Culture Shock – Questioning the Efficacy and Safety of Probiotics

Culture Shock – Questioning the Efficacy and Safety of Probiotics
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In certain medical conditions, probiotic supplements may actually make things worse.

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

When you make sauerkraut at home, you don’t have to add any kind of starter bacteria to get it to ferment, because the lactic acid-producing bacteria are already present on the cabbage leaves themselves, out in the field. This suggests raw fruits and vegetables may not only be a source of prebiotics—fiber—but also a source of novel probiotics.

Researchers have since worked on characterizing these bacterial communities, and found two interesting things. First, that “the communities on each produce type were significantly distinct from one another.” So, the tree fruits harbored different bacteria than veggies on the ground, and grapes and mushrooms seemed to be off in their own little world. So, if indeed these bugs turn out to be good for us, that would underscore the importance of eating not just a greater quantity, but greater variety, of fruits and veggies every day. And second, they found that there were “significant differences in [microbial] community composition between conventional and organic…produce.” “This highlights the potential for differences in the [bacteria] between conventionally and organically farmed produce items to impact human health.” But, we don’t know in what direction. They certainly found different bacteria on organic versus conventional, but we don’t know enough about fruit and veggie bugs to make a determination as to which bacterial communities are healthier.

What about probiotic supplements? I’ve talked about the potential benefits, but there appears to be publication bias in the scientific literature about probiotics. This is something you see a lot with drug companies, where the sponsor, the supplement company paying for their own probiotic research, may not report negative results—not publish it, as if the study never happened. And so, then, we doctors just see the positive studies. 

Using fancy statistical techniques, they estimated that as many as 20 unflattering studies were simply MIA. And, even in the studies that were published, even when the authors were directly sponsored by like some yogurt company, the conflicts of interest were very commonly “not reported.”

There’s also been concerns about safety. A review for the government’s Agency for Healthcare Research and Quality concluded that there’s “a lack of assessment and systematic reporting of adverse events in probiotic intervention studies.” So, while “[t]he available evidence in [randomized, controlled trials] does not indicate an increased risk [for the general public],…the current literature is not well equipped to answer questions on the safety of probiotic[s]…with confidence.”

This is the study that freaked people out a bit. Acute pancreatitis—sudden inflammation of the pancreas—is on the rise, which can become life threatening in some cases, as bacteria break through our gut barrier, and infect our internal organs. Antibiotics don’t seem to work, so how about probiotics? Seemed to work on rats. If you cause inflammation by cutting them open and mechanically damaging their pancreas, not only do probiotics show “strong evidence for efficacy,” but there were “no indications [of] harmful effects.” So, half the people with pancreatitis got probiotics, half got sugar pills, and, within ten days, the mortality rates shot up in the probiotics group, compared to placebo. More than twice as many people died on the probiotics. Thus, probiotics for acute pancreatitis? Probably not a good idea. But, further, probiotics “can no longer be considered to be [completely] harmless.”

The researchers were criticized for not telling patients, not cautioning patients, about the risk before they signed up for the study. (The study subjects were told probiotics had “a long history of [safe] use” with no known side effects). In response to the criticisms, the researchers replied “‘There [were] no side effects,’ until [their] study.”

Please consider volunteering to help out on the site.

Icons created by Laymik, Tinashe Mugayi, Nikita Kozin, and Tomas Knopp from The Noun Project.

Image credit: Kristina DeMuth. Image has been modified.

Motion graphics by Avocado Video.

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

When you make sauerkraut at home, you don’t have to add any kind of starter bacteria to get it to ferment, because the lactic acid-producing bacteria are already present on the cabbage leaves themselves, out in the field. This suggests raw fruits and vegetables may not only be a source of prebiotics—fiber—but also a source of novel probiotics.

Researchers have since worked on characterizing these bacterial communities, and found two interesting things. First, that “the communities on each produce type were significantly distinct from one another.” So, the tree fruits harbored different bacteria than veggies on the ground, and grapes and mushrooms seemed to be off in their own little world. So, if indeed these bugs turn out to be good for us, that would underscore the importance of eating not just a greater quantity, but greater variety, of fruits and veggies every day. And second, they found that there were “significant differences in [microbial] community composition between conventional and organic…produce.” “This highlights the potential for differences in the [bacteria] between conventionally and organically farmed produce items to impact human health.” But, we don’t know in what direction. They certainly found different bacteria on organic versus conventional, but we don’t know enough about fruit and veggie bugs to make a determination as to which bacterial communities are healthier.

What about probiotic supplements? I’ve talked about the potential benefits, but there appears to be publication bias in the scientific literature about probiotics. This is something you see a lot with drug companies, where the sponsor, the supplement company paying for their own probiotic research, may not report negative results—not publish it, as if the study never happened. And so, then, we doctors just see the positive studies. 

Using fancy statistical techniques, they estimated that as many as 20 unflattering studies were simply MIA. And, even in the studies that were published, even when the authors were directly sponsored by like some yogurt company, the conflicts of interest were very commonly “not reported.”

There’s also been concerns about safety. A review for the government’s Agency for Healthcare Research and Quality concluded that there’s “a lack of assessment and systematic reporting of adverse events in probiotic intervention studies.” So, while “[t]he available evidence in [randomized, controlled trials] does not indicate an increased risk [for the general public],…the current literature is not well equipped to answer questions on the safety of probiotic[s]…with confidence.”

This is the study that freaked people out a bit. Acute pancreatitis—sudden inflammation of the pancreas—is on the rise, which can become life threatening in some cases, as bacteria break through our gut barrier, and infect our internal organs. Antibiotics don’t seem to work, so how about probiotics? Seemed to work on rats. If you cause inflammation by cutting them open and mechanically damaging their pancreas, not only do probiotics show “strong evidence for efficacy,” but there were “no indications [of] harmful effects.” So, half the people with pancreatitis got probiotics, half got sugar pills, and, within ten days, the mortality rates shot up in the probiotics group, compared to placebo. More than twice as many people died on the probiotics. Thus, probiotics for acute pancreatitis? Probably not a good idea. But, further, probiotics “can no longer be considered to be [completely] harmless.”

The researchers were criticized for not telling patients, not cautioning patients, about the risk before they signed up for the study. (The study subjects were told probiotics had “a long history of [safe] use” with no known side effects). In response to the criticisms, the researchers replied “‘There [were] no side effects,’ until [their] study.”

Please consider volunteering to help out on the site.

Icons created by Laymik, Tinashe Mugayi, Nikita Kozin, and Tomas Knopp from The Noun Project.

Image credit: Kristina DeMuth. Image has been modified.

Motion graphics by Avocado Video.

Doctor's Note

This is a link to the video I alluded to: Preventing the Common Cold with Probiotics?

I also talk about the potential benefits in my videos Preventing and Treating Diarrhea with Probiotics and Gut Feelings: Probiotics and Mental Health.

Perhaps it would be safer and more effective to instead focus on fostering the growth of the good bacteria by feeding them prebiotics (fiber and resistant starch):

If you haven’t yet, you can subscribe to my videos for free by clicking here.

118 responses to “Culture Shock – Questioning the Efficacy and Safety of Probiotics

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  1. What can you tell me about helping people with nickel allergy with lactobacillus (Probiotic supplementation in systemic nickel allergy syndrome patients: study of its effects on lactic acid bacteria population and on clinical symptoms,
    Authors
    C.L. Randazzo,
    A. Pino,
    L. Ricciardi,
    C. Romano,
    D. Comito,
    E. Arena,
    S. Saitta,
    C. Caggia)?




    0
  2. I take probiotics. After watching this video, I’m at a loss. So does this mean we should not take them? That’s what I get from this. Eat variety of veggies (eww, not a big veggie guy although I understand how important plant based is).




    4
    1. I don’t understand. A vegetable is any edible plant or plant part.

      As the US Merriam Webster dictioary defines it, a vegetable is “a plant or plant part that is eaten as food.” So, whole grains and fruits are also vegetables. That;s why the standard advice from all credible health authorities around the world to eat more fruit, vegetables and grains is in essence advice to eat a more vegetarian or plant-based diet. However, I suspect that the powerful meat, dairy and egg industries lobby governments to prevent that specific language being used.

      So, do you mean that you don’t like any vegetables or is it just a particular subtype of vegetables like green vegetables or root vegetables that you don’t like?




      7
    2. Hi Rix, why not start the day with a green smoothie (or purple smoothie- my favorite breakfast smoothie is kale, beetroot, blueberry, watermelon and two teaspoons flax seed whizzed together with ice and water) That will get you and your inner biome firing on all cylinders :)




      0
    3. Eat your veggies Rix! Lol. I would like to know more about this too. For example, what about dairy free probiotics by a company like Garden of Life who uses organic and natural ingredients only and is known for testing their products for purity? What kind were used in The study and could it have been another factor instead of the bacteria used? Could they have had some bad bacteria in them?
      It astounds me when there aren’t immediate follow up studies after studies like these…




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  3. So, the study seemed to highlight the vast species-specific differences between rats and humans. It was an experiment based on a plausible theory with no obvious contraindications. Consents and waivers were signed, It failed to show an improvement of the condition, and understanding of the efficacy of probiotics in the treatment of acute pancreatitis or lack thereof, in this case ,was established. In the name of medical science, far more horrific things have been done, with less benefit, much more risk, more oppression and exploitation, and more misery and suffering. The doctor intends to treat, using the tools available, with as high a margin of safety given the conditions…… So now we know. No probiotics in the treatment of acute pancreatitis.
    Thanks Dr.Greger.




    5
    1. Love your post! But in honor of the poor rats who suffered for the probiotic experiment mentioned, I want to say that nothing is more horrific than their torture… it isn’t to say that the hell they went/go through is as horrific as it gets, but it’s just to say that unbearable suffering is just that and cannot be considered less horrific or better than other torturous events.
      I don’t think you were saying anything in that regard in the first place but I felt compelled to just mention that.




      0
  4. My concern about probiotics has been wondering how a company which sells probiotics determines which species of bacteria, and how much of each of those bacteria, to include in their pills? And whose gut is used as a representation of which bacteria to choose? An omnivore’s gut? A vegan’s gut? A rat’s gut? Considering that there are hundreds (thousands?) of different types of bacteria in a human’s gut, what might be the repercussions of including only a handful of different species in the pills, leaving out the hundreds/thousands of other species?




    5
    1. Current consumer probiotics only include species found in fermented food, which have generally regarded as safe regulatory status in the US, and qualified presumption of safety status in the EU.

      Of course, the colon environment is vastly different from that of a vat of fermenting yogurt or sauerkraut, and almost none of the species found in probiotics are found in significant numbers in healthy gut microbiota. You can eat wheelbarrows of yogurt, and the sum of Lactobacillus sp. will return to < 0.01% of the composition when you're done.

      Some microbes with suspected benefits like Akkermansia muciniphila, while common in the gut, but doesn’t appear in fermented foods (like most colon inhabitants, its difficult to culture). The high cost of demonstrating safety means that if it becomes available as a probiotic it will be as a patented medicine.




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    2. Excellent points. I’m going to continue finishing my Garden of Life dairy free probiotics and appreciate any benefit that comes with them, but I’m going to stop buying them. It’s dissapointing because who doesn’t want all the extra goodness promised? But at the same time kind of cool to say I can save money and not feel like I’m skimping.




      0
  5. But what about probiotic foods, such as sauerkraut, kimchi, tempeh, and non-dairy yogurt (even kombucha)? All of which I love! Is there a difference here with whole/real foods versus supplements in a capsule?

    Thanks!




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    1. This is also my question. Does the video only refer to probiotic supplements (capsules)? What about probiotic foods? I know that Dr. G has videos on kimchi and kombucha, but those videos are not about probiotic bacteria but about acidity and carcinogenicity.




      0
    2. Pat, Dr. G has a video which explains that kombucha makes your blood insanely acidic. I was dissapointed to hear it cause the promises of the drink are pretty awesome but I definitely stopped drinking after that. So just a heads up :)




      0
    1. They are gone and that’s why you need soil based probiotics, which is a way to eat dirt like a small kid without getting the dangers from pollution.




      1
        1. Thank you for the reply. Having dealt with a numerous serious amoeba incidents, one life-threatening, over our years of living in the developing world, I am a little gun shy. Almost ALL expats here bleach their veggies for 20 minutes if they will not be cooked! Hmmmm, I will ponder your reply. 




          0
  6. So I just looked at the figure description with the doubling in mortality of the probiotic group compared to placebo and it looks like there was only a total of 3 deaths out of 266 people after 90 days. 2 died in the probiotic group and 1 died in the placebo group. I feel like there may be chance at play here? Can anyone give me some insights into this?




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      1. Perhaps sick people should not be given probiotics, just as with a number of foods. And 10% difference with a small group of people does not have statistical significance. This is an example of cherry pick a study that fits one’s agenda.




        3
          1. Of course when you are sick then you need to discuss with your doctor what you are consuming including kale.

            Let’s not confuse the issue of using probiotics in normal cases versus when you are sick.




            2
        1. Hi Jerry Lewis, thanks for your comment. I like to point out that these videos that are put up by Dr Greger and team are after so much research into a particular topic. This particular video about a new finding of harm that probiotic supplements can induce in some individuals with pancreatic cancer is very important information for awareness of general public.




          2
  7. I know doctor Greger is working on some videos on (intermittend) fasting, I just wanted to shift attention towards the errors in the research studies about this subject. Just like the Western trials comparing animal based diets with other animal based diets instead of a WFPB diet, the trials on fasting use the same faulty technique. They compare days of normal eating with so called fasting days, while the patients were eating up to 25% of their daily recommended caloric intake. Then they go on and conlude that fasting isn’t overly potent.

    Offcourse the results will be pauvre, a 25% caloric intake is not fasting it is just caloric restriction… Some trials are using “fake fasting” regimes. Real fasting is prolonged abstaining from food, eating nothing at all with some water or coffee. The body will start a whole beneficial metabolic mechanism when fasting and this simply will not initiate while the participants keep eating no mather how small the portions. Dr. Jason Fung is a Canadian nephrologist who sadly did not yet discover the power of a WFPB diet, he eats meat and adheres to ketogenic diet interventions despite the proven negative effects this has on the brain.

    Despite these obstacles, he wrote two exellent books about the subject of fasting, one of them being “The complete guide to fasting” (2016).
    I urge anyone interested in IF to read his work, he really has the most complete knowledge up to date, at least about this particular subject. It’s sad to see a lot of big names like Garth Davis and others completely missing the ball on the power of the human fasting mechanism, I hope Dr. Greger will make a well rounded observation on the matter.

    Semi fasting is caloric restriction and should not be called fasting.




    4
    1. For what to expect regarding fasting and weight loss, it might be important to put things a little bit in perspective. Fasting is potent for weight loss but it comes with effort, almost as much effort as calorie restriction but that depends on what you find the most suitable method.

      First of all, Satchin Panda, a reseacher on the subject restricts his personal daily eating window (why do some say feeding window, we are not rats are we?) to 12 hours, thus he can eat during 12 hours and after that he fasts for 12 hours, not eating any food. This probably is the most basic form of IF, expect lower risks for certain deseases and it will help you to maintain weight. This will not help you loose weight, Satchin was a bit suprised when he found out about this but it makes sense, it really is not long enough for weight loss. Even fasting for 16 hours a day is more for weight maintenance, there might be some weight loss starting from about 18 hours and more of fasting.

      For weight loss, the optimal strategy seems to be an ADF approach, you eat normally one day and you eat nothing at all the next day (besides coffee and water), ADF seems to promote more weight loss than fasting for several days. Not because anything metabolic, serveral days work just as well if not better, but you can exercise more intensly with ADF while you have to do less intense prolonged exercise when doing longer fasts in order not to burn out.

      So, intermittend fasting is not overly potent for weight loss but good for weight maintenance. Fasting is potent for weight loss (starting with one day fasting like with ADF and prolonged fasts).

      But still, fasting for one day as a solitary intervention has a very modest impact on weight loss, expect to loose 47 grams of weight per fasted ADF day.
      Just like doing exercise without changing your diet, ADF on it’s own will not help you loose much weight.

      Things get more interesting when you combine exercise with fasting, now here is where the magic starts to work.
      Doing ADF with 40 minutes of medium to high intensity of cardio exercise on the fasting day results in about 190 grams of weight loss per fasted day. A lot more then either only fasting or only exercising.

      If we are going to maximize our knowledge about these mechanisms we are now left with the most powerfull weight loss tool available, how can we increase the amount of exercise even more? We are skipping the 40 minute intense workout and we do 8 to 9 hours of low impact cardio like walking and this enables us to extend the fasting period for servarl days. Now we have 800 grams of weight loss per day! This is fat loss to be precise, the water and glycogen weight that rebounds after the fast is already substracted. Read up on the program below.

      https://www.ncbi.nlm.nih.gov/pubmed/24602091

      I have personally preformed what the people in the above study had to do and i can confirm the positive results. Allthough I had to exercise slightly less on some occasions and I am not overweight as in the study I lost 2.5 kilograms of fat in 4 days. 400 grams of water and glycogen that rebounds after the fasts already substracted. And this is permanent fat loss that will not be regained unless you eat them as calorie excess.

      Do not worry about muscle loss, the body raises IGF1 during a fast in proportion to how long a fasts will last. Evolutionary speaking, not eating for up to 7 days is not a big deal, short periods of fasting like this will not destroy muscle mass, you can do this when your body has more then 4% body fat. (-4% BF would be biological starving, this is not the same as the body system that initiates with fasting). So there you have it, good luck.




      1
      1. I practice IF almost every weekend if I don’t have to go anywhere without much effort and without sacrificing any nutrition, by simply eating dinner early the previous day and eating nothing until noon the next day. Coffee is not allowed and only water is allowed. And I read that this is enough to trick your body to think that you fast.




        2
      2. Surely, though, the major benefit of fasting is supposed to be life extension not weight loss important though this is?
        https://www.scientificamerican.com/article/how-intermittent-fasting-might-help-you-live-longer-healthier-life/

        And it has been argued that the life extension benefits of fasting can be achieved more easily with methionine restriction.

        https://nutritionfacts.org/video/methionine-restriction-as-a-life-extension-strategy/
        https://nutritionfacts.org/video/methionine-restriction-as-a-life-extension-strategy/




        4
      3. “we are not rats are we?” < I just wanted to comment, though I know you meant know offense, that rats too are eaters and were never meant to be locked in a cage being fed but just like us would like to be free and eat on their own accord. It's humans who do this to them, it's not their own nature. I think it's important to remember that human exploration of non-human animals does not reflect on who that animal is but rather what we do to them.




        0
        1. that rats too are eaters and were never meant to be locked in a cage being fed but just like us would like to be free and eat on their own accord. It’s humans who do this to them, it’s not their own nature.

          S, just curious where you come down on natural death… that is, a rat in the wild is constantly under stress from predators (like my cats who often drag up a dead rat, gopher, jackrabbit, cottontail, mouse.) I’m not saying the rat is better off in a cage but it is possible it is, depending on the pharmaceutical it is being used for testing.

          I once was against using animals for testing, and still get a twinge when imagining the details, especially when it was dogs and cats. But I’ve come to rationalize that human life takes precedent and so I accept rats and mice as test subjects now.

          There is some good news and though it is in the early stages, I’ve read that science is developing ways to do testing sans animals. Not clear on the details and don’t have a link… just something I’ve read.




          0
          1. Lonie I highly suggest two things to you, one to delve into animal testing and see the demonic nightmare it is… These animals are nothing less than tortured even if the study is done on say, Liption Tea (which it was until animal rights activists won that battle)… You’d think that animals were to just be given sips of tea or at least that’s what the general public would imagine, but they actually underwent horrific torture of being mutilated, having pieces of their intestines cut up and sewn back together and being force fed tea (just one of many of the horrors they underwent). These animals are not given consideration as the sentient beings they are, they’re not given anesthesia and when they’re done being useful to the ones using them, they’re literally just thrown away sometimes not even killed first and just thrown in the trash dying or not dying but simply is severe pain.
            The second thing I would suggest is to get to know a rat and mouse. They are some of the most loving, loyal, affectionate, playful, social, and intelligent little beings you’ll ever know! You’ll be amazed at how much they’re like your cats or dogs.

            As for is it ever better being in a cage, no. In the wild they suffer just like we all suffer, but they’re not imprisoned, exploited, tortured, and then finally die or are killed. Not to mention living a maddening life enclosed in a tiny box, having their friends/family taken from them and tortured in front of them (and yes, these animals form deep bonds), living in terror and at the mercy of the merciless, and literally made to be kept alive so they can be tortured for longer periods of time. At least when a rat is taken by a predator, they didn’t live a life in terror, they were free, and they die relatively quick and sometimes extremely quick.

            We have no rights to decide for someone else if it’s better to lock them up than to allow them to live free and possibly come into harm. But if we did, we’d have to apply that same logic to ourselves. You and I are as free as we can be in this world, but I’m sure we both had horrible things happen to us and will suffer in the future as well… so would that justify someone who considered themselves to be a superior race locking us in a cage and forcing us to live how they decided moment to moment? And further that question with that race of being using us to experiment on.

            Now some rats are domestic and need homes, though I do not condone breeding of ANY animal and want it to stop. Doing our best and needing to use cages while giving them the best and most stimulated, happy lives possible is totally different than exploiting them and torturing them in any amount.

            Your sympathies are biased. First, you say cats and dogs being tested on bothers you, simply because you are familiar with them and have witnessed their sentience. Then you say you justify mice and rats (both of whom are just as brilliant and emotionally intelligent as cats and dogs – I’ve had the privilege of getting to know both mice and rats but would not have needed the experience to know they matter just as much as anyone else) simply because you have not gotten to know them and thus witnessed their sentience. Then you say humans take precedence simply because you ARE a human.
            What justifies this precedence? All animals are equal in their ability to experience pain and suffering, they love their children, they want to live, etc.. Further more, if you’re being completely emotionless and looking at things from an ecological stand point, all other animals actually not only contribute to the planet, but are vital to it whereas humans not only are NOT vital to it but the earth would actually be better off without us. So that could logically be compared to the mindset of a cancer if it had a mindset… that IT must survive above its host and all else simply because it is itself – no actual reasoning behind it. But I’m not that cold, I don’t hate humans, I just recognize our being here is a privilege and one that we mock with that very mindset of “we take precedence.”

            Now let’s say I had no problem being a hypocrite and I only cared about myself and had no empathy for others, I would STILL be whole heartedly against animal testing because it has DRASTICALLY held back science. Every good doctor and scientist (and now even the not so good ones, in fact vivisectors themselves admit that animal testing is unnecessary) knows that animal tests are not relevant. Vivisection has held back cancer research, nutritional science, etc. etc… Most of the time they discard animal test results due to this, in fact. Also, 90% of animal testing is done for cosmetics.
            If animal tests were listened to on the other hand, anesthesia would not be accessible to us, and that is just one example out of a plethora. Ok, two examples out of a plethora: animal tests are not considered relevant even in the courts as pharmaceuticals who have been taken to court for causing mass death among patients have been able to get off on the argument that they used animal tests and animal tests cannot be relied upon.

            If we use logic, we must apply that same logic to all things. If we use compassion, we must apply that compassion to all things. If we use justice, we must apply that justice to all things.




            0
            1. I had no idea this was so important to you. Knowing that now, I realize I was out of line responding to your comment as I did. I sincerely apologize and from a past life, somewhat understand your feelings.

              Best.




              0
    2. Netgeogate, you said “Jason Fung is a Canadian nephrologist who sadly did not yet discover the power of a WFPB diet, he eats meat and adheres to ketogenic diet interventions despite the proven negative effects this has on the brain.” My first thought was that if this guy is a nephrologist, doesn’t he know how hard all that animal protein is on the kidneys? Hel-lo!

      And on the subject of fasting, a wonderful source of information is Dr Alan Goldhamer at TrueNorth Health Center in Santa Rosa, CA. His clinic has cured hundreds – maybe thousands – of people for over 32 years with water only fasting, then transitioning them to a whole foods plant based diet with no sugar, oil, salt, or flour products. He has published research on reversing high blood pressure that had been intractable by any other means tried. He also has great success with MS, heart disease, some cancers, and many autoimmune conditions. Check him out on Youtube or his website, http://www.healthpromoting.com.




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      1. I believe that one can be knowledgeable on one subject and at the same time “dumb” on another subject. The whole aspect of WFPB diet has more to do with one’s perspective than with intelligence. For a westerner to accept the link between diet and health, it often involves looking trough the culture one lives in. There are enough doctors not eating healthy, not because they are dumb… but because they have a differing persperctive.

        Thus Jason Fung, obviously a smart man, has written one of the best books on the subject of fasting, i highly recommend it.

        .

        Don’t miss out on the chance to learn something about fasting, just because this man eats meat, that is not the subject of the book.

        The only disclaimers I want to add is: stick to real fasting, thus not eating anything at all but coffee or water, al the rest is actually calorie restrictionn (eating little bits) – it does not start the same biological process as with real fasting like IGF1 protection for your muscles.

        Also, do not engage in ketogenic diets, they are high in fat and damage the brain. Ketogenic diets mimic fasting but are not real fasting, they are calorie restriction.




        1
  8. Since there are many possible causes of pancreatitis,

    CAUSES: alcohol (80%), gall stones, medications, viruses, bacteria, fungi, parasites, trauma, auto immune, high calcium, etc.

    why would this finding have any significance on using probiotics?




    4
    1. Of course it’s zero significance.

      It’s like saying that diesel engine is more dangerous than gas engine because there are more accidents. But most or all trucks have diesel engine and they are unsafe because of the truck driver who drive long hour and don’t have enough sleep.




      6
    2. That is such an important question. I’d really like to understand why it’s pinpointed that the pro-biotics were the cause of a higher death rate. That would be helpful! Did they do autopsies and look deeper into it than just viewing statistics? I didn’t read the study so maybe someone who has can answer that.




      0
  9. Hurray for fruits and veggies!

    I do wonder (as a complete amateur in the matter) about the, “end point” parameters in the study which may have been contributing factors to the outcomes due to an already strained and/or compromised immune system. Did those people die from being overwhelmed as susceptible hosts?

    I don’t use probiotics because I am confident that my WFPBD is optimal for my health. But I may still consider the use of the same if I had to take antibiotics for any reason.

    Great video with compelling ideas.

    A proud monthly supporter of Nutritionfacts.org




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  10. 1. Interesting that fruits and veggies harbor potentially healthful bacteria. However in order to maximize consumption of these bacteria it would be best not to wash the fruits and veggies. Somewhat scary idea given the periodic e-coli outbreaks of store bought veggies.

    2. I was on antibiotics from age 3-13 (before people knew better) and have been taking probiotics for over 40 years. I try to eat a wide variety of fruits and veggies, take probiotics, and alternate between different probiotics with different strains. For me they have made a huge difference.

    What is the relevance of that study for your readers who don’t have acute pancreatitis (or other severe acute GI illness)? I think you are freaking out many readers unnecessarily.




    8
    1. I make kefir, krauts, pickled veggies, etc. With the pickled veggies you don’t go crazy with washing them. Just add some pickling brine made from pickling salt and water and it’s all good. If there were anything really bad in it, the pickles would go bad. It’s pretty obvious when a batch turns bad.




      4
      1. I’ve been making kefir and sauerkraut for years without incident. In fact I feel super healthy when I eat them regularly. However, I made pickles once, followed directions exactly and all appeared normal….became sick as a dog….never again!




        1
    2. I take this probiotic….

      https://www.swansonvitamins.com/swanson-ultra-dynamic-balance-blend-soil-based-organisms-90-veg-caps

      Found that using it smooths out intestinal issues such as minor infections/irritations. There is not some immediate change…just a gradual improvement. Did have an episode of passing some virulent biotic strain….glad they left.

      As far as the study…there are probiotics and there are other probiotics….I took one kind that had a special capsule to got it through the stomach intact…resulted in the runs.

      My advice…you will only know if you try….don’t go for the most expensive…but use a “reliable” brand if there is such a thing. Pay attention to how you feel. Give it time.




      1
    3. Hey Berner, thanks for writing! The relevance of this story is for folks who are trying to self-treat a disease of unknown origin. Because probiotics have both an anti-(pathogenic) bacterial effect AND an immunomodulatory effect, trying to tweak these on your own can sometimes have unintended consequences. There’s a difference between using probiotics for run-of-the-mill occurrences like antibiotic-induced diarrhea or food infection, and taking these as a method of self-treatment for a severe GI disease that one has very limited knowledge of. I hope this helps!




      1
    4. Berner, hi thanks for your comment. I am one of the volunteer moderators at the website and wanted to mention that this video about probiotics looks at different conditions and for someone with acute pancreatitis could become aware of this profound information and perhaps make a better decision. These videos that Dr Greger has on different aspects of health is for increasing our awareness and not to cause fear rather for us to be curious and become empowered.




      0
  11. This anti supplement stance by Dr G is hurting a lot of people. Granted, nobody denies that real foods should be the number one source of nutrition and probiotics but people do get help. Myself and my family, we are all in good health but probiotics and supplementation in general help a great deal. I literally rescue my 96 year old Dad many times from his deathbed with supplements.

    Just like anything including buying a car or a phone or supplements, there are good and bad ones. And the reason that supplements are not tested and regulated by the FDA is simply because they are afraid that supplements will take over the drug industry. So it’s their fault for having bad apples in the supplements industry.

    Probiotics supplement is known to fix anything from obesity to bloating to diabetes to cancer. Myself since I use probiotics supplement, my gas problem is gone and I don’t have tooth decay and my pollen allergy is gone and I don’t even have bad breath in the morning before I brush my teeth, and let’s be a little personal, my pee and stool even have no smell, and my stool looks very healthy per the definition of experts. This is after I ate plenty of prebiotics and probiotics plant foods and probiotics supplementation still makes a difference.

    The other day, Dr Mercola published an article about spore probiotics. I look it up and it’s soil based (HSO) probiotics, something I already took with great results.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC127533/

    (Google for it since I cannot post the link).

    suppversity blogspot 2016/07 spore-forming-probiotics-better

    http://ajcn.nutrition.org/content/83/6/1256.full

    And last the following article in Healthline gives a good run down on probiotics.

    (Google for it since I cannot post the link).

    healthline nutrition best-probiotic-supplement section7




    4
    1. “Doctor Mercola” is not someone you should be quoting at all. Suppversity has some nice reviews, but again the bodybuilding boys behind this are not exactly of the same “scientific” calibre as dr Greger, Jerry Lewis. Even if you are right, the science today isn’t there yet. There are simply too much variables, taking inuline is good for some and bad for other flora. Your best bed would truly be to trust in evolution and let it work blindly automatically by eating the whole foods instead of following the “science” about probiotics.




      11
    2. “….and let’s be a little personal, my pee and stool even have no smell,”

      Unless….could it be that you’ve lost your sense of smell? :-) (Sorry, couldn’t resist myself.)




      7
        1. Jerry, I was making a comment about the size of your ego, not your actual bathroom habits, which is really none of my business. Just like mine (or anyone else’s) is none of yours.




          1
    3. Actually, Jerry, this is all quite concerning.

      Your statement that “the reason that supplements are not tested and regulated by the FDA is simply because they are afraid that supplements will take over the drug industry.” is straight-out conspiracy nut reasoning. Your claim that Dr G has “an anti-supplement stance” is clearly refuted by the fact – which you should be well aware of – that he recommends strict vegetarians and others to take supplements. His advice is evidence-based unlike yours which appears to be largely ideology based.
      https://nutritionfacts.org/2011/09/12/dr-gregers-2011-optimum-nutrition-recommendations/
      Those comments of yours don’t sound entirely rational.

      Then there is your claim that your pee and poo don’t smell. A poor sense of smell may be an early sign of Alzheimer’s.
      http://www.independent.co.uk/life-style/smell-alzheimers-disease-indicator-poor-sense-warning-sign-study-a7904386.html

      Add these points to your constant, obsessive promotion of dietary saturated fat and defence of high LDL cholesterol, which, while irrational in themselves, also suggest that you eat large amounts of saturated fat and have had high cholesterol in the past. These appear to be significant risk factors for Alzheimer’s.
      “The 3 prospective dietary studies conducted in Chicago,[20] New York,[21] and Rotterdam[22] also examined the relation of dietary fat intake to the development of Alzheimer’s disease. The Chicago study reported the strongest evidence of an association. High intake of saturated fat doubled the risk of Alzheimer’s disease, and even moderate intake of trans fat increased the risk by 2 to 3 times.[20]”

      and
      “an elevated blood cholesterol level (> 6.5 mmol/L) in midlife was associated with 3 times the risk of developing Alzheimer’s disease in late life.[17]

      Two recent studies of patients who had been prescribed statin drugs found a significantly lower risk of Alzheimer’s disease compared with similar patients who were not prescribed these medications.[18,19]”
      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1140705/

      Also, Having low or declining cholesterol now may not be protective becaause:
      “RESULTS:
      Cholesterol levels in men with dementia and, in particular, those with Alzheimer disease had declined at least 15 years before the diagnosis and remained lower than cholesterol levels in men without dementia throughout that period. The difference in slopes was robust to adjustment for potential confounding factors, including vascular risk factors, weight change, alcohol intake, and use of lipid-lowering agents.
      CONCLUSION:
      A decline in serum total cholesterol levels may be associated with early stages in the development of dementia.”
      http://jamanetwork.com/journals/jamaneurology/fullarticle/793179

      Adding all this up Jerry, I have to ask – have you considered being tested for cognitive problems or considered treatment such as turmeric consumption?
      https://nutritionfacts.org/video/treating-alzheimers-with-turmeric/




      8
      1. Doctor TG latest research finding:

        “Then there is your claim that your pee and poo don’t smell. A poor sense of smell may be an early sign of Alzheimer’s.”

        I rest my case because I am no match with Dr TG. He can do a study on 20 people and come up with a finding that gets him the Nobel prize. Just like his Doctor.




        0
  12. Aren’t pro-biotics something you take for awhile after you’ve been prescribed a course of anti-biotics? To replace the “good” bacteria killed off by the anti-biotics right along with the “bad” bacteria? Isn’t that why some people eat some yogurt for awhile as an alternative to pro-biotic capsules? Or consume sauerkraut, kimchi and tempeh like Pat mentioned above?

    I played with the search box here a little and came up with this treasure:

    “There’s a cheap concoction one can make at home that safely wipes out cavity-forming bacteria on our teeth better than chlorhexidine mouthwash and also reduces their plaque-forming ability.” —Dr. Greger
    https://nutritionfacts.org/video/whats-the-best-mouthwash/

    Imagine that…

    …a con-biotic!

    Very clever, Kevin!

    warmest regards…

    Elizabeth

    :-)




    2
  13. The entire surface of earth is coated with a patina of bacteria; so are all surfaces of the body, both inside and out. Every surface of every plant secretes exudates to attract bacteria – no plant exists independent of them.

    To suggest that consuming beneficial bacteria is dangerous is ingenuous; indeed it is impossible not to.




    3
    1. A “beneficial” bacteria would not be dangerous by definition. The point is that all bacteria are not necessarily equally beneficial in all circumstances.




      7
    1. My opinion: they had pancreatitis, at least in part, due to gut barrier issues. Probiotics increased the bacterial burden in the small intestine (where the barrier is intrinsically weak, and bacteria populations are normally low.




      1
    2. Hey Veggievet, thanks for writing! Hypothetically, probiotics could alter the immune response (TH1 vs TH2 cells), change the pattern of cytokines produced by the immune system, or increase the growth of beneficial bacteria to too great a degree. These are not mutually exclusive, and if the result is inflammation that is either too low or too excessive, death by sepsis or by up-regulation of the clotting cascade are both possible.




      1
  14. I’ve been on a great probiotic for the past 5 years and it has done wonders for my health and immune system. Knock on wood, but I have not had a cold or flu or virus in those past 5 years.




    2
  15. I make kefir, krauts, pickled veggies, sourdough starter, nut cheese, etc. It all ferments from bacteria in the air and on the veggies. One is warned to watch out for bad bacteria but so far, I have only experienced one seriously bad batch. And when it is bad, it is BAD so very identifiable.

    I know my kefir will settle my stomach and make me relax, but it turns out it is slightly alcoholic! I don’t know if I trust any of the woo about the benefits of probiotics but I am less trusting of the woo that probiotics are bad as fermented foods have been consumed as long as we have been eating.

    So, I am not giving up my fermented foods! (plus it’s fun to make and I feel like Doctor Frankenstein…)




    4
  16. I think it’s kind of a “no brainer” that probiotic bacteria on organic produce are healthier than those on conventional. No need to wait for the science to come in, as I see no way that dowsing pesticides on growing fruits and vegetables could improve bacterial health.




    4
    1. Hey Greg, thanks for writing! I can’t speak to a study that hasn’t been published yet. I have also all too often seen studies published about the favorable (or at least, a lack of UNfavorable) effects of dairy foods that are funded by (you guessed it!) the dairy industry. Even the National Institutes of Health, if publishing a study favorable to milk products, would be under suspicion, if they were found to be a recipient of a large grant from our friends at Dairy Management Inc. At the same, time, it wouldn’t be surprising if the effects of probiotics in yogurt decreased the pro-inflammatory effects of the saturated fat, so that the benefits of the former were confused with the presumed safe effects of the latter. In general, anyone considering consuming dairy should read up on the effects of dairy products on mTOR (https://www.ncbi.nlm.nih.gov/pubmed/24353195) and the effects of mTOR in chronic disease ( https://www.ncbi.nlm.nih.gov/pubmed/26469771) before they imbibe.




      0
  17. This video leaves out a lot of information. We can’t make recommendations based on just one study – all science needs to be replicated. I wouldn’t advise probiotics as a treatment for pancreatitis anyway – it seems like a strange treatment option. What strains were used and why?

    Taking the right probiotics can greatly improve symptoms of people suffering from Crohn’s, UC, and IBS. This type of video just makes it seem like all nutrition science is a guess.

    Sorry Dr. G, I usually love your videos but this one is a miss.




    6
    1. The group presents their rationales here:

      Timmerman et al, 2007. Design of a multispecies probiotic mixture to prevent infectious complications in critically ill patients. Clinical Nutrition, 26(4), pp.450-459.

      Based on functional tests and general criteria regarding probiotic design and safety, a selection of the following six strains was made; Bifidobacterium bifidum, Bifidobacterium infantis, Lactobacillus acidophilus, Lactobacillus casei, Lactobacillus salivarius and Lactococcus lactis

      Ie, a bunch of easily cultured species from fermented foods, that aren’t all that important in the healthy human GI tract.

      Martínez et al, 2013. Long-term temporal analysis of the human fecal microbiota revealed a stable core of dominant bacterial species. PloS one, 8(7), p.e69621.




      2
  18. If I heard and watched this video correctly, there was no recommendation for anyone to stop or not probiotics.

    This study showed an outcome that was unexpected in people with disease in the pancreas and as such, I would imagine further study is warranted to conclusively rule probiotics as safe or unsafe to use, for whom and for what purpose. Dr. Greger only presented the evidence, which was likely a surprise to many of us.

    If anything, the take away, in my humble opinion, was that fresh fruits and veggies can afford us the benefit of good bacteria to set up house in our bodies and give some gut protection.

    Whether anyone chooses to use probiotics is their business. There is no need to trash the evidence here, because we can’t. It is what it is.

    A proud monthly supporter of Nutritionfacts.org




    6
    1. If I heard and watched this video correctly, there was no recommendation for anyone to stop or not probiotics

      I’m taking no issue with the video or even a side in the discussion here. I am merely pointing out your statement above, taken out of context, is not completely accurate. That is, the video suggested there are problems taking probiotics… therefore, Dr Greger was implying he agreed with the points in the video by merely posting it.




      1
      1. I see your point, Lonie, but for me ‘implying’ doesn’t mean ‘recommendation’. Actually I’m not even sure he’s implying anything at all. I think he’s just showing what’s there, & what’s there is surprising to most people.




        0
        1. I mean, who ever thought that a probiotic supplement could cause any harm? I think it’s interesting in & of itself, without jumping to conclusions as to what he may or not be implying.

          I think when Dr. G makes a recommendation, he usually uses that word. Or we get the red light / green light scenarios.




          0
          1. Nancy a probiotic is not listed on his recommended list of supplements. So I am assuming he hasn’t changed his recommendations. Also I believe he has said a million times that fiber is the most important component of a healthy gut.




            0
  19. This video does not make any scientific sense. And I quote:

    “This is the study that freaked people out a bit. Acute pancreatitis—sudden inflammation of the pancreas—is on the rise, which can become life threatening in some cases, as bacteria break through our gut barrier, and infect our internal organs.”

    Probiotics supplement is supposed to contain good bateria and when you consume it, the good bacteria are supposed to penetrate the intestinal wall to help our immune system. So the fact that beneficial bacteria penetrate the intestinal wall is a plus.

    https://www.ncbi.nlm.nih.gov/pubmed/21537294

    Now if the bad probiotics supplements contain harmful bacteria in there then it is a different story. This is no different from FDA drug that is contaminated.

    So when you buy any supplement, you have to check that it is manufactured by a certified manufacturing facility. A number of reputable supplements that are sold in the U.S. are made by the same manufacturing facility although the content is different. In a certified manufacturing facility then no contamination can happen. If you don’t check this then it is all your fault but don’t lump all probiotics supplements or all supplements into one basket.

    https://www.ncbi.nlm.nih.gov/pubmed/21537294




    2
    1. “This video does not make any scientific sense.”

      Your argument doesn’t make any sense. Why should we ignore studies that suggest a possibility of harm because those probiotics might just possibly be contaminated. No evidence that they were of course. Using that reasoning we would have to ignore every single study on the planet because there might just possibly have been a reason for the results to have been false/positive negatives.

      It is also particularly rich coming from somebody who rejects all scientific evidence and reasoning that do not accord with his opinions.




      9
      1. But one reason studies are written up in detail is to provide a roadmap for duplicating the research, to verify or not the result. If the study was contaminated, it results would not be reproduced. One study is just one point on chart.




        0
    2. the good bacteria are supposed to penetrate the intestinal wall

      This couldn’t be more false. The “good bacteria” tend to be species that metabolize fermentable fiber to produce short chain fatty acids that feed enterocytes, or send signals to enterocytes to produce more mucin, that all act to strengthen the intestinal barrier, against both themselves and pathogenic species.

      Moreover, few of the species that predominate in the human colonic microbiota and act beneficially (like Akkermansia muciniphila, Faecalibacterium prausnitzii, or Roseburia spp.) are found in fermented foods or probiotics.




      4
      1. Bredesen in his “The End of Alzheimer’s” (Amazon) admonishes that if you have leaky gut, fix the leak before taking probiotics which could escape the gut and exacerbate the problem.




        0
      2. Question for Darryl – one thing I have never understood about Akkermansia muciniphila: if, as its name suggests, it is a mucin-muncher, how can it be beneficial when presumably we want a thick mucin layer adding to gut barrier integrity?




        0
  20. Hey folks! Did you see that there is a new How Not To Die cookbook coming out! Finally! Saw Dr. Greger on YouTube talk about it.
    Can’t wait to order some. See this site to get yours!




    6
  21. Great information, Dr. Greger. I’ve always wondered about probiotic capsules and how effective they really are. I no longer take them. Some people resort to fecal transplants in order to reestablish good bacteria in their colon. Aren’t probiotics supposed to do that? On a side note, some people take SBO’s (soil-based organisms). After reading many articles on the subject, I question how safe they are, not to mention if they are effective at all. So many companies, so much hype, I’m not buying it.




    2
  22. I am a 53 year old male who has had IBS-D my whole life. I have been using “Align” for the past 3 months and I have benefitted from it greatly. I went from 135 pounds to 150 pounds. Before the Align, my IBS could kick in at any moment which is hell on your social life, which leads to anxiety and depression, not to mention dehydration from diarrhea. I feel 95% better.

    All these videos that report to eat this – don’t eat that, can get quite overwhelming and counter-productive after awhile which leads to nothing but confusion. The Monsanto Corporation must love people who eat a strictly plant based diet. They create all the pesticides that gets sprayed on the fruits and vegetables. Apples are very healthy for you, except for the pesticides that penetrate the skin and get into the heart of the fruit no matter how well you wash them. You can always spend more money on organic fruits, but even those have an (*) hidden somewhere in the dark where you can’t see it. How do you know it is really organic? How do you know where it was really grown and under what conditions. If I made a computerized sticker that said “organic” on it and placed it on an apple and charged you more money, could you tell the difference? Beef, fish, and poultry, also have huge risks. Organic spinach that is not packaged right can give you e-coli just as well as bad beef. Go ahead and grown your own garden indoors. Oh, by the way, where did that bagged topsoil come from? Near a superfund site?




    1
    1. This Monsanto argument is crazy although I admit you can find it on thousands of crank dietary website.

      The biggest crops in the US are corn and soybeans. Then there is hay and alfalfa. The vast bulk of these crops is used as livestock feed. 95% of the corn crop is used in livestock feed.and over 70% of the soybean crop.

      This shouldn’t be surprising because there are more cattle, sheep, pigs and poultry in the US than there are people. Most of Monsanto’s products are used to support the livestock industries – just like the US Government checkoff programmes.

      https://en.wikipedia.org/wiki/Agriculture_in_the_United_States
      https://www.usda.gov/sites/default/files/documents/coexistence-soybeans-factsheet.pdf
      https://www.aphis.usda.gov/animal_health/nahms/downloads/Demographics2010_rev.pdf

      Monsanto would hate it if everybody became plant based. Their total sales and their profits would plummet.




      5
      1. The point is that fruits and vegetables are sprayed with some type of pesticides either by Monsanto or someone else. Lots of fruits and vegetables are imported from countries like Chile. Who knows what goes on from their dirt to your kitchen table. I am just saying that no matter what you put in your body food-wise, there is always going to be a case where some person or group of persons, under certain situations, are going to have some type of allergic or negative response to it. You can make a video for why it is dangerous to breath air in some locations. So what do you do, make a video that makes everyone nervous and that they should hold their breath? Even the Mafia in Italy are controlling the olive oil market. MOST of the extra virgin olive oil in the USA is NOT extra virgin. It is diluted with other oils to maximize sales and profits. Just because the label says it, doesn’t mean that it really is.




        0
  23. We are a plantbased family with 5 children. Our youngest daughter had an accident and the scratch had to be closed with many stitches. It was right at her eye, so the hospital said she needs antibiotics to prevent an infection. I never gave my kids antibiotics, so that was the first time. Now I am trying to build up her immune system with probiotics and would like to hear your opinion, if I should continue? Is there another way to balance her 4-year-old body out after taking those antibiotics?!? We are eating strict plantbased foods, lots of veggies and fruits and no wheat. Kids are also going to Muse School, a plantbased School!




    2
    1. Hi Sarah and thanks for your question. Your best best to help repopulate her GI tract with health bacteria is by eating prebiotics, or whole plant based foods on which our gut bacteria thrive – sounds like you are already doing this which is great! Fermented plant foods may be another good source as well. On a side note, as a practicing ED doc, I have to admit I am surprised that antibiotics were recommended in the first place…certainly not the standard of care for facial lacerations.




      0
  24. I am looking to teach some healthy eating classes at our small private school. Do you have any printed info I could hand out? I couldn’t find anything on this site. If you do not have any, do you have a source that you recommend?

    Dr. Greger, you are truly wonderful and a huge blessing to this world! Thank you for all you do! God bless you!




    3
  25. I find that adding Inulin powder to Raw Organic Cocoa powder that I mix in a drink seems to satisfy the flora in my gut just fine… judged by the size and shape of my stool.




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  26. Great, untainted material as always. You are a treasure Doc! (first time commenter, long time “listener”)

    As for the subject here, I feel is a window into a new view of health and so I feel compelled to add some generalities, and specifics to the discussion from peanut gallery (i.e. non-professional). It would be a pity if those already inclined to an excessively sanitized view of health, misread this to suggest that bacteria aren’t a crucial partner in keeping us healthy that we have drastically misunderstood in the past.

    In terms of generalities, this is pertinent to the rapidly evolving knowledge of the microbiome, and the vast antimicrobial resistance topic (on pace to kill more people than cancer by 2050 as per http://www.fairr.org) among others. The studies on fecal transplant therapy for C. dificile are astounding examples of how much we can achieve letting nature take us back to school on a subject of our complex relationships with microorganisms that hasn’t been settled science since the Bechamp/Pasteur rift 150 years ago.

    On specifics, I would hazard a guess that a huge % of what is peddled out there in the probiotic market contain low and/or variable levels of live cultures which could create all manner of unpredictable outcomes. Which strains makes sense is also poorly understood thus far too, and with so many theoretically available, “probiotics” as an umbrella term might be argued to have already “jumped the shark”.

    The business end of this hot topic is likely to produce as much garbage as the supplement and pharma industries and biased research clouding matters all the while. Microbiome venture capital funds sprung up years ago in a greedy scramble that is uninterested or blind to the fact that our knowledge here is clearly in its infancy, and nature, not human ingenuity, should be the chief source of rebuilding our understanding here from the ground up (pun very much intended). The irony of the astounding harm shortsightedness and ignorance have caused in the modern medical paradigm (monstrosity?), and this familiar gold rush mentality to profit before understanding certainly has Hippocrates rolling over in his grave (yet again).

    That said, the foundational shift towards a deeper understanding of our symbiotic nature and the reality of some amount of coevolution are critical, fascinating and exciting. We are still deeply invested in the dominant efforts to denude our world and our bodies, but it seems impossible it will continue given the apocalyptic trajectory of AMR (again, I recommend the resources at http://www.fairr.org). The folly of antibacterial everything (topically), and the insanity of drowning our bodies and our food (via animal feed) in the profit driven madness of oceans of antibiotics will reverberate for decades to come even if we let brilliant, honest doctors like yourself and many others take the lead starting tomorrow.

    So however we manage to reignite the right complex dance of bacteria, fungi, and parasites to play their respective roles in our lives, it seems clear we need to do so somehow and somehow spread the understanding that we should never disturb this balance without a compelling reason to do so.

    I’m sure you have and will continue to be on the case distilling the research that aims to decipher the formula. But in the meanwhile, felt it was important from the relative freedom of a layman’s perspective to cut through what might be years of groping for answers in the highly compromised arena of medical research, and snake oil peddlers to defend the foundational point underneath the probiotics craze: that we have been fumbling in the dark on some of the biggest concepts in medical science and health all along. And nature, in all her dirty, bacteria laden splendor, is patiently waiting for us to shut up and listen.

    (FWIW I have occasionally supplemented probiotics from a few carefully selected sources, but mainly eat lots of foods that contain high amounts of little goodies. I also have not had an antibiotic since childhood (I’m 46), can’t remember the last time I had a cold (maybe 3-4 years?), and have eaten plant focused, mostly organic diet for 25 years. I would like to believe this has resulted in a healthy, diverse microbiome, but I’ve never bothered to do tests to confirm. Nature and the produce aisle arey.”doctors offices”, and I’ve followed Dr. Greger and his ilk (i.e. world class Doctors outside of the machinery of health care) past and present (many from the natural hygiene lineage such as Goldhamer, Fuhrman and others less well known).




    2

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