Polycystic ovarian syndrome and the skin

Often, the skin can be a window to what is occurring inside your body. For women with polycystic ovarian syndrome, or PCOS, this this may mean acne, hair loss, excessive facial or body hair growth, dark patches on the skin, or any combination of these issues.

What is PCOS?

Skin and hair issues can be the most readily perceptible features of PCOS, and thus sometimes the reason for seeking medical care. However, features of PCOS also include menstrual irregularities, polycystic ovaries (when the ovaries develop multiple small follicles and do not regularly release eggs), obesity, and insulin resistance (when cells do not respond well to insulin).

The cause of PCOS is not entirely understood, but scientific evidence points to hormonal imbalances, specifically excess testosterone (also known as hyperandrogenism) and insulin resistance. PCOS is the most common cause of infertility in women. The hormonal imbalances in PCOS disrupt the process of ovulation, and without ovulation pregnancy is not possible. PCOS exists on a spectrum, meaning not every woman with PCOS has the same signs and symptoms. Because of the variation in characteristics of this syndrome, it can be difficult to diagnose.

How do I know if I have PCOS?

There is no one specific test that can be used to diagnose PCOS, so a thoughtful and thorough workup, including lab tests and imaging, is needed. Lab tests typically involve measuring levels of various hormones, such as androgens. Imaging tests may include ultrasound of the ovaries. Seeking care from an experienced team, including primary care physicians, gynecologists, endocrinologists, and dermatologists, can establish the diagnosis.

What are the skin manifestations of PCOS?

PCOS-related acne often flares on the lower face, including the jawline, chin, and upper neck. Although not a hard and fast rule, these areas are considered to be a hormonal pattern for acne. Women with PCOS may notice that acne lesions are deeper, larger, and slower to resolve. Acne in PCOS usually worsens around the time of menstrual periods. Dermatologists often recommend the use of oral contraceptive pills or a medication called spironolactone to treat this type of acne. These treatments, when used in the right patients who have no contraindications to them, can be very helpful in clearing acne.

Hirsutism, or excessive hair growth in places where hair is usually absent or minimal, is another dermatologic sign of PCOS. Common areas of hirsutism include the chin, neck, abdomen, chest, or back. On the scalp, however, balding or thinning of the hair can be seen. Both of these hair issues are driven by an excess of testosterone.

Occasionally, another skin condition appears called acanthosis nigricans, which are dark, velvety areas of skin, usually in skin creases such as around the neck and underarms. This type of skin condition is also associated with insulin resistance, and may be due to stimulation of skin cells by insulin, causing them to overgrow.

Treatment options and a tailored approach

Although there is no cure for PCOS, there are many treatment options for managing various symptoms of this syndrome. The types of treatments used depend on a woman’s priorities and symptoms. For example, being at a healthy weight can lead to improvement of symptoms, so lifestyle modifications to nutrition and exercise may help. Hirsutism can be treated with laser hair removal or electrolysis. Some patients may try birth control pills to improve menstrual regularity. Metformin, a commonly used medication for diabetes, can be used to help improve the body’s response to insulin.

Treatment planning is tailored to each person and depends on whether or not pregnancy is a short-term goal. Certain medications, including spironolactone and retinoids for acne, should be avoided if a woman is trying to become pregnant.

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Dental appliances for sleep apnea: Do they work?

Keeping your partner — or yourself — up at night with loud snoring? This might be more than a nuisance. About 25% of men and nearly 10% of women have obstructive sleep apnea (OSA), a serious sleep disorder characterized by explosive snores, grunts, and gasps. Tissue at the back of the throat temporarily obstructs the airway, leading to breathing pauses (apneas) throughout the night. Not only does OSA leave people tired and groggy, but it also puts them at risk for a host of health problems, including high blood pressure, depression, and heart disease.

The most effective and best-studied treatment is positive airway pressure (PAP), a small bedside machine that blows air through a mask to prevent your airway from collapsing. But people with mild or moderate OSA sometimes find PAP challenging to use, and often wonder about alternatives. Dental devices (also known as oral appliances) are an option for some people. But do your homework before going this route, cautions Sogol Javaheri, MD, MPH, MA, a sleep specialist at Harvard-affiliated Brigham and Women’s Hospital.

Who might benefit from a dental device for sleep apnea?

“These devices are supposed to reposition your jaw or tongue to open your upper airway. But they can be really uncomfortable and only work about half the time,” Dr. Javaheri says. It’s hard to predict who might benefit from using an oral device, and people with very mild OSA and few symptoms may not notice any difference. As a result, she generally doesn’t recommend them except for people with mild to moderate OSA or those with severe OSA who can’t tolerate PAP.

Three main categories of dental devices for OSA

Mandibular advancement devices. Made of molded hard plastic, these devices snap over your lower and upper teeth, and also feature metal hinges and screws that can be tightened to push your lower jaw forward. Some dentists make custom mandibular advancement devices, but before you consider buying a custom device, be sure to ask whether your dentist has experience in sleep-related breathing disorders and is certified by the American Academy of Sleep Medicine. Some non-certified dentists simply take a mold of your teeth, send it to a company that makes the device, then sell it to you at a large markup — sometimes totaling $4,000 or more. What’s more, it’s unlikely to be covered by your dental or medical insurance if it’s used for snoring.

Mouth guards. Similar to mandibular advancement devices, these devices also help reposition your lower jaw, although to a lesser degree. Some sleep physicians recommend SnoreRx, which you can purchase online for less than $100. Instead of starting with an impression of your teeth created by a dentist, you use what the company calls the “boil and bite” method. You place the device in a cup of boiling water for a minute and then bite down on the softened plastic so it molds to your teeth.

Tongue-retaining devices. These devices consist of a soft plastic splint placed around your tongue that holds it forward and out of your mouth throughout the night. They tend to make your mouth very dry and can be quite uncomfortable.

Most insurance plans at least partially cover these devices when used for OSA, but not if they’re used for simple snoring. Don’t be tempted to try one unless you’ve been formally diagnosed with OSA, says Dr. Javaheri. And even if you have OSA, be sure to call your insurance company so you understand how much is covered before you have a device made.

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Terrified of needles? That can affect your health

No one likes getting stuck by a needle. Whether for a blood test, vaccination, or blood donation, needle sticks are something most people would prefer to avoid.

Yet, judging only by schedules for routine vaccinations and tests, the average healthy person can expect at least 165 needle sticks over a lifetime. Get hospitalized? That might add dozens or even hundreds more. And the number of needle sticks experienced by people with diabetes, HIV, and some other illnesses hovers in the “don’t ask” range.

For many, this may be more of an annoyance than a real problem. But if you have a strong fear of needles or aversion to the sight of blood, getting a vaccination or any other needle stick is a big deal. If this sounds like you, you may have trypanophobia.

What is trypanophobia?

Fittingly, the name combines the Greek term trypano — meaning puncturing or piercing — with phobia, meaning fear. This remarkably common condition is marked by irrational, extreme fear or aversion to blood or needles. It’s estimated that fear of needles affects up to 25% of adults, and may lead 16% of people in the US to skip vaccinations. Many people who strongly fear needle sticks may avoid doctors and medical care, so it’s likely that the magnitude of this problem is underestimated.

Just to be clear: this phobia is not limited to people who are overly sensitive to pain or aren’t “tough enough.” It can affect anyone. The cause is often unknown, but a particularly traumatic experience during childhood medical illness may set the stage for some people. And there may be a genetic component. Researchers have found genes linked to fainting after needle sticks, and trypanophobia sometimes runs in families.

What are the symptoms of this phobia?

People with trypanophobia who are contemplating a needle stick may experience

• fear or anxiety
• panic attacks, nausea, or sweats
• palpitations
• fainting (due to a reflex in which pain or the sight of blood triggers a drop in blood pressure)
• insomnia in the days or weeks before an expected needle stick.

How does being afraid of needles affect you?

This fear can affect your

• quality of life: It’s quite unpleasant to spend weeks dreading an upcoming doctor’s appointment.
• health: Skipping recommended tests and treatment to avoid needle sticks can lead to missed diagnoses, poorly monitored medical conditions, and undertreatment. A timely example is foregoing a vaccination against COVID-19, which can have serious or even deadly consequences. Also, drug marketers sometimes play on fear of needles in their advertising, or might downplay the fact that a medication requires an injection.
• longevity: Skipping routine medical care can contribute to avoidable suffering and death. For example, a cancerous breast lump that might have been detected during routine examination may go unnoticed until much later, when it’s no longer curable.

What can you do to cope with a fear of needles?

There’s not much high-quality research regarding how best to treat trypanophobia. Still, experts suggest a number of options to help people cope with it.

• Bring support, if allowed. That’s routine for small children. But holding the hand or hearing the voice of a spouse, trusted friend, or family member can calm adults, too.
• Harness the power of distraction (see this amazing video of a pediatrician distracting a young child before a vaccination). Focus on anything other than the needle stick: a spot on the floor, the positive effects of getting a COVID-19 vaccine (soon you can hug your family!), or your upcoming vacation.
• Tell the person giving you a shot or drawing blood that you struggle with this, and let them know what works best for you. Some people prefer to hear about each step before it happens so there are no surprises. Ask if the healthcare provider has tricks of the trade to help you get through it.
• Ask the person giving you’re a shot or drawing blood if they can use a numbing agent similar to novocaine, or a freezing spray to numb skin before a needle stick.
• Don’t watch! It’s not helpful to watch all of the preparation for the needle stick or see the needle itself. Watching may make things worse.
• Learn ways to relax. Try deep breathing or other relaxation techniques that you can practice before having the needle stick.
• Relax the muscle receiving the injection, too. Some shots, such as vaccines that protect you against tetanus or COVID-19, are given in a muscle. Relaxing the muscle can lessen the pain of these shots.
• Lie down before having the needle stick, if you’ve fainted or felt woozy in the past with needle sticks.

Can therapy help?

Seeing a mental health specialist may be helpful. He or she may recommend

• cognitive behavioral therapy, or CBT, which teaches people ways to reframe unhelpful ways of thinking and build coping strategies.
• exposure therapy, a gradual and supervised increase in your exposure to needles, which can lessen the panic they cause. For example, over a number of weeks you may be instructed to look at photographs of needles, then hold a syringe without a needle, then hold a syringe with a needle, and then imagine injection — all with guidance from a therapist — before actually having one.
• medications, such as anti-anxiety or sedative medications, may be prescribed if other measures aren’t effective, and the anxiety around needle sticks is getting in the way of medical care (or just making you miserable).

The bottom line

It’s natural to have an aversion to pain, even when you know it’s coming and even though it’s for a good reason. So, if you’re one of the millions fretting about getting a COVID-19 vaccine or a blood test or any other needle stick, know that you’re not alone, and that there are things you can do to improve the situation. Talk to your doctor about your fear and get help if you need it. Your quality of life, health, and longevity could depend on it.

As for me, I’m going to do what I always do: avert my eyes and stare at that spot on the floor.

Follow me on Twitter @RobShmerling

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Life expectancy: How can we address uneven declines?

Not long ago, during pre-pandemic 2019, the reported life expectancy at birth for non-Hispanic Black, non-Hispanic White, and Hispanic populations was approximately 75, 79, and 82 years, respectively. The higher life expectancy of Hispanic people compared to others in the United States may come as a surprise to some.

This phenomenon, known as the “Hispanic paradox,” was first noted in the 1980s, and its legitimacy has been debated since. A host of explanations have been proposed, including hypotheses about the “healthy immigrant” (people who migrate to the US are healthier than those who stay in their native countries) and “salmon bias” (less healthy US immigrants are more likely to return to their countries of origin). Other experts note that Hispanic communities have lower rates of smoking and greater levels of social cohesion, which certainly may contribute to their presumed higher life expectancy. In the end, this difference remains poorly understood, and is further complicated by research noting US-born Hispanic individuals may have lower life expectancy compared to their foreign-born counterparts.

Now, recent estimates for life expectancy from the Centers for Disease Control and Prevention (CDC) show an alarming change that highlights the disproportionate impact COVID-19 has had on communities of color. Between 2019 and 2020, life expectancy dropped more sharply among Black and Hispanic populations compared to their White counterparts, by three years, two years, and one year, respectively. In fact, the gap in life expectancy between Black and White populations widened from four to six years, the largest gap since 1998. And the advantage in life expectancy previously held by Hispanic populations over Whites decreased from three to two years. In other words, the COVID-19 pandemic has led to a decrease in life expectancy among all individuals in the US, but this impact has been felt most by communities of color.

Many reasons for greater vulnerability to COVID-19

Many factors contributed to this uneven drop in life expectancy. But these remarkable numbers remind us of the vulnerability of Black, Indigenous, and People of Color (BIPOC) in the US, the result of longstanding unequal access to health care and resources needed to achieve upward economic mobility. Many BIPOC populations in the US live on the brink of collapse. With little health or financial reserves, these communities are increasingly vulnerable to sudden events, like the financial collapse of the early 2000s or a global pandemic.

Racism functions largely through structural barriers that advantage some groups and disadvantage others. Rather than causing new disparities, the COVID-19 pandemic simply unmasked chronic failings in our social policies and healthcare delivery for our BIPOC communities. Recently, the CDC acknowledged this and declared racism a public health threat that harms the health and well-being of BIPOC populations.

Longstanding systemic failings lead to poor overall health

Abnormally high and sustained exposure to stress during pregnancy and early childhood leads to sustained release of inflammatory and stress-related hormones such as cortisol, which results in toxic levels of chronic stress. Racism causes chronic stress, which detrimentally affects the development and well-being of BIPOC children. Moreover, many BIPOC children have less overall opportunity to thrive. They live in neighborhoods plagued by pervasive poverty caused by longstanding discriminatory policies such as redlining and residential segregation. These factors compound, ultimately resulting in higher levels of cardiovascular disease, mental illness, and health-risk behaviors. Known as weathering, this contributes to both decreased lifespan and healthspan (the period of a life during which a person is in good health).

Further, BIPOC individuals in the US persistently face barriers in access to quality health care. Examples include higher rates of no insurance and underinsurance, and lower health care literacy. Pervasive bias and discriminatory policies are deeply embedded into our healthcare delivery infrastructure. So, the results of the CDC report should come as no surprise: a population chronically deprived of accessible preventive services would be expected to fare poorly during a pandemic.

Moving forward: What changes could help?

We can all raise our voices to persuade and support the efforts of government officials at every level, and healthcare leaders, to address immediate disparities related to the ongoing pandemic and the chronic flaws that leave BIPOC communities increasingly vulnerable. Below are several measures that could get our system moving in the right direction.

Regular citizens can

• Vote in all elections — especially local elections. Local elected officials, such as a city mayor, town manager, city council members, and county sheriff, can affect the lives of citizens even more personally than state or federal officials. Local news media and websites may have information on policy views and track records to help you choose candidates.
• Be wary of fake news promoted on social media. Social media places a wealth of information at our fingertips, yet also offers ways to spread false information that can greatly affect our decisions. Try to maintain a healthy level of skepticism. Check information with trusted sources. These common-sense tips can help keep you from falling victim to fake news.
• Support local organizations. Local nonprofits and community organizations play a major role in helping to address COVID-19 disparities affecting BIPOC communities and fighting for testing and vaccine equity. If you’re financially able, consider donating to local nonprofits, food banks, and community organizations so that they can keep helping in times of need.

Policy makers and government leaders can

• Fix unemployment insurance. Inject federal funds into refurbishing crumbling state unemployment insurance infrastructures, and pass legislation mandating that standard minimum benefits be provided by all states.
• Make universal healthcare happen. Ensure universal health insurance is achieved, whether via a public option, single payer, or a host of other alternatives. Americans deserve equitable access to quality healthcare, especially preventive care.
• Eliminate historically racist and discriminatory policies. Eliminate discriminatory practices like gerrymandering that contribute to ongoing disempowerment of voters, residential segregation, and pervasive poverty, leaving communities of color in destitute circumstances without a voice.

Editor’s note: At the request of Dr. Perez, terms used to describe all races and/or ethnicities are capitalized in this post, to reflect his view of identity and racial equity.

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Edibles and children: Poison center calls rise

If a 3-year-old finds a cookie on the table, chances are they are going to eat it.

Even if it is made with marijuana or THC, CBD, or other components of cannabis.

As more states have legalized the use of marijuana and an ever-widening range of derivative products, it’s not surprising that more children are being exposed — including by eating marijuana edibles. A research brief published in the journal Pediatrics found that between 2017 and 2019, there were 4,172 calls to regional poison control centers about exposures to cannabis in babies and children through age 9. About half of the calls were related to edibles.

The frequency of these calls, and the percentage related to edibles, went up over the two-year period. Not surprisingly, the exposures were about twice as common in states where marijuana use is legal as in those where it is not.

More calls about edibles involving younger children

The most common age group involved was 3- to 5-year-olds, which makes sense: this is the age where they are old enough for parents to take their eyes off them for a minute or two, but not old enough to understand why they shouldn’t eat that brownie, gummy bear, or piece of chocolate.

Thankfully, the effects of these exposures were mostly minor — but in 15% they were moderate, and in 1.4% they were severe. In rare cases, significant ingestion can lead to trouble breathing or even coma. That’s the problem with edibles: it’s hard to know how much cannabis is in each one, it’s easy to ingest a lot, and the effects can last a long time.

It’s important to remember, too, that this was just a study of calls to poison centers. It’s impossible to know how many exposures there have been that were never reported — including how many went completely unnoticed by parents or caregivers.

Safety first: Children and cannabis

Clearly, there will need to be some regulation around labeling and child-safe packaging. But as an immediate step, parents and others shouldn’t buy marijuana edibles that might appeal to children (just like it’s best not to buy detergent pods that look like candy). If you do buy marijuana edibles that a child might want to eat, they need to be stored securely, out of reach, always.

When parents bring their children to visit friends, it may be a good idea to add marijuana edibles to the list of safety issues to ask about. Think of something along the lines of, “Hey, our daughter is still little and curious, so we like to ask about things like matches, guns, medications, marijuana edibles, or other things that might be dangerous for her if she gets into them. Is there anything that might be in her reach?”

It might be a bit awkward, but if you make it quick and routine, you can decrease the awkwardness. And ultimately, it’s worth a bit of awkwardness to keep your child safe.

Follow me on Twitter @drClaire

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Pills and the planet: Environmentally-friendly steps for your medicine cabinet

Most people might not guess that pills (or creams, patches, and inhalers, for that matter) have a big impact on the environment — but they do.

Climate change is leading to noticeable effects on the environment, as well as to consequences for our health, such as rising rates of asthma and new patterns of infectious diseases. The key driver of climate change is greenhouse gas emissions. Our health care system plays a large role, contributing close to 10% of our nation’s greenhouse gases. The US is also responsible for more than 25% of the world’s total health care emissions.

Within our health care system, pharmaceutical drugs and chemicals are the largest line-item contributor to greenhouse gas emissions. In addition, pharmaceutical waste throughout the global supply chain can lead to environmental and animal toxicities, and in the case of antibiotic residues, to antimicrobial resistance (aka “superbugs”). In 2018, 5.8 billion prescriptions were filled in the US. Meanwhile, consumers spent $34 billion on over-the counter medications.

Many of these drugs are lifesaving, offering us enormous benefits and healthier lives when taken correctly. But with some thought, there may be a few things you can do to make your medicine cabinet more environmentally friendly, while still keeping your health front and center.

Minimize waste when buying medicines

Less is more. Filling 90-day supplies of medications can reduce the overall cost per pill, offer more convenience, and require less packaging. But in some situations, it makes sense to request smaller quantities, such as when you are trying a new medicine, or buying over-the-counter medications that you use infrequently and do not expect to finish before the expiration date.

Do the math. If your doctor is recommending a dose change and the math works out, consider halving or doubling your current pills first. If this is working, you can then request a prescription for the new dose strength for your next refill.

Fill it when you use it. Don’t pick up a prescription unless you are going to use it, except for an emergency medicine you should have on hand. If you are given the option of getting a medication to take if your symptoms get worse or don’t improve, ask your doctor to send the prescription to the pharmacy, and notify the pharmacy that you will let them know if you want it filled.

Downsizing your medicine cabinet

Review the benefits versus harms. Bring all your prescription and over-the-counter medications to your appointments, and periodically review them with your primary care doctor. Make sure your drug regimen offers more benefits than harms for your situation. This is especially helpful if you see a lot of different doctors who prescribe medications for you. Sometimes, people stumble into a cascade, where one drug is added to treat symptoms that are side effects of another. But be sure to discuss with your doctor before making any changes; it may be harmful to stop some medications, and others may need to be tapered slowly.

Incorporate lifestyle medicine. Talk to your doctor about lifestyle medicine, which focuses on healthy habits like regular exercise and healthful foods to prevent disease and promote longevity. Often, these lifestyle changes can help reduce or eliminate the need for medications.

Inhalers: Know your options

Explore options. If you have asthma or chronic obstructive pulmonary disease (COPD), ask your doctor what your options are for inhalers. Metered dose inhalers (MDIs) use hydrofluoroalkane propellants, which are greenhouse gases, to deliver the medication. Check if there is an equivalent dry powder inhaler (DPI) option for you. However, not everyone can use DPIs, which rely on patients to take quick deep breaths to draw the medication into the lungs. (For this reason, rescue inhalers used during an asthma attack are usually MDIs.) Your inhaler choices will also depend on cost and coverage from your insurer. In the end, the important thing is to use the inhaler device that works best for you in controlling your condition.

Proper disposal of medicines

Know when to flush. Do not put medications down the toilet or sink (unless they’re on the FDA flush list), as this may contaminate lakes, rivers, agriculture, and drinking water. Read the packages for any drug disposal instructions. Many pharmacies or local public safety agencies like the police will accept unused medications and dispose of them safely. National Prescription Drug Take Back Day is April 24, 2021, so check for safe collection sites near you.

Some medicines can be discarded in trash. Remove personal identifying labels first, and then mix the medication in a container with coffee grounds, cat litter, or soil. (This is not recommended for controlled substances like opioids and other addictive medicines.) Visit this FDA web page for more information about drug disposal.

Health care is a partnership, and with thought and care, we can work together to have the best of both worlds — a healthier you, and a healthier planet.

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Diet, disease, and the microbiome

There is growing interest in the human body’s microbiome and its connection to chronic disease. A new study examines that connection, along with how the foods we eat influence the composition of our microbiome.

Microbiome protects host and plays role in disease risk

The microbiome consists of the genes of tiny organisms (bacteria, viruses, and other microbes) found in the gastrointestinal tract, primarily in the small and large intestine. The normal gut flora — another term for the microbiome — protects its human host. For the microbiome to flourish, the right balance must exist, with the healthy species dominating the less healthy.

Scientists do not fully understand how the microbiome factors into the risk of developing chronic diseases, such as heart disease, obesity, and type 2 diabetes. Many factors, including differences between individuals and individual diets, have made this a difficult area to investigate.

Study investigates relationships between diet, microbiome, and disease risk

But a new study, published in Nature Medicine, accounts for these factors and sheds light on how our diets shape our microbiome and how our microbiome, in turn, influences our disease risk.

The researchers studied more than 1,100 individuals enrolled in PREDICT 1, a large trial looking at individual responses to food. They used a technique called metagenomic sequencing to identify, classify, measure, and analyze genetic material from the study participants’ microbiomes. They also collected detailed, long-term dietary intake information from all of these individuals, so they could analyze their dietary patterns, including their intake of different food groups, foods, and nutrients. In addition, they collected information from the study participants on a variety of factors that are known to influence metabolism and disease risk, including pre- and post-meal measures of blood sugar (glucose), cholesterol, and inflammation. Finally, they measured personal health attributes of the study participants, including age, weight, body mass index (BMI), body fat, and blood pressure.

Diet influences microbiome and microbiome influences disease risk

The study found that the health of the microbiome is influenced by diet, and that the composition of the microbiome influences the risk of health outcomes. The results showed that specific gut microbes were associated with specific nutrients, foods, food groups, and overall diet composition. Health conditions such as heart disease, type 2 diabetes, obesity, and general inflammation appeared to be most impacted by diet-influenced changes to the microbiome.

For example, less healthy dietary patterns (dairy desserts, unhealthy meats, processed foods) supported gut species that were associated with measures of blood sugar, cholesterol, and inflammation that are significantly associated with higher risk of cardiac events, strokes, and type 2 diabetes.

In contrast, a more diverse gut microbiome was tied to healthy dietary patterns (high-fiber vegetables like spinach and broccoli, nuts, and, heathy animal foods such as fish and eggs) and was linked to measurements tied to lower risk of certain chronic diseases. In addition, the study found that polyunsaturated fats (found in fish, walnuts, pumpkin, flax and chia seeds, sunflower, safflower, and unhydrogenated soybean oils) produce healthy gut species linked to a reduced risk of chronic disease.

Minimally processed, plant-based diet is good for the microbiome and for reducing disease risk

So what do these findings mean for us? First, the study showed that eating more unprocessed plant foods — fruits, vegetables, nuts, seeds, and whole grains — allows the gut microbiome to thrive. Some animal foods, such as fish and eggs, are also favorable. Avoiding certain animal foods, such as red meat and bacon, dairy foods, and highly processed foods (even processed plant foods such as sauces, baked beans, juices, or sugar-sweetened drinks and desserts) prevents less-healthy gut species from colonizing the gut.

It is important to note that food quality matters; processed or ultra-processed plant-based foods were not associated with heathy clusters of gut microbes. When choosing foods, consider whether they are processed or unprocessed, in addition to whether they are a plant or animal food.

It can also be helpful to think in terms of dietary patterns, rather than individual foods or food groups. Meal patterns that emphasize foods beneficial to the microbiome are the whole-food, plant-based dietary patterns. These include vegan (no animal products) and ovo-vegetarian (vegetarian plus eggs) diets. The pescatarian eating pattern, in which oily and white fish are the meats of choice, is also good for the microbiome.

Emphasizing minimally processed plant foods allows the gut microbiome to thrive, providing protection against, or decreasing the risk of, chronic diseases such as heart disease, diabetes, metabolic disease, and obesity.

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