If sugar consumption is considered to be the one and only cause of cavities, can we have any sugar? How much is too much? 

Dental cavities may be humanity’s most prevalent disease, affecting 35 percent of the global population. The average number of decayed, missing, and filled teeth has been estimated at more than two by the age of 12. In the United States, the oral health of our elderly may also be in a state of decay, with one in four missing all of their teeth. “In terms of economic costs,” it is estimated that $100 billion is spent on dental diseases due to sugar consumption.  

As I discuss in my video How to Stop Tooth Decay, sugar consumption is considered to be the one and only cause of cavities. It is often referred to as a multifactorial condition, with other factors including bacteria, plaque, saliva, brushing, and flossing. However, those factors appear to have only mitigating influences. All of those other factors simply modify the speed by which sugar causes cavities. “Without sugars, the chain of causation is broken, so the disease does not occur.” 

“Numerous studies from decades ago showed that in countries where sugar consumption was very low, dental caries [cavities] was almost non-existent,” and “new analyses show that the life-long burden of caries increases as sugar intakes increase from 0%E [zero]…The most comprehensive national data are from…Japan…before, during and after World War II,” where the incidence of cavities tracked per capita sugar intake as it dropped from about 8 percent of calories down to just 0.1 percent, which is less than a teaspoon a week, before rebounding up to about 14 percent. Such studies show that cavities continued to occur even when sugar intake comprised only 2 to 3 percent of caloric intake. Given that more extensive disease in adults doesn’t appear to manifest if sugar intakes are limited to less than 3 percent of caloric intake, a public health goal to limit sugar intake to below 3 percent has been recommended. This led to the suggestion that traffic-light food labels be used to mark anything above 2.5 percent added sugars as “high.” That would make even comparatively low-sugar breakfast cereals such as Cheerios “red-light” foods. 

The recommended 3 percent cap on total daily intake of added sugars wouldn’t even allow for young children to have a single average serving of any of the top ten breakfast cereals most heavily advertised to them, which you can see below and at 2:21 in my video. Obviously, soda is off the table. One can of soda has nearly two days’ worth of added sugar. 

The American Academy of Pediatric Dentistry adopted the more pragmatic goal of recommending sugar intake stay below 5 percent for children and adolescents, matching the World Health Organization’s conditional recommendations for both children and adults. That’s about where added sugar consumption dropped in Iraq when they were under sanctions, and cavity rates were cut in half within just a few years. Of course, the sanctions may have cut other things, too, like the lifespan of children, though that was apparently fake news—a consequence of the “government of Iraq cleverly manipulating survey data to fool the international community.” 

If we were really interested in minimizing disease, the ideal goal would be to drop the intake of free sugars (meaning added sugars) to zero. These are not the sugars naturally found in breast milk or the intrinsic sugars in fruits. When it comes to the intake of added sugars, there does not seem to be a “threshold for sugars below which there are no adverse effects.” An exponential increase in cavity rates can begin for sugar intakes starting as low as 1 percent.  

A Kellogg’s-funded researcher agreed that we might be able to get rid of cavities if there was no sugar in the diet, but suggested that “this ideal is impractical.” The “dictatorial use of foods ‘friendly to the teeth’…might promote a philosophy of dietary celibacy…[that] would not be applicable or acceptable to all individuals.”  

“Instead of recommending draconian reductions in the amount of sugars intake,” the sugar industry responded that “attention would be better focused on…fluoride toothpaste.”  

That’s the perfect metaphor for medicine’s approach to lifestyle diseases in general. Why treat the cause when you can just treat the consequences? Why eat more healthfully to prevent and treat heart disease when we have all of these statins and stents? 

Not all sugars are created equal. To explore this topic, see my videos Flashback Friday: If Fructose Is Bad, What About Fruit? and Flashback Friday How Much Fruit Is Too Much?.

To gain a sense of how powerful the sugar industry is, check out my video Big Sugar Takes on the World Health Organization. 

For more on dental and oral health, see the related videos below. 

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Strokes are one of the leading causes of death and disability in the world. They are the most common cause of seizures in the elderly, the second most common cause of dementia, and a frequent cause of major depression. In short, stroke is a burdensome—but preventable––brain disorder.

 

What Causes a Stroke?

Strokes can kill instantly and without warning. Most can be thought of as “brain attacks”—like heart attacks, but with the rupturing plaques in our arteries cutting off blood flow to parts of the brain rather than parts of the heart.

Nearly 90 percent of strokes are ischemic, from the Latin ischaemia, meaning “stopping blood.” Blood flow to part of the brain gets cut off, depriving it of oxygen and killing off the part fed by the clogged artery. A small minority of strokes are hemorrhagic, caused by bleeding into the brain when a blood vessel bursts. People who experience a brief stroke may only contend with arm or leg weakness, while those who suffer a major stroke may develop paralysis, lose the ability to speak, or die.

The blood clot may last only a moment—not long enough to notice but still long enough to kill off a tiny portion of our brain. These “silent strokes” can multiply and slowly reduce cognitive function until dementia fully develops.

 

How to Prevent a Stroke

According to the Global Burden of Disease Study, the largest study of risk factors for human disease in history, funded in part by the Bill and Melinda Gates Foundation, more than 90 percent of the stroke burden is attributable to modifiable risk factors. For example, about 10 percent of all healthy years of life lost due to stroke may be due to ambient air pollution. Moving away from a city to a more rural area with cleaner air is an option to modify that risk factor, but it may be easier to quit smoking, which accounts for 18 percent of the stroke death and disability. As I discuss in my video What to Eat for Stroke Prevention, diets high in salt are as bad as smoking when it comes to stroke burden, but not as harmful as inadequate fruit and vegetable consumption. Other factors, like sedentary lifestyles, are at play, but they aren’t as bad as not eating enough whole grains, for instance.

As with heart disease, a plant-based diet can reduce stroke risk by reducing cholesterol and blood pressure, while improving blood flow and antioxidant capacity. Most of the studies on plant-based dietary patterns have found a protective effect against stroke, whereas those looking at Westernized eating habits based more on animal foods, added sugars, and fats have found a detrimental effect.

Yes, wrote the director of the Stroke Prevention & Atherosclerosis Research Centre, “learning to make vegetarian meals every other day is a tall order for most North Americans, but is feasible given tasty recipes and a positive attitude.”

 

What Foods Prevent a Stroke?

Fruit and vegetable consumption is associated with lower risk of about a dozen different diseases, including stroke. There appears to be a linear dose-response relationship, a straight-line association between eating more fruits and vegetables and lowering stroke risk. Researchers have suggested that the risk of stroke decreases by 32 percent for every 200-gram increase in fruit consumption, which is about one apple a day, and by 11 percent for each equivalent amount of vegetables eaten. Particularly potent are citrus fruits, apples, pears, and dark green leafy veggies, including one you can drink: the green leaves of green tea. Drinking three cups of green tea a day is associated with an 18 percent lower stroke risk.

Garlic was tested head-to-head against a sugar pill and beat out placebo for preventing CIMT progression, the thickening of the major artery walls in the neck going up to the brain, a key predictor of stroke risk. For those in the placebo group, it continued to worsen, but not so for study participants in the garlic group who had been taking just a quarter teaspoon of garlic powder a day, which costs about a penny.

What about nuts? The original PREDIMED study found that an ounce a day of nuts, which is what I recommend in my Daily Dozen, helped to cut stroke risk nearly in half. When it was republished (after correcting for some irregularities in their randomization procedures), the reanalysis found the same results—the same 46 percent fall in stroke risk in the added nuts group, dropping the ten-year risk of stroke from about 6 percent down to 3 percent.

High fiber intake may also help ward off stroke. Fiber is naturally concentrated in only one place: whole plant foods. Processed foods have less, and animal-derived foods have no fiber at all. Increasing fiber intake by just seven grams a day may be associated with a 7 percent reduction in stroke risk.

Though stroke is considered an older person’s disease, risk factors may begin accumulating in childhood. Hundreds of kids were followed for 24 years, from junior high school to adulthood, and low fiber intake early on was associated with stiffening of the arteries leading up to the brain—a key risk factor.

 

Foods to Avoid to Prevent a Stroke

As I discuss in my video What Not to Eat for Stroke Prevention, when it comes to stroke risk, the worst foods appear to be meat and soda. Eating two sausage links for breakfast, a burger for lunch, and a pork chop for dinner and drinking a 20-ounce bottle of soda may increase stroke risk by 60 percent. Reviewers suggest the meat effect may be its saturated fat, cholesterol, iron-mediated oxidized fat, salt, or the TMAO. The carnitine in meat and the choline in dairy, seafood, and especially eggs are converted by our gut bacteria into trimethylamine, which is oxidized by our liver into TMAO, which may then contribute to heart attacks, stroke, and death.

A 2019 study published in the Journal of the American Medical Association following tens of thousands of Americans for a median of about 17 years up to a maximum of 31 years found that “higher consumption of dietary cholesterol or eggs was significantly associated with higher risk of incident CVD [cardiovascular disease] and all-cause mortality, in a dose-response manner.” Those who ate more eggs or consumed more cholesterol in general appeared to live significantly shorter lives, on average, and the more eggs eaten, the worse it was, including for stroke risk.

And dairy? The bottom line is that dairy fat may be better than other animal fats, such as those found in meat, but something like whole grains would be better still. But you wouldn’t be doing yourself many favors if you simply swapped out dairy in favor of refined grains or added sugar. When it comes to stroke risk, vegetable fat is better than dairy fat, meat fat is the worst, whole grains are better, and fish fat, added sugars, or refined grains are statistically about the same.

 

Food for Thought

The good news is that stroke risk can be reduced substantially by an active lifestyle, cessation of smoking, and a healthy diet. All we have to do now is educate and convince people about the benefits that can be expected from healthy lifestyle and nutrition.

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Meet Sylvia Klinger. We had the pleasure of interviewing her about food history and culture. Read on and enjoy her recipe for Jicama Mango Salad.

 

As an expert in cross-cultural Hispanic nutrition and health issues, how have you found food to tell a story and shape culture?
In our Hispanic culture, food is the essence of our life. It is what keeps us together. We are obsessed with the flavors, colors, and textures of our cuisine. Although our typical Hispanic cuisine includes different preparation and cooking methods, and ingredients and flavors vary from county to country, we quickly adapt and love all of the variations.

How do you inform people about the intersection of food, history, health, and culture?
I love teaching families and health professionals in the community how to cook our favorite dishes. It helps me to share the history of our cuisine and demonstrate the nutritional value of the foods we love. I teach them how to incorporate our favorite foods in a way that combines flavors and nutrition in quantities (portion sizes) for our age, gender, and activity level. 

What are some plant-based foods that are the foundations of Hispanic food traditions?
Plant-based foods are the foundation to our Latin foods, including all types of beans (for example, black, pinto, garbanzo, red, pigeon pea), vegetables (yuca, calabaza or pumpkin, zucchini, plantains, corn, tomatoes), fruits (tropical fruits, citrus fruits, passion fruit, coconut), grains (corn, amaranth, rice, tortillas), and nuts. It is my job as a dietitian-nutritionist to teach our communities about the amazing health benefits of our foods and the roles they play in the prevention of chronic disease. It’s easy, healthful, and delicious to season savory Latin foods with more onions, garlic, chiles, and fresh herbs instead of too much salt, and to flavor Latin desserts with more “canela” (cinnamon), vanilla, ginger, and citrus juices instead of adding too much sugar.

Do these foods or dishes have any significant meaning or history?
Absolutely! Many of our staple ingredients originated in Latin countries. Corn was first domesticated in Mexico by their native indigenous people hundreds of years ago, and chocolate’s history also began in Mexico, where the first cacao plants were found. No wonder many of the famous dishes in Mexico and neighboring countries have corn and chocolate! 

What do you envision as the way forward to encourage people to eat more fruits and vegetables and, in the West especially, return to traditional Hispanic eating patterns?
My mission is to encourage my Hispanic communities to continue eating the foods they love since a lot of them are highly nutritious and to add the foods and nutrients they are lacking. For example, Mexicans love fruits and vegetables, and even their snacks consist of fresh fruits and veggies. 

Please tell us a little bit about your work and career.
I am a dynamic global nutrition expert and a sought-after bilingual consultant, international speaker, communications professional, business owner, award-winning author, mentor, and board advisor for several associations and Fortune 500 companies. I am driven to empower communities toward better health outcomes through professional relationship building, health/nutrition program development, and strategic planning.

I have a relentless passion for understanding dietary behaviors, diet quality, and dietary patterns, as well as generating science-based evidence to develop timely strategies that promote a healthy lifestyle through dissemination of culturally relevant nutrition and health education programs for disease prevention and management. I draw my energy from my compassionate, family focus to help low-income communities establish healthy eating habits within their budget. 

Please tell us a little bit about your books.
I’ve published two books on providing a tasty, healthy, culturally-appropriate lifestyle for Hispanic populations, who face mounting health problems today. The award-winning Hispanic Family Nutrition: Complete Counseling Tool Kit for the Academy of Nutrition and Dietetics provides optimal wellness and nutrition counseling tools, and The Little Book of Simple Eating is filled with practical tips in both English and Spanish for achieving everyday optimal health.  

Jicama Mango Salad 1 garlic clove, minced ¼ cup fresh lemon juice ½ cup cilantro, chopped 2 cups jicama, peeled and julienned 3 cups mangos, peeled and sliced 1 jalapeno, seeded and diced 1 cup red onion, peeled and minced Zest of 1 orange Orange pieces to taste Lemon zest to taste Lemon pepper to taste Black pepper to taste Sliced radishes (optional garnish) Preparation Mix the garlic, lemon juice, and cilantro. Season with lemon pepper and black pepper to taste. Add the remaining ingredients, toss lightly, and serve. Garnish with sliced radishes, if desired. Servings: 4 – 8 people

 

You can find Sylvia on her website here and Instagram here.

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What would happen within just two weeks after swapping the diets of Americans with those of healthier eaters? 

Colon cancer is our second leading cancer killer, but some places, like rural Africa, have more than ten times lower rates than we do in the United States. How do we know it isn’t genetic? “Migrant studies, such as those in Japanese Hawaiians, have demonstrated that it only takes one generation for the immigrant population to assume the colon cancer incidence of the host western population.” The change in diet is considered “most probably responsible for this,” but all sorts of changes occur when you move from one culture to another. “For example, cigarettes, chemicals, infections, and antibiotics might be equally responsible for the change in colon cancer risk.” You don’t know if it’s the diet until you put it to the test. 

It’s rare that I do a whole video on a single study, but I think you’ll agree the one that I cover in The Best Diet for Colon Cancer Prevention is worth it. An international group of researchers was trying to figure out why colon cancer rates were an order of magnitude higher in African Americans and Caucasians in the United States than in rural South Africans. As you can see below and at 1:09 in my video, if you look at American colons, they’re a mess with polyps and diverticulosis, not to mention hemorrhoids, whereas the African colons were “remarkably pristine.” And more importantly, the Africans had sevenfold lower colonic epithelial proliferation rates, a characteristic of precancerous conditions. The researchers measured everything the study participants were eating and concluded that the higher colorectal cancer risk and proliferation rates in African Americans were most closely “associated with higher dietary intakes of animal products and higher colonic populations of potentially toxic hydrogen [acid] and secondary bile-salt-producing bacteria.”  

When put to the test, higher rates of colon cancer were indeed found to be associated with higher intake of animal protein and animal fat, lower fiber consumption, more of those bad bile acids, less of those good short-chain fatty acids like butyrate, and higher mucosal proliferation. But how do we know the diet is what’s mucking things up? We don’t—until an interventional study is performed.  

How about we just swap their diets? Feed the Americans a high-fiber African-style diet, and give the rural Africans the standard American diet. On day one of the experiment, the rural Africans were given sausage and white flour pancakes for breakfast, a burger and fries for lunch, and some meatloaf and white rice for supper, whereas the African Americans ate fruits, vegetables, corn, and beans. To help with compliance, the researchers included some more familiar foods like veggie dogs. Note, though, that it was not a vegan diet, just generally plant-based. You can see the day one menu below and at 2:31 in my video. 

Also, note that the food exchanges weren’t for years. They only swapped for two weeks. Could changes be seen that fast? Indeed, the dietary changes “resulted in remarkable reciprocal changes” in the lining of the participants’ colons in terms of cancer risk and their microbiome. Switching to a more plant-based diet boosted their fiber fermentation and suppressed their carcinogenic bile acid synthesis. The researchers took biopsies and looked under a microscope at the colon lining of African Americans. Before the diet swap, their colon lining was in overdrive with rapidly dividing cells, a sign of premalignancy that is a risk factor for cancer. But, after just two weeks of eating a healthier diet, their colons calmed right down. You can see some before and after pictures below and at 3:07 in my video. The brown dots in the before photo for the African Americans represent dividing cells. In the after photo, they’re nearly gone. In contrast, the rural Africans started out with some proliferation, but it got worse on the American diet. 

Below and at 3:44 in my video, you can also see a different marker measuring inflammation. Each of the brown dots represents an inflammatory cell. In the African Americans, there was rife inflammation on their typical diet that calmed way down after just two weeks on a healthier one, and the opposite happened for the rural Africans who switched to the standard American diet.  

We know that when our friendly flora ferment fiber, they produce beneficial compounds like butyrate, which is anti-inflammatory and anti-cancer. “Impressively, ‘Africanization’ of the diet” more than doubled butyrate production, increasing total quantities, “whereas ‘westernization’ reduced quantities by half.” And in terms of toxic metabolites, there was a significant drop in the healthier diet, whereas the “meatloafy” standard American diet increased the levels of these carcinogens by 400 percent within just two weeks. So, the bottom line is that just by changing the food you eat, you can remarkably change your risk. In fact, that’s how the lead investigator put it. “O’Keefe’s advice is simple, ‘change your diet, change your cancer risk!’” It may never be too late to start eating healthier. 

Based on these kinds of data, “adopting a whole-food vegan or near-vegan diet rich in fruits and vegetables, exercising regularly, and avoiding tobacco, could have a stunningly positive impact on the cancer risks not only of black Americans but of all peoples.” The researchers concluded: “While it would be unrealistic to expect rapid and profound lifestyle changes in the general population, it is gratifying to have sound, effective advice to offer to those who are willing to take the steps needed to optimize their healthful longevity.” 

This is the follow-up to Best Foods for Colon Cancer Prevention. As I mentioned, it’s rare I do a whole video on a single study, but I hope you’ll agree this one is worth it. For more on keeping our colonic colleagues thriving, check out the related videos below.   

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