How does Dr. Greger pressure steam his greens? 

In a review of more than one hundred articles about the effects of cooking on vegetables, researchers tried to find the sweet spot. On the one hand, heat can destroy certain nutrients, but on the other hand, softening the tissues can make them more bioavailable. Researchers settled upon steaming as the best cooking method to preserve the most nutrition because the vegetable isn’t dunked in water or oil where the nutrients can leach out and excessive dry-heat temperatures aren’t reached either. They acknowledge, however, that of all of the common cooking methods, we know the least about pressure cooking, as you can see in the graph below and at 0:37 in my video Does Pressure Cooking Preserve Nutrients?.

There are all sorts of fancy electric pressure cookers, like the Instant Pot. They’re great for quickly cooking dried beans with just a touch of a button, but what happens to the nutrition? Let’s look at black beans. (See the chart below and at 1:01 in my video.) The antioxidant content of presoaked black beans boiled for about an hour, a usual cooking time, is high, but it’s even higher when pressure cooked for 15 minutes. In fact, researchers found six times the antioxidant levels in the pressure-cooked beans. I’ve been pressure-cooking beans just because I like their texture better (the canned ones can be a bit mushy for me) and dried beans are so cheap compared to canned ones. But now we know they’re tastier, cheaper, and healthier. That’s quite the triple threat. 

What about pressure-cooking vegetables? As you can see below and at 1:35 in my video, vitamin C is one of the more heat-sensitive nutrients. Researchers found that sautéing spinach or amaranth leaves in a pan for 30 minutes destroyed about 95 percent of the vitamin C, whereas ten minutes in a pressure cooker wiped out only about 90 percent. But who pressure cooks spinach for ten minutes or sautés it for half an hour? Regardless, even then, not many effects were found either way on beta-carotene levels. 

Vitamin C is but one of many antioxidants, though. What about the effects of pressure cooking on overall antioxidant capacity? At 2:07 in my video and below, you can see a table of different cooking methods researchers compared—for example, 12 minutes of boiling, 5 minutes of pressure cooking, and 6 minutes of microwaving carrots. The researchers found that cooking carrots increased their antioxidant potential and pressure cooking nearly doubled their antioxidant value. In contrast, no matter how peas were cooked, their antioxidant capacities took a hit.  

What about greens? Chard wasn’t affected much across the board, but for spinach, microwaving beat out both pressure cooking and boiling, and pressure cooking beat out boiling—even though pressure cooking is actually boiling, but in less time and at a higher temperature. However, the cooking time appeared to trump the temperature; the researchers saw significantly less nutrient loss when pressure-cooking spinach for three and a half minutes compared to boiling for eight. 

The researchers found the same thing with those magical cancer-fighting glucosinolate compounds in cruciferous greens, which are the healthiest ones, including kale, collards, and turnip greens. As you can see in the graph below and at 3:08 in my video, they had the highest nutrient levels when they were raw. Three-quarters were wiped out by boiling, but less than half were eliminated by pressure cooking. Steaming beat both methods, retaining more nutrients than boiling or pressure cooking, because the greens weren’t dunked in water, which can leach out the nutrients. But, even though the pressure-cooked greens were immersed just as much as the boiled greens were, there were only half the nutrient losses, presumably because it was only half the cooking time—seven minutes pressure cooking compared to 15 minutes boiling. 

What if you cut down that time even more by pressure steaming, for instance, by adding a layer of water at the bottom of an electric pressure cooker, dropping it in a metal steaming basket, then putting in the greens and steaming them under pressure? That’s how I cook the greens I eat every day. I’ve always loved collards, especially in Southern-inspired cooking or Ethiopian cuisine, and I found I could get that same melt-in-your-mouth texture simply by steaming them under pressure for zero minutes. Zero minutes? Yes. Just set the pressure cooker to zero so it shuts off as soon as it reaches the cooking pressure, then immediately open the quick-release valve to release the steam. The greens turn out tender, a bright emerald, and cooked to perfection. Give it a try, and let me know what you think. 

I love covering practical topics—ones we may need to consider day-to-day when making decisions. Check out some of my other videos, including some cooking ones, in the Related Videos below. 

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Even those who test negative for cow’s milk allergy may have hypersensitivity reactions to dairy products. 

Excessive spitting up and vomiting in infants may be treated by putting them down on their left side after meals—of course, never when sleeping. It’s always face-up to wake up to reduce the risk of crib death. Also, as I discuss in my video How to Treat Reflux in Children with Diet, you can try smaller, more frequent feedings, thickening or changing formulas, and in breastfed infants, which is ideally how all babies should be fed, eliminating cow’s milk and eggs from the mother’s diet. 

You may recall that, in my video Treating Reflux in Babies with Diet, I talk about how more than 40 percent of infants with reflux can be successfully treated with cow’s milk removal. It can also affect them on the other end, too, as cow’s milk allergy can be a major contributor to diaper rash and also contribute to chronic constipation in 80 percent of affected kids. In one study, however, only a single kid tested positive for having an actual allergy to cow’s milk, so it seems to be a kind of sensitivity reaction that can really only be diagnosed by giving a cow’s milk-free diet a try. Anal fissures in infants may be practically pathognomonic for cow’s milk allergy, meaning so characteristic of the condition that it could be used as a diagnostic sign, with no allergy testing required. 

It’s like when cow’s milk hypersensitivity was demonstrated in 10 of 17 children with severe reflux. In the majority of patients, the hypersensitivity to cow’s milk was identified only by eliminating it and then re-challenging to confirm. Researchers did endoscopies, measuring the acid that gurgled up before and after milk consumption, then verified by repeating milk exposure with double-blind placebo-controlled challenges when necessary. Yet, all but one of the children proven to have this adverse reaction to dairy tested negative on allergy tests. So, the kids tested negative for a cow’s milk allergy, but they still got better by cutting out the cow’s milk. “In conclusion, an association of cow milk hypersensitivity and severe GERD [reflux] was observed not only in infants but also in preschool/school children.”  

Another disease that can be cured with cow’s milk elimination is eosinophilic esophagitis, a chronic inflammatory disorder of the esophagus, the tube that connects your mouth to your stomach. To figure out what’s causing the inflammation, an elimination diet is prescribed, where you basically remove everything, then each time you add back a food, doctors insert an endoscope down your throat and take biopsies to see if that particular food made things worse. How many freaking foods are there?! You can imagine how difficult, costly, invasive, confusing, and frustrating that may be for families. So, researchers at Northwestern figured why not just see what happens if you remove just one food from their diet instead of making them go through all that. Their finding? Eliminating cow’s milk induced remission in 65 percent of the children they tried it on. Normally, doctors would have to try to coat their patients’ throats with steroids to knock down their immune response. Doing so then sets the stage for infections like thrush, though, and of course, as soon as the steroids are stopped, the esophageal inflammation comes raging back because you aren’t treating the underlying cause. But steroids are considered the standard of care. Too bad there’s never been a head-to-head test of cow’s milk elimination versus steroids…until now. 

As you can see in the graph below and at 3:40 in my video, researchers conducted a comparative effectiveness trial of cow’s milk elimination versus a swallowed steroid and found they both appeared to work just as well, which is to say the cow’s milk elimination worked better because there are no side effects and you’re treating the actual cause. They concluded, “Our results suggest that cow’s milk elimination is an effective treatment option that should be considered as a first-line therapy…” 

In adolescence, cow’s milk protein intolerance can contribute to chronic fatigue syndrome, evidently a common problem in young people with chronic fatigue and most importantly “a treatable contributor to their symptoms.” But again, most were unaware that dairy was a problem, possibly because it can take hours between milk ingestion and when you start feeling worse, so people don’t make the connection. So, even those who report no problems after milk ingestion may still be suffering problems after consuming dairy. 

Finally, what about adults? Well, there’s lactose intolerance. Most people on Earth are lactose-intolerant after weaning, with the exception of some human populations that developed lactose tolerance about 10,000 years ago, thanks to a mutation in the lactase gene that enabled adult humans to digest lactose (milk sugar). As you can see below and at 4:53 in my video, they were mostly select European populations, whereas most Hispanics, Africans, and Asians remain intolerant, which may be a good thing, since acid regurgitation, reflux, and heartburn is so common among adults in the Western world. Food intolerance may play a role in adults as well. Milk was found to be the leading culprit, but researchers were using what’s called a leucocytotoxic test, where you see how someone’s white blood cells react to individual foods in a petri dish. 

This test is frowned upon by professional allergy associations as not being sufficiently sensitive and specific. It can’t hurt, though, to put it to the test. A double-blind, randomized, controlled trial was performed in 38 reflux patients for which proton pump inhibitor drugs failed to completely control their symptoms. What happened when the diet was given a try? As you can see in the graph below and at 5:48 in my video, researchers randomized people to either a diet in which they excluded foods they tested sensitive to (most often dairy) or one that instead excluded foods for which they didn’t test positive to control for the placebo effect. A month later, the symptoms in the control group dropped, but the symptoms in the true diet exclusion group dropped significantly further. The researchers kind of felt bad for the control group, so they switched those participants to the right diet, too, and two months later, everyone was feeling better. 

I covered the effects of maternal diets on breastfed babies in Treating Infant Colic by Changing Mom’s Diet and Infant Seizures Linked to Mother’s Spirulina Use. Breast is best, but you may also be interested in The Best Baby Formula and Formula for Childhood Obesity. 

For more on dairy and child health, check out the Related Videos below. 

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How good is the evidence that flossing is effective? According to randomized controlled trials, what is the optimal toothbrushing and flossing sequence? 

“Over the years, it has been generally accepted that the use of dental floss has a positive effect on removing plaque. The American Dental Association (ADA) even reports that up to 80% of plaque may be removed by this method.” How do we know? You can use what’s called a split-mouth design, where each person can act as their own control—for example, by flossing only one-quarter of their mouth. Researchers asked study participants to stop brushing their lower jaw so that plaque would build up, then they were randomized to floss half and leave the other half as the non-flossed control. As you can see below and at 0:37 in my video Should You Floss Before or After You Brush?, not only did flossing cut plaque by about 60 percent after just three weeks, more importantly, it also halved gingivitis signs—bleeding on probing and another index of gum inflammation. Note, though, that this compared flossing to doing nothing. The study subjects weren’t allowed to brush their lower jaw. So, flossing is better than nothing, but is flossing plus brushing better than just brushing alone? 

“The advocacy of floss as an interdental cleaning device hinges, in large part, on common sense,” but common sense doesn’t go very far as a form of evidence. You don’t really know until you put it to the test. What’s the efficacy of dental floss in addition to a toothbrush? Surprisingly, only 3 out of the 11 studies the researchers looked at found a significant added benefit. 

The anti-flossers were positively giddy, comparing dentists who continued to advocate flossing in the face of the data to flat-earthers. Dentistry is a profession “in denial,” they wrote. “Over 80% do not floss regularly and it is hard to accept that these ‘the great unflossed’ were right and we, ‘the highly educated intelligencia’ may actually have been wrong…Flossing doesn’t work—get over it!” 

So, you’ve heard of the tooth fairy. Is flossing just some tooth fairy tale? The review showing that only 3 out of 11 studies found a significant benefit to flossing in addition to brushing was published back in 2008. Since then, more studies have found that while the evidence on additional plaque reduction is weak, there is at least some evidence that flossing with toothbrushing helps with gingivitis, which is a primary reason you want to reduce plaque anyway. Why might they not have found stronger evidence? “Trials were of poor quality and conclusions must be viewed as unreliable,” so basically, we don’t have good evidence either way because good studies really haven’t been done.  

Why not? Why wouldn’t Big Floss fund the studies? It appears that all floss works the same. If you compare unwaxed to woven to shred-resistant floss, they all have about the same plaque-removal efficacy, something all such studies appear to have found. So, why would a floss company fund a study to show that flossing in general is good if it can’t show that its product is better than another? You might just buy its competitor’s floss. 

Where do we stand today? “Although technically the evidence for flossing is weak, more importantly, the methodology and rigor of the studies examining flossing effectiveness are also weak.” For example, the studies didn’t assess the frequency or quality of people’s flossing. (You can see an incorrect way of flossing below and at 3:18 in my video.) The bottom line is that the American Dental Association continues to recommend brushing and flossing every day. But what’s the proper sequence? Should you floss before or after you brush? 

“Some dentists argue that flossing should come first because you stir up the particles and plaque that the toothbrush can brush away subsequently. The fluoride from your toothpaste is also more likely to reach the interdental areas [the spaces between teeth] if food wedged in between the teeth is removed before brushing.” Others, however, “recommend brushing be done first and their rationale is that brushing teeth first removes the bulk of the particles on the teeth and flossing afterward can remove interdental plaque better. It could also force the remaining bit of fluoride that is left on the teeth from toothpaste into the interdental spaces.” You don’t know until you put it to the test. 

An article titled “The Effect of Toothbrushing and Flossing Sequence on Interdental Plaque Reduction and Fluoride Retention: A Randomized Controlled Clinical Trial” reported that flossing first won—both in terms of getting rid of significantly more plaque, as well as getting more of the fluoride between the teeth. “When we use dental floss after brushing, much of the particles that are removed by dental floss would stay in place.” The bottom line is that flossing followed by brushing is preferred. 

What about oil pulling? Short answer: Don’t do it. Long answer: You’ll find out in my four-part video series listed below in Related Videos.  

Treating the cause of cavities by reducing added sugar intake is the most important thing for protecting your teeth, but is there anything else we can do to improve our oral health? See below. 

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