Should You Be Taking Probiotics?

A large meta-analysis (collection of multiple studies) was just published that claims  probiotics don't work, and are useless.

I'm very sympathetic to the view that supplements are unnecessary and unnatural. I don't think our soils are so nutrient-depleted that we need to take multivitamins. I don't see any evidence that antioxidants or vitamins in pill form do any good for those of us not suffering from clinical nutrient deficiencies like scurvy or beri-beri, and I've come across considerable evidence that our pill popping is doing significant harm.

But the issue of probiotics is different.

I've been studying the recent science on the gut microbiome lately. Listening to lectures by Dr Pam Popper of Wellness Forum Health, and reading the books The Microbiome Solution, by Dr Robynne Chutkan, and Missing Microbes, by Martin J. Blaser, PhD.

And I'm more convinced than ever that a strong probiotic regimen can benefit a lot of us – perhaps all of us. For a few reasons.

1. We need bacteria to survive

When I was a kid, I fell in love with a book called Microbe Hunters, about the first scientists who discovered microbes under the microscope, and began putting together the connection between invisible bugs and human diseases.

What science came to believe – and what doctors, to their shame, still seem to believe, is that the only good bacterium is a dead bacterium.

And when Alexander Fleming accidentally killed some bacteria by growing mold on his PB&J in the lab, the medical world went wild in a quest to synthesize and scale the production of drugs that could wipe bacteria off the face of the earth.

While it's true that some of those microbes (bacteria, fungi, and viruses) are nasty pieces of work (the ones we call “pathogens”), there are a lot of bacteria in our bodies without which we have a hard time surviving, and an even harder time being healthy.

The current understanding is that there are about 100 trillion bacterial cells on and in our bodies, approximately 10 times more cells than human ones! Which means, essentially, that you and I are 10/11 bacteria, and 1/11 human. Which may be a humbling thought. (Probably more humbling to the bacteria.)

2. Antibiotics are Way Overused

Antibiotics kill bacteria. That's what they do. That's why we take them.

Trouble is, they kill bacteria pretty indiscriminately. And the bacteria most susceptible to antibiotics happen to be the beneficial bacteria in our guts, lactobacillus and bifidobacter. When these populations get decimated, that creates a vacuum for the pathogenic species to take hold. And since antibiotics can't kill 100% of any species of bacteria (and 0% of viruses, for which they're often prescribed), the few bacteria that remain can now reproduce unimpeded by competition.

If you've been given lots of courses of antibiotics in your life, it's pretty much a sure thing that your gut bacteria are severely depleted.

3. We're Too Clean

Our modern way of living, with lots of soap and hand-washing and Purell and Lysol and chlorinated water and triple-washed bagged greens, keeps us from getting in contact with lots of microbes. Therefore, our gut and skin microbiomes (the sum total of all our bacterial boarders) is deficient compared to previous generations, and humans in less developed parts of the world.

4. Many of Us Missed Out on the Full Birth Experience

Human birth, done naturally, consists of a vaginal delivery followed by breastfeeding.

There are times when neither is possible, due to true medical emergency.

But most c-sections are elective, and most formula feeding is based on economic, not medical necessity.

When we miss out on those experiences, we miss a crucial window in which our mother's microbes begin to colonize our own bodies. And some studies suggest that while those of us who were formula-fed c-section babies catch up to a certain extent, we never gain the same protections as our luckier counterparts.

5. Animal Agriculture

If you eat animals (or consume their bodily fluids) from any place other than a local, organic farm, you're getting a steady diet of antibiotics along with your chicken, beef, and pork. In fact, animal agriculture accounts for 80% of the antibiotic use in the United States. The main reason is that antibiotics fatten animals up, so they weigh more, and therefore command a higher price in the marketplace.

Many experts connect the introduction of antibiotics into our meat and dairy supply with the epidemic of obesity we face today. And it makes sense – if it fattens up the mammals we eat, why shouldn't it have the same effect on us.

6. Crappy Diets

Turns out we can, to some extent, choose our gut bacteria based on what we feed them. The high-fat, highly processed, low fiber, Standard American Diet creates a breeding ground for pathogenic bacteria. The good bacteria that live in our large intestines ferment and eat the fiber that we can't process by ourselves.

7. Symptoms of Dysbiosis

There are too many symptoms of dysbiosis (an imbalance of our gut microbes) to mention here, from leaky gut, to autoimmune disease, to obesity, to heart disease, to cancer, to diabetes, to you name it. The most “interesting” effects of a messed up gut microbiome, though, are emotional. Turns out our gut microbes control the gene expression that leads to production of the brain chemicals associated with mental health and illness, like dopamine and serotonin.

Unhappy bacteria can lead to unhappy us.

So what about that “probiotics don't work” meta-analysis?

Some of the studies weren't looking at pharmaceutical grade probiotics at all, but small amounts of yogurt and fermented foods. The flaw in studies like these is what Dr David Katz calls the “small parachute” problem: If you toss someone out of an airplane with a parachute the size of a Kleenex, you might assume that parachutes don't work.

Also, the studies were very short-term, ranging from 28-42 days, and they looked at biomarkers, not long-term health outcomes.

Finally, the study participants weren't asked (as far as we know) to improve their diets while they took the probiotics. As we've seen, probiotics won't seed your gut with bacteria that stick around if you continue to eat a crappy diet. That would be like filling your house with cats and feeding them only lettuce.

Are all probiotics created equal?

Totally not.

I wouldn't buy a probiotic off the shelf at a health food store or supermarket. They degrade over time, even under refrigeration, and who knows how long that bottle has been in a warehouse, and in a truck, and on the shelf, before you pick it up.

Also, many brands of supplements are, shall we say, fast and loose with what's actually in their pills and capsules.

Finally, there are many different strains of bacteria, and many different CFUs (strengths), and many different formulations that may or may not include prebiotics. Sometimes you want multiple strains, and sometimes you want just straight lacto and bifido. Sometimes you want prebiotics, and sometimes prebiotics are a terrible idea.

The sales clerk at the health food store does not have the background and experience to recommend the right formulation for you.

Probiotics are serious medicine, and should be approached in a serious manner.

If, after reading this article, you want to find out more about probiotics and whether they are right for you, email me at  and we'll set up a time to talk.

Is It Possible to Prevent Cancer?

No disease is as feared or misunderstood as cancer. Because of this fear and confusion, a diagnosis can shake us to our core. At which point, we’re especially vulnerable to bad advice from the medical establishment, as well as unproven and potentially harmful “alternative” modalities.

While there are many ways of treating cancer, and different cancers have radically different potential outcomes, the best policy is always – when possible – prevention. This article will compare the evidence for the mainstream prevention strategy – early detection – with the kinds of diet and lifestyle changes I promote.

You'll discover that you have a lot more control over your health destiny than we’ve been taught.

Mainstream Prevention: Early Detection and Screening

When you stop to think about it, early detection does not “prevent” cancer. Instead, in theory, it catches cancer early enough to do something about it.

So the question is, does population-wide screening of asymptomatic people help us “do something about it” in a way that reduces suffering, disability, and death. Turns out that with the exception of the pap smear for cervical cancer, screening actually may harm more people than it helps.

The Cochrane Collaboration, a non-profit health research group that does not receive funding from industry, has determined that mammography for early detection of breast cancer has the following risk/benefits profile:

If 2000 women receive biannual mammography for 10 years:

  • One woman will be saved from death by breast cancer.
  • 10 women will be treated for cancers they do not have or that would never have been detectable or become  significant (through partial or complete amputation of the breast and/or drug treatments).
  • 200 women will have a “false alarm” and experience, for a time, all psychological stresses of believing they have cancer when in fact they are perfectly fine.
  • 2000 women will undergo painful mammograms with these radiation screenings increase the risk of lung  cancer and heart disease.

For more information on the science behind these statements, check out Gilbert Welch’s book, Overdiagnosed.

The risk/benefits profiles for population-based PSA testing for prostate cancer and colonoscopies for colorectal cancer are similar. They harm more people than they help, and turn hundreds of thousands of perfectly healthy people into worried patients. (For more information, see The Great Prostate Hoax, by Richard Ablin with Ronald Piana.)

So if we can’t “prevent” cancer through screening, what can we do? Are we powerless to change our fate, or do we just have to wait until we get sick enough to need treatment? And at that point, isn’t it often too late?

To answer that question, we have to look directly at cancer and its causes.

What Causes Cancer?

Cancer is a condition in which normal cells mutate and proliferate without limits. Everyone “knows” that the initial trigger is genetic mutation in those cells. Therefore, the thinking goes, cancer must be a genetic disease – a combination of genetic predisposition and environmental damage.

For now, I’ll leave out the part of the story where cancer is a metabolic disease – in which cells switch from aerobic to anaerobic respiration even in the presence of sufficient oxygen, with genetic mutation following and not causing the damage – and focus on the relative contributions of our genes, the toxins in our environment, and food.

We know that in most cancers, genes play a very minor role. It’s been estimated that only about 3% of all cancers are 100% genetically determined (that is, the person was going to develop that cancer no matter what they might do to try to prevent it). May cancers are genetically predisposed, but can be prevented or mitigated through lifestyle. And some cancers are entirely the result of diet and lifestyle choices.

If cancers were mostly genetic, then identical twins would experience the same fates since their genes are identical, right? Yet a 2004 review of identical twin studies found that if one twin has cancer, there’s, on average, less than a 20% chance of the other twin developing it.

And since most identical twins share common diets and lifestyles in childhood (and often beyond), that 20% concordance actually represents a huge inflation of the role of genetics alone.

The Toxins in Our Environment

When people think of reducing the causes of cancer, one of the factors they think about is lowering exposure to environmental toxins. After all, the atomic bombs and the story of Marie Curie seems to prove that radiation causes cancer, and we hear stories in the news all the time about cancer clusters in places that have toxic waste dumps and polluted air and water.

The problem is, most of the substances that are supposed to cause cancer in humans have never been proven to cause cancer in humans. They are on the list of “suspected” or “known” carcinogens because they have been shown to cause cancer in laboratory rats or mice. Since about half of the substances that cause cancer in mice don’t cause cancer in rats, and vice versa, it’s a huge leap to assume that they will have a known effect in humans. Also, the doses given to the rodents are orders of magnitude higher than those humans consume.

To be clear, I’m not in favor of environmental toxins. I believe we should live on a clean, healthy planet. But the evidence suggests that the carcinogenic effect of most toxins and radiation in our environment can be overcome through diet and lifestyle changes that are within our power to make. (For more information, see Whole: Rethinking the Science of Nutrition, by T. Colin Campbell, with Howard Jacobson, especially chapter 7.)

The real problem with focusing on environmental toxins is that it misdirects us from what is by far the largest contributor to our cancer destiny: the food we eat every day.

The Best Odds Anti-Cancer Diet

We can prevent up to 90% of all cancers by consuming an anti-cancer diet. We are not helpless in the face of our genetic inheritance and our toxic environment. We can control the lion’s share of our risk through our daily choices.

And we don’t need to spend our entire paycheck on exotic anti-cancer superfoods, or spend our days preparing $200 smoothies full of brain dust and moon juice.

Instead, we can eat the way long-lived people around the world eat: lots of fruits, vegetables, legumes, and whole grains; smaller amounts of nuts and seeds; small portions or occasional amounts of animal foods; and little to no highly processed foods.

When we look at populations around the world, there are clear and dramatic correlations between diet and cancer incidence and mortality. In rural China, some areas had 300+ times the risk of certain cancers than others. Prostate cancer was virtually unknown in Japan before they adopted a Western diet high in animal foods. Colorectal cancer was unheard of in sub-Saharan Africa among native populations eating a plant-based diet. (For more information, read The China Study, by T. Colin Campbell and Thomas M. Campbell, and Proteinaholic, by Garth Davis, MD, and Howard Jacobson.)

It’s time that the medical profession and various cancer charities acknowledge and publicize the empowering truth: that we can prevent most cancers with our forks and knives.

Starting soon, Wholistic Health Studio of Durham will be hosting me to teach a series of classes on Preventing Cancer. Click here for additional information or to register.

The Wrongest Lessons from The Biggest Loser

Big article this week in the NY Times (NY apparently stands for Nutritional Yokels) about how contestants in The Biggest Loser TV show gain back the weight after the show. According to “science,” obesity is a disease of a malfunctioning metabolic system, rather than lifestyle choices.

One of the contestants, Amanda Arlauskas, lives in Raleigh, NC, not far from me. According to the Times, she's since regained 13 pounds (or 15% of the total weight she lost) while burning “591.1 fewer calories per day than would be expected for a woman her size.”

She was sponsored by Quest, a company that makes protein powders and paleo bars, and was interviewed on their blog in 2012, after having yo-yoed from 163 to 202 and back down to 161 pounds. Here's how she described her diet:

… because I eat no seafood, and limited red meat, I’m always preparing chicken in different ways. I also love just about every vegetable there is. But don’t get me wrong, I still enjoy my pizza, burger, and glass of wine here and there!

And her biggest learning on The Biggest Loser? This outlook:

I think one of the most important things I learned was counting calories and portion control. When we first started measuring everything, and counting every relentless calorie that entered our bodies, I was shocked to learn what the actual portion sizes really were.

So often we think we know what’s going in our mouths, but fail to realize that if it’s not measured, more than likely we are eating A LOT more than what we are supposed to be eating.

I always recommend to someone who is looking to lose weight or just become healthier, to buy a calorie counter, food scale, and measuring cups/spoons, and really become aware of EVERY calorie they are consuming. That’s when you really notice how much we typically overeat.

Now she sells protein powder for 4FrontNutrition, and unless she discovers the whole food, low fat, plant-based movement, she will struggle with this issue for the rest of her life.

Words cannot describe how sad this makes me. Not only for Amanda, but for all the NY Times readers who will give up on achieving a healthy weight because they now believe, based on “science,” that they have no control over their health destiny.

Update: the NY Times continues its campaign of weight loss misinformation with another “authoritative” article. This one, published on May 4, 2016, says that when it comes to weight loss, it's more important to exercise than to control food intake.

As Ray Cronise points out, the healthiest, longest-lived, slimmest people in the world do not exercise. They are active as part of their daily lives, but they aren't hitting the gym or the track for hours every week.

Instead, the basis of their lean physiques and healthy lifespans is a simple, whole food, plant-based diet.

Once you lose that foundation, then it's a crazy-science free-for-all in which dozens of bad theories compete to confuse and discourage the overweight public.

As the NY Times demonstrates on almost a daily basis.

We know the surefire formula for getting people to a healthy weight and staying there. Unfortunately, the number of people who get the message and follow through on the implementation are rare enough that they don't bend the bell curves of population research.

If you're overweight, you can stop all the tricks and gimmicks and weighing and measuring and counting and restricting right now.

There is a path, and it works, and it won't take you but a couple of weeks to verify it for yourself.

And it doesn't require you to override millions of years of human evolutionary biology with willpower.

If you'd like to take the first step on that journey with me, I'd be honored. Fill out the form below and click Submit to request a free exploratory consultation.