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Chronic viral infections in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).
Rasa, S, Nora-Krukle, Z, Henning, N, Eliassen, E, Shikova, E, Harrer, T, Scheibenbogen, C, Murovska, M, Prusty, BK
Journal of translational medicine. 2018;16(1):268
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The causes of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) are currently unknown, however viruses have been implicated. The absence of well-designed studies has hindered the understanding of this disease and the aim of this review was to discuss the literature regarding viruses and ME/CFS. Several viruses were discussed including the herpes virus, which is responsible for illnesses such as chicken pox and cold sores. This virus has not always been associated with the onset of ME/CFS, however it may be in certain individuals. The enteroviruses, which are responsible for illnesses such as hand, foot and mouth and polio, were also reviewed and it was concluded that it is unlikely that these have a role in ME/CFS. Several other viruses were also discussed. The authors then went on to describe how these viruses can affect human cells, potentially causing ME/CFS. It was concluded that the data available is controversial and only certain individuals may be affected, better studies are required. This study could be used by healthcare professionals to identify individuals at risk of ME/CFS following viral infection and understanding how ME/CFS may develop.
Abstract
BACKGROUND AND MAIN TEXT Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex and controversial clinical condition without having established causative factors. Increasing numbers of cases during past decade have created awareness among patients as well as healthcare professionals. Chronic viral infection as a cause of ME/CFS has long been debated. However, lack of large studies involving well-designed patient groups and validated experimental set ups have hindered our knowledge about this disease. Moreover, recent developments regarding molecular mechanism of pathogenesis of various infectious agents cast doubts over validity of several of the past studies. CONCLUSIONS This review aims to compile all the studies done so far to investigate various viral agents that could be associated with ME/CFS. Furthermore, we suggest strategies to better design future studies on the role of viral infections in ME/CFS.
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Does the microbiome and virome contribute to myalgic encephalomyelitis/chronic fatigue syndrome?
Newberry, F, Hsieh, SY, Wileman, T, Carding, SR
Clinical science (London, England : 1979). 2018;132(5):523-542
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Myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS) (ME/CFS) is a disabling and debilitating disease. Several studies have shown alterations in the gut microbiome (dysbiosis) in patients with ME/CFS. However, in focusing on the bacterial components of the microbiome, the viral component of the microbiome (known as the virome) has been neglected. Viruses can change the microbiome which can influence the health. This area is therefore important for research into ME/CFS. This article provides a comprehensive review of the current evidence supporting microbiome alterations in ME/CFS patients. Additionally, the challenges associated with microbiome studies are discussed. A literature search was done and 11 papers were found that had examined the microbiome ME/CFS patients, dating from 1998 to 2017. It was not possible to compare the studies statistically but from looking at each one individually there is sufficient evidence to support the claim of an altered intestinal microbiome in ME/CFS patients. ME/CFS is multifactorial and potential dysbiosis should be considered to be only part of the picture. Future studies are needed to adopt standardized techniques and analyses. As research increases, it is becoming clear that the virome can directly and indirectly affect host health, and may play a role in the pathogenesis of ME/CFS.
Abstract
Myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS) (ME/CFS) is a disabling and debilitating disease of unknown aetiology. It is a heterogeneous disease characterized by various inflammatory, immune, viral, neurological and endocrine symptoms. Several microbiome studies have described alterations in the bacterial component of the microbiome (dysbiosis) consistent with a possible role in disease development. However, in focusing on the bacterial components of the microbiome, these studies have neglected the viral constituent known as the virome. Viruses, particularly those infecting bacteria (bacteriophages), have the potential to alter the function and structure of the microbiome via gene transfer and host lysis. Viral-induced microbiome changes can directly and indirectly influence host health and disease. The contribution of viruses towards disease pathogenesis is therefore an important area for research in ME/CFS. Recent advancements in sequencing technology and bioinformatics now allow more comprehensive and inclusive investigations of human microbiomes. However, as the number of microbiome studies increases, the need for greater consistency in study design and analysis also increases. Comparisons between different ME/CFS microbiome studies are difficult because of differences in patient selection and diagnosis criteria, sample processing, genome sequencing and downstream bioinformatics analysis. It is therefore important that microbiome studies adopt robust, reproducible and consistent study design to enable more reliable and valid comparisons and conclusions to be made between studies. This article provides a comprehensive review of the current evidence supporting microbiome alterations in ME/CFS patients. Additionally, the pitfalls and challenges associated with microbiome studies are discussed.
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The association of diabetes-related self-care activities with perceived stress, anxiety, and fatigue: a cross-sectional study.
Zhao, FF, Suhonen, R, Katajisto, J, Leino-Kilpi, H
Patient preference and adherence. 2018;12:1677-1686
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Diabetes treatments rely on the individual’s ability to perform diabetes-related self-care activities (DRSCA), which involves tasks such as medication adherence, regulating diet, physical activity, blood glucose monitoring and foot care, however it appears that many individuals do not perform one or all of these tasks. Reasons why have been investigated, but remain insufficient. In this cross-sectional study of 248 individuals with type 2 diabetes (T2D) DRSCA was investigated in relation to stress, anxiety, and fatigue. The results showed that there was evidence of mid-level performance of DRSCA activities and performing DRSCA activities was likely to reduce stress levels but was not related to anxiety or fatigue. Individuals who had T2D for more than 5 years and women were more likely to have anxiety. Interestingly in contradiction to previous studies, support from outside sources did not affect levels of stress, anxiety and fatigue. It was concluded that improving the level of DRSCA may reduce stress. The fact that the performance of DRSCA was not related to anxiety may be because these activities impose restrictions on patients’ lives. This study could be used by healthcare professionals to understand that the performance of DRSCA may reduce stress levels, however as this study was an observational study, direct causal relationships are hard to determine.
Abstract
PURPOSE Many people with type 2 diabetes (T2DM) do not sustain sufficient diabetes-related self-care activities (DRSCA) in their daily lives. To provide additional information about the positive influence of DRSCA, this study was conducted to examine whether DRSCA were associated with reduced perceived stress, anxiety, and fatigue among people with T2DM and to explore the level of DRSCA, perceived stress, anxiety, and fatigue and their association with background information. PATIENTS AND METHODS This study was a cross-sectional survey including 251 participants aged 18 years and older recruited from two hospitals in the eastern part of China. The study utilized self-report questionnaires that consisted of background information, DRSCA, perceived stress, anxiety, and fatigue. Hierarchical multiple regression analysis was conducted to explore the association of DRSCA with perceived stress, anxiety, and fatigue while adjusting for background information. RESULTS The results indicated that the level of self-care activities, stress, and fatigue was around middle level. The prevalence of anxiety was 19%. A high level of DRSCA was likely to reduce perceived stress but was not linked to anxiety and fatigue. Women were more susceptible to stress and anxiety, and people who had diabetes for >5 years were more likely to have anxiety. The background information included diabetes duration, standardized diabetes education, and high social support, all of which are factors that may influence DRSCA. CONCLUSION The findings suggest that improving the level of DRSCA might effectively reduce perceived stress. The potential benefits of DRSCA can provide both motivational and evaluative data for self-care programs. In addition, the findings show that DRSCA were not linked to anxiety and fatigue, which implies that their positive influence on anxiety and fatigue may be offset by the load of frequent DRSCA. It is suggested that helping patients to make tailored plans to integrate DRSCA into their daily lives is needed. Meanwhile, in the background information, it is suggested that standardized diabetes education and high social support can benefit DRSCA; in improving psychological health, more attention should be paid to women and patients with diabetes duration <5 years.
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Food for Mood: Relevance of Nutritional Omega-3 Fatty Acids for Depression and Anxiety.
Larrieu, T, Layé, S
Frontiers in physiology. 2018;9:1047
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The human brain contains high levels of polyunsaturated fatty acids (PUFAs). Of these PUFAs, omega-3s have been widely studied in relation to many brain diseases, including anxiety and depression. This review focuses on the clinical and experimental data linking dietary intake of omega-3s with depression or anxiety. People diagnosed with anxiety and depressive disorders have lower omega-3s and a higher ratio of omega-6s to omega-3s in their blood and brains compared to healthy subjects. Experiments on omega-3 supplementation for depression and post-traumatic stress have had promising results. Numerous mechanisms have been proposed for the effects of omega-3s. These include direct effects on specific receptors in the brain, regulation of the endocannabinoid system, effects on the hypothalamic-pituitary-adrenal (HPA) axis, and reduction of inflammation in the brain. The authors conclude that more research is needed into the potential of omega-3s as treatment for mood-related diseases.
Abstract
The central nervous system (CNS) has the highest concentration of lipids in the organism after adipose tissue. Among these lipids, the brain is particularly enriched with polyunsaturated fatty acids (PUFAs) represented by the omega-6 (ω6) and omega-3 (ω3) series. These PUFAs include arachidonic acid (AA) and docosahexaenoic acid (DHA), respectively. PUFAs have received substantial attention as being relevant to many brain diseases, including anxiety and depression. This review addresses an important question in the area of nutritional neuroscience regarding the importance of ω3 PUFAs in the prevention and/or treatment of neuropsychiatric diseases, mainly depression and anxiety. In particular, it focuses on clinical and experimental data linking dietary intake of ω3 PUFAs and depression or anxiety. In particular, we will discuss recent experimental data highlighting how ω3 PUFAs can modulate neurobiological processes involved in the pathophysiology of anxiety and depression. Potential mechanisms involved in the neuroprotective and corrective activity of ω3 PUFAs in the brain are discussed, in particular the sensing activity of free fatty acid receptors and the activity of the PUFAs-derived endocannabinoid system and the hypothalamic-pituitary-adrenal axis.
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A plant-based diet in overweight individuals in a 16-week randomized clinical trial: metabolic benefits of plant protein.
Kahleova, H, Fleeman, R, Hlozkova, A, Holubkov, R, Barnard, ND
Nutrition & diabetes. 2018;8(1):58
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Suboptimal nutrition is a major cause of obesity, chronic disease, and premature death across the nation and worldwide. The aim of this study was to explore the effects of plant protein, as part of a plant-based diet, on weight control, body composition, and insulin resistance in overweight individuals. This study is a secondary analysis of data from a 16-week randomized clinical trial. Participants were randomly assigned in a 1:1 ratio to a vegan or a control group. Results indicate that: - the quality and quantity of dietary protein from a plant-based vegan diet are associated with improvements in body composition, body weight, and insulin resistance in overweight individuals. - decreased intake of animal protein and an increased intake of plant protein were associated with a decrease in fat mass. - decreased histidine [amino acid] intake was associated with a decrease in insulin resistance. - decreased intake of the amino acids threonine, leucine, lysine, methionine, and tyrosine were each associated with a decrease in insulin resistance (mainly driven by weight loss). Authors conclude that there is the need for additional research to explore the mechanisms explaining the beneficial role of plant protein and specific amino acids in regulating body weight, body composition, and insulin resistance.
Abstract
BACKGROUND AND OBJECTIVES A plant-based diet is an effective strategy in the treatment of obesity. In this 16-week randomized clinical trial, we tested the effect of a plant-based diet on body composition and insulin resistance. As a part of this trial, we investigated the role of plant protein on these outcomes. SUBJECTS AND METHODS Overweight participants (n = 75) were randomized to follow a plant-based (n = 38) or a control diet (n = 37). Dual X-ray Absorptiometry assessed body composition, Homeostasis Model Assessment (HOMA-IR) assessed insulin resistance, and a linear regression model was used to test the relationship between protein intake, body composition, and insulin resistance. RESULTS The plant-based vegan diet proved to be superior to the control diet in improving body weight, fat mass, and insulin resistance markers. Only the vegan group showed significant reductions in body weight (treatment effect -6.5 [95% CI -8.9 to -4.1] kg; Gxt, p < 0.001), fat mass (treatment effect -4.3 [95% CI -5.4 to -3.2] kg; Gxt, p < 0.001), and HOMA-IR (treatment effect -1.0 [95% CI -1.2 to -0.8]; Gxt, p = 0.004). The decrease in fat mass was associated with an increased intake of plant protein and decreased intake of animal protein (r = -0.30, p = 0.011; and r = +0.39, p = 0.001, respectively). In particular, decreased % leucine intake was associated with a decrease in fat mass (r = +0.40; p < 0.001), in both unadjusted and adjusted models for changes in BMI and energy intake. In addition, decreased % histidine intake was associated with a decrease in insulin resistance (r = +0.38; p = 0.003), also independent of changes in BMI and energy intake. CONCLUSIONS These findings provide evidence that plant protein, as a part of a plant-based diet, and the resulting limitation of leucine and histidine intake are associated with improvements in body composition and reductions in both body weight and insulin resistance.
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Impact of vegan diets on gut microbiota: An update on the clinical implications.
Wong, MW, Yi, CH, Liu, TT, Lei, WY, Hung, JS, Lin, CL, Lin, SZ, Chen, CL
Ci ji yi xue za zhi = Tzu-chi medical journal. 2018;30(4):200-203
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Gut microbiota is defined as microbes that collectively inhabit the gut ecosystem. Several factors, including diet, age, birth mode, breast-feeding or formula-feeding, geography, exercise, alcohol consumption, and exposure to antibiotics may influence gut microbiota. Previous conventional culturing together with recent culture-independent molecular studies show that vegan diets appear to affect gut microbiota. Furthermore, recent literature also indicates that vegan diets may have various health benefits, including amelioration of metabolic syndrome, cardiovascular disease and rheumatoid arthritis. Authors conclude that these findings have their limitations. Thus, further research may help to clarify the complex mechanisms and interrelationships between vegan diets and gut microbiota.
Abstract
Numerous studies indicate that microbiota plays an important role in human health. Diet is a factor related to microbiota which also influences human health. The relationships between diet, microbiota, and human health are complex. This review focuses on the current literature on vegan diets and their unique impact on gut microbiota. We also report on the health benefits of a vegan diet for metabolic syndrome, cardiovascular disease, and rheumatoid arthritis concerning relevant impacts from gut microbiota. Despite evidence supporting the clinical relevance of vegan gut microbiota to human health, the whole mechanism awaits further investigation.
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Vegetarian diet and blood pressure in a hospital-base study.
Liu, HW, Liu, JS, Kuo, KL
Ci ji yi xue za zhi = Tzu-chi medical journal. 2018;30(3):176-180
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High blood pressure (BP) accounts for approximately 50% of cardiovascular disease morbidity worldwide. The aim of this study was to examine the effect of a vegetarian diet on BP in participants with or without proteinuria [the earliest marker of kidney damage]. This study is a large retrospective cross-sectional study. The medical records of 36,617 individuals, 16,415 (44.8%) males and 20,202 (55.2%) females were examined. Results indicate that a vegan diet was significantly associated with lower systolic and diastolic BP compared with a nonvegetarian diet in asymptomatic participants with proteinuria. Authors conclude that a vegan diet could be an effective nonpharmacologic approach to reduce BP.
Abstract
OBJECTIVE Previous studies have reported that a vegetarian diet may lower blood pressure (BP), but the effect of diet on BP in asymptomatic participants with proteinuria is unknown. We examined the association of diet and BP in individuals with or without proteinuria. MATERIALS AND METHODS This cross-sectional study analyzed data from participants who were more than 40 years old and received physical checkups at Taipei Tzu Chi Hospital from September 5, 2005, to December 31, 2016. Diets were assessed at baseline by a self-reported questionnaire and categorized as vegan, lacto-ovo vegetarian, or omnivore. There were 2818 (7.7%) vegans, 5616 (15.3%) lacto-ovo vegetarians, and 28,183 (77.0%) omnivores. The effect of different parameters on BP was determined using a multivariate multiple linear regression model with no intercept, with control for important characteristics and lifestyle confounders. RESULTS The vegan group had a lower mean systolic BP (-3.87 mmHg, P < 0.001) and diastolic BP (-2.48 mmHg, P < 0.001) than the omnivore group. Participants with proteinuria had a higher systolic BP (4.26 mmHg, P < 0.001) and diastolic BP (2.15 mmHg, P < 0.001) than those without proteinuria. Interaction analysis indicated that vegan participants with proteinuria had a lower systolic BP (-2.73 mmHg, P = 0.046) and diastolic BP (-2.54 mmHg, P = 0.013) than other participants with proteinuria. However, individuals in the lacto-ovo group with proteinuria had a BP similar to other participants with proteinuria. CONCLUSIONS A vegan diet was associated with lower BP in asymptomatic participants with proteinuria. This diet could be a nonpharmacologic method to reduce BP.
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Cardiometabolic risk factors in vegans; A meta-analysis of observational studies.
Benatar, JR, Stewart, RAH
PloS one. 2018;13(12):e0209086
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Healthy, balanced, plant-based diets have been associated with better health outcomes, however the role of dairy and meat products on heart disease and death due to heart disease is not fully understood. Vegan diets are strictly plant-based and could provide an opportunity to investigate the effect of eliminating animal products on heart disease risk. This meta-analysis of 40 observational studies aimed to evaluate the effect of a vegan diet on heart disease risk factors. The results showed that vegans in most countries had improved heart disease risk factors such as a small waist circumference, lower body mass index (BMI) and balanced blood sugars compared to omnivores, however studies from Taiwan failed to show this trend. It was concluded that a vegan diet in most countries is associated with better health outcomes compared to an omnivorous diet. This study could be use by healthcare practitioners to recommend a vegan diet to those at a higher risk of heart disease.
Abstract
BACKGROUND There is increasing evidence that plant based diets are associated with lower cardiovascular risk. OBJECTIVE To evaluate effects of a vegan compared to an omnivorous diet on cardio-metabolic risk factors. METHODS Meta-analysis of observational studies published between 1960 and June 2018 that reported one or more cardio-metabolic risk factors in vegans and controls eating an omnivorous diet were undertaken. Macro-nutrient intake and cardio-metabolic risk factors were compared by dietary pattern. The Newcastle Ottawa Scale (NOS) was used to assess the quality of each study. The inverse-variance method was used to pool mean differences. Statistical analyses were performed using RevMan software version 5•2 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen. RESULTS 40 studies with 12 619 vegans and 179 630 omnivores were included. From food frequency questionnaires in 28 studies, vegans compared to omnivores consumed less energy (-11%, 95% confidence interval -14 to -8) and less saturated fat (- 51%, CI -57 to -45). Compared to controls vegans had a lower body mass index (-1.72 kg/m2, CI -2.30 to -1.16), waist circumference (-2.35 cm, CI -3.93 to -0.76), low density lipoprotein cholesterol (-0.49 mmol/L CI -0.62 to -0.36), triglycerides (-0.14 mmol/L, CI -0.24 to -0.05), fasting blood glucose (-0.23 mmol/, CI -0.35 to -0.10), and systolic (-2.56 mmHg, CI -4.66 to -0.45) and diastolic blood pressure (-1.33 mmHg, CI -2.67 to -0.02), p<0.0001 for all. Results were consistent for studies with < and ≥ 50 vegans, and published before and after 2010. However in several large studies from Taiwan a vegan diet was not associated with favourable cardio-metabolic risk factors compared to the control diets. CONCLUSION In most countries a vegan diet is associated with a more favourable cardio- metabolic profile compared to an omnivorous diet.
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Anti-Inflammatory Effects of a Vegan Diet Versus the American Heart Association-Recommended Diet in Coronary Artery Disease Trial.
Shah, B, Newman, JD, Woolf, K, Ganguzza, L, Guo, Y, Allen, N, Zhong, J, Fisher, EA, Slater, J
Journal of the American Heart Association. 2018;7(23):e011367
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Inflammation plays a central role in the progression of atherosclerosis and is associated with adverse cardiovascular events. The aim of this study was to determine the effects of a vegan versus American Heart Association (AHA)-recommended diet on high-sensitivity C-reactive protein (hsCRP) [a type of protein found in blood plasma], as well as other markers of inflammation, glucometabolic markers, and lipid profiles in patients with established coronary artery disease (CAD) on guideline-directed medical therapy. This study is a prospective, randomized, open-label, blinded end point study design. The active study duration was 8 weeks, with an interim visit at 4 weeks and a final visit at 8 weeks. Results show: - a significantly greater reduction in hsCRP with a vegan versus AHA-recommended diet in patients with established CAD on guideline-directed medical therapy. - that the degree of weight loss, as measured by both body mass index and waist circumference, did not significantly differ between the 2 diet groups. - that markers of glycaemic control and lipid profiles, overall, also did not significantly differ in the vegan diet group when compared with the AHA-recommended diet group. Authors conclude that in patients with CAD and an elevated hsCRP, despite guideline-directed medical therapy, a vegan diet may be considered to further lower the parameters of inflammation.
Abstract
Background Dietary interventions may play a role in secondary cardiovascular prevention. hsCRP (High-sensitivity C-reactive protein) is a marker of risk for major adverse cardiovascular outcomes in coronary artery disease. Methods and Results The open-label, blinded end-point, EVADE CAD (Effects of a Vegan Versus the American Heart Association-Recommended Diet in Coronary Artery Disease) trial randomized participants (n=100) with coronary artery disease to 8 weeks of a vegan or American Heart Association-recommended diet with provision of groceries, tools to measure dietary intake, and dietary counseling. The primary end point was high-sensitivity C-reactive protein. A linear regression model compared end points after 8 weeks of a vegan versus American Heart Association diet and adjusted for baseline concentration of the end point. Significance levels for the primary and secondary end points were set at 0.05 and 0.0015, respectively. A vegan diet resulted in a significant 32% lower high-sensitivity C-reactive protein (β, 0.68, 95% confidence interval [0.49-0.94]; P=0.02) when compared with the American Heart Association diet. Results were consistent after adjustment for age, race, baseline waist circumference, diabetes mellitus, and prior myocardial infarction (adjusted β, 0.67 [0.47-0.94], P=0.02). The degree of reduction in body mass index and waist circumference did not significantly differ between the 2 diet groups (adjusted β, 0.99 [0.97-1.00], P=0.10; and adjusted β, 1.00 [0.98-1.01], P=0.66, respectively). There were also no significant differences in markers of glycemic control between the 2 diet groups. There was a nonsignificant 13% reduction in low-density lipoprotein cholesterol with the vegan diet when compared with the American Heart Association diet (adjusted β, 0.87 [0.78-0.97], P=0.01). There were no significant differences in other lipid parameters. Conclusions In patients with coronary artery disease on guideline-directed medical therapy, a vegan diet may be considered to lower high-sensitivity C-reactive protein as a risk marker of adverse outcomes. Clinical Trial Registration URL http://www.clinicaltrials.gov . Unique identifier: NCT 02135939.
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The Western Diet-Microbiome-Host Interaction and Its Role in Metabolic Disease.
Zinöcker, MK, Lindseth, IA
Nutrients. 2018;10(3)
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The Western diet is characteristically high in ultra-processed foods, which may change the gut microbiome. As the gut microbiome is unique, any alterations may be associated with disease. This review study aimed to highlight how ultra-processing can affect the gut microbiome and its impact on the development of disease to better inform dietary guidelines. Associations between poor health outcomes and ultra-processed foods have been shown with processed meats, refined grains, and processed fish. Traditionally research has focussed on added salt, sugar and fat, however processed foods may contain or be processed in a way that promotes disease. Gut microbial changes can be driven by diet, which could be detrimental, permanent, and inheritable. Food processing such as heat treatment, and additives such as sweeteners and emulsifiers can all alter the gut microbiota, however these do not need to undergo microbiome testing before being approved for consumption. Effects of ultra-processed foods on the gut microbiome need to be extensively investigated in terms of health outcomes to better inform dietary guidelines. This study could be used by healthcare professionals to better understand how ultra-processed foods play a part in diseases beyond that of added salt, fat and sugar and that the microbiome has a pivotal role.
Abstract
The dietary pattern that characterizes the Western diet is strongly associated with obesity and related metabolic diseases, but biological mechanisms supporting these associations remain largely unknown. We argue that the Western diet promotes inflammation that arises from both structural and behavioral changes in the resident microbiome. The environment created in the gut by ultra-processed foods, a hallmark of the Western diet, is an evolutionarily unique selection ground for microbes that can promote diverse forms of inflammatory disease. Recognizing the importance of the microbiome in the development of diet-related disease has implications for future research, public dietary advice as well as food production practices. Research into food patterns suggests that whole foods are a common denominator of diets associated with a low level of diet-related disease. Hence, by studying how ultra-processing changes the properties of whole foods and how these foods affect the gut microbiome, more useful dietary guidelines can be made. Innovations in food production should be focusing on enabling health in the super-organism of man and microbe, and stronger regulation of potentially hazardous components of food products is warranted.