Michael Greger MD

Michael Greger MD

Posted November 26, 2011

Published in Health

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Ask the Doctor: Q&A with Michael Greger, M.D. (Week 10)

Read More: algae, alkaline water, American Heart Association, amyloid, apple juice, baking soda, chicken, cholesterol, DDT, Dukan Diet, fish oil, flax, Gardein, krill oil, milk protein, nuts, obesity, plant-based diet, Quorn, salt, sodium, soy protein, strokes, veggie chicken, vitamin D

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This is another sampling of the more than 700 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 And remember, there’s a new video posted every weekday, so to make sure you don’t miss any:

maybush1 asked on Dietary guidelines: with a grain of Big Salt: Hello Dr. Greger, I was curious about your take on a new report of a recent study ( that appears to demonstrate possible heart health issues with a low-salt diet (increases cholesterol, increases fat, increases hormone levels). It also appears to be adding to previous studies showing similar results. Thanks for any information you can provide.

None of the studies over 4 weeks in length noted in the review cited by MSNBC showed any negative effects on cholesterol and in fact the American Heart Association (AHA) has just gone further and recommended that everyone shoot for 1500 mg a day (not just those at high risk). According to the AHA, cutting American sodium intake 1,200 mg per day could lead to as many as 66,000 fewer strokes, almost 100,000 fewer heart attacks, and up to 92,000 fewer deaths. It’s hard to get down to the recommended 1,500mg a day, though, unless one sticks to an unprocessed plant-based diet.

 wickedchicken asked on Milk Protein vs. Soy ProteinJust wondering what was their definition of a “handful” of nuts? 25 grams? 8 nuts? Big difference in opinion from one person to the next as to what is a “handful”. Many thanks.

“Handful” of nuts typically refers to an ounce. So that’s like 23 almonds, 14 walnut halves, or 21 filberts. The USDA nutrient database is the go-to place for weight (and nutrient) measurements:

Stacia asked on Vitamin supplements worth takingI just watched your newest video and it was fantastic as usual. The segment about the adult requirement of 2000 units/day for Vitamin D was interesting and helpful. Can you please tell me what a child’s requirement is likely to be? We have a three year old.

I’m so glad you’re finding the videos useful. The official (Institute of Medicine) recommendation for those over 1 year of age is 600 IU a day of vitamin D. In two weeks I’m going to be rolling out a series of vitamin D videos from my volume 6 DVD–stay tuned! (if you can’t wait, I have a special holiday sale on my Latest in Nutrition DVDs–all proceeds to charity, of course).

yummy asked on DDT in Fish Oil SupplementsJust wondering if Krill Oil supplements are any better than fish oil capsules. Do you have any suggestions on the best way to get the benefits of fish without actually eating it?

The longest study I could find done on krill oil was only 3 months in duration, so long-term effectiveness and safety is unknown, but recent short-term studies suggest that krill oil would have comparable bioavailability and metabolic effects. They are lower on the food chain and would be expected to have lower levels of accumulated pollutants, though an upcoming paper in Environmental Pollution suggests that they do take up DDT metabolites. When it comes to industrial toxins, always seek as low as you can go on the food chain, in this case algae that produce bioequivalent long-chain omega-3′s. Check out videos like Algae-Based DHA vs. Flax and The Problem with Organic Salmon.

As an aside, you never know what you’re going to run into in the medical literature. In looking up krill oil for you I stumbled across a paper in the Journal of Plankton Research published this year (with pictures!) entitled: Ocean-bottom krill sex.

 wickedchicken asked on Plant protein preferableI feel sorry for people’s bodies if they are on the Dukan Diet. Logic is clearly out the window when it comes to weight loss diet desperation.

The Dukan Diet appears to be a European spin-off of the Atkins Diet. The UK National Health Service just highlighted that the Dukan Diet is the fad diet to avoid this holiday season, citing the British Dietetic Association’s conclusion that it is “ineffective and without scientific basis.” I wrote a whole book about these types of diets, Carbophobia: The Scary Truth Behind America’s Low Carb Craze, available free, full-text at

Harmony asked on Algae-Based DHA vs. FlaxIs there any information that can help with glaucoma. The drops are sight saving. what nutritionally can counter any side effects of glaucoma drugs such as cosopt.

A review of complementary and alternative treatments for glaucoma was published this year (available here). Unfortunately, as you’ll read, the evidence is scarce. In terms of minimizing side-effects, probably the most important thing is to avoid allowing the tip of the dropper to come in contact with your eye or hands or anything (it can become contaminated with common bacteria that can cause eye infections). If you do experience eye redness, pain, or swelling, discontinue it and call your doc at once. If I find any new information coming out on effective alternatives I will definitely let you know!

wickedchicken asked on Alkaline water: a scam? [...] I wish they said what constituted a “large amount”…. yikes.

Sodium bicarbonate (baking soda) intoxication can be devastating, especially in infants. The 1995 paper “Baking Soda: A Potentially Fatal Home Remedy” in Pediatric Emergency Care led Arm & Hammer to start placing warning labels against use in children under 5 on all their cartons. Too much bicarbonate can overwhelm our kidneys’ ability to excrete it, leading to a metabolic alkalosis, which can lead to seizures or even death. To answer your question, as little as a few pinches can sicken an infant, but based on the series of case reports in adults it appears to take tablespoons for folks with normal kidney function to get into trouble. This is why I encourage anyone trying the three-quarters-of-a-teaspoon-per-quart of water regimen to do it under the supervision of a physician to make sure you don’t have a condition that would preclude such a trial. And there are other ways to lower blood pressure without fear of toxicity: see, for example, my video Fill in the Blank.

wickedchicken asked on Does eating obesity cause obesity? There is so little visible fat on chickens e.g. a skinless chicken breast. I don’t see how it’s such a high ratio.

Much of the fat in chicken is in the muscle (meat) itself, what’s called intramyocellular lipid, where droplets of fat build up inside the muscle cell itself. In fact that’s why chickens are used as experimental models of human obesity, since the buildup of fat inside our own muscles is thought to contribute to the insulin resistance associated with type 2 diabetes, and chickens are one of the few animals fat enough to mirror our obese population. This month in the medical journal Stress, for example, a team of Chinese scientists found that stress hormones may actually facilitate this process of fat accumulation within the muscles of chickens, raising the question of whether the conditions in which most chickens are raised these days may indeed be making their nutritional profile even worse as suggested in the “Modern Organic and Broiler Chickens Sold for Human Consumption Provide More Energy from Fat than Protein” article I profile in the Does Eating Obesity Cause Obesity? video.

Meha asked on Amyloid and apple juiceOk, this is the sixth. I want to know all the top 10. Someone told me no tobacco, no alcohol, no animal products and regular workout is enough to avoid the top 10. Is that true?

If you click on the Sources Cited section under the video you can read the latest CDC report on top causes of death in the United States. The top 10 are 1) heart disease, 2) cancer, 3) COPD, 4) stroke, 5) accidents, 6) Alzheimer’s, 7) diabetes, 8) pneumonia, 9) kidney disease, and 10) suicide. So being a nonsmoker who exercises and eats a plant based diet would certainly dramatically reduce your risk of the majority of these, but you’d still be advised to wear your seat belt, bike helmet, check your smoke detector, etc. For more on maximizing your longevity check out my 37 videos on mortality.

wickedchicken asked on Chicken vs. Veggie ChickenIs this a soy-based or mycoprotein-based fake chicken???? I don’t eat any soy, but I do eat some mycoprotein (QUORN). Would love your opinion on it.

Great question wickedchicken (and true to your namesake :). Gardein (from “garden + protein”) is a soy and grain (wheat, amaranth, millet, quinoa)-based product. Quorn is more like (though technically not) mushroom based. Unlike Gardein, Quorn has a little saturated fat and cholesterol (has some egg and milk products mixed in). Quorn has more sodium, less protein, and comparable fiber, but regardless, both are superior to chicken for a variety of reasons (e.g., see my 40 videos on chicken).

-Michael Greger, M.D.