References for LC

Notes and References

(temporary link to all references in clickable form at )

Chapter 1 - The Camino part 1

1. Our guidebook –there are many Caminos. We were walking the he most popular, the Camino de Santiago or Way of St James that is officially called the Camino Frances. John Brierley, A Pilgrim’s Guide to the Camino de Santiago: St Jean Pied de Port to Santiago de Compostela, available online or in pilgrim offices, updated regularly, and contains some hints from us for the Dragonte variation.

2. The Pass of Roncesvalles is well known due to the Song of Roland, an 11th century epic poem about Charlemagne’s nephew  who died in the battle - most recently popularised by the German folk rock band dArtagnan in 2019

3. “all pilgrims … sick and well, Catholics, Jews, pagans, heretics and vagabonds  … “ - from a Latin poem written in 1199-1215 praising the welcome to pilgrims at Roncesvalles pilgrim hospital (in Spain, hospital means place that provides hospitality) and

4. The average American is about 30 pounds (13 kg) heavier than in 1960 – statistics from the CDC (Centers for Disease Control and Prevention)  In Australia, 67 per cent of adults were overweight or obese  in 2017-2018–

5. Pritikin diet -

6. Intermittent fasting, two or three days a week - Mattson MP et al. Impact of intermittent fasting on health and disease processes. Ageing Res Rev, 2017;39:46-58.

7. Chicken nuggets - deShazo  RD et al. The autopsy of chicken nuggets reads "chicken little". Am J Med, 2013;126(11):1018-9. and

8. Ultra-processed food - A seven year study of more than 44,500 men and women aged 45 and over in France found that every 10 per cent increase in ultra-processed food consumption was associated with a 14 per cent greater risk of death from any cause.  Ultra-processed food was defined as food manufactured through multiple industrial processes usually combined with additives and mostly consumed in the form of ready-to-eat or heat meals, such as packaged snacks, desserts, chicken nuggets, preserved meat products and instant noodle soups. Laure Schnabel et al. Association between ultra-processed food consumption and risk of mortality among middle-aged adults in France. JAMA Intern Med, 2019 Apr 1;179(4):490-498.

Lotte’s asthma



For asthmatics experimenting with diet and doing challenges, it is important to have the support of an experienced dietitian - consult their doctor before reducing medication and keep their medication with them at all times because every time they eat a food they haven’t prepared themselves they could unknowingly be exposed to a sudden high dose of sulphites or other nasties.

 9. Sulphites are the food additives most associated with asthma, though not the only food chemicals that can cause problems:  Towns SJ, Mellis CM. Role of acetyl salicylic acid and sodium metabisulfite in chronic childhood asthma. Pediatrics. 1984;73(5):631-7. ; Hodge L et al. Assessment of food chemical intolerance in adult asthmatic subjects. Thorax, 1996;51(8):805-9.
- Sulfites: Safe for Most, Dangerous for Some by Ruth Papazian from the FDA Consumer Magazine, December 1996.
- A large French study recently found a link between asthma and processed meat but researchers focused on an “unhealthy diet”, not mentioning that sulphites are the preservatives used in sausages: Andrianasolo RM et al. Association between processed meat intake and asthma symptoms in the French NutriNet-Santé cohort. Eur J Nutr. 2019 May 30.

10. The Food Intolerance Network
- Sue’s blog Asthma – Shame on you FSANZ!
- We support the RPAH Elimination Diet from Sydney’s Royal Prince Alfred Hospital Allergy Unit
- Our list of supportive dietitians
- Facebook - Sue Dengate facebook group with 18,000 members
- Note that “failsafe” is our acronym for “Free of Additives including Low in Salicylates, Amines and Flavour Enhancers” – a summary of the Royal Prince Alfred Hospital’s Allergy Unit food intolerance protocol.

11. Spanish wine was likely to be higher in sulphites than what she normally drank: Spanish and English speaking countries are more likely to use higher doses of sulphites than other countries. Howard and I wrote the following paper to show that the use of sulphite preservatives varies by country and can explain the increasing worldwide prevalence of childhood asthma - Dengate S, Dengate H (2004), Contribution of food additives to worldwide variations in the prevalence of childhood asthma symptoms. J Food Intolerance No 1.

12. A Spanish study published while we were walking: Urtiaga C et al. Estimate of dietary exposure to sulphites in child and adult populations in the Basque Country. Food Addit Contam Part A Chem Anal Control Expo Risk Assess, 2013;30(12):2035-42.

13. Delayed effects - Some studies say the asthma-food link hasn’t been proven. This is because many researchers don’t understand that food intolerance is different from IgE-mediated allergy, with delayed effects and the need for a comprehensive elimination diet to establish a baseline against which challenges can be made.
- In one study, asthmatics were given an aspirin tablet they were told was not aspirin. Only those who reacted within 30 minutes made the connection between tablet ingestion and asthma symptoms.  McDonald JR, Mathison DA, Stevenson DD. Aspirin intolerance in asthma. Detection by oral challenge. J Allergy Clin Immunol 1972;50(4):198-207.
- Similarly with sulphites: a few asthmatics will react to sulphites with an immediate asthma attack but for most asthmatics, sulphites will cause irritable airways with no obvious symptoms until they are exposed to a known asthma trigger such as cold air or exercise – then the trigger gets the blame as in Darryl’s story [1516] below. But remove the food chemical and they can be exposed to that trigger with no asthma.

14. Asthma success stories and information from the Food Intolerance Network

Grace [629]
Darryl [1516] it is likely that sulphites will cause irritable airways with no obvious symptoms until exposure to a known asthma trigger such as cold air or exercise, as Darryl described:

“Our son has had asthma on and off and it took us a while to work out … every time he ate dried fruit, three or four days later he’d be sensitive to things. So if he had a chest infection, he’d have an asthma attack where normally he wouldn’t. Or if we had a cold snap in the middle of the night … he’d have an asthma attack, starting out coughing, and then it would develop into a full blown asthma attack. We realised if we could keep the dried fruits and sulphites out of his diet, a lot of his problems would go away.”

Mark [524]  - Mark went from 20 puffs of Ventolin a day to none by changing what he ate:

“I suffered terribly from additive-induced asthma from the age of 10. It took a couple of decades to realise that artificial food additives were THE cause of my condition, thanks mainly to your website. Over 23 years, not a single doctor ever once asked if my condition might be due to food …”.

Mark’s update [1080]
Gayle [1427]
- More information and reader reports from the Food Intolerance Network
Asthma and food factsheet
Sulphite factsheet
Fed Up by Sue Dengate (Random House 2008): Chapter 7 And the asthma went away in
Blog post about how a small reduction in the level of sulphites in Australia led to a small reduction in asthma although doctors had no idea what caused it, Asthma: shame on you FSANZ 

15. Asthma and obesity – Lurbet MF et al. Obesity trends among asthma patients in the United States: a population-based study. Ann Glob Health, 2019 Jan 22;85(1),pii: 11.

16. Asthma is increasing “There has been a sharp increase in the global prevalence, morbidity, mortality, and economic burden associated with asthma over the last 40 years, particularly in children. Approximately 300 million people worldwide currently have asthma, and its prevalence increases by 50% every decade.” Sidney S Braman. The global burden of asthma. Chest, 2006 Jul;130(1 Suppl):4S-12S. 
- In the UK, the rate of asthma deaths  increased by more than 20 per cent in five years, three people per day have fatal asthma attacks and people Lotte’s age (18-29) are most likely to have uncontrolled asthma, yet diet is never mentioned.

17. A1 or A2 milk - A1 milk predisposes to asthma and lung inflammation, post from Keith Woodford, author of Devil in the Milk, 2010. describes new research by Shikha Yadav et al.  Oral Feeding of Cow Milk Containing A1 Variant of β Casein Induces Pulmonary Inflammation in Male Balb/c Mice Sci Rep. 2020 May 15;10(1):8053.
- A2 milk in Belgium -

How to drink alcohol without preservatives
18. Products to reduce sulphites in drinks
– a few drops of simple hydrogen peroxide converts sulphites to inactive harmless thiosulphates, reducing the risk of sulphite-caused asthma. Two commercial sources and

19. Limited himself to one alcoholic drink a day as a way of losing weight - Tony Kevin, Walking the Camino, Scribe publications, 2006.

20. Drinking less may be the better choice: Kunzmann AT et al. The association of lifetime alcohol use with mortality and cancer risk in older adults,  PLoS Med, 2018;15(6):e1002585.

Drug side-effects
21. Cipro and tendonitis
“Tens of millions of prescriptions have been written for Cipro and Levaquin antibiotics. That’s despite FDA warnings that doctors should only prescribe such drugs as a last resort. A great many people have been permanently damaged by FQ medicines. It took the FDA a very long time to warn about some of the most serious complications including aortic aneurysm, tendon and nerve damage.” - From FDA Warning For Popular Cipro and Levaquin Antibiotics! by pharmacologist Joe Graedon who has been described as one of the country's leading drug experts for the consumer, People's Pharmacy website,
- Tendonitis has been reported to occur up to 152 days after onset of therapy and often occurs during walking - Sakaan SA, Self TH. Minimizing the risk of tendon injury associated with fluoroquinolone use. Consultant, 2017;57(9):541-542.
- Nearly one third of 222 new drugs approved by the FDA between 2001 and 2010 were found to have safety problems within five years, so it would seem safer to avoid medications especially new ones, if possible - Nearly one in three drugs found to have safety concerns after FDA approval

22. Food colouring warning “May have an adverse effect on activity and attention in children” – In 2007, a $2 million Southampton University study funded by the UK government found that “normal, healthy” children can be affected by artificial colours and these can reduce the ability of children to benefit from schooling, possibly leading to lifelong disadvantage because children who have problems with reading or behaviour, not addressed by the age of 7, can experience educational disadvantage, occupational disadvantage and depression in adulthood. So, in Europe since 2010, foods containing any of the six artificial colours studied by Southampton University must carry the above warning.  In many countries, manufacturers don’t want to use the warning so they have removed those colours. However, restaurants don’t have to say what is in their food. McCann D et al. Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo-controlled trial. Lancet 2007;370(9598):1560-7.

23. The main behavioural symptoms of food intolerance are irritability, restlessness, inattention and sleep disturbance according to Australian research, and our members agree.  Sleeping difficulties vary with age and can include insomnia, difficulty falling asleep, frequent night waking, restless legs, night terrors or vivid dreams.  Rowe KS, Rowe KJ. Synthetic food coloring and behavior: a dose response effect in a double-blind, placebo-controlled, repeated-measures study. J Pediatr, 1994;125:691-8. and see our Insomnia blog

24. Desayuno plastico with bread preservative - Propionate bread preservatives are some of the worst additives in my opinion, now considered to be neurotoxic, and linked to autism and dementia as well as children’s behaviour problems.  E282 calcium propionate and any of the propionate group E280-E283 can be hidden under innocent sounding names such as cultured or fermented anything , such as dextrose or even starter culture. See how such additives are hidden  See my blog and study Dengate S, Ruben A. Controlled trial of cumulative behavioural effects of a common bread preservative, J Paediatr Child Health, 2002;38(4):373-6.

25. Pamplona university study - Mendonça RD et al. Ultra-processed food consumption and risk of overweight and obesity: the University of Navarra Follow-Up (SUN) cohort study. Am J Clin Nutr, 2016;104(5):1433-1440.

Snoring in Burgos
26. Fast diet guru -
quote from an author interview about The Fast Diet by Dr Michael Mosley and Mimi Spencer, Atria Books, 2013, entitled Lunch with Michael Mosley, the guru behind the 5:2 diet by Xanthe Clay, The Telegraph, 22/4/2013

27. Snoring can be linked to diet-induced stuffy nose - Stradling JR, Crosby JH. Predictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle aged men. Thorax, 1991 Feb;46(2):85-90.
[919] preservatives
[833] cows’ milk
[927] A1 not A2 milk

28. A dietitian wrote to us about an autistic boy – more recently, this Polish study showed that ASD children have much higher levels of BCM7 in their blood than non-autistic children, contributing to the opioid excess hypothesis of autism.  Jarmołowska B et al. Role of Milk-Derived Opioid Peptides and Proline Dipeptidyl Peptidase-4 in Autism Spectrum Disorders. Nutrients, 2019;11(1). pii: E87.

29. Sudden infant death syndrome - Opioids including BCM 7 can linked to irregular breathing and sleep apnoea due to opioid-induced respiratory depression (as well as digestive upsets).
- A Polish study looked at the role of BCM7 in sudden infant death syndrome (SIDS) due to disordered breathing  in infants with “near-miss SIDS” and concluded that opioid-induced respiratory depression may have been induced by BCM7 in the general circulation. Wasilewska J et al. The exogenous opioid peptides and DPPIV serum activity in infants with apnoea expressed as apparent life threatening events (ALTE). Neuropeptides 2011;45(3):189-95.
- A Mexican study described efforts to produce a cows’ milk formula low in BCM7 for safe infant feeding -  Duarte-Vázquez  MA et al., Production of Cow’s Milk Free from Beta-Casein A1 and Its Application in the Manufacturing of Specialized Foods for Early Infant Nutrition. Foods, 2017; 6(7): 50.
- Simon Brooke-Taylor et al. Systematic Review of the Gastrointestinal Effects of A1 Compared with A2 β-Casein. Adv Nutr. 2017;8(5):739-748.
- A1 has been linked to many health conditions, as described in Keith Woodford’s book Devil in the Milk and his website

30. Buteyko mouth-taping for snoring prevention - starting with a small square of tape, the technique progresses to full length tape covering the mouth when comfortable. Since nose breathing involves warm, humid air, taping keeps the nose clear even when eating the wrong food, as described in Patrick McKeown’s book, Sleep with Buteyko: stop snoring, sleep apnoea and insomnia, and includes a free CD, Buteyko Books, 2011.

31. Soups contain nitrate/nitrite preservatives that we won’t eat, and a UK campaign agrees. These preservatives can cause all the usual symptoms of food intolerance, from disordered sleep to irritability to headaches and even stuttering. Worse, nitrites used to cure meats produce carcinogens called nitrosamines when ingested and have been linked to colorectal and breast cancer - Jamie Doward, Stop adding cancer-causing chemicals to our bacon, experts tell meat industry, Guardian, 29th December, 2018,
- More information and how these additives are being hidden by the food industry at

32. Winning the lottery does not make people happyNisslé S, Bschor T. Winning the jackpot and depression: Money cannot buy happiness. Int J Psychiatry Clin Pract. 2002;6(3):183-6. Describes the cases of two female patients who required hospitalisation for depression after large lottery wins.
- Brickman P et al. Lottery winners and accident victims: is happiness relative? J Pers Soc Psychol. 1978;36(8):917-27. Compares lottery winners with others - winners were not happier and took less pleasure from mundane events.
…very rich - Luthar SS, Sexton CC, The high price of affluence. Adv Child Dev Behav, 2004;32:125-62. Paradoxically, the rich may have higher risk of depression, psychological distress, low self-esteem, isolation and feeling friendless:  “…the enhanced vulnerability of the rich lies in the addictive potential of wealth, wherein rapid habituation to accumulated riches leads to an endless escalation of expectations”

33. Meditators are more likely to experience psychic phenomenon - Russell Targ. What do we know about Psi? The first decade of remote-viewing and operations at Stanford Research Institute. J Scientific Exploration, 33(4);569-592. “Psi experiences are described in  detail  by  the  Hindu  sage  Patañjali  in about  the  fourth  century  BCE  … supernormal powers are obtained by … perfect meditation, leading to clarity of insight. This enables the practitioner to gain knowledge of the past, the distant, and the future …”

34. TM Transcendental Meditation -

Chapter 2 - The Camino part 2

1. The name for these drugs, "anti-inflammatory", is not supported by evidence - Peter Gøtzsche, Deadly Medicines and Organised Crime: How Big Pharma Has Corrupted Healthcare. Radcliffe Publishing, London, 2013. Specifically and

Exercise and cancer
2. Exercise and cancer prevention
- Steven C Moore et al. Association of Leisure-Time Physical Activity With Risk of 26 Types of Cancer in 1.44 Million Adults. JAMA Intern Med. 2016 Jun 1;176(6):816-25. and

3. Exercise and prevention of cancer recurrence - Shinichiro Morishita et al. Effect of Exercise on Mortality and Recurrence in Patients With Cancer: A Systematic Review and Meta-Analysis, Integr Cancer Ther. Jan-Dec 2020;19:1534735420917462.

4. Walking lowers risk of mortality including cancer – Patel AV et al. Walking in Relation to Mortality in a Large Prospective Cohort of Older U.S. Adults. Am J Prev Med. 2018;54(1):10-19.

Exercise and diet for cancer
5. Surviving breast cancer through exercise and diet
- McDougall JA. Preliminary study of diet as an adjunct therapy for breast cancer. Breast, 1984;10(1):18-21. 

6. Ruth Heidrich defeats cancer

7. Janette Wakelin-Murray ran a marathon every day for a year while on a raw food vegan diet, as described in her book, Running out of time, Brolga Publishing, 2014

8. Starting small, a gradual introduction to exercise. Jeanne Mithieux’s story –

9. “Conservative” surgery – article by Dr John McDougall. Breast Cancer Treatments: Barbaric and Brutal.

Our plant-based diet trial
10. Spanish diet now “too high in meat and fat”
– Daily intake of meat and meat products per person has increased by about 300 per cent in the last 40 years. Researchers commented that the quality of fats and oils had deteriorated with SFA and PUFA (saturated fatty acids and polyunsaturated fats) consumption too high, and the omega 6/omega 3 ratio that should have been between 4/1 and 5/1 was actually 16/1 in favour of omega 6 due to the much higher consumption of meat and meat products, “which may compromise the potential benefits provided by the omega-3 fatty acids”.  Varela-Moreiras G et al. The Spanish diet: an update. Nutr Hosp. 2013;28 Suppl 5:13-20.

11. The China Study: the most comprehensive study of nutrition ever conducted and the startling implications for diet, weight loss and long-term health by T. Colin Campbell and his son, Thomas M. Campbell II.

12. Adventist Health studies - Tonstad S et al. Type of vegetarian diet, body weight, and prevalence of type 2 diabetes. Diabetes Care, 2009;32(5):791-6. and Le LT, Sabaté J. Beyond meatless, the health effects of vegan diets: findings from the Adventist cohorts. Nutrients, 2014;6(6):2131-47.

13. PCRM (Physicians Committee for Responsible Medicine)

14. Free McDougall Program:

15. Pritikin diet:

16. Salicylates (sals)see Food and health chapter in this book and more at

17. Supporting failsafe eating through our website, books and the Sue Dengate failsafe group on facebook, and see more about the elimination diet in the Food and health Chapter 10 in this book. We support the RPAH Elimination Diet from Sydney’s Royal Prince Alfred Hospital Allergy Unit

18. We kept experimenting – see the Eat, walk, sleep material in this book and Dr McDougall’s free Colour Picture Book: Food Poisoning, How to Cure It by Eating Beans, Corn, Pasta, Potatoes, Rice, etc.

19. Paradoxical therapy – is defined as “a therapeutic technique in which a client is directed by the therapist to continue undesired symptomatic behavior, and even increase it, to show that the client has voluntary control over it,” from the APA Dictionary of Psychology.

20. Vegetarian or vegan athletes - Fauja Singh, world’s oldest marathon runner - Vegan athletes from Business Insider: These 19 elite athletes are vegan — here's what made them switch their diet

21. The Game Changers 2018 documentary produced by Jackie Chan, Arnold Schwarzenegger and James Cameron, 1h 25m, on Netflix

Chapter 3 - Camino Primitivo, English Coast to Coast, round Mt Blanc

1. Vibram Fivefingers    I had spent months getting used to these shoes including wearing them around the house for the first month, because they required a whole new way of using feet and leg muscles. The manufacturers warn it is essential to wear them in slowly. Commercial photos showed them with no socks but in gritty mud on the Camino Primitivo, socks were essential, so I wore Injinji toe socks that are famous for preventing blisters, and I certainly didn’t have any.

2. Old Waterview hotel Patterdale

3. Glenthorne guest house in Grasmere

4. Processed meat raises risk of heart disease - Rachel Hall. Eating processed meat raises risk of heart disease by a fifth, Guardian, 21st July 2021.
- Meat consumption and risk of ischemic heart disease: Keren Papier et al. A systematic review and meta-analysis. Crit Rev Food Sci Nutr. 2021 Jul 20;1-12.
- Processed meat is a cancer risk:  Chapter 1 Reference 31 and Australian Cancer Council, Red meat, processed meat and cancer,

5. Preservatives in bread - due to the Food industry’s Clean Label movement, propionate preservatives E280-283 can now be hidden as any of the following innocent-sounding ingredients: cultured dextrose, cultured whey power or cultured anything; fermented wheat or rice flour or anything; starter culture, and we’ve even seen “calcium powder” - all while claiming “no artificial preservatives” or “free from artificial colours, flavours, preservatives”.
- Sue’s Blog Caution cultured dextrose and how they are hidden
Michelle [1096]
Story [1164]

6. Does porridge cause longevity?
- High on satiety
– 3rd on the satiety index after ling fish and boiled potatoes.
- Lowers cholesterol - Chris Seal. A bowl of porridge a day could be better for you than statins. College of Medicine, and Chris J Seal et al. Health benefits of whole grain: effects on dietary carbohydrate quality, the gut microbiome, and consequences of processing. Compr Rev Food Sci Food Saf. 2021 May;20(3):2742-2768.
- Oldest family in the world says eating oatmeal is the secret to living longer - they also avoided smoking, alcohol and processed foods, ate mostly plant foods including potatoes and Brussels sprouts that they grew themselves on their organic family farm and got plenty of exercise by playing Gaelic football – Porridge the secret of 'the world's oldest family' and Meet the Guinness Book of Records oldest family who swear by a daily bowl of porridge. Irish Examiner, Oct 13, 2017.
- In Scotland, Jessie Gallan at 109 and Alf Smith at the age of 111 both claimed porridge - and exercise - were their secrets to a long life. and
- William Wordsworth, Lakeland poet (1770-1850) ate a simple diet … three meals a day, ”two of which were porridge” – from Cumbria Calling tourist website

7. Survey on overweight/obesity by Public Health England  - almost two-thirds of adults in England classed as overweight by health body by Sarah Boseley, 5 Feb 2014, The Guardian, and OECD, Obesity and the economics of prevention: fit not fat, key facts, United States, update 2014. “Soaring  obesity  rates  make  the  US  the  fattest  country  in  the  OECD.”

8. Mel’s question
- Harvard scientists
- Coronary heart disease is the number one cause of death: “Premature Heart Disease” by Harvard Men's Health Watch:  men should not ignore heart attack warning symptoms just because they are "too young" to have heart disease; prevention should start early.
- Post-mortems of American soldiers – Enos, WF et al. Coronary disease among United States soldiers killed in action in Korea. JAMA 1953;152:1090-3.
- Heart disease is the biggest killer of both men and women, causing 1 in 4 deaths, and about 1 in 5 heart attacks is silent – CDC, Heart disease facts
- People in their 20s can suffer heart attacks - Richard’s family blamed his milk “addiction” from age 14.  “Richard, 26, killed by 5 pints of milk a day,” The free library, 1997.
- Diet during pregnancy: Myles IA et al. Parental dietary fat intake alters offspring microbiome and immunity. J Immunol, 2013;191(6):3200-9.
- A low fat plant-based diet can reverse heart disease - Caldwell B Esselstyn. A plant-based diet and coronary artery disease: a mandate for effective therapy. J Geriatr Cardiol. 2017 May; 14(5): 317–320.
- Ornish D et al. Can lifestyle changes reverse coronary heart disease? Lancet 1990;336(8708):129-33. “Comprehensive lifestyle changes (low fat vegetarian diet, stopping smoking, stress management training, and moderate exercise) may be able to bring about regression of even severe coronary atherosclerosis after only 1 year, without use of lipid-lowering drugs.”
- American College of Cardiology. "Heart attacks increasingly common in young adults: Youngest heart attack survivors have same likelihood of dying as survivors 10+ years older; substance abuse may be contributing to trend." ScienceDaily, 7 March 2019.

9. People with salicylate-sensitivity
- Health nut
- Jennifer depression [1326]
- Lisa migraine [1601]
- Amy Joint pain [1400]
- Alison chronic back pain/depression [1446]
- Tom prostatitis [1600]
- Laura vertigo [1614]
- Kath whining [1093]

10. About 45 per cent of women carry a genetic mutation that reduces their ability to convert betacarotene from plants like carrots into vitamin A. Georg Lietz et al. Single nucleotide polymorphisms upstream from the β-carotene 15,15'-monoxygenase gene influence provitamin A conversion efficiency in female volunteers. J Nutr. 2012 Jan;142(1):161S-5S full text
- This can be associated with a whole range of health problems including hair loss, vision issues, reproductive health, tooth enamel, immune system, development and more.
- Dietary sources of vitamin A

11. Iron in vegetarian diets – Hunt JR. Bioavailability of iron, zinc, and other trace minerals from vegetarian diets Am J Clin Nutr. 2003;78(3 Suppl):633S-639S. and Hunnicutt, J et al. Dietary iron intake and body iron stores are associated with risk of coronary heart disease in a meta-analysis of prospective cohort studies. J Nutr, J Nutr, 2014;144(3):359-66.

12. Described as a Jedi master of trail running” in On the Run - Tom Owens

13. Men lose weight faster than women – a review of 11 studies found that men lost weight faster than women either through diet or diet plus exercise interventions. However, women lost significant amounts of weight too - R L Williams et al. Effectiveness of weight loss interventions--is there a difference between men and women: a systematic review. Obes Rev. 2015 Feb;16(2):171-86.

14. The health benefits of 16 hour fasting, such as cell regeneration and cancer prevention,Ki Wung Chung and Hae Young Chung. The Effects of Calorie Restriction on Autophagy: Role on Aging Intervention, Nutrients. 2019 Dec; 11(12): 2923. and nutritionist Cliff Harvey whose excellent review says
Fasting is generally considered to be safe for most people

 ·         The majority of the benefits result from regulating energy-balance

 ·         Fasting results in increased breakdown of dysfunctional and damaged tissue (autophagy, mitophagy, apoptosis)

 ·         Fasting also improves ‘fat adaptation’ (the use of fat for fuel)

 ·         Fasting increases cortisol and stress hormone levels but these return to normal with adaptation to fasting

 ·         Fasting is at least as effective for weight/fat loss as calorie restriction but is more effective for reducing IGF-1

 ·         Fasting benefits asthma, autoimmune conditions, reduces side-effects from chemotherapy, reduces blood pressure, and improves mood disorders and skin health

15. Satiety index study - boiled potatoes were rated as the most filling. Oat porridge was also very high - S H Holt et al. A satiety index of common foods. Eur J Clin Nutr. 1995 Sep;49(9):675-90. and a discussion with lead author Susanna Holt at

Chapter 4 – Nepal Dolpo trek

1. The Snow Leopard by Peter Matthiessen, Penguin, 1978 describes the two-month trip in 1973 by the author and famous field biologist George Schaller into Upper Dolpo to study the Himalayan blue sheep while hoping to see the rare snow leopard. As a Buddhist, Matthiessen was also visiting the famous Shey Gompa (monastery) at Crystal Mountain.  With a few exceptions, our route followed theirs to Shey.

2. Put together 3 treks: Dhorpatan (Beni to Lingdo), Lower Dolpo (Lingdo to Shey Gompa), Upper Dolpo (Shey Gomba to Jomson), see our tracknotes with photos.

3. Success stories on our website
Emma [1500]
Jacqui [1613]
More information in our ADHD factsheet

Hajur Aama
4. Opened to trekkers in 2010
– We prepared tracknotes at the request of people in the Tsum valley, then rarely visited, which resulted in building of lodges and a large increase in welcome visitors - in general, remote Nepalis have been very positive about all our popular pioneering tracknotes, a simple way to encourage area development, resulting in better education, medical services, income and access to markets

5. Healthspan: What causes longevity, CDC study: Dr Michael Greger

6. Hajur Aama’s food – as described by her family and also in James F Fisher’s Trans-Himalayan Traders: economy, society and culture in northwest Nepal, Motilal Barnarsidass Publishers, Delhi, 1997.

7. Millet and barley for diabetes: Jason Kam et al. Dietary Interventions for Type 2 Diabetes: How Millet Comes to Help. Front Plant Sci, 2016 Sep 27;7:1454.  Articles about this study such as Millet for Diabetes: how it affects blood sugar. Could one humble grain help you control your diabetes? don’t mention that millet is goitrogenic so the diet should include a source of iodine such as iodised salt, see Chapter 8.
- Barley research: Anne C Nilsson et al. Increased gut hormones and insulin sensitivity index following a 3-d intervention with a barley kernel-based product: a randomised cross-over study in healthy middle-aged subjects. Br J Nutr. 2015 Sep 28;114(6):899-907. and

8. Processed foods associated with higher all-cause mortality, thus reducing the lifespan:
- Laure Schnabel et al. Association Between Ultra-processed Food Consumption and Risk of Mortality Among Middle-aged Adults in France. JAMA Intern Med, 2019 Apr 1;179(4):490-498.
- Leonie Elizabeth et al. Ultra-Processed Foods and Health Outcomes: A Narrative Review, Nutrients, 2020 Jun 30;12(7):1955.
- And
- Conversely, whole grain consumption is association with a significant reduction in all-cause mortality. Geng Zong et al. Whole Grain Intake and Mortality From All Causes, Cardiovascular Disease, and Cancer: A Meta-Analysis of Prospective Cohort Studies.  Circulation 2016 Jun 14;133(24):2370-80. Harvard T.H. Chan School of Public Health. and "Eating more whole grains linked with lower mortality rates." ScienceDaily, 13 June 2016.

9. Staying physically active can buy you extra years of function: University of Birmingham. "A lifetime of regular exercise literally slows down aging, study finds." ScienceDaily, 8 March 2018. from Ross D. Pollock et al. Properties of the vastus lateralis muscle in relation to age and physiological function in master cyclists aged 55-79 years. Aging Cell, 2018; e12735. and Duggal et al. Major features of Immunesenescence, including Thymic atrophy, are ameliorated by high levels of physical activity in adulthood. Aging Cell, 2018 Apr;17(2):e12750.

10. The sit-down-stand-up test: Leonardo Barbosa Barreto de Brito et al. Ability to sit and rise from the floor as a predictor of all-cause mortality. Eur J Prev Cardiol. 2014 Jul;21(7):892-8. and

11. A healthy lifestyle could significantly reduce a person's chances of chronic illness according to the Caerphilly study: Peter Elwood et al. Healthy lifestyles reduce the incidence of chronic diseases and dementia: evidence from the Caerphilly cohort study. PLoS One, 2013 Dec 9;8(12):e81877. and

12. A bowl of porridge a day can lower cholesterol as much as statins without the side effects: Hoang V T Ho et al. The effect of oat β-glucan on LDL-cholesterol, non-HDL-cholesterol and apoB for CVD risk reduction: a systematic review and meta-analysis of randomised-controlled trials. Br J Nutr, 2016 Oct;116(8):1369-1382. and .  Interestingly, an eight month study of the effects of exercise on 111 overweight middle-aged Americans found that this was one thing exercise did NOT do: “exercise training had no significant effect on the total cholesterol or LDL cholesterol concentrations,” although there were numerous other health benefits. William E Kraus et al. Effects of the amount and intensity of exercise on plasma lipoproteins. N Engl J Med. 2002 Nov 7;347(19):1483-92.

13. Cataracts in Nepal have been related to sunlight exposure: LB Brilliant et al. Associations among cataract prevalence, sunlight hours, and altitude in the Himalayas. Am J Epidemiol. 1983 Aug;118(2):250-64. although a UK study found cataracts are less common in vegans and vegetarians than fish or meat eaters: Paul N Appleby et al. Diet, vegetarianism, and cataract risk. Am J Clin Nutr. 2011 May;93(5):1128-35.

14. Mountain ranges compared to the human brain by Snow Leopard author Matthiessen, see Reference 1 above

 Altitude sickness
15. By 4,500 m altitude 25 per cent of all trekkers -
Jennifer Vardy et al. Acute mountain sickness and ascent rates in trekkers above 2500 m in the Nepali Himalaya. Aviat Space Environ Med. 2006 Jul;77(7):742-4. “The incidence of AMS was 0% at 2500-3000 m, 10% between 3000-4000 m, 15% between 4000-4500 m, 51% between 4500-5000 m, and 34% over 5000 m. There was no significant association between age or gender and the altitude studied or incidence of AMS. Subjects with AMS ascended significantly further in the preceding 72 h than subjects without AMS”.

16. Dr Peter Hackett is now considered one of the world’s leading authorities on this subject. I found the following one hour Youtube lecture – from a 2018 seminar preparing military special operations personnel to go to high altitudes – extraordinarily useful.  “Dr Peter Hackett presents his lecture: Altitude Illness: What You Need to Know “

17. Howard has the slow acclimatisation rate of an endurance athlete (presumably due to low blood pressure that runs in his family and seems to be associated with doing well in cross-country races) as described in Dr Hackett’s presentation above. We now think Howard’s inability to acclimatise in Peru was due to eating problematic additives in most meals. Ironically, as a food scientist he was in charge of preparing the food for the expedition and deliberately used synthetic antioxidant BHA 320 so the food would last in hot weather while getting there, only to discover later that he is susceptible to the side effects of many additives.  

18. The official cure is resting or descending immediately if symptoms worsen - Himalayan Rescue Association: Mountain sickness and other hazards in the Nepal Himalaya, brochure available at checkposts in Nepal and

19. Headaches and heart palpitations were some of the first MSG symptoms reported in medical journals. Schaumburg HH and others. Monosodium l-Glutamate: its pharmacology and role in Chinese restaurant syndrome. Science, 1969;163:826-828. 
- In 1986, an article called MI or MSG? in the medical journal EMS warned emergency medical technicians to consider whether they were dealing with MI (myocardial infarction/heart attack) or MSG side effects when the patient's symptoms include sweating, numbness around the face and neck, chest pressure and burning sensations, palpitations, nausea and vomiting. EMS, May 1986:14(4) as reported in the book In Bad Taste: the MSG Syndrome by George R Schwartz MD, Signet, New York, 1990).
- These symptoms and many others have been reported by our Network.
- MSG has also been associated with dizziness, mental confusion and other symptoms - Adrienne Samuels. Dose dependent toxicity of glutamic acid: a review. International Journal of Food Properties,2020, 23:1, 412-419.

20. Per capita consumption of instant noodles in Nepal  third highest in the world, after South Korea and Vietnam, according to the WINA (World Instant Noodles Association) report - Instant noodles at a glance, accessed 4/9/2021

21. Dr Hackett on the blood-brain barrier disruption at altitude: Peter H Hackett and Robert C Roach. High altitude cerebral edema. High Alt Med Biol. Summer 2004;5(2):136-46.

22. Animal studies and one human study suggest that the elevation of plasma glutamate levels can increase cerebral edema formation when the blood-brain barrier is disturbed - J F Stover, O S Kempski. Glutamate-containing parenteral nutrition doubles plasma glutamate: a risk factor in neurosurgical patients with blood-brain barrier damage? Crit Care Med. 1999 Oct;27(10):2252-6.

23. At least one food colour is known to cross the blood-brain barrier at low altitude, and the combination of MSG plus a food colour was shown to cause much  greater neurotoxicity than expected: Lau  et al. Synergistic interactions between commonly used food additives in a developmental neurotoxicity test. Toxicological Sciences, 2006, 90(1): 178-187.
- and in Sarah Kobylewski and Michael F Jacobson. Food dyes: A rainbow of risks. Centre for Science in the Public Interest, 2010

24. Irritability, restlessness, inattention, sleep disturbance due to tartrazine yellow colour - K S Rowe and K J Rowe. Synthetic food coloring and behavior: a dose response effect in a double-blind, placebo-controlled, repeated-measures study. J Pediatr. 1994 Nov;125(5 Pt 1):691-8. and full text

25. Most doctors don’t acknowledge the connection between food and behaviour, yet according to behavioural toxicology Professor Bernard Weiss, behavioural symptoms are the first signs of toxicity and the FDA definitions of safety are too narrow. Bernard Weiss Synthetic food colors and neurobehavioral hazards: the view from environmental health research. Environ Health Perspect. 2012 Jan;120(1):1-5.
- Fifty years after the first report of behavioural reactions to artificial colours and flavours, a study found that prolonged use of these additives can cause liver damage: Hanan Mohamed Fathy Abd El-Wahab and Gehan Salah El-Deen Moram. Toxic effects of some synthetic food colorants and/or flavor additives on male rats. Toxicol Ind Health, 2013 Mar;29(2):224-32.

26. KB’s toothpaste, more details in our factsheet The trouble with toothpaste and other dental products,

Barley harvest
27. Barley has high satiety, and lowered food intake in Japan
- Seiichiro Aoe et al. Effect of cooked white rice with high β-glucan barley on appetite and energy intake in healthy Japanese subjects: a randomized controlled trial. Plant Foods Hum Nutr. 2014 Dec;69(4):325-30.
- Although possibly it depends where the barley comes from, or the culture eating it, as subjects felt fuller but still ate as much in the US - Danielle N. Cooper et al. Does whole grain consumption alter gut microbiota and satiety? Healthcare (Basel). 2015 Jun; 3(2): 364–392.

28. A barley/legume diet increased beneficial gut flora and improved cardiometabolic health even better than the similar healthy wheat-based diet recommended by Swedish nutritionists - Juscelino Tovar et al. Combining functional features of whole-grain barley and legumes for dietary reduction of cardiometabolic risk: a randomised cross-over intervention in mature women. Br J Nutr, 2014 Feb;111(4):706-14.

29. Honey for cough prevention - Sultan Ayoub Meo et al.  Role of honey in modern medicine. Saudi J Biol Sci. 2017 Jul;24(5):975-978. This article includes a review on honey for cough: “In all three honey products groups, there was a significant greater improvement compared to the placebo group.”

30. Honey consumption In the Caerphilly study - risk factors for vascular and other diseases in 41 men who recorded eating honey suggested that these men were on the whole healthier than the 624 men who had not recorded honey consumption and all-cause mortality during 25 years of follow-up was considerably lower in the men who had consumed honey. Rose A Cooper et al. Honey, health and longevity, Curr Aging Sci. 2010 Dec;3(3):239-41.

31. Lake Phoksundo

Potatoes are highly nutritious and only fattening due to added fats - Janet C King and Joanne L Slavin. White potatoes, human health, and dietary guidance. Adv Nutr, 2013 May 1;4(3):393S-401S.

33. Satiety index study - boiled potatoes were rated as the most filling. Oat porridge was also very high (unfortunately, barley wasn’t included in the study) whereas croissants, cake and French fries were some of the worst because the feeling of fullness due to fats wears off very quickly - S H Holt et al. A satiety index of common foods. Eur J Clin Nutr. 1995 Sep;49(9):675-90. and a discussion with lead author Susanna Holt at

34. Two researchers in Poland - S K Kon and A Klein. The value of whole potato in human nutrition. Biochem J, 1928;22(1):258-60. In 1928, obesity wasn’t an issue, so these researchers were more concerned to point out that they didn’t lose weight, except towards the end for subject A who had started more intensive training.

35. Chris Voigt's entertaining promotional video on potatoes - 60 Day Potato-Only Diet (4 min)

36. Andrew Taylor’s story is available in his books Spudfit and The DIY Spud Fit Challenge with before and after weight loss photos - there are also numerous interviews e.g.,

37. Eric Valli’s movie Himalaya is about a village in the Dolpo area and their conflict over who will lead the next annual yak caravan to trade for salt, all filmed locally in magnificent scenery, reviewed by film critic Roger Ebert: “It is astonishing to think that lives like this are still possible in the 21st century.”

38. Obesity rankings by selected countries - data from The World Factbook authored by the CIA which gives the adult prevalence rate for obesity, defined as "the percent of a country's population considered to be obese".

How do monks put on weight?
Vegetarian Buddhist monks in China with low BMIs - Hui-Jie Zhang et al. Attenuated associations between increasing BMI and unfavorable lipid profiles in Chinese Buddhist vegetarians. Asia Pac J Clin Nutr. 2013;22(2):249-56.

40. Obesity in Thai monks - In Thailand, “Obesity in Our Monks Is a Ticking Time Bomb” by Muktita Suhartono, New York Times, Aug 12, 2018.

41. UK 13th century Benedictine monks more likely to be obese than the overall population - Fat jolly monks had painful secrets by Jennifer Viegas, Discovery News, Monday, 26 July 2004.
- and Bones reveal chubby monks aplenty, by Martin Wainwright, Thu 15 Jul 2004, The Guardian

42. Our guidebook – we were using the current (at that time) edition of Trekking in the Nepal Himalaya from Lonely Planet.

Travellers’ diarrhoea
43. Probiotics in Nepali dahi -
Sailendra Dewan and Jyoti Prakash Tamang. Dominant lactic acid bacteria and their technological properties isolated from the Himalayan ethnic fermented milk products. Antonie Van Leeuwenhoek, 2007 Oct;92(3):343-52. and a later review mentions some “exotic and rare” beneficial microorganisms that are lesser known in the outside world: Jyoti Prakash Tamang et al. Diversity of beneficial microorganisms and their functionalities in community-specific ethnic fermented foods of the Eastern Himalayas. Food Res Int. 2021 Oct;148:110633.

44. Gut microbiota linked to obesity and the effects of probiotics - F B Seganfredo et al. Weight-loss interventions and gut microbiota changes in overweight and obese patients: a systematic review. Obes Rev. 2017 Aug;18(8):832-851.

45. S Boulardii helps prevent and treat travellers’ diarrhoea - In 158 reviewed articles, S. boulardii was exceptional: “only one of three probiotics showed significant efficacy for the prevention of TD” as described in Lynne V McFarland and Shan Goh. Are probiotics and prebiotics effective in the prevention of travellers' diarrhea: A systematic review and meta-analysis. Travel Med Infect Dis, Jan-Feb 2019;27:11-19.

46. The worst snowstorm in trekking history

Himalayan salt
47. Iodised salt and goitre
– the prevalence of goitre has dropped from 90 to 20 per cent over 25 years thanks to iodised salt to overcome iodine deficient soil but many choose not to eat it, preferring to eat iodine-deficient Tibetan rock salt: Murdoch DR et al. Persistence of iodine deficiency 25 years after initial correction efforts in the Khumbu region of Nepal. N Z Med J, 1999;112(1092):266-8.

48. High rate of high blood pressure and stroke in Tibetans due to excessive salt intake - Zhao X et al. Using a low-sodium, high-potassium salt substitute to reduce blood pressure among Tibetans with high blood pressure: a patient-blinded randomized controlled trial. PLoS One, 2014;9(10):e110131.

49. Low rates of high blood pressure in thin villagers on traditional diets despite high salt intake - Vaidya A et al. Prevalence of hypertension in Nepalese community triples in 25 years: a repeat cross-sectional study in rural Kathmandu. Indian Heart J, 2012;64(2):128-31.

50. Low hypertension in high altitude Sherpas despite high salt intake – Smith, C. Blood pressures of Sherpa men in modernizing Nepal. Am J Hum Biol. 1999;11(4):469-479.

51. Potatoes and kukoamines - Researchers at the Institute for Food Research in Norwich have found blood-pressure lowering molecules in potatoes called kukoamines. Parr AJ et al. Dihydrocaffeoyl polyamines (kukoamine and allies) in potato (Solanum tuberosum) tubers detected during metabolite profiling.  J Agric Food Chem, 2005;;53(13):5461-6. and Agricultural Research Service, USDA Agresearch Magazine, Phytochemical profilers investigate potato benefits

52. Nancy J Aburto et al. Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses. BMJ. 2013 Apr 3;346:f1378.
- The potato is a food rich in potassium - Adam Drewnowski, Colin D Rehm. Vegetable cost metrics show that potatoes and beans provide most nutrients per penny. PLoS One. 2013 May 15;8(5):e63277.

53. Weight loss due to high altitude is so effective that it is now offered as a method of losing weight - Biff F Palmer and Deborah J Clegg. Ascent to altitude as a weight loss method: the good and bad of hypoxia inducible factor activation. Obesity (Silver Spring). 2014 Feb;22(2):311-7.

Chapter 5 - Dolpo revisited

1. Yarsagumba: Curse of Himalayan Annapurna region

2. Hidden treasures - Heller Amy. Hidden Treasures of the Himalayas, Tibetan manuscripts, paintings and sculptures of Dolpo. Chicago 2009, p. 45-75.

3. Route on the Great Himalayan Trail (GHT)
- Bhijer holds unique illustrated manuscripts and carved book covers dating from the 11-16th century in a library of 642 volumes. See Hidden Treasures of the Himalayas by Amy Heller (Serindia Publications, Chicago USA 2009 ISBN 978-1-932476-44-6

4. Jacqui [1613] and researchers report that children “lack self-control” after eating artificial colours. K S Rowe and K J Rowe. Synthetic food coloring and behavior: a dose response effect in a double-blind, placebo-controlled, repeated-measures study. J Pediatr. 1994 Nov;125(5 Pt 1):691-8.

5. Ellen Langer’s Counterclockwise research. Francesco Pagnini et al. Ageing as a mindset: a study protocol to rejuvenate older adults with a counterclockwise psychological intervention. BMJ Open. 2019 Jul 9;9(7):e030411.
- As shown in the BBC 2010 documentary series with Dr Michael Moseley. The Young Ones and described in Dr Langer’s 2015 book, Counterclockwise

6. Belly fat and lack of sleep. “Compared with those who slept 7 hours per day, short sleepers had an increased risk of significant weight gain and central obesity” - Xuejuan Ning  et al. Association of Sleep Duration with Weight Gain and General and Central Obesity Risk in Chinese Adults: A Prospective Study. Obesity (Silver Spring), 2020 Feb;28(2):468-474.

7. How to lose belly fat? Studies show that weight loss through diet and/or exercise will include belly fat loss, although it is harder for postmenopausal women.  “There is no evidence of a weight loss intervention that preferentially targets intra-abdominal fat mass” - Willemijn A van Gemert. Effect of diet with or without exercise on abdominal fat in postmenopausal women - a randomised trial. BMC Public Health. 2019 Feb 11;19(1):174.
- Elaine C Rush et al. Reduction of abdominal fat and chronic disease factors by lifestyle change in migrant Asian Indians older than 50 years. Asia Pac J Clin Nutr 2007;16(4):671-6.
- Also see 7 ways to lose belly fat

Belly fat linked to MSG?
Thai MSG study. Belly fat (abdominal obesity) was considered the most important of “five criteria characterized the metabolic syndrome” - Insawang T et al. Monosodium glutamate (MSG) intake is associated with the prevalence of metabolic syndrome in a rural Thai population. Nutr Metab (Lond), 20128;9(1):50.

9. In a study of over 700 healthy Chinese subjects, MSG users were more likely to be overweight or obese than non-users - He et al. Association of monosodium glutamate intake with overweight in Chinese adults: the INTERMAP Study. Obesity (Silver Spring), 2008;16(8):1875-80.

10. Animal studies also support an association between MSG and obesity. “ the flavouring agent MSG … at concentrations that only slightly surpass those found in everyday human food, exhibits significant potential for damaging the hypothalamic regulation of appetite” from M Hermanussen et al. Obesity, voracity, and short stature: the impact of glutamate on the regulation of appetite. European Journal of Clinical Nutrition (2006) 60, 25–31  - J Bunyan et al. The induction of obesity in rodents by means of monosodium glutamate. Br J Nutr. 1976 Jan;35(1):25-39.
- This appears to be so effective that a commercial laboratory called Creative Biolabs now advertises “monosodium Glutamate (MSG)-Induced Obesity Model” rodents for sale to scientific researchers. According to their sales pitch “Studies about injecting MSG into neonatal experimental animals began in the 1970s. Now it is widely known that adult mice and rats treated neonatally with MSG will trigger the development of obesity coupled with several other endocrine and metabolic abnormalities”. Visited 31/10/2021.

11. 129 ways to add MSG and fool consumers
Of the (now) 131 ways in which glutamate flavour enhancers can be added to food, only 12 are regulated and must appear as additives. The rest are hidden and so in unregulated amounts.

Diabetes and diet
12. Asians develop diabetes at a younger age and lower BMI
than Westerners. In 2013, one quarter of the world’s diabetics were in China, where 12 per cent of adults had diabetes and 50 per cent had prediabetes, compared to 9 per cent and 30 per cent in the US. Diabetes and obesity in America: CDC figures
- Chan JC et al. Diabetes in China: a societal solution for a personal challenge. Lancet Diabetes Endocrinol, 2014;2(12):969-79.

13.  In Taiwan, a study found a strong protective association between the Taiwanese vegetarian diet and diabetes - Chiu TH et al. Taiwanese vegetarians and omnivores: dietary composition, prevalence of diabetes and IFG. PLoS One. 2014 Feb 11;9(2):e88547.

14. The Adventist Health Studies in the US found that increasing conformity to a vegetarian diet protected against risk of diabetes. In the Adventist Health Study-2 with 60,000 Adventists, BMI was lowest in vegans (23.6) and incrementally higher in lacto-ovo vegetarians (25.7), pesco-vegetarians (26.3), semi-vegetarians (27.3) and nonvegetarians (28.8). Similarly, the prevalence of type 2 diabetes increased from 2.9% in vegans to lacto-ovo (3.2%), pesco (4.8%), or semi-vegetarian (6.1%) and 7.6% in nonvegetarians. Conclusion: Increased conformity to vegetarian diets protected against risk of type 2 diabetes. Tonstad S et al. Type of vegetarian diet, body weight, and prevalence of type 2 diabetes. Diabetes Care, 2009;32(5):791-6.

15. A US study comparing a low-fat vegan diet with the diet normally recommended for diabetes showed that people on the vegan diet lost more weight and achieved better blood sugar control.  Barnard ND et al. A low-fat vegan diet and a conventional diabetes diet in the treatment of type 2 diabetes: a randomized, controlled, 74-wk clinical trial. Am J Clin Nutr, 2009;89(5):1588S-1596S. and
- Dr Barnard discusses how to fight and reverse type 2 diabetes with a plant-based diet.

16. The 12-week whole-food plant-based diet BROAD study in New Zealand led to significant improvements in BMI, cholesterol and other risk factors. Researchers commented “To the best of our knowledge, this research has achieved greater weight loss at 6 and 12 months than any other trial that does not limit energy intake or mandate regular exercise”. N Wright et al. The BROAD study: A randomised controlled trial using a whole-food plant-based diet in the community for obesity, ischaemic heart disease or diabetes. Nutr Diabetes. 2017 Mar 20;7(3):e256.

17. This was also shown clearly in the documentary Forks over Knives in which a woman working in a diabetes education office who ironically had diabetes herself managed to reverse her diabetes by going on the whole-food plant-based diet

High altitude weight loss
18. More weight loss
with strenuous exercise at higher altitudes. Tobias Dünnwald et al. Body Composition and Body Weight Changes at Different Altitude Levels: A Systematic Review and Meta-Analysis. Front Physiol. 2019; 10: 430. and Stacie L. Wing-Gaia. Nutritional strategies for the preservation of fat free mass at high altitude. Nutrients, 2014,Feb 13;6(2):665-81. )

19. Hypoxic therapy for obesity. Hun-Young Park et al. Exposure and Exercise Training in Hypoxic Conditions as a New Obesity Therapeutic Modality: A Mini Review. J Obes Metab Syndr. 2018 Jun 30;27(2):93-101. and an example in Australia, the Altitude Gym

Chapter 6 - The Camino in France

1. Miam Miam Dodo guidebook available from the pilgrim office in Le-Puy-en-Velay or online at

2. French fries - Rebecca Rupp, Are French fries truly French, National Geographic, January 8, 2015.

3. Aligot - more details in my blog, 7 things I loved in France (with photos)

Food in France
4. MSG in Germany
- as we have seen for ourselves: “What’s bothering me is how MSG has taken over German cuisine in the past 20 years … I’ve virtually stopped going to traditional German restaurants because I’m afraid I’ll wind up like I did after a goose ‘n’ gravy extravaganza in Leipzig one night, sweating and with my heart racing and unable to sleep.” From A specter is looming over German cuisine: the specter of monosodium glutamate by Ed Ward, a respected American music, food and art critic and author, who lived in Berlin from the mid-1990s until 2008, posted on his blog July 4th, 2008

5. In Spain, where they use nasty additives almost as freely as English-speakers - I explored this when a 1998 worldwide survey showed that English speakers and Spanish speakers had the highest prevalence of childhood asthma in the world. Doctors couldn’t explain it: “What if they all switched to Norwegian?” wrote one doctor, but of course it could be explained by how many additives they ate as described in our paper about sulphites. Dengate S and Dengate H. Contribution of food additives to worldwide variations in the prevalence of childhood asthma symptoms. 2004, J Food Intolerance No 1, at

6. Opposing the introduction of junk food - Wayne Northcutt. José Bové vs. McDonald's: The Making of a National Hero in the French Anti-Globalization Movement. Journal of the Western society for French history, Volume 31, 2003.;view=fulltext

7. Ongoing NutriNet-Santé studies about ultra-processed foods.  In 2009, the NutriNet-Santé study was the first internet-based study of its kind. By 2021, the team was collecting data from 171,000 people and several other countries joined in. What have we learned from the world’s largest nutrition study? and

8. French bread decree (Pain Décret) ne contenant aucun additive”: Randal Oulton. French Bread Law (1993)

9. Meat in France - 7 ways to survive as a vegan or vegetarian in France by Frederic Bibard, February 24, 2016

10. Regulations in France mean vegetarian options are not possible - “… the owner of the table d'hotes must only offer one menu, preferably composed of local products produits du terroir. This means that you cannot offer two starters, two main meals and three desserts”. The differences between a gite, chambre d’hotes and table d’hotes in France by Valérie Aston, 9 May 2017, Start business in France,

The French paradox
11. “Occasional” drinkers lived the longest
- Tim Stockwell et al. Do “Moderate” Drinkers Have Reduced Mortality Risk? A Systematic Review and Meta-Analysis of Alcohol Consumption and All-Cause Mortality. Journal of Studies on Alcohol and Drugs, 77(2), 185–198 (2016). and "Don't drink or, if you do, drink no more than one drink per day"- Adam Sherk et al. Does Drinking Within Low-Risk Guidelines Prevent Harm? Implications for High-Income Countries Using the International Model of Alcohol Harms and Policies. Journal of Studies on Alcohol and Drugs, 2020; 81 (3): 352.

12. “You’d be dead from alcohol poisoning” - Resveratrol was the ingredient in red wine thought to protect wine drinkers from heart attacks - Emma L Wightman. The Conversation, July 11, 2017. Emma Wightman et al. The effects of chronic trans-resveratrol supplementation on aspects of cognitive function, mood, sleep, health and cerebral blood flow in healthy, young humans. Br J Nutr. 2015 Nov 14;114(9):1427-37.

13. Higher consumption of ultra-processed foods was associated with higher risks of cardiovascular, coronary heart, and cerebrovascular disease - Bernard Srour et al. Ultra-processed food intake and risk of cardiovascular disease: prospective cohort study (NutriNet-Santé). BMJ. 2019 May 29;365:451.

14. The traditional Mediterranean-type diet, including plant foods/emphasizing plant protein sources, provides a well-tested healthy dietary pattern to reduce CVD - Sonia S. Anand et al. Food Consumption and its impact on Cardiovascular Disease: Importance of Solutions focused on the globalized food system: A Report from the Workshop convened by the World Heart Federation. J Am Coll Cardiol. 2015 Oct 6; 66(14): 1590–1614.

15. A1 vs A2 dairy products - “… consume 3.23 times more beta-casein A1 … than the French. C N McLachlan. beta-casein A1, ischaemic heart disease mortality, and other illnesses. Med Hypotheses. 2001 Feb;56(2):262-72.

16.Most of the world’s leading dairy companies ... Companies like Nestlé, Danone and Mead Johnson, plus the biggest Chinese Companies, all have their own A2 projects and nutritional products.” post Keith Woodford, author of Devil in the Milk 2007,

17. Up to 15 French speakers – as in Ref 10 above “a chambre d'hotes can only … accommodate a maximum of 15 people”.

18. Horsemeat - Catherine Bremer. Don't say nay to horsemeat: French eaters. February 13, 2013, Reuters

19. French women DO get fat – in 2016 a French survey found nearly half the French adult population were overweight. Joane Matta et al. Overweight, obesity and cardiometabolic risk factors prevalence in France: The CONSTANCES cohort. Bulletin epidemiologique hebdomadaire, 2016, According to the OECD Obesity Update 2017, obesity affected 15.3 per cent of French adults compared to 26.9 per cent in Britain and 38.2 in the US.

20. Updated dietary guidelines - Dan Chaltiel et al. Adherence to the 2017 French dietary guidelines and adult weight gain: A cohort study. PLoS Med. 2019 Dec 30;16(12):e1003007. .

The rosary and the mantra
21. TM meditation
- “Hundreds of published research studies on TM verify its effectiveness for reducing stress, enhancing brain function, strengthening immunity and many more”.  TM official website

22. Effect of rosary and mantra - L Bernardi et al. Effect of rosary prayer and yoga mantras on autonomic cardiovascular rhythms: comparative study. BMJ. 2001 Dec 22-29;323(7327):1446-9.

23. Meditation and longevity – “Can direct change in state of consciousness through specific mental techniques extend human life and reverse age-related declines?“ Alexander CN et al. Transcendental meditation, mindfulness, and longevity: an experimental study with the elderly. Pers Soc Psychol, 1989 Dec;57(6):950-64.

24. Bed bugs - “Check bed for signs of bed bugs in your hotel room … mattress seams, in the cracks and corners of the bed including the headboard  … Do not put luggage on the bed, couch or carpeted floor … place items in a plastic bag until you can follow the directions for vacuuming, steam cleaning, heat treatment or freezing”.  Bed bug factsheet: Got Bed Bugs? Don’t Panic by Stephanie Davio, Beyond pesticides, 2011

Climate change
25. Animal food greenhouse gas emissions are eight times more than those from passenger air travel, which are 1.5 per cent of global emissions
.  Globally, food production is responsible for one-quarter of the world’s greenhouse gas emissions. Livestock and fisheries emissions, including land use impacts, are 12.2 per cent in total. Against this, 1.5 per cent is emitted by all passenger aviation.

26. Vegans - Plant-based diets could save millions of lives and dramatically cut greenhouse gas emissions. The Oxford Martin School, Oxford University, 21 March 2016.
- Marco Springmann et al. Analysis and valuation of the health and climate change cobenefits of dietary change. PNAS, March 21, 2016 113 (15) 4146-4151.

27. The charity Plan B Earth - Plan B & 11 Citizens v UK 2050 Carbon Target

Heart attack in the mountains
28. Cardiologists on exercise
- Too much exercise can lead to cardiac problems, especially for those over 40, heart specialist says, The World Today by George Roberts, 29 Aug 2017.

29. Pritikin - Pritikin’s story  and the Pritikin diet

30. The Pritikin and Fixx autopsies - Nathan Pritikin's heart. N Engl J Med. 1985 Jul 4;313(1):52 described in Healthy at 100: The Scientifically Proven Secrets of the World's Healthiest and Longest-Lived Peoples by John Robbins, ISBN978-0345490117, 2007, pages 183-184, and quoted in

Low-fat versus very low-fat confusion
31. Low-fat confusion
– An international study including researchers from Harvard University and University College London reviewed 38 studies with more than 6,000 adults. Shreya Chawla et al.  The Effect of Low-Fat and Low-Carbohydrate Diets on Weight Loss and Lipid Levels: A Systematic Review and Meta-Analysis. Nutrients, 2020 Dec 9;12(12):3774.

32. Low-fat diets (29 per cent fat from calories) – Results from the large, 7 year Women’s Health Initiative Dietary Modification Trial showed no effect on heart disease, breast cancer, colorectal cancer, or weight.
- Barbara V Howard et al. Low-fat dietary pattern and weight change over 7 years: the Women's Health Initiative Dietary Modification Trial. JAMA. 2006 Jan 4;295(1):39-49.
This study did not prove that low-fat diets do not work; 20,000 women achieved only a modest lowering of fat intake despite their supported efforts. Rather, it was evidence of the real difficulty of lowering fat intake in Western society.

33. Very low-fat diets (10 per cent fat from calories) – In New Zealand, the BROAD study led to significant improvements in BMI, cholesterol and other risk factors. Participants lost an average 11.5kg at one year and decreased their waist circumference by average 9cm, “the largest weight loss of any randomised control trial where participants had no restriction on calories and did not have to exercise”.  N Wright et al. The BROAD study: A randomised controlled trial using a whole food plant-based diet in the community for obesity, ischaemic heart disease or diabetes. Nutr Diabetes. 2017 Mar 20;7(3):e256.

34. Cardiothoracic surgeon Dr Ellsworth Wareham in a video interview at age 98 on the Blue Zones website. Heart disease discussion starts from 6.00 minutes.

35. Only two specialist cardiologists have demonstrated that they can prevent and reverse heart disease:
- Caldwell B Esselstyn Jr. A way to reverse CAD? J Fam Pract. 2014 Jul;63(7):356-364b. and Prevent and Reverse Heart Disease: The Revolutionary, Scientifically Proven, Nutrition-Based Cure by Caldwell B Esselstyn Jr, 2007, also featured in the documentary Forks over Knives
  - Dr Dean Ornish et al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA,  1998 Dec 16;280(23):2001-7. and UnDo Your Heart Disease

36. “Remarkable” cholesterol readings. Sue was 3.6/1.6 (total cholesterol/LDL mmol/L) and at the same time Howard was 4.2/2.7. Recommended ranges are total cholesterol <5.6 mmol/L and LDL <4.1 mmol/L.

Chapter 7 - Nepal Lady’s Lake trek

1. A 30 day epic - see our tracknotes and video (1hr30min)

2. Wetter, steeper, more native forest – Kangchenjunga and Barun Valley

3. The remote village of Olangchung Gola is the birthplace of the famous eye surgeon Dr Sanduk Ruit, protégé of Fred Hollows and claimed to have halved blindness in Nepal as described in The Barefoot Surgeon by Ali Gripper, 2018, preview

4. I saw my aunt lying motionless – according to researchers, such unexplained experiences related to the death of a loved one are common and most often affect women. Milla Mäkikomsi et al. Unexplained experiences in the context of bereavement – qualitative analysis. Mortality, published online: 21 Oct 2021.
- According to the Australian Institute of Parapsychological Research information sheet, such experiences are likely to happen unintentionally during meditation

Osteoarthritic knee pain (OA)
5. In the US, OA is the most common form of arthritis
affecting 32.5 million adults, according to the Osteoarthritis Action Alliance
- but not in traditional communities like Isu’s village or Ecuador’s Vilcabambans. A scientific expedition led by Ecuadorian doctor Vela Chiriboga found no evidence of arthritis (or cancer, diabetes, obesity, heart disease or dementia) in the local inhabitants even in extreme old age. He described “an exemplary diet based on corn, beans, quinoa, peanuts, white cabbage and other vegetables that keep them free of digestive upsets and arteriosclerosis.”-  Guillermo Vela Chiriboga, María del Carmen Alarcón de Vela. Secretos de Vilcabamba para vivir siempre joven. Corporación de Estudios y Publicaciones, Quito, 1989. and described in John Robbins, Healthy at 100

6. Knee osteoarthritis has doubled - Ian J Wallace et al. Knee osteoarthritis has doubled in prevalence since the mid-20th century. Proc Natl Acad Sci USA, 2017 Aug 29;114(35):9332-9336. and

7. High-fat diet after injury increased OA - Mooney RA et al. High-fat diet accelerates progression of osteoarthritis after meniscal/ligamentous injury. Arthritis Res Ther, 2011;13(6):R198.

8. High intakes of total fat and SFAs may be associated with increased structural knee OA progression - Lu B et al. Dietary Fat Intake and Radiographic Progression of Knee Osteoarthritis: Data From the Osteoarthritis Initiative. Arthritis Care Res (Hoboken), 2017 Mar;69(3):368-375.

9. Palmitic and stearic saturated fatty acids (SFAs) cause of OA - Sunderajhan Sekar et al. Saturated fatty acids induce development of both metabolic syndrome and osteoarthritis in rats. Sci Rep, 2017 Apr 18;7:46457. and QUT news

10. Good for heart could be bad for knees? - Anushree S et al. Stearic sunflower oil as a sustainable and healthy alternative to palm oil. Agronomy for Sustainable Development, 2017, volume 37, article number 18.

11. Medieval monk skeletons - Philippa J Patrick. The 'Real' Friar Tuck?: Obesity and Overindulgence in Medieval England. Institute of Archaeology, University College, described in Bones reveal chubby monks aplenty, by Martin Wainwright, Thu 15 Jul 2004, The Guardian.

SFAs in common fats and oils
12. Table of SFAs
- Source: Portland State University, from Gunstone Fatty Acid and Lipid Chemistry 1996. and Anushree S et al. Reference 10 above.

13. Figures are higher for farmed than wild-caught fish - Royce Kurmelovs. The Guardian, 15/12/2021, Calls for independent salmon testing after lab tests allegedly show higher fat content than industry figures.

14. Figures are higher for grain-fed than grass-fed beef
Eric N Ponnampalam et al. Effect of feeding systems on omega-3 fatty acids, conjugated linoleic acid and trans fatty acids in Australian beef cuts: potential impact on human health. Asia Pac J Clin Nutr, 2006;15(1):21-9, funded by the Meat and Livestock industry. and
- Cynthia A Daley et al. A review of fatty acid profiles and antioxidant content in grass-fed and grain-fed beef. Nutr J, 2010 Mar 10;9:10.

Diet for OA (oesteoarthritis)
15. Reduction of pain in as little as two weeks
- Chelsea M Clinton et al. Whole-foods, plant-based diet alleviates the symptoms of osteoarthritis. Arthritis, 2015;2015:708152.
- Dr John McDougall, How to prevent and treat degenerative (osteo) arthritis.
- Similarly, a Mediterranean type diet “abundant in vegetables, fruits, beans, whole grains, olive oil and fish, and less red meat than typical Western diets” was found to increase knee flexion and hip rotation - J Dyer et al. Effect of a Mediterranean type diet on inflammatory and cartilage degradation biomarkers in patients with osteoarthritis. J Nutr Health Aging. 2017; 21(5): 562–566.

16. Trekker diet and porter diet compared - Danilo Bondi et al. Feeding Your Himalayan Expedition: Nutritional Signatures and Body Composition Adaptations of Trekkers and Porters. Nutrients, 2021 Jan 30;13(2):460.

17. Glacial lake outburst flood - Barun Valley Glacier Lake Outburst Flood, April 20, 2017. The SubHimalayan: Science and culture of the PanHimalaya, 

18. Our friend Bill Denz killed in an avalanche on Makalu - Mesca-Dawn: A Remembrance of Bill Denz by David Austin, Alpinist magazine, May 9, 2013

19. The traditional diet in Nepal has changed over the past 40 yearsshifting away from agricultural staple based foods to modern processed foods with higher total energy, total fat, and sugar. The prevalence of overweight/obesity and diet related … diseases is increasing”. Yagya Prasad Subedi et al. Where is Nepal in the nutrition transition? Asia Pac J Clin Nutr, 2017 Mar;26(2):358-367.

20. Arthritis is now an increasing problem for villagers in the Dhaulagiri and Gandaki areas that we walked through on the beginning and ending of our Dolpo treks. Eliya Shrestha and others. Co morbidities among cataract-operated patients in Rural Nepal. Nepal J Ophthalmol. 2017 Jul;9(18):156-159.

21. The three most common forms of arthritis in the US are osteoarthritis, rheumatoid arthritis and gout - CDC Centers for Disease Control and prevention , Gout

The great gout puzzle
22. Gout in Nepal
- “gouty attacks are common and seem to start at a younger age group (less than 40 years) in Nepal than what is usually noted in Western medical textbooks (over 60 years). The reason for this predisposition at a younger age is not known.” - A correspondent, Gout in Nepal, Spotlight news magazine2011, Aug 5:vol 05(4). and K Pokharel et al. Estimation of serum uric acid in cases of hyperuricaemia and gout. JNMA J Nepal Med Assoc, Jan-Mar 2011;51(181):15-20.

23. Per capita consumption of instant noodles in Nepal is the third highest in the world, after South Korea and Vietnam, according to the World instant Noodle Association (WINA) - Instant noodle, Wikipedia

24. The label warning that never happened
- “People suffering from conditions such as gout which require the avoidance of purines should avoid this substance“ – Maurice Hanssen with Jill Marsden, The new additive code breaker, 1989, page 126.
- JECFA Eighteenth Report of the Joint FAO/WHO Expert Committee on Food Additives, Calcium and Sodium-5’-Ribonucleotides, Wld Hlth Org. techn. Rep. Ser., 1974, No. 557. “Ingestion of large amounts of these compounds (inosinate, guanylate and ribonucleotide flavour enhancers E627, E631, E635) … can increase the serum uric acid level and urinary uric acid excretion and this needs to be considered in relation to people with gouty diatheses and those taking uric-acid retaining diuretics. Hence specific mention of the addition of these substances on the label may be indicated..” and see our blog

25. Huge Increase in gout - Huge rise in gout cases, by NT Contributor, Nursing Times, 06 October, 2012.

26. NZ now leads the world in gout, followed by Australia and doctors can’t explain why, although our readers can
- Story [569]

27. Epidemic of short-sightedness in schoolchildren
- In Nepal
- Adhikari S. Myopia in school children from high mountain region of Nepal. Nepal J Ophthalmol, 2013 Jul-Dec;5(2):246-9.
- Not screen time “The myopia boom was first noted in 1980s in the cities of East Asian countries such as Korea, Taiwan and Singapore. The cities of China followed soon afterward…” Short-sightedness in kids was rising long before they took to the screens by David Mackey, The Conversation, 7/1/2020
- MSG - Too much MSG could cause blindness by Duncan Graham-Rowe. New Scientist, 26 October 2002. reporting on Japan study - Hiroshi Ohguro et al.  A high dietary intake of sodium glutamate as flavoring (ajinomoto) causes gross changes in retinal morphology and function. Exp Eye Res, 2002 Sep;75(3):307-15.
- 13 more references about MSG and Retinal Degeneration from the Truth in Labeling Campaign (TLC)

Vertigo (dizziness)
28. Early reports of MSG reactions
- Schaumburg HH et al. Monosodium L-glutamate: its pharmacology and role in the Chinese restaurant syndrome. Science 1969;163:826-8.
- Reif-Lehrer LA. Questionnaire study of the prevalence of Chinese restaurant syndrome. Fed Proc 1977;36:1617-23.

29. Report of dizziness in a 44 year old physician that was “eventually traced to MSG in seasoned salt and vanished over a week when he avoided all sources of  MSG in his diet” - George R Schwartz MD, In bad taste: the MSG syndrome, Signet, NY, 1990, page 59.
- This is denied by the glutamate industry, however, according to the Truth in Labeling Campaign, there is “evidence that industry-sponsored studies used to substantiate the safety of MSG are so badly flawed as to be worthless” Think MSG is safe?  by the author of the following articles:
- Samuels A. The toxicity/safety of processed free glutamic acid (MSG): a study in suppression of information. Account Res. 1999;6:259-310.
- Adrienne Samuels. Dose dependent toxicity of glutamic acid: a review. International Journal of Food Properties, Volume 23, 2020 - Issue 1,412-419.
- More recently -Arnab Banerjee et al. Worldwide flavor enhancer monosodium glutamate combined with high lipid diet provokes metabolic alterations and systemic anomalies: An overview. Toxicol Rep. 2021 Apr 29;8:938-961.

30. Antidote - half teaspoon of soda bicarb/baking soda in a glass of water as an antidote for food intolerance symptoms. Don't overuse it - as well as hastening the excretion of food chemicals such as salicylates, these home remedies also hasten the excretion of essential nutrients. Oliver TK, Dyer ME. The prompt treatment of salicylism with sodium bicarbonate. AMA J Dis Child. 1960 May;99:553-65.

31. ”We didn’t know ...” Our blog posts, 129 ways to add MSG and fool consumers and Hidden additives

32. German researchers reported a marked mismatch - “Substantial differences exist between traditionally cooked and chemically designed ready-to-serve products … glutamate accounts for 96% of all free amino acids” - Hermanussen M. Patterns of free amino acids in German convenience food products: marked mismatch between label information and composition. Eur J Clin Nutr. 2010 Jan;64(1):88-98.
Hermanussen M et al. How much chicken is food? Questioning the definition of food by analyzing amino acid composition of modern convenience products. Anthropol Anz. 2012;69(1):57-69.

Undiscovered Blue Zone
33. Probiotics in Nepalese dahi -
Sailendra Dewan and Jyoti Prakash Tamang. Dominant lactic acid bacteria and their technological properties isolated from the Himalayan ethnic fermented milk products, Antonie Van Leeuwenhoek, 2007 Oct;92(3):343-52. and a later review mentions some “exotic and rare” beneficial microorganisms that are lesser known in the outside world: Jyoti Prakash Tamang et al. Diversity of beneficial microorganisms and their functionalities in community-specific ethnic fermented foods of the Eastern Himalayas. Food Res Int. 2021 Oct;148:110633.

34. Himal Tamang who wonderfully organises our treks – Visit Himalaya Treks

35. Blue Zones - Buettner D, Skemp S. Blue Zones: Lessons From the World's Longest Lived. Am J Lifestyle Med, 2016 Jul 7;10(5):318-321. and the Blue Zones website

Healthspan versus lifespan
36. Healthspan
- Tim Peterson, Healthspan Is More Important Than Lifespan, So Why Don’t More People Know About It? Institute of Public Health, May 30, 2017.

37. Healthy lifestyle gives up to an extra 10 years of disease-free life - Li Y et al. Healthy lifestyle and life expectancy free of cancer, cardiovascular disease, and type 2 diabetes: prospective cohort study. BMJ. 2020 Jan 8;368:l6669.

38. Nepal’s salt iodization program – “Nepal is located in what was once known as the Himalayan Goitre Belt and once had one of the highest prevalence's of iodine deficiency disorders in the world ... through a well-executed universal salt iodization program ... it has achieved optimal iodine intake for its population, effectively eliminating the adverse consequences of iodine deficiency disorders”. Naveen Paudyal et al. The evolution, progress, and future direction of Nepal's universal salt iodization program. Matern Child Nutr. 2020 Feb 3;e12945.

39. Cruciferous vegetables are considered to be some of the healthiest foods around - My best friend's a Brussels sprout by Gail Vines New Scientist, 21 December 1996 “Of course your mother was right about those evil-smelling greens being good for you. But it's not just because of vitamins and minerals.“ However, most people don’t know that these vegetables are goitrogenic and that this may actually be an advantage, see next reference.

40. Dr Giovanni Pes suggests that cruciferous vegetables contribute to longevity because they modulate thyroid function, and in his opinion, mildly reduced thyroid function, as shown by elevated levels of thyroid-stimulating hormone (TSH), is associated with longevity. He explains “A low-functioning thyroid may help you to live longer, in the way that a Cricket lighter with the flame turned down lasts longer. Cruciferous vegetables turn down your thyroid function” - Francesco Tolu et al. Association of endemic goitre and exceptional longevity in Sardinia: evidence from an ecological study. Eur J Ageing, 2019 Mar 22;16(4):405-414. and Dr Pes’s lighter quote is from Dan Buettener’s book The Blue Zones Kitchen: 100 recipes to live to 100,

41. Weightloss at high altitude due to low oxygen - Tobias Dünnwald et al.  Body Composition and Body Weight Changes at Different Altitude Levels: A Systematic Review and Meta-Analysis. Front Physiol. 2019 Apr 16;10:430.

How to avoid joint pain
Lauric acid raises bad (total and LDL) cholesterol, although not as much palmitic acid does - M A Denke et al. Comparison of effects of lauric acid and palmitic acid on plasma lipids and lipoproteins.  Am J Clin Nut, 1992 Nov;56(5):895-8.
- In Sumatra, a case control study found that inhabitants on the traditional plant-based high coconut diet only suffered from cardiovascular disease when they added animal products to their diet. Nur I Lipoeto et al. Dietary intake and the risk of coronary heart disease among the coconut-consuming Minangkabau in West Sumatra, Indonesia. Asia Pac J Clin Nutr. 2004;13(4):377-84.
- “The Real Coconut Oil Miracle: How a High-Fat, High-Calorie Condiment Became a ‘Superfood’” (2022).

43. Studies have found that the whole-food plant-based diet helps with both osteoarthritis (reference 15 above, Clinton et al) and rheumatoid arthritis - John McDougall et al. Effects of a very low-fat, vegan diet in subjects with rheumatoid arthritis. J Altern Complement Med. 2002 Feb;8(1):71-5.
- Dr McDougall recommends an elimination diet as well for anyone not achieving fast improvements

44. Avoids unnecessary medication - RPAH Allergy Unit recommends “Avoid non-essential medications. Wash the colour off tablets, or open capsules and take the powder. Don’t take anything containing aspirin”. Elimination Diet Handbook, Allergy Unit Royal Prince Alfred Hospital and purchase Friendly Food from
- Includes diuretics and antidepressants that have been associated with increasing fractures, possibly due to bone-thinning. and this useful video:

45. Failsafers’ success stories
- knee pain
- osteoarthritis [368]
- rheumatoid arthritis [1379]
- medically diagnosed gout [1532]
- 2 sisters joint pains [1400]

Chapter 8 - The Camino revisited

1. Our guidebook -John Brierley, A Pilgrim’s Guide to the Camino de Santiago: St Jean Pied de Port to Santiago de Compostela, available online or in pilgrim offices, updated regularly, and contains some hints from us for the Dragonte variation.

2. Howard’s hints for happy trekking (for trekking in Nepal, but it works anywhere): hint number 2 don’t ever get blisters; they will ruin your trip

3. Newcastle GP Dr Ben Ewald - New study shows more time walking means less time in hospital by Dr Ben Ewald, Hunter Medical research centre, Feb 22 2017.

4. US study of 5,000 adults over 40 - Saint-Maurice P et al. Association of Daily Step Count and Step Intensity With Mortality Among US Adults. JAMA, 2020. Mar 24;323(12):1151-1160.

5. “Normal to slow down, do less, retire” - Daniel E. Leiberman is an evolutionary biologist at Harvard University - Daniel E. Leiberman et al. The active grandparent hypothesis: Physical activity and the evolution of extended human healthspans and lifespans.  Proceedings of the National Academy of Sciences, 2021; 118 (50): e2107621118

6. Mediterranean diet in Spain - “The Mediterranean diet is gone”: region’s children are fattest in Europe by Sarah Boseley, 24 May 2018, The Guardian.
WHO/Europe COSI Childhood obesity survey initiative 2016-2017.

7. Western eating pattern linked to chronic diseases - Clear evidence for a link between pro-inflammatory diets and 27 chronic diseases. Here’s how you can eat better , by Meghan Hockey and Wolfgang Marx, The Conversation, April 22, 2021 and  The Dietary Inflammatory Index and Human Health: An Umbrella Review of Meta-Analyses of Observational Studies. Wolfgang Marx et al. Advances in Nutrition, Volume 12, Issue 5, September 2021, Pages 1681–1690.

8. Ironman promotes breakfast oatmeal - Vegan ironman oatmeal - Not just for athletes! Zina Serdarevic, Sep 15, 2021. and El vegetariano Patrick Lange devora el Ironman de Hawai, by Javier Sanchez, 14 Oct 2018.

9. Fauja Singh, world’s oldest marathoner - on Wikipedia,

10. Tonsillectomy a missed sign of food intolerance - BF Feingold. Tonsillectomy in the allergic child. Calif Med, 1949 Nov;71(5):341-4.

11. Health improvement due to diet changes
- Vegetarian diet for kidney disease“high protein diets with high meat intake not only result in higher cardiovascular disease risk but also higher CKD (Chronic Kidney Disease)incidence and faster CKD progression” Kamyar Kalantar-Zadeh et al. Plant-Dominant Low-Protein Diet for Conservative Management of Chronic Kidney Disease. Nutrients, 2020 Jun 29;12(7):1931. and Shivam Joshi et al. Plant-Based Diets for Kidney Disease: A Guide for Clinicians Am J Kidney Dis. 2021 Feb;77(2):287-296.
- Pritikin diet for raised cholesterol -
- RPAH elimination diet for food intolerances - Loblay RH and Swain AR “Food intolerance”. In Wahlqvist ML, Truswell AS, Recent Advances in Clinical Nutrition. London: John Libbey, 1986, pages 169-177. and the RPAH allergy unit website
- Free McDougall program (whole-food plant-based) for all of the above except food intolerance

12. Half of all Australians had at least one of eight chronic conditions (which contribute to some 90 per cent of deaths) - arthritis, asthma, back pain, cancer, cardiovascular disease, chronic obstructive pulmonary disease, diabetes or mental health issues. Australia's health 2018, Australian Institute of Health and Welfare, 20 Jun 2018

13. Medical researchers warn about medication side-effects and overuse
“100% of patients suffer unintended effects from their prescriptions”. The free website is run by “a group of high profile medical experts” from the US, UK, Canada and NZ.
- Dr John Abramson’s book Overdosed America: The Broken Promise of American Medicine, 2008.
- Dr Abramson’s latest book, Sickening - City Cub presents Dr John Abramson and Sickening: How Big Pharma Broke American Health Care and How We Can Repair It, 2022.
- Joe Graedon MS and Teresa Graedon PhD, Top screw-ups doctors make and how to avoid them,

14. Medication and third leading cause of death - Martin A Makary and Michael Daniel. Medical error - the third leading cause of death in the US. BMJ, 2016 May 3;353:i2139. This study showed there had been no improvement since a previous study had raised the alarm about the same topic - B Starfield. Is US health really the best in the world? JAMA, 2000 Jul 26;284(4):483-5.

15. Polypharmacy is using five or more prescription drugs, “The most commonly used drugs were cholesterol, high blood pressure, and diabetes medications,” includes a link to the Beers list of potentially inappropriate medication use in older adults: The dangers of polypharmacy and the case for deprescribing in older adults, August 24 2021. National Institute of ageing, NIH.

16. Deprescribing - Ian A Scott et al. First do no harm: a real need to deprescribe in older patients. Med J Aust, 2014 Oct 6;201(7):390-2. and The Australian Deprescribing Network

17. Medications not as safe and effective as people think
- Joe Graedon. How safe and effective are your medicines? You might be surprised! People’s Pharmacy, March 23, 2021. and the Latuda drug commercial that is used as an example (video 1min30sec)
Statins - in the medical journals
- ”this …meta-analysis not find evidence for the benefit of statin therapy on all-cause mortality in a high-risk primary prevention set-up” -  Ray KK et al. Statins and all-cause mortality in high-risk primary prevention: a meta-analysis of 11 randomized controlled trials involving 65,229 participants. Arch Intern Med, 2010 Jun 28;170(12):1024-31.
- “The trial was flawed … The results of the trial do not support the use of statin treatment for primary prevention of cardiovascular diseases and raise troubling questions concerning the role of commercial sponsors” - de Lorgeril M et al. Cholesterol lowering, cardiovascular diseases, and the rosuvastatin-JUPITER controversy: a critical reappraisal. Arch Intern Med. 2010 Jun 28;170(12):1032-6.

18. Nasty Drug side effects
-  Joe Graedon. Drug side effects. People’s Pharmacy
-  Dr John Abramson on statins: “it seems wiser to focus on lifestyle changes (such as adopting a Mediterranean diet, exercising, and not smoking) instead of cholesterol drugs in low-risk patients” from Statins in Persons at Low Risk of Cardiovascular Disease. Am Fam Physician. 2017 Nov 1;96(9): Online
- Joe Graedon. Statins and Diabetes! A LONG Delayed Warning, 24 January, 2022.
-  Joe Graedon. Do doctors hate stories of statin side effects? People’s Pharmacy, November 16th, 2021.
- Joe Graedon. A study on blood pressure control drugs in older patients found they appear to contribute to mental decline. People’s Pharmacy, March 12, 2015. )
- side-effects of drugs for blood pressure – Joe Graedon.  What are natural ways to lower high blood pressure?  People’s Pharmacy, August 30, 2021.

19. Statins or porridge?
- Chris Seal. A bowl of porridge a day could be better for you than statins, College of Medicine.
- Chris J Seal et al. Health benefits of whole grain: effects on dietary carbohydrate quality, the gut microbiome, and consequences of processing. Compr Rev Food Sci Food Saf. 2021 May;20(3):2742-2768.
- low-fat vegan diets effective for cholesterol-lowering – In the McDougall program cohort,  a person with an average cholesterol level of 5.79 IU (220 mg/dl) could expect a 1.1 IU(30 mg) reduction in 2 weeks -  John McDougall et al, Effects of 7 days on an ad libitum low-fat vegan diet Nutr J, 2014 Oct 14;13:99.
- A university of Toronto study found that people eating a plant-based diet rich in special cholesterol-lowering foods such as oats, barley, beans, nuts, wholegrains and certain vegetables, lowered their LDL cholesterol by nearly 30 percent in just four weeks. WC Cyril et al. A dietary portfolio: maximal reduction of low-density lipoprotein cholesterol with diet. Curr Atheroscler Rep, 2004 Nov;6(6):492-8. and more information on the PCRM website: Lowering cholesterol with a plant-based diet.

In the US, cholesterol is typically measured in milligrams per deciliter (mg/dL), but in other English-speaking countries (Canada, UK, Australia, NZ) it’s in millimoles per liter (mmol/L), see cholesterol converter

20. Reversing diabetes with diet
- “in observational studies, individuals following vegetarian diets are about half as likely to develop diabetes, compared with non-vegetarians. In clinical trials in individuals with type 2 diabetes, low-fat vegan diets improve glycemic control to a greater extent than conventional diabetes diets”. Neal D Barnard et al, Vegetarian and vegan diets in type 2 diabetes management. Nutr Rev, 2009 May;67(5):255-63.
- “A year after transitioning to a low-fat plant-based diet, Eric  had lost 103 pounds and reversed his diabetes, lowered his cholesterol by 160 (4.1) points, restored his blood pressure and glucose levels, and gone off all medications.” Eric’s story is on the Diabetes factsheet from the PCRM (Physicians Committee for Responsible Medicine)
- Kate Marsh, Plant-based diets and type 2 diabetes - Review, Australian Diabetes Educator, Oct 2020:23(3).
- Forks Over Knives documentary shows that chronic diseases including heart disease and type 2 diabetes can almost always be prevented - and in many cases reversed - by adopting a whole-food, plant-based diet. Free to watch online
- Long-term use of the Pritikin diet for diabetics - R J Barnard et al. Long-term use of a high-complex-carbohydrate, high-fiber, low-fat diet and exercise in the treatment of NIDDM patients. Diabetes Care, May-Jun 1983;6(3):268-73.

21. Blood pressure
- Potent effect of flaxseed on high blood pressure
- Delfin Rodriguez-Leyva et al. Potent antihypertensive action of dietary flaxseed in hypertensive patients.  Hypertension. 2013 Dec;62(6):1081-9.
- Blood pressure does not increase with age in societies eating their traditional diet and decreases quickly on a whole-food plant-based diet
- Dr  Greger’s 5 minute video How Not to Die from High Blood Pressure, October 17, 2016 Volume 32 and Michael Greger MD with Gene Stone, How not to die, Chapter 7 How not to die of high blood pressure
- Dr McDougall’s website article, Hypertension (and his study below) and John McDougall et al. Effects of 7 days on an ad libitum low-fat vegan diet: the McDougall Program cohort, Nutr J. 2014 Oct 14;13:99.
- Reversing heart disease in an 82 year old “An 82 year old who suffered a near-fatal heart attack had a stent inserted and life-long medications prescribed. He had high blood pressure and high cholesterol after eating a “wholesome Mediterranean diet” with cheese, meat and oil. A few months after switching to a whole-food plant-based diet, he was able to drop three out of four prescription medications, was on track to drop the fourth, and had recovered from years of “medication-induced brain fog” - Andrew B Beauchesne et al. Exclusively plant, whole-food diet for polypharmacy due to persistent atrial fibrillation, ischaemic cardiomyopathy, hyperlipidaemia and hypertension in an octogenarian. BMJ Case Rep. 2018 Dec 17;11(1):e227059.

22. Salt
- “in developed countries, 75% of salt comes from processed foods”- Feng J He et al. Reducing salt intake to prevent hypertension and cardiovascular disease. Rev Panam Salud Publica. 2012 Oct;32(4):293-300.
- Spain was rated one of the worst high-income countries for awareness and control of hypertension.   NCD Risk Factor Collaboration (NCD-RisC) Long-term and recent trends in hypertension awareness, treatment, and control in 12 high-income countries: an analysis of 123 nationally representative surveys. Lancet, 2019 Aug 24;394(10199):639-651.

23. Food intolerance and high blood pressure
- see references in
- tyramines and other amines – caused by an inborn enzyme deficiency, amine sensitivity is like the cheese effect while taking MAOIs (monoamine oxidase inhibitors).  T S Sathyanarayana Rao and Vikram K Yeragani, Hypertensive crisis and cheese. Indian J Psychiatry, 2009 Jan;51(1):65-6.
- MSG-type flavour enhancers (as described in our factsheet MSG, MSG boosters, flavour enhancers and natural glutamates - - Zumin Shi and others Monosodium glutamate is related to a higher increase in blood pressure over 5 years: findings from the Jiangsu Nutrition Study of Chinese adults.  J Hypertens, 2011 May;29(5):846-53.

24. Reports on amines, flavour enhancers and blood pressure
Roslyn [873]
Wayne [564]

Hanna’s depression
25. Drug-induced weight gain
in Rebekah Beddoe’s book, Dying for a Cure: A Memoir of Antidepressants, Misdiagnosis and Madness.,2007

26. Exercise for depression - the Duke University study showed exercise was as effective as Zoloft, the greater the exercise, the less likely depression will return. Babyak M et al. Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months. Psychosom Med, 2000,62(5):633-8.

27. Emotional flatness, technically calledemotional blunting”, is a common side effect of antidepressants that includes emotional numbness, being unable to laugh or cry when appropriate and unable to experience the usual level of enjoyment. G M Goodwin et al. Emotional blunting with antidepressant treatments: A survey among depressed patients. J Affect Disord, 2017 Oct 15;221:31-35.

28. Suicide, homicide, violence, severe withdrawal symptoms
No better than placebo
“Other treatments (e.g., psychotherapy and physical exercise) produce the same benefits as antidepressants and do so without the side effects and health risks of the active drugs. Psychotherapy and placebo treatments also show a lower relapse rate than that reported for antidepressant medication.”  Irving Kirsch. Placebo Effect in the Treatment of Depression and Anxiety. Front Psychiatry, 2019 Jun 13;10:407.
- “The clinical trial data gives a relative risk of suicide on antidepressants over placebo of the order of a 2.0-2.5 times greater risk … It would seem likely that explicit warnings and monitoring in the early stages of treatment could greatly minimize these hazards” - David Healy and Graham Aldred, Antidepressant drug use & the risk of suicide. Int Rev Psychiatry,2005,Jun;17(3):163-72.
- The increase in suicides coincides with the increase in psychiatric medications. In the US, 22 veterans commit suicide every day according to Bart Billings PhD, author of Invisible Scars: How to treat combat stress and PTSD without medication.  and Women are also more at risk than men Justin Karter, Suicide rates rise while antidepressant use climbs, Mad in America, April 24, 2016.
- Violence including homicide- David Healy et al. Antidepressants and violence: problems at the interface of medicine and law. PLoS Med. 2006 Sep;3(9):e372. and Antidepressants and violence: the numbers
- “… withdrawal symptoms from antidepressants are common and that these symptoms can be severe and long-lasting in some patients … should lead to more cautious prescribing practice, with antidepressants given to fewer patients and for shorter periods of time” - Mark Horowitz and Michael Wilcock. Newer generation antidepressants and withdrawal effects: reconsidering the role of antidepressants and helping patients to stop. Drug Ther Bull, 2022 Jan;60(1):7-12.

29. Dr Ed White, a co-founder of the Antidepressant Risks website, story and video (20 sec)

30. David Carmichael’s heartbreaking story, “I killed my 11-year-old son, after taking prescription medication” story and videos, short (3 min) from the Panorama documentary A Prescription for murder or longer (16 mins)

31. More harm than good
- Dr Peter C. Gøtzsche
, Danish physician and medical researcher, former leader of the Nordic Cochrane Center and a co-founder of the Cochrane Collaboration is critical of the pharmaceutical industry and what he sees as its influence on medicine and has published numerous articles and books: “It is absurd to use drugs for depression that increase the risk of suicide and homicide …” from Antidepressants and murder. BMJ 2017;358:j3697.  His book Deadly Psychiatry and Organised Denial, 2015,  Peter C Gøtzsche. Why I think antidepressants cause more harm than good. Lancet Psychiatry, 2014 Jul;1(2):104-6. and Peter C Gøtzsche and Pernille K Gøtzsche. Cognitive behavioural therapy halves the risk of repeated suicide attempts: systematic review. J R Soc Med. 2017 Oct;110(10):404-410.
- Dr David Healy UK psychiatrist was the first to report increasing suicides related to SSRI antidepressants. Since then he has been campaigning for safer drugs through his website and as a founder and CEO of Data Based Medicine Limited which is dedicated to making medicines safer through the website - Teenage antidepressants “doing more harm than good” by Shelley Jofre, BBC,5 February 2018,
- Dr Paul W Andrews, American evolutionary psychologist found that antidepressant users are almost twice as likely to experience relapse of depression. Dr Andrews recommends avoiding antidepressant medication if possible by using non drug therapies such as talking therapies, exercise and good nutrition. Paul W Andrews et al. Primum non nocere: an evolutionary analysis of whether antidepressants do more harm than good, Front Psychol. 2012 Apr 24;3:117. and short video
- Dr Joanna Moncrieff, UK psychiatrist – “We propose an alternative understanding that recognises depression as an emotional and meaningful response to unwanted life events and circumstances. This perspective demands that we address the social conditions that make depression likely … This alternative view is increasingly endorsed around the world, including by the United Nations, the World Health Organization…” John Read and Joanna Moncrieff. Depression: why drugs and electricity are not the answer. Psychol Med, 2022 Feb 1;1-10.

32. Raising awareness
- David Carmichael -
I killed my 11 year old son (3 min)
- Colonel Bart Billings, psychologist – “Help our veterans, don’t label and drug them” (9 min)
- The Batman killer - Panorama - A prescription for murder (58 min)
- The pill that steals lives: a family’s journey to discover the side effects of antidepressants (8 mins) by BBC trained documentary film-maker Katinka Blackford Newman (director of a Prescription for murder, above) about her own experience.
- and more
- The Emperor’s New Drugs
: exploding the antidepressant myth by Irving Kirsch, 2011.
- Children of the Cure: Missing Data, Lost Lives and Antidepressants by David Healy, Joanna Le Noury, Julie Wood, 2020.
- Dying for a cure: a Memoir of antidepressants, Misdiagnosis and Madness, 2007 by Rebekah Beddoe
- The Pill that steals lives: One Woman's Terrifying Journey to Discover the Truth about Antidepressants by Katinka Blackford Newman.
- Invisible scars: How to Treat Combat Stress and PTSD without Medication by Bart Billings, 2016.
- and more
- Antidepressant risks
- SSRI stories - is a collection of over 7,000 stories involving antidepressants
- Could it be my meds? (report drug reactions here)
- David Healy psychiatrist, first to realise suicides were related to antidepressants
- Mad in America
- 37 mass shooters who were on antidepressants
- and more

33. Doctors never warned themangry comments on the Harvard health website, such as “Shame on Harvard for continuing to lie to patients about the severe and debilitating withdrawal of not only antidepressants but all psych meds.” Discontinuation syndrome article

34. WARNING: people who have been prescribed antidepressants should not suddenly stop taking their medication -

35. Non-drug alternatives
More information and references
in my blog Antidepressants or diet
- Exercise -Duke University study REF26 above and Supervised aerobic exercise - 45 minutes of moderate intensity 3 times a week – “showed a significantly large overall antidepressant effect compared with antidepressant medication and/or psychological therapies.” Morres ID et al. Aerobic exercise for adult patients with major depressive disorder in mental health services: A systematic review and meta-analysis. Depression and Anxiety, 2018.
- Talk therapies such as CBT (cognitive behaviour therapy) is as effective as medication and seems to reduce the risk of relapse in the long-term. A simpler, cheaper version was found to be just as effective. Since 2013, in Australia a program called NewAccess has offered six free sessions of low-intensity CBT with a qualified coach. Of 11,000 participants so far, 68 per cent have recovered.
DeRubeis RJ et al. Cognitive therapy versus medication for depression: treatment outcomes and neural mechanisms. Nat Rev Neurosci, 2008;9(10):788-96.
Richards D et al. Cost and Outcome of BehaviouRal Activation (COBRA): a randomised controlled trial of behavioural activation versus cognitive-behavioural therapy for depression. Health Technol Assess, 2017;21(46):1-366.
- Meditation - A review of studies on the effects of relaxation techniques found most of the treatments produced similar effect sizes except that transcendental meditation had significantly larger effect size. Eppley KR et al. Differential Effects of Relaxation Techniques on Trait Anxiety: A Meta-Analysis. J Clin Psychol,1989;45(6):957-74.
A quick introduction to meditation:   Dr Herbert Benson’s 9 min video on what he calls the Relaxation Response or mantra meditation
- or a combination, as was trialled in the 2010 ABC documentary “making Australia Happy”, and it worked

36. Diet and depression
More information and references
in my blog Antidepressants or diet
- Ultra-processed food and depression - Moufidath Adjibade et al. Prospective association between ultra-processed food consumption and incident depressive symptoms in the French NutriNet-Santé cohort. BMC Med. 2019 Apr 15;17(1):78. and Clara Gómez-Donoso et al. Ultra-processed food consumption and the incidence of depression in a Mediterranean cohort: the SUN Project, Eur J Nutr, 2020 Apr;59(3):1093-1103.
- Western diet linked to depression, healthy diets reduce depression - Laurel Cherian et al, DASH and Mediterranean-Dash Intervention for Neurodegenerative Delay (MIND) Diets Are Associated With Fewer Depressive Symptoms Over Time. J Gerontol A Biol Sci Med Sci. 2021 Jan 1;76(1):151-156.
- Australian researchers now recommend dietary improvement for depression - R S Opie et al, Dietary recommendations for the prevention of depression. Nutr Neurosci. 2017 Apr;20(3):161-171.
- Psychiatrists and psychologists astonished - A 12 week controlled trial of a Mediterranean style diet found that a healthful diet could improve depression symptoms within three weeks. Jacka FN et al. A randomised controlled trial of dietary improvement for adults with major depression (the “SMILES” trial). BMC Med, 2017;15(1):23.  Professor Felice Jacka is Director of the Food and Mood Centre and founder and president of the International Society for Nutritional Psychiatry Research (ISNPR)
- studies looking at plant-based diets - Megan Frances Lee et al. Plant-based dietary quality and depressive symptoms in Australian vegans and vegetarians: a cross-sectional study. BMJ Nutr Prev Health. 2021; 4(2): 479–486.
- Isabel Iguacel et al. Vegetarianism and veganism compared with mental health and cognitive outcomes: a systematic review and meta-analysis. Nutr Rev. 2021 Mar 9;79(4):361-381.
- In ten days her psychiatric problems had vanished - Ben F Feingold, MD, Why your child is hyperactive, 1985.
- Diet-induced “depression that is sometimes sufficiently intense to provoke suicidal thoughts” - Loblay RH and Swain AR, Food intolerance. In Wahlqvist ML, Truswell AS, Recent Advances in Clinical Nutrition. Volume 2,1986,John Libbey, London, pp 169-177. and the RPAH allergy unit website
- Aspirin and worsened depression - Michael Berk et al. Effects of aspirin on the long-term management of depression in older people: a double-blind randomised placebo-controlled trial. Mol Psychiatry. 2021 Sep;26(9):5161-5170.
Michael Berk et al, Youth Depression Alleviation with Anti-inflammatory Agents (YoDA-A): a randomised clinical trial of rosuvastatin and aspirin. BMC Med. 2020 Jan 17;18(1):16.

37. Depression success stories from our database
David [1434]
Kylie [1296]
Leesa [875]
Tiffany [1117]

38. Antidepressant drug intolerance may indicate food intolerance - Gordon Parker and Tim Watkins. Treatment-resistant depression: when antidepressant drug intolerance may indicate food intolerance. Aust N Z J Psychiatry. 2002 Apr;36(2):263-5.

39. propionate preservatives hidden in healthy looking foods including vegan products – blogs  and

40. natural food chemicals that can be exceptionally high in “healthy” diets reports
Rachel [1372]
Danielle [1368]
facebook thread [1227]
Sarah’s video – teenager for whom medication didn’t work (1min video) 
- and the last word

41. Neuroplasticity-based course for MCS - Annie Hopper’s DNRS (Dynamic Neural Retraining System) at  A McMaster University observational study with 102 subjects on this course showed significant improvement in health outcomes. Guenter D et al. Neuroplasticity-based treatment for fibromyalgia, chronic fatigue and multiple chemical sensitivity: feasibility and outcomes. (2019)
- for long COVID  - Long-Haulers Treatment: Neuroplasticity-Based Approach Showing Promising Results
- for depression and anxiety
-  a personal air purifier – Wein ionizer air purifiers (personal and room)
- our blog Brain retraining for fragrance sensitivity and MCS

42. Feelgood chemicals in the brain are linked to stress management techniques
- Tobias Esch and George B Stefano. The neurobiology of stress management. Neuro Endocrinol Lett. 2010;31(1):19-39.
- positive mood induction, exposure to natural light, exercise, diet - a fascinating discussion of how to increase serotonin in the human brain without drugs - Young SN. How to increase serotonin in the human brain without drugs. J Psychiatry Neurosci (2007)Nov;32(6):394-9.
- nature experience and depression - a 90-min walk in a natural setting improved mental well-being compared to a 90 min walk in an urban setting - Bratman GN et al. Nature experience reduces rumination and subgenual prefrontal cortex activation. Proc Natl Acad Sci USA (2015);112(28):8567-72.
- nature and health - people spending two hours or more per week in nature are significantly more likely to report good health and life satisfaction - University of Exeter. "Two hours a week is key dose of nature for health and wellbeing." ScienceDaily. ScienceDaily, 13 June 2019.
- socialisation - simply going out for a coffee or chatting to a friend can reduce the symptoms of depression experienced by people with mental health problems, according to a study by University College Dublin - Sheridan AJ et al. Improving social functioning and reducing social isolation and loneliness among people with enduring mental illness: Report of a randomised controlled trial of supported socialisation. Int J Soc Psychiatry, 2015;61(3):241-50.
- hugging - oxytocin researcher Dr Paul Zak says we should all be doing more to boost oxytocin. Natural methods include hugging - he recommends a minimum of eight hugs a day (with people or pets), massage, receiving gifts and watching romantic comedies. Morhenn V1, Beavin LE, Zak PJ. Massage increases oxytocin and reduces adrenocorticotropin hormone in humans. Altern Ther Health Med. 2012;18(6):11-8.
- meditation increases dopamine in the brain - a study of participants practicing Yoga Nidra meditation in a PET scanner found a change corresponding to a 65 per cent increase in dopamine. Yoga, meditation and Tai Chi are now recommended for people with Parkinson’s Disease which is characterised by dopamine deficiency. Kjaer TW et al. Increased dopamine tone during meditation-induced change of consciousness. Brain Res Cogn Brain Res. 2002;13(2):255-9.

43. Dementia
- currently no effective treatment for dementia
- “The FDA just approved the first new drug for AD in nearly 20 years. Is Aduhelm a breakthrough as some suggest? ... The science is questionable ... ” Joe Graedon. New Alzheimer’s Drug Aduhelm: Breakthrough or Boondoggle? People’s Pharmacy June 22, 2021.

44. Dementia linked to commonly used medications
- benzodiazepines – the Caerphilly study found a clear association between dementia and benzodiazepine use, particularly when it was used at a younger age rather than more recently.  Gallacher J et al. Benzodiazepine use and risk of dementia: evidence from the Caerphilly Prospective Study (CaPS). J Epidemiol Community Health. 2012 Oct;66(10):869-73.
- Sophie Billioti de Gage et al, Is there really a link between benzodiazepine use and the risk of dementia? Expert Opin Drug Saf, 2015 May;14(5):733-47.
- medications for depression or insomnia, and anticholinergics used for allergies, colds, motion sickness, depression, high blood pressure, and incontinence are associated with dementia, with effects related to the size of the dose and the duration of use, and a recommendation for seniors to stop taking these drugs before symptoms appear. Kathryn Richardson et al. Anticholinergic drugs and risk of dementia: case-control study, BMJ, 2018 Apr 25;361:k1315.

45. Sylvia Hatzer – Mark’s Alzheimer’s story “We were living a nightmare we couldn’t wake up from”, Alzheimer’s Society UK

46. Leaky blood brain barrier - Leaky blood brain barrier and Alzheimer’s disease: “A compromised blood-brain barrier may be part of a cascade of pathologic events that eventually lead to cognitive decline and dementia”. van de Haar HJ et al. Blood-Brain Barrier Leakage in Patients with Early Alzheimer Disease. Radiology, 2016;281(2):527-535. accessed 8/8/2018

47. Common food additives ... linked to dementia
- "Nitrates May Be Environmental Trigger For Alzheimer’s, Diabetes And Parkinson's Disease." ScienceDaily, 6 July 2009. and
- Killingsworth J et al. Propionate and Alzheimer's Disease (2021). Front Aging Neurosci, 2021 Jan 11;12:580001. and Morris A. (2019). Metabolic safety of common preservative under scrutiny. Nat Rev Endocrinol. 2019 Jul;15(7):378.
- More references in
- Iced donut story [1133]

48. Meditation to prevent dementia
A brain imaging study from the University of South Florida compared 120 non-demented Chinese elders in 4 randomised groups: Tai Chi, socialisation, walking and no intervention. Tai Chi showed the greatest improvement in brain volume and cognition, with some improvement from socialisation, some improvement only in the faster walkers and no improvement in the no intervention group.  Mortimer JA et al. Changes in brain volume and cognition in a randomized trial of exercise and social interaction in a community-based sample of non-demented Chinese elders.  J Alzheimers Dis. 2012;30(4):757-66.
- A brain imaging study from Harvard University and Fuzhou, China, found an increase in grey matter and memory function in older adults. Tao J et al. Tai Chi Chuan and Baduanjin Increase Grey Matter Volume in Older Adults: A Brain Imaging Study.   J Alzheimers Dis. 2017;60(2):389-400.
- A Harvard review of meditation studies found positive effects reported on attention, memory, executive function, processing speed and general cognition, suggesting that meditation may counteract age-related cognitive decline. Gard T et al. The potential effects of meditation on age-related cognitive decline: a systematic review. Ann N Y Acad Sci,2014;1307:89-103.

49. Diet and dementia
- “The most important dietary link to AD appears to be meat consumption, with eggs and high-fat dairy also contributing … Diets high in grains, fruits, vegetables, and fish are associated with reduced risk of AD, but these factors cannot counter the effects of meat, eggs, and high-fat dairy … Higher vitamin D status is associated with reduced risk of AD” - Grant WB et al. Using Multicountry Ecological and Observational Studies to Determine Dietary Risk Factors for Alzheimer's Disease. J Am Coll Nutr. 2016;35(5):476-89. and
- The Adventist health Study:  Matched subjects who ate meat (including poultry and fish) were more than twice as likely to become demented as their vegetarian counterparts and the discrepancy was further widened when past meat consumption was taken into account. Giem P et al. The incidence of dementia and intake of animal products. Neuroepidemiology 12:28–36, 1993.
- The Caerphilly study In Wales monitored the lifestyle habits of 2,500 men over 35 years. Those who consistently followed five healthy behaviours - regular exercise, non-smoking, maintain a low body weight, a high fruit and vegetable intake and a low/moderate alcohol intake - experienced a 60 per cent decline in dementia and cognitive impairment. Elwood P et al. Healthy Lifestyles Reduce the Incidence of Chronic Diseases and Dementia: Evidence from the Caerphilly Cohort Study. PLoS ONE, 2013; 8 (12): e81877

50. Medication for seniors 80 per cent of older Australians (defined as over 65) are dispensed medications for at least two chronic medical conditions. Richard Ofori-Asenso et al. Patterns of Medication Dispensation for Multiple Comorbidities among Older Adults in Australia. Pharmacy (Basel). 2018 Dec 17;6(4):134.

51. Diet NOT genes - Mokdad AH et al. The State of US Health, 1990-2016: Burden of Diseases, Injuries, and Risk Factors Among US States; JAMA 2018;319(14):1444-1472.  and

52. Diet can lower cholesterol and hypertension - “A low-fat, starch-based, vegan diet eaten ad libitum for 7 days results in significant favorable changes in commonly tested biomarkers that are used to predict future risks for cardiovascular disease and metabolic diseases.” John McDougall et al. Effects of 7 days on an ad libitum low-fat vegan diet: the McDougall Program cohort. Nutr J. 2014 Oct 14;13:99. (the average decrease in total cholesterol in just 7 days was 0.6 mmol/l (22 mg/dL)).

Chapter 9 - and then there was COVID …

1. Masala dosa
available in Australia e.g., from the Dosa Hut chain
- healthy - Is Dosa good for weight watchers? Times of India, 2019
- obviously not failsafe: there is evidence that the capsaicin in chilis can reduce the effects of salicylates

2. Weight loss through exercise – recommended levels are “generally inadequate for clinically significant weight loss or weight maintenance without caloric restriction”
- Damon L Swift et al. The Role of Exercise and Physical Activity in Weight Loss and Maintenance. Prog Cardiovasc Dis, Jan-Feb 2014;56(4):441-7.
- Damon L Swift et al. The Effects of Exercise and Physical Activity on Weight Loss and Maintenance. Prog Cardiovasc Dis. Jul-Aug 2018;61(2):206-213.

3. Weight loss harder for women – Planet Obesity: How We're Eating Ourselves and the Planet to Death by Garry Egger and Boyd Swinburne, 2011,

4. McDougall MWL (maximum weight loss) program – 10 point checklist on the website

5. fasting (500 calorie a day) – I originally started this after seeing Dr Michael Mosley’s 2012 BBC Horizon documentary Eat, fast and live longer, although I don’t follow his recommendations about meals, especially high protein/low carb. I fast on two days a week and eat 400 calories of the most filling plant foods I can find (e.g., potatoes, oats, barley or millet) with 100 calories of low calorie veg for chewing (e.g., celery, choko/chayote, green beans,  green peas, cos lettuce, butternut) in four small meals starting at midday.

6. Overnight 16 hour fasting - Stephen D Anton et al. Flipping the Metabolic Switch: Understanding and Applying the Health Benefits of Fasting. Obesity (Silver Spring). 2018 Feb;26(2):254-268.  (described in  )

Benefits of wholegrains
7. Benefits of barley
– reduces hunger and increases fullness. Seiichiro Aoe et al. Effect of cooked white rice with high β-glucan barley on appetite and energy intake in healthy Japanese subjects: a randomized controlled trial. Plant Foods Hum Nutr. 2014 Dec;69(4):325-30.
- Akula Annapurna. Health benefits of barley. Asian Journal of Pharmaceutical Research and Health Care (AJPRHC), April 2011, 3(2).

8. improves gut health; anti-cancer, cardiovascular disease, diabetes, obesity - Susan M Tosh and Nicolas Bordenave. Emerging science on benefits of whole grain oat and barley and their soluble dietary fibers for heart health, glycemic response, and gut microbiota. Nutr Rev. 2020 Aug 1;78(Suppl 1):13-20.
- Emmanuel Idehen et al. Bioactive phytochemicals in barley. J Food Drug Anal, 2017 Jan;25(1):148-161.

9. Millet - Jaber Alyami et al. Glycaemic, gastrointestinal, hormonal and appetitive responses to pearl millet or oats porridge breakfasts: a randomised, crossover trial in healthy humans.  Br J Nutr. 2019 Nov 28;122(10):1142-1154.

Long term weight loss maintenance
10. About 80 per cent of the lost weight will be regained
over five years - Gina Cleo, The Conversation,
- figure 1 in Kevin D Hall and Scott Kahan. Maintenance of Lost Weight and Long-Term Management of Obesity. Med Clin North Am. 2018 Jan;102(1):183-197.

11. Long term weight loss
- “The majority of weight lost by NWCR members is maintained over 10 years. Long-term weight-loss maintenance is possible and requires sustained behavior change.” J Graham Thomas et al. Weight-loss maintenance for 10 years in the National Weight Control Registry. Am J Prev Med. 2014 Jan;46(1):17-23.

Avoiding ultra-processed foods
12. Ultra-processed food linked to obesity
- Children’s appetite diminished [1175] and more in blog
- Association of monosodium glutamate intake with overweight in Chinese adults (752 healthy Chinese aged 40-59 years, randomly sampled from three rural villages in north and south China)
- Consumption of monosodium glutamate in relation to incidence of overweight in Chinese adults (10,095 healthy Chinese adults aged 18-65 y at entry from 1991 to 2006)

13. Study: ultra-processed versus unprocessed - Hall KD et al. Ultra-Processed diets cause excess calorie intake and weight gain: an inpatient randomized controlled trial of ad libitum food intake. Cell Metab. 2019 May 16. pii: S1550-4131(19)30248-7.

14. Weight loss stories from Network members
- Joan [1636]
- Sarah [1536]

15. Plant-based failsafe
- Peter
combined failsafe and plant-based and lowered his cholesterol without drugs: “My total cholesterol has come down by 27%, the LDL by 38% without any medication (total/LDL was 5.3/3.4 on 1 Sept 2012 mmol/l = 205/131 mg/dl and on 6/11/2013 this was 3.9/2.1 mmol/l or 151/81 mg/dl)” [1243]
- How to tolerate more salicylates – blog

16. Vitamin A conversion on plant-based diets
“…about 45 per cent of the population carry polymorphisms that make them “low responders” to beta carotene.” Denise Minger. 4 reasons why some people do well as vegan (while others don’t). Healthline, 2020
- Georg Lietz et al. Single nucleotide polymorphisms upstream from the β-carotene 15,15'-monoxygenase gene influence provitamin A conversion efficiency in female volunteers. J Nutr. 2012 Jan;142(1):161S-5S.

17. Recent blood analysis 








<5.6 mmol/L




<2.1 mmol/L




>0.9 mmol/L




<4.1 mmol/L





18. Eating animal products occasionally - Dietary metabolism, the gut microbiome, and heart failure. Tang W et al. Nat Rev Cardiol. 2019 Mar;16(3):137-154. “The production of TMAO from dietary phosphatidylcholine is dependent on metabolism by the intestinal microbiota. Increased TMAO levels are associated with an increased risk of incident major adverse cardiovascular events.” 
- Intestinal microbial metabolism of phosphatidylcholine and cardiovascular risk. Tang W et al. N Engl J Med. 2013 Apr 25;368(17):1575-84.
- Dr Greger video (9 min) Carnitine, Choline, Cancer, & Cholesterol: The TMAO Connection. Choline in eggs, poultry, dairy, and fish produces the same toxic TMAO as carnitine in red meat—which may help explain plant-based protection from heart disease and prostate cancer.
- Dr Greger video (7 min) How to Reduce Your TMAO Levels. Should we be concerned about high-choline plant foods, such as broccoli, producing the same toxic TMAO that results from eating high-choline animal foods, such as eggs?

19. Good for the planet – IPCC report
- ‘Now or never’ if world is to stave off climate disaster
- What’s the beef with cows and the climate crisis? Reducing methane emissions is seen as the biggest opportunity for slowing global heating by 2040 )

20. The EAT-Lancet diet - Summary report of the EAT-Lancet Commission
- Prof Walter Willett quote – Professor Willett is one of the leaders of the commission convened by the Lancet medical journal and the Eat Forum
- Unfortunately, the EAT-Lancet committee’s generous allowance of vegetable oil, or their stance on starchy vegetables especially potatoes that they regard as evil, does not agree with whole-food, plant- based approach.
- Tamar Haspel. Potatoes get a bad rap. They don’t deserve it. Washington Post January 20, 2017.
- the study that provoked anti-potato sentiment can be differently interpreted. Dariush Mozaffarian et al. Changes in diet and lifestyle and long-term weight gain in women and men. N Engl J Med. 2011 Jun 23;364(25):2392-404.

Nutrition education for doctors
Bad diets are now ranked as the leading risk factor for premature death worldwide

Number of deaths for leading causes of death, USA 2020

     1. Heart disease 696,962

     2. Cancer 602,350

     3. COVID-19 350,831

     4. Accidents (unintentional injuries) 200,955

     5.  Stroke (cerebrovascular diseases) 160,264

     6. Chronic lower respiratory diseases 152,657

     7. Alzheimer’s disease 134,242

     8. Diabetes 102,188

     9. Influenza and pneumonia 53,544

    10. Nephritis, nephrotic syndrome, and nephrosis 52,547

 Bold are proven diet-related

22. Medical students are not getting the nutrition training they need
- Dr Michael Greger’s exceptional 5-min video covers the journal articles below
How much do doctors actually know about nutrition? (2021)
- Jennifer Abbasi. Medical Students Around the World Poorly Trained in Nutrition. JAMA. 2019 Nov 19;322(19):1852.
- Jennifer Crowley et al. Nutrition in medical education: a systematic review. Lancet Planet Health. 2019 Sep;3(9):e379-e389.
- Stephen Devries. A global deficiency of nutrition education in physician training: the low hanging fruit in medicine remains on the vine. Lancet Planet Health. 2019 Sep;3(9):e371-e372.
- Maria G Grammatikopoulou et al. Is continuing medical education sufficient? Assessing the clinical nutrition knowledge of medical doctors. Nutrition. 2019 Jan;57:69-73.
- Monica Aggarwal et al. The Mismatch of Nutrition and Lifestyle Beliefs and Actions Among Physicians: A Wake-Up Call. Am J Lifestyle Med. 2019 Nov 5;14(3):304-315. “Studies show that HCPs [health care professionals] who engage in healthy behaviors are more likely to promote these behaviors and are perceived as more credible and motivating to their patients.”
- David L Katz. How to Improve Clinical Practice and Medical Education About Nutrition. AMA J Ethics. 2018 Oct 1;20(10):E994-1000.  “Failure to address the contributions of food to health in the clinical context is an ethical lapse.” ... “Physicians are ethically obligated to highlight cultural transgressions—such as the aggressive marketing of junk food to adults and children alike and manipulations of food formulations to promote overconsumption—that conspire against the crucial contributions of diet to health.”

23. Forks over Knives free documentary – “The film follows everyday Americans with chronic conditions as they seek to reduce their dependence on medications and learn to use a whole-food, plant-based diet to regain control over their health and their lives.”

24. Find a doctor who knows about the whole-food plant-based diet
- Plant based health Australia
- In the USA, the Physicians Committee for Responsible Medicine (PCRM)
- Also in the USA, The Pritikin Diet and Eating Plan
- Dr McDougall The quickest and easiest way to bring down your cholesterol

25. Vegetarianism is increasing
F. Bailey Norwood and Courtney Bir. 1 in 10 Americans say they don’t eat meat – a growing share of the population. The Conversation, March 2, 2022.

26. Vegetarian diets and weight reduction
- “appeared to have significant benefits on weight reduction compared to non-vegetarian diets”. Ru-Yi Huang  et al. Vegetarian Diets and Weight Reduction: a Meta-Analysis of Randomized Controlled Trials. J Gen Intern Med. 2016 Jan;31(1):109-16.
- Evelyn Medawar et al. Less Animal-Based Food, Better Weight Status: Associations of the Restriction of Animal-Based Product Intake with Body-Mass-Index, Depressive Symptoms and Personality in the General Population. Nutrients. 2020 May 20;12(5):1492.

27. Nathan Pritikin’s story

28. Sydney cardiologist George Roberts. Too much exercise can lead to cardiac problems, especially for those over 40, heart specialist says. The World Today,

29. A workable option
- Prevent heart disease with diet - Caldwell B Esselstyn. A plant-based diet and coronary artery disease: a mandate for effective therapy J Geriatr Cardiol. 2017 May; 14(5): 317–320.
- Exercise contributes to a long healthy life - Daniel E Lieberman et al. The active grandparent hypothesis: Physical activity and the evolution of extended human healthspans and lifespans. Proc Natl Acad Sci USA,2021,Dec14;118(50):e2107621118.