Home » Dr. Michael Greger on Food as Medicine: Preventing and Treating The Most Common Diseases with Diet (Transcript)

Dr. Michael Greger on Food as Medicine: Preventing and Treating The Most Common Diseases with Diet (Transcript)

Dr. Michael Greger

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Good evening. For those of you unfamiliar with my work, every year I read through every issue of every English-language nutrition journal in the world so you don’t have to. Every year, my talks are brand new, because every year the science is brand new.

I then compile all the most interesting, the most groundbreaking, the most practical findings to new videos and articles I upload every day, to my nonprofit site, NutritionFacts.org.

Everything on the website is free. There’s no ads, no corporate sponsorships; it’s strictly noncommercial, not selling anything. I just put it up as a public service, as a labor of love. New videos and articles every day, on the latest in evidence-based nutrition.

In my 2012 review, I explored the role diet may play in preventing, treating, and reversing our deadliest diseases. In 2013, I covered our most common conditions. And, in 2014, I went through our leading causes of disability. This year, I’d like to address some of our most dreaded diseases, and cancer tops the list in the latest Gallup Poll.

The number one cancer killer in the United States, of both men and women, is lung cancer. But, if you look at the rates of lung cancer around the world, they vary by a factor of ten. If there’s nothing we could do to prevent lung cancer, you’d assume the rates would be about the same everywhere, just having kind of randomly. But since there’s a huge variation in rates, you assume there’s some contributing cause. And indeed, we now know smoking is responsible for 90% of lung cancer cases. So, if you don’t want to die of the #1 cancer killer, by just not smoking, you can take 90% of your risk and throw it out the window.

Colorectal cancer is our second leading cause of cancer death, and for that there’s an even bigger spread around the world. So, it appears colon cancer doesn’t just happen; something makes it happen. Well, if our lungs can get filled with carcinogens from smoke, maybe our colons are getting filled with carcinogens from food. Why do African Americans get more colon cancer than native Africans? Why that population? Because colon cancer is extremely rare in native African populations; like more than 50 times lower rates than Americans, white or black.

We used to think it was all the fiber that they were eating, however, the modern African diet is highly processed, low in fiber, and yet there has been no dramatic increase in colon cancer rates. And we’re not just talking low fiber intake, we’re talking United States of America-low fiber intake, down around half the recommended daily allowance. Yet, colon disease remains rare in Africa, still 50 times less colon cancer.

Maybe it’s because they’re thinner and exercise more? No, they’re not, and no, they don’t. If anything, their physical activity levels may actually be lower than ours. So, if they’re sedentary like us, eating mostly refined carbs, few whole plant foods, little fiber, like us, why do they have 50 times less colon cancer? Well, there is one big difference. The diet of both African Americans and Caucasian Americans is rich in meat, whereas the native Africans’ diet is so low in meat and saturated fat, they have cholesterol levels averaging 139, compared to over 200 in the U.S.

So yes, they don’t eat a lot of fiber anymore, but they continue to minimize meat and animal fat intake, supporting evidence that perhaps the most powerful determinants of colon cancer risk are the levels of meat and animal fat intake. So, why do Americans get more colon cancer than Africans? Maybe, the rarity of colon cancer in Africans is associated with their low animal product consumption.

But why? Did you ever see that take-off of the industry slogan, “Beef: It’s What’s For Dinner”“Beef, It’s What’s Rotting in Your Colon”? I remember seeing that on a shirt with some friends, and I was such the party pooper, no pun intended — explaining that meat is fully digested in the small intestine, and never makes it down into the colon. It’s no fun hanging out with biology geeks but, it turns out, I was wrong.

It turns out, up to 12 grams a day of protein can escape digestion, and when it does, it reaches the colon, it can be turned into toxic substances, like ammonia. This degradation of undigested protein in the colon is called putrefaction; so, a little meat can actually end up putrefying in our colon. The problem is some of the by-products of this putrefaction process can be toxic.

The same thing happens with other animal proteins. If you eat egg whites, for example, some of that can putrefy, too. But, there’s protein in plants as well. The difference is that animal proteins tend to contain more sulfur-containing amino acids like methionine which is found concentrated in fish and chicken, and then eggs, less in beef and dairy, and much less in plant foods, which can be turned into hydrogen sulfide in the colon, the rotten egg gas that, beyond the smell, that can produce changes in the colon that increase cancer risk.

Now, there is a divergence of opinion as to whether it’s the animal fat, cholesterol, or animal protein that’s most responsible for the increased cancer risk, as all three has been shown to have carcinogenic properties. But, does it really matter since a diet rich in one is high in the others.

But the protein does more than just putrefy, though. Animal protein consumption causes an increase in blood levels of a cancer-promoting growth hormone called IGF-1. But, remove meat, egg whites, and dairy proteins from our diet, and our bloodstream can suppress cancer cell growth about eight times better. An effect so powerful, that Dr. Ornish and colleagues appeared to able to reverse the progression of prostate cancer without chemo, without surgery, without radiation; just a plant-based diet and other healthy lifestyle changes.

The link between animal protein and IGF-1 may help explain why those eating low-carb diets tend to die sooner, but not just any low-carb diet — specifically those based on animal sources, whereas, vegetable based low-carb diets are associated with a lower risk of death. But, meat based low-carb diets are high in animal fat as well; so, how do we know it wasn’t the saturated fat and cholesterol that was killing people off and had nothing to do with the animal protein?

What we would need is a study that follows a few thousand people and their protein intake for 20 years or so, and see what happens, who gets cancer, who doesn’t, who lives longer. But, there has never been a study like that…until now.

6,000 men and women over age 50, across the U.S, followed for 18 years, and those under age 65 with high protein intake had a 75% increase in overall mortality and a 4-fold increase in dying from cancer. But, not all proteins. Specifically, animal proteins, which makes sense given the higher IGF-1 levels in those eating excess protein. Eating animal protein increases IGF-1 levels, which increases cancer risk.

The sponsoring university sent out a press release with a memorable opening line: “That chicken wing you’re eating could be as deadly as a cigarette,” explaining that eating a diet rich in animal proteins during middle age makes you four times more likely to die of cancer — a mortality risk factor comparable to smoking. And look, everyone is going to have a cancer cell or pre-cancerous cell in them at some point. The question is: does it progress? That may depend on what we eat. See, most malignant tumors are covered in IGF-1 receptors, but if we have less IGF-1, the tumor may not progress.

And, it wasn’t just more deaths from cancer. Middle-aged people who eat lots of proteins from animal sources were found to be more susceptible to early death in general. Crucially, the same did not apply to plant proteins like beans, and it wasn’t the fat, it was the animal protein that appeared to be the culprit.

So what was the response to this revelation that diets high in meat, eggs, and dairy could be as harmful to health as smoking? One nutrition scientist replied that it was wrong, and potentially dangerous. Not the discovery that animal protein may be killing people, but the way they were telling people about it; it could damage the effectiveness of important public health messages. A smoker might think: ”why bother quitting smoking if my cheese and ham sandwich is just as bad for me?”

This reminds me of a famous Phillip Morris cigarette ad that tried to downplay the risks by saying: “you think second-hand smoke is bad, increasing the risk of lung cancer 19%, drinking one to two glasses of milk every day may be three times as bad — 62% increased lung cancer risk, or doubling the risk frequently cooking with oil, or tripling your risk of heart disease eating non-vegetarian, or multiplying your risk six-fold eating lots of meat and dairy.” So, they conclude, let’s keep some perspective, the risk of lung cancer from second-hand smoke may be well below the risk reported for other everyday activities.

That’s like saying, “Don’t worry about getting stabbed, because getting shot is much worse.” Uh, how about neither? Two risks don’t make a right.

The heme in the ham may also play a role. Heme iron is the form of iron found in blood and muscle, and may promote cancer by catalyzing the formation of carcinogenic compounds. Cancer has been described as a ferrotoxic disease: a disease, in part, of iron toxicity.

Iron is a double-edged sword. Iron deficiency causes anemia; however, excessive iron may increase cancer risk, by acting as a pro-oxidant, generating free radicals that may play a role in a number of dreaded diseases like stroke. But, look, only the heme iron, the blood and muscle iron, not the nonheme iron that predominates in plants. Same with heart disease — only the heme iron, and same with diabetes — only the heme iron, and same with cancer.

In fact, you can actually tell how much meat someone is eating by looking at their tumors. To characterize the mechanisms underlying meat-related lung cancer development, they asked lung cancer patients how much meat they were eating and examined the gene expression patterns in their tumors, and identified a signature pattern of heme-related gene expression. Though they just looked at lung cancer, they expect these meat-related gene expression changes to occur in other cancers as well.

The safest form of iron, then, is non-heme iron, found naturally in abundance in whole grains, beans, split peas, chickpeas, and lentils, dark green leafy vegetables, dried fruits, nuts, and seeds. How much money can be made on beans, though? So, the food industry came up with a blood-based crisp bread made out of rye, and cattle, and pig blood, one of the most concentrated sources of heme iron, about two thirds more than chicken blood. If blood-based crackers don’t sound appetizing, they do have cow blood cookies or blood filled biscuits. The filling does end up a dark-colored, chocolate flavored paste with a very pleasant taste,” dark-colored because spray-dried pig blood can have a darkening effect on the food product’s color, but the worry is not the color or taste, it’s the heme iron, which, because of its potential cancer risk, is not considered safe to add to foods for the general population.

This reminds me of nitrosamines, a class of potent carcinogens found in cigarette smoke. They are considered so toxic that carcinogens of this strength in any other consumer product designed for human consumption would be banned immediately. If that were the case, they’d have to ban meat.

One hot dog has as many nitrosamines and nitrosamides as five cigarettes. And these carcinogens are also found in fresh, unprocessed meat as well: beef, chicken, and pork. But practice Meatless Mondays and you could wake up Tuesday morning with nearly all of these carcinogens washed out of your system.

So, toxic nitrosamines should be banned immediately, but are still allowed for sale in cigarettes and meat because the carcinogens are found there naturally, just like the heme iron. Not safe enough to expose the general population to, but allowed for sale at the deli counter.

The irony is that the iron and the protein are what the industry boasts about — those are supposed to be the redeeming qualities of meat: protein and iron, but sourced from animal foods, may do more harm than good. And that’s not to mention all the other stuff like the saturated fat, industrial pollutants, and hormones that may play a role in our third leading cancer killer, breast cancer.

Steroid hormones are unavoidable in food of animal origin, but cow milk may be of particular concern. The hormones naturally found in even organic cow’s milk may have played a role in the studies that found a relationship between milk and other dairy products and human illnesses, not just like teenagers’ acne but prostate, breast, ovarian, and uterine cancers; many chronic diseases plaguing the Western world as well as male reproductive disorders, from increased risk of early puberty all the way to endometrial cancer in older women. But hormonal levels in food could be particularly dangerous in the case of vulnerable populations, such as young children and pregnant women in which even a small hormonal intake could lead to large change in metabolism.

Look, dairy milk evolved to put a few hundred pounds onto a calf with the consequences of lifetime human exposure to growth hormone in milk have not been well studied. We know milk consumption increases IGF-1, which is linked to cancer, and we’re milking cows while they’re pregnant, leading to particularly high levels of hormones.

Although dairy products are an important source of hormones, other products of animal origin must be considered as well. This could explain why women can cut their breast cancer risk by more than half by not just being normal weight and limiting alcohol, but also by eating mostly foods of plant origin. To help differentiate the effects of diet from other behaviors, like smoking and drinking, on overall cancer incidence, Adventists were compared to Baptists. Both discourage alcohol and tobacco, but the Adventists go further, encouraging a reduction of meat. In general, the Adventists had less cancer than the Baptists, and within Adventist populations, the vegetarians did even better, and those eating the most plant-based did the best.

All edible tissues of animal origin contain estrogen. This may explain why women avoiding all animal products have a twinning rate which is one fifth that of vegetarians and omnivores. It appears that vegan women have five times fewer twins, presumed to be because they’re not exposed to all these hormones in the diet. Why is that a good thing? Because twin pregnancies can unfortunately be risky pregnancies, both for mom and the babies, who may be ten times more likely to die at birth. To avoid these complications, women attempting conception may want to consider avoiding milk and dairy products.

And this isn’t even talking about the synthetic hormones that are injected, implanted and fed into farm animals. In 1979, an epidemic of breast enlargement was noted in Italian children. Poultry or veal was suspected, given they are using estrogens to accelerate weight gain. So after this episode, Europe banned the use of anabolic growth promoters in agriculture and banned the importation of American meat ever since, because we continue to inject animals with drugs like Zeranol, sold as Ralgro Magnum.

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You drip Zeranol-containing blood from implanted cattle onto normal human breast cells in a petri dish, and you transform them into breast cancer cells within 21 days. But people are not petri dishes. Because these anabolic growth promoters in meat production are by far the most potent hormones found in human food, we really should be testing people, especially children, before and after eating meat — until we do that, we really don’t know what kind of threat they pose, though the fact that Zeranol is as potent as DES should concern us. DES is another synthetic estrogen marketed to pregnant women – all pregnant women until 1971 when it was shown to cause cancer of the vagina in their daughters. But it was also used in meat.

In the absence of effective federal regulation, the meat industry uses hundreds of animal feed additives, with little or no concern about the cancer causing and other toxic effects. Illustratively, after decades of misleading assurances of the safety of DES in the meat supply, we finally banned it some 40 years after it was first shown to cause cancer. The meat industry then promptly switched to other potentially carcinogenic additives, such as this Ralgro Magnum.

When girls started dying from vaginal cancer, DES-treated meat was subsequently banned in Europe. However, misleading assurances, including the deliberate suppression of residue data, managed to delay a US ban on DES in the meat supply for another eight years.

Where are we today? Virtually the entire U.S. population consumes, without any warning, label, or information, unknown and unpredictable amounts of hormonal residues in meat products over a lifetime. If all hormonal and other carcinogenic feed additives aren’t banned immediately, the least we could do is label them, label the hormone residue levels in all meat products, including dairy and eggs.

Speaking of eggs, the next on the dreaded list of diseases is heart disease. Eggs are the #1 source of choline, which can be converted by gut bacteria into a toxin that increases the risk of stroke, heart attack, and death. Eggs are also the #1 source of cholesterol.

Why does it matter if we have lots of cholesterol circulating throughout our bloodstream? Cholesterol doesn’t just infiltrate our arteries and help form those inflamed pockets of pus within our arterial walls, but may play an active role in the final fatal plaque rupture. Cholesterol crystals may actually pop our plaque. If you look at ruptured plaques from autopsies, they are filled with cholesterol crystals protruding from the plaque. Cholesterol in the plaque may get so supersaturated that it reaches a point that it crystallizes, like rock candy. The growing crystals may then burst the plaque open.

Here’s a cholesterol crystal shooting out the top of a test tube, and when you look at the tips of the crystals under a microscope, they are sharp jagged needles. They placed a thin membrane over the top of the test tube to see if the cholesterol needles would poke through, and indeed, the sharp tips of the cholesterol needles cut through the membrane. So, they showed that as cholesterol crystallized the peak volume then increases rapidly and then sharp-tipped crystals can cut through and tear membranes, suggesting that the crystallization of supersaturated cholesterol in atherosclerotic plaques can induce those final ruptures.

And that’s what you see on autopsy. All patients who died of acute heart attacks had these perforating cholesterol crystals like this, sticking out of their plaques, but no crystals were found perforating the arteries of people who had severe atherosclerosis but first died of other, non-cardiac causes. This can explain why dramatically lowering cholesterol levels with diet and drugs if necessary can reduce the risk of fatal heart attack, by pulling cholesterol out of the artery walls, decreasing the risk of crystallizing these cholesterol needles that can then pop the plaques in our arteries.

High cholesterol can also cause what’s called fatty liver disease, our next global chronic disease epidemic. Fatty deposits in our liver can trigger inflammation, and result in liver cancer, failure, and death. And again, it may be these crystals, cholesterol crystals, triggering the progression of fatty liver into serious hepatitis. We’re talking dietary cholesterol, the cholesterol people eat in eggs and other animal products. A strong association between cholesterol intake and hospitalization and death from cirrhosis and liver cancer. And beyond just the crystals, dietary cholesterol may oxidize and directly cause toxic and carcinogenic effects.

It was not appreciated until recently that the average cholesterol level in the United States, the so-called “normal” levels were actually abnormal, accelerating the blockages in our arteries and putting a large fraction of the normal population at risk. Having a normal cholesterol in a society where it’s normal to drop dead of a heart attack, not necessarily a good thing. Normal cholesterol levels may be fatal cholesterol levels.

In cholesterol lowering, moderation kills. Even if all Americans kept their total cholesterol below the recommended 200, millions would develop coronary artery disease. Strong evidence shows we need to keep our total cholesterol under at least 150 to stem the epidemic. What kind of evidence? Well, in many cultures, coronary disease is practically unheard of when total serum cholesterol is under 150. And here in the U.S., in the famous Framingham Heart Study, few under 150 developed heart disease, and none died from it.

We cannot continue to have these public and private organizations on the forefront of health leadership recommending to the public a dietary plan that guarantees that millions will perish of the very disease the guidelines are supposed to prevent. The reason given by health authorities to not tell people the truth, for not advocating what the science shows is best, was that it might frustrate the public, who may have difficulty getting their cholesterol levels that low. But the public’s greatest frustration might come from not being informed of the optimal diet for health. Heart disease can be reversed with a plant-based diet. The evidence justifies igniting a social movement, let the people lead, and eventually the government will follow.

Some criticize plant-based diets as being extreme. You want extreme, though? Check out the consequences of our present diet. Having a breastbone sawed in half for bypass surgery or having a stroke that renders one mute, or having a breast, prostate, colon, or rectum removed for cancer, now that’s extreme. Eating a bean burrito is easy.

Instead of just bypassing the problem, literally, you can treat the cause, arrest and reverse heart disease, our #1 killer, with a whole food, plant-based diet.

Next on the list is arthritis, such as rheumatoid arthritis, a chronic inflammatory systemic disorder causing progressive destruction of the joints. As many as 80% become disabled, can cut 18 years off one’s lifespan. There are drugs, but unfortunately they’re often associated with severe side effects, blood loss, bone loss, immune suppression, and toxicity to the liver and eyes. There’s got to be a better way.

Well, populations that eat more meat do seem to have more rheumatoid arthritis, and there have been some dramatic case reports of rheumatoid arthritis attacks being triggered by consumption of animal products, starting six to ten hours after ingestion of animal protein and lasting a few days, but they stopped when patients stopped consuming animal products. The researchers suggest that immune complexes formed by the body attacking animal proteins may promote autoimmune reactions inside the joints themselves. And indeed, those with rheumatoid arthritis have striking elevations in antibodies to foods like fish, pork, egg whites, dairy proteins, and even some cereals. But it could also be a pro-inflammatory effects of meat fats or free radicals from the iron accumulating in the joints or other mechanisms, but case reports and country-by-country analyses can only raise questions. To prove cause-and-effect, you need an interventional study to put it to the test.

And here we go: a 13-month-long randomized controlled trial of plant-based diets for rheumatoid arthritis. Patients were put on a vegan diet for three and a half months and then switched to an egg-free vegetarian diet for the remainder. Compared to the control group, that didn’t change their diet, the plant-based group had a significant improvement in morning stiffness within the first month, cutting the number of hours they suffered from joint stiffness in half, a drop in pain, a drop in disability. They reported subjectively feeling better, significant improvement in their grip strength, fewer tender joints, fewer tenderness per joint, and less swelling. They also had dramatic drops in inflammatory markers in the blood, sed rate, C-reactive protein, and white count; highly significant and clinically relevant findings.

What about osteoarthritis? Most frequent cause of physical disability among older adults, affecting about 20 million Americans, affecting maybe 20% of Americans in the coming decades, and becoming more and more widespread among younger people.

Osteoarthritis is characterized by loss of cartilage within the joint. We used to think there’s just kind of wear and tear, but it is now generally accepted as an active joint disease with an inflammatory component. So if the loss of cartilage is caused by inflammation, maybe if we put people on an anti-inflammatory diet, it could help; like with rheumatoid arthritis. Using optimal nutrition and exercise as the first-line intervention could well be the best medical practice.

So where’s the best science on what optimal nutrition might look like? The China Study is a prime example, showing the serious health consequences of high consumption of pro-inflammatory foods — meat, dairy, fat, and junk — and low consumption of anti-inflammatory plant foods: whole grains, vegetables, fruits, beans, split peas, chickpeas, and lentils. The unnatural Western diet contributes to low-grade systemic inflammation, oxidative stress, tissue damage, and irritation, placing the immune system in this kind of overactive state, a common denominator for these conditions like arthritis.

Next on the list is stroke and high blood pressure, which go together because high blood pressure is the #1 risk factor for stroke. The PREDIMED study found that a Mediterranean diet with nuts could cut stroke risk nearly in half, though they were still having strokes. Half as many strokes, but it was still a stroke promoting diet and heart attack promoting as well. That’s what Dr. Ornish noted when he wrote in: “There was no significant reduction in the rates of heart attack, death from cardiovascular causes, or death from any cause”,  just that stroke benefit. But hey that’s something. A Mediterranean diet is certainly better than what most people are consuming, but even better may be a diet surrounding whole plant foods, shown to actually reverse heart disease, not contribute to it. That may be true, the authors of the study reported, but the major problem with Ornish’s diet is that it doesn’t taste good, and so, hardly anyone sticks to it.

But it’s not true. Ornish got extraordinary adherence in his studies with no difference in any of the acceptability measures, same enjoyment compared to their regular diet. They even had success in barbecue country, rural North Carolina. See, stricter diets may meet greater acceptance among patients than more modest diets because they may work better. Greater adherence means greater disease reversal.

But you don’t have to be facing certain death. Even those who are young and healthy with no health problems had no problem sticking to a plant-based diet. In fact, it worked a little too well. This is a crossover study where they asked people to eat plant-based for a few months and then switch back to their original diet to note the contrast, but people felt so good eating healthy some refused to go back to their regular diet, which kind of messes up the study. They were losing weight with no calorie counting or portion control, they had more energy, their periods got better, better digestion, better sleep, many were like no way, we’re not going back.

But if doctors just presume people aren’t going to eat this way, a self-fulfilling prophecy. Just like smoking doctors are less likely to tell their patients to stop smoking, and couch potato docs are less likely to counsel exercise or things like more fruits and vegetables, we need to role model healthy behavior. This greatly enhances our credibility and effectiveness. Gone are the days of traditional authority when the fat physician, dropping cigarette ash down his gravy-stained vest, could credibly prescribe a change in behavior.

One reason why plant-based diets can save so many millions is because the #1 risk factor for death in the world is high blood pressure, laying to waste nine million people every year. And in the United States, killing off more than a thousand a day; 400,000 Americans dead every year.

High blood pressure affects nearly 78 million Americans, that’s one in three of us, and as we age, our pressures creep higher and higher, such that by age 60, it strikes more than half. If it affects most of us when we get older, maybe it’s less a disease and more just a natural, inevitable consequence of aging? No. We’ve known for nearly a century that high blood pressure need not occur. Researchers measured the blood pressure of a thousand people in rural Kenya who ate a diet centered around whole plant foods. Whole grains, beans, vegetables, fruit, and dark green leafy vegetables. Up until age 40, the blood pressures of rural Africans were about the same as Europeans and Americans, around 120s over 80s, but as Westerners age, their pressures creep up such that by age 60 the average person is hypertensive, exceeding 140 over 90.

But what about those eating plant-based? Their pressures improved with age, not only did they not develop hypertension, their blood pressures actually got better.

Now this whole 140 over 90 thing is arbitrary. Just like studies show that the lower the cholesterol the better; there’s really no safe level above about 150. Blood pressure studies also support this kind of “lower the better” approach to blood pressure reduction. Even people starting out with blood pressures under 120 over 80 appear to benefit from blood pressure reduction. So, the ideal blood pressure, the no-benefit-from-reducing-it-further blood pressure, is actually 110 over 70. But is it possible to get blood pressures down to 110 over 70? It’s not just possible, it’s normal for those eating healthy enough diets.

Over two years at a rural Kenyan hospital, 1,800 patients were admitted. How many cases of high blood pressure did they find? Zero. Wow, so they must have had low rates of heart disease. No, they had no rates of heart disease. Not low risk, no risk. Not a single case of arteriosclerosis, our #1 killer, was found.

Rural China too, about 110 over 70 their entire lives. Now, look, Africa and China have vastly different diets, but they share the common theme that they are plant-based day-to-day, with meat only eaten on special occasions. Why do we think it’s the plant-based nature of their diets that was so protective? Because in the Western world, as the American Heart Association has pointed out, the only folks really getting down that low are the strict vegetarians, coming in at about 110 over 65.

So, does the American Heart Association recommend a strict vegetarian diet? No, they recommend the DASH diet. The DASH diet has been described as a lactovegetarian diet, but it’s not. It emphasizes fruits and vegetables and low-fat dairy, but just a reduction in meat. Why not vegetarian? We’ve known for decades that food of animal origin was highly significantly associated with blood pressure. In fact, you can take vegetarians, pay them enough to eat meat and you can see their blood pressures go right up.

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So, when the DASH diet was created, were they just not aware of this landmark research, done by Harvard’s Frank Sacks? No, they were aware. The Chair of the Design Committee that came up with the DASH diet was Frank Sacks. See, the DASH diet was explicitly designed with the #1 goal of capturing the blood pressure lowering benefits of a vegetarian diet, yet contain enough animal products to make it palatable to the general public. In fact, Sacks found that the more dairy the lactovegetarians ate, the higher their blood pressures went, but they had to make the diet acceptable.

A recent meta-analysis showed that vegetarian diets were good, but strictly plant-based diets may be better. Vegetarian diets in general confer protection against cardiovascular disease, some cancers and death, but completely plant-based diets seem to offer additional protection for obesity, hypertension, type-2 diabetes, and heart disease mortality. Based on a study of 89,000 Californians, those eating meat-free diets appeared to cut their risk of high blood pressure in half, but those eating meat-free, egg-free, and dairy-free diets cut their risk 75%.

If, however, you’re eating a whole food, plant-based diet, and still not hitting 110 over 70, there are few plants recently found that may offer additional protection. A randomized placebo-controlled study found that a cup of hibiscus tea with each meal significantly lowers blood pressure. In fact, tested head-to-head against a leading blood-pressure drug, Captopril, two cups of strong hibiscus tea every morning as effective as the drug.

Another randomized placebo-controlled trial found that a few tablespoons a day of ground flaxseeds induced one of the most potent antihypertensive effects ever achieved by a dietary intervention, two to three times more powerful than instituting an endurance exercise program, though, there’s no reason you can’t do both).

Red wine may help, but only if the alcohol has been taken out. Raw vegetables or cooked? And the answer is both, though raw may work better. Kiwifruit didn’t seem to work at all, even though the study was funded by a kiwifruit company. Maybe they should have taken direction from the California Raisin Marketing Board, which came out with this study showing that raisins can reduce blood pressure, but only, apparently, compared to fudge cookies, Cheez-Its, and Chips Ahoy! They know the Big Pharma trick of choosing the right control group.

Next on the dreaded list is diabetes and vision loss, which go together, since diabetes is the leading cause of preventable middle-aged blindness. Even with intensive diabetes treatment, at least three injections of insulin a day with this implantable insulin pumps, the best we can offer is usually just a slowing down of the progression of the disease. So, we can slow down your blindness with modern medicine, but a half century ago, Kempner at Duke proved you could reverse it with an ultra-strict plant-based diet of mostly rice and fruit. 44 consecutive patients with diabetic retinopathy, and in 30% of the cases, their eyes improved. From like this, to this. That’s not supposed to happen. Diabetic retinopathy had been considered a sign of irreversible damage. What does this mean in real life? Unable to even read headlines to normal vision.

How do we treat diabetic retinopathy these days? With steroids and other drugs injected straight into the eyeball. And if that doesn’t work, there’s always pan-retinal laser photocoagulation, in which laser burns are placed over nearly the entire retina. Surgeons literally burn out the back of your eyeball. Why would they do that? The theory is that by killing off most of the retina, the little remaining piece you have will get more of the blood flow.

When I see this, along with Kempner’s work, I can’t help but feeling like history has been reversed. Like, “can you believe 50 years ago we had that barbaric burn-out-your-socket surgery, but thankfully we know that through dietary intervention alone, we can sometimes reverse the blindness.” Instead of learning, medicine seems to have forgotten.

The most efficient way to avoid diabetic complications is to simply eliminate the diabetes in the first place, and this is often feasible with a healthy enough diet.

 

A plant-based diet beat out the conventional American Diabetes Association diet in a head-to-head randomized controlled clinical trial, without restricting portions, no calorie or carb counting. A review of all such studies found that those following plant-based diets experience better improvements compared to those following diets that include animal products, but this is nothing new.

The successful treatment of type 2 diabetes with a plant-based diet was demonstrated back in the 1930’s, showing that a diet centered around vegetables, fruits, whole grains, and beans was more effective in controlling diabetes than any other diet.

Randomized controlled trial: after 5 years, no big change in the control group, but in the plant-based group, insulin needs were cut in half, and a quarter ended up off of insulin altogether. Now, this was a low calorie diet, though; maybe their diabetes just got better because they lost weight?

To tease that out, what we would need is a study where they switch people to a healthy diet, but force them to eat so much food that they’d actually maintain their weight. Then, we could see if a plant-based diet had benefits independent of all the weight loss. We’d have to wait another 44 years, but here it is. Subjects were weighed every day, and if they started losing weight, they were made to eat more food. In fact, so much food some of the participants had trouble eating it all, but they eventually adapted; so, there was no significant alterations in body weight despite restricting meat, dairy, eggs, and junk.

So, with zero weight loss did a plant-based diet still help? Here’s the before and after insulin requirements of the 20 people they put on the diet. This is the number of units of insulin they had to inject themselves with before and after going on the plant-based diet. Overall insulin requirements were cut about 60%, and half were able to get off insulin altogether, despite no change in weight. How many years did this take? Was it five years like the other study? No, 16 days.

So, we’re talking diabetics who’ve had diabetes as long as 20 years, injecting as much as 20 units of insulin a day and then, as few as 13 days later, they’re off insulin altogether, thanks to less than two weeks on a plant-based diet. Diabetes for 20 years, then off all insulin in less than 2 weeks. Here’s patient 15: 32 units of insulin on the control diet and then 18 days later on none. Lower blood sugars on 32 units less insulin; that’s the power of plants.

And as a bonus, their cholesterol dropped like a rock, in 16 days to under 150. Just like moderate changes in diet usually result in only modest reductions in cholesterol, asking patients with diabetes to make moderate changes achieves equally moderate results. Which is one possible reason they end up on drugs, injections, or both.

Everything in moderation is a truer statement than people realize. Moderate changes in diet can leave one with moderate blindness, moderate kidney failure, and moderate amputations — maybe just a few toes. Moderation in all things is not necessarily a good thing.

The more we as physicians ask from our patients, the more we are likely to get. The old adage “shoot for the moon” seems to apply. It may be more effective than limiting patients to small steps that may sound more manageable but not sufficient to actually stop the disease.

The only thing better than reversing diabetes is to not get it in the first place. That study that purported to show that diets high in meat, eggs, and dairy could be as harmful to health as smoking supposedly suggested that people under 65 who eat lots of animal protein are four times as likely to die from cancer or diabetes. But if you look at the actual study, you’ll see that’s not true. Those eating a lot of animal protein didn’t have just 4 times more risk of dying from diabetes, they had 73 times higher risk of dying from diabetes.

As one eats more and more plant-based, there appears to be a stepwise drop in the rates of diabetes down to a 78% lower prevalence among those eating strictly plant-based. Protection building incrementally as one moved from eating meat daily, to less than daily, to just fish, to no meat, and then, to no eggs and dairy either. A similar pattern was found for the leading cause of vision loss among the elderly, cataracts. This suggests that it’s not all or nothing; any steps we can make towards eating healthier may accrue benefits.

But why? Why is total meat consumption associated with higher risk of diabetes, and especially processed meat, particularly poultry? Well, there’s a whole list of potential suspects, culprits in meat. Yes, it may be the animal protein, but maybe it’s the animal fat, maybe it’s the cholesterol, maybe it’s the iron leading to free radical formation which can cause inflammation.

Advanced glycation end products are another problem. They promote oxidative stress and inflammation, and food analyses show that the highest levels of these so-called glycotoxins are found in meat. Here are the 15 most contaminated food found with glycotoxin contamination: chicken, pork, pork, chicken, chicken, beef, chicken, chicken, beef, chicken, turkey, chicken, fish, beef, and… McNuggets — I don’t know if you can call those chicken.

Though, other foods from animal sources can also harbor these pro-oxidant chemicals.  In this study, they fed diabetics foods packed with glycotoxins; like chicken, fish, and eggs, and their inflammatory markers shot up, like tumor necrosis factor and C-reactive protein. Thus, in diabetics, dietary AGEs promote inflammatory mediators, leading to tissue injury. The good news is that restricting these kinds of foods may suppress these inflammatory effects. So, these glycotoxins may be a missing link between the increased consumption of animal fat and meats and the subsequent development of type 2 diabetes in the first place, as well as Alzheimer’s disease, the final disease on our dreaded list.

Dietary AGEs appear to be important risk factors for Alzheimer’s disease as well. If you measure the urine levels of glycotoxins flowing through the bodies of older adults, those with the highest levels went on to suffer the greatest cognitive decline over the subsequent nine years, as well as the greatest brain shrinkage, it’s called cerebral atrophy, all helping to explain why those who eat the most meats may have triple the risk of getting dementia compared to long-time vegetarians. The bottom line is that the same diet that may help prevent the other dreaded diseases: cancer, heart attack, arthritis, stroke, high blood pressure, diabetes, and vision loss, may also help prevent brain loss and Alzheimer’s as well.

One disease that’s not on the list is ALS, or Lou Gehrig’s disease, which strikes healthy, middle-aged people seemingly at random, and holds little hope for treatment and survival. Although mental capabilities stay intact, ALS paralyzes people, and most patients die within three years when they can no longer breathe or swallow. At any given time, an estimated 30,000 Americans are fighting for their lives. We each have about a 1 in 400 chance of getting this disease in our lifetime. And it appears to be on the rise around the world.

What causes it? Well, there’s a neurotoxin produced by blue-green algae in our rivers, lakes, and oceans that ends up in seafood, which is currently a strong contender as the cause of, or at least a major contributor to, ALS and maybe Alzheimer’s and Parkinson’s as well. Researchers in Miami found this BMAA neurotoxin in the brains of Floridians who died from sporadic Alzheimer’s disease and ALS, significant levels in 49 out of 50 samples from Alzheimer’s and ALS patients. The same thing was found up in the Pacific Northwest and in the brains of those dying from Parkinson’s disease. You can also apparently pick up more of this neurotoxin in the hair of live ALS patients compared to controls.

So, is BMAA present in Florida seafood? Yes, in both freshwater fish and shellfish, like oysters and bass, and out in the bay. And not just in Florida, on up the Eastern seaboard, and out into the Midwest. This could explain ALS clusters around lakes in New Hampshire, or fish in Wisconsin, or blue crabs from the Chesapeake, around where I live or seafood eaters in France, or in Finland’s Lakeland district, or around the Baltic Sea, building up particularly in fish, mussels and oysters. There is a general consensus that these harmful algal blooms are increasing worldwide thanks in part to industrialized agriculture, which may increase the exposure to this neurotoxin, leading to a possible increased risk of these horrible neurodegenerative diseases. With substantial and ever growing evidence that neurotoxin [BMAA] does play a role in the onset and progression of neurodegenerative diseases, the most important question is, “what mode of activity does BMAA exert?” No, it’s not. The most important question is, “how do we reduce our exposure?”

We know that the presence of this neurotoxin in aquatic food chains could be a significant human health hazard. So, until more is known, it may be prudent to reduce our risk by limiting exposure to BMAA in the human diet. There are neurotoxins in the dairy supply too, which may explain the link between milk consumption and Parkinson’s. High levels of organochlorine pesticide residues are found in milk and in the brains of Parkinson’s patients, and other pollutants, like tetrahydroisoquinoline, which is what scientists actually use to try to induce the disease in primates. So, maybe the dairy industry should do these toxin screenings of milk.

You could always just not drink this stuff, but then what about your bones? That’s a marketing ploy. If you look at the science, milk does not appear to protect against hip fracture risk whether drinking during adult years, or drinking milk during one’s teen years. If anything, milk consumption was associated with a borderline increase in fracture risk in men. This suggests a partial explanation for the long-standing enigma that hip fracture rates are highest in populations with the greatest milk consumption.

This enigma irked a Swedish research team, puzzled because studies again and again had shown a tendency for higher risk of fracture with higher milk consumption. Well, there is a rare birth defect called galactosemia, where babies are born without the enzymes needed to detoxify the galactose in milk, so they end up with high levels of galactose in their blood stream, which causes bone loss. So maybe, the researchers figured, even in normal people that can detoxify the stuff, maybe it’s not so good for the bones to be consuming all that galactose on all day. And galactose doesn’t just hurt the bones; that’s what scientists use to cause premature aging in lab animals. They slip them a little galactose, and can shorten their lifespan, cause oxidative stress, inflammation, and brain degeneration, just like one to two glasses of milk worth of galactose a day. We’re not rats, though, but given the high amount of galactose in milk, recommendations to increase milk intake for prevention of fractures could be a conceivable contradiction; so, they decided to put it to the test, looking at milk intake and mortality, as well as fracture risk, to test their theory.

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A hundred thousand men and women followed for up to 20 years, and milk drinking women had higher rates of death, more heart disease, and significantly more cancer for each daily glass of milk. Three glasses a day was associated with nearly twice the risk of death. And they had significantly more bone and hip fractures too. More milk, more fractures. Milk drinking men also had a higher rate of death, but for some reason you never see any of this in any of the milk ads.

Okay, so where does that leave us? What are the common threads? If you look at four of the major dietary quality scoring systems, which have all been associated with extending lifespan, less heart disease, less cancer, they all share only four things in common. What are those four things? More fruit, more vegetables, more whole grains, and more nuts and beans. They are all built around a common core of diets rich in plant foods, whereas opposite food patterns, Western diet, higher risks. So, we need to optimize the food environment to support whole grains, vegetables, fruit, and plant-based sources of protein.

Taking the diet quality indexes to their logical conclusion, the most plant-based diet comes out the most healthy diet. But again, it doesn’t have to be all or nothing. We now have evidence that simple advice to increase the consumption of plant foods and decrease the consumption of animal foods actually has a survival advantage.

And boy, do we need it. In terms of life expectancy, the U.S. is down around 27 of the 34 leading free-market democracies. People in Slovenia live a year longer than citizens of the United States. Why? Most deaths in the United States are preventable and related to nutrition. According to the most rigorous analysis of risk factors to date ever published, the number one cause of death in the United States and the number one cause of disability is our diet, bumping tobacco smoking to number two. Smoking now only kills about a half million Americans a year, whereas diet now kills hundreds of thousands more.

Let me end with a thought experiment. Imagine yourself a smoker in the 1950’s. The average per capita cigarette consumption was about 4,000 cigarettes a year. Think about that. The average American smoked a half a pack a day.

The media was telling you to smoke and famous athletes agreed. Even Santa Claus cared enough about your health to want you to smoke. I mean, you want “to keep fit”, and “stay slender”, so you make sure to smoke and eat hot dogs to stay trim, and eat lots of sugar to stay slim and trim, less fattening than that apple, I mean sheesh. “Though apples do connote goodness and freshness”, reads one internal tobacco industry memo, which brings up many possibilities for youth-oriented cigarettes. Shameless!

In addition to staying fit and slender and soothing your throat, “for digestion’s sake”, you smoke. I mean “no curative power is claimed for Phillip Morris — but, an ounce of prevention is worth a pound of cure.” So, better safe than sorry, and smoke.

Like eating, smoking was a family affair. “Gee, Mommy, you sure enjoy your Marlboro.”

“You’re darn tootin’.”

“Just one question, Mom, can you afford not to enjoy smoke Marlboros?”

Your kids were giving you cigarettes in the 50’s, even your dog was giving you cigarettes.

“Blow in her face, and she’ll follow you anywhere.”

“No woman ever says no”, after all, they’re “so round, so firm, so fully packed!”

After all, John Wayne smoked them — until he got lung cancer and died. Even the paleo folks were smoking, and so were the doctors.

This is not to say there wasn’t controversy within the medical profession. Yes, some doctors smoked Camels, but other physicians preferred Luckies; so, there was some disagreement. Eminent doctors, on high and impartial medical authority, call for Phillip Morris. Even the specialists could not agree which cigarette was better for your throat; so, best to stick to the science, and more scientists smoke this brand.

This should not be rocket science — but even the rocket scientists had their brand, “for the man who thinks for himself.”

What was the government saying? Smoke Luckies. I mean who wouldn’t want to give their throat a vacation. Not a single case of throat irritation. How could your nose and throat be adversely affected when cigarettes are “just as pure as the water you drink.”?

And if you do get irritated, no problem; your doctor can write you a prescription for cigarettes. This is from the Journal of the American Medical Association. After all, “don’t smoke is advice hard for patients” to swallow. Reminds me of the recent survey of doctors that found the #1 reason doctors don’t prescribe heart-healthy diets today was their perception that patients fear being deprived of all the junk they’re eating. After all, Phillip Morris reminded us, we want to keep our patients happy, and “to make a radical change in habit would do harm.” You’re a doctor; you don’t harm your patients.

The tobacco industry gave medical journals big money to run ads like these. Not a problem, though, Phillip Morris claims come from “completely reliable sources”, based on studies by recognized authorities published in leading medical journals. Even kindly offering to sell free packs of cigarettes to doctors so they can test them out themselves. So, see you at the next AMA convention.

What did the American Medical Association have to say for itself? Like most other medical journals, they accepted tobacco ads. They have yet to see an autopsy with a single lesion that had a Marlboro label on it. So, when mainstream medicine is saying that smoking on balance may be beneficial for you, when the American Medical Association is saying that, where could you turn back then if you just wanted the facts? What’s the new data advanced by science? She was “too tired for fun, and then she smoked a Camel.”

Babe Ruth spoke of “proof positive” medical science, that is when he still could speak, before he died of throat cancer.

Now, some of the science did leak out, causing a dip from about 11 cigarettes a day per person down to 10, but those that got scared could always choose “the cigarette that takes the fear out of smoking,” or even better, choose the cigarette that “gives you the greatest health protection.”

Now, if by some miracle, there was a SmokingFacts.org website back then that could deliver the science directly bypassing commercially corruptible institutional filters, you would have become aware of studies like this: an Adventist study in California in 1958 that showed that nonsmokers may have at least 90% less lung cancer. But this wasn’t the first. When famed surgeon Michael DeBakey was asked why his studies published back in the 30’s linking smoking and lung cancer were ignored, he had to remind people about what it was like back then. We were a smoking society; it was in the movies; medical meetings were one “heavy haze of smoke.”  It’s like the debates over cigarettes and lung cancer in Congress taking place in smoke filled rooms. Makes me wonder what’s served at the Dietary Guidelines Committee meeting breakfast buffets to this day.

A famous statistician, by the name of Ronald Fisher, railed against what he called propaganda to convince the public that cigarette smoking was dangerous. He made invaluable contributions to the field, but his analysis of lung cancer and smoking was flawed by an unwillingness to examine the entire body of data available. His smokescreen may have been because he was a paid consultant to the tobacco industry, but also because he was himself a smoker. Part of his resistance may have been to the association, may have been because of his own fondness for smoking, which makes me wonder about some of the favorite foods that nutrition researchers may have of this day.

It always strikes me as ironic when vegetarian researchers come forward and list their diet as a potential conflict of interest, whereas not once in the 70,000 articles on meat in the medical literature have I ever seen a researcher disclose their nonvegetarian habits, because it’s normal. Just like smoking was normal.

So, back to our thought experiment. If you’re a smoker in the 50’s in the know, what do you do? With access to the science, you realize that the best available balance of evidence suggests that your smoking habit is not good for you. So, do you change your smoking habits or do you wait? If you wait until your physician tells you, between puffs, to quit, you may have cancer by then. If you wait until the powers that be officially recognize it, like the Surgeon General did in the subsequent decade, you could be dead by then.

It took 25 years for the Surgeon General’s report to come out. It took more than 7,000 studies and the deaths of countless smokers before the first Surgeon General’s report against smoking was finally released in the 1960’s. You’d think maybe after the first 6,000 studies, maybe they could have given people a little heads up or something? It was a powerful industry. One wonders how many people are currently suffering needlessly from dietary diseases. Maybe we should have stopped smoking after the seven hundredth study like this.

With so much money and personal habit at stake, there’s always going to be dissenters. But given the seriousness of these diseases and the sum total of evidence, we shouldn’t wait to put preventive measures in place.

As a smoker in the 50’s, on one hand, you had all of society, the government, and the medical profession itself telling you to smoke. And, on the other hand, the science if you were lucky enough to know about studies like this.

Now, fast forward 55 years. There’s a new Adventist study out of California, warning Americans about the risks of something else they may be putting in their mouth. And it’s not just one study; according to the latest review, the total sum of evidence suggests that mortality from all causes put together, and many of the dreaded diseases – ischemic heart disease, and circulatory and cerebrovascular diseases like stroke – were significantly lower in those eating meat-free diets, in addition to less cancer and diabetes.

So, instead of going along with America’s smoking habits in the 50’s, imagine you or someone you know going along with America’s eating habits today. What do you do? With access to the science, you realize that the best available balance of evidence suggests that your eating habits are probably not good for you. If you wait until your physician, between bites, tells you to change your diet, it could be too late. In fact, even after the Surgeon General’s report, the medical community still dragged their feet. The AMA actually went on record withholding support from the Surgeon General’s report. They didn’t endorse it. Could that have been because they had just received $10 million from the tobacco industry?

Look, we know why the AMA may have been sucking up to the tobacco industry, but why weren’t individual doctors speaking out? There were a few gallant souls ahead of their time just as there are today, standing up against industries killing millions, but why not more? Maybe it’s because the majority of physicians themselves smoked cigarettes, just like the majority of physicians today eat foods that contribute to our epidemic of dietary disease. What was the AMA’s rallying cry back then? “Everything in moderation.” Sound familiar? “Extensive scientific studies have proved that smoking in moderation is OK.”

Today, the food industry uses the same tobacco industry tactics: supplying misinformation and twisting the science. The same scientists-for-hire paid to downplay the risks of second hand smoke and chemicals are the same hired by the National Confectioners Association to downplay the risks of candy, and the same hired by the meat industry to downplay the risks of meat.

Consumption of animal products and processed foods cause at least 14 million deaths around the world each year. 14 million deaths. 14 million people dead every year. This is not a failure of individual willpower, says the Director-General of the World Health Organization. This is a failure of political will to take on big business, which is a formidable opposition. Few governments are willing to prioritize health over big business. As we learned from experience with the tobacco industry, a powerful corporation can sell the public just about anything.

If there’s one thing we’ve learned from the tobacco experience, wrote one district judge, it’s how powerful profits can be a motivator, even at the cost of millions of lives and unspeakable suffering.

It may have taken 25 years for the Surgeon General’s report to come out, and still longer for mainstream medicine to get on board, but now there are no longer ads encouraging people to “inhale to your heart’s content!” Now, there are ads from the CDC fighting back.

Food-wise, there was “meat…for health defense,” or “nourishing bacon,” or “doctors prescribe… meat”, or soda for that matter. “Thank heavens, Trix are habit forming”.

Now, just like there were those in the 30’s, 40’s, and 50’s on the vanguard trying to save lives, today there are those turning ads about what you can do with pork butt to what the pork can do to your butt: The Physicians Committee for Responsible Medicine’s “Meat is the new tobacco” campaign. As Dr. Barnard tried to get across in an editorial published in the American Medical Association’s Journal of Ethics, plant-based diets can now be considered the nutritional equivalent of quitting smoking.

How many more people have to die, though, before the CDC encourages people not to wait until open heart surgery to start eating healthy, as well? How long’s that going to take, though?

Just like we don’t have to wait until our doctors quit smoking to quit ourselves, we don’t have to wait until our doctor takes a nutrition class or cleans up their own diet before changing our own eat habits. Look, it’s not your doctor’s fault, writes a group of prominent physicians. There is a severe deficiency of nutrition education at all levels of medical training. We were just never taught it.

We know a whole foods, plant-based diet has been proven to reverse our #1 killer, and protect against type 2 diabetes and cancer. So, how has this knowledge affected medical education? It hasn’t. Despite the neglect of nutrition in medical education, the public considers physicians to be trusted sources, but if doctors don’t know what they’re talking about, they could actually be contributing to diet-related diseases. To stem the surging tide of chronic illness, physicians need to become part of the solution. But we don’t have to wait for that to happen. No longer do patients have to be so patient.

Doctors no longer hold a professional monopoly on health information. There’s been a democratization of knowledge, and so until the system changes, we have to take responsibility for our own health and for our family’s health. We can’t wait for society to catch up to the science, because it’s a matter of life and death.

In 2015, Dr. Kim Williams became President of the American College of Cardiology. He was asked why he follows his own advice to eat a plant-based diet. “I don’t mind dying,” Dr. Williams replied. “I just don’t want it to be my fault.”

Thank you.

 

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