Benefits of Oatmeal for Fatty Liver Disease

Benefits of Oatmeal for Fatty Liver Disease.jpeg

If oatmeal is so powerful that it can clear up some of the ravages of chemotherapy just applied to the skin (see my video Oatmeal Lotion for Chemotherapy-Induced Rash), what might it do if we actually ate it? Oats are reported to possess varied drug-like activities like lowering blood cholesterol and blood sugar, boosting our immune system, anticancer, antioxidant, and anti-atherosclerosis activites, in addition to being a topical anti-inflammatory, and reprtedly may also be useful in controlling childhood asthma and body weight.

Whole-grain intake in general is associated with lower risk of type 2 diabetes, cardiovascular disease, and weight gain, as shown in my video Can Oatmeal Help Fatty Liver Disease?. All of the cohort studies on type 2 diabetes and heart disease show whole grain intake is associated with lower risk.

Researchers have observed the same for obesity--consistently less weight gain for those who consumed a few servings of whole grains every day. All the forward-looking population studies demonstrate that a higher intake of whole grains is associated with lower body mass index and body weight gain. However, these results do not clarify whether whole grain consumption is simply a marker of a healthier lifestyle or a factor favoring lower body weight.

For example, high whole grain consumers--those who eat whole wheat, brown rice, and oatmeal for breakfast--tend to be more physically active, smoke less, and consume more fruit, vegetables, and dietary fiber than those that instead reach for fruit loops. Statistically, one can control these factors, effectively comparing nonsmokers to nonsmokers with similar exercise and diet as most of the studies did, and they still found whole grains to be protective via a variety of mechanisms.

For example, in terms of helping with weight control, the soluble fiber of oatmeal forms a gel in the stomach, delaying stomach emptying, making one feel full for a longer period. It seems plausible that whole grain intake does indeed offer direct benefits, but only results of randomized controlled intervention studies can provide direct evidence of cause and effect. In other words, the evidence is clear that oatmeal consumers have lower rates of disease, but that's not the same as proving that if we start eating more oatmeal, our risk will drop. To know that, we need an interventional trial, ideally a blinded study where you give half the people oatmeal, and the other half fake placebo oatmeal that looks and tastes like oatmeal, to see if it actually works. And that's what we finally got--a double-blinded randomized trial of overweight and obese men and women. Almost 90% of the real oatmeal-treated subjects had reduced body weight, compared to no weight loss in the control group. They saw a slimmer waist on average, a 20 point drop in cholesterol, and an improvement in liver function.

Nonalcoholic fatty liver disease, meaning a fatty liver caused by excess food rather than excess drink, is now the most common cause of liver disease in the United States, and can lead in rare cases to cirrhosis of the liver, cancer of the liver, and death. Theoretically, whole grains could help prevent and treat fatty liver disease, but this is the first time it had been put to the test. A follow-up study in 2014 confirmed these findings of a protective role of whole grains, but refined grains was associated with increased risk. So one would not expect to get such wonderful results from wonder bread.

How can you make your oatmeal even healthier? See Antioxidants in a Pinch.

Whole Grains May Work As Well As Drugs for hypertension, but refined grain intake may linked with high blood pressure and diseases like diabetes. But If White Rice is Linked to Diabetes, What About China?.

More on keeping the liver healthy in videos like:

In health,
Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank / Flickr. This image has been modified.

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Benefits of Oatmeal for Fatty Liver Disease

Benefits of Oatmeal for Fatty Liver Disease.jpeg

If oatmeal is so powerful that it can clear up some of the ravages of chemotherapy just applied to the skin (see my video Oatmeal Lotion for Chemotherapy-Induced Rash), what might it do if we actually ate it? Oats are reported to possess varied drug-like activities like lowering blood cholesterol and blood sugar, boosting our immune system, anticancer, antioxidant, and anti-atherosclerosis activites, in addition to being a topical anti-inflammatory, and reprtedly may also be useful in controlling childhood asthma and body weight.

Whole-grain intake in general is associated with lower risk of type 2 diabetes, cardiovascular disease, and weight gain, as shown in my video Can Oatmeal Help Fatty Liver Disease?. All of the cohort studies on type 2 diabetes and heart disease show whole grain intake is associated with lower risk.

Researchers have observed the same for obesity--consistently less weight gain for those who consumed a few servings of whole grains every day. All the forward-looking population studies demonstrate that a higher intake of whole grains is associated with lower body mass index and body weight gain. However, these results do not clarify whether whole grain consumption is simply a marker of a healthier lifestyle or a factor favoring lower body weight.

For example, high whole grain consumers--those who eat whole wheat, brown rice, and oatmeal for breakfast--tend to be more physically active, smoke less, and consume more fruit, vegetables, and dietary fiber than those that instead reach for fruit loops. Statistically, one can control these factors, effectively comparing nonsmokers to nonsmokers with similar exercise and diet as most of the studies did, and they still found whole grains to be protective via a variety of mechanisms.

For example, in terms of helping with weight control, the soluble fiber of oatmeal forms a gel in the stomach, delaying stomach emptying, making one feel full for a longer period. It seems plausible that whole grain intake does indeed offer direct benefits, but only results of randomized controlled intervention studies can provide direct evidence of cause and effect. In other words, the evidence is clear that oatmeal consumers have lower rates of disease, but that's not the same as proving that if we start eating more oatmeal, our risk will drop. To know that, we need an interventional trial, ideally a blinded study where you give half the people oatmeal, and the other half fake placebo oatmeal that looks and tastes like oatmeal, to see if it actually works. And that's what we finally got--a double-blinded randomized trial of overweight and obese men and women. Almost 90% of the real oatmeal-treated subjects had reduced body weight, compared to no weight loss in the control group. They saw a slimmer waist on average, a 20 point drop in cholesterol, and an improvement in liver function.

Nonalcoholic fatty liver disease, meaning a fatty liver caused by excess food rather than excess drink, is now the most common cause of liver disease in the United States, and can lead in rare cases to cirrhosis of the liver, cancer of the liver, and death. Theoretically, whole grains could help prevent and treat fatty liver disease, but this is the first time it had been put to the test. A follow-up study in 2014 confirmed these findings of a protective role of whole grains, but refined grains was associated with increased risk. So one would not expect to get such wonderful results from wonder bread.

How can you make your oatmeal even healthier? See Antioxidants in a Pinch.

Whole Grains May Work As Well As Drugs for hypertension, but refined grain intake may linked with high blood pressure and diseases like diabetes. But If White Rice is Linked to Diabetes, What About China?.

More on keeping the liver healthy in videos like:

In health,
Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank / Flickr. This image has been modified.

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Does Oatmeal Lotion Work?

Does Oatmeal Lotion Work?.jpeg

A review in the Journal of Drugs in Dermatology notes oatmeal has been used for centuries as a topical soothing agent on the skin to relieve itch and irritation in dermatology. Of course, that was coming from Johnson & Johnson, which sells a brand of oatmeal lotion. But if it helps with dry skin or a bug bite, I can imagine it having some soothing quality. One study out of Georgetown University, though, shocked me.

There's a class of chemo drugs, like Cetuximab, that can cause an awful rash. Various treatments have been tried and failed. There was no clear preventive or curative treatment for this eruption, until this remarkable study, which you can see in my Oatmeal Lotion for Chemotherapy-Induced Rash video.

The researchers had heard about a study where human skin fragments from plastic surgery were subjected to an inflammatory chemical, and adding an oatmeal extract appeared to help. Of the ten patients with chemo rashes who the researchers were able to get to try some oatmeal lotion, six had a complete response, and four a partial response, giving an overall oatmeal response rate of 100%.

Doctors wrote in from around the world. Significant improvement in all patients seemed too good to be true, but out of desperation they tried it and got the same astonishing results. Oatmeal--a simple topical agent producing such spectacular benefit where more complex therapies have failed. In an age when ever more expensive treatments are consistently being championed, it would be a great pity if this inexpensive, natural approach to relieving distressing symptoms were to be overlooked.

Ironically, two of the cancer cell lines found resistant in vitro to this type of chemotherapy were found to be sensitive to avenanthramides, which are unique phytonutrients found in oats, suggesting that people should be applying oatmeal to their insides as well.

Normally I wouldn't make a whole video for such a rare use, but I was so impressed with the results I figured that even if I could help one person in this situation it would be worth it. Reminds me of my videos Treating Gorlin Syndrome With Green Tea and Topical Application of Turmeric Curcumin for Cancer.

If oatmeal is so powerful that it can clear up some of the ravages of chemotherapy just applied to the skin, what might it do if we actually ate it? That's the subject of my video Can Oatmeal Help Fatty Liver Disease?.

Cetuximab is often given for metastatic colorectal cancer. Better to try to prevent the disease in the first place:

In health,
Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank / Flickr. This image has been modified.

Original Link

Does Oatmeal Lotion Work?

Does Oatmeal Lotion Work?.jpeg

A review in the Journal of Drugs in Dermatology notes oatmeal has been used for centuries as a topical soothing agent on the skin to relieve itch and irritation in dermatology. Of course, that was coming from Johnson & Johnson, which sells a brand of oatmeal lotion. But if it helps with dry skin or a bug bite, I can imagine it having some soothing quality. One study out of Georgetown University, though, shocked me.

There's a class of chemo drugs, like Cetuximab, that can cause an awful rash. Various treatments have been tried and failed. There was no clear preventive or curative treatment for this eruption, until this remarkable study, which you can see in my Oatmeal Lotion for Chemotherapy-Induced Rash video.

The researchers had heard about a study where human skin fragments from plastic surgery were subjected to an inflammatory chemical, and adding an oatmeal extract appeared to help. Of the ten patients with chemo rashes who the researchers were able to get to try some oatmeal lotion, six had a complete response, and four a partial response, giving an overall oatmeal response rate of 100%.

Doctors wrote in from around the world. Significant improvement in all patients seemed too good to be true, but out of desperation they tried it and got the same astonishing results. Oatmeal--a simple topical agent producing such spectacular benefit where more complex therapies have failed. In an age when ever more expensive treatments are consistently being championed, it would be a great pity if this inexpensive, natural approach to relieving distressing symptoms were to be overlooked.

Ironically, two of the cancer cell lines found resistant in vitro to this type of chemotherapy were found to be sensitive to avenanthramides, which are unique phytonutrients found in oats, suggesting that people should be applying oatmeal to their insides as well.

Normally I wouldn't make a whole video for such a rare use, but I was so impressed with the results I figured that even if I could help one person in this situation it would be worth it. Reminds me of my videos Treating Gorlin Syndrome With Green Tea and Topical Application of Turmeric Curcumin for Cancer.

If oatmeal is so powerful that it can clear up some of the ravages of chemotherapy just applied to the skin, what might it do if we actually ate it? That's the subject of my video Can Oatmeal Help Fatty Liver Disease?.

Cetuximab is often given for metastatic colorectal cancer. Better to try to prevent the disease in the first place:

In health,
Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank / Flickr. This image has been modified.

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Paleo Diet May Undermine Benefit of CrossFit Exercise

NF-Sept6 Paleo Diets May Negate Benefits of Exercise.jpeg

Much of the low-carb and paleo reasoning revolves around insulin. To quote a paleo blogger, "carbohydrates increase insulin, the root of all evil when it comes to dieting and health." So the logic follows that because carbs increase insulin, we should stick mostly to meat, which is fat and protein with no carbs, so no increase in insulin, right?

Wrong.

We've known for half a century that if you give someone just a steak: no carbs, no sugar, no starch; their insulin goes up. Carbs make our insulin go up, but so does protein.

In 1997 an insulin index of foods was published, ranking 38 foods to determine which stimulates higher insulin levels. Researchers compared a large apple and all its sugar, a cup of oatmeal packed with carbs, a cup and a half of white flour pasta, a big bun-less burger with no carbs at all, to half of a salmon fillet. As you can see in the graph in my video Paleo Diets May Negate Benefits of Exercise, the meat produced the highest insulin levels.

Researchers only looked at beef and fish, but subsequent data showed that that there's no significant difference between the insulin spike from beef, chicken, or pork--they're all just as high. Thus, protein and fat rich foods may induce substantial insulin secretion. In fact, meat protein causes as much insulin release as pure sugar.

So, based on the insulin logic, if low-carbers and paleo folks really believed insulin to be the root of all evil, then they would be eating big bowls of spaghetti day in and day out before they would ever consume meat.

They are correct in believing that having hyperinsulinemia, high levels of insulin in the blood like type 2 diabetics have, is not a good thing, and may increase cancer risk. But if low-carb and paleo dieters stuck to their own insulin theory, then they would be out telling everyone to start eating plant-based. Vegetarians have significantly lower insulin levels even at the same weight as omnivores. This is true for ovo-lacto-vegetarians, lacto-vegetarians, and vegans. Meat-eaters have up to 50% higher insulin levels.

Researchers from the University of Memphis put a variety of people on a vegan diet (men, women, younger folks, older folks, skinny and fat) and their insulin levels dropped significantly within just three weeks. And then, just by adding egg whites back to their diet, their insulin production rose 60% within four days.

In a study out of MIT, researchers doubled participants' carbohydrate intake, and their insulin levels went down. Why? Because the researchers weren't feeding people jellybeans and sugar cookies, they were feeding people whole, plant foods, lots of whole grains, beans, fruits, and vegetables.

What if we put someone on a very-low carb diet, like an Atkins diet? Low carb advocates such as Dr. Westman assumed that it would lower insulin levels. Dr. Westman is the author of the new Atkins books, after Dr. Atkins died obese with, according to the medical examiner, a history of heart attack, congestive heart failure, and hypertension. But, Dr. Westman was wrong in his assumption. There are no significant drop in insulin levels on very low-carb diets. Instead, there is a significant rise in LDL cholesterol levels, the number one risk factor for our number one killer, heart disease.

Atkins is an easy target though. No matter how many "new" Atkins diets that come out, it's still old news. What about the paleo diet? The paleo movement gets a lot of things right. They tell people to ditch dairy and doughnuts, eat lots of fruits, nuts, and vegetables, and cut out a lot of processed junk food. But a new study published in the International Journal of Exercise Science is pretty concerning. Researchers took young healthy people, put them on a Paleolithic diet along with a CrossFit-based, high-intensity circuit training exercise program.

If you lose enough weight exercising, you can temporarily drop our cholesterol levels no matter what you eat. You can see that with stomach stapling surgery, tuberculosis, chemotherapy, a cocaine habit, etc. Just losing weight by any means can lower cholesterol, which makes the results of the Paleo/Crossfit study all the more troubling. After ten weeks of hardcore workouts and weight loss, the participants' LDL cholesterol still went up. And it was even worse for those who started out the healthiest. Those starting out with excellent LDL's (under 70), had a 20% elevation in LDL cholesterol, and their HDL dropped. Exercise is supposed to boost our good cholesterol, not lower it.

The paleo diet's deleterious impact on blood fats was not only significant, but substantial enough to counteract the improvements commonly seen with improved fitness and body composition. Exercise is supposed to make things better.

On the other hand, if we put people instead on a plant-based diet and a modest exercise program, mostly just walking-based; within three weeks their bad cholesterol can drop 20% and their insulin levels 30%, despite a 75-80% carbohydrate diet, whereas the paleo diets appeared to "negate the positive effects of exercise."

I touched on paleo diets before in Paleolithic Lessons, and I featured a guest blog on the subject: Will The Real Paleo Diet Please Stand Up?

but my favorite paleo videos are probably The Problem With the Paleo Diet Argument and Lose Two Pounds in One Sitting: Taking the Mioscenic Route.

I wrote a book on low carb diets in general (now available free full-text online) and touched on it in Atkins Diet: Trouble Keeping It Up and Low Carb Diets and Coronary Blood Flow.

And if you're thinking, but what about the size of the cholesterol, small and dense versus large and fluffy? Please see my video Does Cholesterol Size Matter?

In health,
Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations--2013: Uprooting the Leading Causes of Death, More Than an Apple a Day, 2014: From Table to Able: Combating Disabling Diseases with Food, 2015: Food as Medicine: Preventing and Treating the Most Dreaded Diseases with Diet, and my latest, 2016: How Not To Die: The Role of Diet in Preventing, Arresting, and Reversing Our Top 15 Killers.

Image Credit: Vincent Lit / Flickr

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27 Tantalizing Oil-Free Vegan Bowls

  Food tastes more fabulous when it is all thrown together (or politely placed strategically) into a big bowl and perhaps drizzled with a sauce. I personally enjoy most of my meals this way. No limitations exist for the potential creativity and nutritional aptitude you can display via this mode of feasting. From “smoothie bowls” and “power bowls” to “soul bowls” and …

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Oatmeal-Raisin Cookies

There’s nothing like a soft, homemade, oatmeal-raisin cookie! Dates and almond butter stand in for the more traditional ingredients of butter, eggs, and refined sugar. These cookies are rich and sweet, but without being heavy and greasy. Print Oatmeal-Raisin Cookies Prep time:  15 mins Cook time:  13 mins Total time:  28 mins Serves: 8 to 9 (makes...

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The post Oatmeal-Raisin Cookies appeared first on Straight Up Food.

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Which are More Anti-Inflammatory: Sweet Cherries or Tart Cherries?

NF-Oct6 Anti-inflammatory life is a bowl full of cherries.jpg

Haggis, the national dish of Scotland, is a savory pudding of heart, liver, lungs, and oatmeal traditionally stuffed inside of a stomach. When that stomach goes into our own stomach, our digestive enzymes and stomach acid have no problem digesting it away. How do our bodies digests the stomach lining of a sheep on our plate without digesting our own stomach linings? It's meat and we're meat, so why don't we digest our own stomach every time we eat?

Partly because we have an enzyme called cyclooxygenase (COX) that protects the lining of our stomach. There are two types, COX-1 and COX-2. COX-1 is thought to be the primary protector of our stomach, whereas COX-2 is an enzyme responsible for pain and inflammation. In fact, anti-inflammatory drugs like ibuprofen and naproxen work by inhibiting the COX-2 enzyme. But these are non-selective drugs, so in addition to inhibiting COX-2 they also inhibit COX-1, which is trying to protect our stomach linings. Thus, although drugs like ibuprofen are great at relieving pain and inflammation, they kill thousands every year due to ulcerations through the stomach wall that result in life-threatening bleeding and perforation.

What are the risks on an individual level? On average, one in about 1,200 people who take this class of drugs for at least two months will die as a result. To put this into perspective, we can compare the death rate from anti-inflammatory drug side-effects to the risks associated with some well-known events. For example, it may be safer to go bungee jumping a few hundred times.

What we need is a selective COX-2 inhibitor, inhibiting the pain and inflammation of COX-2 without inhibiting the stomach protection of COX-1. We thought we got it with Vioxx, a blockbuster drug that brought in billions in profits before it started killing tens of thousands of peoples. Internal emails reveal how the drug manufacturer responded to the revelation that they were killing people: They drew up a list of doctors who were trying to warn people to "neutralize" them. If that didn't work, they tried to discredit them (You can see the emails in the video, Anti-inflammatory Life Is a Bowl of Cherries).

We're left then with two options: death from internal bleeding from one type of drug or death from side effects from another type of drug. If only there was some sort of natural COX-2 inhibitor. There is: cherries, which unlike ibuprofen suppress COX-2 more than COX-1.

In videos I did on insomnia and reducing muscle soreness (See Tart Cherries for Insomnia and Reducing Muscle Soreness with Berries), I talked about the benefits of sour cherries, the types of cherries used in baking. But sweet cherries, the kind you eat fresh, seem to be the MVP for COX-2 inhibition. Tart cherries had less of an effect. Regular red sweet cherries (Bing sweet cherries) were shown to have a greater anti-inflammatory activity than tart cherries. This makes sense since we think it may be the anthocyanin phytonutrients, and there are much more in sweet red cherries than in tart, and nearly none in yellow Rainer cherries.

Because fresh cherries have limited availability, what about other cherry products? In terms of anthocyanin phytonutrients, fresh is best, but frozen would appear to be the second-best choice.

Here are two ways I incorporate cherries into my diet:

Other studies in which anti-inflammatory drugs were compared natural dietary remedies include: Turmeric Curcumin and Osteoarthritis and Turmeric Curcumin and Rheumatoid Arthritis.

Anti-inflammatory activity in a test tube is one thing, but can cherries actually be used clinically to treat inflammatory diseases? See Gout Treatment with a Cherry on Top.

In health,
Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, From Table to Able, and Food as Medicine.

Image Credit: Valdemar Fishmen / Flickr

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What Do Eggs Do To Our Arteries?

NF-Aug20 Eggs and Arterial Function.jpg

In reaction to the study that found a similar exponential increase in artery clogging plaque in both smokers and egg eaters, one critic countered that eggs have beneficial effects on vascular endothelium, the inner lining of our arteries, citing a 2005 study on egg consumption and endothelial function, funded by the American Egg Board (highlighted in my video, Eggs and Arterial Function).

The study was done on a group of men and women eating the standard American diet, were overweight, had "normal" cholesterol, (which is to say extremely high cholesterol--LDL levels twice as high as could be considered optimal). As the authors of a paper published in the Journal of the American College of Cardiology note, it's often not appreciated "that the average blood cholesterol level in the United States, the so-called normal level, was actually too high," accelerating heart disease and "putting a large fraction of the so-called normal population at a higher risk" for coronary heart disease, our number one killer.

If we threw a lit match into a flaming pool of gasoline and saw no real difference in the height of the flames, we can't conclude that throwing lit matches into gasoline is not a fire hazard. But that is exactly what the Egg Board study concluded. When the addition of eggs didn't make the arterial function worse than it already was, they concluded that "short-term egg consumption does not adversely affect endothelial function in healthy adults."

The egg board paid for a follow-up study using folks who were even worse off, with a mean total cholesterol of 244. They reported that egg consumption had no effect on endothelial function... as compared to sausage and cheese. Yet instead of sounding the alarm that eating eggs is as bad for arterial function as a McDonald's Sausage McMuffin (!), the researchers concluded that egg consumption was found to be non-detrimental to endothelial function and cholesterol levels. The subjects started out with life-threatening cholesterol, and ended up with life-threatening cholesterol.

Why don't endothelial function and cholesterol levels get even worse? Because there's a plateau effect. We can basically max out on our cholesterol absorption. After a certain level of intake, it's just another match to the fire. If we're already consuming the standard American diet averaging 400mg of cholesterol daily, even adding two jumbo eggs to our diet may not have a sizeable impact. But to people trying to eat healthy, those two eggs could shoot their cholesterol up 20 points.

However, a fat-free, cholesterol-free egg substitute was found to be beneficial. That is, not eating eggs lowers cholesterol levels and improves endothelial function--and that's what these people needed. Their arteries were already hurting, they needed something to bring the fire down, not more matches. The subjects were apparently eating so unhealthy that adding eggs couldn't make things much worse, but eating oatmeal instead of eggs made things better, helping to quench the fire. So even the Egg Board-funded studies said that not eating eggs is better for our arteries, yet these are the same studies that pro-egg folks cite to claim beneficial vascular effects.

More on the reaction to the Eggs vs. Cigarettes in Atherosclerosis study in my video, Debunking Egg Industry Myths, as well as further discussion of the effects of the cholesterol in eggs on the cholesterol levels in the blood of egg consumers. More on that in:

I previously featured a food that actually does benefit vascular function. See Walnuts and Artery Function. Though the nut industry did try a similar tactic, see my video Nuts and Bolts of Cholesterol Lowering. The beef, soda, and dairy industries may also be guilty of experimental manipulation. See BOLD Indeed: Beef Lowers Cholesterol and Food Industry "Funding Effect".

In health,
Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my videos for free by clicking here and watch my full 2012 - 2015 presentations Uprooting the Leading Causes of Death, More than an Apple a Day, From Table to Able, and Food as Medicine.

Image Credit: Pietro Bellini / Flickr

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How Should I Take Probiotics?

 

 

 

 

 

 

 

 

How Should I Take Probiotics?

Foods appear to be better carriers for probiotics than supplements, but if one chooses to go with the supplement route, should they be taken before, during, or after meals?

The package labeling on probiotic supplements is often confusing. Sometimes the consumer is instructed to take the probiotics with meals, sometimes before or after meals, and occasionally on an empty stomach. I was surprised to find so few actual data in the scientific literature concerning this topic, but that is par for the course for most dietary supplement advice. See, for example, my video series about how little pharmacists and natural food store employees know:

The lack of information on how to take probiotics has led to serious confusion, both for the industry and the consumer. Surprisingly it doesn’t appear as if any studies had ever examined this question–until now.

Researchers hoped to be able to measure probiotic concentrations throughout the entire process after taking a probiotic supplement minute-by-minute.  To do this, they had to build a fake digestive track with a fake stomach and intestines, but complete with real saliva and digestive enzymes, acid, bile, and other digestive fluids. What did they find? If you check out my 2-min video Should Probiotics Be Taken Before, During, or After Meals?, you can see the survival of three different types of probiotics before, during, and after meals. You can also see how the probiotics fared when taken in oatmeal and milk, milk alone, apple juice, or water.

What did they find? Like vitamin D supplements, which should also probably be taken with meals for maximum efficacy (Take Vitamin D Supplements With Meals), probiotic bacterial survival was best when provided within 30 minutes before or simultaneously with a meal or beverage that contained some fat content.

This study didn’t shed light on what dose we should take and under what circumstances, however. To see what the best available science says, see the first video in this series, Preventing and Treating Diarrhea with Probiotics. Then I compared probiotics to prebiotics in Preventing the Common Cold with Probiotics? and moved to the effect of your gut flora on your mood in Gut Feelings: Probiotics and Mental Health.

-Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death and More Than an Apple a Day.

Image credit: Eric C Bryan / Flickr

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