One world, one health

As people increasingly move to cities, their lifestyles profoundly change. Sonnenburg and Sonnenburg review how the shift of recent generations from rural, outdoor environments to urbanized and industrialized settings has profoundly affected our biology and health. The signals of change are seen most strikingly in the reduction of commensal microbial taxa and loss of their metabolic functions. The extirpation of human commensals is a result of bombardment by new chemicals, foodstuffs, sanitation, and medical practices. For most people, sanitation and readily available food have been beneficial, but have we now reached a tipping point? How do we conserve our beneficial symbionts and keep the pathogens at bay?

Science, this issue p. eaaw9255

The collection of trillions of microbes inhabiting the human gut, called the microbiome or microbiota, has captivated the biomedical research community for the past decade. Intimate connections exist between the microbiota and the immune system, central nervous system, and metabolism. The growing realization of the fundamental role that the microbiota plays in human health has been accompanied by the challenge of trying to understand which features define a healthy gut community and how these may differ depending upon context. Such insight will lead to new routes of disease treatment and prevention and may illuminate how lifestyle-driven changes to the microbiota can impact health across populations. Individuals living traditional lifestyles around the world share a strikingly similar microbiota composition that is distinct from that found in industrialized populations. Indeed, lineages of gut microbes have cospeciated with humans over millions of years, passing through hundreds of thousands of generations, and lend credence to the possibility that our microbial residents have shaped our biology throughout evolution. Relative to the traditional microbiota, the industrial microbiota appears to have lower microbial diversity, with major shifts in membership and functions. Individuals immigrating from nonindustrialized to industrialized settings or living at different intermediate states between foraging and industrialization have microbiota composition alterations that correspond to time and severity of lifestyle change. Industrial advances including antibiotics, processed food diets, and a highly sanitized environment have been shown to influence microbiota composition and transmission and were developed and widely implemented in the absence of understanding their effects on the microbiota.

Here, we argue that the microbiota harbored by individuals living in the industrialized world is of a configuration never before experienced by human populations. This new, industrial microbiota has been shaped by recent progress in medicine, food, and sanitation. As technology and medicine have limited our exposure to pathogenic microbes, enabled feeding large populations inexpensively, and otherwise reduced acute medical incidents, many of these advances have been implemented in the absence of understanding the collateral damage inflicted on our resident microbes or the importance of these microbes in our health. More connections are being drawn between the composition and function of the gut microbiota and alteration in the immune status of the host. These relationships connect the industrial microbiota to the litany of chronic diseases that are driven by inflammation. Notably, these diseases spread along with the lifestyle factors that are known to alter the microbiota. While researchers have been uncovering the basic tenets of how the microbiota influences human health, there has been a growing realization that as the industrial lifestyle spreads globally, changes to the human microbiota may be central to the coincident spread of non-communicable, chronic diseases and may not be easily reversed.

We suggest that viewing microbiota biodiversity with an emphasis on sustainability and conservation may be an important approach to safeguarding human health. Understanding the services provided by the microbiota to humans, analogous to how ecosystem services are used to place value on aspects of macroecosystems, could aid in assessing the cost versus benefit of specific microbiota dysfunctions that are induced by different aspects of lifestyle. A key hurdle is to establish the impact of industrialization-induced changes to the microbiota on human health. The severity of this impact might depend on the specifics of numerous factors, including health status, diet, human genotype, and lifestyle. Isolating and archiving bacterial strains that are sensitive to industrialization may be required to enable detailed study of these organisms and to preserve ecosystem services that are unique to those strains and potentially beneficial to human health. Determining a path forward for sustainable medical practices, diet, and sanitation that is mindful of the importance and fragility of the microbiota is needed if we are to maintain a sustainable relationship with our internal microbial world.

Aspects of lifestyle, including those associated with industrialization, such as processed foods, infant formula, modern medicines, and sanitation, can change the gut microbiota. Major questions include whether microbiota changes associated with industrialization are important for human health, if they are reversible, and what steps should be taken to prevent further change while information is acquired to enable an informed cost-versus-benefit analysis. It is possible that a diet rich in whole foods and low in processed foods, along with increased exposure to nonpathogenic microbes, may be beneficial to industrial populations.

The human body is an ecosystem that is home to a complex array of microbes known as the microbiome or microbiota. This ecosystem plays an important role in human health, but as a result of recent lifestyle changes occurring around the planet, whole populations are seeing a major shift in their gut microbiota. Measures meant to kill or limit exposure to pathogenic microbes, such as antibiotics and sanitation, combined with other factors such as processed food, have had unintended consequences for the human microbial ecosystem, including changes that may be difficult to reverse. Microbiota alteration and the accompanying loss of certain functional attributes might result in the microbial communities of people living in industrialized societies being suboptimal for human health. As macroecologists, conservationists, and climate scientists race to document, understand, predict, and delay global changes in our wider environment, microbiota scientists may benefit by using analogous approaches to study and protect our intimate microbial ecosystems.

Ecosystems change. Seasonal or periodic fluctuations may occur over short time scales, trajectories of lasting change can occur over time, and sudden perturbations can result in instability or new stable states. Ecosystems can also reach tipping points at which biodiversity crashes, invasive and opportunistic species take over, and the services expected of the original ecosystem are lost, which may result in further damage and/or extinctions. Each human is an ecosystem composed of thousands of species and trillions of members, the host body of Homo sapiens being just one of those species. Most of these community members are microorganisms that reside in the gut, which is the focus of this article. Sequencing of the microbiota shows that human microbiomes are composed of a stunning array of species and functional diversity. An intricate set of interactions, just now being mapped, connects microbial species within a microbiota to one another and to human biology and is beginning to show how profoundly these microbes influence our health.

The first steps in human microbiota assembly occur upon birth, with microbes vying to colonize environment-exposed surfaces in and on the body. This process is influenced by many factors, including mode of birth, nutrition, environment, infection, and antibiotic exposure (1, 2). Specific taxa of microbes have codiversified with Homo sapiens, consistent with vertical transmission over hundreds of thousands of generations (3). The millions of years of association have provided ample opportunities for our biology and theirs to coevolve (4).

Intimate connections between the microbiota and the human immune system, nervous system, and metabolism have been revealed over the past decade (59). The specific microbes that first colonize the infant gut and the ensuing succession of the community can irreversibly influence mucosal and systemic immune development (10). Orchestrating the assembly of a health-promoting gut microbiota or manipulating a mature community to alter human physiology has vast therapeutic potential, which has captured the attention of the biomedical community. Beyond the importance of the microbiota to human health, recent research has also demonstrated its vulnerability. This ecosystem is susceptible to change by selective forces (11, 12). For example, a single course of one type of antibiotic can decimate and reshape the gut microbiota (13). Exciting research is racing to identify disease treatments using microbiome manipulation, but less focus has been placed on how to protect the microbiota from damage that may be deleterious to human health (14).

The germ theory of disease, formalized in the 1860s by Louis Pasteur, portrayed microbes as an enemy to be controlled and eradicated. The subsequent war on microbes deploying hand washing, sterile surgical techniques, and antibiotics has saved countless lives. In 1900, pneumonia, tuberculosis, and infectious enteritis were the three leading causes of mortality in the United States, accounting for almost one-third of all deaths (15). By the end of the millennium, these infectious disease killers were replaced by chronic diseases, including heart disease, cancer, and stroke, which offered evidence of our ability to effectively manage germs. However, the inverse relationship of infectious and chronic disease rates may share a similar underlying cause. Consistent with tenets of the hygiene hypothesis, limited exposure to microbes may result in defects in immune function and/or regulation, leading to an increasing burden of allergic and autoimmune diseases. In light of our new knowledge about the role of the microbiota in health, the war on microbes likely needs to be reconsidered in less combative terms. The profound success of germ-killing techniques and drugs developed in the past century that have minimal acute side effects has led to overuse. The rise of superbugs that are resistant to antibiotics and chemical bactericides reveals that there is a cost to our war on microbes (16). However, the longer-term and less obvious costs to human health of disrupting the microbiota may come from chronic metabolic and immune diseases. Although intimate, the communities that live in our guts are hard to study, and at present we do not fully understand the health impact of the differences in the microbiota observed between human populations.

Microbiota composition, diversity, and gene content in industrialized peoples vary substantially from that of more traditional rural populations and likely from that of our ancient ancestors, indicating that aspects of our lifestyle are changing our resident microbes (4, 1720). Antibiotics are not the only potential contributor to this effect. Other recent changes in practice, including Caesarean section (C-section) delivery, infant formula, and consumption of industrially produced foods, have all been shown to influence the gut microbiota of humans (2123). Although these technological and medical advances have had undeniable benefits (especially for emergency health care), their implementation and widespread use have occurred without an understanding of their impact on our resident microbial communities. At one extreme, microbiota shifts coincident with industrialization may have no impact (or even a beneficial impact, for example, by removing or reducing microbes with pathogenic potential) on human health and longevity. At the other extreme, the microbiota alterations observed in industrialized populations may be a major contributor to the misregulation of the human immune system that drives chronic inflammation (4, 24). Noncommunicable diseases (NCDs), such as stroke, heart disease, some cancers, chronic kidney disease, diabetes, and dementias, all of which are fueled by chronic inflammation, are associated with the worldwide expansion of industrialized lifestyles and are predicted to create a global health crisis in the coming century (25, 26).

In many ways, the rapid changes experienced by the microbiota of urban humans are analogous to those observed in macroecosystems throughout the world (27). Over time and with tremendous efforts to generate and analyze data, a global scientific consensus has emerged that human-induced climate change will have a devastating impact on Earths species and ecosystems if not curtailed and reversed (28, 29). Likewise, as we become increasingly cognizant of the importance of the microbiota in dictating the duration and extent of our health, it is vital that we reframe our relationship with microbes and use strategies similar to the sustainability and biodiversity conservation efforts under way around the globe. What steps should we take now to protect resident microbes, given the current data and range of possible outcomes?

That the gut ecosystem would change in response to marked lifestyle alterations is not surprising. What is notable is that the microbiota of traditional populations share taxa that have been lost or reduced in individuals living in the industrialized world, which we have termed VANISH (volatile and/or associated negatively with industrialized societies of humans) taxa (Fig. 1A) (30). A study comparing the industrialized microbiota with that of three Nepalese populations living on a gradient from foraging to farming showed the shift in microbiota composition that takes place as populations depart from a foraging lifestyle (31). Intermediate states of lifestyle change toward urbanization are accompanied by less extreme but evident changes in the microbiota (Fig. 1, B and C).

(A) Aggregation of gut microbiota composition from multiple studies separated by principal component analysis of BrayCurtis dissimilarity of 16S rRNA enumerations [adapted from Smits et al. (33)]. Top panel: The first principal component explains 22% of the variation in the data from 18 populations living lifestyles spanning from uncontacted Amerindians in Venezuela (top) to fully industrialized populations in Australia, the United States, Canada, and Ireland (bottom). Bottom panel: Mapping the relative abundance of bacterial families on PCo1 reveals global patterns in the VANISH taxa, which are associated negatively with industrialized societies, and BloSSUM taxa (bloom or selected in societies of urbanization/modernization), such as the Bacteroidaceae and Verrucomicrobia. (B) Heat map adapted from Jha et al. (31) displaying taxa that change across lifestyles in one geographic location (Nepal) of individuals living as foragers (Chepang), settled foragers (Raute, Raji), or agriculturalists (Tharu) versus industrialized individuals in the United States. (C) Model adapted from Jha et al. (31) of strain loss and/or reduction versus gain and/or increase across a lifestyle gradient. Different patterns of changing abundance correspond with specific aspects of lifestyle that change as populations move away from foraging and toward urbanization. The model could also reflect the historical progression of industrialized humans from foraging (Homo sapiens arose ~200,000 to 300,000 years ago) to agriculture (starting 10,000 to 20,000 years ago) to industrialization (starting 100 to 200 years ago).

Similarly, a longitudinal study of individuals immigrating from a Thai refugee camp to the United States showed a loss of VANISH taxa within months of immigrating (32). The longer the immigrants lived in the United States, the more profound the changes. In addition to changes in microbial membership, functional differences in the microbiota correspond to lifestyle. Traditional populations such as the Hadza, a hunter-gatherer group living in Tanzania, like the immigrants from Southeast Asia, harbor microbiota with a larger and more diverse collection of carbohydrate active enzymes (CAZymes) than their industrial counterparts. CAZymes digest complex plant polysaccharides, characteristic of traditional dietary fiber intake (32, 33). By comparison, the microbiota of U.S. residents are enriched in CAZymes that degrade host mucus, which serves as a backup food source for gut microbes when dietary fiber is limited, a hallmark of the industrialized diet (33, 34). The selection of mucus-utilizing bacteria in industrialized populations is evident in the enrichment of Akkermansia muciniphila (a mucin-loving bacterium in the phylum Verrucomicrobia) that was found in a worldwide comparison of industrialized and nonindustrialized microbiomes (Fig. 1A) (33). Whether the loss or reduction of VANISH taxa cause or contribute to the growing burden of NCDs in humans remains to be determined. However, determining the potential importance of VANISH taxa to human biology will require efforts to maintain their diversity before it is lost (35, 36).

We must not forget how the attempted eradication of pathogenic microbes with antibiotics, increased sanitation, and medicalized birth has saved countless lives. Other features of industrialized life, such as the Western diet and infant formula, have added convenience, increased human productivity and met the food demands of a growing population. The development and widespread implementation of these technological advances occurred before there was an understanding of their effect on the microbiota and the significance of the microbiota to human health. One difficulty in understanding the effects of different aspects of industrialization on the human gut microbiota is that so many lifestyle factors covary. Below, we summarize studies that have sought to disentangle facets of the industrialized lifestyle that change the microbiota.

The development and use of antibiotics have accompanied human population growth, industrialization, and rapid technological advances. Antibiotics have become the prototypic factor associated with industrialization that negatively affects the gut microbiota. Antibiotic resistance and increased susceptibility to enteric pathogens are well-known negative effects of antibiotic use. Accumulating data also show that oral antibiotic use has long-term effects on the composition of the gut microbiota (37). Just 5 days of ciprofloxacin was shown to decimate the gut microbial community, which only recovered slowly over the ensuing weeks and months (13). Recoveries were individualized, were incomplete, and differed in their kinetics (13). Similarly, other studies have shown that antibiotics can have a long-term impact on the microbiotaperhaps we should not be surprised because most of these medicines were originally designed to have broad-spectrum effects (38).

For most of human existence, humans consumed food and water laden with microbes, some of which caused disease. But humans also routinely consumed benign bacteria, both through incidental environmental exposure (e.g., from dirt or unsanitized food or on the skin) and from fermented foods (39). The recent shift to consuming largely sterile food and water has likely also influenced the microbiota. For example, the source of drinking water was significantly associated with microbiota composition in the cross-sectional study of Nepalese individuals living on a lifestyle gradient, as well as the Hadza (31). As industrial populations removed microbes from drinking water, the burden of diseases such as cholera and other waterborne illnesses decreased. Recent studies in mice suggest that sanitization in the form of cage cleaning does exacerbate extinctions in the microbiota after perturbation (40). The industrialized human microbiota also bears the hallmarks of sanitation, showing greater interindividual differences in microbiota composition (an indication of less microbe sharing between people) compared with traditional human populations in Papua, New Guinea, where individuals share more bacterial species with one another (20). Risking increased infectious diseases by reducing standards of sanitation would be misguided, but a better understanding of how hygienic practices shape our microbiota and the resulting impact on human health is needed. Restoring the consumption of nondisease-causing microbes may ameliorate diseases that are common among populations that consume sterile food and water (41).

Antibiotics and sanitation are intended to limit exposure to pathogenic microbes, but other practices such as the Western diet and C-section births that are not targeted at microbe control may nevertheless be having a profound effect on the microbiota.

Diet is a major driver of the composition and metabolic output of the microbiota (4244). Humans have shifted from a diet of exclusively wild animals and gathered foods to one of domesticated livestock and agricultural produce (10,000 to 20,000 years ago) to a more recent shift to industrially produced foods, including chemically managed livestock and produce and sterilized, ultraprocessed foods containing preservatives and additives (45, 46). These shifts have resulted in a food supply capable of supporting a growing human population, but perhaps at the cost of the populations health (47).

One notable change to foodstuffs is the unintentional depletion of a major form of sustenance for the microbiota: microbiota-accessible carbohydrates (MACs; the complex carbohydrates found in the dietary fiber of edible plants such as legumes, whole grains, vegetables, nuts, etc.) (42). A high-MAC diet was commonplace when humans exclusively foraged for nutrition, and low-MAC diets have been associated with lower microbiota diversity and poor markers of health in humans and in animal models (4850). The paucity of MACs in the industrialized diet was compensated for by additional protein, simple carbohydrates, and fat, which had the effect of altering the composition and functional output of the microbiota (43, 51). The use of additives such as emulsifiers and non-nutritive sweeteners is pervasive in industrialized food. Both have been shown to alter microbiota composition and promote intestinal inflammation. In addition, emulsifiers promote adiposity and non-nutritive sweeteners alter the metabolic output of the microbiota toward one that resembles that of type 2 diabetics (21, 52).

Small changes to the microbiota have the capacity to amplify over generations. For example, mice fed a low-MAC diet showed reduced microbiota diversity that compounded over generations. Restoration of a high-MAC diet was not sufficient to regain microbiota diversity, which indicated that species within the microbiota had gone extinct during the four-generation length of the experiment (50). In another study, antibiotic treatment of pregnant mice altered the microbiota of the offspring and resulted in metabolic derangement that predisposed the pups to diet-induced obesity (53). Similarly, C-section delivery in humans results in colonization of the infant with microbes derived from skin instead of the mothers vaginal microbiota (54). Acute perturbations from diet, antibiotics, and medical practices could have been propagated over generations and synergized with heightened hygiene and sanitation to result in the population-wide ecosystem reconfigurations observed today. The effects of other factors associated with an industrialized lifestyle on the microbiota, including increased sedentary behavior, stress, exposure to new chemicals (e.g., plastics, herbicides, and pesticides), and social isolation, have only begun to be explored (5557).

It is not a given that the microbiota found in traditional populations, which likely shares more commonality with that of our ancient ancestors, would improve the health of a person living in an industrialized society (4). For example, several members of a traditional gut microbiota, such as parasites, are frank pathogens. Some functions of a traditional microbiota may have beneficial effects in the context of a traditional lifestyle but may not in a more urbanized context. We have simplified these points and recognize that some parasites may confer benefits to human health, but how benefit is defined may depend on context and the individual. For example, parasites that protect against intestinal inflammatory diseases may cause opportunistic infections in immunocompromised individuals (58).

While remaining agnostic about broad connections between change in the microbiota and human health, it is worth considering underlying evolutionary principles that might predict whether microbiota changes are likely to be beneficial, deleterious, or neutral. A very conservative view is that until we have a good understanding of which microbes or communities are beneficial or deleterious, including how context determines this answer, we should recognize that (i) our resident microbes have the potential to affect our health in profound ways and (ii) individual lifestyle and/or medical choices and population-level lifestyle, medical, and dietary choices can change these communities. Similar to early, albeit insufficient, steps to address climate change before the full scope of the problem was understood, such as developing renewable alternatives to fossil fuels, a hedge against potential catastrophe seems warranted. In the case of our gut microbes, acting to minimize unintended loss of biodiversity is likely a wise strategy until we know more. We discuss possible strategies below.

An important question is whether loss or reduction of resident, codiversified microbes and associated functions could have a negative health impact on humans. Some properties of the human microbiota appear to have been stable during much of human evolution before industrialization. It is expected that the combined biology and genome of the human body and its commensal microorganisms would have coevolved to maximize human reproductive success (fitness) during that time (59). Because industrialized humans are interested in a long, healthy life, it is worth asking whether long life is consistent with the reproductive success of early humans. The reproductive success of modern hunter-gatherers corresponds to being long lived (as demonstrated by evidence supporting the patriarch hypothesis); therefore, the components of the microbiome that lived within humans throughout most of our existence as a species likely promote biology consistent with a long, healthy life (60).

From the microbial point of view, a bacterial species is chiefly concerned with making more of itself. Therefore, it is worth considering whether it is possible for members of the microbiota that increase host health and longevity to arise. In other words, the question is not only whether the interests of host and microbiota are aligned (i.e., to promote a long, healthy life of the host), but whether microbes that promote the health and longevity of their hosts are retained and favored over evolutionary time.

Gut-resident microbes that improve host health and life span are most likely to arise when the health-promoting function does not incur a short-term fitness cost to themselves (61, 62). For example, imagine a microbial pathway that not only generates energy for the microbe by fermenting a dietary complex carbohydrate but also produces a fermentation end product that can be absorbed by the host and play beneficial metabolic and/or regulatory roles. These microbes would contribute to host health without incurring a fitness cost and could be selected over time as a result of host fitness, longevity, and transmission to offspring and other individuals. We might expect that loss of these coevolved microbes and associated functions would have a negative health impact.

The industrialized microbiota could be considered better adapted to an industrialized host lifestyle by harboring more resistance to antibiotics and being less proficient at dietary fiber degradation. However, such a microbiota may not be optimized for our health.

Learning how to minimize harm to an ecosystem is an easier prospect than rebuilding one that has deteriorated; however, the realization of an ecosystems importance often only becomes apparent after major change has taken place. In the case of the gut microbiota, we may have to confront the daunting task of reconfiguring an ecosystem that we are just beginning to understand. Biodiverse ecosystems are characterized by complex networks of interactions; delete or add one node and the cascade of changes through the network of interactions can be difficult to anticipate. Predicting ecosystem changes from species reintroduction, such as wolves into Yellowstone National Park, is a challenge long faced by conservation biologists (63, 64) (Fig. 2A).

(A) Gray wolves were introduced into Yellowstone National Park in 1995 to control the swelling elk population (105). The rewilding of Yellowstone set off a trophic cascade that resulted in a decreasing elk population (thereby promoting new growth in aspens), an increase in berries available to bears, and stream morphology changes caused by increased woody plants (64). This provides an example of how wildlife management can be used to restore a more diverse and perhaps functional ecosystem, as well as how reintroduction of species into a habitat can lead to unanticipated changes to that ecosystem. (B) Rewilding of a C. difficileinfected microbiota by FMT results in largely predictable outcomes in host health, but the specifics of the resulting microbiota composition are difficult to predict. (C) Long-term strategies for managing the microbiota include precision approaches of adding defined cocktails of microbes, engineered bacterial species, and improving ecosystem habitat quality. For example, increasing dietary MACs encourages commensal growth and provides fermentation end products such as butyrate to the epithelium, which can help keep oxygen tensions lower in the gut and prevent the growth of facultative anaerobes with pathogenic potential (106).

Fecal microbiota transplantation (FMT) is an example of how ecosystem remodeling through multispecies rewilding can be applied to the gut microbiota. In this procedure, all of the bacterial species of a healthy human donors stool microbiota are introduced into a diseased recipient in an attempt to reconfigure a maladaptive ecosystem (Fig. 2B) (65). FMT has been highly effective in treating Clostridium difficile infection (CDI) refractory to conventional antibiotic-based treatment (66). Although this procedure cures CDI, the addition of hundreds of microbial species into an equally complex, although disrupted, ecosystem results in an unpredictable community that is composed of strains from the donor, recipient, and other sources (67, 68). CDI represents an extreme case of ecosystem disruption; therefore, the lack of precision in dictating the resulting community after ecosystem rewilding is clinically tolerable, as almost any resulting microbiota configuration lacking or minimizing C. difficile is preferred. However, FMTs are not an ideal long-term solution for the treatment of many diseases. In many cases, they are simply ineffective, and in others, the unintended consequences may include transmission of antibiotic-resistant microbes or other infectious agents and the transference of unwanted phenotypes from the donor (69). Gut microbiota rewilding through FMT has currently only been consistently successful for C. difficile cases. Similar to cases of animal reintroduction in macroecosystems, success as defined by the ability of these reintroduced species to thrive has been mixed (70).

Targeted rewilding through discrete changes in habitat quality or the introduction of specific species chosen based on known interactions may be a more predictable and successful approach to ecosystem management in a disrupted gut microbiota. Habitat quality is a key element of success in macroecosystem restoration and is also an important consideration in the gut (71). Ecosystems are made up of interacting species and their physicochemical environment. Factors that influence the suitability of the gut habitat, including temperature, pH, osmolality, redox status, water activity, and chemical and nutrient availability, will likely affect the success of microbiota reconfiguration efforts. Mice chronically infected with C. difficile can be effectively treated using a diet containing MACs. This simple change to habitat quality enabled the recovery of a robust indigenous community and reestablished important functions such as short-chain fatty acid (SCFA) production (72). Diet can also create a niche for a newly introduced microbial strain to colonize. For instance, feeding mice the seaweed polysaccharide porphyran allowed engraftment of a porphyran-utilizing Bacteroides strain (73). This example of engrafting a new species into a microbiota may provide a strategy that can be extended to help targeted rewilding (Fig. 2C).

An additional challenge to managing ecosystems is identifying the features within an ecosystem that are beneficial and thus worthy of conservation. One strategy used by ecologists is to assess the services provided by an ecosystem. Ecosystem services, popularized in the Millennium Ecosystem Assessment, enable value to be placed on different components of an ecosystem (74). For example, if a lake provides fresh drinking water and recreation (swimming, fishing), then pollution of that lake would put those services in jeopardy. Likewise, we can consider the ecosystem services supplied by the gut microbiota (75) (Fig. 3). However, determining whether a microbiota ecosystem service is beneficial is difficult enough in itself, and establishing whether this benefit is universal or specific to a subpopulation of people or even only one individual, a developmental period of life, or during disease or reproduction adds complexity. For example, extraction of calories was an important microbiota ecosystem service rendered in the preindustrialized world, but when eating modern, calorie-dense foods, this service becomes less important.

Identifying the benefits provided by the gut microbiome to human health is one way to determine when the ecosystem is functioning well. (A) List of benefits provided by the gut microbiota. This list is not intended to be comprehensive, and the categorization is only one of many possibilities, but it is presented as a potentially useful framework for conceptualizing how to value specific features of microbiota. (B) Current data suggest that, along with the shift in the composition of the industrialized microbiota, certain services may be lost or out of balance, resulting in suboptimal states of host physiology or disease. A more nuanced understanding of which services are beneficial and in what context will be enabled by longitudinal high-dimensional profiling of microbiome and host biology combined with long-term monitoring of health in humans.

Studying microbiota configurations in different contexts may reveal associations that are positive for human health. For example, work on the gut microbiota in individuals undergoing immunotherapy to treat cancer has shown associations between specific microbiota components and improved outcomes (76). Although many specifics remain to be determined, these findings are consistent with the ability of different microbiotas and their services, such as SCFA production, to alter host immune status and function. Unfortunately, such observational work is usually conducted on people living in industrialized countries and therefore is limited in the microbiota configurations and features that are queried.

If humans have developed a dependence upon microbiota services that have been lost during industrialization, then might reintroduction of these services be analogous to complementing a lost portion of human biology and provide broad benefit? Even if this is not the case, given the recent success of prophylactic antibiotics in low- and middle-income countries in improving health and reducing mortality in children, rewilding the microbiota after treatment using defined key strains may become a standard treatment to aid in ecosystem recovery (77). Should this be the case, then considerations of how to make reintroductions self-sustaining, especially in the face of spreading industrialization, will be important.

The goals of a managed microbiota should be to optimize ecosystem services to prevent disease and improve health and longevity. Optimization requires precise, targeted approaches that consider an individuals genotype, microbiome, or subcategory of disease. Given the large global health impact, strategies to protect the microbiome in all populations should be considered to maximize the palette of microbial and molecular tools available. Efforts are under way to archive the microbial diversity found in the gut of humans around the globe (35, 36). Whether these efforts will result in new therapeutics remains to be seen, but at the very least they provide a time capsule of microbial diversity in a rapidly industrializing world. Industrialization of the microbiome, and its accompanying loss or reduction of certain species, can occur on a time scale of months within an individual, creating some urgency for the banking of vulnerable species (78). An additional challenge is navigating the changing restrictions on the distribution of bacterial strains for research and therapeutic development while protecting the rights and recognizing the contribution of the people from which they came (79, 80).

Reshaping ingrained aspects of industrialized societies to moderate practices that have negative impacts on the microbiota will be a challenge but will be more practical than reversion to preindustrial practices (see Box: Sustainable ecosystem management approaches). Antibiotic use will remain an important aspect of industrial life; however, regulation in clinical and agricultural settings is needed to maintain efficacy and to protect the microbiome. Similarly, rationally engineered microbial cocktails or fermented foods could offer safe microbe exposure to compensate for sanitization. Government subsidies similar to those provided for certain crops could be justified to make MAC-rich and fermented foods cheaper and more widely available. Until food policy reflects the findings of biomedical research, short-term solutions, such as supplementing processed foods with MACs or probiotic bacteria, could provide a gradual progression toward health-optimizing food systems in industrialized countries.

Expanding cohort and interventional studies in humans from a wide representation of humans while simultaneously documenting microbiome and health changes is key for healthy, sustainable microbiota. Numerous associations have been made between the microbiota and human disease, but additional microbiome datasets from longitudinal, prospective observational and interventional studies of humans will provide insight into causal relationships. High-resolution measurements of host biology, including omics approaches and high-dimensional immune profiling, will be important to elucidate the specific lifestyle practices that lead to the most meaningful microbiome changes for human health (44, 81, 82). Animal models informed by human-derived data can be used to perform controlled studies with the goal of developing strategies to rebuild and maintain a healthy microbiota (83).

Some of the specific forces that are bad for Earth appear also to harm our microbiota. For example, animal meat production removes forest habitat for pasture and results in increased methane production. Excessive meat consumption has been coupled to trimethylamine-N-oxide (TMAO) production by the microbiota, and TMAO is a risk factor for cardiovascular events (84). It may be wise to approach climate and health and microbiota sustainability simultaneously to identify solutions that align Earth and human health (i.e., One World, One Health) (85). Given that environmentally sustainable agricultural practices are compatible with producing food generally recognized to promote health, solutions for the planet and human health may be compatible (86). As Earths microbes adapt to our changing environment, we can expect our bodys ecosystem to reflect our external environment in ways that are difficult to anticipate. Determining microbial or molecular equivalents of rewilding will require a much better understanding of community dynamics and hostmicrobiota interactions than we presently have. Continually monitoring and managing a healthy internal ecosystem may be an effective strategy to combat and prevent the litany of chronic diseases that are currently spreading with industrialization.

As we continue to learn of the multitude of benefits afforded by our microbial symbionts, developing alternative strategies to manage microbial ecosystems will enable us to promote short- and long-term public health priorities simultaneously (87). Listed here are a few examples of successes in using beneficial microbes to manage microbial ecosystems.

Sterility in skin-injury repair has been viewed as an important factor in effective wound healing. However, maintaining a sterile wound-healing environment is a difficult prospect considering the exposure of most wounds to the environment (88). Recent evidence suggests that populating wounds with commensal microbes can reduce infections after surgery and minimize the need for antibiotic treatment (89). Similar strategies are also being tested in treating skin conditions including atopic dermatitis (clinical trial NCT03018275) and acute wounds (90).

Health careassociated infections are pervasive in both high- and low-income countries and are a leading cause of death in the United States (91). Germicidal treatments of hospital surfaces are not completely effective, leaving behind dangerous pathogens, some of which can inhabit surfaces for months and also lead to increasing antibiotic resistance. The use of probiotic-containing cleaners can be an effective, alternative method to decontaminate hospital surfaces that does not select for antibiotic-resistant strains (92).

Concerns over increasing antibiotic resistance, consumption of antibiotic-laden meat, and antibiotic-induced reduction of natural resistance to pathogens have led to the exploration of alternatives to antibiotics in livestock. Probiotic use in chickens has resulted in better growth rates, reductions in pathogen load and antibiotic resistance genes, and improved egg quality (93, 94). Probiotics have also been used to prevent infections and improve milk production in dairy cows and to aid growth in beef cattle (95). Use of probiotics is also beneficial in aquaculture, improving water quality, resistance to pathogens, and growth (96).

There is growing evidence that the use of beneficial bacteria is a promising path forward for managing pathogenic microbes in humans (97). Probiotics can reduce the duration and severity of infectious diarrhea and may be an effective alternative to antibiotics in the treatment and prevention of bacterial vaginosis (98, 99). A synbiotic mixture of Lactobacillus plantarum and fructo-oligosaccharides reduced the incidence of sepsis and lowered rates of respiratory tract infection in a cohort of infants from rural India (100). The use of bacteriophage to control pathogens, especially those that are resistant to multiple antibiotics, is another emerging alternative with recent success (101).

Antibiotics are commonly used in cancer treatment to minimize the risk of infection in a patient population with a disrupted immune system. However, in animal models, antibiotic treatment can alter the microbiota in ways that reduce treatment efficacy (102, 103). In fact, specific manipulation of the microbiota improved immunotherapy-based tumor control in a mouse model of melanoma (102, 103). Optimization of the microbiota to optimize immune status, whether augmenting immunotherapy or enabling bone marrow transplantation, will likely be integral to the future treatment of diseases such as cancer.

Given newly acquired data about the importance of early microbiota assembly in the health of the infant, a rethinking of medicalized birth is warranted. A recent pilot study showed that infants delivered by C-section who were seeded with their mothers vaginal microbes developed microbiota more closely resembling those of vaginally delivered infants (104). Future studies are required to determine whether vaginal seeding after C-section delivery provides any lifelong health benefit to the infant.

Acknowledgments: We thank members of the Sonnenburg lab and collaborators for helpful discussions. Funding: This work was supported by the NIH (R01-DK085025 and DP1-AT00989201). J.L.S. is a Chan Zuckerberg Biohub Investigator. Competing interests: The authors declare no conflicts of interest.

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Vulnerability of the industrialized microbiota - Science Magazine

When a man in North Carolina was pulled over on suspicion of driving drunk, police didnt believe him when he said he hadnt had any alcohol.

The man, in his late 40s at the time, refused to take a breathalyzer test and was taken to a hospital, where his initial blood alcohol level was found to be 0.2% about 2.5 times the legal limit and the equivalent of consuming 10 drinks an hour. Despite the man swearing up and down that he hadnt had anything to drink, doctors didnt believe him either.

But researchers at Richmond University eventually discovered that the man was telling the truth. He wasnt downing beers or cocktails instead, there was yeast in his gut that was likely converting carbohydrates in the food he ate to alcohol.

In other words, his body was brewing beer.

The findings were reported in a study in BMJ Open Gastroenterology. The man, whose identity has not been revealed, had a rarely diagnosed medical condition called auto-brewery system (ABS), also known as gut fermentation syndrome.

Gut fermentation system occurs when yeast in the gastrointestinal tract causes the body to convert carbohydrates ingested through food into alcohol. The process typically takes place in the upper GI tract, which includes the stomach and the first part of the small intestine.

These patients have the exact same implications of alcoholism: the smell, the breath, drowsiness, gait changes, Fahad Malik, the studys lead author and the chief internal medicine resident at the University of Alabama at Birmingham, told CNN. They will present as someone whos intoxicated by alcohol, but the only difference here is that these patients can be treated by antifungal medications.

Things werent the same for the man after he completed a course of antibiotics to treat a thumb injury. His personality started to change, researchers wrote in the study, and he experienced episodes of depression, brain fog, memory loss and aggressive behavior that was out of character for him.

Three years later, after his suspected drunk driving arrest, the mans aunt bought a breathalyzer to record his alcohol levels. She had heard about a similar case that had been successfully treated by a doctor in Ohio and convinced her nephew to seek treatment there too.

His basic lab tests turned out normal. But doctors found two strains of yeast in his stool: Saccharomyces cerevisiae, a yeast commonly used in beer brewing, winemaking and baking, as well as another fungus.

The man was successfully treated at the Ohio clinic and told to stick to a strict carbohydrate-free diet along with some special supplements. But after a few weeks, his symptoms started to flare up again. This time, no treatment seemed to work despite visits to numerous medical professionals.

At one point, the man became so inebriated that he fell and experienced bleeding in his brain. He was taken to a neurosurgical center where he spontaneously recovered in 10 days, researchers said.

In this institution, his blood alcohol levels ranged from 50 to 400mg/dL, the researchers wrote. Here too, the medical staff refused to believe that he did not drink alcohol despite his persistent denials.

Finally, the man sought help from an online support group and got in touch with the researchers at Richmond University, who said in the study that they believed the antibiotics he took years ago altered his gut microbiome and allowed fungi to grow in his gastrointestinal tract.

The researchers then used antifungal therapies and probiotics to help normalize the bacteria in his gut, a treatment that he has continued. And aside from one relapse that occurred after he binged on pizza and soda without telling the researchers, it seems to be working.

And he can eat pizza again.

Approximately 1.5 years later, he remains asymptomatic and has resumed his previous lifestyle, including eating a normal diet while still checking his breath alcohol levels sporadically, the authors wrote in the study.

There have only been a few studies documenting cases of gut fermentation syndrome and the condition is rarely diagnosed, Malik said. In the past, its even been regarded as a myth.

Gut fermentation syndrome was described in 1912 as germ carbohydrate fermentation, and was studied in the 1930s and 1940s as a contributing factor to vitamin deficiencies and irritable bowel syndrome. A group of 20 to 30 cases popped up in Japan in the 1970s and the first US cases were reported about 10 years later.

There have been a handful of reported cases in recent years. A 2013 study described a case of a 61-year-old man who for years seemed to be drunk all the time before he was diagnosed with gut fermentation syndrome. In 2015, a woman in upstate New York had a DUI dismissed after presenting evidence that she had the condition.

The authors of the Richmond University study recommend that doctors investigate for the condition especially when a patient shows elevated blood alcohol levels despite denying that they consumed alcohol.

Early signs of gut fermentation syndrome can include mood changes, delirium and brain fog, the researchers wrote, even before a patient starts exhibiting symptoms of alcohol inebriation.

The study says more research should be done on the use of probiotics as a treatment for the condition.

This is a condition that is treatable with dietary modifications, appropriate antifungal therapy, and possibly probiotics, the researchers wrote. The use of probiotics and faecal microbiota transplantation could be considered for future studies.

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No one believed him when he said he hadnt been drinking. Then researchers found his body was producing alcohol - WTVR CBS 6 News

Looking for the best meal kit delivery service? It seems like the field of options, forhealthy eatingandconvenience, gets bigger with each passing month. But knowing the differences between all the options will help you make the best possible choices for your home meal kit needs.

Read more:Find the best wine clubs and subscriptions for your taste|The best vitamin subscription services

If you live anywhere where it's even a little bit possible to glimpse the stoops of your neighbors, you've probably noticed cheerful boxes from the likes ofFreshly,Home Chef,Sakara Life, Purple CarrotandGobblemaking ever more frequent appearances on said stoops over the last several years. The age of the meal kit food delivery service is upon us. It's a type of convenience service that combines the efforts of chefs, nutritionists and personal shoppers, and delivers them into the hands of enthusiastic eaters or willing home cooks, with weekly menus and delicious, preportioned fresh ingredients for you to easily prepare.

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I once met one of the founders of Blue Apron, whose delivery box I'd become familiar with, thanks to the denizens of my apartment building. I mentioned that I thought the service sounded like a cool idea, but inundated him with a litany of reasons why such a thing didn't apply to me: I work in an industry where tasty meals are often provided, I'm rarely home, I'm culinary school-trained and so on. His counterargument was flawless: "Can I send you a free box?" I mean, duh.

Despite my protestations, the reasons I enjoyed the meal plan were plenty, and inspired me to continue my subscription with an occasional box of ingredients. Even with culinary school cred, I liked having ingredients I didn't know of or would rarely seek out put directly into my hands. I was especially moved by the concept of getting provided the single rib of celery that a recipe demanded, sparing me the heartache of watching an entire head of celery languish in my produce drawer when left to my own devices.

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There are now dozens of meal kit delivery programs to choose from, like Sun Basket, Martha & Marley Spoon andPurple Carrot, with niche customizations, ingredients and menus to fit special diets like vegan gluten-free, vegetarian gluten-free, plain old gluten-free, paleo, low-carb, vegetarian pescatarian, keto, a plant-based diet and just about anything else. You'll also often find promotional offers for new customers and convenient features like being able to skip weeks and cancel anytime. With limited or no commitment, if you're a calendar master and an account-management ninja, you can dabble in any or all of these services and choose, week-by-week, which best suits your circumstances.

Note: CNET may get a share of revenue from the sale of the services featured on this page.

Special offer: $80 Off Home Chef: $20 Off Your First 4 Boxes with Code CNETHOMECHEF80

Home Chef boasts over 38 meal kits to choose from in any given week, including the all-new grill packs and one-pan dinners. Plus, you can customize the protein in your meal choices, which makes Home Chef dishes stand out from the pack. For example, with some Home Chef recipes, you can order double the protein without doubling the overall portions. With other Home Chef options, you can choose to order antibiotic-free protein instead of the standard version. Meal kits and ingredients are usually pretty standard in their offering (which is what keeps Home Chef efficient to the masses).

One new and unique offering from Home Chef is their oven-ready meals, which come with everything you'll need to make the meal including the cooking tray (no mess and no dishes). See an example of anoven-ready meal here.

Subscription: Starting at $7.99 per serving with additional premium Home Chef recipes offered at market price.

Blue Apron is largely accepted to be the granddad of meal kit delivery programs in the US. The eight menu choices available weekly range from simple pastas to delicious international options, with a seafood and vegetarian option always available. Even the simplest recipes might include an unfamiliar component or two, and the website often highlights these ingredients as an educational opportunity. Recipes are tagged with helpful keywords such as "customer favorite," "quick and easy," "great for grilling" and so on. Occasional promotions include a menu from guest celebrity chefs, or recipes that highlight popular travel destinations. An optional wine pairing service is also offered.

Subscription: Price per serving ranges from $7.49 to $9.99, with options to prepare two to four recipes per week and two or four servings per recipe.

Healthy and fresh are common favorite meal kit descriptors, but Sun Basket goes a step further. Sun Basket is committed to organic, non-GMO, sustainably and responsibly raised products and ingredients, which it packages in 100 percent recyclable materials to boot. Sun Basket's recipes are developed by Justine Kelly, a San Francisco chef known for her work at the James Beard Award-winning Slanted Door restaurant, and for her appearance on Top Chef. All of her easy and delicious meals with organic ingredients are nutritionist-approved (500 to 800 calories per serving), and most meals take only about 30 minutes to put together, with online Sun Basket tutorials available if you need a little extra guidance. You've got options too -- you'll be able to choose from a selection of six to 18 different organic meal recipes each week, including paleo, vegan meal, vegetarian and gluten free meals, so you'll always get what you want. Sun Basket delivery is available in 36 states, and Sun Basket shipments arrive on Tuesdays and Wednesdays between 8 a.m. and 9 p.m. For three Sun Basket meals each week, you'll pay $74.93 for the two-person plan (or $11.99 per serving) and $143.87 for the four-person plan ($10.99 per serving), with a $5.99 shipping fee either way.

Subscription: For three Sun Basket meals each week, you'll pay $74.93 for the two-person plan (or the $11.99 price per serving) and $143.87 for the four-person Sun Basket plan ($10.99 per serving), with a $5.99 shipping fee either way.

At just $4.99 per serving and with an emphasis on delicious, hearty meal options and generous portion sizes, EveryPlate is the best plan for those whose journey into meal kit delivery is based on affordability. It keeps its overhead low by offering eight easy recipes to choose from weekly, which does mostly exclude vegetarians and those on special diets, but the eight available meals are full of variety and flavor otherwise. Get 18 meals for only $3.33 each, free shipping on your first order, plus the ability to skip or cancel anytime.

Subscription:Each serving is only $4.99. Each weekly box includes three recipes with either two or four servings apiece.

Dinnerly rolls out some pretty exciting-sounding and delicious meals such as summery chicken panzanella and risotto with asparagus and cannellini beans. But with no more than six ingredients per recipe, the damage done to your time and kitchen is minimized. Along with not overwhelming you with myriad ingredients and multiple steps, the price tag for Dinnerly puts it squarely in the budget-friendly category, clocking in with a cost per serving of around $5.

Subscription: The options include a Two-Person Box for $30, or a Family Box for $60, each with three recipes for the week.

With a whopping 20 weekly recipes to choose from, including a couple of dessert options, the very name Plated inspires fantasies ofPadma Lakshmistanding over your kitchen table sampling forkfuls of chef-designed recipes whose components you might have had to practice pronouncing. That being said, relative ease is still largely the point, and sustainable and thoughtfully sourced ingredients are emphasized.

Subscription:Options range from $9.95 to $11.95 per serving, with options for two to four recipes per week and two to four servings per recipe.

Gobble takes the template from the old guard of meal delivery kits but speeds it up by prechopping and part-cooking many of the components so that all recipes have a prep time of 15 minutes or less. Despite the "fast food" angle, each menu has a sophisticated and worldly vibe. Weekly recipe choices are cleverly categorized into From the Range, From the Ranch, From the Sea and From the Earth options.

Subscription: Options range from $11.99 to $13.99 per serving, with options for two to four servings of two or three (or more!) recipes.

A few of these services provide fully cooked prepared meals to your doorstep, and Freshly is a good one if you desire wholesome, tasty comfort foods such as peppercorn steak, penne bolognese or chicken and rice pilaf. Meals are prepared right before delivery and are never frozen. With minimal reheating required by you, it's like having Mom cook dinner for you in your kitchen, without having Mom live with you. (Sorry, Mom.)

Subscription: $8.99 to $12.50 per serving, with up to 12 servings per week. Shipping is free.

We like Green Chef for its versatility in the different specific diet plans available. Green Chef offers paleo, keto, pescatarian, vegan, and vegetarian options as well as gluten-free meals. No matter which diet you're following (for health or personal reasons) you'll be able to find a Green Chef plan that works for you. Because it offers so many different diet plan choices, this also makes Green Chef one of the most versatile meal kit delivery services since you get a plethora of different tasty menu options per week.

Subscription: $12.99-$11.99 per serving for a two-person Green Chef subscription at three meals/week; $10.99 per serving for a four-person Green Chef subscription at two meals/week.

HelloFresh helpfully tags each recipe accordingly, whether you are allergic to (or avoiding) dairy, gluten, soy, nuts and so on. Familiarity of ingredients is key, even when applied to dishes from various world cuisines. A "dinner to lunch" element is a unique twist that provides the home cook a variation on tonight's dinner to serve as a tasty portable lunch tomorrow.

Subscription: Options range from $8.74 to $9.99 per serving, with options for two to four recipes per week and two or four servings per recipe, customizable along Classic, Veggie and Family plans.

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SHE may be 50 but Jennifer Aniston has the body of a woman half her age.

And the Friends star, who made her debut on Instagram last week, has now revealed the secret behind her fantastic figure - intermittent fasting.

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Jen says she uses the 16:8 fasting diet, which means she eats for eight hours of the day, while fasting for the remaining 16 hours.

She said: "I do intermittent fasting, so no food in the morning.

"I noticed a big difference in going without solid food for 16 hours."

Studies say the diet will help shed the pounds without causing you to starve yourself.

4

Researchers found that those who followed the time-restricted eating diet consumed fewer calories, lost weight and had improvements in blood pressure.

It is also said to help reduce the risk of cancer and heart disease, lower cortisol levels (ie. eliminate stress) and reduce inflammation.

Jen previously admitted that she also likes to stayin shape with daily yoga, boxing, cardio and meditation sessions.

I do intermittent fasting, so no food in the morning. I noticed a big difference in going without solid food for 16 hours

She said:"I feel really beautiful when I finish a great workout.

"Because I've taken care of my body, my endorphins are going, my blood is pumping. I'm taking care of the one body I have.

"I have a spin bike, an elliptical bike and a treadmill and I do cardio for at least 20 minutes a day. Even that short burst makes a difference.

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"Of course I take days off. It's important to rest the body.

"I can go a whole week saying, 'I'm not going to work out'. Your body will tell you what it needs."

However, she says the key to staying in shape is happiness.

She added: "It's hard work, you know. You work out, you just take care of yourself and you exercise.

What is the 16:8 diet?

The 16:8 diet allows you to eat for eight hours of the day, while fasting for the remaining 16 hours.

Known as intermittent fasting, it is believed to be one of most popular dieting plans out there at the moment, and appears to be effective for most dieters.

It helps to keep to a healthy diet for the eight hours you can eat so as to get the most out of the plan.

The diet stems from the book 8 Hour Diet by author David Zinczenko and editor-in-chief of Mens Health Peter Moore.

They suggest that a longer fasting time between eating gives the body the time it needs to process the food and burn away extra fat stores.

This diet doesnt suggest you cram all your food into an eight-hour window.

Instead, it encourages the consumption of balanced foods that can burn fat and boost overall health.

Experts suggest dieters opt for lean meat, eggs, dairy, vegetables, nuts and beans each day during their eight hour window.

For the remaining 16 hours, dieters can consumer water, tea and coffee.

"You eat right, you sleep, you're happy.

"Happiness is the big key. My dad is 100 per cent Greek, he barely has a wrinkle.

"Neither did my grandmother, who was 95 when she died. My life is a happy life. It's a choice."

Jenniferused to moan that her bum wobbled, saying it "has a tendency to go right and left and I'd like it to go up".

But after hitting her half century, she has stopped putting so much pressure on herself and learned to love her body.

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She says: "When we're kids, we are constantly working out for smaller arms, a leaner butt, a flat tummy. Let it be. I can be a little soft."

Jen made the revelation about her 16:8 diet while speaking to Radio Times, alongside her The Morning Show co-star Reese Witherspoon.

And Reese admitted she turns to Jen for advice on health and fitness.

She added: "I just have a green juice and a coffee in the morning.

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"Jen knows so much about health and fitness that I always defer to her. Shes great at wellbeing advice."

Jen, who is best known for playing Rachel Green in Friends, managed to crash Instagram last week as she racked up 6.9million followers in less than 24 hours.

And the TV favourite, who has only uploaded four posts so far, now has a staggering 15.5million followers.

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Weight loss: Jennifer Aniston reveals intermittent fasting is key to her incredible figure at 50 - The Irish Sun

What if the secret to dieting is not to diet at all?

Thats the premise of several dieting books that have hit the shelves in 2019. Caroline Dooners bestselling The F*ck It Diet, Laura Thomass Just Eat It, Jenna Hollensteins Eat to Love, and celebrated Food Psych podcast host Christy Harrisons forthcoming Anti-Diet all boast bright, simple covers and carry similar messages: that diets are damaging and even toxic to our bodies and minds, and that if we really want to take back ownership of our bodies, the only way out is to dispose of dieting altogether. The answer, according to these authors, is something called intuitive eating. And you dont need a health shake, a meal plan, a fitness routine, or even a calorie-counting app to make it work. You simply need to listen to your bodys own natural hunger and fullness cues.

If you think that idea sounds too good to be true, youre not alone in your skepticism. Despite the boom of anti-diet dieting, 2019 has also been the year of keto, celebrities like Reese Witherspoon and Jennifer Aniston swear by intermittent fasting, and you need look no further than Instagram to find physical trainers who swear by paleo or parents who proudly caption images of the meals they prepare for their families with #whole30mom. Thanks to social media platforms like Facebook and Twitter, ridiculous menus like Helen Gurley Browns wine and egg diet that Vogue published in the 1970s can go viral.

But even if diet culture remains alive and well, the rising popularity of books that advocate abandoning your diet makes one thing clear: Consumers who are fed up with chronic dieting may be hungry for a revolution. The same social media platforms that can be used to spread diets are now becoming a space where people recommend intuitive eating-friendly podcasts like Food Psych, form supportive Intuitive Eating Facebook groups, and circulate cheerful illustrations like the one of intuitive eating (IE) cofounder Evelyn Tribole declaring that food is not a moral issue.

Radical as it may be, ditching diet culture isnt actually such a new idea. The founders of the intuitive eating movement, Elyse Resch and Evelyn Tribole, published the first edition of their book Intuitive Eating: A Revolutionary Program That Works over two decades ago, in 1995. According to Resch, she and Tribole were both registered dieticians who shared an office space. They were each working on their own separate writing projects, and when they realized their ideas overlapped, they decided to join forces. Their bookwhich has since spawned second, third, and fourth editions, and most recently the Intuitive Eating Workbook for Teenswas born.

Resch told the Daily Dot that she thinks the current spike in interest in intuitive eating is thanks in part to the Me Too movement. She explained: The #MeToo movement has [spread] the idea that our bodies are not to be controlled by other people, and I think that there is a correlation between women finally starting to stand up for themselves and not being physically or sexually abused [and saying no to diet culture]. I think that dieting is abusive and weight stigma is abusive.

Reschs hypothesis may not be such a big logical leap. Its no secret that diet culture teaches us our bodies need to be restricted and controlled. So, in an era when women are saying theyre tired of having to fight for ownership of their bodies, it follows that wed see a departure from traditional diet culture.

Just as women employed social media to create a collective swell of voices for Me Too, the new leaders of intuitive eating and their followers are vocal and passionate about sharing their dieting discoveries online. Likewise, though the aims of intuitive eatings founders and its followers may be noble, the attention-seeking world of social media often muddies messages and warps images. The internet may be spreading the good word of intuitive eating, but its also spreading a new aspirational image of what freedom from dieting looks like. And its one that may not always be so healthy.

Intuitive eating founder Evelyn Tribole is grateful for the advances of social media. Im thrilled at how much attention its getting, she told the Daily Dot. Facebook groups like Intuitive Eating for Beginners boast nearly 5,000 members. The Intuitive Eating and Body Love Support Group has over 6,000 members. And that influence has spilled over into the professional realm. We now have over 900 professionals who are certified and trained in [intuitive eating] in 23 countries, Tribole said. Meanwhile, over on Instagram, there are over 1.1 million posts hashtagged #intuitiveeating. I couldnt believe how many donuts I saw! Evelyn Tribole said, laughing as she scrolled through the hashtag recently. The enthusiastic posting of cakes, pizzas, and burgers tickled her. Its like, oh my God, people get excited about what they can eat!

Perhaps more so than #MeToo, intuitive eatings online evolution mirrors the complications of the #BodyPositivity movement. Many have critiqued body positivity posts where thin women in skimpy clothing wax poetic about embracing the skin theyre in. The effect can be othering: Instead of creating the feelings of inclusion that the body positivity movement originally intended to evoke, anyone with a less than perfect figure is reminded that there is a hierarchy of which bodies are deemed beautiful and lovable and which are seen as less than. While there are largely image-free forumslike an intuitive eating subreddit where one can learn about intuitive eating without being inundated with aspirational images of thin women learning to love themselvesscroll through Instagram, and youll likely notice a distinct pattern.

Much like influencers post glam shots of the views from their hotel rooms, influential intuitive eaters post boastful images of all the indulgent treats they get to eat. Consider, for example, a picture intuitive eating coach Alissa Rumsey recently shared with her 22,000 followers of herself eating a chocolate-dipped key lime pie.

Rumseys caption reflects on rejecting traditional beauty standards, explaining that she prefers joy. Rumsey later edited the post to acknowledge her thin privilege after a follower called her out, but scroll down further, and youll see that the same post is promoting an online course called Body Image Reboot. According to Rumseys website, nutrition coaching starts at $299 a month, includes a 75-minute initial consultation, two 35-minute follow up sessions per month, copies of Intuitive Eating and the Intuitive Eating Workbook, weekly intuitive eating journal reviews and feedback, and unlimited email support.

Similarly, Claudia Felty, a non-diet dietician with over 50,000 followers, often posts split-screen images of truths and myths about the foods we deem healthy and unhealthy. In many posts, she shares images of herself feigning misery while dieting alongside herself grinning while not dieting. In one post, she holds a bowl of chocolates while grimacing anxiously under the label silly. Under the smart alternative, Felty smiles as she lifts a chocolate to her lips.

The posts illustrate what makes intuitive eating so enticingand what makes it so confusing. IE coaches insist that they arent here to help you lose weight, but its impossible to disentangle any diet, even one where you avoid dieting, from issues of body image. After all, diets are sold to us as a way to shrink our bodies to a more ideal size. And, since so many of the women marketing intuitive eating today are doing so in very small bodieswhile eating sugary, fatty, or high-carb foods like cake and pizzaits hard to imagine that its popularity isnt also thanks to the highly Instagrammable ideal that it promises its clients. Intuitive eating seems to be saying you can have your cake and eat it, too.

So what is intuitive eating, really? Traditionally, the operating principle of diets is restriction. There are things you cannot eat in certain quantities for a specified period of time. Intuitive eating turns that principle on its head. All food is allowed, there is no portion-sizing, no calorie-counting, and there are no windows of time when eating is forbidden. You eat, quite simply, when you are hungry until you arent hungry anymore. And eating when you arent hungry is allowed, too. The idea isnt to eat donuts for every meal, nor is it to stick to leafy greens every day, but rather to make room for all kinds of food and to eat according to what your body is actually asking fora simple, but often challenging task for anyone whos spent years ignoring her bodys signals.

In fact, intuitive eating is so deceptively simple that it can easily be warped into a tool for dieting. If you do a cursory search of Instagram for intuitive eating coaches, youll find women who call themselves intuitive eating experts who also say theyll teach you how to lose weight. According to Resch, anyone who advertises such a service is perverting the true message of intuitive eating. Intuitive eating is about radical acceptance, she said, and she cautioned against anyone who presents intuitive eating as a tool for intentionally changing your body size.

Resch did, however, note that over the years she and Tribole have had to edit out weight-focused language to clarify their message. We were not as evolved as we thought, she explained. We thought we were doing this really great thingit was a non-diet approach, it was making peace with foodbut there was an agenda, probably for some people, of if you tune into your signals, youll get to a better body weight. A lot of people thought that.

Author of The F*ck It Diet, Caroline Dooner, recalls that when she first read Intuitive Eating, she misinterpreted its message. I read it when I was 18 years old and had seriously disordered eating, but had no idea that I did So I interpreted it as a way to lose weight. [I thought] it was supposed to be about listening [to your body] so closely that you eat the smallest possible amount. Dooner explained that she rediscovered the principles of what she now recognizes as intuitive eating through many years of blogging and personal research. In a quest to understand her own complicated relationship with food, Dooner began blogging anonymously on her website, the F*ck It Diet, around 2012.

I was writing about it and it was really scary to me because it was so new, Dooner said. Dooner had pursued acting and found herself constantly obsessing over maintaining or reducing her weight.

It was only when she started to read about the Health At Every Size movement that she realized that, The scapegoating of weight can put us in a tumultuous relationship with food. According to the Association for Size Diversity and Health, the principles of Health at Every Size are weight inclusivity, health enhancement, respectful care, eating for wellbeing, and life-enhancing movement. In other words, anyone at any size can pursue health through nutrition, care, and movement, with allowance for personal choices and without the goal of altering their body size. While there is no formal relationship between HAES and intuitive eating, the movements are often uttered in the same breath because of their shared body acceptance philosophies.

Although Dooner identifies neither as a dietician nor a scientist, she felt compelled to write about her journey. What I am is a communicator and a writer. I felt comfortable to share the information [I was learning] and infusing it with humor. She eventually began working as a life and nutritional coach. When she turned her blog into a book, she said she was inspired to share the emotional message she, personally, had been longing to hear. Intuitive Eating has a wonderful message, but I couldnt hear it from that book. According to Dooner, the aggressive and funny language in her book is based on a desire to connect with the more emotional aspects of the challenges of making peace with food.

One of the big emotions Dooner mentioned repeatedly was fear. People are scared of how hungry they are I needed someone to tell me that [hunger] is normal. It actually makes sense if we reframe it.

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Brooklyn, New York-based social worker Caitlin Steitzer practices the principles of intuitive eating with her clients, but she said she, too, has found that language is crucial to getting her message across. She has also found that choosing the wrong words may even deter clients who might benefit from the principles of intuitive eating. Last winter, Steitzer started an intuitive eating support group in Bay Ridge, Brooklyn. When I called the group an intuitive eating group, no one signed up, said Steitzer. So I changed the name to Overcoming Emotional Eating and suddenly so many people were interested.

Rachel Coleman, a personal assistant based in Brooklyn, found intuitive eating through the recommendations of other women online. Coleman, who said she struggled with disordered eating in high school, had recently gotten engaged. [In the past] I had lost a bunch of weight successfully on Weight Watchers and then worked for them, which was a nightmare, she said. Having had a terrible experience, Coleman had quit Weight Watchers, but with her wedding approaching, she found herself feeling pressure to rejoin their program. I consider myself very feminist and anti-captialist and all that and I was like, Its bullshit that people have to lose weight for their weddings. But then I found myself rejoining Weight Watchers because I was paranoid that if I didnt have a bunch of rules, I wasnt going to fit into my dress. That was my diet bottom. When she turned to her Facebook groups for guidance, podcasts like Food Psych and books like Intuitive Eating and The F*ck It Diet came highly recommended.

Excited by these new ideas, Coleman began posting pictures of her anti-diet journey on Instagram and captioning them with hashtags like #thefuckitdiet, #antidiet, and #antidietbride. At first, Coleman said, she marveled at her own bravery. But she soon came to realize that she had been ignorant of her privilege. When I made the decision that I wasnt going to lose weight for the wedding, I was like, Oh my God, Im an activist! This is incredible! But then within a few months I had to realize that my body is not the [most] important body in the conversation.

For Coleman, who describes herself as being in a medium-sized body, listening to Harrison interview diverse guests on the Food Psych podcast has been instrumental in raising her awareness about fatphobia and fat activism. The social justice component has become huge to me. My eyes are open to the fat phobia of the world and I cant stand idly by anymore. At first, I wanted to have peace and now I feel like I can never diet again because if I do Im playing into white supremacy.

The argument that diet culture is racist has been gaining traction in the wellness community in recent years. Possibly the most in-depth look at this theory is Sabrina Strings Fearing the Black Body: The Racial Origins of Fat Phobia. Strings, who explained her research on an episode of Food Psych earlier this year, traces the roots of diet culture as far back as the 18th century, when fatness was derided as evidence of African savagery and immorality. Slenderness, by contrast was considered evidence of Christian elevation and Anglo-saxon superiority. To put it more plainly, Strings research shows that fatphobia was never really rooted in science, or even nobler aims of improving health, so much as it was about categorizing bodies and races as superior or inferior.

In the early days of The F*ck It Diet blog, Dooner discovered that she wasnt the only nontraditional researcher in the world of intuitive eating. Comedian Margaret Cho had blogged about her own version of the fuck-it diet in 2003. Cho also did a bit about her diet onstage.

In the bit, Cho describes a process of going within as she contemplates whether or not to eat food. She inhales deeply before saying Ah, fuck it! and pantomimes eating the food anyway. Its a hilarious bit, but its impossible to ignore the fact that while she tell it, Cho looks remarkably slender. On her blog, Cho explains in earnest that she had been asked the secret to her recent weight loss. But, she says, the secret was that there was no secret. She had quit chronic dieting and it had, temporarily, led to weight gain, but it had also eventually led to a better relationship with food, which ultimately caused her to lose a significant amount of weight.

Chos anecdote points to the deceptive allure of intuitive eating. While its founders and many of its modern leaders insist that the goal of intuitive eating should never be weight loss, its impossible to overlook the fact that the most visible women preaching this message today happen to be pretty, white, and very thin. Would the public be as receptive to their messages if they werent? Or, perhaps more importantly, would a publisher even consider such ideas marketable enough to offer a book deal if the woman pitching them was a woman of color in a larger body?

Dooner acknowledges that her privilege is real. For now, she has chosen to not use her image as much as possible. Her books cover is simply its title in splashy colorful letters across a black background. In addition to being aware of how she markets her book, Dooner said, I think its just important for me to never claim to be an authority on the fat experience or fat politics because that is really something I need to defer to other people and their experience.

Kara Loewentheil, a body-positive life coach and host of the Unf*ck Your Brain podcast, practices intuitive eating. But she struggled with it for years before getting to a place of greater comfort. She reflected that initially, the appearance of her own intuitive eating coach, Jenna Hollenstein, both attracted her to the program and made her feel as though intuitive eating might not work for her. I for sure felt conflicted, Loewentheil said. I could feel the power of what she was teaching me, but my brain was like, OK but when you stopped restricting, you ended up smaller than Ive ever been, even when I was starving myself.

According to Loewentheil, it took years of her own thought-work to get more comfortable with the principles of Health at Every Size and intuitive eating. And while she acknowledges that the mainstream images of the intuitive eating movement are thin white women, she doesnt anticipate that it will always be that way. Said Loewentheil, We need messengers of all shapes and sizes and appearances. I benefit from white privilege, Im hourglass-shaped and femmey, but Im for sure fat and I do have a successful coaching business. Part of it is the bias in the public and some of it is the book publishing bias. I believed I couldnt be a fat life coach for years until I changed that thought, and now Ive found the opposite to be true.

In episode 190 of the Food Psych podcast, Christy Harrison interviews Caroline Dooner for the third time. Over the course of the episode, Dooner and Harrison marvel at how much their lives have changed since their first conversation over four years ago. At one point Dooner laughs, I feel like a different person! The conversation feels authentic, but it points to what, perhaps, the new wave of Intuitive Eating books and coaches are selling us: the promise of transformation. Even if we are no longer being sold the idea that we need to change our bodies to be happy, its possible to pin a new, idealistic, and equally unattainable fantasy onto this shifted model of wellness.

According to Resch, however, the key to intuitive eating isnt focusing on altering yourself or your life. Its centering feelings of satisfaction. Resch, who is now in her 70s, called eating one of the greatest pleasures in life. She added, When youre having a meal and your taste buds are bursting and it looks great and smells greatits a wonderful experience. I think we have to accept that this is one of our rights to have pleasure. And I think intuitive eating brings you to that pleasure.

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The hottest diet of 2019 is the one where you dont diet - The Daily Dot

A recent review searches for links between dietary choices and prostate cancer. The authors conclude that there may be an association between plant based diets and a decreased risk of prostate cancer, as well as a link between dairy intake and increased risk.

According to the National Cancer Institute, there will be an estimated 174,650 new cases of prostate cancer in the United States this year.

In the U.S., about 11.6% of men will receive a diagnosis of prostate cancer at some point during their lifetime.

As with other types of cancer, scientists are still uncovering the full range of risk factors for prostate cancer.

Some scientists have turned to nutrition, but for various reasons measuring the effect of the diet on disease is notoriously difficult. As one example, food intake can fluctuate wildly from day to day, month to month, and year to year.

Also, certain dietary habits tend to tie in with lifestyle factors that influence health. For instance, someone who exercises regularly is also generally more likely to eat healthfully. These associations make it difficult to unpick whether it is lifestyle, diet, or both that have a protective effect.

For these reasons and many more, studies investigating the links between prostate cancer and diet have produced conflicting results.

Recently, researchers from Mayo Clinic in Rochester, MN, carried out an extensive literature review in an effort to cut through the noise. They published their findings in The Journal of the American Osteopathic Association.

According to the authors of the latest study, there is some circumstantial evidence that diet might influence prostate cancer risk.

They note that Western countries have much higher levels of prostate cancer than Asian countries, where people consume much lower levels of dairy.

Also, they explain that "decreasing mortality rates in the U.S. for several common cancers, including [prostate cancer], coincides with decreased meat and dairy intake and increased plant based food consumption."

Of course, these correlations do not prove that dietary choices can influence prostate cancer risk. As the authors explain, the decrease in the mortality rates of cancer might be, at least partly, thanks to improved cancer screening and treatment. However, they believe that these correlations merit further scrutiny.

To investigate, they carried out a review of relevant studies that researchers published between 2006 and 2017. In all, they examined 47 studies, which included more than 1 million participants. The authors outline their overall findings:

"Most studies showed that plant based foods are associated with either decreased or unchanged risk of [prostate cancer], whereas animal based foods, particularly dairy products, are associated with either increased or unchanged risk of [prostate cancer]."

The authors found neither an increase nor a decrease in prostate cancer risk in studies that assessed red meat, white meat, processed meat, or fish intake.

In short, even with access to an impressive quantity of data, uncovering solid links between diet and cancer is still challenging.

With that said, the authors believe that the potential increase in risk relating to dairy is worth investigating further.

"Our review highlighted a cause for concern with high consumption of dairy products. The findings also support a growing body of evidence on the potential benefits of plant based diets."

Lead author Dr. John Shin

With any study, there are limitations. Firstly, the authors explain that they were not able to carry out a meta-analysis because the studies were so different from each other that it was not possible to compare them.

The authors also remind us that association does not prove causation, writing that "epidemiologic data cannot prove causation, so any change in risk for [prostate cancer] is by association and subject to confounding factors."

Another issue that haunts most observational nutrition studies is dietary recall. When participants have to report what they have consumed in the past days, weeks, or months, they are likely to make errors or, perhaps, even massage the truth.

Similarly, prostate cancer does not occur until later in life, which brings further confusion. It is unclear whether an individual's current diet influences prostate cancer risk as much as their diet 10, 20, or 30 years earlier.

Overall, the authors conclude that "despite the [...] discordant conclusions found in the literature, our review shows that, in general, plant based foods may be associated with a decreased risk of [prostate cancer], whereas dairy products may be associated with an increased risk of [prostate cancer]."

If nothing else, this review demonstrates the substantial difficulties of studying the effects of the diet on health. In their paper, the authors explain that one of the "biggest obstacles in the field of dietary research is the lack of standardized methods for capturing and reporting diet and lifestyle data."

Without standardization, it is difficult to compare the results of one study with those of another, as well as to replicate the findings.

Currently, the topic of nutrition and health is popular among both scientists and the public. This subject is of vital importance as obesity and diabetes become increasingly prevalent.

Food clearly plays a role in health, but when questions become specific such as whether a particular food influences a specific condition it becomes much more challenging to demonstrate causation. No doubt, more investigations will follow.

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Prostate cancer: Investigating the impact of diet - Medical News Today

By Ruby Prosser Scully

Eleonora Festari / EyeEm/Getty Images

Eating too much salt may lead to cognitive impairment, and now scientists may know why. It kicks off an immune response that causes the build-up of a protein that stops brain cells from working properly.

Scientists have long known that a high-salt diet increases the risk of stroke. It was first thought that salt led to high blood pressure, which damaged the brain, but recent research shows that too much salt can cause problems even among those with normal blood pressure.

Costantino Iadecola at Weill Cornell Medicine in New York and his colleagues wanted to find out why salt itself appears to be harmful to the brain.

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To do so, they fed mice a diet containing between eight and 16 times the normal amount of salt, then had them perform cognitive tests. After two months on this diet, the mice were unable to recognise new objects they were presented with and were much slower at finding their way out of a maze than those on a normal diet.

Initially the team believed that excess salt was reaching the brain and causing damage there. However, an analysis of brain tissue suggested something else was going on. In the brain tissue, the team found a build-up of tau, a protein linked to Alzheimers disease.

The researchers think they know why the tau began accumulating. They found that the high-salt diet also increased the number of immune system T-cells in the gut. These cells produce small chemical messengers that travels to blood vessels in the brain, where they reduce the production of nitric oxide.

Lower levels of nitric oxide in the brain led to reduced blood flow and also increased the activity of an enzyme in brain cells called CDK5. It is this enzyme that prompts the build-up of tau proteins.

When Iadecola and his colleagues restored nitric oxide production in the mice, their cognitive ability improved. Similarly, mice bred without the ability to produce tau protein, or those who were treated with anti-tau antibodies, exhibited no cognitive impairment.

This indicates that there is a causal link between dietary salt, blood vessel dysfunction in the brain and problems with tau production in the brain.

The new study also challenges the idea that lower blood flow to the brain can trigger dementia, because the research shows that counteracting tau reverses the dementia even if blood flow is still low, says Iadecola.

Journal reference: Nature, DOI: 10.1038/s41586-019-1688-z

Read more: High blood pressure in older people linked to Alzheimers disease

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Mice fed a high salt diet lose the ability to perform simple tasks - New Scientist News

Eating for two isnt just the mother-to-bes job anymore. A new study has found that the quality of a father-to-bes diet influences the long-term cardiovascular health of the child.

Researchers at the University of Nottinghams School of Medicine conducted an experiment on mice. They fed male mice with poor quality low protein diet and found that the offsprings had impaired blood vessel functioning which is a key indicator of cardiovascular diseases.

Previous researches have made it evident that maternal diet and health during conception impact the development of the fetus and can also result in cardiovascular dysfunction and metabolic diseases later in life. But there have been hardly any studies that look into the impact of a paternal diet and well-being and the effects it can have on the offsprings heart health.

This new study seems to bridge the gap in our understanding by using an animal model that has explored the long-term heart health of offsprings from male mice that had consumed a poor quality low protein diet.

The researchers had fed such a diet to the mice for about 7 weeks prior to conception. Their findings suggested that the poor quality diet might have altered the genetic information carried by the sperm which could have possibly changed the way blood vessels formed in the developing embryo and thereby influenced its cardiovascular health. They also found that the seminal plasma (the fluid the sperms get carried in) also affected the offsprings heart health.

"Our findings indicate that a poor quality paternal low-protein diet may have altered the genetic information carried in the sperm or the composition of the seminal plasma. Our study shows that a father's diet at the time of conception may affect how the blood vessels form, which then leads to permanent changes in how the blood vessels work, resulting in 'programmed cardiovascular ill-health in his offspring said the studys lead author Dr Adam Watkins (Assistant Professor in Reproductive Biology, University of Nottinghams School of Medicine), "These findings are significant for people's health, as it shows that some conditions are attributed to a disturbance in early development processes which can be affected by a father's diet."

A vegetarian diet could do wonders for your intenstinal flora. The prebiotics in vegetables encourage your stomach to produce more beneficial bacteria. Photo: silviarita / Pixabay

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Dad-to-be's Diet Could Affect Long-Term Heart Health Of His Child - International Business Times

Based on the candles on her last birthday cake, Kelly Ripa is 49 years old. However, there is a lot of convincing photographic evidence that she's defying aging. And that's not the only proof. The Live With Kelly And Ryan host recently took the Epigenetic Aging and Stress test and discovered her biological age is 35. That shaves a full 14 years off. But wait, is that really possible?

Well, Kelly's personal nutritionist Dr. Daryl Gioffre shared exactly what that number means. "The Epigenetic test is basically a state-of-the-art technology that measures how your brain and nervous system are functioning, because ultimately that is what controls and coordinates your entire health," Gioffre told People.

"It measures how you eat, how you think, how you move your body, how you handle stress," he continued. "It looks at your energy indexKelly had one of the highest numbers Ive ever seen."

Gioffre also explained how the talk show host is still living in her 30s. For one, she prioritizes fitness. Kelly's routine includes running, SoulCycle classes, and the AKT method's cardio-strength classes. She has trained for years with AKT's founder Anna Kaiser, and Kelly has the ripped arms to prove it.

Kelly's diet also helps her defy the aging process. Gioffre, who founded the alkaline wellness plan Alkamind and wrote Get Off Your Acid, guides her on a plant-based, alkaline diet.

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"She lives 80/20, so 80 percent of the food she puts into her body are alkaline to the body," Gioffre told the publication. "Things like dark green leafy vegetables, lots of salads, lots of soups, lots of smoothies."

That's not all. Kelly also takes anti-inflammatory supplements, including Omega 3 fish oil, black cumin seed oil, and turmeric. Plus, she drinks Alkamind Daily Greens every morning and Alkamind Daily Minerals during her workouts.

"Why is she so energetic and smiling? Because health equals energy," Gioffre told the publication. "She works as hard on her health as she does on the show she probably [works] harder than anyone I know."

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Kelly Ripa's 'Biological Age' Is Actually 35, Thanks To Her Workouts And Plant-Based, Alkaline Diet - Women's Health

More than half of 1,500 people dealing with IBS or other gastrointestinal issues who recently responded to a survey about their experiences reported waiting a year or more to seek help with 21% taking more than six years to find symptom relief in large part because they were embarrassed to discuss their symptoms.

In fact, 58% of millennials surveyed said they were too embarrassed to share their struggles with food, 39% worried they would be judged for their digestive discomfort and 25% didnt think people would believe them, according to the survey, which was conducted by Fody Food Co.

Steven Singer, the CEO and founder of the company, which makes pantry staples and comfort foods without the common ingredients that can trigger gastrointestinal issues, believes that encouraging consumers to talk about their experiences will help them feel less anxious and more empowered to find solutions that allow them to live their lives to the fullest.

In this episode of FoodNavigator-USA's Soup-To-Nuts Podcast, Singer discusses the broad reach of gastrointestinal issues in America, how they impact individuals and how products, like his, that comply with the low-FODMAP diet can help. He also shares advice for other entrepreneurs navigating diet trends based on his experience at Fody and previously as the founder of the gluten-free trailblazing brand Glutino.

[Editors Note: Dont miss a single episode of FoodNavigator-USAs Soup-To-Nuts podcast. Subscribe on iTunes.]

According to the survey conducted by Fody, gastrointestinal distress can have a wide-ranging negative impact on everyday life for those who suffer from it.

The survey found nearly three-quarters of those who manage digestive discomfort struggle with everyday routines with one in three regularly showing up to work late and two-thirds of those younger than 24 years arriving to school late due to their symptoms.

In addition, it found 72% of people suffering from IBS or other digestive issues avoid eating at restaurants, 47% were unable to hang out with friends, 27% didnt want to go on a vacation and 16% were late to a significant occasion or milestone.

On the bright side, three-quarters also reported that following a low-FODMAP diet can provide complete symptom relief, which is where Singer says Fody Food Co. fits in.

One in seven Americans cant eat many, many different foods and ingredients across menus or grocery store aisles, and basic foods like garlic, like onion, like honey, like pistachios and cashews and apples and watermelon, but Fody can help with the hard work of identifying triggers by making foods without ingredients that commonly lead to symptoms, he said.

One of the key certifications that Fody earns for each of its products comes from the Monash University in Australia and signifies that the food complies with the low-FODMAP diet, which Singer explains researchers at the university created as way to identify and manage many digestive issues.

The diet is a way to identify food intolerances by breaking ingredients into different categories of short chain carbohydrates that are difficult for the body to absorb and which make up the FODMAP acronym. These include fermentable oligo-, di-, mono-saccharides and polyols. All foods falling into these categories are initially eliminated and slowly reintroduced with sufficient time to uncover any reactions.

While the low-FODMAP diet may be effective, it isnt easy to follow even with the recommended help of a healthcare professional or dietitian because so many of the potential triggers are ubiquitous in the American diet and finding options without them is difficult.

I think what Fody loves to do for people is say, Hey, we will cover you. We have the pasta sauce so you can have a plate of pasta or we have the barbeque sauce so you can still have your meats and chicken and fish. You can have a Caesar salad, but use our vegan garlic-free, onion-free Caesar dressing. You can still have fries with ketchup, but guess what, you are going to have the Fody delicious ketchup instead of some of the other household name brands, Singer said.

Even though the low-FODMAP diet is designed as a temporary elimination diet, Singer believes that once consumers with a history of digestive distress discover the brand they will remain loyal.

Most of these people have been suffering for a long time and when they find a sauce they like that makes them feel or doesnt make them feel discomfort, they are not running back they are happy they feel better, he said.

Singer also says that Fodys products will appeal to consumers beyond those who suffer from gastrointestinal issues to include those who are looking for products made from clean, better-for-you ingredients.

We use avocado oil in some of our sauces. We use Himalayan pink salt, extra virgin olive oil .. and every product is certified vegan, every product is gluten-free, every product is non-GMO. So, we tap into many other reasons for people to buy and to love Fody, he said.

Beyond creating products that are convenient and appropriate for consumers following the low-FODMAP diet, Fody Foods is trying to open a broader conversation about digestive distress so that those who suffer from it are less embarrassed and will help spread the word that the brand offers a solution.

Bathroom talk is somewhat of a taboo subject, but Fody is working on social media, with retailers, with healthcare providers and others to raise awareness of the extent of digestive issues and how the brand can help, he said.

Singer says the brand also is expanding its distribution. Already available in more than 3,000 stores across the US, including top natural food retailers as well as many conventional chains, Singer says the brand has many, many lined up for the New Year. Plus, he says, the brand is available online on Amazon.

The brand also is focused on innovation and expanding its product portfolio a strategy that Singer says is key not only for Fody but also for Glutino and other emerging brands that are catering to diet-specific consumer bases.

Make sure you have innovation. You cant sit still and hope for the best. You have to keep reinventing yourselves, he said.

Singer also advises entrepreneurs catering to consumers with specific dietary needs to build their brands on trust and a strong sense of purpose.

People are, in some cases, relying on you and in some cases need that level of trust that they are going to feel better if they eat your food. So you just have to make sure what you put in is real, and safe, he said.

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Soup-To-Nuts Podcast: Is the low-FODMAP diet the next big trend? - FoodNavigator-USA.com