Since I started learning about plant-based health, learning about the microbiome and gut health has been one of the most fascinating and influential topics I have come across. I started my journey into healthy eating (as opposed to dieting to lose weight) after losing my dad to an aggressive cancer. I think that's why learning about the immune system (and then the critical bit - the gut's influence on it) has been so rewarding and has stuck with me. So Dr. Monica Aggarwal's presentation on its role in her health and in preventing heart disease was much anticipated at the Advanced Study Weekend I attended this February. The following notes discuss her own transformation from an immune mediated disease, and what she has discovered about the importance of the microbiota in her work as a cardiac surgeon.
For more information on Dr. Aggarwal, visit her site at DrMonicaAggarwal.com.
Notes from Dr. Aggarwal's presentation
These are notes taken during a presentation given at the McDougall Program's Advanced Study Weekend.
What does that mean?
- Because these notes were typed during a presentation by the noted doctor, and are being written by a "lay person". While I did my best to make notes about what they said, these notes may not be entirely accurate. However, I will link resources (such as the peer-reviewed studies referenced within the presentation) whenever possible within the text.
- Please direct any questions you have to the speaker noted here. Their website and social channels are linked whenever possible.
- If you are currently in treatment for any condition, do not use this to change what you are doing. Do take this information to your doctor to ask questions in order to make informed medical decisions with a professional.
- You can find MORE PRESENTATION NOTES listed at this page.
- The ideas presented are those of the presenter. If I (the author) add any notes, references, or other items to refer to, I will note that they are my additions within the text.
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Disease is increasing
Disease is statistically increasing, and doctors are witnessing so much of it in their practice. There is more autoimmune disease, peanut allergies, arthritis, heart disease. When you look at the statistical graphs representing what is happening in the US, all the graphs are going way up.
When you observe the worldwide cancer stats, cancer is predominantly a western problem.
And cardiac problems are still the biggest killer, but the biggest difference is 8/9 of the risk factors for cardiovascular problems are fixable with diet and lifestyle.
Importance of rest
People have forgotten how to recharge. When you are told "Go get some rest" people wonder how do you actually do that. Focusing on it, creating awareness, need to make that balance come back.
If you are "always on" (as we are in the modern world), your cortisol is up and your blood pressure is up, and so on.
If your cortisol is always up, you will have problem with weight and sugar due to the hormone (cortisol).
Then, your immune system in overdrive and eventually gets suppressed and you get sick. You are always imbalanced, so then you are set up to get sick.
Hence: It is important to REST and RECHARGE.
Related diets and studies
Many studies in the past support the health of these diets. Dr. Aggarwal mentioned the following studies (I am adding links to resources regarding each study for your reference):
- Ornish study (1996). (Author note: I'm not positive which one in reference, but here are several journal articles related to studies by Ornish et al)
- Prudent Pattern Diet (and related studies) (Author: See this overview, and references at end for related research, and this 2007 study comparing the standard Western diet and Prudent diet).
- DASH diet -- this was a pivotal discovery. Low fat, whole grain, with the oldest trials. Focused NOT on low salt, but lots of fruits and vegetables. DASH is not about low sodium. (Author: This page provides links to several DASH related scientific studies.)
- PREDIMED study that looked at polyphenols. The nutrients in plants are called polyphenols. These are also known as phytochemicals, or phytonutrients. Discovered that there is a 37% reduction in cardiovascular mortality. Just related to the polyphenols. (Author: See this analysis of the PREDIMED study.)
Dr. Aggarwal noted that constipation is one of the biggest problems in clinic. (Author: Animal based foods can be a cause of constipation due to a lack of fiber.)
The benefits of wine are said to be stillbenes / resveratrol. Resveratrol is a vasodilator, reduces inflammation, lowers oxidative stress, platelet oxidation, reduces thrombus formation. If you drink moderate wine, it may be associated with decreased cardiovascular events. However, do note that resveratrol supplements do NOT WORK. Studies show it does not have benefit. (Author: See this article for an overview about the hype and supplements.)
Influence of the body's microbiota on health, and related studies
Bug Hotel = gut. This is the microbiota / microbiome. 90% of us is bug. Seratonin in gut (happiness). Dopamine in gut. Histamine, in gut.
3 types, the primary being Fericutes / Bacteroides. The "FB ratio" measures these two types. A "high FB ratio" is associated with dysbiosis which refers to an unhappy gut due to maladaptation or imbalance. An unhappy gut is associated with IBD, diabetes, and cancer. See this page for more information on dysbiosis.
Ratio shifts for the better can come from the following:
- Restricting calories, such as a gastric bypass.
- Probiotics can also change the ratio too.
- Resistant starches (such as whole and unprocessed carbs) are complex carbs that are digestible and are associated with a low ratio. (Authors note: think whole and unprocessed carbs: fruits, vegetables, whole grains, and legumes).
Endotoxemia: it is a high level of endotoxin in the blood (Author: for more info on endotoxins, see this page), and is associated with atheromatous disease (fatty plaque buildup in your arteries).
When you eat a high fat meal, you end up with a higher level of endotoxins in your blood, and this is directly linked to heart disease.
Certain prebiotics and probiotics can decrease the endotoxin load.
Related: See the TMAO trial. (Author note: TMAO is located in the gut, and much of it's production is linked to the consumption of meat and eggs. Journal articles - TMAO and heart disease and also this, TMAO and increased clotting, and you may find this overview useful as well)
When people eat a lot of dietary phophalcchloine -- higher rates of death. (Author's note: phosphocholine is the phosphate of choline, and you can find out more information about choline in the TMAO studies linked above.)
What happens when take bugs away from the gut? (Author's note: I took poor notes here. But I believe Dr. Aggarwal is talking about mice studies where the microbiota has been removed or transplanted. There are many mouse-based studies on the microbiome, and here are a couple and there are many more if you search further: Removing and reshaping the microbiota , and this study about using mouse guts in studies.)
Celiac Disease. Systemic inflammation from gut -- systemically inflamed. (Author's note: Here are two studies about the links between celiac disease and the microbiota: Intestinal Microbiota and Celiac Disease: Cause, Consequence or Co-Evolution? and Gut Microbiota and Celiac Disease)
Cancer, diet, and genetics. There were marked differences between African Americans and rural Africans when it comes to cancer polyps. Changed to add them in 2 weeks of diet change. (Processed diet vs high fiber diet). The study found that participants who did not have heart disease then had markers for heart disease in just eating the Standard American Diet. In two weeks, participants who did not have polyps then had polyps in this short period of time. Importantly, the change was shown to be not genetically related.
Author's note: I believe she is referencing this study. Here is the study's abstract:
Rates of colon cancer are much higher in African Americans (65:100,000) than in rural South Africans (<5:100,000). The higher rates are associated with higher animal protein and fat, and lower fibre consumption, higher colonic secondary bile acids, lower colonic short-chain fatty acid quantities and higher mucosal proliferative biomarkers of cancer risk in otherwise healthy middle-aged volunteers. Here we investigate further the role of fat and fibre in this association. We performed 2-week food exchanges in subjects from the same populations, where African Americans were fed a high-fibre, low-fat African-style diet and rural Africans a high-fat, low-fibre western-style diet, under close supervision. In comparison with their usual diets, the food changes resulted in remarkable reciprocal changes in mucosal biomarkers of cancer risk and in aspects of the microbiota and metabolome known to affect cancer risk, best illustrated by increased saccharolytic fermentation and butyrogenesis, and suppressed secondary bile acid synthesis in the African Americans.
Summary: What's the problem
- Have to go back to roots, educating professionals to pass correct and clear information to patients.
- Nutrition is confusing, and people experience time constraints.
- Food labeling has become real problem. For example: serving size. And the AAHA labels make bad food appear to be healthy.
One way to improve your diet: remove all preservatives.
Regarding health: reducing inflammation is key
Take a leap of faith. When you observe a pattern, there is something there.
Learn more or find Dr. Aggarwal online
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