8 Q&As from the 2018 “Ask the Doctor: Q&A Session with Michael Greger”
On our 15th-anniversary cruise last February, guests spent an afternoon with plant-based guru Dr. Michael Greger, a physician, New York Times bestselling author, and internationally recognized speaker on nutrition, food safety, and public health issues. Attendees had the opportunity to ask their burning nutritional questions to Dr. Greger, one of the world’s foremost authorities on the details of vegan nutrition.
Topics covered hot flashes, bipolar disorder, Crohn’s disease, chronic spine and hip pain, and low white blood counts, among others. One guest asked about treating advanced prostate cancer with diet (Dr. Greger encouraged her to view the video online here: part one and part two). The author of How Not to Die (2015), Dr. Greger had in-depth answers and pointed people in the right direction on the path to wellness.
Insight from the HHAS Session
Dr. Greger began the session by explaining, “I’m here to share the good news that we have tremendous power over our health destiny, longevity, and the vast majority of premature death and disability is preventable with a plant-based diet and other healthy lifestyle behaviors.”
Below, we highlight eight questions from the session and summarize Dr. Greger’s responses.
Q. My partner has really bad psoriasis. We are vegan in the house and use very little oil. Tried juicing and fasting. Anything they can do?
A. Psoriasis is a chronic, inflammatory skin disease that affects about 5 in 40 people, making it one of the most frequent chronic skin diseases worldwide. There are lots of drugs for it, some of which cost $100,000 a year to get a response. There are cheaper drugs like cyclosporine, but it carries the long-term risk of kidney damage, hypertension, and malignancies. The drug can cause cancer. Kidney toxicity in more than 50% of the patients treated long term, and in terms of risk of malignancies, up to 42 times the rate of cancer. And it doesn’t even work that well, keeping the disease at bay in a little more than half of patients over a four-month period. There’s got to be a better way.
What about plants? Well aloe vera gel is said to possess anti-inflammatory, anti-itching, and wound-healing properties. Yeah, but as stated in this video, “Is Aloe Effective for Blood Pressure, Inflammatory Bowel, Wound Healing, & Burns?”, when it was put to the test for wound-healing, it actually made things worse. The exploitation of aloe preparations has been accompanied too often by misinformation and exaggerated claims, but there is impressive evidence. For example, to test its anti-inflammatory properties, it was tested head-to-head against steroids, against mustard gas exposures. Mustard gas is probably our most popular chemical warfare agent, starting in World War I. Its last widespread military use was in the ’80s during the Iraq-Iran war, with more than 100,000 exposed and many still suffering from the long-term complications, predominately itching. Even decades after surviving a gas attack, 70% to 90% are still suffering.
Because other agents failed miserably at helping, the study took 67 chemical warfare-injured vets and randomized them to apply an aloe vera olive oil cream or the steroids and the aloe vera mixture appeared to work as well as the drug. Ok, well let’s try it for the management of psoriasis.
By the end of the month-long study, the aloe vera cream had cured 83% of the patients, compared to the placebo cure rate of less than 10%, resulting in significant clearing of the psoriatic plaque skin lesions. All right, but that’s compared to an inactive placebo. How about compared to steroids? It was found to be more effective in reducing the clinical symptoms.
In a double-blind placebo controlled study of a commercial aloe vera gel in the treatment of slight to moderate psoriasis, things got better in 70% of the aloe treated sites, but 80% placebo-treated sites improved. The placebo beat out the aloe. The high response rate of the placebo gel indicated a possible effect in its own right. The placebo was just basically xanthum gum in water and they were like, ‘Hey, instead of aloe failing, maybe xanthum gum works, too!’
All in all, the results on the effectiveness of aloe vera for psoriasis are contradictory but applying on the skin appears safe, so I figure why not give it a try?
Q. I had a coronary bypass six and a half years ago and changed to a plant-based diet six years ago. I have been 100% compliant with the diet for those six years and what has happened is once I got off the medications, now a few years later, my blood pressure has gone up and my cholesterol—they wanted it down under 150. I think I produce so much that even on the ‘perfect diet’ it’s still [not there]… The lowest I ever had it was 176 and that’s where I am now. I am trying … the daily dozen. Do you have any other suggestions?
A. The average whole-food plants-based (WFPB) cholesterol bell curve comes out at 145— half are better, half are worse— so you may fall on one side of the bell curve. Just like the average blood pressure for people eat WFPB diets is this perfect 110/65. That’s your median. Half on one side, half on the other. That’s why in the book How Not to Die, every chapter doesn’t just say ‘Go plant-based, duh.’ It says, ‘Wait a second if that doesn’t work, here’s what you can do next.’
Once you’re WFPB, you’re removing the three things that increase cholesterol. One is the sedentary fats, two is trans fats (hydrogenated oils, junk food), and three is dietary cholesterol. You take those out of your diet. For most people, their cholesterol drops down perfectly. If it doesn’t, you may have to start adding things to your diet to actively pull cholesterol from you body. This is where Dr. David J.A. Jenkins’ Portfolio Diet comes in. Different foods bring down cholesterol via different mechanisms. He made this portfolio of different foods to add to one’s daily diet. For example, slimy foods every day – okra, oatmeal, eggplant – all that soluble fiber brings it down. Nuts every day. Soy every day, he goes through the list. I encourage you to check out the Portfolio Diet. We know the stuff that is increasing it, but your liver is not getting the message and is not getting lipids fast enough. But we can help that by adding additional foods, we should be able to get you down. I love your doctor’s recommendation for a total under 150 or even more importantly get that LDL, which you’re really concerned about, down 50, 60 70.
Q. What is the best B12 supplement?
A. Cyanocobalamin is preferable because it’s shelf stable… It happens to be the cheapest… Because it’s so critically important—not something you mess around with—you all need a regular, reliable source of vitamin B12. I recommend 2500 mcg of cyanocobalamin a week (more here)… And now there’s vitamin B12 toothpaste!
Q. I am asking questions about a broken neck from 1996, resulting in nerve damage. The person is not paralyzed, but lives with chronic pain and many other issues. They cannot take a bath because it hurts. Bowel issues, high blood pressure, high cholesterol. Those, I know are not necessarily related to nerve damage. Can the nerve damage be reversed or helped with WFPB nutrition?
A. There is one way to find out! The most likely reason that this person will die is probably heart disease, like everybody else. Particularly if she already has some risk factors. So just because she wants to continue to exist on this planet, she should be healthy. And then can see if indeed— like in the case of diabetic neuropathy, there is evidence for remarkable regression and reversal of putting people on whole-foods plant-based diets—whether or not she will experience that same benefit, we won’t know. But, if only there was something that not only didn’t have bad side effects, but had good side effects, also would probably save her life in the meanwhile, then she should probably do it. But you bring up a good point. You can still get hit by a bus, everyone, so still eat healthy, but also seatbelt, bike helmets, and all that stuff!
Q. Can a healthy diet help reverse cataracts?
A. We have some beautiful evidence. In fact, last year, I gave a talk that included some of the cataract data (informative video here). Showed this remarkable drop in risk of getting cataracts in the first place. There was a stepwise drop. Compared the meat eaters to the so-called “flexitarians,” to pesco-vegetarians (no meat except fish), to lacto-ovos to vegans. The stepwise drop in cataracts risk as one goes more and more plant-based. But the question is, if you already do have them, what can you do? You call a surgeon. Cataract surgery—of all surgeries—is very low risk and can show remarkable improvement. The reason we get cataracts is that it’s our body’s protection against these blue rays from the sun. This yellowing. It protects our retina. Instead of getting cataracts, what we can do is eat lots of lutein and zeaxanthin. These are wonderful yellow compounds found in dark leafy vegetables, like spinach. Our body sucks it up and directs it straight to the retina and protects. It is like an internal sunscreen. Our body doesn’t need to make cataracts. It’s already protected.
Q. Are there any organizations that you are aware of who would be interested in doing research on my whole-foods, plant-based body after death?
A. That’s a great question. It’s going to be a while! *Laughter in the room*
Not that I know of. If you do know, let me know and I can let people know about it.
Q. If we bring meat to the home, it can change our microbiome. Should we be concerned about bringing in raw meat for our pet dogs and what can we do about it?
A. Yes, particularly chicken. If you have a roommate whose chicken is dripping on your broccoli in the fridge, you’re in fact at more risk. Why? Because they’re at least going to cook their chicken. Whereas your broccoli may get a light stir fry or just get eaten raw in a salad. This presentation I gave a year or two ago talked about bringing in fresh and frozen chicken in the household, it gets everywhere throughout the kitchen, on the countertop. Even if you have people spritzing bleach. The best way to guarantee that you’re not going to affect yourself or your family is to not bring it home in the first place. If you’re going to have meat products, in terms of safety, pre-cooked meat products only in the household. I would be very careful about handling raw meat from your pets. Sanitize stuff. Make sure to wash your hands. Use gloves. There are different risks associated with different meat… Handle it like toxic waste. We should all have those BioSuits.
Q. Should we cook the greens or eat them raw?
A. You should eat greens in whichever way gets you to eat more of them. Like them raw? Eat them raw. Like them cooked? Eat them cooked. The only exception is deep fried… Any other way. It makes little difference. If you came to me and said you liked them identically, now tell me. Then, there’s all sorts of really cool data we can go through…You can blend the greens. There are all sorts of things you can do to maximize (their nutritional value). But basically, we’re talking about 10-20%… But that’s completely overwhelmed by quantity. If I said do twice as much of one form of greens than another. If you say you love your collard greens boiled, you could say, ‘Boiling greens? Think of all the nutrition you’re losing.’ Yeah, but if you love boiled collard greens…then boil those collard greens. But then take all that green juice at the bottom and make some soup out of it!
Hungry for More?
More than a thousand of Dr. Greger’s nutrition videos are freely available at NutritionFacts.org, with new videos and articles uploaded every day. You can also download Dr. Greger’s Daily Dozen app for free. All the servings and all the foods that he encourages to incorporate in our daily diet. If you haven’t read it yet, pick up a copy of How Not to Die. Dr. Greger’s next book covers weight loss. Titled How Not to Diet, the book will be on stands by December 2019.
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