Digestive Care Expert Brenda Watson

You may have heard that eating fish during pregnancy is good for you. Conversely, you may have also heard that you should limit your fish intake during pregnancy. What’s a soon-to-be mama to do with all the conflicting advice? I’d like to help clear up the confusion on this important topic.

Currently, the FDA recommends that women who might become pregnant, who are pregnant, or who are nursing, along with young children all avoid fish that are known to contain high levels of mercury. Most notably:

  • Shark
  • Swordfish
  • King mackerel
  • Tilefish

The National Resources Defense Council issued a more complete list of high-mercury fish which adds to the FDA’s list the following:

  • Orange roughy
  • Marlin
  • Ahi tuna
  • Bigeye tuna

The FDA also recommends that these women and children eat up to 12 ounces a week (the equivalent of two average meals) of a variety of fish and shellfish that are lower in mercury. Five of the most common they recommend are:

  • Shrimp
  • Canned light tuna*
  • Salmon
  • Pollock
  • Catfish

Two advocacy organizations recently sued the FDA, demanding that they require labeling of canned and packaged fish to inform consumers of the mercury content. The fish industry is concerned that such labels will scare people from eating fish altogether, however. They do have a point, but I think that the more we know about the foods we’re eating, the better

There is one other important factor that they are not taking into account—which fish are low in mercury and also high in beneficial omega-3 fats? Those are the fish we need to be eating as much as possible. Unfortunately, the list is quite short. The three fish lowest in mercury and highest in omega-3 fats are:

  • Salmon
  • Sardines
  • Herring

If you are a fan of one or more of these three fish, that’s great news. Eat these fish as often as possible. If you are not—some people simply can’t take the stronger fish flavor of these three fish—then your best bet is a high-potency, purified fish oil supplement that is enteric coated for less fishy aftertaste. Look for a high-potency supplement with the IFOS label to ensure that the fish oil meets or exceeds international standards for purity, potency, and freshness.

*Not albacore tuna, which is high in mercury.


Children, fish, herring, mercury, nursing, omega-3, pregnancy, pregnant, purified fish oil supplement, recommendations, salmon, sardines, women

It has generally been considered that an infant’s gut microbial composition resembles that of an adult by the age of about 12 months. Gut bacterial composition during the first year of life is in flux, with great variation seen between infants and even within the same infant over time. A recent study is changing how we view the early establishment of gut microbes, however. In a recent study published in the journal Applied Environmental Microbiology, researchers determined that microbes in the infant gut continue to transform over the first three years of life.1

The infant gut microbial composition is dependent on a number of factors, including mode of delivery, antibiotic use, and diet (breastfeeding or formula feeding). It is known that vaginal birth, as well as breastfeeding, promotes the growth of beneficial Bifidobacteria—well-known to be protective of infant health, while suppressing the growth of harmful bacteria.

Most studies of infant microbial composition have focused on colonization right after birth, during weaning, or up to one year of age. In this new study, the researchers analyzed changes in gut microbiota of Danish infants between ages 9 to 18 months and from 18 to 36 months. They noted clear changes during both periods, but particular between ages 9 and 18 months.

During the period between 9 to 18 months, they observed an increase in Bacteroidetes species, consistent with the introduction of food. At the same time, they observed a decrease in the abundance of Bifidobacterium. Specifically, B. longum and B. breve decreased while B. adolescentis increased. This makes sense when you consider that B. longum, B. breve utilize prebiotics found in breast milk as food, while B. adolescentis does not. Lactobacillus species and Enterobacteriaceae also decreased during the period between 9 to 18 months, also consistent with cessation of breastfeeding and introduction to formula or cow’s milk.

Interestingly, changes continued between 18 to 36 months, suggesting that a change toward adult-like stability was still occurring during this period. This is in line with another recent study that found a similar occurrence.2 These studies are shaking up what we thought we knew about infant microbial development.

Infants who were breastfed at 9 months had higher amounts of Lactobacillus and Bifidobacterium and lower amounts of other bacteria in the Clostridium and Eubacterium taxa, changes that were still evident at 18 months, but disappeared by 36 months. The researchers also looked at physiological parameters such as measures of growth and body composition and found a correlation between duration of breast milk consumption and overall energy intake—those infants who breast fed longest had lower energy intake. They also found a link between body mass index and an increase in Firmicutes bacteria, a group of bacteria that has been linked to body fat accumulation in a number of studies.

Lastly, the researchers found considerable changes between bacterial composition during the 9 to 18 month period and again during the 18 to 36 month period. They noted two distinct enterotypes, or dominant gut bacterial types, by 36 months of age, which is in accordance with findings of two or three enterotypes in adults. The two enterotypes observed in these infants were made up of Prevotella species in one and Bacteroides species in another. These enterotypes were able to change over time, which is in contrast to findings in adults.

It would be interesting to compare the gut microbiomes of these Danish children with those of the infants in Burkina Faso Africa, where they have found bacteria in children that are non-existent in Western cultures due to dietary differences. Many of these bacteria are very good at breaking down fiber due to the high-fiber diet of this culture. In many parts of the world, children are breastfed until at least age 3 or 4. Comparing Western children to these children would help us to learn more about the benefits of breastfeeding.

More studies will be needed to better determine gut microbial changes in infants, what factors affect these changes, and how these changes relate to health outcomes. One day, we will have available bioidentical breastmilk for women unable to breast feed. Until then, probiotics during infancy may be the best bet for babies unable to be breastfed.



  1. Bergstrom A, Skov TH, Bahl MI, et al., “Establishment of intestinal microbiota during early life: A longitudinal, explorative study of a large cohort of Danish infants.” Appl Environ Microbiol. 2014 Feb 28.
  2. Yatsunenko T, Rey FE, Manary MJ, et al., “Human gut microbiome viewed across age and geography.” Nature. 2012 May 9;486(7402):222-7.

Bacteroides, Bifidobacteria, breastfeeding, enterotypes, gut microbes, gut microbial composition, Health, infant, Lactobacillus, Prevotella


A Test for Early Alzheimer’s

It sometimes seems as though the research behind Alzheimer’s disease moves forward at a snail’s pace. There are still no effective medications for the disease, no way to prevent it, and little hope that it can be detected early. But researchers at Georgetown University Medical Center are trying to change that. According to a recent study published in the journal Nature Medicine, researchers were able to predict with over 90 percent accuracy whether someone would develop Alzheimer’s or not within the next three years.

The researchers created a test that identifies 10 lipids, or fats, that are found in the blood of people who go on to develop Alzheimer’s within three years. “Our novel blood test offers the potential to identify people at risk for progressive cognitive decline and can change how patients, their families, and treating physicians plan for and manage the disorder,” stated lead author, Howard Federoff, MD, PhD.

While the test is not ready for prime time—or even clinical trials—it shows that we are making some progress toward identifying this devastating disease at an earlier stage. The researchers plan to further test the lipid panel for use in people at high risk of developing Alzheimer’s so that they can investigate a therapeutic drug that might delay or prevent its development. Only time will tell what they find. For now, any progress is a step forward. But we still have a long way to go.

Alzherimer’s disease, cognitive decline, lipids, mild cognitive impairment

In a new dietary proposal, the World Health Organization (WHO) is advising that sugar intakes drop from 10 percent of total calories to 5 percent. They base their recommendations on two papers that found added sugars increase body mass index (BMI), and diets that reduce added sugar consumption to less than 5 percent reduce dental cavities.

“There is increasing concern that consumption of free sugars, particularly in the form of sugar-sweetened beverages, may result in both reduced intake of foods containing more nutritionally adequate calories and an increase in total caloric intake, leading to an unhealthy diet, weight gain, and increased risk of non-communicable diseases [chronic disease].” The recommendation has not officially accepted but is in the proposal state.

I applaud the WHO for tightening up their recommendations on added sugar intake. Reducing sugar intake is a step in the right direction. But honestly, I believe that added sugar has no place in a healthy diet. Overconsumption of sugary foods, along with foods high in refined and starchy carbohydrates, are a major—if not the major—contributor to chronic disease. And if you have ever experienced sugar cravings (who hasn’t?), you know that there is a fine line between “just one bite” and “just ate the whole cake/pint of ice cream/box of cookies.

If you’ve checked your local grocery store lately, you will see that we have a long way to go before added sugar no longer laces many of the foods available for purchase. In the meantime, we can all make the right choices for ourselves. Read the labels of the foods you buy. Try to eat foods that are very low in sugar and that do not contain sugar (or its many derivatives) in the ingredient list.

added sugar, body mass index, chronic disease, dental cavities, sugar, WHO recommendations

Almonds have a newly found prebiotic benefit, according to a recent study published in the journal Anaerobe. That crunchy, healthy nut you love is even better for you than you thought. Both almonds and almond skins were found to increase beneficial Bifidobacterium and Lactobacillus while also reducing levels of the potential pathogen Clostridium perfringens.

The study involved 48 healthy young adults aged 18 to 22 who were randomly assigned to one of three groups. The first group ate 56 grams (about 1/3 cup) of roasted almonds each day; the second group ate 10 grams of almond skins daily; and the third group added 8 grams of the prebiotic fructooligosaccharide (FOS).

Not long after beginning the study, bifidobacteria and lactobacilli levels increased in the groups eating almond skins and taking FOS. It took longer for levels of these good bacteria to increase in those eating whole almonds, but by the end of six weeks, they, too, enjoyed higher levels of friendly bifido and lacto bacteria. “These results indicated the stimulation effects of almond skin and almond intake were typical prebiotic effects,” noted the scientists.

More studies will be needed to confirm these effects, but I bet that before long almonds will be known as a true prebiotic food. Until then, keep eating those almonds. Sprouted almonds are my personal favorite.

almonds, bifido, Bifidobacterium, good bacteria, lacto, Lactobacillus, prebiotic

In some parts of the country (especially here in Florida where I live) allergy season is in full swing. So many people are suffering with congested sinuses, stuffy noses, and feeling like, well, not so great. Over 11 million people in the United States are diagnosed with allergic rhinitis, or hay fever—what most people simply call allergies—each year. I am sure there are many more people who do not get officially diagnosed, adding to this staggering number.

A recent study published in the European Journal of Clinical Nutrition found that people taking the probiotic Lactobacillus paracasei daily for five weeks in addition to their usual allergy medication had improved quality of life along with improved ocular symptoms (less watery, itchy, red, and swollen eyes). Improvement in specific nasal symptoms was not found, however.

“Probiotic foods or food supplements seem to be popular and widely used by subjects suffering from allergic rhinitis, however, a study under real-life conditions and in subjects receiving a medicinal treatment was needed,” noted the researchers. While they did find a benefit of the probiotic, more studies will be needed to determine whether the addition of other strains will increase the effect.

A number of probiotic strains have already been studied in people with allergic rhinitis, but most of them have been single strain studies with mixed results. Researchers have begun to look at multiple strain formulas for allergies, but we are still in the early stages of research. My hunch is that the multi-strain probiotic formulas will be more effective because they target a wider range of immune functions. I will keep you posted as I learn more.

allergic rhinitis, allergies, allergy, congested, hay fever, Lactobacillus paracasei, Probiotics

April is IBS Awareness Month—a time for individuals and communities across the country to spread awareness about irritable bowel syndrome and the millions of Americans it affects every day. Coast to coast, activities and events are in the works to help people understand this debilitating disorder, its signs and symptoms, and how it is diagnosed and treated.

Quick Facts about IBS

Irritable bowel syndrome affects between 25 and 45 million Americans every day. Although its cause is still unknown, many experts believe the symptoms of IBS—which include abdominal pain and bloating along with diarrhea, constipation or both—are closely linked to the interaction between the gut, brain, and central nervous system. (It’s possible the nerves along the gut alter normal pain perception so that the bowel becomes oversensitive to normal stimuli.)

If you or someone you know is living with IBS, here are 9 natural solutions to help you take the first steps toward better bowel health:

1.     Add More Fiber. In addition to its role in heart health and weight management, fiber supports healthy digestive function by helping to absorb and eliminate toxins in the colon that may contribute to IBS symptoms.

2.     Limit Fatty Foods. Eating foods that are high in fat such as fried foods and certain meats may contribute to IBS. Be sure to consume these types of foods in moderation.

3.     Cut Back on Caffeine. Highly caffeinated foods and beverages (such as coffee, tea, soda and chocolate) have been shown to worsen IBS symptoms.

4.     Avoid Foods High in Sulfur. Some foods that are healthy—including vegetables such as brussels sprouts, cabbage, garlic, onions and broccoli—are high in sulfur and may actually trigger IBS symptoms. Opt for low-sulfur veggies such as carrots or green beans.

5.     You May Have a Food Sensitivity. Some people have IBS because they are dealing with an underlying food sensitivity. Gluten and dairy are the two most common foods to which a sensitivity may develop. A gluten-free diet, dairy-free diet, or both can help to improve IBS symptoms in these people.

6.     Show Your Digestive Tract a Little TLC. Many herbs and nutraceuticals such as marshmallow root, slippery elm, and the amino acid L-glutamine can help nourish and soothe the intestinal tract and bowel.

7.     Balance with Probiotics. Probiotics are the beneficial bacteria in the gut that work to maintain a balanced internal environment and promote optimal digestion and immune health.

8.     Drink Plenty of Water. Drinking plenty of water (at least half your body weight in ounces every day) will help flush out toxins and other harmful microbes that may be causing IBS symptoms.

9.     Try Colon Hydrotherapy. IBS sufferers—especially those with severe symptoms—may find that natural colon hydrotherapy can help cleanse the system and improve digestive health and elimination.

Learn More about IBS with the New Mobile App!

The International Foundation for Functional Gastrointestinal Disorders (IFFGD), which first designated April as IBS Awareness Month back in 1997, just launched a new mobile app (for iOS and Android platforms) to help people learn more about IBS, its symptoms and treatment options. The free app is called IBS Info and offers real-time information from experts in the gastrointestinal field to promote awareness and education about irritable bowel syndrome. Be sure to check it out!

The more we study and understand, the closer we come to helping millions of IBS sufferers live healthier, happier lives—so help me spread the word this month and all year long!

abdominal pain, amino acid, beneficial bacteria, bloating, bowel, brain, caffeine, central nervous system, colon hydrotherapy, Constipation, dairy, dairy-free, Diarrhea, Digestive Health, digestive tract, fatty foods, fiber, food sensitivity, fried foods, gluten, gluten-free, gut, herbs, IBS, IBS Awareness Month, IBS symptoms, immune health, intestinal tract, Irritable Bowel Syndrome, L-glutamine, marshmallow root, microbes, nutraceuticals, Probiotics, slippery elm, sulfur, water

In a recent meta-analysis published in the journal Annals of Internal Medicine, researchers selected 72 individual studies on the effects of polyunsaturated and saturated fats on coronary disease (heart disease).1 They concluded, “Current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of total saturated fats.”

As you can imagine, the media went to town with this one. Somehow omega-3 fats were teased out, yet again, as ineffective for heart disease protection. And saturated fats were let off the hook as the heart disease villain. While there is some truth to the saturated fat findings—other recent studies have come to similar conclusions—when we take a closer look at the data, we see a completely different picture when it comes to the omega-3s.

Those people with the highest levels of circulating long-chain omega-3 fats were found to have a 16 percent decreased risk of coronary disease compared to those with the lowest levels. That’s a substantial decrease if you ask me. However, according to the statistical analysis, it was not “significant” enough. Quite interestingly, when we look at the data for EPA and DHA—the two fatty acids most important for heart disease prevention—there was absolutely a significant decreased risk. Those people with the highest levels of EPA, DHA, or both EPA and DHA together, had a 22, 21, and 25 percent decreased risk of developing heart disease. Incredulously, no one even mentioned this. I call that irresponsible reporting of the data.

Irresponsible indeed. As it turns out the data was incorrect. Shortly after the study was published, the lead author, Rajiv Chowdhury, MD, PhD, was called out for a large number of inaccuracies. One of the most important corrections made was to the omega-3 data. People with the highest levels of circulating long-chain omega-3 fats actually had a 13 percent decreased risk of developing heart disease, but now the data was statistically significant. I know that may not make much sense, but it has to do with the range of all values. As Mark Twain has said, “Figures don’t lie, but liars figure.”

One of the study’s own authors, Dariush Mozzafarian, MD, DrPH, stated, “Personally, I think the results suggest that fish and vegetable oils should be encouraged,” but his voice was drowned out by other authors, a group of 14 total authors. Harvard School of Public Health’s own Walter Willet, MD, DrPH, stated, “They have done a huge amount of damage.” He called for a retraction of the study “with similar press promotion.” He continued with his opinion of the current state of meta-analysis research, “…these days meta-analyses are often done by people who are not familiar with a field, who don’t have the primary data or don’t make the effort to get it.” This is exactly what happened in this meta-analysis.

The bottom line is that the omega-3 fats that come from fish oil are absolutely beneficial for the heart, and this study actually proves it now that the data has been corrected. Yet these results are still being downplayed.

The studies we really need to notice are the ones that analyze red blood cell membrane levels of omega-3s. Those are the omega I pay most attention to because they show how much omega-3 was actually ingested and absorbed over a long time period, which is the most accurate reflection of tissue levels of these beneficial fats. That’s where the magic happens.

I am getting tired of seeing inadequate omega-3 studies blasted through the news media, giving consumers incorrect and even dangerous information about these beneficial fats. There are literally thousands of clinical studies and tens of thousands of preclinical studies that show the benefits of these fats. Let’s not forget about all that data.



  1. Chowdhury R, Warnakula S, Kunutsor S, et al., “Association of dietary, circulating, and supplement fatty acids with coronary risk.” Ann Int Med. 2014;160:398–406.


coronary disease, DHA, EPA, fats, fish, heart disease, omega-3, polyunsaturated fatty acids, saturated fats

You have long heard that fat is the enemy. Dietary recommendations over the past few decades have stated that fat should be greatly minimized—saturated fat in particular. Fat raises cholesterol, you’ve been told. A high-fat diet leads to heart disease, you’ve been led to believe.

The low-fat diet craze began in the late seventies with the recommendation to decrease saturated fat and cholesterol in the diet. (These recommendations were based on flawed studies and reasoning, a topic too long to cover here. I recommend the book Why We Get Fat by Gary Taubes. Or his New York Times article on the topic here.)

From there, the low-fat diet craze gained traction through the 80s and was in full swing in the 90s. We have been so entrenched in this message for so long—and lied to by established medical and nutritional agencies—that even today many people fear eating fatty foods. While Gary Taubes is one leading voice trying to turn the tables of our ingrained misperceptions, other scientists are stepping up to the plate to join him.

In a recent article published in the journal Open Heart, James DiNicolantonio, PharmD, sets the record straight about saturated fat. The main problem, he states, is that we are replacing saturated fat with carbohydrates and omega-6 fats, both of which contribute to poor cardiovascular health, the problem we are trying to avoid in the first place.

To highlight the detriments of a low-fat diet, he cited a 2008 study from the journal Lipids that found a low-carbohydrate diet reduced body fat, blood lipid levels, blood sugar and insulin levels, inflammation, and blood clotting factors all while improving good cholesterol (HDL) levels, while all of these markers worsened in people eating a low-fat diet.

After analyzing a number of randomized trials comparing low-fat versus a low-carbohydrate diet, DiNicolantonio concluded, “From these data, it is easy to comprehend that the global epidemic of atherosclerosis, heart disease, diabetes, obesity, and the metabolic syndrome is being driven by a diet high in carbohydrate/sugar as opposed to fat, a revelation that we are just starting to accept.”

As for the replacement of saturated fat with polyunsaturated fats high in omega-6 (like corn oil, safflower oil, sunflower oil, and other similar vegetable oils), a 2010 meta-analyses of randomized controlled trials found that replacing saturated and trans fats with omega-6 fats without simultaneously raising omega-3 fats increases risk of death. This was confirmed in another recent meta-analysis in 2013.

That means that if you are avoiding saturated fats (found in full-fat dairy, butter, and red meat) by replacing them with vegetable oil without eating enough omega-3, then you are at greater risk of death than if you had eaten the saturated fat in the first place. Eye opening isn’t it?

DiNicolantonio summarized:

“The potential harms of replacing saturated fat with carbohydrates:

  • Increase in small, dense LDL particles. [these are the most dangerous LDL particles]
  • Shift to an overall atherogenic lipid profile (lower HDL-C, increase in triglycerides and an increase in the ApoB/ApoA-1 ratio).
  • Smaller improvements in glucose tolerance, body fatness, weight, inflammation, and thrombogenic markers.
  • Increased incidence of diabetes and obesity.

The potential harms of replacing saturated fat with omega-6 polyunsaturated fats

  • Increased risk of cancer.
  • Increased risk of coronary heart disease, cardiovascular events, death due to heart disease and overall mortality.
  • Increased oxidized LDL-C.
  • Reduction in HDL-C.”

It is going to take a whole lot of awareness to reverse the tide of fear about fat. But slowly, slowly, people are starting to get it. It’s all about eating the right fats and not overcompensating with nutrient-poor carbohydrates.

carbohydrates, cardiovascular health, diabetes, diet, fat, heart disease, low-carbohydrate diet, low-fat diet, obesity, omega-6 fats, saturated fat

BPA is one of the most highly covered toxins by the press, and for good reason. It is one of the most widely found toxins in everyday household items such as metal food and beverage cans, plastic bottles and containers, cash register receipts, and even dental fillings. A recent primate study funded by the National Institute of Environmental Health Sciences has found that low-dose exposure to BPA alters development of infants in utero.

“Previous studies in rodents have demonstrated that maternal exposure to very low doses of BPA can significantly alter fetal development, resulting in a variety of adverse outcomes in the fetus,” noted the researchers. “Our study is one of the first to show this also happens in primates.” Why study primates? Because they closely mimic human physiology and so study results can be extrapolated to humans more accurately. What this tells us is that the case against BPA just got stronger.

The researchers found significant damage to mammary glands, ovaries, brain, uterus, lung, and heart tissues of primate infants even before birth when compared to those infants not exposed to BPA. “Our findings suggest that traditional toxicological studies likely underestimate actual human exposure and show, unequivocally, that biologically active BPA passes from the mother to the fetus,” they state.

The United States has been slow to regulate BPA, although consumers have been asking for it to be removed from certain products. BPA-free plastic products can be found, but we still have a long way to go. In the meantime, when you buy canned foods and plastic containers, purchase the BPA-free versions when possible. And if you want to be proactive, ask the stores you shop at to use BPA-free thermal receipt paper. Change like this usually begins with consumers.

BPA, BPA-free, infants, low-dose exposure, receipts, toxins

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