‘Cultured’: A Look At How Foods Can Help The Microbes Inside Us Thrive

February 24, 20197:00 AM ET

Jonathan Lambert

Korean kimchi, made of salted and fermented vegetables, contains microbes that contribute to its distinctive taste.

Katherine Harmon Courage wants us to think about digestion as a collaborative journey between us and our microbes. In her new book, Cultured: How Ancient Foods Can Feed Our Microbiome, she envisions digestion not as a simple food-in, excrement-out process, but as a series of encounters with varying microbial players that takes place along the winding 30-foot tunnel of our gastrointestinal tract. Along the way, microbes digest the food we can’t, and in return we give them a warm, well-stocked place to live.

But a surge in microbiome research over the past two decades has revealed they do much more than simply digest food. They can mediate weight gain, fight off infection, and even alter our mood. Scientists still have much to learn about the identity of these microbes, which are important, and how the beneficial ones work their magic.

Incomplete understanding hasn’t stopped the burgeoning probiotic industry, which argues that we can improve our gut health by taking a pill stuffed with billions of beneficial strains of bacteria, or eating a probiotic-infused yogurt with breakfast. The thinking goes that we just need to eat the right microbes to construct a healthier gut.


Courage believes this focus on the microbes themselves is myopic. She views the process of digestion as collaborative because the food we put into our bodies affects the kinds of bacteria that live and thrive there. In her book, she explores the science behind how what we feed our microbes affects our health.

She thinks we can learn how to better work together with our microbial partners by looking to the past. From Greenland to Greece, Courage explores the ancient gut-friendly foods that have become integral parts of many food cultures, and offers suggestions on how to diversify the kinds of foods we feed our microbiome.

We spoke with Courage about the science behind pro- and prebiotics, and what she learned exploring fermented staples across the world. The interview has been edited for brevity and clarity.

A lot of the buzz around the microbiome has been about the microbes themselves, and what they do for us. You focus much of your book on what they eat, the ” prebiotics” we feed them. Why?

It may be less interesting to talk about fiber than about all these new species we’re learning about and infusing into foods, but what we feed our microbes is just as important as what microbes are there.

I think that, from our human perspective, it’s helpful to think about microbes in two broad categories. There are microbes that we have in our guts throughout our lives that are adapted for living there, and then there are the microbes we get from food or supplements. Those latter ones just kind of pass through. They can survive the journey, and can certainly provide benefits along the way, but they aren’t long-term residents of the gut, and they’re not going to have the long-term health impacts that more-permanent residents might have.

We’re starting to learn more about how we can create the conditions for those resident microbes to thrive and potentially benefit us, and a large part of that is what we feed them. And much of what we feed them is fiber.

What happens if we don’t feed our microbes?

So then they start to eat us — our lower intestine, which is only a single human cell thick, which helps us absorb as much as we can from our digested food before we expel it. But it also makes it easy for things to escape.

When our microbes don’t get enough fiber, they can start eating away the mucus lining protecting this thin layer, and sometimes the lining can break, which can lead, literally, to leaky gut syndrome, which is associated with many poor health outcomes.

When I think of fiber, I think processed, cardboard-like breakfast cereal. Is fiber more diverse than that? How important is having a diverse diet of fiber to cultivating a healthy microbiome?

Prebiotic fiber is just any kind of carbohydrate that we can’t digest ourselves that instead passes through out digestive system as food for microbes. There are many different types of fiber that get broken down by different microbes at different stages of digestion. That’s why it’s a good idea to eat a wide variety of foods, and not just focus on a particular supplement here and there. Lots of different kinds of fibers help lots of different microbes thrive and create different beneficial compounds for us. Which is good because we’re learning that generally, a more diverse microbiome is an indicator of health. If you look at people’s guts around the world — and even in the same society — people with more diverse microbiomes tend to be healthier overall.

You Don't Have To Go No-Carb: Instead, Think Slow Carb

The Salt

You Don’t Have To Go No-Carb: Instead, Think Slow Carb

What are some examples of different types of fiber and the foods that carry them?

One kind of fiber that’s gotten a lot of focus is inulin. We’ve actually been adding it to foods for longer than we’ve been looking closely at it, but it’s commonly found in foods like chicory root or sunchokes. It’s a very long carbohydrate chain, which means it takes a bit longer to pass through our system and get broken down by microbes. Research shows that it encourages growth of bifidobacteria, lactobacteria [two strains of bacteria commonly associated with health benefits].

Another big one comes from fruits and veggies, called Fructo-oligosaccharides. It’s shorter than inulin and adding it to your diet has been shown to reduce markers of inflammation.

Galacto-oligosaccharides are another form of fiber found in milk, and are broken down in the colon.

I was really surprised to learn about resistant starch as another form of fiber. It comes from more simple carbohydrates that have been cooked and then cooled; think of cold potato or pasta salad. So once those starches are crystallized, they become the type of resistant starch that our bodies can’t break down anymore [but our microbes can]. Even cold pasta, which you don’t necessarily think of as being healthy, can be a great source of resistant starch.

Do other aspects of our diet besides fiber affect the microbiome?

Almost everything we eat has some kind of impact on our microbes. One example I talk about in the book is meat. Really kind of fatty meats like pork can have a negative health impact on us via our microbes, because they produce a metabolite called TMAO, which has been linked to negative health outcomes. But fish oil has been shown to be beneficial — the microbes of mice fed fish oil instead of pork lard produced much fewer TMAOs.

Another exciting area of research is looking at how gene expression in the same microbial strains can change, based on what they’re being fed. Different metabolites get produced not by different microbes, but by the same microbes being fed differently.

Chowing Down On Meat, Dairy Alters Gut Bacteria A Lot, And Quickly

The Salt

Chowing Down On Meat, Dairy Alters Gut Bacteria A Lot, And Quickly

You looked at a lot of research comparing Western diets to more traditional, hunter-gatherer diets. How did their diets and microbiomes differ?

Researchers look to hunter-gatherer societies to try to understand what our ancestral diets looked like, before the advent of agriculture. This can give us clues potentially to the kinds of diets humans are adapted for.

These studies find that we eat a lot less fiber than we probably used to.

The FDA recommends something like 30 grams of fiber a day, but most Americans don’t even get that. Traditional hunter-gatherer cultures, like the Hadza group in Africa, eat 100-plus grams of fiber a day.

So people eating modern, Western diets are getting maybe 15 to 30 grams of fiber a day, when our bodies may be adapted to expect over 100. This lack of fiber seems to be making a big impact on the diversity of our microbiome. These traditional, high-fiber dieters have a much more diverse microbiome than [people eating] more modern diets, [and the former] is often linked to better health outcomes. It’s hard to draw hard conclusions about cause and effect here, because there are so many other lifestyle factors at play, but it certainly seems that our low-fiber diet is not great for our health.

In reporting your book, you go on a culinary quest exploring all these different fermented and microbial foods. What was the most surprising food you encountered?

By far it was Kiviak, which is a traditional Inuit food from Greenland. Kiviak is birds, specifically Auks, fermented inside a seal skin. So when Auks are in season they capture the birds and stuff [up to 500] in the seal skin, sew it up and leave it underground to ferment for a year, and then dig it up and eat it.

It’s important to remember that fermentation didn’t necessarily come about because people were thinking about the health benefits. It was a way to preserve foods and make it through a harsh Greenland winter.

A lot of these foods are not seen as individual things to be eaten for a specific benefit, but rich, integral parts of food culture. How does culture shape how we feed our microbiome?

There’s really not a culture out there that doesn’t incorporate some kind of fermented food, and many have a rich diversity of different kinds of fermented foods.

We think about things like kimchi as being the Korean fermented food, and it is actually their national food, but they have so many other kinds of fermented foods that they infuse throughout the whole cuisine.

These foods aren’t really viewed as this separate thing. You’re not eating kimchi as a little healthful snack for your microbes and then going back to your normal diet. These fermented foods are incorporated into the food culture — they’re condiments, sides, flavorings. A meal seems incomplete or unbalanced without them.

And that kind of consistency is a healthier, more sustainable way to feed our microbiome?

Yes. Generally, the kind of wild fermented foods — like kimchi, sauerkraut, or pickles — tend to have a higher diversity of microbes than your store-bought, probiotic-infused yogurts. Whether each individual strain in these foods is good for us is still unknown, but again, higher diversity tends to be associated with better health.

What advice do you have for those wanting to boost the health of their microbiome?

It’s really about creating the right environment for our native microbes, and the best way to do that is by eating a lot of diverse types of fiber for them. I don’t think probiotics or seeking out specific fermented foods is bad, of course, but focusing on fiber is a good first step.

2018 Highlight – We Stand Up for Science & Medicine Amid Archaic American Health Model

AAOSH Responds to JADA Editorial that Claims Promoting Oral-Systemic Connection is ‘Premature and Misleading’


June 15, 2018

Jacque Russo, RN, DDS; Susan Estep, DDS; Susan Maples, DDS; DeWitt Wilkerson, DDS; Michael Milligan, DMD; Victoria Richards; Jan Lazarus, RDH; Doug Thompson, DDS; Mark Cannon, DDS; Gary Kadi; Amy Doneen, DNP, ARNP; William Domb, DMD; Chris Kammer, DDS

In the recent issue of the Journal of the American Dental Association, the guest editorial, “Promoting oral health care because of its possible effect on systemic health is premature and misleading,” by Bruce L. Pihlstrom, et. al. expressed the opinion that “there remains a need for more convincing and higher quality evidence that oral health care actually has a measurable impact on specific systemic diseases before it can be claimed that attaining good oral health can prevent systemic diseases or conditions.” 

As the board of the American Academy for Oral Systemic Health, we find this editorial piece to be highly disheartening due to its failure to see the bigger picture when it comes to the relationship between oral health and systemic disease.  

It is a disservice to unknowing patients when practitioners neglect the mounting associations, causation, and level-A evidence published in prominent medical journals like Circulation, the Journal of the American Heart Association, and Lancet that infection in the mouth significantly contributes to medical conditions like Alzheimer’s disease, heart attacks, stroke, pre-term births, diabetes, cancers, rheumatoid arthritis, and a host of other inflammatory conditions. (And that’s not even touching the associations involved with airway development, sleep apnea, and myofunctional disorders.) Major universities and medical institutions like the Cleveland Clinic are already changing their standard of care to incorporate the oral-systemic associations that research has uncovered. We have a responsibility not to overstate the relationship, but we are obligated to be informed and to inform our patients.  

The old model in traditional medicine of treating symptoms and body parts in isolation is flawed. Body parts and organ systems are connected via the bloodstream, the lymphatic system, the endocrine system, the gastrointestinal system, the nervous system, and the immune system. To say that what happens in one part of the body does not affect the rest is simply irrational.  

It is true that correlation does not equal causation, and patient care cannot and should not be dictated by a single piece of research. However, we must not let the perfect be the enemy of the good. To ignore significant associations and positive outcomes just because scientific studies have not yet proved causality is negligent. The link between cholesterol and heart disease is not one of causality, yet the medical community encourages millions of people every day to take medication (not without side effects) and make lifestyle changes that will help lower cholesterol with the goal of mitigating risk of heart disease.   

Furthermore, we find it offensive that the authors would suggest that dental professionals are using the oral-systemic connection as a means of acquiring new patients and increasing profits. Due to the intense training and additional resources involved in practicing oral-systemic health dentistry, you’ll find very few oral-systemic dentists who are “in it for the money.” 

There are, however, tremendous financial advantages to our population by treating people holistically.  Research by insurance companies has shown that improving oral health actually saves patients money on healthcare costs by reducing complications and hospital admissions for chronic health conditions.  

Not only do dental professionals see patients more frequently than medical practitioners, we are in the unique position of seeing patients primarily when they are healthy—when they are open to learning how the mouth can affect their oral and overall health. Because the mouth is such an amazing indicator of systemic health, we have a unique opportunity to address nutrition, sleep, airway development, acid reflux, food allergies, smoking cessation, caries, HPV-oral and pharyngeal cancers, eating disorders, and more in the context of the patient’s health history and in a way that encourages the patient to become an advocate for his or her own health. What other healthcare professional out there is providing such a well-rounded discussion? And how can that possibly cast a negative light on our profession? 

We know that having good oral health has many advantages and that poor oral health has many disadvantages. Effective and efficient chewing, enjoyment of food, pleasing appearance, self-confidence, and freedom from pain and infection are just a few of the benefits of good oral health. Educating patients about the potential systemic risks and side effects associated with poor oral health, malocclusion, and airway issues just gives patients more reason to take our care seriously. No one is suggesting dental care is the magic pill to cure all disease.  

Science changes daily, as does our understanding of it. As recently as the 1950s, physicians were prescribing cigarettes to help with conditions ranging from coughing to anxiety. And a little over a decade ago, we had no idea that the complexity of periodontal disease was enough to negatively influence glycemic control or cardiovascular health. Change is never easy, but the evidence of a significant association between oral and systemic health is incontrovertible. We must not let the complexity of this association deter us from expanding the nature and scope of our care when it is so clearly warranted.  

Treating and reversing chronic disease must be a collaborative effort among practitioners across different disciples. Practitioners are moving from their silos to co-diagnose and co-treat. For the good of our country, our patients, practitioners, and our profession, dentistry cannot afford to miss the opportunity to be part of this collaborative effort. A growing number of dentists are working with physicians and other healthcare practitioners for more optimal treatment results. Unless we stand up and take our role as the physicians of the mouth, we, dentistry, and oral heath will not be viewed or accepted in our vital and important roles. 

We are excited about the growing recognition of the important role dentistry can and must play in the battle against the epidemic of chronic disease. With this recognition, we draw attention to the high-quality research publications the authors called for. The medical literature has numerous articles, published in the highest rated peer-reviewed journals, documenting the oral-systemic link. It is very important for all dental professionals to not just read a few dental publications for their continued education, but to embrace the vast amount of scientific literature available.  

Below you will find some additional study links and resources that discuss the relationship between oral and systemic health. We encourage JADA’s readers to explore these, do their own research, and establish their own conclusions about what the science says.   

We also encourage anyone interested in this topic to visit our website, join the conversation with us online, and/or to make plans to attend our Annual Scientific Session in conjunction with the American College for the Advancement of Medicine (ACAM) and the American Academy of Physiological Medicine and Dentistry (AAPMD)—our first joint medical/dental conference. 


Research Studies 



Raw vs Cooked: The Healthiest Ways to Eat Your Veggies

Raw vs Cooked: The Healthiest Ways to Eat Your Veggies

bundled raw asparagusWhen it comes to raw vs cooked vegetables, what are the healthiest ways to eat them to get the most nutrients? Learn what the science and the experts say about the best ways to prepare your veggies to get the most benefits.

Raw diets have been getting a lot of attention. Some people believe eating raw foods means you’re getting more nutrients. Or that cooking food kills the natural enzymes in plants, as well as the vitamins and minerals.

On the other hand, other people say cooked foods are easier on your digestion, are healthier, and sometimes taste better.

So what’s the truth about raw vs cooked vegetables? How should you be eating your veggies to get the most benefits?

Are More Nutrients Always Better?

Raw vegetables often contain more nutrients. So naturally, many people think they’re healthier for you. And, sometimes, that’s true. But the reality is more complex.

When it comes to the good-for-you components of foods, Michael Greger, MD, says: “It’s not what you eat, it’s what you absorb.”

A 2010 study published in the American Journal of Clinical Nutrition found that when women followed either an average Western diet, a wholesome nutrition diet (based on healthy dietary recommendations), or a raw food diet, more nutrients weren’t always better.

For example, participants in the raw food diet group consumed more beta-carotene per day than any other group. But participants in the wholesome nutrition diet group absorbed the most of this critical antioxidant.

When you cook your veggies, you lose some nutrients. But others become more available for your body to use.

Raw vs Cooked: Some of the Benefits of Cooked Vegetables

In addition to apparently supplying you with more absorbable beta-carotene, as mentioned in the study above, cooked veggies give your body more of certain other antioxidants, such as lutein(which is good for your eyes) and lycopene (which helps protect your heart and your bones).

Cooked vegetables can also give you more minerals. Heating releases bound calcium, making more of the mineral available for the body to absorb. And the difference can be significant. Cooked spinach has 245 mg/cup of calcium, while raw spinach only has 30 mg/cup!

Cooking can have other benefits too. A 2009 study published by the Cold Spring Harbor Symposia on Quantitative Biology journal and conducted by Harvard University showed that cooking:

  • Aids chewing
  • Increases digestibility, and
  • Improves the net energy value of foods

Plus, some evidence suggests that cooked foods contributed to the evolution of the human brainbecause it “greatly increases the caloric yield of the diet, as a result of the greater ease of chewing, digestion, and absorption of foods.”

With many vegetables, the best way to prepare them is the way that gets you to eat them. If cooking them means you’ll eat more, that could be a very good thing.

9 Foods That May Be More Nutritious When Cooked

Sometimes, adding heat makes veggies better for you in some ways. Here are nine vegetables that might be better for you when cooked:

  • Spinach — This dark green leafy vegetable shrinks up when cooked, which makes it easier to eat more. And more spinach equals more nutrients! Spinach contains oxalic acid, which can hurt your body’s absorption of calcium and iron. But steaming spinach has been shown to cut the oxalic acid by five to 53%. Steaming also allows the spinach to retain its folate content, a B-vitamin that helps your body produce DNA.
  • Asparagus — A 2009 study published in the International Journal of Food Science & Technology found that cooking asparagus increased its antioxidant and cancer-fighting activity (including phenols, quercetin, rutin, beta-carotene, lutein, and zeaxanthin) by 16 to 25%. And a 2009 study published in the International Journal of Molecular Sciences found that cooking asparagus increased the level of two types of phenolic acid, which has been linked to lower cancer rates.
  • Tomatoes — Lycopene (found in many red and pink pigmented foods) is an antioxidant and an anti-inflammatory, and has been linked to lower levels of cancer and heart attacks. A 2002 study published in the Journal of Agriculture and Food Chemistry found that cooking actually boosted the amount of lycopene in tomatoes. Also, lycopene is a fat-soluble antioxidant, which means it’s better absorbed by your body when consumed with some healthy form of fat.
  • Mushrooms — Mushrooms retain more antioxidants when cooked. A 2006 study published in the journal Food Chemistry found that using heat significantly enhanced the overall antioxidant activities of Shiitake mushrooms. Additionally, some types of raw mushrooms contain a potentially carcinogenic substance called agaritine. Joel Fuhrman, MD, says cooking mushrooms for even a few minutes gets rid of most of the mild toxins they contain.
  • Potatoes — In general, raw potatoes contain a lot of resistant starch, which can cause gas and bloating. Raw potatoes also have anti-nutrients (which can interfere with the absorption of key vitamins and minerals) that decrease during cooking.
  • Carrots, Celery, and Green Beans — A 2009 study published in the Journal of Food Sciencefound two vegetables that actually become healthier with cooking — carrots and celery. Green beans did, too, except when they were boiled or pressure cooked. Cooking and pureeing carrots (with the skins on) can multiply their antioxidant power threefoldRoasting can also boost nutrients.
  • Legumes — Most legumes can’t be eaten raw, though some can be sprouted as an alternative to cooking. Some beans (red kidney beans in particular) contain a specific lectin that can cause gastrointestinal issues; however, cooking deactivates this compound. Nutritionally, a 2013 study published in the journal Food Chemistry found that both sprouting and cooking beans improved some of their health benefits including their neuroprotective and anticancer effects.

Which Cooking Methods Should You Avoid?

Frying creates free radicals and carcinogens, which do major damage to your cells.

Fried foods also often contain trans fats, which are unsaturated fats that have been hydrogenated and are linked to cancer, diabetes, heart disease, and obesity.

And when it comes to preserving the antioxidants in your vegetables, steaming is better than boiling.

Why? Because when you boil foods, some of the nutrients get lost in the water. In fact, in a 2009 study, 14% of antioxidants were lost on average across 20 vegetables when boiled.

With that said, eating more of the boiled vegetables can make up for the loss. Also, keeping the water and using it to cook grains means you can still absorb those good-for-you compounds!

Raw vs Cooked: Reasons to Eat Raw Vegetables

Eating the phytonutrients found in plant foods has been associated with reduced risks of certain chronic diseases, such as heart disease and strokecancer, and age-related eye disease.

But many of these beneficial compounds can be destroyed by heating and many types of food processing.

In addition, water-soluble vitamins, such as vitamin C and B vitamins, leach out during the cooking process. According to a 2007 review published in the Journal of the Science of Food and Agriculture, you lose as much as 55% of the vitamin C in vegetables during cooking, compared to eating them raw.

Eating raw vegetables may also help boost mental health and relieve symptoms of depression. A 2018 study published in the journal Frontiers in Psychology found that people who consumed more produce in its natural, uncooked state reported higher levels of psychological well-being compared to those who ate mostly cooked alternatives.

For those who are watching their weight, eating raw produce can be beneficial because it requires more chewing — thus slowing down the eating process.

What About the Enzymes in Raw Food?

Advocates for raw or mostly raw diets often point out that raw plant foods carry natural enzymes. These enzymes have digestive and other health benefits which are destroyed when heated. And from a certain perspective, they’re correct.

Heating does destroy enzymes. But we make our own digestive enzymes, and healthy people have no trouble synthesizing the enzymes they need for digestion. In addition, most plant enzymes get destroyed in the human gut, anyway.

So while there may be some digestive benefit from eating the enzymes that come with raw fruits and vegetables, there’s little evidence to support the notion that this is a major reason to eat raw foods. There are, of course, other good reasons to include plenty of raw foods in your diet.

The best way to ensure you have plenty of enzymes to support your digestion is by nurturing your overall digestive health. (For help improving your gut health, read this article.)

4 Foods You May Want to Eat Raw, At Least Sometimes

Raw vs Cooked Vegetables: The Healthiest Ways to Eat Your Veggies

These are some of the foods that have bigger benefits for you (at least for some nutrients) when you eat them raw. Of course, they are wonderful cooked, too.

  • Bell Peppers — Whether you like your peppers red, green, or orange, it’s better to eat them raw. A 2009 study published in the Journal of Food Science found that bell peppers lost up to 75% of their antioxidants when cooked.
  • Broccoli — According to a 2008 study published in the Journal of Agricultural and Food Chemistryraw broccoli contains three times the amount of the cancer-fighting compound sulforaphane.
  • Onions — While cooked onions have plenty of health benefits, raw onions contain antiplatelet agents, which protect against heart disease.
  • Garlic — Raw garlic contains special sulfur compounds which have an anticarcinogenic (anti-cancer) effect. A 2001 study published in The Journal of Nutrition found that cooking can destroy these sulfur compounds.

Why Too Many Raw Crucifers Can Harm Your Health

Can too much kale be a bad thing? Sometimes it can.

Eating too many raw crucifers can lead to hypothyroidism, a condition in which the thyroid gland doesn’t make enough of the thyroid hormones.

How much is too much? According to 1993 study published in the Journal of the Science of Food and Agriculture10 cups of raw kale a day on a regular basis is probably the limit.

Plus, the amount varies for different types of cruciferous veggies.

Dr. Michael Greger says, “You could probably get away with, theoretically, 50 cups of raw cauliflower a day. But just three cups of raw mustard greens a day.” Another study found that a woman eating 15 cups of raw bok choy daily for several weeks went into a hypothyroid coma.

But reasonable amounts of raw cruciferous vegetables should be fine. And the goitrogenic properties of kale and other cruciferous veggies dissipate when you cook them. So a better approach is to switch up your greens, eat some raw and some cooked, and to consume a wide variety of colorful vegetables.

How to Get the Most Benefits from Cooked Cruciferous Vegetables and Garlic

If you want to cook broccoli and other cruciferous vegetables, including Brussels sprouts, cabbage, cauliflower, kale, radish, rutabaga, turnip greens, and arugula, here are three science-backed steps you can take to maximize their health benefits:

  • Pre-chop them first and let them sit for 40 minutes before cooking
  • Add some mustard seed powder (or some daikon radish, horseradish, or wasabi) after cooking, or
  • Add a small amount of fresh, raw cruciferous veggies to your cooked ones

And here’s how to get the most benefit from cooked garlic:

  • Cancer-fighting allicin is relatively heat-stable. If you want to cook garlic, crush or chop it, then wait 10 minutes before cooking. This will allow the allicin to form.

Can A Raw Food Diet Be Beneficial for Health?

A raw food diet typically contains 70% (or sometimes 100%) of food that hasn’t been cooked or processed. To be considered raw, food can’t reach above 104 degrees Fahrenheit (40 degrees Celsius) when heated. Instead, people eating a raw food diet consume a lot of fresh, dehydrated, and fermented foods.

Thousands of anecdotal reports exist of people using raw diets to cure conditions, such as acne, autoimmune disorders, candida, cancer, IBS, and numerous other ailments. However, few scientific studies exist to support these claims.

Here are a couple of studies that have shown positive results:

  • A 2000 study published in the Scandinavian Journal of Rheumatology found that a low-salt, raw vegan diet helped alleviate the symptoms of fibromyalgia.
  • A 2009 study published in the journal Complementary Therapies in Medicine showed that people who stayed for one to three weeks at a raw, vegan retreat center saw improved mental and emotional health.

Why Raw Food Diets May Not Be Beneficial Long-Term

While raw food diets have been found to give remarkable results in the short-term, they are difficult to follow. Raw diets are also typically time-intensive — and they don’t seem to support long-term health.

Chris Wark used a raw food diet (including his cancer-fighting salad and his anti-cancer smoothie), along with lifestyle changes, to beat cancer. But he says, “Raw food can be healing, but it’s not sustainable long-term.”

Dr. Michael Greger says the reason switching to a raw food diet can improve health is because it’s an extremely healthy diet.

He says, “One of the benefits that raw diets have over vegan diets is [they] cut out all the crap.” (Like vegan marshmallows and donuts.)

Researchers have also found that long-term adherence to a raw diet can lead to a high loss of body weight, which can cause health issues from being underweight, including amenorrhea in women — a condition in which menstruation ceases.

And a 2005 study published in the Archives of Internal Medicine associated a 100% raw, plant-based diet with a lower bone mass — which is usually a sign of osteoporosis and increased fracture risk.

A Must-Have Resource If You Want to Try A Raw Diet

If you want to try a raw diet, you want to take steps to be sure you get the nutrients you need.

Brenda Davis, RD, and Vesanto Melina, MS, RD, wrote what could be the definitive book on how to eat a raw (or mostly raw) diet and meet your needs for vital nutrients. It’s called Becoming Raw: The Essential Guide to Raw Vegan Diets.

It’s important to note, however, that neither Brenda nor Vesanto practice or broadly recommend a purely raw diet on a long-term basis.

Raw + Cooked = The Winning Combo for Your Health

A spread of raw and cooked veggie dishes on a a table

The consensus among most nutrition experts is that you need both raw and cooked veggies to get the most vitamins and minerals.

While some might be better cooked and some might be better raw, the bottom line is this: More fruits and vegetables is better, period.

“We should be eating a lot of raw foods each day, but to think that a diet that is 100% raw is better than one that has some steamed vegetables or soup in it is just a distortion of the science; it’s not accurate,” says Dr. Joel Fuhrman.

He recommends starting both lunch and dinner with a large raw salad or some raw vegetables. And then, he may eat a cooked vegetable-based meal.

Eat Your Veggies the Way You Want and Listen to Your Body

It’s well established that people who eat more vegetables and fruits are less likely to suffer from chronic diseases.

When it comes to consuming more healthy, colorful fruits and vegetables, it’s best to eat them the way you prefer.

As Dr. Michael Greger says: “The best way to eat your veggies is really whichever way will get you to eat the most of them, with the exception of frying, which just adds way too many empty calories.”

And when it comes to raw vs cooked, listen to your body and find a balance that works for you because we are all unique. You may want to make changes in how you eat based on the seasons, as your health changes, and as you age. But, ultimately, eating more veggies, whether raw or cooked, is what matters the most for your health.

Taming the Fire Within

Taming the Fire Within, with Tieraona Low Dog M.D.

Systemic, chronic inflammation is at the core of so many health issues today. In this interview with Tieraona Low Dog M.D., she offers pragmatic advice on how to address systemic inflammation. Dr. Low Dog unpacks her medical kit of foods, supplements and pragmatic advice on how to quell this instigator of chronic illness. Interviewed by Kimberly Lord Stewart

KLS: The foundation for any anti-inflammatory therapy is diet. What is known now about the role of diet and inflammation? TLD: We are learning a great deal about how fats and carbohydrates interact within the body to affect inflammation. I think one of the big mistakes that we made in nutrition science was to demonize fat, which resulted in people dramatically increasing their consumption of sugar-laden and high glycemic load carbohydrates. A diet that habitually causes a rapid and steep climb in insulin and insulin growth factors is going to drive inflammation. Anything that drives obesity also drives inflammation. They are intertwined.The problem is that people consume far too many highly processed and refined carbs. Pop-tarts or white bagels for breakfast, spaghetti for dinner, mac-n-cheese, French fries, soda pop, candy, cookies and the like. The dramatic increase in added sugars in the diet over the past seventy years is nothing short of mind-blowing. The human body was not designed to process this much readily available sugar, especially when combined with a population that is increasingly sedentary.While I don’t believe that whole grains can’t be part of a very healthy diet, I do think we need to ditch the food pyramids that put grain at the bottom. The DASH (Dietary Approaches to Stop Hypertension) diet, which has been shown to lower inflammatory mediators, improve blood glucose levels in diabetics and reduce blood pressure has the vegetables and fruits at the base of the pyramid. Much better!


KLS: Clinical science is leading to a better understanding of theories behind glycemic index and inflammation. What is your take on glycemic loads, inflammation and insulin growth factors?

TLD: There was an interesting study that came out recently on breast cancer. Women with breast cancer were put on a low glycemic diet or a control diet. The women on the low glycemic load diet that had insulin growth factor receptors (IGF-1R) on their tumors had a dramatically reduced risk of recurrence and longer survival times. IGF was contributing to the cancer growth. We know without question that elevated insulin and IGF-1 can increase tumor aggressiveness and growth (see the reference list at the bottom of the article.).

This study was one of the few to actually look for IGF receptors on the tumors themselves. Half the women had it. This may explain why some cancer studies that compare low fat and low-carb diets show mixed results –because we are not looking at specific tumor typing. And no one is routinely checking IGF-1R on breast cancer tumors.  I don’t think it will be that far in the future when this level of personalized medicine becomes more commonplace. Then we will know what kind of diet is right for each person. But for now, given what we know our goal should be to drive down insulin and insulin related-growth factors.

It’s not just cancer. Insulin resistance and chronic lingering inflammation are responsible for much of the chronic disease we see today whether we are talking about diabetes, cardiovascular disease, metabolic syndrome, periodontal disease, osteoporosis or depression. It would not hurt us to weave a bit of evolutionary biology into our current understanding of health. The diets of our ancestors were comprised of meat, animal fat, and plants – not processed grains and added fructose.

KLS: What about Omega 3 fatty acids and inflammation reduction?

TLD: I am fascinated by the field of resolution biology, which is based upon the premise that nature seldom makes an “on Delicious portion of fresh salmon fillet with aromatic herbs,switch” without an “off switch. We used to think that inflammation just sort of fizzled out when it ran out of fuel. We weren’t looking for the “off” switch. Well, it just so turns out that the long chain omega 3 fatty acids EPA and DHA are responsible for putting out the fire. This is why you want a lifetime of including grass fed beef, omega 3 enriched eggs, and cold-water fish in your diet.

If you are otherwise healthy, regularly eat fatty fish and/or other omega 3 rich foods, and consume a low-glycemic load diet you may not need to supplement. However, for most of us – taking a marine omega 3 supplement is probably a good idea.

KLS: What about other ways to reduce inflammation?

TLD: I am a huge fan of magnesium. It serves many functions but one that is vitally important is its role in maintaining the sensitivity of insulin receptors.* Low magnesium levels raise blood glucose and insulin levels. Unfortunately, when blood sugar is elevated it subsequently increases magnesium excretion, further aggravating insulin resistance. Multiple studies show that high intakes of magnesium can improve insulin-mediated glucose uptake, while also helping maintain cardiovascular health.* Of course, vitamin D is also another player when it comes to maintaining a healthy inflammatory response.*

The plant world provides an abundance of ingredients that are commonly used in cooking and in integrative health for their profound antioxidant activity.* Turmeric is way up on the list. Curcumin and other curcuminoids (the yellow pigments) in turmeric inhibits multiple inflammatory pathways including NF-kappa B, tumor necrosis factor alpha (TNF-alpha), IL-1, IL-6, IL-8, and COX2 to name a few.* I also love ginger, a cousin of turmeric, which inhibits NF-kappa B, and both COX and LOX pathways.*

I also like the berberine-rich plants like Oregon grape root and barberry root bark. These are critically important for reducing small intestinal bacterial overgrowth and decreasing intestinal permeability.* Intestinal permeability drives inflammation. One would consider the use of a berberine rich plant for 6-8 weeks, while turmeric and ginger can be used for extended periods of time.

Probiotics are incredibly important for insulin signaling, insulin sensitivity and reducing hemoglobin A1C. And then there is holy basil, as well as other adaptogens and nervines that help the body better adapt to stress, a state of being that itself drives inflammation by altering gut microflora and decreasing intestinal integrity.*

Then, there are spices like cinnamon. I recommend patients sprinkle ½ teaspoon cinnamon on yogurt in the morning, along with some walnuts and fruit. Cinnamon can help lower post-prandial glucose.* Essentially all spices and culinary herbs can play a role in calming inflammation: turmeric, cinnamon, cumin, cayenne, black pepper, cardamom, fennel, parsley, garlic, cilantro, chamomile and basil.*

KLS: In summary, what is your nutshell message to practitioners?

TLD: Figure out where you patient is willing and able to make changes. Shifting over to a low glycemic load diet for 8 weeks can often “jump-start” someone’s journey as they often find that they simply feel better. If dietary changes seem difficult, use wearable technology or a pedometer to help them step up their activity. One of the very best ways for the body to use sugar and drop insulin levels is through movement. Have your patient work up to 10,000 steps a day.

While getting rid of the processed carbs and increasing physical activity are foundational, when considering treatment – consider ordering your treatment in the following way: healing the gut, restoring gut integrity, improving the gut microflora and reducing systemic inflammation. I believe that you must address the gut if you really want to deal with persistent inflammation. Consider which supplements would be most beneficial: turmeric, omega 3 fatty acids, magnesium, berberine, pre and probiotics, etc. Remember, if the tree’s roots are sick, trimming the branches will not heal it. You’ll keep trimming forever. You’ve got to get to the bottom of it.

References cited in the interview:

1. Shin SJ, Gong G, Lee HJ, Kang J, Bae YK, Lee A, Cho EY, Lee JS, Suh KS, Lee DW, Jung WH. Positive expression of insulin-like growth factor-1 receptor is associated with a positive hormone receptor status and a favorable prognosis in breast cancer. J Breast Cancer. 2014 Jun;17(2):113-20.

2. Takada K, Ishikawa S, Yokoyama N, Hosogoe N, Isshiki T. Effects of eicosapentaenoic acid on platelet function in patients taking long-term aspirin following coronary stent implantation. Int Heart J. 2014;55(3):228-33. Epub 2014  May 7. PubMed PMID: 24806387.

3. Abdolahi A, Georas SN, Brenna JT, Cai X, Thevenet-Morrison K, Phipps RP, Lawrence P, Mousa SA, Block RC. The effects of aspirin and fish oil consumption on lysophosphatidylcholines and lysophosphatidic acids and their correlates with  platelet aggregation in adults with diabetes mellitus. Prostaglandins Leukot Essent Fatty Acids. 2014 Feb-Mar;90(2-3):61-8.

4. Pettit LK, Varsanyi C, Tadros J, Vassiliou E. Modulating the inflammatory properties of activated microglia with Docosahexaenoic acid and Aspirin. Lipids Health Dis. 2013 Feb 11;12:16.

*These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure or prevent any disease.