Plant-Based Basics. Plant-based milks have been around for centuries, tracing back to ancient cultures. Soymilk, coconut milk, and almond milk are the oldest, and they are among the most common today, though cashew, hemp, quinoa, macadamia, flax, pea, and many more varieties are rising in popularity. They are made from nuts, seeds, legumes, and grains that have been soaked, if needed, ground, blended with water, and often strained. Flavors, vitamins and minerals, and other ingredients, like thickeners and stabilizers are sometimes added in manufactured plant-based milks. They are also simple to make at home.

Milk Goals. If you’re considering making the switch from dairy to plant-based milk, or you just want to give it a try, Sharon Palmer, MSFS, RDN, The Plant-Powered Dietitian, says “think about your goals for plant-based milk. Will it be one cup or more per day or merely a splash in your coffee? If it’s a big part of your diet, think about choosing a nutrient-rich one, especially if it’s replacing dairy milk in your diet, and for children.” Cow’s milk is rich in protein, vitamins and minerals, including calcium and B vitamins, and it’s fortified with vitamin D. Not all plant-based milks can compare. In fact, says Palmer, “Some plant milks have barely one gram of protein per serving!”

Read Labels. Each plant milk is different, so it’s important to read the labels. First, be aware of possible allergies or intolerances to ingredients like nuts, soy, or those that contain gluten. Then, scan the list of ingredients, making sure there are no added ingredients you don’t want, like sugars, flavors, and additives. “Look for those that are unsweetened,” says Palmer. “These plant milks are naturally sweet, based on the plant ingredients they start with. There is no need for extra sweeteners.” As for nutrition, look for a good source of protein, calcium, and vitamin D. Palmer suggests choosing one with at least six grams of protein per serving and that’s fortified with calcium and vitamin D. Although almond milk, for example, is not a nutrient-rich option, some products are protein fortified, says Palmer.

Eco-Friendly Choice. Research shows that plant milk has a much lower carbon footprint than dairy milk. Research shows that a dietary shift from animal products to plant products is the single most impactful move consumers can make for the planet, reducing greenhouse gasses, land use, and water use (See: Which Milk Should I Choose?). The starkest differences were in meat products and dairy milk. “Soy and oat milk are especially eco-friendly,” says Palmer. “They have a much lower carbon footprint compared to dairy milks. In addition, many of these milks have a lower water footprint—meaning they take a lot less water to produce—compared to dairy milks. They also take less land to produce.”

DIY. Making plant-based milks at home is not only best for the planet (no industrial production, trucking, or packaging) and the surest way to avoid unwanted added ingredients, it’s really simple, budget-friendly, and delicious! The method is about the same for nut milks and similar for other plant milks from grains, legumes, seeds, and more.

Here’s a rundown of options:

• Grains: barley, oat, quinoa, rice, wheat
• Legumes: pea, peanut, soy
• Nuts: almond, brazil, cashew, hazelnut, macadamia, pistachio, walnut
• Seeds: chia, flax, hemp, pumpkin, sesame, sunflower
• Other: coconut, potato

The Bottom Line. Plant milks can be an ideal way to align values, lifestyle, and dietary choices. Be sure your decision also fits your nutrition needs and budget—plant milks tend to cost more than dairy milk (unless made at home), and taste preferences vary, so it may take a little trial and error to find your favorite.

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Recognizing IBS isn’t always easy, because its symptoms are also common to other gastrointestinal disorders, such as celiac disease, as well as food allergies and adverse reactions to foods, such as lactose intolerance and nickel allergic contact mucositis.

Until a definitive diagnosis is made and a treatment plan is prescribed by your physician, it may help to implement lifestyle changes that ease IBS symptoms for some people. For instance, IBS symptoms are often lessened by avoiding trigger foods such as dairy products, chocolate, caffeine, and foods that contain poorly digested sugars known as FODMAPs. FODMAPs, which stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, are found in many foods. Foods with the highest FODMAP content include, but are not limited to, garlic, onions, pears, apples, artificial sweeteners, and foods containing lactose (dairy products) and gluten (wheat, barley, and rye). FODMAPs can cause bloating because bacteria in the colon consume them, which produces gas. Most IBS patients don’t have to avoid all FODMAPs. Once foods are eliminated from your diet, the foods can be added back into your diet one at a time to identify which ones trigger symptoms. Also, overeating to the point of being excessively full can trigger IBS.

Other things to keep in mind: Stress can worsen symptoms of IBS. Try mindfulness meditation or guided imagery, or find a mental health professional who can teach you relaxation techniques. Exercise is also an effective stress reliever. © Oleksandr Hruts | Getty Images

My recent blood test shows I have a low red blood cell (RBC) count. What might be causing this?

Red blood cells contain a substance called hemoglobin, which transports oxygen around the body. The amount of oxygen that’s delivered to your body’s tissues depends on the number of red blood cells you have and how well they work. Women usually have a lower RBC count than men, and the level of RBCs tends to decrease with age. The common term for a low RBC count is anemia. Symptoms of anemia include dizziness, fatigue, and shortness of breath. Blood tests can point to the source of your anemia by measuring iron, folate, and vitamin B12, which are nutrients needed for red blood. A low RBC count may have several causes, including diseases and conditions that reduce the production of red blood cells, such as aplastic anemia, cancer, chronic kidney disease, cirrhosis, and Hodgkin’s lymphoma.

If your low count is due to a deficiency of vitamin B12, a condition that is common in older adults, include more B12-rich foods, such as fish and shellfish, lean meat and poultry, low-fat dairy products, and eggs, in your diet. Your doctor also may recommend a B12 supplement or monthly B12 shots. Folate is present in leafy, green vegetables such as spinach, broccoli, Brussels sprouts, and mustard greens, as well as fortified breakfast cereals.

If you have an iron deficiency, your anemia might be caused by internal blood loss. If your doctor suspects this, he or she may request an endoscopy (which looks for signs of bleeding in the stomach), colonoscopy (which can identify bleeding in the colon), or a stool occult test that can detect hidden blood. Health conditions that are associated with a low RBC count include ulcers in the digestive tract, chronic kidney disease, and underactive thyroid.

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Background. The body produces and secretes digestive enzymes throughout the gastrointestinal system. Their primary role is to aid the digestion of food. Digestion starts in the mouth with the salivary enzymes (amylase). Digestive enzymes are also in the pancreas, stomach, and small intestines that break down carbohydrates, fats, and proteins. While there are many digestive enzymes, the pancreas is responsible for producing the most important enzymes: amylase (breaks down carbohydrates), lipase (breaks down fats), and protease (breaks down proteins). The small intestine also produces enzymes lactase and sucrase to break down lactose and sucrose. Many foods, primarily fruits and fermented foods, contain digestive enzymes including pineapple (bromelain) and papaya (papain).

Evidence. So, if the body produces digestive enzymes and they are in foods, why do people use supplements? Generally, most healthy individuals don’t need additional enzymes to adequately digest and absorb foods. However, people with enzyme insufficiency often require exogenous digestive enzymes since they don’t release adequate amounts. These typically include exocrine pancreatic sufficiency, lactose intolerance (cannot digest milk sugar), or congenital sucrase-isomaltase deficiency (cannot digest certain sugars). Despite the large market and popularity of digestive enzyme supplements for a wide variety of conditions (IBS, gluten intolerance) or common digestive complaints, there’s limited and mixed data on the effects of over-the-counter (OTC) digestive enzymes for healthy adults. However, a small clinical trial reported that consumption of prescription enzymes given to healthy adults before and after a high-fat meal reported significantly less gas, bloating, and fullness versus controls.

Safety and Side Effects. The only FDA-regulated enzyme replacement therapy pancreatic insufficiency and it is available by prescription. However, the risks of taking other OTC supplemental digestive enzymes are low for the general population. The most reported side effects are mild digestive complaints. Individuals on blood thinners should be cautious of bromelain since it could increase risk of bleeding. In high doses, papain may cause as esophageal perforation. Please connect with your doctor before starting a new supplement.

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Food Allergy.

Approximately eight percent of children and 11 percent of adults in the U.S. have a known food allergy.

One of the ways your complex immune system fights intruders is by creating antibodies— proteins in the blood that recognize specific unwanted germs or substances. One type of antibody is immunoglobulin E (IgE). “The majority of food allergies are IgE-mediated,” says Leung. For an unknown reason, your body thinks a food or food component is dangerous and creates IgE antibodies. The next time you eat that food, the IgE “army” is called up, which signals cells to release chemicals to fight the “invader.” Unfortunately, these chemicals cause symptoms like eczema, hives, runny nose, trouble breathing, swelling, and even anaphylaxis—a severe, potentially life-threatening allergic reaction.

There are other immune-mediated allergic responses that do not involve IgE antibodies. One well-known example is celiac disease. “In celiac disease, immune cells called T-cells react to the protein gluten, which is found in wheat, rye, and barely,” says Leung. “This reaction damages the lining of the small intestine.” Other less well-known non-IgE mediated allergies include eosinophilic esophagitis (EoE), which causes narrowing of the esophagus, difficulty swallowing, and possible choking, and FPIES (Food Protein Induced Enterocolitis Syndrome), a life threatening allergic reaction that causes vomiting, diarrhea, dehydration, and, potentially, hypovolemic shock in infants.

IgE-mediated reactions typically occur immediately. Non-IgE mediated immune reactions can take up to 48 hours to develop.

Food Intolerance.

About 25 percent of people in the U.S. have some kind of food intolerance. These reactions do not involve the immune system. They are not life threatening, but they can cause lifedisrupting discomfort.

The most well-known example is lactose intolerance. Lactose is a milk sugar. The body makes an enzyme called lactase that breaks down this sugar during digestion so it can be absorbed. If the body does make enough of this enzyme, the lactose cannot be fully digested and is instead fermented by gut bacteria, causing gas, bloating, pain, and diarrhea.

Dietary fructose intolerance (also called fructose malabsorption), in which the intestines cannot absorb the sugar fructose, is often a trigger for symptoms of irritable bowel syndrome (IBS).

“Intolerances are not driven by immune reactions, so they are not allergies,” says Leung. “Even experts often use these terms incorrectly. Celiac disease, for example, is often called gluten intolerance, even though it is immune-mediated.” Food sensitivity is another term often loosely applied to intolerances.

Diagnosis.

IgE-mediated reactions can be diagnosed with a blood test. Skin prick tests can also be used: A health-care provider puts a tiny bit of the allergen on the skin and then scratches or pricks the skin so the allergen can get into the body. If you are allergic, you will develop a small red bump at the site within about 15 to 20 minutes.

Non-IgE mediated immune reactions are harder to diagnose. “We do not currently have research-supported tests that can detect non-igE mediated immune responses,” says Leung. Several companies advertise tests for immunoglobulin- G (IgG) responses, but these have not been scientifically proven to do what the companies claim they do. Due to the lack of evidence to support it, many organizations, including the American Academy of Allergy, Asthma & Immunology, have recommended against the use of IgG testing.

Lactose and fructose intolerance can be diagnosed using breath tests that measure gases created when gut bacteria ferment undigested or unabsorbed sugars in the intestines.

Diagnosis of celiac disease is done by looking at the small intestines (endoscopy) and running a special blood test.

If diagnosable diseases and allergic conditions have been ruled out, an elimination diet is another way to determine which foods, if any, are causing your symptoms. If you suspect a particular food or ingredient is causing your discomfort, you can try removing it from your dietary intake and see if your symptoms resolve.

A true elimination diet, which involves removing almost all foods from the diet and adding them back in a prescribed way over time, should only be performed under the guidance of a health-care professional to avoid unnecessary restrictions and possible malnutrition.

Treatment.

With IgE-mediated food allergies, avoiding even trace amounts of the allergen is essential. That said, some people allergic to milk or eggs can tolerate small amounts if they are fully cooked. (This is not true for all allergens.) Non-IgE mediated allergies may require complete avoidance as well. Immunotherapy— where the immune system is exposed to small amounts of an allergen in a medical setting—is being tested as a treatment for food allergies, but it is not yet approved by the U.S. Food and Drug Administration.

With food intolerances, avoidance will prevent discomfort, but is not a matter of life and death. Importantly, people with an intolerance can often consume some amount of the trigger food without symptoms. People with lactose intolerance have the option of taking lactase enzymes before eating dairy or choosing lactosefree dairy products.

What to Do.

While IgE-mediated allergies are severe and readily apparent, non-IgE mediated reactions have symptoms that might not be obviously related to eating.

If you often feel unwell after eating, or if you have unexplained symptoms like fatigue, “brain fog,” and headaches that cannot be attributed to other conditions, see a health-care professional. Your primary care provider is a good place to start. You may then be referred to an allergist, gastroenterologist, and/or registered dietitian for testing, diagnosis, and treatment.

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Bad Belly.

Short term bowel changes and/or abdominal (belly) pain can have a variety of causes, including food poisoning, a virus, or gas. Food allergies or an intolerance (such as lactose intolerance) and irritable bowel syndrome are possible causes of recurring incidents. But abdominal pain can also be a sign of something critical (such as appendicitis, diverticulitis, or kidney stones) or chronic (like celiac disease, inflammatory bowel disease, or irritable bowel syndrome).

How bad the pain is does not indicate how serious the disorder is. For example, gas pains can be very painful, and appendicitis may cause only a mild ache.

When to Worry.

“If your symptoms concern you, see a health-care provider to get peace of mind,” says John Leung, MD, a gastroenterologist and adjunct clinical assistant professor at the Friedman School. “Signs that definitely require looking into include unexplained weight loss, loss of appetite, persistent abdominal pain, and blood in your stool (which can be bright red or maroon or cause tarry, black stools). Additionally, if you have difficulty swallowing, you should see a doctor immediately.” If you can’t keep anything down and have been unable to have a bowel movement, have a tender or hard belly, have pain that lasts more than a day or two or is getting worse, or have diarrhea for more than five days, seek help.

“I see a lot of patients concerned about foamy or pale stools or mucous in stool,” says Leung. “Stool size, texture, color, or odor changes may worry you, but if you do not have other associated symptoms such as pain, fever, blood, weight loss, or jaundice and you feel otherwise well, it’s fine to wait and see if your stool normalizes.”

What to Do.

“It can be difficult to determine what can be dealt with at home and what cannot,” says Leung. “If your symptoms are mild, it’s fine to try some over-the-counter treatments. But if symptoms get worse or don’t get better, I suggest seeing a doctor right away.” Fiber supplements, antacids, anti-gas products, enzyme tablets that help digest dairy, and sports drinks to replace fluids lost with diarrhea and vomiting are some first-line options.

Dietary changes play a role in many short-term abdominal problems, allergies, intolerances, and food sensitivities. If you suspect ongoing issues are related to what you eat, don’t try to make major dietary changes without guidance. “I do not recommend overly restrictive or drastic diet changes,” says Leung. “These can lead to malnutrition and cause more problems long term.”

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Common symptoms of LI include bloating, gas, diarrhea, abdominal pain, and nausea. People with LI usually experience symptoms within 30 minutes to two hours after consuming foods or beverages that contain lactose.

It is estimated that 36 percent of the U.S. population has some degree of LI. The prevalence of LI is highest among certain ethnic groups, including Native Americans, African Americans, Asian Americans, and Hispanics/Latinos.

Foods that contain lactose include milk, cream, ice cream, yogurt, cheese, and butter. In addition, many prepared foods, such as breads, cookies, pastries, instant potatoes, nutrition bars, processed meats, snack chips, and salad dressings, are made with ingredients that contain lactose.

Severity Varies

People have varying levels of lactase enzyme production, so not everyone with LI will have the same symptoms or the same degree of severity. Many people with LI are able to tolerate yogurt, especially Greek yogurt, since it contains less lactose than regular yogurt. Some people with LI also tolerate cheeses, especially aged varieties such as Parmesan, Asiago, cheddar, and Swiss. In general, most cheeses, as well as cream cheese, sour cream, and butter, contain less lactose than milk.

Tests for LI

If you suspect you may have LI, report it to your primary care physician and ask to be tested. The hydrogen breath test is a simple test that can be performed in a doctor’s office. Another test, a lactose intolerance test, involves drinking a liquid that contains lactose and then having a blood test that measures the amount of glucose (sugar) in your bloodstream.

Some people conclude they have LI, and they eliminate all dairy products from their diets. However, if you think you have LI, it’s wise to have this confirmed by your doctor. Otherwise, you could be unnecessarily following a restricted diet. It’s also possible that your symptoms may be caused by a different condition, such as inflammatory bowel disease. If that’s the case, an accurate diagnosis is essential for getting appropriate treatment and preventing possible complications.

Managing LI

If you are lactose intolerant but you enjoy dairy foods, you can take lactase enzymes prior to eating foods that contain lactose; one popular brand name is Lactaid. If you want to include milk in your diet, try lactose-free milk; you’ll find it in the same area as the regular milk products.

Eating other foods along with the food that contains lactose may help minimize symptoms. For example, you may be able to put a small amount of milk in your coffee or on your breakfast cereal or have a slice of cheese on a sandwich without any discomfort. You can do a trial and error with different types and amounts of dairy foods to determine exactly what you can eat without suffering from symptoms.

Get Enough Calcium

Milk and milk products are rich in calcium, a nutrient that plays an important role in blood clotting, muscle contraction, nerve function, and regulating heart rhythm, as well as healthy bones and teeth. If you don’t consume any dairy foods, include other foods that contain calcium in your dietary pattern, such as sardines, shellfish, leafy greens such as kale and spinach, beans and peas, and almonds. Many non-dairy beverages are fortified with calcium.

Also, talk with your doctor about whether you would benefit from taking a calcium supplement.

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Inflammatory bowel disease (IBD) is a general term that encompasses ulcerative colitis (UC) and Crohn’s disease (CD), as well as several other, less common gastrointestinal diseases.

“IBD is an interruptive illness that is lifelong,” explains Ellen Scherl, MD, the Jill Roberts professor of inflammatory bowel disease at Weill Cornell Medicine. “IBD patients sometimes achieve remission (absence of symptoms), but many patients experience recurrences of symptoms, which are called ‘flares.’ Our goal is to help people with IBD achieve remission and to control symptoms during flares.”

If you have a form of IBD, an accurate diagnosis is essential so you can get the treatment needed to effectively manage the condition.

Some Symptoms Are Similar

UC is superficial inflammation of the colon (large intestine). UC can start in the rectum and goes contiguously up the colon. Common symptoms are persistent diarrhea, abdominal pain, and cramping.

“To be diagnosed with UC, a person must have blood in the stool or rectal bleeding,” explains Dr. Scherl. “However, this doesn’t mean that all bloody diarrhea is caused by UC.”

CD can affect the gastrointestinal (GI) tract anywhere from the mouth to the anus. The inflammation of CD goes into deeper layers than UC, and CD can be present in multiple segments of the GI tract. Symptoms may include diarrhea, abdominal pain, nausea, weight loss, mouth sores, fever, blood in the stool, and rectal bleeding.

Effects of Crohn’s Disease

According to Dr. Scherl, CD can have three distinct effects: inflammatory, stricturing, and fistulizing.

Inflammation occurs because the body mistakenly mounts a defense against its own tissues—the key feature of an autoimmune disorder.

A fistula starts as an ulcer that extends through the intestinal wall and forms a tunnel to another section of the intestine, to another organ such as the bladder or vagina, or to the skin’s surface.

Stricturing is narrowing of the intestinal tract that can cause a blockage in the bowel.

CD may also cause kidney stones, joint pain, and skin lesions. And the inflammation can cause reduced absorption of nutrients, which may result in malnutrition.

Testing and Treatment

A person suffering from a GI condition must get a correct diagnosis in order to be treated successfully. Diagnosis can be challenging, since many conditions produce similar symptoms.

For example, UC and CD need to be treated with anti-inflammatories and medication that suppresses the immune response, but irritable bowel syndrome, which commonly causes diarrhea and/or constipation and abdominal pain, is not inflammatory or autoimmune in nature and must be treated differently.

Diagnostic tests may include blood tests, stool studies, endoscopy (examination of the esophagus, stomach, and first section of the small intestine), colonoscopy (examination of the colon, or large intestine), magnetic resonance imaging, or computed tomography.

IBD that is undiagnosed and/or untreated can result in serious complications, such as dysplasia (the formation of abnormal cells that may become cancerous) or a bowel blockage that may require surgery.

Ease Symptoms with Lifestyle

Research has shown that high stress levels can make IBD symptoms worse, so stress management is often recommended for people with IBD; meditation, breathing exercises, and physical activity may help.

And diet often is important for people with IBD. In general, foods that contain insoluble fiber, caffeine, alcohol, and greasy or fried foods often make symptoms worse. However, some foods trigger flares for some people but not others. A registered dietitian can help you create an eating plan that eliminates trigger foods while providing adequate nutrition.

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How IBS Is Diagnosed

The official definition of IBS is recurrent abdominal pain or discomfort and a marked change in bowel habits for six months. Technically, IBS is not a disease; it is a group of symptoms, which is referred to as a “syndrome.”

Diagnosing IBS can be tricky, since the symptoms may mimic those of other conditions, including ovarian cancer, diverticulitis, and celiac disease.

“For example, if a patient has diarrhea, it could be from medications, like proton pump inhibitors; supplements, such as magnesium; or diseases, such as infectious colitis (foodborne illness) or Crohn’s disease. All of these disorders may present in a similar way, but when there is fever, blood, or weight loss, we know something serious is happening,” says Christine Frissora, MD, a gastroenterologist at Weill Cornell Medicine.

Ruling Out Other Conditions

How do doctors distinguish between IBS and other gastrointestinal conditions, such as celiac disease, gluten sensitivity, and lactose intolerance?

“We rely on a person’s medical history and a physical exam in 90 percent of cases,” says Dr. Frissora. Sometimes, tests are needed to rule out other conditions, but they’re determined on a caseby- case basis.

“For example, if there is a family history of a gastrointestinal disorder such as colon cancer, then the patient may need a colonoscopy. If someone has been suffering from diarrhea, a typical workup might include a stool test. Some people who suffer from anxiety, weight loss, and diarrhea may need to have their thyroid function and iron levels tested,” explains Dr. Frissora.

Ruling out other conditions is important. For example, someone who’s constipated may have something called pelvic floor dysfunction. “That’s when the muscles in the lower pelvis squeeze in an ineffective manner, actually holding the stool in rather than expelling it. Biofeedback and physical therapy are very helpful for this condition, and they can cure some patients with constipation,” says Dr. Frissora.

Dietary Recommendations

Many studies have shown that a diet low in “FODMAPs” can help relieve IBS symptoms. FODMAPs—fermentable oligosaccharides, disaccharides, monosaccharides, and polyols—are found in many foods. Foods with the highest FODMAP content include garlic, onions, pears, apples, artificial sweeteners, and foods containing lactose (dairy products) and gluten (wheat, barley, and rye). FODMAPs can cause bloating because bacteria in the colon consume them, which produces gas.

Most IBS patients don’t have to avoid all FODMAPs. Once foods are eliminated from your diet, the foods can be added back into your diet one at a time to identify which ones trigger symptoms.

Medication Options

Some IBS patients don’t get complete symptom relief with dietary changes and require medication, which is chosen based on what type of IBS you have. (IBS with constipation as a primary symptom is called IBS-c, IBS with diarrhea is called IBS-d, and some patients have alternating bouts of both.) Linaclotide (Linzess) is a drug that treats IBS-c; a medical food, EnteraGam, may be used to treat IBS-d; and a gut-only antibiotic, called rifaximin (Xifaxan), may help relieve symptoms of IBS-d.

Get an Accurate Diagnosis

If you suspect you may have IBS, it’s important to have a medical evaluation to confirm your suspicions.

“You can’t rely on self-diagnosis; you may be making the wrong assumption about what’s causing your symptoms. We don’t want people to have celiac disease or colon cancer and think they have IBS,” says Dr. Frissora.

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Your Genes 101. The human genome (the genetic material found in all living cells) consists of about 25,000 genes. Despite the obvious physical differences among people from around the world, 99.9 percent of these genes in humans are identical. Differences in that 0.1 percent of our genetic material is what makes us look different and, in part, what determines our individual disease risk, and differing nutritional needs. But genes don’t work in isolation. They’re only a part of a much bigger picture.

What the DNA Tests Look for. DNA testing varies greatly from one company to another. They promise to test for everything from food cravings to oxidative stress. The factors tested most often include testing for lactose intolerance, caffeine sensitivity, alcohol sensitivity, lipid metabolism, metabolism of vitamins D, C, A, B₆, B₁₂, E, and folic acid, and factors related to weight management. If you’ve had your DNA tested by 23andMe or AncestryDNA, you can even upload the results to some of the DNA-and-diet testing companies to be analyzed for the promise of a diet uniquely tailored just for you.

We’re still learning how genetics affect our dietary needs.
©-AYDINOZON | Getty Images

The U.S.Department of Health and Human Services says that only about 10 percent of your health is dictated by genes and biology, compared to 70 percent dictated by social and economic factors and health-related behaviors, such as smoking, drugs, exercise, and environmental exposures. While the promise of having a diet prescribed specifically for you, based on your genetic makeup, is incredibly appealing, the truth is there is very little research to show that’s the case for most diet-related diseases—at least not yet. If you’re shopping around, it might be hard to make comparisons for what the companies will test for. One study out of Italy looked at companies in several countries that tested DNA and diet connections and found that less than half provided a sample report on their website to allow you to know in advance what your results will look like.

Research on DNA and Your Diet. The theory behind DNA testing is that your genes reveal which diseases you might be at risk for, and which foods you eat that could turn genes on and off. But it’s complicated. One gene can affect another and your diet and lifestyle, which many companies don’t factor in, can determine what your DNA profile really means for your health. For example, someone who is found to have a gene for a high risk of heart disease and is obese and not physically active would have a very different risk from someone with the same high-risk gene, but who is at a healthy weight and physically active. In other words, you might have a gene that indicates a high risk for a disease, but your diet and lifestyle, as well as other genes in your genome, could determine if that disease-causing gene is turned on or left dormant. However, says dietitian Angelone, “Most over-the-counter tests don’t account for your uniqueness and lifestyle. Dietary recommendations really should not be made from the test results alone.”

Should You Take the DNA-Diet Leap? There is a lot of misinformation about DNA testing and how it can be used to create individualized dietary recommendations, but Angelone says that she believes nutrigenomics is the way of the future in nutrition and health. “A good test should be available only through a qualified healthcare profession, who can interpret the results. The appropriate test with targeted recommendations can help you focus on optimal health and decrease risk for chronic diseases.” 

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A wide body of evidence has demonstrated that diet shapes the gut microbiome, and it turns out one way we can give our colony of microorganisms a boost is to feed it more not-so-fresh foods. After analyzing blood and stool samples of healthy adult participants, Stanford School of Medicine researchers discovered that a 10-week diet high in fermented foods (6 servings daily) resulted in measurable improvements in microbiome diversity and decreases in markers of inflammation, suggesting improved immune status. This is noteworthy because science has identified that healthy people typically have a more diverse microbiome composition than those suffering from chronic conditions.

Fermentation is a process where microorganisms like yeast and bacteria break down food components (e.g., sugars such as glucose) into other products (e.g., organic acids or alcohol). Historically, this has been used to extend shelf-life of items like vegetables and dairy. Beyond the potential microbiome benefit, the fermentation process may bring about other important perks, including generating bioactive compounds in the food, as well as the reduction of anti-nutrients. It also generates new flavor compounds and is why yogurt does not taste just like thick milk.

The optimal daily amount of fermented food intake is still yet to be determined, as well as whether certain options are more powerful than others. But, it does appear that including one or more of these foods into your daily diet is good for the gut.

Yogurt. Fermentation makes this dairy easier to digest, even for those with lactose intolerance. But, make sure it includes live active cultures.

Miso. Made from cooked whole soybeans combined with koji (a bacteria starter), salt, and rice or barley, this umami-rich paste is great whisked into salad dressings or try stirring a tablespoon or two into mashed potatoes.

Tempeh. Whole soybeans are soaked, cooked, left to ferment, and pressed into a firm meaty patty. Marinate and grill it like steak or crumble and use it as a substitute for ground meat in chili, pasta sauces, and tacos.

Sauerkraut. Submerged in a salty liquid for several days, cabbage slowly ferments into a crunchy, tangy condiment. To guarantee it still has probiotics, look for the words “unpasteurized” or “raw” on labels. A couple of forkfuls can instantly jazz up your meal.

Kefir. Most brands contain a higher probiotic count than yogurt, which accounts for its extra tang. Drink straight-up or use in smoothies and as a replacement for buttermilk in recipes.

Kimchi. This Korean staple is made when vegetables are mixed with a fiery garlic chili seasoning and left to ferment for several days by lactic acid bacteria. Use as a topping for eggs, burgers, sandwiches, tacos, and pizza.

Sourdough. Its quintessential tang hails from the old-school baking method of kickstarting fermentation with a bacteria- and yeast-rich starter. Enjoy a warm slice with olive oil. 

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