Front-of-package nutrition labels are having a moment. The FDA is proposing to require front of package nutrition labeling and a recent report in the Journal of the American College of Cardiology calls for clearer, more effective labeling to improve cardiovascular health. The premise is straightforward: make it easier for people to identify healthier options at a glance and guide better decisions at scale.

It is a meaningful step forward. But it also highlights a deeper limitation in how we think about food and health, one that becomes clear when we look beyond individual nutrients and consider how we actually eat.

What Are We Measuring?

Most labeling systems evaluate foods one at a time. They focus on components like sugar, fat, sodium, and calories, then translate those into a simplified score or symbol. This reduction makes complex information easier to interpret, particularly in fast-paced environments like grocery stores.

But this approach assumes that foods are consumed in isolation. In reality, they are almost always part of meals, recipes, and broader dietary patterns. Butter, oil, bread, rice, and even a cookie are rarely eaten alone. Each may appear unbalanced when viewed on its own. Oils are energy-dense and refined, carbohydrate-rich foods may lack fiber, and processed foods may concentrate salt or sugar, but these snapshots miss the context in which they are actually consumed.

Approaches that evaluate nutrients and foods in context, rather than in isolation, can help bridge this gap and better reflect how people actually eat.

Foods & Nutrients Don’t Act Alone

Health is not determined by individual nutrients or foods, but by how they are combined. Nutrition, at its core, is a problem of balance, how nutrients relate to one another within a meal and across the diet as a whole. Looking at nutrients in isolation captures only part of the picture.

Ratios such as carbohydrate to fiber, saturated to unsaturated fat, and sodium to potassium, and energy to weight begin to reflect this deeper structure. They capture quality within categories and balance across them. These relationships also align more closely with how the gut microbiome interprets diet, responding not to isolated nutrients but to the overall pattern of inputs that arrive together and shape its function.

What Traditional Diets Understood

Long before nutrition labels or nutrient databases, traditional cuisines arrived at balance through experience. Food combinations evolved over generations, shaped by how people felt, functioned, and maintained health over time.

Meals like pasta with tomato sauce, rice with seaweed or legumes, and tortillas with beans or avocado reflect this accumulated knowledge. These pairings balance refined and intact components, energy and fiber, and sodium and potassium. Without formal scoring systems, they created dietary patterns that supported both human biology and the gut microbiome.

From Foods to Patterns

Modern labeling systems are designed to evaluate foods, but what we ultimately need is a way to evaluate diets. This requires shifting from a focus on individual components to the relationships that define overall balance.

The Nutrient Consume Score is one framework that assesses this gap. Instead of asking whether a single food is “good” or “bad,” it evaluates how foods and combinations of foods contribute to dietary balance. It measures key nutritional ratios, including the carbohydrate to fiber ratio, the saturated to unsaturated fat ratio, the protein to energy ratio, and the sodium to potassium ratio.

The ratios are evaluated individually, and these are then combined into an overall score, not by simple averaging, but by integrating how each dimension contributes to overall balance.

Because it focuses on nutrition ratios and relationships, it can be applied across levels, from individual foods to meals, recipes, and overall dietary patterns, better reflecting how people actually eat. It is available as a public-good mobile app that allows quick scanning of foods, meals, and recipes, providing overall scores and suggestions for improvement.

A Shift in Perspective

This perspective shifts how we think about food, from labeling nutrients as good or bad to focusing on context. Nutrition has long swung between extremes, vilifying fat, then carbohydrates, and now elevating protein, but these shifts reflect changing narratives more than biology. Carbohydrates, fats, and proteins are not opposing forces, but parts of a broader system that can be combined to support balance.

In this framework, a single food does not define a diet. A traditional sugar cookie on its own may be unbalanced, but paired with a fiber-rich food like a carrot, the overall pattern improves. The focus shifts from elimination to composition, from avoiding ingredients to building balanced snacks and meals that shape metabolism, satiety, and the microbiome.

The Bigger Picture

Front-of-package labels remain a valuable tool. They simplify complex information and can help guide better decisions, particularly at the point of purchase. But they are only one piece of a larger puzzle.

If we want to meaningfully improve health, we need to move beyond evaluating foods in isolation and toward understanding diet as a system, one defined by balance, relationships, and context. Food quality is not just about what a food contains, but how foods fit together to shape biology, the microbiome, and long-term health.

Tools that evaluate how foods work together, not just on their own, can help translate this perspective into everyday choices when shopping, cooking, or building meals.

Christopher Damman, Associate Professor of Gastroenterology, School of Medicine, University of Washington. Editor-in-Chief of Gut Bites MD.

Food additives are suddenly back in the headlines. Regulators are phasing out artificial dyes, companies are reformulating ingredients, and consumers are paying closer attention to long ingredient lists. Much of the conversation assumes a simple story: additives are harmful, so removing them should solve the problem.

The science suggests something more nuanced. Some additives may indeed have effects that were not detected in traditional safety testing, in part because most evaluations historically focused on direct toxicity, while giving less attention to whether these compounds might alter the gut microbiome that helps regulate metabolism, immunity, and inflammation.

But the microbiome perspective also reveals a deeper issue. Ultra-processed foods influence the gut ecosystem in more than one way. They introduce compounds the microbiome did not evolve to encounter in these combinations while also removing many of the plant fibers and phytochemicals that normally nourish it.

The result is a one-two punch. If the gut microbiome is an ecosystem, ultra-processed foods can act like both pollution and deforestation at the same time.

Not all additives are created equal

Food additives include emulsifiers, sweeteners, preservatives, colors, stabilizers, and thickeners. Many likely have little impact on the gut microbiome at typical exposures, while others raise more credible concerns. Viewed through a microbiome lens, current evidence points most strongly toward certain emulsifiers and sweeteners.

Emulsifiers stabilize fat-water mixtures and create the smooth textures expected in foods such as salad dressings, sauces, ice cream, and packaged baked goods. Experimental studies show that some emulsifiers can alter microbial communities, thin the intestinal mucus barrier, and promote low-grade inflammation. Human evidence now supports some of these concerns. In a controlled feeding study, the emulsifier carboxymethylcellulose altered the gut microbiome and metabolome and, in some individuals, allowed bacteria to encroach into the mucus layer.

Evidence for non-nutritive sweeteners also depends on the specific molecule. Some artificial sweeteners such as saccharin and sucralose have been shown in several studies to alter the gut microbiome and influence glucose metabolism. Human trials indicate that these responses vary between individuals and may depend on the composition of the existing microbiome. In contrast, many naturally derived compounds such as monk fruit, stevia, and allulose, appear to have less adverse impact on the gut microbiome at typical intake levels, although evidence remains limited.

Other additives such as carrageenan, titanium dioxide, and some synthetic dyes show signals in experimental models but limited human evidence. Additives therefore remain an important area of study. But focusing only on what gets added to food misses an equally important part of the story.

The story’s missing half

Ultra-processed diets likely affect the microbiome through both added compounds and missing food components. Some additives may directly stress the gut ecosystem. But industrial processing also removes many of the features of foods that normally support microbial communities.

Whole plant foods contain complex fibers, intact cellular structures, and diverse phytochemicals that shape microbial ecology. Polyphenols are especially important. These compounds, abundant in berries, tea, cocoa, coffee, herbs, spices, and colorful vegetables, often reach the colon where microbes transform them into smaller metabolites that influence inflammation, metabolism, and gut barrier function.

When processing strips away these compounds, the microbiome loses an important source of ecological support. Diets dominated by ultra-processed foods therefore deliver a double effect: they introduce novel compounds while simultaneously removing many of the nutrients and structures that normally sustain microbial diversity and resilience.

Reducing problematic additives addresses part of the issue, but restoring whole plant foods helps rebuild the habitat the microbiome depends on.

Nature’s built-in additives

An ironic twist is that many additives exist because manufacturers must recreate properties that whole foods naturally provide but that are removed by industrial processing.

Plants contain pigments such as anthocyanins and carotenoids that produce vibrant colors. Polyphenols contribute flavor complexity and antioxidant stability. Herbs and spices contain antimicrobial phytochemicals that help slow spoilage.

Whole foods also contain natural thickeners and stabilizers. Plant fibers, pectins, and starches influence texture and water retention, helping foods maintain structure without the need for synthetic stabilizers.

Traditional cuisines relied on these naturally occurring compounds to shape flavor, appearance, and shelf life. Industrial processing often removes many of these natural compounds and structures, then reintroduces additives designed to recreate their functions.

Processing by fermentation

Processing itself is not inherently harmful. Fermentation is also a form of processing, long used for preservation, flavor enhancement, and nutrient enhancement, but it works very differently from industrial processing.

Fermentation uses microbes to transform foods. Their metabolism generates organic acids that preserve, aromatic molecules that build flavor, and molecules such as glutamate that deepen savory taste. These microbiomes can also synthesize certain vitamins, including B vitamins and vitamin K, and make minerals like iron more available, increasing the nutritional value of some foods.

Traditional food systems relied heavily on fermentation. Fermented vegetables like cabbage were preserved as kimchi or sauerkraut through fermentation-driven acidity. Cocoa fermentation created the characteristic flavor of chocolate. Cheeses, yogurts, and breads similarly depend on microbial activity.

Rather than simplifying food, fermentation increases biological complexity by generating new metabolites and microbial signals that stabilize the gut ecosystem and metabolic processes in the body.

Industrial processing frequently moves in the opposite direction. Natural food structures are broken down and many biological signals are removed, while flavor, color, and texture are rebuilt using refined ingredients and additives.

Putting perspective into practice

In summary, the microbiome perspective suggests that additives, particularly some emulsifiers and non-nutritive sweeteners, warrant closer scrutiny, while evidence for others remains mixed. But additives alone do not explain the effects of ultra-processed foods. What processing removes matters just as much. Fibers, polyphenols, plant structures, and fermentation-derived compounds help shape the gut ecosystem and total health.

In practice, this means:

• Build meals around intact plant foods such as vegetables, legumes, whole grains, nuts, and seeds that deliver fermentable fiber and plant structures.

• Include polyphenol-rich foods regularly such as berries, herbs, spices, tea, coffee, and colorful fruits and vegetables.

• Add fermented foods when possible including yogurt, kefir, kimchi, sauerkraut, or other traditionally fermented foods.

• Be mindful of long ingredient lists, which often signal highly formulated foods with multiple additives and fewer intact plant structures.

• Consider a food quality scoring tool to quickly assess foods and compare options, especially when navigating packaged products.

The goal is not simply to remove additives from food. It is to rebuild diets that restore the biological signals the gut microbiome evolved to recognize.

Christopher Damman, Associate Professor of Gastroenterology, School of Medicine, University of Washington. Editor-in-Chief of Gut Bites MD.

GLP-1 has changed the conversation around metabolism. Once a relatively obscure gut hormone, it now seems impossible to open an article about nutrition, weight, or metabolic health without seeing GLP-1 in the headline.

Medications that amplify GLP-1 signaling can meaningfully reduce food intake, lower body weight, and improve the metabolic dysfunction underlying many chronic diseases. For many patients, these medications are a true game changer.

But beneath the headlines sits an important physiological reality. GLP-1 was never meant to work alone.

In normal human biology, GLP-1 is just one component of a coordinated signaling system involving multiple hormones, microbiome signals, and nerve pathways.

If metabolism were an orchestra, GLP-1 would be one important instrument but not the conductor. Food itself coordinates the performance, and food quality still matters even in the era of powerful GLP-1 therapies.

Pharmacology vs Physiology

GLP-1 medications work by producing sustained activation of the GLP-1 receptor at levels the body would not normally generate in the brain, gut, and endocrine organs. This pharmacologic signal suppresses appetite, slows stomach emptying, and improves how our bodies process sugar.

Physiology works differently. After a meal, the intestine releases a cascade of signals including nutrients, factors produced by our microbiome, and a set of gut hormones: GLP-1, GIP, and PYY. Circulating hormone levels are typically far lower than those produced by medications, but the system functions as a coordinated regulatory network rather than a single dominant signal.

Many of these signals act locally within the gut. The vagus nerve, the gut’s information highway, relays this information to the brain, stomach, and other organs. As a result, their effects are not necessarily reflected by generating highest hormone concentrations in the bloodstream. In fact, less processed foods often produce lower GIP and GLP-1 levels in the blood while generating a more coordinated and sustained response within the gut and through vagal signaling.

The Ileal Brake

One of the most important mechanisms in this network is the ileal brake.

When nutrients reach the lower small intestine (the ileum) and colon, they trigger feedback signals that slow stomach emptying and appetite. Specialized cells release hormones such as GLP-1 and PYY that signal through the vagus nerve to the brain. Together these signals slow digestion and help limit further intake.

Rather than producing a high spike in circulating hormones, this system functions as a gradual and subtle braking mechanism that helps regulate appetite over time. How strongly it activates depends largely on what foods reach the lower intestine.

Evidence for the importance of the break comes from weight loss surgery. Gastric bypass leads to more rapid delivery of less-digested nutrients to the lower intestine, strongly activating GLP-1, PYY, and other satiety signals. This enhanced stimulation of the distal gut and improved appetite control is thought to be a key reason these surgeries are so effective for weight loss and metabolic disease.

Food Structure and Composition Determines What Reaches the Brake

Food processing also strongly influences how much intact nutrient material reaches the distal gut, often in the opposite direction.

Minimally processed foods retain structural complexity such as plant cell walls, intact fibers, and resistant starches. These structures slow digestion and allow portions of food to travel further down the intestine before absorption.

Food composition also matters. Components common in less processed foods such as fibers, polyphenols, and unsaturated fats can independently slow digestion and absorption by inhibiting digestive enzymes and slowing glucose absorption.

Highly processed foods often disrupt both structure and composition. Industrial processing breaks down plant structures and concentrates refined carbohydrates and saturated fats while removing fibers, polyphenols, and unsaturated fats. It allows calories to be absorbed rapidly in the upper intestine before the distal gut’s braking signals are fully engaged.

The Microbiome: Fiber and Polyphenols

The microbiome adds another important layer to this system.

Fibers, resistant starches, and many polyphenols escape digestion in the upper gastrointestinal tract and reach the colon, where microbes transform our food’s leftovers into biologically active metabolites.

Fermentation of fiber produces short-chain fatty acids such as butyrate that interact with specialized cells that produce hormones like GLP-1 and neural pathways involved in appetite regulation. Many polyphenols are also transformed into metabolites that influence hormone signaling and inflammation within the gut.

Microbial fermentation therefore acts almost like a slow-release capsule for satiety. While nutrients absorbed earlier in digestion create short-term signals, microbial metabolism provides a longer and steadier signal that helps extend fullness and stabilize appetite. Dietary patterns rich in diverse plant foods tend to strengthen this microbial signaling system.

Food Quality in the Era of GLP-1 Therapy

GLP-1 medications reduce appetite effectively, but they do not automatically determine what foods people choose to eat.

Some studies suggest that individuals using these medications shift modestly toward healthier foods because smaller portions feel more satisfying. Reduced appetite alone, however, does not guarantee adequate protein, micronutrients, or microbiome-supporting foods.

This matters because rapid weight loss without attention to nutrition can contribute to loss of lean muscle mass, nutrient deficiencies, and reduced metabolic resilience. Research supports the important of working with nutrition professionals during GLP-1 therapy so that reduced appetite translates into higher-quality food choices rather than simply lower food intake.

Simple tools that help people measure and score the quality of foods, meals, and recipes can also make this process easier by helping individuals quickly identify whole and better-for-you processed options that support metabolic health.

Principles That Support Physiologic Satiety

Several dietary components consistently support the gut’s natural satiety systems:

• Diverse fermentable fibers from intact plant foods

• Polyphenol-rich foods such as berries, herbs, spices, tea, coffee, and colorful produce

• Whole-food protein paired with fiber and healthy fats

• Unsaturated fats from foods such as nuts, seeds, olive oil, and fish

• Reduced reliance on ultra-processed foods

These components increase the likelihood that digestion, microbial fermentation, and distal gut signaling work together to regulate appetite.

A Practical Perspective

GLP-1 medications represent an important advance in treating metabolic disease because they can meaningfully reduce appetite and help many patients achieve weight loss that was previously difficult to sustain.

At the same time, the deeper biology of appetite regulation still depends on the interaction between food structure, digestion, microbial metabolism, and gut–brain signaling. Medications can amplify one part of the system, but food still conducts the orchestra.

For that reason, improving food quality and having practical tools to quantify and track that quality in everyday eating remain powerful ways to support metabolic health whether GLP-1 therapy is part of the plan or not.

Christopher Damman, Associate Professor of Gastroenterology, School of Medicine, University of Washington. Editor-in-Chief of Gut Bites MD.

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If you’re coming over from Gut Bites, welcome. If you’re new, this is where I translate microbiome science into practical decisions about food and health.

For decades, nutrition debates have played out like rival sports fandoms. Keto versus carbs. Vegan versus carnivore. Low-fat versus low-carb. Each camp comes armed with studies, success stories, and unwavering conviction.

And yet, a curious pattern keeps emerging: two people can follow the same diet, with the same discipline, and get completely different results. One feels energized and loses weight; the other feels bloated, fatigued, and frustrated. This isn’t failure or lack of willpower. It’s biology.

I’m a gastroenterologist and professor at the University of Washington, where I study how diet interacts with the gut microbiome, the trillions of microbes living in our digestive tract. Increasingly, research suggests that many diet debates aren’t about which diet is “right,” but about which diet is right for whom. And one of the biggest reasons may be the microbial ecosystem each of us carries.

The same food, different biology

Nutrition science historically treated the human body as if it responded predictably to nutrients: carbohydrates raise blood sugar, saturated fat affects cholesterol, protein supports muscle. That framework helped solve nutrient deficiencies and transform public health.

But it missed a critical layer. Food doesn’t just feed us. It feeds our microbiome. And that microbiome acts like a metabolic translator, transforming what we eat into bioactive compounds that influence inflammation, metabolism, appetite, and even mood. Diet is one of the most powerful forces shaping microbiome composition and function.

Because each person’s microbiome is different, the same diet can produce very different internal chemistry. This might help explain why diet “tribes” form in the first place. People aren’t imagining their success. They’re experiencing a real biological response, one that may not translate to someone else.

Where personalization is already happening

We’re not starting from scratch, several areas of nutrition already show how differences in the microbiome shape how people respond to food.

In gastrointestinal care for irritable bowel syndrome (IBS), this pattern is already visible in clinical practice. Dietary approaches such as low-FODMAP eating patterns can shift the microbiome and improve symptoms in some patients, and baseline microbial features may help predict who benefits most. Breath testing and microbiome-informed strategies are increasingly used to tailor dietary advice, offering a real-world example of personalization already in practice.

Metabolic research shows the same principle at work in blood sugar regulation. Landmark studies demonstrate that individuals have highly personalized blood sugar responses to identical foods and fibers, and that adding microbiome data significantly improves the ability to predict those responses. In clinical trials, personalized dietary recommendations built from these models lowered post-meal glucose levels, reinforcing a simple idea: carbohydrate responses aren’t universal, they’re microbiome-dependent.

Weight-loss research tells a similar story. In randomized trials, people with certain baseline microbiome profiles, particularly a higher Prevotella-to-Bacteroides ratio, lost significantly more weight and body fat on higher-fiber diets than those without that profile. In other words, the same “healthy” diet can produce different satiety signals and metabolic outcomes depending on how an individual’s microbes process it.

What about a keto versus plant-based diets?

What about keto versus carbs? This is where the science is still emerging, but there are some intriguing signals. Different dietary patterns, including ketogenic diets and plant-based diets, consistently reshape the gut microbiome, and people vary widely in their metabolic and symptomatic responses to these approaches.

Early evidence suggests that while baseline microbiome composition may not predict weight loss in low-carb vs. low-fat diet, how the microbiome responds to diets dynamically does correlate with with sustained weight loss.

The same principles driving IBS diet tailoring, personalized glycemic response, and fiber responsiveness could apply to macronutrient patterns like keto versus higher-carb diets. Diet wars may be arguments over population averages in a world of biological individuality.

As nutrition enters the era of GLP-1 therapies, ultra-processed food debates, and personalized health tracking, this variability is becoming impossible to ignore.

You’re not crazy, and neither is your friend

One of the most striking clinical patterns I see is how differently people respond to the same dietary changes. One patient feels dramatically better when they reduce carbohydrates, while another becomes sluggish and constipated. One thrives on plant-rich, fiber-heavy meals, while another develops bloating and discomfort.

These reactions often leave people wondering if something is wrong with them, but what if both responses are valid? Each person’s microbiome is shaped over time by early life exposures, antibiotics, environment, diet history, geography, and stress. As a result, two people may share only a fraction of microbial species, meaning they’re not starting from the same metabolic baseline when they try a new diet. What feels energizing, satiating, or gut-friendly for one person may not land the same way for another.

Diet debates often frame disagreement as ignorance, noncompliance, or bias. Viewed through a microbiome lens, though, those differences look less like confusion and more like biological diversity.

From diet debates to precision nutrition

Instead of asking whether keto is better than carbohydrates, the more useful question may be who benefits from carbohydrate restriction, and why. Likewise, rather than assuming all fibers are universally beneficial, we should be asking who truly thrives on which fibers and what biological factors explain this response.

The real challenge is learning how to identify these differences earlier, before people cycle through diets that leave them frustrated or discouraged. Precision-nutrition research is already moving in this direction, focusing on inter-individual variability rather than average effects. A growing number of new companies are now building services around these insights. The future of nutrition may look less like universal rules and more like microbiome-informed personalization.

How to personalize now, before the science catches up

You don’t need a microbiome sequencing report to begin applying this idea.

1. Keep a food journal. Track what you eat alongside energy, mood, digestion, sleep, and hunger.

2. Use a structured tool. A food-quality scoring app or tracker can reveal patterns between what you eat and how you feel over time.

3. Listen to your gut. Persistent bloating, fatigue, or crashes after certain foods are signals, not weaknesses.
   

4. Experiment systematically. Try small, structured changes. Reduce refined carbs for two weeks, increase fiber gradually, or shift fat sources, and observe how you respond.
   

5. Focus on food quality first. Minimally processed foods consistently support healthier microbial ecosystems.
   

The end of diet tribes?

Nutrition may be entering a phase similar to medicine’s shift toward personalization. We no longer expect the same drug to work identically for every patient. Diet may follow the same path.

The goal isn’t to pick a winning diet. It’s to understand the biological individuality behind why different diets work for different people, and to use that insight to help everyone eat in a way that supports their own metabolism, microbiome, and well-being.

You’re not crazy if keto works for you. You’re not wrong if carbs work better. You’re human. And your microbiome is part of what makes your nutritional needs uniquely yours. That’s the future Gut Bites will be exploring.

What have you noticed works best for your body—lower carb, higher fiber, higher fat, or something else?

Now, the rise of GLP-1–based medications has added another layer; highlighting just how powerfully appetite, metabolism, and food intake are regulated by biology, not just willpower.

The problem isn’t a lack of information. It’s that we’re often asking the wrong question. Instead of debating nutrition camps, the more useful question is:
What actually changes metabolism in everyday life?

Again and again, the answer comes back to one core driver: food quality.

The missing link: microbiome → metabolism → appetite

What we eat doesn’t just provide calories and nutrients. It shapes:

• the gut microbiome

• metabolic signaling

• inflammation

• appetite hormones like GLP-1

• energy stability

Different foods create different biological environments. Some support microbial ecosystems that produce beneficial metabolites and help regulate appetite and metabolism. Others push toward volatility: spikes, crashes, cravings, and long-term metabolic strain.

This is why two people can eat “the same diet” on paper and feel completely different. It’s not just the label. It’s how the foods interact with the body.

GLP-1 medications have made this visible. They work by altering appetite and metabolic signaling, but these pathways are also influenced every day by what we eat, how food is processed, and how the microbiome responds.

Food is not a drug. But it does shape the same biology.

Why Gut Bites exists

As a gastroenterologist and microbiome researcher, I see this disconnect constantly. Patients aren’t failing nutrition advice. Nutrition advice is often too abstract, too polarized, or too disconnected from real life. People don’t need more rules. They need clearer signals.

Gut Bites exists to translate credible science into practical insight:

• how food shapes the gut microbiome

• how the microbiome shapes metabolism and appetite

• how metabolic signaling affects everyday health

Not as theory. As decisions you can use while choosing foods, building meals, and noticing how you feel.

What you’ll find here

This publication focuses on the patterns that consistently matter:

• why food quality often beats diet labels

• how different foods influence appetite, energy, and digestion

• how microbiome activity connects to metabolic health

• how GLP-1 biology fits into everyday eating

• how small, repeatable changes outperform extreme diets

• how to make better choices without moralizing food

The goal isn’t perfection. It’s clarity.

From ideas to tools

Over time, this work is also moving beyond writing. Gut Bites connects to a broader effort to make healthier eating easier in daily life, translating science into tools that help people:

• evaluate food quality

• refine meals

• see patterns between what they eat, appetite, and energy

This includes emerging tools that bring food quality, microbiome, and nutrition science into everyday decisions.

Because insight matters most when it changes what happens at the grocery store, in the kitchen, and across the week.

A different tone for nutrition

Nutrition doesn’t need more arguments. It needs better translation.

Less:

• rigid camps

• moral language

• one-size-fits-all advice

More:

• biological understanding

• practical guidance

• personalization over time

The future of nutrition will likely look less like universal rules and more like understanding how different people respond to different foods, and using that information earlier, before metabolic problems compound.

GLP-1 therapies are part of this shift. They’re not the whole story, but they’re a clear signal that metabolism is governed by biology we can influence, not just calories we count.

The simple starting point

Before sequencing the microbiome, starting a medication, or following a specific diet, most people benefit from the same first move. Focus on food quality.

Minimally processed foods, fiber diversity, and metabolically supportive patterns consistently create more stable signals: for the microbiome, for appetite regulation, and for metabolism. That foundation makes everything else work better.

If you care about:

• energy that lasts

• appetite that makes sense

• digestion that feels predictable

• health that compounds over time

You’re in the right place.

MD-authored gut health literature digests and first-in-class food quality app to power your microbiome.

Ultra-processed foods have received quite a lot of press, and a bit of a bad rap, recently, and perhaps rightfully so. They’ve been linked to expanding waistlines, declining brain health, and even higher risks of cancer.

But what exactly is an ultra-processed food—and are they all equally harmful? How do they affect the body in such adverse ways, and what role might the microbiome—the trillions of bacteria and viruses living in our digestive tract—play in this process?

My name is Chris Damman, and I’m a professor of gastroenterology at the University of Washington, where I see patients and study the microbiome. I’m also a former Gut Health and Microbiome Program Officer at the Bill & Melinda Gates Foundation, where I helped develop next-generation supplemental foods for women and children facing malnutrition.

The Forgotten Upside of Processing

We don’t often consider that food processing helped address hunger in many parts of the world and remains essential for famine relief today. Early nutritional science, understanding macronutrients like protein, fat, and carbohydrates, along with micronutrients such as vitamins and minerals, allowed us to prevent devastating deficiencies like kwashiorkor (deficient protein), pellagra (deficient vitamin B3), and scurvy (deficient vitamin C).

Modern ultra-processed foods grew out of this reductionist approach to food. And while the science initially helped address nutrient deficiencies, processed foods have since taken on a Frankenstein life of their own, meticulously engineered to co-opt our taste buds and reward pathways. The right combination of sugar, salt, fat, and flavor additives keeps us coming back for more.

What’s Missing Matters as Much as What’s Added

What’s less discussed is what’s been removed from ultra-processed foods rather than what’s been added. For every nutrient that’s concentrated, refined carbohydrates, sodium, saturated fats, there are missing components: potassium, micronutrients, fiber, healthy fats from nuts and fish, and phytochemicals like polyphenols from plants.

These missing ingredients are critical for both nutritional balance and for feeding our microbiome, which in turn supports our immune system, metabolism, and even mood. The health harms of ultra-processed foods arise not just from excess sugar or salt, but also from the absence of microbiome-accessible nutrients that whole foods naturally contain.

The Microbiome: The Missing Piece of the Puzzle

For decades, these “other” components—fiber, which give plants their structure, and polyphenols, which give plants their color—were thought to be unnecessary waste streams of food processing. But we now know they’re essential substrates for our gut microbes, which ferment fiber into short-chain fatty acids like butyrate and transform polyphenols into postbiotic compounds like urolithin A that regulate metabolism, immunity, and even mitochondrial function.

This missing microbial perspective has reshaped our understanding of nutrition: we weren’t just feeding ourselves. We were meant to feed our microbes too.

What Do We Mean by “Ultra-Processed”?

The term “ultra-processed food” was coined by Dr. Carlos Monteiro and colleagues at the University of São Paulo, Brazil, who developed the NOVA food classification system.

In short, ultra-processed foods (NOVA Group 4) are industrial formulations made mostly from refined ingredients and additives—sugar, starches, oils, protein isolates, and artificial flavorings—with few intact whole-food components. These foods are designed for long shelf life, convenience, and sensory appeal, not for microbiome nourishment.

Monteiro’s focus was on the ingredients added and intensified—not necessarily on what was lost. Yet the omissions may be just as harmful. Much like the macronutrient deficiencies of the early 20th century, today we face “microbiome nutrient deficiencies”—missing fiber, polyphenols, and healthy fats—linked to modern conditions such as obesity, diabetes, cancer, autoimmune disease, and neurodegeneration.

Can We Make Processed Foods Healthier?

Given the importance of processed foods for feeding the world, the question isn’t how to eliminate them, but how to make them incrementally better. The answer lies in restoring the natural balance once found in whole foods.

This means adding back fiber, healthy fats, micronutrients, and polyphenols—often lost as industrial waste streams—a practice now called “upcycling.” Ironically, our waste is becoming a new wellness commodity.

These reformulated products are not as healthy as whole foods, but they can be healthier than conventional ultra-processed ones, offering better nutrition, shelf stability, and flavor. After all, who doesn’t enjoy a good Oreo or bag of Doritos? The real question is: can we make a healthier Oreo or Dorito?

Empowering Consumers

Food companies are beginning to explore this space, but it’s difficult for consumers to know which claims: “Good for gut health,” “High in fiber” are credible.

Countries like France and Australia have introduced front-of-pack labeling systems such as Nutri-Score and the Health Star Rating to help distinguish better options. These tools work well for separating whole from processed foods, but they’re less effective at identifying the healthier processed foods within that category.

To address this, I developed a nutrient balance scoring system that targets the core nutritional imbalances in modern foods—ratios like sodium to potassium, carbohydrate to fiber, saturated to unsaturated fat, and artificial additives to phytochemicals.

This system has been integrated into a smartphone app that lets users scan foods in grocery aisles and see a score instantly. The hope is that widespread use will not only improve individual health, but also drive industry change by shifting consumer demand toward better products.

A Path Forward

Healthier ultra-processed foods may initially cost more and be considered an add on feature, just like power steering or power locks once did, but with scale, these innovations can become standard.

Just as we have significantly reduced nutritional deficiencies like pellagra, kwashiorkor, and scurvy, we can now address the microbiome-related nutrient deficiencies underlying many modern diseases—cancer, obesity, autoimmune disease, and Alzheimer’s.

With better science, smarter design, and informed consumers, even ultra-processed foods can evolve from part of the problem to part of the solution.

MD-authored gut health literature digests and first-in-class food quality app to power your microbiome.

MD-authored gut health literature digests and first-in-class food quality app to power your microbiome.

The post Ultra-Processed Foods: What the Media & Consumers are Missing appeared first on Gut Bites MD.

Colorectal cancer is steadily rising. Learn how diet & the gut microbiome affect risk, and which dietary practices & tools might reduce it.

Chances are you know someone impacted by colorectal cancer. The disease is on the rise, especially in young adults, with rates increasing 50% over the past 30 years. In another 5 years, it is projected to become the leading cause of cancer deaths in adults under 50. 

Contributing to this rise, more than 1 in 4 people ages 45-50 already have precancerous polyps, a figure that climbs to over 1 in 3 people for people after age 50. That is why 45 is the new 50 for starting colon cancer screening, to ideally catch the polyps early before they become cancer. But what’s behind this alarming trend? 

I’m Chris Damman, a gastroenterologist at the University of Washington, where I perform colorectal cancer screening colonoscopies, and study the microbiome’s impact on gut health. Over my 15 years in practice, I’ve personally witnessed an unsettling rise in early colorectal cancer.  Growing evidence suggests that the microbes in your gut may play a key role

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Colon Cancer‘s Microbial Suspects

Modern changes in diet and lifestyle have been repeatedly linked to rising rates of colorectal cancer. Factors include ultra-processed diets, reduced physical activity, obesity, increased stress, as well as exposure to frequent, broad-spectrum antibiotics. 

One lesser-known, but increasingly studied factor is our gut microbiome–30 trillion plus bacteria, viruses and fungi that live in our colon and help regulate immunity and metabolism as well as protection from bad acting microorganisms. 

While a diverse microbiome can protect our health and may help prevent the development of colon cancer, some unsavery components of the microbiome can attach to the colon lining, cause inflammation, and even alter DNA, transforming healthy colon cells into cells that may become cancerous. 

The same lifestyle factors that influence colon cancer risk also disrupt the microbiome: processed foods, sedentary lifestyles, obesity, stress, and antibiotics. They reduce protective butyrate producers and promote inflammatory species.

These data raise the intriguing question of how much well-known lifestyle factors act directly on the colon versus indirectly through their effects on the microbiome.

Bad Actors at Play in the Colon

Research shows that certain strains of bacteria—with well-known names like E. coli and lesser-known ones like Fusobacterium nucleatum and Bacteroides fragilis—produce toxins and other factors that over time disrupt normal cell function and promote uncontrolled growth. 

Combinations of tests to detect these various strains are being used to develop new colorectal cancer diagnostics and prognostics. Ongoing research is also exploring whether these bacteria are merely associated bystanders or active instigators in cancer development.

Findings from animal model studies suggest the later may be true. In these experiments, researchers introduce specific microbes into germ-free or antibiotic-treated mice and directly observe whether tumors develop—offering the experimental control needed to demonstrate cause and effect in ways that human studies cannot.

Some human clinical studies suggest that these bacteria can also promote cancer cells spreading to other parts of the body, and may even hitch a ride with cancer cells during metastasis.

The Many Biotics Being Studied

This naturally raises the question: can colorectal cancer be treated or prevented by targeting bacteria?

There is precedent for targeting bacteria to treat GI cancers. Dr. Barry Marshall famously proved that H. pylori causes stomach ulcers by infecting himself and then curing the infection with antibiotics, a discovery that later helped establish H. pylori as a cause of certain stomach cancers and earned him the 2005 Nobel Prize.

The colon, however, is far more complex, containing thousands of bacterial species. Proving that any one type or collection of unhealthy bacteria causes cancer (rather than simply coexisting with it) is more challenging. Still, early trials are testing whether selective antibiotics, combined with standard chemotherapy treatments, might improve colorectal cancer treatment outcomes.

Other studies are exploring probiotics (beneficial bacteria) and prebiotics (the food that nourishes them) to reduce inflammation and potentially lower cancer risk, though data remains too preliminary for any formal recommendations

A Healthy Diet for Good Microbes

In the absence of strong evidence supporting various biotics for colorectal cancer prevention, the best approach is to focus on proven lifestyle measures for general health: eat well, exercise regularly, and manage stress. Recent research adds an important dimension to this advice—nurturing a healthy gut microbiome. 

The microbiome transforms components of food we can’t digest, such as fiber (which gives plant foods their structure) and polyphenols (which give them their color), into beneficial metabolites like butyrate and microbiome-modified polyphenols. These compounds can help reduce unhealthy bacteria and inflammation in the colon and may play a key role in preventing colorectal cancer.

Recent research also supports the use of calcium-rich dairy products and/or fermented dairy products, as well as increased omega-3 rich fish consumption as potentially protective in colon cancer and supportive of the microbiome.

Microbiome-supportive eating largely boils down to choosing more whole plants, dairy, and fish, but we all have our sweet and salty packaged food vices. Some packaged foods contain more fiber and polyphenols, less sugar and salt, and are more microbiome-friendly than others. I developed this public service smart app to help you find them.

Hazards For Microbial Dysbiosis

And what not to do? Smoking and most alcohol, especially hard alcohol and beer, disrupt the microbiome and are strongly associated with higher colorectal cancer risk (Group 1, definite carcinogens).

Current medical guidelines recommend avoiding both tobacco & alcohol altogether, but if you are going to consume alcohol, an occasional glass of wine may be the least associated with colorectal cancer risk.

Likewise, it is best to avoid processed meats—like hot dogs, bacon, sausage, deli meats, jerky (Group 1 carcinogens)—and limit red meats like beef, pork, lamb, and goat, (Group 2A carcinogens). The heme iron that gives red meat its color disrupts the microbiome and can promote the formation of precancerous polyps.

Meats charred at high temperatures during grilling also contain polycyclic aromatic hydrocarbons and heterocyclic amines, compounds that damage DNA, disrupt the microbiome, and raise colon cancer risk.

45 is the New 50 for Screening

And if lifestyle measures aren’t adequate, screening helps catch colorectal cancer early—or ideally prevent it altogether. Most people should start at age 45, or possibly earlier if there’s a family history of cancer or large polyps.

If you notice blood in your stool, change in your bowel habits, or unexplained abdominal pain or weight loss, check in with your primary doctor to see if further testing is needed.

A colonoscopy is the gold standard test, done about every 10 years if normal, or sooner if precancerous polyps are found. It involves drinking a prep solution the day before to clean the colon, sedating medications during the procedure, and usually a quick recovery by the next day.

Stool-based tests are noninvasive and done at home. They check for hidden blood or abnormal DNA—annually for FIT and gFOBT, and every three years for stool DNA tests (like Cologuard). If any test is positive, a colonoscopy is needed to follow up.

A Prescription for Prevention

In short, consume more plants, dairy, and fish and less processed/red meat, alcohol, and tobacco to support a healthy microbiome & colon. As for all the packaged items at the store, tools like this app with barcode scanner can help you choose the most microbiome-supportive foods. Beyond diet, exercise regularly, manage stress, and remember, 45 is the new 50 for screening. Here is a short list of the do’s and don’ts:

Dietary Do’s:

• Increase whole grains, beans, nuts, seeds, fruits and vegetables

• Increase fermented and unfermented dairy products & fish

• Try a scanner to explore the more microbiome-friendly foods

Dietary Dont’s:

• Avoid processed meat: hot dogs, bacon, sausage, deli meats, jerky

• Limit red meat, especially grilled beef, pork, lamb, and goat

• Avoid tobacco & alcohol, especially hard alcohol and beer

Additional Do’s:

• Get daily physical activity-at least 30 minutes of moderate/day.

• Manage stress through meditation, mindfulness, and quality sleep

• Discuss colon cancer screening strategy with your primary doctor

Christopher Damman, Associate Professor of Gastroenterology, School of Medicine, University of Washington

MD-authored gut health literature digests and first-in-class food quality app to power your microbiome.

The post Why Colorectal Cancer is Rising–The Microbiome, Diet & How to Lower Your Risk appeared first on Gut Bites MD.

Is the old adage “calories in, calories out” true? The short answer is yes, but the full story is more nuanced.

From the moment food touches your tongue to the time it leaves your body, your digestive system and gut microbiome work to extract its nutrients. Enzymes in your mouth, stomach and small intestine break down food for absorption, while microbes in your large intestine digest the leftovers.

“Calories in, calories out” refers to the concept that weight change is determined by the balance between the calories you consume and calories you expend. This includes not only the number of calories you eat due to appetite and absorb via digestion, but also how well those absorbed calories are burned through metabolism.

Recent research indicates that a significant factor influencing people’s variable appetites, digestion and metabolism are biologically active leftover components of food, known as bioactives. These bioactives play a key role in regulating the body’s metabolic control centers: your brain’s appetite center, the hypothalamus; your gut’s digestive bioreactor, the microbiome; and your cells’ metabolic powerhouses, the mitochondria.

I’m a gastroenterologist who has spent the past 20 years studying the gut microbiome’s role in metabolic disease. I’ll share how dietary bioactives help to explain why some people can eat more but gain less and offer some dietary tools to improve metabolism.

Ruminating on appetite and digestion

Research has shown that consuming whole foods still “packaged” in their original fibers and polyphenols – the cellular wrappers and colorful compounds in plants that confer many of their health benefits – leads to more calories that pass through to your stool, when compared to processed foods that have been “predigested” by factories into simple carbs, refined fats and additives.

This is one way calorie-free factors influence the “calories in, calories out” equation, which can be beneficial in a society where calorie intake often exceeds needs. Eating more whole foods and less processed foods simply lets you eat more because more of those unprocessed calories go to your microbiome and out the other end.

Fiber and polyphenols also help regulate your appetite and calorie intake through the brain. Your microbiome transforms these leftover bioactives into metabolites – molecular byproducts of digestion – that naturally decrease your appetite. These metabolites regulate the same gut hormones that first inspired the popular weight loss drugs Wegovy, Ozempic and Monjaro, controlling appetite through your brain’s satiety center, the hypothalamus.

Processed foods lack these bioactives and are further formulated with salt, sugar, fat, and additives to be hyperpalatable, causing you to crave them and eat more.

Mitochondrial maestros in the middle

A full accounting of calories also depends on how effectively your body burns them to power your movement, thoughts, immunity and other functions – a process largely orchestrated by your mitochondria.

Healthy people typically have high-capacity mitochondria that easily process calories to fuel cellular functions. People with metabolic diseases have mitochondria that don’t work as well, contributing to bigger appetites, less muscle and increased fat storage.

Healthy folks also have less of a mitochondria-rich type of fat called brown fat. Rather than storing calories, this fat burns them to produce heat. Less brown fat may help explain why some people with obesity can have lower body temperatures than those who aren’t obese, and why there has been a decline in average body temperature in the U.S. since the industrial revolution.

Healthy mitochondria that burn more calories might also help explain why some people can eat more without gaining weight. But this raises the question: why do some people have healthier mitochondria than others?

Your mitochondrial health is ultimately influenced by many factors, including those usually associated with overall well-being: regular exercise, adequate sleep, stress management and healthy eating.

Who turned off the metabo-lights

The latest nutrition research is revealing the roles previously underappreciated dietary factors play in mitochondrial health. Beyond the essential macronutrients – fat, protein and carbohydrates – and micronutrients like vitamins and minerals, other leftover factors in food, including fibers, polyphenols, bioactive fats and fermentation products are also key for metabolism.

Unlike a Western diet, which often lacks these bioactives, traditional diets like the Mediterranean and Okinowan diets are rich in foods – nuts, seeds, fruits, vegetables, whole grains and fermented foods – replete with these factors. Many bioactives pass undigested through the small intestine to the large intestine, where the microbiome converts them into activated metabolites. These metabolites are then absorbed, influencing the number of mitochondria in cells and how they function.

At the most fundamental level of cell biology, metabolites turn on and off molecular switches in your genes through a process called epigenetics that can affect both you and your offspring. When the metabolic “lights” are turned on, they enliven the mitochondria responsible for a faster metabolism, effectively increasing the calories you use.

Please mind the microbiome gap

A healthy microbiome produces a full range of beneficial metabolites that support calorie-burning brown fat, muscle and metabolic health. But not everyone has a microbiome capable of converting bioactives into their active metabolites.

Long-term consumption of processed foods, low in bioactives and high in salt and additives, can impair the microbiome’s ability to produce the metabolites needed for optimal mitochondrial health. Overuse of antibiotics, high stress and lack of exercise can also adversely impact microbiome and mitochondrial health.

This creates a double nutrition gap: a lack of healthy diet and a deficiency in the microbes to convert its bioactives. As a result, well-studied nutritional approaches like the Mediterranean diet might be less effective in some people with an impaired microbiome, potentially leading to gastrointestinal symptoms like diarrhea and negatively affecting metabolic health.

In these cases, nutrition research is exploring the potential health benefits of various low-carb diets that may bypass the need for a healthy microbiome. While the higher protein in these diets can reduce the microbiome’s production of beneficial metabolites, the lower carbs stimulate the body’s production of ketones. One ketone, beta-hydroxybutyrate, may function similar to the microbiome metabolite butyrate in regulating mitochondria.

Emerging microbiome-targeting approaches might also prove helpful for improving your metabolic health: butyrate and other postbiotics to provide preformed microbiome metabolites, personalized nutrition to tailor your diet to your microbiome, intermittent fasting to help repair your microbiome, and the future possibility of live bacterial therapies to restore microbiome health.

Tools to transform fat into fuel

For most people, restoring the microbiome through traditional diets like the Mediterranean diet remains biologically achievable, but it is not always practical due to challenges such as time, cost and taste preferences. In the end, maintaining metabolic health comes back to the deceptively simple healthy lifestyle pillars of exercise, sleep, stress management and nutritious diet.

Some simple tips and tools can none-the-less help make nutritious diet choices easier. Mnemonics like the 4 F’s of food – fibers, polyphenols, unsaturated fats and ferments – can help you focus on foods that best support your microbiome and mitochondria with “leftovers.”

Bioactive-powered calculators and apps can also aid in selecting foods to control your appetite, digestion and metabolism to rebalance your calorie “ins and outs.”

Christopher Damman, Associate Professor of Gastroenterology, School of Medicine, University of Washington

This article is republished from The Conversation under a Creative Commons license. Read the original article.

More Resources:

Gutbites.org — where you’ll find more practical food & microbiome digests to improve gut and overall health.

Gut Microbiome Nutrition App — to help in gut healthy food choice and meal preparation.

MD-authored gut health literature digests and first-in-class food quality app to power your microbiome.

The post Beyond calories in, calories out: your gut microbes, mitochondria & last meal’s leftovers count in metabolism appeared first on Gut Bites MD.

When milliseconds can mean the difference between silver and gold, endurance athletes in sports like marathon running, cycling, rowing and swimming optimize every aspect of their physiology for a competitive edge.

Many of these efforts result in enhancing the performance of mitochondria, the tiny but mighty energy-generating powerhouses within your cells. Carefully calibrated doses of exercise combined with beneficial stress – altitude, cold and heat – and optimized recovery in the form of nutrition, meditation and sleep, positively affect the number and health of mitochondria in the cells of your muscles, heart and brain.

But there is another aspect of endurance training that may have largely been overlooked by athletes and trainers – the role of the gut microbiome in optimizing your mitochondrial health and fitness.

I am a physician-scientist and gastroenterologist who has studied how food affects the gut microbiome’s role in health and disease for over 20 years. While research evaluating food’s effects on the microbiome and mitochondria is improving our understanding of conditions like obesity, cancer, rheumatoid arthritis and Alzheimer’s disease, it might also help athletes achieve new levels of performance through innovative approaches to nutrition.

Of microbiomes and mitochondria

The gut microbiome, a hidden factory of highly collaborative microorganisms in your intestines, ensures that your metabolism, immune system and brain run smoothly. Some researchers liken it to another organ that senses nutritional inputs, manufactures signaling molecules and prepares your body to respond appropriately.

Research has shown that endurance athletes have different gut microbiomes compared with the general population. Their microbiome’s composition and function, like increased production of a short-chain fatty acid called butyrate, are associated with increased VO₂ max, a fitness benchmark that measures your ability to consume oxygen during intense exercise. One organism in particular, Veillonella is found in some elite runners and may help raise lactate threshold, a fitness metric closely linked to mitochondrial function and how long an athlete is able to sustain intense effort.

A healthy microbiome communicates with the mitochondria, the tiny structures within your cells that convert calories into the raw cellular energy required for muscle contraction and other essential functions. It does this by transforming undigested food components of a healthy diet – like fiber, polyunsaturated fats and polyphenols – into molecules that increase the number and health of your mitochondria.

Some of these metabolites – butyrate, conjugated linoleic acid and urolithin A among them – have been shown to specifically improve muscle strength and endurance. Combining exercise with diets high in fiber, polyphenols – a chemical compound from plants – and healthy fats may thus augment mitochondrial fitness and improve exercise performance.

Nutritional gaffes and gaps

Healthy diets are critical for microbiome and mitochondrial health. Conversely, ultra-processed diets have been linked to conditions ranging from obesity and cancer to autoimmune disease and Alzheimer’s disease. Some people believe athletes are protected from the adverse health effects of ultra-processed diets due to the beneficial effects of exercise. While this may partially be true, it’s important to consider other factors in diet beyond just the calories burned.

Additives used to improve the taste and appearance of food, like emulsifiers, can negatively affect the gut microbiome, compromising the gut barrier and causing systemic inflammation, an unhealthy state linked to metabolic disease, cancer, autoimmune conditions and neurodegenerative diseases. Ultra-processed foods have also removed key factors like fiber, polyphenols and healthy fats found in whole foods that support gut health and signal to the mitochondria that there are calories to be metabolized.

The drinks, shakes, bars and gels used for endurance sports are processed foods formulated to provide concentrated and accessible energy during intense exercise. While unhealthy in other contexts, they can be key for enhancing performance during long endurance events when your body depletes its own version of accessible carbohydrates called glycogen.

But it’s important to complement these energy supplements with a healthy diet in the recovery hours following exercise. The combination of an unhealthy baseline diet with high-intensity exercise could compromise your gut barrier and increase inflammation. This has been linked to various training-related issues including gastrointestinal upset, musculoskeletal injuries and respiratory illnesses.

Performance-enhancing microbes

Reintroducing a diet rich in foods that positively affect your microbiome — beans, nuts, seeds, whole grains, fruits and vegetables — during the recovery phase of training can help most people prevent the adverse effects of high-intensity exercise and optimize performance.

However, due to antibiotic misuse and processed diets, some people lack key microbes and metabolic machinery needed to convert fibers and polyphenols into useful molecules the body can use. This shortage may explain why some healthy foods and diets might not be beneficial or tolerated by everyone.

Healthy diets might then benefit from reintroducing key microbes into the gastrointestinal tract. Research has shown that specific strains of probiotic bacteria can improve barrier function, reduce systemic inflammation and potentially enhance athletic performance by mitigating the side effects of high-intensity exercise. An alternative approach is to increase consumption of fermented foods, such as yogurt and pickled vegetables, which can increase microbiome diversity and decrease systemic inflammation.

In some cases, healthy foods might also be complemented by directly providing the body the key metabolites that microbes produce. Research shows that these metabolites – also called postbiotics or exercise mimetics – enhance muscle strength and exercise performance. Some postbiotics also function as prebiotics that fuel the growth of healthy microbes and help restore a damaged microbiome.

From research to podium

While the benefits of nutrition targeting your microbiome and mitochondria for general health are increasingly clear, this approach is still in the early days of exploration in endurance sports.

For the occasional exerciser and weekend warrior, whole nutrition strategies that support the microbiome and mitochondria could be quite helpful. These strategies have the potential to improve performance, protect against adverse training effects and prevent chronic health conditions like obesity, cancer and Alzheimer’s disease.

For elite athletes seeking even the smallest of improvements in an already finely tuned training regimen, further research into the gut microbiome’s influence on performance might be invaluable. In a highly competitive field where nothing can be left off the table — or in the cupboard — such interventions might just be the deciding factor between finishing on the podium or off it.

Christopher Damman, Associate Professor of Gastroenterology, School of Medicine, University of Washington. Editor-in-Chief of Gut Bites MD.

More Resources:

Gutbites.org — where you’ll find more practical food & microbiome digests to improve gut and overall health.

Gut Microbiome Nutrition Calculator — to help in gut healthy food choice and meal preparation.

MD-authored gut health literature digests and first-in-class food quality app to power your microbiome.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The post Athletes looking for a competitive edge may find it within their gut microbiome appeared first on Gut Bites MD.

Microbiome research to date has been much like the parable of the blind men and the elephant. How much can be said about an elephant by examining just its tail? Researchers have studied what is most readily available – stool rescued from a flush down the toilet – but have been missing the microbial masterminds upstream in the small intestine. Until recently.

Likened by some scientists to another human organ, your microbiome is collectively the tens of trillions of microorganisms that live in interconnected populations on and in your body. They serve as miniature sentinels that help protect your body’s surfaces from pathogenic invaders. In the upper intestine, distinct microbial populations also aid in digestion, metabolism and even immunity.

I am a gastroenterologist who has spent the past 20 years studying the microbiome’s role in health and disease. Advances in technology are helping scientists investigate the small intestine microbiome and the promise it holds for better understanding and treating many diseases.

Big transformations come from small places

Certain members of the small intestine microbiome are linked to obesity and overweight, while other microbial members are linked to a healthy metabolic state. Indeed, small intestine microbes aid in digestion by turning certain simple carbohydrates into the molecular building blocks of a healthy gut and body.

While analogous in function to the colon, small intestine metabolites can be quite distinct from the fiber-derived metabolites of the large intestine microbiome. Some small intestine metabolites help regulate the upper gut’s production of GIP, a sister molecule to the lower gut hormone GLP-1, which makes up the weight loss and type 2 diabetes drugs Wegovy and Ozempic. Together, with another lower gut hormone called PYY, this triumvirate is critical for coordinating your body’s response to food by regulating your appetite and blood sugar.

Monjaro is an incrementally more powerful combination of GIP and GLP-1 compared with Wegovy and Ozempic. The full complement of these hormones is naturally stimulated by the breakdown of products from both the large and small intestine microbiome.

The upshot on gut breakdown

Research has linked a disrupted small intestine microbiome to diseases of the gut. These include irritable bowel syndrome (IBS), small intestinal bacterial overgrowth (SIBO), Crohn’s disease and Celiac disease.

These diseases are thought to arise partly from disturbances in the way the microbiome breaks down food. Celiac disease, for example, is associated with the small intestine microbiome’s decreased ability to digest gluten. IBS and SIBO are linked to the opposite: the small intestine microbiome’s ability to too readily ferment fibers and sugars.

Foods like wheat, garlic, onion, beans and certain processed products that are high in FODMAPs – a set of fermentable short-chain carbohydrates – have been shown to contribute to symptoms in individuals with SIBO and IBS. Lactose-rich dairy is a high FODMAP food group implicated in lactose intolerance and linked to an overzealous small intestine microbiome.

The body’s not-so-diplomatic immunity

Diseases associated with the small intestine microbiome aren’t limited to metabolism and the gut. In the gut’s lining resides a virtual embassy of immune cells that remain in an ever-vigilant state surveying the motley stream of microbial and nutritional antigens passing through your gut.

Compromise in the security systems that separate the fecal stream from the rest of the body and the processes that keep immune responses in check are hypothesized to play a role in triggering various autoimmune conditions in which the body becomes confused as to who’s friend and who’s foe.

Studies have linked inflammatory changes in the small intestine microbiome to type 1 diabetes, where the body’s circulating immune cells attack insulin-producing cells in the pancreas, and to the extra-intestinal symptoms of Celiac disease, where immune cells can lead to destructive processes in the body’s eyes, skin and joints.

Lights shed in and on the tunnel

Up until very recently, small intestinal research has moved slowly. Scientists relied on upper endoscopy procedures, which involve sedation and inserting a small camera at the end of pinky-thick tubes through the mouth into the very first part of the small intestine.

One of the few alternatives to endoscopies has been studying patients who have had intestinal surgeries that leave direct portals into their small intestine via a hole in their abdominal wall.

Newly developed technologies are removing the need for sedating medications and unique anatomical situations by allowing scientists to more easily sample the furthest reaches of the gut. Such technologies include camera capsules tethered to angel-hair-thin filaments and other even more streamlined devices that create minimally invasive direct lines of access to the small intestine. Researchers have also developed capsules with sample compartments that open when they reach certain acidity levels in the body.

These new sampling techniques have unlocked unprecedented access to the upper gut, paving the way for new insights and therapies. In a real-life parallel to a childhood favorite, “The Magic School Bus, Inside the Human Body,” researchers can now ride along through the gut like Ms. Frizzle and her class, shining light on the microbial secrets held within.

Accrued alliance in a still-crude science

Therapies based on early understandings of the gut microbiome have included approaches ranging from probiotics to fecal transplants and prebiotics to fermented foods.

But new treatments for gut health are still in their early days. Studying the small intestine could provide insights to improve therapeutic development. A couple of promising future possibilities include partnering small intestine bacteria with their preferred prebiotics and personalized combinations of low FODMAP prebiotics designed to avoid small intestine fermentation.

Treatments that partner food and the microbiome are likely early harbingers of what’s to come in the rapidly developing field of microbiome medicine. Researching the small intestine – and not only the gut’s tail end – might just be microbiome medicine’s most pioneering upstream start.

Christopher Damman, Associate Professor of Gastroenterology, School of Medicine, University of Washington. Editor-in-Chief of Gut Bites MD.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

MD-authored food & microbiome digests and first-in-class food quality app to power your microbiome.

The post Gut Health’s Final Frontier: Voyages Into The Small Intestine Microbiome appeared first on Gut Bites MD.

People have been using salt since the dawn of civilization to process, preserve and enhance foods. In ancient Rome, salt was so central to commerce that soldiers were paid their “salarium,” or salaries, in salt, for instance.

Salt’s value was in part as a food preservative, keeping unwanted microbes at bay while allowing desired ones to grow. It was this remarkable ability to regulate bacterial growth that likely helped spark the development of fermented foods ranging from sauerkraut to salami, olives to bread, cheese to kimchi.

Today, salt has become ubiquitous and highly concentrated in increasingly processed diets. The evidence has mounted that too much salt – specifically the sodium chloride added to preserve and enhance the flavor of many highly processed foods – is making people sick. It can cause high blood pressure and contribute to heart attacks and stroke. It is also associated with an increased risk of developing stomach and colon cancer, Ménière’s disease, osteoporosis and obesity.

How might a substance previously thought worth its weight in gold have transformed into something many medical institutions consider a key predictor of disease?

Salt lobbyists may be one answer to this question. And as a gastroenterologist and research scientist at the University of Washington School of Medicine, I want to share the mounting evidence that microbes from the shadows of your gut might also shed some light on how salt contributes to disease.

Blood pressure cookers

Sodium’s role in blood pressure and heart disease results largely from its regulating the amount of water inside your blood vessels. In simple terms, the more sodium in your blood, the more water it pulls into your blood vessels. This leads to higher blood pressure and subsequently an increased risk for heart attack and stroke. Some people may be more or less sensitive to the effects salt has on blood pressure.

Recent research suggests an additional way salt may raise blood pressure – by altering your gut microbiome. Salt leads to a decrease in healthy microbes and the key metabolites they produce from fiber. These metabolites decrease inflammation in blood vessels and keep them relaxed, contributing to reduced blood pressure.

With the exception of certain organisms that thrive in salt called halophiles, high levels of salt can poison just about any microbe, even ones your body wants to keep around. This is why people have been using salt for a long time to preserve food and keep unwanted bacteria away.

But modern diets often have too much sodium. According to the World Health Organization, healthy consumption amounts to less than 2,000 milligrams per day for the average adult. The American Heart Association recommends less than 2,300 milligrams per day.

While the specific sodium needs may vary by individual, by the amount of potassium in the diet, and specific medical conditions like heart failure, the global mean intake of 4,310 milligrams of sodium has likely increased the amount of salt in the gut over healthy levels for most adults.

Lowering sodium has been associated with and causally linked to increases in healthy members of the microbiome and their metabolites.

Salt of the girth

Sodium is connected to health outcomes other than blood pressure, and your microbiome may be playing a role here, too.

High sodium diets and higher sodium levels in stool are significantly linked to metabolic disorders, including elevated blood sugar, fatty liver disease and weight gain. In fact, one study estimated that for every one gram per day increase in dietary sodium, there is a 15% increased risk of obesity.

A gold-standard dietary study from the National Institutes of Health found that those on a diet of ultraprocessed foods over two weeks ate about 500 more calories and weighed about 2 pounds more compared with those on a minimally processed diet. One of the biggest differences between the two diets was the extra 1.2 grams of sodium consumed with the ultraprocessed diets.

A leading explanation for why increased salt may lead to weight gain despite having no calories is that sodium increases cravings. When sodium is combined with simple sugars and unhealthy fats, these so-called hyperpalatable foods may be linked to fat gain, as they are particularly good at stimulating the reward centers in the brain and addiction-like eating behaviors.

Salt may also connect to cravings via a short circuit in the gut microbiome. Microbiome metabolites stimulate the release of a natural version of weight loss drugs Wegovy and Ozempic, the gut hormone GLP-1. Through GLP-1, a healthy microbiome can control your appetite, blood sugar levels and your body’s decision to burn or store energy as fat. Too much salt may interfere with its release.

Other explanations for salt’s effect on metabolic disease, with varying amounts of evidence, include increased sugar absorption, increased gut-derived corticosteroids and a sugar called fructose that can lead to fat accumulation and decreases in energy use for heat production.

Desalin-nations

While many countries are implementing national salt reduction initiatives, sodium consumption in most parts of the world remains on the rise. Dietary salt reduction in the United States in particular remains behind the curve, while many European countries have started to see benefits such as lower blood pressure and fewer deaths from heart disease through initiatives like improved package labeling of salt content, reformulating foods to limit salt and even salt taxes.

Comparing the nutrition facts of fast-food items between countries reveals considerable variability. For instance, McDonald’s chicken nuggets are saltiest in the U.S. and even American Coke contains salt, an ingredient it lacks in other countries

.

The salt industry in the U.S may have a role here. It lobbied to prevent government regulations on salt in the 2010s, not dissimilar from what the tobacco industry did with cigarettes in the 1980s. Salty foods sell well. One of the key voices of the salt industry for many years, the now-defunct Salt Institute, may have confused public health messaging around the importance of salt reduction by emphasizing the less common instances where restriction can be dangerous.

But the evidence for reducing salt in the general diet is mounting, and institutions are responding. In 2021, the U.S. Department of Agriculture issued new industry guidance calling for a voluntary gradual reduction of salt in commercially processed and prepared foods. The Salt Institute dissolved in 2019. Other organizations such as the American Frozen Food Institute and major ingredient suppliers such as Cargill are on board with lowering dietary salt.

From add-vice to advice

How can you feed your gut microbiome well while being mindful of your salt intake?

Start with limiting your consumption of highly processed foods: salty meats (such as fast food and cured meat), salty treats (such as crackers and chips) and salty sneaks (such as soft drinks, condiments and breads). Up to 70% of dietary salt in the U.S. is currently consumed from packaged and processed foods.

Instead, focus on foods low in added sodium and high in potassium such as unprocessed, plant-based foods: beans, nuts, seeds, whole grains, fruits and vegetables. Fermented foods, though often high in sodium, may also be a healthier option due to high levels of potassium, short-chain fatty acids, fiber, polyphenols.

Indeed, it’s important to consider the ratio of sodium and potassium as a dietary guide. While sodium helps keep fluid in your blood vessels, potassium helps regulate sodium levels in your blood and stool. Here’s a calculator tool to help maintain the healthiest balance.

And remember, while all advice is best taken with a grain of salt, your microbiome gently asks that it just not be too large.

Christopher Damman, Associate Professor of Gastroenterology, School of Medicine, University of Washington. Editor-in-Chief of Gut Bites MD.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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