Eating Garlic and Raisins May Help Prevent Preterm Birth

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The United States has one of the worst premature birth rates in the world, now ranking 131st worldwide. Even worse, over the last few decades, the rate of preterm birth in the U.S. has been going up.

We've known that preterm delivery is associated with significant problems during infancy, and almost three quarters of all infant deaths. Unfortunately even preemies who survive past infancy may carry a legacy of health issues, such as behavioral problems, moderate to severe neurodevelopmental disabilities and psychiatric disorders in half of those born extremely preterm by the time they reach school-age. There's even evidence now that adults born very prematurely are at increased risk for things like heart disease and diabetes. And babies don't even have to be born that premature to suffer long-term effects. Even so-called near-term births at 36 or 37 weeks are now thought to be related to subtle developmental problems. So what can pregnant women do to decrease this risk?

66,000 pregnant women were studied to examine whether an association exists between maternal dietary patterns and risk of preterm delivery. Researchers compared a so-called "prudent," which was more plant-based versus a Western or traditional Scandinavian diet (vegetables, fruits, oils, water as beverage, whole grain cereals, fiber rich bread) versus the "Western" (salty and sweet snacks, white bread, desserts, processed meat products), and found that the "prudent" pattern was associated with significantly reduced risk of preterm delivery.

Inflammation is thought to play a role in triggering delivery, so a diet characterized by high intakes of vegetables, fruit and berries can reduce both systemic and local inflammation, and the lower saturated fat levels would also be associated with reduced inflammation. Any foods in particular?

A significant percentage of preterm deliveries are thought to be related to infections and inflammatory conditions in the genital tract. Garlic is well-known for its antimicrobial properties, and also has probiotic dietary fibers that feed our good bacteria. Dried fruit is also packed with fiber and has antimicrobial activities against some of the bacteria suspected to play a role in preterm delivery.

Researchers (highlighted in my video, Garlic and Raisins to Prevent Premature Birth) studied the garlic, onion and dried fruit intake of nearly 19,000 pregnant women, and indeed, they observed a reduced risk of spontaneous preterm delivery related to groups of garlic and onion family vegetables and dried fruits. In particular, garlic stood out for the vegetables and raisins stood out for the dried fruit. Both were associated with a reduced risk of both preterm delivery and preterm pre-labor rupture of membranes, which means your water breaking prematurely (before 37 weeks). And it didn't seem to take much. The so-called "high" garlic intake associated with the lowest risk was just about one clove a week or more, and "high" raisin intake was defined as just one of those mini snack boxes of raisins a month.

Here's the video on aspartame (NutraSweet) and diet soda during pregnancy: Diet Soda and Preterm Birth.

Some other popular pregnancy videos include:

More on garlic in #1 Anti-Cancer Vegetable and Cancer, Interrupted: Garlic and Flavenoids.

Videos on dried fruit include:

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: Isabel Eyre / Flickr

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How a Gluten-Free Diet Can Be Harmful

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Until only a few years ago, almost the whole of the scientific world maintained that the wheat protein gluten would provoke negative effects only in people with rare conditions such as celiac disease or wheat allergies. But by the early part of 2013, it was largely becoming accepted that some non-celiac patients could suffer from gluten or wheat sensitivity. Indeed, a consensus panel of experts now officially recognizes three gluten-related conditions, wheat allergy, celiac disease and gluten sensitivity.

What percentage of the population should avoid wheat? About 1 in a 1,000 may have a wheat allergy, and nearly 1 in a 100 may have celiac disease. Celiac disease appears to be on the rise, though there's still less than about a 1 in 10,000 chance an American will be diagnosed with celiac in a given year. Our best estimate for wheat sensitivity is in the same general range as celiac, slightly higher than 1 percent. That's still potentially millions of people who may have been suffering for years who could have been cured by simple dietary means, yet who were unrecognized and unaided by the medical profession.

Although gluten sensitivity continues to gain medical credibility, we still don't know how it works. We don't know how much gluten can be tolerated, if it's reversible or not, or what the long-term complications might be of not sticking to a gluten-free diet. Considering the lack of knowledge, people with gluten sensitivity should consider reintroducing gluten back into their diet every year to see if it's still causing problems.

The reason health professionals don't want to see people on gluten-free diets unless absolutely necessary is that, for the 98 percent of people that don't have gluten issues, whole grains--including the gluten grains wheat, barley and rye--are health promoting, linked to reduced risk of coronary heart disease, cancer, diabetes, obesity and other chronic diseases.

Because some people have a peanut allergy doesn't mean everyone should avoid peanuts. There is no evidence to suggest that following a gluten-free diet has any significant benefits in the general population. Indeed, there is some evidence to suggest that a gluten-free diet may adversely affect gut health in those without celiac disease, gluten sensitivity, or wheat allergy. A study out of Spain, highlighted in my video, Gluten-Free Diets: Separating the Wheat from the Chat, found that a month on a gluten-free diet may hurt our gut flora and immune function, potentially setting those on gluten-free diets up for an overgrowth of harmful bacteria in their intestines. Why? Because the very components wheat sensitive people have problems with, like FODMAP and fructans, may act as prebiotics and feed our good bacteria.

Gluten, itself, may also boost immune function. After less than a week on added gluten protein, subjects experienced significantly increased natural killer cell activity, which could be expected to improve our body's ability to fight cancer and viral infections. Another study found that high gluten bread improved triglyceride levels better than regular gluten bread.

Ironically, one of the greatest threats gluten-free diets pose may be the gluten itself. Self-prescription of gluten withdrawal may undermine our ability to pick up celiac disease, the much more serious form of gluten intolerance. The way we diagnose celiac is by looking for the inflammation caused by gluten in celiac sufferers, but if they haven't been eating a lot of gluten, we might miss the disease. Hence, rather than being on a gluten-free diet, we want celiac suspects to be on a gluten-loaded diet. We're talking 4-6 slices of gluten packed bread every day for at least a month so we can definitively diagnose the disease.

Why does it matter to get a formal diagnosis if you're already on a gluten-free diet? Well, it's a genetic disease, so you'll know to test the family. But most importantly, many people on gluten-free diets are not actually on gluten-free diets. Even 20 parts per million can be toxic to someone with celiac. Many on "gluten-free diets" inadvertently eat gluten. Sometimes gluten-free products are contaminated, so even foods labeled "gluten-free" may still not be safe for celiac sufferers.

As editorialized in the Lancet, the irony of many celiac patients not knowing their diagnosis, while millions of non-sufferers banish gluten from their lives, can be considered a public health farce.


Though the medical profession now recognizes wheat sensitivity as a discrete entity, it's still not clear if it's actually the gluten to which people are reacting. For a review of the controversy, see Is Gluten Sensitivity Real?

In How to Diagnose Gluten Intolerance, I go step by step how someone may want to proceed who suspects they might be sensitive to gluten-containing grains.

More on the benefits of whole grains in general in Whole Grains May Work As Well As Drugs and Alzheimer's Disease: Grain Brain or Meathead?

More on keeping our gut flora happy in videos such as Prebiotics: Tending Our Inner Garden and How to Change Your Enterotype.

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.

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How Fruits and Vegetables Can Prevent Asthma

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Asthma is the most common chronic disease in children and the prevalence is increasing around the world. Despite this, most research dollars are spent on adult chronic disease. "One might ask," a group of researchers posited "whether this is because our politicians and senior administrators feel themselves to be more likely to suffer from the latter, and thus ignore allergic diseases as they mostly impact children and young adults" - who don't vote.

An enormous study about asthma and allergies in childhood, highlighted in my video, Preventing Asthma with Fruits and Vegetables, was published that includes more than a million children in nearly a hundred countries, making it the most comprehensive survey of asthma and allergies ever undertaken. The researchers found striking worldwide variations in the prevalence and severity of asthma, allergies, and eczema--a 20 to 60-fold difference in prevalence of symptoms of asthma, allergic runny nose, and atopic eczema around the world. The large variability suggests a crucial role of local characteristics that are determining the differences in prevalence between one place and another.

What kind of environmental factors? Why does the prevalence of itchy eyes and runny noses range anywhere from 1% in India, for example, and up to 45% of kids elsewhere? There were some associations with regional air pollution and smoking rates, but the most significant associations were with diet. Adolescents showed a consistent pattern of decreases in symptoms of wheeze (current and severe), allergic rhinoconjunctivitis, and atopic eczema with increases in per capita consumption of plant foods. The more their calories and protein came from plant sources, the less allergies they tended to have.

In general, there seems to be an association between an increase in asthma prevalence and a decrease in consumption of fresh fruits, green vegetables, and other dietary sources of antioxidants, helping to explain why the prevalence of asthma and respiratory symptoms are lower in populations with high intake of foods of plant origin. High intakes of fat and sodium, and low intakes of fiber and carbohydrates, are linked with asthma, while traditional and vegetarian diets are associated with lower rates. For example, if we look closer within India, in a study of more than 100,000 people, "those who consumed meat (daily or occasionally) were more likely to report asthma than those who were strictly vegetarian." This also meant avoiding eggs.

Eggs have been associated (along with soft drink consumption) with increased risk of respiratory symptoms and asthma in schoolchildren. On the other hand, consumptions of soy foods and fruits were associated with reduced risk of respiratory symptoms. In fact, removing eggs and dairy from the diet may improve lung function in asthmatic children in as little as eight weeks. Therefore, it may be a combination of eating fewer animal foods and more plants.

High vegetable intake, for example, has been found protective in children, potentially cutting the odds of allergic asthma in half. And fruit has also shown a consistent protective association for current and severe wheeze and runny nose in adolescents, and for current and severe asthma, allergies, and eczema in children.

Why is this? I've talked about the endocrine-disrupting industrial pollutants (see Dietary Sources of Alkylphenol Endocrine Disruptors) building up in the meat supply that may increase the risk of allergic disease, but the increase in asthma may be a combination of both a more toxic environment and a more susceptible population. One review notes that, "The dietary changes which have occurred over recent years may have led to a reduction in these natural antioxidant defenses, resulting in a shift of the antioxidant status of the whole population and leading to increased susceptibility to oxidant attack and airway inflammation."

In adults, for example, the risk of airway hyper-reactivity may increase seven-fold among those with the lowest intake of vitamin C from plant foods, while those with the lowest intake of saturated fats may have a 10-fold protection, presumably because of saturated fat's role in triggering inflammation.

The protective effect of plant-based food may also be mediated through effects on intestinal microflora. It turns out that differences in the indigenous intestinal flora might affect the development and priming of the immune system in early childhood. Kids with allergies, for example, tend to be less likely to harbor lactobacilli, the good bacteria that's found in fermented foods, and naturally on many fruits and vegetables. Lactobacillus probiotics may actually help with childhood asthma, which may help explain why children raised on largely organic vegetarian diets may have a lower prevalence of allergic reactions. Infants raised this way tend to have more good lactobacilli in their guts compared to controls, though they were also more likely to have been born naturally, breastfed longer, and not been given antibiotics, so we can't really tell if it's the diet until we put it to the test (See Treating Asthma with Fruits and Vegetables).

More on preventing allergic diseases can be found in my videos Preventing Childhood Allergies and Preventing Allergies in Adulthood.

More on protecting lung function with fruits and vegetables can be found in Preventing COPD With Diet.

Surprised probiotics can affect immune function? Check out my video Preventing the Common Cold with Probiotics? And if you think that is wild, wait until you see Gut Feelings: Probiotics and Mental Health.

What might be in plants that's so beneficial? See Anti-inflammatory Antioxidants.

What might be in animal products that is harmful to lung function? There are endocrine-disrupting industrial pollutants that build up in the food chain that may be playing a role. See my video Alkylphenol Endocrine Disruptors and Allergies. Also there's an inflammatory omega-6 fatty acid found predominantly in chicken and eggs that may contribute to inflammation as well. See Inflammatory Remarks About Arachidonic Acid.

Choosing fragrance-free personal care products may also help reduce airway reactivity: Throw Household Products Off the Scent.

I compare the efficacy of plants to pills (Treating Asthma With Plants vs. Supplements?) and explore the role an entire diet filled with plants might play in Treating Asthma and Eczema With Plant-Based Diets.

-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, and From Table to Able.

Image Credit: EdTech Stanford University School of Medicine / Flickr

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How Probiotics Affect Mental Health

 

 

 

 

 

 

 

 

 How Probiotics Affect Mental Health

Before Thorazine was invented in 1950, mental illness was often treated surgically. In fact, in 1949 the inventor of the lobotomy was awarded the Nobel Prize. Before tens of thousands were lobotomized, however, colectomy was all the rage. There was a theory that bad bacteria in the gut­ was the cause of mental illness. So the cure was to surgically remove the colon. Yes, the surgery killed about one in three–but when they didn’t die, surgeons claimed positive results. Some, for example, bragged that when they resected the colons of schoolchildren as a preventive measure there was a cessation of “abnormal sex practices” like masturbation (which was viewed at the time as a precursor for mental illness later in life). Reminds me of the mastectomies they used to perform for menstrual breast pain (Plant-Based Diets For Breast Pain).

Others, though, suggested a less drastic approach, proposing that one could instead treat this "intestinal putrefaction" by changing the intestinal flora. Indeed, over a century ago there were reports of successfully treating psychiatric illnesses like depression with a dietary regimen that included probiotics. Doctors perceived a connection between depression and “feces deficient in quantity and moisture and very offensive in odor.” Reportedly, after the probiotic regimen not only did people feel better psychologically, but they had their “feces increase in quantity, become softer, and of regular consistency, and the offensive smell diminish….” Concurrent with the probiotics, however, all patients were started on a vegetarian diet—so it may not have been the probiotics at all.

Why might the vegetarian diet alone have improved mood? Check out my videos Plant-Based Diet & Mood and the follow-up Improving Mood Through Diet as well as my serotonin series starting with Human Neurotransmitters in Plants.

This entire field of inquiry remained dormant for about a hundred years, but a new discipline has recently emerged known as enteric (meaning intestinal) neuroscience. Our enteric nervous system—the collection of nerves in our gut—has been referred to as a “second brain” given its size, complexity, and similarity. We have as many nerves in our gut as we do in our spinal cord! The size and complexity of our gut brain is not surprising when considering the challenges posed by the interface. We have a hundred times more contact with the outside world through our gut than through our skin. We also have to deal with our 100 trillion little friends down there. That takes a lot of processing power.

Anyone who’s had butterflies in their stomach knows that our mental state can affect our gut. Studies show that every day stresses can actually affect gut flora populations. An innovative study out of Australia looked at feces scraped from toilet paper used by undergrads during exam week. If you check out my 5-min video Gut Feelings: Probiotics and Mental Health, you can see how many bacteria the undergrads had in their feces before and after the exam. You’ll notice the effect lasted the whole week. Their findings show that our mental state can indeed affect our gut, but can our gut affect our mental state? We didn’t know until recently.

Many suffering from chronic fatigue syndrome complain of gut dysfunction, so researchers tried giving sufferers probiotics to see if their mental and emotional state could be improved and it did appear to help. You can learn more about treating chronic fatigue syndrome in:

What about for healthy people, though? A study entitled “Assessment of the Psychotropic Properties of Probiotics” marked a turning point in our thinking. Researchers found that one month of probiotics appeared to significantly decrease symptoms of anxiety, depression, anger and hostility. Until that study was published, the idea that probiotic bacteria administered to the intestine could influence the brain seemed almost surreal–like science-fiction. Well, science yes, but maybe not fiction. 

Might people suffering from certain forms of mental health problems benefit from a fecal transplant from someone with more happy-go-lucky bacteria? We don’t know, but this apparent ability of probiotics to affect brain processes is one of the most exciting recent developments in probiotic research.

Gut Feelings: Probiotics and Mental Health closes out my 4-part video series on the latest in probiotic science. I started with the two most established indications for their use in Preventing and Treating Diarrhea with Probiotics, then moved onto a more speculative use in Preventing the Common Cold with Probiotics?, and then offered practical advice on how to best take probiotic supplements in Should Probiotics Be Taken Before, During, or After Meals?

What else might our good bacteria be doing for us? They may help with weight control (Fawning Over Flora and Gut Flora & Obesity) and serve up anti-cancer compounds! (Flax and Fecal Flora and Sometimes the Enzyme Myth Is True).

-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: Ana_Cotta / 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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Probiotics During Cold Season?

 

 

 

 

 

 

 

 

Probiotics During Cold Season?

Babies delivered via caesarean section appear to be at increased risk for various allergic diseases. The thought is that vaginal delivery leads to the first colonization of the baby’s gut with maternal vaginal bacteria. C-section babies are deprived of this natural exposure and have been found to exhibit a different gut flora. This concept is supported by research noting that a disturbance in maternal vaginal flora during pregnancy may be associated with early asthma in their children. This all suggests our natural gut flora can affect the development of our immune system (for better or for worse).

In adulthood, two studies published back in 2001 suggested that probiotics could have systemic immunity-enhancing effects. Subjects given a probiotic regimen saw a significant boost in the ability of their white blood cells to chomp down on potential invaders. (You can watch a video of white blood cells doing their thing in my video Clinical Studies on Acai Berries. A must-see for biology geeks :). And even after the probiotics were stopped, there was still enhanced immune function a few weeks later compared to baseline (check out my 4-min video Preventing the Common Cold with Probiotics? to see the graph). A similar boost was found in the ability of their natural killer cells to kill cancer cells.

Improving immune cell function in a petri dish is nice, but does this actually translate into people having fewer infections? For that, we had to wait another 10 years, but now we have randomized double-blind placebo controlled studies showing that those taking probiotics may have significantly fewer colds, fewer sick days, and fewer symptoms. The latest review of the best studies to date found that probiotics, such as those in yogurt, soy yogurt, or supplements, may indeed reduce one’s risk of upper respiratory tract infection, but the totality of evidence is still considered weak, so it’s probably too early to make a blanket recommendation.

Unless one has suffered a major disruption of gut flora by antibiotics or an intestinal infection—in other words unless one is symptomatic with diarrhea or bloating—I would suggest focusing on feeding the good bacteria we already have, by eating so-called prebiotics, such as fiber. After all, as I noted in Preventing and Treating Diarrhea with Probiotics, who knows what you’re getting when you buy probiotics. They may not even be alive by the time we buy them. Then they have to survive the journey down to the large intestine (Should Probiotics Be Taken Before, During, or After Meals?). Altogether, this suggests that the advantages of prebiotics—found in plant foods—outweigh those of probiotics. And by eating raw fruits and vegetables we may be getting both! Fruits and vegetables are covered with millions of lactic acid bacteria, some of which are the same type used as probiotics. So when studies show eating more fruits and vegetables boosts immunity, prebiotics and probiotics may be playing a role.

How else might we reduce our risk of getting an upper respiratory infection? See:

The immune boosting fruit and vegetable video I reference in Preventing the Common Cold with Probiotics? is Boosting Immunity Through Diet. See also Kale and the Immune System and the subject of my post last week, Boosting Immunity While Reducing Inflammation.

-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.

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Probiotics and Diarrhea

 

 

 

 

 

 

 

 

Preventing & Treating Diarrhea With Probiotics

Probiotics have slowly moved from the field of alternative medicine into the mainstream, particularly for the prevention of antibiotic-associated diarrhea and the treatment of gastroenteritis.

After taking antibiotics, up to 40 percent of people experience diarrhea. Administering probiotics along with the antibiotics, though, may cut this risk in half. Which kinds and how much? Lactobacillus rhamnosis and Saccharomyces boulardii appeared to be the most effective strains, and studies using more than 5 billion live organisms appeared to achieve better results than those using smaller doses. For example, taking 100 billion organisms seemed to work nearly twice as well as 50 billion in preventing antibiotic-associated diarrhea.

Of course the best way to avoid antibiotic-associated diarrhea is to avoid getting an infection in the first place. See, for example:

We can also try to avoid consuming antibiotics in our diet: Lowering Dietary Antibiotic Intake and More Antibiotics In White Meat or Dark Meat?

The second well-established indication for the use of probiotics is in the treatment of acute infectious diarrhea, shortening the duration of symptoms by about a day. We still don’t know the best probiotic doses and strains. Studies have used between 20 million organisms a day to 3 trillion, and there are thousands of different strains to choose from. Then, even if we wanted a particular strain, odds are the label is lying to us anyway. Less than a third of commercial probiotic products tested actually contained what the label claimed. About half had fewer viable organisms than stated, and half contained contaminant organisms–including potentially pathogenic ones–as well as mold.

The mislabeling of probiotic supplements will come as no surprise to those who’ve been following my work. For example:

Ideally, we’d repopulate our gut with the whole range of natural gut flora, not just one or two hand-picked strains. This has been attempted for serious infections, starting back in 1958. Patients were given a fecal enema. Gut bacteria was taken from a healthy colon and inserted into someone else's unhealthy colon. Or we can go the other route and administer the donor stool through the nose. Evidently, this route of administration saves time, is cheaper, and less inconvenient for the patient.

Preferred stool donors (in order of preference) were spouses or significant others, family members, and then anyone else they could find (including medical staff). Doctors pick a nice soft specimen, whip it up in a household blender until smooth, put it through a coffee filter and then just squirt it up the patient’s nose through a tube and into their stomach. Don’t try this at home!

How receptive were the patients to this rather unusual smoothie recipe? None of the patients in this series raised objections to the proposed stool transplantation procedure on the basis that it “lacked aesthetic appeal.”  However, since production of fresh material on demand is not always practical, researchers up in Minnesota recently introduced frozen donor material as another treatment option.  All described in great detail in the latest review on the subject out of Yale entitled, “The Power of Poop.”

Another mention of frozen “poopsicles” can be found in my video Relieving Yourself of Excess Estrogen.

Preventing and Treating Diarrhea with Probiotics is the first of a four-part series on the current state of probiotic science. See also:

-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: Groume / Flickr

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