Dr Greger

[Adrienne]

Hi Jeff

I listened to AJ's recent interview with Dr Greger and I had a few questions that I hope you don't mind answering:

Dr G said that last year there were 24 000 nutrition articles published on nutrition and that if you are still saying the same thing you said 10 years ago then you are not keeping up in the field. Do you agree with that? And of all those articles how many do you think are actually relevant?

And on the subject research, Dr G mentioned that he was in fact enrolled to a joint MD/PhD program but then decided to switch to a straight MD program. In your opinion, how important is formal training in conducting/interpreting studies? Do you think that a joint MD/ PhD physician scientist degree would have offered Dr Greger an advantage, and therefore improved the quality of his videos and articles?

When AJ asked if he missed working with patients he said yes, but that he doesn’t “have the luxury to do that anymore when our society is so sick." Right before that he said that when he was seeing patients perhaps he could reach dozens of people a day, when he was speaking he could reach thousands, but now he can use the same research, skills and background to spread this lifesaving info to as many people as possible.

I assumed he was referring to the work he does with Nutrition Facts (reading studies, making videos) since, after all, people are not “so sick” with bird flu, mad cow and other infectious d diseases related to his work at the humane society, but with obesity, heart disease, diabetes etc…

So basically it came across like he thinks he can help more people making three five-minute videos a week than seeing a handful of patients a day. Do you agree with that? Do you think the world would be better off if suddenly you, Dr McD, Craig McD, Dr Ess, Dr Davis, Dr Ostfeld etc suddenly decided to stop seeing patients b/c, technically, you all could “reach” more people sitting at home making with You Tube videos? Of course this would require the “luxury” of being able to do that, which Dr Greger seems to have. (It must take A LOT of time to read through and carefully evaluate thousands of studies.)

Have you ever met, worked with, or heard of anyone who credits Nutrition Facts with profoundly changing their lives for the better, similar to Star McDougaller stories or FOK success stories?

I find it ironic that he switched from the MD/PhD program to the straight MD program b/c he realized that the world needed conversion of the research for clinical practice, yet he himself isn’t even doing that anymore. I can't help but think that if Dr G was seeing patients he could make a HUGE difference in the lives of a small - yet significant - number of people. As you often point out, implementing a WFPB diet can be so difficult for many. This type of one on one, doctor/patient interaction is not something that can be replaced with short You Tube clips. On top of that if he was seeing patients he could introduce the whole concept of a WFPB diet from the beginning and explain the benefits, which are still unknown to too many people. I could be wrong but I get the feeling that most loyal NF viewers are already converted and have already reaped the benefits, to a certain degree anyway.

Also, he mentioned that in his new book he discusses the benefits of turmeric. Do you know of any benefits to adding a little turmeric for people already eating plant-based? Is this one of those instances of unique positioning/market differentiation?

Finally I wish there would have been some discussion regarding the enormous benefits AJ has experienced by eliminating all nuts, limiting seeds, eating a lot of white potatoes, and essentially adhering to guidelines that he once called "ego-based," "outdated" and "not the best science-based advice." It’s too bad that she didn’t call him out on that!

Thanks

[JeffN]

Thanks.

You have raised some good points.

I'll get back to this later in the week or early next week.

In Health
Jeff

[JeffN]

Dr G said that last year there were 24,000 nutrition articles published on nutrition and that if you are still saying the same thing you said 10 years ago then you are not keeping up in the field. Do you agree with that?

As you may now, I do not agree with that perspective and I have discussed this and the reasons why in this forum on many occasions.

Here is one..

https://www.drmcdougall.com/forums/view ... 22&t=28191

I have also discussed how science really works and fortunately, it does not work as implied by the above comment. Science is a very slow moving process that inches forward making minor shifts along the way. Studies may shift it ever so slightly but it rarely makes a sudden major shift.

http://www.jeffnovick.com/RD/Articles/E ... ews!!.html

Most studies will never be replicated or be of any value...

https://www.drmcdougall.com/forums/view ... 30#p421908

"A number of empirical studies show that 80-90% of the claims coming from supposedly scientific studies in major journals fail to replicate."

And in this discussion, "The Information Myth: Is More (Always) Better," I point out 4 key points to understand comments like the one you mention above

https://www.drmcdougall.com/forums/view ... 8&p=461664

To me, understanding the 4 key points, is way more important than reading 10's of1000's of articles.

In addition, I have an article I am working on called The Greatest Health Discoveries in the Last 50 Years, which is when most nutrition science has happened. By this, I mean revolutionary information that actually made us change the way we think about nutrition and/or changed the way we eat. A major paradigm shift in thinking. I surveyed dozens of doctors, dietitians, public health officials, scientists, researchers from many fields and perspective and scoured the medical literature for any published responses. At best, I get about 10 items, several of which I will show are not really that big of a deal, are anything new or resulted in any actual changes.

Included in the survey was most all of the WFPB doctors and the most responses I got from any one of them was about 5 things. That is it. Think about it, in 50 years, 5-10 great discoveries that changed the way we think about food and eating and/or caused us to make a major shift. That is about 1 every 5-10 years. So, how many happened this year? This month? This week? Today?



Let us not forget, Pritikin is still publishing results every year using the same original reversal program. Same with Dr Ornish. Same with Dr McDougall, The CHIP program, TrueNorth, Dr Esselstyn, etc... These program not only still work, they are some of the best and most effective programs out there and over all the years, they have made only minor changes in their programs.

http://www.jeffnovick.com/RD/Articles/E ... _Pt_1.html

As I pointed out here, even in the 2012 year end video, the best data used to show how dietary interventions can prevent, treat and reverse CVD, Cancer, Diabetes, etc, was the data from Pritikin, Ornish, McDougall, etc.

https://www.drmcdougall.com/forums/view ... 0r#p310350

The same here just 6 months ago...

http://nutritionfacts.org/video/kempner ... nto-shape/

And of all those articles how many do you think are actually relevant?

Let's put that number (24K) to the test assuming it is accurate and about the same each year. That would mean about 12k in 6 months.

I went and analyzed all the videos to date for the first 6 months of 2015. There were 68 videos produced in the first 6 months of 2015. Of those 68 videos, I was only able to find 2 references to studies published in 2015. 2/12,000 is .0167%

Apparently, another forum member has recently found a similar issue.

https://www.drmcdougall.com/forums/view ... 19#p502203

Perhaps there are more that have been covered in blogs, articles and social media posts, which I did not look through. However, many of the video topics are not only nothing new, many have been well covered already by Dr McDougall, Pritikin, Dr Ornish, Dr Barnard, me, etc, etc.

Perhaps it is exposing a new and different audience to the info but from my understanding, the biggest exposure by far has been from the FOK movie which remains the biggest influence. And that is based on a single film.

Last week, I posted a review of the studies I have covered in this forum in the first 6 months of 2015, which totaled 49.

https://www.drmcdougall.com/forums/view ... 22&t=48778

Now, I admit that I do not post every single one I think is relevant or important, just the most relevant and important ones. For arguments sake, lets double my 49 to 98, though my guess is, it is not double but more like an additional 10-15 studies. Using the 98, 98/12000 is .8%.

This number is actually more inline with my thoughts/comments on the issue, especially in regard to the way research is done today, that about 1% of the stuff published is of any true value. As I have said in the forum, you can go away for 6 months to a year (or more) and not pay attention to any of the "breaking" health news and not miss a thing. In fact, of the 49 studies I posted, not one, was breaking health news. Not one. Not one required a major change in thinking or how you eat. They just added to the body of evidence on many of the topics I am already discussing here.

The only possible exception is 2 areas that have been developing over the last few years. The first is the negative effect of excessive exercise and that the "runners heart" that was once thought to be benign, may actually be harmful. We don't know for sure yet but to me it seems like the evidence is building in that direction. The second, is the impact of Intermittent Fasting. While this has been practiced by certain health philosophies and certain religions for quite some time, it is now being formally studied for its health impact. Again, we don't know for sure yet and there seems to be some advantage in the preliminary studies but there is so much more to learn about it. What will be important is whether or not any long term benefit equals or exceeds the benefit already conferred by this WOE, how healthy a diet must be adhered to on the non fasting days, etc etc.

On a final note, to put this in even better perspective, lets say there was one new study each day that was worth discussing and was featured in a blog, articles, video, etc. That would be 365 studies. 365/24K is 1.5%. That is it. 1.5% and I think we can all agree that there just is not even 1 new study a day worth discussing.

So, not only to I disagree, I don't recommend that perspective at all.

And on the subject research, Dr G mentioned that he was in fact enrolled to a joint MD/PhD program but then decided to switch to a straight MD program. In your opinion, how important is formal training in conducting/interpreting studies?

As you know from my discussion on nutrition education, I think formal training, education and proper licensing and credentialing are all very important. While some things can be learned on ones own by some, formal training has many advantages.

While I do not have a PhD, I did choose to go the thesis route for my MS which means I got training in research. I also made a point of taking classes in statistics and epidemiology. During my nutrition education, I also started a Journal Club and had the top nutrition researcher at my school mentor us so we could learn from him about studies, how to read them, interpret them, etc.

Do you think that a joint MD/ PhD physician scientist degree would have offered Dr Greger an advantage, and therefore improved the quality of his videos and articles?

I don't know.

When AJ asked if he missed working with patients he said yes, but that he doesn’t “have the luxury to do that anymore when our society is so sick." Right before that he said that when he was seeing patients perhaps he could reach dozens of people a day, when he was speaking he could reach thousands, but now he can use the same research, skills and background to spread this lifesaving info to as many people as possible.

I assumed he was referring to the work he does with Nutrition Facts (reading studies, making videos) since, after all, people are not “so sick” with bird flu, mad cow and other infectious d diseases related to his work at the humane society, but with obesity, heart disease, diabetes etc…

So basically it came across like he thinks he can help more people making three five-minute videos a week than seeing a handful of patients a day. Do you agree with that? Do you think the world would be better off if suddenly you, Dr McD, Craig McD, Dr Ess, Dr Davis, Dr Ostfeld etc suddenly decided to stop seeing patients b/c, technically, you all could “reach” more people sitting at home making with You Tube videos? Of course this would require the “luxury” of being able to do that, which Dr Greger seems to have. (It must take A LOT of time to read through and carefully evaluate thousands of studies.)

I touch on this issue here...

https://www.drmcdougall.com/forums/view ... 22&t=47205

As I have discussed in this forum, I think we need two things for this movement to grow, a health supporting environment and more experts in the trenches seeing patients and working with them on a day-to-day basis.

From my perspective, there is more than enough information, and has been for quite some time, to make a strong case for this WOE (and for those interested, a move towards an animal free diet). I don't think we need more of that nor will more make the case much better. We already have "proof of concept" beyond the shadow of a doubt. If you do this and if you stick to it, it works and works very well in virtually all cases. What we need more of, is not more studies showing why this is great or effective (unless it is expanding its effectiveness to new areas), but more work in how to create sustainable behavior change.

Therefore, I take my hat off to the likes of Dr Craig McDougall, Dr Ostfeld, Dr Lederman, Dr Seale, etc and the others like them who are working every day to implement these programs in their every day practice. There are dozens of other doctors just like them who have no interest in fame, fortune, bestselling books, tv shows, etc and that is why you don’t know their names. However, they are working every day in the trenches and changing lives. There are a 1/2 dozen doctors who work with Pritikin who are in their 80's and work p/t seeing patients every week and have been doing it for decades and personally impacted the lives of 10's of 1000's of people. I bet no one, outside of the work they do, know their names.

On the other hand, remember the thread I linked above, The Information Myth: Is More (Always) Better

There is a point where we have too much information coming out at us and instead of it being a help, it is a hinderance. In fact, one of the problems I see today is just this, people are so confused and mostly because there is too much information, too much good and too much bad, but to most people it is just too much information.

I see it in the patients who come to the 10-Day. The issue is not only they have too much bad information, they also have too much (what may be called) "good" information. They heard, "only eat red cabbage and not white," or "this bean is better than that bean," or "this fruit is the best fruit", or "this nut vs that nut," or, "only cook vegetables this way, etc etc" and it only confuses them and gets in their way and makes the process of triage, which is the one of the keys to success, harder, not easier.

http://www.jeffnovick.com/RD/Articles/E ... _Ugly.html

http://www.drmcdougall.com/forums/viewtopic.php?t=7875

In a way, it is just another form of distracted health...

https://www.drmcdougall.com/forums/view ... 1&#p457049

Remember, 5 Basic Simple Healthy Lifestyle Behaviors will eliminate 80-90% of CVD, Diabetes, Stroke, 40-70% of cancer and 65%-75% of the premature death from chronic disease. Nothing else comes even close. Yet, less than 5% of Americans follow these 5 Lifestyle Habits and around 1% (at most) follow the dietary ones (which are very basic).

Have you ever met, worked with, or heard of anyone who credits Nutrition Facts with profoundly changing their lives for the better, similar to Star McDougaller stories or FOK success stories?

From my observations and interactions, not in the same way we do. To me, it seems like the message is more to get people to be a vegan, than to help them address their personal health issues, as specific guidance for that is not given or put in perspective, nor can it be. So, I have met people who have become vegan because of it, but, for the details on the how to apply it to their health and personal situation, they have then had to go to Dr McDougall, Dr Esselstyn, Dr Barnard, etc. Now, we have all made video's as support for the work we do, but the work we do with patients/clients comes first.

I find it ironic that he switched from the MD/PhD program to the straight MD program b/c he realized that the world needed conversion of the research for clinical practice, yet he himself isn’t even doing that anymore. I can't help but think that if Dr G was seeing patients he could make a HUGE difference in the lives of a small - yet significant - number of people. As you often point out, implementing a WFPB diet can be so difficult for many. This type of one on one, doctor/patient interaction is not something that can be replaced with short You Tube clips. On top of that if he was seeing patients he could introduce the whole concept of a WFPB diet from the beginning and explain the benefits, which are still unknown to too many people.I could be wrong but I get the feeling that most loyal NF viewers are already converted and have already reaped the benefits, to a certain degree anyway.

I agree and it is the route I chose.

At one of the ASW weekends, one of the questions asked of H. Gilbert Welch, MD, after his talk, was, "What if we just got everyone to eat this way?" He responded saying that is not what it will take to make the change, nor where a doctor earned his real stripes (and I am paraphrasing). He said, what it will take and what makes a doctor a great doctor is not when they have recommended to a patient to make the needed lifestyle changes or seen a patient who wants to do this.

What really matters is when, in 3 months, when the patient comes back struggling with all the challenges facing them in implementing the changes, and the doctor then takes the time to really listen to them and to work with them on an individual ongoing basis over time, so they can make and implement the needed changes. That is what makes the difference.

Also, he mentioned that in his new book he discusses the benefits of turmeric. Do you know of any benefits to adding a little turmeric for people already eating plant-based? Is this one of those instances of unique positioning/market differentiation?

I discuss this issue here, which I think is a very important one, and that is the relevance and application of studies on the general population to those on a low fat, WFPB, low/no SOS diet.

https://www.drmcdougall.com/forums/view ... 22&t=43681

Finally I wish there would have been some discussion regarding the enormous benefits AJ has experienced by eliminating all nuts, limiting seeds, eating a lot of white potatoes, and essentially adhering to guidelines that he once called "ego-based," "outdated" and "not the best science-based advice." It’s too bad that she didn’t call him out on that!

In Health
Jeff

[Adrienne]

Thank you for your lengthy reply. I am sure everyone reading appreciates all the time and effort you put into it.

Question: Who is Dr Seale? Are they from Pritikin? I have never heard you mention them before.

[JeffN]

Question: Who is Dr Seale? I have never heard you mention them before.

Dr Seale is Dr Stewart Seale who is a family medicine doctor and was the Chief Medical Officer for Lifestyle Center of America. This was a live-in center that focused mostly on diabetes though it is closed now.

http://www.lifestylemedicine.org/LMMB0511

I met him a few years ago in Arizona where he was in private practice. I think he has recently retried.


In Health
Jeff

http://www.lifestylemedicine.org/LMMB0511

[Adrienne]

I have some more comments to make about Dr Greger and Nutrition Facts.

Last week Dr G did a video entitled, “Fatty Meals May Impair Artery Function.” The caption next to it reads, “We finally discovered why a single high-fat meal can cause angina chest pain.”

Finally? As in we just discovered this now? For years both you and Dr McD have been talking about the effects that just one fatty meal can have on the arteries. And Dr Ess wrote about this in his 2005 book, citing research by Dr Vogel, which Dr Greger also cited. PCRM also put out several articles on this subject, as did Pritikin and Engine 2.

This subject has been discussed at length outside the plant-based world as well. I remember when James Gandolphini (aka Tony Soprano) died a couple of years ago it was all over the news that he had consumed a fatty meal right before succumbing to a fatal heart attack. This sparked a lot of discussion about how your last meal before your heart attack can truly be your last meal. In addition, a quick Google search reveals that the major news outlets reported on the hazardous effects of one high fat meal many years earlier.

There was nothing new mentioned in this video. In fact all the studies referenced relating to diet were published prior to 2007. So I really don’t get where “finally” came from. This was not the first time Dr G has tried to make it seem like what he is presenting is from recently published research. There are several videos where he says something like, “we didn’t know until now” and “now” refers to a study published several years earlier. An example is a video posted last week on dry eyes when he says, “it was never studied, until now” and refers to a 2012 study.

Then there is the issue of him using the word “we.” Dr G did not conduct these (or any) studies nor was he the first to talk about them. Yet he acts like he somehow discovered all of this and is presenting it all to his viewers for the first time, like a magician claiming to be full of exciting new tricks and then pulling a rabbit out of a hat.

Another issue is how often he appears to borrow ideas and references from you and Dr McD. A recent example is his video on olive oil and artery function where he said the following:

So why do some studies suggest people’s endothelial function improves on a Mediterranean diet, a diet rich in olive oil? Perhaps because it’s also rich in whole grains, fruits, vegetables, beans, and walnuts, as well. Dietary fruits and vegetables appear to provide some protection against the direct impairment of endothelial function produced by high-fat foods, including olive oil. So, improvements in health may be in spite of, rather than because of the oil. In terms of their effects on postprandial endothelial function, the beneficial components of the Mediterranean diet may primarily be the antioxidant-rich foods, the vegetables, fruits, and their derivatives such as balsamic vinegar. Just adding some vegetables to a fatty meal may partially restore arterial functioning and blood flow.
http://nutritionfacts.org/video/olive-o ... -function/

You wrote something similar for Pritikin in 2006:

“The beneficial components of the Mediterranean diet,” concluded Robert Vogel, MD, and colleagues at the University of Maryland School of Medicine, “appear to be antioxidant-rich foods, including vegetables, fruits, and their derivatives such as vinegar, and omega-3-rich fish…” These foods, he continued, “appear to provide some protection against the direct impairment in endothelial function produced by high-fat foods, including olive oil.”

The point here is that olive oil is not the magic bullet that made populations along the Mediterranean in the 1950s so healthy. “Olive oil was simply a bellweather, or marker, for other features of the Mediterranean diet, like plenty of fruits, vegetables, whole grains, and exercise, that were in fact healthful,” argues Jeff Novick.
https://www.pritikin.com/your-health/he ... e-oil.html

And in 2008

7) the Mediterranean diet was healthy not because of the olive oil, but in spite of the olive oil. If the olive oil added any benefit, it was because of some phytonutrients in the olive oil, and not any specific fat or fatty acid. These same phytonutrients are also abundant in plant foods.
viewtopic.php?f=22&t=6678&p=46329

Dr G did a video in January about Simple Seven, a topic you have been covering for years. And in the past 9 months he has done a few videos on Dr Kempner that pretty much cover everything that Dr McD has been saying about him for years. It’s no secret that Dr Kempner is one one Dr McD’s heroes. Dr McD is even mentioned several times in the book “Dr Kempner and the Rice Diet.” Would Dr Greger even know about Dr Kempner if it weren’t for the fact that Dr McD has talked and written about him so much over the years?

I don’t have an issue with Dr G borrowing from other people. I realize that there are only so many topics to cover and there is no ownership of these studies. What I have issue with is that there is an “acknowledgements” section for each video and not once are you or Dr McD acknowledged for discussing these same topics years earlier and referencing these same studies.

Sometimes the lack of originality is far more obvious. Take this video from this past February on insulin resistance where he said the following:

Here’s some blood sugar outside waiting patiently to come in. Insulin is the key that unlocks the door to let the glucose in the blood enter the muscle cell…So insulin is the key that unlocks the door into our muscle cells…What if there’s enough insulin, but the insulin doesn’t work. The key is there but something’s gummed up the lock. This is called insulin resistance. Our muscle cells become resistant to the effect of insulin. What’s gumming up the door locks on our muscle cells, preventing insulin from letting glucose in? Fat.
http://nutritionfacts.org/video/what-ca ... esistance/

This analogy is not new. Dr Barnard uses it all the time.

A few random examples, one from 2011:

Let me draw an analogy: I arrive home from work one day, and put my key in my front door lock. But I notice the key does not turn properly, and the door does not open. Peering inside the lock, I see that someone has jammed chewing gum into the lock. Now, if the insulin "key" cannot open up the cell to glucose, there is something interfering with it. It's not chewing gum, of course. The problem is fat. In the same way that chewing gum in a lock makes it hard to open your front door, fat particles inside muscle cells interfere with insulin's efforts to open the cell to glucose.
http://www.huffingtonpost.com/kathy-fre ... 12219.html

And 2012

Imagine how a key works with a lock. If the lock is jammed with gum, the key won't work. Diabetes occurs when fat—from cheeseburgers, hot dogs, and other junk foods—gums up cells. That fat stops insulin from moving sugar out of the blood and into muscle, fat, and liver cells—where it’s needed. It also increases the risk of heart disease, amputations, and blindness.
http://www.pcrm.org/nbBlog/archive/201212

And also throughout his 2007 book:
https://books.google.ca/books?id=C6KTAT ... ck&f=false

This analogy actually goes back to 1920 (Banting), although the "gum" part was added by Barnard (who seems to use the analogy without explaining where it originated from). So, if Dr G is not going to acknowledge Dr Barnard, at least give a nod to the Nobel prize winner who came up with the analogy all those years ago.

The real issue is not who said what first, but that he is acting as if he is the messiah bringing all this good news to us for the first time, yet not only is it not new news, much of it has been said long before by many others in these WFPB programs and in some cases, outside these programs by others too.

I have no issue with Dr G’s lack of desire/ability to come up with analogies of his own. But if he is going to copy others then at least admit that he is doing so. You and Dr McD always acknowledge those who came before you, who you worked with, and who influenced you.

Dr McD and Dr Barnard are both listed under “Health Topics.” Clicking on these link this leads to a selection of videos centered around the studies that they have conducted, and in the case of Dr McD, the attempt to get nutrition education mandatory for MDs in California. So basically Dr Greger mentions them when it’s impossible not to: when they are the focal points of the videos.

But when it’s possible to get away with it, too often it seems like he recites the work of others, attempts to pass it off as his own, and fails give credit when credit is due.

The sad part is that those who are unfamiliar with his trickery sit back and go “wow” and think he is like brilliant!

I realize that Dr G has hired a bunch of “researchers” to help him out so for all I know he is not even aware that this is occurring. But it is all put out under his name so in the end, he is accountable. It almost seems like Dr G and his Nutrition Facts team come here to this website and forum - as well as the sites of other WFPB docs - to find interesting topics, and then they produce a video and make it sound like "we" just discovered something fascinating.

Often Dr G does include references and commentary in his videos that appear to be all his own. Sometimes this adds to the discussion. Other times, however, his additions and interpretations lead to more confusion. His recent videos on coffee (mortality, prevention of liver cancer) are a good example of that. People watching them are likely to walk away thinking that a cup or 2 a day is harmless or perhaps beneficial (if they could tolerate the caffeine). But if the same people were to read yours or Dr McD's comments they would be more likely to re-think the idea, or at least realize that it offers no additional benefits for those already eating this way. Unlike Dr G, you and Dr McD treat patients and are well aware that coffee can raise BP and cause other problems.

Another example is the recent video entitled, “How Much Fruit Is Too Much” where he pretty much implies that people – including type 2 diabetics – can eat as much fruit as they want without experiencing any negative health consequences.

I know from reading Dr McD’s articles, your comments on this forum, as well as the comments from forum members that this is simply not true. Whether it is due to high TGs, high blood sugar, or excess weight there are some people who, even after adopting a plant-based diet, need limit their fruit intake.

You wrote about that here:

As I did say, in my experience in working with 1000's of these patients over the years, about 25% of them are very sensitive to fruit and processed carbs, even whole grain flour products and their "numbers" look better when they remove these foods or restrict them "until" the IR is reversed or mostly reversed. In these people, we see elevated TGs, insulin and blood sugars during this time and when we remove the fruit or other foods, these numbers go down.

Once they reverse their IR, most all are able to enjoy a more liberal intake of these foods that may have been limited, though occasionally some may still need to restrict fruit.
viewtopic.php?f=22&t=7752&p=264194&#p264820

And here, when asked about eating 67% calories from fruit:

The question is answered in this forum in several threads discussing the topic. Unfortunately, as I am traveling, I can't provide all the links. However, as quoted above, it isn't an issue for everyone (and apparently not you), but for those who are sensitive, limiting fruit, at least for some time, is recommended. This is based on the both the science & physiology of digestion, fruit, fructose & triglycerides and our decades of clinical experience in a residential setting. You will also find quite a few long term successful Mcdougallers who must continue to limit fruit or they find their triglycerides go up.

There is no single answer as it depends on the individual.
viewtopic.php?f=22&t=46789&p=482267

In the video, when Dr G said that the “intake of fruit should not be restricted in patients with type 2 diabetes,” he was reading off a study where those in the “high fruit” group went from eating roughly 2.5 servings of fruit a day to 4 servings. Given that an extra 1.5 servings a day is not exactly a giant leap, 4 servings of fruit is not exactly high, and there is no info on whether fruit replaced brownies or brown rice, perhaps a little caution is warranted.

In comments below the video someone asked about why Dr McD suggests limiting fruit for weight loss. I found the response, provided by Joseph Gonzales, RD - Nutrition Director for Nutrition Facts, a paid position - to be rather nonsensical:

Good question. The short answer is I am not sure? I know he has a forum, too I am sure other members may know more. Keep in mind Dr. McDougall counsels folks with specific illnesses and has established a specific program. Dr. Greger discusses the latest research that may apply more to the general population. Diet is very personalized. Some folks don't function well eating tons of fruit. Some folks do! If these studies hold true, more fruit (especially whole fruit) doesn't seem to be a problem. I think the U.S. has more of a problem under consuming fruit, so I am not worried about portion control. This study is a large randomized trial on 300 obese or diabetic participants. Half were asked to follow a strict low-fat plant-based diet with no portion control or changes (so no restrictions on fruit). A multicenter randomized controlled trial of a plant-based nutrition program to reduce body weight and cardiovascular risk in the corporate setting: the GEICO study. The results were very positive as many participants reduced their body weight and improved blood sugar control. So perhaps looking at the diet as a whole is more important than focusing on "how many servings of fruit per day is good"? From these studies in the video it is shocking how much was really consumed! For more on fruit If Fructose is Bad, What About Fruit? and a Ask the Doctor Q&A: How much fruit is safe to consume?. Hope that helps.

Huh? So the McDougall diet doesn’t apply to the general population? Dr McD has been recommending this “specific program” to the public for over 30 years! Included in his program guidelines are adjustments individuals may need to make depending on their weight (he says fruit is easy to overeat) and/or health situation. Little has changed in these guidelines throughout the decades despite all the published studies on the so-called benefits of consuming on nuts, low-glycemic foods, avocados for nutrient absorption, turmeric and other spices, among other stuff endorsed on NF. Yet the Star McDougaller stories keep coming! And despite their differences in health issues, these people seem to have gotten well eating the same basic (boring) things.

As for diet being “very personalized,” Dr G has been making dietary recommendations for years:

http://www.bostonveg.org/Optimum2009handout.pdf

http://nutritionfacts.org/2011/09/12/dr ... endations/

Then he goes to say that some people are ok with eating tons of fruit and some do not. So in the end he agrees with you and Dr McD.

A quick comment about that GEICO study he links to: There is no info on fruit intake. The full text does state, however, that the intervention group went from 50% calories from carbs to just 56%, and increased their fiber intake from about 19 g to 23 g. This is hardly a reason to advocate for unlimited fruit for diabetics. These “very positive” results are more likely due to the much more noteworthy drop in total calories, saturated fat and dietary cholesterol (as in animal food).

This all highlights the difference between being reading studies (or supposedly reading them) and working clinically with patients.

If Dr G had been treating patients over the years with a plant-based diet he would likely have a different perspective, and not just with regards to coffee and fruit: It’s likely he would not bother with – much less have time for – discussions about which beans are best for diabetics (rather he would simply encourage any bean), nutritional yeast to enhance immune function (switching/adhering to a plant-based diet would have a far greater impact), a few Brazil nuts a month, turmeric, hibiscus tea etc. All of this would likely have little relevance in the lives of his patients, as I assume it has no relevance to your patients or Dr McD’s, other than to cause confusion. Just to add about the hibiscus tea, he used to be very enthusiastic about it and admittedly drank it like it was water. But he recently changed his position because other studies pointed to the possibility of excess mineral exposure. So what about the people who saw all those earlier videos but didn’t tune into see the one about the possible harms? This is the problem with making all these dietary adjustments/recommendations based on a study here and a study there, and demonstrates the limitations of the information presented in terms of its applicability in the real world.

Sometimes his interpretations are flat-out wrong, like the nuts and weight gain. When Jeff nelson pointed this out to him, he made some corrections. But as Jeff stated, not nearly enough:
http://www.vegsource.com/news/2012/08/n ... ought.html

While Dr G felt the need to devote an entire video towards discussing an “elegant” study that tested the appetite-suppressing effects of walnuts, Jeff Nelson explained why this study was, in fact, total “BS.”
https://www.facebook.com/vegsource/post ... 5434097192

So Dr G’s conclusions on nuts subject are way off. But hey at least he scores points here for originality.

Jeff Nelson also did a great job outlining the flaws in Dr Greger’s “Arteries of Vegans vs. Runners” video:
http://www.vegsource.com/news/2013/12/d ... oners.html

One more time that Jeff Nelson, a movie maker, outsmarts and understands the data better than Dr Greger. I highly doubt Jeff Nelson reads thousands of studies every year. But by taking the time and effort to meticulously go through a select few, he was able to sort through all the confusion. Shows how sometimes quality matters more than quantity.

Then there are all of Dr G's inconsistencies, like criticizing very low-fat diets and promoting the benefits of nuts one day, and then the next day highlighting Ornish and Pritikin studies and using them as examples of the benefits of vegan/plant based diets. He typically fails to mention that the diets used in these studies were nut-free, very low-fat, not even vegan, and in the case of Pritikin, not even vegetarian.

If I only learned about plant-based diets from Dr Greger then I would be downright confused by now. I can’t say the same regarding you or Dr McDougall.

All of this is compounded by the fact that, unlike this forum, Nutrition Facts is reliant upon donations to keep it running. Obviously people are free to do what they want with their money, but there is only so much to go around. IMO all of this money would be far better spent on extending Dr McD’s MS study or even sending people to 10 day programs.

Finally, I saw this in the comments section of a July video and thought it was worth posting:

I regularly eat a plant-based diet as does my wife however she loves to make fun of my breakfast smoothie. I am accused of adding a new ingredient whenever I hear of a beneficial plant based additive which is true. As a result, my breakfast smoothies includes Amla, Gogi berries, blueberries, flaxseed, turmeric, cinnamon, black pepper, kale, strawberries and walnuts. It is kind of funny but my question is am I defeating the purpose by dumping all these ingredients into the same mea?. By the way, it isn't delicious but I like it.
•

Great Job! I do the same. I also add rosemary, sage, ginger, fenugreek, rose hips, ashwaghanda, hibiscus, psyillium, and inulin to mine. I'll also add a few dates to make it sweeter.
•

Thanks Tom. You are inspiring.

I could go on and on about what is wrong with that exchange, but those reading this likely understand what I am talking about. I will just say that in all my years on the forum I have never seen this type of discourse here. I’m not sure if that is due to the information disseminated by you and Dr McD, the higher intelligence level of the people who read/post on this forum, or perhaps a combination of the two.

I’m not saying Nutrition Facts has no value or nothing to offer. At times Dr G does post interesting studies that I have not seen before or makes videos on a subjects that I haven’t heard too much about, if at all (MRSA, neurocysticercosis, egg industry making false claims in their ads, for example). Additionally, as you said you have met some people who have become “vegan” thanks to Nutrition Facts, and I don’t mean to minimize any benefits that these individuals are experiencing as a result of their dietary changes.

But overall though, IMO what Dr G accomplishes most with Nutrition Facts is making people appreciate what is offered here – a huge amount of high-quality, accurate, relevant information presented in a straightforward, non-illusory, non-gimmicky way – that much more.

[Adrienne]

I saw the Reddit interview that was posted in the Lounge recently and wanted to add to this discussion b/c of his response to one of the questions:

https://www.reddit.com/r/IAmA/comments/ ... nd_fellow/

Dear Dr. Greger, In 2013 and 2014, some studies were published that are not so positive on vitamin D supplementation. The studies I'm talking about are also cited in this piece by Dr. McDougall (who himself is also not in favor of supplementing vitamin D).

If I am not mistaken, the videos on nutrionfacts.org dating from 3 to 4 years ago are quite positive on vitamin D supplementation. Do you think these most recent studies will require a re-evaluation on whether or not to supplement vit. D?

[–]MichaelGregerMD[S] 42 points 10 days ago

Great question! My current recommendations can be found here, but indeed I haven't reviewed the D literature for years. What I do (if you pay really close attention you can catch it) is cycle through the alphabet, so you'll notice on NutritionFacts.org berry videos follow bean videos follow avocado videos, etc. Well I'm finally on V! An unprecedented 14,000 papers were published on nutrition in the medical literature last year and so I'm still catching up. But I just finished a slew of vinegar videos, and next up? Vitamin D! So I should have an answer soon, and indeed my recommendations may change if the science has indeed changed. Sorry I'm so far behind!

So basically even with all of his paid staff and volunteers he is years behind an important topic and admits it!

Surely he gets asked about Vitamin D all the time. He even lists recommendations for Vitamin D on the NF website and it’s likely that people follow these recommendations. You would that think for these reasons – along with curiosity – he would make it a priority to keep up with the latest studies on this subject. Over the past few years you have posted at least half a dozen studies about how low Vitamin D may be a result of illness not a cause, how the tests are unreliable, how the normal ranges are set too high, how more may not be better, how the amount of Vitamin D actually in the supplements is not always what is stated on the package etc.

viewtopic.php?f=22&t=20770&start=60

Some were published in major journals like JAMA and Lancet. And Dr McD wrote his fourth newsletter on Vitamin D this past March and mentioned some of these new studies.

https://www.drmcdougall.com/misc/2015nl ... tamind.htm

How is making videos about vinegar (or even more videos about diet and gut health and WFPB diets for diabetes) more important than reading the latest research on Vitamin D and updating his recommendations?

I don’t have his book but I see via the Amazon preview that he discusses Vitamin D on four pages. I guess this means that his just-published book is already outdated.

I also saw that he devoted roughly a page to a section called, “Brazil Nuts For Cholesterol Control?” He failed to mention that this one study he talked about has zero relevance to people who are following the type of diet he recommends.

And on the subject of the book, I found these comments from someone who “enjoyed” the book rather interesting (emphasis mine):

viewtopic.php?f=1&t=50489&start=60

I think that 2nd part of the book should have focused more on the long lived Okinawans, the Seventh Day Adventists and other long lived populations and then moved on over to Pritikin, McDougall, Ornish and Esselstyn. In other words, "These are the folks who have shown us how to do this." Instead, we got into the weeds of which type of cabbage to buy.

And I do not think that Nathan Pritikin worried too much about whether his clients were eating white potatoes or sweet potatoes, green cabbage or red cabbage, white onions or red onions. Dr Greger might have a point here. But it seems trivial considering that most Americans aren't eating any cabbage at all.

While I am add it, here are a few more things that I noticed recently:

He made a video entitled, “Kiwifruit For The Common Cold.”
http://nutritionfacts.org/video/kiwifru ... mmon-cold/

In the comments section several viewers were critical of the quality of the studies he used. The response to these criticisms by paid staff member, Joseph Gonzales, RD, included the following statements:

If you think other studies are more equipped to cover this topic please just post them so we can all learn.

This is only what we've found and what we're sharing.

What I take from this study and others in the video is that kiwifruit may help prevent the common cold, but of course this doesn't mean other fruits are less beneficial. That's why Dr Greger has videos on citrus, beets, peppermint, nutritional yeast, and so many other foods to help us put this video and this individual study into perspective.

A few thoughts came to mind when I read this:

1) If they don’t have good quality studies on a topic, then why even bother doing a video about it at all?
2) Actually, the study he was referring to was not put into perspective. And while Dr G does have videos on the foods listed above rarely are the studies in those videos put into perspective either. It’s more like a smoregesboard of this food for this and that food for that etc.

That is one of the problems with Nutrition Facts!

Another recent video I wanted to comment on is entitled, “Transcript: Preserving Athlete Immunity with Chlorella.”
http://nutritionfacts.org/video/preserv ... lorella-2/

In the “Doctor’s Note” section underneath the video, he said the following:

There is, however, a caveat to the use of chlorella. See my last chlorella video Treating Hepatitis C with Chlorella to make up your own mind if the benefits outweigh the risks.

You wrote about the risks with chlorella years ago on the forum. Since the benefits are questionable at best (the three studies he cited for justification were industry-funded) and there is a real risk for harm involved then I am sure you would agree that the prudent decision would be not to use it.

So why bother making this video at all? And why is this topic, along with “Kiwi for the common cold,” more important than keeping up to date with Vitamin D?

Despite all of his shortcomings, it seems the praise for Dr G and Nutrition Facts keeps coming.

I am sure you saw the responses to the comments by Mark Simon regarding this thread:
viewtopic.php?f=1&t=49487

Several members thought it was counterproductive and a waste of time to criticize Dr Greger and that we should support all the docs in our camp and direct our criticism towards the low-carb docs.

Since when does promoting a WFPB diet make a doctor immune to valid criticism? Dr. Campbell and Dr. Esselstyn didn’t feel that way when they publicly criticized Dr. Fuhrman. And you and Dr McD have been criticized several times over the years right here on this forum!

Of all the comments, this one stood out the most:

I honestly can't imagine intelligent people [in the plant-based community, anyway] being unable or unwilling to see the value in Dr. Greger's gathering of research, hints and videos.

The way I see it, if “intelligent people” don’t find value in his work it is simply because they are paying close attention and are able to (correctly) interpret it for what it is!

Several members pointed out that Dr Greger has the support of Dr. McD and other WFPB docs. This is true. However, I strongly suspect that many/most of these doctors simply to not have the time to pay close attention to what Nutrition Facts is all about and therefore are not fully aware of what they are endorsing.

While I would never say Dr G's work has no value, there is a lot of room for improvement, to put it mildly.

Furthermore, I caught this from Dr G's latest blog post:
http://nutritionfacts.org/2015/12/17/ho ... ller-list/

My goal is to not let a single nutrition study fall through the cracks. There are 30 to 40 papers published on straight nutrition alone every day, in addition to 100 daily studies on cancer, about 20 on heart disease, 20 on obesity, and 20 on diabetes, etc. Even I can’t read 200 papers a day. Twenty people, though, can read 200 papers a day. We can’t afford 20 people, but total coverage is my ultimate goal; otherwise we fall hopelessly behind

It is becoming increasingly clear to me that it does not matter how many thousands of studies he reads a year. What is so much more important is the quality of studies, if they are interpreted correctly, if they are put into proper context/relevance etc. This is where you and Dr McD distinguish yourselves from Dr Greger. And you and Dr McD keep up to date with important topics which Dr G admitted he does not do despite all his donations and staff.

More from the blog post:

The more people that access the site, the more lives we save, but the higher the server and email costs.

Again, who are these people? I am not saying there are none, but how many are there really? Videos about nutritional yeast, chlorella etc don’t save people’s lives.

You know what does? Dr McD’s free program.
https://www.drmcdougall.com/health/educ ... l-program/

It has not changed in all the years since I have been on this forum. It’s the same regardless if Dr McD reads one study a year or one thousand. No donations required. The China Study has saved many lives. Same with Dr Ess’s book. Both are 10 years old but still relevant, despite all the new studies out there. Same with Forks over Knives, now five years old.

Dr G had the opportunity in his book to explain to people the most basic way they can stay on the program long term – and therefore save their own lives – but, as mentioned above, he missed it by diverting attention away to details that have minimal relevance.

Finally, I thought this comment from Jeff Nelson was worth noting.

Based on my 26 years in the plant based world, McDougall got it right; the rest have something to sell. These guys who are all about "more is better" really have very little to back them up beyond speculation on very limited and dubious research.
https://www.youtube.com/watch?v=VhLd0URhyho

[JeffN]

I thought you would enjoy this recent thread, which covers some of the above issues and a few other related ones.

viewtopic.php?f=22&t=56124

In Health
Jeff

[JeffN]

Now, I admit that I do not post every single one I think is relevant or important, just the most relevant and important ones. For arguments sake, lets double my 49 to 98, though my guess is, it is not double but more like an additional 10-15 studies. Using the 98, 98/12000 is .8%.

This number is actually more inline with my thoughts/comments on the issue, especially in regard to the way research is done today, that about 1% of the stuff published is of any true value.

My numbers were an estimate based on “all” available data. The following is based on the “articles most likely to be consumed (viewed).”

This has all been well covered in several other threads and articles.

In Health
Jeff

https://www.metacausal.com/CLAIMS/

STUDY

The CLAIMS (Causal language and strength of inference in academic and media articles shared in social media) study is a systematic review of the state of causal inference in health research as it reaches the consumer through social media. This site serves both as a public explainer of the study and a public access repository of the full protocol, review tool, dataset generated during the review process, analysis code, reviewer profiles, and results from the CLAIMS study. In addition, we will be discussing this study and related topics in the main blog section.

The full, published version of this study is in PLOS ONE, and can be found here.
Citation: Haber N, Smith ER, Moscoe E, Andrews K, Audy R, Bell W, et al. (2018) Causal language and strength of inference in academic and media articles shared in social media (CLAIMS): A systematic review. PLoS ONE 13(5): e0196346. https://doi.org/10.1371/journal.pone.0196346

What did we find..

Among the scientific articles most likely to be consumed in 2015, only 6% of the scientific articles were rated as having strong enough causal inference that it should be utilized in practice. In other words, very few studies show that a change in X would actually cause the change in Y at the level reported, just that they were related in some way. When looking at how the academic authors talked about their own results, we found that 20% of them strongly implied causal results, and that 34% of them used language that was too strong given our reviewers’ assessment of strength.

When looking at the media articles, we found that 44% of the media articles used causal language that was stronger than the academic articles, remembering that many of those studies were overstated to start with. Furthermore, 58% of the media articles contained at least one substantial inaccuracy about the study.

[JeffN]

Last week, I posted a review of the studies I have covered in this forum in the first 6 months of 2015, which totaled 49.

viewtopic.php?f=22&t=48778

Now, I admit that I do not post every single one I think is relevant or important, just the most relevant and important ones. For arguments sake, lets double my 49 to 98, though my guess is, it is not double but more like an additional 10-15 studies. Using the 98, 98/12000 is .8%.

This number is actually more inline with my thoughts/comments on the issue, especially in regard to the way research is done today, that about 1% of the stuff published is of any true value. As I have said in the forum, you can go away for 6 months to a year (or more) and not pay attention to any of the "breaking" health news and not miss a thing. In fact, of the 49 studies I posted, not one, was breaking health news. Not one. Not one required a major change in thinking or how you eat. They just added to the body of evidence on many of the topics I am already discussing here.

The only possible exception is 2 areas that have been developing over the last few years. The first is the negative effect of excessive exercise and that the "runners heart" that was once thought to be benign, may actually be harmful. We don't know for sure yet but to me it seems like the evidence is building in that direction. The second, is the impact of Intermittent Fasting. While this has been practiced by certain health philosophies and certain religions for quite some time, it is now being formally studied for its health impact. Again, we don't know for sure yet and there seems to be some advantage in the preliminary studies but there is so much more to learn about it. What will be important is whether or not any long term benefit equals or exceeds the benefit already conferred by this WOE, how healthy a diet must be adhered to on the non fasting days, etc etc.

Another four years have gone by since the above post.

What has changed in the world of nutritional science and dietary intervention?

Nothing!

And what about the two items I mentioned above.

1) Excessive exercise. Research is about the same on this right now. Not much has come out but what has become more clear (which is like the flip side of excessive exercise) is how powerful even a minimal amount of exercise is. The most important message in regard to exercise is that the biggest impact on our health (personal and public) is moving from sedentary to about 30 minutes of moderate exercise. Moving up to an hour may confer some additional benefit but it will be small in comparison to what they first 30 minutes provided.

2) Intermittent fasting. Nothing has changed other then they media (and sadly some health care professional) hype. It has not proven out more effect in any area than regular consistent healthy eating. However, it has been shown to have some adverse health effects and higher drop out rates. So the main message remains, eat when hungry until comfortably full of the recommended foods. What we eat remains the most powerful aspect of dietary intervention, not when.

I am willing to wager that there will be no major breakthrough in 2020 either

In Health
Jeff

[geo]

I am willing to wager that there will be no major breakthrough in 2020 either

I'm willing to wager there will be no better nutritional advise given in our lifetimes, than what is currently given here today...afterall, nothing has really changed in the last 45 years as far as I can see.

[JeffN]

I am willing to wager that there will be no major breakthrough in 2020 either

I'm willing to wager there will be no better nutritional advise given in our lifetimes, than what is currently given here today...afterall, nothing has really changed in the last 45 years as far as I can see.

Agreed.

In Health
Jeff

[DanTheYogi]

Last week, I posted a review of the studies I have covered in this forum in the first 6 months of 2015, which totaled 49.

https://www.drmcdougall.com/forums/view ... 22&t=48778

Now, I admit that I do not post every single one I think is relevant or important, just the most relevant and important ones. For arguments sake, lets double my 49 to 98, though my guess is, it is not double but more like an additional 10-15 studies. Using the 98, 98/12000 is .8%.

This number is actually more inline with my thoughts/comments on the issue, especially in regard to the way research is done today, that about 1% of the stuff published is of any true value. As I have said in the forum, you can go away for 6 months to a year (or more) and not pay attention to any of the "breaking" health news and not miss a thing. In fact, of the 49 studies I posted, not one, was breaking health news. Not one. Not one required a major change in thinking or how you eat. They just added to the body of evidence on many of the topics I am already discussing here.

The only possible exception is 2 areas that have been developing over the last few years. The first is the negative effect of excessive exercise and that the "runners heart" that was once thought to be benign, may actually be harmful. We don't know for sure yet but to me it seems like the evidence is building in that direction. The second, is the impact of Intermittent Fasting. While this has been practiced by certain health philosophies and certain religions for quite some time, it is now being formally studied for its health impact. Again, we don't know for sure yet and there seems to be some advantage in the preliminary studies but there is so much more to learn about it. What will be important is whether or not any long term benefit equals or exceeds the benefit already conferred by this WOE, how healthy a diet must be adhered to on the non fasting days, etc etc.

Another four years have gone by since the above post.

What has changed in the world of nutritional science and dietary intervention?

Nothing!

And what about the two items I mentioned above.

1) Excessive exercise. Research is about the same on this right now. Not much has come out but what has become more clear (which is like the flip side of excessive exercise) is how powerful even a minimal amount of exercise is. The most important message in regard to exercise is that the biggest impact on our health (personal and public) is moving from sedentary to about 30 minutes of moderate exercise. Moving up to an hour may confer some additional benefit but it will be small in comparison to what they first 30 minutes provided.

2) Intermittent fasting. Nothing has changed other then they media (and sadly some health care professional) hype. It has not proven out more effect in any area than regular consistent healthy eating. However, it has been shown to have some adverse health effects and higher drop out rates. So the main message remains, eat when hungry until comfortably full of the recommended foods. What we eat remains the most powerful aspect of dietary intervention, not when.

I am willing to wager that there will be no major breakthrough in 2020 either

In Health
Jeff

It's been another 4 years since this post Jeff! Has anything changed in the world of nutritional science and dietary intervention since then?

[JeffN]

Not that I know of.

However, I would said IF has lots a lot of its wind as it turns out most of the benefit is that it is a form of calorie restriction and that is where the benefit comes from.

How about you??

Jeff