 Let's say you really need to find reliable information about the best diet for high blood pressure, or heart disease, or diabetes. Where do you go? Do you go to a website sponsored by Big Pharma that wants to sell you pills to fix your problem? Or do you want to treat the cause? Welcome to the Nutrition Facts Podcast with the latest peer-reviewed research on the best ways to eat healthy and live longer. It's time today for the Nutrition Facts Grab Bag, where we look at the latest science on a whole variety of topics. In our first story, we find out if the health benefits of peanut butter include longevity. According to the largest study of risk factors for death in human history, a poor diet causes more death than anything. Cigarettes only kill about 8 million people a year, whereas humanity's diet kills millions more. What's the worst aspect of our diet? Process meat, Twinkies, soda? No, the five deadliest things about our diet are inadequate fruit intake, not enough fruit, not enough whole grains, not enough vegetables, too much salt, and not enough nuts and seeds. Nuts should come as no surprise, since interventional trials have shown that eating nuts improves artery function, and arterial diseases like heart disease are among our leading killers. But that's not all nuts can do. They may also improve blood sugar control, lower cholesterol suppress, inflammation reduce oxidative stress, and feed our friendly gut flora. All nuts are just tree nuts. What about peanuts? What about peanut butter? About 50% of peanut consumption in the U.S. is through peanut butter, but the association between peanut butter and mortality has not been thoroughly evaluated. To get that granular, though, we can call on the NIH AARP study, the largest prospective health and diet study in history, that followed more than half a million people since the 1990s. And nut consumption in general appeared to protect against all-cause mortality, meaning nut eaters live on average longer lives, and specifically are less likely to die from cancer, cardiovascular disease, respiratory disease, infectious causes, so maybe they help immunity as well, liver disease, and kidney disease. However, no such associations were found for peanut butter. So when it comes to living longer, peanut butter doesn't seem to count. Why? Well, we know peanut butter consumers tend to eat more meat, smoke cigarettes, and we're less likely to exercise, but the researchers controlled for all that, red meat, white meat, tobacco use, exercise, and vegetables, fruits, and whole grains, so it's not like the peanut butter eaters were just eating more white bread sandwiches or something. The researchers didn't control for sugar, though, so it's possible they could have been eating more sugary jelly. It could also be the processing that goes into making peanut butter, the added trans fat, oil, salt, and sugar, but regular nuts are also often eaten with added oil, sugar, and salt. Could it just be the peanuts themselves? I mean, technically they aren't nuts, so maybe they just don't have the same benefits, but no, a meta-analysis of all such studies found the same nut-like benefits for whole peanuts, just not peanut butter. Well, one thing missing from even no salt, oil-free, sugar-free, nut-and-seed butters is intact cellular structure. As I noted, and how not to diet, no matter how well we chew, whole or chopped nuts, some of the nutrients remain trapped in tiny particles that deliver a bounty of prebiotic goodness to our friendly flora. That makes me wonder if there would have been any difference between chunky and smooth peanut butter. In the meanwhile, there is compelling evidence to recommend the use of nuts, preferably raw nuts over salted or toasted, and whole or chopped nuts rather than nut butters at least three times a week in order to maximize our chances of living longer and healthier lives. In our next story, we look at what physicians can do to promote healthy, life-extending lifestyle changes. A pivotal paper published in Europe more than a decade ago, entitled Healthy Living is the Best Revenge, found that adhering to just four simple healthy lifestyle factors compared to none could potentially have a strong impact on the prevention of chronic diseases. We're talking nearly 80% less chronic disease risk, slashing diabetes risk by 93%, dropping heart attack risk by 81%, and cutting stroke risk in half, and cancer by 36%. Think about what that means. The potential for preventing disease and death is enormous. In the U.S. alone every year, there are a half million heart attacks, half million strokes, a million new cases of diabetes, and a million new cancer diagnoses. The message is clear. Adopting a few healthy behaviors can have a major impact. What are those four fabled factors? Never smoking, not being obese, averaging about a half hour of exercise a day, and adhering to healthy dietary principles, like lots of fruits, vegetables, and whole grains, and less meat. Follow those four simple rules and boom! Enjoy nearly an 80% reduced risk of major chronic diseases. What does that mean for mortality risk? A similar batch of four healthy behaviors combined predicted a fourfold difference in total mortality, with an estimated impact equivalent to 14 years in chronological age, meaning the individuals were dying at such a reduced rate that it was as if they were 14 years younger. Finally, a regiment to extend human life expectancy. This commentary was in reference to this study, where a similar analysis of the impact of healthy lifestyle behaviors on life expectancies was made, but this time it looked directly at the U.S. population, which is a particular importance since Americans have a shorter life expectancy compared with residents of nearly all other high-income countries. The researchers concluded that adopting a healthy lifestyle could substantially reduce premature mortality and prolonged life expectancy in U.S. adults. Okay, but by how much? They estimated that adherence to a low-risk lifestyle could prolong life expectancy at age 50 by 14 years in women and 12.2 years in men. So, if you're 50 right now, instead of only living to 79 if you're a woman and 75.5 if you're a man, taking just basic care of yourself could propel you to an average life expectancy of 93 if you're a woman and 87.5 if you're a man. The bottom line is it's never too late to turn back the clock. A mid-life switch just to the basics, like at least five servings of fruits and vegetables a day, walking even like 20 minutes a day, maintaining a healthy weight and not smoking, results in a substantial reduction in mortality even in the following few years. We're talking a 40% lower risk of dying in the subsequent four years. So, making the necessary changes to adhere to a healthy lifestyle could be considered extremely worthwhile, and middle age is certainly not too late to act. As an aside, realizing the 12 to 14 years of added life study was based on data from health professionals, that got me excited about all the potential knock-on effects. If health professionals start getting healthier, they could become role models for more healthful living and potentially save more lives than just their own. But that may have just been wishful thinking. Practicing what you preach can sometimes backfire. Evidently, displays of excellence can paradoxically turn off the very people you're trying to inspire. I mean, you'd assume that not being a hypocrite and trying to walk the walk would just lead to positive consequences, inspiring confidence in others, right? Don't you want a dance instructor who can dance, a music teacher who can play, a health professional who's healthy? But this simple intuition fails to take into account concerns about making other people feel inadequate. Like, you know how vegetarians are the targets of a surprising amount of hostility and ridicule? That's because they may come off as morally superior and make people feel like they're being looked down upon. There was an elegant demonstration in this phenomenon in this study, where principal deviants who take the high road threaten others' moral self-worth. This is what they did. Research subjects were asked to complete a racist task by an experimenter, and those moral rebels who refused to obey were cheered by observers, but were disparaged by participants who had themselves gone through with it, and for whom the rebel stance, thus implied an indictment of their spinelessness, isn't that interesting? So, when doctors portray themselves as the picture of health, patients might think they're being holier than thou and unintentionally alienate people, potentially turning off the very patients who most need their help. You can see how someone with a weight issue might feel threatened and judged by a physician triathlete. But what are we supposed to do? We want healthy practitioners—physicians who smoke are less likely to tell their patients to quit smoking, physicians who are overweight are less likely to counsel their patients about weight, and physicians who don't work out are less likely to talk about exercise. What we can do to make patients more comfortable is emphasize that our role is to help people meet their own personal health goals, whatever they may be. Studies show that when doctors do this, take this approach, it increases the appeal of fitness-focused physicians to overweight patients, so we can then display exemplary behavior while at the same time not inadvertently alienate the very people who could benefit most from our guidance. Finally today, we look at cancer-causing contaminants in medication and meat. In 2018, one of the best-selling blood pressure drugs Val Sartin sold as Diavan was found to be contaminated by the probably carcinogenic nitrosamine known as N-nitrosodymethylamine or NDMA. It's believed that approximately 20 million people worldwide were prescribed the drug tainted with this contaminant whose cancer risk has been shown to exceed that of many known potent carcinogens, including asbestos, benzoate pyrene, and PCBs. The US Food and Drug Administration estimated that taking the drug for a few years could cause cancer in as many as one in 8,000 people, whereas the European equivalent of the FDA estimated the cancer risk could be as high as one in 5,000. It is unlikely, researchers wrote in the spring 2019 paper, that drugs like Val Sartin are a unique case. And indeed, a few months later, the FDA announced it had found NDMA in renitidine. Renitidine, the acid reflux drug sold as Zantac, is one of the most prescribed drugs on the planet, in addition to being sold over the counter. Give people a single tablet, and the amount of NDMA flowing through their bodies jumps up more than a hundredfold. Then, in 2020, some formulations of metformin, a popular diabetes drug sold as Glucophage, were found to be contaminated. The finding of NDMA in common medicines led the FDA to call for the immediate withdrawal of all Zantac from store shelves, yanking the drug from the market, because their testing showed NDMA levels could in some circumstances exceed the acceptable daily intake limit of 96 nanograms per day. It was so bad that the FDA found levels of this carcinogenic contaminant NDMA in Zantac similar to the levels you would expect to be exposed to if you ate grilled or smoked meats. Wait, what? NDMA has not only been found in contaminating drugs, it is a known by-product of pesticide manufacturing, leather tanning, and tire plants, and is found in multiple food and beverages, including processed meat and beer. Now that we know NDMA can transfer through the placenta, this may explain the relationship between maternal cured meat consumption during pregnancy and the risk of childhood brain tumors. For example, hot dog consumption during pregnancy may increase childhood brain tumor risk by 33%, or sausage consumption by 44%. Baking consumption may increase childhood brain tumor odds by 60% or 70%, but it's not just processed meat. Researchers have found it in poultry products as well. A single serving of chicken contains more than 100 nanograms of NDMA. Remember how the FDA said the acceptable daily intake limit is 96 nanograms per day? Half of a chicken breast contains 110. Now raw poultry doesn't have any, it's the cooking process. In fact, the dry heat cooking of meat, like broiling or grilling, even creates airborne NDMA, releasing this very potent carcinogenic compound into the air. So even if you're only getting a salad or something in a charcoal grill restaurant, just being indoors where meat is being cooked could pose a significant cancer risk. These nitrosamines are also found in cigarette smoke, and pressure was put on the tobacco industry to try to remove them, arguing that there's simply no logical reason why a removable carcinogen should be allowed to remain in a consumer product. That's the same reason Zantac was yanked from store shelves. Okay, so let me get this straight. One of the best-selling drugs in history was pulled from the market, a drug that brought in billions of dollars, because it contained a probable carcinogen that exceeded the acceptable daily limit. But there may be more of the contaminant in a single serving of chicken. So my question is, why aren't they pulling the poultry off the shelves as well? We would love it if you could share with us your stories about reinventing your health through evidence-based nutrition. Go to nutritionfacts.org slash testimonials. We may share it on our social media to help inspire others. To see any graphs, charts, graphics, images, or studies mentioned here, please go to the Nutrition Facts Podcast landing page. There you'll find all the detailed information you need, plus links to all the sources we cite for each of these topics. For a timely text on the pathogens that cause pandemics, you can order the e-book, audiobook, or hard copy of my last book, How to Survive a Pandemic. For recipes, check out my second to last book, My How Not to Diet Cookbook. It's beautifully designed with more than 100 recipes for delicious and nutritious meals. And all the proceeds I receive from the sales of all my books goes to charity. NutritionFacts.org is a non-profit, science-based public service where you can sign up for free daily updates on the latest in nutrition research via bite-sized videos and articles. Everything on the website is free. There's no ads, no corporate sponsorship. It's strictly non-commercial. I'm not selling anything. I just put it up as a public service as a labor of love as a tribute to my grandmother, whose own life was saved with evidence-based nutrition.