Anti-Inflammatory Diet

All health care starts with diet. My recommendations for a healthy diet are here:
Anti-Inflammatory Diet and Lifestyle.
There are over 190 articles on diet, inflammation and disease on this blog
(find topics using search [upper left] or index [lower right]), and
more articles by Prof. Ayers on Suite101 .

Friday, May 28, 2010

Necrotising Enterocolitis, Low Birth Weight and Formula

Human Milk and Milk Supplements Protect Newborns

Babies born prematurely are at risk of a serious bacterial infection of the intestines, necrotizing enterocolitis (NEC), that can be prevented if formula based on cow’s milk products is avoided and human milk is used for all feedings.
Human Milk Protects Against Formula Based NEC
Feeding low birth weight, premature babies formula made from cow’s milk increases their risk of NEC ten fold.  Replacement of some of the cow’s milk formula with human milk from a milk bank reduces NEC. 
Human Milk and Cow’s Milk Are Very Different
What is present in human milk that protects against NEC?  The major components in milk are proteins, lactose, fats and oligosaccharides (short to medium length chains of sugars.)  Human milk and cow’s milk have the same amount of fat (35 grams/liter) and about the same amount of lactose (65 vs. 45 g/l) and protein (10 vs. 35 g/l).  The big difference is in the amount (5-10 vs. 0.05 g/l) and quality of oligosaccharides.  Human milk has more than 100 times the amount of oligosaccharides as cow’s milk.  That also means that about 10% of the carbohydrates in human milk are non-nutritive human milk oligosaccharides (HMOs).
HMOs Are Not FOS
Human milk oligosaccharides are complex, with over 200 different structures identified so far.  Essentially they are made up of a lactose (a disaccharide consisting of galactose linked to glucose) extended by different numbers of N-acetyllactosamine (lactose with a modified glucose) and a few other sugars attached a various locations.  A different enzyme is used for each modification and the synthesis of these oligosaccharides has not yet been figured out in detail.  More than a dozen different genes are devoted to the synthesis of these oligosaccharides.  These oligosaccharides are not structurally or functionally related to the frucose oligosaccharides used as prebiotics.
HMOs Are Prebiotic and Stop NEC
Human milk oligosaccharides have been tested both for their ability to act as prebiotics to encourage the development of normal baby gut flora and to suppress NEC.  The HMOs were found to be the elusive bifidus factor that stops the development of adult gut flora and facilitates only the development of the Bifidobacterium bifidum monoculture found in exclusively breastfed babies.  HMOs also reduce NEC in the same way as whole human milk.  Another interesting aspect of HMOs is that they modify the oligosaccharides produced on the surface of baby intestinal cells.  Babies fed human milk also secrete HMOs in their urine, indicating that ingested HMOs are absorbed in the intestines and reach the blood stream.
Neonatal Nurseries Should Use Only Human Milk
Human milk is now available to neonatal intensive care nurseries through milk banks and purified components of human milk are also available to supplement feedings for very low birth weight premature babies.  Nursing is still best for baby and mother, but those mothers who choose not to nurse need not compromise the health and development of their babies by using cow’s milk-based formula or supplements.  Every dollar spent on pasteurized donor milk ($3/oz.) reduces costs in neonatal intensive care units by more than ten dollars.  It seems to be time to eliminate the added risks of formula use in hospitals and provide every baby with a healthy start and normal gut flora by only using human milk products in hospitals.
Lars Bode. 2009.  Human milk oligosaccharides: prebiotics and beyond 
Nutrition Reviews® Vol. 67(Suppl. 2):S183–S191 


Chris Kresser said...

Are the galacto-oligosaccharides some companies have started selling recently as prebiotics similar in structure to those found in mother's milk?

Dr. Art Ayers said...

Those galacto-oligosaccharides are related, in that they start from lactose, but they lack the complexity and are essentially a synthetic scattershot rather than an evolved optimization. In this regard, they will have an unpredictable impact on gut flora, similar to the FOS. Neither would be suitable for newborns to replace human milk.

Thanks for the question.

Chris Kresser said...

Thanks for your reply, Art. I'm thinking more about using them in adults with gut problems - especially in those unlucky enough not to have been breastfed.

The other probiotics I've seen use FOS, inulin, arabinogalactan, beta-glucan or some combination. In your opinion, which of these should be used in adults hoping to improve their gut flora?

Or do you advise against prebiotic supplementation altogether? There is quite a large body of research indicating that prebiotic use selectively increases bifidobacteria and lactobacilus, without increasing pathogenic species. That would seem to be a good thing, no?

Anna said...

I wish this was known more widely. Our former next-door neighbors' baby was born 11 weeks prematurely and was small for his gestational age, further complicating his fragile health. He had several surgeries to treat/repair NEC, and it was touch and go several times. His family and medical team spent the first year of life entirely focused on keeping him alive.

My son was born 5 weeks after this baby, and I'll bet if his parents and we had known about the risk posed by the cow's milk formula, we could have perhaps improved his situation if we had given him my breast milk (I had an ample supply in the freezer for much of my son's infancy).

Dr. Art Ayers said...

Hi Anna,
Don't feel bad that you didn't know. Most of the people in neonatal intensive care don't know the literature either. They think that their supplements are essential for putting weight on tiny premies, but they are also putting them at risk by compromising their gut. Those little babies need the special oligos in mother's milk. Most of the data shows that mother's milk from a milk bank is better than the expensive special formulas for premies. It is sad that they think that stuff is superior to the mother's milk.

Mothers shouldn't feel bad about their experience, because they do the best they can with the information they are given.

Thanks for your attentive input.

WhiteFox said...

Dr. Ayers,

I have severe small intestinal bacterial overgrowth that was initially caused by very high doses of PPIs (Prilosec) that drastically reduced my stomach acid and likely the ph of my intestines resulting in severe dysbiosis and overgrowth.

I have been diligently trying to restore my gut health through very low-carb diets, increasing D3 (now stable), probiotics, glutamine, polyphenols (green tea, fresh herbs), coconut oil, raw garlic, and other various experiments with only minor success. Stool tests reveal that the probiotics rarely stick (0 bifido or lactobacillus).

I did have a lot of success at one point by taking a lot of betaine HCL to increase what I thought (wrongly based on Heidelberg test) was low stomach acid. I gave myself bad gastritis but did seem to succeed in destroying/altering bacteria so that I could eat unlimited fruit but still not grains. But an antibiotic messed everything up and I am hesitant to damage my stomach again with the betaine. So I have 3 questions:

1. Do you think breast milk from my wife could be beneficial?

2. Any recommendations for those with SIBO who can't eat fruits, products with lactose, beans, fiber, etc.? The bacteria in SI just eat them and produce gas and toxins.

3. Do you have any thoughts regarding the importance of proper Ph levels to gut bacteria and any ideas for obtaining proper ph levels in intestines?

Any other suggestions? I am suspicious of gut biofilms and slow motility (which is often caused by SIBO even if not present before).

Dr. Art Ayers said...

I don't have much familiarity with SIBO, but the symptoms that you have, just sound like typical dybiosis associated with constipation after antibiotics. It would make sense to feed the anaerobes that can't survive in the small intestines by eating soluble fiber (pectin and inulin-rich fruits and vegetables).

Lactulose may also be useful. It is said to reduce SIBO and enhance colon gut flora.

You can expect discomfort as you build up the 100+ species of bacteria that you need for a healthy gut flora. You need to get used to eating diverse veggies and lots of herbs and spices.

Let me know how you do.

Garry said...

Whitefox, have you tried rifaximin, an antibiotic that is not systemically absorbed? Normally antibiotics should be avoided, as has been noted here many times. However if you can't seem to eradicate your sibo, you may have to bite the bullet, then do your best to rebuild.

WhiteFox said...


I did finally try rifaximin in Jan. I was feeling 90% better by the end of the course, but within a week I was worse that I was before. Also, I had not really had a problem with constipation before, but now I do. I assume the rifaximin killed out much of the good things left in my gut.

I did have a lot of success with Keflex a couple years ago. I felt fine and could eat anything for 2 months, but then the problems came back worse than before.

The extra stomach acid + Align led to vast improvements for over 2 months until I had to take an antibiotic for an ear infection (amoxycillin), which really messed me up.

Raw Garlic + Coconut oil as an antibiotic seems to work as well as anything.

WhiteFox said...

Dr. Ayers,

What about breast milk for adults? Good idea or bad idea?

And no opinion on proper Ph levels for healthy gut flora?

Dr. Art Ayers said...

Breastmilk would be good, but it is impractical for several reasons. First, after adult gut flora have become established, the breastmilk isn't powerful enough and the beneficial components just get eaten by the gut flora. That is why any use of formula at all will permanently damage a newborn's gut flora. I would think that milk would favor SIBO.

The lactoferrin in milk could help control bacterial overgrowths and is useful for controlling hospital-based Clostridium infections. Whey (low in lactose) also contains plenty of lactoferrin.

In most cases what you eat has no impact on the pH of your stomach or intestines, so gut flora do just fine. The pH of the intestines is controlled by the intestines and not the food. I wouldn't see the point in ever trying to adjust the pH of the GI tract. There is usually nothing wrong with stomach acid production. The problems arise when drugs are used to alter acid production. Antibiotics are also seldom needed for ear infections.

Why are you using so many drugs to alter your body. It seems that you are making yourself sick. Just switch to the anti-inflammatory diet, start eating more "muddy greens" and get lots of exercise. Your gut may rebel for a little while, but it should gradually settle down and be much more tolerant.

Keep me updated.

Dr. Art Ayers said...

I think that all of those and polysaccharides in a variety of leafy veggies are a good idea. I would not recommend beta-glucans, since they are related to fungal wall polysaccharides that are uniformly inflammatory in both animals and plants.

FOS may directly work on establishing probiotics like the bifidobacteria, but I would expect the rest of the plant polysaccharides, including pectin and inulin, to stimulate the colon gut flora.

I would tend to focus on a variety of veggies, rather than numerous purified polysaccharides. The phytochemicals and especially those in herbs and spices are probably also of benefit in controlling pathogens.

Thanks for your comments.

Anonymous said...

Dr Ayers. I am a pharmacist and get many infants with problems. Will giving tylenol to a 3 month old adversely affect their gut flora permanently? I say this because I think many formulations have high fructose corn syrup.

If so, what alternative are there?

Monika said...

This is a little off topic,
Dr.Ayers, but I was wondering if you know anything about the connection between Vit D levels and cold sores(herpes). I get fever blisters about once every year.

Anonymous said...

Dr Ayers,

As you recommend to keep Vit.D level (25OHD) near 60 ng/ml and beyond, maybe this article would be an interesting reading.

Any ideas about it would be very appreciated.



Dr. Art Ayers said...

I don't think that the impact on the gut flora will be as bad as the impact of NSAIDs on the development and leakiness of the gut itself. With my kids, I always tried to avoid using NSAIDs and antibiotics, and in most cases we succeeded. I think with the three girls, we had antibiotics used for appendicitis, strep throat/scarlett fever and a couple of stich-up jobs, and NSAIDs for probably a dozen instances. The rest of the time we used Vick's, castor oil, etc.

I think that most of the childhood sicknesses are the result of previous drug treatments. Pediatrician offices would be empty without antibiotics.

I hope that this is useful. Thanks for your comments/questions.

Dr. Art Ayers said...

I haven't looked up the impact of vitamin D levels and herpes outbreaks.

Perhaps some other readers have some answers.

Dr. Art Ayers said...

Hi Marco,
The article that you cite basically says that info on the benefits of serum vitD above 30ng/ml have not been demonstrated in clinical trials. One of the arguments against higher levels is that the affinity for enzymes acting on vitD would all be saturated at that level. That argument seems silly to me, because the vitD is interacting with so many other components, including carriers, that the impact body-wide is not so simply predictable.

I can only relate my impression from anecdotal accounts of people benefiting from higher levels. I do agree with the contention that as supplements are used to obtain higher levels, then the actual results needed to be tested.

Vitamin D treatments should be more actively studied.

Thanks for your questions.

Claire said...

I have a random question, but first - great topic!

I breastfed my two sons until 4-5 years age and my daughter is 2 years and still going strong :) Most people think it's crazy but I don't care, they love AND most importantly ALL THREE have NEVER been ill, no ear infections, nothing, none have ever had antibiotics! Isn't that just great? For me that's worth the criticism I get for breastfeeding so long!

My question is not regarding breastfeeding and I am sorry to disrupt the thread with my randomness, I am wondering what your opinion is on colonic hydrotherapy and the results on gut bacteria and if you think it is a beneficial therapy?

Also as a side issue I have been diagnosed with relapsing polychondritis and you mentioned using Castor oil on areas of inflammation, I have tried applying it several times now for minor flare ups (hot read ears that last a few hours) it worked wonderfully well! Also I have cut seeds out of my diet and I seem to be less inflamed so thanks for that advice too!

kind regards,


Dr. Art Ayers said...

Extended breastfeeding is the world-norm. Brief, trial-nursing is a modern innovation, like processed food and formal schooling, that only permits survival of kids, because the kids are isolated from the real world. Check out the healthy nurturing and schooling in the new movie, "Babies." I liked watching the kids chowing down on auditioning gut-flora present in/on soil, siblings and random animals.

I don't think that any kind of routine cleansing of the bowels is necessary or desirable. There is no build-up of anything, but perhaps a thin biofilm on the surface of the bowels. There are no toxins or left over food. Healthy gut flora should just grow on soluble fiber and that hydrated stool should be the only contents of the bowel.

I think that an established, healthy gut flora is the best defense and treatment for autoimmune diseases, such as relapsing polychondritis. I think that real treatment of autoimmune diseases is based on eliminating sources of inflammation (diet, gum infections, etc.) and restoring suppression of autoimmunity by restoring a normal gut flora interacting with the gut-associated immune system. Diet and persistence should go a long way toward reversing autoimmune disease.

I enjoy your input.

Wendy said...

I have some information for Susanne on Vitamin D.

This is of course only anecdotal but I used to get cold sores inside my nostrils almost once a month. Luckily they weren't really visible but they were still painful and irritating. BTW, coconut oil works wonders on the blisters.

I had been eating an anti-inflammatory paleo diet and taking a daily multivitamin with 2000 iu of Vitamin D and still had the cold sores. Two years ago, I added 5000 iu of Vitamin D for a total of 7000 iu per day and got tested after six months. By then, my level was above 80 ng/ml so I'm not sure what level did the trick. But I can report that my cold sores completely disappeared, I haven't had one since starting the higher dose of Vitamin D except for one episode when I stopped taking the Vitamin D for about a month. Also, I haven't had a UTI since taking the higher dose of Vitamin D when I used to have about 3 a year.

Monika said...

Wendy- thanks for the info. That is very encouraging.- Do you still take the VIT D3 to maintain your high levels? Any other benefits you notice form the vitamin?

Wendy said...

You're welcome, Susanne. Yes, I still take the same amount of Vitamin D. I've also noticed an improvement in mood from the Vitamin D.

Viktor said...

Dear Art

Apologies for being off-topic: I was wondering if you have any further thoughts on Eczema in general and Seborrheic Dermatitis in particular. I know that eczema was discussed in general a couple of months ago in the comments section – perhaps you have additional insight at this point.

I am currently eating a strict “paleo” diet (i.e. no grains, sugar and dairy). Earlier this week I cut out nightshades as well and started to supplement 5.000 IU of Vit-D3.

From experience, symptoms have flared up when consuming large amount of sugar (esp. fructose) and when I have been drinking alcohol. However, some times I have been able to eat very unhealthy and/or drinking alcohol without any problems so there is not always an immediate or clear link.

Symptoms have started to slowly recede, but I have yet seen any significant improvements. Do you think glutamine could be beneficial?

Kind regards,

Matt Metzgar said...


Have you ever looked into mineral baths?

Art, this is off-topic, but I had a question. I am wondering why you advocate a low-starch diet. I am sure you have read Stephan's posts about many high-carb/high-starch cultures remaining healthy.

Is there something specific about starch that you feel upsets the gut bacteria?

Dr. Art Ayers said...

I see no advantage to producing high blood sugar and increasing the growth of problematic Klebsiella by eating starch. The spike in blood sugar by hyperglycemic starch causes a corresponding spike in insulin and a sudden drop in blood sugar. Starch is like burning paper.

Those eating high carb diets suffer the intermittent risks of diabetes, and periodic hunger, with no benefit. It seems much simpler to eliminate starch that only contributes to obesity, high triglycerides and Klebsiella-associated diseases.

Wheat and corn-based cultures also suffer from many additionals diseases. In some cases many of the pitfalls of starch are avoided by hard physical labor, but I am skeptical of the benefits of high starch to any agricultural society. The major benefit may be to stimulate high levels of inflammation to permit people to survive communicable diseases at high population density.

Thanks for your comments.

Dr. Art Ayers said...

I suspect that most of your continuing problems come from a disruption of your mucosal immune system, centered at the end of your small intestine. That will require restoration of your gut flora. Probiotics should be helpful and I think that in this context, the use of yogurt and associated lactic acid bacteria is desirable, since these are the bacteria that reside in and influence the mucosal immune system.

I would also build up colon bacteria with pectin and inulin - containing vegetables and protect your gut flora with plenty of herbs and spices.

Responses to high starch and alcohol may indicate the involvement of yeasts. You might also consider fasting.

Have you tried menthol/Vicks/castor oil in the vicinity of inflamed skin to see if it reduces inflammation?

Do you also suffer from constipation?

Thanks for your queries.

Unknown said...

Hi Dr. Ayers -

I have been trying to get off my fat-free, gluten-free, vegan diet for the last few months since I discovered your site. I have been on this diet for 8 years due to inflammatory arthritis. While it has kept my flare-ups at bay, it has left me grossly underweight and suffering from decalcifying bones and teeth. I just can't seem to incorporate the full-fat yogurt without the painful arthritic flares. I have also been eating leeks and sunchokes for the inulin content. I must be going about this the wrong way. Am I starting with the wrong foods? And is there a specific order and quantity that I should be going by to add back these foods? Would taking a cortico-steroid with new food be a good way to add things back? Sorry for my ignorance, but I'm just so discouraged by my lack of progress.

Jeff A.

Dr. Art Ayers said...

Starting with a low-fat, vegan diet, it will take time for your gut flora and bile production to adjust to a more varied diet.

I would begin with a test of serum vitamin D and then supplement until a subsequent test gave a value over 50 ng/ml. You should also be careful of your vitamins A, C and K. You are probably also low on minerals.

I would suspect a yeast infection, if you have had prior antibiotic treatment or have constipation.

I would gradually introduce new foods with a broad range of fresh, raw vegetables.

You will have to continue the starch until you have enough gut flora to tolerate probiotics/live yogurt. You have probably also developed a lactose intolerance.

To relieve pain/inflammation in feet and hands, you can coat them in castor oil. Vicks works faster, but doesn't last as long. I think that cortico-steroids cause to many problems and should be avoided. NSAIDs also cause problems, such as leaky gut. I would think that the goal would be to get your gut functional enough to tolerate saturated fats and then add omega-3 fish oils to suppress the inflammation/pain. It will be important to get as much motion in your joints as possible to repair damage. Connective tissue only heals under controlled physical stress.

Ultimately, you will want to suppress the inflammation by restoring your immune function via a functional gut-associated immune system. That means restoring a more normal diet that tolerates probiotics and colon friendly pectin and inulin. You will need more protein and saturated fat to provide the bulk of your calories. This will make you less hungry as you lower the starch in your diet.

Let me know how you progress.

Viktor said...

Dear Dr Art Ayers

Many thanks for your response – highly appreciated.

I have not had any problems with constipation and I am currently intermittent fasting (16hrs fasting 8hrs eating window split in two large meals). I have recently started with a probiotic (Bio-Kult) and consume normally large quantities of onions – will increase carrot consumption going forward. Got my first batch of sauer kraut ready in a week or two.

I have not tried vicks/menthol/castor oil – I have previously used mild topical steroids/anti-fungals but always kept one area clear – the inflammation always increases/decreases in all areas which make me believe that the condition is “regulated” by inside factors and any topical solutions would not target the problem.

In your experience, how long does it take to see benefits for probiotics?

Since giving up nightshades and dairy earlier this week improvements have been slow but consistent. Will keep you posted.

Kind regards,

Unknown said...

Thank you so much Dr. Ayers. I will let you know how I progress.

Jeff A.

Anna said...


Count me as another who sees benefits from keeping Vit D levels at a fairly high level - about 60-80 ng/mL. I take 5000iU daily on average to keep my 25 (OH)D test results in that range. My husband and son also take similar doses (based on their weight and a general formula of 1000iU per ea 25 pounds body wt) to stay in the that range. I came to my conclusions after a lot of self-experimentation with no supplementation/non-burning midday sun exposure and various supplementation doses, with frequent 25 (OH)D tests to check levels.

My family has excellent resistance to colds and flu on this dosing regimen, esp the past two years, and even the 1-2 times we've started to show symptoms, it was over within 1-3 days and was extremely mild. We usually bump up our dose a few days if we are spending time around people with raging colds and that seems to protect us.

I noticed improved balance and strength the last time I went skiing (we usually only ski once annually, sometimes skipping a year). I actually fell more than I have in years, because I skiied more confidently and wasn't as cautious as usual, but the falls were not very hard on my 40-something joints, which surprised me a great deal.

I've noticed Vit D is beneficial for mood elevation, esp in winter.

I've experienced other benefits, too. Vit D is one of the few supplements that I can see a clear benefit from and really notice if I stop it for a while.

I've been reading the Vit D research for several years and understand the caution some are recommending, but I think in many cases, one can be too cautious. I agree with Dr. Ayers, much more Vit D research and clinical trials are needed. Until recently, the majority of the research was epidemiological studies.

Garry said...

Perhaps this is yet another reason to not bother counting calories:

All 3 videos are interesting, but in the "Conclusions" video, they remind us that the calories listed on a food label are just an estimate, and that the true caloric value will vary based on each of our personal gut microflora and the efficiency at which those microflora are able to extract calories from our food.

Dr. Art Ayers said...

These are impressive videos for their provocative content and conclusions. Some of the points that I found important:

Species of gut flora in an individual are essentially a fingerprint -- the species stay the same, but the relative population of each species changes with diet/physiological status.

Exchanging gut flora changes obesity/leaness, determined by the gut flora.

Efficiency of converting food to human fat/energy is determined by the gut flora, so the same amount of food to different people/gut flora can represent different food calories.

Gut flora can learn to utilize/digest soluble fiber.

Thanks for the input.

Medjoub said...

I have a question regarding the ability to digest fiber. You provided a link to Monastyrsky's site at some point for a "general discussion" of gut health. Unfortunately, the contrasts between his, yours, Stephan's, and some of the low-carbers' perspectives on fiber are confusing me. According to Monastyrsky, excessive fiber obliterates gut function and destroys/restructures the colon. Dr. Harris at Panu thinks that fiber is neutral in a "normal" environment and bad in an IBS/IBD environment. Stephan certainly doesn't demonize fiber. You clearly think that some fiber is requisite for gut flora health. Is the issue here that these writers are, rightfully, attacking the mainstream notion of a "healthy, high fiber" diet? Your perspective relates more to gut issues that none of the others discuss (or even have knowledge of, perhaps), so I'm having difficulty trying to understand how to balance these perspectives in my mind. My concern isn't purely intellectual, as I'd like to alleviate my own struggles with gut function (constipation, etc.) but don't want to cause further "damage" with too much fiber. Clearly, grains are out. I'm looking more for understanding than for recommendations, which I've solicited from you before.

Thanks for any insight on this apparently contentious point.

Dr. Art Ayers said...

I think, as you indicate, that most people talking about fiber think of it as passing through the gut unaffected by starch or protein hydrolyzing enzymes of the GI tract. This view would suggest that bulk of stools is composed of this undigestible fiber and that more abundant stools or normal bowel movements would be produced with abundant fiber in the diet.

It turns out that normal stools are produced by providing adequate nutrients for existing gut flora and the bulk of normal stools are made of the gut bacteria.

Part of the confusion comes from the need for gut bacteria to adapt to the types of food/fiber eaten, since fiber (plant polysaccharides other than starch) is the primary food for gut flora. Most people on Western diets, for example, can't digest sea weed, but most Japanese can. Japanese gut flora produce enzymes that can hydrolyze the unusual polysaccharides (fiber) in sea weed.

The same digestibility issues are true for even simple carbohydrates, such as milk sugar, the disaccharide lactose. People who avoid milk products for extended periods may lose the bacteria that utilize lactose and those people are lactose intolerant. If those people eat yogurt with live bacteria that can utilize lactose, they will lose their lactose intolerance in a few weeks.

The time that it takes to adapt gut flora to new food/fiber depends on prior exposure and additional sources of bacteria with the needed enzymes.

Bran from grains is very hard for bacteria to adapt too, because it is so dense. So bran tends to pass through. Most cultures have developed ways to remove at least some of the bran from grains, because the bran can actually absorb some minerals and deplete the diet.

So, fiber to which your gut flora are adapted are healthy and support diverse gut bacteria (>100 species required for health), whereas other fiber may actually cause problems. This suggests that it is useful to augment a high fat, low carb diet with diverse herbs, spices, fruits and vegetables.

I hope that this clarifies at least some of the major points. Please ask if some parts are not clear.

Anonymous said...

Dr. Ayers, are you familiar with the book Primal Blueprint or FatHead(a movie) Both go well along with your recommendations. I was just wondering if you or any other of your blog readers have any thoughts on them.
I enjoy your blog!

Anonymous said...

Dr Ayers.
If you get swelling and abdominal distension from eating a modest portion of lettuce (or some full fat cream), what does that mean in your opinion?
Gut flora not adapted?

Thank you.

Dr. Art Ayers said...

I have only read Mark's blog. I would say that he does a better job than I do encouraging people to eat and exercise sensibly. As you say, we both recommend essentially the same approach. He provides an excellent guide for daily eating and exercising. I try to explain why the diet works and how it avoids disease. Mark tries to make sense from a cultural evolutionary perspective, whereas I try to make sense from a molecular/cellular perspective. His recipes are better. My science is better. Most people would rather ponder recipes than science. I think that both approaches provide cheap, effective guides to healthy living. If people followed these guides, there would be no healthcare crisis.

Thanks for the questions.

Dr. Art Ayers said...

I would say that in the case of the lettuce, you are experiencing both a problem of poorly adapted gut flora and poorly adapted detox system in the intestines. Lettuce and many other plants contain substantial amounts of toxic phytochemicals that are neutralized in the walls of the intestines and in the liver. I think that these enzyme systems adapt to your diet. Thus, if you keep eating small amounts of lettuce, your gut and gut flora will adapt and you will not over react.

The fat in cream needs to be treated with bile in order to be absorbed. It takes exposure to fat to build up your capacity to handle it. Just gradually increase the amount of fat you consume, and your reaction to it will diminish.

Thanks for your questions.

Viktor said...

Dear Dr Art

With regard to our previous discussion about Seborrhoeic dermatitis:

I came across some studies which supports the gut flora connection - unfortunately I was not able to read the full studies.

1. The oral
probiotic Lactobacillus paracasei achieved substantial, clinically meaningful reductions in dandruff in a double-blind, placebo controlled randomized trial.

2. Probiotics in primary prevention of atopic dermatitis.

"Taken together, published results suggest that the administration of selected strains of probiotics during the perinatal period may be helpful in the prevention of AD."

3. In additon, low levels of lactoferrin could also be a potential clue:

"Though within the normal range, tear lactoferrin levels in patients with acne rosacea and seborrheic blepharitis were lower than controls. Low concentrations of lactoferrin may play a role in the ocular surface inflammatory components associated with these diseases."

I will switch to a probiotic containing paracasei.

Do you think lactoferrin supplementation would be benefitial - unfortunately I am not familiar with that substance.

Kind regards,

Dr. Art Ayers said...

Hi Viktor,
The positive impact of probiotics suggests both an anti-inflammatory and a gut-associated immune system response, e.g. autoimmune. There are lots of examples of secondary infections in the context of an immune system defect, e.g. skin mites in rosacea, thrush in HIV.

Even a simple immune deficit caused by problems in gut flora can have significant ramifications.

Lactoferrin is an iron chelator and is produced in milk and secreted onto wet surfaces of the body and at sites of infection. It is a heparin binding protein and is digested in the stomach into peptides that are anti-microbial -- heparin binding domains are anti-microbial. All of the protein sequences similar to heparin binding domains have been patented for use as acne treatments.

Lactoferrin is available in capsule form. It is effective in avoiding hospital Clostridium infections. I doubt that oral lactoferrin would impact the skin micro-organisms directly, but it might still be useful for its gut impact. I don't know if it is effective against Candida.

Thanks for your questions.

Dr. Art Ayers said...

I just look for article on the ability of lactoferrin and lactoferrin peptides to kill Candida. It seems to work and the human lactoferrin, with its stronger heparin binding domain:
is even more effective.

Lactoferrin is also a major component of milk whey protein. Note that the Eades 6 Week Cure starts with protein shakes made from low carb milk whey.

Thanks for giving me an excuse to talk about heparin-binding proteins.

Medjoub said...

Dr. Ayers -

I appreciate the long reply regarding fiber and gut health. I think I understand the basic processes, but need clarification on this point:

"So, fiber to which your gut flora are adapted are healthy and support diverse gut bacteria (>100 species required for health), whereas other fiber may actually cause problems. This suggests that it is useful to augment a high fat, low carb diet with diverse herbs, spices, fruits and vegetables."

How does the concerned individual pursue these good qualities in certain kinds of fibers (presumably inulin and pectin) without consuming the difficult-to-digest or useless kinds? Further, is there an effective strategy for "collecting" these >100 bacteria that are essential to health? There are commercial/conventional and organic vegetables of all kinds everywhere, but it seems to be a shot in the dark trying to figure out which might contain this or that bacteria. Am I wrong? I'm certainly not skeptical, I just wonder how a person can effectively approach this proactively. Perhaps the "problem" is just that you aren't pitching a diet and some of us are used to specific diet pitches. :-)

Thanks again for your insight and for the time you so freely give to answering questions...

Mrs. Ed said...

I've been looking into Lactoferrin now. If you go to PubMed and type in "lactoferrin sepsis", there are many articles on necrotising enterocolitis and that it may help as well, such as this one:

Very Interesting!!!

Dr. Art Ayers said...

To make fiber simple, exclude bran as toxic and just discuss the remaining polysaccharides that the human body doesn't produce enzymes to digest, i.e. all polysaccharides except starch. These are fiber.

Without gut flora, all fiber just passes through the gut untouched. People who routinely eat the same fiber and are exposed to diverse bacteria, e.g. soil, develop a collection of bacteria that can digest the fiber. This is the same process as spilling oil on soil and waiting for the development a bacterial population that digests oil. It happens.

How long the adaptation takes is dependent on frequency of eating the new fiber polysaccharide and exposure to new bacteria. Clearly, eating the same food as everyone else provides access to adaptive bacteria. Living in a modern, mostly sterile environment with people on unhealthy diets tends to undermine public and individual health.

Proactively exposing oneself to diverse bacteria to expand the fiber adaptation of gut flora is a problem, because that exposure is also effective for the bacteria to adapt to you as a nutrient source, i.e. it is a way of searching for pathogens. There is probably a cultural practice somewhere that optimizes gut flora adaptation and minimizes encountering pathogens, but I don't know what it is. Perhaps that is why babies are healthier if they continue breastfeeding while they begin eating solid food, i.e. they are protected by the mother's adapted immune system while they accumulate new gut flora.

Excessive cleanliness of hands and food, that is promoted to sell cleansing products is the source of many health problems. Being around small children with access to backyards and animals is probably a health benefit (unless the kids are in daycare.)

So, I don't worry about finding good or bad fiber. I just avoid grains and eat lots of different veggies and follow what is available from my garden and local farm produce. I don't bother to clean the veggies too much and I eat some raw. The appendix provides a gut flora reservoir to weather diarrhea or short term antibiotics.

Yes, I am not promoting a special diet, because I don't think that it is necessary. Protein and fat from meat/fish/eggs/dairy supply most of the nutrition and calories. Veggies feed gut flora, provide vitamins, minerals and that's about it. Olive and coconut oil are used for dressing and cooking, and other vegetable oils with omega-6 polyunsaturated fats are avoided as inflammatory. These guidelines provide a satisfying diet that is easy to maintain for life and avoids the hunger associated with starch-based diets.

Thanks for your questions.

Dr. Art Ayers said...

Mrs. Ed,
In some of my early articles, I discussed my experiments with lactoferrin. Lactoferrin is a cheap source of heparin-binding peptides. My students just emptied capsules of the nutrichemical, removed the rice powder filler, hydrolyzed with pepsin and purified the heparin-binding peptides on an affinity column of heparin-sepharose. We could use fluorescent derivatives of the peptides to follow heparan sulfate proteoglycans in cartilage secreting cells in culture. That was almost as cool as using tonic (quinine is fluorescent and binds heparin) to light up cells in microscopy.

Anonymous said...

Hi Dr Ayers
If allergies have been a problem for a long time (ie. anaphylatic response to fish), does this indicate a chronic inflammation problem? would you recommend the use of saturated fats in the diet if this was the case?

Anonymous said...

I have adapted most of your dietary recommendations to great success, but I have a question regarding carbs. I replaced bread with Indian dosa which is made from fermented legumes and rice. I takes the consistency of a pancake but is gluten free. Do you see this as harmful to include in the diet?

I also eat buckwheat as it is not a grain and is thus gluten free. Is this OK? I ferment the batter I make with it and keep this as a small portion of my diet.

Cassandra said...

I have been following your diet suggestions and am feeling great, thank you. Also, I'm eating such a huge variety of vegetables, and I found out I like leeks!

My question concerns bran. It sounds like we should just avoid it, but I was reading a blog which referenced this review article ( which apparently says:

After adjustment for age and lifestyle and other dietary factors, only bran consumption was inversely associated with all-cause mortality: 25% lower risk of death for those eating an average of 10 g per day compared to 1 g per day. In other words,the women who ate the most bran had the lowest risk of dying from any cause.

I got the original reference from this site:

Heart disease runs in my family and I sure would like to avoid it. Thoughts on eating bran to reduce heart disease? Thank you so much.

Viktor said...

Dear Dr Art

Very interesting - I will supplement with lactoferrin and keep you posted on any further developments.

Kind regards,

Dr. Art Ayers said...

Allergies and saturated fats:
From my perspective, the cause of allergies is typically chronic diet-based inflammation plus a disruption of the gut flora to produce a defect in the immune system.

Curing allergies means changing diet to stop the chronic inflammation and reconstructing the gut flora to regain immune system function and suppress the inappropriate attack on common molecules.

Using saturated fats as the major source of calories, instead of starch and polyunsaturated fats, is a major factor in reducing diet-based inflammation.

The diet that I recommend is designed to eliminate all of the common sources of dietary inflammation. I also make suggestions on restructuring gut flora.

Treating allergies requires persistence, but the triggering allergen is only the most obvious symptom of substantial underlying problems than cannot be addressed by just avoiding the allergen.

Thanks for your comments/questions.

Dr. Art Ayers said...

Switching from grains to non-gluten starches.

I recommend avoiding grains, because the majority of people react to gluten and bran, and their gut is not fully functional. I think that grain/gluten intolerance is a major entry point for autoimmune diseases.

Many people try to avoid grains, by switching to other high starch foods. That misses the point that starch and the spike in blood sugar and insulin that it causes are a significant health problem. There is no need for substantial amounts of carbs in the diet and for most people they are a problem. Saturated fats as the source of dietary calories is much safer and satisfying. Eliminating the starch, eliminates most hunger due to crashing blood sugar.

I think that your approach using fermented grain substitutes is sound, except that the amount of these sources of starch in the diet should, in my opinion, be small. I think that starch in the diet is just a bad habit.

Thanks for your comments and congrats on your health successes.

Dr. Art Ayers said...

I think that the structure of the study used to conclude that bran contributes to health is limited and only shows the people eating bran are healthier. It can't actually show the direct contribution of bran to health.

The bottom line is that most people who stop eating grains and bran feel better, and most cultures eating grains as a major part of the diet have some way of reducing the bran content.

There is no convincing evidence of bran benefits, no explanation of why bran would be healthful and convincing reasons to not eat it. Putting bran in foods and advertising it as healthful is just a way of marketing a waste product of the processed food industry.

Thanks for your comments/questions.

Monika said...

Dr. Ayers

I am a rosacea sufferer. I recently got a blood test for Vit D. My 25-OH-D level is 32ng/ml. How high do you think it should be for me to see improvements?

Anonymous said...

I saw you comment on bran, Dr.Ayers. Is oat bran and rice bran as bad a wheat bran. I always thought that oat bran is a valuable prebiotic.

Dr. Art Ayers said...

Vit.D deficiency may be one source of inflammation that is contributing to your symptoms and it may also compromise attack on cryptic bacteria.

I would recommend using an anti-inflammatory diet as I outline to eliminate diet-based contributions to inflammation, an make sure that your gut flora is functional, e.g. normal bowel movements and not constipation, to avoid immune system problems. Also be aware that candidiasis may be a problem following antibiotic treatments.

Then, some rosaceans find that slowly increasing serum vit.D above 80ng/ml attacks some of the root causes of flareups. Avoid setbacks by proceeding no faster at increasing your serum vit.D than you can without flareups that quickly recover.

Please let me know if this is helpful.

Anonymous said...

Pooled human breast milk given to neonates is usually pasteurized thereby greatly reducing the antimicrobial effectiveness of the milk. Studies have shown that babies fed raw breast milk gain weight more rapidly than those fed pasteurized breast milk, a fact attributed to destruction of lipase by pasteurization. Babies fed pasteurized breast milk are also at greater risk for infection than those fed raw breast milk apparently due to inactivation of lactoferrin, lactoperoxidase and other factors.

It has been found that raw cows milk does not support the growth of pathogens such as Salmonella, E.coli0157:H7, or Listeria whereas these pathogens thrive in pasteurized milk. It seems that raw A2 cows milk would be more beneficial to neonates than pasteurized human breast milk.

The study, "Human Milk Inactivates Pathogens Individually, Additively and Synergistically" attributes much of the antibacterial capacity of human breast milk to the conversion of lipids in the milk to antibacterial triglycerides in the gut.

Dr. Art Ayers said...

Oat and rice bran
It is hard for me to have a balanced evaluation of brans. They are excessively hyped for their benefits and their problems are avoided. Most people like oat bran, because it encourages them to overeat starches. I don't consider oats to be nutritious and they are bad choices for breakfast, because of their high starch content.

The insoluble beta-glucans, I consider to be medicinal, i.e. potentially unhealthy because they are inflammatory ("stimulate the immune system"). They can be used to improve the performance of vaccines, for example, because they heighten inflammation that is conducive to aggressive antibody production. This is not something that would normally be healthful, because it also contributes to autoimmune disease. Stimulating the immune system is not normally healthful. At the same time, blocking immune reactions is also only appropriate in emergencies, e.g. anaphylatic shock or cytokine storm.

Bran can be considered to be modestly prebiotic, because your gut flora can learn to digest some portions of the polysaccharides, but I think that as the repository of the defensive molecules responsible for protecting seeds against pathogens, brans of all types are more toxic than healthful.

Related note: Essentially all toxic plant phytochemicals would be classified as good anti-oxidants. The term anti-oxidant is usually meaningless in reference to the actual action of a phytochemical when eaten.

Thanks for your questions.

Dr. Art Ayers said...

Jack C,
Milk is highly adapted to provide nutrition, development and defense to neonate GI tracts. Proteins, lipids and carbohydrates, as well as maternal cells contribute to those activities. In addition, the milk components interact with cells of the intestinal lining to produce still more complex reactions. Many of these interactions are species specific and inactivated by increased temperature, e.g. pasteurization.

Pasteurization of milk compromises the healthful properties of milk and may actually make it contribute to some health problems. The same can be said for using milk from different species and that is why cow's milk is unhealthy for infants. Cow's milk is nutritionally unbalanced and stimulates inappropriate gut flora for human infants. Formula attempts to minimize the unhealthy aspects of cow's milk, but still has many severe problems. The proteins, lipids and carbohydrates (particularly oligosaccharides) are very different between human and cow's milk. Cow's milk also has a form of sialic acid (Neu5Gc) that is not tolerated well.

Pasteurization of human milk is necessary to make it acceptable as a commodity (to avoid fear of pathogens), but is probably no more appropriate than pasteurization of blood. After all, both milk and blood contain living cells.

Any form of cow's milk, raw or pasteurized or A2, is not as healthy for infants as any form of human milk. All forms of cow's milk, including formula, should be avoided in hospitals for use with infants.

Thanks for your comments.

Steve said...

Dr Ayers,

At what stage does a child generally move towards a more 'adult' type gut flora? While dairy is obviously a bad choice for infants, when would you consider it "least bad" or even benificial to add some high quality dairy (greek yoghurt, artesian cheese, some milk; biodynamic, grass-fed, raw if possible) to the diet.
I encourage real 'adult' food (meat/vege/fat) to any infant/child not being breast fed (albeit in a different form) and wanted to make sure I (or the parent) wasn't sabotaging my own work by adding dairy to early.



Dr. Art Ayers said...

The rule of thumb that my wife and I found to be true was to start supplementing breastmilk with solid food when our daughters had some top and bottom teeth for chewing. It takes about six months for the growth factors in breastmilk to close the infants GI tract and start the development of the immune system. Formula or other forms of modified cow's milk disrupt the normal infant gut flora and cause inflammation. A recent study of gene expression in exclusively breastfed vs. formula fed infants demonstrated that the intestines developed differently with hundreds of differences in the activity of individual genes.

I think that any form of dairy or grain products during the first year is probably not a good idea. The dairy is discouraged because of the content of non-human sialic acid (Neu5Gc) and the grain because of the prevalence of gluten intolerance and mineral leaching of bran. I also think that infants probably lack the capacity to detoxify most phytochemicals in plants and should avoid leafy veggies and seeds.

It seems that the world is a dangerous place and nothing is free of fangs or thorns. Under the best of circumstances an infant would progress from exclusive breastfeeding to home-crushed meat and starchy fruits and vegetables to avoid the perils of any use of formula or processed baby foods. That's what we did with our three daughters. It was easy, cheap and healthy.

Thanks for the questions.

kim said...

Dr Art
Do you have an email I can reach you at.
Regards Kim

Wanda said...

Hi Dr. Art,
I have a 4 week baby who seems to have colic. My midwife is suggesting the use of a prebiotic supplement in drop form to help relieve the colic. Do you typically advise against pre (pro?) biotics in infants? Have you heard if it is harmful to the flora formation? I should mention that my baby is breastfed only, no formula at all.

Dr. Art Ayers said...

I would not recommend prebiotics for infants that are breastfed, because they are not appropriate for infants and promote the development of bacteria that could potentially disrupt the normal bifidusbacteria of an exclusively breastfed infant. Only the bifidus factor (elongated oligosaccharides starting with lactose) derived from human breast milk would be appropriate and that isn't normally available. Prebiotics are not natural for human babies.

I think that the problem of cholic starts with the mother's immune system and its response to cow antigens. (Although there are probably several types of cholic.) If your baby is already primed by your response to cow/meat antigens, then avoiding dairy would be the first step. Breastfeeding until your baby's immune system starts to function independently is a wonderful beginning.

I spent numerous endless nights rocking, walking and otherwise trying to pacify my babies and I didn't have breasts for complete nurturing, so I can understand some of your frustration. It is very harsh, but baby necks still smell nice and my arms still miss them decades after I have forgotten the exhaustion.

I hope that you are familiar with the 5 S's.

Wanda said...

Dr. Ayers,
thanks for the reply. The bacteria is Lactobacillus reuteri, not sure if that makes a difference. What are the 5 s's?