Plant-Based Diets: Pluses and Minuses

Eating You Alive: One Bite at a Time

Directed by Paul David Kennamer Jr (2018)

Film Review

In essence, this documentary is a series of glowing testimonials from patients who reversed life threatening illnesses by switching to an organic whole food plant-based (ie vegan) diet. Although the film is disappointingly short on research evidence, the list of illnesses overcome with this diet is extremely impressive: end stage pancreatic cancer, lupus, stage 4 metastatic ovarian cancer, stage 4 renal cancer, severe heart disease, dementia, rheumatoid arthritis, breast cancer, cervical cancer, uterine cancer, malignant hypertension, type II diabetes, and morbid obesity.

Although I have no reason to doubt the sincerity of any of the patients (who include Penn the magician and the actor Samuel L Jackson), I had reservations about some of the film’s basic premises. Given its heavy emphasis on obesity and type II diabetes, I was surprised it made no mention of insulin resistance or dysfunctional gut bacteria as triggers for obesity. In my experience, patients with insulin resistance are far more likely to lose weight on a high fat ketogenic diet. The latter is also extremely helpful for treatment-resistant seizures.

Unfortunately some of the doctors advocating for plant-based diets also make statements that aren’t strictly accurate. For example, decades of research has totally debunked the myth that consuming large amounts of cholesterol causes high blood cholesterol levels. It is now established that cholesterol is part of the body’s normal defense against inflammation, that the main cause of high cholesterol in otherwise “healthy” people is inflammation caused by excess dietary sugar. See How Sugar Really Affects Your Cholesterol

I was also concerned about the way featured doctors trashed olive and coconut oil as major culprits in cardiovascular disease and cancer. Numerous studies suggest otherwise.

The statement one of the doctors makes about no prior human culture relying on meat-based diets (as most of the industrialized world does at present) is simply untrue. Both the Massai people of Africa and the Inuit people of the Arctic traditionally ate 100% meat-based diets. Likewise all hunter gatherer societies relied on occasional meat in addition to a routine diet of fruits and vegetables.

I was also concerned that the doctors featured saw no need to caution viewers about limitations of a 100% plant-based diet in terms of specific key nutrients: Vitamin B12, zinc, iron (in menstruating and pregnant women), Vitamin D and omega 3. Most of the doctors I know recommend their vegan patients take supplements providing these nutrients. Pregnant women following a vegan diet also need to be monitored closely to ensure their protein intake is adequate.

The full film can be viewed free at https://tubitv.com/movies/475193/eating-you-alive

 

 

The Evidence: Vitamin D for Prevention and Treatment of COVID-19

Vitamin D and COVID 19: The Evidence for Prevention and Treatment of Coronavirus (SARS CoV 2)

Medcram – Medical Lectures Explained Clearly (2020)

Film Review

In this interview, board certified internist Professor Roger Seheult MD explains growing research evidence that Vitamin D is effective in both prevention and treatment of Covid19.

He begins by explaining that Vitamin D, which is really a hormone rather than a vitamin, has a direct effect on mRNA transcription in many cells. This effect on white blood cells confers a major effect on immune function.

Seheult goes on to explain the role of sunlight in the skin’s production of Vtamin D and the high prevalence of Vitamin D deficiency in regions with less exposure to the sun (above 35 degrees latitude in the northern hemisphere and below 35 degrees in the southern hemisphere). Dark skinned and elderly people, who produce Vitamin D less efficiently, are more prone to Vitamin D deficiency no matter where they live. Likewise people who are overweight or obese have lower Vitamin D blood levels because they tend to store the hormone in their fat cells.

People who don’t produce enough endogenous Vitamin D can also get it from specific foods (fish, egg yolks, meat) or supplements.

Seheult goes on to examine the multitude of studies related to Vitamin D’s role in protecting people against viral infections and COVID 19 specifically.

The most impressive study followed Vitamin D levels of 10,000 patients age 50-70. Subjects who were Vitamin D deficient experiencied significantly higher mortality from respiratory infections.

Seheult also cites

  • A randomized controlled Japanese study showing school children taking Vitamin D were less likely to contract influenza A.
  • A British Medical Journal meta analysis of 25 randomized control trials showing Vitamin D reduced the risk of respiratory illness.
  • Several randomized controlled studies showing that Vitamin D supplementation reduced inflammatory biochemical markers.*
  • Three early randomized Covid studies showing ICU admissions were reduced in patients who started Vitamin D on admission to hospital.

Seheult indicates that Vitamin D toxicity (manifested by hypercalcemia) is extremely rare except in patients with sarcoid and other granulomatous conditions or kidney failure.

People who don’t get enough Vitamin D from the sun (ie who are over 70, have dark skin or live too far from the equator) need a daily Vitamin D dose of 2,000-5,000 to avoid because deficient. People who are overweight need 1 1/2 times as much, while those who are obese should triple the dose.

Dr Fauci takes Vitamin D supplements.


*Another finding of these studies is the remarkable similarity between biochemical inflammatory markers found in Vitamin D deficiency and those found in Covid 19. Seheult also finds it significant that patient populations prone to high Covid mortality (dark skinned people, the obese and the elderly) are the same as those prone to Vitamin D deficiency.

Medicalizing the Menstrual Cycle

pmd

I have blogged previously (see Menopause: Made in the USA) about the negative effects of the “corporatization” of health care in the US. “Disease mongering” is a particularly nasty one. This occurs when pharmaceutical companies “medicalize” common conditions in order to market drugs that supposedly treat them.

Thanks to skillful marketing, Eli Lilly has turned premenstrual syndrome (PMS) into a profit-making commodity nearly as lucrative as menopause and “childhood bipolar disorder” (see Drug Companies: Killing Kids for Profit).

In 1994, the American Psychiatric Association (APA) included premenstrual dysphoric disorder (PMDD) in their diagnostic manual “as a possible mental disorder requiring more research.” They have continued the diagnosis in DSM V. Although DSM IV lists PMDD as a strictly “research” diagnosis, Eli Lilly immediately seized on it as a genuine disorder and devised a marketing strategy to profit from it.

The Difference Between PMS and PMDD

Approximately 80-90% of women worldwide report physical and emotional changes in the 7-10 days prior to the onset of menstruation. For most women, these consist of minor physical changes similar to those of early pregnancy (water retention, breast swelling and tenderness and abdominal bloating).

Approximately 1/3 of women note mental and emotional changes (aka PMS) – depression, anxiety, fatigue, irritability, insomnia, difficulty concentrating – that have a minor impact on their daily functioning.

Although the APA has yet to agree PMDD even exists as a disorder, there are numerous claims in psychiatric and women’s health literature that approximately 3-8% of women suffer from it. By definition, a woman can only qualify for a PMDD diagnosis if they experience a “marked” decrease in normal functioning due to premenstrual mood changes. A rigorous Swedish study ascertained that the true percentage of women experiencing a “marked” decrease in functioning before their period closer to 1.3%.

A Golden Marketing Opportunity for Eli Lilly

Once the patent on a drug expires, other manufacturers are free to produce cheaper generic versions, resulting in plummeting sales of the original brand name drug. In 1999 Lilly, facing the expiration of its patent on Prozac, exploited the new “diagnosis” of PMDD by re-branding Prozac as a feminine pink and purple tablet called Sarafem.

In 2001, the FDA approved Sarafem for “PMDD,” on the basis of double blind studies involving several hundred women. Lilly reported a 60% response rate in women who took it for five cycles, with greater effectiveness in women who took it continuously throughout the month (as opposed to 7-10 days before their period).

Hopefully psychiatrists aren’t quite so gullible as the FDA, given Prozac’s limited effectiveness in treating depression. Thirty years of double blind studies reveal that depressed patients who take Prozac have an average response rate of 38-40%. In fact, statistical analysis of all randomized controlled trials reveal that all SSRI’s (i.e. Prozac, Zoloft, Paxil, citalopram, etc) are only slightly more effective than a placebos, which works 33-37% of the time.

Skillful Marketing Adds Billions to US Health Care Bill

Charging three dollars per dose for their pink and purple Sarafem tablets (in contrast to 41 cents per dose for generic fluoxetine), Lilly launched a massive marketing campaign to convince women they suffered from PMDD. In 2001, the year Serafem came out, nearly 100,000 prescriptions were sold, reaping Lilly $85 million in profits.

Given the soaring cost of health care in the US (the main reason millions of Americans go without medical care), it strikes me as unethical and immoral to trick doctors and women into wasting nearly a billion dollars on pink and purple pills with a fancy name, when generic fluoxetine would have been equally effective at 1/9 the cost.

Research Evidence for “Natural” Treatments

What I find really fascinating about the PMS/PMDD controversy is that it’s one of the few women’s health “conditions” in which there are more double blind placebo trials of “alternative” or “natural” treatments than medication trials. The three “alternative” treatments that have shown clear effectiveness in randomized controlled trials are omega 3 supplements, Vitamin D and the chaste tree berry or chasteberry. In fact, much of this research suggests that PMS-related mood changes may actually represent a nutritional deficiency of omega 3 and/or Vitamin D.

Omega 3 oil is the most studied in PMS-related mood changes, largely owing to its proven efficacy in depression and large cross cultural studies revealing that populations (for example Asians and Norwegians) consuming large amounts of fish (a primary source of omega 3) in their diets have an extremely low incidence of depression.

Vitamin D, has also proved helpful for depression in double blind studies, especially in elderly depressives suffering from documented Vitamin D deficiency. Other studies show that 1,000 – 2,000 international units of Vitamin D is helpful in alleviating premenstrual symptoms.

This finding correlates with an extremely low incidence of PMS in Asian women. The same oily fish that are a rich source of omega 3 are the only natural food source of Vitamin D (the majority of us derive Vitamin D from exposure to sunlight).

Three double blind studies in the British Medical Journal, the Archives of Gynecology and Obstetrics and the Journal of Women’s Health and Gender-based Medicine reveal that chasteberry helps approximately 52% of women with PMS. Chasteberry is an herbal remedy used by Hippocrates in ancient Greece for pre-menstrual symptoms. It’s believed to work by lowering prolactin (a pituitary hormone influencing milk production). High prolactin levels are a recognized, but infrequent, cause of depression.

Take Home Message: Try Natural Remedies First

In light of all the above studies, common sense would dictate that women who suffer from PMS should try a combination of omega 3 and 1,000-2,000 IU of Vitamin D for a minimum of six months before resorting to either Sarafem or generic fluoxetine. Both have potentially serious long term side effects. Owing to their effect on serotonin receptors in the brain, SSRI’s can be very difficult to stop. Moreover they are associated with a loss of bone density, which increases the risk of osteoporosis and hip fracture in later life, and possibly linked to breast and ovarian cancer

photo credit: taberandrew via photopin cc