Doctor's Note

I touched on this in my new live presentation From Table to Able: Combating Disabling Diseases with Food that just came out, but what I didn’t get to discuss is the relative bile acid binding abilities of different foods. I’ll cover that in my next video Which Vegetable Binds Bile Best?

What intestinal transit time should we be shooting for? See Food Mass Transit. That may be why Stool Size Matters. We can improve speed and size by Bulking Up on Antioxidants and eating lots of whole plant foods (Prunes vs. Metamucil vs. Vegan Diet).

Fiber may also help women remove excess estrogen from their body. See my video Fiber vs. Breast Cancer. For more on the wonders of fiber, see Dr. Burkitt’s F-Word Diet.

For more of my latest videos on breast cancer prevention and survival, see:

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  • Matheo

    Great video, I have a question, though. When it comes to constipation issues, food combining is often mentioned. Is there any science that supports food combining? And is it worth the effort? I mean things like eating fruit only on its own would accordingly speed up the digestion, but is that really advisable? Blood sugar wise it would be better to actually add some protein or fat to fruit, same for absorption of E, D, K and A, right? Please let me know if there are any good NutritionFacts about that, the internet is as always very confusing and does not help!

    Thanks in advance

    • I haven’t found any evidence to support food combining rules–so combine whatever healthy foods you want! :)

    • Christo Okulian

      i agree with doc Michael, i try to seek their evidence but found nothing… i get their logic but their logic is not the very truth to lead people to the basic understanding of “what is healthy food ?”. many people found the food combining as their way out… i found out that because previously they live a screw up (live to eat) diet. so those people just like people that previously live in chaos, now they live BETTER becoz of the “order of combining food” but that doesnt mean they found the very truth of healthy diet. matheo… becareful the internet is full of fraud diets. i suggest that always seek for the very truth,the evidence, the studies, like what doc. michael provides.

      • Matheo

        Thanks Christo, thats actually pretty much what I’m doing. I tried food combining for a couple of weeks, but didn’t feel much of a difference and thought it was quite a boring way of eating. I mean, my diet consists of whole plants only anyway and I think I’m doing quite well health-wise and don’t have constipation issues… I just wanted to know if there actually is any science behind it, as I’m constantly seeking for ways to improve my diet a little bit further. Cheers, Matheo

        • Christo Okulian

          Good to hear Matheo, if u are living in the plant based diet you already in the right track based on reliable evidence. and may be if you already in the the healthiest state of yourself, you cant go more coz u r on the edge of the sky Ahahhaahha, well am happy for you. if i am on your shoes… may be i will try to…. (this is something that i hardly do in my country bcoz of price tag) having berries as my breakfast and cook my veggies with “plant brooth” (the last one,i am too lazy to do it). cheers, Christo

    • Julot Julott

      Eat a lot of fruits with fat and you will see combining rules can be important in some cases. ;D

      • Confused

        Julot J— Please explain your comments further. What cases and what benefits. Thanks

        • Julot Julott

          No benefits, it digest very badly and will often finish in diarrhea or loose stools~

  • bobluhrs

    I got a bit hooked on mixed nuts lately, wash them down with low sodium V8 juice. Great tasting combination. But wondering what are the limits on the nuts? Esselstyn says only moderate amt of walnuts and only if you don’t have heart disease. (I don’t).
    The v8 seems harmless with the low sodium. I also use paint brush and wire collander to brush off most salt from the mixed nuts, that works very well.

    • b00mer

      Greger, Esselstyn, McDougall, Fuhrman, Barnard, and Novick are all in agreement that 1 ounce per day is fine, though in slightly different contexts:

      Greger: advocates that 1-2 oz per day can have health benefits

      Esselstyn, Novick, & McDougall: their explicit recommendations state that 1-2 oz maximum per day is fine (barring advanced heart disease as you said), but since they don’t trust people to limit their own consumption, they often appear and are incorrectly interpreted to be against nut consumption completely

      Barnard: 1 oz per day is fine

      Fuhrman: 1 oz minimum per day is mandatory for good health

      I don’t believe any of them would recommend nuts with added oil. And salt, combined with the inherently high fat content even in dry-roasted nuts, can indeed make it easier to exceed the recommended serving sizes. But if overall sodium content in your diet is not an issue, and you are still able to control your servings then it may not be an issue.

      • Christo Okulian

        cool u notice their statement so well

  • oceanfrontcabin

    So we know that breast cancer risk is increased by bile absorption from the intestine. Is high fat diet (that requires more bile to digest) actually the breast and prostate cancers culprit?

    I have a 2X normal length colon according to my GI doctor. Although I drink water, eat whole flaxseeds with my oatmeal each AM and follow a WFPBD, I tend toward constipation. McDougall has suggested I need to take Rx only stool softener; but I have resisted. Should I, or is my diet enough protection against both breast and colon cancer [my mother’s father, brother, and son (my brother) all had colon cancer]. I’ve thought maybe a SAD diet in all plus perhaps an inherited extra long colon were the culprits . . . but maybe bile? I have no gallbladder (removed before my lifestyle change 15 years ago). My intestine receives bile directly. Should I be taking the stool softener?

    • eric

      Hi just wondering if you get plenty of exercise? Eric

      • oceanfrontcabin

        get some but not a lot. I ride a stationery bike and walk a fair amount. I’m a very active person and live in a neighborhood where I can walk to most services inc grocery stores.

    • Lawrence

      Hi oceanfrontcabin,
      I hope by ‘whole flaxseeds’ you mean ground flaxseeds or flaxseed meal. Dr. Greger has several videos on flaxseeds to make this point. You may also think about adding some dried plums (aka prunes) to your oatmeal and maybe drinking some prune juice once in a while. Finally, I sometimes take flaxseed meal and add a teaspoon or two to a full glass of water and drink it down like metamucil, only much better (see flaxseed videos). I am not qualified to comment on Rx stool softeners. Good luck!

      • oceanfrontcabin

        No, I do mean whole flaxseeds. They absorb water and swell in the colon increasing bulk and improving constipation. Dr McD told me to take them. I eat sometimes even more than 100Gm of fiber/day. I don’t think I need more fiber.

        • Rebecca Cody

          Chia seeds work really well for moving things along. A friend of mine had terrible problems, like impacted colon, requiring who-knows- what painful help from her doctor. She found chia worked wonders. Like flax, it becomes mucilagenous (sp) as it sits a few minutes in water or juice. Chia also provides complete protein and some of the elusive omega 3 fats. They sell it in bags at Trader Joe’s in the cereal section, but it’s cheaper at my food co-op.

    • Christo Okulian

      am sorry to hear your family cancer related-history. i dont have direct answert that could help you. but i were you, i will browse videos in this web that highly correlated with “colon cancer” and “anti cancer” those fruits or spices or beverages will protect u from colon cancer and other cancer. for your constipations… have you try to consume fruits like papaya or banana ?i hope its helps. Be Prime. Christo

  • george

    Thank you Doctor Gregor. Isn’t the bile salt production in the liver regulated by a negative feedback mechanism, in which case the greater the reabsorption of bile salts in the small intestine, the lower their production in the liver? Doesn’t this mean that the fraction of reabsorbed bile acids have no effect on the concentration of bile acids in circulation, unless there’s is some problem with the regulatory process?

    • Darryl

      The feedback system itself may be regulated by diet. Bile acid production is negatively regulated by activation of liver FXR, but this in turn may be regulated by gut microbiota, which are substantially altered by plant based diets. Its all rather recent science, so the dots aren’t fully connected.

      • Ben

        What do you think is happening to those consuming a fruit-based WFPBD? They aren’t getting any resistant starch. They will eat a lunch of, say, 10-15 very ripe bananas. What is their gut microbiota like? I used to be one of them, fruit-based Doug Graham follower, until I realized it was sub-optimal to a diet based in starch. Thank you Mr. McDougall.

        • largelytrue

          Where are you bringing the focus on RS from? The transcript of the video doesn’t contain the term. Darryl’s comment explicitly mentions bananas as a valuable prebiotic food. Highly ripe bananas of the sweet variety contain no dietary starch per se, so it’s no surprise that they lack resistant starch, but they do have soluble fiber, and much of that fiber content is fermentable.

  • Guest

    Dr.Greger, how can one help its liver process the fats, if it has a problem with this?

  • Rodica Atzberger

    Dr.Greger, how can one help his liver process the fats, if it has an issue with processing lipids?

  • Rich in Cinci

    Seems to me that dairy is very constipating and certainly linked strongly to breast/prostate cancer so it may not be the constipation, just the one cancer promoting food that also constipates.

    • Rebecca Cody

      Dairy (even human milk) has growth factors that stimulate the growth of hormone-related cancers. Read Jane Plant’s work on the subject and you will want to avoid dairy after the age of weaning. Her breast cancer came back FIVE times before she discovered this connection. She was only eating a yogurt daily. Her newest cancer went away after getting off all dairy products. She took an oral chemo pill at the same time, but her doctor says he didn’t expect it to heal her. She already had a pretty clean diet before that. By the way, Jane Plant is a British scientist who was in a highly placed position and all her writings are backed by science she researched. She has written several books about female and prostate cancers and has helped many people heal themselves.

  • Ann

    Awesome info!! Love you!

  • Matt K

    Funny how the study below suggests the OPPOSITE to what you’re saying here. That reducing fiber consumption reduces constipation and its associated symptoms.

    Not to say that fiber is bad, but what’s going on here in this contradictory study?

    • Wade Patton

      Holy cow it does say the opposite. Methinks maybe the problem is that the study starts with constipated individuals who have not responded to high-fiber diets, to the exclusion of the “normal” population that certainly does respond to high-fiber diets with easy regularity. Love to see a learned professional opinion on the matter. Thanks for posting it (confusing as it may be).

    • lemonhead

      That’s been my experience, unfortunately. I need to find something that can safely stimulate gut motility without side effects.

  • Rebecca Cody

    Do any of your videos talk about triple negative breast cancer? It is very aggressive and usually fatal, but is not involved with hormones or Her2nu. I’ve been amazing doctors for about three years, because with that diagnosis, had I been a good little cancer patient and followed doctors’ orders I’d have been expected to die about 18 months after diagnosis.

  • Delbert Parkinson

    Dr. Gerger, I have discovered the main cause for most unexplained cancers. Lets talk 360-438-3636 Del..

  • Christo Okulian

    Dear Doc and NF teams. Kindly enlighten me. i read this… and found that table 2: total bile acids mg/day in Vegan is lowest which is in line with…conclusion (below probiotic intervention) that “However, it appears that individuals on vegetarian diets might excrete less mutagenic feces and that probiotics might have a potential in decreasing fecal mutagenicity” but am confuse with this…… that this study show vegetarian GC bile binding is lower than others but the GCDC bile binding higher than others.. this result doesnt in line withthe… table 3 and 4 that shown cholic and chenodeoxycholic of vegetarian are both relatively higher than others diet. correct me if i am wrong, may be i miss some details . Last question.. why there are primary and secondary bile acids what differentiate them ?which part of bile acids responsible for mutagenicity ?primary ?secondary ?or both ?thx much for liberate me from confusion.

  • lemonhead

    Women tend to become constipated as they approach menopause due to a drop in estrogen levels relative to progesterone. I think the breast cancer-constipation link needs to be studied in light of this; it could be that hormone balance is influencing both breast cancer and constipation.