Wednesday, February 12, 2014

Is There Any Harm In Eating Lots of Vegetables?


I recently made a statement to a colleague that eating an excessive number of vegetables could be harmful. He asked for supporting documentation to back up my comment.  As my statement was based on previous readings, I sought out the clinical literature that associated too many vegetables consumed with what I believed to be the following seven potential problems.  

1.    Certain vegetables, such as cassava, are goitrogenic, which means they cause goiter, a thyroid condition that results in an enlarged thyroid that may or may not impair function. 

2.    Certain vegetables, such as kale, are rich in purine, which can possibly lead to the build up of uric acid in joints, a painful condition known as gout. 

3.     Certain vegetables, such as carrots, are rich in beta-carotene, an anti-oxidant, which can lead to carotenosis, a  benign condition in which the skin turns orange. 

4.     The fiber, particularly insoluble fiber, in vegetables can cause intestinal blockage, gas, and    bloating if over consumed. 

5.      Minerals in vegetables, such as potassium and phosphorus, can be difficult for the kidney to  process in high amounts if the kidney is not working properly such as in certain people with high blood pressure. 

6.      Excessive vegetables can lead to hypervitaminosis, which means too much vitamin, such as excessive Vitamin A, which can be harmful to the body. 

7.      Certain vegetables, such as potatoes and corn, contain high calories from starch  that can contribute to weight gain if eaten excessively.

8.    Certain vegetables, such as spinach, can interfere with calcium absorption.

9.    Certain vegetables, such as tomatoes, contain oxalates which can bind to calcium to form calculi of calcium oxalate. Calcium oxalate build-up can lead to kidney stones.

So are the statements above true? Even though in making my statement I relied on my previous recollections, the question asked deserved specific citations of valid clinical studies. However, after spending three hours searching the literature for supporting documentation, I was disappointed to discover that the literature I could find showed limited support.  I went as far back as the 1950s and still could find almost nothing on the topic. Based on this search, It appears that there do not exist any reliable studies demonstrating harms associated with excessive vegetable consumption, other than for reported individual case reports of reactions to specific high intakes.  The goiter and gout arguments had the weakest supporting evidence. The oxalate, a little stronger. 

Therefore, after reviewing the literature, I have to modify my statement about vegetables to say it is inconclusive if eating too many assorted vegetables for people without underlying medical conditions, such as kidney or liver disease, Chrohn’s disease, irritable bowel syndrome, etc. is necessarily harmful, particularly as it appears that most people would have difficulty eating too many vegetables due to the high fiber content. 

That said, I still think that even vegetables should only be eaten in moderation because there are no good studies to show what happens when they are eaten in excess. The absence of evidence is not always evidence of absence.  Sometimes it is, but I prefer not to speculate in this case having already made one misstatement.  

The lesson here for me is what I always say: Caveat lector--let the reader beware. Don't trust what you read unless there is good science to support it.

I'm glad I was asked to support with proof my inaccurate statement. 

Saturday, February 1, 2014

The Case For and Against Fruits: Are Fruits Healthy? Are They Good for a Diet? Is There A Best Time To Eat Them?

Fruits have been around a really long time. Most anthropologists and evolutionary biologists believe that the diet of early man consisted mainly of fruit, until such time when we diversified our food consumption by becoming hunter-gatherers and then eventually farmers. Even as access to fruits sometimes became limited due to climate change, it never completely disappeared from the human diet. But some people now argue that it should.

The anti-fruit crowd highlight four major arguments against fruits available today.

Argument 1: Fruits are contaminated and nutritionally depleted.

First, they claim that fruits have been so genetically modified and tainted by man-made chemicals that they no longer contain sufficient nutrients to meet human needs for such nutrients or that you should only eat them if they are organic. These arguments are usually put forth by pill-pushers who want you take to a pill instead of, or in addition to eating fruits.  To the former point, I say that my own extensive review of the scientific literature supports that fruits have been altered, but that they still contain more than sufficient nutrients to meet our daily needs, particularly if you eat even a few servings per day.

As to the organic issue, it's really a question of money. No rational person can argue that there is something good to be gained from eating something that has been exposed to pesticides, herbicides, fungicides, and other man made chemicals, and/or has been genetically modified.  Although the specific harms from these chemicals is still hotly debated, if you can afford to avoid them, you should surely do so, especially the Environmental Working Group's "Dirty Dozen." (See http://www.ewg.org/foodnews/)  If not, then rinse very carefully. I tend to rinse my blueberries at least three times under pressure before having them for breakfast.


Argument 2: Fruits are high in a sugar called fructose and that is not good for your liver, lipid levels, and diabetes

The next reason often given for avoiding fruits is their high fructose content. First of all, not all fruits have the same amount of fructose (For a more detailed description of how the body processes fructose, please read the American Journal of Clinical Nutrition primer found at



To summarize the primer, the pancreas doesn't react to fructose until is is metabolized like it does to sucrose and glucose. Moreover, we don't need any dietary fructose to function.  However, even though fruits have fructose, the fructose is interwoven with the fruits' fiber and is therefore digested more slowly than fructose from other sources. Please note, fructose and high fructose corn syrup are two completely different beats. The latter should be viewed as extremely harmful like a man with a loaded gun.

Therefore, contrary to the advice of pundits that state you can eat all the fruits you want because of the robust nutrient content including various vitamins, minerals, antioxidants and other synergistic nutrients, fruits should be a staple of a healthy diet, but only eaten in moderation. Weight Watchers is simply wrong to assign fruits '0' points, In fact, type two diabetics are told to limit their fruit intake to no more than 15 grams at a sitting because more than that may be problematic. (That's a whole other topic for another day.)

Nevertheless, fruits have plenty to offer, particularly in regards to antioxidants, but do note, that many, if not most, of the same healthy nutrients found in fruits can also be found in vegetables. For examples, the beta-carotene in melons can be found in carrots and yams; lycopene in watermelon can be found in tomatoes (although technically a fruit because it grows on trees,); anthocyanins in blueberries can be found in eggplant; phytosterols and polyphenols can be found dispersed in both groups. The list goes on.

Fruit skins can be good sources of insoluble fiber, helping move things along in the gastrointestinal track and can also contain flavonoids, which are plant secondary metabolites that have antioxidant capabilities that may diminish inflammation. Fruits are also contain other not as fully studied nutrients, like pectins, B-Cryptoxanthin, and A-carotene, which can be in apples. As with other nutrients, they also occur in vegetables.  One area of limited research is the synergistic affects of all the different nutrients found in all the different fruits.  Either way, fruits are a tasty and sweet alternative to less desirable man-sweetened foods.

Argument 3: Fruit calories add to weight gain

The final argument against fruits is the calories they contain. It's true, virtually everything we eat contains calories and fruits are no exception. Even though the theorem of calories in/caloires out is not perfect because not all calories are processed the same because of the fiber content of the food they come from, it is true that fruits, if eaten in large quantities can contribute to weight gain.  It's not the fruits themselves that are causing the weight gain; its the totality of what you are eating.  So as long as you go easy on other foods, your weight loss plans can easily accommodate some measured amount of fruit calories.

Argument 4: They can only be eaten before meals as they will ferment in your intestinal tract after meals

It is simply a myth that you can't eat fruit after meals. You can.  The fermentation arguments are pue rubbish. I searched the entire clinical study database back to the 1950s and couldn't find a single valid study to support such nonsense.
(Don't take my word for it. Read this from the University of Missouri:



The flip-side: Eat only fruits

Some people have gone to the other extreme and have taken to a mostly fruit diet. Steve Jobs tried and failed to cure his cancer with a mostly fruit only diet.  (See my previous blog on fruits and cancer prevention, which can be found at http://mdprevent.blogspot.com/2012/11/do-fruits-and-vegatables-prevent-cancer.html)

These fruit obsessed dieters claim they possess more energy and feel healthier. This is not surprising because the fructose in fruit is a carbohydrate that fuels energy. But as I wrote above, too much fructose is not a good thing as it can overwhelm the liver and eventually raise blood glucose to levels that precipitate large amounts of insulin release that can predispose to diabetes. Fructose breaks down to substances that can lead to glucose or blood sugar production.

My four golden rules of eating healthy

So in summation, let me finish with my four golden rules of eating healthy.

1. Don't eat more than you need to feel reasonably full.
2. Make sure that the combination of foods eaten over a course of a week contain all the essential nutrients your body needs to function properly.
3. Avoid or severely limit exposure to chemicals and highly processed ingredients stripped of most nutrients, and definitely avoid products that contain many of such ingredients rolled into one.
4. Loosely monitor your total salt, fat, sugar of any kind including fructose, and calorie intake to levels that work for your body. If you are not sure what those levels are, discuss them with your physician.

The final analysis

Fruits have been a staple of the human and pre-human diet for time immemorial.  Yes, its true that fruits may not be of the same nature and quality than they were tens or hundreds of thousands of years ago, but they are still awfully darn good. They offer many key essential nutrients, but as with most foods, you can overdue eating them.  They are a good part of a comprehensive approach to healthy eating.

By the way, do avoid fruit juices that are robbed of most of the fruits' fiber and have concentrated fructose.  However, contrary to the popular belief, the reason to avoid fruit juices is not because fruit lose most of their nutritional value during the juicing process. (See
http://www.ncbi.nlm.nih.gov/pubmed/9806122)

So now that you know the facts, you can figure out when and how much to eat, and enjoy fruit on your own.  Bon Appetite.