Which nutrients from plant foods can reduce dementia risk?

This is part two of this series of quick responses to questions that are asked about plant-based diets. The answers to such questions are truly brief (usually in 75 words or less). The answers are by no means meant to be comprehensive or definitive, of course; rather they are meant to encourage you, the reader, to think about how you would answer such questions yourself. You can click on the photos to get more information on each answer.

1. Why do some health professionals endorse plant-based diets?

Some health professionals endorse plant-based diets for the very simple reason that they are healthier than animal-based diets.

Of course, this would only apply to those plant-based diets which avoid the ubiquitous processed fatty/sugary elements that, unfortunately, form a major part of the standard Western diet.

The latter is widely regarded as being one of the major causes of the rapid rise in non-communicable diseases, such as diabetes, obesity, and heart disease. 1


2. Are all plant-based diets the same?

All plant-based diets are not the same, although all make plants central to the plate. Plant-based diets include: different variations of vegetarians: lacto-vegetarians (dairy), lacto-ovo-vegetarians (dairy and eggs), ovo-vegetarians (eggs), and vegans (no animal products including honey).

Pescatarians (fish and/or shellfish), flexitarians (occasional meat, fish, eggs and dairy) and Mediterranean diet (includes animal-foods but plants are a major component) are not strictly vegetarian. WFPB (wholefood plant-based) diets involve only whole plants and no processed foods. 2


3. Are all plant foods healthy?

All “wholefood” plants that are safe for human consumption are healthful (unless one has an allergy – e.g. to nuts), but not all “plant-based diets” are healthful. In the case of healthy and balanced plant-based diets, evidence suggests that they are protective against a wide range of diseases (including heart disease) and, hence, healthful.

However, additional research suggests that unhealthy plant-based diets are not protective against such diseases and may, in fact, have distinctly unhealthful effects. 3

4. What affects our gut microbiota?

Our gut microbiota is affected (both in quantity and quality) by diet, lifestyle factors (e.g. smoking, drinking, exercise, stress), gastrointestinal infections, medications (e.g. antibiotics), and environmental factors (e.g. pesticides, heavy metals).

Whilst the gut microbiota is largely established in the womb and during early stages of life, it’s obvious that diet is going to be the major consistent influence, since almost everything we put into our mouths will pass through the GI tract. 4

5. Where are most of our immune cells located?

Most of our immune cells (around 70%) are located in the gut-associated lymphoid tissues (GALT) in the mucosa lining of the gut inner wall.

They are also located in other principal sites within the GI tract, including:

Peyer’s patches (nodules) in the ileum;

the appendix;

and solitary lymphoid follicles in the colon and rectum. 5

6. With what is dysbiosis associated?

Dysbiosis is associated with a number of factors, including: food type (e.g. different bacteria thrive with animal-food diets, whilst others – arguably healthier ones – require a rich diversity of plant foods, especially high in MACs or microbiota-accessible carbohydrates); smoking; alcohol; exercise; stress; genetics; ageing; antibiotics/medications; dental hygiene; environmental toxins.

Basically, any interruption in the balance of gut microbiota may cause dysbiosis which, in turn, can have diverse effects on the body, including weakening the immune system. 6


7. What is known about autoimmune diseases and diet?

The relationship between autoimmune diseases (ADs) and diet remain largely unclear, according to evidence-based research. However, it appears that balanced/healthy diets are beneficial. Increased vitamin D is correlated with reduced ADs.

Gut microbiota appear to be linked to ADs – e.g. work with pre-/probiotics. Omega-3’s anti-inflammatory role is attracting research interest. Overall, however, few definitive conclusions have yet been drawn about the specific roles of genetics, environmental and dietary factors in the aetiology of ADs. 7

8. Which nutrients from plant foods can reduce dementia risk?

Plant food nutrients that potentially reduce risk of dementia are varied and, working together, produce a cumulative effect.

Antioxidants are the family of phytochemicals leading the fight against dementia – reducing oxidative stress caused by free radicals: including vitamins A (beta-carotene in plants), C, E and B3 (niacin – nuts, legumes, grains); flavonoids (a class of polyphenol) such as anthocyanins, resveratrol, catechins and curcumin; sulphur compounds (e.g. from alliums); omega-3 (e.g. walnuts, flax and chia). 8

9. Should nutrition be combined with other lifestyle factors to improve brain health?

Indeed, nutrition should be combined with other lifestyle factors (internal/external) to improve brain health.

These ‘avoidable’ factors include: – avoiding smoking and binge drinking, alcohol/drug abuse; maintaining a healthy body weight; getting regular physical exercise; avoiding emotional stress; getting sufficient good quality sleep; eating regularly; keeping mentally active; being sociable and ‘involved in life’; maintaining low blood pressure/cholesterol levels where possible through the latter approaches – of course some factors are genetically influenced. 9

10. What have plant-derived foods been shown to improve?

Plant-derived foods have been shown to improve overall health, including the following: preventing obesity; reducing the risk of a range of non-communicable diseases (e.g. diabetes, cardiovascular disease, certain cancers); lowering cholesterol/blood pressure/triglycerides; increasing energy levels; improving sleep quantity and quality; improving brain function and the symptoms of autoimmune disorders.

This is partly attributed to plants being high in antioxidants, dietary fibre, vitamins, minerals and countless other phytochemicals all working together to promote improved mental/physical health. 10


  1. https://nutritionfacts.org/topics/standard-american-diet/ []
  2. https://nutritionfacts.org/2018/02/01/plant-based-is-not-the-same-as-vegetarianism/ []
  3. https://www.wholefoodplantbaseddiet.com/greggs-vegan-sausage-rolls-why-veganism-can-fail/ []
  4. https://www.wholefoodplantbaseddiet.com/how-do-plant-based-diets-affect-our-gut-microbiota-part-one/ []
  5. https://nutritionstudies.org/autoimmune-disease-genes-infection-environment-gut/ []
  6. https://www.hopkinsmedicine.org/health/wellness-and-prevention/what-are-common-symptoms-of-autoimmune-disease []
  7. https://nutritionstudies.org/autoimmune-disease-genes-infection-environment-gut/ []
  8. https://nutritionfacts.org/video/how-to-prevent-alzheimers-with-diet/ []
  9. https://nutritionfacts.org/video/is-it-the-diet-the-exercise-or-both/ []
  10. https://www.health.harvard.edu/blog/what-is-a-plant-based-diet-and-why-should-you-try-it-2018092614760 []

What Do Health Professionals Think About Plant-Based Diets?

The question in the title, and others like it related to plant-based diets, are often being asked. So, I thought it would be useful to give some really brief answers (usually in 75 words or less) to such common questions. These answers are by no means meant to be comprehensive or definitive, of course; rather they are meant to encourage you, the reader, to think about how you would answer such questions yourself.

1. What’s the difference between a vegan and someone who eats a wholefood plant-based diet?


You can be a vegan without eating a wholefood plant-based diet (WFPBD).

Equally, you can eat a WFPBD without being a vegan.

It’s possible to eat a truly unhealthy diet if you’re a vegan, although it’s pretty much impossible to do so if you eat a WFPBD.

Veganism is about more than just what you eat – it’s also about moral choices regarding animals and usage of any foods/products derived from them.

2. What do health professionals think about plant-based diets?

The general agreement amongst health professionals regarding plant-based diets is one of endorsement for such diets being both nutritionally sound and a healthy choice when they are well-planned (which would, of course, include some supplementation, particularly of B12), offering health benefits for the prevention/treatment of certain diseases.

Apart from the German Society for Nutrition, the consensus is that such diets are appropriate during all life stages, including pregnancy, lactation, infancy, childhood, adolescence, and for athletes.

3. What’s veganism?

Veganism is a way of life that seeks to exclude, as far as is possible and practicable, all forms of exploitation of, and cruelty to, animals, whether it’s with respect to the food we eat, the clothes we wear, or for any other purpose.

In terms of diet, veganism means that all foods are plant-based, and all animal or animal-derived foods are excluded: including meat, fish, dairy and eggs and honey.


4. How many vegans are there in the UK today?

Without exact figures for 2019. we can look at the previous year.

In the UK (as of 2018), there was estimated 1 to be around 600,000 people aged 15 or over.

This represents a doubling between 2014 and 2016 (0.25% to 0.46%) and then another doubling between 2016 and 2018 (0.46% to 1.16%).



5. What are the four basic food groups in the vegan diet?

In general terms, the four basic food groups in the vegan diet are: legumes, grains, vegetables and fruits.

Of course, nuts, seeds and fungi are also usual components of any plant-based diet. Some nuts (Brazil nuts, pine nuts, pistachios, and peanuts) are, botanically-speaking, seeds rather than fruit, while some nuts (tree nuts like chestnuts, hazelnuts, pecans and walnuts) are the plant’s fruit.

Seeds and fungi are just that – seeds and fungi.


6. What’s considered key to making a global step towards more plant-based eating?

The factor considered key to making a global step towards more plant-based eating is for vegan food to become normalised within society. A 2010 UN report 2 said a global shift towards a vegan diet is vital to save the world from hunger, fuel poverty and the worst impacts of climate change. A PNAS study 3 said a global move to a vegan diet would avert 8.1 million premature deaths per year.

7. What’s ethical veganism?

Ethical veganism can be defined as a philosophy that avoids the use of animals, not only for food, but also for anything that relies on animal products (e.g. clothes, furniture, perfumes, etc).

It also extends to occupations, entertainment, sports, etc.

Ethical veganism has a deep respect for all life, believing that we have no right to exploit animals for our own benefit, nor to treat other animals as though they have no rights.


8. What’s environmental veganism?

Environmental veganism can be defined as the belief that there is sufficient evidence to show that eating a plant-based diet is both more sustainable and significantly less damaging to the environment than eating an animal-based diet.

Animal-based industries are considered to be unsustainable and to play a huge part in causing environmental damage – including: greenhouse gas emissions, pollution, deforestation, and the use of water, fossil fuels, and land.



9. What’s a sustainable diet?

A sustainable diet has low environmental impact; adds to food and nutritional security; provides healthy lives for current and future generations; is protective of ecosystems and biodiversity; is culturally acceptable, socially accessible, economically affordable, fair, safe and healthy and can optimise human and natural resources.

The UN’s FAO 4 considers that the following should be included in the definition: nutrition, the environment, economic impact and socio-cultural impact.

10. What does the human food supply chain incorporate?

The food supply chain incorporates all aspects of food production, consumption and disposal, including: processed/non-processed food production, shopping habits, food packaging, food waste, food miles, appropriate calorie/nutrient intake.

A major reason for being concerned about the food supply chain is the carbon footprint of our food. For instance, there is a big difference in the impact of buying out-of-season products from half way around the world, when compared with buying locally produced, seasonal products.


11. What does the concept of trade-offs mean?

A trade-off is a decision that involves reducing or losing a quality or quantity of one option in return for gaining a quantity or quality of an alternative option.

Examples of food trade-offs:

Organic costs more than non-organic, but may be better for human health and the environment;

Sustainably-produced food from distant countries is good for the producing country, but has a high carbon footprint;

Processed food is cheaper, but worse for human health.


Final comment

I hope you found this interesting. Expect a few more of these plant-related questions and answers in future blogs…


  1. The Vegan Society []
  2. Assessing the Environmental Impacts of Consumption and Production
    Priority Products and Materials []
  3. PNAS. Analysis and valuation of the health and climate change cobenefits of dietary change. 2016 []
  4. Tracking progress on food and agriculture-related SDG indicators
    A report on the indicators under FAO custodianship []

Dr Neal Barnard Wins Plant-Based Award

Neal Barnard MD

The Plantrician Project aims to “…educate, equip and empower our physicians and healthcare practitioners with knowledge about the indisputable benefits of plant-based nutrition. To provide them with the resources they, in turn, use to inform and inspire their patients to shift from the Western industrialized diet to a life-changing, whole-food, plant-based way of living.” 1

A plant-based diet is not just ideal for human health – it respects animals and protects the environment.

Sadly, it appears to be only in the US that such organisations are making inroads into the mostly pharmaceutical-based world of western medicine, and it would be great to see such organisations spreading throughout the rest of the world – specifically, from my point of view, in the UK.

However, it’s gratifying to see that one of my personal plant-based medical heroes, Dr Neal Barnard, president of the US-based Physicians Committee for Responsible Medicine 2 , is to receive the 2019 Plantrician Project Luminary Award at the International Plant-Based Nutrition Healthcare Conference 3 .

This will be in recognition of his invaluable scientific contribution through his prolific publication of thoughtful research; his pioneering work in public policy that has shaped numerous national initiatives and key legislative decisions; his selfless leadership and compassionate service; as well as his creative development of practical resources that have transformed millions of lives around the world. 4 .

For over 30 years, Dr. Barnard has not only been an unwavering advocate of the power of plant-based nutrition to change the way physicians treat chronic illnesses, he has also selflessly and compassionately pioneered significant improvements in the effectiveness of medical education and research.” Dr. Scott Stoll, Plantrician Project chairman and co-founder 5 .

Previous plant-based doctors who have received this prestigious award are:

  • T. Colin Campbell, PhD 6  
  • Caldwell B Esselstyn, Jr., MD 7 
  • Dean Ornish, MD 8 
  • Michael Klaper, MD 9 , and
  • Hans Diehl, MD 10 

Final thought

You might be interested in some of the literature and video resources made available by the Plantrician Project 11 . It’s important that people are aware that such internationally-renowned medical specialists are preventing and treating even the most serious conditions – from cardiovascular disease and diabetes to cancer and obesity – by getting their patients to make simple dietary and lifestyle changes to treat the causes of the problems, rather than by the now-habitual (and financially profitable!) medical route of throwing more and more drugs and medical procedures to merely treat the symptoms.


  1. The Plantrician Project []
  2. Dr Neal Barnard, president of the US-based Physicians Committee for Responsible Medicine []
  3. Int’l Plant-Based Nutrition Healthcare Conference []
  4. Dr. Neal Barnard Honoured as 2019 Recipient of The Plantrician Project Luminary Award []
  5. Dr Scott Stoll []
  6. T. Colin Campbell, PhD []
  7. Caldwell Esselstyn, Jr., MD []
  8. Dean Ornish, MD []
  9. Michael Klaper, MD []
  10. Hans Diehl, MD []
  11. Plantrician Project Resources []

Diabetes and Erectile Dysfunction Reversed with Diet

Three previous blogs 1 2 3  looked at inspirational videos from the H.O.P.E. Project. In this blog, another video from the same producers covers the story of a 51-year old man, Marc Ramirez, who “cured” his diabetes with a WFPB diet.

He was able to dump all his medications and get rid of all the usual symptoms of diabetes – including the frequently experienced side-effect of erectile dysfunction. All down to the power of plants!

About Marc Ramirez

Marc Ramirez’s family were plagued by diabetes, diagnosed himself in 2002 he was told by his doctor that he’d need to take medication for the rest of his life. After hearing about the benefits of a wholefood plant-based diet in 2011, Marc and his wife Kim decided to give it a go.

His health and their sex life haven’t been the same since…

The Video

H.O.P.E. The Project – Healing Of Planet Earth

The H.O.P.E. Project 4 tries to inform people about the endless benefits of a wholefood, plant-based diet and to inspire them to adopt a conscious, sustainable and kind lifestyle.

H.O.P.E.’s 3 main aims

1. Live a healthy and long life

Eating a wholefood plant-based diet without animal products has the potential to prevent and reverse diseases and obesity, which improves our health and longevity.

2. Conserve nature and the environment

A plant-based diet (ideally organic) conserves natural resources, saves biodiversity and helps to reduce our ecological footprint.

3. Protect animals

The lives of countless species of animals are affected by the food we eat. Choosing to eat a WFPB diet goes hand in hand with efforts to promote a more peaceful world in which people understand that all living beings are entitled to compassion, dignity and life.

Final thoughts

The above aims seem pretty sound to me and, without too much doubt, appear to be the most effective way each of us can promote optimal health, preserve the environment, and protect animals – all by simply changing our dietary habits.



  1. I H.O.P.E. You Watch & Share This Film []
  2. Heart Surgery or Plant-Based Diet? []
  3. The Healing Power of Plants []
  4. The H.O.P.E. Project website. []

How Do Plant-Based Diets Affect Our Gut Microbiota? Part Two

In Part One we looked at various aspects of how our intestinal microbiota was affected by the food we put in our mouths, particularly with regard to variations that occur between plant- and meat-based diets and in relation to the macronutrient, carbohydrate. In Part Two, we’ll take a look at the microbial effects of the other two macronutrients:

  • protein, and
  • fat

as well as the following:

  • polyphenols
  • postbiotics
    • SCFAs 1
    • phytoestrogens
    • isothiocyanates
    • aryl-hydrocarbon receptor ligands
    • Coprostanol and secondary bile acids
    • trimethylamine N-oxide (TMAO), and
    • vitamins


In previous blogs 2 3 4 5 , we’ve looked in great detail at the effects of protein (both animal and plant) on human health. Studies mentioned in the latter blogs have shown how consumption of animal protein (especially in large quantities) is associated with a wide range of common diseases.

When it comes to the effects of protein on gut microbes, the majority of studies suggest 6 that plant protein consumption has a strongly positive correlation with improved healthy microbial diversity.

Impact of dietary protein on intestinal microbiota and health outcomes. SCFAs short chain fatty acids, TMAO trimethylamine N-oxide, Tregs T regulatory cells, CVD cardiovascular disease; IBD inflammatory bowel disease. Source: Singh RK, Chang H-W, Yan D, Lee KM, Ucmak D, Wong K, et al. . Influence of diet on the gut microbiome and implications for human health. J Transl Med. (2017).

The following bacteria are commonly increased in number within the gut microbiota of those individuals consuming a high animal protein diet:

  • Alistipes 7
  • Bilophila wadsworthia 8
  • Bacteroides 9
  • Clostridia 10

The latter are bile-tolerant microbes 11 . Bile increases when animal-protein consumption increases, when compared with increased plant-protein consumption, so it’s no surprise that a meat-based diet will mean that bile-tolerant microorganisms will increase in number 12 .

On the other hand, the following bacteria are commonly decreased in number within the gut microbiota of those individuals consuming a high animal protein diet:

  • Roseburia 13
  • Eubacterium rectale 14 , and
  • Ruminococcus bromii 15

The latter are important for metabolising dietary plant polysaccharides 16 . Again, it’s no surprise that these plant polysaccharide-loving bacteria will frequent the guts of plant-eaters.

It’s a zero-sum game

Another factor which needs to be taken into account is that diet is a zero-sum 17 game: the more protein in your diet, the less room there is for healthy plant carbohydrate. The result of this will be a decrease in butyrate-producing bacteria, and thus an increase in the proinflammatory bodily state and an increased risk of colorectal cancer 18 .

When individuals have eaten pea protein, for instance, it’s been shown 6 that there is a corresponding increase in beneficial Bifidobacterium and Lactobacillus, while the pathogenic Bacteroides fragilis and Clostridium perfringens reduce. The result of this is that there is an increase in intestinal SCFA levels (more on SCFAs below). The latter study drew the conclusion that eating plant-derived proteins reduces mortality when compared with eating animal-derived proteins.


Both quantity and quality of consumed fat have been shown 18 to have significant impact on the composition of gut microbiota.

When you eat a plant-based diet (and here we’re talking about whole, unprocessed plant foods), it will be naturally low in fat. This favours the beneficial Bifidobacteria 19 .

Plant-based fats

The fats from a plant-based diet are made up of mainly mono and polyunsaturated fats. On a phyla level, the result of this is that the Bacteroidetes:Firmicutes ratio 20 increases, while on the genera level, lactic acid bacteria (Bifidobacteria and Akkermansia muciniphila) increase  6 .

Nuts about gut bacteria

Previous blogs 21 looked at how walnuts are particularly good plant-based sources of omega-3 fatty acids (the ALA within them being converted to DHA and EPA within our bodies); however, it doesn’t stop there. Walnuts, and other nuts in general, have been shown 22  to increase Ruminococcaceae and Bifidobacteria while, at the same time, decreasing Clostridium species.

Saturated fat & your guts

Whilst coconut contains unusually high levels of saturated fat for a plant food, saturated fat is almost exclusively found in animal foods.

Studies suggest 23 that saturated fat activates systemic inflammation (by inducing pro-inflammatory cytokines such as IL-1, IL-6 and TNF-α) and thus makes us much more vulnerable to systemic infections 24 and metabolic disorders 25 , such as type 2 diabetes and obesity.

Consuming high levels of saturated and trans fats – something increasingly common in the Western diet – increases the risk of cardiovascular disease and has been shown 6 26 to:

  • increase 
    • Bilophila
    • Faecalibacterium prausnitzii 27 , and
    • Firmicutes
  • decrease
    • Bacteriodetes
    • Bifidobacterium
    • Bacteroides
    • Prevotella
    • Lactobacillus ssp. 28 , and
    • Bifidobacterium spp. 29


Polyphenols are secondary metabolites of plants and are generally involved in defence against ultraviolet radiation or aggression by pathogens 30 . These and other naturally occurring plant metabolites in plant foods have been shown to provide cardiovascular protection 6 as well as both anti-inflammatory and anti-pathogenic effects 31 .

In plant foods, polyphenols increase:

  • Bifidobacterium, and
  • Lactobacillus

Whilst all plants have polyphenols, some of the most common polyphenol-rich foods include:

  • fruits
  • seeds
  • vegetables
  • tea
  • cocoa products, and
  • wine *

*N.B. The many negatives associated with alcohol consumption per se (for both gut health 32 and general health 33 ) suggest that the small quantities of polyphenols in wine are insufficient reason to drink the stuff.

Spice up you guts

Spices and herbs are also very high in antioxidant polyphenols 34 , although the quantities that one can consume are, of course, limited.

And, of course, it’s widely known that tea contains high levels of polyphenols (including catechins, theaflavins, tannins, and flavonoids). Tea consumption increases Bifidobacterium and Lactobacillus–Enterococcus spp., something which appears 35 to result in increased SCFA production within human microbiota.


Part One introduced this relatively new term. The postbiotics we’ll look at here are SCFAs, phytoestrogens, isothiocyanates, aryl-hydrocarbon receptor ligands, Coprostanol and secondary bile acids, trimethylamine N-oxide (TMAO), and vitamins.

It’s important to understand the difference between prebiotics 36 /probiotics 37 on the one hand, and postbiotics, on the other. Basically, prebiotics (e.g. indigestible fibre) are put into the mouth and swallowed; probiotics are the microbes themselves which exist within the gut, but can also be consumed as dietary supplements; whilst postbiotics are the products of microbial activity within our guts.

Both prebiotics and postbiotics are, of course, vital for health. And to clarify once again: Probiotics are microbes that exist already in the GI tract, awaiting prebiotics (the substrate or source material). The products resulting from microbial activity are postbiotics – metabolites that research is showing are of fundamental importance for pretty much every functional system within the host (you and me) – from the gut-brain, gut-lung, and gut-liver axes, to immunoprotection 38 and mental health. 39 40 41

The various systems within our bodies are linked with each other via communication mechanisms that stem from the microbial products/metabolites (postbiotics) produced from the nutrients we ingest. As it happens, some products are diet-independent (for instance, lipopolysaccharides 42 , ribosomally synthesised and post-translationally modified peptides 43 etc.). We’ll set aside these diet-independent postbiotics, and look, instead, at the diet-dependent postbiotics mentioned above.

Location, location, location

The complexity of the human digestive system never fails to amaze. Not only do different foods encourage different microbes to produce different end products, but different locations along the intestinal tract result in different bioactive molecules being produced from the different prebiotics and nutrients 39 44 .

Diet & postbiotics

The type of food you eat is shown 45 to determines the range of postbiotic positive health effects that you enjoy, including:

  • local anti-inflammatory and immunomodulatory 46
  • antiobesogenic
  • antihypertension
  • anticholesterolemic
  • antiproliferative 47 , and
  • antioxidant
How postbiotics work

Postbiotic effects derive from a range of factors, including:

  • modulation of gene expression
  • metabolism
  • intestinal function
  • substrate composition
  • microbiota composition

We’ll now look at the most well-known probiotics – i.e. SCFAs, phytoestrogens, isothiocyanates, aryl-hydrocarbon receptor ligands, Coprostanol and secondary bile acids, trimethylamine N-oxide (TMAO), and vitamins.

Short-Chain Fatty Acids (SCFAs)

The SCFAs acetate, propionate, and butyrate are mostly microbial metabolites of fermented fibre and other carbohydrates, although a tiny fraction does derive from proteins. Levels of these SCFAs significantly increases when a person begins to eat a plant-based diet 48 .

One of the roles of SCFAs is to act as a substrate for the maintenance of healthy colonic epithelium 49 . There is a correlation 50 between plant-based food consumption and improved epithelium health. Maintaining this intestinal barrier prevents endotoxemia 51 and subsequent inflammatory effects 52 53 .

Specific gut microbes are predisposed to produce SCFAs, and different bacteria produce different SCFAs, such as:

  • acetate is produced by enteric bacteria 54 , such as:
    • Akkermansia muciniphila
    • Bifidobacterium spp.
    • Prevotella spp., and
    • Bacteroides spp.
  • propionate is produced by:
    • Bacteroides spp.
  • butyrate is produced by:
    • Coprococcus 55 , but mainly by
    • Clostridium Cluster XIVa, IV, and XVI – species positively correlated with plant-food diets

These SCFAs would not be produced (or, at least, not produced in sufficiently high quantities to maintain optimal health) unless a largely or wholly plant-based diet were consumed.

SCFA protection

SCFAs (acetate, propionate and butyrate, in particular), protect against different types of disease, such as:

  • type 2 diabetes 56
  • inflammatory bowel disease 57
  • immune diseases 58
  • immunity against pathogens 55
  • microglia 59 function and maturation/control of blood–brain barrier integrity 60
  • thermogenesis 61 regulation 62
  • preventing/treating NAFLD 63 and obesity 64
Propionate and gluconeogenesis

Gluconeogenesis (GNG) is a metabolic pathway that results in the generation of glucose from certain non-carbohydrate carbon substrates, such as protein and fat – and reverses the energy-production process of glycolysis. It provides the body’s cells with energy if carbohydrate stores are depleted. The SCFA, propionate acts as a gluconeogenic substrate in both the liver and intestine 55 . As well as helping to provide energy stores for the body, SCFAs are increasingly thought to play important roles as signalling molecules 65 .

The beauty of butyrate

A previous blog 66 looked in some detail at butyrate. This SCFA, and the bacteria which produce it, are becoming increasingly accepted 55 as being highly beneficial to human health, including:

  • acting as a major carbon source for colonocytes 67
  • helping to regulate critical intestinal functions, such as 68 69 :
    • intestinal motility
    • mucus production
    • visceral sensitivity
    • epithelial barrier maintenance
    • immune homeostasis, and
    • maintaining the mucosal oxygen gradient 70 71

The foregoing barely scratches the surface of the vast range of functions and interactions of SCFAs; but the take-home message is that diets rich in fibre seem to provide huge benefits to both the intestine and overall health.


Phytoestrogens are plant-derived polyphenols that interact with oestrogen receptors with either agonist or antagonist actions 72 . They are found in various plant foods (e.g. seeds, grains, beans) and are concentrated in flax and soy – and, oddly enough, beer – the reason that beer-swilling men develop man boobs 73 .

Phytoestrogens appear 74 to have significant health-promoting properties. Research 75 76 77 has shown them to be:

  • anticarcinogenic   
  • antidiabetic
  • antiinflammatory
  • antioxidant
  • protective against cardiovascular disease
  • antiobesogenic
  • antidiabetic
  • protective against osteoporosis and amyloid formation 78

Phytoestrogens have around a 1% bioavailability 79 , and so lots of them are able to get down to the gut.  This is important because increasing evidence 80 81 suggests that the above positive health effects are only reached after bioactivation of the polyphenols by gut microbiota.

The players in polyphenol metabolism

As with most aspects of nutritional science, knowledge is limited about how many microbes are involved in polyphenol metabolism. However, the following are currently known 45 81 to be involved in the following process:

  • converting polyphenols to equol 82 , urolithins 83 , and enterolignans 84 :
    • Bifidobacterium
    • Lactobacillus sp.
    • Coriobacteriaceae
    • Clostridium sp.
    • Bacteroides, and
    • Saccharomyces yeast

Coriobacteriaceae, Eubacterium and other species appear to be responsible for various other polyphenol transformations.

It works both ways

There’s a bidirectional relationship between gut microbiota and polyphenols 85 86 . That is, gut bacteria produce microbial metabolites (postbiotics) from polyphenols, and, in turn, these postbiotics act as prebiotics for various gut bacteria. The net result of this postbiotic production (especially the production of urolithins) encourages the growth of Lactobacillus and Bifidobacterium.


Sulforaphane, discussed in detail in a previous blog 87 in relation to the incredible health-giving power of broccoli, is perhaps the most extensively studied isothiocyanate – that is, a compound converted enzymatically from particular plant components called glucosinolates 88 . Isothiocyanates can be derived from cruciferous 89 or brassica 90 vegetables. The latter are rich sources of glucosinolate, the precursor of isothiocyanates.

The following gut bacteria are largely responsible for facilitating the conversion of the glucosinolates in plant foods to the isothiocyanates our bodies need:

  • Escherichia coli
  • certain Bacteroides
  • some Enterococcus
  • Lactobacillus agilis
  • certain Peptostreptococcus spp., and
  • Bifidobacterium spp.

These bacteria secrete their own myrosinase enzyme 91 in order to metabolise the glucosinolates to isothiocyanates 92 .

Health benefits of isothiocyanates

Isothiocyanates are metabolites which are thought  93 94 to have a range of health-benefiting properties, including being:

  • cytoprotective 95
  • anticarcinogenic
  • antioxidative 
  • antitumoural, and
  • antiinflammatory
  • detoxifying

Aryl-Hydrocarbon Receptor Ligands (AHRLs)

In terms of diet, intestinal aryl-hydrocarbon receptor 96 ligands 97  are mainly derived from eating plant food, especially cruciferous vegetables. Once again, gut bacteria are responsible for producing these AHRLs.

Using aryl-hydrocarbon receptors, these ligands are able to promote gut homeostasis and intestinal immune function 98 , as well as xenobiotic 99 detoxification and maintenance of energy metabolism, including lipid metabolism.

AHRLs and fat

A plant-based diet appears to be better at maintaining an appropriate level of AHRLs, while a high-fat diet appears to decrease the number of aryl-hydrocarbon receptor ligands. A decrease in either aryl-hydrocarbon receptors or in the associated ligands appears to compromise the healthy maintenance of intraepithelial lymphocytes 100 and the ability to control microbial load and composition. This can result in increased immune activation which can, in turn, cause epithelial damage 101 .

The result of this negative process can be gut permeability and inflammation. Both of these can promote the development of metabolic syndrome. Interestingly, some research suggests 98 102  that when metabolic syndrome is produced because of this process, the condition can be improved by supplementing the diet with a probiotic – namely, a strain of Lactobacillus.

Coprostanol and secondary bile acids

Dietary cholesterol is only found in animal-derived foods and, when consumed, it gets broken down in the gut by bacteria. The two resulting cholesterol metabolites (postbiotics) are coprostanol 103 and secondary bile acids.

Coprostanol is poorly absorbed by the human intestine after being isolated from cholesterol by several strains of gut bacteria. This is a good thing as far as cardiovascular disease risk is concerned, since it means that serum cholesterol in the host is reduced, with the coprostanol mostly being excreted in faeces rather than being absorbed back into the bloodstream 104 105  .

The situation is somewhat different when it comes to the other cholesterol postbiotic, secondary bile acids. One of the major uses of cholesterol is in the synthesis of bile acids in the liver. Bile acids are, of course, essential for the absorption of fat from the contents of the intestine; however, when the gut microbiota convert the bile acids synthesised from cholesterol into secondary bile acids 106 , they can be absorbed into the bloodstream and find their way into various tissues within the body. This is a problem.

Being hydrophobic 107 , these secondary bile acids are thought 108  capable of causing direct damage to cell membranes and inducing the generation of reactive oxygen species resulting in DNA damage, apoptosis 109 , and necrosis 110 . Additionally, it’s believed 104 44 that secondary bile acids are involved in maintaining the equilibrium of health and disease – being associated with inflammatory bowel disease, colon and liver cancer.

Trimethylamine N-Oxide (TMAO)

Trimethylamine N-oxide (TMAO) is a molecule generated from choline 111 , betaine 112 , and carnitine 113 via gut microbial metabolism. TMAO is associated with cardiovascular and neurological disorders. Carnitine and choline, precursors of TMAO, are mostly found in foods of animal origin (e.g. eggs, beef, pork), with lower amounts found in beans and fish 114 .

Diets containing animal proteins and fats (particularly red meat) tend to have decreased numbers of Bifidobacterium and increased numbers of L-Ruminococcus, Bacteroides, Alistipes, Ruminococcus, Clostridia, and Bilophila. Such diets are associated with elevated levels of TMAO 48 and, thereby, increased risk of cardiovascular disease and inflammatory bowel disease 23 6 .

The reason plant-eaters have a different gut microbiota composition to omnivores is that they have a reduced capacity to produce trimethylamine (TMA), the precursor to TMAO 115 . This reduced capacity appears to be due to both a reduction in the number of enzymes responsible for converting TMA to TMAO and to the general remodelling of gut microbiota that results from eating a plant-based diet.


We finally come to the gut microbiota which are essential for producing and maintaining adequate vitamin levels within our bodies.

Not a lot of people know this, but our gut microbes produce or process several vital vitamins 93 :

  • menaquinone (vitamin K2)
  • thiamine (vitamin B1)
  • riboflavin (vitamin B2)
  • niacin (vitamin B3)
  • pantothenic acid (vitamin B5)
  • pyridoxine (vitamin B6)
  • biotin (vitamin B7)
  • folate (vitamin B9)
  • cobalamin (vitamin B12*)

* N.B. vitamin B12, while being produced by gut bacteria, is not absorbed back in to the body. This means that vitamin B12 needs to be taken as a supplement by vegans and, arguably, by most other people irrespective of their dietary choices. This is discussed in great detail in previous blogs 116 117 118 119 .

Different bacteria possess specific biosynthetic properties for different vitamins, such as:

  • Bifidobacteriumvitamins K, B1, B7, B9, and B12
  • Bacillus subtilis and Escherichia coliriboflavin 120
  • LactobacillusB12, and other B vitamins 121

The latter is by no means a comprehensive analysis of the relationship between intestinal bacteria and vitamin production/processing; but it does provide a brief insight into one more essential role played by the microbes that live within us.

Final thoughts

It’s thought that, on average, around 25% of the plasma metabolites resulting from gut microbial activity are different between omnivores and vegans, with current research consistently indicating that diet is the essential factor for the composition and health of human gut microbiota. In turn, this is vital for metabolising the nutrients we consume into postbiotics that our bodies need.

All known research continues to suggest that a plant-based diet may be the most effective way of promoting a diverse ecosystem of beneficial microbes that can support overall health. Nutrition is a complex field, with inter-individual differences abounding. This means that further research is necessary if we are every going to be able to fully characterise the interactions between microbiome, diet and health.

But, in the meantime, it looks like you’d be doing your overall health a huge favour if you choose to…

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How Do Plant-Based Diets Affect Our Gut Microbiota? Part One

What happens “down below” in our intestines is of such vital importance to our health that I’ve previously covered aspects of this subject in relation to a variety of specific subjects, such as alcohol 1 , obstructive sleep apnea 2 , depression 3 , physical activity 4 , and multiple sclerosis 5 . However, a new review 6 just published puts more meat on the bone – or more fruit on the tree!

The review looks at how the food we put in our mouths determines the type and quantity of our gut flora (also known as gut bacteria, microbes, microbiota or microbiome) and, in turn, how these dietary choices affect the direct and indirect actions performed by these vital microscopic inhabitants of our bodies.

This is Part One of a two part blog on this study. Here, we’ll look at the types and activities of microbes found in the intestinal microbiome of those eating plant- and meat-based diets, finally focusing on the microbial effects of consuming the macronutrient, carbohydrate.

In Part Two, we’ll look at the microbial effects of the other two macronutrients (protein and fat), polyphenols, and the influence on human health of microbiome postbiotics7 derived from such things as vitamins and TMAO.

Definition of terms

“Microbiota”and “microbiome” tend to be used interchangeably; however, “microbiota” refers to the total of all microbial taxa associated with humans (including bacteria, viruses, fungi, protozoa and archaea), while “microbiome” refers to the complete catalogue of microbes plus all their genes.

Each human’s gut microbiota is estimated 8 to consist of over 3 trillion microbes – although I don’t know if anyone has actually sat down and counted them…

The human gut microbiome consists of around 3.3 million non-redundant 9 microbial genes. Amazingly, this is much more than our human genome, which only contains around 21,000 genes. So there are around 150 distinct microbial genes in our guts for every one of our human genes 10 .

Omnivore vs plant-based microbiota

Previous blogs 11 12 have looked at the evidence for significant differences between the microbiota of meat eaters and plant eaters. Plant-based diets appear to promote the development of more diverse and stable microbial systems, with significantly more Bacteroidetes-related operational taxonomic units compared to omnivores.

Important components of a plant-based diet include:

Fibre (non-digestible carbohydrates that are only found in plants) increase lactic acid bacteria (e.g. Roseburia, Ruminococcus, and E. rectale) while reducing certain pathogenic bacteria (e.g. Clostridium and Enterococcus species). Lactic acid bacteria can help improve lactose digestion, prevent and treat diarrhoea, and act on the immune system, helping the body to resist and fight infection.

SCFAs (short-chain fatty acids) have a plethora of health benefits. A diet high in fibre encourages species that ferment fibre into metabolites in the form of SCFAs (such as acetate, propionate and buyrate). We previously looked in detail at butyrate 13 and saw how such bacteria-produced SCFAs can improve immunity against pathogens, increase the integrity of the blood–brain barrier, provide energy substrates, and regulate critical intestinal functions.

And it’s not just SCFAs that mark the difference between plant- and meat-based diets –  for instance, the former contains phytoestrogens, and isothiocyanates such as sulforaphane 14 , whilst the latter contains TMAO 15 and secondary bile acids 16 . These and other basic constituents of each diet will determine the type of gut bacteria that can survive within your body. We’ll look at the latter in more detail in Part Two.

Polyphenols (again, only found in plants) increase bacteria species which can provide anti-pathogenic/anti-inflammatory properties as well as cardiovascular protection (e.g. Bifidobacterium and Lactobacillus).

It’s no surprise, then, that a diet which is high in the foregoing will likely result in a diverse ecosystem of beneficial bacteria that supports the health of the host – that is, you and me.

Diversity & distribution matter

Plant-based diets also appear to promote good health by developing a richer, more diverse gut microbial system, and/or by producing an even distribution of a variety of species 17 18 .

Microbiome is a separate “organ”

The range of functions of the human gut microbiome is so wide-ranging (immunity, gastrointestinal, brain, cardiovascular systems, cellular and genetic activity) that it’s increasingly common for researchers to regard it as a distinct “organ” within the human body.

Three basic bacterial enterotypes

Several studies 19 20 have suggested that there are three basic bacterial enterotypes 21 :

  1. genus Prevotella (largely anti-inflammatory and protective)
  2. genus Bacteroides (more pro-inflammatory and possible associations with heightened risk of metabolic syndrome and other pathological conditions)
  3. genus Ruminococcus (whose biological significance is still largely unclear)

The effects of imbalanced gut microbiota

Imbalanced gut microbiota has been linked 22 23 24 25 with a surprisingly large number of conditions, including the following:

  • acid reflux 26
  • peptic ulcers 27
  • irritable bowel syndrome 28
  • non-alcoholic liver disease 29
  • inflammatory bowel disease 30
  • obesity 31
  • atherosclerosis 32
  • type 2 diabetes 33
  • cancer
  • Alzheimer’s 34
  • Parkinson’s 35
  • motor neurone disease 36
  • lateral sclerosis 37
  • autism spectrum disorder 38 39
  • atopy40 41

Microbiota and personalised nutrition

Because of the amount of evidence being accumulated in support of the role of our gut microbiota in acting as a mediator of dietary impact on the host metabolic status, an increasing amount of research is being focused on establishing causal relationships in individual people between the food they eat, what it does to their gut microbiota and the consequent effects on their overall health. It’s anticipated that this will allow for the development of therapeutic interventions such as personalised nutrition (18).

One such study concludes: “Convincing accumulating evidence shows that the human gut microbiota contributes to many aspects of human health via molecular pathways that we only begin to understand. The GI microbiota entertains deep mutualistic relationships and co-evolves with the human host, albeit at a much faster rate and demonstrates deep ecological links with the host which are being studied at the interface between Biology, Ecology, and Medicine. Experimental probing of the deep and reciprocal ties characterizing the microbiota-host relationship constitutes a formidable challenge, yet holds the promise to shed light on unknown aspects of human and microbial physiology and novel therapeutic possibilities in the manipulation of microbiota composition via antibiotics, probiotics, and microbial transplantation.” 42

Microbiota and postbiotics

The term “postbiotics” is relatively new. It refers to the vast range of compounds (metabolites) produced by the metabolic activity of our gut bacteria depending, to a large extent, on what nutrients they receive from the diet we eat. These probiotic-produced postbiotic compounds play vital roles in the regulation, not only of the host’s health, but also in the maintenance of a healthy gut microbiome.

The postbiotics produced by probiotic bacteria appear to be responsible for many of the beneficial effects claimed for probiotics.

N.B. In most cases, it can be argued that a healthy and balanced WFPB diet will provide all the natural probiotics you need without having to resort to commercially-produced stuff with dubious effectiveness or, indeed, safety. 43 44 Whole plants are covered with bacteria that have been interacting effectively with our bodies for millions of years; and the postbiotics produced by microbes inside vegetarians/vegans have been shown 45 to be particularly effective in reducing various risk factors for chronic inflammation and chronic degenerative diseases.

What determines gut microbiota composition?

Variations in microbiota composition from one person to another are likely to be a combination of the following:

  • different directly-consumed foodborne bacteria 46
  • differences in the substrates 47
  • variations in transit time through the GI tract 48
  • pH level 49
  • host secretion influenced by dietary patterns 50
  • regulation of gene expression of the host and/or his/her microbiota 51 45

Gut Microbiota – Why diversity matters

Microbial diversity associated with plant-based diets – particularly seen in research on long-term fruit, vegetable and whole grain intake 52 53 – appears to have important associations with many health indicators, including:

  • reduced BMI
  • reduced risk of obesity
  • improved vascular compliance 54 55

It takes time to achieve optimal gut health

Dietary changes are shown 56 to have relatively rapid impact (within a week) on microbial composition and, hence, on the effects of their metabolites. However, it’s important to note that these effects can be modest and reversible if the individual reverts to their prior dietary habits 51 .

One study showed 57 that changes in microbiota and associated immune parameters after just 3 months on a vegetarian (not a WFPB or vegan) diet can be pretty significant; but these changes pale into comparison when compared with the degree of change that occurs with a long-term plant-based diet.

Microbial “stress” and high-fibre diets

Whilst high-fibre diets are excellent for gut health, there is a suggestion that microbes may experience stress at the point when a sudden change from low- to high-fibre diets takes place. One indicator of such stress is an increase in Enterobacteriaceae, known as a pathogenic species of bacteria. Short-term dietary interventions which increase fibre consumption were shown to cause a slight but significant decrease in diversity, possibly associated with a slight but, once again, significant increase in Enterobacteriaceae – a species which is typically lower in vegan compared with omnivorous diets 58 .

This is probably the case because of the fact that longer-term dietary habits that favour high-fibre foods are known to produce greater amounts of butyrate-producing bacteria, which lower the colonic pH and, thus, prevent the growth of pathogenic bacteria, such as Enterobacteriaceae 59 .

Obesity & reduced microbial diversity

Studies have shown 60 reduced microbial diversity in obese individuals. In addition, it was shown that obese individuals have a reduction in the Bacteriodetes:Firmicutes ratio – that is, increased numbers of Bacteriodetes and decreased numbers of Firmicutes (more on this ratio below), an increase in Proteobacteria (a pro-inflammatory phylum), and an increase in C-reactive protein (which is inversely correlated with a healthy Bacteriodetes:Firmicutes ratio – that is, more C-reactive protein means a less favourable Bacteriodetes:Firmicutes ratio).

It’s possible to see quite the opposite results when looking at the ~60,000 participants in the Adventist Health Study-2 61 . The individuals who followed a vegan diet shown the lowest BMI values when compared with vegetarians or omnivores. The suggestion followed that the lower body weight associated with vegan diets might produce a microbial diversity which protects against systemic inflammation.

Why the Bacteroidetes:Firmicutes ratio matters

Out of thousands of bacterial species-level phylotypes 62 inhabiting the human gut, the majority belong to two dominant phyla, the Bacteroidetes and Firmicutes . Members of the Bacteroidetes in particular have been associated with human metabolic diseases.” 63 So, even taking into account the wide range of inter-individual variations in human intestinal microbiomes, it’s known 64 65 that these Bacteroidetes and Firmicutes phyla dominate healthy human microbiomes.

However, it’s the actual ratio between them that seems to matter most. Diets heavier in animal fat and protein than in whole grains and plant-based foods (rich in starch, fibre and plant protein) have been shown 66 to cause a significant decrease in Bacteroidetes and increase in Firmicutes.

See the following video by Dr Greger for more information on this important ratio:

In the video, Dr Greger offers a useful way of remembering which bacterial phyla is associated with which body type: Bacteroidetes for bony, and Firmicutes for fat!

Bacteroidetes:Firmicutes ratio and obesity

As the above video explained, a decrease in Firmicutes levels usually favours an increase in Bacteroidetes and Bifidobacteria – something that happens when you eat lots of resistant starches 67 . The typical result of this is that obesity/high BMI can be prevented and treated 68 .

A decreased Bacteroidetes:Firmicutes ratio has a strong negative correlation with BMI 60 . This may be explained by the observation that a 20% increase in Firmicutes with a corresponding decrease in Bacteroidetes abundance is associated with a 150 kcal/day increase in energy harvest 69 – something which would, over time, result in weight gain. Thus, an increased Bacteroidetes:Firmicutes ratio (as seen in high-fibre, plant-based diets) could result in weight loss by causing a reduction in the amount of energy being extracted from the diet.

Additional studies are required to decide whether increased energy harvest is caused by the Bacteroidetes:Firmicutes ratio promoting adiposity or by a host-mediated adaptive response to limit energy uptake 70 .

Nothing is plain and simple in the world of microbes, and there are sufficient conflicting results from various studies on the Bacteroidetes:Firmicutes ratio to support the argument that making wide-sweeping statements about which phyla are good and which are bad is likely to be inaccurate and over-generalised. Increased awareness is growing about a need to appreciate the complexity of dynamic interactions between microbes within the microbiome, rather than trying to match one microbe with one health outcome 71 52 72 73 .

How gut bacteria enterotypes are affected by diet

As mentioned above, there are three main enterotypes observed in human microbiomes:

1. Prevotella

2. Bacteroides

3. Ruminococcus

1. Prevotella is a genus of the Bacteroidetes phyla. Studies suggest 74 75 76 77 that it’s significantly richer in the microbiome of vegans.


Studies with mice have suggested 78 that Prevotella improves glucose metabolism by improving glycogen storage. It has also been observed 79  to confer anti-inflammatory effects, and additional research suggests 80 that it can decrease the growth of other bacteria by competing for fibre as an energy substrate.

2. Bacteroides is another main enterotype and genus of the Bacteroidetes phyla. Whilst still appearing to be affected by the type of diet eaten, Bacteroidetes has been positively associated 81 52 with long-term diets high in saturated fat and animal protein.


An explanation of this is that such bacteria are better able to tolerate bile – something common in the gut environments of meat-eaters. It’s no surprise, therefore, that high proportions of Bacteroides are found 76 in the intestinal environments of those who eat the modern Western diet, while the opposite is the case for those eating lots of legumes, fruits and fibre.

3. Ruminococcus is an enterotype and genus also associated with long-term fruit and vegetable consumption. An explanation of this is that species of this genus are specialists in degrading complex carbohydrates (e.g. cellulose and resistant starch which are only found in plants) and, thereby, producing butyrate, an anti-inflammatory SCFA56 .


Increased communities of Ruminococcus have been associated with the following:

  • low BMI and healthy lipid profiles 52
  • lower endotoxemia82 and lower arterial stiffness 55

“A high fat diet increases the absorption of LPS [lipopolysaccharides or LPS are an integral component of Gram negative microorganisms], which, in turn, has been found to be associated with metabolic endotoxemia and to induce inflammation resulting in obesity.” 83

Walnuts, refined grains and Ruminococcus

Studies have shown 65 that eating walnuts appears to enrich the Ruminococcus community within our gut environment.

Interestingly, however, one study showed 84 an increase of Ruminococcus in college students who had low dietary fibre intake in their diets. This may be explained by the ability of these bacteria to also break down resistant starches in the many refined grain products eaten by this group.

How plant food components influence gut microbiota

This final section will look at both nutrient bioavailability and the microbial responses to the consumption of carbohydrates.

Nutrient Bioavailability

It may seem counter-intuitive, but less is more when it comes to certain aspects of nutrient bioavailability85 . When you consume food nutrients with low bioavailability (normally found in intact plant cell walls, larger food particles, and the latter foods without thermal treatment), more nutrients are able to pass through the stomach and small intestine to reach lower in the gastrointestinal tract. This is important since it allows our gut microbiota, lurking down in the colon, to receive a delivery of rich nutrients 86 .

A rich supply of nutrients will help support the normal development and functions of gut microbiota. The modern Western diet has loads of ultra-processed foods and acellular nutrients87 . The small intestine can more easily absorb these components and, thus, deprive the colon of important nutrients. Eating acellular food has been shown 88 to alter the composition and metabolism of the gut microbiota, and induce inflammation in young infants, adolescents, women of child-bearing age, and older adults.

On the other hand, whole plant foods have protective effects, and favour the growth of beneficial fibre-degrading bacteria in the colon.


Both digestible and non-digestible carbohydrates appear able to influence gut microbiota.

Digestible carbohydrates (e.g. glucose, sucrose, and fructose from fruits) have been shown 89 to reduce the following:

  • Bacteroides 90
  • Clostridia 91 .

The following diagram 92 provides more detail on the absorption of digestible carbohydrates:

Non-digestible carbohydrates (NDCs) generally:

  • increase the following:
    • lactic acid bacteria
    • Ruminococcus
    • Eubacterium rectale
    • Roseburia,
  • reduce the following:
    • Clostridium
    • Enterococcus

The following diagram 93 provides a little more in-depth detail on NDCs.

Both digestible and non-digestible carbohydrates have been shown to increase Bifidobacteria (a genus of the Actinobacteria phylum)

Bifidobacteria are some of the good guys. As a butyrate-producing genus, with known protective properties for the human gut barrier, Bifidobacteria provide effective defences against pathogens and diseases, and increase in number when “fed” with health-giving short-chain fructooligosaccharides (scFOS) and fibre – both forms of carbohydrate found in abundance in natural plant foods, such as bananas, artichokes, onions, etc 94 . On the other hand, high consumption of cholesterol (only found in animal foods), was strongly associated with a lower abundance of Bifidobacteria 95 .

Prebiotic fibres

A recent study found 96 that the following fibres have differing prebiotic effects on gut microbiota:

  • inulin
  • alpha-linked galacto-oligosaccharides
  • beta-linked galacto-oligosaccharides
  • xylo-oligosaccharides (from corn cobs and high-fibre sugar cane)
  • beta-glucan (from oats)

Inulin and all oligosaccharides have a strong bifidogenic effect 97 .

Beta-glucan induces Prevotella and Roseburia growth with associated increase in production of the SCFA, propionate – a good thing, since it’s known 98 99  to promote weight loss and provide many other health benefits, including being anti-carcinogenic and anti-inflammatory.

All natural sugars, especially non-digestible forms like inulin and oligosaccharides, increase SCFA levels 100 101 .

Prebiotic effects vary depending on which type of bacteria breaks down which type of fibre. The specificity of bacterial activity in relation to fibre is determined by specific gene clusters within the bacterial genome that dictate which saccharolytic 102 enzymes the bacteria can produce and, hence, whether they can metabolise the particular prebiotic substrate 103  .

Other protective effects of non-digestible carbohydrates

NDCs don’t just act as prebiotics by promoting the growth of beneficial microorganisms, they are also shown 89 to do the following:

  • reduce proinflammatory cytokine 104 production
  • reduce concentrations of serum triglycerides
  • reduce total cholesterol
  • reduce LDL-cholesterol

It can be seen from the above that NDCs are, thus, likely to confer significant protective effects against cardiovascular disease as well as central nervous system disorders.

Final thoughts

An increasing body of research indicates that diet is the essential factor when it comes to the composition of human gut microbiota. These microbes are then responsible for converting nutrients into active postbiotics that we (the hosts) absolutely need. The weight of evidence is favoured towards a plant-based diet being the most effective way in which we can ensure a diverse ecosystem of beneficial microbes is promoted within us, so that they can support overall health.

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  73. Andoh A, Nishida A, Takahashi K, Inatomi O, Imaeda H, Bamba S, et al. . Comparison of the gut microbial community between obese and lean peoples using 16S gene sequencing in a Japanese population. J Clin Biochem Nutr. (2016) 59:65–70. 10.3164/jcbn.15-152 []
  74. Claesson MJ, Jeffery IB, Conde S, Power SE, O’Connor EM, Cusack S, et al. . Gut microbiota composition correlates with diet and health in the elderly. Nature. (2012) 488:178–84. 10.1038/nature11319 []
  75. Ruengsomwong S, La-Ongkham O, Jiang J, Wannissorn B, Nakayama J, Nitisinprasert S. Microbial community of healthy thai vegetarians and non-vegetarians, their core gut microbiota, and pathogen risk. J Microbiol Biotechnol. (2016) 26:1723–35. 10.4014/jmb.1603.03057 []
  76. Jeffery IB, O’Toole PW. Diet-microbiota interactions and their implications for healthy living. Nutrients. (2013) 5:234–252. 10.3390/nu5010234 [] []
  77. Matijašić BB, Obermajer T, Lipoglavšek L, Grabnar I, Avguštin G, Rogelj I. Association of dietary type with fecal microbiota in vegetarians and omnivores in Slovenia. Eur J Nutr. (2014) 53:1051–64. 10.1007/s00394-013-0607-6 []
  78. Kovatcheva-Datchary P, Nilsson A, Akrami R, Lee YS, De Vadder F, Arora T, et al. . Dietary fiber-induced improvement in glucose metabolism is associated with increased abundance of prevotella. Cell Metab. (2015) 22:971–82. 10.1016/j.cmet.2015.10.001 []
  79. to confer anti-inflammatory effects. However, perhaps all that can be currently stated is that Prevotella is merely a genus that describes an overall ecosystem of human gut bacteria which is mainly experienced on a plant-based diet. Prevotella has been observed  ((De Filippo C, Cavalieri D, Di Paola M, Ramazzotti M, Poullet JB, Massart S, et al. . Impact of diet in shaping gut microbiota revealed by a comparative study in children from Europe and rural Africa. Proc Natl Acad Sci USA. (2010) 107:14691–6. 10.1073/pnas.1005963107 []
  80. Chen T, Long W, Zhang C, Liu S, Zhao L, Hamaker BR. Fiber-utilizing capacity varies in Prevotella- versus Bacteroides-dominated gut microbiotaSci Rep. (2017) 7:2594. 10.1038/s41598-017-02995-4 []
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  82. Endotoxemia is essentially an innate immune response that becomes a sub-clinical, persistent, low- grade inflammation because of increased, circulating endotoxins, primarily LPS or lipopolysaccharides. The presence of such endotoxins in the blood, if derived from gram-negative rod-shaped bacteria, like LPS, may cause haemorrhages, necrosis of the kidneys, and shock. Metabolic endotoxemia is a condition that is estimated to affect approximately 33% of the western population. []
  83. World J Gastrointest Pathophysiol. 2015 Nov 15; 6(4): 110–119. New-found link between microbiota and obesity. Chandra Kanti Chakraborti. []
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  85. Several definitions exist, but nutrient bioavailability is broadly defined as the proportion of a nutrient that is absorbed from the diet and used for normal bodily functions. []
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  87. Acellular nutrients are those which do not have any cells, such as refined flour, processed grains and white sugar []
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  90. Bacteroides fragilis has two main traits that allow it to switch from good to bad – an ability to easily incorporate genes shared by other bacteria and an ability to turn specific genes ‘on’ or ‘off’ as needed. Combined, these traits allow these bacteria to exploit new nutrition pathways, protecting themselves from toxic substrates, and changing the molecules expressed on its
    surface. This ‘commensal chameleon’ is the perfect opportunistic pathogen. []
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Wholefood Plant-Based Diet Reversed Angina without Medications or Procedures

Unfortunately, the standard medical practice for dealing with angina has been a dash to dish out the drugs1 . This may well relieve the symptoms, but it does not deal with the underlying causes. And what’s the main cause? You guessed it, diet. This blog deals with a case study 2  of a 60-year old male who, having been diagnosed with angina, refused both drug therapy and invasive testing in favour of making a dietary change to a WFPB diet. But did it work?

The study

The study subject reported a 12 month history of progressive severe mid-sternal chest discomfort after either walking only half a block, experiencing emotional stress or being out in cold weather. His family history included a mother who had coronary artery bypass surgery and a brother who had an acute myocardial infarction, both while they were in their early sixties.

With medical advice and counselling, he chose to adopt a wholefood plant-based diet (WFPB), which consisted primarily of the following:

  • vegetables
  • fruits
  • whole grains
  • potatoes
  • beans
  • legumes
  • nuts

Subject’s previous diet

He described his diet as having been a “healthy” diet of the following:

  • skinless chicken
  • fish
  • low-fat dairy
  • some vegetables, fruits, and nuts

Study results

Within just a few weeks of dietary change, his symptoms improved.

After four months, the following biometrics were recorded:

  • BMI fell from 26 kg/m2 to 22 kg/m2
  • blood pressure normalised
  • LDL (low-density lipoprotein) cholesterol decreased from 158 mg/dL to 69 mg/dL
  • ability to walk one mile without angina symptoms

Two years after starting the WFPB diet, he was able to jog more than 4 miles without incident and remained asymptomatic, off drug therapy for coronary artery disease, and has not required cardiac catheterisation 3 .

Study discussion

The study subject’s angina symptoms improved rapidly, as did his weight, blood pressure, and cholesterol levels. And this case study is supported by plenty of evidence that WFPB diets are strongly associated with:

  • improved plasma lipids 4
  • improved glycaemic control in patients with type 2 diabetes mellitus 5 6
  • weight reduction 7
  • blood pressure reduction 8 9 10
  • improved vascular function 11
  • profoundly improved coronary artery disease risk/symptoms 12 13 14 15
  • reduced overall mortality 16 17 18 19

The more the merrier

Studies 20  have shown a dose-response-like effect – that is, the greater the adherence to a healthy lifestyle (including a WFPB diet), the greater the apparent benefit.

When less is more

A growing body of evidence suggests that any and all animal-based foods may not be optimal for health 21 22 23 .

Coronary artery disease in plant-eating populations

This case reinforces research showing that great improvements in our “modern” Western NCDs (non-communicable diseases) can be achieved without the need for medications or medical procedures. Previous epidemiological studies24 have documented the near-absence of coronary artery disease in indigenous populations that eat largely or exclusively plant-based diets, including:

  • rural parts of China 25
  • a highland population of New Guinea 26
  • the Tarahumara Indians of Mexico 27
  • rural parts of South Africa 28
  • Norway during World War II 29

Study conclusion

A whole-food plant-based diet helped reverse angina without medical or invasive therapy. It appears prudent that this type of lifestyle be among the first recommendations for patients with atherosclerosis.

Final thoughts

Whilst some people might think it’s too difficult to live a “normal” life while eating a WFPB diet, it’s actually quite achievable within a real-world setting 30 and, with proper education and support, anyone can make the transition 31 .  Additionally, a WFPB diet is not associated with markedly increased food costs 32 ; and, in any case, what price can you put on a healthier and longer life?

Whilst the above research only covers one case study, its findings are completely in line with copious research data showing impressive results on the prevention and treatment of cardiovascular diseases through eating a WFPB diet, ideally – and optimally – without any added salt, oils or sugar. Take a look at some of the research links to find out more.

Finally, an excellent explanation of how simple dietary changes can effect such radical health improvements is presented in the following video, where Dr Caldwell B Esselstyn explains how you can make yourself “heart-attack proof”.

References & Notes

  1. Typical angina drugs: Clot-preventing drugs -clopidogrel (Plavix), prasugrel (Effient) ticagrelor (Brilinta); beta blockers – these work by blocking the effects of the hormone epinephrine, also known as adrenaline. As a result, the heart beats more slowly and with less force, thereby reducing blood pressure, they also help blood vessels relax and open up to improve blood flow, thus reducing or preventing angina; statins – these are drugs used to lower blood cholesterol, and work by blocking a substance the body needs to make cholesterol; calcium channel blockers – also called calcium antagonists, relax and widen blood vessels by affecting the muscle cells in the arterial walls. thereby increasing blood flow in the heart, reducing or preventing angina; blood pressure-lowering drugs – if you have high blood pressure, diabetes, signs of heart failure or chronic kidney disease, doctors tend to prescribe a drug to bring the blood pressure down. The two main classes of blood pressure drugs are angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs); finally, a drug called Ranolazine (Ranexa) may be used alone or with other angina medications, such as calcium channel blockers, beta blockers or nitroglycerin. []
  2. Case Rep Cardiol. 2015;2015:978906. doi: 10.1155/2015/978906. Epub 2015 Feb 10. A Whole-Food Plant-Based Diet Reversed Angina without Medications or Procedures. Massera D, Zaman T, Farren GE, Ostfeld RJ. []
  3. Cardiac catheterisation is the insertion of a catheter into a chamber or vessel of the heart. This is done both for diagnostic and interventional purposes. []
  4. Ferdowsian H. R., Barnard N. D. Effects of plant-based diets on plasma lipids. The American Journal of Cardiology. 2009;104(7):947–956. doi: 10.1016/j.amjcard.2009.05.032. []
  5. Barnard N. D., Cohen J., Jenkins D. J. A., et al. A low-fat vegan diet improves glycemic control and cardiovascular risk factors in a randomized clinical trial in individuals with type 2 diabetes. Diabetes Care. 2006;29(8):1777–1783. doi: 10.2337/dc06-0606. []
  6. Barnard N. D., Cohen J., Jenkins D. J. A., et al. A low-fat vegan diet and a conventional diabetes diet in the treatment of type 2 diabetes: a randomized, controlled, 74-wk clinical trial. The American Journal of Clinical Nutrition. 2009;89(5):1588S–1596S. doi: 10.3945/ajcn.2009.26736h []
  7. Mishra S., Xu J., Agarwal U., Gonzales J., Levin S., Barnard N. D. A multicenter randomized controlled trial of a plant-based nutrition program to reduce body weight and cardiovascular risk in the corporate setting: the GEICO study. European Journal of Clinical Nutrition. 2013;67(7):718–724. doi: 10.1038/ejcn.2013.92. []
  8. Jenkins D. J. A., Wong J. M. W., Kendall C. W. C., et al. The effect of a plant-based low-carbohydrate (‘Eco-Atkins’) diet on body weight and blood lipid concentrations in hyperlipidemic subjects. Archives of Internal Medicine. 2009;169(11):1046–1054. doi: 10.1001/archinternmed.2009.115. []
  9. McDougall J., Thomas L. E., McDougall C., et al. Effects of 7 days on an ad libitum low-fat vegan diet: the McDougall Program cohort. Nutrition Journal. 2014;13(1, article 99) doi: 10.1186/1475-2891-13-99. []
  10. Fraser G., Katuli S., Anousheh R., Knutsen S., Herring P., Fan J. Vegetarian diets and cardiovascular risk factors in black members of the adventist health study-2. Public Health Nutrition. 2015;18(3):537–545. doi: 10.1017/s1368980014000263. []
  11. Dod H. S., Bhardwaj R., Sajja V., et al. Effect of intensive lifestyle changes on endothelial function and on inflammatory markers of atherosclerosis. The American Journal of Cardiology. 2010;105(3):362–367. doi: 10.1016/j.amjcard.2009.09.038. []
  12. Ornish D., Brown S. E., Scherwitz L. W., et al. Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. The Lancet. 1990;336(8708):129–133. doi: 10.1016/0140-6736(90)91656-u. []
  13. Esselstyn C. B., Jr., Ellis S. G., Medendorp S. V., Crowe T. D. A strategy to arrest and reverse coronary artery disease: a 5-year longitudinal study of a single physician’s practice. Journal of Family Practice. 1995;41(6):560–568. []
  14. Esselstyn C. B., Jr. Updating a 12-year experience with arrest and reversal therapy for coronary heart disease (an overdue requiem for palliative cardiology) The American Journal of Cardiology. 1999;84(3):339–341. doi: 10.1016/s0002-9149(99)00290-8. []
  15. Esselstyn C. B., Gendy G., Doyle J., Golubic M., Roizen M. F. A way to reverse CAD? The Journal of Family Practice. 2014;63(7):356–364. []
  16. Orlich M. J., Singh P. N., Sabaté J., et al. Vegetarian dietary patterns and mortality in adventist health study 2. JAMA Internal Medicine. 2013;173(13):1230–1238. doi: 10.1001/jamainternmed.2013.6473. []
  17. Bamia C., Trichopoulos D., Ferrari P., et al. Dietary patterns and survival of older Europeans: the EPIC-Elderly Study (European Prospective Investigation into Cancer and Nutrition) Public Health Nutrition. 2007;10(6):590–598. doi: 10.1017/s1368980007382487. []
  18. Wang X., Ouyang Y., Liu J., et al. Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: systematic review and dose-response meta-analysis of prospective cohort studies. The British Medical Journal. 2014;349 doi: 10.1136/bmj.g4490.g4490 []
  19. Bao Y., Han J., Hu F. B., et al. Association of nut consumption with total and cause-specific mortality. The New England Journal of Medicine. 2013;369(21):2001–2011. doi: 10.1056/nejmoa1307352. []
  20. Gupta S. K., Sawhney R. C., Rai L., et al. Regression of coronary atherosclerosis through healthy lifestyle in coronary artery disease patients—Mount Abu Open Heart Trial. Indian Heart Journal. 2011;63(5):461–469. []
  21. Michaelsson K., Wolk A., Langenskiold S., et al. Milk intake and risk of mortality and fractures in women and men: cohort studies. The British Medical Journal. 2014;349 doi: 10.1136/bmj.g6015.g6015 []
  22. Koeth R. A., Wang Z., Levison B. S., et al. Intestinal microbiota metabolism of L-carnitine, a nutrient in red meat, promotes atherosclerosis. Nature Medicine. 2013;19(5):576–585. doi: 10.1038/nm.3145. []
  23. Tang W. H. W., Wang Z., Levison B. S., et al. Intestinal microbial metabolism of phosphatidylcholine and cardiovascular risk. The New England Journal of Medicine. 2013;368(17):1575–1584. doi: 10.1056/nejmoa1109400. []
  24. Epidemiological studies look at the distribution and determinants of health and disease conditions in defined populations. Such research often forms the cornerstone of public health, and shapes policy decisions and evidence-based practice by identifying risk factors for disease and targets for preventive healthcare. []
  25. Campbell T. C., Parpia B., Chen J. Diet, lifestyle, and the etiology of coronary artery disease: the Cornell China study. The American Journal of Cardiology. 1998;82(10):18T–21T. []
  26. Sinnett P. F., Whyte H. M. Epidemiological studies in a total highland population, Tukisenta, New Guinea. Cardiovascular disease and relevant clinical, electrocardiographic, radiological and biochemical findings. Journal of Chronic Diseases. 1973;26(5):265–290. doi: 10.1016/0021-9681(73)90031-3. []
  27. Connor W. E., Cerqueira M. T., Connor R. W., Wallace R. B., Malinow M. R., Casdorph H. R. The plasma lipids, lipoproteins, and diet of the Tarahumara Indians of Mexico. The American Journal of Clinical Nutrition. 1978;31(7):1131–1142. []
  28. Trowell H., Painter N., Burkitt D. Aspects of the epidemiology of diverticular disease and ischemic heart disease. The American Journal of Digestive Diseases. 1974;19(9):864–873. doi: 10.1007/bf01071948. []
  29. Strom A., Jensen R. A. Mortality from circulatory diseases in Norway 1940–1945. The Lancet. 1951;1(6647):126–129. []
  30. Esselstyn C. B., Jr., Ellis S. G., Medendorp S. V., Crowe T. D. A strategy to arrest and reverse coronary artery disease: a 5-year longitudinal study of a single physician’s practice. Journal of Family Practice. 1995;41(6):560–568. []
  31. Peters N. C., Contento I. R., Kronenberg F., Coleton M. Adherence in a 1-year whole foods eating pattern intervention with healthy postmenopausal women. Public Health Nutrition. 2014;17(12):2806–2815. doi: 10.1017/s1368980014000044. []
  32. Hyder J. A., Thomson C. A., Natarajan L., et al. Adopting a plant-based diet minimally increased food costs in WHEL study. American Journal of Health Behavior. 2009;33(5):530–539. []

The Fat You Eat is the Fat You Wear

An April 2019 study 1 looked for dietary reasons that would account for the shockingly high rate of obesity and cardio-metabolic diseases within the US Hispanic and Latino population 2 .

The study

The Adventist Multi-ethnic Nutrition Study (AMEN) enrolled 74 Seventh-day Adventists from five Hispanic and Latino churches within a 20 mile radius of Loma Linda, CA into a cross-sectional study of diet and health. The information analysed was based on questionnaires, anthropometrics 3 and biomarkers 4 . By comparing US Hispanic and Latino omnivores with a similar plant-based population (namely, Hispanic and Latino vegetarian/vegan Seventh-day Adventists), the researchers hoped to find out whether better health generally found in the latter group could be attributed to their continued adherence to a plant-based diet. Particular attention was paid to differences in adiposity and adiposity-related biomarkers between the two groups.

Study findings

It appears that the reason US Hispanic and Latino populations experience such high rates of obesity and cardio-metabolic disease is largely down to their transition towards the SAD (Standard American Diet) and away from traditional Hispanic and Latino diets that emphasised whole plant foods, such as were still consumed by the vegetarian/vegan Seventh-day Adventists included in this study.

When compared with the general non-vegetarian Hispanic and Latino population, vegetarian/vegan dietary patterns within the Seventh-day Adventist Hispanic and Latino population were associated with:

  • significantly lower BMI (24.5 kg/m2 vs. 27.9 kg/m2, p = 0.006) 5
  • significantly lower waist circumference (34.8 cm vs. 37.5 cm, p = 0.01)
  • significantly lower fat mass (18.3 kg vs. 23.9 kg, p = 0.007)

Comparative results can be seen in the following table.

These findings are consistent with previous studies that have looked at other populations, including:

  • non-Hispanic white Adventists 6 7 8
  • black/African American Adventists 8 9 10
  • Asian Adventists 11

Traditional Latin American diets

There’s a rich cultural tradition of diverse regional plant foods within traditional Latin America cuisine:

  • the Mexican Tarahumara Indians traditionally ate a diet of beans, corn, and squash and very little meat – a pattern associated with lower risk of cardiometabolic disease 12 . The risks are significantly increased when the Tarahumara change to the typical US diet 13 .
  • Peruvian and Brazilian populations that follow traditional cultural choices which contain high amounts of plant foods have lower rates of hypertension, dyslipidemia, and obesity when compared to omnivores 14 .

The researchers consider that encouraging populations to re-introduce healthy plant foods, which have long-held and strong roots in their cultural heritage, is a potentially useful means of achieving high impact health interventions.

Study conclusions

Plant-based eating as practised by US-based Hispanic and Latino Seventh-day Adventists is associated with relatively healthy BMI15 . The study concludes that further research is needed to characterise the precise type of diet that should be recommended for use in obesity-related interventions among Hispanic and Latinos in the US.

Final thoughts

This study adds to the already considerable body of evidence suggesting that naturally-low-fat plant-based diets are the way to go if you want to remain healthy – particularly if you want to ensure that obesity and obesity-related diseases don’t reduce both the quality and length of your life. Of course, the more wholefood, non-processed the diet, the better. This would, I suspect, result in much improved biomarkers when compared, not only with the above omnivores, but also with the vegetarian/vegan group reviewed within this study – a group which included lacto-ovo vegetarians and pescotarians.

Additionally, I could not get a clear picture of whether and how this study drew distinctions between whole and processed plant foods, with the latter consistently failing to provide the health benefits of the former 16 .

From whatever perspective you may look, when it comes to obesity, there’s a weight of truth in the saying: “The fat you eat is the fat you wear.”

References & notes

  1. Plant-Based Diets Are Associated With Lower Adiposity Levels Among Hispanic/Latino Adults in the Adventist Multi-Ethnic Nutrition (AMEN) Study. Singh PN, Jaceldo-Siegl K, Shih W, Collado N, Le LT, Silguero K, Estevez D, Jordan M, Flores H, Hayes-Bautista DE, McCarthy WJ. Front Nutr. 2019 Apr 9;6:34. doi: 10.3389/fnut.2019.00034. eCollection 2019. PMID: 31024919. []
  2. Hispanic and Latino are often used interchangeably though they actually mean two different things. Hispanic refers to people who speak Spanish and/or are descended from Spanish-speaking populations, while Latino refers to people who are from or descended from people from Latin America. []
  3. Anthropometry refers to the measurement of the human individual. An early tool of physical anthropology, it has been used for identification, for the purposes of understanding human physical variation. []
  4. What are biomarkers? []
  5. The p-value is a number between 0 and 1 and os interpreted in the following way: A small p-value (typically ≤ 0.05) indicates strong evidence against the null hypothesis – that is, that there is no evidence to support a relationship, so you reject the null hypothesis and accept that there is a potentially causal relationship. Basically, the smaller the number, the more evidence there is for some form of relationship between the two or more elements under discussion. In this case, 0.006 indicates that there is a strong probability that a lower BMI is associated with a vegan/vegetarian diet. []
  6. Vang A, Singh PN, Lee JW, Haddad EH, Brinegar CH. Meats, processed meats, obesity, weight gain and occurrence of diabetes among adults: findings from Adventist Health Studies. Ann Nutr Metab. (2008) 52:96–104. doi: 10.1159/000121365 []
  7. Singh PN, Sabate J, Fraser GE. Does low meat consumption increase life expectancy in humans? Am J Clin Nutr. (2003) 78(Suppl. 3):526S−32S. doi: 10.1093/ajcn/78.3.526S []
  8. Tonstad S, Butler T, Yan R, Fraser GE. Type of vegetarian diet, body weight, and prevalence of type 2 diabetes. Diabetes Care. (2009) 32:791–6. doi: 10.2337/dc08-1886 [] []
  9. Singh PN, Clark RW, Herring P, Sabate J, Shavlik D, Fraser GE. Obesity and life expectancy among long-lived Black adults. J Gerontol A Biol Sci Med Sci. (2014) 69:63–72. doi: 10.1093/gerona/glt049 []
  10. Akbar JA, Jaceldo-Siegl K, Fraser G, Herring RP, Yancey A. The contribution of soul and Caribbean foods to nutrient intake in a sample of Blacks of US and Caribbean descent in the Adventist Health Study-2: a pilot study. Ethn Dis. (2007) 17:244–9. doi: 10.1093/aje/163.suppl_11.S31-c []
  11. Singh PN, Arthur KN, Orlich MJ, James W, Purty A, Job JS, et al. Global epidemiology of obesity, vegetarian dietary patterns, and noncommunicable disease in Asian Indians. Am J Clin Nutr. (2014) 100 (Suppl. 1):359S−64S. doi: 10.3945/ajcn.113.071571 []
  12. Connor WE, Cerqueira MT, Connor RW, Wallace RB, Malinow MR, Casdorph HR. The plasma lipids, lipoproteins, and diet of the Tarahumara indians of Mexico. Am J Clin Nutr. (1978) 31:1131–42. doi: 10.1093/ajcn/31.7.1131 []
  13. McMurry MP, Cerqueira MT, Connor SL, Connor WE. Changes in lipid and lipoprotein levels and body weight in Tarahumara Indians after consumption of an affluent diet. N Engl J Med. (1991) 325:1704–8. doi: 10.1056/NEJM199112123252405 []
  14. Navarro JA, Caramelli B. Vegetarians from latin america. Am J Cardiol. (2010) 105:902. doi: 10.1016/j.amjcard.2009.10.031 []
  15. The American Heart Association defines a healthy BMI as 18.5 kg/m² to 24.9 kg/m². []
  16. All Ultra-Processed Foods Linked to Increased Cancer Links []

Who Drinks & Smokes Most – Meat-Eaters or Plant-Eaters?

An April 2019 UK study 1 looked at the sort of food, drink and lifestyle choices made by meat-eaters and plant-eaters to see if differences in health outcomes of the two groups were partly the result of these choices.

The study

The researchers analysed data from FFQs (food frequency questionnaires) completed by 30,239 participants involved in the EPIC-Oxford study 2 . They assessed intakes of major protein-source foods and other food groups after dividing the participants into six groups of meat-eaters and non-meat-eaters:

  1. regular meat-eaters
  2. low meat-eaters
  3. poultry-eaters
  4. fish-eaters
  5. vegetarians
  6. vegans

The foods listed in the FFQs were categorised into 45 food groups and the results were analysed for variance in health outcomes between the 6 groups. Figures 1 (men) and 2 (women) give a rough idea of the results:

Study findings

There are large differences in dietary intakes between meat-eaters and non-meat-eaters:

non-meat-eaters consumed higher amounts of:

  • soy
  • legumes
  • pulses
  • nuts and seeds
  • whole grains
  • vegetables and fruits

non-meat-eaters consumed lower amounts of:

  • refined grains
  • refined carbohydrates
  • fried foods
  • alcohol
  • sugar-sweetened beverages (SSBs)
  • other foods high in free sugars (e.g. ice cream)

Contrary to expectations, vegetarians and vegans did not replace meat with higher intakes of animal-sourced protein alternatives (dairy and eggs) and non-animal protein alternatives (including legumes and nuts), respectively.

Vegetarians and vegans were found not to completely replace meat consumption with non-meat protein sources and high protein plant-sources but, rather, they increased their consumption of a large variety of plant-based foods and consumed lower amounts of high protein-sourced foods compared with meat-eaters.

The positive health benefits of lower protein intake (specifically, animal protein) have been discussed previously 3 4 5 6 .

The proportion of total energy from high protein-sourced foods:

  • regular meat-eaters – 33%
  • vegetarians – 25%
  • vegans – 20%

Compared with the 5 other groups, vegans consumed the highest amount of:

  • plant milk
  • nuts
  • brown rice
  • wholemeal pasta
  • couscous
  • wholemeal bread

Vegetarians consumed:

  • lower amount of dairy and eggs than meat-eaters
  • highest amount of cheese compared with other 5 groups

Egg consumption was low in all 6 groups, possibly because this study looked at a cohort that might be more ‘health conscious’ than the rest of the population. 7

Compared with regular meat-eaters, all the other groups:

  • were younger
  • had a higher education level
  • had a lower socio-economic status
  • were less likely to smoke and consume alcohol
  • had higher levels of physical activity
  • had lower BMI
  • had higher intakes of carbohydrates
  • had lower intakes of protein and fat

Table 1 shows more detail on the above:

Study conclusions

The findings suggest that non-meat-eaters might be consuming an overall “healthier” diet than meat-eaters.

In this large study of British men and women, we compared intakes of major protein-source foods and other food groups. …Our results show that meat-eaters and low and non-meat-eaters do not only differ in their meat consumption but in their overall dietary intake…The dietary intakes consumed by low and non-meat-eaters might explain the lower risk for some diseases in these diet groups and can be used as a real-life guide for future work assessing the health impacts of replacing meat intake with plant-based foods or dietary recommendations.

Final thoughts

On the whole, the results are what one would have expected. However, there were some surprises, particularly the findings that non-meat eaters tend to drink less booze, smoke less, and eat less processed and sweetened foods.

It’s often speculated, by those who are unfamiliar with plant-based diets, that life must be more boring when you stop eating animals – I mean, where’s the fun in eating grass?! However, if life were so dull when eating a supposedly buzz-free diet, wouldn’t you imagine that plant-eaters would eat a lot more comfort food 8 (sugary, fried, processed foods) and drink and/or smoke themselves silly whenever they could?

Some clarification is provided by research data showing that, not only does physical health generally improve on a plant-based diet, but mental health 9 10 11 and general outlook on life 12 also tends to improve – obviating the need to get caught in that “pleasure trap” 13 .

It was also interesting to note from this study, that the improved health outcomes for plant-eaters does not just derive from the fact that they eat more healthy foods – it’s also that they generally appear to eat less unhealthy food, exercise more, smoke and drink less. There was also variance by age, socio-economic and educational status between the groups – with the youngest group being vegan, highest socio-economic status being meat-eaters, and the most educated being fish-eaters. Food for thought…

Of course, this is not to say that there are no vegetarians and vegans eating horrendously unhealthy plant-based diets. This is something that’s been covered in previous blogs 14 15 16 . This can probably be seen by the surprisingly low amount of fruit and veg eaten by vegetarians and vegans, when compared with how much rice, pasta and bread they eat.

Since WFPB (especially when non-SOS) would guarantee a maximum amount of fruit and veg, with a minimum amount of the sort of junk foods that can find themselves included in a vegetarian or vegan diet, it would be interesting to see future studies which are able to include the WFPB diet within a list of food groups.


  1. Comparison of Major Protein-Source Foods and Other Food Groups in Meat-Eaters and Non-Meat-Eaters in the EPIC-Oxford Cohort. Papier K, Tong TY, Appleby PN, Bradbury KE, Fensom GK, Knuppel A, Perez-Cornago A, Schmidt JA, Travis RC, Key TJ. Nutrients. 2019 Apr 11;11(4). pii: E824. doi: 10.3390/nu11040824. []
  2. European Prospective Investigation into Cancer and Nutrition (EPIC)-Oxford study []
  3. The Problem with Protein []
  4. Eat Enough Food & You Eat Enough Protein []
  5. Animal Protein & Your Kidneys []
  6. Plant Protein, Fibre & Nuts Lower Cholesterol & Blood Pressure []
  7. Sobiecki, J.G.; Appleby, P.N.; Bradbury, K.E.; Key, T.J. High compliance with dietary recommendations in a cohort of meat eaters, fish eaters, vegetarians, and vegans: Results from the European Prospective Investigation into Cancer and Nutrition–Oxford study. Nutr. Res. 2016, 36, 464–477. []
  8. Ghrelin & Obesity – A Tentative Step Through the Minefield []
  9. Depression is Linked to Inflammation []
  10. Gut Microbiota & Depression []
  11. Depression & IBD / Crohn’s Disease / Ulcerative Colitis []
  12. What’s the Psychology of Plant-Eaters? []
  13. Bliss Points, Pleasure Traps & Wholefood Plant-Based Diets []
  14. Greggs’ Vegan Sausage Rolls – Why Veganism Can Fail []
  15. Vegan Pie Comes Top in British Pie Awards 2019 []
  16. Vegan Burgers – Healthy & Yum Yum? Forget it! []

Gout & Vegetarian Diets

A 2019 Taiwanese study 1  recently reported on the results of two large-scale cohort studies which were analysed in order to establish whether following a vegetarian diet reduces the risk of developing gout, when compared with following a non-vegetarian diet.

What is gout?

This subject has been covered extensively in a previous blog 2 so, in brief terms:

  • gout is the most common inflammatory joint disease and is an important risk factor for hypertension, diabetes, kidney diseases, cardiovascular diseases, and all-cause and cardiovascular mortality 3 4 5 6
  • gout pathogenesis begins with excess serum urate that forms monosodium urate crystals – a salt or ester of uric acid – in the joints, triggering gouty inflammation and resulting in excruciating pain 78
  • cases of gout have doubled or tripled in many countries in the past decades 9 10 making it a serious public health threat which desperately requires preventive strategies
  • Taiwan is particularly affected, with one of the highest incidences and prevalences of gout in the world 11

The study

Two cohort groups, representing almost 14,000 Taiwanese, were followed for between 7 and 9 years. They were divided into vegetarians (n=4684) and non-vegetarians (n=9251), and appropriate tests were undertaken to establish gout occurrence.

Study assumptions

  • the standard therapeutic diet aimed at preventing/managing gout restricts purine intake which is metabolised into urate and contributes to one-third of the body’s total urate pool 12
  • however, purine exclusion diets have only moderate urate-lowering effects and are generally regarded as an insufficient remedy 13
  • the researchers considered that the ideal diet for gout prevention/management should be able to simultaneously reduce uric acid and inflammation, while preventing gout-associated comorbidities
  • they conjectured that a vegetarian diet may be a promising dietary pattern to target multiple pathways in the gout pathogenesis, since:
    • vegetarians avoid purine-rich meat/seafood, while consuming increased amounts of vegetables, whole grains, seeds and nuts 14 15
    • plant foods contain polyphenols which potentially reduce uric acid via both an inhibition of xanthine oxidase16 activities and the enhancement of uric acid excretion 17
    • plant foods contain phytochemicals which potentially attenuate the NLRP3 18  inflammatory pathway 19 20
    • vegetarian diets have already been shown to reduce gout associated comorbidities, such as cardiovascular diseases 21 , diabetes 22 23 , and hypertension 24 25

Study results

In these two prospective cohort studies, a Taiwanese vegetarian diet is associated with lower risk of gout. This association persists after controlling for demographic, lifestyle, cardiometabolic risk factors, and baseline hyperuricemia. This finding does not differ across subgroups of sex, lifestyle factors, or comorbidities.

  • it’s most likely that vegetarians experienced a lower risk of gout simply because they had lower uric acid levels since their diets avoid purine-rich meat and seafood – a diet which in prospective studies has been shown to increase gout incidence and recurrence26 27 28 29
  • the results appear to go beyond the single effects of uric acid levels, since they were not consistently wide apart between all vegetarians and all non-vegetarians. The other potential factors influencing the reduction of gout in vegetarians may also be accounted for by the following:
    • vegetarian diets have higher alkalinity which has been shown to facilitate more effective uric acid excretion than an acidic diet – i.e. one that is fish/meat-based 30
    • vegetarian diets usually contain lower saturated fat, higher unsaturated fat and phytochemical-rich plant foods 14 15 31
    • the latter may prevent inflammatory responses which trigger gout attacks by dampening the inflammatory activation of NLRP3 inflammasome 32
    • fibre (high in plant-based diets) on its own, and when metabolised into short chain fatty acids by gut microbiota, has been shown to resolve inflammatory responses involved in gout attacks in mice 33  and in humans 34

Final thoughts

We saw in the previous gout blog 2 that there’s plenty of strong evidence to suggest that the best possible dietary option for gout-avoidance is a WFPB diet (with zero alcohol!). Of course, any diet which favours plant over animal foods will be of some benefit, and the more the latter is replaced with the former, the better in terms of gout-avoidance.

One interesting finding from this Taiwanese study relates to soy. Taiwanese vegetarian diets replace meat and seafood with soy products. But there appears to be a paradox here. Soy has a high purine content and has attracted an infamous reputation – even amongst health professionals – for causing gout 35 . However, contrary to this widely-held belief, the vegetarian diets with high soy content covered in this present Taiwanese study appear to lower gout risk.

And this is not the only study to show this. The researchers’ findings are consistent with the “Singapore Chinese Health Study” which found that soy was protective toward gout 27 .

A potential explanation for this rests in the fact that the potential of soy purines – mainly adenosine 36  and guanine 37 – to raise uric acid levels is considerably lower than those in meat and fish, which have a higher proportion of their purines in the form of hypoxanthine 38 39 40

A 2012 prospective study 41 of gout patients found that the impact of plant purine on gout attacks was significantly less than the purine from animal sources.

Finally, research suggests 42 that soy may have the ability to prevent gout through the inhibition of both the above-mentioned NLRP3 inflammatory pathway and the activity of the caspase-1 enzyme. The latter is an essential effector of inflammation, pyroptosis 43 , and septic shock 44 .

So, hurrah for the plants, boo hiss for meat and seafood, and don’t be shy about eating soy…

References & Notes

  1. Vegetarian diet and risk of gout in two separate prospective cohort studies. Chiu THT, Liu CH, Chang CC, Lin MN, Lin CL. Clin Nutr. 2019 Mar 27. pii: S0261-5614(19)30129-3. doi: 10.1016/j.clnu.2019.03.016. []
  2. Gout, Uric Acid, Urea, Purines & Plant-Based Diets [] []
  3. Bardin T, Richette P. Impact of comorbidities on gout and hyperuricaemia: an update on prevalence and treatment options. BMC Med 2017;15:123. []
  4. Kuo CF, See LC, Luo SF, Ko YS, Lin YS, Hwang JS, et al. Gout: an independent risk factor for all-cause and cardiovascular mortality. Rheumatology (Oxford) 2010;49:141e6. []
  5. Choi HK, Curhan G. Independent impact of gout on mortality and risk for coronary heart disease. Circulation 2007;116:894e900. []
  6. Teng GG, Ang LW, Saag KG, Yu MC, Yuan JM, Koh WP. Mortality due to coronary heart disease and kidney disease among middle-aged and elderly men and women with gout in the Singapore Chinese Health Study. Ann Rheum Dis 2012;71:924e8. []
  7. Desai J, Steiger S, Anders HJ. Molecular pathophysiology of gout. Trends Mol Med 2017;23:756e68. []
  8. So AK, Martinon F. Inflammation in gout: mechanisms and therapeutic targets. Nat Rev Rheumatol 2017;13:639e47. []
  9. Roddy E, Doherty M. Epidemiology of gout. Arthritis Res Ther 2010;12:223. []
  10. Kuo CF, Grainge MJ, Zhang W, Doherty M. Global epidemiology of gout: prevalence, incidence and risk factors. Nat Rev Rheumatol 2015;11:649e62. []
  11. Kuo CF, Grainge MJ, See LC, Yu KH, Luo SF, Zhang W, et al. Epidemiology and management of gout in Taiwan: a nationwide population study. Arthritis Res Ther 2015;17:13. []
  12. Fam AG. Gout: excess calories, purines, and alcohol intake and beyond. Response to a urate-lowering diet. J Rheumatol 2005;32:773e7. []
  13. Khanna D, Fitzgerald JD, Khanna PP, Bae S, Singh MK, Neogi T, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res (Hoboken) 2012;64:1431e46. []
  14. Chiu TH, Huang HY, Chiu YF, Pan WH, Kao HY, Chiu JP, et al. Taiwanese vegetarians and omnivores: dietary composition, prevalence of diabetes and IFG. PLoS One 2014;9:e88547. [] []
  15. Orlich MJ, Jaceldo-Siegl K, Sabate J, Fan J, Singh PN, Fraser GE. Patterns of food consumption among vegetarians and non-vegetarians. Br J Nutr 2014;112:1644e53. [] []
  16. Xanthine oxidase is a type of enzyme that generates reactive oxygen species. These enzymes catalyse the oxidation of hypoxanthine to xanthine and can further catalyse the oxidation of xanthine to uric acid. []
  17. Mehmood A, Zhao L, Wang C, Nadeem M, Raza A, Ali N, et al. Management of hyperuricemia through dietary polyphenols as a natural medicament: a comprehensive review. Crit Rev Food Sci Nutr 2017:1e23. []
  18. J Inflamm Res. 2018 Sep 25;11:359-374. doi:10.2147/JIR.S141220. eCollection 2018. Spotlight on the NLRP3 inflammasome pathway. Groslambert M1,2,3,4,5, Py BF []
  19. Joseph SV, Edirisinghe I, Burton-Freeman BM. Fruit polyphenols: a review of anti-inflammatory effects in humans. Crit Rev Food Sci Nutr 2016;56:419e44. []
  20. Tozser J, Benko S. Natural compounds as regulators of NLRP3 inflammasomemediated IL-1beta production. Mediat Inflamm 2016;2016:5460302. []
  21. Crowe FL, Appleby PN, Travis RC, Key TJ. Risk of hospitalization or death from ischemic heart disease among British vegetarians and nonvegetarians: results from the EPIC-Oxford cohort study. Am J Clin Nutr 2013;97:597e603. []
  22. Chiu THT, Pan W-H, Lin M-N, Lin C-L. Vegetarian diet, change in dietary patterns, and diabetes risk: a prospective study. Nutr Diabetes 2018;8:12. []
  23. Tonstad S, Stewart K, Oda K, Batech M, Herring RP, Fraser GE. Vegetarian diets and incidence of diabetes in the adventist health study-2. Nutr Metab Cardiovasc Dis 2013;23:292e9. []
  24. Yokoyama Y, Nishimura K, Barnard ND, Takegami M, Watanabe M, Sekikawa A, et al. Vegetarian diets and blood pressure: a meta-analysis. JAMA Intern Med 2014;174:577e87. []
  25. Chuang SY, Chiu TH, Lee CY, Liu TT, Tsao CK, Hsiung CA, et al. Vegetarian diet reduces the risk of hypertension independent of abdominal obesity and inflammation: a prospective study. J Hypertens 2016;34:2164e71. []
  26. Choi HK, Atkinson K, Karlson EW, Willett W, Curhan G. Purine-rich foods, dairy and protein intake, and the risk of gout in men. N Engl J Med 2004;350: 1093e103. []
  27. Teng GG, Pan A, Yuan JM, Koh WP. Food sources of protein and risk of incident gout in the Singapore Chinese health study. Arthritis Rheum 2015;67:1933e42. [] []
  28. Williams PT. Effects of diet, physical activity and performance, and body weight on incident gout in ostensibly healthy, vigorously active men. Am J Clin Nutr 2008;87:1480e7. []
  29. Zhang Y, Chen C, Choi H, Chaisson C, Hunter D, Niu J, et al. Purine-rich foods intake and recurrent gout attacks. Ann Rheum Dis 2012;71:1448e53. []
  30. Kanbara A, Miura Y, Hyogo H, Chayama K, Seyama I. Effect of urine pH changed by dietary intervention on uric acid clearance mechanism of pHdependent excretion of urinary uric acid. Nutr J 2012;11:39. []
  31. Rizzo NS, Jaceldo-Siegl K, Sabate J, Fraser GE. Nutrient profiles of vegetarian and nonvegetarian dietary patterns. J Acad Nutr Diet 2013;113:1610e9. []
  32. Ralston JC, Lyons CL, Kennedy EB, Kirwan AM, Roche HM. Fatty acids and NLRP3 inflammasome-mediated inflammation in metabolic tissues. Annu Rev Nutr 2017;37:77e102. []
  33. Vieira AT, Galvao I, Macia LM, Sernaglia EM, Vinolo MA, Garcia CC, et al. Dietary fiber and the short-chain fatty acid acetate promote resolution of neutrophilic inflammation in a model of gout in mice. J Leukoc Biol 2017;101:275e84 []
  34. Lyu LC, Hsu CY, Yeh CY, Lee MS, Huang SH, Chen CL. A case-control study of the association of diet and obesity with gout in Taiwan. Am J Clin Nutr
    2003;78:690e701. []
  35. Messina M, Messina VL, Chan P. Soyfoods, hyperuricemia and gout: a review of the epidemiologic and clinical data. Asia Pac J Clin Nutr 2011;20:347e58. []
  36. Adenosine is a chemical that is present in all human cells. It readily combines with phosphate to form various chemical compounds including adenosine monophosphate (AMP) and adenosine triphosphate (ATP). []
  37. Guanine is one of the four main nucleobases found in the nucleic acids DNA and RNA, the others being adenine, cytosine, and thymine. []
  38. Hypoxanthine is a naturally occurring purine derivative. It is occasionally found as a constituent of nucleic acids, where it is present in the anticodon of tRNA in the form of its nucleoside inosine. []
  39. Kaneko K, Aoyagi Y, Fukuuchi T, Inazawa K, Yamaoka N. Total purine and purine base content of common foodstuffs for facilitating nutritional therapy for gout and hyperuricemia. Biol Pharm Bull 2014;37:709e21. []
  40. Clifford AJ, Riumallo JA, Young VR, Scrimshaw NS. Effect of oral purines on serum and urinary uric acid of normal, hyperuricemic and gouty humans. J Nutr 1976;106:428e50. []
  41. Zhang Y, Chen C, Choi H, Chaisson C, Hunter D, Niu J, et al. Purine-rich foods intake and recurrent gout attacks. Ann Rheum Dis 2012;71:1448e53. []
  42. Bitzer ZT, Wopperer AL, Chrisfield BJ, Tao L, Cooper TK, Vanamala J, et al. Soy protein concentrate mitigates markers of colonic inflammation and loss of gut barrier function in vitro and in vivo. J Nutr Biochem 2017;40:201e8. []
  43. (Pyroptosis is a highly inflammatory form of programmed cell death that occurs most frequently upon infection with intracellular pathogens and is likely to form part of the antimicrobial response. []
  44. Septic shock is a potentially fatal medical condition that occurs when sepsis, which is organ injury or damage in response to infection, leads to dangerously low blood pressure and abnormalities in cellular metabolism. []