Friday Links: Art Ayers Keeps Cooling Inflammation; New Potential Type 2 Diabetes Drug; Case Study
~ Dr. Art Ayers contacted me yesterday for comments prior to his latest post and really, the only meaningful thing I had was to make sure Tim and Dr. BG were in for lots of credit.
I was shocked to learn that there were some paleo (meat and veggie) eaters who were getting cured with resistant starch. I didn’t know that some were sick and, as I said in a previous post, I would not have guessed that starch was good for anything, but spikes in blood sugar. I was rudely awakened by the shouts of Richard Nikoley on Free the Animal, though I suspect the sanity behind the argument came from Tim and Dr. BG (She is always right.) He presented a kind of Second Coming of Paleo with resistant starch to feed the gut flora as soluble fiber. How could I question food for flora? (How could I question Nikoley without my karate gi?) […]
paleo Diet without Soluble Fiber is Hard on Gut Flora
People get sick on paleo, because they don’t feed their flora. Gut flora are needed to supply vitamins, short chain fatty acids and immune system stimulants. If you don’t feed your flora you get vitamin deficiencies, gut inflammation and autoimmune diseases (Treg deficiency). It is very important to remember that feeding your flora means matching the soluble fiber with the existing flora. Most people make the mistake of assuming that if they change their diet, then their flora will also change. Their flora will adapt with each of their hundred different species of gut bacteria increasing or decreasing in numbers, but no new genes will be present to digest new soluble fiber. Eating a meat diet will eventually eliminate gut bacteria needed to digest some plant materials and produce intolerances. The missing bacteria will not be regained upon return to eating plants again. [emphasis added]
Use it or lose it. Art goes on to talk a lot about the need for probiotics, and not all that stuff in yogurt, kefir, or any other lacto-strains. Rather, you need the bacteria from dirt. Ironically, it appears some of the primary keys to healing broken guts are to be found in shit pills, dirt, and even baby-poop sausages. Then you feed them well (e.g., resistant starch) to keep them established. Go read it. Perhaps—coming from a PhD in Molecular, Cellular, and Developmental Biology who has professored all over the world—some of the ignorant pip-squeaks and clowns I see in comments mostly elsewhere will get a clue, since it’s not coming from me. Yes, I’m lafing at you, and you know who you are. Keep on reading, though, even the comments I post. All y’all seem to know every last detail about me.
Tim and I owe Dr. BG AnimalPharm (link removed) (Grace) on this. Art’s post is essentially what Grace has been telling us. She blew her stack at us for some of what we said in that Latest in Paleo podcast, where we downplayed probiotics in place of feeding the gut. So, we ended up making peace by making her science editor of the book and I also went and got three soil-based probiotic products to try for myself. I’m a solid 2+ weeks into those. I’ve taken the store-bought lacto stuff, chowed yogurt, made my own kefir, but have never noticed anything particular.
That has now changed. I’ll post about it next week, along with the products I’m using. In impressed, to say the least. So yea, perhaps the reason RS doesn’t work for some, or in some cases seems to exacerbate some conditions, is that it can’t feed what doesn’t exist.
~ Successful Clinical Trial of Type 2 Drug That Works on Intestinal Organisms
DiabetesHealth
BROOMFIELD, Colo.–microbiome TherapeuticsTM has announced positive results from its clinical trial of a microbiome modulator, NM504, in development for type 2 diabetes and pre-diabetes.
NM504 is designed to improve glucose tolerance and other metabolic parameters in patients with diabetes by shifting the gastrointestinal microbiome–the micro-organisms that inhabit the human body.
Studies have shown that people with type 2 diabetics typically have gastrointestinal dysbiosis, or microbial imbalances, that may contribute to the metabolic dysfunction associated with the condition.
The double-blind, randomized, placebo-controlled trial assessed whether NM504 administered for four weeks could improve the glucose tolerance of subjects with pre-diabetes and untreated type 2 diabetes by modulating the gastrointestinal microbiome. The study enrolled 42 subjects.
Top-line results show that twice-daily oral administration of NM504 reduced postprandial serum glucose levels and increased insulin sensitivity in these subjects. The results were statistically significant as measured by an oral glucose tolerance test. NM504 also decreased markers of chronic inflammation and blood lipids in treated subjects, and it decreased appetite as determined by a validated physician-administered scale. NM504 was well tolerated and patient compliance was excellent.
“”This trial represents a milestone both for MBT and the emerging field of microbiome therapy,” noted Steve Orndorff, CEO of microbiome Therapeutics. “”NM504 is the first therapeutic shown to directly modulate the GI microbiome in diabetics, and this study is among the first randomized, placebo-controlled trials of a microbiome-based therapy to achieve a statistically significant medical outcome. We look forward to reporting more detailed data on this study at upcoming scientific meetings.”
Whether some probiotics, cheap potato starch and other fermentable fibers from food will work just as well or better is immaterial to me. Only a fraction or people will do that. Most love the attention they get from their doctors and look upon pills as a panacea. They always call it “medication.” They love to require “medication.” So, oh well. Good, I suppose.
~ NM504 is also being studied in a placebo-controlled, double-blinded, proof of concept trial testing its utility in combination with metformin in type 2 diabetes patients with adverse gastrointestinal effects.
From the same DiabetesHealth article
In a recently-published case study, NM504 demonstrated the potential to mitigate the GI side effects associated with metformin.
The gut microbiome plays an important role in regulation of metabolic processes, including digestion, absorption, and synthesis of bioactive molecules that signal physiological host mechanisms. Changes in the human gut microbiome are associated with type 2 diabetes and insulin resistance. Water-soluble dietary fibres like inulin and beta-glucan are fermented in the colon, and beta-glucan increases viscosity. Blueberries improve insulin sensitivity through an antioxidant effect. A cobiotic, consisting of purified inulin, sugar-free blueberry pomace extract, and an oat preparation of purified beta-glucan was developed for twice a day (bid) consumption as a smoothie drink to repair the gastrointestinal dysbiosis in type 2 diabetes. A 30-year-old man presented with new onset type 2 diabetes and a fasting glucose (FBS) of 375 mg/dl. Metformin 500 mg bid was initiated and increased to 1 g bid after 1 week. During the first 9 days of metformin treatment, he developed diarrhoea, but his FBS only dropped to 325 mg/dl. The cobiotic bid was added on the 9th day of metformin treatment, and after 2 days, his FBS dropped to 175 mg/dl. After 8 weeks on metformin and the cobiotic, his blood sugar was 100 mg/dl and he lost 5.5 kg. His stools became soft and formed on the cobiotic, reverted to diarrhoea when off of it for 2 days, and returned to normal on resuming the cobiotic formulation. Metformin is a safe, effective and inexpensive generic medication favouring weight loss, recommended as initial treatment of type 2 diabetes by the American Diabetes Association. However, a 20% incidence of diarrhoea limits its tolerability. A safe food supplement that can increase the efficacy of metformin and its tolerability, as occurred in this case report, would have significant positive public health consequences. A controlled clinical trial of the cobiotic with metformin is planned.
Interesting times lie ahead.
MBT is developing microbiome modulators that alter microbial populations and their environment in the gastrointestinal tract to address serious health conditions. The company’s microbiome modulators are designed to act on multiple factors, augmenting the growth of targeted desirable bacterial strains and discouraging the growth of others. NM504 is formulated to promote microbiome shifts that positively affect metabolism and weight.
We’ll see. At minimum, it appears the focus in now on actual root causes of things.
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Free The Animal is an eclectic writing project about everything since November 2003. 23 years, 5,500 posts, 5 million words.
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The suspense of your upcoming soil test is killing me! Not since the TV series Breaking Bad have I experienced such excitement over the next instalment of a series.
Regarding digestion of vegetables: prior to RS beetroot and corn would come out the same colour it went in. It was like shitting paint the colour was that bright. Not anymore! Corn completely, yes completely, dissappears and beetroot does nothing but add a slightly darker shade of brown.
I hear the sound of tectonic plates shifting.
The question now is, why is the effect temporary? A few weeks ago someone linked to a study in Mali, where the starving children were given a different diet, and they were finally able to put on weight. When they put on weight, their gut bacteria changed to match the healthy children who ate the traditional Mali diet.
When the gut bacteria were “normal”, they switched the children back to the Mali diet. The gut bacteria changed back to how it was before, and they went back into starvation, not being able to process food.
Now in this news, the people taking the probiotic pill lose the benefits after two days of not taking it.
So…. what is going on? What is it in the body that is killing the good bacteria? 2 days seems way too fast for the gut bacteria to die out completely, even if you aren’t supplementing with RS.
Having the right bacteria and balance of bacteria isn’t enough.
Once you add back in the bacteria that were killed by anti-biotics and other causes, there is still something else that is wiping out beneficial gut bacteria.
I haven’t noticed any particular changes from RS (no downsides either, so its all good). I’m ready to start taking probiotics, if I can find good ones. Some fellas were advocating shit transfusions, but I’m not sure I’m that desperate yet. Besides, who does anyone know that is healthy enough you’d trust it? This is as dangerous as blood transfusions.
This is definitely a rich field for study.
I’ve read about the loss of therapeutic effect following the suspension of probiotics before.
Apparently the bacteria in the probiotic are unable to establish a permanent colony in the gut. Why it seems to work with fecal swaps while it doesn’t with probiotics in a capsule, I’ve not seen explained. I can imagine a few explanations, but they would just be guesses. I am curious what the real difference is, and I hope someone figures it out.
Be interesting to see if fecal transplants would permanently fix those kids in Mali, after the diet change only gave temporary benefits.
I wasn’t aware that fecal transplants give long lasting benefits; perhaps it isn’t just the bacteria that is needed, but the “bacteria colony” including some of the matter that they reside on, sort of like with kefir. With kefir you can’t just isolate the bacteria and get new kefir; the whole colony, with the ropes and everything is needed.
So if fecal transplants are what is needed, how do you find healthy donors? How do you identify someone who is healthy?
Alan, nice to see your name pop up. Have you guys got the poop test kits yet?
I haven’t got any proof, but my theory would be that the bacteria need some time to settle down, buying a house, getting a car and stuff before they are permanent residents in the area.
Just the other day I think Richard posted something about how the appendix stores bacteria to reboot the gut flora, if that’s the case maybe it takes a while before the new bacteria moves in to the appendix.
Eating foods treated with antibiotics and anti-pesticides?
If people are eating conventional meat and veggies, are we constantly attacking our gut flora?
Oops, sorry for the drive-by comment (ie. delayed response). Yep, got the kits and have sent in the “before” samples. We’re one week into the experiment at this point. Some time this weekend I was going to post a bit of an update over at the blog page with some of my early thoughts and experiences. Thanks for asking.
Getting Dr. Ayers on the team is a great move, if that’s what’s happening here.
“The missing bacteria will not be regained upon return to eating plants again.”
I don’t see the support for that statement. In fact, the seasonal pattern of hunter-gatherer eating would directly contradict that. Hadza seem to do ok eating nothing but honey for a few months out of the year.
This is similar to a contention from Dr. Ayers’s last post, stating that it might be necessary to consume some probiotics to make RS work. I don’t see support for that either — exogenously consumed LAB bacteria (and SBOs, for that matter) don’t really colonize and wouldn’t play a significant role in this.
My understanding of the SBOs is to outcompete and use bacterial produced anti-biotic to eliminate pathogenic bacteria, especially from the small intestine. For example, subtilisin produced by B. subitilis is antibiotic against bacterial dysentery and probably others as well.
The missing bacteria consequent from antibiotic use and poor eating habits will have to gradually repopulate via food sources which are ‘contaminated’ with the ones that are missing. Probably a slow process.
“I don’t see the support for that statement.”
That’s because you come from the context of Western Civ clean rooms, that we all live in, compared to bushmen. It may be that gut bacteria don’t really colonize as we think of it, building cities and suburbs, watching Jonny “E. coli” Carson and Craig “C. diff” Ferguson every night.
These people are ingesting live and dead bacteria and spores all the time.
That’s a difference you have to account for.
“Use it or lose it.”
Great advice. That is why I eat a diet that includes everything: meat, dairy, fruit, vegetables, grains, starches, and everything else in between. This was an idea that was floating around on the 180 Degree Health blog quite a few years ago.
I’m like the borg. Assimilate everything and make it part of my being. Absorb what is useful and shit the rest out.
I’ve been following this since the beginning and have experimented along, and my only question is: if I pay attention to my gut and butt flora and my husband doesn’t, will my flora automatically transfer? We share a lot of fluids :)
Richard, forgive me if this has been answered elsewhere = can you please list (or point me to one) the most beneficial strains of probiotic? I’m researching new sources in my neck of the woods and want to get the best bang for my buck.
Karen
I’m using these
– Prescript Assist
– AOR Probiotic-3
– Primal Defense Ultra
One of each, twice per day. I’ll be posting about it next week.
Ah. These ones aren’t available domestically. Could you tell me the names of the various strains they incorporate? Sorry! And thank you!
If you Google around for the product info I’m sure it’s not to hard to find. Prescript assist has like over 20 strains.
Hello wondering what your thoughts are regarding this article.
Thanks!
fixyourgut.com/hso-probiotics-not-as-safe-as-they-are-believed-to-be/#comments
Marie, I had been reading various reports as well. The Italian guy with leukemia who died because of taking B. subtilis.
I watched Natasha Campbell Mcbride’s presentation and she acknowledges that people with severe problems must not take SBOs at regular doses. She recommends a capsule be opened and only a tiny amount taken and certainly not every day. I can’t remember now how infrequently (? once per week) but she says it can take a long time before SBOs can be taken at full dose. Then only for a certain period of time while needed.
Meh, the date is 2003, 11 years ago, for the principle reference. Natasha Trenev is a competitor, so there’s 2 strikes there.
Perhaps I’ll drop dead. Until then, at least I can breath clearly for the first time since I can remember.
Strike 3.
Marie,
Chris Kresser responded to those concerns here.
Sounds like people in the dairy-based probiotics industry decided it would be good for business to spread false and unsubstantiated rumors about SBOs.
Thanks to everyone for your input on this!
Ah, just saw this. Sorry for asking redundantly…
Thanks Duck ;)
I believe anyone on chemotherapy (which breaks the gut and induces instant intestinal permeability) and anyone with low WBCs (white cell counts, aka super low immunity), many probiotics are contraindicated.
A search of pubmed will produce a list of septicemia with any probiotics (LAB, bifido and otherwise) with severe immunocompromised states.
Gab~ I love u and this article you brought up earlier. This explains FTA and the ‘failures’ no? This article was almost 20 years ago. I bet the results would be somewhat worse now, my suspicion…
Br J Nutr. 1996 May;75(5):733-47.
Digestion and physiological properties of resistant starch in the human large bowel.
Cummings JH, Beatty ER, Kingman SM, Bingham SA, Englyst HN.
Author information
Dunn Clinical Nutrition Centre, Cambridge.
Abstract
The digestion of four sources of resistant starch (RS) has been studied in twelve healthy volunteers who ate controlled diets for 15 d periods. RS from potato, banana, wheat and maize (17-30 g/d) was compared with a starch-free diet, a diet containing wheat starch that was fully digested in the small intestine, and with 18.4 g NSP from brand/d. RS increased stool wet weight by 1.6 g/d per g RS fed for potato, 1.7 for banana, 2.5 for wheat and 2.7 for maize, but this was significantly less than bran NSP at 4.9 g/g. RS was extensively digested in twenty-seven of thirty-four diet periods but five subjects were unable to break down one or two of the RS sources. Faecal N and energy excretion were increased. RS decreased NSP breakdown and RS2 (resistant starch granules) tended to prolong transit time. All forms of RS increased faecal total short-chain fatty acid excretion. RS2 (from potato and banana) gave greater proportions of acetate in faeces, and RS3 (retrograded starch from wheat and maize) more propionate. We have concluded that RS2 and RS3 are broken down in the human gut, probably in the colon although in 26% of cases this breakdown was impaired.RS exerts mild laxative properties, predominantly through stimulation of biomass excretion but also through some sparing of NSP breakdown.
Natasha Trenev is the owner of Natren, a producer of lactic acid based probiotics – agenda perhaps? Her recommendations and fear mongering against SBO’s has not a single relevant citation behind it. And so miss Jini Patel is basing her entire recommendation on the scientifically unsubstantiated word of Natasha Trenev? Pfff…
Whether it’s a bushman or David Letterman, your gut will be largely comprised of bacteroides, prevotella, or clostridia, with a few other leading characters. These are not in fermented foods, or probiotic pills, or the potato chip on the ground that falls within the 5 second rule. They are in you. The amount and proportions will depend on diet.
That’s why FMT is probably the only thing that holds any real promise (if something other than diet is really called for). But even then, the jury’s out on everything but C. diff infections, because all you’re really doing is eradicating a pathogen by flooding it with a hostile environment for a while. Doesn’t really require anything to stick long term.
My mind boggleth ath these blog comments.
Linking Heisenbug’s lack of certainty with TempestuousCup’s question on transfers of butt flora with her husband produces the advice that FMT (Friendly Microbiotic Transfer) heavenly peaks can be achieved between consenting adults while listening to
youtube.com/watch?v=GeisCvjwBMo
Sláinte
Vagabond
PS
And Les Francaises & Francophiles do it “Chic to Chic”.
While Desert Lovers do it ” ….k to ….k”.
Oh also, Richard, to be clear, I do see your point on the continuous exposure of the environmental bugs, and how “colonization” wouldn’t really apply. I agree. I just think they are involved in (very important) processes that are outside of the commensal/fermentation/SCFA process. That’s where I think Ayers gets things mixed up.
Use it or lose it. Art goes on to talk a lot about the need for probiotics, and not all that stuff in yogurt, kefir, or any other lacto-strains.
I’m at a loss here Richard….I’ve been reading Art’s blog almost as long as I’ve been reading yours. I found this latest convergence of RS with his Cooling Inflammation pretty neat, but I am puzzled to see you omit Art’s recommendation for adding missing gut bacteria – eating fermented vegetables.
” So, here comes the part that was missing from Nikolay’s Paleo plus RS. He left out the missing gut flora. RS is a panacea for those with some gut bacteria that can digest RS, but for those with profoundly crippled gut flora, e.g. some of those with autoimmune symptoms, RS is just inert fiber, not flora food.
New bacteria must be eaten, and I think that the cure, short of the real deal fecal transplant, is still available in the original, paleo form of naturally fermented, live foods. The answer (and please forgive the fervor, because I think health can be this simple) is Fermented Vegetables”
I have eaten a whole bag of BRM potato starch, 4 tbsps a day with my organic yogurt last month, thanks to your blogging on the topic. I noticed almost zero difference in health, feeling, digestion etc….the only noticeable thing was perhaps a little bit more vivid dreams and that’s about it.
But this entire experience helped me realize that I’ve been consistently eating a good amount of fermented vegetables (kim chee, sauerkraut, poi) and RS in the form of cold rice for a number of years now, so great. I also quit being a germophobe several years ago, and haven’t taken any antibiotics in well over 5 years.
Anyhow, keep up on preaching the good word on RS. I used to always refer people that asked me about diet to Mark’s place…but lately I’ve been telling folks about RS and FTA almost as much as Mark’s Primal paradigm.
Keoni, not an oversight to not address that, because I plan to address it when I post about probiotics specifically next week.
Now, I’m off to go get some fresh sauerkraut, pickles and kimchi. Oh, and some natto.
I started taking those three probiotics a couple of months ago, and there was a definite period of adjustment after just taking Prescript Assist for the first four+ months with PS.
Also, I just made a “smoothie” with water, 15 g. BCAAs, 15 g. of a Glutamine-Alanine di-peptide, a couple of tablespoons of potato starch, some matcha powder, a little stevia and a hand full of blueberries. I couldn’t eat anything right now if you set my favorite food reward junk food (pulled-pork nachos!) in front of me and held a gun to my head. (I put “smoothie” in quotes because it’s not the most delicious thing you ever ate, though it’s not too bad.) The Glutamine-Alanine dipeptide is to help repair leaky gut, if anyone is interested.
Hi Richard,
Just started going through your blog. I have gone through about 10 of your RS posts and really like how you pile on the research on people. I would like to do that type of research myself but it’s just nice and convenient when there is a guy like you who can do that for us.
Anyways, I am really interested in hearing about the probiotic supplements that you use because I realized that I have been going through a stage of daytime fatigue that wasn’t always there. I attribute this to a 1-month stint on Accutane (an acne anti-biotic) that I took in high school. I got a yeast infection that appeared on my face within 2 weeks of using it and stopped at the end of the 4th. The yeast infection went away and my skin did get clearer but I feel tired all the time now. Been reading various health blogs for a while to figure out what to do and I think that this RS info is going to help me. I am particularly interested in hearing more about what probiotics you used and mentioned in this post and will keep my eyes on the blog to know which probiotic supplements you recommend!
Also, I am willing to take poop pills (honestly) if that’s what you recommend. As long as they’re in capsule form I mean.
It would be really interesting to figure out what ingestable would assist the development of NM504 in the gut. Why wait for the approvals, the development, the marketing, the distrubtion? There must be a DIY for this one as well!
Jeez….so NM504 is just a mix of “NM504 – a proprietary combination of purified inulin, beta-glucan and blueberry pomace extract”…I thought there would be some special kind of bacterial strain in there. F*&^$
I thought of this site during a workshop with Sandor Katz on the weekend where he suggested that we can make sauerkraut by building alternate layers of cabbage and cooled mashed potato. An FTA complete food!
My Oma always served boiled potatoes with her sauerkraut and spareribs.
All the critters are dead, but the elements are there.
Richard~
AWESOME POST! I appreciate you having me on board so I can keep kicking ur cute ass. ;)
Thank you for posting on MBT NM504. O M G Hey this product sounds oddly familiar like the 7-steps (g banana/RS + SBO probiotics + Amazing Grass high ORAC green powder) for a high GI IQ and ultimate gut healing!!
Maybe they will even REVERSE T2D if probiotics were added????!
“A cobiotic, consisting of purified inulin, sugar-free blueberry pomace extract, and an oat preparation of purified beta-glucan was developed for twice a day (bid) consumption as a smoothie drink to repair the gastrointestinal dysbiosis in type 2 diabetes.”
Grace
Which Amazing grass product? Amazon sells a bunch of different ones.
15,000 ORAC value!
iherb.com/Amazing-Grass-Green-SuperFood-Antioxidant-Berry-Drink-Powder-7-4-oz-210-g/35730
Have you heard of WAPF and Pottenger? Raw foods are what our ancestors evolved on, no? We need their outsourced enzymes and nutrients that cooking can destroy. This formula though pricey also has some additional fiber and detoxing plant extracts that makes the combo BIONIC FIBER: g banana flour + RS + NSP/flavonoids.
Personally I don’t like the cacao products — when I was ill something in it didn’t agree and I think it’s because it’s a raw legume (phytates? lectins?)
It’s worth noting that some of these “green” powders have some quality control issues.
consumerlab.com/results/print.asp?reviewid=greens
For instance, the “Paradise energy greens” had excessive lead contamination at one point.
oag.ca.gov/system/files/prop65/notices/2012-00308.pdf
But, I believe the “Amazing Grass” brand passed the quality control tests from what I’ve come across, so it looks like a very good brand.
Been on PS up to 4 TBL about a month. Smaller amounts for about 2 weeks before. I am going to have to take a break as my eczema is nasty, painful and huge on my hand and on my leg actually wakes me up at night. It has only flared up this way since the PS intake. Never had eczema until 1 yr. into LC Paleo. This is the only thing eating differently, other than increasing my carbs to about a 1/2 cup of parboiled rice, sweet potatoes and some white potatoes. I have eaten these things fine on a LC transitioning Paleo in the last year. The good benefits are not outweighing the discomfort and ugliness of the eczema. I will see if things calm down after stopping and go from there. I am not on probiotics as of yet–kind of wanted to read Richard’s post first and these things are costly. Sorry, but $$ is a factor. I got bills! If the probiotics will help this situation, give me a shout and I will get them ordered because I would really like to see where this goes on RS with me.
Heisenbug, check out his entry about the eczema he gets on his hands and the kimchi that seems to clear it up. Fermented vegetables have a lot of lactobacillus, so I guess that could be a start.
Thanks. I will check this out and perhaps I can just get started with the lactobacillus, which I notice is in abundance in the local drug stores. His case sounds just like mine. There is sooooooo much out there, just in the Paleo world. I get confused. High histamine, FODMAP, creams–in some ways the internet can produce crazeee.
I do make my own kombucha, but stopped a couple of months ago. I need to check what kind of probiotics are in that.
Does anyone have thoughts on why Korea appears to have such high rates of colorectal cancer despite consumption of large amounts of fermented vegetable fibers? I realize that smoking is a risk factor, but other countries are heavy smokers and do not appear to have the high risks for colorectal cancer that Korea does. I was looking at the info here:
The link mentions that height is also a risk factor but then says calcium is likely protective yet Norway, Denmark and Netherlands (high dairy consumers) didn’t seem protected at all. I’m thinking that the stats may be generally useless because of all the confounding factors but the fact that Korea ranked so high seems odd if fermented veggies are in fact protective.