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How Not to Hurt—Live Presentation — Transcript

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0:00"How Not to Hurt Presentation"
0:10So, you are going to be the first audience ever
0:13to see this talk, which is so cool.
0:16At the same time, it's like, I don't have any timing.
0:20I don't know if the jokes are gonna work, you know, so--
0:22But, whereas at the end of the year, you know,
0:25it's memorized, I'm walking around the stage,
0:27and I got it perfect, but by then,
0:29it's like a year old, and so--
0:31Anyway, there's benefits to both, I guess.
0:34(audience laughing)
0:35All right.
0:37Are you ready?
0:39(cheering)
0:44(hums)
0:46Pain is such an epidemic...
0:51that at it's height,
0:53U.S. doctors were handing out
0:55250 million prescriptions a year for opioids
1:01in a country where the entire adult population
1:04was only 240 million...
1:08contributing to the opioid crisis
1:11that may have killed hundreds of thousands of people.
1:16It was a story of good intentions gone bad,
1:20a drug industry gone rogue,
1:22and government watchdog agencies gone to sleep.
1:28What I discovered, writing How Not to Hurt,
1:32is that this same story applies to much
1:37of modern pain management.
1:39A litany of drugs, devices, and procedures
1:42that sometimes do more harm than good,
1:46acknowledged to be worse than useless,
1:49yet continue to this day.
1:54Allow me to run through a few examples
1:56before getting to the good news,
2:00that there are some safe, simple,
2:01side-effect free strategies
2:03that we were just never taught about in medical school,
2:05because there was no corporate budget
2:07driving their promotion.
2:10We can start with over-the-counter painkillers,
2:14like ibuprofen, which may collectively
2:17kill tens of thousands of Americans every year
2:21from ulcers, strokes, heart attacks.
2:25Tylenol is considerably safer,
2:27yet remains the only over-the-counter drug
2:29that leads reliably to death at overdose
2:33from liver failure, though even at so-called
2:37safe recommended doses in healthy volunteers,
2:41about a third experience
2:42clinically significant liver damage.
2:46And surprisingly,
2:48Tylenol may cause similar amounts
2:50of gastrointestinal bleeding
2:53as NSAID drugs like ibuprofen, naproxen, aspirin.
2:56Stick a scope down people's throats,
3:00and you can see extensive damage in the lining of the stomach
3:03and intestines in 90% of individuals taking aspirin,
3:07buffered or not, at the recommended doses.
3:12How many hours does this take for damage to occur?
3:16None. It can happen within five minutes.
3:20No wonder 10-30% of people who regularly take NSAIDs
3:25develop stomach ulcers.
3:29If deaths, from the cardio-- excuse me,
3:32the gastrointestinal toxic effects from NSAIDs
3:35were tabulated separately,
3:38they would constitute the 15th leading cause of death
3:42in the United States.
3:44Something you can buy at any corner store!
3:49Okay, so even over-the-counter drugs can be risky,
3:52but we're willing to swallow risks for effective treatments.
3:57The question is, how effective are they?
4:01For back pain, for example,
4:03the amount of relief from NSAIDS compared to a sugar pill
4:06is considered not clinically relevant,
4:10and they may actually increase the risk of chronic pain.
4:16Treating acute pain with anti-inflammatory drugs
4:19like ibuprofen may ironically prolong the pain.
4:24In other words, "Anti-inflammatory drugs
4:26could cause chronic pain."
4:30Acute inflammation is a natural process
4:33that triggers healing and actually protects
4:36against the development of chronic pain,
4:39which may explain why back pain patients treated with NSAIDs
4:42appear to have a 76% increased risk
4:45of developing chronic back pain.
4:49Anti-inflammatory drugs can cause chronic pain.
4:55You know, we've long prescribed anti-inflammatory drugs
4:57on the very premise, "Look, if we allow the pain to persist,
5:01it could become chronic."
5:03But as a renowned Harvard neuroscientist noted,
5:06this new research suggests
5:07that the complete unexpected opposite,
5:10which is that the inflammation is actually helping.
5:14So, risky, no appreciable back pain relief
5:18and in fact, may even make the pain worse in the long run,
5:21yet these are the recommended drugs.
5:26Effectively all risk, no benefit,
5:28yet these drugs are recommended
5:29in 90% of clinical practice guidelines
5:33for acute back pain.
5:36So, this is the kind of thing that started clueing me in
5:39to the state of modern pain management.
5:44Surely, prescription drugs work, though.
5:50When a senior executive at drug giant GlaxoSmithKline
5:53admitted the dirty little secret
5:56that the "vast majority of drugs" in general
5:59don't work for most people, it set off a media firestorm.
6:03But, "This is of course no news to doctors,"
6:07the editor of a leading medical journal wrote,
6:11acknowledging the open secret
6:13that most drugs are ineffective for most patients.
6:18And it's even worse in the field of pain management.
6:23You know it's bad when the coordinator
6:26of gold standard reviews
6:28on Evidence-Based Pain Management
6:30starts off by quoting Colonel Jessup
6:34from A Few Good Men.
6:37"You can't handle the truth..."
6:43which is that "failure is the norm."
6:49Failure rates of painkillers for osteoarthritis
6:52range from 71-86%.
6:55These are the failure rates for individual patients.
6:58For chronic low back pain, 82-87% failure.
7:03For painful neuropathies, 70-87% failure rate.
7:08And fibromyalgia drugs failed 87-95% of the time
7:14to reduce pain even by 50% after months of treatment,
7:18compared to taking placebo sugar pills.
7:2090% of the time, couldn't even do that.
7:24The analysis concluded that the field of pain medicine
7:28needs to "confront its failings"
7:31and acknowledge that drugs cannot successfully
7:33treat more than a minority of people
7:38with painful conditions.
7:41What about suzetrigine, the first non-opioid painkiller
7:45approved in over 25 years?
7:48Well, it was approved under the same expedited
7:50FDA fast-track approval process as oxycontin,
7:55and it's worth noting
7:56that the last new class of painkillers included Vioxx,
8:00which was pulled from the market after causing
8:03maybe 100,000 cases of serious heart disease.
8:08This was after years of the drug giant Merck
8:11trying to silence critics, drawing up lists of doctors
8:16daring to question the drug's safety
8:18to be neutralized or discredited.
8:23As one executive VP wrote,
8:26"We may need to seek them out
8:28and destroy them where they live.”
8:32Nice.
8:35But hey, suzetrigine works, according to the press release,
8:40causing a clinically meaningful reduction in pain.
8:44An executive VP is quoted,
8:46"Suzetrigine has again demonstrated its potential
8:49to fill an important unmet need in the treatment of pain."
8:52After all, on the drug,
8:53sciatica pain drops from an average of 6 out of 10
8:57and highly significantly drops down to a 4,
8:59whereas the placebo group...
9:02(audience laughing)
9:04...starts out at a 6 out of 10
9:06and highly significantly dropped down to a 4--
9:09Wait a sec.
9:11So, the drug doesn't work at all.
9:17The drug, sold as JOURNAVX for $200,
9:20appears to offer exactly zero benefit.
9:24The press release could have just as accurately touted
9:27a "clinically meaningful reduction in pain"
9:30from sugar pills, right?
9:32Bragging that, once again,
9:35Smarties have demonstrated their potential
9:38to fill an important unmet need in the treatment of pain.
9:42(audience laughing)
9:47What about compounded drugs?
9:50Compounding has become an increasingly lucrative industry
9:53over the past two decades.
9:55Compounding pharmacies prepare custom-made medications,
9:57like topical pain creams,
10:00typically costing thousands of dollars.
10:02After spending six million dollars per day
10:05on these medications,
10:07the U.S. Department of Defense decided to put them to the test.
10:12Hundreds were randomized to pain creams
10:15compounded for all sorts of different pain conditions
10:18and they did not work any better than a placebo cream.
10:23So, basically, millions of dollars wasted every day
10:26on something that couldn't beat out moisturizer.
10:30(audience laughing)
10:32We inject millions of arthritic knees with steroids
10:36that ultimately offer only harm...
10:41making you more likely to end up
10:43having to get a total knee replacement
10:45because of the greater cartilage degeneration
10:49caused by the steroids.
10:51Any extremely short-term pain relief
10:54cannot possibly outweigh the long-term harms.
10:58The best time to have stopped using them was years ago.
11:01The second-best time to stop them is now,
11:04yet we continue to harm millions of patients with them.
11:12It's the same with arthroscopic surgery.
11:14Only documented long-term harms without benefits.
11:19The only actual reason to keep recommending steroid injections
11:23and arthroscopic surgery is the "status quo."
11:26But there is something badly wrong with the status quo
11:32in the treatment of our leading cause
11:34of physical disability among older adults.
11:37The same with steroid injections for tennis elbow
11:41resulting in worse clinical outcomes,
11:44and quadrupling the rate of recurrence.
11:47So, your doctor is not only making it worse,
11:50but quadrupling the chances it comes back.
11:54Now that's a business model.
11:57(audience laughing)
12:00Stop injecting corticosteroids into patients with tennis elbow.
12:05You're actively slowing down the healing.
12:09And a common surgery for tennis elbow is a sham too,
12:14compared to sham surgery, placebo surgery,
12:17where they cut you open, but don't actually do anything.
12:20The same with shoulders.
12:21Steroid injections for shoulder pain
12:23may have deleterious effects on rotator cuff healing,
12:28associated with up to seven times
12:30the rate of subsequent tendon tearing.
12:35Yes, a small, transient pain relief,
12:38but the potential to ultimately make the disease worse.
12:43So, why do doctors keep doing them?
12:47Their widespread use may be attributable to habit,
12:51under appreciation of the placebo effect,
12:53incentive to satisfy rather than discuss
12:56a patient's drive towards physical intervention,
12:58or because they get paid to do it.
13:03And rocking the shoulder surgeon's world,
13:06the most common surgery for shoulder pain
13:08found to be useless
13:10compared to placebo surgery, fake surgery.
13:13No improvement in pain, function, or quality of life,
13:17and, of course, actually worse than useless
13:19because there's always the risk
13:20for rare but serious side effects.
13:23Even surgery journal editorials started to say this surgery
13:27should not even be offered to patients
13:30because truly informed patients,
13:33offered no benefit, only harm,
13:37would avoid it.
13:39We first learned the surgery
13:41was effectively useless back in 1993.
13:43So, surely surgery rates plummeted, right?
13:48Surgery rates just shot up,
13:50and remaining to this day one of the most
13:52frequently performed shoulder surgeries in the world.
13:55How is that possible?
13:58Why would surgeons continue to do
14:00all-risk-no-reward surgeries by the millions?
14:05Why would surgeons be allowed to do them?
14:09Well, there's confirmation bias, the tendency to ignore evidence
14:15that doesn't support your beliefs,
14:16a lack of science literacy, some kind of magical thinking,
14:23as well as "perverse incentives" to operate,
14:26that are just kind of built into the system.
14:29You know, of all the thought
14:31put into disentangling surgeons' conflicts of interest,
14:34the most fundamental conflict
14:37may be the one most seldom discussed, right?
14:39Surgeons like surgery, and the more they operate,
14:45the more most get paid.
14:47And hey, look, if they want to take the moral high ground
14:50and not do an unnecessary surgery,
14:53another surgeon is just gonna step right in and do it, right?
14:57So, why not do it?
14:59A long-time editor of a prestigious medical journal
15:02started his editorial on conflicts of interest
15:05by describing a fantasy.
15:08"Doctors treat patients using simply the best evidence,
15:11and their experience.
15:13They are not influenced by money or self-interest."
15:16"This is, of course, nonsense."
15:22Consider this survey of orthopods.
15:25"Do Surgeons Treat Their Patients
15:27Like They Would Treat Themselves?"
15:30Presented with the same case, they were 80% more likely
15:34to recommend surgery for the patient,
15:36than they would choose to have to undergo
15:38the same procedure for themselves.
15:41The bottom line is that "every year,"
15:45wrote the editor-in-chief of the journal
15:46of the Association of Bone and Joint Surgeons,
15:48"hundreds of thousands of patients undergo unnecessary,
15:52unhelpful, painful procedures."
15:54And a subset of those patients will experience serious,
15:57sometimes catastrophic complications
15:59for operations they never should have had in the first place.
16:06And don't even get me started on how we treat back pain.
16:12(audience laughing)
16:14A magnum opus regarding the evidence on low back pain
16:18in one of the most prestigious medical journals in the world
16:21highlighted the massive gap that exists
16:24between what the evidence shows when it comes to low back pain,
16:28and the actual management in everyday care.
16:32It was a devastating critique,
16:36offering the "dramatic and disturbing messages"
16:40that "much of modern back care is ineffective
16:43or outright harmful,"
16:46leading to a "massive wave of disabling over-treatment
16:50and mistreatment."
16:51Strong evidence that drugs, devices,
16:54diagnostics, syringes, and surgeries,
16:56can be hazardous for most patients with low back pain,
17:01causing "harm to millions across the world."
17:06Sadly, even when treatments are overwhelmingly proven
17:11to be unhelpful or even harmful,
17:13it may take decades for practices to change.
17:18Why do these medical malpractices continue?
17:22Well, back pain is the single costliest chronic condition.
17:27In other words, it's the most profitable.
17:33Key challenges providing evidence-based care
17:35may be the financial interests of payers,
17:38providers, and corporate profiteers.
17:40For example, Pfizer's illegal marketing of gabapentin,
17:45the drug they sold as Neurontin.
17:48Internal documents show, "The campaign involved
17:50the systematic use of deception and misinformation
17:53to create a biased evidence base,"
17:55and to manipulate physicians' beliefs and behaviors.
17:58They pled guilty, but drug sales continue to soar.
18:03They paid a few hundred million in criminal fines, no biggie,
18:08as the drug was bringing in a few billion dollars a year.
18:14The use of these so-called gabapentinoids,
18:17gabapentin and pregabalin, sold as Neurontin and LYRICA,
18:20continue to be prescribed to treat low back pain,
18:24even though they demonstrate a significant risk
18:26of adverse effects without any demonstrated benefit.
18:31It's the same with muscle relaxants like Flexeril,
18:34which continue to be among the most common medications
18:37prescribed for low back pain,
18:39which makes sense based on the published data.
18:43But when researchers included the unpublished trials
18:47that the drug companies tried to sweep under the rug,
18:50about 90% of the benefit vanished into thin air,
18:54turning a respectable drop in pain of 20 points
18:56on a 0 to 100 scale down to a clinically insignificant
19:002 points out of a hundred.
19:02So, appreciable risk with no appreciable benefit,
19:06yet years after this revelation, we're still prescribing
19:10tens of millions of these drugs every year.
19:16To which you say, "Fine.
19:18If I ever have back pain,
19:19I'm going to a back pain specialist."
19:24Queue this paper.
19:26"Doctors with a Special Interest in Back Pain
19:28Have Poorer Knowledge About How to Treat Back Pain."
19:33What?
19:34Physicians who expressed
19:36particular interest in the subject
19:38were more likely to harbor back pain management beliefs
19:43"contrary to the best available evidence."
19:46"These findings raise serious concerns
19:48about how back pain is currently being managed."
19:54Medical device companies pay out more largesse to doctors
19:58than even the drug companies.
20:00Even though it's a much smaller industry,
20:02device manufacturers annually pay out
20:06a total of $900 million
20:09to 200,000 physicians in the U.S.,
20:11compared to the drug pushers
20:13who only gift physicians around $800 million a year.
20:18And the top recipients on that list,
20:20edging out even the orthopedic surgeons who get all the money
20:24from the knee and hip replacement companies
20:25are the neurosurgeons,
20:27who implant the spinal cord stimulators for back pain,
20:33which appeared to offer no benefit
20:36for back pain function or quality of life,
20:38stimulating only revenue.
20:44A surprisingly candid mea culpa editorial
20:48recently described
20:49the "overwhelming influence of industry"
20:52as a defining feature of interventional pain medicine,
20:56a field increasingly seen "as one driven more by industry
21:01than evidence,
21:02and by expedience rather than inquiry."
21:06On a payola-per-device basis,
21:08only coronary stents beat out
21:11implantable spinal cord stimulators.
21:14And based on sham trials, angioplasty and stents
21:18have been shown to unequivocally offer
21:20no benefit for stable angina chest pain.
21:26Wait, how do doctors convince patients
21:29to sign up for these procedures
21:31when they don't lower the risk of death or heart attack,
21:33or offer long-term symptom relief?
21:35Well, apparently, they do it by conveniently failing
21:39to inform their patients that they don't
21:42reduce the risk of death or heart attack
21:43or offer long-term symptom relief.
21:45What they do do, of course, is cause bleeding complications
21:49or damage to the blood vessel in 2 out of 100 people,
21:52and one poor schmuck will suffer a serious complication,
21:56such as a heart attack, stroke, or death.
21:59And during the first year after the stent,
22:02three will have a bleeding event
22:04because of the blood thinners you have to be on
22:05because you have foreign material in your body.
22:08Of course, the blood thinners don't always work,
22:09so two people will have their stent clog up,
22:12leading to a heart attack.
22:14But you don't have to wait to suffer damage.
22:17During the stent procedure itself,
22:19as many as 28% suffer irreparable damage
22:24to the heart muscle, as evidenced by MRI.
22:29Perhaps of even greater concern are the silent mini-strokes.
22:32About 1 in 7 stent patients
22:35come away with new brain lesions.
22:38And these so-called silent infarcts
22:41may actually not be so silent,
22:44contributing to memory loss,
22:46cognitive decline, and dementia.
22:49For stable angina,
22:52stents are all risk, no reward.
22:55Who in their right mind would get them?
22:56Who in their right mind would do them?
23:00Yet even now, after all the evidence is in,
23:02hundreds of thousands of these procedures
23:05are performed unnecessarily every year in the United States
23:08at a cost of billions of dollars,
23:11but billions in cost means billions in revenue.
23:16Risky, worse-than-useless interventions generate
23:20large revenue streams for hospital systems.
23:24It's like, wait, why are hysterectomies
23:27such a popular option for a range of female problems?
23:31Used as a treatment of first resort
23:36for fibroids, for example.
23:39Hospitals are businesses.
23:41It's like an open secret, right?
23:42They have a quota to meet every month,
23:45and the hysterectomy, a "well-priced procedure,"
23:48may seem a reasonable direction for an income boost.
23:52But, all right, back to stents:
23:53"It's been difficult
23:55for physicians to accept the evidence
23:57that, actually, there is no benefit
24:00compared to a fake procedure
24:02in this post-truth science era."
24:06But that's how they figured it out, right,
24:08compared to a fake procedure, compared to sham surgery.
24:12Fake placebo pills test whether drugs are effective;
24:16fake placebo surgeries
24:17test whether procedures are effective.
24:19There have been 25 such trials
24:21involving thousands of patients
24:23comparing various invasive procedures
24:26for the treatment of pain,
24:28most commonly low back pain, angina, arthritis.
24:32The conclusion?
24:33"It seems prudent that invasive procedures
24:36for chronic pain be avoided."
24:40When a former FDA commissioner was asked
24:43at an American Heart Association meeting
24:45whether sham controls should be required
24:47for the approval of all devices,
24:48he replied, "Do you want to get the truth or not?"
24:56Physical therapists
24:58use all sorts of questionable devices
25:02that clinical practice guidelines
25:04recommend strongly against.
25:05Like traction for low back pain,
25:07for which there is overwhelming evidence
25:10that it lacks clinically significant benefit,
25:12yet three quarters of physical therapists
25:15in the U.S. may use it.
25:18Similarly, chiropractic manipulation
25:21may not be all it's cracked up to be.
25:26Manual therapies, like chiropractic, osteopathic,
25:29don't seem to do much better than sham manual therapies.
25:34Or frankly, even compared to doing nothing at all.
25:38But, hey, manual therapy is safer than opioids.
25:45The fact that so many other back pain treatments
25:47are worse than useless
25:49is actually a pretty decent selling point.
25:52I mean, no, like, like, just worthless?
25:56Pfft, I'll take it!
25:57Right? I mean...
25:58(audience laughing)
26:00Back pain pa--and it's actually been tested--
26:02back pain patients going to physical therapists
26:04or chiropractors experience reduced risks
26:08from spinal injections and surgery,
26:10so the primary benefit may be avoiding
26:13the more harmful medical mismanagement of back pain
26:16(in which case, of course, you could get the same benefit
26:18sending them to a witch doctor or something).
26:20You know, right, but...
26:21The bottom line concluded the editorial board
26:24of one of the most prestigious medical journals in the world:
26:27"Over-reliance on drugs or devices
26:29may be spurred on by aggressive industry marketing
26:33and perverse financial incentives
26:35for shorter visits, drug prescribing,
26:37and invasive interventions."
26:41(sighing)
26:43Are you ready for the good news?
26:45(audience laughing)
26:47(applause)
26:51One of the success stories in pain medicine
26:54was the development in the 1990s
26:56of abortive therapies for migraine headaches.
26:58Drugs like sumatriptan, sold as Imitrex,
27:00only fail, like, 57 percent of the time.
27:03Guess what has been shown to work just as well
27:05in a randomized, double-blind,
27:07placebo-controlled clinical trial?
27:09Just an eighth of a teaspoon of ginger powder.
27:12I mean, you can hardly tell the ginger curve
27:14from the drug curve.
27:16In response to the billion-dollar blockbuster drug,
27:1944% of patients were pain-free within two hours.
27:23In response to less than a penny's worth
27:26of ground ginger you can buy at any store,
27:2944% were pain-free within two hours.
27:32There was one significant difference, though.
27:35Fewer side effects in the ginger group.
27:39Cinnamon can help prevent migraines in the first place,
27:44based on a randomized, double-blind,
27:46placebo-controlled trial
27:47found that quarter-teaspoon doses
27:49could significantly decrease migraine frequency,
27:52severity, and duration.
27:54For example, in the placebo group,
27:56pain dropped from about an 8 out of a 10,
27:58down to a 7,
27:59whereas in the group secretly slipped some cinnamon
28:02hidden in capsules,
28:04pain dropped from an 8 out of a 10, down to a 3.
28:09And, no, it was not funded by Big Bark.
28:13(audience laughing)
28:16Prescription drugs
28:19may kill more than 100,000 Americans every year,
28:22making medications a leading cause of death.
28:26So, that's why, you know, doctors are rightly resistant
28:29to changing their clinical practice
28:31based on a some single, small, new suggestive study, right?
28:36But when it comes to something as safe, simple,
28:38and side-effect-free as cinnamon,
28:42what's the downside of telling all our migraine patients
28:46to give it a try, right?
28:48They probably even have it
28:49sitting in their pantry right now.
28:52Even if this cinnamon study was, like, some total fluke,
28:54what's the worst that can happen?
28:57Tastier oatmeal?
28:59(audience laughing)
29:03This is just one of many examples
29:05that you'll find throughout my new book,
29:06simple foods that are safer, cheaper,
29:09sometimes even more effective than drugs.
29:13The reason your doctor never said anything
29:16about these natural remedies
29:17is probably because they never heard of them.
29:19Right, the clinical trials were published
29:21in the peer-reviewed medical literature,
29:23but there are more than a million papers
29:26published every year.
29:28Which of those million
29:31do you think most doctors hear about?
29:34The ones with corporate budgets.
29:36The ones that drug reps tell us about
29:38over their "free" lunch.
29:41Plants aren't profitable
29:44because plants aren't patentable.
29:48The latest migraine drugs
29:50can cost more than $100 per pill.
29:55And don't even work as well
29:57as the common migraine medication sumatriptan.
30:00Patients at risk pay more for less effective drugs
30:05because they're safer.
30:06See, triptan drugs have artery-constricting effects
30:10and may triple one's odds of a heart attack or stroke.
30:13Whereas ground ginger could work just as well,
30:17without the same risks,
30:18and be literally a thousand times cheaper.
30:24But that's the problem.
30:26There's just no money to be made.
30:30No company is going to thrill their stockholders
30:32selling something that costs less than a penny per day.
30:38There are fruits that fight pain,
30:40like figs for painful periods.
30:43There are vegetables that fight pain,
30:45like comforting cruciferous.
30:47Comparing the painkilling effects of kale
30:50versus ibuprofen after wisdom tooth surgery,
30:53a randomized, double-blind split-mouth clinical trial,
30:57and the equivalent of a quarter cup of cooked kale
31:00worked better than taking two ibuprofen.
31:04Even some weeds work.
31:07Anyone recognize this plant?
31:10Oh, look at this smart crowd!
31:14Purslane is one of the most common weeds in the world,
31:16found growing out of cracks in the sidewalk
31:19everywhere you look once you start noticing it.
31:22Pitted against an inflammatory autoimmune condition
31:25known as oral lichen planus,
31:27in which our immune system
31:28attacks the lining of our mouth,
31:30a randomized, double-blind, placebo-controlled trial
31:32found that 83 percent of those in the purslane group
31:35experienced partial or complete clinical improvement,
31:39compared to 83 percent in the placebo group
31:41either not responding at all or getting worse.
31:46In a comparison of the safety and efficacy
31:49of nine different treatments,
31:50including immunosuppressants and steroids,
31:53this simple common weed appears to be the most--
31:56the safest--both the safest
31:58and most effective treatment available.
32:03There are beans that can balm.
32:05A significant improvement
32:07in the joint-and-muscle pains of menopause for soybeans
32:12compared to--comparable to that of hormone therapy.
32:16How about cocoa for claudication?
32:19Cocoa is kind of a bean.
32:20Well, claudication is the crampy calf pain
32:24due to peripheral artery disease.
32:25In the six-minute walk distance test,
32:2934 meters is considered a large meaningful change.
32:33Those randomized to three tablespoons of cocoa a day
32:35got about 43 meters farther
32:39compared to a fake chocolate placebo powder.
32:42And it wasn't just due to improved blood flow.
32:45Muscle biopsies showed the cocoa actually improved
32:48mitochondrial function,
32:49the little power plants within our cells.
32:52Cardiologist commentators concluded
32:54that such studies are insufficient
32:56to advocate "widespread prescription of cocoa"
32:59to peripheral artery disease patients.
33:01I mean, though they concede
33:03the "negligible risk, low costs, potential benefit,"
33:06they demand "further proof."
33:08Now, this makes sense
33:10if we're talking about a new drug, right?
33:14But what's the downside of making your life
33:15just a little more chocolaty
33:18by adding some natural cocoa powder
33:20to your daily diet?
33:21They stress that the "'therapeutic pleasure'
33:24of cocoa consumption must not replace
33:27established standards such as exercise,
33:29smoking cessation,
33:30and vigorous optimization of cardiovascular risk."
33:34I agree, but, wait, who said anything about replacing?
33:39We can do all of the above, right?
33:42That's the nice thing about dietary approaches-
33:45they can be done in addition
33:47to however else we're being treated.
33:50There are even grains for pains.
33:53Less than a quarter teaspoon of wheat germ
33:55hidden in capsules taken every six hours
33:58after vaginal delivery
33:59significantly reduced postpartum pain
34:03and the need for painkillers, compared to placebo.
34:05That's another single-cent strategy.
34:09I go through dozens of different foods and beverages
34:12shown to help in randomized controlled trials
34:13with each specific condition,
34:15but certain foods came up over and over
34:18in chapter after chapter.
34:19In particular, there are seven-and only seven-
34:22that have been shown to help
34:23with three or more different diseases.
34:27I call them my Soothing Seven.
34:29I talk about the dosing for each,
34:31the good side effects, and the caveats.
34:33I already touched on cinnamon for one of the four conditions
34:36it can help with.
34:37Garlic powder is another single-cent solution.
34:41Endometriosis affects millions of women.
34:44What happened when women in pain
34:47were randomized to a daily eighth of a teaspoon
34:50of garlic powder hidden in pills
34:52compared to placebo?
34:54They experienced significant relief of back pain,
34:58pelvic pain, painful sex, and painful periods.
35:02The overall pain of the placebo group
35:04started out at about a 6 or 7 out of 10
35:07and didn't budge throughout the study.
35:10Whereas those secretly slipped just a pinch of ginger powder
35:15started out about the same, but the pain dropped
35:18month after month down to a two out of 10.
35:23Same thing with pelvic pain.
35:26Same thing with back pain.
35:29Same thing with painful periods.
35:31Same thing with painful sex.
35:32A penny-a-day's worth of a spice
35:36that you may already have in your kitchen.
35:41Garlic also protects against two other painful conditions-
35:44and against those who want to suck your blood literally!
35:49A study conducted by the Swedish military
35:51found a significant reduction in tick bites
35:54in soldiers randomized to garlic.
35:58I talked about ginger for migraines.
36:00Less than a quarter teaspoon of ground ginger a day
36:02can also beat out placebo for joint pain.
36:06Researchers conclude that ginger is to be recommended
36:09as a "safe drug" for these patients,
36:11but by "drug," they're just talking
36:13about a couple, you know, pinches
36:15of the ground ginger you can buy at any store.
36:17There was even a study on topical ginger-
36:21at least, when applied to the scrotum.
36:25Paper-thin slices of ginger
36:28applied over the inflamed testicles-
36:30and the researchers were on-the-ball...
36:33(audience laughing)
36:36...healing nearly three times faster than the control group.
36:39(audience laughing)
36:43Next up is turmeric,
36:44the golden spice taking the gold
36:46for the broadest pain-fighting effects,
36:49with randomized controlled trials
36:51showing significant benefit
36:52against nine different pain conditions.
36:56If I had to pick just one to highlight,
36:57a multicenter, randomized, double-blind,
36:59placebo-controlled trial of patients
37:01with ulcerative colitis
37:02that were not responding to a maximum dose
37:06of an anti-inflammatory drug.
37:08And, of course, we know what happens after that.
37:10They can go on for a colectomy.
37:13Okay, so what about adding an anti-inflammatory spice?
37:17A month later, the disease kept raging
37:20in 100% of the placebo group,
37:22zero percent remission,
37:24whereas in the group given the turmeric pigment curcumin,
37:28more than half were in remission.
37:33Berries.
37:35There are studies showing significant pain relief
37:37from strawberries, bilberries, barberries.
37:39Here's one on blueberries for what we used to call
37:43juvenile rheumatoid arthritis.
37:46Two hundred kids randomized to receive a biologic drug
37:48with or without blueberry juice,
37:51equivalent to about a third cup of blueberries a day.
37:55Significantly more kids had a reduction in disease activity
37:59in the blueberry juice group,
38:00compared to the drug-only group
38:02or the placebo juice group.
38:06This resulted in significantly less joint pain, tenderness,
38:10swelling, stiffness, and fatigue,
38:13but not only fewer symptoms,
38:15fewer side effects from the drug.
38:19Compared to the placebo-berry-group-on-the-drug,
38:23those getting the real blueberries
38:25suffered significantly fewer adverse psychological effects,
38:29less nerve inflammation, weight gain, infections,
38:31blood vessel inflammation,
38:33less diarrhea, eye inflammation,
38:35bone marrow failure,
38:36less weakness, chest pain, and chronic cough-
38:38so, about 30 blueberries a day
38:42made the treatment significantly safer
38:44and more effective, right?
38:46This is a great example
38:47of how dietary approaches aren't either/or,
38:50but can support whatever else we're doing.
38:55Flaxseeds.
38:57A soothing seed against four pain conditions,
38:59including cyclic mastalgia, menstrual breast pain.
39:04A tablespoon of ground flaxseeds
39:05versus a ground wheat placebo.
39:08Women in both groups started out
39:10with about a week of breast pain every month,
39:13down to 6 days in the placebo group,
39:15but cut in half, down to just 3 days a month
39:18in the flaxseed group.
39:19In terms of pain severity:
39:2120% drop in the placebo group
39:23versus a 70% drop in the flaxseed group.
39:27There's been four such studies to date
39:30such that the official guidelines
39:32of the Society of OB/GYNs in Canada,
39:34dating back 20 years,
39:37recommends flaxseed as a first-line therapy
39:41for menstrual breast pain.
39:44Flaxseed oil can even be used topically.
39:47Five drops on the front of the wrist twice a day
39:51versus a placebo oil for carpal tunnel syndrome,
39:55not only yielded significant improvements
39:57in pain and function,
39:58but an improvement in nerve conduction velocity,
40:02suggesting it's more than just kind of symptomatic relief.
40:06Also works rubbed on arthritic knees,
40:09significant improvement in pain, function,
40:12quality of life...
40:14Flax--this has been--rubbing flaxseed oil on arthritic knees
40:18has been recommended in traditional medical texts
40:20going back to the Middle Ages,
40:22but it took 'em a thousand years
40:24before it was finally put to the test.
40:28I have a bunch of recipes throughout the book
40:31for both topical and oral remedies
40:33where I tie together
40:34kind of multiple natural treatments together,
40:37but no guarantees they aren't gonna taste
40:40or smell disgusting.
40:41Just gonna have a little note there.
40:44And finally, while I talk about the benefits
40:47of chamomile tea, and nettle tea,
40:48and rose and lavender teas-
40:50soy milk for specific conditions,
40:52the only beverage I could find
40:54that could, um, alleviate three, um,
40:57different pain conditions was green tea.
41:00Uterine fibroids, for example.
41:03Over a period of four months, fibroid volume increased
41:07by 24 percent in the placebo group.
41:09And that's what fibroids do; they continue to grow.
41:13However, those randomized to the green tea
41:16showed a 32% shrinkage of their fibroids.
41:22This then translated into a significant decrease
41:25in symptom severity
41:27and improvements in both quality of life and anemia,
41:30an increase in blood counts
41:32due to reduction in heavy flow.
41:35The dose used in the extract
41:36to disguise the tea in capsules
41:39would be equivalent to about five cups of green tea a day,
41:41or a few teaspoons of matcha.
41:44Plants are powerful.
41:49Where do you think morphine came from, right?
41:52The opium poppy.
41:54Aspirin grows on trees, right?
41:57Originally derived from willow tree bark.
41:59We open up nature's medicine cabinet
42:01every time we pull out the crisper in our fridge.
42:05Okay, what if our entire diet
42:08was centered around whole healthy plant foods?
42:11Well, for chronic migraines,
42:14a whole food plant-based diet may offer
42:15a safe, effective, and permanent treatment
42:18for reversing chronic migraines,
42:20particularly in those with refractory disease.
42:23Prescribing optimal nutrition is also suggested
42:26as a first-line intervention for osteoarthritis:
42:30a diet centered around whole plant foods,
42:32but it wasn't put to the test until 2015,
42:36resulting in a significant reduction of pain
42:39starting within two weeks.
42:43What happened after the study ended though?
42:46In the "Plants for Joints" trials,
42:50hip and knee osteoarthritis patients
42:53randomized to advice to eat a whole food plant-based diet
42:56experienced significant improvements in pain,
42:59stiffness, function, and overall symptoms
43:02and saw similar benefits in rheumatoid arthritis,
43:07a significant reduction in disease activity,
43:10including nearly five times greater odds
43:13of achieving remission.
43:16Now, after 16 weeks, both studies were over.
43:20But 8 months later the researchers followed up,
43:23and at the end of the year,
43:25improvements in disease activity
43:26in both rheumatoid arthritis and osteoarthritis patients
43:29were largely maintained
43:32because many stuck with the diet on their own,
43:35such that half of the rheumatoid patients
43:39and two-thirds of the osteoarthritis patients
43:41were able to decrease or stop
43:43their pain medications altogether.
43:46Plants for joints.
43:50You know, arthritis patients tend to have higher risk
43:53of getting cardiovascular disease
43:56and dying from cardiovascular disease.
44:00And so, as a bonus,
44:02the extraordinary 60% drop in LDL cholesterol you can get
44:08switching arthritis patients to a plant-based diet,
44:10in U.S. units,
44:11that's an 80-point drop
44:14over control from dietary change alone.
44:18An 80-point drop in LDL would be expected
44:20to cut the risk of cardiovascular disease
44:22over a dozen years in half.
44:26So, for arthritis patients, plant-based diets
44:29can be a lifesaver in more ways than one.
44:34And for those with heart disease,
44:37a plant-based diet and lifestyle program
44:39can reduce the frequency of chest pain angina attacks
44:41by 90%.
44:44In contrast to the control group patients,
44:46who were instead told to follow the diet
44:48and lifestyle advice
44:49from their personal physicians,
44:51suffering a 165 percent increase
44:54in angina attacks.
44:55The marked reduction, in frequency,
44:59severity, and duration of angina,
45:03was comparable to that of open-heart surgery,
45:06but without a bone saw bisecting our breast bone.
45:14Dr. Ornish later reflected
45:17that he had thought that his studies
45:18would have a meaningful effect
45:20on the practice of mainstream cardiology,
45:22but he underestimated how much influence
45:25the business of medicine would have
45:27on the practice of medicine,
45:29realizing that reimbursement may sometimes
45:32be a much more powerful determinant
45:33of medical practice than research.
45:36Peripheral artery disease too, impaired walking capacity
45:40from inadequate blood flow,
45:42boosted 5,000% on a plant-based diet
45:46and exercise program over exercise alone...
45:51including a patient who couldn't walk
45:53more than a hundred yards without extreme pain
45:56going on to run marathons.
46:01What about neuropathic pain?
46:0321 diabetics suffering from painful neuropathy
46:07for up to ten years were placed on a whole food,
46:10plant-based diet, and after years of suffering,
46:1317 out of the 21 patients reported they experienced
46:17complete relief from their pain within days.
46:23Now, the study was a live-in program that provided meals.
46:26I mean, what happened after they were sent back home
46:28into the real world?
46:30Those 17 were followed for years,
46:32and in all cases but one,
46:34the relief from their painful neuropathy continued,
46:36or improved even further.
46:39How were the researchers able to achieve such a high degree
46:43of dietary compliance even in an uncontrolled setting?
46:46"Pain and ill health," the researchers wrote,
46:49"are strong motivating factors."
46:51In other words, because the diet worked.
46:55Think about it.
46:57Patients hobble in with one of the most painful,
47:01frustrating, and difficult conditions
47:04to treat in all of medicine,
47:06and three quarters seemed cured in a matter of days
47:09using a natural, nontoxic treatment,
47:11namely, a diet centered around whole healthy foods,
47:14should have been front-page news.
47:18As one commentator wrote,
47:19"The neglect of this important work
47:21by the broader medical community
47:23is little short of unconscionable.”
47:27Of course, the best way to get rid of diabetic neuropathy
47:30may be to get rid of the diabetes.
47:33There's a new diagnostic code in town.
47:36Type 2 diabetes in remission.
47:39And an expert consensus statement
47:40put out by the American College of Lifestyle Medicine,
47:42co-sponsored by the Endocrine Society,
47:45endorsed by the American Association
47:46of Clinical Endocrinology,
47:48concluded that diet as a primary intervention
47:51for Type 2 diabetes can achieve remission in many,
47:55and that diet is most effective in achieving remission
47:58when emphasizing whole plant foods,
48:00with minimal consumption of meat and other animal products.
48:04(cheering)
48:07(applause)
48:12Trigeminal neuralgia. Some of the worst of the worst.
48:17For an average of eight years,
48:19most had severe daily attacks of 9 out of 10,
48:23or 10 out of 10 pain despite medications...
48:27and nearly a third had already gone through
48:29dozens of failed surgeries.
48:32They even included a set of patients
48:33with atypical trigeminal neuralgia,
48:35with "continuous never ending discomfort,"
48:38and put them all on a low saturated fat diet.
48:43Not vegan. They could eat as much, like, skim milk
48:45and Jell-O as they wanted.
48:47But within one month
48:49of cutting down on saturated fat,
48:5296% of those with typical trigeminal neuralgia
48:56had their pain levels drop to lower than 2 out of 10.
49:01And this was after most of them had already reduced
49:03or stopped their medications altogether.
49:07They went from an average pain of more than 9 out of 10,
49:11to an average pain of less than 1
49:14within an average of 16 days
49:18after suffering for an average of 8 years.
49:24Even the continuous pain patients
49:26went from about 9 out of 10 pain down to 2 in a matter of weeks.
49:32The post-surgical patients,
49:34after a total of dozens of failed surgeries,
49:37still suffering severe pain?
49:39Same thing.
49:40More than 9 out of 10, excruciating pain,
49:43down to less than 1 out of 10, which is like, what,
49:46a little paper cut or something?
49:50Now, the post-surgical group
49:52took 20 days to get better instead of 16 days,
49:55but they had been suffering for 11 years straight.
49:58Years of extreme suffering, then 20 days later, gone.
50:04They apparently had the power all along,
50:09but were just never told about a plant-based diet.
50:15Every day of the last decade, they were just 20 days away,
50:19at any time, from being free.
50:26By this time, the study was sent for publication,
50:28patients had been on the low saturated fat diet
50:30for an average of 20 months,
50:31and the only reported side effect
50:33was losing up to 75 pounds.
50:36(audience laughing)
50:38The researchers recognize
50:40that placebo effects could not be excluded,
50:42"although," look, "dramatic and sustained improvements
50:45even in the post-surgical group
50:47with severe and intractable pain
50:50does make it unlikely."
50:52They acknowledge that the results
50:53seem too good to be true
50:55and call for further trials to be performed.
50:59Yet, no such studies have been forthcoming.
51:04How is that possible?
51:06They reported some of the most striking findings
51:08in the entire field of pain medicine,
51:11originally presented in the single most widely read
51:14and highly cited neurology journal in the world,
51:17yet their study was lost down the memory hole.
51:21The only reference to it I could find
51:23in the medical literature was a single mention
51:25in a dental journal back in 2014.
51:29Plants are powerful,
51:30but there's just no money to be made.
51:35What about inflammatory bowel disease?
51:40Mitsuro Chiba, IBD Chief at a hospital in Japan,
51:46noting a correlation between the increase in animal foods
51:50and the 400-fold explosion
51:53in Crohn's disease in his country,
51:55decided to put plant-based diets to the test
51:58and found they appeared to beat out everything else out there.
52:04Not only did they find that plant-based diets
52:07were effective for all degrees of severity,
52:10in both Crohn's disease and ulcerative colitis,
52:12they achieved far better outcomes
52:16in both ulcerative colitis and Crohn's disease,
52:19compared to current standard therapy
52:21in both the induction phase
52:22and quiescent phases of both diseases.
52:25Lower relapse rates for ulcerative colitis,
52:29compared to conventional treatment.
52:31Higher induction of remission
52:33with biologics in Crohn's disease,
52:36compared to conventional treatment.
52:38And higher relapse free rates 10 years later,
52:42compared to conventional treatment.
52:46Plant-based diets, they conclude,
52:47are unreservedly recommended for Inflammatory Bowel Disease.
52:52Of course, plant-based diets would be advisable
52:55even if they didn't help at all because cardiovascular disease
52:58is the leading cause of death, of IBD patients,
53:01in fact disproportionately so.
53:04And the heart-healthiest diet,
53:06the one capable of even reversing
53:08the progression of cardiovascular disease,
53:11is a plant-based diet.
53:13So, the bar isn't just low
53:15for recommending IBD patients follow a plant-based diet.
53:18I mean, it'd have to be actively harmful
53:20to justify not endorsing it.
53:22Instead, it's not just helpful.
53:25There's evidence to suggest eating plant-based
53:27may be the single most effective
53:29IBD treatment ever published in all of medicine.
53:34A real-world study of advanced therapies,
53:37for severe ulcerative colitis
53:39using some of the latest biologic drugs
53:42described their efficacy rate of 30% as "satisfactory."
53:48Dr. Chiba published a response in the journal,
53:52noting his plant-based protocol was far more effective,
53:55not to mention safer and cheaper.
53:57In reply, the lead author of the study,
54:00for which the conflicts of interest with Big Pharma
54:03took up nearly an entire page...
54:06countered that patients should be able to decide for themselves
54:10on the content of their meals based on their own preferences.
54:15Of course, patients should be able to decide
54:18on what to put in their stomachs and lungs, for that matter.
54:22The question is what we, as doctors,
54:24should be recommending.
54:27If these researchers were truly interested in patient autonomy,
54:33they would disclose all the available options
54:35and let patients decide for themselves.
54:39One of the wonderful things about lifestyle improvements
54:42is that they aren't either/or.
54:43We can eat more healthfully
54:45in addition to whatever other interventions we may choose.
54:48But patients are robbed of this choice
54:50when they're not fully informed of the power of their fork.
54:54Dr. Chiba laments that it may take a few decades
54:57to accept plant-based diets for IBD in the guidelines.
55:00I mean, it's a pity that the majority of patients
55:03are not told about eating plant-based
55:05and are suffering from the disease.
55:08Now, not all responses in the medical literature
55:11to Dr. Chiba's groundbreaking work
55:13were as defensive.
55:14The authors of a landmark special report
55:17on lifestyle medicine published in the journal
55:19of the largest nonprofit
55:20healthcare organization in the U.S. wrote,
55:23"Dr. Chiba and colleagues have made a major contribution
55:26to moving healthcare forward with their extensive work
55:29in the field of IBD.
55:30We are totally in concurrence
55:32with their conclusion that dietary guidelines,
55:34focusing on a whole food, plant-based diet
55:37as treatment for chronic diseases
55:39is not only needed, but must be implemented."
55:45Let me close with an amazing fact...
55:51about the human body.
55:54Nearly every year, we are reborn.
55:59We destroy, and create anew,
56:02our entire body weight in cells about every year and a half.
56:08Every second of every day,
56:11about four million of our cells die
56:14and about four million new cells are born.
56:17Every second!
56:19We replace about 300 billion cells every day.
56:23Now some cells, like heart cells,
56:26can last for years, and a few,
56:27like some of the cells in our brain,
56:29in the lenses of our eyes, can last a lifetime.
56:32But the other 99.5% of the cells in our body
56:36are continuously replaced.
56:40What are they replaced with?
56:45Every new cell in our body is ultimately made up
56:48of only three things.
56:50Air, water, and food.
56:53Those are essentially the only inputs.
56:55The air we breathe, the water we drink,
56:57and the food we eat.
56:59We are what we eat, literally, physically.
57:03No wonder our dietary choices
57:05can have such a profound influence
57:08on the functioning of our bodies.
57:10In a sense, our body has to re-form itself
57:13about every 18 months with the building materials
57:15that we deliver to it through our stomachs.
57:19Our mouths are like the access road
57:22to the continual construction site that is our body.
57:28Trucks roll in three times a day.
57:31What do we want them to deliver?
57:34Do we want to buy some cheap,
57:36shoddy building materials at the drive-through?
57:39(chuckles)
57:41Or do we want to build our foundation solid?
57:45Each of us lives inside
57:48the greatest known architectural structure in the universe.
57:54Let us not ruin such grand blueprints by consuming crap.
58:01The power to live a long healthy pain-free life
58:04may lie in our pantry.
58:07And the nice thing about side-effect-free strategies
58:09is, look, you can just give 'em a try
58:10and see if they help, right?
58:12You have nothing to lose but your pains.
58:16Okay. So, I was only able to cover about 60 studies.
58:20If we can actually put back my slides up.
58:24How Not to Hurt ended up
58:26with over 6,000 citations.
58:31So, I was only able to cover about 1% of the book today.
58:35For the other 99%, please feel free
58:37to check it out from your local public library.
58:40It does go on sale in December, but you can pre-order it now.
58:43And if you do choose to buy it,
58:45know that all proceeds I receive,
58:46every penny from the sales of my books,
58:48goes directly to charity.
58:50I just want you and your loved ones
58:52to live long healthy lives, free of suffering.
58:56Thank you.
58:57(applause, cheering)
59:15Thank you.
59:17Before I go, if you would like me
59:19to come speak in your city, at your hospital,
59:22to your community group, please reach out.
59:24I'm booking my 2027 book tour now
59:27and would love to reach your neighbors, your colleagues.
59:29Go to see.nf/speaking.
59:31That's see.nf/speaking.
59:34Thank you so much, everybody!
59:37(cheering)
59:40Do you time for questions?
59:42Oh! Yeah! I love questions! Oh, let's do it.
59:45We do have time for a couple of questions.
59:47Uh, well, thank you so much, Dr. Greger,
59:49for sharing some of your research.
59:53So, say a patient is kind of starting at ground zero.
59:57They're in a lot of pain.
59:59They're following the standard American diet.
1:00:02Where do they need to start?
1:00:04-Where are they going to start? -Yeah.
1:00:06Well, you know, I don't know if you know this,
1:00:08there's this amazing organization
1:00:10called Physicians Committee for Responsible Medicine.
1:00:13They have all these resources.
1:00:14There's the Clinicians Guide to Nutrition.
1:00:16Oh, my God. Check it out, pcrm.org.
1:00:21And say someone's already following
1:00:23the whole food, low-fat plant-based diet.
1:00:25Is there-- of the Soothing Seven,
1:00:27say specifically for migraines,
1:00:30or if they're having a specific type of pain,
1:00:34is there any that's giving the most benefit?
1:00:36-Any of the Soothing Seven-- -Oh!
1:00:37No, absolutely. So, I mean, so,
1:00:39I mean, the Soothing Seven are really just
1:00:41for things that we actually don't have any diagnosis for
1:00:44or one of the conditions is not covered by the book.
1:00:46But I have a whole chapter on migraines.
1:00:48So, you go straight to the migraine chapter
1:00:50and you just do all the things that help with migraines,
1:00:52many of which only help with migraines
1:00:54or one or two conditions,
1:00:55so they never made the Soothing Seven,
1:00:56but I go through dozens of different foods
1:00:58that work for different conditions.
1:00:59And, look, maybe they'd help for something else.
1:01:02But they just haven't been tested yet.
1:01:04I mean, we're kind of limited
1:01:06to the available data that we have.
1:01:09Perfect.
1:01:10And how quickly--I think I heard you say it.
1:01:13Is it true within even a couple of days
1:01:16that people will notice measurable decreases in pain?
1:01:20Well, it depends on the condition
1:01:22we're talking about.
1:01:24But, yeah, I mean, as I mentioned,
1:01:25there's just these remarkable, right?
1:01:27So, osteoarthritis, the leading cause
1:01:28of physical disability among older adults, right?
1:01:31Within two weeks, significant reduction in pain.
1:01:33Amazing. And then, right, it just gets better
1:01:36the longer people stay with this.
1:01:38And so, actually, the studies,
1:01:39most of these are relatively short-term studies,
1:01:42lasting only months.
1:01:44And remember, like, that amazing--
1:01:48The endometriosis study, right?
1:01:51Where with a little pinch of garlic powder,
1:01:53and it's like every single month,
1:01:54better, better, better, better.
1:01:56And then, at the end of four months,
1:01:58it was like a straight line decrease.
1:01:59What happened to month five? Do you think it went back?
1:02:01I mean, presumably, right,
1:02:04that's when they stop the study, right?
1:02:08And so, we would presume
1:02:10that whatever mechanism is going on.
1:02:12And you know, for many of these foods,
1:02:13we just don't know, like,
1:02:14why does kale beat out ibuprofen?
1:02:16Like, what is in cruciferous
1:02:18that's so pain-killing, or anti-inflammatory?
1:02:20I mean, we presume it's an anti-inflammatory effect.
1:02:23But for many of these, we actually don't know.
1:02:25And frankly, it's like, "Who knows, who cares," right?
1:02:29I mean, if you're in pain, like, you know,
1:02:30in fact, the publisher came to me and says,
1:02:32"Okay, you're doing a book on pain. All right.
1:02:34I want a chapter on, like,
1:02:36describe the nervous system, the central nervous system,
1:02:39you know, how pain signals work, and blah, blah, blah."
1:02:41I'm like, "Oh, come on. No. Screw that.
1:02:44I'm going straight to the practicals.
1:02:46If you're in pain, you're not gonna be like,
1:02:48'Oh, this is nociceptive pain.'
1:02:50No! Give me, you know."
1:02:52And so, it's just practical, practical, practical.
1:02:54This is what--you have this, do this, try this.
1:02:57And it's like, what level of evidence,
1:02:59I mean, many of these, there's really just one trial.
1:03:01You know? I mean, yes, it may be a randomized,
1:03:03double-blind, placebo-controlled trial,
1:03:04kind of the gold standard of evidence,
1:03:06but it's just one little trial.
1:03:07Maybe it only had, you know, a couple dozen people in it.
1:03:09But again, like, how much evidence do you need
1:03:11to try something with literally no downsides,
1:03:13and in many cases, it's healthy anyway.
1:03:15So, it's like, "Look, blueberries!"
1:03:17Feeding blueberries to kids, healthy anyway.
1:03:20So, the fact that it also just happens to, you know,
1:03:23significantly improve the effect of this drug,
1:03:26decrease the side effects is just, like,
1:03:29"Maybe that study was a total fluke!"
1:03:32Just crazy out of nowhere and, you know,
1:03:34one-in-a-million kind of thing.
1:03:36And the blueberries didn't help at all.
1:03:37Guess what? Blueberries are still gonna be good for kids.
1:03:40Right? And so, it's like, what do you need?
1:03:43(audience laughing)
1:03:45Absolutely.
1:03:46And in your research,
1:03:47were there any seemingly healthy plant-based foods,
1:03:51or foods that we should be aware of
1:03:52that were triggering any type of--
1:03:55Oh, interesting. Yeah.
1:03:56So, I mean, this talk, and this is kind of a, you know,
1:04:01a strategy that many of us use to talk to our patients.
1:04:04You know, they come to us and they think
1:04:05we're gonna be, like, wagging our finger,
1:04:07"Don't eat this. Don't eat this favorite food.
1:04:08No more pepperoni pizza, blah, blah, blah."
1:04:10And so, you know, one of the strategies we use
1:04:13is to be like, "No, no, no.
1:04:14Just, let's add some--
1:04:17you know, how about eating an apple
1:04:18before every lunch and dinner?
1:04:19And they're like, "That's a little weird.
1:04:21Oh, I'm eating more food? Oh, okay."
1:04:23Or, you know, "How about drinking
1:04:25a few glasses of water, blah, blah, blah."
1:04:26And you start like that as kind of a soft entry.
1:04:30And so, from this presentation, you'll notice,
1:04:33I'm just talking about all the good foods,
1:04:35but there are lots of proalgesic--
1:04:38you know, there's analgesic, pain-killing.
1:04:40There's proalgesic foods.
1:04:41There are foods that actually increase pain.
1:04:43So, I've talked a little bit--
1:04:44Like, the reason a saturated fat lowering diet helps
1:04:46is because saturated fat
1:04:48has been causing all this suffering.
1:04:51And so, there certainly are a lot of things that you take,
1:04:57like sodium plays a role
1:04:59in many auto-immune inflammatory processes.
1:05:02You can get remarkable benefits for psoriasis
1:05:04and psoriatic joint pain by decreasing sodium
1:05:08and all sorts of, you know.
1:05:11But in terms of, well, wait a second,
1:05:12we're gonna need, like, good foods, that maybe...
1:05:16Well, so, no.
1:05:17And Hana actually talked about this
1:05:19a little bit on the panel
1:05:21that some people have these idiosyncratic food intolerances.
1:05:24So, they aren't allergies.
1:05:26Like, you don't have IgE reaction to this.
1:05:29They aren't typical allergies.
1:05:31But you can do these blinded food challenge trials.
1:05:37So, you take people and so, for example,
1:05:39you cut out dairy, which is kind of the typical example,
1:05:41and all of a sudden, they feel amazing, you're like,
1:05:43"Oh, maybe that's the placebo effect."
1:05:45You changed your diet, you know...
1:05:47And you could have a control group, but still, who knows?
1:05:49So, what you do is you give them a blinded food challenge.
1:05:50You give them, you know, skim milk powder in capsules,
1:05:53versus cornstarch or something.
1:05:55And all of a sudden, "Oh, my God,
1:05:57the flaring, all of the symptoms have come back."
1:05:58And you're like, "Okay, now we know it's dairy."
1:06:00And this is the case.
1:06:02So, for example, like 1 in 20 people
1:06:04with joint pain feel better
1:06:06cutting out nightshade vegetables, right?
1:06:08Tomatoes and eggplant, bell peppers and stuff,
1:06:12which is fantastic news.
1:06:14Oh, my God. If you have joint pain,
1:06:17you would wish that you'd live in a planet
1:06:18where all you have to do is a simple dietary change
1:06:20and all of a sudden, you feel better.
1:06:21That's amazing, right?
1:06:22So, hey, worth a try.
1:06:24I mean, that kind of thing, literally.
1:06:25So, I go through-- So, some of the--
1:06:27So, most of the common triggers are what you expect.
1:06:29Like, meat and dairy and eggs,
1:06:31and whether it's the pro-inflammatory
1:06:33like the arachidonic acid
1:06:35or who knows what--
1:06:37But, you know, corn, in some cases,
1:06:41or particularly some of these New World foods
1:06:45that we didn't necessarily evolve
1:06:47eating a lot of in kind of Sub-Saharan Africa.
1:06:52And so, it's worth doing--
1:06:54So, I have this whole thing about elimination diets, right?
1:06:57So, if you go on, you know, there's various--
1:07:01I talk about various methods.
1:07:02But so a few, like, just stopping everything
1:07:04but, like, water, sweet potatoes,
1:07:06and tapioca or something.
1:07:08And all your pain, which is basically things that,
1:07:10like, no one is really sensitive to.
1:07:12And all of a sudden, all your pain goes away.
1:07:14You're like, "Holy shit.
1:07:15Something about the diet is doing it.
1:07:17We don't know what.
1:07:18Now, if you do that, and your pain stays the same,
1:07:21well, obviously, diet is not playing
1:07:23a significant role, right?
1:07:24But if all of a sudden, two weeks later, like,
1:07:26you feel amazing like you never have,
1:07:29then you're like, "Oh, my God, okay."
1:07:31So, then, what do you do?
1:07:32You start adding back food groups.
1:07:34And so, you start with, like, the most common culprit.
1:07:38It's because you want to determine what to eat first
1:07:39and not wait, like, three years in,
1:07:41"Oh, now I know that I could," you know.
1:07:43And so, you start with the common culprits.
1:07:45Okay, so then, you know, you add back this,
1:07:47and you're looking for the symptoms
1:07:48to come raging back.
1:07:50And so, and we hope to find that one thing.
1:07:53And sometimes, it can be some crazy, you know,
1:07:56"Oh, this person has some weird corn reaction,"
1:07:59which is not, I mean,
1:08:01corn is in so many foods that, I mean,
1:08:02it can be a difficult--
1:08:03But what a miracle for these people.
1:08:06And so, there's just a protocol where every few days,
1:08:08you've got to make your food group,
1:08:09you do it in this order,
1:08:10and see if you can actually determine
1:08:12what is causing it.
1:08:13And sometimes, it really is.
1:08:14I'm like, "What?
1:08:15You can't eat bananas? Okay. Don't eat bananas."
1:08:18Like, amazing. That's awesome. Yeah.
1:08:21Awesome. Well, another round of applause for Dr. Greger.
1:08:23-Thank you so, so much. -Thank you!
1:08:25(applause)

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