Good evening. For those of you who are unfamiliar with my work, every year I read through every issue of every English language nutrition journal in the world so you don't have to. Every year my talks are brand new because every year the science is brand new. I think Kapala is the most interesting, most groundbreaking, most practical findings to new videos and articles I upload every day to my non-profit site nutritionfacts.org. Everything on the website is free. There's no ads, no corporate sponsorships, strictly non-commercial, not selling anything. Just put it up as a public service, as a labor of love. New videos and articles every day on the latest in evidence-based nutrition. In my 2012 review, I explored the role diet may play in preventing, treating and reversing our deadliest disease. In 2013 I covered the most common conditions, and in 2014 I went through our leading causes of disability. This year I'd like to address some of our most dreaded diseases, and cancer tops the list in the latest Gallup poll. The number one cancer killer in the United States of both men and women is lung cancer. But if you look at the rates of lung cancer around the world, they vary by a factor of 10. If there's nothing we could do to prevent lung cancer, you'd assume the rates would be about the same everywhere. I mean if it just happened kind of randomly. But since there's a huge variation in rates, you assume there's some contributing cause, and indeed we now know that smoking is responsible for 90% of lung cancer cases. So if you don't want to die the number one cancer killer by just not smoking, you could take 90% of your risk and throw it out the window.  So it appears colon cancer doesn't just happen, something makes it happen. Well if our lungs can get filled with carcinogens from smoke, maybe our colons are getting filled with carcinogens from food. Why do African Americans get more colon cancer than native Africans? Why that population? Because colon cancer is extremely rare in native African populations. Like more than 50 times lower rates than Americans, white or black. And we used to think of it as all the fiber that they were eating. However, the modern African diet is highly processed, low in fiber, yet there's been no dramatic increase in colon cancer rates. And we're not just talking low fiber intake, we're talking United States of America low fiber intake down around half the recommended daily allowance. Yet colon disease remains rare in Africa, still 50 times less colon cancer. Maybe it's because they're thinner and exercise more. No they're not, and no they don't. If anything, their physical activity levels may actually be lower than are. So if they're sedentary like us, eating mostly refined carbs, few plant foods, little fiber like us, why do they have 50 times less colon cancer? Well there is one big difference. The diets of both African Americans and Caucasian Americans is rich in meat, whereas the native Africans diet is so low in meat and saturated fat. They have cholesterol levels averaging 139 compared to over 200 in the US. So yeah, they don't need a lot of fiber anymore. They continue to minimize meat and animal fat intake.  So why do Americans get more colon cancer than Africans? Maybe the rarity of colon cancer in Africans is associated with their low animal product consumption. But why? Did you ever see that take off of the industry slogan beef? It's what's for dinner, beef. It's what's rotting in your colon. I remember seeing that on a shirt with some friends and I was such the party pooper, no pun intended. Explaining that no meat is completely digested in the small intestine, never makes it down to the colon, no fun hanging out with biology geeks. But it turns out I was wrong. Turns out up to 12 grams a day of protein can escape digestion. And when it does, it reaches the colon. It can be turned into toxic substances like ammonia. This degradation of undigested protein in the colon is called putrefaction. So a little meat can actually end up putrefying in our colon. The problem is some of the byproducts of this putrefaction process can be toxic. The same thing happens with other animal proteins. If you eat egg whites, for example, some of that can putrefy too. He said, well, what do you think? There's protein in plants too. Ah, the difference is that animal proteins tend to contain more sulfur containing amino acids like methionine, which is found concentrated in fish and chicken. Then eggs less in dairy and beef, but much less in plant foods, which can be turned into hydrogen sulfide in the colon, the rotten egg gas that doesn't just smell bad, but can produce changes in the colon that increase cancer risk. Now, there's a divergence of opinion as to whether it's the animal fat, cholesterol, or animal protein that's most responsible for the increased cancer risk. But, you know, as all three has been shown to have carcinogenic properties. But, I mean, does it really matter since the diet high in one is high in the others? But the protein does more than just putrefy, though. Animal protein consumption causes an increase in blood levels of cancer promoting growth hormone called IGF-1. But remove meat, egg white and dairy proteins from our diet and our bloodstream can suppress cancer cell growth about eight times better. In effect, so powerful that Dr. Ornish and colleagues appeared able to reverse the progression of prostate cancer without chemo, without surgery, without radiation, just a plant-based diet and other healthy lifestyle changes. The link between animal protein and IGF-1 may help explain why those eating low-carb diets tend to die sooner. But not just any low-carb diet, specifically those based on animal sources, whereas actually vegetable-based low-carb diets were associated with a lower risk of death. But meat-based low-carb diets are high in animal fat as well.  It had nothing to do with the animal protein. But what we need is a study that, you know, falls a few thousand people and their protein intakes out for 20 years or so and just see what happens. Who gets cancer? Who doesn't? Who lives longer? But there had never been a study like that until now. 6,000 men and women over age 50 across the U.S. fall for 18 years and those under age 65 with high protein intakes had 75% increase over all mortality, four-fold increase in dying from cancer. But not all proteins, specifically animal protein, which makes sense given the higher IGF-1 levels in those eating excess protein. Eating animal protein increases IGF-1 levels, which increases cancer risk. The sponsoring university sent out a press release with a memorable opening line. That chicken wing you're eating could be as deadly as a cigarette. Explaining that eating a diet rich in animal protein during middle age makes you four times more likely to die of cancer. A mortality risk factor comparable to smoking. Look, almost everyone is going to have a cancer cell or a pre-cancer cell and then at some point the question is, does it progress? And that may depend on what we eat. See, most malignant tumors are covered in IGF-1 receptors, but if we have less IGF-1, the tumor may not progress. And it wasn't just more deaths from cancer. Middle-aged people eat lots of proteins from animal sources were found to be more susceptible to early death in general. Crucially, the same did not apply to plant proteins like beans. And it wasn't the fat, it was the animal protein that appeared to be the culprit. So what was the response to this revelation that diets high in meat, eggs, and dairy could be as harmful to health as smoking? One nutrition scientist replied that it was wrong and potentially dangerous. Not the discovery that animal protein may be killing people, but the way they were telling people about it. It could damage the effectiveness of important public health messages. A smoker might think, why bother quitting if my cheese and ham sandwich is just as bad for me? You know, that reminds me of a famous Philip Morris cigarette ad that tried to downplay the risks by saying that you think secondhand smoke is bad, increasing the risk of lung cancer 19%, drinking one to two glasses of milk every day, maybe three times as bad, 62% increase lung cancer risk. We're doubling the risk frequently cooking with oil. We're tripling the risk of heart disease eating non-vegetarian. We're multiplying the risk sixfold, eating lots of meat and dairy. So they conclude, let's keep some perspective. The risk of lung cancer, the risk of secondhand smoke may be well below the risk reported for other everyday activity. So breathe deep, basically. That's like saying, oh, don't worry about getting stabbed, because getting shot is much worse. How about neither? Two risks don't make a right. Though you'll know when Philip Morris bought craft, they stopped throwing dairy under the bus. The heme in the ham may also play a role. The heme iron is the form of iron found in blood and muscle and may promote cancer by cataloging the formation of carcinogenic compounds. Cancer has been described as a ferrotoxic disease, a disease in part of iron toxicity. Iron is a double-edged sword. Iron deficiency causes anemia, but excessive iron may increase cancer risk by acting as a pro-accident, oxidant generating free radicals that may play a role in a number of dreaded diseases like stroke. But look, only the heme iron, the blood and muscle iron, not the non-heme iron that predominates in plants. Same with heart disease, only the heme iron. Same with diabetes, only the heme iron, and same with cancer. In fact, you can actually tell how much meat someone is eating by looking at their tumors to characterize the mechanisms underlying meat-related lung cancer development. They asked lung cancer patients how much meat they're eating and examined the gene expression patterns in their tumors and identified a signature pattern of heme-related gene expression. Though they just looked at lung cancer, they expect these meat-related gene expressions, changes to occur in other cancers as well. The safest form of iron then is non-heme iron found naturally in abundance and whole grains, beans, split peas, chickpeas, and lentils, dried fruit, nuts, and seeds. How much money can be made on beans though? So the food industry came up with blood-based crispa bread made out of rye and cattle and pig blood, one of the most concentrated sources of heme iron, about two-thirds more than chicken blood, though. If blood-based crackers don't sound appetizing, they do have cow blood cookies or blood-filled biscuits. The filling does end up dark-colored chocolate-flavored paste with a very pleasant taste. Dark-colored because sprayed-dried pig's blood can have a darkening effect on food products' color, but the worry is not the color or the taste. It's the heme iron, which because of the potential cancer risk is not considered safe to add to foods for the general population. This reminds me of nitrosamines, a class of potent carcinogens found in cigarette smoke. They are considered so toxic that carcinogens of this strength in any other consumer product destined for human consumption would be banned immediately. And if that were the case, they would have to ban meat. One hotdog has made on nitrosamines and nitrosamines as five cigarettes. And these carcinogens are also found in fresh, unprocessed meat as well, beef, chicken, pork. But practice meatless Mondays and you have a wake-up Tuesday morning with nearly all these carcinogens washed out of your system. So toxic, nitrosamines should be banned immediately, but are still allowed for sale in cigarettes and meat because the carcinogens are found there naturally. Be illegal to add them, but hey, if they're found there, right? Just like the hemi are not safe enough to expose the general population to, but allowed for sale at the deli counter. The irony is that the iron and the protein are what the industry boasts about, right? Those are supposed to be the redeeming qualities of meat, protein and iron. But sourced from animal foods may do more harm than good. And that's not to mention all the other stuff like the saturated fat and industrial pollutants and hormones that may play a role in our third leading cancer killer, breast cancer. Steroid hormones are unavoidable in food of animal origin, but cow milk may be a particular concern. The hormones naturally found in even organic cow's milk may have played a role in the studies that found that a relationship between milk and dairy products with human illnesses, not just like teenagers' acne, but prostate, breast, ovarian and uterine cancers, many chronic diseases plaguing the Western world as well as male reproductive disorders from an increased risk of early puberty all the way to endometrial cancer in older women. But hormonal levels in food could be particularly dangerous in the case of vulnerable populations such as young children and pregnant women in which even a small hormonal intake could mean a large change in metabolism. Look, dairy milk evolved to put a few hundred pounds onto a calf, but the consequences of a lifetime of human exposure to growth hormones and milk has not been well studied. Look, we know milk consumption increases IGF-1, which is linked to cancer, and we're milking cows while they're pregnant, leading to particularly high levels of hormones. Although dairy products are an important source of hormones, other products of animal origin must be considered as well. This could explain why women can cut their breast cancer risk more than half by not just being normal weight and limiting alcohol, but also eating mostly foods of plant origin. Now to help differentiate the effects of diet from other behaviors like smoking, drinking on overall cancer incidents, Adventists were compared to Baptists. Now both discourage alcohol and tobacco, but Adventists go further encouraging reduction of meat. In general, the Adventists had less cancer than the Baptists, and within Adventist populations, the vegetarians did even better, and those eating the most plant-based did the best. All edible tissues of animal origin contain estrogen. This may explain why women avoiding all animal products have a twinning rate, which is one fifth that of vegetarians and omnivores.  Now why is that a good thing? Because twin pregnancies can unfortunately be risky pregnancies for both mom and the babies, which may be 10 times more likely to die at birth. To avoid these complications, women attempting conception may wanna consider avoiding milk and dairy products.  In 1979, an epidemic of breast enlargement was noted in Italian children. Poultry or veal was suspected because they're using astrogens to accelerate weight gain. So after this episode, Europe banned the use of anabolic growth motors in agriculture and banned the importation of American meat ever since. Because we continue to inject animals with drugs like zirinol, sold as ralbromagnum.  Okay, but people aren't petri dishes because these anabolic growth motors in meat production are by far the most powerful, potent hormones found in human food. We really should be testing people, especially children before and after eating meat, until we do that. We really don't know what kind of threat they pose. Though the fact that zirinol is as potent as DES should concern us.  But it was also used in meat. In the absence of effective federal regulation, the meat industry uses hundreds of animal feed additives with little or no concern about the cancer causing and other toxic effects, illustratively. After decades of misleading assurances about the safety of DES in the meat supply, we finally banned it some 40 years after it was already shown to cause cancer. The meat industry then promptly switched to other potentially carcinogenic additives such as this ralrow magnum. When girls started dying of vaginal cancer, DES treated meat with subsequently banned in Europe. However, misleading assurances, including the deliberate suppression of residue data managed to delay US ban on DES in the meat supply for another eight years. Where are we today? Virtually the entire US population consumes without any warning, label or information unknown unpredictable amounts of hormone residues in meat products over a lifetime. If all hormonal and carcinogenic feed additives aren't banned immediately, the least we could do is label them, label the hormone residue levels in all meat products, including dairy and eggs. Speaking of eggs, the next on the dreaded list of diseases is heart disease. Eggs are the number one source of choline, which can be converted by gut bacteria into a toxin that increases the risk of stroke, heart attack, and death. Eggs are also the number one source of cholesterol. Why does it matter if we have lots of cholesterol circulating throughout our bloodstream? Cholesterol doesn't just infiltrate our arteries and help that form those inflamed pockets of pus within our arterial walls, but may play an active role in the final fatal plaque rupture. Cholesterol crystals may actually pop our plaque. If you look at ruptured plaques from autopsies, they're filled with cholesterol crystals protruding from the plaque. Cholesterol in the plaque may get so super saturated that it reaches a point where it crystallizes like rock candy, and the growing crystals may then burst the plaque open. Here's a cholesterol crystal shooting out the top of a test tube. When you look at the tips of the crystals under a microscope, they are sharp, jagged needles. They place a thin membrane over the top of the test tube to see if the needles would poke through, and indeed the sharp tips of the cholesterol needles cut through the membrane. So they show that as cholesterol crystallizes, the peak volume then increases rapidly, and then sharp tip crystals can cut through and tear membranes, suggesting that this crystallization of super saturated cholesterol in atherosclerotic plaques that can induce those final ruptures. And indeed that's what you see on autopsies. All patients who died of acute heart attacks had these perforating cholesterol crystals like this sticking out of their plaques, but no crystals were found perforating the arteries of people with severe atherosclerosis that first died of other kind of non-cardiac causes. This can explain why dramatically lowering cholesterol levels with diet and drugs if necessary, can reduce the risk of fatal heart attack by pulling cholesterol out of the artery wall, decreasing the risk of crystallizing these cholesterol needles that can then pop the plaques in our arteries. High cholesterol can also cause what's called fatty liver disease, our next global chronic disease epidemic. Fatty deposits in our liver can trigger inflammation and result in liver cancer, failure, and death. And again, and maybe these crystals, cholesterol crystals, triggering the progression of fatty liver into serious hepatitis. We're talking dietary cholesterol, the cholesterol people eat in eggs and other animal products, strong association between cholesterol intake and hospitalization and death from cirrhosis and liver cancer. And beyond just the crystals, dietary cholesterol may oxidize and directly cause toxic and carcinogenic effects. And it was not appreciated until recently that the average cholesterol in the United States, the so-called normal levels, were actually abnormal, accelerating the blockages in our arteries and putting a large fraction in the normal population at risk, having a normal cholesterol. And it's decided where it's normal to drop dead of a heart attack, not necessarily a good thing. Normal cholesterol levels may be fatal cholesterol levels. And cholesterol lowering, moderation kills. Even if all Americans kept their total cholesterol below the recommended 200 millions would develop coronary artery disease. Strong evidence shows we need to keep our total cholesterol under at least 150 to stem the epidemic, what kind of evidence? Well, in many cultures, coronary disease practically unheard of when total serum cholesterol under 150. Here in the US famous Framingham Heart Study, few under 150 develop heart disease and none died from it. We cannot continue to have these public and private organizations, the forefront of health leadership recommending to the public a dietary plan that guarantees that millions will perish of the very disease that the guidelines are supposed to prevent. The reason given by health authorities to not tell people the truth for not advocating what the science shows is best was that it might frustrate the public who may have difficulty getting their cholesterol levels that low. But the public's greatest frustration might come from not being informed of the optimal diet for health. Heart disease can be reversed with a plant-based diet. The evidence justifies igniting a social movement, let the people lead and eventually the government will follow. You know, some criticize plant-based diets for being extreme. You want extreme though? Check out the consequences of our present diet. Having a breast bone sawed in half for bypass search. You're having a stroke that renders one mute or having a breast colon prostate or rectum removed for cancer. Now that's extreme, bean burrito. Easy, right? Instead of just bypassing the problem, literally, you can treat the cause. Arrest and reverse heart disease are number one killer with a whole food plant-based diet. Next on the list is arthritis, such as rheumatoid arthritis, chronic inflammatory systemic disorder causing progressive destruction of the joints. So many, 80% become disabled, can cut 18 years off one's lifespan. There are drugs, but unfortunately, they're often associated with severe side effects, blood loss, bone loss, immunosuppression, toxicity of liver and eyes. There's got to be a better way. Well, populations that eat more meat do seem to have more rheumatoid arthritis and there have been some dramatic case reports of rheumatoid arthritis attacks being triggered by consumption of animal products, starting about six to 10 hours after ingestion of animal protein, lasting a few days, but they stop when patients stop consuming animal products. The researchers suggest that immune complexes formed by the body attacking animal proteins may promote autoimmune reactions inside the joints themselves, and indeed, those with rheumatoid arthritis have striking elevations in antibodies to foods like fish, pork, egg whites, dairy proteins, and even some cereals. It could also be because of a pro-inflammatory effect of meat fats or free radicals from the iron, accumulating the joints or other mechanisms, but look, case reports, country by country analyses, can really only raise questions. To prove cause and effect, you need an interventional study to put it to the test. Here we go. 13 months, long randomized controlled trial, plant-based diets for rheumatoid arthritis. Patients put on a vegan diet for three and a half months and then switched to an egg-free vegetarian diet for the remainder. Compared to the control group that didn't change their diet, the plant-based group's significant improvement in mourning stiffness within the first month, cutting the number of hours, they suffered from joint stiffness in half, a drop in pain, a drop in disability. They reported subjectively just feeling better, significant improvement in their grip strength, fewer tender joints, fewer tenderness per joint, and less swelling. They also had dramatic drops in inflammatory markers in the blood-sed rate C-reactive protein, white count, highly significant and clinically relevant findings. What about osteoarthritis, most frequent cause of physical disability among older adults, affecting about 20 million Americans, affecting maybe 20% of Americans in the coming decades, becoming more and more widespread among younger people? You know, osteoarthritis is characterized by loss of cartilage within the joint. And we used to think it was just kind of wear and tear, but it's now generally accepted it's an active joint disease with an inflammatory component. So if the loss of cartilage is caused by inflammation, maybe if we put people on an anti-inflammatory diet, it could help, like with rheumatoid arthritis. Using optimal nutrition and exercise as a first-line intervention could well be the best medical practice. So where's the best science on what optimal nutrition might look like? The China study is a prime example, showing the serious health consequences, the serious health consequences of high consumption of pro-inflammatory foods, meat, dairy, fat and junk, and low consumption of anti-inflammatory plant foods, or whole grains, vegetables, fruits, beans, split peas, chickpeas, lentils. The unnatural Western diet contributes to this low-grade systemic inflammation, oxidative stress, tissue damage, irritation, placing the immune system in this kind of overactive state, which can be kind of a common denominator for these conditions like arthritis. Next on the list is stroke and high blood pressure. We'll go together because high blood pressure, number one, risk factor for stroke. The predimed study found that a Mediterranean diet with nuts could cut stroke risk nearly in half though they were still having strokes, half as many strokes, but it was still a stroke-promoting diet and heart attack-promoting as well. So that's what Dr. Ornish noted when he wrote in, no significant reduction in the rates of heart attack, death from cardiovascular disease, death from any cause, just that stroke benefit.  I mean, Mediterranean diet is certainly better than what most people are consuming, but even better, maybe a diet surrounding whole-plant foods shown to actually reverse heart disease, not contribute to it. That may be true, the authors of the study reported, but the major problem with Ornish's diet is it just doesn't taste good to hardly anyone, it sticks to it, but it's not true. Ornish got extraordinary adherence in his studies with no difference in any of the acceptability measures, same enjoyment compared to the regular diet. They even had success in barbecue country, rural North Carolina. See, stricter diets may meet greater acceptance among patients with then more modest diets because they may work better. Greater adherence means greater disease reversal. But you don't have to be facing certain death. Even those young and healthy, no health problems had no problem sticking to a plant-based diet. In fact, it worked a little too well. This is a crossover study where they asked people to eat a plant-based diet for a few months and then go back to their original diet to note the contrast, right? But people felt so good eating healthy. Some of them refused to go back to their regular diet, which kind of, it actually messes up the study. So they were losing weight with no calorie counting or portion control, they had more energy, the periods got better, better digestion, better sleep, and many were like, no way we're not going back, right? But if doctors just presume people aren't going to eat this way, self-fulfilling prophecy, right? Just like smoking doctors are less likely to tell their patients to stop smoking and couch potato docs are less likely to cancel exercise or things like fruits and vegetables, we need to role model healthy behavior. This greatly enhances our credibility and effectiveness. Gone are the days of traditional authority when the fat physician dropping cigarette ash down his gravy stained vest could credibly prescribe a change in behavior. One reason why plant-based diets can save so many millions because the number one risk factor for death in the world is high blood pressure, letting to waste 9 million people every year.  High blood pressure affects like 78 million Americans. This is one in three of us and as we age, our pressures creep higher and higher. So it's like by age 60, strikes more than half. If it affects most of us when we get older, maybe it's less a disease and more just kind of a natural and inevitable consequence of aging. No. We've known for nearly a century that high blood pressure need not occur. Researchers measured the blood pressure of 1,000 people in rural Kenya who had a diet centered around whole plant foods, whole grains, beans, vegetables, fruit, dark green leafy vegetables. Up until age 40, the blood pressures, the rural Africans about the same as Europeans and Americans, 120s over 80s. But as Westerners age, their pressures creep up such that by the age 60, the average person is hypertensive, exceeding 140 over 90. What about those eating plant-based? Their pressures improved with age. Not only did they not develop hypertension, their blood pressures actually got better. Now this whole 140 over 90 thing is arbitrary. Just like studies show that lower the cholesterol, the better, really no safe level above 150. Blood pressure studies also support this kind of lower the better approach to blood pressure reduction. Even people starting out with blood pressures under 120 over 80 appeared a benefit from blood pressure reduction. So the ideal blood pressure, the no benefit from reducing it further blood pressure, is actually 110 over 70. Is it even possible to get blood pressures down to 110 over 70? It's not just possible, it's normal for those eating healthy enough diets. Over two years at a rural Kenyan hospital, 1800 patients are admitted. How many cases of high blood pressure did they find? Zero. Wow, so they must have had low rates of heart disease. No, they had no rates of heart disease. Not low risk, no risk, not a single case of arteriosclerosis, our number one killer was found. Rural China too. About 110 over 70, their entire lives. Now look, Africa, China, vastly different diets, but what they share is the common theme that they're plant-based day to day with need only even kind of on special occasions. Now why do we think it's the plant-based nature of their diet that was so protective? Because in the Western world, as the American Heart Association has pointed out, the only folks really in getting down that low are the strict vegetarians, coming in at about 110 over 65. So, does the American Heart Association recommend a strict vegetarian diet? No, they recommend the dash diet. The dash diet has been described as a lacto-vegetarian diet, but it's not. It emphasizes fruits and vegetables and low-fat dairy, but just a reduction in meat. Why not vegetarian? I mean, we've known that decades, for decades, food of animal origin highly significantly associated with blood pressure.  So when the dash diet was created, were they just not aware of this landmark research done by Harvard's Frank Sacks? No, they were aware. The chair of the design committee that came up with the dash diet was Frank Sacks. See, the dash diet was explicitly designed with the number one goal of capturing the blood pressure-lowering benefits of the vegetarian diet, yet contain enough animal products to make it palatable to the general public. In fact, Sacks found that the more dairy vegetarians ate, the higher their blood pressures went, but you have to make the diet acceptable. Recent meta-analysis found that vegetarian diets were good, but strictly plant-based diets may be better. Vegetarian diets, in general, confer protection against cardiovascular disease, some cancers and death, but completely plant-based diets seem to offer additional protection for obesity, hypertension, type 2 diabetes, and heart disease mortality. Based on a study of 89,000 Californians, those eating meat-free diets, appeared to cut the risk of high blood pressure in half, but those eating meat-free, egg-free, and dairy-free diets cut their risk 75%. Now, if, however, you're still, you're eating a whole-food plant-based diet and still not getting hitting 110 over 70, there are a few plants recently found that may offer additional protection. Randomized placebo-controlled study found that a cup of hibiscus tea with each meal significantly lowers blood pressure. In fact, tested head-to-head against a leading blood pressure drug called CAPTAPREL, two cups of hibiscus tea every morning, as effective as the drug. Another randomized placebo-controlled trial found a few tablespoons of ground flax seeds a day induce one of the most potent anti-hypertensive effects ever achieved in the dietary intervention, two to three times more powerful than instituting an endurance exercise program. There's no reason you can't do both. Red wine may help, but only if the alcohol has been taken out. Sorry. Raw vegetables are cooked, and the answer is both, though raw may actually work better. Kiwi fruit didn't seem to work at all, even though the study was actually published by a kiwi fruit company. Maybe they should have taken direction from the California Raisin Marketing Board, came out with this study, showing the raisins can reduce blood pressure, but only apparently compared to fudge cookie cheeses and chips. Ahoy! They know like the big pharma trick of choosing the right control group. Next on the dreaded list is diabetes and vision loss, which go together since diabetes the leading cause of preventable middle-aged blindness. Even with intensive diabetes treatment, at least three injections of insulin a day are these implantable insulin pumps. The best we can offer is usually just a slowing down of the progression of your disease. We can slow down your blindness with modern medicine. But a half-century ago, Kempner and Duke proved you could reverse it with an ultra-strict plant-based diet, mostly rice and fruit. 44 consecutive patients with diabetic retinopathy, 30% of the cases their eyes improved from like this to that. That's not supposed to happen. Diabetic retinopathy was considered a sign of irreversible damage. What does this mean in real life? Unable to even read headlines too, normal vision. How do we treat diabetic retinopathy these days with steroids and other drugs injected straight into the eyeball? And if that doesn't work, there's always pan-retinal laser photo-coagulation in which laser burns are placed over nearly the entire retina.  Now why would they do that?  Now when I see this, along with Kempner's work, I can't help but feeling like history's been reversed. Can you believe 50 years ago we had that barbaric burn-out-your-socket surgery, but now thankfully we know that through dietary interventions alone, it's time to reverse the blindness, right? But instead of learning, medicine seems to have forgotten. The most efficient way to avoid diabetic complications is to simply eliminate the diabetes in the first place. Resolve them feasible with a healthy enough diet. Plant-based diabetes beat out the Conventional American Diabetes Association that had randomized controlled clinical trial without restricting portions. No calorie or carb counting. A review of all such studies found that those following plant-based diet experienced better improvements compared to those diets that include animal products. But this is nothing new. The successful treatment of type 2 diabetes of the plant-based diet was demonstrated back in the 1930s, showing that a diet centered around vegetables, fruits, whole grains and beans, more effective in controlling diabetes than any other diet. Randomized controlled trial. No big change in the control group, but the plant-based group, insulin needs were cut in half and a quarter ended up off of insulin altogether. Now, this was a low-calorie diet, though, so maybe the diabetes just got better because they lost weight. To tease that out, what we would need is a study where they switch people to healthy diet but force them to eat so much food that they'd actually maintain their weight. Then we could see if a plant-based diet had benefits independent of all the weight loss. We'd have to wait another 44 years, but here it is. Subjects were weighed every day, and they started losing weight. They were made to eat more food. In fact, so much food, some of the participants had trouble eating all... But eventually they adapted, so no significant alterations in body weight despite restricting meat, dairy, eggs, and junk. Okay. So with zero weight loss, did plant-based diets still help? Here's the before-and-after insulin requirements of the 20 people that put on the diet. So the number of units of insulin they had to inject themselves before and after going plant-based. Overall, insulin requirements were cut about 60%, and half were able to get off insulin altogether, despite no change in weight.  Was it five years like the other study? No, 16 days. So we're talking diabetics who have had diabetes for as long as 20 years, injecting as much as 20 units of insulin a day, and then as few as 13 days later, they're off insulin altogether, thanks to less than two weeks of a plant-based diet. Diabetes for 20 years then off all insulin in less than two weeks. Here's patient 15. 32 units of insulin on the control diet, and then 18 days later on none. Lower blood sugars on 32 units less insulin. That's the power of plants. And as a bonus, their cholesterol dropped like a rock, too, in 16 days to under 150. You know, just like moderate changes in diet usually result only in modest reductions in cholesterol, you know, asking patients with diabetes to make moderate changes achieves equally moderate results, which is one possible reason they end up on drugs, injections, or both. Everything in moderation is a truer statement than people realize. Moderate changes in diet can leave one with moderate blindness, moderate kidney failure, moderate amputations, maybe just a few toes. Moderation in all things is not necessarily a good thing. The more we as physicians ask from our patients, the more we are likely to get. The older does shoot for the moon seems to apply, maybe more effective than limiting patients to small steps that may sound more manageable, but not sufficient to actually stop the disease. The only thing better than reversing diabetes and not get it in the first place, you know, that study that purported to show that diet's high in meat, eggs, and dairy could be as harmful to health as smoking supposedly suggested that people under 65 who eat lots of animal protein, four times as likely to die from cancer or diabetes, but if you look at the actual study, you'll see that's not true. Those eating a lot of animal protein didn't have just four times more risk of dying from diabetes. They had 73 times higher risk of dying from diabetes. As one eats more and more plant-based, there appears to be a stepwise drop in the rates of diabetes down to 78% lower prevalence among those eating strictly plant-based. Protection building incrementally as one move from eating meat daily to less than daily, right? To just fish, to no meat, to no eggs, and dairy, either. Similar pattern was found leading cause of vision loss among elderly, cataracts, right? This suggests it's not all or nothing. Any steps we can make towards eating healthier may accrue benefits. But why? Why is total meat consumption associated with higher risk of diabetes? Especially processed meat, particularly poultry? Well, there's a whole list of potential suspects, culprits, and meat. Yes, it may be the animal protein. Maybe it's the animal fat, maybe it's the cholesterol. Maybe it's the iron leading to free radical formation, which can cause inflammation. Advanced glycation end products are another problem. They promote oxidative stress and inflammation, and food analysis shows the highest levels of these so-called glycotoxins are found in meat. Here are the 15 most contaminated foods found with glycotoxin contamination. Chicken, pork, pork, chicken, chicken, beef, chicken, chicken, beef, chicken, turkey, chicken, fish, beef, and McNuggets. Call that chicken. Though other foods from animal sources can also harbor these pro-oxidant chemicals, in this study, they fed diabetics foods packed with glycotoxins. Chicken, fish, eggs, and their inflammatory markers shot up like tumor necrosis factor, C-reactive protein. Thus, in diabetics, these dietary AGEs can promote inflammatory mediators leading to tissue injury. The good news is that restricting these kinds of foods may suppress the inflammatory effects of these glycotoxins, maybe kind of the missing link between increased consumption of animal fat in meat and the subsequent development of type 2 diabetes in the first place. As well as Alzheimer's disease, the final disease on our dreaded list. Dietary AGEs appear to be important risk factors for Alzheimer's disease as well. If you measure the urine levels of glycotoxins flowing through the bodies of older adults, those with the highest levels went on to suffer the greatest cognitive decline over the subsequent nine years, as well as the greatest brain shrinkage, it's called cerebral atrophy. All helping to explain why those who eat the most meats may have triple the risk of getting dementia compared to long time vegetarians. The bottom line is that the same diet that may help prevent the other dreaded diseases cancer, heart attacks, arthritis, stroke, high blood pressure, diabetes, vision loss may also help prevent brain loss and Alzheimer's as well. One disease not on the list is ALS or Lou Gehrig's disease which strikes healthy middle aged people seemingly a random, holds little help hope for treatment and survival.  At any given time 30,000 Americans are fighting for their lives. We each have about one in 400 chance of getting this disease in our lifetime and it appears to be on the rise around the world. What causes it? Well, there's a neurotoxin produced by blue-green algae in our rivers, lakes and oceans that ends up in seafood which is currently a strong contender as the cause of or at least a major contributor to ALS and maybe Alzheimer's and Parkinson's as well. Researchers in Miami found this BMA neurotoxin in the brains of Floridians that died of Alzheimer's and ALS. Significant levels in 49 out of the 50 samples from Alzheimer's and ALS patients. Same thing was found up in the Pacific Northwest and in the brains of those dying from Parkinson's disease. You can also apparently pick up more of this neurotoxin in the hair of live ALS patients compared to controls. So is this neurotoxin present in Florida seafood? Yes, in both freshwater fish and shellfish, oysters, bass, etc. out into the bay. Not just in Florida. On up the eastern the seaboard, out in Midwest so this could explain ALS clusters around lakes in New Hampshire or fish in Wisconsin or blue crabs from the Chesapeake around where I live or seafood eaters in France or in the Finland's Lakeland District or around the Baltic Sea building up particularly in fish, mussels there is a general consensus that these harmful algal blooms are increasing worldwide thanks apart to industrialized agriculture which may increase the exposure to this neurotoxin leading to possible increased risk of these horrible neurodegenerative diseases with substantial and ever-growing evidence that this neurotoxin does play a role in the onset and progression of neurodegenerative diseases the most important question is what mode does activity, does BMA exert? Oh it's not. The most important question is how do we reduce our exposure? We know the presence of this neurotoxin in aquatic food change could be a significant human health hazard so until more is known it may be prudent to reduce our risk by limiting exposure to BMA in the human diet. Now there are neurotoxins in the dairy supply too explain the link between milk consumption and Parkinson's high levels of organic, organochlorine pesticide residues are found in milk and the brains of Parkinson's patients and other pollutants like tetrahydride so quinoline which is actually what scientists use to try to induce the disease and primates found in the milk supply particularly cheese so maybe the dairy industry should do these toxin screenings of milk good luck with that. You could always just not drink the stuff but then what about your bone? That's a marketing ploy. If you look at the science milk does not appear to protect against hip fracture risk whether drinking during the adult years or drinking during one's teen years if anything milk consumption is associated with a borderline increase in fracture risk in men. This suggests a partial explanation for the long-standing enigma that hip fracture rates are highest in populations with the greatest milk consumption. This enigma irked Swedish research team puzzled by studies again and again had shown a tendency for higher risk of fracture with higher milk consumption. Well there is a rare birth defect called galactosemia where babies are born without the enzyme needed to detoxify the galactose in milk so they end up with high levels of galactose in their bloodstream which causes bone loss so maybe the researchers figured even in normal people that can detoxify the stuff maybe it's not so good for the bones to be consuming all that galactose all day and galactose doesn't just hurt the bones that's what scientists use to cause premature aging and lab animals they slip them a little galactose short in their lifespan oxidative stress inflammation brain degeneration just like one to two glasses of milk's worth of galactose a day. We're not rats though but given the high amount of galactose and milk recommendations to increase milk intake for the prevention of fracture could be a conceivable contradiction so they decided to put it to the test. Looking at milk intake and mortality as well as fractured risk to test the theory. 100,000 men and women fall for up to 20 years and milk drinking women had higher rates of death more heart disease significantly more cancer for each daily glass of milk three glasses a day was associated with nearly twice the risk of death they also had significantly more bone and hip fractures too more milk more fractures milk drinking men also had higher rates of death for some reason you never see any of this in any of the milk ads I don't know. So where does this leave us? What are the common threads? If you look at four of the major dietary quality scoring systems which have all been associated with extending lifespan less heart disease less cancer they all share only four things in common what are those four things more fruit more vegetables more whole grains more nuts and beans they're all built around a common core of diets rich in plant foods where the opposite food patterns western diet higher risk so we need to optimize the food environment to support whole grains vegetables fruit and plant-based sources of protein taking the diet quality indexes to the logical conclusion the most plant-based diet comes out the most healthy diet but again doesn't have to be all or nothing we now have evidence that simple advice to increase the consumption of plant foods and decrease the consumption of animal foods actually has a survival advantage and boy do we need it in terms of life expectancy US is down around 27th of the 34 leading free market democracies people in Slovenia live a year longer than citizens of the United States why? most deaths in the United States are preventable and related to nutrition according to the most rigorous analysis of risk factors to date ever published the number one cause of death in the United States and the number one cause of disability is our diet bumping tobacco smoking to number two smoking now only kills about a half million Americans a year whereas diet now kills hundreds of thousands let me end with a thought experiment imagine yourself a smoker in the 1950s the average per capita cigarette consumption was about 4000 cigarettes a year think about that the average American smoked half a pack a day the media was telling you to smoke and famous athletes agreed even Santa Claus cared enough about your health to want you to smoke I mean you want to keep fit and stay slender so you make sure to smoke and eat hot dogs to stay trim and eat lots of sugar to stay slim and trim less fattening than that apple I mean she should come on apples do connote goodness and freshness reads one internal tobacco industry memo which brings up many possibilities for youth-oriented cigarette shameless in addition to staying fit and slender and soothing your throat for digestion's sake you smoke I mean no curative power is claimed for Philip Morris but an ounce of prevention is worth a pound of cure so safe and sorry better smoke like eating smoking was a family affair g-mommy you sure enjoy your Marlboro darn tootin just one question mom can you afford not to enjoy smoke Marlboro your kids were giving you cigarettes in the 50s even your dog was giving you cigarettes blow in her face and she'll follow you anywhere after all they're so round so oh no woman ever says no to Winchester they're so round so fully packed after all John Wayne smoked them till he got lung cancer and died even the paleo folks were smoking so were the doctors yes this is not to say there wasn't controversy within the medical profession yes some doctors smoke camels but other physicians preferred lucky so there actually was disagreement there was eminent doctors on high and impartial medical authority call for Philip Morris even the specialist could not agree which cigarette was better for your throat so best to stick to the science and more scientists smoke this brand actually this should not be rocket science but even the rocket scientists have their own brand for the man who thinks for himself was the government saying smoke lucky I mean who wouldn't want to give their throat a vacation not a single case of throat irritation how could your nose or throat be adversely affected when cigarettes are just as pure as the water you drink look and if you do get irritated no problem your doctor can write you a prescription for cigarettes this is from the Journal of the American Medical Association after all don't smoke is advice hard for patients to swallow reminds me of a recent survey of doctors found the number one reason doctors don't prescribe heart healthy diets today was their perception that patients fear of being deprived of all the junk they're eating after all Philip Morris reminded us we want to keep our patients happy to make a radical change in habit would do harm you're a doctor you don't harm your patients the tobacco industry gave these medical journals big money to run ads like these not a problem though Philip Morris claims come from completely reliable sources based on studies by recognized authorities publishing leading medical journals even kindly offering to sell free packs of cigarettes to doctors so they can test them out themselves so see you at the next AMA convention in the smokers lounge what did the American Medical Association have to say for itself like most other medical journals they accepted tobacco as they've yet to see an autopsy the official editorial board said with a single lesion with a Marlboro lesion on it right label on it so when mainstream medicine is saying smoking on balance may be beneficial for you when the American Medical Association is saying then where could you turn back then if you just wanted the facts what's the new data advanced by science she was too tired for fun and then she smoked a camel Babe Ruth spoke of proof positive medical science that is when he still could speak before he died of throat cancer now some of the science did leak out causing a dip from about 11 cigarettes a day per person down to about 10 but those that got scared would always choose the cigarettes that take the fear out of smoking or even better choose the cigarette that gives you the greatest health protection now if by some miracle there was a smokingfacts.org website back then that could deliver the science directly bypassing commercially corruptible institutional filters you would have become aware of studies like this an Adventist study in California in 1958 where the non-smokers may have at least 90% less lung cancer this wasn't the first when famed surgeon Michael DeBakey was asked why his studies published back in the 30s linking smoking and lung cancer were ignored he had to remind people what it was like back then we were a smoking society it was in the movies medical meetings were one big haze of smoke it's like debates over cigarettes and lung cancer in smoke filled rooms that makes me wonder what they serve at the Dietary Guidelines Committee breakfast buffets to this day a famous statistician by the name of Ronald Fisher railed against what he called propaganda to convince the public that cigarette smoking was dangerous he made invaluable contributions to the field but his analysis of lung cancer and smoking was flawed by an unwillingness to examine the entire body of data available smoke screen may have been because he was a paid consultant to the tobacco industry but also because he himself was a smoker part of his resistance to the association may have been because of his own fondness for smoking which makes me wonder about some of the favorite foods that nutrition researchers may have of this day it always strikes me as ironic that when vegetarian researchers come out forward and list their diet as a potential conflict of interest whereas not once in the 70,000 articles on meat in the medical literature have I ever seen a researcher disclose their non-vegetarian habits because it's normal just like smoking was normal so back to our thought experiment if you're a smoker in the 50s in the know what do you do with access to the science you realize that the best available balance of evidence suggests that your smoking habit is not for you so do you change your smoking habits or do you wait if you wait until your physician tells you between puffs to quit you may have cancer by then if you wait until the powers that be officially recognized like the surgeon general did in the subsequent decade you could be dead by then it took 25 years for the surgeon general report to come out it took more than 7,000 studies and the deaths of countless smokers before the first surgeon general report against smoking was finally released in the 1960s you'd think maybe after the first maybe 6,000 studies it would have maybe give people a little heads up or something powerful industry one wonders how many people are currently suffering needlessly from dietary diseases maybe we should have stopped smoking after the 700th study like this with so much money and personal habit at stake there's always going to be dissenters but given the serious disease some total of evidence we shouldn't wait to put preventive measures in place as a smoker in the 50s on one hand you had all of society the government the medical profession itself telling you to smoke and on the other hand the science if you were lucky to know about studies like this now fast forward 55 years there's a new event to study out of california warning americans about the risks of something else they may be putting into their mouth it's not just that one study according to the latest review total sum of evidence suggests that mortality from all causes put together many of the dreaded diseases scuba vascular diseases like stroke significantly lower in those eating meat free diets in addition to less cancer diabetes so instead of going along with america's smoking habits in the 50s imagine you or someone you know going along with america's eating habits today what do you do with access to the science you realize that the best available balance of evidence suggests that your eating habits probably not good for you if you wait until your physician between bites it's not going to change your diet it could be too late in fact even after the surgeon general's report the medical community still dragged their feet the AMA actually went on record withholding support from the surgeon general report they didn't endorse it could it have been because they had just received 10 million dollars from the tobacco industry hmm so look we know why the AMA we've been sucking up to the tobacco industry but why weren't individual doctors speaking out well there were a few gallant souls ahead of their time just as there are today standing up against industries killing millions but why not more maybe it's because the majority of physicians themselves smoke cigarettes just like the majority of physicians today eat foods that contribute to our epidemic of dietary disease what was the AMA's rallying cry back then everything in moderation sound familiar extensive scientific studies prove smoking in moderation okay today the food industry used the same tobacco industry tactics supplying misinformation twisting the signs the same scientists for hire paid to downplay the risks of second hand smoke and chemicals are the same hired by the national confectioners association to downplay the risks of candy and the same hired by the meat industry to downplay the risks of meat consumption of animal products and processed foods caused at least 14 million deaths around the world 14 million deaths 14 million people dead every year this is not a failure of individual will power says the director general of the world health organization this is a failure of political will to take on big business which is a formidable opposition a few governments are willing to prioritize health over big business as we learn from the experience with the tobacco industry powerful corporation can sell the public just about anything there's one thing we learned from tobacco experience wrote one district judge it's how powerful profits can be a motivator even at the cost of millions of lives and unspeakable suffering may have taken 25 years for the surgeon general report to come out still longer for mainstream medicine to get on board but now there are no longer ads encouraging people to inhale to their hearts content now there are ads from the CDC fighting back food wise there was meat for health defense or nourishing bacon or doctors prescribe meats or soda for that matter think heavens tricks are habit forming now just like there were those in the 30's 40's and 50's on the vanguard trying to save lives today there are those turning ads about what you can do with pork butt to what the pork can do to your butt the physicians community for responsible medicines meat is the new tobacco campaign is Dr. Barnard tried to get across an editorial published in American medical journal association's journal of ethics based diets can now be considered the nutritional equivalent of quitting smoking how many more people have to die how many more people have to die before the CDC encourages people not to wait until open heart surgery to start eating healthy as well just like we don't have to wait until our doctors quit smoking to quit ourselves we don't have to wait until our doctor takes a nutrition class or cleans up their own diet for changing our own eating habits look it's not your doctor's fault writes a group of prominent physicians there is a severe deficiency of nutrition education to all levels of medical training we just never taught it we know a plant whole food plant based diet has been proven to reverse our number one protect against high tube diabetes and cancer so how is this knowledge effective medical education it hasn't despite the neglect nutrition medical education the public considers physicians to be trusted sources but if doctors don't know what they're talking about they could be contributing to diet related diseases to stem the surging tide of chronic illness physicians need to become part of the solution but we don't have to wait for that to happen no longer do patients have to be so patient doctors no longer hold a professional monopoly on health information it's been a democratization of knowledge and so until the system changes we have to take responsibility for our own health for our family's health we can't wait for society to catch up to the science because it's a matter of life and death in 2015 Dr. Kim Williams became president of the American College of Cardiology he was asked why he follows his own advice to eat a plant-based diet he said I don't mind dying Dr. Williams replied I just don't want it to be my fault thank you if you missed last year's talk I have it on DVD and the year before that and the year before that you should have come to Summerfest that's it but as well as 25 other DVDs all proceeds from sale of my books DVDs speaking engagements all goes to charity speaking of which mark your calendars December 8th of this year new book coming out How Not to Die December 8th, very excited about not only the compilation of all my work with all the science thousands of citations but also a practical guide I go through my kind of daily dozen checklists of all the things I try to include my own diet how much greens to eat, how much beans to eat I'm working on it for over a year can't wait for everyone to read it and in the meantime all my work is available free at nutritionfacts.org thanks again we are so fortunate to have Dr. Greger with us I don't think there's anyone else on the planet that could do what you do thank you so much we are honored for you to debut this with us every year thank you so much see everyone over at the LLC


Well, hello there. My name is Mike Panisi and I work at Boku. I train people on testing front-end applications. In this screencast, we're going to look at how you can use Amazon Web Services to run a distributed stress test. Before we get started, I wanted to point you to the article I wrote for Boku.com that served to inspire this screencast. So this has a lot more detail about specifics. It has a lot of references that you'll want to check out if you decide to go through with this whole process yourself. But this screencast should be good for you if you just want to see, generally, what the process looks like and what it might mean to stress test your own app. So we'll get started looking at the Bees with Machine Guns tool. This is a tool written in Python by the folks over at the Chicago Tribune. So it's hosted on GitHub. It was built to work over the Apache Benchmark tool. And that's not quite appropriate for NodeApp. So I've forked the project and generalized it just to work with arbitrary command line commands. So you can use this fork of the project to work specifically with your Node.js app. And that's what we'll be using in this screencast. So it's defined here as Bees. And you see we have a bunch of commands that we can use. Right now we're interested in starting up EC2 instances. So we're going to start up, I think, 10 instances we'll do and have them run our stress test, our client simulator. So that means we're going to start with this Bees up command. And now, actually, Bees up takes a lot of arguments. So I'm going to cheat a bit and just paste these in. I'll step through what they mean, generally, because it takes a lot to tell this tool what it is that you want to do. So here you can see that we're saying where our key is. This is the key that we associated when we created our instance, the security group that it belongs to. And we made this so that we could SSH into these machines. And this is how Bees is operating under the hood. It's SSHing into each one of these and forwarding our commands along. The zone that they're all in, the Amazon instance, the machine instance ID. So you can get that from the dashboard here. We go over to AMIs and we'll see that it has an AMI ID. And so you can imagine if you had a lot of AMIs, this would be really important to be able to specify which specific AMI you wanted to use. So the login and then finally the number of servers that you want to start up. And so, like I said, we'll do 10. So I'm going to go ahead and start that. And so now they're all cutely loading their machine guns. We can go back to our instance listing here and refresh this page. And we'll see that indeed, yes, 10 new instances are starting up. They're all pending. And so this is going to take a few minutes while they all kind of get started. So we'll wait for those to be ready and then keep going. Okay, so they're all started up now. We're ready to go. Note though that we're not actually doing anything yet. They're just kind of just sitting there idly, not attacking anything or shooting anything with machine guns or anything. They're just up and ready to respond to our commands. So our server, which we have two windows open here onto our server to kind of keep track. Our server is here unsuspecting. No idea what's about to happen to it. The bees are pretty much idle right now. So what we can do to convince ourselves that this is working and the bees are actually going to do whatever we tell them to is we'll just do this kind of test command to see what that looks like. So we'll use bees exact this time. And you can use help to find information about any of these sub commands. In this case, we'll do bees exact. We're going to put the results into results.txt and then a dash. And everything comes after the dash as the command. So I'll put it in quotes and we'll just do date. And so this command just prints out the current date in terms of nanoseconds. So I'll send that command out to all 10 bees. All 10 bees are going to execute that command and then print it to standard out. That standard out is going to pipe back through SSH to this local machine. And then this machine is going to append all 10 results to the same file which is, as we said, results.txt. So I can take a look at results.txt and see that yes, all 10 of the responses have been added onto this file so there are no slouches out there. All those bees are hard at work and ready to do whatever we want. In this case, it's going to be to attack that server. And so what we'll do is get that server ready, is running the server itself, or running the node process I should say. So we'll change into our project directory and from there into the back end code. And I'm going to export an environmental variable. This is just kind of specific to my server. You don't have to worry too much about that and run server.js. All right, so the Socket.io service is started. Over in this tab, we'll use SAR, as we covered in the last screencast, use SAR to track system information over the course of this stress test. So SAR, we want information about sockets. We're going to print out to results.sar and we want to do this once every second. Good, okay. Looks like we're idling at 9 open socket connections. And now we're ready to initiate the attack. So we'll use bees exec. This time, we'll actually have this do something meaningful. So what we'll do is change into, each bee is going to change into the project directory. Specifically, they're going to change into the back end into the stress testing code. From there, they're going to use the forever utility. This is a globally installed NPM module that backgrounds a node process. They're going to start it and the client code is served from the client directory. So my client simulator has a number of command line flags that I can pass it so that I can be a little bit more flexible when I'm running the tests and change some of the parameters. So in this case, I'm going to specify how many clients I want each one of these instances to simulate. So each one is going to simulate 500. And since there's five instances, we should expect to see a total of 5,000 connections coming into our back end service. And then finally, I'll specify the number of seconds that these connections should be dispersed over. Without this, all the connections will be remade immediately and that's a little bit unrealistic. So we'll have these connections occur over the course of 10 seconds. So recap, we have our server running with a node service. We have our statistics collecting. So we're ready to go. I'll initiate this command and looking at the number of open socket connections, we can see that this number is steadily rising as each one of those instances attempts to connect 500 clients over the course of 10 seconds. But it's already been more than 10 seconds and we still don't have the 5,000 that we're expecting to see. So the best explanation I can come up with for this is that our server, as we covered in an earlier screencast, our server is running on EC2 itself. And our server is a micro instance and I'm guessing that it's not really intended for this heavy usage. To its credit, it's trying to handle all these connections and although we can't be sure it's not dropping them, it is steadily increasing the number of open socket connections. So there's definitely some sort of bottleneck going on here. So really our stress test is, how should I say this? Our server is failing but our stress test is successful and that we've demonstrated some sort of bottleneck in our system and we're now through SAR collecting a lot of data that we can now come back and pour through and look at what is it that is limiting and that will give us some insight into how we can better our code and our server to handle the connections that we want to handle. So given that things look about done here, what we'll do, oh one thing, we can look over at the node service and kind of see that it's freaking out. This is a little bit my bad because I didn't turn off debugging and I highly recommend that in a production environment you turn off socket is debugging information. But that's alright just for this stress test and just for our kind of learning purposes here. So now that we have our data collected and we want to start analyzing it, we should probably stand down these bees and there's two ways we could do it.  Or we might want to leave the actual EC2 instances on and hanging around so that we can perform a few more tests before we're truly done. So we'll go through that step first. So that's just going to be another call to bees exec except this time we're going to use the forever utility. Which again it's installed globally so we don't need to change the specific directories for this. And we're just going to say stop all. So now all processes that we're back rounded with forever will be killed. We'll go back over to the server and watch as the number of open TCP sockets drops, drops down to around 10 maybe. See if I'm right. Alright cool, 9. So we're back to idling at 9's open socket connections and this says calm down bees. It's no longer serving anyone. So now we'll say that we could run this command again. We could change some of the parameters and get more data but we'll say that we're done. Probably the most important thing you do when you're done is you actually stand down the instances or stand on the bees or turn off the instances. And so this is a very easy command from bees with machine guns. It's just bees down. And so it just stood down 10 bees. We can jump back over to the control panel here and hit refresh. We'll see that these are now all shutting down. So cool. It'll take a few minutes before they're listed as terminated and then don't freak out because they're going to hang around for a little bit. As far as I can tell this is just for kind of accounting purposes to verify that yes you did run these instances and yes they are shut down. And so then in about like 20 minutes they'll actually be cleared out from this view here. So from here you would basically just cancel your statistics gathering. You'll find that your results are all here. You can use SAR like we talked about in the last screencast to pour into this data and start playing with the numbers and seeing what is going wrong. And that just about covers what basically the stress testing procedure looks like. So as I said at the beginning of the screencast I recommend that you check out this article for more detail and more references. And if you have any questions about the process then feel free to leave a comment at the bottom of it. But that'll just about do it for us today so don't forget with great power comes great responsibility. Use it wisely and have fun.