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What Your Microbiome Wants for Dinner

204 points| dnetesn | 10 years ago |nautil.us | reply

97 comments

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[+] asciimo|10 years ago|reply
This article opens with, "[New science] is also showing us that advocates of trendy paleo and vegan diets are missing the big picture of how our omnivorous digestive system works." But it concludes with, "Pick a modest-sized plate and make meals using vegetables, legumes, leafy greens, beans, fruits, and unmilled whole grains as the main ingredients. Add some meat if you want and dollops of healthy fats on the side or sprinkled through the plant foods. Desserts and sweets are special, so save them for the special times." Omit the optional meat an you have a vegan diet. What about the "big picture" are vegans missing?
[+] shanusmagnus|10 years ago|reply
And omit the legumes and grains and you have paleo. Agreed, it's pointlessly contrary.
[+] codingdave|10 years ago|reply
The "add some meat if you want" part.
[+] edem|10 years ago|reply
If you omit something it is not the same anymore. It is like omitting pasta from a spaghetti bolognese: you will end up with something completely different and not even remotely pleasant.
[+] 1535536|10 years ago|reply
Err not really. The typical vegan diet contains large amounts of potato, heavily refined carbohydrates, and processed foods. It also lacks an emphasis on probiotic and prebiotic foods such as sauerkraut. The article also didn't say the diets were massively different, but rather that they had a different emphasis. You can eat a vegan diet and avoid all of the prebiotic and probiotic foods.
[+] mark_l_watson|10 years ago|reply
Well, the author points out that meat is beneficial, but eat just a small amount with meals so it largely gets absorbed in the small intestine (and he explains why this is important).

The other valuable information is why whole grains are OK to eat (I favor them in small portions only) and processed grains are so bad for us.

[+] hondo77|10 years ago|reply
Dairy.
[+] kefka|10 years ago|reply
That's an interesting article, for sure. It also applies to what I've been diagnosed with as well. Type 2 diabetes.

I'm applying data science to this disease. It's what I do, and can afford. Unfortunately, my doctor thinks that pushing pills is an adequate response, which I heartily doubt.

The more I understand this disease, it has to do with either: pancreas is dead (type 1), or your glucose response/insulin response is badly out of whack due to a metabolic carbohydrate problem (type 1.5/2). I was diagnosed with a fasting glucose of 161 and a1c of 7.1 . Met with doctor, and talked about it shortly. Was prescribed metformin and testing kit with 100 strips. I am currently not taking any drugs.

I keep reading that the problem is carbohydrate overload to my genetics. Can I validate or invalidate that? Indeed. I was told to test blood sugar 1x a day for 3 months. That's inadequate, as it's only an instantaneous sample. What about after I eat? What about when I go to bed and wake up? Can I deduce anything about my pancreas and its slow and fast response to glucose? Indeed.

I've started testing myself 4x every meal(1 before meal, 3 half hour increments after meal ends), and 1 when I wake up and go to bed. Turns out that yes, carbs has, in my body a direct correlation to my blood sugar. And it's pretty stark.

Now, if my hypothesis is correct, I can control my blood sugar purely with carb counting and eating to the glycometer. If after 2 weeks this does not show significant changes in my basal glucose rate, as well as weight losses, then I will go on drugs.

However, I already have 2 good side effects: I'm not craving for food any longer, and I no longer overheat. I'm not sure how to classify those effects, but not being slave to extremely annoying bodily issues does seem very beneficent.

[+] shanusmagnus|10 years ago|reply
Congrats on your approach to managing your condition. Couple of things to think about.

First, you may find a continuous glucose monitor helpful to get a more granular view of what's going on. Dexcom [1] makes the most popular one, which is also hackable [2].

Second, keep in mind that all carb avoidance isn't equal. If you up your protein a lot, you could still get postprandial glucose spikes due to gluconeogenesis from protein breakdown. A good low-carb diet for you will be a low-carb, high-fat diet.

Third, for extra bang for your buck, go for a walk after you eat. The CGM, if you get one, will verify the efficacy of that.

Fourth, look into high-intensity exercise, which will help combat your insulin resistance. All exercise is not the same. Weight training is particularly good.

Your MD's reaction is sadly typical. You're taking the right approach by taking matters into your own hands, using her as a backup.

[1] http://www.dexcom.com/dexcom-g4-platinum-share

[2] http://www.nightscout.info

[+] amlgsmsn|10 years ago|reply
Here's an interesting study that found that different people have different blood glucose reponses to the same foods.

http://news.meta.com/2015/11/19/cell-nutrition-is-personal-i...

>Participant A maintained a stable blood glucose level after eating a cookie but responded with elevated glucose levels after eating a banana. Conversely, participant B experienced an increase in blood glucose level after eating a cookie, but not after consuming a banana.

>In another striking example one of the participants, a middle-aged woman who was obese and pre diabetic learned that her “healthy” eating habits may have actually been unhealthy for her. The researchers found that in her case, eating tomatoes resulted in an “unhealthy” blood sugar spike, as the woman ate tomatoes frequently over the course of the week long monitoring period, this “healthy” habit may have been undermining her health.

[+] montecarl|10 years ago|reply
I like your scientific approach. It would be awesome to have continuous monitoring of blood sugar, heart rate, body temperature, blood pressure, and other vital signs.

From what I have read, early type 2 diabetes can be completely controlled via diet changes as you have already started to see. The amount of insulin your body needs to make is by far the largest for carbohydrates, then somewhat less for protein, and then near zero form fat.

I liked this talked which summed up the argument for treating diabetes (type II at least) with diet and not drugs: https://www.youtube.com/watch?v=da1vvigy5tQ

[+] mrfusion|10 years ago|reply
This is awesome. What are the most informative times to test after you eat?

My fasting glucose was 99 so I'm not sure what to make of that. I ordered a glucose monitor just to learn how different foods affect me.

[+] ilurk|10 years ago|reply
Did you notice any differences depending on the carbs? White rice, brown rice, sweet potatoes.

And what about accompanying seasoning? Olive oil, coconut oil, fatty meat/fish.

[+] stevenkovar|10 years ago|reply
It may be worth looking into how different forms of exercise may affect insulin sensitivity; additionally, fasting (as well as the two combined).
[+] SergeyHack|10 years ago|reply
I've heard a number of times that proper water fasting can heal diabetes.

P.S. Absolute fasting can be dangerous.

[+] pixelglow|10 years ago|reply
I've been a Type 2 diabetic officially for 18 years but impaired glucose tolerance for longer. You're on the right path, there's a lot you can do to slow down the progress of the disease.

I'm not a doctor however so take any advice with a grain of salt. (But not sugar, definitely not that.)

> I keep reading that the problem is carbohydrate overload to my genetics.

Read up on "glycemic index". This index tells you how close your food is to pure glucose e.g. table sugar has a glycemic index of 68 so it has 68% of the insulin response of pure glucose. The index correlates to the type of carbohydrate and how processed it is, although there are some surprises e.g. premium ice cream has a G.I. of 37.

http://www.glycemicindex.com/index.php

You don't have to commit the entire index to memory. Usually you can come up with several heuristics e.g. tropical fruit tends to have higher G.I. than temperate fruit.

Obviously you should test this with your own blood sugar readings as individual response to a carbohydrate challenge can be quite different.

The other components to a meal also affect blood sugar. For example, acid, protein and fat tend to slow down digestion and thus blood sugar spiking. If you must take pasta for example, take it with a tomato-based sauce (acidic) rather than cream-based. YMMV.

> Unfortunately, my doctor thinks that pushing pills is an adequate response, which I heartily doubt.

It's important, although somewhat depressing, to see this disease as a progression. A progression that you have to slow down as much as possible, but still a progression.

Know that in the future, you may have to resort to the first line of pills, and then possibly stronger ones. Try to slow down the progression as much as possible, and research the pills to see their efficacy and benefit.

Metformin is usually the first line of defence and it has a long history and little side effect. It generally fools your body into thinking it's in starvation mode, which means you can lose weight, both fat and muscle. It actually lowers insulin resistance rather than increasing insulin. Generally in amounts >1g it gives you loose bowels, so when you have to use it keep on low doses as long as possible.

When metformin doesn't work as well, generally you'll get prescribed sulfonylureas. Since they increase insulin secretion, they tend to exacerbate your insulin resistance. There is some inconclusive research that they burn out the pancreatic beta cells. Better to avoid these as long as possible, but if your glucose control is bad you may not have a choice.

I'm currently on an incretin enhancer (gliptin) + metformin.

Also look up supplements on examine.com. It's hard to tell the effectiveness of supplements, the only one that had a distinct effect on me was berberine.

The other thing you can do is exercise. Lots of it. Strength training for more muscle and more insulin receptors. Aerobic exercise to burn/absorb more glucose and lose weight. There's even recent evidence that high-intensity interval training improves diabetic markers more than sustained, low-intensity exercise.

[+] fasteo|10 years ago|reply
Mind sharing your readings ?
[+] _fs|10 years ago|reply
One topic that was not mentioned in the article that I have found fascinating is that your gut microbiome can actually affect your cravings. (1) Your microbiome accomplishes this through a host of mechanisms including changing the expression of taste receptors, making certain foods taste better; they may release hunger-inducing hormones; or they may manipulate the vagus nerve (which connects the stomach to the brain) to control their hosts’ eating behavior.

Are you sure you really want that extra side of chips? Or has your gut biome decided it wants that extra fat, and influences you to eat it.

Additionally, you can "reseed" your gut biome by changing your diet. Do you crave greasy food? Go vegan for 2 weeks. The new gut biome that develops and takes hold may soon have you start craving healthier foods. A change in diet can change your biome in as little as 4 days. (2) You can witness this phenomena in the movie Super Size Me. At the start of the movie Spurlock is disgusted by eating McDonalds for every meal. But, by the end of his experiment, his gut biome has significantly changed, and you can literally see his mood darken when he is not eating greasy fries and burgers. He craves, or should I say, his microbiome craves those happy meals, and is influencing both his taste receptors, health, and general mood in order to manipulate him in to a trip to the drive though.

1. http://www.theatlantic.com/health/archive/2014/08/your-gut-b... 2. http://www.scientificamerican.com/article/the-guts-microbiom...

[+] magicalist|10 years ago|reply
> One topic that was not mentioned in the article that I have found fascinating is that your gut microbiome can actually affect your cravings

It's worth noting that the study[1] does not suggest that. It says that there has been some "circumstantial evidence for a connection between cravings and the composition of gut microbiota" and notes that there would be evolutionary pressure on microbes to be able to influence cravings, but gives no evidence on this point.

The thing the study was actually researching was ways microbes could influence cravings, not whether or not any of them actually were.

Meanwhile, it does appear you can noticeably change the expression of your microbiome by long term changes in your diet, but the effects we've actually found are still fairly subtle (at least in terms of metabolic outputs), and I've found no studies that indicate you can change cravings due to those changes. For example, in [2], "chocolate desiring" subjects had noticeably different microbiomes than "chocolate indifferent" subjects, but that difference was significant even when on the exact same diet (which was necessary for the study's methods).

You have to be careful not to extrapolate from actual data to "what makes sense". Spurlock's stuff appeals at a gut instinct level, but that's often the most dangerous kind of thing for science since our brains desperately want to make patterns out of data even when there isn't one.

[1] http://onlinelibrary.wiley.com/doi/10.1002/bies.201400071/fu...

[2] http://pic.plover.com/chocolate.pdf

[+] cimbal|10 years ago|reply
I think cravings are mostly an expression of a finely tuned feedback mechanism of the body to tell you what kinds of nutrients and minerals are currently lacking the most. The better you train this system by eating very varied, trying out all kinds of non processed foods, the better it works. Search for 'magnesium deficiency and cravings' for a start. There should be other papers on the topic but i can't find anything right now.

But i'm not saying that there is no such thing as the microbiome directly influencing your brain, bacteria produce a wide array of by-products. In which way these by-products affect our bodies is exactly the question. I just want to point out that there are types of dysbioses that can reduce the ability to absord certain nutrients and by that could exacerbate the problem of cravings.

[+] joeatp|10 years ago|reply
Would love to see this tested in a more detailed way, what if your vegan diet consists of high amounts of non-animal oils, would you still crave oily burgers eating a vegan diet with high amounts of canola or olive oil? Would you lose the cravings with lower oil intakes on the same vegan diet?
[+] blakesterz|10 years ago|reply
Somewhat interesting and different look at what different types of foods do to us by focusing on our guts and those little things that help us digest. His recommendation seems to be more complex carbohydrates, less sugar... same old conclusion, different way of getting there I guess. It's still "Eat food, not too much, mostly plants."
[+] stevenkovar|10 years ago|reply
The take-away, to me, is to append one more variable when we consider wehat goes in our mouth: the bioavailability / effect in your microbiome.

"We realize a diet like this doesn’t lend itself to being packaged and sold. It emphasizes how to think about food in the context of one’s microbiome, rather than prescribing a narrow choice of foods, counting calories, or advocating “dieting” as a daily activity. This advice is far from sexy and certainly not earth-shattering."

[+] skadamat|10 years ago|reply
Agreed, but I liked that he walked through the reasoning and the processes that inform that conclusion. The more something looks like a mystery, the less we understand it / the less scientific it really is.
[+] classicsnoot|10 years ago|reply
Rolled out this idea in a thread long ago about Apple not including a Period Tracker in their health app and it was taboo then, but here is as best a place to try again... There should be a poop tracking app. It would help a user track their waste over time, identify important red flags, act as an incredibly detailed source of diagnostic data for health care professionals, and promote healthy and happy living. Two topics that people seem so afraid of discussing are shitting and masturbating which seems so silly to me, as those are two things all humans do. If you want to be healthy, start with your poo; understanding your waste will tell you how to eat, sleep, exercise, and live better.
[+] OldSchoolJohnny|10 years ago|reply
Um..."very solid today", "kind of soft today"...what exactly would you track, without more tools to analyze it?
[+] jensen123|10 years ago|reply
It's nice to see an article that explains that too much animal protein can be bad for your health, without advocating a 100% plant-based/vegan diet. We humans are apes, and when you look at other apes, they eat mostly plants, but not always only plants. For example, chimpanzees eat small amounts of meat.

I'm a bit skeptical to the claim that whole grains is a nearly perfect food, though. Think about it - we apes have not eaten huge amounts of grains for most of evolution. Also grains contain various anti-nutrients, otherwise they would have been eaten by insects. It does not seem inconceivable that some of these insect-harming anti-nutrients could also be harmful for humans.

Many dietary studies are done with rodents, but I think (I'm not an expert here) rodents have eaten far more grains than apes during most of evolution. So studies with rodents showing that high-grain diets are healthy, are perhaps showing just that - that high-grain diets are healthy for rodents (and not necessarily apes).

[+] Joof|10 years ago|reply
What? Looking at other apes is a poor indicator. What an animal eats has to do with it's environment and it's digestion mechanisms. Some apes largely ate grasses. Nutrients matters, but largely is solved by eating a varied diet.

You might have noticed that we do something other species don't. Cooking! It's a pre-digestion mechanism that saves a lot of work. Combined with our omnivorous digestive system we can probably be considered radically distinct from our ape ancestors (in a good way).

[+] scholia|10 years ago|reply
It's a book extract: "Excerpted from The Hidden Half of Nature: The Microbial Roots of Life and Health by David R. Montgomery and Anne Biklé. Copyright © 2016 by David R. Montgomery and Anne Biklé. With permission of the publisher, W.W. Norton & Company, Inc. All rights reserved."

Based on that section, I would look for an extract from The Good Gut (1) instead. It leans more towards science and less towards popularization....

(1) http://www.amazon.com/The-Good-Gut-Control-Long-term-ebook/d...

[+] OldSchoolJohnny|10 years ago|reply
I just read Good Gut, it's a very very very bad book. About 10% enlightening accepted science and about 90% rampant and very wild speculation. Filled with little chapters that take in many cases very tenuous unproven theories (they come out and say that) and then use weasel words to then write a whole speculative chapter about it.

I learned a lot about how digestion works and then a lot about how to make a book out of very thin gruel.

[+] justinph|10 years ago|reply
As someone who's going through a not very fun period of C. Diff, this is pretty relevant. There is still so much we don't know about what makes a healthy and un-healthy biome, it's maddening.
[+] js2|10 years ago|reply
Ugh, went through that a couple years ago after a course of antibiotics due to a dog bite. Wouldn't wish it in my worse enemy. I'm also much more wary about ever taking antibiotics again.
[+] triangleman|10 years ago|reply
What I would like to know is what happens to the colon when you go on a 20-day regimen of broad-spectrum antibiotics such as ciprofloxacin?
[+] clock_tower|10 years ago|reply
Nothing good, I'd imagine; intestinal flora tend to be antibiotics' first casualties. It's always a good idea to consume probiotic foods once you're off the medicine (or take intestinal-flora pills).
[+] edem|10 years ago|reply
> The amount of meat in the Western diet can also pose problems. When consumed in relatively large quantities, animal protein is not completely broken down by the time it reaches the lower end of the small intestine. Eat too much meat and your overwhelmed small intestine delivers partially digested animal protein to the colon. When bacteria in the colon encounter intact or partially digested protein, a different kind of alchemy gets underway—protein putrefaction.

Do someone has any information on the "relatively large quantities" part? How much meat can I eat before protein putrefaction kicks in?

[+] coldcode|10 years ago|reply
When I was in graduate school in the early 80's I wanted to get a PhD in toxicology (but didn't, became a programmer instead). Today if I was at that same stage I would study the microbiome, it's a fascinating melange of chemistry, microbiology and food science, and we still know very little about it, plus it can make a huge difference in the world. Toxicology seemed too much like slaughtering rats for a living.