Hello and welcome to Nutrition Facts. I’m your host, Dr. Michael Greger. Today, we’re going to explore smart nutrition choices based, naturally, on facts. Whenever there’s a new drug or surgical procedure, you can be assured that you and your doctor will probably hear about it because there’s a corporate budget driving its promotion; but, what about advances in the field of nutrition? That’s what this podcast is all about.

Today, we bring back the Nutrition Facts grab bag with the latest news on a whole variety of topics. First up – Vitamin D supplements are put to the test for treating fibromyalgia. Here’s the story.

Fibromyalgia is one of the most common joint and muscle diseases, affecting millions of Americans, characterized by widespread musculoskeletal pain, and often accompanied by other symptoms, such as fatigue. The medical profession used to think it was all in people’s heads, “but today there is irrefutable evidence” that it is, indeed, a disorder of the body and not just the mind.

Back in 2003, an influential paper was published out of the Mayo Clinic, in which a shocking 93% of fibromyalgia-type patients were found to be vitamin D deficient; and so, they concluded that all such patients are at high risk of severe vitamin D deficiency. But wait a second, said the skeptics, there was no control group. Where’s the Mayo Clinic located? Minnesota. Maybe 90% of everyone in Minnesota is D deficient.

When controlled studies were done, some did, indeed, find that those suffering from these kinds of pain syndromes were significantly more likely to be D deficient, but other studies did not. Even if all the studies did, though, that doesn’t mean that low vitamin D levels cause fibromyalgia. Maybe, chronic widespread pain disorders, like fibromyalgia, cause low vitamin D. It’s the sunshine vitamin, after all, and fibromyalgia patients may not be running around outside as much as healthy controls. To know if vitamin D is contributing to the disease, you have to put it to the test.

Studies found that the majority of those with pain syndromes and low D levels appeared to benefit from vitamin D supplementation. Clinical improvement in up to 90% of patients. (You can imagine how rife vitamin D deficiency is among Arab women in the Middle East.) But these studies weren’t controlled either. Maybe they would have gotten better on their own without the supplements, or maybe it was the placebo effect. There are many examples in the medical literature of treatments that looked great in uncontrolled trials, like hyperbaric oxygen therapy for multiple sclerosis, but when put to the test in randomized controlled trials, they failed miserably.

And, that’s what seemed to happen in the first randomized controlled trial of vitamin D for a fibromyalgia-type syndrome in 2008. No significant difference in pain scores, though the study only lasted three months, and in that time, researchers were only able to get vitamin D blood levels up to about 30. Unfortunately, no controlled study had ever been done pushing levels any higher, until 2014. Fibromyalgia patients were given up to 2400 units of D a day for 20 weeks; and so their D levels rose up to like 50 and, then, once they stopped the vitamin D, levels came back down to match the placebo and that was reflected in their pain scores, a significant drop in pain severity while they were on the D and then, back to baseline when they were off of it. The researchers concluded “that this economical—[in fact, over-the-counter]—therapy with a low side effect profile may well be considered in patients with [fibromyalgia syndrome.]”

In our next section we do some math on white blood cell counts. Since white blood cell count is such a strong predictor of lifespan, what should we aim for and how do we get there?

A higher white blood cell count may be an important predictor for cardiovascular disease incidence and mortality, cancer mortality, all-cause mortality, a decline in lung function, so an important predictor for heart attacks, strokes, declining lung function, dying from cancer, and premature death in general. No surprise, as the number of white blood cells we have circulating in our bloodstream is a “marker of systemic inflammation.” Our body produces more white blood cells day to day in response to inflammatory insults.

We’ve known about this link between higher white counts and heart attacks since the ‘70s, when we found that higher heart attack risk was associated with higher white blood cell counts, just like it was with higher cholesterol levels and higher blood pressures—something that’s been found in nearly every study done since then. Decades of studies, involving hundreds of thousands of patients, showing “dramatically higher…mortality rates” in those with higher white counts.

But why? “Why does…white blood cell count predict mortality?” Maybe because it’s a marker of inflammation and oxidation in our body; in fact, maybe even a biomarker for how fast we’re aging. But, it may be more than just an indicator of inflammation, but an active player, contributing “directly” to disease via a variety of mechanisms, including the actual “obstruction” of blood flow.

The average diameter of white blood cells is like seven and a half micrometers, whereas our tiniest vessels are only like five micrometers wide. So, the white blood cell has to squish down into like a sausage shape to squeeze through. And, when there’s inflammation present, these cells can get sticky.

Whether white count is just a marker of inflammation, or an active participant, it’s better to be on the low side. How can we reduce the level of inflammation in our body? Staying away from even secondhand smoke can help drop your white count about half of a point. Those that exercise also appear to have an advantage, but you don’t know if it’s cause and effect unless you put it to the test. Two months of Zumba classes—just one or two hours a week—led to about a point-and-a-half drop in white count. In fact, maybe that’s one of the reasons exercise is so “protective.” But is that just because they lost weight?

“Fitness and fatness” appear to both play a role. More than half—51.5%—of obese persons with low fitness have white counts above 6.6. But those who are more fit, or who have less fat, are less likely to be up that high. Of course, that could just be because exercisers and leaner individuals are eating healthier, eating less inflammatory diets.

How do we know excess body fat itself increases inflammation, increases the white count? You’d have to find some way to get people to lose weight without changing their diet or exercise. How’s that possible? Liposuction! If you suck about a quart of fat out of people, you can significantly drop their white count by about a point. So, maybe this should get us to rethink the so-called normal reference range for white blood cell count. Maybe we should revise it downward, like we’ve done for cholesterol and triglycerides.

Up until now, we’ve just based normal values on people that might be harboring significant background inflammatory disease. If you just restrict it to those with normal C-reactive protein, another indicator of inflammation, then instead of normal being 4.5 to 10, maybe we should instead revise it closer to 3 to 9.

Okay, but where did the healthiest populations fall—those not suffering from the ravages of chronic inflammatory diseases, like heart disease and common cancers? Populations eating diets centered around whole plant foods average about 5, whereas in the U.S., at the time, it was closer to 7 or 8. The reason we know it’s not genetic is if you take those living on traditional rural African diets, who are down around 4 or 5, and move them to Britain, they end up closer to 6, 7, or 8. Ironically, the researchers thought this was a good thing—referring to the lower white counts on the uncivilized diet as neutropenic, meaning too few white blood cells. They noted that during an infection or pregnancy, where you really do need more white cells, the white count came right up to wherever necessary. So, bone marrow of those eating traditional plant-based diets had the capacity to create as many white cells as needed but “suffers from understimulation.” They’re just not smoking enough cigarettes and eating as many inflammatory foods.

Similar findings were reported in Western plant-eaters, with an apparently stepwise drop in white count as diets got more and more plant-based. But maybe there are non-dietary factors, such as lower smoking rates, in those eating healthier? What you need are interventional trials to put it to the test. Just 21 days of removing meat, eggs, dairy, alcohol, and junk affected a significant drop in white count, even in people who started out down at 5.7.

Those that started out even higher—patients with rheumatoid arthritis starting up around 7; no change in the control group that didn’t change their diet, but a one-and-a-half point drop within a month on whole food, plant-based nutrition. That’s a 20% drop. That’s more than the drop in inflammation one might get quitting a 28-year pack-a-day smoking habit.

The most extraordinary drop I’ve seen was in a study of 35 asthmatics. After four months of a whole food, plant-based diet, their average white count dropped nearly 60%, from up around 12 down to 5, though there was no control group, and not enough patients to achieve statistical significance.

If white blood cell count is such a clear predictor of mortality, so inexpensive, and reliable, and available, why isn’t it used more often for diagnosis and prognosis? Maybe it’s a little too inexpensive. The industry seems more interested in fancy new risk factors you can bill for.

Here’s a story about a condition that even I have trouble pronouncing.

It’s called hidradenitis suppurativa –a kind of inflammatory autoimmune disease. It turns out that dietary changes can reverse it. Here’s the story.

Hidradenitis suppurativa can be a pretty gruesome disease. Starts out with just like pimples, though, typically along parts of the body where there are folds—armpits, groin, buttocks, under the breast. Then, “painful…nodules form,” which turn into abscesses and drain a “thick…foul-smelling” pus. And then, it gets even worse, forming these active tunnels of pus inside your body.

And, it’s not that rare. An estimated prevalence of like 1 to 4 percent. That’s like 1 in 50. Clothes typically cover it up; so, it remains hidden, but you can often smell the pus oozing out of people. There are all sorts of surgical options and chemotherapy, but why did they even think to try diet for the condition? I mean, you can see Crohn’s disease as a disease of intestinal inflammation, how a food you react to could make things worse; but why a disease of armpit inflammation? Because there seems to be a link between hidradenitis suppurativa and Crohn’s disease. Having one may make you five times more likely to have the other. So, there may be “an immunopathogenic link” between the two. They may share similar abnormal immune responses.

So, if cutting yeast out of Crohn’s patients’ diets helps them, then maybe cutting out yeast might help with HS. A dozen patients with hidradenitis suppurativa put on a diet that eliminated foods with yeast, like bread and beer, and they all got better—12 out 12. “[I]mmediate stabilization of their clinical symptoms, and the skin lesions regressed,” reversed, went away within a year on the diet.

Okay, but how do we know it was the yeast? By cutting out a food like pizza, you also may be cutting out a lot of dairy, and that’s the one other thing that appears to help. “A dairy-free diet” led to improvement in like five out of six patients.

See, these tunnels of pus are caused by the rupture of the same kind of sebaceous glands that can cause regular acne. But, in hidradenitis suppurativa, they explode, and “[d]airy products contain 3 [things] that drive the process” of clogging up your pores, and contributing to the “leakage, rupture, and ultimate explosion.”

First, there’s the casein, which elevates IGF-1 (I’ve got probably a dozen videos on that). Then, there’s the whey and lactose, and third, the hormones in the milk itself: six hormones produced by the cow, her placenta, and mammary glands that end up in the milk. So, why not try cutting out dairy, and see if things improve?

There’s a whole series of nasty drugs you can try to beat back the inflammation. But, as soon as you stop them, the disease can come roaring back. Even after extensive surgery, the disease comes back in like 25 to 50% of cases. So, we are desperate to research new treatment options.

But, patients aren’t waiting. They’re getting together in online communities, sharing their trial and error through social media, and people reported successes cutting out dairy and refined carbs, like white flour and sugar. So, this dermatologist in New Hampshire was like, okay, let’s give dairy-free a try, and 83% of his HS patients he tried it on started to get better, and he didn’t even try cutting out the sugar and flour.

Now, this wasn’t a clinical trial or anything, he just figured, why not? It’s not easy to do a randomized clinical dietary intervention, but that doesn’t stop individual patients from giving things a try. I mean, you understand why there has to be institutional review boards and stuff when they out new, risky drugs and surgeries. But if it’s just a matter of trying switching to soy milk or something, why do they have to wait? “As patients search for an effective path to [clearing this horrible disease], they need support and guidance to follow the most healthful diet available, free of dairy and highly processed sugar and flour. Nothing could be more natural.”

What about the yeast, though? How do we know it was the yeast? And look, 8 of the 12 patients just went through surgery; so, maybe that was why they got so much better. It’s like when I hear someone who has cancer and goes through the conventional chemo/surgery/radiation followed by some quack clinic in Mexico, and then attributes their cure to the wheatgrass colonics or whatever they got. How do they know it wasn’t the chemo/surgery/radiation that saved them? In this study, why do we suspect it was the yeast?

Because not only did every single one of the patients get better; every single one showed “an immediate recurrence of skin lesions following accidental or voluntary consumption of beer or other foods [like bread].” So, not only did the elimination of yeast result in “rapid stabilization” and “complete, regression” of the lesions “within a year,” but, in every single case, take a little brewer’s yeast or something, and within 24 to 48 hours, BAM—symptoms are back. So, that’s why the researchers concluded that “[a] simple exclusion diet could promote the resolution of the skin lesions involved in this disabling and [perhaps actually not-so] rare disease.”

What was the response in the medical community to this remarkable landmark study? “Why was there no mention of informed consent and ethics committee approval…?” Letter after letter saying, wait a second, you violated “the Declaration of Helsinki,” which is like the Nuremburg Code or Geneva Convention to protect against involuntary human experimentation. Yet where was the institutional review board approval for this yeast-exclusion study? To which the researchers replied, look, we just told them to avoid a few foods. We gave them the choice; look, we can put you on drugs that can have side effects, cause liver problems, or you can try out this diet. And “[t]he patients preferred the diet.” Not to mention, I would add, that they were all cured!

Anyway, bottom line, by avoiding foods, like pizza, which contains both dairy and yeast, sufferers may be able to prevent their armpit from turning into stage three of the disease.

To see any graphs, charts, graphics, images, or studies mentioned here, please go to the Nutrition Facts podcast landing page. There, you’ll find all the detailed information you need plus links to all the sources we cite for each of these topics.

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Everything on the website is free. There’s no ads, no corporate sponsorship. It’s strictly non-commercial. I’m not selling anything. I just put it up as a public service, as a labor of love, as a tribute to my grandmother, whose own life was saved with evidence-based nutrition.

Thanks for listening to Nutrition Facts. I’m Dr. Michael Greger.

This is an approximation of the audio content, contributed by Allyson Burnett.