 I know you work hard to make the best lifestyle choices, so you can improve your health, destiny, and longevity. And there's lots of information out there on how to do just that. So where do you start? Well, we start with the facts. Welcome to the Nutrition Facts Podcast. I'm your host, Dr. Michael Greger. My job is to bring you the latest peer-reviewed nutrition and health research, and share it with you here. 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, fasting, followed by a plant-based diet, is put to the test for treating autoimmune inflammatory joint disease. Alan Goldhammer is the founder of the True North Health Center in Santa Rosa, California, which has fasted 10,000 people for conditions ranging from diabetes and cardiovascular disease to autoimmune diseases. He noted that conditions that seem to be tied to dietary excess tend to respond predictably to the use of fasting, followed by a health-promoting diet, which he describes as a low salt, all plant, high fiber, low fat, low protein, and low sugar diet. This approach offers people an option to eliminate the cause of lifestyle diseases, often to the point where the medication is no longer needed, in contrast to conventional medicine, which is more about the suppression of the symptoms associated with the disease, rather than removing the underlying root cause. Goldhammer put it this way, if you treat high blood pressure type 2 diabetes or autoimmune disease medically, they'll tell you you'll be on these medications the rest of your life. That's them, in effect, promising you if you follow their advice to the letter, you will be sick the rest of your life. Preliminary data suggests fasting may benefit metabolic diseases, pain syndromes, high blood pressure, chronic inflammatory diseases, allergic diseases, and psychosomatic disorders. But the highest level of evidence we have for the benefits of fasting are in regards to rheumatic diseases, autoimmune inflammatory joint diseases, like rheumatoid arthritis. Nearly a century ago, it was written that diet treatment is not generally recognized by the medical profession as one of the weapons with which to attack such diseases. This attitude persisted until relatively recently, but a systematic review of controlled trials has since shown a statistically and clinically significant beneficial long-term effect. Rheumatoid arthritis is a well-known genetic component, but the concordance rate, the chance that a pair of identical twins both get it when one has it, is probably under 30%, despite having the same genes leaving 70% to be explained by non-genetic factors. Even if we don't know exactly what those factors are, fasting has been compared to rebooting the hard drive in a computer. Sometimes, a drive gets corrupted and you don't know exactly what the problem is, but if you just turn it off and reboot it, that corruption may get cleared out. The evidence base started with case reports, fasting followed by a plant-based diet. Remarkable reports of years of pain and stiffness gone within a week, and more importantly, stayed gone on the healthier diet. One after another like that, but case reports are just glorified anecdotes. I mean, there have been studies going back decades suggesting fasting may represent the most rapid available way to induce relief of arthritic pain and swelling for patients who have rheumatoid arthritis, but the studies often failed to have control for the placebo effect, which is especially important when it comes to relying on self-reported subjective symptoms such as pain and general well-being. But there are objective measures, lab tests of inflammation that don't appear to be affected by placebos, and that's what you can see in control trials, starting immediately and remaining down for at least a year. Ten different measures of inflammation significantly decreased after the fasting subsequent meat and egg-free diet, whereas none of the parameters budged in those disease victims that continued to eat their regular diets. And the squelching of inflammation translated into a significant reduction in pain, morning stiffness, a loss of grip strength, and a number of tender and swollen joints. Even a year after the trial was over, those who benefited from the diet continued to benefit in terms of pain, stiffness, tender and swollen joints, presumably because they stuck with it. There's little doubt that while fasting, both inflammation and pain are relieved, but if you go back to the same diet you were on before, the inflammation returns on less, evidently, the fasting period followed by a vegetarian diet. Why might that be? Well, it could be due to the changes in the microbiome, the improvement in symptoms coincided with a significant alteration of the intestinal flora, which may somehow be beneficial, perhaps by strengthening the gut barrier. You know fasting can decrease the leakiness of the gut in rheumatoid arthritis patients, but we don't yet know what role, if any, it plays in the disease process. It could be as simple as icostinol, the mediator of inflammation that are formed from arachidonic acid. Arachidonic acid is a long-chain inflammatory omega-6 fatty acid found in animal fats. The biggest contributors are chicken and eggs, which together contribute nearly half of American intake. That's been suggested as an explanation of why those eating more plant-based appear to have better mental health. They're not suffering the cascade of neuro-inflammation caused by arachidonic acid. While removing eggs, chicken, and other meat was shown in a randomized control trial to improve mood, suggesting the arachidonic acid might be negatively impacting mood states and may help explain the impact of more plant-based diets on inflammatory diseases like rheumatoid arthritis. So that may help explain why maintaining a plant-based diet appears to be necessary after the fast to prevent the recurrence of symptoms and inflammatory activity. Or as one popular press article put it, fasting may just be a tool to get you to radically kick-start a change in the way you eat. Next up, we look at how to reverse heart failure with diet. It is a hopeful sign of the times when entire issues of cardiology journals are not just dedicated to nutrition, but to plant-based diets in particular. Dr. Williams passed president of the Merrin College of Cardiology and starts out with a quote attributed to Schopenhauer. All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as like, well, duh, and the truth for the benefits of plant-based diets. Plant-based nutrition continues to mount. The evidence we got, the problem is the inertia. Culture, habit, and widespread marketing of unhealthy foods. Our goal must be to get the data out to the medical community and the public working and actually change lives. That's like my personal life's mission in four words. Get the data out, right? Based on what we already know in the existing medical literature, plant-based nutrition clearly represents the single most important yet underutilized opportunity to reverse the pending obesity and diabetes-induced epidemic of morbidity and mortality, meaning disease and death. The issue included your typical heart disease reversal cases. 77-year-old woman with heart disease so bad she couldn't walk more than a half block or go up a single flight of stairs, severe blockages, and all three of her main arteries and referred to open-heart surgery for a bypass. She chose, however, instead to adopt a whole-food plant-based diet, which included all vegetables, fruits, whole grains, potatoes, beans, legumes, and nuts. Even though she said she was trying to eat pretty healthy before, within a single month of going plant-based, her symptoms had nearly resolved. And forget about a block. She was able to walk on a treadmill for up to 50 minutes without just chest discomfort or becoming out of breath. Her cholesterol dropped about 100 points from around 220 down to 120 with an LDL under 60. But then, a few months later, she must have started missing her chicken, fish, and low-fat dairy and went back to her prior eating habits and within a few weeks. With no change in her meds or anything, her chest pain was back and she went on to have her chest soared in half. After all, then she continued to eat the same diet that contributed to the cause of her disease in the first place and went on to have further disease progression. This one, though, has a happier ending. Started out the same 60-year-old men's severe chest pain after as little as a half block, decided to take control of his health destiny and switched to a whole-food plant-based diet from his, quote-unquote, healthy diet of skinless chicken, fish, low-fat dairy that had been choking off his heart and within a few weeks, the same amazing transformation from not being able to exercise at all to walking a mile to then being able to jog more than four miles completely asymptomatic off all drugs, no surgery, off to live happily ever after. Now, of course, case reports are just really glorified anecdotes. I mean, what we need is a randomized controlled trial to prove heart disease can be reversed with lifestyle changes alone and guess what? There was one published literally 30 years ago proving angiographic reversal of heart disease in 82% of the patients opening up heartaches without drugs, without surgery. So these case reports are just to remind us that hundreds of thousands of Americans continue to needlessly die every year from what was proven to be a reversible condition decades ago. The conventional use of case reports, though, is to present some novel results in hopes of inspiring trials to put it to the test. For example, a case report on a plant-based diet for congestive heart failure. So not just coronary artery disease, but the heart muscle itself was so weakened it couldn't efficiently pump blood, only able to eject about 35% of the blood in the main heart chamber with every beat, whereas normally the heart can pump out at least half, which is exactly what his heart was able to do just six weeks after switching to a whole food plant-based diet, instead of choosing to get his chest cracked open. The first report of an improvement in heart failure following adoption of a plant-based diet, but not the last 54-year-old woman obese type 2 diabetic presenting with swelling ankles due to her heart failure. She switched from her chicken infusion to whole plant foods. She started out eating healthier and lost 50 pounds, reversed her diabetes, meaning normal blood sugars on a normal diet without the use of diabetes medications, and her heart function normalized, from an abysmal ejection fraction of just 25% up to normal. Since this is not a randomized controlled trial, all we can say is that her improvements coincided with her adoption of a whole food plant-based diet, but given the burden of heart failure as a leading cause of death, how it just usually gets progressively worse and the overall evidence to date, a plant-based diet should be considered as part of heart failure care. And look, we already know it can reverse her coronary artery disease, and so any heart failure benefits would just be a bonus. Now, we just need good strategies for healthcare practitioners to support patients in plant-based eating. Here are some excellent suggestions to pause and reflect on. For example, doctors can use the Plantrition Project's prescription pads and prescribe a good website or two. While it is certainly true that many people would be resistant to fundamental dietary changes, look, it's equally true that, look, millions of intelligent people motivated to preserve their health are now taking halfway measures that may provide only modest benefit, right? Choosing leaner cuts of meat, using reduced fat dairy products, right? Most of these people have neither the time nor the training to actually see what the science shows themselves, right? Don't they deserve honest, forthright advice when their lives are at stake? I mean, those who wish to ignore that advice or implement it only partially, certainly at liberty to do so, right? I mean, you want to go smoke cigarettes, go bungee jumping, right? It's your body, your choice, right? It's up to each of us to make our own decisions as to, you know, what to eat and how to live, but we should make these choices consciously, right? Educating ourselves about the predictable consequences of our actions. Finally today, we look at the health benefits of pole walking. Let me explain. Exercise recommendations for obesity have been referred to as the mysterious case of a public health guideline that is almost entirely ignored. Governmental, scientific, and professional organizations call for at least an hour of exercise a day for weight management, but almost no obese adults meet this target. Surveys suggest American men and women watch TV 10 times more than they exercise it for obese Americans. It may be even worse. Just 2% even reach 30 minutes a day, and the percentage exceeding an hour a day is expected to be close to zero. Why don't obese individuals exercise more? How about we just ask them? When questioned, obese adults typically describe exercise as being unpleasant, uncomfortable, and unenjoyable. How can we break this vicious cycle where inactivity can lead to weight gain, which can lead to further inactivity, even more weight gain? The first thing to recognize is that it is normal and natural to be physically lazy, right? Nothing in biology makes sense except in the light of evolutions. The title of a famous essay written by a noted geneticist, Laziness is in our genes. We evolved to instinctually avoid unnecessary exertion to conserve energy for survival and reproduction. These days, there's no shortage of available fuel, yet the hardwired inertia remains. Our ancient ancestors exercised only when it was necessary or when it was fun as a form of play. Just like dietary change for weight control, the only way exercise is going to work long term is if it becomes a stable lifelong habit. Exercise is really only effective if it's sustainable. So we need to restructure our surroundings to require more physical activity, like using a treadmill desk, and figure out how to make exercise more enjoyable. It should just be like, you know, walking the park. Literally, perhaps. Wise advice from a 1925 medical journal entry. The best prescription to be written for a walk is to take a dog and a friend. Listening to your favorite music might also help. Music has been described as a legal method for improving peak performance and, more importantly, the enjoyment of high intensity interval training. During exercise, listening to a preferred playlist can significantly reduce your rate of perceived exertion, which is how hard you feel your body is working. Put severely obese youth on a treadmill and have them go into exhaustion with or without music, and those listening to their favorite tunes tended to make it about 5% longer. This was chalked up to attentional distraction. The music may have just helped them keep their mind off of the feelings of fatigue. I mean, if that's the case, maybe listening to a podcast or audiobook might have a similar effect. One way to up your walking game is with walking poles. So-called Nordic walking, also known as exerstriding, or Viking hiking, was originally developed in Scandinavia to maintain a cross-country ski athlete's training in the summer. But it's since gained in popularity worldwide as a general fitness activity. The augmented engagement of the upper body musculature may result in an 18-22% increased calorie expenditure over walking alone, depending on your pole handling technique. The question I wanted to know for my new book, though, does that actually translate into accelerated weight loss? Before and after studies demonstrate weight loss with pole walking compared to a sedentary control, what about compared to regular walking? Of the four such studies I could locate, comparing thrice weekly 40-60-minute sessions of Nordic walking compared to regular walking, every single one found no significant difference in body fat measures, after 8 weeks, 12 weeks, or 13 weeks. There are certainly other benefits over regular walking, such as increased upper body muscle bulk, muscular endurance, and strength, though not as much as resistant span training. But to date, there's no evidence for a weight loss enhancing effect, which is why Nordic walking didn't make the cut for my new book. But just as we were going to press it, this study was published the first ever to combine Nordic walking with diet, compared to the same dietary program with regular walking, and once again, no significant difference in body weight, or anything else. Now there was a hint that those in the pole group enjoyed it more, and in the end, right, exercise only works, if you do it. And there may be other benefits. Nordic walking beat out regular walking in terms of reducing symptoms of depression and improving sleep quality. Perhaps this should not be surprising, giving the greater exercise intensity of Nordic walking, even approaching that of jogging at higher speeds. And that's where I see the role of walking poles, to fill the intensity gap between people who are ready to graduate from walking, but not yet ready for more rigorous activities such as running. The only potential downsides are the added expense, and reminded of Monty Python's Ministry of Silly Walks, sketch the indignity of looking a bit ridiculous. 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, links to all the sources we cite for each of these topics. For a vital, timely text on the pathogens that cause pandemics, you can order the e-book, audiobook, or the hard copy of my last book, How to Survive a Pandemic. For recipes, check out my new How Not to Diet Cookbook. It's beautifully designed with more than 100 recipes for delicious and nutritious meals. And all proceeds ever seen from the sales of all my books goes to charity. Nutritionfacts.org itself 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.