 Did you ever wonder if the food you eat has a direct effect on your health, well-being, and longevity? Well, I'm here to end that mystery. You are the food you eat. Welcome to the Nutrition Facts Podcast. I'm your host, Dr. Michael Greger. It's time for the Nutrition Facts Grab Bag, where we look at the latest science on a whole variety of topics. In our first story, we look at how a condition called syncope, also known as fainting, is triggered and prevented. Syncope is the sudden brief loss of consciousness caused by diminished blood flow to our brain. That occurs at least once in about 1 in 5 people. About 1 in 10 may happen over and over, responsible for millions of emergency room visits and hospitalizations. Though sometimes fainting can be caused by heart problems, most often it's triggered just by standing, because blood pools in our legs, or strong emotions, and are caused, are called viso-vegal reactions. Under certain circumstances, such as blood donation, syncope has important medical and societal significance, when 150,000 people experience fainting spells, or near fainting spells, each year when they're giving blood. So it would be good to find a way to avoid it. But if you think that has medical and societal significance, what about fainting when you're driving? Those without saying that losing consciousness while driving can pose a serious threat to the patient and society. Of a group of folks getting tested for it, 9% report that they had lost consciousness while driving. When it happens over and over, drugs and surgery are used, installing a pacemaker, but such therapy is expensive, efficacy is questionable, and adverse effects are common. In fact, the results of most drug treatment trials have been disappointing, and the value of implanting pacemakers have been repeatedly questioned, and now there's evidence for their lack of effectiveness. So what do we do? Well, in Italy, evidently the older generation of general practitioners advise patients prone to fainting carry a wooden egg, using the old days for darning socks, and to apply muscle tension by gripping the wooden egg forcefully as soon as a faint was imminent. These folklore stories inspired an Italian cardiologist to apply arm muscle tensing to combat vasal vagal fainting, but it wasn't put to the test until now. About a minute before losing consciousness, most about to faint experienced so-called prodromal symptoms. They feel dizzy, queasy, or break out in a sweat, signaling they're just about to black out. When that happens, there are a number of maneuvers shown to successfully abort the impending episode. One is called isometric arm counter pressure, where you grip one hand and the other, and exert pressure trying to pull your arms apart, and you keep it up until the symptoms go away. How successful is it? Patients were shown how to do it, and reported it was successful 99% of the time. Safe and effective. It's supposed to be the new first-line treatment for those who start to feel faint. Leg crossing and muscle tensing has also been shown to work where you cross your legs, squeezing them together as you tense your leg, stomach, and butt muscles. Safe, inexpensive, effective. They're proposed having patients try this before having a cardiac pacemaker surgically implanted. Squatting down is another maneuver that all else fails. Is there anything we can do to prevent the symptoms in the first place? Do we have to wait until we're all dizzy, clammy, and sweaty, and nauseous? Well, speaking of cheap, safe, and effective, just drinking water can prevent it. So if you know needles make you woozy, five minutes before you get stuck, chug down two cups of water, which can dramatically bring the pressures up within minutes to be predisposed to fainting and have similar effects in normal, healthy adults. The fact that water exerts such profound effects can be exploited by blood donation programs, for example, to help prevent people from fainting. It's also the currently recommended treatment for so-called blood injury or injection phobia, which is actually pretty common, affecting about 125 people. 35% of which report a history of fainting in response. The problem is not just that they won't donate blood. Avoiding anything related to blood injury or injections could pose a particularly serious threat if people neglect to seek medical care when necessary. But all one may have to do is just preload with two cups of water. The knowledge that such simple self-help maneuvers are readily available and could be life-saving and valuable and helpful in everyday life. In our next story, plant-based diets can be 98% effective in keeping ulcerative colitis patients in remission, blowing away other treatments. One of the most common questions physicians treating patients with inflammatory bowel disease are asked is whether changing one's diet can positively affect the course of their disease. Traditionally, our answer had been, we have no clue. But this may now be changing given the evidence that hydrogen sulfide may be playing a role in ulcerative colitis. And since the sulfur-containing amino acids concentrated in meat cause an increase in chronic levels of this rotten egg gas, maybe we should take off the meat. See, animal protein isn't just associated with an increased risk of getting inflammatory bowel disease in the first place, but also IBD relapses once you have the disease. This is a recent development. Because the concept of IBD as a lifestyle disease mediated mainly by a westernized diet is not widely appreciated, an analysis of diet in the follow-up period after diagnosis in relation to a relapse of inflammatory bowel disease had been ignored, but not any longer. Ulcerative colitis patients in remission and their diets were fall for a year to see which foods were linked to the bloody diarrhea coming raging back in the strongest relationship between a dietary factor and an increased risk of relapse observed in the study was for a high intake of meat. So what if you have people lower their sulfur-containing amino acid intake by decreasing their consumption of animal products? They tried it on four ulcerative colitis patients, and without any change in meds, they experienced like a four-fold improvement in their loose stools. In fact, they felt so much better that they didn't think it ethical to try switching them back. Since sulfur-containing amino acids are the primary source of dietary sulfur, a low sulfur diet essentially means a shift from a typical diet, high in animal protein and fat, and low in fiber to more of a plant-based diet. Westernized diets are pro-inflammatory, and plant-based diets are anti-inflammatory. Let's see what treatment with a plant-based diet can do after the onset of ulcerative colitis during a low-carbohydrate weight loss diet. A 36-year-old man lost 13 pounds on a low-carb diet but also lost his health, diagnosed with ulcerative colitis. Put him on a diet centered around whole plant foods, though, and poof, symptoms resolved without medication. Okay, but this is just one case. Case reports are like glorified anecdotes. The value of case reports lies in their ability to inspire researchers to put it to the test, and that's exactly what they did. There had never been a study published focusing on using plant-based diets for the treatment of ulcerative colitis until now, considering the lack of a suitable diet to be the biggest issue faced in the current treatment of inflammatory bowel disease. Regarding it as a lifestyle disease caused mainly by our omnivorous diet, a group of Japanese gastroenterologists had been providing a plant-based diet to all patients with IBD for over a decade, and publishing extraordinary results far better than have today been reported in the medical literature, found to be effective in the maintenance of remission in Crohn's disease by 100% at one year, 90% at two years. So how about a plant-based diet for relapse prevention in ulcerative colitis? Educational hospitalization meant bringing patients into the hospital to control their diet and educate them about the benefits of plant-based eating so they'd be more motivated to continue it at home. Most patients, about three-quarters, experienced improvements, such as disappearance or decrease in bloody stool during hospitalization. Fantastic! OK, but here's the really exciting part. Then they followed the patients for five years, and 81% were able to remain in remission the whole time, and 98% were able to keep the disease at bay for at least a year. That blows other treatments away. Those relapse rates are far lower than those reported with medication under conventional treatment. Other studies found that about half relapse compared to only 2% among those taught to eat healthier. A plant-based diet was previously shown to be effective in both the active and quiescent stages of Crohn's disease. The current study has shown that a plant-based diet is effective in both the active and quiescent stages of ulcerative colitis as well. And so they did another study on even more severely affected cases with active disease and found the same thing, far beating out conventional drug therapy. People felt so much better they were still eating more plant-based even six years later. The researchers conclude that a plant-based diet is effective for treating ulcerative colitis to prevent a relapse. Why? Well, plant-based diets are rich in fiber, which feeds our good gut bugs that may partly explain why a plant-based diet prevents a variety of chronic diseases. And so that's what we may be seeing with inflammatory bowel disease, suggesting that replacing an omnivorous diet with a plant-based diet is the right approach. It's like using a plant-based diet to treat the cause of heart disease, our number one killer, not just safer and cheaper, but works better. No adverse side effects noted for plant-based eating. Let's compare that to the side effects of immunosuppressants used for ulcerative colitis like cyclosporine. And now we have even fancier drugs that cost about $60,000 a year. That's $5,000 a month. And they don't even work very well with clinical remission in one year of only like 17 to 34%, and instead of no adverse side effects, they can give you a stroke. They can give you a heart failure. They can even give you cancer, including a rare type of cancer that often results in death. Or how about a serious brain disease known as progressive multifocal leukolencephalopathy, which can kill you and for which there is no known treatment or cure? Yeah, yeah, increased risk of death, but did we mention how nice and small the pill was and the easy to open bottle? Finally today, we look at what hospitals have to say for themselves for feeding people meals that appear to be designed to inspire rumpy business. Hospital food needs a revolution. I was surprised to find out that most inpatient meals served in hospitals are not required to meet any sort of national nutrition standards for a healthy diet. And indeed, analysis on the nutritional value of food served to patients in teaching hospitals found that many did not meet dietary recommendations. Warning! Read the headline's Hospital Food Bad for Health. A registered dietitian wrote in to defend the hospital, saying, hey, at least over half the hospitals met at least over half the guidelines, and hey, they're so stringent anyway, little eggs and dairy you can blow through your limits. The provocative conclusions of their analysis only lead the media and the public to conclude that we're a bunch of dunces who have no understanding of the relation between nutrition and disease prevention. Well, if the white coat fits, look, we spend a fortune on training doctors. You'd think we could follow through on some of the simplest things like food. A good diet is as necessary to the recovery of health as anything else, and it's folly to pretend that it's beyond the power of our profession to change this, a line written 75 years ago and still, there's pushback. Or perhaps we should question whether a healthy diet, given to a helpless patient during a 2-10-day hospital state benefits anyone or anything other than the dietitian's sense of doing good, responded one doctor. Always bothered when patients are deprived of a desired morning egg because a healthy diet has been ordered. I mean, what's a few days of a little heart unfriendly diet in the scheme of things? But it's the message we're sending, where the presence of foods in the hospital transcends a message to patients as to what's healthy and acceptable for them to eat, responded the researchers that did the hospital foods analysis. We still can think of no better place or opportunity to set an example of good nutrition than when patients are in hospitals. After all, public schools in California have banned the sale of soda for over a decade. Why not children's hospitals? In a study of California health care facilities serving children, 3 quarters of foods and drinks wouldn't have been allowed in schools. We're talking soda and candy. Having unhealthy items in health care facilities and seeing staff consume these products contradicts the hypercritical nutrition and health messages children may get from health care providers. On adult menus, nearly all meals contained excess salt with 100% of daily menus exceeding the American Heart Association's recommendation for staying under 1,500 milligrams of sodium a day. This means meals offered to patients may actually contribute to the exacerbation of the very conditions that may have led them to the hospitalization. But if hospitals stuck to the recommended limits of salt, the food wouldn't taste as good, responded an executive from the Salt Institute to which the researchers replied, taste is good. We're talking about hospital food. It doesn't taste good no matter how much salt you put on it. In the very least, we should prepare all meals with low sodium. And then look, if they want to add salt, it's their choice, right? They want to get someone to wheel them out in the parking lot and smoke? That's their business. But we shouldn't be blowing cigarette smoke in people's rooms three times a day whether they want it or not. Interestingly, studies suggest that when individuals are allowed to salt food to taste, they rarely add as much as often becomes prepackaged within the food. Switch people to low sodium diet. And sure, they use their salt shakers more, and overall, their salt intake dips way down. And the study subject said it tasted just as salty, right? Because salt added to the surface of foods makes it taste saltier. But when a hospital meal comes to you pre-salted to the hilt, inpatients may not even have the option to consume healthier levels. In defense of their unhealthy food, one hospital food service provider explained that they're just giving people what they want. Are we really going to deny people who are going through difficult times any small comfort they can get? Hospitals used to sell cigarettes, primarily for patient convenience. I don't think I could deny a paying patient the right to smoke a cigarette, said one administrator. I'll have to insist we have cigarette machines in the hospital as a service to the patient. But some made the radical suggestion that tobacco products should not be sold in the hospital. This wasn't from the 1950s, but from the 1980s. Yet the irony of hospitals allowing the sale of a major cause of preventable illness and death in this country had really been discussed in the medical literature, and especially ironic that smoking was, of course, permitted in the doctor's lounges. To their credit, though, U.S. hospitals underwent the first industry-wide ban on smoking in the workplace by the mid-90s. Well, now hospitals again have the opportunity to take the lead and create food environments that are consistent with their mission to cure the sick and to promote health. Though the simple act of serving food that meets national nutritional standards, our hospitals will act in the best health interests of their patients and their staff, and will undoubtedly again be leaders in our ongoing dialogue on how to improve the food supply, which in turn will improve the health of us all. You know, strict anti-smoking regulations were often criticized as being too harsh, if disease and premature death brought on by smoking were any easier. Think my smoking diet parallel is hyperbole? Well, guess what? Today, the major cause of preventable illness and death in this country is no longer tobacco. The leading cause of death in America is now the American diet. Hospitals in the United States serve millions of patient meals each day from a position to model a healthy diet. 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 vital, timely text and the pathogens that cause pandemics, you can order the e-book, audio book or the hard copy of my second to latest book, How to Survive a Pandemic. For recipes, check out my latest, the How Not to Diet Cookbook. It's beautifully designed with more than 100 recipes for delicious and nutritious meals. And of course all proceeds I received from the sales of my books go to charity. NutritionFacts.org is a non-profit, science-based public service where you can sign up for free daily updates and 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.