What Meat and Eggs Do to Our Microbiome

As I’ve explored before, whether young or old, male or female, smoker or non-smoker, with high blood pressure or low blood pressure, high cholesterol or low, having high levels of a toxic compound called TMAO—trimethylamine oxide—in the bloodstream is associated with a significantly higher risk of having a heart attack, stroke, or dying over a three-year period. Where does TMAO come from? As I investigate in my video How to Develop a Healthy Gut Ecosystem, the choline in foods like eggs can be turned by gut bacteria into TMAO, which is then absorbed back into our system. And, the more eggs we eat, the higher the levels climb, as you can see at 0:41 in my video.

Given the similarity in structure between carnitine and choline, Cleveland Clinic researchers wondered if carnitine found in red meat, energy drinks, and supplements might also lead to TMAO production and put it to the test. As you can see at 1:00 in my video, if you feed omnivores, those who regularly eat meat, a steak, their TMAO levels shoot up. Those who eat strictly plant-based may start out with almost no TMAO in their system, presumably because they’re not eating any meat, eggs, or dairy. But, even if vegans eat a sirloin, still almost no TMAO is made. Why? Presumably, they don’t have steak-eating bacteria in their guts. Indeed, it was found that no TMAO is produced if you don’t have TMAO-producing bacteria in your gut. If you don’t regularly eat meat, then you’re not fostering the growth of the meat-eating microbes that produce TMAO.

This suggests that once we develop a plant-based gut ecosystem, our bacteria will not produce TMAO, even if we eat meat every once and awhile. However, we still don’t know how rapidly gut bacteria shift after a shift in our diet—but it does not appear to be all or nothing. If men eating the standard American diet are given two sausage, egg, and cheese biscuits before and after just five days of eating lots of similarly high-fat meals, their TMAO production boosts even higher, as you can see at 2:09 in my video. So, it’s not just whether we have the bad bugs or not. Apparently, we can breed more of them the more we feed them.

Meat-free diets, on the other hand, can also have been “demonstrated to have a profound influence on human metabolism.”Just by analyzing a urine sample, we can tell what kind of diet people eat, based on measurements like how low TMAO levels are in the urine of those eating egg-free vegetarian diets, as you can see at 2:26 in my video. At 2:43 in my video, you’ll see that we can even take the same people rotate them through three different diets, and determine who is on a high-meat diet, low-meat diet, or no-meat diet, based in part on the different compounds churned out by the different gut flora or different flora activity after just about two weeks on the different diets. It’s possible that some of the beneficial effects of whole plant foods may be mediated by the effects they have on our gut bacteria. At the same time, the standard American diet may increase the relative abundance of undesirables that produce toxic compounds including TMAO (as you can see at 3:07 in my video).

Strictly plant-based diets have gained acceptance as a dietary strategy for preventing and managing disease. Perhaps, in part, this is because of their rather unique gut flora, with less of the disease-causing bacteria and more of the protective species. So, all along, we thought the reason those eating plant-based had lower heart disease rates was because they were eating less saturated fat and cholesterol, but maybe their lower TMAO levels may also be contributing to their benefits, thanks to their reduced ingestion of carnitine and choline.

I talked about the egg industry response to the choline revelation in Egg Industry Response to Choline and TMAO. How has the carnitine supplement industry reacted? In response to the research implicating carnitine in TMAO production, the former vice president of AdvoCare—a multilevel marketing company that sells carnitine supplements like AdvoCare Slam while getting slammed with lawsuits finding them guilty of being “engaged in false, misleading or deceptive acts or practices” and forced to pay more than a million dollars—questioned whether there was a secret vegan conspiracy at the Cleveland Clinic. Restricting our intake of meat or carnitine supplements to prevent our gut bacteria from making TMAO, he argued, is like trying to prevent car accidents by restricting the sale of fuel.

Okay…but there are benefits to transportation. We’re talking about TMAO, which may be fueling our epidemic of heart disease, the number-one killer of men and women in this country. As far as I’m concerned, the more we can cut the fuel for that, the better.


For more background on TMAO, see Carnitine, Choline, Cancer, and Cholesterol: The TMAO Connection, then find out How to Reduce Your TMAO Levels.

Our gut flora are what we eat. Check out:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:

Using Green Tea to Help Prevent Cancer and Treat Cancer

Tea consumption is associated with a reduced risk of heart disease, stroke, and premature death in general, with each additional cup of green tea a day associated with a 4-percent lower mortality risk. So, perhaps “drinking several cups of tea daily can keep the doctor away,” as well as the mortician—but what about cancer?

As I discuss in my video Can Green Tea Help Prevent Cancer, there is “growing evidence from laboratory, epidemiologic [population], and human intervention studies that tea can exert beneficial disease-preventive effects” and, further, may actually “slow cancer progression.” Let’s review some of that evidence.

Not only do those who drink a lot of tea appear to live longer than those who drink less, as you can see at 0:49 in my video, drinking lots of tea may also delay the onset of cancer. At 0:56 in my video, you can see a table titled “Average age at cancer onset and daily green tea consumption.” The green tea intake is measured in Japanese tea cups, which only contain a half a cup, so the highest category in the table is actually greater than or equal to five full cups of tea, not ten as it appears in the table. Women who did get cancer appeared to get it seven years later if they had been drinking lots of tea compared to those who had consumed less. Men, however, had a three-year delay in cancer onset if they had consumed more than five full cups of green tea daily, the difference potentially “due to higher tobacco consumption by males.”

Green tea may be able to interfere with each of the stages of cancer formation: the initiation of the first cancer cell, promotion into a tumor, and then subsequent progression and spread, as you can see at 1:24 in my video. Cancer is often initiated when a free radical oxidizes our DNA, causing a mutation, but, as you can see at 1:44 in my video, we can get a nice “spike of antioxidant power” of our bloodstream within 40 minutes of drinking green tea. “This increase may, in turn, lower oxidative damage to DNA and so decrease risk of cancer.”

Furthermore, in terms of genoprotective effects—that is, protecting our genes—pre-existing oxidation-induced DNA damage was lower after drinking green tea, suggesting consumption can boost DNA repair as well. We didn’t know for certain, however…until now.

There is a DNA-repair enzyme in our body called OGG1. As you can see at 2:15 in my video, within one hour of drinking a single cup of green tea, we can boost OGG1’s activity, and after a week of tea drinking, we can boost it even higher. So, “regular intake of green tea has additional benefits in the prevention and/or repair of DNA damage.” In fact, tea is so DNA-protective it can be used for sperm storage for fresh samples until they can be properly refrigerated.

What’s more, tea is so anti-inflammatory it can be used for pain control as a mouthwash after wisdom tooth surgery, as you can see at 2:41 in my video. In terms of controlling cancer growth, at a dose of green tea compounds that would make it into our organs after drinking six cups of tea, it can cause cancer cells to commit suicide—apoptosis (programmed cell death)—while leaving normal cells alone. There are a number of chemotherapy agents that can kill cancer through brute force, but that can make normal cells vulnerable, too. So, “[g]reen tea appears to be potentially an ideal agent for [cancer] prevention”: little or no adverse side-effects, efficacious for multiple cancers at achievable dose levels, and able to be taken orally. We have a sense of how it works—how it stops cancer cells from growing and causing them to kill off themselves—and it’s cheap and has a history of safe, acceptable use. But, all of this was based on in-vitro studies in a test tube. “It needs to be evaluated in human trials,” concluded the researchers. Indeed, what happens when we give green tea to people with cancer? Does it help?

Tea consumption may reduce the risk of getting oral cancer. Not only may the consumption of tea boost the antioxidant power of our bloodstream within minutes and decrease the amount of free-radical DNA damage throughout our systems over time, but it can also increase the antioxidant power of our saliva and decrease the DNA damage within the inner cheek cells of smokers, though not as much as stopping smoking all together. You can see several graphs and tables showing these findings in the first 35 seconds of my video Can Green Tea Help Treat Cancer?.

Might this help precancerous oral lesions from turning into cancerous oral lesions? More than 100,000 people develop oral cancer annually worldwide, with a five-year overall survival rate of less than the flip of a coin. Oral cancer frequently arises from precancerous lesions in the mouth, each having a few percent chance of turning cancerous every year. Can green tea help?

Fifty-nine patients with precancerous oral lesions were randomized into either a tea group, in which capsules of powdered tea extract were given and their lesions were painted with green tea powder, or a control group, who essentially got sugar pills and their lesions painted with nothing but glycerin. As you can see at 1:23 in my video, within six months, lesions in 11 out of the 29 in the tea group shrunk, compared to only 3 of 30 in the placebo group. “The results indicate that tea treatment can improve the clinical manifestations of the oral lesions.”

The most important question, though, is whether the tea treatment prevented the lesions from turning cancerous. Because the trial only lasted a few months, the researchers couldn’t tell. When they scraped some cells off of the lesions, however, there was a significant drop in DNA-damaged cells within three months in the treatment groups, suggesting that things were going in the right direction, as you can see at 1:46 in my video. Ideally, we’d have a longer study to see if they ended up with less cancer and one that just used swallowed tea components, since most people don’t finger-paint with tea in their mouths. And, we got just that.

As you can see at 2:15 in my video, there were the same extraordinary clinical results with some precancerous lesions shrinking away. What’s more, the study lasted long enough to see if fewer people actually got cancer. The answer? There was just as much new cancer in the green tea group as the placebo group. So, the tea treatment resulted in a higher response rate, as the lesions looked better, but there was no improvement in cancer-free survival.

These studies were done on mostly smokers and former smokers. What about lung cancer? As you can see at 2:46 in my video, population studies suggest tea may be protective, but let’s put it to the test. Seventeen patients with advanced lung cancer were given up to the equivalent of 30 cups of green tea a day, but “[n]o objective responses were seen.” In a study of 49 cancer patients, 21 of whom had lung cancer, the subjects received between 4 and 25 cups worth of green tea compounds a day. Once again, no benefits were found. The only benefit green tea may be able to offer lung cancer patients is to help lessen the burns from the radiation treatments when applied on the skin. Indeed, green tea compresses may be able to shorten the duration of the burns, as you can see at 3:21 in my video.

The protective effects of green tea applied topically were also seen in precancerous cervical lesions, where the twice-a-day direct application of a green tea ointment showed a beneficial response in nearly three-quarters of the patients, compared to only about 10 percent in the untreated control group, which is consistent with the benefits of green tea compounds on cervical cancer cells in a petri dish. When women were given green tea extract pills to take, however, they didn’t seem to help.

I talked about the potential benefit of green tea wraps for skin cancer in Treating Gorlin Syndrome with Green Tea, but is there any other cancer where green tea can come into direct contact? Yes. Colon cancer, which grows from the inner surface of the colon that comes into contact with food and drink. As you can see at 4:13 in my video, in the colon, tea compounds are fermented by our good gut bacteria into compounds like 3,4DHPA, which appears to wipe out colon cancer cells, while leaving normal colon cells relatively intact in vitro. So one hundred thirty-six patients with a history of polyps were randomized to get green tea extract pills or not. Now, this study was done in Japan, where drinking green tea is commonplace, so, effectively, this was comparing those who drank three cups of green tea a day to subjects who drank four daily cups. A year later on colonoscopy, the added-green tea group had only half the polyp recurrence and the polyps that did grow were 25 percent smaller. With such exciting findings, why hasn’t a larger follow-up study been done? Perhaps due to the difficulty “in raising funds” for the study, “because green tea is a beverage but not a pharmaceutical.”

There is good news. Thanks to a major cancer charity in Germany, researchers are currently recruiting for the largest green tea cancer trial to date, in which more than 2,000 patients will be randomized. I look forward to presenting the results to you when they come in.


What about prostate cancer? See my videos Preventing Prostate Cancer with Green Tea and Treating Prostate Cancer with Green Tea.

You may also be interested in these somewhat older videos:

How interesting was that about wisdom teeth? Green tea can also be used as an anti-cavity mouth rinse, which I discuss in my video What’s the Best Mouthwash?.

Is Caffeinated Tea Dehydrating? Watch the video to find out.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:

The Difference Between Alpha and Beta Receptors Explain Soy’s Benefits

“[S]oyfoods have become controversial in recent years…even among health professionals…exacerbated by misinformation found on the Internet.” Chief among the misconceptions is that soy foods promote breast cancer because they contain a class of phytoestrogen compounds called isoflavones, as I explore in my video, Is Soy Healthy for Breast Cancer Survivors? Since estrogens can promote breast cancer growth, it is natural to assume that phytoestrogens might, too, but most people do not realize there are two different types of estrogen receptors in the body, alpha and beta. Unlike actual estrogen, soy phytoestrogens “preferentially bind to and activate ERβ,” estrogen receptor beta. “This distinction is important because the [two types of receptors] have different tissue distributions within the body and often function differently, and sometimes in opposite ways. This appears to be the case in the breast,” where beta activation has an anti-estrogenic effect, inhibiting the growth-promoting effects of actual estrogen—something we’ve known for more than ten years.

The effects of estradiol, the primary human estrogen, on breast cells are “completely opposite” to those of soy phytoestrogens, which have “antiproliferative effects on breast cancer cells…even at [the] low concentrations” we get in our bloodstream after eating just a few servings of soy. This makes sense, given that after eating a cup of soybeans, the levels in our blood cause significant beta receptor activation, as you can see at 1:27 in my video.

Where did this outdated notion that soy could increase breast cancer risk come from? The concern was based largely on research that showed that the main soy phytoestrogen, genistein, stimulates the growth of mammary tumors in a type of mouse—but, it turns out, we’re not mice. We metabolize soy isoflavones very differently from rodents. As you can see at 2:00 in my video, the same soy phytoestrogens led to 20 to 150 times higher levels in the bloodstream of rodents. The breast cancer mouse in question had 58 times higher levels. What does this mean for us? If we ate 58 cups of soybeans a day, we could get some significant alpha activation, too, but, thankfully, we’re not hairless athymic ovariectomized mice and we don’t tend to eat 58 cups of soybeans a day.

At just a few servings of soy a day, with the excess beta activation, we would assume soy would actively help prevent breast cancer. And, indeed, “[s]oy intake during childhood, adolescence, and adult life were each associated with a decreased risk of breast cancer.” Those women who ate the most soy in their youth appeared to grow up to have less than half the risk. This may help explain why breast cancer rates are so much higher in the United States than in Asia, where soy foods are more commonly consumed. Yet, when Asians come to the United States and start eating and living like Americans, their breast cancer risk shoots right up. Women in their 50s living in Connecticut, for example, are way at the top of the breast cancer risk heap, as you can see at 3:00 in my video, and have approximately ten times more breast cancer than women in their 50s living in Japan. It isn’t genetic, however. When Japanese women move to the United States, their breast cancer rates go up generation after generation as they assimilate into American culture.

Are the anti-estrogenic effects of soy foods enough to actually change the course of the disease? We didn’t know until the first human study on soy food intake and breast cancer survival was published in 2009 in the Journal of the American Medical Association, suggesting that “[a]mong women with breast cancer, soy food consumption was significantly associated with decreased risk of death and [breast cancer] recurrence.” That study was followed by another study, and then another, each with similar findings. That was enough for the American Cancer Society, which brought together a wide range of cancer experts to offer nutrition guidelines for cancer survivors, concluding that, if anything, soy foods should be beneficial. Since then, two additional studies have been published for a total of five—five out of five studies that tracked more than 10,000 breast cancer patients—and they all point in the same direction.

Pooling all of the results, soy food intake after breast cancer diagnosis was associated with both reduced mortality and reduced recurrence—that is, a longer lifespan and less likelihood that the cancer comes back. This improved survival was for women with estrogen receptor negative tumors and estrogen receptor positive tumors, and for both younger women and for older women.

Pass the edamame.


Flaxseeds are protective for likely the same reasons. For more on this, see my videos Flaxseeds and Breast Cancer Survival: Epidemiological Evidence and Flaxseeds and Breast Cancer Survival: Clinical Evidence.

What about women who carry breast cancer genes? I touched on that in BRCA Breast Cancer Genes and Soy and Should Women at High Risk for Breast Cancer Avoid Soy?.

What about genetically modified soy? See GMO Soy and Breast Cancer.

Who Shouldn’t Eat Soy? An excellent question I answer in that video.

For even more information on soy, see:

Not all phytoestrogens may be protective, though. See The Most Potent Phytoestrogen Is in Beer and What Are the Effects of the Hops Phytoestrogen in Beer?.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations: