a healthy vasculature since the conversion does not occur in a decreased acidic environment. Examples of greens include:
      1. Dandelion greens. The highest concentration of phytonutrients of all the greens. 10x more than the next one on the list.
      2. Kale
      3. Swiss Chard
      4. Spinach
      5. Beet Greens
      6. Arugula
      7. Bok Choy
      8. Swiss Chard
      9. Collard Greens
      10. Mustard Greens
      11. Turnip Greens
      12. Cauliflower
      13. Brussels Sprouts
      14. Cilantro
      15. Parsley
      16. Asparagus
      17. Cabbage
  2. WHOLE GRAINS. Breads (whole grain and/or sprouted), pasta, whole grains like oats, buckwheat, quinoa …
  4. FRUIT. They are all good. Just no fruit juice. You lose all the fiber and many nutrients in the flesh and skin.
  5. COMPLEX CARBOHYDRATES like potatoes, sweet and white are fine, even for diabetics.

ANTIOXIDANTS from whole food. Foods which have a high ORAC (Oxygen Radical Absorptive Capacity) value: Greens and Berries have the highest.



According to the World Health Organization, there is enough evidence worldwide to categorize processed meats (sausage, bacon, lunch meat…) as a class 1 carcinogen, meaning that it definitely causes cancer. It’s in the same class as tobacco, asbestos and plutonium. Meat in general, red meat specifically, is category 2a, meaning that it probably causes cancer. If that is not enough of a reason to limit your meat consumption, here are a few other reasons:

  1. TMAO. There is a lot more about this toxic substance below (click here) but in a nutshell, this compound is formed by unhealthy bacteria in our gut and causes inflammation, vascular disease and contributes to diabetes. It’s formed from compounds found exclusively in meat. Carnitine in red meat and choline in eggs gets converted into TMA by bacteria in the gut and the TMA gets converted into TMAO in the liver. TMAO is found as an individual compound in fish as well. No conversion needed. The bacteria which make this conversion grow in the gut exclusively in people who eat meat and fish regularly. If you give meat to a plant-based person, because they lack the bacteria which makes TMA, they don’t form TMAO.
  2. RED MEAT ALLERGY. A bite from the Lone Star Tick can cause people to develop an allergy to red meat, including beef and pork. This specific allergy is related to an antibody developed to a carbohydrate called alpha-gal which is found in all mammals except apes, including humans. If you have been bitten by this tick and have developed anti-gal antibodies, when you eat red meat which does contain the gal carbohydrate, you can develop a lethal anaphylactic (allergic) reaction leading to death. In addition, a new virus called the Bourbon Virus has been identified which gets transmitted by the Lone Star tick and can be lethal, independent of the allergic reaction.
  3. RED MEAT ALLERGY AND HEART DISEASE. In addition to the allergic reaction that occurs, the IgE antibody which is formed also causes a massive rise in atherosclerosis, independent of other atherogenic risks like elevated cholesterol, lack of exercise and diabetes.
  4. Neu5Gc ANTIBODIES. N-Glycolylneuraminic acid (Neu5Gc) is a molecule found in most nonhuman mammals, in other words, the meat we eat, both red and white. Humans cannot synthesize Neu5Gc because we lack an enzyme Cytidine monophosphate-N-acetylneuraminic acid hydroxylase (CMAH) that converts Neu5Ac, which we do produce, into Neu5Gc. When we eat meat, we form antibodies to Neu5Gc which cross reacts with proteins in our blood vessels. This autoimmune reaction results in inflammation specifically targeting blood vessel walls and atherosclerosis and heart disease.


The Whole Heart Solution” Joel Kahn, MD


Prevent and Reverse Heart Disease” Caldwell Esselstyn, MD



The Widow Maker”. Movie about the hidden risks of heart disease.

The Transformative Power of Lifestyle Medicine”  TEDex Lecture on YouTube by Dean Ornish, MD

American College of Cardiology Heart Disease Risk Assessment Tool. You will need to know your Blood pressure, total cholesterol, HDL and LDL levels to use this tool. Cardiologist Dr. Steven Lome’s site about heart health.




Nitric Oxide (NO) is a gas molecule, produced by the single layer of cells, endothelial cells, which line all of our arteries. As we age, there is a natural deterioration in the number and function of these cells so dietary sources of nitrates from the foods we eat since NO can also be produced by external compounds also. It’s half life is less than a second but it is a signaling molecule which sets up a cascade of other cellular mechanisms which lead to arterial arterial wall relaxation, improved arterial function and lowered blood pressure.

Healthy nitrates leading to NO production ultimately reduce the amount of O2 the muscles need to work. As a result, you can do more work for longer using the same muscular output or a greater muscular output in the same amount of time when nitrates are consumed, assuming they are actually converted into NO.

Your endothelium is not the only source of NO. In addition to the incredibly rich vasculature of the nose lined with NO producing endothelium, enzymes have been found in the nose and, to a greater degree, the nasal sinuses that produce NO. 25% percent of overall nitric oxide is produced in the nasal passages, and it’s imperative that they are kept moist through nose breathing. As compared to mouth breathing, when we breathe through our nose, nasal resistance increases by approximately 200% and helps in the release of Oxygen, in addition to generating 6x more NO. Breathing through your nose is much cleaner and efficient resulting in as much as 10% more oxygen transfer into our bloodstream. Mouth breathing does not let our bodies take advantage of the sinuses production of Nitric Oxide. Although thought for years to be relatively side-effect free, nasal steroid sprays have actually been shown to reduce NO production. They may help with allergies, but hinder NO production.  Click here for more information about NO and the nose: Nitric Oxide From the Nose

NO does many things important to good health. 

  • As a vasodilator it decreases blood pressure and improves blood flow to the organs 
  • It acts as an arterial lubricant allowing cellular material and nutrients to flow through the arteries better.
  • Anti-inflammatory action in the arteries 
  • Prevents blood clotting and obstructions in the arteries 
  • Immune defense: destruction of viruses and parasitic organisms 
  • Plays a role in cellular respiration 
  • Improves glucose uptake and metabolism, reducing the risks for pre-diabetes and diabetes
  • Enables erectile function 
  • Improve gastric function
  • Improves sleep function
  • Enhances insulin signaling
  • Enhances memory and learning 
  • Improves sleep quality
  • Protects the skin from harmful ionizing radiation 
  • Promotes a healthy digestive tract by regulating the secretion of digestive hormones and enzymes
  • Hormonal effects: influences secretion of hormones from several glands 
  • Regulates bladder function 
  • Acts as a signaling molecule to maintain normal bodily functions 
  • Regulation of binding and release of O2 to and from hemoglobin

Keeping your nose healthy and moist is also critical to NO production. Stay hydrated and manage allergies but try to do so without medications.

  1. NASAL BREATHING. Specialized cells in the sinus lining produce NO, which expands alveoli by relaxing smooth muscle, dilates blood vessels all of which improves oxygenation through the lungs. Breathing through the nose improves oxygenation by 40% and keeps the air we breath in moist. Mouth breathing is much less efficient and leads to 40% more moisture loss, very little NO production and poorer oxygenation.
  2. HUMMING. The vibration produced by humming causes airflow oscillation which then amplifies the release of NO. Studies measure the increase in NO production from humming by 15x. The ideal frequency is 130Hz, which is approximately the vibration produced by a deep male voice, or the 2nd lowest B key on a piano.

Although our nose and sinuses, along with the endothelial lining of our arteries make nitric oxide, we get a lot of it from the food we eat as well. This is more and more important as you age because NO production by the endothelial cells decreases with age. Levels drop off by 50% by 50 years of age and by 78% by the time you are 80. The top sources of nitrates which are then converted into nitric oxide are:

  1. Leafy greens, especially arugula, kale, Swiss chard, beet greens and spinach.
  2. Cruciferous vegetables, especially Brussels sprouts and broccoli.
  3. Beets.
  4. Garlic.
  5. Dark Chocolate.
  6. Citrus Fruits.
  7. Pomegranate.
  8. Nuts and Seeds.
  9. Watermelon.
  10. Red Wine.

This NO production however is conditional. If you use mouthwashes, especially if they contain alcohol, toothpastes with fluoride or acid reducers, for example for reflux), then you do not generate NO. The mouthwashes and fluoride products kill the beneficial bacteria in the mouth responsible for converting nitrites from plants into nitrates. The acid reducers impair the function of the stomach enzyme responsible for then converting the nitrates into nitric oxide. It’s important to chew the greens well, which releases the nitrite. Then, the healthy bacteria in the grooves of your tongue, saliva and around your teeth convert nitrite from these foods into nitrate. In the stomach, the stomach acids activate an enzyme which then converts nitrite into NO. One last tip when eating greens is to use balsamic vinegar, or any other vinegar which contains acetic acid. This has been shown to restore the nitric oxide synthase enzyme contained within the endothelial cells, which is responsible for generating NO. In addition, greens alone have been shown to stimulate the bone marrow to generate new endothelial progenitor cells which then replace the aging and damages endothelial cells in your arteries. GREENS = TRIPLE BONUS!

Insulin resistance, the earliest, often no identifiable precursor to diabetes, also has a significant impact on NO production and function. In early stages of blood sugar dysregulation, also known as insulin resistance (IR), areas in the brain responsible for signaling to produce NO are disrupted. Secondly, IR impacts on the function of NO Synthase, the enzyme in our endothelial cells responsible for NO production. As blood sugar (BS) rises, oxygen’s affinity to HgB increases as well. In addition, sugar binds to NO making it no longer bioavailable. NO is crucial to proper blood flow and O2 delivery since it relaxes blood vessels. NO also reverses autoimmune disease. The endothelium, which makes NO naturally, lines the arteries, capillaries, veins as well as bronchioles and lymph channels.

Although nitrates are found in both animal and plant foods, there is a very big difference. Nitrates from meat and other animal products are converted into carcinogenic nitrosamines when they are cooked whereas the nitrates from plants are converted into NO in the body, assuming that you are not using mouthwashes and fluoride toothpastes, both of which kill beneficial oral bacteria or acid reducers, which deactivate the enzyme responsible for the final conversion of nitrates into NO. For a lot more on NO, look at this document: NITRATES and NITRIC ACID.

It is interesting to think that this simple, common air pollutant, could exert important functions in the body.   In fact, it is the most abundant pollutant which is formed when nitrogen burns in automobile exhaust fumes. NO is totally different from any other known signal molecule and so unstable that it is converted to nitrate and nitrite within 10 seconds. NO was known to be produced in bacteria but this simple molecule was not expected to be important in higher animals such as mammals.

NO is a signal molecule of key importance for the cardiovascular system and it also exerts a series of other functions. We know today that NO acts as a signal molecule in the nervous system, as a weapon against infections, as a regulator of blood pressure and as a gatekeeper of blood flow to different organs. NO is present in most living creatures and made by many different types of cells.

– When NO is produced by the innermost cell layer of the arteries, the endothelium, it rapidly spreads through the cell membranes to the underlying muscle cells. Their contraction is turned off by NO, resulting in a dilatation of the arteries. In this way, NO controls the blood pressure and its distribution. It also prevents the formation of thrombi.

– When NO is formed in nerve cells, it spreads rapidly in all directions, activating all cells in the vicinity. This can modulate many functions, from behavior to gastrointestinal motility.

– When NO is produced in white blood cells (such as macrophages), huge quantities are achieved and become toxic to invading bacteria and parasites.

Heart: As we age, but more importantly as a function of atherosclerosis, the endothelium has a reduced capacity to produce NO. However, NO can be furnished by treatment with nitroglycerin. Large efforts in drug discovery are currently aimed at generating more powerful and selective cardiac drugs based on the new knowledge of NO as a signal molecule.

Infection: When you have an infection, white blood cells (WBCs) increase in number to combat the infection. White blood cells react to bacterial products by releasing enormous amounts of NO that dilate the blood vessels. In mild to moderate infections, the NO they produce beneficial effects by increasing delivery of nutrients as well as infection-neutralizing cells and compounds. However, in very severe infections leading to shock, the opposite can happen.

Shock: Severe bacterial infections can lead to sepsis and circulatory shock. In this situation, NO actually plays a harmful role. Too much vasodilation becomes counterproductive. The blood pressure drops too much and the patient may become unconscious. Too much oxygen may also “feed” the invading pathogen. In this situation, inhibitors of NO synthesis may be useful in intensive care treatment.

Lungs: Intensive care patients can be treated by inhalation of NO gas. This has provided good results and even saved lives. NO gas has been used to reduce dangerously high blood pressure in the lungs of infants. But the dosage is critical since the gas can be toxic at high concentrations. Too much of anything, even oxygen, is not good.

Cancer: White blood cells use NO not only to kill infectious agents such as bacteria, fungi and parasites, but also to defend the host against tumors. Scientists are currently testing whether NO can be used to stop the growth of tumors since this gas can induce programmed cell death, apoptosis.

Impotence: NO can initiate erection of the penis by dilating the blood vessels to the erectile bodies. This knowledge has already led to the development of new drugs against impotence.

Memory and Nerve Function: In addition to direct nerve cell signaling, NO helps stimulate production of myelin, the “insulation” which covers all nerves. It gets broken down in conditions like dementia and Multiple Sclerosis.

Fascia and Connective Tissue. NO is also a fascial inhibitor. By inhibiting facial tension, the muscles are able to relax more also. 

Diagnostic Analyses: Inflammatory diseases can be revealed by analyzing the production of NO from e.g. lungs and intestines. This is used for diagnosing asthma, colitis, and other diseases.

Smell and Taste: NO is important for the olfactory sense and our capacity to recognize different scents. 

Alfred Nobel invented dynamite, a product in which the explosion-prone nitroglycerin is curbed by being absorbed in kieselguhr, a porous soil rich in shells of diatoms, a type of plankton called phytoplankton, the most common of the plankton types.. Diatoms are responsible for over 40 percent of photosynthesis in the world’s oceans, and without them, the ocean would be unable to support the amount of life that it does. When Nobel was taken ill with heart disease, his doctor prescribed nitroglycerin. Nobel refused to take it, knowing that it caused headache and ruling out that it could eliminate chest pain. In a letter, Nobel wrote “It is ironic that I am now ordered by my physician to eat nitroglycerin”. It has been known since last century that the explosive, nitroglycerin, has beneficial effects against chest pain. However, it would take 100 years until it was clarified that nitroglycerin acts by releasing NO gas.

NO  can also be generated from the amino acids Arginine and Citrulline, which are the precursors to NO. Some foods rich in these amino acids include:

  • Pumpkin seeds
  • Soy beans
  • Pine nuts
  • Watermelon
  • Chickpeas
  • Lentils
  • Peanuts
  • Spirulina

Nasal breathing has been linked to significantly improved cardiovascular function since NO is also generated in the nose and sinuses (as much as 25% of it). When we induce slow nasal breathing, 18% more NO is produced in the sinuses, as well as in our endothelial and bronchiole linings.

In addition to the foods high in nitrates, you can also generate NO with a supplement. The amino acid L-Citrulline will boost NO in the body by raising the levels of a different amino acid L-arginine. which is then converted by a completely different pathway into NO.


The most commonly purchased drugs in the US are acid reducers. The strongest class of these are called Proton Pump Inhibitors, or PPIs. Most commonly, they are taken for “reflux” but the irony is that they do nothing to stop reflux (see the section on GERD below). They do reduce acidity but in the long term, this is very damaging. One of the side effects of taking these medications long term is increased risk of heart attacks or strokes, by 30%!. The reason has to do with their impact on the production of NO. PPIs increase asymmetric dimethylarginine (ADMA), a molecule which acts as an inhibitor of nitric oxide synthase (NOS). NOS is crucial for the production of NO which relaxes the smooth muscle in arteries, making them more soft and supple and lowering blood pressure. Elevated plasma ADMA is associated with increased risk for cardiovascular disease, likely due to its attenuation of the vasoprotective effects of endothelial NOS and NO.



  1. NASAL BREATHING. Specialized cells in the sinus lining produce NO, which expands alveoli by relaxing smooth muscle, dilates blood vessels all of which improves oxygenation through the lungs.
  2. HUMMING. The vibration produced by humming causes airflow oscillation which then amplifies the release of NO. Studies measure the increase in NO production from humming by 15x. The ideal frequency is 130Hz, which is approximately the vibration produced by a deep male voice.
  3. EXERCISE. The shear stress on the inside of blood vessels from the increased blood flow during exercise activates the endothelial cells to produce more NO. This occurs by activation of ENOS (endothelial NO synthase, the enzyme which converts the amino acid L. Arginine into NO. The result is increased vasodilation with improved oxygen and nutrient delivery to tissues. With regular exercise, this effect persists even when active exercise is not occurring.
  4. NITRATE RICH FOOD. Beets and spinach are the kings here. Other nitrate rich foods include arugula, celery and plaine old lettuce.The bacteria in the mouth convert the nitrates in foods into nitrite which is then converted into NO in the stomach as a result of acid activation of enzymes. There is a recirculating pathway as well since nitrates concentrate in the saliva when they get absorbed by the gut. The recirculation results in a continuous creation of NO.
  5. PHOTOBIOMODULATION. Called PBM for short, this is the exposure of tissues to the red light (660 nm wavelengths) to tissues. This releases the NO which binds to mitochondria, allowing the mitochondria to function better and increasing the NO pool in the blood.
  6. SUPPLEMENTATION WITH L ARGININE AND CITRULLINE. Citrulline supplements are more effective as they are not taken out of circulation as L Arginine is.
  7. ORAL MICROBIOME HEALTH. As mentioned abpve, a helthy oral microbiome is key to NO production, both from primary productionof NO from the nitrates consumed, but also from thenitrates which recirculate in out saliva.



Also known as “Syndrome X”, “Insulin Resistance Syndrome” and sadly “American Syndrome”, Metabolic Syndrome is a clustering of at least three of the five following medical conditions:

  1. Obesity (which affects 40% of Americans).
    • 40% of people with a NORMAL BMI will actually have metabolic abnormalities and Metabolic Syndrome so being slim is no guarantee.
    • This can be also measured by waist circumference. For men, it should be less than 40 inches. For women, less than 35.
    • Another measure is waist to hip ratio, measured at the belly button and widest part of the hips. >0.85 for women and >0.9 for men suggests central adiposity.
  2. High Blood Pressure (31% overall incidence and 63% over 60 years of age). Anything over 135/80 is now considered elevated.
  3. Diabetes and Pre-diabetes (at least 38%, some estimate significantly higher) of Americans have diabetes or pre-diabetes). These are traditionally measured by fasting blood sugar (should be <100) and a longer, 3 months average blood marker called the Hemoglobin A1C, both of these could still be normal and blood sugar abnormalities may still be present. The gold standard test is an oral glucose tolerance test (OGTT), which measures the body’s response to a potent glucose drink at various time intervals. It measures blood sugar as well as insulin levels.
  4. High Triglycerides (30% incidence in adults, 42% in over 60-year old’s). Anything over 150 is too high.
  5. Low High-Density Lipoprotein (HDL) levels. It should be >40 in men and >50 in women.

But keep in mind that any abnormalities indicate something slowly simmering in your body and should be addressed. Having less than 3 of these findings does not mean you are healthy!

Only 12% of Americans are considered metabolically healthy! That 88% of Americans being metabolically unhealthy. That’s crazy.

Metabolic syndrome is associated with the risk of developing most chronic inflammatory conditions including cardiovascular disease and type 2 diabetes. Among US adults aged 18 years or older, the prevalence of metabolic syndrome rose by more than 35% from 1988 to 2012, increasing from 25% to 34%. The prevalence increases with age (more than a 50% incidence over the age of 65), with racial and ethnic minorities being affected most. Part of the reason that minorities and the poor are affected more has to do with the lack of availability of healthy food and how inexpensive unhealthy, hyper-processed packaged food is.

Metabolic syndrome, insulin resistance and pre-diabetes are closely related to one another and have many overlapping features. The fundamental problem with all these conditions, including diabetes is dysfunction and overproduction of insulin.

The syndrome is thought to be caused by an underlying disorder of energy utilization and storage. Most patients are obese, sedentary, and have a degree of insulin resistance. Although blood sugar values can be normal, insulin resistance can be an underlying problem. The incidence is estimated at upwards of 90% of Americans, primarily because of a poor diet and lack of activity. Stress is also a contributing factor. The most important risk factors are:

  1. Poor Diet, particularly sugar-sweetened beverage consumption, processed food, not enough fruits and vegetables and too much meat and dairy. One study showed that daily diet soda consumption increased the risk of metabolic syndrome by 34%.
  2. Genetics, although as mentioned elsewhere, genetics is more an inheritance of lifestyle habits rather than true genetic predisposition.
  3. Aging, however we are seeing this in younger and younger people, even obese children.
  4. Sedentary Behavior or Low Physical Activity.
  5. Disrupted Sleep.
  6. Mood Disorders and Psychotropic Medication Use.
  7. Alcohol Excess.
  8. Toxic exposures.

This syndrome can be reversed but major lifestyle changes are necessary. You can pay for it now and enjoy a longer, healthier life or pay for it later suffering with chronic illness and premature death.

METABOLIC DYSFUNCTION. As mentioned above, 88% of Americans have some metabolic abnormality. There are 3 phases to this.

  1. Phase 1: Silent, slowly simmering problems not manifesting as any abnormality on routine parameters or symptoms. People just don’t wake up one day with type 2 diabetes. Your pancreas, which produces insulin, is taxed for years, if not decades by poor lifestyle choices until it says “That’s Enough!” and your blood sugars start to rise. As mentioned above, insulin resistance starts up to 13 years before routine lab tests reveal pre-diabetes.
  2. Phase 2: A chronic disease is diagnosed, usually during some routine testing or exams. These include things like type 2 diabetes or hypertension. A medication may be prescribed which manages, but does not address the underlying cause of the disease, which is almost always poor lifestyle choices.
  3. Phase 3: The disease has progressed to a stage where quality of life is affected. For example, if diabetes is allowed to progress, kidney damage might result requiring dialysis. Heart disease may have progressed to the point where you have a heart attack, need surgery or even simply are having trouble moving. Basically, the Sh*&^*t is hitting the fan.


NON-ALCOHOLIC FATTY LIVER DISEASE. Also called NASH, Non Alcoholic Sheato Hepatosis. The most common cause of liver scarring (hepatitis) used to be alcohol, followed by the virus Hepatitis C. These often led to liver failure and the need for a liver transplant, if the patient was healthy enough for that. Today, the #1 disease leading to liver transplant is simply eating and drinking (non alcoholic drinks mind you) yourself into liver failure. The SAD (standard American Diet) is directly responsible for this condition and is often associated with diabetes, the most common disease in the US. Although you would think that, based on the name of the condition, eating too much fat would be the main culprit, it isn’t. It’s sugar. Fat is also significant, but not as much as sugar. Below is the list of the most common culprits when it comes to developing this reversible condition:

  1. Sugar sweetened beverages. We drink so much soda, juice (yes it’s bad) and flavored beverages (even the “0” calorie ones) that separated out from all the other sugar we consume, it is the worst offender.
  2. Added sugars in other forms like salad dressings, condiments, spreads and sauces.
  3. Fried Food. Anything fried is simply unhealthy. In addition to all the aded fat from the oil, cancer-causing compounds are formed in the heating process.
  4. Oils, especially vegetable oils like sunflower and safflower. In addition, tropical oils like coconut and palm are very unhealthy. They contain upwards of 95% saturated fat.
  5. Processed foods. Not just a source of sugar and fat, they contain chemicals which break down the intestinal barrier and lead to gut disruption. This leads to poor digestion and various chronic diseases.
  6. White bread. Although clearly a processed food, Americans eat so much of it that it deserves it ranks high all by itself. Not only is it terrible for NAFLD, but it is one of the highest sources of salt in the American diet contributing significantly to elevated blood pressure.
  7. Animal products. The vast majority of the unhealthy fats we eat, especially saturated fat, come from animal products. In addition, animal products contain NO fiber which is essential for good health.

It IS reversible if scarring (fibrosis) has not yet occurred. But you must eliminate the bad foods and replace them with whole plants. Fruits (not juice), Vegetables, Whole grains, Beans, Nuts and Seeds.



Elevated uric acid (UA) levels have been traditionally associated with gout, a painful inflammation of joints, often involving the feet and toes. It is thought to be caused by precipitation of uric acid crystals in the tissues leading to inflammation. Today we know that uric acid is also associated, and even may be the main contributor, to weight gain and inflammation in the body overall. Levels of UA are highest in humans, of all mammals. This has to do with a genetic mutation which occurred thousands, if not millions of years ago.

Uric acid is a danger signal in the body, preparing it for anticipated food or water scarcity. It leads to increased blood sugar, blood pressure as well as increased fat storage and fat production in the body. This was all good when our ancestors were truly facing famine, but in today’s age of overabundance, it just causes disease. Elevated UA levels lead to inflammation, turns on oxidative stress and damages mitochondria, the powerhouses of all cells. All of these things may be helpful in the very short term to dampen down metabolism since we are facing starvation, but chronically it is very harmful. Most uric acid dissolves in blood and travels to the kidneys and passes out in urine. But if we overwhelm our bodies with food which leads to excessive production of UA, we can’t get rid of it fast enough and it starts to appear outside the blood, in various tissues, including the joints.

Although uric acid levels are traditionally thought as being normal in men under 7 mg/dl and 6 in women, these levels only apply to the risk of developing gout. When it comes to cardio metabolic risks, the levels should be 5.5 or less.

There are 3 consumed compounds which lead to majority of increases in UA levels in humans: 

  • Purines, 
  • Fructose and 
  • Alcohol, especially beer.

Purines are organic compounds found in foods. They are converted into uric acid so overeating these foods can cause excessive build up or UA in the blood. They are found most abundantly in animal products such as fish, seafood and shellfish, including anchovies, sardines, herring, mussels, codfish, scallops, trout and haddock.

Some meats, such as bacon, turkey, veal, venison and organ meats like liver and kidney also contain high concentration of purines. Some plant products also contain purines but to a much lower extent. These include legumes (lentils and black eye peas), spirulina (an algae),  asparagus, cauliflower, spinach, mushrooms, green peas, oatmeal, wheat bran and wheat germ. Although purines are essential to various biological processes, including being integral to DNA and RNA structure and function, too much is detrimental. They are broken down into UA so too much purine in the diet leads to excessive levels of UA.

Fructose is ultimately broken down into UA. This is another reason to avoid added sugars in the diet. More on this below.

Alcohol is a significant source of purines as well. Although it could be listed above with the other high-purine foods, it deserves its own section as a UA producer. The “beer belly” seen in many people is not just a result of all the calories consumed and time spent sitting on a bar stool. The yeast in beer contains high levels of purines which lead to elevated UA levels. This leads to fat storage, fat production as well as glucose dysregulation, significantly contributing to weight gain. It’s also why there is a greater occurrence of gout seen in beer drinkers.

Xanthine oxidase (XO) is the enzyme required to produce uric acid by the breakdown of purine nucleotides. The gout drug allopurinol works by blocking this enzyme, leading to less UA production. Luteolin is a flavonoid found in such plants like celery and green peppers and is known to inhibit XO activity. Another antioxidant which accomplishes this is quercetin. The active dose of these compounds when taken as a supplement is 100 and 500 mg daily respectively. Vitamin C also helps with UA reduction. The mechanism of this is less clear but probably has to do with how the kidney clears UA, with Vitamin C improving that process.

As far as natural sources go, Quercetin is contained in abundance in apples, honey, raspberries, onions, red grapes, cherries, citrus fruits, green leafy vegetables and onions, which contain the highest concentration. Luteolin rich vegetables and fruits include celery, parsley, broccoli, onion leaves, carrots, peppers, cabbages, apple skins, and chrysanthemum flowers. We think of citrus fruits as high in vitamin C, and they are, but there are plenty of others also, including broccoli, Brussels sprouts, and cauliflower, green and red peppers, spinach, cabbage, turnip greens, and other leafy greens, sweet and white potatoes tomatoes and tomato juice and winter squash.

Fructose, particularly artificial fructose, is the biggest culprit however. Fructose differs from other sugars because of its ability to cause intracellular adenosine triphosphate (ATP) depletion and nucleotide turnover and promote the generation of uric acid. Our bodies can’t process fructose the same way it processes glucose. It can’t use it as an energy source until it gets converted into fat by the liver, the only organ which can process fructose.

Our consumption of sugar in general has increased dramatically in the last 100 years. Today, the average American consumes over 55 lbs. of sugar a year. That’s about 17 tsp. (71 grams) a day! Between 1970 and 1990, fructose consumption alone rose by 1000%. Not surprisingly, the UA levels have also gone up from on average 3.5 mg/dl in the 1920 to 6 mg/dl today, below the levels concerning for developing gout, but much higher than the levels at which cardio-metabolic disease is triggered. 72% of total energy (calories) consumed today is in the form of dairy, which is very high in sugars, refined sugars, refined oils, refined grains and alcohol.

What’s worse, in times of perceived threat like dehydration or starvation, or simply chronic stress, our bodies actually make fructose, converting it from glucose, the main source of immediate cellular energy. More fructose leads to more UA further reinforcing the survival mode, leading to fat storage and production. Just having a high glucose level in the blood triggers fructose conversion, leading to even more glucose production by the liver. Evolutionarily, it makes sense since the brain is the biggest glucose user (25% of all the glucose in our system) so if you are under threat, you need your brain working to figure out what to do to survive. When you are dehydrated, sodium levels go up since the blood is more concentrated. The kidney senses this and glucose is converted into fructose, leading to more body fat storage and production. Why would this be? The camel is a perfect example of why this happens. Camels are amazing creatures which can cross vast distances in the desert without any food or water. They are able to accomplish this because of their hump. The hump of a camel does not contain water, as many people believe. It contains fat. When fat is burned by mammals, 2 things are created. CO2 and metabolic water. The CO2 is exhaled and the water contributes to maintaining hydration. The same goes for whales. They have a lot of blubber, partly for energy, but also to provide metabolic water. Hummingbirds’ body weight increases by 40% before their long migratory treks and the majority of that excess weight is fat. It’s also for calories, but primarily for water. Hummingbird feeders typically have sugar water. They love the sugar because it provides the fructose which turns into UA triggering fat production and storage, eventually providing them with energy and water. 

Human’s UA levels are 4-5x higher than other mammals because at some point in our evolution, we lost the enzyme uricase which would lower our uric acid. 

Although we can lower the consumption of foods and beverages which contain higher levels of purines, fructose is the biggest driver of UA formation and subsequent fat production, storage as well as glucose metabolism dysregulation.

Table sugar is 50% fructose and high fructose corn syrup (HFCS), the dirt-cheap sweetener used in most beverages and processed foods, is at least 55% and often higher. In addition, something about how that HFCS is produced makes the fructose even more potent as a metabolic disruptor. Although it may not be listed directly, whenever you see the term “added sweetener” in an ingredient list, it is likely HFCS, or more likely one of its derivatives, which don’t need to be listed specifically.

Watch the salt consumption as well. Higher salt signals the kidney that you are dehydrated and fructose production is turned on. As a result, UA is produced and fat is made and stored, with the idea that we need to make more metabolic water. 

What does a bear do in the early fall in preparation for the winter when it needs to ratchet down its metabolism to survive the winter in hibernation? It consumes massive amounts of fructose, mostly in the form of berries. 

Adenosine triphosphate (ATP) is an organic compound and hydrotrope, a compound which dissolves water soluble compounds,  that provides energy to drive many processes in living cells, such as muscle contraction, nerve impulse propagation, condensate dissolution, and chemical synthesis. ATP energy is broken down, phosphates are removed and we are left with Adenosine monophosphate, AMP, the end currency of our energy utilization. We metabolize AMP primarily via a pathway driven by the enzyme AMP Kinase (AMPK). AMPK signals the body that there is an abundance of food. “The hunting is good” for the bear. Therefore, we don’t need to make or store fat and we don’t need to store sugar. One of the most powerful tools to increase AMPK is exercise. Quercetin does the same thing. AMPK tells the liver not to engage in gluconeogenesis (formation of blood sugar). The most popular diabetes drug metformin does the same thing.

Going back to the bear example, when a bear is preparing to hibernate, it shuts off AMPK because it wants to store body fat and turn down its metabolism. A different pathway is activated calling upon the enzyme AMP deaminase which does the opposite of Amp kinase. Uric acid determines which is active. Elevated uric acid levels shut down AMPK, leading to “hibernation mode” of slowing metabolism and storing fat.

Cognitive decline is also influenced by uric acid. UA elevation causes all of the things known to impact on our brain function including oxidative stress, inflammation as well as insulin resistance. A Japanese study following people for over a decade revealed that those who had a UA level over 7 had an 80% greater risk of becoming demented, a 55% greater risk of developing full blown Alzheimer’s Disease and a 166% increased risk of developing vascular dementia. Simply in the presence of elevated UA, there is a 4x increase of cognitive dysfunction.

In a nutritional nutshell:

  • Fructose. Eliminate it. No added sugars or processed foods. No soda. No fruit juices (they have no fiber). This is far and away the most significant contributor to elevated uric acids. Just avoid them. The fructose from fruits and vegetables are fine.
  • Purines. Found mostly in animal products, keep these to a minimal, if not avoid animal products altogether. Although some plants also contain purines, they also contain fiber which mitigates the effects and plants also come with various nutrients.
  • Limit alcohol, especially beer. Beer is very high in purines. 
  • Exercise more.
  • Take quercetin and chlorella (a very healthful blur-green algae).
  • Tart cherries, in moderation, also lower uric acid levels and are often recommended for gout, no surprise.

For more information about the impact of uric acid on weight, far beyond its contribution to gout, check out Dr. David Perlmutter‘s book “Drop Acid”.





Diabetes is so prevalent in the US and the rest of the world now that the CDC (Center for Disease Control) has officially classified it as a pandemic. 30 million Americans have been diagnosed with either Type 1 or Type 2 diabetes. It is estimated that another 90 million have it but don’t know it. That’s 33% of the country’s population! At night, everyone is diabetic because your pancreas goes to sleep but the liver is very active synthesizing glucose and fatty acids.

The term “Diabetes” is short for the more accurate diagnosis “Diabetes Mellitus”. The name is derived from the Latin translation of “Sweet Urine” which comes from the fact that when blood sugar levels are high, the kidneys filter out extra sugar and urine sugar levels ago up. The first documentation of this disease comes from ancient Egypt when the temple priests, also the traditional physicians, would pour Pharaoh’s urine onto the sand. If the ants were attracted to it, the Pharaoh was suffering from high sugar levels. In Medieval times, physicians would taste patients’ urine to see how sweet it was to make the diagnosis

These three conditions, diabetes, pre-diabetes and insulin resistance, are part of a spectrum of disease that deal primarily with how our bodies manage and store sugar and fat but they have far greater reaching implications on all kinds of aspects of good health. It all starts with Insulin Resistance (IR) which describes how efficiently our insulin, and the processes it triggers, actually work. Insulin, a hormone produced by the pancreas, is released in response to consumption of all of the tree macronutrients, carbohydrate, protein AND fat. Most people are not aware of the protein connection and assume that it is strictly produced in response to sugar in the blood. In fact, when protein is consumed along with sugar, the insulin spike is greater than what would result from the sugar alone. As your insulin becomes more and more inefficient and as the beta cells in your pancreas (the cells which actually make insulin) slowly burn out and/or die off, you start to develop pre-diabetes and eventually diabetes. Unfortunately, most people are not diagnosed with a problem until they have frank diabetes. Obviously identifying pre-diabetes and addressing it is good but starting well before that, with insulin resistance, is even better. When poorly controlled, diabetes can shorten one’s life by 10-20 years whereas if all the cancer in the US were cured today, life expectancy would only rise by 2.8 years! Preventing and treating cancer is important but diabetes is so much more prevalent and impactful on society as a whole.

There are some organs which do not need Insulin for glucose transport. There are cell membrane and cell plasma molecules called GLUT, or SLC2A, transporters. They are family is a protein family that is found in most mammalian cells and there are 14 GLUTS encoded by the human genome. The organs which do not need insulin to take up glucose using Glut transporter can be remembered using the pneumonic BRICKLE:

  • B – brain
  • R – RBCs
  • I – intestine
  • C – cornea
  • K – kidney
  • L – liver, under times of excess glucose in the blood. The liver tries to protect the rest of the organs by taking up excess glucose.
  • E – exercising skeletal muscle. When not actively exercising, muscle cells still need insulin.

As far as skeletal muscle is concerned, it’s independent uptake of glucose helps to lower after-meal blood sugar spikes. Even walking, done within an hour of a meal, will have as much as a 30% lowering effect on blood sugar, with a corresponding lowering of the insulin spike. Even walking 30 minutes before a meal, will impact after meal blood sugar, lowering it by as much as 20%. Muscle runs on glucose and soaks it up from the blood.

Insulin is not only responsible for sugar transport and storage. It also is involved in signaling cells to take up and store fatty acids as well as amino acids. It also signals cells to stop breaking down energy, since there is a surplus to begin with (otherwise it would not be in the bloodstream). 

Insulin also promotes DNA and RNA synthesis and impacts on cell regulation.

As an aside, insulin also upregulates the enzyme aromatase which converts testosterone into estrogen. This is the connection between IR, diabetes, obesity and increased breast cancer risk.

ANY cellular and biologic process is wither directly or indirectly impacted by insulin.

Although mostly used in patients with Type 1 diabetes, insulin is also used in advanced cases of type 2 diabetes. More insulin is NOT good though. If you give 2 patients with diabetes insulin, the patient who gets the insulin has lower blood sugars and you also see less microvascular disease, fewer amputations, less impotence, less kidney disease…. If however, blood sugars come down on the heels of increased doses of insulin, you don’t see improvements in CVS disease. Lowering glucose with insulin does not reduce CVS mortality, clearly the most common cause of death. Insulin is the problem. Insulin is the storage hormone. It ushers sugar into cells and fat into belly fat, if there is extra. Weight loss is very difficult on insulin. Insulin and cortisol are “obesity” hormones. Diabetics MUST get their weight down. Insulin stimulates hunger, weight gain, fluid retention, accelerates atherosclerosis. 

DIABETES. Diabetes rates have been gradually rising for many years and are now at epidemic levels.

  • Worldwide, diabetes related deaths have increased by 60% from 2000 to 2015
  • 38% of all Americans have pre-diabetes.
    • 50% of 40-60-year old’s.
    • 66% of 60-75-year old’s.
    • 75% of those older than 75.
  • 15% or more are known diabetics.
  • 25% of diabetics are not even aware they have the disease. Using continuous glucose monitoring (CGM) devices, studies show that 15% of healthy adults with normal blood work, including Hemoglobin A1C (a 3 months blood sugar average – click here for more) are actually pre-diabetic and 2% have outright diabetes.
  • 50% of adult Americans are predicted to be diabetic or pre-diabetic by 2020, at a cost of $3.35 trillion to treat.
  • In 2017, the healthcare costs to treat diabetes topped $325 billion with n additional $90 in estimated lost work productivity from absenteeism alone. Add to that lost productivity from not being able to do an effective job and the costs go up a lot!
  • Diabetes increases the risk of developing Alzheimer’s Disease by 4 times!
  • 84% of diabetics die of heart disease.
  • Statin drugs, taken for elevated cholesterol, increase the risk of developing diabetes by 71% in women and 41% in men, shown in a recent study of over 150,000 people.
  • Depression is twice as likely in diabetics since insulin resistance impacts on serotonin levels in the brain. Insulin reduces the stress response in the brain and dysregulates emotional responses in the brain. Pathways involved in reward, which involve dopamine, and learning are also affected.
  • Although the most common oral diabetes drugs are generic, Insulin is not and will likely never be because it comes from biologic sources. 3 companies, Eli Lilly, Novo Nordik and Sanofi, have a monopoly on the world insulin market and have been accused of colluding to keep prices high.

There are a few types of Diabetes:

  1. Pre-Diabetes. This should really be thought of as diabetes, just not as advanced. But do not mistake the fact that bad things are not going on simply because we label you as “pre” diabetic. There are plenty of complications developing in pre-diabetics.
  2. Type 1 Diabetes. In this form, your pancreas does not make any insulin, the hormone responsible for controlling sugar transport and storage in the cells. Insulin does a lot more than that but sugar regulation is it’s most important role. We think the pancreas stops producing insulin as a result of an autoimmune reaction causing the body to attack it’s own tissue destroying the beta cells which are responsible for producing insulin. Without insulin, you die very quickly so patients with this condition must inject insulin multiple times a day. This disease used to be primarily called Juvenile Diabetes since it usually started in children or adolescents but the incidence of this disease occurring in adulthood is rising. We have known since the 1970’s that there is a significant association between dairy consumption and developing diabetes.
  3. Type 2 Diabetes. By far the most common form of diabetes, it used to be called Adult Onset Diabetes but the incidence in kids is growing at an alarming rate because it is essentially a lifestyle disease. Poor diet, lack of exercise, chemical exposures… all contribute to the insulin produced by the pancreas to not work well, a condition known as Insulin Resistance. IR is thought to develop many years before the diagnosis of diabetes is made because of how well our bodies compensate for our poo lifestyle but eventually the body says “ENOUGH”. It can be divided into insulin-dependent and non-insulin dependent. In a nutshell, as the diabetes progresses, eventually the pancreas can’t keep up with the terrible diet and it poops out leading to insulin dependence. This is almost a 100% reversible disease!!!
  4. Type 1.5 Diabetes. A more recently defined classification, it is a mixture of Type 1 and Type 2. Like in Type 2, there is early insulin resistance and like in Type 1, eventually the pancreas stops producing insulin completely leading to insulin dependence to live. It is thought to also be an autoimmune condition but the exact trigger/cause is not known. It is also known as LADA, Latent Autoimmune Diabetes of Adulthood. Most of these patients don’t look like typical adult diabetics since they are usually thin. By the way, this is the form of diabetes that I have!
  5. Gestational Diabetes. This is a form of diabetes which occurs during pregnancy. Also on the rise (doubling in it’s incidence in the last 10 years and now occurring in almost 10% of pregnancies), it is also felt to be related to insulin resistance. These women have a 5-7x greater risk of developing diabetes later in life. There is more about this below.
  6. There are other forms of diabetes such as those cause by taking steroids chronically or having your pancreas removed but these are relatively uncommon.

Diabetes is not a disease of “too much sugar in the blood”. Too much sugar in the blood is the result of the disease which fundamentally has to do with the body’s inability to transport sugar from the blood into the cells where it is used as energy or stored as fuel for future energy expenditure. Glucose (sugar) is the body’s principal energy source and is used by every organ, including the brain which only represents 2% of body weight but uses 20% of the calories we consume. As far as sugar in the blood is concerned, 85% of normal amounts of sugar in the blood gets taken up by muscle where it is used and stored as energy, which is why is is extremely important to maintain muscle mass as we age. We are capable of using fat as an energy source but this is supposed to occur when all the sugar in the body has been depleted and/or under times of stress. The molecule responsible for transporting sugar into the cells is INSULIN, a hormone made by the Beta cells of the pancreas. Insulin acts like a key which attaches to a receptor on the surface of cells which then set up a series of chain reactions resulting in the opening of a door (channel) for the sugar to enter the cell. When insulin is not made at all (type 1 or autoimmune diabetes) or the insulin is not working well (type 2 diabetes, and also type 1), the result is higher and higher levels of sugar in the blood. Too much sugar in the blood is toxic to tissues (just like too much oxygen). The higher the sugar level in your blood, the more insulin you need to transport the sugar into the cells. The faster the rise in sugar, as you see when you consume sugary or refined foods, the faster and higher the insulin spike. Type 2 diabetics, who generally eat a lot of refined, processed foods, produce 2-10x more insulin than the average healthy person. this is in part because of the amount of sugar they are consuming but also partly because their insulin isn’t working well. They are insulin resistant.

That insulin demand on the pancreas eventually results in the pancreas wearing out and that’s why type 2 diabetics eventually need to inject insulin like type 1 diabetics do. In both types of diabetes, how efficiently insulin works is a factor. In both types of diabetes, if insulin is not working well (known as INSULIN RESISTANCE or IR), you need more and more insulin to get the job done and elevated insulin levels has all kinds of secondary effects on the body which are not healthy. Insulin stimulates more fat storage, usually in organs not meant to store fat like the liver and muscles. Higher than normal insulin levels also stimulate angiogenesis (growth of new blood vessels), cellular growth and can promote growth and stimulation of cancer cells. But insulin also has other functions. One of them is sending signals to our fat cells. Insulin tells the fat cells to pick up fat from the bloodstream, store it and to avoid burning the fat that they already carry. This is partly why diabetics are at greater risk of getting cancer and having more aggressive cancer. The insulin essentially feeds the cancer cells as does elevated blood sugar levels. Fiber, however has a stabilizing effect on blood sugar leading to less insulin secretion. Higher insulin levels are associated with higher cancer rates and higher central adiposity (fat) because it assists in the growth of fat cells and stimulates blood vessels to grow into the fat. Fat is metabolically active producing estrogen and inflammatory mediators which increase arterial disease (heart and peripheral vascular disease) and increase rates of dementia.

By the time someone is diagnosed with even pre-diabetes, the pancreas has already been damaged enough that it’s ability to produce hormones, in particular insulin, is reduced by 60%. That may sound quite dire but if caught early enough, the pancreas can bounce back and recover some function. In addition, even if it does not fully recover, or even remains at its 40% functional capacity, as long as insulin sensitivity is maintained, the residual pancreas will continue to function normally for the rest of your life. Improving your diet and lifestyle is always worth pursuing.

Glucagon is a peptide hormone, produced by alpha cells of the pancreas. It works to raise the concentration of glucose and fatty acids in the bloodstream, and is considered to be the main catabolic (body building) hormone of the body. It is also used as a medication to treat a number of health conditions. One of the ways it increases blood sugar is by stimulating the liver to make more sugar, a process called gluconeogenesis. Some of the medications used to treat diabetes target this hormone.

In addition to Insulin which some people must inject, there are many drugs on the market to “treat” diabetes. Some decrease our bodies ability to absorb sugar (how about just not eating as much refined sugars in the first place). Some decrease the livers ability to produce sugar. Some force the pancreas to produce more insulin (again, if you put less pressure on the pancreas by eating better, you wouldn’t have diabetes). All the drugs have side effects of one kind or another. Click here for a full list and description of the various drugs available to treat diabetes: DIABETES MEDICATIONS

Most people think that if diabetes is associated with elevated blood sugars, diabetics simply need to consume less sugar. This idea is further reinforced by the typical diet recommended to diabetics by doctors and nutritionists: cut back on carbohydrates (foods containing sugar like processed foods, sweets but also grains, starchy vegetables, fruit…) and increase protein and fat. By definition, a low carbohydrate diet is a high fat and protein diet (often promoted as a diet where you consume more meat and dairy). Although this approach will lower how much sugar you consume and your blood sugar values will improve, this does nothing to the fundamental problem of insulin resistance. In fact, it worsens it significantly. Insulin resistance is caused quite simply by:

  1. FAT, both consumed and stored in cells, which causes insulin and its receptor on the surface of cells, not to work
  2. EXCESSIVE INSULIN LEVELS, usually produced in response to blood sugar spikes most often caused by eating unhealthy sugars like processed foods.

Plenty of studies show that insulin sensitivity improves on a high, healthy carbohydrate diet (lots of fruit and vegetables) assuming that fat consumption (added oils and even excess healthy fats from healthy foods like nuts, seeds and avocados) is kept to a minimum. In addition, studies of patients consuming a low carbohydrate, high protein and fat diet do have improvements in their blood sugar values but when they are challenged, they can’t handle even a small amount of carbohydrate indicating that their insulin sensitivity is not good.

Studies going back as far as 1923 have linked dietary fat, NOT sugar, to causing diabetes! Click here for a historical review of the studies: DIET AND DIABETES STUDIES. Other studies dating back decades have linked the development of type 1 diabetes to cow’s milk/dairy consumption in early childhood. For more on the dairy/diabetes link, click here.

Despite 80% of their calories coming from sweet potatoes, the Okinowans (at least those still eating a traditional diet) have one of the longest lived and healthiest populations on the planet. But not only are they living longer, they are living healthier with one of the lowest rates of chronic diseases including on of the lowest Diabetes rate. Their fat and animal product consumption is extremely low representing less than 10% of their calories consumed. This proportion is typical of the “Blue Zones” populations. Another example of this were the pre-potato famine Irish population. In 1900, a typical Irishman consumed almost 4000 calories a day from white potatoes! Despite that, the death rate from diabetes or its complications was less than 2 per million people. Again, meat consumption was a rarity and delicacy. Carbs are clearly not the problem.

There are many medications available to treat diabetes. In patients who do not make any insulin or whose type 2 diabetes is extremely advanced, they have to inject insulin multiple times a day. Without it, they would die. For type 2 diabetes, medications improve how insulin works, how much insulin we secrete, how we absorb or metabolize sugar and how much sugar our livers produce (which normally occurs continuously). Although medications can help improve your blood sugar values, with the exception of insulin which is life-saving, all the other medications have not been shown to extend life or prevent complications, the most common of which are cardiovascular. They do not address WHY you have diabetes. Fix the WHY and you don’t need the medications. This graph shows how much better improvements in lifestyle work than medications. Metformin, the most commonly prescribed diabetes medication, is better than a placebo (ironically known as a “sugar” pill) but lifestyle changes are still the best.

For more information about diabetes medications, both traditional and natural supplements, click here: DIABETES MEDICATIONS

GESTATIONAL DIABETES. This is a form of diabetes which occurs during pregnancy, usually appearing in the middle of the pregnancy. It likely is a result of pre-existing Insulin Resistance since there is a 5-7x (500-700%) increased risk of developing Type 2 Diabetes later in life. The rate of gestational diabetes doubled from 2006 to 2016 and occurs in almost 10% of pregnancies. It is often associated with a poor diet and, just like with all other forms of diabetes, and, just like all other forms of diabetes, a low fat, plant-based diet helps to manage or even reverse it. Unfortunately, oral medications commonly used to treat Type 2 Diabetes are not allowed in pregnancy because they can harm the developing fetus, many cases need to be treated with insulin if the blood sugar is not controlled with diet and lifestyle changes. Although pregnant women do need to eat more, they are not really “eating for 2” as is commonly said. They are at best eating for 1 and 1/2. Protein requirements go up at most by 25 grams a day and only in the 2nd and 3rd trimesters. This can easily be achieved on a plant based diet with the addition of some nuts, seeds or beans. Any more impacts on the health of both the mother and baby. Protein, particularly animal protein, causes release of insulin, independent of carbohydrate (sugar) consumption. For example, beef can raise insulin levels as much as brown rice. High insulin levels are dangerous. Risks of elevated blood sugars include:

  • Extra large baby, leading to increased risks during delivery including possibly needing a cesarean delivery.
  • The baby is at increased risk of developing diabetes.
  • Preeclampsia (hypertension). If left uncontrolled, this is both unhealthy for the mother and baby.
  • Hypoglycemia (low blood sugar). This can be fatal if not identified properly.

INSULIN RESISTANCE (IR) It’s not just a diabetic issue. Insulin resistance is felt to affect upwards of 90% of Americans because of the Standard American Diet in addition to other lifestyle factors like lack of exercise and poor sleeping patterns. Regular blood tests (fasting blood sugar or Hemoglobin A1c) won’t identify IR. Low blood sugar does not mean that your insulin is working. Seeing how the body responds to glucose (i.e. a glucose tolerance test) is the true indicator of insulin function. In both types of diabetes, insulin resistance is an important issue. IR is associated with numerous health risks. For one thing, it causes hyperinsulinemia, or high circulating insulin levels, which may be directly damaging to blood vessels. Hyperinsulinemia is also associated with high blood pressure, heart disease and heart failure, obesity (particularly abdominal obesity), osteoporosis (thinning bones), and certain types of cancer, such as colon, breast, and prostate cancer. In contrast, having low circulating insulin levels is associated with greater longevity. Most centenarians without diabetes have low circulating insulin levels.

As you become more and more insulin resistant, there is more pressure on the pancreas to produce more and more insulin. It pumps out as much as 500% more insulin before it starts to poop out and blood sugar levels rise. In the mean time however, high levels of insulin cause all kinds of other problems.

Insulin is not just a hormone which deals with sugar transport in our cells. It is also involved in fatty tissue and even protein transport. Abnormally elevated levels however are not good. When insulin is not functioning well, tissues become glycated (sugar becomes attached to the surface). When red blood cells (RBCs) become glycated,  the Hemoglobin A1C level (proportion of glycated cells) increases. The Hemoglobin A1C gives a rough estimate of the blood sugar level during the previous 2-3 months. The same glycation process occurs in other tissues including your LDL cholesterol. Alone, it’s bad, but when glycated, it increases plaque production even more.  Insulin is also a growth hormone which increases the activities of such cells as macrophages and it puts nutrients inside of cells. Some bodybuilders actually foolishly inject themselves with insulin as a muscle cell growth stimulant. It also stimulates the growth of cancer cells.

Elevated insulin levels also decrease levels of Sex Hormone Binding Globulin (SHBG) which binds hormones in the blood. Estrogen in particular is affected by this and elevated estrogen levels contribute to various hormone-related cancers like breast and prostate.

Type 3 Diabetes. It is well known that diabetics and even pre-diabetics have a significantly greater risk for dementia. Insulin plays many roles in the brain. First, it is what ushers glucose into cells and the brain, despite only representing 2% of the body’s weight, uses 25% of the glucose. When insulin doesn’t work, it can’t use glucose for energy efficiently. Elevated blood sugar levels also cause microvascular damage. Insulin however, also has other roles in the brain. It is important in neuronal signaling and messaging. It impacts on gene expression. It also is important in neuronal growth.

Low grade inflammation, whether targeting the pancreas directly or if generalized (for example from arthritis), contributes to the amyloid precursor amylin depositing in the pancreatic cells as a reaction to the inflammation. The more of the amylin builds up, the worse the pancreas functions. Type 2 diabetes can be referred to as “Alzheimer’s of the pancreas” in the same way that Alzheimer’s Disease has been also referred to as Type 3 diabetes.

The compound Insulin Degrading Enzyme (IDE) helps to lower insulin levels which increase as a response to high levels of sugar in the blood. IDE prevents excessive levels of insulin from developing which can lead to hypoglycemia, a much more dangerous situation than hyperglycemia. IDE also degrades the amyloid which builds up in the brain, preventing dementia. In a nutshell, the higher the levels of sugar in the blood, the more insulin is produced and released by the pancreas and the more IDE is used up to degrade the insulin. The more IDE is needed in the rest of the body, the less is available to degrade the amyloid in the pancreas as well as in the brain. More sugar leads to more diabetes and more dementia.

Although many people have IR and have no symptoms, there are a few subtle physical signs which can give clues to it’s presence:

  1. Skin Tags. It’s not clear why they form but it is seen often in overweight people with IR.
  2. Acanthosis Nigrans. This is a skin condition characterized by areas of dark, velvety discoloration in body folds and creases. The affected skin can become thickened. Most often, acanthosis nigricans affects your armpits, groin and neck. As with tags, the exact etiology id not known but similarly to tag, it tends to occur in overweight people with IR.

Insulin Resistance is caused by 4 things:

  1. Too much processed sugars forces the pancreas to overproduce insulin, a state known as hyperinsulinemia. With rapid rise in sugar comes a rapid rise in insulin. The cells, primarily in muscle and the liver, protect themselves from this “insulin overload” by decreasing the number of insulin receptor cells. The receptors for insulin just stop working because of constant exposure to insulin. They also become internalized as a protective mechanism.
  2. Excess fat both in the diet, especially in the form of saturated fat, impacts greatly on how the liver function leading to, in part, excessive production of sugar (gluconeogenesis) and also production of new triglyceride/fat molecules (liponeogenesis).
    • From the INSIDE. When saturated fat enters the cell, it gives rise to diacylglycerols and ceramins which then affect the insulin signaling pathway affecting the effectiveness of the insulin receptor.
    • From the OUTSIDE. Caveolin is a protein that is essential to the formation of cavelike membrane structures called caveolae. Typically, caveolae are surface plasma-membrane invaginations or flask-shaped structures and cavins are deep structural shapes which house the insulin receptors. They are altered by cholesterol making the receptor non-functional. Insulin can’t bind.
  3. Excess fat is stored in the body. The fat in cells, especially muscle cells (intramyoepithelial fat) affects how the insulin receptors work and actually lead to fewer receptors being available. Saturated fat in particular incorporates into cell walls, making them much more rigid. This stiffness causes the embedded insulin receptor not to work.
  4. People who follow a ketogenic/low carbohydrate diet develop a temporary form of IR (assuming they don’t also have diabetes or pre-diabetes). This occurs because they consume very little carbohydrates. As a result, their cellular and mitochondrial energy use pathways are shifted to using fat as a fuel source. This also preserves whatever glucose is in their blood for use by cells like red blood cells which cannot use fat as an energy source. It takes about 3 days after reintroducing carbohydrates for their cells to recover their sugar-metabolism pathways.

Fat is like glue clogging up the lock which insulin, the key, fits into allowing the sugar to enter the cells. Fat also impacts on the fluidity of cell membranes, also affecting the insulin receptor. The less fat in your body and diet, the more efficiently your insulin works. Even one fatty meal impacts on insulin sensitivity within an hour and it can last for up to 3 days! On the flip side, only one 24-hour fast, letting the pancreas rest and produce very little insulin, improves insulin function which last for days as well. Insulin sensitivity is also diminished by high levels of insulin which occurs when you consume refined carbohydrates like sugar and processed foods. The more refined the carbohydrate, the quicker the absorption, the greater and higher the sugar spike in the blood resulting in a greater the insulin spike. The more complex the carbohydrate, the slower the absorption and the slower the insulin secretion. Eating processed foods and lack of exercise also decrease insulin sensitivity. Remember that insulin is also secreted when protein is consumed so excessive amounts of protein, especially if consumed along with sugars raises insulin levels. The more plant-based your diet is, the better your insulin works and the less likely you are to develop diabetes. If you have type 1 diabetes and need insulin, your requirements for insulin are much lower on a plant-based diet. Consuming animal products (meat, fish, dairy and eggs) is linked to developing diabetes and poorer insulin regulation in type 1 diabetics. Insulin resistance also contributes to weight gain, heart disease, cancer, hormonal disruption and many other diseases, even if you don’t have diabetes! Just because your blood-work is good doesn’t mean your insulin is working well.

Saturated fat, in addition to being toxic to arterial walls contributing to atherosclerosis, is also directly toxic to the pancreatic islet cells. Hormones produced in the pancreatic islets are secreted directly into the blood flow by (at least) five types of cells. In rat islets, endocrine cell types are distributed as follows:

  • Alpha cells (20% of total islet cells) producing glucagon. Glucagon is responsible for raising the concentration of glucose and fatty acids in the bloodstream.
  • Beta cells (70%) producing insulin, responsible for sugar and fat transport and storage, and amylin which plays a role in blood sugar regulation by slowing gastric emptying and promoting satiety (the feeling of fullness)
  • Delta cells (<10%) producing somatostatin. Also known as growth hormone-inhibiting hormone (GHIH), somatostatin has many hormonal functions including inhibiting insulin and glucagon secretion.
  • Epsilon cells (<1%) producing ghrelin. Produced by enteroendocrine cells of the gastrointestinal tract, especially the stomach, ghrelin is often called a “hunger hormone” because it increases food intake.
  • Gamma cells (<5%). Also called PP cells or F cells, they produce pancreatic polypeptide which regulates other pancreatic hormone secretion, and also impacts liver glycogen storage and gastrointestinal secretion.

Studies have shown that, as compared with low fat meals (4 grams of total fat), high fat meals (containing 44 grams) lead to 33% increased insulin needs in type 1 diabetics. Another study showed that adding animal protein to a meal resulted in a 65% increase in insulin requirements. The increase was seen in both low fat meals but was seen to the greatest degree in the higher fat group. Both groups were matched with respect to their carbohydrate (sugar) intake.

Fats impact on insulin function in 4 ways:

  1. Impaired insulin receptor function.
  2. Reduced number of insulin receptors.
  3. Reduced numbers of glucose transporters getting to the cell surface.
  4. More inflammation at the level of the mitochondria, the powerhouse of the cell.

In addition to leading to diabetes, Insulin Resistance causes:

  • Dementia. Insulin helps with the processes that cleans the amyloid which develops naturally in various tissues including the brain. A small amount of amyloid can get eliminated by the body but too much leads to dementia. 
  • Obesity.
  • Increased levels of VLDL, one of the bad cholesterol markers.
  • Raised blood pressure partly by elevated insulin levels casing depletion of nitric oxide, which relaxes arteries.
  • Inflammation, by increasing secretion of inflammatory molecules called cytokines from immune cells.
  • Salt retention.
  • Increased breast cancer risk.
  • Raised testosterone levels in women contributing to Polycystic Ovarian Syndrome (PCOS).
  • Cancer cells have insulin receptors which are slightly different than normal receptors. In fact, cancer cells have more insulin receptors than normal cells. These receptors are more sensitive to insulin than normal receptors and even a small amount of insulin will cause rapid proliferation of cancer cells.

Other lifestyle issues can also contribute to IR include:

  • Chronic stress which results in continuous production of cortisol which raises blood sugar levels, leading to overproduction if insulin and IR.
  • Sleep deprivation also contributes. Only one night of sleep deprivation can have as much of an effect on insulin resistance as 6 months of eating junk food.
  • Aging can lead to decreased muscle mass which can also contribute to IR.
  • Low vitamin D levels.
  • Intestinal bacterial imbalances (microbiome).

This is a great YouTube lecture about how to reverse Insulin Resistance. Insulin Resistance Diet

How to improve insulin sensitivity?

Many things will increase insulin sensitivity, and most can be accomplished through lifestyle changes. Here are some insulin sensitizers to consider:

  • Consume as much of a low fat, whole foods, plant-based diet as possible. Consume as little animal products as possible. Eliminate dairy, minimize meat, eggs and fish.
  • Regular aerobic and resistance exercise. This is one of the most impactful lifestyle issues to help with insulin sensitivity. Just one session of weight training can improve insulin sensitivity for 2-3 days!
  • Increase in muscle mass, primarily by lifting weights. Lifting weights also stimulates transport of sugar into the cells, independent of insulin. This phenomenon is called “Exercise Induced Glut-4 Translocation”. Glut-4 is one of the molecules responsible for glucose transport. It is site specific which means that if you exercise your biceps, the bicep muscle cells have increased glucose transport. So, a whole body workout really increases glucose transport all over the body, leading to less insulin requirements and less pressure on the pancreas.
  • Loss of body fat, particularly intra-abdominal (or visceral) fat, extra fat stored in the liver, and excess fat in muscles. This is best achieved by limiting or eliminating animal products from your diet.
  • Improved blood glucose control and avoidance of highs and lows.
  • Reduced levels of circulating fats in blood, including triglycerides and free fatty acids
  • Reduction in low-level, systemic inflammation, which can be accomplished through physical activity and eating foods rich in antioxidants, such as darkly colored fruits and vegetables.
  • More effective action of leptin, a hormone released by fat cells, causing reduced food intake. This can be accomplished through increased physical activity and loss of excess body fat. If you are concerned about whether or not you may have insulin resistance, check out this document: Insulin Resistance Checklist

LATENT AUTOIMMUNE DIABETES OF ADULTHOOD (LADA). Also known as T1.5 Diabetes, this form of autoimmune diabetes starts after 30 with fewer antibodies and slower progression. Many patients thought to have type 2 diabetes actually have LADA, as many as 10%.

Latent Autoimmune Diabetes of Adulthood (LADA), AKA Type 1.5 diabetes, is a rapidly increasing and more frequently identified problem. It is increasing in frequency partly because previously misdiagnosed Type 2 diabetics, as many as 10%, are now being re-diagnosed with it as we are discovering that they also have autoantibodies, not typical for T2D. Secondly, all autoimmune conditions are on the rise. The exact cause is not clear but some of the possibilities include exposure to toxins (and we have an endless supply of toxic sources including our foods, hygiene products and even the air we breathe in our homes…), viral or other pathogen infections and genetics.

LADA is diagnosed in part based on presentation, usually occurring in middle age, but also through basic blood work. Sometimes the blood work suggests Type 2, but it’s more accurately diagnosed with blood tests looking for various autoantibodies as well as assessing levels of the pancreatic molecule C Peptide. Only 1 autoantibody needs to be positive to be able to make the diagnosis. The 5 antibodies tested are:

  • Glutamic Acid Decarboxylase Antibody (GADA or Anti-GAD)
  • Insulinoma-Associated Autoantibody (IA2)
  • Islet Cell Cytoplasmic Autoantibody (ICA)
  • Insulin Autoantibody (IAA)
  • Zinc Transporter 8 (ZnT8AB)

Although Type 1 and Type 1.5 diabetes are both autoimmune and result in the destruction of the pancreatic beta cells which make insulin, the rate of destruction of those cells is very fast with Type 1 and much slower with Type 1.5. The absolute need for insulin in someone diagnosed with Type 1.5 is on average 3-5 years after diagnosis.

There are 2 goals in managing Type 1.5 diabetes.

  1. Get your blood sugar under control with appropriate lifestyle changes and if needed, medications.
  2. Protect the remaining Beta cells. 

The two are intertwined since there is less stress on the beta cells if your blood sugar is better controlled and medications can improve blood sugar control, thus preserving beta cell function for longer.

Some patients are started on insulin very quickly, despite still being able to make insulin. It all depends on how much insulin the pancreas can still make. Insulin can be measured directly, both fasting and in response to a sugar challenge however its half life in the blood is only 3-5 minutes. It degrades quickly. Another important compound to measure is C Peptide which is secreted in equal amounts to insulin but it has a much longer half life, as long as 30 minutes.

Before insulin becomes active, it has to be separated from its precursor molecule, proinsulin. This is made up of alpha and beta units, connected by a C peptide molecule. Proinsulin is converted to active insulin by two reactions, cleavage by the prohormone convertases PC2 and PC3, and removal of basic residues by carboxypeptidase H. These reactions are performed in the secretory granules of pancreatic beta cells.

As mentioned above, insulin is degraded much faster in the blood than C peptide (5 minutes vs 30 minutes). As a result, C peptide is a more accurate measurement of how much insulin a person is producing. This is important because the pancreas can make up for a bad diet for a long time before someone’s blood work indicates even pre-diabetes, let alone diabetes. As our demands on the pancreas increases and insulin resistance develops, a function of the fat in our diet and in our cells, the pancreas starts to crank out more and more insulin. As early as 20 years before someone is diagnosed with diabetes, the pancreas is already overworking, producing as much as 500% greater amounts than under normal circumstances.

Antigens which trigger the autoimmune reaction which lead to LADA, as well as Type 1 diabetes include:

  • Cow’s milk proteins like casein and whey. This is a similar process which affects kids who develop Type 1 diabetes at an earlier age. This used to be called Juvenile Diabetes. This link was actually discovered in the 1970’s.
  • Meat – Mycobacterium Avium ParaTuberculosis (MAP). This is an infectious bacterium which cows get. Johne’s disease is a chronic enteritis of ruminants caused by MAP. Based on the 2007 Dairy NAHMS study, about 68% of U.S. dairy herds have at least one cow that tests positive for Johne’s disease with herd prevalence of MAP infection approaching 100% in large dairy herds. This bacterium embeds itself in the wall of the lower part of the small intestine known as the ileum. Infected animals can shed MAP in feces and milk, and the organism can become disseminated in tissues remote from the gut and its associated lymph nodes. When cows infected with MAP go to slaughter, workers become infected and it then gets into the packaging… MAP is resistant to cooking and triggers an autoimmune reaction. Although not definitively linked to human disease, it has been identified in people with Crohn’s Disease and autoantibodies to it have been found in Type 1 diabetics.
  • The Coxsackie virus which is a common infection in kids and causes ulcers as well as Hand-Foot and Mouth Disease.

COST OF INSULIN. Why is insulin so expensive in the US? Simply put, companies charge as much as they do because they have a monopoly and they can. All drugs are more expensive in the US and Insulin, in most cases a life-saving drug, is certainly among them. Insulin in the US costs 8x more than in all other wealthy nations. Even if you takin into account manufacturers rebates and discounts, Insulin in the US is 4 times more expensive. Here is a comparison with other countries:

  • Japan – 5.9 times
  • Canada – 6.3 times
  • Britain – 9 times
  • Turkey – 28 times

It is dumfounding that our drugs are so expensive. There are a lot of reasons and it does take years and a lot of money to develop drugs, but ultimately, it’s bout greed and profit.

The bottom line, fix your health and you won’t have to spend the money. Pay now with effort to improve, or pay now financially and pay later in terms of complications and premature death. It’s up to you.


Here are a few references:

Insulin Resistance survey. “How Insulin Resistant Are You?”

Do I Have Prediabetes? Take the survey and get informed. Click here.

Insulin Resistance (Mastering Diabetes) – handout about Insulin Resistance for the Mastering Diabetes Program.

Mastering Diabetes Online Coaching Program      www.mastering

Simply Raw”. Movie documenting how nutrition can reverse diabetes (link is to the YouTube version).

“Sicker, Fatter, Poorer. The urgent threat of hormone-disrupting chemicals to our health and future… and what we can do about it” Leonardo Trasande, MD

Neil Barnard’s Program for Reversing Diabetes”  Neal Barnard, MD



Goodbye Diabetes”  Wes Youngberg, MD



The End of Diabetes”  Joel Fuhrman, MD










A rapidly growing epidemic, dementia is now the 3rd leading cause of death in the US (which by some authorities is thought to be an underestimation) and its incidence is on a rapid rise. In Japan and Britain, it’s the #1 cause of death. Rates in the US have gone up by 70% in the last 10 years and projected to increase by 400% in next 10-20 years. Right now, after the age of 65, 10% of the population has dementia. Every decade thereafter, the percentage doubles, especially Alzheimer’s dementia. At 85, more than 50% of the population has some form of dementia. The direct and indirect costs of Alzheimer’s treatment in 2018 were $426 billion. That’s almost 1/2 of a TRILLION dollars a year to manage this horrible, mostly preventable disease.

Even more shocking is the age at which these changes leading to dementia begin. Even in kids, MRI studies of the brain done for other reasons are showing findings of white matter changes, usually seen in much older people. This is attributable to the terrible diet of fast food and saturated fat.

Dementia is an umbrella term for all the different kinds of dementia. There are over 200 types. While most have characteristic early symptoms, all eventually merge and have the same generalized brain function decline. Some of the more common forms include:

  • Alzheimer’s Dementia, also know as “the long goodbye”, accounts for about 60% of all dementia cases. In this form, proteins known as Tau bodies and amyloid, two proteins produced in the brain in response to inflammation, build up and disrupt nerve condition. The parts of the brain affected tend to be the Temporal and Parietal lobes and especially the Hippocampus, where memories are formed and solidified. This is why the hallmark of AD is maintenance of old memories but patients are unable to form new ones.
  • Vascular Dementia is when chronic vascular insufficiency causes brain tissue to age prematurely. This process basically affects anyone with high blood pressure or vascular disease of any kind.
  • Type 3 Diabetes. It is well known that diabetics and even pre-diabetics have a significantly greater risk for dementia. Insulin plays many roles in the brain. First, it is what ushers glucose into cells and the brain, despite only representing 2% of the body’s weight, uses 25% of the glucose. When insulin doesn’t work, it can’t use glucose for energy efficiently. Elevated blood sugar levels also cause microvascular damage. Insulin however, also has other roles in the brain. It is important in neuronal signaling and messaging. It impacts on gene expression. It also is important in neuronal growth.
  • Lewy Body Dementia. In this form, abnormal deposits of a protein called alpha-synuclein occur inside the brain’s nerve cells. These deposits are called “Lewy bodies” after the scientist who first described them. The deposits interrupt the brain’s messages. This disease tends to affect the Occipital (posterior) lobe of the brain. Early symptoms include visual hallucinations, spatial distortions and movement disorders.
  • Fronto Temporal Dementia is similar to Alzheimer’s in the the same proteins build up, they just build up in a different part of the brain. With this form of dementia, a person may have symptoms such as sudden onset of memory loss, behavior changes, or difficulties with speech and movement.
  • Parkinsonian Dementia. Another neurological condition rapidly on the rise, Parkinson’s Disease is more known for movement abnormalityes and tremmors. But dementia is also associated with it occuring in 80% of cases.

Although there are definitely some genes which increase the risks of getting dementia, 97% od dementias are lifetyle related. As the common saying goes, “Genes load the gin but lifestyle pulls the trigger”. The most well known gene coding for a specific protein is the APOE-4, which results in productionof APOE-4 protein. One of the mechanisms that APOE-4 impacts on dementia has to do with what it does. This gene type results in poorer fat metabolism in the brain. With more fat around, there is more dementia. Thats why a high fat diet is linked to dementia. For more information about this gene and its proteins, please click this link APOE4, DEMENTIA and VASCULAR DISEASE.

Low grade inflammation, whether targeting the pancreas directly or if generalized (for example from arthritis), contributes to the amyloid precursor amylin depositing in the pancreatic cells as a reaction to the inflammation. The more of the amylin builds up, the worse the pancreas functions. Type 2 diabetes can be referred to as “Alzheimer’s of the pancreas” in the same way that Alzheimer’s Disease has been also referred to as Type 3 diabetes.

The compound Insulin Degrading Enzyme (IDE) helps to lower insulin levels which increase as a response to high levels of sugar in the blood. IDE prevents excessive levels of insulin from developing which can lead to hypoglycemia, a much more dangerous situation than hyperglycemia. IDE also degrades the amyloid which builds up in the brain, preventing dementia. In a nutshell, the higher the levels of sugar in the blood, the more insulin is produced and released by the pancreas and the more IDE is used up to degrade the insulin. The more IDE is needed in the rest of the body, the less is available to degrade the amyloid in the pancreas as well as in the brain. More sugar leads to more diabetes and more dementia.

Although most chronic diseases are reversible, dementia is much harder to reverse once it sets in. However, much can be done about preventing, delaying and slowing progression of all forms of dementia. 90% of Alzheimer’s cases can be prevented. Only 2% of all cases of dementia, including Alzheimer’s dementia are purely genetic and even those forms can be delayed and slowed. The genes strongly linked to dementia are Presenelin 1, Presenelin 2 and APP. In addition, the APOE4 gene is also associated with increased risk, but less definitively. There are 3 types of APOE genes. Type 2, 3 and 4. Type 2 is protective, type 3 is neutral and type 4 is the one associated with increased risk. With one of those genes inherited from your parents, the risk of developing dementia is 4x greater and with 2 copies of the gene, one from each parent, the risk is 12-20x greater. All that having been said, genes again are not your destiny. 60% of all Alzheimer’s cases have no genetic risk or family history.

THE NIGERIAN PARADOX. Althpugh genetic mutations are important, they are by no means definitive with respect to causing or leading to dementia. For example, the populationof Nigeria has the highest rate of carrying th APOE4 gene. Hopwever, they also have one of the lowest dementia rates in the world. There are obviously other factors as to whether these genes actually get turned on and a big factor diet. Theirs if devoid of any significant ampunts of added sugars or processed foods and they consume a lot of wholeplant foods, with limited animal products.

Sadly, the brain damage leading to dementia starts decades (20-30 years) before symptoms even develop so NOW is the time to take action. Brain volume starts to decline after 40 and does so at a rate of 5% per decade afterwards. there are ways to minimize this however (see below). Although cholesterol does not cross the blood-brain barrier and effect the brain directly, the generalized blood flow problems it creates in the rest of the body indirectly affects brain function. Elevated cholesterol, defined as a total cholesterol level of 240 mg/dl, in mid-life is associated with a 3x increase in risk of dementia and cognitive decline later in life. Even a level of 220, considered borderline high, is associated with a 2x increased risk. The risk of Alzheimer’s Disease follows the same curve as the risk of cardiovascular disease with respect to consumption of fat, especially saturated fat. The more you consume, the greater the risk. 

There are real differences between men and women as well. Women are twice as likely to develop dementia as me are. They are also twice as likely to develop other problems such as depression anxiety, headaches and migraines. Women are also 3x more likely to develop various autoimmune diseases such as Multiple Sclerosis, which affect the brain as well as the rest of the nervous system. women are also significantly more likely to die of a stroke if they have one, than men. All these risks increase after menopause and some recent research seems to correlate these risks to hormone levels. Although hormone levels drop off in both men and women as we age, they drop off a lot faster after menopause in women, resulting, along with other lifestyle risk factors, to all those increased risks mentioned above. in addition, women who have undergone, surgical removal of their ovaries and even uterus have elevated risks, all again related with hormonal changes. The highest risk is if all those reproductive organs are removed, followed by both ovaries, one ovary and the the just the uterus. There are some studies showing that closely monitored hormone replacement therapy (HRT) can be protective of the brain and prevent or delay the onset of dementia but there are also increased risks of breast, uterine and ovarian cancer as well as potential effects on the cardiovascular system. This needs to be closely monitored by a physician and all other sources of potential hormonal imbalances should be addressed (foods, plastics…). There is much more on hormones and disease in a section below.

The damage leading to brain issues, as well as many other issues, start early in life. Significant cognitive impairment, a precursor to dementia, is now being seen in people as young as 40. Even minor elevation in blood pressure and cholesterol in mid-life (30’s-40’s) put you at significantly greater risk of brain shrinkage, microvascular disease, dementia and strokes.

The brain is an incredibly complex organ consisting of over 86 billion neurons and trillions of connections. As a comparison, there are more neurons in the brain than there are stars in the Milky Way. Neurons form at a rate of 250,000/minute during early pregnancy. Each neuron has connections and communicates with as few as 2 and as many as 30,000 other neurons. These connections break down and are reformed continuously, even into very old age. Previous impressions that the brain stops growing and adapting when we are older is simply not true. Studies show that parts of the brain grow when stimulated appropriately even well into our 90’s. All parts of the brain interact with each other in varying ways which is why complex activities including socializing are so important for brain health. 

The brain weighs only 2-3 pounds (2% of our body weight) but uses 25% of the body’s energy supply, primarily in the form of sugar. It is estimated that it takes 40 seconds for the fastest supercomputers to compute what the human brain can in only 1 second. There are over 87 billion brain cells and over 1 quadrillion connections. We need to take care of the brain since it orchestrates everything else that goes on in the body. It is said that we only use 10% of our brains capacity. That’s not true. We actually use 100% of our brain however only at an efficiency rate of only 1%.

The brain is by far the most vascular organ. If all the capillaries were put end to end, they would extend over 400 miles. All these little capillaries are what supply the brain tissue/neurons with nourishment. Atherosclerotic disease in one place means you have atherosclerotic disease everywhere, including the brain.

Prevention is the key. Many neurodegenerative conditions are not reversible and the changes in the brain leading to them start many years before symptoms develop. For example:

  • Dementia. The amyloid deposits and neurofibrillary tangles leading to many forms of dementia start as early as 30 years before there are symptoms.
  • Parkinson’s Disease. By it’s diagnosed, at least 80% of the dopaminergic neurons in the substantia nigra, whose dysfunction is responsible for movement are already dead.

Differences between the brain and the rest of our organs:

  • Brain cells, neurons, are irreplaceable (for the most prt). Cells in all other organs are constantly replaced. The brain lacks the capacity to grow new neurons (except for cells in the hippocampus, the memory center). New connections between neurons, yes. New neurons, no. Some neurons do continue to grow as we age but most do not. That’s why the damage is cumulative.
  • The brain does not have pain sensors. That’s why we don’t feel the damage which is occurring. Headaches are exactly that, “head” aches, not “brain” aches. Some headaches are a result of muscle and tendon tension or inflammation. Some are related to nerve inflammation outside the brain but none of them are from the brain per se. Not only can’t our brain cells be replaced, they can’t even let us know there is a problem. Fortunately, our brain has a lot of reserve to deal with the damage, until it doesn’t.
  • The brain uses more glucose than any other organ in the body.
  • The brain is 80% water. Most other organs are ~ 60% water. It’s not as fatty as most people think.
  • The brain has the most mitochondria of any organ (esp. the frontal cortex).
  • The brain is the only organ in the body which makes it own cholesterol, the vast majority of which is during infancy and early childhood.
  • The brain has a barrier, the blood-brain barrier, which allows certain things across into the brain and prevents others from crossing. This includes nutrients like cholesterol and amino acids, but also medications. Some are capable of crossing, some are not.

The brain is the fattiest organ in the body. It’s 60% fat, 70% of which are phospholipids and sphingolipids. Most of the fat we talk about in the rest of the body is white fat or adipose which is basically storage fat. Mostly derived from our diet. The fat in the brain is mostly structural fat, not the type that floats around in the blood. Myelin, the insulation that wraps all our brain cells, is all the cholesterol in our brains. Neurons are also surrounded by other types of fat, like omega 3, which act as membranes allowing both signals and nutrients to flow in and out.

Dementia and cognitive impairment is NOT a consequence of old age. It represents the endgame of years of accumulated brain insults. Although there are some genetic risk factors, lifestyle and environmental factors play a greater role. One major contributor is fat, especially saturated fat which is derived primarily from animal products like dairy (especially cheese) and meat.

In 1993, the Chicago Age and Healthy Project was started. They followed thousands of older people to see what sorts of things impacted on cognitive decline and dementia. There was a clear effect from saturated fat consumption, more than tripling the rate of both mild cognitive changes, “aging memory issues”, and dementia outright. The low saturated fat group consumed 13 or fewer grams and the high saturated fat group consumed 25 or more grams.  A Finnish study showed a similar (more than doubling) rise in dementia and cognitive decline at even lower levels, 21 grams of saturated fat a day. As an example of how little it takes to get to that level, here is an example of a standard American day of meals and saturated fat content:

  • 2 eggs 3.3 grams
  • 1 slice of bacon 1 gram
  • Chicken thigh (skinless) 4.7 grams
  • Milk, whole, 1 cup 4.5 grams
  • DiGiorno Pizza for 1, 12 grams
    TOTAL = 25.5 – An most Americans are consuming much more saturated fat daily than that!

Serum cholesterol of over 10,000 people was followed for over 30 years. Elevated cholesterol in midlife was associated with a:

    • 57%increased risk of of developing Alzheimer’s Disease
    • 26% increased risk of developing vascular dementia.

Alzheimer’s disease was first described by Dr. Alwyss Alzheimer in Germany after he cared for a middle-aged woman, Augusta Deter, who died if this disease in 1906. His autopsy of her and similar cases, mostly women in their 50’s-60’s, showed plaques and tangles just like today and, just like today, this disease remains just as difficult, if not impossible, to treat. That doesn’t mean we shouldn’t continue to try. Despite causing almost the same number of annual deaths as all forms of cancer combined in the US, it gets 1/10th the research funding. In addition, this devastating disease costs twice as much to treat. 1/5th of Medicare spending is on Alzheimer’s disease treatment. The numbers are already staggering and are only expected to grow. As of 2015, 40 million people worldwide had the disease and by 2050, the estimate is that there will be over 150 million.

MEDICATIONS TO TREAT DEMENTIA AND COGNITIVE DECLINE2 recent reviews of the benefits of the most commonly prescribed medications to treat dementia and cognitive decline, one looking at the top 15 drugs and another looking at the top 10 drugs, showed NO benefit. In fact, the latter study showed that these drugs led to a more rapid decline in cognitive function. These drugs are so ineffective that some drug companies are no longer funding studies or developing new drugs for cognitive decline. After over 400 drug trials costing over 15 Billion dollars, not one single drug has shown any benefit. The only “prescription” that the American Academy of Neurology recommends that neurologists write is a prescription for exercise which does improve memory loss and early cognitive decline.

Factors contributing to dementia and cognitive decline.

All the lifestyle changes mentioned on this website are proven to be helpful in preventing, delaying and slowing progression of dementia, even in people who have a genetic predisposition to getting it. Most importantly however is nutrition including limiting or eliminating animal products (meat, fish, dairy and eggs), sugar and processed foods, all of which causes inflammation in the brain. A recent study showed that people who ate meat, including exclusively chicken and fish, had double the risk of developing dementia as compared with vegetarians. Adding lots of colorful fruit and vegetables, especially berries is very helpful. Vigorous exercise, staying mentally and socially engaged and proper sleep are also extremely important. In addition, hearing loss contributes to dementia because of lack of brain stimulation and social isolation so get tested and get hearing aids if you have trouble hearing. For more information about hearing loss, click here: “HEARING LOSS and TINNITUS”

Click “Dementia Information” for a lot more information about dementia.

It is extremely important to try to maintain a healthy weight as well as stable normal blood sugar levels for normal brain function. Dementia is now being referred to as Type 3 Diabetes. With consumption of processed foods, sugar levels soar and the body responds by producing lots of insulin. High fat diets lead to poorly functioning insulin. These two dietary patterns lead to insulin resistance which impacts on how amyloid is cleaned out of the brain. We think of amyloid as the protein than causes brain damage and dementia when in reality, amyloid is a normal protein produced as a defense mechanism against inflammation primarily from foods. Recent research has shown that amyloid actually has antimicrobial activity, again protecting the brain. It gets cleaned out of the brain by an insulin-sensitive hormone which does its job at night while we sleep (another reason to get good quality sleep). With insulin resistance and with poor sleep, the amyloid doesn’t get cleaned out and builds up and that’s when problems start. Studies show that as weight increases and as blood sugar levels rise, brain size and function both decrease. There is a correlation between body mass index (BMI) and brain volume. Only being in the “overweight” category, brains have 8% less volume and look significantly older than those with a healthy weight. If you are obese, there is even more shrinkage and brains look 16 years older than their healthy-weighted counterparts. 

There are 4 basic damaging pathways resulting in dementia:

  1. OXIDATION. Oxidative stress is an imbalance between free radicals and antioxidants in your body.
  2. INFLAMMATION. This causes damage to tissues all over the body.
  3. LIPID DYSREGULATION. Too much fat and cholesterol leading to atherosclerosis and poor blood flow, among other damaging effects.
  4. GLUCOSE DYSREGULATION. Poor blood sugar control has a myriad of brain-damaging effects.

Dr.s Dean and Ayesha Sherzai, neurologists who run the Alzheimer’s Prevention Program at Loma Linda University Medical Center in California have an excellent book about our Alzheimer’s and dementia epidemic (listed below) and they have a simple mnemonic about how to prevent and slow the onset of dementia. NEURO:

  • N – NUTRITION, focusing on a whole food, plant-based diet and limiting all animal products.
  • E – EXERCIZE and movement. Minimum 75 minutes a week of getting your heart rate up, even a bit.
  • U – UNWIND. Manage stress. Meditate, pray, exercise, read…
  • R – RESTORE. Specifically, get good sleep. The brain heals and cleans itself during restful sleep.
  • O – OPTIMIZE cognitive activity, especially in the context of social interaction. Playing cards is great, but doing it in a group is much better. The importance of having a sense of purpose in your life is becoming more and more evident as well.


Factors which prevent or slow progression of dementia and MCD

  1. EAT PLANTS! DON’T EAT ANIMAL PRODUCTS. The science is clear. The only diet which will prevent, delay, slow and even in some cases reverse dementia is a whole-foods, plant-based, low fat, low salt and low sugar diet. Of 3000 patients the Dr.s Sherzai followed in their dementia clinic in Loma Linda, only 19, that’s 0.6% were on such a diet. All the rest ate a standard American diet including significant amounts of animal products. Alzheimer’s disease risk alone is reduced by 53% following such a diet. Eat greens, beans, colored vegetables, berries, nuts and seeds. Even if you have a borderline elevated cholesterol level in mid-life raises your risk of developing Alzheimer’s Disease by 23%. If it elevated, your risk goes up to 57%. Again, EAT MORE PLANTS!
  2. EXERCISE daily. A recent study published in the most prominent neurology journal reviewed the efficacy of 15 of the most commonly prescribed medications for cognitive decline and dementia. ALL were completely ineffective at preventing progression of these dreaded conditions. The only effective prescription that the paper recommended neurologists give out is DAILY EXERCISE! Both aerobic and resistance exercises are great.
    1. Aerobic exercise has been shown to be helpful in producing Brain Derived Neurotropic Factor (BDNF) which helps to stimulate and grow the hippocampus, the memory center of the brain.
    2. High intensity interval training (HIIT) boosts dopamine, the happy chemical in the brain.
    3. Yoga and meditation aleviate anxiety, a significant cause for brain shrinkage with age.
  3. PLAY MUSIC. Playing music or learning an instrument is tremendously impactful. It engages so many parts of the brain simultaneously.
    • Reading notes (on paper or even on a screen) engages the language center in the left parietal lobe.
    • Visual processing of the information engages the visual cortex in the occipital lobe.
    • Processing the notes intellectually engages the frontal cortex.
    • Creative thinking engages the right parietal lobe.
    • Physical movement engages the motor cortex, the sensory cortex as well as the cerebellum which coordinates everything.
    • Emotional engagement activates the limbic system.
  4. Address HEARING LOSS. Hearing loss is a serious problem which, if left unaddressed, causes more rapid cognitive decline, worsens memory and significantly increases the risks of dementia. A 2019 study revealed that even your risks of getting dementia doubles if you ignore even a mild hearing loss in you 40’s. The World Health Organization (WHO) estimates show that approximately 800 million adults have hearing loss globally and has reported that today more than a billion young people are at risk of hearing loss. According to the US National Institutes of Health, approximately 90% of those with hearing loss are affected by sensorineural hearing loss (SNHL). Noise exposure is difficult to avoid in modern society and, based on our estimates, we believe that 59 million people in the United States alone may have SNHL, based on numbers of diagnosed and undiagnosed.
  5. PLAY competitive games, also known as “speed of processing” games, with and against other people. Board games, cards,…. Even video games. Rapid, interactive decision making is particularly helpful for brain health and dementia prevention.
  6. Practice MEMORY GAMES. Although not as beneficial as interactive games as far as dementia prevention is concerned, Sudoku, puzzles, crosswords and other individual memory games do help to maintain and improve memory function. Some great apps for smartphones and computers are BrainHQ and the Merrion Dictionary app which has a “word of the day” feature. Learn a new word, repeat it 5 times (which takes it from short term to long perm memory and teach it, all of which consolidate memories. Quality sleep is the glue which finally keeps is all together.
  7. LEARN SOMETHING NEW. Learn a language, a new instrument, a new hobby, a new subject, a new exercise regimen… Keep learning and engaging your brain.
  8. PURPOSE. It is extremely important to have some kind of purpose in your life. It can be your family and friends, volunteering, visiting the sick and less fortunate… whatever makes you feel good about waking up every day.
  9. Drink alcohol moderately. A little is OK but all alcohol is toxic so limit it.
  10. Drink LOTS of water. 8-10 glasses a day. Even a small amount of dehydration leads to poorer cognitive function.
  11. REDUCE STRESS. Join a religion… All helpful at combating stress. Meditation, specifically Transcendental Meditation has been shown to significantly reduce stress and dramatically improve the interactions between many parts of the brain.
  12. Use your non-dominant hand. The left and right sides of your brain are responsible for different functions and by using your other hand for routine tasks, you force both sides to communicate better. This creates newer and stronger neural pathways.
  13. Change your routines. Routines, if done often enough, become reflexes. By changing things up, you are forced to focus more. Something as simple as driving home a different way is an example of changing up a routine. Changing exercise routines is another.
  14. Sleep better. Different stages of sleep are responsible for different aspects of both physical and psychological recovery. BDNF (Brain-Derived Neurotophic Factor) and Insulin Degrading Enzyme (IDE) are both produced and function during sleep and are affected by poor sleep. They repair the brain at night. Both neurons and their supportive cells regenerate during sleep. Lack of sleep impacts on brain volume and function. People who sleep better spend less time in doctors’ offices and have less chronic disease including dementia. Quantity (shoot for 7-8 hours) and quality of sleep are equally important. Some tips to improve quality are: 
    • Stop looking at any screen (TV, Kindle, Nook, iPad, Smartphones… at least 1 hour before sleep. The light halts melatonin (the sleep hormone) production and disrupts sleep/wake cycles. Reading a paper book is fine though. Light also delays the peak production of melatonin by 2 hours.
    • Do not eat or drink anything within 2-3 hours of sleep. First of all, it can cause reflux which disrupts sleep by causing heartburn. Second, the body needs to rest, not spend energy and resources digesting and moving food through your small and large intestine.
    • Do not exercise within 2 hours of sleep. The increased adrenaline disrupts sleep.
    • No caffeine after noon. Caffeine does not only prevent you from getting to sleep, it also disrupts sleep/wake cycles, even if you fall asleep easily. Caffeine clears the body slowly. Its half-life is 6-8 hours so even a small amount of caffeine-free coffee or tea (which still has 5-10 mg of caffeine which is enough to cause problems) at 3 pm will significantly impact on sleep quality.
    • Avoid alcohol. It’s breakdown product acetaldehyde negatively affects sleep/wake cycles and it causes reflux. It also causes dehydration in the brain, which is what causes hangover headaches.
    • Avoid sleeping pills. They create artificial sleep with abnormal/poor sleep cycles.
    • Keep your sleeping schedule regular, even on weekends.
    • Keep the bedroom as dark and quiet as possible.
    • Keep the temperature cool. Under 68 degrees. Cooler temperatures improve sleep quality.
  15. Less TV. Although some TV (½ hour or less) can stimulate the brain, the more you watch, the worse it impacts on brain function, not to mention the fact that it prevents you from doing other brain-healthy activities.
  16. Read. It’s better for sleep. It keeps your brain engaged and you learn something.
  17. Recite, Repeat and Teach out loud. Activating the vocal center of the brain helps to reinforce memories. Teaching reinforces these memories as well and stimulates the brain.
  18. Dance. This is a very complex physical activity and the music stimulates the brain in many other ways. The social component has its own advantages as well.
  19. Limit cooking with cast-iron or copper pots. These metals get absorbed and excess amounts contribute to progression of dementia and cognitive decline. Occasionally is fine, just don’t make them your daily cookware.

DRUGS AND COGNITIVE FUNCTION. Be mindful of medications which either worsen brain function or even masquerade as dementia. Many medications can impact on mental clarity, fatigue and memory. Any medication which affects brain biochemistry can impact on brain function. These include medications prescribed or used for depression, anxiety or sleep function. These include over the counter medications as well. Even cholesterol lowering drugs like Lipitor have been shown to cause major changes in memory. There are documented cases of people on statins being diagnosed with dementia and even admitted to dementia units whose mental function returns to normal after the statins are discontinued.


  • Water! Drink lots.
  • Avocados.
  • Legumes like beans, peas, lentils…
  • Broccoli.
  • Blueberries.
  • Coffee. One study indicated that those who consumed 3-5 cups of coffee a day had a 65% decrease in dementia. However, all the benefits of coffee are negated by adding dairy and sweeteners. Plant-based milks like soy or almond are fine. Coffee consumption was also linked to lower rates of Parkinson’s disease. Just watch the caffeine, especially after noon since if affects sleep quality and reflux.
  • Dark Chocolate, but not chocolates that have dairy or sweeteners though. Dark chocolate is full of flavonoids, antioxidants and minerals, which increase dopamine and serotonin in the brain. It also decreases the risk of strokes by relaxing arteries and decreasing inflammation.
  • Leafy Greens (kale, Swiss chard, bok choi, dandelion greens, arugula…). People who eat one salad a day with dark leafy greens reduce brain aging by 11 years.
  • Herbs and Spices like turmeric, ginger, garlic, cumin…
  • Mushrooms. All kinds including regular button and Portobello which are actually the best ones. Include the stems which are packed with beta glucans.
  • Nuts (all kinds) & Seeds (chia, sunflower, flax, pumpkin). Great sources of Omega 3 (especially walnuts), Vitamin E and Selenium. One handful a day. More leads to excess amounts of fat however so be careful not to overdo it.
  • Omega-3 Fatty Acids. Try to stick to algae-based sources. They are much cleaner than fish and it’s where the fish get it from anyway. Other sources include walnuts and flax seeds.
  • Sweet Potato.
  • Tea, Herbal (mint, lemon balm, hibiscus) teas and green tea.
  • Whole Grains like quinoa, oats, buckwheat, millet…


  1. Sugar. It causes inflammation and feeds cancer cells.
  2. Processed Food. High in salt, saturated fat, sugar and various chemical additives.
  3. Processed Meat. It’s a class 1 carcinogen (definitely causes cancer. Same class as tobacco, asbestos, and plutonium).
  4. Red Meat. It’s a class 2a carcinogen (means it probably causes cancer).
  5. Chicken. It’s the main source of fat and cholesterol in the American diet. It has 3x more fat than protein and it’s loaded with arsenic. It is also the #1 source of food-borne infections.
  6. Butter and Margarine. High in saturated and trans-fat.
  7. Fried and Fast Food. High in trans-fat.
  8. Cheese. High in saturated fat. Highest source of salt in the American diet.
  9. Pastries and Sweets. High in sugar and refined carbohydrates. Causes inflammation.
  10. Alcohol excess. It’s a neurotoxin and damages brain cells directly.

Skip the supplements unless you are actually deficient. For the most part, they do not work.

NEUROGENESIS – Growing New Brain Cells.

There has always been a prevailing, accepted belief that when you are born, whatever brain cells you have is all you get. It’s all downhill from there. But this is simply not true. As far back as the 1960’s, research showed that we can indeed grow new brain cells, a phenomenon known as known as neurogenesis. Other more recent studies on the brains of 90 year old’s have even found brand new stem cells. 

A particular area where we know for a fact that neurogenesis occurs in humans is in an area known as the hippocampus. This is a small, curved formation in the brain that plays an important role in the limbic system. There is one such area on each side of the brain located in the temporal lobe on the side of the brain. The hippocampus is responsible for:

    • Learning.
    • Memory formation, both quality and capacity, especially the formation of new memories.
    • Spatial and pattern recognition and separation.
    • Mood and Emotions.

We can generate up to 700 new cells in the hippocampus a day however many lifestyle choices we make can influence whether neurogenesis occurs or not. 

Things which IMPAIR neurogenesis include:

  • STRESS. We are not talking about acute stress, like the reaction you have to an intruder or an acute danger. It’s the chronic, low grade stress which halts production of new hippocampal cells which is why chronic stress leads to depression, as well as deterioration of all the other functions of the hippocampus.
  • DIET. In particular, a diet high in saturated fat, mostly coming from animal sources like meat and dairy as well as a lack of fresh, unprocessed fruits and vegetables. Avoid added sugar as well as processed foods. All of these cause inflammation and stop neurogenesis.
  • ALCOHOL. Even one drink is enough to impair neurogenesis. The more you drink, the worse things get. If you do choose to drink, red wine is the best choice since resveratrol, one of the plant compounds found in red grapes, stimulates neurogenesis.
  • SLEEP. We know that even one night of poor sleep impacts on cognitive function. Wildwood also now know that long term sleep deprivation impairs neurogenesis and contributes to more rapid progression of overall memory, cognitive decline and dementia.
  • AGEING. As we age, there is a natural decrease in the amount of neurogenesis which occurs.

Things which PROMOTE neurogenesis include:

  • LEARNING. Anything is good but complex things like learning to play an instrument or a language is particularly helpful.
  • SEX. Regular sexual activity stimulates neurogenesis in both men and women equally. But if you become obsessed and have trouble with sleep as a result, there is a point of diminishing returns.
  • EXERCISE. This is a real boost to neurogenesis. Shoot for 20-30 minutes of anything which makes your heart rate increase. Also, regular movement all day long is crucial. Sitting on the couch all day can’t be overcome by one session of exercise. It’s also important to enjoy what you do. In studies on mice, neurogenesis only occurred in those mice who ran on their treadmills because they wanted to but not if they were forced.
  • CALORIC RESTRICTION and TIME RESTRICTED FEEDING. Decreasing how much we eat and having a fasting period also stimulates neurogenesis. Try eating less overall and also consuming all your food with a 10-12 hour window.
  • DIET. The more fruits and vegetables you eat and the fewer animal products you consume, the better. It is also interesting to note that you get more benefit if you chew your food (eating it whole) rather than in the form of a smoothie. It’s not surprising that people in nursing homes, fed soft, bland diets, continue decline at a much more rapid rate. There are a few standout compounds however:
    • Flavanols. These plant compounds are found in many fruits and vegetables but some specific ones include apples, grapes, pears, tea, wine, and cocoa (dark chocolate).
    • Omega 3 fatty acids. Although you can get omega 3s in some types of cold water fish, assuming they are wild caught, better sources are algae (which is where the fish get it from anyway) and things like flax seeds and walnuts.



There is an increasing body of evidence of the role insulin has on brain function and how insulin dysfunction impacts greatly on brain function. For example we know that diabetics have double the risk for dementia. In fact, certain forms of dementia are now being called Type 3 Diabetes. 

The brain makes its own insulin and some gets through the the Blood Brain Barrier (BBB) from the peripheral circulation. Certain parts of the brain, like the hippocampus responsible for new memory formation and consolidation of material learned that day, are particularly sensitive to insulin. Chronically elevated insulin leads to decreased insulin transport across the BBB as well as a decrease in the number and function of insulin receptors on the surface of brain cells.

Insulin resistance (IR) contributes to brain cell degeneration and eventual death.

With Alzheimer’s Disease, insulin resistance affects the function of kinase enzymes, particularly glycogen synthase kinase 3 (GSK-3) which is responsible for the breakdown and clearance of tau and amyloid, allowing them to accumulate. Specifically with tau bodies, IR allows them to become phosphorylated leading to the unraveling of cellular micro-tubules, the “scaffolding” and “information highway” in cells. Amyloid is also a normally occurring protein. Its primary function is not known, though it has been implicated as a regulator of synapse formation, neural plasticity, antimicrobial activity, and iron export. But buildup of this protein leads to problems with function being impaired rather than supported. IR leads to increased production and over-expression of amyloid precursor proteins (APPs). As a result, more amyloid gets produce, less gets cleared and more amyloid becomes permanently deposited.

Ketogenic (low carbohydrate, high fat and protein) diets have not been shown in ANY long term study to be of any benefit for dementia.

  • The ketogenic diet was developed to help kids with intractable, uncontrollable seizures. Although there was short term benefit, long-term they all had significant cardiovascular disease and cognitive problems.
  • The longest study  for brain health with a ketogenic diet was only 12 weeks. Most of the patients were not even able to get into real ketosis. There was some minimal improvement in some patients but all those who stopped the diet after the twelve weeks either reverted to their pre-existing state of dementia or were even worse.
  • Why do people who try ketogenic diets report less brain fog? Most likely because their brains are so badly damaged that they are no longer able to use glucose and ketones are a more usable alternative. In people with dementia, this inability to use glucose is not reversible but in most people, it is. And most people also have other metabolic dysfunction like elevated cholesterol, hypo or hyperthyroidism.


The Alzheimer’s Solution” Dean Sherzai, MD

Power Foods for the Brain” Neil Barnard, MD

“The End of Alzheimer’s”  Dale Bredesen, MD




“Brain Food – The Surprising Science of Eating for Cognitive Power”  Lisa Mosconi, PhD







Cancer is a collection of related diseases where the body’s cells begin to divide uncontrollably without stopping and begin spreading into surrounding and distant tissues and organs eventually, overtaking our bodies energy supplies and functions. Cancer can start in any tissue in the human body. As crazy as it sounds, cancer formation is actually a natural and continuous process. We have trillions of cells which are constantly dividing. When errors occur during the dividing process, the cells can start to grow out of control and they stop responding to normal cellular signals. In a typical day, there are over 10,000 cell divisions which contain enough DNA errors that cancers could arise from them. DNA has its own repair mechanisms.

At its core, cancer is a genetic disease in that there is a genetic change which creates this unresponsive, autonomously growing cell. That having been said, true genetic causes account for less than 10% of all cancers. Our cells are constantly exposed to a barrage of inflammatory and toxic insults. Cancer is largely a preventable disease but it does require major lifestyle changes. From the sun’s UV rays, cigarette smoke, toxic chemicals in our environment to the foods we eat, there is a long list of things constantly attacking our cells and causing changes, sometimes leading to mutation of DNA. When our bodies are functioning normally, these individual cells or small nests of cells are identified and destroyed, or are told to kill themselves, a process called apoptosis. When our bodies are running inefficiently, these monitoring systems, like the immune system, don’t work well and cancers are allowed to grow. Think of cancers as  “seed” and our bodies as the “soil”. Whether the seed sprouts, takes root and grows depends on the micro-environment and “health” of the soil around it. 

As mentioned at the top, in 1971, President Richard Nixon announced a “war on cancer”. At that time, the overall cancer rate was 1:8 (12%) and cure was less than 28%. In 2017, the cancer rate rose to 1:3 (38%), not even including skin cancers, and survival has only improved to 31%. Proportionally, many people are dying of cancer today than in 1971. Of the millions diagnosed with cancer every year, as many as 90 to 95% of cancers are caused by “lifestyle factors,” and only 5% to 10% are caused by bad genes. We know this because of the significant differences in the incidence of different forms of cancer around the world, which then change when people move from one place to another. For example, breast cancer rates differ by an order of magnitude (10x), with the lowest rates in parts of Africa and Asia. However, once they move and start eating and living like Americans, their cancer rates rise and equal the rates in this country. Many things contribute to the rest of the genetic mutations leading to cancer. These include things like smoking, toxic exposures, radiation, chronic inflammation, an unhealthy animal product-based diet and simple aging. These triggers can cause direct damage and can also impact on certain cancer genes, both turning them on and off.

We constantly have cancerous cells forming in our bodies. You probably have some right now floating around or sitting in an organ in your body. Just sitting there. Autopsy studies show that 40% of 40-50-year old women have microscopic, undetectable breast cancers and 50% of men in their 50’s have microscopic prostate cancer. 100% of 70-year old’s, both men and women, are shown to have thyroid cancer. These microscopic cancers may never develop into full-fledged life-threatening cancers but they are kept under control only if the immune system is healthy and can identify and destroy these cells. There is a lot of research and clinical trials looking into how we can improve our own immune system and cells to identify and cure our own cancers. Most cancers take years, if not decades to become clinically identifiable. The initial changes and exposures eventually leading to cancer may have even occurred in the womb so you are, in essence, born with cells destined to turn into cancer. An example of this is a hormone DES (diethylstylbeterol). It was prescribed to pregnant women between 1940 and 1971 to prevent miscarriage, premature labor, and related complications of pregnancy but was later shown to be linked to cancers in those babies as they became older.


According to the International Agency for Research on Cancer (IARC), the top preventable causes of cancer are:

  1. Diet 30%. This primarily includes lack of fruit and vegetables and too much sugar, processed foods and animal products.
  2. Smoking 20% (87% of lung)
  3. Infections 15% (Hep B & C, HPV, HIV, Bovine Leukemia Virus) ( click here Viruses That Can Lead to Cancer, for more information about viruses and cancer)
  4. Obesity 20%
  5. Alcohol 5%
  6. Other (stress, radiation, low physical activity…) 5%

Looking at that list, obesity and alcohol can be included as dietary components so what you put into your mouth accounts for at least 55% of all cancers.

When did my cancer start?

The simple answer is that the first cancer cells may have mutated DECADES before they become apparent as tumors or metastases (spread).

Cells replicate (divide) differently depending on your age and biology. It can take 3-6 months for a doubling of cells to occur. The following are averages:

  • Under 50, cells double every 80 days.
  • Between 50-70, doubling time is 157 days.
  • Over 80, doubling occurs every 188 days.

As an example, a 61-year-old with a 1 cm tumor (about the size of a sugar cube and housing about 1 billion cells) probably had the first cell mutate more than 10 years ago, assuming about 20% are actively dividing at any one time.

There are 5 basic pathways that can either prevent or promote cancer cell growth:

  1. Inflammation – both from without and from within.
  2. Immune function.
  3. Angiogenesis – the growth of new blood vessels.
  4. Growth factors – both internal and external from our foods and exposures.
  5. Hormone levels – also influenced by our own production as well as outside sources like animal products and plastic exposure.

For cancers to grow they need a blood supply. Angiogenesis is the growth of new blood vessels. This occurs naturally during wound healing or unnaturally when cancers grow. One approach to stopping or eliminating cancer is halting angiogenesis. A healthy, plant-based diet is the best way to prevent the abnormal angiogenesis that occurs with and feeds cancer. This is a great YouTube TED talk on the subject.

The best way to treat cancer is to do whatever you can not to get it in the first place. Although the word “Cancer” strikes fear in every person out there, we should really be more concerned about all the chronic diseases mentioned above that are much more commonplace and often considered a “normal” part of aging. As mentioned above, if all the cancers in the US were all of a sudden cured, life expectancy would only increase by 2.8 years! Type 2 Diabetes on the other hand can cut life expectancy down by 20 years. All the lifestyle changes that help with chronic disease also help prevent and even treat cancer.  If you look at the contribution of chemotherapy (cancer treatment drugs) to five-year survival in cancer patients overall, it’s on the order of only about 2%. There are some cancers modern medicine has gotten good at treating like testicular cancer, Hodgkin’s disease as well as a number of pediatric cancers but if you look at our most common cancers: colon, lung, breast, and prostate, the success rate is only about 1% from the addition of chemotherapy. In other words, out of nearly 14,000 colon cancer patients, only 146 lived out five years thanks to chemotherapy. So, the chance of survival benefit is only 1 in 100. All that having been said, if you have cancer, there is a lot that you can do to help avoid, treat and cure your cancer. 


  • Eat more plants. Plants contain phytonutrients and antioxidants. There is a lot of information about these compounds in my nutrition section but in a nutshell, phytonutrients and antioxidants prevent and remove cancerous cells. Phytonutrients are plant compounds which they produce as defense mechanisms to the toxic and environmental stresses they are exposed to. In many cases, these protective benefits are passed along to us when we eat them. Antioxidants are compounds which remove damages, oxidative molecules which can cause inflammation and damage. Greens, beans, nuts, seeds, lentils, colorful vegetables, fruits… They are all good. Even just adding berries to an meat heavy meal decreases the duration of inflammation caused by the meat significantly. Instead of near continuous inflammation measured by elevated oxidated LDL cholesterol levels seen with standard American diet meals, rich in animal products, simply adding some berries decreases the  amount and duration of oxidated LDL by significant amounts and many hours after each meal. Research reveals that phytochemicals exude significant anti-carcinogenic powers by:
    • Providing antioxidant activity and scavenging harmful, cancer causing free radicals.
    • Preventing DNA damage
    • Repairing broken DNA
    • Destroying harmful cells in our body
    • Tempering the growth rate of cancer cells
    • Inhibiting angiogenesis (growth of new blood vessels to supply tumor cells)
    • Stimulating the immune system
    • Regulating hormone metabolism
    • Reducing inflammation
    • Supplying antibacterial and antiviral effects
  • Eat less animal protein. The essential amino acid methionine can be recycled by normal cells but not cancer cells. They will die off when they are lacking this amino acid. Although plant protein also contain this amino acid, the concentration is much higher in animal sourced protein (meat, eggs, dairy…).
  • SOY is exceptionally protective against hormone-driven cancers like breast and prostate. It’s a myth that it causes cancer. Just keep it organic since it’s one of the most contaminated crops out there. For more information about soy and cancer, click here to go to this topic on another page.
  • Don’t use any tobacco products.
  • Limit alcohol consumption (1 drink a day for women and 2 for men). Why is alcohol so carcinogenic, especially with breast cancer?
    • It increases estrogen levels.
    • It impairs immune function.
    • It can cause bone marrow suppression leading to low red blood cells (anemia) and low white blood cell counts, impairing immune function.
    • It creates toxic metabolites, especially acetaldehyde, which is produced even if you gargle with alcohol-based mouth rinses.
    • It inactivates an enzyme, methylenetetrahydrofolate reductase (MTHFR), which converts folic acid into its active form, methyl folate.
    • It depletes thiamine (vitamin B1) leading to Wernicke’s Encephalopathy, characterized by confusion, as well as visual, balance and coordination problems. If left untreated, this evolves to Korsakoff Dementia which is a permanent form of dementia.
    • It directly causes DNA damage.
    • It causes oxidative stress.
  • Cut out added SUGAR. Excessive amounts of sugar cause inflammation leading to cancer. In addition, overall, cancer cells metabolize sugar 50x more than normal cells, having a 10x greater affinity for glucose and a 100x greater affinity for fructose than normal cells. This does not include the natural sugars found in whole fruits and vegetables however. The reason for this affinity is that one of the mechanisms though to cause cancer is the abnormal deterioration and malfunction of the cell mitochondria, the powerhouse of the cell, which generates ATP. They can be thought of as the “lungs” of the cell. When they don’t work, cancer cells need to rely on another energy source and sugar is the easiest, most readily available source.
  • Although sugar is a key energy source for cancer cells, they are also very metabolically flexible and will use both fat and protein as energy sources if needed. This is why people with advanced cancer become emaciated and why fasting is a great way to treat cancer, especially when getting chemotherapy. When the cells are suddenly starved of energy, they are not active and chemotherapy has a better chance to work and kill them off.
  • Avoid dairy. Dairy has hormones and other chemicals which stimulate cancer cell growth. All animal products contain high levels of IgF 1 (Insulin Like Growth Factor 1). This is a naturally occurring hormone which helps us grow when we are younger and does help muscles grow in bodybuilders but it also feeds and promotes cancer cell growth. Dairy has been shown to contribute to the development of hormone driven cancers like prostate, testicular, breast, ovarian and uterine cancer. Women who have had breast cancer have a 49% increased risk of dying from recurrence with only one additional serving of dairy daily. A recent study of prostate cancer patients showed a 73% increase risk of cancer recurrence with 4 or more dairy servings per week. This risk increased even more (3x more) if they were overweight. There is actually a stronger link between prostate cancer and dairy than there is between smoking and lung cancer!
  • Limit meat consumption. Again, animal products are filled with hormones as well as many environmental contaminants, not to mention that eating too much animal protein itself is not healthy. Animal fats contain arachidonic acid. Our body produces inflammatory compounds like prostaglandins from arachidonic acid. Inflammatory compounds then go on to stimulate breast cancer growth and may also play a role in colon cancer, lung cancer, and head and neck cancer. If you must eat meat, keep it local, organic, grass-fed, wild caught and hormone and antibiotic free. Do NOT eat any processed meats like bacon, lunch meats and sausage. Processed meat has been classified as a class 1 carcinogen (cancer causing agent) by the World Health Organization (WHO) and the International Agency for Research on Cancer (IARC). This is the same category as smoking, asbestos and plutonium! A study of over 500,000 people tracked the development of bladder cancer. Just a 3% increase in animal protein led to a 15% increase in the risk of bladder cancer however if you increased replaced that animal protein with plant protein, there was a 23% decreased risk of bladder cancer! Colorectal cancer rates are on a rapid rise, mostly attributable to meat consumption. Someone born in 1990 has 2x the risk of developing colon cancer and 4x the risk of rectal cancer compared with someone born in 1950. In people under 50, colon cancer rates have doubled in only 25 years, prompting the recommendation to start colon cancer screening at 40, rather than 50. In fact, in comparison to people born in 1950, those born in 1990 have a 4x greater rate of rectal cancer and 2x increased rate of colon cancer.
  • In a nutshell, animal products:
    • increase estrogen levels stimulating hormone-driven cancers like breast and prostate.
    • stimulate angiogenesis which allows nests of cancer cells increase delivery of nutrients for more rapid growth, tumor formation and eventually permit spreading to other organs.
    • increase growth hormone levels, especially IgF-1, a potent cancer cell growth promoter.
    • initiates inflammation and free radical formation
    • creates oxidative stress, the spark which starts the process of cancer cell formation.
  • Limit toxin exposure such as: 
    • radiation (too many medical and dental tests, radon).
    • limit cell phone use and keep them off the body when not in use.
    • deodorants and antiperspirants.
    • cleaning products and sprays.
    • contaminated water sources, including bottled water.
    • avoid using or consuming pesticides like Roundup (use vinegar instead).
    • avoid contaminated foods: metals like mercury in fish and antibiotics and salmonella in meat.
    • don’t use Teflon or other chemical non-stick cookware.
  • Avoid medications which affect how our immune system works. Part of the immune system’s job is to watch out for and eliminate unhealthy cells from the body. This includes cancerous cells. That’s why cancer rates are higher in patients who take immune modulating drugs like steroids, Remicade, methotrexate, Imuran, cyclosporine and biologics. These are used to treat conditions like psoriasis, arthritis, lupus, lichen planus and eczema.
  • Exercise daily and move your body as often as possible.


  • Mushrooms.
  • Garlic.
  • Berries (blueberries, pomegranates, cranberries…).
  • Turmeric.
  • Cabbage and other Crucifers (broccoli, cauliflower…).
  • Leafy Dark Green Vegetables (kale, chard, spinach, bok choy, mustard greens…).
  • Legumes (beans, lentils, peas).
  • Red Grapes.
  • Nuts and Seeds (especially walnuts). 1 handful a day can cut your risk of getting cancer by 30% and getting it back after you’ve had it by almost 50%.
  • Soy
  • Celery.
  • Any colorful fruit or vegetable.
    • Anthocyanins (blue and purple in blueberries and cabbage) stop angiogenesis (new blood vessel growth which feed cancer cells), stimulate healthy gut bacteria and boost immune function.
    • Beta carotene (orange and red in carrots, peppers and turmeric) is a potent antioxidant.
    • Lycopene (red from tomatoes) lowers cancer and heart disease risk.

There are literally thousands of published peer-reviewed studies demonstrating that the 100,000+ phytonutrients in plants have the ability to prevent and reverse cancer. But because the pharmaceutical industry can’t figure out how to extract these compounds, synthesize them, and patent them for profit, they are ignored.

There was a notion that low cholesterol levels can cause cancer. Not only is this not true, the opposite is actually reality. Cancer causes low cholesterol levels. Cancer cells use 18x more glucose than normal cells do but only once they have built up their microvascular network (blood supply). In the early stages of the disease, cancer cells use cholesterol as their primary fuel to build this network which is why cancer patients often have a low cholesterol level.

CANCER TREATMENT AND INDUSTRY INFLUENCE. There is no question that the diagnosis and treatment of cancer is itself an industry. Billions of dollars are made annually by drug companies, hospitals and clinics doing tests, and treating patients with cancer. In October 1985, National Breast Cancer Awareness Month became official. It was a collaborative effort between the American Cancer Society and the former Imperial Chemical Industries, now Astra Zeneca. As mentioned above, detecting cancer may be important but the emphasis should be “cancer prevention”. Astra Zeneca makes drugs to treat cancer. They have a vested interest in people being diagnosed, and then eventually treated for cancer. There is a very valid argument that diagnosing cancer earlier does nothing other than exactly that; earlier diagnosis. This is called “lead-time bias”. Treating cancer earlier may make it seen like there is better survival but some epidemiologists argue that because death rates are not improving, in fact they are getting worse, all we are doing with early detection is treating more people with more drugs sooner and for longer periods of time without providing any significant survival advantage. More treatment however is certainly making drug companies and cancer treatment centers a lot more money.

Animal products are linked to cancer. The fact is quite simple; pants are protective against cancer and animal products promote cancer cell formation and growth. 

  1. Saturated fat. Fat causes insulin resistance (IR) which raises sugar levels in the blood and cancer cells LOVE sugar. Also, IR leads to even higher levels of insulin, which is also a growth hormone.
  2. Heterocyclic amines (HCAs) and Polycystic Aromatic Hydrocarbons (PAHs). These carcinogens are formed when meat is cooked at high, dry heat like frying and barbecuing. HCAs form on the surface of the flesh while PAHs result when the fat from the meat burns. The smoke is rife with it. 
  3. N-Nitroso Compounds (NOCs).Nitrates and nitrites are added to processed meats as a preservative, primarily to prevent the formation of the deadly botulism bacteria, but also to give the meats an attractive pork color. These compounds however cause cancer when they turn into NOCs by cooking and interacting with digestive enzymes. These same NOCs are also formed from the cooking and digestion of red meat from naturally occurring nitrates and nitrates. These however are different from the nitrates in plants which do not form these NOCs but actually form the beneficial compound nitric oxide (NO) which relaxes arteries and improves oxygen transport and absorption.
  4. Persistent Organic Pollutants (POPs). Now present in just about every animal and plant on the planet, some of these chemicals from pesticides, herbicides and other chemicals were actually banned more than 40 years ago yet they still persist. These compounds can be measured in the bodies of ants in the deepest parts of the Amazon and, sadly, in the cord blood of newborn infants, indicating that they are being passed along from the mother. These compounds build up in animal fat which is why humans build them up as well. “Healthy” fatty fish are some of the worst culprits.
  5. IGF-1. Insulin like growth factor 1 is a potent growth hormone which is in high concentration in milk as well as meats. It is important to help a nursing infant grow but only triggers and encourages cancer cells to grow in adulthood.


Enzymes named COX, cyclooxygenase, take the pro-inflammatory omega-6 fatty acid arachidonic acid that our body makes, or we get directly in our diet mainly from chicken, eggs, plant oils and processed foods, and turn it into even more inflammatory mediators, like thromboxane, which produces thrombosis (clots), and prostaglandins, which cause inflammation.

Aspirin suppresses these enzymes though. So, less thromboxane means fewer clots and less prostaglandin means less pain, swelling, and fever. Prostaglandins can also dilate the lymphatic vessels inside tumors, allowing cancer cells to spread. So, one of the ways cancer tries to kill us is by boosting COX activity.

That’s one of the ways we think aspirin can help prevent cancer, by counteracting tumor attempts to dilate those vessels allowing more nutrients into tumors and allowing cancer cells to spread throughout the body. The reduction in mortality due to some cancers occurred within 2 to 3 years after aspirin was started. That seems too quick to be accounted for by an effect only on the formation of cancer, which can take decades to develop.

So, the only way aspirin could save us that fast is by suppressing the growth and spread of tumors that already exist. Aspirin appeared to cut the risk of metastases in half, ,particularly for adenocarcinomas, like colon cancer.

Using aspirin in healthy people just for cardiovascular protection is a wash, in fact causing more risk from the potential adverse effects of taking aspirin regularly. By contrast, the cancer prevention rates might save twice as many lives. So, the benefits may outweigh the risks. If you put it all together, heart attacks, strokes, cancer, and bleeding, aspirin comes out looking protective overall, potentially extending our lifespan.

The aspirin phytonutrient isn’t just found in willow trees, but throughout the plant kingdom. This explains why the active ingredient in aspirin is found normally in the bloodstream even in people not taking aspirin.

Even those low levels caused by smoothie consumption significantly suppressed the expression of that inflammatory enzyme at a genetic level.

Some vegetarians had the same level in their blood as people actually taking aspirin. Vegetarians pee out as much of the active metabolite of aspirin as aspirin-users do, just because they’re eating so many fruits and vegetables.

Because the anti-inflammatory action of aspirin is probably the result of this active ingredient in aspirin, salicylic acid, and the concentrations of [salicylic acid] seen in vegetarians [have] been shown to inhibit [that inflammatory COX enzyme] in vitro, [it’s] plausible that dietary salicylates may contribute to the beneficial effects of a vegetarian diet, although [they say] it seems unlikely that most omnivores would be able to achieve sufficient dietary intake of salicylates to have a therapeutic effect.” Though, they could certainly eat more fruits and veggies, too.

Some vegetarians had the same level in their blood as people actually taking aspirin. Vegetarians pee out as much of the active metabolite of aspirin as aspirin-users do, just because they’re eating so many fruits and vegetables.

Because the anti-inflammatory action of aspirin is partly the result of salicylic acid, and the concentrations of it seen in vegetarians has been shown to inhibit the inflammatory COX enzyme in the lab, it’s likely that dietary salicylates may contribute to the beneficial effects of a vegetarian diet. It is unlikely that most omnivores would be able to achieve sufficient dietary intake of salicylates to have a therapeutic effect.

Although salicylic acid, the main active ingredient in aspirin, is ubiquitously present in fruits and vegetables, herbs and spices contain the highest concentrations.

Chili powder, paprika, turmeric in particular have a lot, but cumin contains the highest aspirin by weight. Eating a teaspoon of cumin is like taking a baby aspirin. Consequently, populations that incorporate substantial amounts of spices in foods may have markedly higher daily intakes of salicylates. Indeed, it has been suggested that the low incidence of colorectal cancer among Indian populations may be ascribed in part to high exposure to dietary salicylates throughout life from spice consumption.

People in rural India have one of the lowest rates of colorectal cancer in the world in part because their diet is extremely rich in salicylic acid, given the substantial amounts of plant foods flavored with large quantities of herbs and spices. Some have proposed it’s the curcumin in the spice turmeric but maybe it’s the salicylic acid in cumin. And, the spicier, the better.

We may also want to eat organic. Because salicylic acid is a defense hormone of plants, the concentration is increased when plants become stressed, for example, when plants are bitten by bugs, unlike pesticide-laden plants, which have relatively stress-free growth. Soups made from organic vegetables were found to have nearly 6x more salicylic acid than soups prepared from conventionally-grown ingredients.

We should also choose whole foods. Whole-grain breads, which are high in salicylic acid, contain about a 100x more phytochemicals than white bread.


90% of people who die from any kind of cancer, die as a result of the primary cancer spreading to other organs, a process known as metastasis. The primary cancer can erode and invade vital structures, but death as a result of that is less common. There is a whole area of study looking at how cancers develop their own blood supply, called angiogenesis, the event which leads to exponential growth and eventually spread outwards, and how to minimize not just that vascular growth, but also spread through other means. Unfortunately, the rate of death from metastatic disease has not changed for the last 30 years, despite all the advances in therapeutics. We are marginally better at treating primary sites with surgery, medications and radiation, but not metastatic spread.

Although necessary to make a diagnosis, cutting into cancers, and even just doing needle biopsies, can be a source of spread, but so can chemotherapy and radiation which impact, not only on the primary cancers, but also on the surrounding healthy tissues, possibly providing an environment more conducive to spread.

Another trigger is lifestyle, particularly through the foods we eat. There is a receptor on the surface of many cells called the “Fat Controller”, CD36. Also involved in the progression of atherosclerotic disease as well as other chronic conditions, it is implicated in metastatic spread of cancer cells. It is found in higher concentrations of some types of cancers, especially those prone to spread. It is unregulated by fat, especially saturated fat, and in particular, palmitic acid. Originally described after it was discovered in palm oil, it is also found in high concentrations in meat and dairy. Animal studies have shown that various cancers metastasize to a much greater extent when they are fed diets higher in saturated fat. If those receptors are blocked, the cancers do not spread to the same degree. We know from human studies that diets higher in fat not only increase the rate of cancer formation, but also the incidence of recurrence, usually because of undetected metastatic disease. So, although developing treatments to block these receptors is important, why not just remove the trigger?  The fat in the diet! In doing so, not only do you reduce the risk of getting cancer and having it spread and/or return, but you also reduce various other conditions such as vascular disease, diabetes and obesity

Cancer cells love fat since it’s a potent source of energy. Fat has the highest stored energy of any molecule. Cancer cells love sugar because of its immediate energy supply, but they also love fat because of its stored energy supply. Studies looking at animal fat suggest that it is in fact the fat, and not the animal protein, which is the causal link. The protein has its own issues, but not when it comes to cancer. Animal protein has a higher proportion of acidic amino acids, leading to more osteoporosis since calcium is used by the body to buffer acidity. It is also very proinflammatory.


Viruses That Can Lead to Cancer

Viral infections rank 3rd with respect to causes of cancer, behind smoking and a poor diet. They cause about 15% of all cancers. Keep in mind that even if you’re infected with a virus that’s linked to cancer, it doesn’t mean you’ll get the disease for sure. And there are things you can do, from vaccines to lifestyle changes, to prevent yourself from catching the virus in the first place. Here is a list of some of the more common ones.

Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV)
Kaposi Sarcoma-Associated Herpesvirus (KSHV)
Merkel Cell Polyomavirus (MCV)
Human Papillomavirus (HPV)
Human Immunodeficiency Virus Type 1 (HIV-1, or HIV)
Bovine Leukemia Virus

Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV)

HBV and HCV can cause a liver infection that can sometimes lead to liver cancer. You pick up these viruses if you share needles used to inject drugs, have unprotected sex, or get a transfusion with contaminated blood.

Although there is no way to get rid of HBC, you can often get rid of HCV after a few months of treatment. 

There’s a vaccine to prevent HBV, but not HCV. Those with higher chances of getting HBV, like healthcare workers, should get vaccinated. That also includes people who have HIV or those who inject drugs. These viruses originated in horses.

Kaposi Sarcoma-Associated Herpesvirus (KSHV)

KSHV is a herpes virus that can cause Kaposi sarcoma, a cancer of the blood vessels, as well as two types of lymphoma, a blood cancer of lymph cells. You’re more likely to get cancer from KSHV if you have a weakened immune system, which can occur not only by having an HIV infection, but are also taking any kind of medication for arthritis, chemotherapy or even have a poor, pro-inflammatory diet. Herpes viruses originated in apes.

Merkel Cell Polyomavirus (MCV)

MCV is a common virus that infects the skin. It usually doesn’t cause symptoms or lead to cancer but in some people, MCV causes a rare skin cancer called Merkel cell carcinoma. To help prevent Merkel cell carcinoma and other skin cancers, it is important to use sunscreen with an SPF of at least 30 when you go outside for more than 20 minutes of direct sunlight exposure

Human Papillomavirus (HPV)

HPV is a group of more than 200 viruses, and at least a dozen of them can cause cancer. HPV can spread during vaginal or anal intercourse and oral sex. HPV often goes away on its own and doesn’t cause any health problems. Some people stay infected permanently though. If they have the HPV that causes cancer, it can lead to cancers of the cervix, vulva, vagina, penis, anus, tonsils, or tongue. HPV vaccines are available for anyone over 9 years of age (basically the age kids start to be sexually active) and can keep you from getting infected with the virus. 

Human Immunodeficiency Virus Type 1 (HIV-1, or HIV)

HIV spreads through unprotected sex and infected needles or through exposure to blood products in healthcare. An unborn baby can also catch it during pregnancy, and a mother with HIV can spread it to a baby if they breastfeed. People with HIV have a weakened immune system and have a greater chance of getting cancers such as:

  • Kaposi sarcoma
  • Non-Hodgkin’s lymphoma
  • Cervical cancer

You can help prevent HIV if you practice safe sex and don’t share needles used to inject drugs. You can also use HIV prevention medicines such as pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP).

While there’s no cure, you can control HIV with treatment and many people with HIV live normal lives.

Human T-Cell Lymphotropic Virus Type 1 (HTLV-1)

HTLV-1 infects T cells, which are a type of white blood cell. It can cause leukemia and lymphoma. HTLV-1 spreads several ways, including:

  • From mother to child during birth or through breastfeeding
  • Sharing needles with infected people
  • Organ transplant
  • Unprotected sex

About 2% to 5% of people who have the virus get adult T-cell leukemia or other health conditions. Symptoms and how it develops are different for each person. There isn’t a cure or treatment for HTLV-1. It’s a lifelong condition. 

Epstein-Barr Virus (EBV)

EBV is a common virus. Most people get infected with it at some point in their lives. Most of the time, people with EBV stay healthy and don’t have symptoms. For others, EBV can cause mononucleosis and other more serious conditions, from viral meningitis to pneumonia. Several cancers are linked with EBV as well:

  • Burkitt’s lymphoma
  • Nasopharyngeal carcinoma (cancer of the upper throat)
  • Hodgkin’s and non-Hodgkin’s lymphoma
  • T-cell lymphomas
  • Post-transplant lymphoproliferative disorder (too many white blood cells)
  • Leiomyosarcoma (cancer in the soft tissue)

You can help protect yourself from EBV by not kissing or sharing drinks, food, or personal items with someone who has the virus. There’s no specific treatment if you have EBV, but you can ease symptoms if you drink plenty of fluids, get rest, and take medicines for pain and fever.

Bovine Leukemia Virus (BLV)

Bovine leukemia virus (BLV) is a retrovirus which causes a disease called enzootic bovine leukosis in cattle. It is closely related to the human T‑lymphotropic virus type 1 (HTLV-I). In cattle, most infected animals are asymptomatic. Leukemia is rare (about 5% of infected animals), but lymphoproliferation is more frequent (30%).

BLV DNA is generally found at higher rates in humans who have or will develop breast cancer, according to research done with subjects from several countries. These findings have led to a hypothesis that BLV transmission plays a role in breast cancer oncogenesis in humans. Although it is transmitted from cow to cow through contaminated, reused needles when they inject steroids and growth hormones, humans can get infected by eating contaminated meat.


For more detailed information about the basics of cancer, click here.

Top10 Cancer Fighting Super Foods

Can You Eat To Fight Cancer YouTube Video – Describes how we can reverse or even cure cancer growth by reversing angiogenesis (new blood vessel formation)

Eat To Beat Cancer Program (

Breasts: The Owner’s Manual” Dr. Kristi Funk. Breast cancer surgeon.

Radical Remission. Surviving Cancer Against all Odds“. Kelly Turner, Ph.D. A must read for anyone with cancer or anyone taking care of or knows someone with cancer. – great nutritional information for cancer patients as well as a cancer prevention strategy. Online courses available – great breast cancer resource run by Dr. Kristi Funk, breast surgeon and cancer specialist.





(Some of this information was summarized from Dr. Kristi Funk’s book Breasts: The Owner’s Manual)

Breast cancer is clearly a concerning issue for most women and deserves a separate discussion. As concerning as it is, it’s incidence, relative to other chronic and debilitating conditions, should be kept in perspective. Heart disease is 21x more prevalent than breast cancer and it’s 7x more likely to kill women than breast cancer. Diabetes occurs at the same rate as breast cancer (~ 1 in 8) but has a higher mortality rate, mostly due to cardiovascular disease, but pre-diabetes affects 30% of women. The good news is that whatever you do to minimize the risks of one disease, also go a long way to minimize the risks of the others.

In the US, 1 in 8 women will be diagnosed with breast cancer during their lives. Risks increase with age with the median age being 62. Based on age, the odds break down as follows:

  • 20’s – 1:1567
  • 30’s – 1:220
  • 40’s – 1:68
  • 50’s – 1:43
  • 60’s – 1:29
  • 70’s – 1:25
  • 80’s – 1:8

Only 2-5% of women with breast cancer are positive for the BRCA mutation and only 30% of those actually express it. Even in identical twins with the mutations, there is only a 20% chance of the second twin getting breast cancer if the first twin got it. Over 500 genes have been mapped to increased risk of breast cancer. Actually, 87% of breast cancer diagnoses occur in women who do not have a first degree relative with the disease. The vast majority of breast cancers are related to lifestyle choices, not genetics. By following a healthy lifestyle, breast cancer risk drops by 50% at menopause and by 80% for older women. These healthy choices include:

  1. Following a diet prioritizing whole fruits and vegetables and minimizing or eliminating meat and dairy.
  2. Regular exercise. Helps lower weight and improves clearance of estrogen compounds.
  3. Not smoking.
  4. Not drinking alcohol. It increases estrogen production, impairs immune function and impairs enzymes which monitor DNA mutations.
  5. Losing weight. Adipose (fat) cells make estrogen along with many other inflammatory compounds.

ALCOHOL is the most prevalent controllable risk factor for breast cancer across all cultures and populations.

  • 1 drink a day increases the risk of developing breast cancer by 10%.
  • 2 drinks a day increases the risk by 30%.
  • 3 a day, the risk goes up by 40%.
  • For each drink above that, the risk goes up an additional 10%.

Why is alcohol so carcinogenic, especially with breast cancer?

  • It increases estrogen levels.
  • It impairs immune function.
  • It can cause bone marrow suppression leading to low red blood cells (anemia) and low white blood cell counts, impairing immune function.
  • It creates toxic metabolites, especially acetaldehyde, which is produced even if you gargle with alcohol-based mouth rinses.
  • It inactivates an enzyme, methylenetetrahydrofolate reductase (MTHFR), which converts folic acid into its active form, methyl folate.
  • It depletes thiamine (vitamin B1) leading to Wernicke’s Encephalopathy, characterized by confusion, as well as visual, balance and coordination problems. If left untreated, this evolves to Korsakoff Dementia which is a permanent form of dementia.
  • It directly causes DNA damage.
  • It causes oxidative stress.

BREAST CANCER MYTHS. Although there are rumors floating around out there, there is little to no proof that the following is linked to breast cancer:

  • Bras. Size, design, tightness, wires, material… no known risk increase.
  • Antiperspirants and deodorants. There is an argument that the aluminum in many antiperspirants, gets absorbed and can be toxic, especially when applied after shaving armpits but this has never been definitively proven. Many of the chemicals in these products, especially parabens are not great though.
  • Hair relaxers and hair products. Although some, especially in the African American community, do contain estrogen compounds and can cause other problems. These products, along with all cosmetic and personal care products, are full of unhealthy chemicals however.
  • Nipple piercings and tattoos.
  • Mobile phones have not been linked, even if carried in the bra. It looks terrible but that’s about it. There is a lot of debate about this however as far as overall health is concerned.
  • Living near power lines does not cause cancer.
  • Caffeine. It may contribute to fibrocystic breasts and pain and such changes may make identifying breast cancer more challenging but the condition in and of itself does not cause cancer.
  • Oral contraceptive pills. Overall, the risk is very small and only while you are taking them. While on an OCP, there is a 14% increased risk (pretty tiny) which drops to 16% within 4 years of stopping and then to 7% within 10 years. All in all, a pretty small risk. The fewer hormones you can put into your body, the better though.
  • Previous abortions or miscarriages. Neither increase your risk, despite the flood of hormones.
  • Breast Implants do not cause breast cancer. They may make detection a little more difficult but that’s it.
  • Breast reductions also do not cause cancer. They actually reduce the risk because of the loss of breast tissue. The loss of extra fat helps but it’s really the loss of actual glandular tissue which is where the cancer come from in the first place.
  • Large breast size, is a risk factor however. Breasts are made up of glandular tissue and fat. The more overweight you are, a risk factor in general for breast cancer, and/or the more glandular tissue you have, the greater the risk. More fat = more estrogen. More glandular tissue = more tissue which can mutate into cancer cells. This is why, although only accounting for 1% of cases, breast cancer also affects men.
  • Dairy is not all bad. Although dairy has many downsides to it (see below), it does contain some compounds beneficial to breast tissue like calcium, lactoferrin, vitamins D, butyrate and linoleic acid. However, the downsides of excess hormones, saturated fat, viruses and other chemicals outweigh the benefits. All those beneficial compounds are also available in healthier plant sources. In particular, calcium is found in significant amounts in dark leafy greens, broccoli, beans, soy and almonds.

What you eat is the is the single most important lifestyle habit which determines cancer risk. ALL cancer risk, especially hormonal cancers like breast cancer.


  • Dietary Fiber, which only comes from plants. Animal products contain no fiber. 30 grams a day reduces breast cancer risk by 30%. Only 20 grams reduces risk by 15%.
  • Cruciferous vegetables like
    1. Broccoli. Include sprouts, which have much higher concentrations of phytonutrients.
    2. Cauliflower
    3. Cabbage
    4. Brussels sprouts
    5. Radishes
  • Leafy greens like:
    1. Dandelion. This “weed” had 10x the phytonutrient concentration than spinach and kale
    2. Spinach
    3. Kale
    4. Arugula
    5. Collards
    6. Bok choy
    7. Beet greens
    8. Swiss chard..
  •  Berries:
    1. Indian gooseberry (Amla) which has 124x the antioxidant concentration as blueberries.
    2. Blueberry, wild preferably.
    3. Cranberry.
    4. Raspberry.
    5. Strawberry
    6. Cherry
  • Apples. 1 a day decreases breast cancer risk by 24%
  • Sweet potatoes. Different from yams, sweet potatoes are high in a unique protein sporamin which has aromatase-inhibitor activity. This leads to less estrogen in the body and lowers all endocrine cancer risks.
  • Tomatoes. When cooked, their lycopene content goes up by 5-10 times.
  • Mushrooms. Only 10 grams (½ a button mushroom) a day decreased BC risk by 64%. This also has to do with aromatase-inhibitor activity. Some studies have actually shown the consuming mushrooms daily has the same cancer reducing benefit as such drugs as Arimidex, without all the side effects.
  • Garlic, Onions, Leeks, Chives, Scallions.
  • Spices:
    1. Turmeric (curcumin). It’s the orange/yellow spice in curry
    2. Clove (second to Amla in antioxidant concentration)
    3. Ginger
    4. Paprika
    5. Cumin
    6. Cinnamon
    7. Sage
    8. Rosemary
    9. Oregano
    10. Thyme
  • Sea vegetables like seaweed, wakame…
  • Cacao. The pure but bitter form of chocolate is great. Anything else has dairy so avoid it.
  • Soy products. They actually block cancer formation and prevent recurrence.
  • Nuts and seeds. Just not too much . Each handful, regardless of the nut, is about 15 grams of fat. the proportions of healthy fats are better but a whole bag is still not good.
  • Coffee and Tea, especially Green tea, but black, Oolong and Pu’er are good. Herbal teas have other benefits but since they are net derived from the Camellia sinesis plant like the caffeinated forms of tea are, they do not the potent tea flavonoids like EGCG. Matcha tea is basically concentrated green tea which includes the whole leaf. Super good.
  • Plain old water is essential. Just filter it and do not drink it from plastic bottles. The most common ones are basically filtered tap water anyway but you also get a dose of hormone mimicking chemicals from the plastic.
  • Vitamins and Minerals. Although it is always better to get them from whole fruits and vegetables, sometimes you need supplementation. Here are the important ones shown to reduce cancer, including breast cancer:
    1. Vitamin A – carrots, sweet potatoes, kale, spinach, broccoli and yellow squash.
    2. Beta-carotene (which becomes Vitamin A in your body) – apricots, cantaloupe and sweet peppers
    3. Vitamin B6 – avocado, pinto beans, sunflower seeds, sesame seeds and pistachios.
    4. Vitamin B12 – not found in any plant foods unless they are not washed, since it comes from a bacterium in the soil. Animal meats contain B12 if the animals eat grass which still have the bacteria or are fed supplemented feed.
    5. Folic Acid (Folate). Along with B6 and 12, it creates glutathione, a powerful intracellular antioxidant which detoxifies and eliminates carcinogens. It’s found in peas, beans, nuts, spinach, collard greens, asparagus and fortified wheat.
    6. Vitamin C – the typical sources like oranges, lemons, limes, grapefruits and tangerines are great but other vitamin c sources include carrots, sweet potato, greens and broccoli.
    7. Vitamin D – basically you get it from the sun or fortified foods.
    8. Calcium – kale, broccoli, dark greens, soy and fortified cereals. Dairy contains calcium but less of it gets absorbed and you consume all the other bad stuff which comes with dairy (fat, hormones, chemicals…)
    9. Long-Chain Omega 3 Alpha Linolenic Acid (ALA). Fatty fish (salmon, sardines…) do contain high amounts of these beneficial fats, they don’t make it but get it from the algae they eat. This is why farm-raised fish, fed unnatural grains like soy and corn, have much lower levels of omega 3s. It’s better to get them from algae directly or some plant sources like flax seeds and walnuts.

Top 12 anti-estrogenic foods

  1. Soy products. Keep them organic.
  2. Flaxseeds. You must grind them to absorb them. Otherwise, they just give you bigger poop.
  3. Cruciferous veggies (broccoli, cauliflower, Brussels sprouts…)
  4. Amla (Indian gooseberry). It is anti-estrogenic, anti-atherosclerotic and anti-diabetic. It lowers LDL and decreases inflammation
  5. Fiber in general (all plants – no fiber in animal products)
  6. Berries
  7. Apples
  8. Tomatoes 
  9. Allums (onions and garlic)
  10. Mushrooms
  11. Turmeric
  12. Seaweed
  13. Cacao
  14. Red grapes
  15. Whole grains
  16. Citrus
  17. Aloe
  18. Tea, especially green tea. Adding lemon increases ECGC absorption by 5x


MEAT. In the US, 58% of meat consumed is red meat (beef, pork, veal, mutton, lamb, sheep, goat and game). 32% is poultry, mostly chicken and only 10% is fish. In addition to all the fat and excess protein which we don’t need, there are lots of unwanted and unhealthy compounds that come with meat like:

  • naturally occurring estrogens and other hormones, especially in dairy (it IS breast milk after all). You don’t need any extra hormones in your body.
  • synthetic estrogens like zeranol (Ralgro) which 100,000 more potent than BPA from plastics and has been shown in humans to be potent enough to accelerate puberty. It’s still routinely given to American and Canadian cattle and is why imports of beef from our 2 countries have been banned in Europe since the 1980’s.
  • rBGH. Recombinant Bovine Growth Hormone, as its name suggests, is a growth hormone known to increase dairy cow milk production by 10-15%. This gets into the milk and also the meat that those cows are eventually slaughtered for.
  • Insulin-like growth factor 1 (IgF-1). This compound is normally produced to stimulate cellular growth. It’s partly how your hair and skin grows, how muscles get big and how new cells develop but any extra floating around also stimulates cancer cells to grow and spread. Animal protein, not plant protein, stimulates our bodies to produce unnecessary amounts of IgF-1. The more you have floating around, the more cancer cells are stimulated to grow and spread. Animal protein sources also contain IgF1 adding more fuel to the fire.
  • Mutagens (mutation-causing compounds). When cooked, meats produce many compounds known to cause cancer like polycyclic aromatic hydrocarbons (PAHs) and heterocyclic amines (HCAs)
  • Nitrates. Healthy when obtained from plants but when obtained from meat and combined with other meat-born compounds, they are turned into nitrosamines and nitrosamides, known carcinogens. Everyone has by now heard how the World Health Organization has categorized red meat and processed meat (bacon, salami, cold-cuts…) as class 1 carcinogens. That’s the same category as smoking, asbestos and plutonium.
  • Saturated fat. Although you can get some saturated fats from some plant sources like coconut oil (95% saturated fat) and vegetable oils, the vast majority of it comes from meat and dairy. Cheese is actually the #1 source of saturated fat in our diet. Surprisingly, based on % of calories, skinless broiled chicken breast has more saturated fat than red meat along with the same amount of cholesterol.
  • Other damaging and inflaming compounds like
    1. Heme iron,
    2. N-nitroso compounds,
    3. TMAO
    4. Neu5CG
    5. Chemicals like pesticides, herbicides and heavy metal contaminants.

DAIRY. Milk products have been linked to many chronic diseases because of their pro-inflammatory effects, hormonal effects and allergic load. Here are some of the issues with dairy:

  • Remember that dairy is breast milk that a cow produces for her calf to make it grow from 50 lbs. at birth to over 600 lbs. in a year. A cow’s milk evolved to have the right combination of proteins and hormones for it’s own baby, not for human babies and certainly not for human adults. Estrogen, artificial hormones like zeranol, rBGH (recombinant bovine growth hormone) are just a few of the hormones which come from dairy. The higher the fat content of the dairy, the more estrogen is also passed along since it is fat soluble.
  • It contains the growth promoting compound Insulin-like Growth Factor 1 (IgF-1). Normal for a growing infant, it only feeds cancer cells in adults.
  • It’s loaded with chemicals it either is injected with (like hormones or antibiotics) or fed. Their feed is almost always genetically modified and heavily pesticide and herbicide laden corn or soy which the animals concentrate in their fat. these chemicals then get passed along to those who consume it.
  • Bovine Leukemia Virus (BLV). This cow virus infects their mammary (milk-producing) glands and gets into the milk and dairy products we consume. This virus is extremely common occurring in 100% of cows on farms of over 500 heads (the average herd size is 234, up from 73 in 1992). It is so common because it is spread through body fluid contamination and ranchers do not sterilize their blood contaminated instruments like injection needs, tail and horn clipping shears or inseminating equipment, between cows. In a survey of humans, 74% were positive for antibodies against this virus indicating previous exposure to the virus. The estimates are that as much as 37% of breast cancers may be linked to this virus. Programs to eradicate this virus in cattle have been successful in 20 other industrialized countries. The US however is not one of them. Dairy companies claim that it costs too much to implement such programs and they are certainly not going to do it voluntarily. It’s less expensive for them for their customers to get cancer!!! For more on this topic, click here.

CHICKEN AND EGGS. Until 2016, when forced to do stop doing it, the poultry industry routinely fed their chickens arsenic as a means to eradicate parasites like tapeworms and mites. Chicken is still contaminated with arsenic because they are fed rice and soy grown in arsenic contaminated soil. After rice, chicken is the 2nd highest contaminated food product in the US, after rice. A 2012 study of preschool children found that 100% of them had arsenic levels so high that they exceeded the arsenic-cancer risk ratio allowable by the government. The source of the contamination in these kids was chicken. Farmers are not required to disclose what chemicals are in their feed but they are almost universally contaminated with antibiotics and pesticides. Some of these contaminants include acetaminophen (Tylenol), Prozac, anti-fungal medications, caffeine, antihistamines and illegal antibiotics like fluoroquinolones, which come for their feathers which are ground down and fed back to the chickens in their meal. It’s actually called “feather meal”.

As far as eggs are concerned, up to 2 a week seems to pose no risk but for every 2 eggs consumed daily, there is a 22% increased risk of developing breast cancer. Eggs contain a lot of saturated fat, linked not only to breast cancer but also heart disease. They also contain choline, a compound which is turned into tri methyl amine oxide (TMAO) which is also linked to breast cancer and atherosclerotic heart disease and stroke. Egg consumption is also linked to type 2 diabetes.

The estrogen found in chicken meat is identical to human estrogen and thus adds to the estrogen pool in your body. This is partly why chicken consumption is linked to increased breast cancer risk.

All animal meats contain the potent growth hormone Insulin-Like Growth Factor 1 (IgF-1). It helps babies grow but later, it helps cancer cells grow. A study was done on women consuming chicken regularly. IgF-1 as well as a compound which binds, and eliminates IgF-1, IgF-1 Binding Protein, were measures and their blood was also dripped onto petri dishes in lab on which breast cancer cells grew. In the women eating chicken, IgF-1 levels were high, IgF-1 Binding Protein levels were low and their blood had no significant impact on the cancer cells. When those same women had all animal products removed from their diet, after only 2 weeks, IgF-1 levels plummeted, IgF-1 Binding Protein levels soared and 90% of the beast cancer cells on the dishes died! Thus shows 2 things.  A plant predominant diet is great for you and it only takes a few short weeks for the health benefits to become clinically evident. All the women felt great by the way on the vegan diet.

FAT. Simply put, fat generates and stores estrogen. The more fat on your body, the more estrogen you produce. The more fat you consume, the higher the risks of many diseases including breast cancer, other cancers like colon cancer, heart disease, stroke, diabetes and Alzheimer’s disease. Some fats are worse than others.

  • TRANS FATS. The worst type of fat to consume are trans fats. These mostly man-made fats are found primarily in processed foods like doughnuts, margarine, shortening, fried foods, microwave popcorn and French fries. When trans fats were banned in Denmark, their deaths from cardiovascular disease rate dropped by 50%. Breast cancer patients who continue to consume butter, lard or margarine daily have a 212% increased death rate. Trans fats also go by other names on labels like “partially hydrogenated oil” and “high stearate”. Trans fats also occur naturally in meat and dairy.
  • SATURATED FATS. Found primarily in meat and dairy, some vegetable foods also contain saturated fat. Many oils, like coconut oil, save significant amounts of saturated fat. Coconut oil is actually 95% saturated fat. In a study of 4400 breast cancer patients, the highest trans fats consumers had a 78% increased death rate, saturated fat consumers had a 41% increase death rate compared with the lowest consumers. The following is a list of the top 10 foods eaten by Americans based on the amount of calories coming from fats. Notice where chicken breast is on the list! Higher than red meat!
    1. Cheese
    2. Pizza
    3. Grain-based desserts (cake, cookies, pastries, donuts)
    4. Ice Cream
    5. Chicken (one skinless breast = 19% fat. With skin = 36% fat).
    6. Processed meats (sausage, hot dogs, bacon, ribs…)
    7. Burgers
    8. Mexican dishes
    9. Beef
    10. Reduced fat milk. 2% milk is still 30% fat by calories. Whole milk is 3.25% fat.
  • MONOUNSATURATED FATS (MUFAs) and POLYUNSATURATED FATS (PUFAs) are healthier choices however they can also be problematic depending on the source and the amount.
    • PUFAs are liquid at room temperature and are essential since we cannot make them. They help with muscle metabolism and improve blood clotting. Omega 3 PUFAs, also called alpha-Linolenic acid (ALA), are found in:
      • Flaxseed
      • Walnuts
      • Canola oil (only organic, cold pressed)
      • Non hydrogenated soybean oil
      • Oily, cold-water fish like salmon, mackerel, herring and sardines.
    • MUFAs are found in:
      • Olive oil (extra virgin)
      • Canola oil
      • Other, less beneficial plant oils like sesame, walnut, sunflower, safflower
      • Avocados
      • Olives
      • Nuts like walnuts, almonds, cashews, pecans, macadamia and nut butters.

ALCOHOL. Simply put, alcohol is a toxin which increases estrogen levels, impairs immune function, creates toxic metabolites and inactivates the enzyme MTHFR (methyl tetra hydro folate reductase) which converts folic acid into methyl folate, a potent DNA damage surveillance and repair compound. There are studies showing that a small amount of alcohol is protective from a cardiovascular standpoint but it does increase breast cancer risks. Even one drink a day. 

The more folate you have around, the better. Foods high in folate include:

  • Broccoli
  • Brussels sprouts
  • Leafy greens, especially cabbage, kale and spinach
  • Peas
  • Chickpeas (think hummus) and Kidney beans.

ARTIFICIAL SWEETENERS. Although they are not directly linked to breast cancer risk, they are indirectly by contributing to insulin resistance and obesity.



LOSE WEIGHT. Being overweight is the single most preventable contribution to the causation of breast cancer worldwide with 25% of worldwide cases being due to the combination of being sedentary and overweight. Studies show that gastric bypass surgery leads to an 85% decreased risk of breast cancer. Based on body mass index (BMI) which is a ratio of your height to weight, your breast cancer death risks increase as follows:

    • BMI 18.5-25 (normal weight) = baseline risk of death
    • BMI 25-30 (overweight) = 34% increased risk
    • BMI 30-35 (obese) = 63% increased risk
    • BMI 35-40 (morbidly obese) = 70% increased risk
    • BMI > 40 (severely obese) = 112% increased risk

Another weight-related breast cancer statistic looks at your present weight as it compared to your high school weight.

  • If your weight is up by 8-13 lbs., risks of developing breast cancer increase by 25%
  • If your weight is up by 14-29 lbs., the risk increases by 60%
  • >25lbs, it’s 100% (double the risk).

Increased weight doesn’t just increase the risks of developing cancer, but also have a larger tumor at the time of diagnosis and a much greater risk of metastasis (spread) of the cancer.

Before menopause, the ovaries make most of a woman’s estrogen. After menopause, it’s the fat which produces it. The more fat you have, the more estrogen is produced and the greater the risk of breast cancer. Fat cells make an enzyme aromatase which converts other hormones into estrogen. Obese women have 130% higher estradiol (the precursor to estrogen) than lean women partly explaining their increased risk of breast cancer. The fat in breast tissue, along with the cancer cells themselves also produce aromatase. In fact, the fat in breasts makes almost 10x more estrogen than what is measured in the blood. Fat cells, also known as adipocytes, produce a variety of other inflammatory and tumor cell growth-promoting compounds such as:

  • TNF alpha – Tumor Necrosis Factor alpha (TNF alpha), an inflammatory cytokine
  • IL-6 – Interleukin 6, another pro-inflammatory cytokine
  • VEGF – Vascular endothelial growth factor (VEGF) is a signaling protein that promotes the growth of new blood vessels. Good when healing is needed. Bad when tumors want to grow.
  • HGF – Hepatocyte growth factor  is a paracrine (hormone) cellular growth and motility
  • IGF-1 – Insulin Like Growth Factor 1 stimulates cellular growth, also important when we are growing but it also stimulates cancer cell growth.
  • Leptin – this hormone helps regulate and alter long-term food intake and energy expenditure. More of it disrupts proper hunger signals to the brain leading to even more weight/fat gain.

. People who move more have less disease, of all kinds. Just walking 1.5-2 hours a week drops your breast cancer risks by 18%. Increase that to 3-4 hours a week of moderate exercise and the risks drop by 40%. More than 4 hours and rates drop by 58%. It doesn’t matter what you do, just find something you like and do it. There are a variety of reasons why exercise helps reduce cancer risks. Here are a few:

    1. Estrogen levels alone drop, even compared with equal weight women.
    2. You lose weight.
    3. Hormones and toxic compounds produced by fat decreases as you lose weight.
    4. Insulin resistance improves.

In addition, other conditions improve like:

  • Heat disease
  • Blood pressure
  • Diabetes
  • Mood (anxiety and depression)
  • Sleep improves
  • Bone health, endurance
  • Decreased lymphedema
  • Stress improves

Although doing both aerobic (running, biking, swimming… anything which raises your heart rate for a regular period of time) and anaerobic (resistance training like weights or high impact aerobics, boot camp…) are both important. Resistance is particularly important because of how good it is for bone health as well as maintaining muscle mass both of which decline after 30 years of age). However, ultimately, the best exercise for you is the one you like because it’s the one you are going to do consistently.

GET PREGNANT. The earlier the better. Studies show that the younger you are when you get pregnant, the lower the rate of breast cancer relative to women who never have kids.

DON’T SMOKE OR VAPE. In a nutshell, women who smoke have at least a 50% increased risk of developing breast cancer. If you smoke before you have your first child, the risks increase to over 70%. Not to mention all the other diseases smoking contributes to like lung, colon and other cancers, heart disease, strokes, dementia and lung diseases of various kinds.

HORMONE REPLACEMENT THERAPY (HRT). Although the symptoms of menopause can be quite debilitating for women, you have to balance the symptomatic benefits with the clear increased risks of developing not only breast, but also uterine cancer. In addition, HRT increases the risks of developing other conditions such as heart disease, osteoporosis, strokes and dementia.

MINIMIZE TOXIC EXPOSURES. We have polluted our environment and daily lives to the point that we can’t even keep up with all the toxic exposures we have to deal with every day. By the time a woman leaves her home, just the daily preparations for life have exposed her to hundreds of chemicals. We have to live in the world we have created but we can also control a lot of what we expose ourselves to. It starts with education. Here are a few examples of controllable toxic exposure we can minimize:

  1. Radiation. This comes in a variety of forms including radon, cell phones, Bluetooth, Wi-Fi and even the sun but the vast majority of our exposure comes from medical tests and treatment. Even just one spine X-ray to monitor scoliosis (curvature of the back) increases breast cancer risks by 170%. Chest radiation for Non-Hodgkin’s lymphoma prior to the age of 15 increases breast cancer rates by 136x. That’s 13,500% increased risk. Now you obviously have to treat lymphoma but the point is, limit tests to those you absolutely need. You don’t need dental X-rays every time you get a teeth cleaning. You don’t need CTs of the sinuses if you are not really sick. As mentioned above, the data on non-ionizing radiation like cell phones and Bluetooth, even microwave ovens is not that solid but we didn’t evolve with it so I would still minimize it.
  2. Endocrine Disruptors. 90% of the over 100,000 synthetic chemicals in the US have not been tested for their effects on human health. Only 70 compounds are monitored in municipal water supplies and not one chemical has been added to this list in over 20 years! Many of the compounds behave as hormone mimickers. Some of the hormones which these chemicals mimic include insulin testosterone, PTH (parathyroid hormone), growth hormone, thyroxin (thyroid hormone) and even melatonin. The most prolific however are the xeno-estrogens, compounds which behave like human estrogen. Although the EPA formed the Endocrine Disruptor Screening Program in 1998, it wasn’t until 17 years later in 2015 that they came out with their first review of only 52 pesticides. That leaves about 98,950 other chemicals to look into! The list of chemicals and their sources is exhaustive, not to mention depressing. Keep in mind that if it’s in the air, in your food, or even on your skin, it is IN YOU! Here are some tips to minimize exposures:
  3. BAN PLASTICS. All of them. Certainly NEVER COOK in them. Plastic bottles, can liners, food packaging, cups, dish-ware, sippy cups, straws, even our clothing (like synthetic sports clothing) leach chemicals which we absorb. Even BPA-free plastics still harbor other, non-tested plastics which are harmful. Choose glass or stainless steel. Even cans of soda and beer are lined with plastics. One can of coke or beer raises you blood BPA levels by 1600%.
  4. Wash your hands but avoid soaps with chemicals like triclosan, which is found in most commercial liquid hand soaps. It’s toxic.
  5. Dust and vacuum. Chemicals come off even our electronics, furniture and carpeting. Try to use a HEPA filtered vacuum with a closed system so the particles are not recirculating.
  6. Eat wisely. If possible, choose organic products, especially if you are going to eat the skin, and always wash your produce. Check out the Environmental Working Group’s “Dirty Dozen” and “Clean Fifteen” for the foods which you should try to buy organically and which ones you don’t have to worry about. Even if not organic, it is still better to lean more of fruits and vegetables which you can wash rather than animal products which you can’t. There are too many hormones and chemicals in meat, dairy and fish to count. Although washing with just water is quite effective, a 10% salt solution or using baking powder and some white vinegar does a great job.
  7. Choose better household products. Chemicals, chemicals, chemicals… Enough said. Vinegar or lemon and water does just as good a job as many harsh chemicals. Avoid non-stick cookware. Use bleach-free paper products… The cleaner, the better.
  8. Grow house plants. Indoor air can be as much as 100x more polluted that what is outside your door. Plants act as detoxifiers. Some examples of good ones include: philodendrons like spider plants, peace lilies, mother-in-law’s tongue and mums.
  9. Choose cleaner personal care products. Shampoos, conditioners, lipstick, mascara, deodorants, hair products, sunscreen… the list is long and it’s scary how many chemicals we put on our bodies. Again, if it’s on you, it’s in you. The EWG also has some great resources to find safer products, including sunscreens.
  10. Exercise. In addition to all the other benefits of exercising, it helps eliminate toxins. They are excreted in sweat, separately from urine and stool. Sweating out toxins is also why saunas are reportedly quite beneficial.

STRESS MANAGEMENT. Acute stress is normal, as are our normal physiologic responses which include increased blood pressure and heart rate, rises in blood sugar and cortisol, all basically meant to deal with an acute danger. Chronic daily stress however, with these responses, even at low levels over long periods of time contribute to all diseases, including breast cancer. Long term stress results in elevation of various inflammatory compounds like interleukin 1 and 6, lowering of protective compounds like natural killer cells and elevation of various hormones including estrogen and cortisol. Just about every disease we know of is worsened by chronic stress. Stress is a result of what happens to you. It doesn’t matter what happens to you. What matters is what you do with what happens to you. There is a lot that can be done about stress, from simple self-management things like meditating to more extreme, sometimes necessary measures like leaving an abusive marriage or a job you hate. Here are a few examples of stress management techniques:

  1. Better outlook and attitude goes a long way and matter in everything you do. For each positive attribute such as feeling happiness, joy, contentment… researchers in Canada found a 22% decrease in heart attacks.
  2. Just that simple act raises not only your mood but the mood of all those around you.
  3. Carrying around toxic grudges is very impactful in a negative way.
  4. Deep breathing stimulates the parasympathetic (rest and digest) nervous system. The sympathetic system (fight or flight) is what is engaged when you are acutely stressed and you see it in you shorter, shallower and more rapid breathing.
  5. Gratitude stops stress before it starts.
  6. Spirituality and faith-based communities help a lot.
  7. Sleep is a biggie. Even one night of poor sleep impacts negatively on everything in our bodies. Sleep is when your brain and body recover. Regardless of what you might think, you need a minimum of 7-8 hours of quality sleep a night. There is a TON on sleep in other parts of my site.

The UNCONTROLLABLE risk factors for breast cancer. As the Serenity Prayer says:

“God, grant me the serenity to accept the things I cannot change,
Courage to change the things I can,
And wisdom to know the difference”

You can’t do anything about things which have occurred which is why you must control everything you can. Here are some of the incontrollable things:

  • Gender. 99% of breast cancer occurs in women. About 1% of cases do occur in Men. Although heart disease is still far and away the leading cause of death in women and en, breast cancer is the #1 cause of cancer deaths in women worldwide. Rates vary 4-fold with the US being #1 followed by European countries and then other developed countries. We have rates about 10% higher than any other country.
  • Age. The older you are, the greater the risk of getting any cancer, not just breast cancer. Stats on risks and age at the start of this section.
  • Age of First Menstrual Period. The earlier your period, the longer your breasts are exposed to elevated estrogen. It’s that simple. Girls used to start having their periods in their late teens. Now, it can happen as early as 9. This is thought to be related to hormone containing foods like dairy and meat as well as the hormone disrupting effects of chemicals and plastics.
  • Age of Menopause. Again, the later you stop menstruating, the longer your breasts are exposed to the effects of elevated estrogens. After menopause, the fat in your body takes over estrogen production which is why the less fat you are carrying around, the lower your risks of getting breast cancer.
  • Race. Although Caucasian women have the highest rates of breast cancer, mostly due to poor lifestyle choices, they are followed closely by African American women and then things drop off with Native Americans followed by Hispanics and last Asian women. The death rate from breast cancer is different however being highest for African Americans. Although there are socio-economic issues at play such as less access to healthcare and education with poorer lifestyle choices, most of the differences in death are from actual biologic differences in their cancers including more advanced and more aggressive cancer being more common among African Americans.
  • Height. The taller you are, the greater your risk. Although some of height is genetic, some of it is also what you eat and the hormones you consume leading to increased height. Again, more hormone = increased risk.
  • Bone Density. Higher bone density actually correlates with increased breast cancer risk. To maintain strong bones, which actually also have estrogen receptors, IGF-1 and growth hormone are produced which build and protect bones. These two hormones fuel cancer cell growth as well. This does NOT mean that you should strive for weaker bones however. The behaviors which favor healthier bones like exercising, not smoking, eating a healthy plant-based diet limiting alcohol and consuming calcium rich foods and vitamin D also protect you against breast cancer.
  • Breast Density. Denser (not necessarily larger) breasts means more glandular tissue. The more glandular tissue, the more tissue available to mutate and develop into cancer. The fatter the breasts, usually correlating with generalized excessive weight, the more estrogen you produce and the greater the risks of breast cancer. So size matters, whether just dense or not.
  • Marker Lesions. Although not cancer per se, there are a number of cell changes and benign lesions in the breasts which can lead to cancer and should be removed, if not followed closely.
  • Personal History of Breast Cancer. Although treatment for breast cancer lowers your risks of getting it on the other side, if you follow the prescribed treatments, there is still a 7% chance of getting it on the other side. All the more reason to continue to work towards lifestyle changes which minimize your risks.
  • Family History. Although there is a link, it is not as much as you would think. The largest reviews of the genetics of breast cancer reveal the following: If baseline risk is 12%, having 1 first-degree relative (sister, mother or daughter) with breast cancer raises the risk to 17%. That’s only a 5% increase in risk which is quite small. Having 2 first degree relatives with the disease increases risks to 25%, still only a 13% increase. The risk is slightly higher if it’s you sister rather than your mother and if it occurs before 50 years of age. Second-degree relatives (grandmothers and aunts) with cancer raise the risks by half the amount as first-degree relatives. Just like with every other chronic disease and most other cancers however, what we inherit which impacts on our lives more than genes is lifestyle habits.
  • BRCA (BReast CAncer) Gene Mutations. This gene suppresses the growth of tumor cells by removing faulty cells before they can form a mass. Although carrying one of these gene mutations does increase your lifetime risk of developing breast cancer by 25x and ovarian cancer by 30x, only 10% of breast cancers and 14% of ovarian cancers occur in patients with these mutations. In addition to breast and ovarian cancers, the BRCA gene mutation increases the risk of pancreatic cancer and melanoma in both women and men as well as prostate cancer in men.

Breast Cancer Screening. The whole issue of screening for all types of cancer has become a bit controversial. Some argue that finding cancers early just means that you are living with cancer longer, a phenomenon known as “lead time bias” and that we are not really curing cancer any sooner or to a greater degree. When taken as a group, the cure rate for all cancers attributed to chemotherapy (that excludes surgery or radiation without chemo) has only increased from 27% in 1972 when President Nixon declared the “war on cancer” to only 32% in 2017. That having been said, there does appear to be some value in identifying breast cancer early. Three important means of doing so is

  1. Get an annual gynecologic exam. This will not only screen for breast cancer but also cervical cancer and other gynecologic issues also.
  2. Do routine self-breast exams.
  3. Get a regular mammogram (x-ray of the breast). There is a lot of paranoia about these studies arguing that the radiation exposure is greater than the benefit of doing it regularly. Although it is not a perfect modality, it does work and the radiation exposure is tiny. You are exposed to more radiation just living in the world for 7 weeks than what you get from one mammogram. The same is true for 8 dental x-rays. One chest X-Ray = 4 mammograms and the whole-body screening PET/CT = 62 mammograms. It may not be a comfortable procedure but the risks are minimal and the benefits could potentially be life-saving.

When did my cancer start?

The simple answer is that the breast cancer cells may have invaded the walls of the duct anywhere from 3 to 20 years go. It didn’t just happen overnight.

Cancer cells are continuously developing and are being removed by our properly functioning immune system. A study of women without a history of cancer who died in car accidents found that 39% of 40-49-year olds had ductal carcinoma in situ (DCIS), an early, microscopic form of cancer. Most of these may not have ever progressed to formal cancers. Interestingly, only 10% of 50-70-year old’s had DCIS. Something about menopause was protective against DCIS progressing. As an aside, a similar study found that over the age of 70, 100% of both men and women were found to have cancerous thyroid cells present without knowing it. Cancerous cells can sit around in small groups for years, even decades, undetected, and as long as they do not invade local tissues or blood vessels, they don’t cause harm. They have to get to a critical size, which only occurs when they develop a blood supply, before they cause trouble. The exposure leading to cancer may have even happened in the womb, as is the case where the mother was taking DES (diethylstylbestrol), an estrogen compound which was used in infertility. Prenatal DES exposure is linked to vaginal cancer as an adult.

Cells replicate (divide) differently depending on your age and biology. It can take 3-6 months for a doubling of cells to occur. The following are averages:

  • Under 50, cells double every 80 days.
  • Between 50-70, doubling time is 157 days.
  • Over 80, doubling occurs every 188 days.

As an example, a 61-year-old with a 1 cm. tumor (about the size of a sugar cube and housing about 1 billion cells) probably had the first cell mutate more than 10 years ago, assuming about 20% are actively dividing at any one time.





Our immune system has many functions. It used to be primarily involved in protection against infection from foreign pathogens or healing wounds sustained in everyday life. Today, between improved hygiene, immunizations and antibiotics, their importance with respect to infection is much less called upon. Autoimmune diseases are the new “infectious disease” plaguing our immune system. Over the last 30-40 years, there has been an explosion of autoimmune diseases, rising at a rate of 7% per year worldwide, especially in developed countries. Although 30% are felt to be genetic, that means that 70% of cases are not. Lifestyle still plays a key role. Toxic exposures, diet, stress, exercise… all play a role. In identical twins, with presumably identical genes, autoimmunity rates are not identical indicating other influences. Many people with one autoimmune disease develop another one pointing to global immunity issues. 

Autoimmunity has a strong female bias, occurring 3 more often than in men. This may have to do with the fact that testosterone decreases inflammation and estrogen can stimulate certain immune cells. The female X chromosome also has more genes known to be involved with autoimmunity whereas the male Y chromosome has many fewer of these genes. In addition, pregnancy, an essentially transplant-like event, causes the female immune system to change in ways to allow a pregnancy to occur, in effect lowering a woman’s immune system. Almost half the women who develop an autoimmune condition do so within the first year after pregnancy. During pregnancy, the number of TRegs (T Regulatory cells), increase 100x and remain elevated for up to 5 years after pregnancy. It is partly this rise in TRegs that, in many cases, women already diagnosed with an autoimmune condition experience some degree of remission during pregnancy.

These are inflammatory conditions where the body mistakes its own tissues for something foreign and attacks them. Some feel that this is actually a chronic infection that the body is battling and the organ damage is incidental (collateral damage) but this is very controversial. The exact cause of autoimmune conditions is not clear and is different for every condition. They rarely arise from one single cause and most people who have one autoimmune disease, develop another one, suggesting a global problem with our immune system. Genetics are felt to only account for 30% of autoimmune diseases so there are other factors, including things like diet, infections and toxic exposures.

The basics are as follows: after exposure to some kind of foreign body (toxins, microbes, chemicals, foods, pollen, dust…), the immune system recognizes them as foreign and makes antibodies against them. Antibodies allow the body to react to and attack the foreign invader faster the next time there is exposure to that substance. This is actually a normal protective reaction but when the immune system is over sensitive, more common things like seasonal and food allergies develop. Rarely, certain proteins and other molecules on the surface of our own healthy tissues and organs just happen to be similar enough in structure to those foreign bodies that the immune system mis-recognizes those normal proteins as foreign and attacks them. Slowly over time, those tissues and organs are destroyed resulting in various diseases. There are over 100 autoimmune diseases that we know of. Some common autoimmune conditions include:

  • Type 1 Diabetes. The pancreatic Beta cells, responsible for insulin production, are attacked and they slowly die off.
  • Rheumatoid Arthritis. The cartilage in joints are attacked and destroyed.
  • Thyroiditis (Hashimoto’s and Graves Diseases). Different kinds of thyroid cells are targeted and destroyed.
  • Lupus. Various connective tissues throughout the body are affected.
  • Celiac Disease. Antibodies to gluten are formed which cause a myriad of symptoms.
  • Multiple Sclerosis. It’s not completely clear but this disease is thought to be autoimmune.
  • Crohn’s Disease and Ulcerative Colitis. Both types of Inflammatory Bowel Diseases (IBD) where the intestinal lining is affected.
  • Psoriasis. Inflammation of the skin resulting in overproduction and thickening of skin cells.
  • PANDAS, Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infections. This disease typically affects children, usually between 3 and late teens. It’s very rare in adults. The antibodies against strep attack the basal ganglia in the brain, a part involved in movement control. Changes in kids can develop overnight with uncontrolled tics, uncontrolled touching and anxiety. Although more like a result of inflammation caused by the antibodies, it may also represent the bacteria’s attempt to continue propagating itself. The infected child can’t stop touching things like toys and handles, spreading the bacterium.

With some of these conditions like Type 1 Diabetes and Thyroiditis, there has been so much tissue damage that those organs no longer produce the hormones they are supposed to and hormone replacement is required. In Diabetes, patients have to inject insulin daily or multiple times a day and with thyroid disease, thyroid hormone replacement is necessary. With other conditions, you can either manage the symptoms by taking symptom-suppressing drugs or avoid triggers and potentially cure the disease.

The standard methods of treating such conditions are to avoid triggers if you can identify them (like gluten if you have celiac disease) and to prescribe medications that block or suppress our own immune system so it doesn’t over-react as intensely. Some common medications include methotrexate, Imuran, Rituxan and even steroids like prednisone. By decreasing our over-reactive immune system, inflammation decreases and the symptoms improve. These drugs however also result in our immune system becoming less efficient or unable to do normal and protective surveillance. Such medications result in increased risks of infections and cancer.

We are too quick to prescribe medications and do not spend the time to figure out the potential triggers and causes of these conditions. Commonly overlooked and ignored causes are foods, the chemicals used to grow foods, the contaminants in food as well as general environmental toxins like chemicals in cosmetics and personal care products. Identify the cause and you can control or reverse the disease. Being overweight contributes or causes many conditions and autoimmune diseases are among them. If you are overweight, your chances of developing Rheumatoid Arthritis are as much as 60% higher. In addition, being overweight decreases the efficacy of many medications prescribed to treat RA by as much as 60%.

A few facts about thyroid function:

  • Circadian rhythms effect of T4 and TSH production. We produce more at night. The highest levels are produced in the middle of the night and lowest at 2-3 in the afternoon. This might account for some people’s “afternoon lull”.
  • Furthermore, when you exercise, thyroid hormone levels rise, but not so when you take meds. This is partly why thyroid medications don’t always work well, or consistently, in people.
  • Caloric deficit also stops the conversion of T4 to t3. It’s a protective, energy preserving response to caloric “stress”. This is why people who severely restrict caloric intake in an attempt to lose weight are actually battling their own body since the response is to turn down metabolism.
  • Iodine deficiency used to be the main cause of hypothyroidism until iodine was put into table salt in the 1930s. Today, it is auto immune diseases, caused by the toxic load we experience every day.
  • Iodine is very closely controlled in the body. Too little is not good but neither is too much.
    • The Wolff-Chaikoff effect. Too little or too much Iodine inhibits T4 production leading to hypothyroidism.

    • Jod Basedow effect. Hyperthyroidism which occurs after Iodine supplementation. It is seen when people are Iodine deficient and start taking too much or if the gland is inflamed to begin with.

  • Any kind of inflammatory process, like an infection or arthritis, will cause an increase in thyroid autoantibodies resulting in thyroid dysfunction. This is the case for all autoimmune conditions.
  • Although there is a strong family link with thyroid disease, the link is strongest if the father has a thyroid condition. These are less common in men, but the genetic link is much stronger if it occurs.

Most of the autoimmune conditions respond well to some basic nutritional changes.

  • Eliminate sugar and processed foods, both known to be pro-inflammatory and carcinogenic.
  • Eliminate ALL dairy products. The additional hormones and other toxins don’t do anyone any good.
  • Some authorities allow for meats as long as they are clean (pasture-raise, hormone free, wild caught…). But only in limited amounts. Strive for less than 10% of your daily calories coming from animal sources.
  • Eliminate environmental toxins like metals, sprays, cosmetics, non-stick pans…
  • Minimize stress since constant cortisol (the stress hormone) production impacts negatively on all kinds of hormonal issues.
  • STRESS definitely impacts on thyroid disease. ALL hormonal systems interact. Stress causes cortisol, the stress hormone, to be secreted. Chronic caress leads to lower production of T4 and less conversion of T4 to T3, the active form of it. In addition, causes more T4 to converted into rT3, reverse T3, the storage form of T3. When more is stored, less is circulating and doing its thing.
  • There are some autoimmune sufferers, especially with thyroid disorders, who benefit from limiting or eliminating soy products which contain isoflavones. These compounds can mimic estrogens but keep in mind that for most people, soy is fine. There is more on this topic on my “Common Questions” page.

The body of scientific evidence supports a plant-based diet as being the best one for treating all chronic disease. That having been said, some people do well following other protocols. The authors (both doctors) below suffered with their own debilitating autoimmune issues. Both of them incorporate animal products into their diets but without question it has to be clean (non-GMO and Organic). They both recommend getting rid of sugars, processed foods and unclean foods. If you are struggling, it’s worth looking into.

THYROID DISEASE. Worldwide, the most common cause of thyroid disease is iodine deficiency. This is becasue people do not eat enough iodine-rich foods. Although this used to me the case in the US, ever since the Morton Salt Company added iodine to table salt in 1924, that no longer has been a significant issue for most (other salts do not have iodine unless from the sea or otherwise stated on the label). Today, in the US, the majority of thyroid diseases consist of one of two conditions, Hashimoto’s Hyperthyroidism and Graves Disease (hyperthyroidism). Both conditions are autoimmune, meaning the body recognizes its own tissues for something foreign and attacks it. Probably due to hormonal issues, women develop thyroid disease 8x more often than men and about 13% of women will develop an autoimmune thyroid disease. The exact cause of this of these conditions is not clear and probably multi-factorial since both conditions have been known for over 100 years but it is clear that our diet is certainly a significant modern day contributor. Studies on these conditions and nutrition show that omnivores, people who eat meat, dairy, fish and eggs, have the highest rate of both conditions whereas vegans have the lowest. Vegetarians who consume dairy have a slightly lower rate than meat eaters leading to the thought that dairy may be a significant contributor. There are many cases of thyroid disease patients being able to reverse their condition by switching to a whole-food plant-based diet.

Iodine-rich foods for healthy thyroid function:

  • sea vegetables like seaweed, nori and dulse.
  • strawberries.
  • navy beans.
  • potatoes.
  • cranberries.
  • Brazil nuts (high in selenium which helps with thyroid hormone production).
  • some common animal sources of iodine include:
    • boiled eggs
    • fish
    • raw organic cheeses

Some practitioners recommend avoiding certain cruciferous vegetable like Brussels sprouts, broccoli and cauliflower but I think these recommendations are overblown. You have to eat a LOT of these vegetables in their raw form to impact in any way on thyroid function. Once cooked, this negative impact is eliminated anyway. In addition, you have to eat a rain-barrel full of raw greens for thyroid function to be affected. Literally. There was only one anecdotal study highlighting a German woman who ate pounds of raw greens whose thyroid was affected.

GLUTEN AND THYROID DISEASE. About 5% of thyroid disease patients also have Celiac Disease, a gluten allergy. It turns out that the antibodies to gluten and the thyroid autoantibodies are very similar and can cross react. Consider a gluten free diet for  while and see how you feel. You may even be able to get off of your thyroid medicine if you improve enough.

BIOTIN. Taken for skin, nail and hair support, it can cause problems with bloodwork for thyroid function. It will often cause abnormal levels of various thyroid markers, leading to misdiagnoses and often unnecessary thyroid medications. In addition, it doesn’t really help the skin, nails or hair.



Goodbye Lupus: How a Medical Doctor Healed Herself Naturally With Supermarket Foods Brooke Goldener, MD. Suffering with life-threatening lupus for years, she reversed her condition using lifestyle changes including switching to a plant-based diet.


The Autoimmune Solution: Prevent and Reverse the Full Spectrum of Inflammatory Symptoms and Diseases” Amy Myers, MD. This physician suffered with debilitating Hashimoto’s Thyroiditis an describes her protocol for treatment.



The Wahls Protocol: A Radical New Way to Treat All Chronic Autoimmune Conditions Using Paleo Principles” Terry Wahls, MD. She developed the “Wahls Protocol” to manage and treat Multiple Sclerosis.



Fiber Fueled” Will Bulsiewicz, MD. The Plant-Based Gut Health Program for Losing Weight, Restoring Your Health, and Optimizing Your Microbiome.




Body on Fire” by Dr. Monica Aggarwal, a cardiologist who struggled for years with debilitating rheumatoid arthritis.

“What’s Missing from Medicine: Six Lifestyle Changes to Overcome Chronic Illness” Dr. Saray Stancic, a physician who took control of her debilitating MS describes important lifestyle changes to reverse disease. 

Autoimmune Fix” Tom O’Bryan – An online resource dealing with Rheumatoid Arthritis, along with other inflammatory conditions.




As mentioned in many places on this website, overweight and obesity are at epidemic levels. Worldwide, 30% of our population is overweight or obese. The US and Mexico however battle between 1st and 2nd when it comes to whose on top. Most recently, it’s Americans. 75% of the US population is overweight or obese with 42% being obese! 20% of kids are obese. It is insane. Not surprisingly, all the chronic conditions associate with weight (ALL of them essentially) are also on epidemic rises.

In addition, if one uses the “Blue Zones” (places in the world where people are the healthiest and live the longest) as a model of ideal weight, approximately 88% of Americans are overweight or obese. Add to that all the people whose weight is low because of chronic disease like smoking, cancer or eating disorders, and only 2.4% of Americans are in a healthy weight range because of healthy lifestyle habits.

40,000 people die a month, almost half a million a year, in the US alone from complications of obesity. And that is only looking at the top 3 causes: cancer, diabetes and heart disease. Only 50 a month die from gunshots and that gets significantly more attention.

The is lots of information on other pages (click here) on my website discussing weight and weight loss but below is some information about genetics, gender and age issues related to weight gain.

Cancer may be 5-10% related to genetics but lifestyle choices play a much greater role. With weight and obesity however, genetics may play a much greater role, but how much is not clear and you still have great control over it. Lifestyle modifications are still crucial. An interesting study showed that kids who had 2 overweight parents were 27% more likely to be overweight themselves. Adopted children however were only 21% more likely to be overweight suggesting that genes do play a role but environment plays a bigger one.

There are at least 120 different identified genes or more specifically gene mutations that are associated with being overweight. Some forms of obesity are the result of of monogenic genes, single gene mutations leading to obesity. If you have a mutation in one of the monogenic obesity genes, obesity starts very early in life, usually in childhood or teen years. An example of a monogenic obesity gene would be the leptin receptor gene. Leptin, a hormone released from the fat cells located in adipose tissues, sends signals to the hypothalamus in the brain. It helps regulate and alter long-term food intake and energy expenditure. We all have the gene but if we have a specific mutation in this receptor, then the brain doesn’t see leptin. The fat mass and obesity gene (FTO) is another common monogenic obesity gene. It encodes for and enzyme involved in stimulation of food intake.

Most forms of obesity however are a result of polygenic genes, multiple different affected genes acting together. An example is the melanocortin 4 receptor (MC4R) which binds a hormone  which is involved in controlling feeding behavior.

Why do we even have these genes? Are these obesity genes helping us survive and reproduce? Yes, they are because fat is the way we store nutrients and energy. Being efficient in storing fat allows us to survive, and allows us also to reproduce because we need the fat in order to have maturation of our sexual organs. We also need fat to produce our sexual hormones. The problem is that our diet contains so much fat that it leads to over-storage.

The center, where we control energy balance is in the brain. The three genes mentioned above are all highly expressed in the brain.

Although some genes are either turned on or off, some are turned on to varying degrees, like a dimmer switch. A gene’s degree of expression is definitely influenced by the foods we eat. Other lifestyle issues like exercise, sleep quality and stress management are important but food has a major effect and not all the foods are created equal.

Fats (specifically saturated fat) and protein (specifically branched chain amino acids, BCAAs), have the greatest impact on obesity gene expression, especially FTO. The foods that are naturally very high in saturated fat and very high in branched chain amino chains come primarily from animal sources. Some plant foods like avocado, nuts and various oils, especially coconut oil have saturated fat but they are also packaged with fiber, vitamins, minerals and phytonutrients so they do not have the same effect. Eat enough of them however and it will impact on your health negatively. 1 handful of nuts and seeds has about 17 grams of fat and 95% of the fat in coconut oil is saturated fat. So, don’t shovel it in!


A high fat diet changes the microbiome composition in our gut which also impacts on genetic expression. A high fat diet changes expression, for instance, of the Brain Derived Neurotrophic Factor (BDNF) gene. BDNF is a protein that clears our brain from beta-amyloid, a naturally occurring protein which is produced as a result of stress but when it builds up in excessive amounts, it causes Alzheimer’s disease. Obese people and lean people will have different classes of gut bacteria. People that are obese will have more bacteria called Firmicutes. Lean people are going to have more Bacteroidetes. Firmicute bacteria are more efficient in harvesting energy. If you have more Firmicutes, you’re going to break down more of your food. In addition, obese people are going to absorb more calories than lean people. On average, if they ate the same amount of food, a lean person is going to absorb 27% less calories than someone who is obese. Just because of the bacteria in their gut. Eating fat leads to overgrowth of the bacteria which absorb more fat. It’s a downward spiral.

We can store 40,000 calories in 10 pounds of fat. If we were to store the same amount of glucose, in the form of glycogen, we would need 20 pounds more. It’s a very effective way of storing energy


When women go through menopause, body energy requirements drop by 35%. If you do not adjust your lifestyle, the inevitable result is increased weight gain. In addition, since the ovaries are no longer working and producing estrogen, the body turns to fat as a source of estrogen. Fat is an active organ, making various hormones including estrogen. After menopause, since fat is now the only source of estrogen, the body tends to try to keep the fat around since it is the only source left of estrogen.

Genes also function differently as we age. For instance, the FTO gene activity increases expression by 20% between our 20’s and our 40’s. The impact of FTO is much greater the older we get.

There are also differences in gender. The MC4R gene mutation, for example, is twice as common in women than it is in men. Women will also tend to produce less thyroid hormone as they age, slowing metabolism. Men on average can eat 51% more calories than women can since men’s bodies burn more energy. In general, men have a third more lean body mass than women do also.


Excessive weight, especially post menopausal weight, increases breast cancer risk because of the additional estrogen which is produced by fat cells through the activity of the enzyme aromatase. This enzyme converts testosterone, which women do produce, and the adrenal gland hormone androstenedione, into estrogen. The more fat cells you have, the more estrogen you produce. The more estrogen floating around, the greater the risk of breast cancer. A commonly used breast cancer chemotherapy drug is known as an aromatase inhibitor because it inhibits the function of this enzyme in the fat cells. Mushrooms are very high in compounds similar to aromatase inhibitors which is why they are very healthy and inhibit breast cancer cells. 

Overweight or obese women have between 50-250% increase in breast cancer incidence, a 50% increased risk of recurrence and 50% increased risk of death if it does reoccur. If you have gained weight since high school, this is the relative risk increase:

  • 8 lbs. heavier leads to 0% increased risk.
  • 8-14 lb. weight gain increases risks by 25%
  • 14-20 lbs. leads to a 60% increase
  • More than 20 lbs. of weight gain leads to a 100% increased risk. That’s double the risk.

Not only does the extra weight increase estrogen production but it also increases the inflammatory environment throughout the body. Molecules like CRP, TNF alpha, IGF1 and veg2, all associated with increased inflammation, provide a pro-cancer growth environment. 

If you lose the weight, you lose the risk. With gastric bypass surgery, breast cancer incidence drops by 85%. You lose both the estrogen making machine and you also lose all the inflammation which comes with the weight.


For each pound you carry above the waist, up to 10 pounds of pressure is added to your hips, knees and ankle joints which translated into 20 tons of pressure of the course of only 1 day. Adipose tissue (fat) is not just passive additional tissue we carry. It is an organ and as such is metabolically active. It makes hormones like estrogen and leptin, which actually helps control appetite. But it also makes adipokines, compounds which cause inflammation of joints and attack joint cartilage itself. The more fat you have, the more adipokines you produce, the greater the inflammation and joint damage. The standard American diet, high in fat, salt, oil and animal products is pro-inflammatory and destroys joint by itself. Just switching to a plant-based diet alone often improves joint pain by 60-80% because of fewer pro-inflammatory molecules being consumed and created, even before they start to lose weight.

Being obese increases the likelihood of needing a joint replacement by 200%. If you are obese by 18 (and remember that 20% of people under 20 are obese), that rate goes up by 500%. The weight not only causes increased pressure and mechanical damage, the adipose tissue also impairs blood flow, decreasing nutrient flow as well as delivery of repair molecules. Overweight people tend to have elevated cholesterol which actually increases the risk of tendon injury and rupture as well as increasing the risks of re-tearing after repair. This has mostly to do with good blood flow as well.

If you are overweight, your chances of developing Rheumatoid Arthritis are as much as 60% higher. In addition, being overweight decreases the efficacy of many medications prescribed to treat RA by as much as 60

FAT AND TOXINS. Fat is one of the main storage sites for toxins like chemicals and heavy metals in our blood. Adipose (fat) contains 300x more toxins than what can be measured in our blood. The more fat you have, the more toxins you are storing. As fat breaks down, toxins are released at such levels that the liver, our primary filter and toxin remover, can’t keep up and blood levels rise. Keeping weight down allows the liver to keep up with toxin breakdown.

VACCINE EFFICACY. People who are overweight or obese also have less of a response to vaccine since their immune systems are also compromised. Specifically, their T-cells, crucial to immune reactions and developing antibodies, don’t function as well. In addition, people who are overweight or obese are also more prone to complications from various vaccines.


Many lifestyle choices are influenced by our families and friends. Studies show that if your friend is obese, your chances of being obese are 57% greater. If your friend has an obese friend, even if you do not know them, your chances of being obese are 10% greater! Surprisingly, if you spouse is obese, your chances are 37%, less than the influence of the friend! If a sibling is obese, your chances of being obese are 40% greater.

For more on Obesity and health, please go to “Diseases” page or click here.

The Hungry Brain: Outsmarting the Instincts That Make Us Overeat“. Stephan Guyenet, Ph.D. Excellent analysis and discussion about why we overeat and gain weight.

“Sicker, Fatter, Poorer. The urgent threat of hormone-disrupting chemicals to our health and future… and what we can do about it” Leonardo Trasande, MD




About 50% of Americans and Europeans and 40% of the worlds population in general have some degree of cholesterol elevation. In fact, Lipitor (atorvastatin) is the most commonly prescribed medication worldwide. Not everyone with cholesterol elevation needs to be on a statin however it depends on a number of other factors involving your diet and lifestyle.

We tend to focus on numbers too much. The fact is that of all first heart attack patients, 70% have normal (about 50%) or only slightly elevated cholesterol. It is all the other values and lifestyle issues which are just as important. The real enemy is inflammation, which causes damage to blood vessel walls and that is when cholesterol becomes a problem, invading the wall and setting up an inflammatory response, eventually leading to plaque formation and clots. Processed food is the worst dietary evil.

That having been said, it is important to think about cholesterol, but in the context of overall health.

Cholesterol is a molecule known as a sterol, a type of lipid molecule. Also known as steroid alcohols, sterols are a subgroup of the steroids and an important class of organic molecules. They are a type of lipid and thus are not soluble in water, which is what makes up our blood. They occur naturally in plants, animals, and fungi, and can also be produced by some bacteria (however likely with different functions). The most familiar type of animal sterol is cholesterol, which is vital to cell membrane structure, and functions as a precursor to fat-soluble vitamins and steroid hormones. Sterols of plants are called phytosterols and sterols of animals are called zoosterols. The most important zoosterol is cholesterol. Notable phytosterols include campesterol, sitosterol, and stigmasterol. Ergosterol is a sterol present in the cell membrane of fungi, where it serves a role similar to cholesterol in animal cells.

Sterols and related compounds play essential roles in the physiology of eukaryotic organisms. For example, cholesterol forms part of the cellular membrane in animals, where it affects the cell membrane’s fluidity and serves as secondary messenger in developmental signaling. In humans and other animals, corticosteroids such as cortisol act as signaling compounds in cellular communication and general metabolism. Sterols are common components of human skin oils.

Fats and cholesterol are two distinct types of lipids, which are organic compounds that are insoluble in water. Although they are often found together in food and in the blood, they have very different structures and only a few functions in common. Fats provide energy in calories but cholesterol does not. Cholesterol is crucial for proper function of every cell of your body. Some of its crucial functions include:

  • It is a structural molecule and it makes up part of the walls of all cells, allowing them to be more pliable and facilitate movement. Different types of cells contain differing am amounts of cholesterol in their walls based on what they do.
  • It functions as signaling messenger between cells.
  • It’s an important component of the lining of neurons in the brain. It is like insulation around wires. The cholesterol in the brain lasts for years whereas circulating cholesterol is removed relatively quickly.  And levels in the brain are not related to levels in the blood elsewhere in the body.
  • It’s the starter molecule for all the hormones our bodies produce.
  • It makes up digestive bile acids in the intestine which bind and help clear waste metabolized by the liver.
  • It allows the body to produce vitamin D.

Our bodies make all the cholesterol we need. Although all our cells can make cholesterol, about 75% of total daily cholesterol production occurs in the liver, which is also the only organ which can process and eliminate cholesterol. Other sites of higher production include the intestines, adrenal glands, and reproductive organs. Our bodies make exactly the right amount of cholesterol we need except when someone takes cholesterol lowering medications or when we consume large amounts of extra cholesterol. In addition, when the liver is full of fat, which occurs with fatty liver disease, the ability of the liver to monitor circulating cholesterol is impaired and it continues to make more and more cholesterol. Although about 75% of the measured cholesterol in the blood is made by our own tissues, most people consume so much extra that it does elevate the blood levels. In addition, saturated fat in our diet stimulates the liver to make more cholesterol than we need and it also it forces the liver to process less of the cholesterol we consume, both contributing to elevated serum (blood) cholesterol levels. All dietary cholesterol (which comes exclusively from animal products) is just extra cholesterol our bodies need to process and get rid of.  It is an oil-based substance and does not mix with the blood, which is water-based. It is carried around the body by 4 main types of lipoproteins, distinguished by how much fat lipid they carry around. They are essentially protein molecules with attached lipids, hence the name lipo-protein. The more lipid, the less they dissolve in serum, essentially water, and the lower the density, meaning the higher in a test tube of blood they settle when spun down in a centrifuge. The more lipid, the less dense the particle.

  • Low-Density Lipoprotein (LDL) – known as “bad” cholesterol, it only becomes bad when it is in excess and inflamed. It does serve a healthy purpose, delivering fat and cholesterol to tissues which need them to build their cell walls and produce compounds like hormones. But again, in excess, they start to cause problems like depositing their fatty payload into the arterial walls where it can cause inflammation and vascular disease. They carry around a lot of lipid so they float a lot. LDL has 2 patterns. The large, fluffy LDL are pattern A. The smaller, denser and more dangerous particles are pattern B. Furthermore, LDL can be expressed in 2 ways:
    • LDL-P = LDL particle number. The total number of LDL particles, fluffy or dense. This is essentially the most important number since all the other “bad” particles are of much smaller amounts.
    • LDL-C = amount of cholesterol in the LDL particles, which can vary my 2x.
  • High-Density Lipoprotein (HDL) – known as “good” cholesterol, it too can be problematic if in excess and in an inflamed environment. Their main role is to return excess or used up fat and cholesterol back to the liver for processing. They have very little lipid and are dense so they sink to the bottom of the test tube since they are more dense and compact. Low levels of HDL are lionized with elevated risk for heart disease, heart attack and stroke. HOWEVER, recent studies suggest that high levels of HDL, above 70 mg/dl, previously though of as being protective, is actually also a risk for heart attacks and strokes.
  • Very Low-Density Lipoprotein (VLDL) – cholesterol formed as a result of excess sugar in the blood being converted in the liver. Once saturated with sugar as an energy source as glycogen, excess sugar gets converted into palmitic acid which gets packaged with cholesterol. This phenomenon is known as lipogenesis, the creation of fat.
  • Intermediately Density Lipoprotein (IDL) –  similar to VLDL, these two cholesterol molecules, previously though of as less significant, are becoming more and more important and need to be considered.
  • Lp(a) – Although we have known about this lipoprotein molecule for a number of decades and 30% of the worlds population has elevated levels of this dangerous, purely genetically inherited molecule, it is not routinely checked. There is more about this below.

VLDL is made by the liver and it’s half life is 2-6 hours. They are created, delivering TG and phospholipids and then they are gone. IDL, which is a transition molecule between a VLDL molecule losing lipids and  it’s end product, LDL, lasting for an hour or less. It is not very useful to look at. As the VLDL becomes smaller and smaller as it loses its lipids, it eventually becomes an LDL particle. Normally, 30-40% of the LDL is made de-novo in the liver. LDL has a much longer half life, lasting for 3-5 days.

Here are some grim statistics about cholesterol in Americans:

    • 37% of American adults have elevated low-density lipoprotein (LDL) cholesterol levels.
    • 40% of American adults are on statins (cholesterol lowering medications). They are the most prescribed class of drugs in the world. Lipitor alone is the most prescribed drug worldwide.
    • 39% of U.S. adults age 20 or older have total cholesterol levels greater than 200 mg/dL.
    • 7% of U.S. children and adolescents ages 6 to 19 have high total cholesterol.
    • Autopsy studies of otherwise healthy Viet Nam soldiers who died in the field (most of whom were late teens to early 20’s) revealed a 30% rate of significant atherosclerotic heart disease primarily caused by cholesterol excess.
    • An Australian MRI study showed that infants still in the womb showed traces of cholesterol deposits in their hearts if their mothers had elevated cholesterol levels.

Obviously, we have a problem. Dietary cholesterol and its effect on health is one of those topics that the press has unfortunately misrepresented based on exaggerated and biased studies. These studies are almost exclusively backed by the meat, dairy and egg industries. Just like with any topic where “experts” seem to disagree, the public in general doesn’t know who to believe so they just keep on eating what they want until someone figures it out. People love to hear good (or even equivocal) news about their bad habits. The facts however, based on real unbiased science, are clear. Dietary cholesterol and fat DO contribute to serum cholesterol elevation resulting in plaque formation leading to atherosclerotic vascular disease significantly increasing the risks of heart attack and stroke along with other serious problems including insulin resistance. Period. A 1% rise in your dietary saturated fat intake translates into a 2% rise in your serum LDL cholesterol.

There are industry sponsored studies which do show that adding more cholesterol to a diet does not significantly raise blood serum cholesterol levels. The problem with these studies is that:

  1. Cholesterol absorption is curvilinear. Meaning, if you consume little to no added dietary cholesterol, your blood levels WILL rise significantly when you add in cholesterol to the diet. But, the more cholesterol in your diet already, the less of a  rise there would be with added cholesterol. Meaning, if you eat 3 eggs a day, adding one more will do almost nothing to your levels but the damage is already occurring. That is why vegans are rarely included in these studies. They would skew their numbers.
  2. Most of these industry studies include very low numbers of patients so the strength of their data is poor. Statistically significant results can’t be claimed but this is all in the small print.

It is true that our bodies need cholesterol but our livers actually make it already and our bodies know when we have enough and stop producing it. The problem with dietary cholesterol, which comes exclusively coming from animal products, is that no such stop-gap measure exists. As a result, the body just keeps absorbing and depositing the fat and cholesterol in tissues not meant to store fat and cholesterol like muscle cells, arterial walls causing plaque buildup resulting in arterial narrowing and the liver, causing fatty liver disease which today is the most common condition requiring liver transplants.

Although saturated fat is a major contributor to elevated cholesterol levels, dietary cholesterol itself is also a major player as well. Some argue that dietary cholesterol has no or very impact on serum cholesterol levels, however that is not completely true. If you consume a significant amount of cholesterol already, the relative change in cholesterol levels may not be as great as the rise in someone who consumes very little cholesterol, however it still rises. It’s like saying  that adding 2-3 cigarettes to a daily habit of 2-3 packs a day doesn’t matter that much. If you don;t smoke, 2-3 cigarettes a day will make you feel like crap and impact greatly on your physiology. Those same 2-3 cigarettes will have very little impact on the 2-3 pack a day smoker. Neither is good. Dietary cholesterol comes exclusively from animal products. Although usually associated with red meat, beef is only third on the list of where Americans consume their cholesterol. #1 is eggs and actually #2 is chicken. 100 mg of dietary cholesterol results in about a 10 point rise in total serum cholesterol. NOnly 1 egg had 180 mg of cholesterol. 1 cup of chicken breast has 120 mg.

STATINS (cholesterol lowering medications). The most commonly prescribed medication worldwide is Lipitor (atorvaststin). They are effective and do lower the risk of heart attacks. Statins in general work by blocking an enzyme called HMG CoA Reductase that the liver uses to make cholesterol. In addition to producing cholesterol, the liver helps clear excess cholesterol from the blood. It has receptors that “capture” LDL, bad cholesterol particles, that are floating around. These receptors “suck” this excess cholesterol up and out of the blood, which means there’s much less cholesterol seeping into our artery walls, building plaque. Statins help to increase these LDL receptors in the liver. There is no question that they work and can significantly lower cholesterol levels but the reason why your cholesterol is elevated in the first place is not addressed. In addition, there is little evidence that after 75 years of age statins do anything at all other than cause side effects. Skip the meds and fix the diet and activity level. You’re better off.

Just like with medications, supplements can make biochemical markers look better but do not change long-term outcomes. An example of this are niacin and folic acid, both of which make cholesterol markers look better but have not been shown to decrease heart attacks or longevity. You still have to do the hard work of living and eating better. Men who take statins are also 30-50% more likely to get diabetes but women are at 70% greater risk. The exact cause is not clear but it probably has to do with the fact that statins inhibit normal liver function and the liver also participates in blood sugar control. The enzyme pathway that statins affect is also responsible for production of the important compound CoQ10. This compound is a potent antioxidant but its main function is in production of ATP, the fuel our mitochondria use to produce cellular energy. You must supplement with CoQ10 if you take a statin. Whole foods, plant-based diets have been shown to lower cholesterol levels, particularly LDL just as well as Lovastatin, a popular drug.

Excessive amounts of dietary fats and cholesterol reduce the number and effectiveness of LDL receptors. There’s nothing statins can do to counteract this process. Again, fix the problem by fixing the diet.

Statins have a slew of side effects which affect 20% of people taking them. Some of the side effects include myopathies (muscle pain), myositis (inflammation of the muscles), liver inflammation and damage and sexual dysfunction. They also cause cognitive impairment, particularly the “lipophilic” or fat soluble statins like Lipitor atorvastatin). Crestor (rosuvastatin) causes less cognitive impairment since it is not fat soluble so it doesn’t cross the barrier into the brain as readily. Statins also increase the risks of developing Diabetes. A recent study of 150,000 women showed a 71% increased risk of developing diabetes in those who were taking statins. Just like with other diseases, these drugs improve numbers but do not address why cholesterol is elevated in the first place! People placed on statins are often told that they must be on them for the rest of their lives however they are rarely told how better nutrition and other lifestyle improvements could reverse their disease, eliminating the need for drugs. People often claim that it is “genetic”. True genetically inherited cholesterol problems are uncommon, affecting only 1 in 500 (0.2%) of the population. The “genetic” issues are the eating and lifestyle habits we learned and inherited from our parents and families. In addition, up to 66% of patients prescribed statins stop taking their medications on their own within 6 months whereas those patients who make successful lifestyle changes are 90% compliant at 1 year. Sadly, so many people are on statins and discard them down the toilet that in many municipalities, it can be identified in the drinking water. 

There are also issues with cognitive function. Statins impair production of cholesterol, not inly in the liver but in the brain also. The brain needs cholesterol for proper function but it cholesterol does not cross the blood-brain barrier (Omega-3 fatty acids do cross that barrier however). The brain must make cholesterol so by impairing this function, it can impair brain activity.

Statins, like many other medications, give people a false sense of security. “I can eat this steak because my statin will get rid of the cholesterol anyway!” It’s an illusion. Studies have shown that all else being equal, people who take statins gain more weight than those who don’t.

If you’re among the millions of Americans who takes a cholesterol-lowering statin, you may want to avoid is grapefruit juice. This tangy fruit contains furanocoumarins, compounds that block an intestinal enzyme that normally breaks down statins. As a result, more statin gets into the bloodstream, increasing the risk of side effects such as muscle aches. Although this problem is most likely to occur if you drink 4 or more cups of the juice, you may want to play it safe and avoid grapefruit in any form if you take a statin.

Without question, whole food, low-fat plant-based diets not only prevent elevated cholesterol and all its secondary diseases, but it also reverses it.

Again, there are 3 basic types of cholesterol: HDL, LDL and Triglycerides (there are a few others but these are the main ones).

  1. LDL (Low Density Lipoprotein). Dubbed The “bad” cholesterol, LDL is actually necessary and serves a function in the body. Excessive amounts of LDL however is a problem.  When inflammation occurs, it causes small tears or abrasions in the inner wall of the arteries allowing blood to seep through to the middle lining of the artery which causes further irritation.  LDL is sent to “patch up” the weak spot. The problem is that LDL is rather unstable and can float around re-patching patches or adhering elsewhere where it is not needed. For every 37-point lowering of your LDL, there is a 22% decreased risk of heart attack. Combine elevated LDL with uncontrolled diabetes and you have a real problem. When there is excess sugar i the blood, LDL becomes glycated (sugar gets attached) which makes it significantly more inflammatory leading to even more plaque formation. There has been a lot of recent press about the “large fluffy” LDL particles which are less concerning than the “small dense” ones. Although that is true, the difference is not anything to hang your hat on. The risk of heard disease is increased by 43% if your small dense LDL is elevated but the risk is still 31% greater if you LDL is light and fluffy. The bottom line, all LDL is bad.
  2. HDL (High Density Lipoprotein). Known as the “good” cholesterol, it acts as the “solvent” that loosens LDL patches and removes excess amounts of LDL. We have known for a long time that low levels of HDL is a risk factor for heart disease and strokes, but we now also know that high levels are just as much as a risk.
  3. TRIGLYCERIDES (TG) are another type of lipid (fat) found in your blood. Your body uses TG for energy. You need some triglycerides for good health but high triglycerides raise your risk of heart disease and may be a sign of metabolic syndrome.2 others worth mentioning are:
  4. Very Low-density lipoprotein (VLDL) – is a third form of “bad” cholesterol formed as a result of excess sugar in the blood being converted in the liver, once saturated with sugar stored as glycogen, into palmitic acid which gets packaged with cholesterol into lipoproteins resulting in the creation of fat.
  5. Lp(a) – Although we have known about this lipoprotein molecule for a number of decades and 30% of the worlds population has elevated levels of this dangerous, purely genetically inherited molecule, it is not routinely checked. There is more about this below.

As a general rule, HDL levels rise and fall as a function of how much LDL is around. When the ratio is to off-balance and LDL levels rise too high, you get increased plaque formation and atherosclerotic disease. More specifically, the small, dense LDL particles (as opposed to larger, fluffy particles) are problematic.

Lipoprotein a (Lp(a)). – The missing link in many cases!

Lp(a) is a complex cholesterol molecule which is dictated primarily by genetics. There are over 2000 gene mutations involved in its expression, accounting for its variability. However, it is a dominantly inherited mutation, meaning that if one of your parents had it, you likeley have it as well. Some researches suggest that by age 2, levels start to rise and stabilize by age 5.

Humans, hedgehogs and old world primates (baboons and macaques), but surprisingly not apes, are the only animals who are known to be affected by this cholesterol molecule. In humans, it can affect as many as 20% of the population and is thought to be responsible for most of the heart attacks which occur in people with otherwise unremarkable cholesterol numbers.

Some think that Lp(a) is evolutionarily protective since one of its effects is to promote clotting. This would protect our ancestors from excessive bleeding from trauma as well as during childbirth. It is an acute phase reactant and as such, rises with inflammation and stress. It is pointless to test after an MI given the stress of the event and Covid infection also leads to elevated levels, partly accounting for more clotting since Lp(a) is a pro-coagulant.

It rises from birth and plateaus by only 2 years old and remains at that level throughout life. It can increase after menopause, by as much as 20%, since estrogen helps to lower Lp(a) and less estrogen is produced at that stage of life.

It affects almost 30% of the world’s population but it is not clear why it is so prevalent. There is some thought that it provides an evolutionary advantage because it contributes to accelerated wound healing  and repairing tissues and blood vessels after a wound or trauma. The only animals which have elevated Lp(a) are humans, old-world non-human primates such as the rhesus monkey and baboons and the European hedgehog. Lp(a) can unfortunately, prevent breakdown and even promote growth of blood clots. As a result, it can cause heart attacks (up to 5x increased risk), strokes (3 x increased risks), peripheral arterial disease, aortic valve disease (3x greater risk) as well as heart failure.

Lp(a) can vary in shape quite a bit, depending on the size of the apolipoprotein (a) component attached to the LDL cholesterol. In addition, Lp(a) comes in over 40 different shapes. The smaller the Lp(a) particles are made more rapidly and can lead to higher blood levels and are related to more atherosclerosis and heart valve damage.

It’s a variant of the LDL particle which has the APOa attached rather than APOb. It’s a genetic variant affecting as many as ⅓rd of people and thought to be the cause of ~10% of heart attacks without any other risk factors. About 85% of heart attacks and strokes overall are felt to be because of acute ischemia from plaques rupturing leading to acute clotting. It takes about 70% of narrowing for symptoms to occur. The acute problems are felt to be because of sudden rupturing of inflamed plaques and clot formation.

Lp(a) causes a lot of problems. It’s:

  • Thrombogenic (causes clotting) because it’s surface molecule is similar to the clotting molecule plasminogen.
  • Pro-Inflammatory.
  • Atherogenic. It leads to plaque formation and stiffening of our arteries.

Pregnancy can triple Lp(a) levels. This is partly why clots and other cardiovascular complications increase during pregnancy. Estrogen, testosterone and thyroid hormone can lower Lp(a) levels.

Statins do not help lower levels and can at times actually raise them. Niacin, which contains nicotinic acid or nicotinamide, has been shown to lower Lp(a) by as much as 30% however, the non-flush variety, which contains inositol hexaniacinate, has not been shown to be effective for cholesterol lowering. There are some drugs on the horizon  such as Antisense drugs, which can lower it by 50-80% but are not yet available.

If you have this Lipoprotein variant (and 20-25% of us do), there is not much you can do about it. There are some potential medical treatments on the horizon. Presently, the only medications which have shown to help a little bit, in some people, are aspirin and niacin (Enduracin). It’s essential to maximize all the other things you can do to keep your overall cholesterol levels in check like:

  • Eat a whole-foods, plant-based, low oil, low sugar diet limiting animal products which are full of saturated fats. Some foods which have been shown to lower Lp(a) in varying but limited degrees are black cumin seeds, flax seeds and amla (Indian Gooseberry).
  • Move more and exercise daily.
  • Manage your stress.
  • Sleep better.
  • Socialize more.

When elevated, it significantly increased the risks for developing heart disease and raises heart attack risk. As mentioned above, niacin shows some limited promise in lowering it but only in a limited way. A whole-foods plant-based diet has been shown to be as, if not more effective at lowering Lp(a).

To learn more about how Lp(a) plays a unique role in cardiovascular disease, have a look at this document: COLLAGEN, Lp(a) AND HEART DISEASE

TOTAL CHOLESTEROL is actually a calculation based on all three, LDL + HDL + ½ TG. It should be used as a guide but the most important number correlating to atherosclerotic disease is LDL (more specifically high particle sized LDL). Please note that on routine cholesterol measurements, LDL is in many cases a calculated number, not a true measure. When getting blood-work, always ask for more detailed testing (at Quest, it is called Cardio IQ) which will detail true levels as well as LDL particle size which is more important.

The best way to lower LDL cholesterol is to avoid eating foods containing high levels of saturated fat (meat, fish, dairy, eggs, all oils and even some foods like avocado and coconut) and dangerous trans fats (margarine, ramen soup cups, fried foods, and cookies/candy). Certain foods actively lower LDL, like those rich in soluble fiber (whole grains, oatmeal, beans, and fruits). Animal products contain no fiber!

Smoking, obesity, diabetes (especially type 2 diabetes), and having a sedentary lifestyle all lower the good HDL cholesterol. To raise HDL cholesterol, the first steps are to avoid tobacco smoke, lose weight, improve glucose control, and try to get an hour of physical activity every day. Consuming alcohol in moderation (1-2 servings a day), and eating foods high in omega 3 fatty acids such as fish oil, algae (what the fish eat and where they get their omega 3), walnuts, and flax seeds can also raise HDL cholesterol levels. If you choose to consume fish or fish oil, make sure that it’s clean. Just about every fish that comes out of any body of water is contaminated with something bad. The number of fish that are killed to make fish oil supplements is in the billions! Here is are 2 articles about it.

Is LDL really that bad? Yes!!! Why then do some people with sudden heart attacks have normal LDL?

  1. Patients taking statins will often have normalized LDL. But by the time they start their statin, significant arterial damage has already been done. Any increased damage, even minimal, could initiate a complete occlusion and subsequent heart attack.
  2. Any acute phase event will often result in a sudden drop in cholesterol levels. This is temporary and following up on cholesterol levels will often show that baseline levels are not as low as original tests would suggest.
  3. Blood level thresholds of LDL for plaque development is not what “normal” lab values would suggest. Plaque starts at levels as low as 60 mg/dl even though most labs consider normal to be below 100.

Some people argue that there are many people with elevated LDL levels who have not had any cardiovascular issues. But using that fact to justify accepting elevated LDL as less concerning is like saying that because most smokers don’t die of lung cancer, that smoking is safe.


Lipoproteins consist of lipids (fats) bound to proteins. Lipid + Proteins = lipoproteins. The proteins which bind the “bad” lipids are called APO-B (or beta) proteins in a ratio of 1:1. Today, measuring APO-B particles in the blood is a better indicator of the level of the harmful lipoproteins than LDL alone. The protein which binds HDL, the “good” lipoprotein, is APO-A and it binds in a varying ration so it is not very useful to measure.

Although there are a few different types of problematic lipoproteins, LDL is by far the most abundant, accounting for 95% of the APO-B, and thus unhealthy LP particles. It also lasts the longest in circulation.

    • VLDL lasts only 4-6 hours in circulation
    • IDL – 1 hour
    • Chylomicrons – <1 hour
    • LDL – 2-4 days
    • HDL (the good one which is bound to APO-A) last for 4-6 days

How to Lower APO-B

  1. Lose weight. Excess fat produces VLDL (very low density lipoprotein) which in turn becomes LDL. Losing just 6% of your body weight results in significant lowering of APO-B. 6% is not a lot. For a 250 pound person, this is only 15 pounds.
  2. Increase consumption of mono and polyunsaturated fats. Although substituting less healthy saturated fats with healthier fats is a good thing, adding these healthier fats alone reduces APO-B. Monos like avocado and extra virgin olive oil or polyunsaturated fats like flaxseeds, chia seeds or walnuts helps.
  3. Fiber. Particularly soluble fiber, adding things like apples or oats, both very high in soluble fiber, helps by soaking up more LDL cholesterol. Adding psyllium also helps.
  4. Plant phytosterols. These are cholesterol molecules which come from plants. The cell structure of phytosterols looks and acts like cholesterol, so it competes with cholesterol for absorption by your digestive system. When your body digests plant sterols instead of cholesterol, it removes some of the cholesterol as waste.
  5. Lower Fructose consumption. Fructose from sugar sweetened beverages, including fruit juices, dramatically increase production of VLDL by adipocytes and the liver. This again gets converted into LDL. The fructose in fruit does not count since it comes packed with all kinds of other healthful things, including lots of fiber.
  6. Trans Fats. These are clearly unhealthy and the good news is that they have been eliminated from processed foods. However, other fats in these products get converted into trans fats and trans fats also can be consumed in cooked animal products, including red and white meat.
  7. Soy products, particularly soy isolate products and supplements lower APO-B.
  8. Overall dietary patterns which focus on whole plant foods are the best. The mediterranean diet, especially ones focusing on whole plant foods, seem to win out.

CAN CHOLESTEROL LEVELS BE TOO LOW? Simply put no. Our bodies make all the cholesterol we need. However, if artificially lowered, the occasionally, but very rarely, can be a problem. The Framingham Study has followed 3 generations people, over 14,000, for over 35 years. Not a single patient with a cholesterol of 150 has ever had a heart attack. Click here for more information about this on my “Common Questions” page.

THE GUT MICROBIOME AND CHOLESTEROL. It’s not just cholesterol. It’s LDL and even more important is the particle size. Small, dense particles are the problem. LDL is not actually cholesterol. It’s actually a lipoprotein which transports cholesterol. LDL transports cholesterol to your cells. Liver, kidney, muscle… because every cell needs cholesterol to make the cell membrane as well as support metabolic functions like hormone production. When the LDL gets to the cell, the cholesterol gets cleaved off and the LDL then goes back to the liver and gets recycled. The LDL is now smaller since it donated the cholesterol.

HDL brings the cholesterol back from the cells or damaged atherosclerotic arteries back to the liver. HDL is important if you have too much of the bad, mostly small dense cholesterol around.

In the gut, the 100 trillion gut bacteria are busy metabolizing the foods we eat, making them into amino acids, fatty acids, extracting and even making vitamins and minerals… We also have the highest concentration of immune cells in the gut. This is because the gut is actually the biggest exposure we have to the outside world. As such, it needs to have the most robust immune system available to respond to potential foreign invaders. They are separated by the git barrier. When this barrier is broken down, our immune cells start to kill the bacteria in our gut, which it thinks is foreign. This results in the release of endotoxin. Endotoxin is a type of pyrogen, or fever-causing agent, and is a component of the exterior cell wall of Gram-negative bacteria, like E. coli (see image). Endotoxin is a lipopolysaccharide or LPS, consisting  of the lipid A portion containing fatty acids and disaccharide phosphates, core polysaccharides and O-antigen. The lipid A portion of LPS is the cause of the molecule’s endotoxin activity. While lipid A does not directly harm any tissue, the immune cells of humans and animals alike see it as an indicator for the presence of bacteria. Thus, these cells stimulate a response that is meant to fend off the unwelcome intruders. This reaction is entirely innate, i.e. no previous exposure to endotoxin is required. When there is a lot of endotoxin present in the blood, toxic shock can occur. When in the bloodstream, endotoxin binds to LDL cholesterol which has a very high affinity for it. In fact, whenever we are inflamed, our production of LDL increases to deal with the increased amount of endotoxin which is circulating in our bloodstream. This is why you should do LDL blood levels over a few days or at times when you are not stressed or ill. The LDL may be artificially high, a result of the body’s attempt to soak up the endotoxin. The receptor to which the endotoxin binds to on the LDL particle also happens to be the same receptor which binds the cholesterol particle which was just “donated” to the cell. This results in the LDL particle not being able to get back to the liver or metabolism, allowing the endotoxin bound to its surface to remain in circulation causing an inflammatory response by our immune system. The inflammatory response leads to the formation of a foam cell, essentially an LDL particle with all these immune cells stuck to it, leading to plaque formation. 

So, saturated fat, which does increase LDL cholesterol, is not such a bad thing unless there is chronic inflammation at the level of the gut. It all goes back to the gut. The mucin, or mucus layer, separates the immune system from the bacteria in the gut. Mucin is produced by the single layer of cells, enterocytes, making up the gut lining. In order to produce mucin, the enterocytes need energy, primarily in the form of short chain fatty acids (SCFFAs) which are produced by the healthy, commensal bacteria in the large bowel, when they ferment the fiber we consume, exclusively from fruits and vegetables. The SCFFAs consists of compounds such as butyrate, acetate, propionate and lactate. Up to 90% of these SCFFAs go straight to the gut cells to produce mucin. 

When you replace healthy carbohydrates, the healthy whole fruits and vegetables where fiber comes from, with refined carbohydrates and sugars, other unhealthy bacteria which thrive on these simpler sugars overgrow. They basically occupy the space normally taken up by the healthy bacteria. The more sugar you eat, the more insulin resistance occurs at the level of the gut cells. As a result, they can’t use the sugars for energy and can’t produce mucin. In fact, the remaining mucin actually gets broken down. 

Great sources of the fiber so important for gut health include oats, barley, mushrooms and just about any other whole fruit and vegetable you can consume.


Although inherited Lp(a) occurs in 20% of people, familial hypercholesterolemia, another genetically inherited form of elevated cholesterol, affects an estimated 1 in 250 (0.4%) people in most countries and is thought to be the most common inherited condition affecting the heart and blood vessels (cardiovascular disease). The condition occurs even more frequently in certain populations, including Afrikaners in South Africa, Lebanese, and Tunisians. Familial Hypercholesterolemia mechanisms include:

  1. A defect in the LDL receptor resulting in less processing of LDL
  2. A mutation in the apo-B lipoprotein. apo-B is a protein that is involved in the metabolism of lipids and is the main protein constituent of lipoproteins such as very low-density lipoprotein (VLDL) and low-density lipoprotein (LDL, the “bad cholesterol”). Mutations in this protein results in the LDL no longer fitting into the receptor.
  3. A PCSK9 gene mutation. The PCSK9 gene provides instructions for making a protein that helps regulate the amount of cholesterol in the bloodstream. The PCSK9 protein controls the number of LDL receptors on the surface of cells. These receptors play a critical role in regulating blood cholesterol levels. The receptors bind to LDL particles, which are the primary carriers of cholesterol in the blood. LDL receptors are particularly abundant in the liver, the organ responsible for removing most excess cholesterol from the body. The number of LDL receptors on the surface of liver cells determines how quickly cholesterol is removed from the bloodstream. The PCSK9 protein breaks down LDL receptors before they reach the cell surface, so more cholesterol remains in the bloodstream.
  4. LDL receptor-related protein changes. The low-density-lipoprotein (LDL) receptor is a cell-surface protein that plays an important part in the metabolism of cholesterol by mediating the uptake of LDL from plasma into cells. Although LDL particles bind to the LDL receptor through their apolipoprotein B (apo B) and apolipoprotein E (apo E) binding sites, other apo E-containing particles, like chylomicron remnants, are not dependent on the LDL receptor for uptake into cells. Chylomicrons, which are cholesterol-rich lipoproteins, formed in the intestinal lining during the absorption of the products of digestion, are processed by the peripheral circulation by the enzyme lipoprotein lipase, which is involved in the breakdown of triglycerides in chylomicrons into free fatty acids and glycerol. The resulting chylomicron remnants are subsequently taken up and recycled in the liver. Changes in how this recycling system functions can also result in elevations of circulating LDL.

Fish Count Estimates

How The Fish Oil Industry Kills Dolphins and Whales



Our bones are constantly being broken down and built back up again. This constant turnover is what keeps them strong.  The main stimulus for this turnover is EXERCISE! Osteoporosis is NOT a calcium deficiency problem. It’s a DISUSE ATROPHY problem. In other words, if you don’t use it, you lose it!

This process occurs throughout life, even well into old age. As we age however, there is a gradual loss of bone which naturally occurs, despite regular exercise. This is especially true in women who lose more than men after child-bearing years, accelerating even more after menopause. When the balance between breakdown and buildup occurs, then bones start to lose their density and strength.

Osteopenia refers to a mild form of decreased bone density which is again, naturally occurring. This term did not exist until the advent of bone scanning called DEXA Scanning (Dual-Energy X-ray Absorptiometry). This technology was developed and then heavily marketed by the pharmaceutical company Merck which, big surprise, developed one of the first drugs to treat osteoporosis, Fosamax. This is a drug known as a Bisphosphonate, which slow down or prevent bone loss. Bisphosphonates inhibit osteoclasts which are responsible for breaking down and reabsorbing minerals such as calcium from bone (the process is known as bone resorption). The drug was not doing very well until Merck, in conjunction with our own health department, started to promote the idea that bone loss was an epidemic. Earlier, and in many cases unnecessary screening resulted in more diagnosis of osteopenia (again, a naturally occurring event not labeled as a disease). Part of the problem with DEXA scanning is that it is very inconsistent, inaccurate and the degree of bone loss is assessed by comparing results to the bone density of healthy, young women. The error average of the test can add 10 years to estimated bone age. This is an unrealistic and exaggerated scale.

When the breakdown of bone is severe however, osteoporosis does occur at pathological and dangerous levels. This is a real disease. This decreased density leads to fragile bones and an increased chance of breaking a bone if there is a fall. Keep in mid that bones break most often when there is some kind of accident or fall which tends to occur in older people so environment and safety, focusing on fall prevention, is extremely important.

Although bone loss can occur in both men and women, women are more affected for a variety of reasons including differences in body mass and bone impact as well as hormonal influences. Osteopenia actually starts to occur after the age of 30, at the same time that muscles start to atrophy, especially if one is not active. Women over the age of 65 and any postmenopausal woman are at greater risk however.

Osteoporosis literally means “porous bone”. It is the progressive thinning of bone which occurs naturally with aging. If allowed to progress out of control, however, it can lead to fractures, especially in the wrist, ribs, spike and hip. If bones are protic enough, simple daily tasks like stepping off a curb can result in a fracture, let alone falling. Excessively thinned bone is responsible for over 1.5 million fractures a year in the US. Although many bones can be involved, the most common and most life changing and threatening are hip fractures. 1/3rd of women will suffer a hip fracture. 15% of men will have a hip fracture. Of those, 50% will require long term home care and 20% of those will die as a result of complications

Although men are also at risk of developing osteoporosis, women are at significantly greater risk. In fact they are twice as likely to suffer a hip fracture, the most devastating type of fracture. 1 in 3 women and 1 in 6 men will suffer a hip fracture during their lifetimes. 20% of those who suffer a hip fracture will die from complications and 50% will need long-term nursing home care. There are 2 basic reasons that women suffer more.

  1. Women simply have smaller bones, 30-40% smaller. In addition, men have larger muscles which put additional stress against their bones and stress is the key to bone health, which is why exercise is so important.
  2. Estrogen and progesterone, hormones which are much higher and fluctuate much more in women, are very important to bone health. Both of those level drop off significantly after menopause which is why the rate of osteoporosis increases dramatically after that transition. Estrogen prevents excessive action of osteoclasts, cells which are responsible for breaking down old and unhealthy bone. Whereas progesterone controls osteoblasts, the cells responsible for building up bone with healthy, newer material. Osteoblasts remove calcium, magnesium and phosphorus from the blood and deposit it into new forming bone.

Common causes and risk factors for osteoporosis include:

  • The #1 cause of osteoporosis is lack of exercise. Osteoporosis is NOT a calcium deficiency problem. As mentioned above. it’s a DISUSE ATROPHY problem. In other words, if you don’t use it, you lose it!
  • Aging. Again, bone loss does occur naturally.
  • Inflammation.
  • Diet. Increased consumption of animal products including dairy is linked with greater osteoporosis. This occurs because animal proteins contain a greater proportion of acidifying, sulfur-containing amino acids which the body then has to neutralize. It does so by using calcium primarily from muscle but also from bone. 
  • Protein. Excessive consumption of protein, especially proteins from animal sources, is also associated with more osteoporosis. This partly because of the excess stress placed on the kidneys, but also because animal proteins are more acidifying, resulting in more leaching of calcium from bones to balance the pH.
  • Vitamin D Deficiency. Vitamin D helps the body absorb calcium. It also blocks the release of parathyroid hormone which controls bone re-absorption and calcium release from bones.
  • Excessive intake of calcium, including from calcium supplements. In addition to increasing the risks for kidney stones and being linked to increased risk for prostate cancer, excessive amounts of calcium actually block the formation and function of vitamin D.
  • Soda consumption. The excessive amounts of phosphorus prevent calcium absorption and the phosphoric acid leads to calcium being removed from the bones to buffer the acidity in the blood.
  • Genetics. Although just like with many other conditions, sometimes “genetics” is more the lifestyle and dietary habits we inherited rather than the genes.
  • Hormonal causes, including decreased estrogen (such as in women after menopause) or testosterone.
  • Smoking.
  • Alcohol excess.
  • Caffeine excess. This can cause excess loss of fluid which can cause more calcium loss because of the diuretic effect.
  • Immobility. There is a much higher rate of osteoporosis in inactive and debilitated people.
  • Medications such as corticosteroids including prednisone and anti-seizure medications.
  • Malabsorption due to conditions like Celiac Disease.
  • Chronic inflammation due to medical conditions, such as rheumatoid arthritis.
  • Parathyroid abnormalities such as benign tumors called adenomas. This gland secretes a hormone which controls calcium metabolism and can lead to increased calcium removal from bone. This is usually diagnosed with a high calcium level and high parathyroid hormone level in the blood.
  • Chronic kidney disease which causes issues with calcium metabolism and can impact on proper parathyroid function.
  • Hyperthyroidism. By ramping up metabolism, there is an imbalance between bone breakdown, which lasts 3-5 weeks, and bone remodeling, which lasts 3 months. The cycle repeats continuously but favors breakdown in hyperthyroidism. It leads to about 10% greater bone loss overall.
  • Medications:
    • Anticonvulsants, which cause vitamin D absorption and B vitamin deficiencies.
    • Benzodiazepines for anxiety and depression. The mechanism here has to do with excess pituitary gland production of the hormone prolactin. This then leads to suppression of the pituitary glans, resulting in diminished production of the estrogen stimulating hormones LH (luteinizing hormone) and FSH (follicle stimulating hormone). Lower estrogen leads to osteoporosis.
    • Antacids, by impacting on various nutrient absorptions.
    • SSRIs (antidepressants)
    • Opioids. These also cause excessive prolactin production.
    • Steroids. They impact on function of the cells which regenerate bone and also deplete vitamin D.
  • Fluoride. This also impacts on osteoblasts and osteoclasts. Although it may increase bone density in the short term, just like the many osteoporosis medications, the bones become weaker over time.

Diet and lack of exercise have the most crucial role in the development and prevention of osteoporosis.

DRUGS TO TREAT OSTEOPOROSIS. Most common medications to treat osteoporosis do so fundamentally by altering how our bodies break down or build up bone. Mostly the former. Remember that your bones are continuously, your whole life, remodeling. Removing older, less healthy bone and depositing newer, healthy bone. That’s assuming that the building blocks for bone like calcium, magnesium, boron and phosphate, as well as the cells making this deposit, are available. When bone breakdown is prevented, you may have more solid bone, but over time, that bone becomes less and less healthy, and more and more brittle, actually increasing fracture risk. In addition, they all have side effect, many of which sound horrible:

  • Osteonecrosis (death) of the jaw bone. This not only increases fracture risk of this bonbe, but also mouth and dental infections.
  • Atrial Fibrillation. A potentially lethal heart arrhythmia associated with the risk of stroke and bleeding, as a result of the blood thinning medications patients with this condition need to keep taking.
  • Esophageal diseases like erosions, reflux and even cancer.
  • Muscle aches.
  • Kidney disease.
  • Hypocalcemia (low calcium). They actually cause a condition which leads to osteoporosis in the first place!
  • Immune suppression leading to:
    • Infections throughout the body
    • Increased cancer risk because of diminished immune surveillance.
  • Hypercalcemia (elevated calcium) which causes various problems including arrhythmias.
  • Hyperuricemia (elevated uric acid levels) which leads to gout and general inflammation.
  • Hypomagnesemia (low magnesium) which impacts on muscle function, nerve problems like tremors and serious sleep disturbances.

In women with a history of breast cancer, there is some evidence that at least in the short term, some of these meds may provide some benefit at preventing metastasis to bone. However, again long term, the benefits are outweighed by the risks.

In addition, when stopping these medications, the impact on bone can continue for upto a year.


  • A significant dietary cause of osteoporosis is over consumption of animal products. Animal protein, whether from meat, fish, diary or eggs, have a higher concentration of sulfur containing amino acids which make the blood more acidic. Our bodies are very efficient at neutralizing pH but it does so by using minerals in the body, primarily calcium. When you eat too much meat or dairy, your blood becomes more acidic leading to more calcium being removed from muscles and bones to neutralize it and hence more osteoporosis. The connection between osteoporosis and animal protein is a little controversial but it is clear that the countries that consume the most meat and dairy have the highest rates of osteoporosis. Just dairy alone is a significant contributor. Dairy doesn’t help with bone strength, it worsens it. Milk does NOT do a body good. The acidifying of blood has nothing to do with consuming acidic or alkaline foods or beverages. The hydrochloric acid normally produced on your stomach is much more acidic than anything you can possibly eat (other than poison). The issue is what happens when foods are absorbed into the body.
  • Calcium absorption from meat and dairy is very inefficient. Less than 30% of it gets absorbed and about half of the absorbed calcium gets secreted and not used. Calcium from plants on the other hand is absorbed at a much higher rate (>50%) and is much more easily metabolized.
  • Calcium supplements. As mentioned above, calcium supplements actually contribute more to developing osteoporosis than they help. They also contribute to prostate cancer and kidney stones.

Although calcium levels are the highest in dairy products, we absorb less of it that we absorb from plants. In addition, animal products are more acidifying, leading to more bone loss whereas plants cause the blood to be slightly alkaline, preserving bone. Spinach and collard greens rival the amount of calcium from dairy , and its absorption is better. Here are some foods high in calcium:

  • Cow’s milk – 1 cup – 297mg
  • Spinach – 1 cup – 245 mg
  • Collard greens – 1 cup – 226 mg
  • Sesame seeds – ¼ cup – 351 mg

To absorb calcium, regardless of the source, you need stomach acid. This is why people who regularly take acid reducing medications have a higher rate of osteoporosis. The highest rate occurs in those taking PPIs (proton pump inhibitors) like Nexium and Prevacid, both available without a prescription. These drugs essentially turn off all acid production. In addition to malabsorption of various nutrients, these drugs also cause bacterial imbalances in the small and large intestines and are even associated with SIBO, small Intestinal Bacterial Overgrowth.

SUPPLEMENTS. There are a few supplements which do help. The two we know the most about are Vitamin D3, which helps in calcium absorption and Vitamin K2, which helps direct calcium absorption into bones and redirects it from arteries. Vitamin K2, particularly the MK7 form, has been shown to help with limiting calcium deposits in coronary (heart) arteries. K2 also stimulates Osteocalcin, also known as bone gamma-carboxyglutamic acid-containing protein (BGLAP), which is a hormone found in bone and dentin (in teeth). Osteocalcin is secreted solely by osteoblasts (bone-building cells). It is also implicated in bone mineralization and calcium ion homeostasis. Osteocalcin acts as a hormone in the body, causing beta cells in the pancreas to release more insulin, and at the same time directing fat cells to release the hormone adiponectin, which increases sensitivity to insulin.

Other important supplements to consider are magnesium, vitamin C, omega 3 fatty acids and selenium.


  • Exercise, particularly impact routines like lifting weights, are the most important way we can prevent and reverse osteopenia and osteoporosis.
  • Movement. We just don’t move enough nor do we get outside enough. The more sedentary you are, the greater the risk and degree of osteoporosis.

Your Bones: How You Can Prevent Osteoporosis and Have Strong Bones for Life―Naturally” . A great reference about bone health by Larra Pizzorno



Migraines are quite common. According to the Center for Disease Control, 25% of women aged 18-44 report at least 1 migraine every 3 months. Of 45–64-year old’s, 20% women report migraines and in 65–74-year old’s, it drops down to 10% have migraines regularly. In all those same categories in men, the rates were about half that of women. This has to do with many things, including hormonal changes as well as various other stresses and lifestyle differences. Worldwide, over 3 billion people, mostly women, suffer with regular migraines. Although classic Migraine headaches have specific symptoms (headache, nausea, light sensitivity, lights flashing in the eyes…), there are a number of other “atypical” migraine headaches called Migraine Variant Headaches. These can have a variety of presenting neurological symptoms some of which can include visual disturbances, even blindness, dizziness, hearing loss, tinnitus, difficulty speaking and even symptoms mimicking sinus infections (facial pressure and eye pain). 

There are many triggers such as:

  • Stress – #1 cause.
  • Most people are walking around chronically dehydrated. This also causes brain fog.
  • Sensory stimuli like lights, odors and tastes. These can both cause, and be a result of migraines.
  • Neck and shoulder problems. Again, both a trigger for and a result of migraines.
  • Hormones and hormonal fluctuations, which is why they are worse for some women around their menstrual cycle.
  • Poor sleep, including sleep apnea. Poor sleep inpacts on hpw our brain functions the next day. As far as apnea is concerned, the chroicly lower than normal oxygen levels cause nerve dysfunction.

Although many foods can be migraine triggers, sometimes the craving of a food is an early sign that a migraine is already evolving, so it isportant not to ignore cravings. Any food can cause symptoms and sometimes a food elimination diet needs to be followed (see below) to determine specific triggers.  The following is a list of common food triggers, also known as the “dirty dozen” for migraines:

  • dairy products. 50% of adult migraine sufferers improve off dairy. 92% of kids with migraines had complete resolution (88%) or improvement.
  • chocolate
  • eggs
  • citrus fruits
  • meat (both red and white meat, poultry and fish)
  • wheat (bread, pasta, etc.)
  • nuts and peanuts
  • tomatoes
  • onions
  • corn
  • apples
  • bananas

Specific chemical trigger include:

  • Tyramine and Amines: This is found in: Yogurt, Avocado, Cheese, Banana, Red Plum, Tomato, Potato, Spinach, Orange Pulp, Eggplant
  • Casein. Major protein (78% of it) found in dairy.
  • Potassium Metabisulfite: Preservatives, Beer, Lettuce
  • Nitrates: Bacon, Packed Luncheon Meats, Sausage, Hot Dogs
  • Other: Monosodium glutamate (MSG), Cola Drinks (too many chemicals to list), Pesticide residues
  • Citric acid. This ubiquitous preservative originally derived from citrus fruits but today, it’s cheaper to use genetically modified manufactured citric acid, mostly from China. It’s grown using fungi.

Other known triggers of migraines include:

  • Dehydration. ALL headaches are caused or worsened by not drinking enough Water and almost 80% or Americans are walking around chronically dehydrated.
  • Poor sleep, including catch-up sleep attempts. Regularity is extremely important.
  • Regular meals. Keeping things regular stabilizes blood sugar and gets your body used to a rhythm.
  • Sleep apnea. Chronic low oxygen is not good for the heart, brain or any organ system for that matter.
  • Electronic devices. Over stimulation of the brain and visual cortex.
  • Patterns on clothing, furniture, wallpaper…
  • Hormonal imbalances. Women are 3x more likely to have migraine than men, and up to 75% of women find that they experience attacks around the time of their menstrual period. This is called “menstrual migraine,” occurring only during a woman’s period due to the change in estrogen and progesterone levels.
  • Stress, both acute, chronic and delayed. Meditation really helps.
  • Sudden temperature and pressure changes (like a storm weather front or going from hot to cold or vice versa)
  • Medications, like hormone replacements and antidepressants.
  • Vigorous physical activity (including sex)
  • Nutritional deficiencies, especially:
    • Magnesium
    • CoQ10
    • B12
    • Vitamin D


Dr. Buchholtz’s (see book reference below)Dietary Triggers: Top 10 List:

Caffeine. Found in coffee, tea, colas and certain other sodas. Going off caffeine suddenly can also trigger headaches.

Chocolate. Anything with cocoa. Chocolate contains phenylethylamine, which may cause blood vessels to expand and contract.

Nuts. From almonds to pistachios, they can all be culprits, as can nut butters.

Monosodium glutamate. Famously found in Chinese food, but also in seasoned salt, salty snacks, prepared soups, many low-fat and low-cal foods, and even veggie burgers. Steer clear of hydrolyzed vegetable, soy or plant proteins, which can contain similar compounds.

Deli meats and fish. If it has been aged, canned, cured, fermented, marinated, smoked or tenderized, it may trigger headaches. Preservation with nitrites or nitrates is a no-no. Avoid beef livers and chicken livers, as well.

Dairy products, especially cheese. This includes all kinds of hard cheeses and foods prepared with cheese. The more aged the cheese, the worse the trigger. White cheeses, including cottage cheese, ricotta and cream cheese, have not been implicated, but yogurt has.

Alcohol, especially Red wine. Too much red wine or any dark alcohol can stack the deck against you. Of all alcohols, vodka is tolerated the best. Also avoid vinegar; balsamic being the most problematic, but white should be OK. Alcohol also impacts on poor sleep quality.

Certain fruits and vegetables. In his book Heal Your Headache, Buchholz lists the fruits and vegetables most implicated in triggering headaches. Among the problematic fruits are: citrus fruits and fruit juices, bananas, raisins and other dried fruits preserved with sulfites, raspberries, red plums, papayas, passion fruit, figs, dates, and avocados. Vegetable culprits include: sauerkraut, pea pods and beans (from fava to navy to lentils). The worst vegetable offender may be onions, though baby onions are OK.

Freshly baked breads risen with yeast. Especially problematic is sourdough. Also look out for bagels, doughnuts, pizza dough and soft pretzels less than 24 hours out of the oven.

Artificial Sweeteners. Compounds like Sucralose (Splenda) and Aspartame (Equal and NutraSweet) are found in many diet soft drinks and processed foods. Artificial sweeteners contain excitotoxins known to affect nerve cells.


BOTOX injections for MIGRAINES

Botox is a neurotoxin, a poison made by the bacteria Clostridium botulinum. It can cause a deadly reaction called botulism if you eat it in spoiled food because it blocks signals from your nerves and paralyzes your muscles. It is safe in small doses when injected however because the toxin isn’t digested in your stomach and the amount is much smaller than you’d get in spoiled food. It is used in a variety of medical conditions where there is excessive muscle tension or spasms such as esophageal spasms and even some forms of hoarseness. It also helps people who have tics and spasms because of a nerve disease like cerebral palsy. It is most commonly used however in the cosmetic world to smooth wrinkles because it relaxes muscles in the face. 

When people who had migraine headaches used Botox to treat their wrinkles, they told their doctors that their headaches were better. Doctors began to study it as a migraine pain treatment. Studies of adults who get chronic migraine headaches, shots of Botox showed that nearly half the people who took two rounds of Botox shots reported that the number of days they had a headache each month was cut in half. After five rounds of treatment, that increased to about 70% of the people. It’s thought that Botox works for migraine headaches because it blocks chemicals called neurotransmitters that carry pain signals from your brain. Botox is like a roadblock in that pathway stopping the chemicals before they get to the nerve endings around your head and neck.



  1. Caffeine. Although it can also cause rebound if overused, a strong cup of black coffee can often abate an oncoming migraine.
  2. Ginger.
  3. Feverfew, names such as it was used to reduce fevers in traditional medicine.
  4. Capsaicin. The compound which makes spicy foods spicy, can also help. There are even nasal sprays with this compound.

Most OTC treatments for migraines include 2 compounds. Caffeine and decongestants. These bot constrict blood vessels which reduce swelling leading to pain relief. There are many more potent medications, including new injectable medications which are very effective, but ultimately, addressing the cause is still the best approach.

A supplement which has shown some promise is Migravent. It includes some common nutrients associated with migraines like magnesium and CoQ10.

Sleep. Often a good sleep will help eliminate a migraine.

Migraine Elimination Diet

Although any food, animal or plant, can be a migraine trigger, there are some common ones, as described above. Below is one which is fairly straight forward.

There is a great YouTube video describing a study performed by Dr. Neal Barnard that is worth reviewing when it comes to a migraine elimination diet. It is linked here. I summarized the basics below.

  1. A) Eliminate all animal products from your diet for 1 MONTH. This includes all:
  2. Meat (red, white, marbled…)
  3. Fish, including shellfish.
  4. Eggs
  5. Dairy products, including milk, cheese, yogurt and products containing dairy components like whey and casein. You MUST read labels. Dairy is at the top of just about every elimination diet.

If that works, you’re done. You know that animal products contribute significantly or cause your migraines. At that point, it’s up to you what you do. You can try to introduce some things back one at a time, or just accept that animal products are not healthy, cause inflammation and cause your headaches. If you continue following a plant-based diet, you will also gain all the other benefits of this pattern of eating. Less cardiovascular disease, diabetes, arthritis, anxiety, gastrointestinal problems, cancer… If you must continue to consume animal products and are willing to accept the headaches and other consequences, it’s up to you.

  1. B) If eliminating all animal products does not help, there are some additional products to eliminate. Here are the most common 12. I list some of the ones which should have been eliminated in the vegan diet, but are very difficult for many people to do.
  2. Dairy. I know it was part of the above elimination, but dairy is so prevalent and so many people are “addicted” that this can be a tough one to eliminate. You MUST read labels since dairy is in everything.
  3. Meat. All meats. Especially the processed meats which are cured and contain many additional inflammatory compounds but all of them should be eliminated.
  4. Eggs. Again, you must read labels because eggs are added to many products.
  5. Citrus.
  6. Chocolate. Not only do most chocolates contain dairy, but even the rawest cacao contains some compounds which can trigger migraine. Some chocolates also contain nuts, which are next on the list.
  7. Nuts.
  8. Tomatoes.
  9. Wheat. In many patients, gluten can be the culprit.
  10. Onions.
  11. Corn.
  12. Apples.
  13. Bananas

Once you have done this for a month, and assuming you feel better, it is time to start reintroducing the healthy plant foods back into your diet. Start with bananas and eat 4-5 in one day. If that load does not cause migraines, then it’s not the bananas and you can resume eating them. Next try apples. Eat a few in a day and see what happens. And so forth. You may find that there are multiple triggers and you may simply be sensitive to those foods. ALSO consider that sometimes it is the chemicals ON the foods which may be triggers so make sure to wash your produce well, even if it is organic.

One last but important note; many times, the foods which trigger migraines are also the foods we crave. It does not seem to make sense but given out cravings for unhealthy foods, it is actually not all that surprising.

Migraine Diet – document about migraines, triggers and doing an elimination diet.

A good book resource for migraine headache management is:


Heal Your HeadacheDavid Buchholtz, MD



Victory Over Vestibular Migraine” Dr. Shin C. Beh






Inflammatory bowel disease (IBD) represents a group of intestinal disorders that cause prolonged inflammation of the digestive tract which is comprised of the mouth, esophagus, stomach, small intestine, and large intestine. In addition to its responsibilities to break down food, extract the nutrients, and remove any unusable material and waste products, the GI tract also is responsible for 70% of our overall immune system. In addition, we are learning more and more about its importance as a neurologic and signaling organ, now being dubbed our “second brain”.

ALL inflammatory gut issues are impacted by a healthy microbiome. Leaky gut, one of the diseases under the “inflammatory bowel disease” umbrella is also impacted. Contributors to inflammation include:

  • Medications like antibiotics, NSAIDS, acid reducers, metformin (the most commonly prescribed diabetes drug) and even antihistamines.
  • Gluten, if you have Celiac disease or true gluten sensitivity
  • Eating excessively large meals.
  • Eating large amounts of fats, especially saturated fats.
  • Fructose, without fiber. This is essentially all processed foods and sweetened beverages.
  • Snacking and grazing. The gut needs to rest.
  • Over sanitized environments.

Dysbiosis does not only affect the intestines, but also the nose and mouth. Mouth rinses, especially those which contain alcohol and chlorhexidine kill beneficial bacteria allowing the bad ones to overgrow. Sugary drinks also impact on bacterial balance. Studies have shown that those who use mouth rinses have no increase in the arterial-relaxing compound nitric oxide (NO) which comes from dietary nitrates from fruits and vegetables.

24% of over 1000 marketed drugs were tested and were shown to have a negative impact on the gut microbiome. They include some commonly prescribed drugs as antibiotics, NSAIDS like ibuprofen and aspirin, acid reducers, metformin (the most commonly prescribed diabetes drug) and even antihistamines.

Inflammation anywhere along the digestive tract disrupts these normal processes and set us up for many other medical problems by causing “leakiness” of the intestinal wall. IBD can be very painful and disruptive, and in some cases, it may even be life-threatening. Many diseases are included in this IBD umbrella term.

The two most common diseases are Ulcerative Colitis and Crohn’s disease. Crohn’s disease can cause inflammation in any part of the digestive tract. However, it mostly affects the tail end of the small intestine. Ulcerative colitis involves inflammation of the large intestine only.

The exact cause of IBD is unknown. Although there are definite genetic and immunologic components to these diseases, IBD is a classic example of “genetics loading the gun but lifestyle pulling the trigger”. Genes may increase your risks of getting a disease but what you eat and how you live increase or decrease the odds significantly.

Normally, the immune system defends the body from pathogens. A bacterial or viral infection of the digestive tract triggers a normal immune response. As the body tries to fight off the invaders, the digestive tract becomes inflamed. When the infection is gone, the inflammation usually goes away but in people with IBD however, the digestive tract inflammation continues since the immune system attacks the body’s own cells, now misidentifying them as foreign. This is known as an autoimmune response.

About 1:165 Americans have IBD. Most other developed countries have a rate of 1:300 but their numbers are also on the rise as they adopt a more Western diet and lifestyle.

The biggest risk factors for developing IBD include:

DIET. The more animal products and processed foods you eat, the greater the risk of getting IBD or worsening the symptoms of IBD. Meat, dairy, fish, eggs, refined and processed foods are all significant contributors. The more fruits, vegetables, fiber, legumes you eat, the lower the risk and the more controllable the symptoms. Diets high in animal protein (but not plant protein) are strongly linked to IBD.

FOOD ADDITIVES and PRESERVATIVES. Polysorbate 80, an emulsifier which gives food its creamy texture, increases the adherence of invasive gut bacteria to the intestinal wall which worsens Crohn’s inflammation. Maltodextrin, an artificial carbohydrate powder made from corn, rice, potato, or wheat that manufacturers add to many foods to improve their texture, taste, or shelf-life. It increases the ability of these toxic bacteria to get through the gut wall, into your bloodstream. Cruciferous vegetables like broccoli actually decrease these bacteria’s ability to cross the gut barrier by 50%!

SMOKING. Smoking not only causes IBD, it also aggravates the pain and other symptoms of it and increases the risk of complications.

ETHNICITY. IBD is present in all populations but Caucasians and Ashkenazi Jews have a higher risk.

AGE. IBD can happen at any age, but it usually starts before the age of 35.

FAMILY HISTORY. People who have a parent, sibling, or child with IBD are at a much higher risk for developing it themselves. However, just like with all other chronic diseases, the inheritance is more the lifestyle habits we learned than actual genes.

GEOGRAPHY. It’s a Western disease. People who live in urban areas and industrialized countries have a higher risk of getting IBD. Those with white collar jobs are also more likely to develop the disease. This can be partially explained by lifestyle choices and diet. Countries who traditionally had little IBD are now having rapidly increasing rates as they adopt a Western diet, including more processed foods, meat and dairy, and lifestyle. These countries, like Egypt and Saudi Arabia, heavily recruit GI doctors since they are not familiar with treating these once uncommon conditions in their countries.

GENDER. In general, IBD affects both genders equally however UC is more common among men, while Crohn’s disease is more common among women.

There are a number of different treatments for IBD although prevention and lifestyle management is always better than taking medications.


Anti-inflammatory drugs such as sulfasalazine and corticosteroids are the first step in IBD treatment. These drugs decrease inflammation of the digestive tract however, they have many side effects. Other anti-inflammatory drugs used for IBD include Immune suppressants (or immunomodulators) such as the heavily advertised tofacitinib (Xeljanz) which prevent the immune system from attacking the bowel and causing inflammation. Immunosuppressants can have many side effects including rashes, infections and they even increase the risk of developing various cancers. Our immune system is responsible for immune surveillance, searching and destroying early cancer cells. When that system is suppressed, cancer cells are allowed to reproduce and grow.

The mechanism by which aspirin and NSAIDs cause gastritis, stomach inflammation, is very specific. They work by decreasing the formation of chemicals called prostaglandins. Although prostaglandins can cause pain and inflammation, they also protect the stomach from its own acid. The damaging effects of these drugs on the stomach (and in fact, on the whole intestinal tract) are a direct extension of their anti-inflammatory effects. That’s why gastritis is such a common side effect of their use. Gastritis not only causes pain, it can cause bleeding. A large study found that the use of one adult-strength aspirin (325 milligrams) per day triples a person’s risk of being hospitalized for a major GI bleed. Aspirin and NSAIDs are among the most dangerous medications you can buy without a prescription. Aspirin is the drug which causes the most side effects and deaths of all medications in the world. 1 in 15 people who take it regularly suffer a complication and 1 in 564 will die as a direct result.

Antibiotics are used to kill bacteria that may trigger or aggravate IBD symptoms.

Antidiarrheal drugs and laxatives are used to treat symptoms but they do not treat the disease.


  • Drinking plenty of fluids helps to compensate for those lost in your stool.
  • Avoiding dairy products and stressful situations also improves symptoms.
  • Avoiding all processed foods and limiting animal products also helps.
  • Adding more fruits and vegetable is the key since they contain fiber. Animal products do not.
  • Exercising and quitting smoking can further improve your health.


IRRITABLE BOWEL SYNDROME (IBS) is a functional (in medical jargon this means “we don’t know what causes it and it may be in your head”) gastrointestinal (GI) disorder characterized by abdominal pain and altered bowel habits in the absence of a specific and unique organic identifiable pathology. Microscopic inflammation has been documented in some patients although this is not characteristic. Population-based studies estimate the prevalence of irritable bowel syndrome at 10-20%. Many patients diagnosed with irritable bowel syndrome actually simply have lactose intolerance or possibly an allergy to casein or whey, the main proteins in dairy. 

About 60% of IBS patients do report food sensitivities so these are usually worth investigating. As far as eliminating FODMAP foods (click on this link for more information), although this may help symptoms a bit, this should only be used temporarily. Too many beneficial fruits and vegetables are eliminated in this type of diet.



Fiber Fueled” Will Bulsiewicz, MD. The Plant-Based Gut Health Program for Losing Weight, Restoring Your Health, and Optimizing Your Microbiome.





Although not really appreciated in the medical community, the inability to tolerate and break down regular sugar can be a culprit when it comes to undiagnosed bowel/GI symptoms. Congenital Sucrase-Isomaltase Deficiency (CSID) occurs in about 1 in 5000 Americans. Incidence can be as high as 10% in certain populations like Canadian Inuit. Simply put, people who have this condition lack the enzyme to properly break down sucrose, in the same way that people with lactose intolerance lose the enzyme to break down the primary sugar in dairy, lactose. Some cases of IBS (irritable Bowel Syndrome), essentially a garbage can diagnosis used when we really don’t have an explanation for a patient’s symptoms, could actually be CSID. The same goes for diagnoses like Small Bowel Bacterial Overgrowth (SIBO) and constipation. 

It can be diagnosed by eliminating sugar and then reintroducing it to see how you feel. The 4-4-4 Simple Oral Sugar Challenge is such a test. The carbon-13 breath test is thought to directly measure sucrase activity and is the most definitive method to aid in diagnosing CSID that does not require an invasive procedure to obtain tissue samples from your intestine. Unlike the breath test for SIBO which is only 50% accurate, the SCID breath test is more than 85% accurate. Lastly, there is a Disaccharidase Assay, which is a blood test but it is only performed by specific labs.

Sucraid (sacrosidase) Oral Solution is an FDA-approved drug for use as an oral enzyme replacement therapy for CSID. Sucraid replaces the activity of sucrase, which is the digestive enzyme that breaks down sucrose. Sucraid may lessen the gastrointestinal (GI) symptoms associated with CSID. This is similar to Lactase, an enzyme replacement for people who have lactose intolerance and have a lot of GI symptoms.

Of course, the simplest way to avoid symptoms and feel better is to avoid dairy, in the case of lactose intolerance, or sugars, in the case of CSID.



LEAKY GUT – Intestinal Permeability

Although the skin is often thought of as the largest organ of the body, with a total area of about 20 square feet, this size pales in comparison to the actual largest organ, our gut. The surface area of our intestines is over 4000 square feet. The intestines use up more than 40% of our total energy expenditure. The primary role of the intestines is to protect us from the environment, primarily what we ingest. What separates our blood stream from the outside world is a single layer of cells with very tight junctions, covered by a layer of mucus. When those junctions separate and the barrier is disrupted, many problems arise.

Many things will impact the integrity of the gut barrier. Common drugs like aspirin and ibuprofen (Motrin), even just one dose, impact negatively on the gut barrier. Within 5 minutes of taking an aspirin, changes in the gut barrier can be seen. Even such healthful compounds like vitamin C can cause damage, especially when taken along with aspirin.

The use of NSAIDS, non-steroidal anti-inflammatory drugs, like Aspirin and Motrin, are involved in 25% of food induced anaphylaxis. This is partly a result of the breakdown of the gut barrier, which allows undigested food particles to enter the bloodstream where they are identified as foreign and an allergic reaction ensues. Taking such medications increases the risks of a food reaction by 10x.

Exercise also increases the risks of anaphylaxis and other severe reactions to foods by shunting blood away from the gut, which also leads to damage and increased permeability.

Alcohol also increases gut permeability.

Diets high in saturated fat lead to damage by feeding and increasing the number of damaging bacteria which consume the important mucus layer. Without that layer, the cells which make up the intestinal wall have less protection and are more prone to damage.




Diverticulosis is a condition where small outpouchings called diverticula form in the intestinal lining, similarly to how the inner tube of a bicycle can pooch out through defects in the outer tire. Although these pouches can form anywhere there is a lining with a muscle layer, the most common and most problematic are the ones which form in the large intestine, the colon. This consition barely existed 100 years ago.

  • In 1907, there were 25 reported cases of diverticulitis in the US literature. Today, 70% of Americans over 70 have diverticulitis.
  • 50% of black Americans over 50 have diverticulitis whereas <1% of their African counterparts have it. It’s because of their diet.

Diverticula form when the lining of the intestinal wall pushes through the muscle layer and bulges outside the intestines in the abdominal cavity. They typically form because of elevated pressures in the cavity along with an area of weakness in the muscle layer. In the colon, when material such as stool or undigested food gets trapped in these outpouchings, it starts to break down leading to inflammation of the pouch lining. This can cause a variety of symptoms such as pain, cramping, bloating… If left unchecked, it can lead to bleeding, infections and abscesses (walled off infections). Just like in the appendix, which is essentially a naturally occurring outpouching of the colon, if material gets stuck in it, causes inflammation, progresses to an infection, the diverticulum can rupture and can cause intra-abdominal infections which can be lethal. When infections spread outside the colon, this is called peritonitis and has a 50% mortality rate. 90% of people who die from a ruptured diverticulum didn’t even know they had diverticulitis.

They are essentially caused by a poor diet consisting of meat, dairy and processed food with little dietary fiber which you only get from fruits and vegetables. The lack of fiber is associated with constipation and subsequent straining which increases intra-abdominal pressure, leading to the formation of the pouches. Another contributing factor is the slow digestion (fermentation) of meat and dairy in the colon. This slow fermentation creates a continuous production of gas which dilates the colon increasing the pressure inside. The risk factors include:

ADVANCING AGE. Diverticula are present in nearly half of Americans by age 60, and more than 2/3 of Americans over age 80 are affected. In contrast, less than 5% of people under age 40 are affected however, between 1998 and 2005 there was an observed 82% increase in admission rates for diverticulitis in patients ages 18-44.

AFFLUENCE. Industrialized countries have a much higher prevalence of diverticular disease, approaching 40%, than developing nations like Asia and Africa have prevalence well below 1%. Their rates are rapidly on the rise as they adopt our  Western lifestyle.

LOW FIBER INTAKE. Large studies have linked a low fiber intake to the development of symptomatic and complicated diverticular disease. Those who consume a plant-based diet with high fiber intake (≥ 40 g/day) have significantly decreased prevalence of diverticulosis. The average American consumes less than 18 grams/day.

RED MEAT INTAKE. Red meat consumption has been correlated with a higher risk for diverticular disease, independent of fiber intake.

SEDENTARY LIFESTYLE. Regular physical activity of at least moderate intensity, such as running, reduces risk for diverticulitis by about 40%. Constipation is a risk factor for diverticulitis and is related to inactivity.

OBESITY. In a large prospective cohort study, among men ages 40-75, elevated BMI, waist-to-hip ratio, and waist circumference were all significantly associated with diverticulitis or a diverticular bleed.


Acute inflammation and infections need to be treated with anti-inflammatories, antibiotics and often limiting or avoiding anything by mouth until the acute situation settles down. These acute episodes often require hospitalization. Surgery is sometimes necessary including removing parts of the bowel or even the entire colon in some situations.

You can’t get rid of the diverticula without surgery once they form. You can however prevent recurrence of complications like inflammation, bleeding or infections. The main way to treat diverticulitis and prevent its recurrence is by improving lifestyle factors, primarily by improving diet. Diverticular disease is associated with a fiber-poor diet, basically one a low in fruits, vegetables, whole grains, and legumes but high in animal products and/or refined foods. Switch this around and your likelihood of getting this disease is minimized.

Some practitioners have suggested avoiding nuts, seeds, popcorn, corn, and other high-residue foods thinking that they may lodge within a diverticulum or abrade the lining and cause inflammation or bleeding. This idea has had little objective support. In the Health Professionals Follow-up Study including 47,228 men aged 40-75 years, nut and popcorn consumption was inversely associated with the risk of diverticulitis. That is, nut and popcorn consumption is associated with reduced risk.

The following factors have been associated with a reduced risk of diverticulitis:

A HIGH-FIBER DIET. Fiber-poor diets are the main root cause of diverticular formation. Fiber protects against colon perforation by increasing stool bulk and water content. This results in decreased fecal transit time and reduced colon pressure. Moreover, fiber beneficially alters the gut microbiome and reduces inflammation.

Individuals eating generous amounts of insoluble fiber (e.g., wheat bran, legumes, fruit skin, nuts, seeds) have roughly a 40% lower risk of symptomatic diverticulitis. 

AVOIDING MEAT. Fiber intake and meat intake are not entirely independent variables. Like all animal products, meat contains no fiber. However, meat consumption stands out as a risk factor for diverticular disease. Eating a diet low in fiber and high in meat is associated with a 3x increased risk for symptomatic diverticular disease.

In persons eating the largest amount of meat, the risk for right-sided diverticulosis in particular is roughly 25x that of persons eating the least. Men in the Health Professionals Follow-Up Study in the highest 20% of meat consumption were 58% more likely to develop diverticulitis. As little as 1 serving of meat per week increased risk in this cohort. Unprocessed meat, such as steak, had the highest risk, possibly due to higher cooking temperatures which generates inflammatory and carcinogenic compounds or from larger pieces reaching the large intestine undigested which then start to putrefy (rot) generating gas and inflammatory debris as well.

In contrast, people following vegetarian or better yet, vegan diets, typically consume more fiber, but their lower risk of diverticular disease is partly independent of fiber intake, suggesting the possibility of other mechanisms by which plant-based foods reduce risk.

LOSE WEIGHT. Prospective studies have found a linear increase in risk for diverticulitis for BMIs greater than 25, the upper limit of “normal”. A cross-sectional study with 126 white males found those with a waist circumference greater than 45 inches were 8x more likely to have diverticulosis than those with a waist circumference less than 38 inches.

During symptomatic episodes, avoiding solid foods and staying hydrated on a liquid diet or intravenous fluids in combination with antibiotics is helpful.



SIBO (Small Intestinal Bacterial Overgrowth)

Small Intestinal Bacterial Overgrowth, or SIBO, occurs when the bacteria in your small intestine get out of balance and overgrows. 

As mentioned above, the bacteria in your GI tract, which make up your gut microbiome, play a vital role in your immune system, thyroid function, bone health, and overall health. The GI tract starts in the mouth and ends at the anus. The breakdown and processing of food occurs at every point, even the mouth. In the small bowel, pancreatic enzymes like lipase, amylase and trypsin, start to digest, ie: break down, food whereas in the colon, where most of your gut bacteria is meant to be located, fermentation of food occurs. Those colon bacteria also synthesize vitamins, and eliminate waste. When these “healthy” bacteria, normally found in the large intestine and colon, colonize the small intestine, SIBO occurs. SIBO can also be caused by an overgrowth of otherwise normal bacteria in the small intestine itself. The bacteria ferment food producing CO2, Methane and Nitrogen. All cells in the body produce CO2 but methane and nitrogen are only produced by gut bacteria during fermentation which mainly occur in the large intestine. When these gases are produced in the small intestine is when the painful bloating occurs. These gases get absorbed into our bloodstream and are them exhaled while we breathe. This is how we can measure increased levels of methane and nitrogen, signaling the presence of SIBO.  The “breath tests” however they can be inaccurate.

Our stomach make acid whenever you eat or even think about or smell food. When the acid gets into the small intestine, it gets neutralized by bicarbonate, produced by the pancreas. The stomach is acidic but the small intestine is alkaline. The stomach has a mucus layer which protects us from the acid. If that rhythm of acid and bicarbonate gets disrupted, small intestinal bacterial overgrowth (SIBO) results because it’s not normal to have an alkaline stomach which happens when you take antacids.

The excess bacteria feed off of the undigested food in your small intestine. In particular, they love to feed on sugar, simple and complex carbohydrates, starches, and alcohol. As the bacteria feeds, it causes the carbohydrates to ferment, which produces hydrogen as a byproduct. Hydrogen can in turn feed single-celled organisms in your small intestine called archaea, which then produce methane as a byproduct. So, when you have SIBO you have excess levels or hydrogen, methane, or both in your digestive system.

Risk factors for SIBO include:

    • Constipation and conditions which cause slow gut motility.
    • Hypothyroidism (~ 50% of hypothyroid patients have SIBO since T4 and T3 influence bowel motility)
    • Multiple courses of antibiotics. Probably the most common cause.
    • Probiotics can also cause SIBO.
    • Acid reducing medications like Tagamet, Pepcid, Nexium and Prevacid. 
    • Reflux itself can cause it.
    • Folate deficiency.
    • Oral contraceptives.
    • Moderate alcohol consumption.
    • Overuse of NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) like Motrin, Ibuprofen, Aleve, Naproxen…
    • Low stomach acid. This is much more common than you would think and is usually the result of eating too much fat.
    • Irritable Bowel Syndrome. All SIBO=IBS but not all IBS=SIBO.
    • Inflammatory Bowel Disease like Crohn’s Disease and Ulcerative Colitis.
    • Celiac disease (long-standing).
    • Prior bowel surgery. 
    • Diabetes Mellitus (type I and type II). This is partly because of slow gut motility and partly because of changes in gut microbiome.
    • Organ system dysfunction, such as liver cirrhosis, chronic pancreatitis or renal failure.
    • Eating disorders. Causes are not clear but most likely related to years of vomiting causing confusion of gut motility neurologic reactions leading to slow gut motility.

Although limiting overall carbohydrate consumption can help control, SIBO, it’s really the unhealthy carbs that cause most of the problems. There are 4 steps to treating SIBO:

Step 1: Identify and Treat the Underlying Cause. THE MOST IMPORTANT STEP. You can do all the following steps and feel better but if you don’t identify and fix the underlying cause, the symptoms will come right back. The MOST common cause is a poor, fiber-poor and animal-product-rich diet. Many systemic diseases can also cause SIBO. Common ones include Hypothyroidism, Liver and Kidney disease as well as Diabetes which affects at least 1/3rd of Americans.

Step 2: Starve the Overgrown Bacteria. Remove the foods that feed the bacteria in your small intestine, including sugar, alcohol, and carbohydrates. This includes the usual suspects, such as bread, cookies, cake, and fruit juices, as well as some complex carbohydrates such as whole grains and legumes. Ultimately these foods are broken down into sugar in your gut, which feed the bacteria. During this time, you’ll eat plenty of non-starchy vegetables, leafy greens, lean proteins, and healthy fats, with minimal fruit. Many of these foods are healthy and may be re-introduced later but for the treatment period, they may need to be minimized.

Step 3: Attack the Bacteria. There are some antibiotics that can be used to attack the bad bacteria in the small bowel. This is very controversial. Some of the antibiotics include:  Xifaxan and Neomycin. These antibiotics kill the pathogenic bacteria with the least amount of disruption to the good bacteria in your microbiome.

If you are treating your SIBO at home, as many have done successfully, there are protocols such as Microb Clear™, which can help. This specific one is a blend of magnesium caprylate, berberine, and extracts from tribulus, sweet wormwood, grapefruit, barberry, bearberry, and black walnut which can work to kill off the bacteria naturally. You can also consume these ingredients separately on your own as well.

Step 4: Restore Your Good Bacteria. The final step is to restore the good bacteria in your gut to support a strong immune system and optimal digestion and nutrient absorption. Proper nutrition with lots of pre-biotcs described in the microbiome section are a great way to start. Probiotics can help but when it comes to SIBO you want to be particularly careful because certain probiotics can actually add more fuel to the fire.




Reflux is the most common gastrointestinal disease in the United States affecting 60% of Americans. Despite being on medictions, 30% of Americans have symptoms at least once a week. It’s a condition in which material from your stomach and small bowel refluxes back up into the esophagus, the throat and even as far up as the sinuses. It is NOT an excess acid problem. It’s an acid and digestive enzyme “in-the-wrong-place” problem. It’s fundamentally a malfunction of the lower esophageal sphincter (LES), which is the valve which opens and closes keeping stomach contents in the stomach and allowing material we swallow into the stomach. If the sphincter is A) too loose or B) it relaxes at the wrong times, then material in your stomach back washes up through the sphincter into areas it is not supposed to be. 

Our stomach lining cells, called gastrin cells, make acid continuously but production really increases whenever you eat or even think about or smell food. When the acid gets into the small intestine, it gets neutralized by bicarbonate, produced by the pancreas. The stomach is acidic but the small intestine is alkaline. The stomach has a mucus layer which protects us from the acid. If that rhythm of acid and bicarbonate gets disrupted, small intestinal bacterial overgrowth (SIBO) results because it’s not normal to have an alkaline stomach which happens when you take antacids.

Remember that our stomach acids do a lot. They maintain the proper balance of microbes in the gut, as well as the stomach and even the esophagus. People on acid reducers are at increased risks of C. Diff for example. Also, as mentioned above, reduced acids lead to overgrowth of bacteria in the small bowel, SIBO (Small Intestinal Bacterial Overgrowth), leading to bloating, constipation and various malabsorption syndromes and nutritional deficiencies. The acids also activate digestive enzymes and themselves help in food digestion. Lastly, they sterilize the food we eat, both animal and plant foods alike.

The lower esophageal sphincter (LES) is the key to controlling reflux. All fat but especially saturated fat impacts on how this sphincter works. In addition, when your stomach acids are neutralized, you can’t create various beneficial compounds from your foods. A great example is nitric oxide, which relaxes arterial walls and lowers blood pressure. When you chew and consume foods high in nitrates, the bacteria in the grooves of your tongue convert the nitrates into nitrite which then gets converted into nitric oxide by the acids in your stomach. When you take antacids, that final conversion does not occur!

When you eat fatty foods, there is a hormone called cholecystokinin (CCK), also known as pancreozymin, is produced by cells called enteroendocrine enterocytes which line the first part of the small bowel, the duodenum. It suppresses hunger and stimulates release of pancreatic digestive enzymes and stimulates the gall bladder to contract and express the bile acids into the small bowel to help process the fat but it also relaxes the LES. This CCK effect does not happen from fats from whole foods such as nuts, seeds or avocado because of the beneficial effect of fiber, which animal sources do not contain. It does occur with oils however since they contain no fiber. The most commonly purchased medications at pharmacies are over the counter acid reducers.

GERD is not caused by excess acid. It is caused by malfunction of the lower esophageal sphincter (LES) valve and poor esophageal motility, allowing stomach contents to enter the esophagus and not be quickly expelled. GERD is basically a motility disorder. The main trigger for GERD is a full, distended stomach. The proper treatment for GERD, then, is not acid suppression, but reversal of the motility disorder and avoidance of stomach distension.

Normal esophageal motility (contraction of the smooth muscle in the walls of the esophagus) is stimulated by 3 major factors: chewing, swallowing and calcium. Calcium is required for normal esophageal motility and for the proper and appropriate closing of the lower esophageal sphincter (LES). When your esophagus is healthy, there is enough calcium stored inside the cells of the esophagus to properly regulate motility. However, when the esophagus is inflamed, esophageal motility becomes dependent upon external sources of calcium. Calcium supplements, when properly taken, can actually improve esophageal motility and reduce or prevent GERD. Most people misunderstand the role of calcium in preventing GERD. They think of chewable calcium tablets, which usually consist of calcium carbonate, as antacids. But they are not very effective antacids and often do not significantly affect the acidity in the stomach or esophagus. Calcium can actually prevent reflux by two mechanisms: 

  1. Calcium can quicken esophageal motility, moving whatever has refluxed into the esophagus back into the stomach 
  2. Calcium can tighten the lower esophageal sphincter (LES).

Calcium citrate (~250mg mixed in water), which is a mildly acidic form of calcium, often works better than calcium carbonate, the form usually found in antacid tablets like Tums. It’s more effective because calcium citrate is more soluble than calcium carbonate, so the calcium gets into the cells of the esophagus faster. Calcium pills do not work for this purpose. The calcium must be chewed or swallowed as a powder or liquid, because it must be available in solution in the lower esophagus and upper stomach to be an effective anti-reflux remedy.

Excessive amounts of acid can make it worse but only if the sphincter is simultaneously not working. It can be a serious condition and causes many symptoms and diseases such as:

  • Heartburn and esophagitis (chronic inflammation of the esophagus).
  • Ulcers in the esophagus.
  • Esophageal and throat cancer.
  • Cough and throat clearing.
  • Erosion of tooth enamel.
  • Sinusitis.
  • Mouth Ulcers.
  • Diminished sense of taste.

Causes of GERD include:

  • Obesity. Additional weight and abdominal fat put excess pressure on and weaken the sphincter.
  • A hiatal hernia, often caused by the excess pressure caused by obesity.
  • Poor Diet. A diet heavy on animal products include a lot of fat which slows stomach emptying and impairs proper gall bladder function.
  • The Milk and Cookie Disease. Sugar, fat and dairy all slow gastric emptying and increase acidity. Here is a link to this topic on my Kid’s Health page.
  • Fat, especially saturated fat, relaxes the lower esophageal sphincter, allowing stomach contents to splash up.
  • Food sensitivities in some people. Common ones include:
    • Milk and other dairy products.
    • Eosinophilic esophagitis, often causing reflux, is very highly correlated to allergy to casein and whey proteins from dairy.
    • Gluten.
    • Sugar.
    • Coffee, regular or decaf.
    • Caffeine, all sources, which relaxes the sphincter, even many hours after it is consumed.
    • Alcohol. It also relaxes the LES.
    • Fruit juices.
    • Onions, especially raw.
    • Chocolate.
    • Fermented foods.
  • Fast eating and not chewing food well, leading to overeating and poorly broken-down food. Mindless eating is often a problem since it contributes to overeating.
  • Excess fluids consumed with meals. There is only so much room in the stomach and distention puts pressure on the sphincter.
  • Constipation also causes excessive pressure on the sphincter.
  • Dairy products can be constipating and should be avoided. It contributes to reflux for other reasons also.
  • High fat intake in general. Fat increases the frequency and degree of sphincter relaxations.
  • Overeating.
  • High levels of H. Pylori, a bacterium which is actually normal but too much can be a problem in some people. The goal should be to reduce, not eliminate it.
  • Stress.
  • Mouthwashes. In addition to the alcohol which is a direct irritant, they destroy the healthy bacteria in your mouth and disrupt the gut microbiome, leading to GERD.
  • Prescription drugs can cause it. Some common ones are:
    • Blood pressure medications, especially calcium channel blockers which relax the lower esophageal sphincter (LES).
    • Beta Blockers taken for blood pressure and arrhythmias.
    • Statins which can cause neuropathy leading to a dysfunctional LES.
    • Valium (it relaxes the sphincter).
    • Dopamine.
    • Morphine.
    • Asthma drugs.
    • Hormones like progesterone and estrogen.
    • Fish oils

If you watch television, you undoubtedly see the commercials for “purple pill”, an acid reducer to “treat” reflux. It usually shows overweight people eating garbage who miraculously become happier and have fewer symptoms when they take the pill. This is the WORST message possible. “Take this pill and your symptoms will go away. Eat what you want. This pill will fix it!” Even the American Gastroenterological Society advises against using these drugs since they have been shown NOT to work but many doctors prescribe them anyway.

These drugs have been linked to osteoporosis by affecting how calcium is absorbed, increased risk of pneumonia, kidney issues, microbiome changes and poor digestion and some studies even suggest an association with dementia.

GERD is diagnosed based on symptoms or sometimes though examination including evaluation by endoscopy however, many patients are self-diagnosing and unfortunately, self-medicating with acid reducers, the most potent and dangerous of which are all now available over-the-counter. Studies show that these medications do not decrease the risk of developing esophageal cancer. As mentioned above, even the GI societies advise against using them.

Reflux and asthma. There is definitely a connection between these 2 conditions since treating asthmatics for GERD often will reduce the frequency and severity of their asthma attacks. GERD causes symptoms of asthma by irritating the airways when the acids get into them. It is estimated that 80% of asthmatics also have reflux, especially in kids.

Silent reflux occurs when reflux occurs but the traditional symptoms of heartburn do not. This can occur both in adults and children. Common symptoms of silent reflux include:

  • Throat clearing and cough.
  • The feeling of a “lump” or “bubble” in the throat.
  • Swallowing difficulties like feeling like food gets stuck.
  • The feeling of post nasal dripping (which is actually a normal phenomenon) or excessive mucus.
  • Recurrent or persistent sore throats.
  • Ear infections.
  • Bitter taste.
  • Hoarseness.

Another significant contributor to symptoms of GERD is excessive amounts of the pancreatic enzyme pepsin, produced in greater amounts when we eat excessive amounts of protein, particularly animal protein. Excessive amounts of bile salts, produced by the gallbladder in response to fat consumption, is also a major issue.


  • Eat less and eat more slowly. Chew your food.
  • Switch to a whole food, plant-based diet.
  • Eat less fat, especially from animal sources.
  • Eat less protein, especially from animal sources.
  • Stop drinking sodas and other carbonated beverages.
  • Maintain a healthy weight. Excess weight puts more pressure on the upper esophageal sphincter.
  • Do NOT eat or drink, even water, within 2 hours of going to bed. If your sphincter is loose, and there is something in your stomach, it will come up! It’s simple physics.
  • Fix the constipation, easily done by following a whole foods, plant-based diet with lots of fiber.
  • Head of bed elevation. Keep in mind that using pillows can make it worse by causing you to flex in the abdominal area, increasing pressure on the stomach worsening reflux.
  • Avoid ANY caffeine within at least 10-12 hours of sleep. Caffeine relaxes the LES and only a small amount can cause this effect. In addition, caffeine leaves the body very slowly. Its half-life is 6-8 hours which means that if you consume some caffeine at 3 pm, half of it is still in your body at bedtime. Keep it to before noon.
  • Don’t exercise within 2 hours after eating, especially dinner. Obviously if you exert yourself with a full stomach, some of it is bound to come up. In the evening, exercise has the added effect on contributing to poor sleep.
  • SLEEP POSITION. In addition to head elevation, position is very important.
    • Sideways on the left is the best. This position is most efficient at draining the stomach contents down into the intestines rather than into the esophagus.
    • Laying flat on your back is the worst position. Stomach contents drain into the esophagus rather than into the small intestine in this position.
    • Sideways on the right is second worst, again because the stomach drainage is not in a position for gravity to work.
    • Laying on your stomach is actually the second best.

Traditional Therapies

MILK. One traditional misconception is that milk will help with GERD. Milk is alkaline so in the short term it will help heartburn, just like tums, since it neutralizes the acid. But in the long term, and even in the short term, it makes things worse. First, the fat from the dairy relaxes the lower esophageal sphincter, so even though it may soothe symptoms now, a few hours from now, things rebound even worse. Secondly, those fats and proteins lead to increases in bile acids, which also reflux into the esophagus causing damage. Lastly, the dairy proteins themselves are pro-inflammatory and cause further damage.

APPLE CIDER VINEGAR (ACV) has also been touted as a home remedy for GERD. Although for some, diluted ACV can help reflux symptoms, it does so by improving the microbiome of the gut, which takes time. For some, what is thought of as GERD is actually a relative absence of acidity in the stomach which can happen naturally with age. However for some with real GERD, too much or undiluted ACV can make symptoms and the esophageal erosions worse.

HERBAL REMEDIES which may help include chamomile, slippery elm and licorice.

ACID REDUCERS – They help the symptoms but don’t stop the disease. The most commonly purchased medications in US pharmacies, whether prescription or over-the-counter, are acid reducers. These medications are used to treat heartburn or its more advanced form, gastroesophageal reflux. Although they seem innocent enough and they can relieve heartburn and reflux symptoms, they do not treat the underlying disease, can make the problem worse by masking the problem. As with any other medication, they have many side effects, some of them quite serious.

There are 2 kinds of acid reducing medications. Those which “put out the fire” of heart burn like Tums, Rolaids, Maalox or Gaviscon. These neutralize the acid but do not stop further acid production. Taking these on occasion when you overdo it is not a problem. If you need to be taking these regularly, you might have an issue. The other types of acid reducers do not put out the fire but stop further acid production. They fall under 2 categories:

  1. H2 blockers. These block a receptor called a Histamine 2 receptor (different from the Histamine 1 receptor which is activated during allergic reactions). Examples include:
    1. Tagamet (cimetidine)
    2. Zantac (ranitidine)
    3. Pepcid (famotidine)
    4. Axid (nizatidine)
  2. Proton Pump Inhibitors or PPIs. These act by turning of the proton pump (the part of the cell producing the acid ) in the cells of the stomach lining. They essentially shut acid production off and are 10x stronger than H2 blockers. Examples include:
    1. Prevacid (lansoprazole)
    2. Nexium (esomeprazole)
    3. Prilosec (omeprazole)
    4. Dexilant (dexlansoprazole)
    5. Protonix (pantoprazole)

The acid produced in our stomachs is hydrochloric acid, a much more acidic substance than anything we eat, and it serves multiple purposes. It activates enzymes responsible for breaking apart and digesting food. It also destroys and kills foreign substances we ingest either by swallowing or from the regular drainage of nasal and lung mucus along with our saliva. In total, we produce almost a gallon of secretions a day which are normally swallowed (⅓-½ gallon of nasal secretions, ¼ of a gallon of lung mucus and ¼ of a gallon of saliva – a day!). When our stomach acid levels are reduced, which can occur through simple aging, or artificially through medications, a slew of medical issues can develop.

  • Allergies, both environmental and medications.
  • SIBO (Small Intestinal Bacterial Overgrowth)
  • Poorer digestion and absorption of food overall.
  • Low magnesium levels because of poor absorption which can result in:
    • Hypertension
    • Weakened bones
    • Kidney disease
    • Muscle weakness
    • Muscle cramping
  • Pneumonia, because of decreased bacterial destruction. In addition, PPIs lead to gut microbiome changes favoring formation of bacteria which commonly cause pneumonia.
  • Dementia. The mechanism is not clear but may have to do with altered gut microbiome and insulin function. Another thought is that naturally produced Beta amyloid, the buildup of which causes Alzheimer’s Dementia, is broken down by lysosomes which are activated by acid. Lower acid levels lead to poorer lysosome function and build up of amyloid.
  • Alterations in the gut microbiome.
  • Vascular disease, because of decreased nitric oxide production (gastric acid helps convert nitrite from foods such as green leafy greens and beets, into nitric oxide which relaxes arterial smooth muscle).
  • Malabsorption of various nutrients including:
    • Vitamin B12
    • Folate
    • Iron
    • Magnesium
    • Calcium (which is why people who take PPIs long term often develop osteoporosis)
    • Zinc
    • Copper
    • Certain amino acids
  • Increased risk for Clostridium Difficile, H. Pylori and other gut microbial infections.
  • Stomach cancer.

TAPERING OFF OF ACID REDUCERS. If you have taken a Proton Pump Inhibitor (PPI) like Prevacid, Omeprazole, Nexium, Dexilant or Prilosec for more than a few weeks, if you quit cold-turkey, you will get a rebound increase in acidity above your normal baseline range. This occurs because the acid producing cells have been suppressed and need to re-set to produce a normal amount of acid. In the meantime, you make more and will DEFINITELY have heartburn. This rebound effect does not occur with the class of acid reducers known as H2 Blockers such as Zantac, Pepcid or Tagamet. They are about 10x less potent than PPIs. So, it is better to combine the two and taper off the PPIs over a 10 day period or so. Here is a tapering protocol to follow:

  • Take Pepcid Complete after dinner. It is a less potent antacid but does not result in rebound when discontinued.
  • Week 1, take the PPI (Nexium, Protonix, Omeprazole…) every other night 30-60 minutes before dinner (or whenever you are used to taking it.
  • Week 2, take it every third night, then discontinue altogether.
  • Continue the Pepcid Complete for another week then discontinue and take as needed.

Risks associated with chronic acid suppression:

  1. Bone loss, increasing the risk of hip fracture.
  2. Food-borne infection (food poisoning). 
  3. C. Diff. A life-threatening inflammation of the large intestine caused by toxic bacteria (Clostridium difficile colitis).
  4. Vitamin B12 deficiency.
  5. Bacterial overgrowth in the upper GI tract, a cause of irritable bowel syndrome and of malabsorption
  6. Food allergies. Impaired digestion of protein in the stomach makes food protein more allergenic; this effect occurs within 3 months of daily use of acid-suppressing drugs.
  7. Pneumonia All of these effects can result from suppression of stomach acid.
  8. PPIs can have direct effects on bone and the immune system. 
  9. Heart attacks and strokes. A recent study showed that those on PPIs for over 3 years had a 30% greater risk of both problems.
  10. They may decrease formation of new bone and may inhibit the activity of white blood cells. 
  11. H2 blockers may contribute to memory loss, presumably by interfering with normal brain chemistry. 
  12. If daily use of acid-suppressing drugs is continued for several years, profound changes in the stomach lining usually occur, making it too thin (this is called atrophic gastritis) or creating islands of excessive growth (these are called gastric polyps).

When the secretion of stomach acid is turned off, your stomach responds by increasing the number of acid-producing cells and by increasing the amount of the enzyme gastrin, which signals the stomach cells to make more acid, since the levels are too low. This poses problems when trying to stop these meds. Dong so suddenly, often leads to major gastric and esophageal distress. If you taper off of them, the body adjusts and this can be avoided.

Non-acid reflux can still be irritating and damaging. Bile and digestive enzymes present in gastric juice can cause just as much damage as stomach acid.

Some drugs and supplements that can cause or contribute to GERD include: NSAIDs and aspirin, antidepressants, calcium channel blockers and beta-blockers for blood pressure and arrhythmias, aspirin, hormones like progesterone or estrogen, peppermint oil and  fish oils.

The mechanism by which aspirin and NSAIDs cause gastritis, stomach inflammation, is very specific. They work by decreasing the formation of chemicals called prostaglandins. Although prostaglandins can cause pain and inflammation, they also protect the stomach from its own acid. The damaging effects of these drugs on the stomach (and in fact, on the whole intestinal tract) are a direct extension of their anti-inflammatory effects. That’s why gastritis is such a common side effect of their use. Gastritis not only causes pain, it can cause bleeding. A large study found that the use of one adult-strength aspirin (325 milligrams) per day triples a person’s risk of being hospitalized for a major GI bleed. Aspirin and NSAIDs are among the most dangerous medications you can buy without a prescription. Aspirin is the drug which causes the most side effects and deaths of all medications in the world. 1 in 15 people who take it regularly suffer a complication and 1 in 564 will die as a direct result.

ONE LAST THING ABOUT ACIDITY. Most people start to have decreasing amounts of stomach acid as they age and The symptoms of too little acid can be the same as reflux (which again as NOT a problem with too much acid, just acid in the wrong place). A simple test to see if you have too low acid is to take a supplement known as Betaine HCL. This is a link to protocol to try: Betaine HCL Instruction

Link to my Reflux handout. Gastro Esophageal Reflux Disease




Although this problem might lead to different types of symptoms, often, they are exactly the same. Since most people overeat, eat too late and are overweight, there is a reflexive reaction that they have reflux. Although most of the time that is correct, it’s not always the case.

Hypochlorhydria is a deficiency of stomach acid. If you don’t have enough stomach acid, you can’t digest food properly or absorb its nutrients. This leads to indigestion, malnutrition and sometimes bacterial overgrowth. In addition, lower than normal stomach acids also impact on the balance of healthy and unhealthy bacteria in the small and large intestines. Chronically low acid also increases the risks of stomach cancer, as well as increasing the risks of cardiovascular disease and even diabetes. Fortunately, hypochlorhydria is relatively simple to test and treat.

What is hypochlorhydria? Hypochlorhydria means low stomach acid, specifically, low hydrochloric acid (HCI), which is the most powerful acid your stomach produces. HCL plays an important role in your digestion and immunity. It helps break down protein and absorb essential nutrients, and it helps control viruses and bacteria that might otherwise infect your stomach.

If you have hypochlorhydria, you’ll have trouble digesting food properly, especially protein. Over time you can develop serious nutritional deficiencies. You’ll also be prone to infections, which can cause further damage to your stomach and digestive system.

Hypochlorhydria means your stomach isn’t producing enough hydrochloric acid. Hyperchlorhydria means it produces too much. In the U.S., people most often attribute their digestive problems to hyperchlorhydria, and they often use medication to suppress their stomach acid. But in fact, symptoms of chronic acid reflux, laryngopharyngeal reflux or heartburn can also be caused by hypochlorhydria. Poor digestion from the lack of stomach acid can create gas bubbles that rise into your esophagus and throat, carrying not only stomach acid, but also bile acids as well as digestive enzymes with them. Even trace amounts of these substances in your esophagus can feel like too much.

Stomach acid is necessary for digestion and absorption of protein, vitamin B12 and several minerals. When your body is no longer able to break down and absorb these nutrients, you end up with undigested food and nutritional deficiencies. Protein and vitamin B12 deficiencies lead to iron deficiency anemia as well as vitamin deficiency anemia, which affects your nervous system. Calcium and magnesium deficiencies lead to osteoporosis.

Undigested food in your GI tract causes a range of uncomfortable GI symptoms in the short term and leads to more serious problems in the long term. For example, undigested food left to ferment in your GI tract can lead to gut bacteria overgrowth in your small intestine (SIBO). Low stomach acid also leaves you vulnerable to overgrowth of other common bacteria, including H. pylori, which is associated with chronic gastritis and peptic ulcer disease. The small intestine is not meant to harbor large amounts of bacteria, which occurs when you lower stomach acid levels.

What causes hypochlorhydria?

The most significant causes include:

  • Aging. As we get older, we produce less stomach acid. Although most people still generate enough, some need extra.
  • Acid-reducing medications. The other causes mentioned below used to be more common but so many people take acid reducers, they have taken over as by far the most common cause. Chronic use of antacids, H2 receptor blockers, and especially proton pump inhibitors (PPIs) can cause low stomach acid. PPIs were originally approved only for short-term use only, but they are now commonly overprescribed and used to treat chronic symptoms such as GERD and heartburn. Eventually, they can cause the acid-secreting glands in the stomach to stop working. PPIs are the most purchased medication, prescribed or OTC, in the US
  • Atrophic gastritis. This is the second most common cause and occurs when the cells that secrete stomach juices atrophy (shrink and die) and stop working. Atrophic gastritis is the end result of chronic inflammation of the stomach (gastritis). Chronic gastritis can be caused by a variety of things, including bacterial infection (H. Pylori), alcoholism and autoimmune disease when the immune system attacks the stomach lining.
  • H. pylori infection. This common bacterial infection affects about half of the U.S. population but is even more common in Asia and India. In some people, H. pylori causes no symptoms, but in others, it can take over, fighting and eventually decreasing stomach acid. Ironically, low stomach acid can also allow for H. pylori to take over.

What are the symptoms of hypochlorhydria?

Immediate symptoms involve indigestion, including:

  • Abdominal pain, Bloating and Gas.
  • Diarrhea and/or Constipation.
  • Undigested food in your poop.
  • Heartburn and Reflux.

Prolonged hypochlorhydria may produce symptoms of nutritional deficiencies, including:

  • Brittle fingernails.
  • Hair loss.
  • Paleness.
  • Fatigue and Weakness.
  • Numbness or tingling in hands and feet.
  • Memory loss.
  • Headaches.

Other contributing causes to achlorhydria may include:

  • Advanced age. Cells age as we do, and over time, the cells that produce stomach acid can begin to die off.
  • Chronic stress. This doesn’t mean common, everyday stress. But if you have significant stress sustained over a long period of time, it can affect your stomach acid production.
  • Stomach surgery, including gastric bypass surgery, is known to affect stomach acid production.

What risk factors are associated with hypochlorhydria?

  • Being over the age of 65.
  • Prolonged use of antacids or PPIs.
  • H. pylori infection.
  • History of gastritis or stomach ulcers.
  • History of stomach surgery.


How can I tell if I have low stomach acid?

The symptoms of hypochlorhydria — symptoms of indigestion, nutritional deficiencies and possibly bacterial infection — can be caused by many things. Hypochlorhydria is only one possible cause. If you have several of the risk factors associated with low stomach acid, you might suspect that is your problem. But there’s no way to know for sure without taking a stomach acid test.

Healthcare providers use a variety of tests to diagnose hypochlorhydria. There are also some DIY tests you can try at home. These may not be as accurate, but they offer a relatively simple and inexpensive way of exploring your theory. We recommend that if you do get a positive result from an at-home test, you follow up with a trained healthcare provider.

The baking soda test

The theory behind this at-home is that baking soda combined with stomach acid produces carbon dioxide (C02), which will cause you to burp. For the test, you’ll drink half a glass (4 ounces) of cold water combined with a quarter teaspoon of baking soda, on an empty stomach. Then time how long it takes you to burp. If it takes longer than three to five minutes, the theory goes, you don’t have enough stomach acid.

How is hypochlorhydria diagnosed?

Your healthcare provider will conduct a physical exam and listen to your symptoms and health history. If they suspect hypochlorhydria, they will suggest one of several stomach acid tests.

Medical tests to diagnose stomach acid include:

  • The Heidelberg pH test. For this test, you’ll swallow a small capsule with a radio transmitter that measures the pH levels in your stomach. After taking a baseline measurement, you’ll drink a baking soda solution to neutralize your stomach acid. Then the test measures how long it takes your stomach to return to baseline acid levels. This tells healthcare providers how well your stomach produces and secretes acid.
  • The SmartPill test. The SmartPill is another wireless transmitter that you swallow. Unlike the Heidelberg test, which measures pH levels, the SmartPill measures gastric acid levels.
  • The gastric string test. This test involves swallowing a capsule attached to a string, then pulling it out by the string after 10 minutes. The string is tested with pH paper. Normal stomach acid has a pH level of one to two, which is highly acidic, with zero being the most acidic level on the scale. If you have hypochlorhydria, your stomach acid might be more in the range of three to five. Above five is a severe condition called achlorhydria, which means you have virtually no hydrochloric acid.

If you test positive for hypochlorhydria, your healthcare provider may want to follow up with additional tests to detect nutritional deficiencies or bacterial infections. They’ll use all of this information to design your treatment plan.


How is hypochlorhydria treated?

Treating hypochlorhydria is a three-pronged process.

  • Address underlying causes. If your healthcare provider has been able to identify the cause of your hypochlorhydria, the first step will be to address that. This might mean adjusting your medication prescriptions, treating an underlying health condition, or fighting a bacterial infection with antibiotics.
  • Supplement hydrochloric acid. To treat the hydrochloric acid deficiency itself, your healthcare provider may prescribe an HCI supplement (betaine hydrochloride) to take with meals. HCI supplements are often combined with the enzyme pepsin. These supplements can help your digestion. Sometimes, they help your stomach acid gradually return to normal levels, and you can discontinue taking them. They are available over the counter, but they are not for everyone, so you should talk to your healthcare provider first before self-prescribing.
  • Supplement nutritional deficiencies. If your low stomach acid caused other deficiencies, such as iron, calcium or vitamin B12, your healthcare provider may recommend supplements to help replace those nutrients.
  • Betaine. As mentioned in the previous section, betaine is hydrochloric acid tablet which can be purchased at many pharmacies or health food stores. Here is an article about how to a trial of and take betaine: Betaine HCL Instruction.


What is the prognosis for hypochlorhydria?

This condition can often be reversed, or at least successfully treated, with HCI supplements. It’s important to address the underlying causes, however. If you have an infection, disorder or inflammatory condition, these will continue to cause problems, including hypochlorhydria and others. Make sure to get a thorough medical screening before treating with HCI supplements. Your healthcare provider can help ensure you’re treating the causes and effects of hypochlorhydria, including specific nutritional deficiencies.

What’s a good diet for low stomach acid?

Diet alone won’t restore your stomach acid, but these guidelines may help improve your digestion while living with hypochlorhydria:

  • Eat protein first. Protein at the beginning of your meal helps to stimulate acid production.
  • Drink fluids later. Save drinks until at least 30 minutes after you’ve finished your meal. This gives your stomach more time to produce acid and metabolize proteins.
  • Eat probiotic foods, including yogurt, miso and sauerkraut, to help boost your good gut bacteria and keep harmful bacteria in check.
  • Avoid overly fatty and processed foods, which are harder to digest and offer little nutrition.
  • Fortify your vegetarian diet. Many of the deficiencies associated with low stomach acid, including protein, iron, calcium and vitamin B12, are most abundant in animal-sourced foods, such as meat, fish and dairy products. If you’re a vegetarian, make sure you’re supplementing these nutrients. This might be easiest with a quality health shake blend.
  • Eat smaller meals and chew thoroughly to give your digestive system its best chance to break the food down.
  • Finish your last meal two to three hours before bedtime. Give your body time to digest before lying down.





CELIAC DISEASE (CD) is an autoimmune disease in which antibodies are formed to a compound in gluten, resulting in inflammation and leading to the destruction of the villi (folds) in the intestinal wall. It occurs in about 1% of people but is on a rapid rise. It can be quite debilitating and causes a myriad of symptoms. 

Tissue Transglutaminase (tTG) is an enzyme which can be found both in the intracellular and extracellular spaces of various types of tissues and organs including the heart, liver, and small intestine. Intracellular tTG is thought to play an important role in apoptosis (programed cell death). In the extracellular space, tTG binds to proteins, has been linked to cell adhesion, membrane stabilization, wound healing, receptor signaling, cellular proliferation, and cellular motility. One of its effects is to change the shape of the gliadin molecule, making it more prone to identification by the immune system. When the tTG attaches to gliadin, the immune system mis-recognizes it as foreign as well, also attacking it leading to inflammation. Autoantibodies are formed to both the gliadin and the tTG. The result is not only inflammation and destruction of the gut wall but also the other organs where tTG is located, like the heart and liver.

As a result of the damage to the gut lining, absorption of nutrients is affected and more autoimmune reactions can occur since the immune system is now able to interact with many new microbes and proteins it was not meant to interact with.

The common pediatric symptoms of Celiac Disease include diarrhea, bloating and cramping. These symptoms are less common in adults however. There are over 200 different symptoms of CD, some of which include:

  • Anemia and Osteoporosis, usually as a result of malabsorption of nutrients because of the damaged gut
  • Joint and bone pain from inflammation.
  • Migraine headaches.

40% of patients with Celiac Disease have “Silent Celiac”, meaning they have no symptoms. Because of the genetic connection, if you have a relative with CD, you should get tested. In addition, CD is associated with many other autoimmune disorders such as Rheumatoid Arthritis, Type 1 Diabetes, Autoimmune Hepatitis.

CD increases the risks of various other diseases like:

  • Coronary Artery Disease, by 2x
  • Non-Hodgkin’s Lymphoma, by 3x
  • Small Bowel cancers by 4x
  • And various other conditions such as neurologic problems and infertility

GLUTEN SENSITIVITY. Although 70% of Americans are trying to avoid gluten, less than 5% are truly sensitive and less than 1% have true Celiac Disease. Most are probably just reacting to the poor-quality processed foods they are eating, not the actual gluten. In a review of more than 10 studies of people claiming to be gluten sensitive, only 16% really were. Furthermore, 40% of the people who thought they were eating gluten but actually were not, reported symptoms. This symptom “expectation” is called the “nocebo effect”, the development of symptoms despite not being exposed to the target item. This is the opposite of the “placebo effect”, the improvement in symptoms because you think you are getting a drug, despite really not getting anything which has any impact. In addition, many people who claim to be gluten sensitive are perfectly fine eating the same foods when they travel abroad. It’s not not the gluten but probably the chemicals and food quality which is much more regulated everywhere outside of the US and Canada.

Wheat also contains a compound known as a fructan, a polymer of fructose molecules. Some people have trouble digesting this compound, also known as a FODMAP (the the Fodmap link elsewhere on my site). This is usually not a result of the inability to digest the food, just an indication of an unhealthy gut microbiome, incapable of digesting the food. When you improve gut health by eating whole fruits and vegetables, beans and legumes, your ability to digest and tolerate these foods improves.

As mentioned above, most Americans are concerned about gluten even though they don’t need to be. Yes, they should be concerned about refined and processed foods, but not about healthy sources of gluten like whole grains. These foods contain many important nutrients like B vitamins, folate and fiber. Most Americans are sorely lacking in fiber and most what they are getting come from grains. By limiting these foods, they limit their diet even further. In addition, “gluten-free” foods are usually more expensive. Food companies market their products “gluten-free” knowing they’ll sell more. Americans spent more than $15 billion in 2016 on gluten-free foods, twice as much as in 2011. According to the FDA, a product can be labelled as “gluten-free” if it has less than 20 ppm (parts per million) of measurable gluten. It’s gotten so ridiculous that even water bottles have been labeled gluten-free!

Lastly, one of the problems with consumers just blindly eliminating gluten is that by doing so, it might actually mask another serious underlying problem or even mask gluten sensitivity or even Celiac Diseases itself. If you don’t drive a car for 6 months, you can’t claim being accident-free! If you don’t consume gluten, your sensitivity to it will diminish. If you have some symptoms which are not clear, see your doctor. Appropriate tests can be done and they an be artificially impacted by limiting foods which may be the actual problem.



ADHD – Attention Deficit Hyperactivity Disorder

ADHD, also known as Attention Deficit Hyperactivity Disorder, is a type of behavioral disorder primarily seen in children although it is being diagnosed with increasing frequency in adults as well. It is characterized by restlessness, inattentiveness, difficulty concentrating, high levels of unfocused energy and impulsive behavior. According to the Centers for Disease Control and Prevention (CDC), ADHD diagnoses in children increased by about 41% between 2003 and 2011. Since then it has been relatively stable. As of 2016, the ADHD rate is approximately 10% in kids between the ages of 4 and 17 years old. The rates are slightly lower between 4-11 and slightly higher between 11-17. The rates are also higher in boys who are diagnosed 3x more often than girls. Approximately 4% of adults have ADHD. Here are some statistics:


  • On average, every classroom of 30 students has 1 to 3 children with ADHD.
  • ADHD is 3 x more prevalent in boys than girls.
  • The average age of onset is 5 for severe ADHD, 7 for moderate symptoms, and 8 for mild symptoms.
  • About half of kids with ADHD are noted to have “severe impairment.”
  • 6.1% of U.S. children (ages 4-17) took stimulant medication for ADHD in 2011, up 28% from 4.8% in 2007.
  • 40% of youth with ADHD symptoms don’t get treatment.
  • The rate of emotional development for children with ADHD is up to 30% slower than it is for children without the condition. For example, a 10-year-old with ADHD operates at the maturity level of about a 7-year-old. A 16-year-old beginning driver is using the decision-making skills of an 11 or 12 year old.
  • 75% of boys with ADHD are hyperactive whereas 60% of girls with ADHD are hyperactive.
  • 40% of children who have ADHD have at least one parent who has ADHD.
  • As many as 40% of kids diagnosed with ADHD have an undiagnosed or untreated sleep disorder.


  • 3-5% or about 2 million, of American teens suffer from ADHD.
  • 7% of parents will have a teen with ADHD.
  • About 80% of children who need medication for ADHD still need it as teenagers.
  • Teenagers with ADHD have 2-4x as many traffic citations as their peers without ADHD.
  • Teens with ADHD have 4x as many car wrecks and are 7x more likely to have a 2nd accident.
  • Teenage drivers with ADHD sustain 3x as many car-crash injuries as do teens without ADHD.
  • Teenage drivers with ADHD are at fault for car crashes 4x more often than are their peers.
  • Teenage drivers with ADHD are 6-8x more likely to have their license suspended or revoked for poor driving behavior.
  • 21% of teens with ADHD skip school repeatedly.
  • 35% of teens with ADHD eventually drop out of school.
  • 45% of teens with ADHD have been suspended.
  • 30% of teens with ADHD have failed or had to repeat a year of school.


  • 4.4% of the US adult US have ADHD, 41% of which are considered severe.
  • Less than half of adults with ADHD seek treatment.
  • The rate in men is also 3x that of women, just like kids and teens.
  • 30-60% of kids diagnosed with ADHD will continue to be affected into adulthood.
  • Adults with ADHD are 5x more likely to speed and 50% more likely to be in a serious car crash.
  • Having ADHD makes you 3x more likely to be dead by the age of 45.
  • Anxiety disorders occur in 50% of adults with ADHD.
  • Parents of a child with ADHD are 3x more likely to separate or divorce than are parents of children without ADHD.

Conditions Related to ADHD

  • 65% of children with ADHD have problems with defiance, non-compliance and other problems with authority figures, including verbal hostility and angry outbursts.
  • 25% of students with ADHD have other learning disabilities in one or more of these areas:
    • oral expression
    • listening skills
    • reading comprehension
    • math.
  • Half of all students with ADHD also have listening comprehension problems.
  • About one-third of students with ADD have one or more of the following:
    • Language deficits (poor listening comprehension, verbal expression or reading comprehension)
    • Poor organizational skills
    • Poor memory
    • Poor fine motor skills
  • Students with ADHD are 3x more likely to have problems with expressive language
  • 50% of children who have ADHD also have sleep problems.
  • Substance abuse is 4x greater than the national average for those with untreated ADHD.

Although there is no one exact cause of ADHD, environmental influences are certainly partly to blame. Below is a list of things to avoid and potential treatments for ADHD.

  • FOOD. Eating particular foods can trigger ADHD symptoms in patients, particularly children, so it’s important to avoid certain foods thought to spark a reaction.
    • ARTIFICIAL DYES and PRESERVATIVES. Clearly linked to various behavioral issues including ADHD, avoid foods with any artificial dyes and preservatives (most have been banned in other countries):
      • sodium benzoate, found in carbonated beverages, salad dressings, and fruit juice products
      • FD&C Yellow No. 6 (sunset yellow), found in breadcrumbs, cereal, candy, icing, and soft drinks
      • D&C Yellow No. 10 (quinoline yellow), found in juices, sorbets, and some fish!
      • FD&C Yellow No. 5 (tartrazine), found in foods like pickles, cereal, granola bars, and yogurt
      • FD&C Red No. 40 (allura red), found in soft drinks, children’s medications, gelatin desserts, and ice cream
    • DAIRY. Dairy products, especially ice cream and yogurt, can trigger ADHD. Someone who is sensitive to dairy products may feel tired both physically and mentally after consuming foods such as ice cream. In addition, ice cream and yogurts often have other ingredients like sugar and artificial dyes, also linked to triggering ADHD.
    • CHEESE. Although this is dairy, it deserves a special mention. Known to trigger ADHD, improved symptoms from eliminating dairy can take a few weeks of abstinence to see a difference. Also, cheese and other forms of dairy are hidden in many processed foods so you must read labels.
    • SUGAR. A diet high in sugar can spark a flare in ADHD patients. In addition to its effects on various neurotransmitters and receptors in the brain, sugar impacts on mood stabilizing vitamins, enzymes and minerals.
    • CAFFEINE. Many people rely on coffee and various other caffeine sources for an energetic start to their mornings. All-natural stimulants like caffeine are known to trigger ADHD symptoms. If symptoms worsen after drinking coffee, try drinking herbal teas or decaffeinated coffee instead. Be aware of other sources of caffeine such as power drinks (often containing both caffeine and natural stimulants like guarana) kombucha (usually made with tea) and both black and green or green tea themselves, which simply contain caffeine.
    • FISH. Fish high in the heavy metal mercury, such as tuna and swordfish, have been known to trigger ADHD symptoms. Mercury can decrease one’s ability to focus and impair concentration.
    • CHOCOLATE. Chocolate, like coffee, contains a significant amount of caffeine and other stimulants. Caffeine has been known to trigger ADHD symptoms and can make symptoms worse. Many chocolates also contain dairy as well as artificial colors and other chemicals.
    • SUGAR SWEETENED BEVERAGES. Many beverages contain artificial colors and flavoring, known to trigger ADHD. In addition, many sodas also have higher levels of caffeine. These are a double whammy.
    • FROZEN PIZZA/PROCESSED FOODS. These are packed full of artificial colors and flavorings, just like soda. The ingredients used to help enhance these types of products can increase hyperactivity and decrease concentration in individuals with this disorder.
    • FOOD SENSITIVITIES. Although some claim that naturally yellow vegetables like corn and squash can trigger or worsen ADHD symptoms, the reality is that any food sensitivity can cause problems. Figuring these sensitivities out can be a challenge since food testing is not reliable. You should do a diet diary and eliminate, hopefully only temporarily, foods that are consumed often or have resulted in reactions. The most common classes of foods that can cause problems include dairy, wheat, corn, soy and eggs.
    • FRUIT JUICE. Most fruit juices are loaded with artificial colors and flavors. Avoid them unless they are 100% natural, organic with containing no artificial coloring or flavoring and even then, limit it.
    • FAST FOOD. Fast Food is on the top of most “Do Not Eat” lists. The fried foods found in most fast food meals are incredibly unhealthy and the ingredients have been known to cause an increase in ADHD symptoms. Assume that anything from a restaurant is packed with sugar, salt, fat and various flavorings and chemicals.
    • RED MEAT (and other animal products). Known to cause an increase of ADHD symptoms, cutting back on, or better yet eliminating red meat intake may prove great benefits in controlling ADHD. Partly related to the contamination from chemicals, naturally occurring compounds in meat are also associated with worsening ADHD symptoms. If you choose to eat animal products, make sure they are from clean, organic sources to minimize the additional chemicals always consumed from traditionally raised animals.
  • MEDICATIONS can help improve symptoms by enhancing and balancing neurotransmitters but just like with any other condition, they are not a cure, just a band-aid. Neurotransmitters are chemicals that carry signals between neurons in your brain and body. There are several different types of medications used to treat ADHD, including:
    • stimulants, such as an amphetamine or Adderall (which help you to focus and ignore distractions)
    • non-stimulants, such as atomoxetine (Strattera) or bupropion (Wellbutrin), can be used if the side effects from stimulants are too much to handle or if other medical conditions prevent use of stimulants

While these drugs can improve concentration, they can also cause some serious potential side effects. Side effects include:

  • sleep problems
  • mood swings
  • loss of appetite
  • elevated blood pressure
  • heart problems
  • suicidal thoughts or actions

Few studies have looked at the long-term effects of these medications, but some research has been done, and it raises red flags. An Australian study published in 2010 found no significant improvement in behavior and attention problems in children between the ages of 5 and 14 years old who took medications for their ADHD. Furthermore, their self-perception and social functioning didn’t improve either. Instead, the medicated group tended to have higher blood pressure. They also had slightly lower self-esteem than the non-medicated group and performed below age level. The authors of the study emphasized that the sample size and statistical differences were too small to draw conclusions.

SPENDING TIME OUTDOORS will benefit children with ADHD. There is strong evidence that spending even 20 minutes outside can benefit them by improving their concentration. Greenery and nature settings are the most beneficial. Being indoors often also leads to increased screen time, which is bad on many fronts.

BEHAVIORAL THERAPY. For children with more severe cases of ADHD, behavioral therapy can prove beneficial. The American Academy of Pediatrics states that behavioral therapy should be the first step in treating ADHD in young children. Also called behavioral modification, this approach works on resolving specific problematic behaviors and offers solutions to help prevent them. This can also involve setting up goals and rules for the child. Because behavioral therapy and medication are most effective when used together, it can be a powerful aid in helping your child. Parental therapy can help provide parents with the tools they need to help their child with ADHD succeed. Equipping parents with techniques and strategies for how to work around behavioral problems can help both the parent and the child in the long term.

SUPPLEMENTS. Treatment with certain supplements may help improve symptoms of ADHD however results are mixed. Some which have shown some benefit include:

  • Zinc (helps to regulate dopamine in the brain)
  • L-carnitine
  • Vitamin B-6
  • Magnesium (helps with sleep)
  • Vitamin C
  • Iron
  • Omega 3

GET BETTER SLEEP. Sleep and ADHD are intimately connected and play off each other. Getting enough hours of sleep every night helps ADHD will help with symptoms however, ADHD behavior, not to mention the medications which cause side-effects, can negatively affect sleep quality. Having a busy mind can make falling asleep feel impossible. This, in turn, makes waking up in the morning hard because you are sleep-deprived. Getting less sleep than you need affects your ability to focus and concentrate. It also affects your mood and general health. Although making sleep a priority and changing habits around sleep might feel like a daunting task, it is a great natural way to help ADHD. Please see my section on sleep hygiene for tips to help getting a better night’s sleep.




Acne is the most common chronic skin condition affecting upwards of 50 million Americans. It is often treated unnecessarily with medications. Just like with other chronic conditions, the medications don’t treat the cause, just the symptoms. Although food sensitivities and food choices impact on only about 5% of 4000-5000 known skin conditions, the ones it does impact on, account for more than 50% of all problems seen by dermatologists. These include:

    • Acne.
    • Eczema.
    • Psoriasis.
    • Hidradenitis, a chronic skin condition featuring lumps in places such as the armpits or groin.
    • Hair loss.

Diet also impacts on what 100% of people experience: aging skin. A high fat, animal product, added sugar and processed food diet ages skin and adds to wrinkles to much greater degree than a plant-based diet, full of whole, unprocessed fruits and vegetables.

Dairy is the number one culprit when it comes to causing or worsening all skin problems. And when it comes to acne, it’s the worst. Studies looking at dairy and acne find the it’s actually skim milk and skim milk products which have the greatest effect. Dairy contains as many as 60 different hormones which wreak havoc on human hormonal balance.

Animal products in general cause skin problems. When you eat plant-based, without all the hormones and chemicals from animal products, especially dairy, the skin cells are not stimulated anywhere as much and things like acne, eczema and rashes disappear.

  • A study following plant-based populations in the South Pacific failed to identify a single pimple in over 1300 people over 2 years.
  • A Harvard study following 6000 girls aged 9-15 for several years showed a clear connection between acne and dairy. Other culprits included added sugar, meat and simply excess calories. These impair protein signaling leading to excessive production of acne-causing oil and sebum.

In addition, the skin is the first organ to be affected be even a slight amount of dehydration. It’s also the last organ to receive moisture when properly hydrated. The point is that skin hydration is more a function of generalized hydration rather than moisturizers we apply. DRINK MORE WATER!

Alcohol and the Skin

Alcohol is a toxin which causes inflammation. Not just in your liver and brain, but throughout the body, including the skin. The skin of those who consume too much alcohol suffers more damage and ages faster. In addition, it increases the risks of developing skin cancers. Just having more than 1 drink while outside increases the risk of melanoma by 20%. If you consume 5 or more beers, your melanoma rates go up by 55%. The rates of other common skin cancers like squamous cell and basal cell carcinomas also increased, but not as much as is seen with melanoma.

Drinking alcohol definitely changes behavior, making you less disciplined. As a result, you stay out longer, lose track of time and don’t reapply sunscreen or just blow it off altogether, all which increase the incidence and risks of sunburns. But in addition to those factors, there are some actual physiologic changes which result in alcohol causing more sunburns.

  • Alcohol increases the rate at which your skin burns. 
  • It causes an immune dysregulation, preventing the body from protecting you from the harmful UV rays. The damaged cells from UV rays are not cleared by the immune system. They live longer and have a greater chance of becoming cancerous.
  • Normally, we get a release of protective carotenoids which is inhibited by alcohol.
  • There are other, less understood molecular processes which are disrupted as well.

Please check out this topic discussed in much more detail on the Kid’s Health section.


Without the right food, the medicine won’t work. With the right food, you won’t need the medicine

Ayurvedic saying



There is no prescription that overcomes physiology. Prescription drugs are either inhibitors of some reaction, or stimulators of some enzyme that is not working. Chronic disease is caused by 2 things:

  1. Your body is missing something that it needs or
  2. Your body is exposed to something that it doesn’t need.

I have a lot more about medications on a different page (click here to go there) but there is the important issue of invented and exaggerated diseases, often created by the pharmaceutical industry itself. A great example is Late-Onset Hypoandrogenism, also known as “Low T” or the apparent low testosterone crisis in men. Although some men truly have testosterone issues and there are many treatable causes, testosterone levels are quite sensitive and for many men, they are over prescribed testosterone as a prescription. Levels go up when a man holds a gun and go down when he holds a baby. If his sports team is winning, testosterone goes up. If they’re losing, it goes down. It fluctuates throughout the day normally to quite significant degrees. By your mid 30’s, average testosterone levels start to drop naturally by about 2% a year. These standards are set by the AMA however, testosterone levels and function are not necessarily related. By 60, 20% of men have low testosterone based on standard levels accepted as normal. By 70 years old, 30% and by 80, 50% have lower than “normal” levels. But this is just a number on paper. It does not necessarily correlate with testosterone function.

Although there was a successful ad campaign to treat Low T with testosterone, increasing use of testosterone supplementation by 4x between 2000 and 2011, there is little evidence that it does anything significant to improve libido, ED and sexual satisfaction. Furthermore, testosterone drugs do nothing for energy or mood. They do however increase your risks for heart attack and strokes, especially if you are older and are getting injections.

MACA. Maca is a cruciferous plant that originates in Peru. Proponents say it has a host of benefits, including enhancing fertility and blocking estrogen in men. There are 13 varieties of Maca and they are reported to have slightly different effects. It has no harmful side effects so it may be worth a try, however, make sure the source is clean.
Some non-pharmaceutical ways to improve testosterone include:

  • Get more sleep. Men who sleep only 5-6 hours a night have testosterone levels of men 10 years older.
  • Minimize stress. When stressed, the body prioritized cortisol production over testosterone.
  • Exercise. Especially resistance training.
  • Eliminate processed foods and eat more whole foods.
  • A plant-based diet.  Animal products, including meat and dairy contains hormones, especially estrogen, not to mention all the chemicals used in their production.
  • Minimize alcohol intake.
  • Maintain a healthy body weight. As belly fat goes up, so does production of the enzyme aromatase which converts your testosterone into estrogen in your fat cells. Even the testosterone medication some men take gets converted.
  • Limit exposure to BPA and other plastics. This hormone disruptor was found in the urine of just about everyone. Some common everyday sources include:
    1. Bottles.
    2. Shopping receipts.
    3. Bottled products.
    4. Cooking (microwave, boiling, baking…) in plastic containers, even if they say “cooking safe”

Some other examples of artificial or exaggerated diagnoses include:

  • Hypoactive Sexual Desire Disorder (HSDD). Companies have popularized  this diagnosis even if your partner seems to have decreased interest in sexual activity.
  • Social Anxiety Disorder. Shyness is not a disease which needs medications.
  • Pediatric Bipolar Disorder. Children as young as 18 months have been prescribed anti-psychotics with deadly side effects for symptoms that am mount to normal behavior.
  • Reflux. Although some people truly have a problem with this, most just eat too much, too late and eat fatty, processed food.
  • Excessive Sleepiness. Join the club! Work harder at trying to get a good night sleep.
  • Osteopenia. It is normal for bones to become less dense with age. We ALL have weaker bones compared with much younger people. It’s called life!
  • Menopause. This is a normal part of life. Not a disease.





For more detailed information about this topic, check out Dr. Neal Barnard’s Latest book on this topic, “Your Body in Balance. The New Science of Food, Hormones, and Health”.

Simply put, what you put in and on your body changes your hormone levels and how your hormones work, making you feel well or unwell, energetic or lethargic, in pain or pain-free. In most cases, you can control it. The most serious and common conditions we face like cardiovascular disease, diabetes, cancer and autoimmune diseases are significantly affected by the foods we eat and the chemicals we are exposed to. Even natural, normal hormone elevations are not healthy. Some examples of how excessive hormones can be problematic are acromegaly, a condition where organs grow out of control when there is too much growth hormone in the system or hyperthyroidism (excessive thyroid hormone), which can be deadly if not under control.

Some of the hormonally related conditions affected by by foods and chemicals include:

INFERTILITY. About 10-15% of couples have trouble conceiving for more than a year. Both ovarian function and sperm counts and morphology are affected. The highest rates of infertility are seen in the most overweight people (the fat impacts hormones as you will see below) as well as chemical exposures (also detailed below). Sperm counts in men have decreased by 52% in Western over the last 50 years, especially in the last 30. In the US, 1/3rd of men have sperm counts below fertility levels.

MORNING SICKNESS. Rather than a sickness, this is the body’s attempt to protect itself. During pregnancy, a mother’s natural defenses are reduced because the body is trying to protect the baby, technically a foreign invader because of dad’s ½ of the genetic profile. There is a natural decrease in important defensive cells known as Natural Killer (NK) cells, impacted by progesterone, one of the hormones which rise during pregnancy. There are natural aversions during pregnancy like tobacco, alcohol and meat. These all make sense since they are toxins. With meat in particular, they are often contaminated with microbes like E. Coli, Toxoplasma, Salmonella and Listeria. Saturated fat, found in high amounts in cheese and meat, are also associated with morning sickness. A study found that for every 15 grams of saturated fat (the same you get in 2.5 oz of cheese) in a woman’s diet, her risk of morning sickness went up 5x.

PREMENSTRUAL SYNDROME. PMS is a combination of physical and emotional symptoms which accompany the onset of the menstrual cycle. When the symptoms are severe, it is labeled “Premenstrual Dysphoric Disorder”. Symptoms can include feeling poor, mood swings, irritability, anger, depression and anxiety. You can lose energy, focus and concentration. Apatite and sleep are also affected. As menstruation actually begins, often the PMS symptoms get better. This also has to do with the hormonal shifts which occur during the cycle. The greater the shifts, the more severe the symptoms can be. In studies looking at plant-based diets, not only were the severity and duration of periods improved, but so were PMS symptoms. Lower levels of estrogens also translates into lower levels of prostaglandins, both implicated in PMS and menstrual symptoms.

PREMENSTRUAL PAIN. Estrogen helps to stimulate the uterine lining to thicken, preparing for the possible implantation of a fertilized egg. If implantation does not occur, estrogen levels fall rapidly and the uterine lining sloughs off, resulting in the bleeding associated with a woman’s period. As the lining breaks apart, it releases prostaglandins, hormones which are the cause of the cramps and pain women experience. Any additional estrogen in the bloodstream leads to a thicker lining and more prostaglandins and as a result, more cramping and pain.

ENDOMETRIOSIS. Affecting 10% of women, this is a condition where cells, normally found in the uterine lining, are located outside the uterus. These cells can be on the outside of the uterus, along the Fallopian canals, on the ovaries and even in the intra-abdominal cavity, around the intestines and bladder. During a woman’s cycle, these cells respond to estrogen the same way that the cells inside the uterus do, meaning they multiply and grow and then shed, often causing much more pain than a typical period. It also causes infertility by scarring the ovaries, uterus and Fallopian tubes.

FIBROIDS and ADENOMYOSIS. Fibroids are basically uterine muscle “knots” also called leiomyoma. Most women develop fibroids by age 50 but the majority are not symptomatic. They can however cause pain and heavy menstrual bleeding. Adenomyosis is a condition where cells normally lining the uterus end up in the muscle layer. As with fibroids, they can be asymptomatic but for some, they cause pain and excessive bleeding. Once again, hormones impact their growth and activity.

CANCER. In a nutshell, all cancers associated with hormones can be affected by outside hormonal influences. These include cancers of the:

    1. Breast
    2. Ovaries
    3. Uterus
    4. Thyroid
    5. Prostate
    6. Testicles

Anything you can do to minimize additional hormonal exposure or normal hormonal function decreases the risk of getting one of these cancers, the degree of aggressiveness or their potential for coming back and killing you.

POLYCYSTIC OVARIAN SYNDROME (PCOS). This is a condition, first described in 19435, results in fluid filled cysts forming on the ovaries which can interfere with fertility. The fiundamental problem is excessive production of male sex hormones, androgens, like testosterone, and dihydroepiandrosterone (DHEA). Although these are normally produced by the ovaries and adrenal glands, in PCOS, excessive hormones are made. Excessive androgens also cause a change in the pattern and distribution of body fat, moving it from the hips and thighs, which is less dangerous, to the waistline, which is associated with more disease. Some of the effects of excess androgens in this condition include:

    1. Cystic ovaries with enlarged follicles surrounding the eggs.
    2. Irregular, prolonged and heavy periods.
    3. Skin changes including acne and body and facial hair.
    4. Infertility. 

MENOPAUSE. When the ovaries start to run out of eggs, estrogen and progesterone levels start to decrease. As a result, menstrual periods become less frequent and irregular and eventually stop altogether. Once a year has passed without a period, women are considered to be in menopause. Menopause is NOT a disease. It is a normal stage of life. 

The significant symptoms of menopause are a western phenomenon. In Japan for example, there wasn’t even a word for “hot flashes” or “night sweats” as they relate to menopause. They just did not occur. Other associated symptoms like irritability, depression and sleeping problems were also very rare. This is because their traditional diet was high in soy products and fruits and vegetables and contained little meat and dairy. As soon as they started to westernize their diet with more meat, dairy and processed food, these symptoms started to appear and worsen. A 2005 study showed that hot flashes were reported twice as often as in 1980. The same was found in studies of Chinese and Mayan women.

When did menopause become a disease? In 1941, the first hormone replacement therapy (HRT) was made. Premarin, an estrogen compound, was first developed and marketed in Canada to treat hot flashes. It is made from PREgnant MAres uRINe, and the way they produce and collect it is not very friendly to horses. In 1966, a big marketing push was started to “cure” menopause and “restore vigor and youth of a healthy female body… to fulfill all wifely duties”. Premarin’s popularity climbed and in 1992, it became the most widely prescribed drug in the US despite the fact that as early as 1975, studies started to show a link between HRT to endometrial cancer. In 1991, the NIH ran a study of 160,000 women looking at the benefits and side effects of HRT, specifically Premarin and Prempro (Premarin with an artificial progesterone). It was quickly determined that the group of women receiving the HRT were starting to suffer significant complications so the study was terminated by 2002. The HRT arm of the study had significant increased risks of: 

  • Strokes (41% greater risk)
  • Blood clots (100% increased risk)
  • Dementia
  • Breast cancer (26% greater risk)
  • Heart attacks (29% increased risks of coronary artery disease).

When the study findings became known publicly, HRT sales dropped by 63% and not surprisingly, breast cancer rates as well as the other complications started to drop as well. It is estimated that the decrease in HRT use resulted in 126,000 fewer breast cancer cases, 76,000 fewer cases of cardiovascular disease. Another 10 year follow up on those women showed continued, but diminishing risk of breast cancer. By 2017, the risks were back down to baseline, but it took 16 years to get there.  

Despite all that, many doctors still question the study findings and enough time has passed that the company which makes Prempro is once again trying to market and sell it! 

If conventional therapy is still needed or desired, there are safer choices. There are non-horse, plant-derived (from yams and soy) estrogen replacements such as Estrace, Estraderm, Conestin. Bioidentical hormones are becoming popular. These are hormones which have the exact same chemical structure as your own hormones. Human hormones however, even identical to your own, are still hormones which you may not need. Remember that increased hormone levels are directly linked to various hormone-related cancers.

SEXUAL FUNCTION. With the decreased estrogen production after menopause, there are some normal changes which occur in a woman’s anatomy.

  1. Vaginal lining (mucosa) becomes thinner.
  2. The vaginal canal becomes shorter and narrower, both of which contribute to:
  3. Intercourse can become painful.
  4. Pelvic floor muscles become weaker and the bladder and urethral mucosa dries leading to incontinence and sometimes painful urination.

As is typical in modern western medicine, these changes have been given names and have been labeled as diseases. Mucosal thinning is called “atrophic vaginitis”, and the changes in shape of the vagina is “vulvovaginal atrophy”. These, along with the bladder and urinary changes together are labeled as “genitourinary syndrome of menopause”.

Estrogen creams have been found to be helpful with these conditions. Although safer than oral HRT drugs, there are still some issues:

  1. They still contain small amounts of estrogens which you do absorb. They are admittedly small amounts but it is still there. No studies have linked these drugs specifically to increase cancer or other disease risk yet.
  2. The partner can also absorb some of these estrogens. Again, traces are absorbed but it can add up.
  3. Improving comfort during sex does nothing for libido. You may still not want to have sex, even though it is more comfortable. “Hypoactive Sexual Desire Disorder” is another made-up disease marketed by the pharmaceutical industry as a way to promote testosterone patches for women.

ERECTILE DYSFUNCTION. Viagra was first studied as a drug to treat heart disease. It did nothing for that but it was found to selectively increase blood flow to the penis, and as a result, improve symptoms of ED temporarily. Although some cases of ED are caused by psychological issues like depression, serotonin reuptake inhibitor anti depression medications themselves (like Prozac, Sertraline, Celexa or Zoloft) or as a result of complications from prostate surgery, the vast majority of cases have to do with impaired blood flow. ED is called “the canary in the coal mine” when it comes to heart disease. Blood flow problems in one place mean that you have blood flow issues in ALL places, including the heart and brain. In fact, ED increases the risks of having heart disease by 4000%, significantly more than smoking.

Viagra’s effectiveness has also been shown to significantly decrease, with 29% less blood concentration, when taken after a fatty meal.

LOW TESTOSTERONE. Although there was a successful ad campaign to treat Low T with testosterone, increasing use of testosterone supplementation by 4x between 2000 and 2011, there is little evidence that it does anything significant to improve libido, ED and sexual satisfaction. Furthermore, testosterone drugs do nothing for energy or mood. They do however increase your risks for heart attack and strokes, especially if you are older and are getting injections. Dr. Dean Ornish has demonstrated conclusively, using cardiac angiography, that lifestyle changes such as following a plant-based diet, stress management, exercise and social support improves blood flow and improves vascular disease, including ED. Even patients on cardiac transplant lists have improved to the point where they no longer needed transplants. In as many as 82%, there is significant improvement. Adding to that equation quitting smoking, a significant arterial toxin, you are well on your way to much better health.

DEMENTIA. We are discovering that, among a number of other risk factors, hormones play a significant role in the development and progression of dementia, especially Alzheimer’s Disease. There are real differences between men and women as well. Women are twice as likely to develop dementia as men are. They are also twice as likely to develop other problems such as depression, anxiety, headaches and migraines. Women are also 3x more likely to develop various autoimmune diseases such as Multiple Sclerosis, which affect the brain as well as the rest of the nervous system. women are also significantly more likely to die of a stroke if they have one, than men. All these risks increase after menopause and some recent research seems to correlate these risks to hormone levels.

Although hormone levels drop off in both men and women as we age, they drop off a lot faster in women after menopause, resulting in, along with other lifestyle risk factors, increased risks mentioned above. In addition, women who have undergone surgical removal of their ovaries and even uterus have elevated risks, all again related with diminished hormone levels. The highest risk is if all those reproductive organs are removed simultaneously, followed by both ovaries, one ovary and then just the uterus. There are some studies showing that closely monitored hormone replacement therapy (HRT) can be protective of the brain and prevent or delay the onset of dementia but there are also increased risks of breast, uterine and ovarian cancer as well as potential effects on the cardiovascular system. This needs to be closely monitored by a physician and all other sources of potential hormonal imbalances should be addressed (foods, plastics…).

SKIN and HAIR HEALTH. Hair grows from a small hair follicle which resides in a “well’, known as a pore. Oil is produced in the pore and overproduction can clog it up, leading to bacterial overproduction leading to acne. Androgens, male hormones, impact greatly on oil production and too much androgens cause acne. Foods can trigger this as well. Foods like chocolate, pizza and potato chips can all impact skin health. Studies which show no impact are all done by the chocolate and dairy industry and are simply false. The exact mechanism is not clear. It could be the dairy in the chocolate, the fat or the combination along with a genetic predisposition.

Dairy definitely impacts acne for many reasons.

  1. Dairy contains hormones. As many as 60 different kinds. In addition to estrogens, dairy contains pragnenedione and androstanedione which are converted to dihydrotestosterone (DHT) which triggers acne, as well as hair loss.
  2. Dairy contains IgF-1  and boosts our own liver’s production of IgF-1, a cellular growth hormone. It stimulates oil producing cells in hair follicles. Many bodybuilders develop acne because of the increased IgF-1 they are exposing themselves to through protein powders, most of which are based on whey, a dairy protein by-product of the cheese making industry.
  3. Dairy proteins can stimulate inflammation and sensitivity.
  4. Dairy is loaded with saturated fat.

Age-related hair loss is almost exclusively related to hormones. The fundamental hormone involved in hair growth and death is DHT, dihydrotestosterone. It causes gradual shrinkage and death of hair follicles. This process is based on time and exposure to this hormone. Certain parts of the body are more sensitive than others. Male pattern balding is called that because of this phenomenon. The hair follicles on the front and top of the head are more sensitive than those on the sides and back of the head. Interestingly, the hair follicles  on the face and chest are stimulated by DHT. The drug Propecia (finastride) blocks DHT which is why taking it slows or stops hair loss. As soon as you stop it however, you almost immediately lose all the hair follicles you would have lost had you not taken it. Identical twin studies have proven this. The twin taking Propecia does not lose his hair but as soon as he stops, he loses his hair quickly and within a few short months, he looks exactly as his non-Propecia taking twin. Rogaine (minoxidil) is a vasodilator and works by increasing nutrient delivery to hair follicles, maintaining their health but it does not help with male pattern baldness.

Baldness was rare in Asian countries, until they started Westernising their diets with more meat dairy and processed foods. This all basically has occurred because of the hormonal effects of animal foods which contain more hormones and more fat, leading to decreased levels of  Sex Hormone Binding Globulin (SHBG) which keeps hormones bound and is stimulated by plant-based diets.

FOOD and MOOD. 8-year follow up on a large group of people in Spain showed a 26% risk reduction in depression on those following a plant-based diet (PBD). A similar Taiwanese study following over 1600 older people showed a 62% decreased risk for depression on PBD.

Postpartum depression is associated with casomorphins in breast milk. These are compounds found in milk and as a byproduct of digestion of casein, dairies main protein. These are mild opioids, having about 10% of the effect of heroin in the brain. The opioids are absorbed from the breast ducts. It may also be partly why women can get constipated after pregnancy and certainly contributes to childhood constipation.

In Japan, depression was a rarity until the 1990s. As they Westernized their diet, depression rates, along with many other industrial-society diseases like breast and prostate cancer as well as diabetes started to rise significantly and almost rivals our rates here in the US.

Plant-based diets decrease inflammation. CRP, a marker for inflammation, was shown to decrease by 30%, as did symptoms, in a group of patients with rheumatoid arthritis.

Fiber is also a key component as it improves gut health. By only increasing fiber intake from the minimum US RDA of 16 (most poeple should actually get at least 40 grams a day) to  only 21 grams of fiber, depression risks dropped by 41%. More fiber led to 70% decreased risk. Fiber also stabilizes blood sugar and improves the health of gut bacteria. Improving gut health seems to be what helps with mood since 90% of brain’s neurotransmitters, including serotonin, the “happy mood” transmitter, are produced in the gut.

Plant protein itself, taken earlier in a meal, seems to benefit mood as well. Although ALL plants have protein, some like beans and bean products like tofu, have a larger amount. Try to eat these first before everything else.



FAT. The reason excess, or much less commonly lack of, fat can impact on fertility has to do with the fact that fat cells produce hormones. They are not just static cells occupying space. The hormones produced by the ovaries, testicles and adrenal glands are converted by your fat cells into male and female sex hormones. In fact, after menopause, a woman’s fat cells are the primary source of estrogens. The more fat you have, the higher the levels of estrogen. The adrenal glands produce androstenedione. Fat cells convert it into testosterone and then to estradiol and estrone, two forms of estrogen. In young women, the main form of estrogen circulation is estradiol and after menopause, it is estrone.

  1. Fat cells produce extra female sex hormones (estrogens) and also extra male sex hormones (androgens).
  2. Body fat reduces the amount of sex hormone-binding globulin (SHBG) in the bloodstream. This compound circulates in the bloodstream and binds the sex hormones, keeping them in check until they are needed. With lower levels of this protein, more hormones are floating around causing problems.
  3. Fat affects insulin function which impacts on sugar and fat storage. Insulin dysregulation contributes to weight gain, as well as heart disease, autoimmunity and cancer.

Other than the essential omega 3 fats, you do not need any added fat in your diet. We get plenty from fruits and vegetables, all of which have some amount of fat. Here are some tips on cutting down on fat:

  1. Avoid animal products. These are the main source of fat in our diet.
  2. Limit plant foods higher in fat like:
    1. Oils, especially tropical oils like coconut and palm and grains like cottonseed
    2. Nuts and seeds, including nut butters. 1 handful or tablespoon a day is fine but each handful has 19 grams of fat so it adds up fast.
    3. Avocados and Coconuts.
  3. Packaged, processed foods. They often have added oils and certainly have lots of added sugar..
  4. Sauté or fry without oil using water or broth. If you need oils, use a sprayer.
  5. Steamed, boiled or baked foods are lower in oil. You can roast using a silicone mat.
  6. Skip the margarine and butter on toast or potatoes. Use jelly, jam, cinnamon, mustard…
  7. Instead of salad dressings with oil, try simple flavored vinegars or non-fat dressings.
  8. When you go out to eat, assume that anything you get, other than a cheese-free salad with vinegar, is loaded with sugar, salt and oil. You can ask them to use less and most times, they are happy to work with you.

FIBER. Normally, the liver filters our blood, removing toxins and hormones, sending them via the bile duct into the small intestine where they are bound by the fiber in our diet and are excreted. Fiber also binds the cholesterol we heat. Bile contains bile acids, which are critical for digestion and absorption of fats and fat-soluble vitamins in the small intestine. The average American gets only 16 grams a day. You should get a minimum of 40. There is NO fiber in anything that comes from animals, meat, eggs, dairy or fish. Only fruits and vegetables have fiber.

DAIRY. Although fertility rates decline in all cultures as women age from their 20s into their 30s, those societies which consume the most dairy have the highest rates of decline. For example, in Thailand, where little dairy is consumed, the rate of decline in fertility is around 25% whereas in Finland, New Zealand and Denmark where dairy consumption is highest, fertility rates decline by 80%. The US is not far behind. Not only that but the cultures which consume the most dairy have the highest rates of hip fractures, osteoporosis, hormonal cancers, vascular disease and various autoimmune diseases. There are a few reasons for this.

  1. Dairy contains extra hormones like estrogen. Levels of this hormone can rise 15x during different stages of the cow’s pregnancy. It all evens out however because cows’ milk is pooled before it is processed.
  2. Dairy cows are injected with the hormone progesterone to increase lactation. You absorb that as well.
  3. Dairy has extra fat. Fat affects hormones as mentioned above.
  4. Lactose, the main sugar in dairy, is what 70% of humans are not able to digest (lactose intolerance). Lactose is broken down into glucose and galactose. Galactose is linked with ovarian dysfunction and ovarian cancer.  
  5. Proteins from dairy, as do all animal proteins, are inflammatory and acidify the blood because they contain a higher percentage of sulfur-containing amino acids. This leads to osteoporosis and all inflammatory conditions.

MEAT. In addition to the issue with fat in meat, and that includes chicken which is really not far behind red meat in its fat content and has the same amount of cholesterol, there are additional hormones you consume. In addition to the natural hormones in meat, there are injected hormones. Cattle are implanted with as many as 6 growth promoting hormones, all of which you consume when you eat the meat.



Chemicals like BPA and Phthalates, found in just about any plastic product you can think of as well as lining most cans of food and beverages, leach into your foods and drinks as well as directly through your skin. These chemicals are called hormone-mimickers and disrupt our own normal hormone function. In addition they add to the circulating hormone amounts in the blood. They have been directly linked to all the above mentioned conditions. Pesticides and herbicides like DDT and glyphosate (in Roundup) sprayed onto and injected into our foods also impact on hormone function, in addition to causing various neurologic problems and causing cancer. They accumulate in our tissues. Other sources of plastics include makeup, personal care products and even clothing. There is more information about some of these chemicals below.

BPA. Bisphenol A is an industrial plastic compound used to line cans of foods as well being a common component of various plastic containers containing food. It is known as a hormone-mimicker since it has a similar structure to our own hormones and can wreak havoc. It’s been linked to diabetes, heart disease, liver disorders, cancer, obesity and various hormonal problems including infertility in both men and women. It is also found in thermal paper including such common sources as:

  • Cash register receipts.
  • Cleaner receipts.
  • ATM receipts.
  • Gas pumps… essentially, any receipts which use thermal paper.

Although you absorb BPA through dry skin, levels really go up significantly if your hands are wet or you have alcohol gel on them. Even at doses far below what the EPA says is safe, male BPA-exposed workers had lower sperm counts, higher incidence of libido and erectile dysfunction. A study of 2800 kids aged 6-19 in NYC showed that the higher the level of BPA in their urine, the greater the risk of obesity with the highest concentrations doubling the risk. 

Although some cans and bottles may have a BPA-free label, they undoubtedly are using a different plastic lining like BPS or BPF. These have also shown to disrupt hormones and unfortunately, up to 40% more BPS is used so BPA-free cans may be even worse! In addition, well known hydration bottles like Nalgene and Contugo use a plastic called tritan, also shown to disrupt hormone function.

PHTHALATES. This compound makes plastics pliable and bendable. They are in things like plastic raincoats, bathroom curtains and kids toys. Phthalates are not firmly bound to the plastics and leach out, especially when heated. It dissolves very well in fatty foods like dairy products or meat. It is very commonly seen in fast foods. In kids, the more fast food they ate, the higher the phthalate levels in their blood.

In children, phthalates have been linked to:

  • Developmental and behavioral problems
  • Insulin resistance
  • Elevated blood pressure
  • Allergies

In adults, they have been linked to:

  • Diabetes
  • Metabolic syndrome
  • Obesity
  • Elevated blood pressure, blood sugar and cholesterol

PESTICIDES AND HERBICIDES. There are hundreds of chemicals used in agriculture and thousands in our food supply. Many of them have not been tested on their effects on humans. The University of London’s Center of Toxicology tested only 37 pesticides for their effects on human cells. 30 of them (81%) had hormonal effects. 7 were androgenic, behaving like male sex hormone, and 23 had anti-androgenic effects, meaning they interfered with hormonal function. In women, pesticides have been linked to:

  • Infertility
  • Menstrual irregularities
  • Stillbirths and 
  • developmental defects in children

Three of the most well known pesticides and herbicides are DDT, Glyphosate (in Roundup) and Atrazine.

  1. DDT, dichloro diphenyl trichloroethane, was originally used to kill malaria, typhus and dengue fever. It was then used to treat mosquitos back home but it also was found to kill birds and fish. It was also found to impact on human health, causing infertility, infant growth, thyroid diseases and increased cancer risk. It bio-accumulates, builds up in fat, and despite being banned in 1972, it is still found in newborns today!
  2. Glyphosate, the main ingredient in Roundup, is the most commonly used herbicide in the world. It kills plants by blocking the enzyme needed for cellular growth. It does so not only in plants but in humans also. It also is a hormone disruptor and has been linked to a slew of human diseases.
  3. Atrazine is the second most commonly used herbicide in America, widely used in the corn and sorghum crop industries. Both are used in animal feed. It gets into the ground water and has been measured in drinking water in communities surrounding such farms. Levels increase 7x in spring reflecting the time of year it is most used.

Other common chemicals to worry about include:

  1. PCBs (polychlorinated biphenyls). Banned in 1977, these synthetic chemicals still appear in fish, dairy and animal meat. They can harm the immune system and nervous system. It can also cross the placenta and cause cognitive problems in babies.
  2. Dioxins. These industrial by-products also bio-accumulate so they basically never leave our bodies and cause a slew of problems. They are consumed, again, in fatty foods such as dairy, meat and fish.
  3. Citric Acid. Originally sourced from lemons, hence the name “citric”, this preservative is now factory made in China from fungus and causes a slew of problems such as migraines, allergies and autoimmune reactions.
  4. Triclosan. This chemical antibacterial has been linked to various health risks including thyroid function. Popular in many soaps, it is also found in Colgate toothpaste, even being hailed as helpful in “fighting gingivitis”.

Simple steps to avoid chemicals.

  1. Avoid animal products. They are injected with and fed chemicals which end up in our bodies.
  2. Favor organic products. The fewer chemicals you can expose yourself to, the better.
  3. Favor fresh or frozen food over canned. Jarred is also OK.
  4. Prepare beans from scratch.
  5. NEVER use plastic in the microwave or oven.
  6. Avoid bagged microwave popcorn or any product heated in a plastic container (soups, Easy-Mac…).
  7. Look for BPA-free plastic if you must use it. If recycling triangles have a 3 or 7, it probably contains BPA unless it is marked as BPA-free specifically.
  8. Drink filtered water. Limit plastic bottles. Use stainless steel or glass refillable bottles.
  9. Skip thermal receipts
  10. Check labels on personal care products.

For more on the impact of chemicals on hormones and health, click here.


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