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Michael Greger MD

Michael Greger MD

Posted November 12, 2011

Published in Health

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Ask the Doctor: Q&A with Michael Greger, M.D. (Week 8)

Read More: blood type, calcium, celiac, cinnamon, dairy, diet, drugs, durian, fruits, kidney stone, meat, Methotrexate, orange juice, oxalates, rheumatoid arthritis, salt, sugar, vegetables, water

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This is another sampling of the more than 600 comments and questions I’ve responded to on the site (so far!). Please feel free to leave any follow-up questions here or on any of the hundreds of videos on the more than a thousand topics covered on NutritionFacts.org. And remember, there’s a new video posted every weekday, so to make sure you don’t miss any:

Veguyan asked on Dietary guidelines: pushback from the sugar, salt, and meat industriesSome people I know tell me that because they are not a Blood Type A, they need to eat meat or dairy or whatever; and I know people who claim that they were vegan for blah blah years and they almost died, and felt so much better after they started eating the meat or dairy or whatever again. I don’t know what to say to them.

I was just actually interviewed about D’Adamo’s Blood Type Diet astrology in the Chicago Tribune. Probably best summed up by a quote from a review published in the Journal of the Norwegian Medical Association: “The theories of D’Adamo must be viewed as lacking a scientific basis and should not be taken seriously….[H]ad D’Adamo been practicing in Norway, his practice would have been a violation of the so-called quack law….[I]t is difficult not to see the whole thing as a crass fraud.”

Nouh Alaoui said on Dietary Guidelines: progressing from pyramid to plateOhh my God, I didn’t see the small bottles of drugs!  Very funny.

If anybody missed the Pyramid to Plate video, you've got to see it. I caught the weirdest thing in a USDA infomercial.

vetstud asked on Oxalates in cinnamon: I just had a kidney stone and really don’t want to have another one. I looked online and there are conflicting things about what I should eat to prevent a recurrence. What is the best diet?

I'm going to assume you have what's called idiopathic calcium nephrolithiasis (but if you can actually catch a stone and have it analyzed, your physician can make more specific recommendations). ICN, the formation of calcium oxalate stones (sometimes mixed with calcium phosphate), accounts for about 80% of cases (though you should see your physician to rule out a variety of hereditary and acquired diseases that can cause those in the 20%).

The most important thing folks with ICN can do is drink lots of water, at least 2 liters a day, to dilute the concentration of calcium, oxalate, and uric acid in your urine to decrease the likelihood of stone formation and flush away seeding crystals. Water's probably the best, but if you are going to drink other liquids, OJ is preferable to grapefruit juice, apple juice, and tea.

In terms of food, according to the latest review on the subject, the most important thing is to reduce meat consumption (vegetarians may  have only half the kidney stone risk). The reasons given why animal proteins are bad is because of hypercalciuria, hyperoxaluria, hyperuricosuria, hypocitraturia, and the acidification of the urine. You should also cut down on salt, and the more fruits and vegetables the better--they tend to have a high water, potassium, and magnesium content; a low sodium chloride content; and a high urine alkalinization power because of the presence of bicarbonate and citrate. I would warn against megadosing with vitamin C (as you'll see across the internet) as this may exacerbate stone formation.

Lucyna Jacobs asked on Diet and Rheumatoid ArthritisWhy there is no research about drugs vs diet among the arthretic children. Is it because they are the best silent golden goose in the history of the disease? Methotrexate facilitators pronounce to us a life sentence of pain and deformation and say that diet has no meaning in curing this ailment. What segment of society is more vulnerable to such a threat if not that of little girls and their frightened mothers?... Is being an immigrant even better an oportunity to the health care providers to say that we have no other choice but DNA altering drug?

Thank you for sharing your story, Lucyna. Methotrexate is indeed a pretty harsh drug, but as you know better than most, juvenile arthritis can be a pretty harsh disease. Though typically reserved as a second-line treatment for those who don’t respond to less toxic drugs, methotrexate may be prescribed right up front if there is serious multiple joint involvement. In both these cases the benefits are expected to outweigh the risks. The nice thing about healthy dietary interventions is that there are no risks–just benefits–and perhaps particularly in juvenile rheumatoid arthritis patients, who tend to suffer from inadequate nutrition. So it’s not either/or. Hopefully you can find a physician who respects your family enough to talk to you about improving your daughter’s diet in addition to other medical interventions they have in mind. Two of the first things I would suggest is cutting out dairy (as there is a report in the medical literature of complete remission of the disease “after the elimination of all cow’s milk protein from her diet.”) and gluten-free trial, since (rarely) celiac disease can manifest with strictly joint symptoms.

Kevin McCaffrey commented on the NutritionFacts.org facebook pageDr. Greger, have you ever eaten a durian fruit? They are so fascinating, though I've never seen a real one.

Durians have to be the most badass of fruits. Imagine a 5 pound football covered in sharp spikes like some medieval mace. What other fruit can be described in the literature as causing "severe bodily injury" in articles with titles like Penetrating Ocular Injury by Durian Fruit? And we haven't even gotten to the distinctive quality, the smell! With an odor perhaps best described as "pig-shit, turpentine and onions, garnished with a gym sock," durian fruits are banned from many public spaces such as subways and airports in Southeast Asia where it is grown. I just had to get me some. 

My big break came when I moved to Boston to attend medschool at Tufts, right smack in Chinatown. They were sold frozen. (I would soon realize why.) I hacked off a piece; it tasted like a caramelized onion popsicle. I left the rest in my locker—mistake!

I arrived the next day at school to find an entire floor of the medical center (including the dean's office) cordoned off. They were going locker to locker, cutting off all the locks, searching in vain for the cause of a stench so overpowering you couldn't even locate it. It was like a fog of stink.  They seriously thought someone was stealing body parts from gross anatomy lab. And then it struck me. Uh oh. The durian had thawed. When I realized it was all my fault, I crawled to the dean and I'll never forget what he said: "Why am I not surprised you had something to do with this."

More on my medical school trials and tribulations in my book Heart Failure: Diary of a Third Year Medical Student.

-Michael Greger, M.D.


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