Diet Types

Diet types cater to diverse health and ethical preferences. Low carbohydrate/high protein diets like Keto focus on fats for weight loss, while low fat/high carbohydrate diets emphasize heart health. Plant-based, vegetarian, and vegan diets exclude animal products, chosen for health or ethical reasons.

LC/HP Diet

LF/HC Diet

Plant-based Diet

Mediterranean Diet

Ketogenic Diet

Intermittent Fasting

Western Diet

Best Diet?

Different Diet Types & Benefits

Healthy nutrition plays an essential role in reducing cardiovascular risk and heart disease. In 2015, an estimated 630,000 Americans died from heart disease, of which 366,000 died due to coronary artery disease. [1] The mortality rate secondary to heart disease rose in 2015 by 1%, although it gradually declined over four decades, most likely due to the obesity epidemic. [1]

Conventional diets generally include a macronutrient composition of 30% fat, 50% carbohydrate, and 20% protein. Although all individuals should be encouraged to follow a heart-healthy lifestyle, the limitation of scientific evidence with a variety of available diet formats leads the public more confused about choosing the best diet type. Here, we will discuss various diet types available and their effect on heart disease with published scientific evidence.

Low Carbohydrate & High protein Diet

What are Low carbohydrate and high protein diets (LC/HP)?

LC/HP diet contains a large amount of protein and a significantly lower amount of carbohydrates. Although there is various carbohydrate restriction with a broad spectrum of LH/HP style, one can start from limiting carbohydrate intake less than 100 g/day with protein consumption at least more than 0.8 g/kg of body weight or >20% of daily calories count. [2]

Based on 2000 Kcal diet

Atkins diet: 2 types – LC (~20-30 g/day), High protein and high fat diet – 2.3 g protein/kg/day (35%), 6% carb, 59% fat. [3]
Zone diet (LC/HP): Protein >2-2.3 g/kg/day (34%), 36% Carbohydrate, 29% fat [4]
South Beach diet (LC/HP): Protein ~2.6 g/kg/day (39%), 28% Carbohydrate,33% fat [4]
Stillman diet (Very low carb): Protein ~ 4.3g/kg/day (64%), 3% Carbohydrate,33% fat [4]
High protein normal carbohydrate: Protein ~1.3-1.4 g/kg/day (21%), 50% Carbohydrate,29% fat [5]
USDA 2015-2020 guideline: Protein 10-35% of total calories, 45-65% Carbohydrate, 25-35% total fat with <10% of saturated fat [6]

Weight Loss

Low-carbohydrate with the combination of high-protein diets (LC/HP) have gained widespread popularity to control weight. The concept is mainly driven due to the potential deleterious effect of carbohydrate consumption, while LC/HP could lead to better weight management or even weight loss.[7] Foster et al. performed a one-year duration randomized controlled trial involving 63 obese men and women who were assigned to either a low-carbohydrate, high-protein, high-fat diet or a low-calorie, high-carbohydrate, low-fat (conventional) diet. The finding showed a short-term weight loss (4% more) with a low carbohydrate diet. [8] However, the difference disappeared in one year.

Trichopoulou A and colleagues performed a study to demonstrate the impact of LC/HP diet on mortality rate. Participants were 22 944 healthy adults whose diet was assessed through a validated questionnaire over 10 years period. The findings showed that prolonged consumption of diets with LC/HP is associated with a ~22% increase in total mortality. [9] Moreover, another study from ARIC showed an 18% increase in mortality rate with low carbohydrate diets using animal-derived protein and fat sources (e.g., lamb, beef, pork, chicken), but plant sources (e.g., vegetables, nuts, peanut butter, whole-grain bread) were associated with lower mortality rate. [10]

The concern regarding renal function is – how much protein can we consume without impacting renal function?

A study including 1,624 individuals on a high protein diet (~76.6 g/day – 50% of recommended protein intake) analyzed blood samples for serum creatinine and glomerular filtration rate (GFR). The conclusion was high protein intake not associated with renal dysfunction in women with normal GFR while it may probably increase GFR in those with mild renal insufficiency [defined as a serum creatinine of 0.88 mg/dl (range 0.77 to 1.09 mg/dl) and a GFR of 71.0 ml/min/1.73 m2.2]. [11]

Rather than emphasizing specific food categories, we should focus on a healthy diet such as lean protein, vegetables, fruits, and whole grains. Carbohydrates can be divided into two groups, simple or complex forms based on underlying chemical structure. Simple carbohydrates are digested quickly with a rapid increase in blood sugar level, whereas digestion of complex carbohydrates is slower with a gradual release of glucose into the bloodstream. Therefore, the recommendation from AHA is to limit processed, refined simple sugar while getting more complex carbohydrates.

Among various protein sources, we should choose more healthful protein sources instead of red meat. Good protein options are Fish, chicken, turkey, lean meats, low-fat dairy products, whole grains, nuts, beans, and legumes.

References

Low Fat & High Carbohydrate Diet

A low fat/high carbohydrate diet (LF/HC) is considered an alternative option to lower total fat intake, including saturated and trans-fat, while increasing carbohydrate intake. Although low carbohydrate consumption may allow your body to burn fat, it can paradoxically promote unhealthy fat absorption. An alternative hypothesis is that eating an LF/HC diet may stimulate a better physiological response for burning fat and weight loss.

In the REGARDS study, it had shown that trans-fat was associated with a higher all-cause mortality rate. [1] A study done by the National Institutes of Health showed that LF/HC diet was associated with increased fat loss compared to a low carbohydrate/high-fat diet.[2] Women’s Health Initiative study reported that those on a low-fat, high-carb diet lost more weight over a seven-year interval among women. [3]

However, the effect of low or high carbohydrates on cardiovascular health remains controversial. In 2017, Prospective Urban Rural Epidemiology (PURE) study was performed, including 135,335 individuals from 18 countries across five continents with a median follow-up of 7·4 years. The study reported that high carbohydrate intake was associated with increased risk of mortality while saturated and unsaturated fats were not significantly associated with risk of myocardial infarction or cardiovascular disease mortality. [4]

However, the limitations of those studies are as follows. The quantification of carbohydrate intake was mainly specific to the population studies due to internal reference and failed to account for the potential effects of food sources (i.e., animal-based versus plant-based). Therefore, Seidelmann SB and colleagues attempted to investigate the association between carbohydrate intake and mortality. Both high (>70%) and low percentages (<40%) of carbohydrate intake were associated with increased mortality, with minimal risk observed at medium carbohydrate intake (50–55%).[5]

We should focus on healthy food from each category (fat or carbohydrate) rather than the general classification. Concerning carbohydrates, we must avoid simple carbohydrates and high processed ones as it could cause dramatic alteration in blood glucose levels. Low fat intake is vital to control daily calorie intake as well as blood cholesterol. One should aim to avoid saturated fat and trans-fat (such as fatty beef, lamb, pork, poultry with skin, beef fat (tallow), lard, butter, and cheese) and encourage to eat more poultry, fish, nuts, and whole grain.

Carbs to Avoid	Carbs to Eat
White bread	Whole fruits, Nuts
Potatoes	Whole grain
Cornflakes	Non-starchy vegetables
Rice crackers	Legumes
Fruit juice
White rice

Whole grains: quinoa, amaranth, buckwheat, steel-cut oats, muesli, barley or wheat bran

Non-starchy vegetables: artichoke, broccoli, leafy green vegetables, eggplant, Brussels sprouts, tomatoes, cucumber

Legumes: chickpeas, black beans, kidney beans

References

Plant-based diets vs. Lacto Ovo Vegetarian vs. Vegan Diet

What are different types of vegetarian diets?

Plant-based diets mean that the diet is mainly comprised of plant food. However, the option to eat certain animal-derived products allows.

Lacto–Ovo vegetarian diet is a plant-based primarily diet including dairy and eggs and without meat, fish, and poultry. It is like a plant-based diet and has many health benefits.

A vegan diet is another type of vegetarian with complete exclusion of all animal products. Vegetarians don’t eat meat but can consume animal-derived products like cheese and honey.

Pescatarians eat fish and shellfish without red or white meat.

Flexitarians, semi-vegetarian, eat mostly plant-based food while consuming meat occasionally.

Potential benefits of Vegan Diets

Moreover, plant-based diet or vegetarian diet had shown to be associated with cardiovascular benefits and the correction of CKD-accompanying complications, partly due to the inclusion of large amounts of dietary fibers, n-6 fatty acids, folic acid, potassium, magnesium, vitamin E, vitamin C, and carotenoids, as well as many phytochemicals. [8] The finding was verified in other studies, which demonstrated a lower risk of coronary artery disease while improving risk factors such as better blood pressure control, decreased atherosclerosis. [9,10]

Plant-based diets have been associated with a lower risk of coronary heart disease based on small and observation studies. [1,2] However, the type of plant-based diets were poorly characterized in these studies as simple carbohydrates from refined grains and sugar-sweetened beverages are associated with higher cardiovascular risk. [3,4]

Satija A and colleagues performed a population cohort study to analyze the cardiovascular risk of healthful and unhealthful plant-based diets. The plant-based diet was divided into three categories- healthy plant-based diet index (hPDI), which includes healthy plant foods (whole grains, fruits/vegetables, nuts/legumes, oils, tea/coffee), less-healthy plant foods (juices/sweetened beverages, refined grains, potatoes/fries, sweets), and unhealthful PDI. The study showed that a higher intake of a plant-based diet index rich in healthier plant foods is associated with substantially lower CHD risk. In contrast, a plant-based diet with less-healthy plant foods is associated with higher CHD risk.[5] A post hoc analysis from the PREDIMED cohort that assessed participants based on pro-vegetarian food patterns showed that high adherence to a diet composed primarily of plants and lower in animal-derived foods resulted in a 41% relative risk reduction compared to the lowest adherent group.

As not all plant-based diets are created equal, clinicians should remind their patients of less healthy plant food while sugar-sweetened and sweetened beverages are linked to increased risk for diabetes, and sweets and refined carbohydrates are associated with increased risk for coronary events. [6,7]

It can help to prevent or lower the risk of developing type 2 diabetes. [11,12]

Due to higher fiber content, digestion is slower and improves blood sugar control.[13]

Moreover, vegetarian diets help maintain a healthy weight as it has higher fiber content, resulting in fullness and reduce overeating.

In a large study (37,875 participants) of finding correlation of BMI with different diet patterns, vegetarians and fish-eaters had lower BMI than meat-eaters. [14]

What to do in daily life?

Plant-based or Vegetarian diets are a healthy diet and a way to avoid unhealthy fat, animal products, refined grains, and sugars while eating plenty of healthy plant foods. Overall, a plant-based diet is an excellent choice to take care of your health and the planet.

References

Mediterranean Diet

The Mediterranean diet is a particular type of traditional diet from the countries near the Mediterranean Sea, such as Greece, Italy, France, and Spain. There is no standardized format for Mediterranean diets; instead, each country has its own culture and styles. Moreover, the Mediterranean diet type emphasizes the specific kind of diets rather than calories or macronutrients.

A Mediterranean diet style mainly includes the following:

fruits, a wide variety of vegetables, bread, nuts, seeds, legumes, beans, and whole grains
Healthy fats, olive oil
Poultry, Dairy, Fish, seafood, eggs, and red wine in moderate amount

Foods to avoid:

Processed foods and meats: Chips, fast food, popcorn, sausage, bacon
Sugars and sweetened beverages: Soda, Juice, Sport and energy drinks
Refined grains or carbohydrates: White rice, white bread, pasta, flour tortillas
Saturated fats

Processed meats are any meat preserved by smoking, curing, or salting, or additional chemical preservatives.

Potential benefits of a Mediterranean diet

The Mediterranean diet has been studied in scientific literature and showed one of the healthiest diets available for several health problems.

PREDIMED study had done a multicenter trial including 7444 participants assigned to three diets style- Mediterranean diet supplemented with extra-virgin olive oil, a Mediterranean diet supplemented with mixed nuts, or a control diet (advice to reduce dietary fat). The Median follow-up was 4.8 years. It showed a 30% decrease in vascular events. The Mediterranean-style diet is higher in extra-virgin olive oil or mixed nuts than the reduced-fat diet category. [1]

The Lyon Diet Heart Study was a secondary prevention trial that reported a 72% reduction in cardiovascular events in the alpha-linolenic acid-rich Mediterranean-style diet group compared with the control group following a prudent Western-style diet.

The Mediterranean diet invigorates eating nutrient-rich foods and limits processed food and sugars. So, it can promote weight loss if one can pair it with a healthy lifestyle.

One of the largest cohorts, including 32,119 members, attempted to investigate the impact of a Mediterranean diet and long-term changes in weight and waist circumferences. The conclusion was that long-term adherence to the Mediterranean diet is associated with reduced weight gain and reduced waist circumference increase over five years. [3]

Several observational and randomized studies have shown the weight loss effect of a Mediterranean diet. Therefore, a meta-analysis of five RCT, including 998 individuals – comparing the Mediterranean diet to a low-fat diet, low carbohydrate diet, and American Diabetes Association diet. The finding was that the Mediterranean diet produced similar weight loss as other diets style (i.e., low fat or low carbohydrate) at 1-year duration with an average weight loss of 10-22 lb. [4]

Recently, clinicians or dietitians started to think of using the Mediterranean diet in peri/postmenopausal women to intervene in menopause-related obesity. While retrospective analysis showed some promising effects, a future randomized study is required to verify the hypothesis. The research was done by Ford C and colleague to evaluate diet pattern and weight gain in postmenopausal women (Women’s Health Initiative Observational Study). The finding was interesting and suggested that a low-fat diet may promote weight gain, whereas a reduced-carbohydrate or Mediterranean diet may decrease the risk of postmenopausal weight gain. [5]

MedDiet is found to have a protective effect against diabetes mellitus.

One large randomized study, PREDIMED-Reus nutrition intervention randomized trial, attempted to find the impact of MedDiet on the incidence of diabetes. Participants were randomly assigned to education on a low-fat diet (control group) or to one of two MedDiets, supplemented with either free virgin olive oil (1 liter/week) or nuts (30 g/day). When the two MedDiet groups were pooled and compared with the control group, diabetes incidence was significantly reduced by ~52%. [6]

Moreover, those with DM may have better glucose control and lower HbA1c if they follow greater adherence to a Mediterranean-type diet. A study from South Italy conducted a cross-sectional analysis in 901 outpatients with Type 2 diabetes. The lower level of blood glucose and HbA1C was found in those with long-term adherence to a Mediterranean-type diet.[7]

Coronary atherosclerosis represents the most common pathological substrate of coronary artery disease, and the characterization of the disease as a chronic low-grade inflammatory condition is now largely accepted. Moreover, chronic inflammation could contribute to the development of cancer, diabetes, and dementia.

Researchers sought to assess the effect of MedDeit on the inflammatory maker and 598 individuals involved in the study. Various inflammatory markers such as adiponectin (AD), leptin, tumor necrosis factor-alpha (TNF-α), plasminogen activator inhibitor 1 (PAI-1), and high-sensitivity C-reactive protein (hs-CPR) were measured. The present study showed that adult males with higher adherence to the MD showed a better inflammatory profile than the group with lower adherence.[8] Another report from Casas R group showed long-term adherence to MeDiet could decrease the plasma concentrations of inflammatory biomarkers related to different steps of atheroma plaque development in elderly persons at high cardiovascular risk.[9]

How do you apply this diet to daily life?

No doubt the Mediterranean diet is a healthy eating pattern. It encourages eating nutritious foods like vegetables, fruits, whole grains, beans, legumes, low-fat or fat-free dairy products, fish, poultry, non-tropical vegetable oils, and nuts while limiting processed food and sugars.

A Mediterranean diet will help enhance a healthy heart and reduce various cardiovascular risk factors – blood pressure control, sugar control, and reduce inflammation.

References

Ketogenic Diet

The diet consists of high-fat content and very low carbohydrate, which is somewhat similar to a low carbohydrate and high-fat diet. The idea behind including a higher range of a fat diet is to steer the body’s energy metabolism into burning fat rather than carbohydrate.

What is Ketosis, and where does it come from?

Ketone bodies are the water-soluble molecules containing the ketone group produced by the liver from fatty acids during periods of low food intake (fasting), restrictive carbohydrate diets, starvation, prolonged intense exercise, alcoholism, or untreated (or inadequately treated) type 1 diabetes mellitus.

Ketosis is a metabolic condition of your body, which burns fat for an energy source instead of carbohydrates. The entrance to ketosis limits carbohydrate intake while increased consumption of natural fats and protein—such as meat, fish, and poultry.

Potential benefits of a Ketogenic diet

One of the questions is “Is Keto Diet Safe?“ especially with cholesterol levels. Generally, a low carbohydrate, high protein, and fat diet are potentially unhealthy as it may cause a rise in LDL cholesterol and TGs, and this issue is of particular importance in obese individuals. Multiple studies demonstrated that reducing carbohydrate intakes could lower total cholesterol and blood triglycerides level while increasing HDL cholesterol levels. [1,5] Furthermore, Keto Diets have been reported to increase the size and volume of LDL-C particles along with the reduction of cardiovascular disease risk. [6]

There is ample supportive evidence of using Keto diets for weight loss therapy, but the underlying mechanisms remain unclear. [1] Although it is difficult to pinpoint an exact mechanism, we have probable hypothesized mechanisms of Keto Diet’s weight loss effects:

Reduction in appetite due to higher protein intake and possible direct appetite suppressant action of the ketone bodies. [2]
Increase fat utilization. [3]

Moreover, a very low carb, a ketogenic diet was more effective for long-term weight loss than a low-fat diet, resulting in extra weight loss with an average of 2 pounds (0.9 kg). [1] Another research in 34 elder adults was done comparing keto diet and low-fat diets. In 8 weeks, the keto group had 3-fold greater decreases in belly fat than the LFD group and 5-fold greater reductions in total body fat mass in the keto group. [4]

Overall, the Keto diet could lead to a more significant reduction in body weight than a low-fat diet while providing a feeling of being sated.

Some people believe that it’s dangerous when your body enters ketosis. However, it’s essential to understand the difference between ketosis, which is nutritionally safe, and ketoacidosis, which is caused by a lack of insulin and can increase blood sugar significantly.

The use of keto diets in DM has been tested in many research studies. One study showed improvement in insulin sensitivity up to 75% while reducing HbA1C. [7] A recent study of the Keto diet in the diabetes population demonstrated a significant reduction in hemoglobin A1C, body weight, blood pressure, and cholesterol level. [8] Another study tested the effect of the Keto diet on 84 individuals with diabetes and reported a significant reduction in blood sugar levels. Moreover, Five individuals who were taking over 20 units of insulin at baseline were no longer taking insulin at the end of the study. [9]

The Keto diet may reduce or improve other health-related problems such as cancer, dementia, Parkinson’s disease, and epilepsy in children. [10-13]

Keto Diet in daily life

The most important thing to do is to avoid eating too many carbs. It would be better to keep carbohydrate intake under 50 grams per day, ideally below 20 grams. You should plan your meal based on the following:

fatty Fish: salmon, tuna, and mackerel
eggs
butter and cream: grass-fed butter and heavy cream
cheese: like cheddar, cream, or mozzarella
nuts and seeds: almonds, walnuts, flaxseeds, pumpkin seeds, etc.
healthy oils: extra virgin olive oil and avocado oil
avocados: whole avocados or freshly made guacamole
low carb veggies: green veggies, tomatoes, onions, peppers, etc.
meat: red meat, steak, ham, sausage, bacon, chicken, and turkey

References

Intermittent Fasting

Intermittent fasting is one of the popular diet patterns in fitness and is used for various purposes such as weight loss, improving overall health, and lifestyles. It is not a particular type of diet; instead, an eating pattern emphasizes a specific eating and fasting period.

Intermittent fasting has been practiced in various structures throughout human history and religious reasons, including Buddhism, Judaism, Christianity, and Islam.

The basic concept of intermittent fasting is to reduce overall calorie intake, hence enhance weight loss if you don’t make up by eating more foods during eating periods.

The story of Intermittent fasting:

Although intermittent fasting has been around for ages, it got the media and people’s attention after the BBC broadcast “Eat Fast, Live Longer” and “the Fast Diet” by Dr. Michael Mosley. It further emphasized “The Obesity Code” by Dr. Jason Fung in 2016.

What is the scientific explanation of the benefits of fasting?

When you are not eating or fasting, several hormonal changes happen in your body. Whenever we eat, the food is broken down into glucose or sugar and enters the cells with the help of insulin. If you have extra calories and our cells don’t use glucose, excess glucose will be stored as fat cells.

During fasting, insulin levels go down, and fat cells start to be used as an energy source. Hence, the whole processes improve insulin sensitivity and promote weight loss. [1]

Evidence from animal and human studies suggested improved cellular repair, increased level of growth hormone, and many health conditions such as cardiovascular disease, diabetes mellitus, cancers, neurologic disorders, and antiaging. [2]

Different Methods of Intermittent Fasting

It is known as Lean–gain protocol. The schedule involves 16 hours fasting and 8 hours eating period.

It involves limiting your calorie intakes up to 500-600 calories for two days and normal intakes for five days.

It includes eating a normal diet one day and fasting or eating a reduced calorie intake the other day.

The schedule includes 24 hours fasting one-two day a week.

It involves small meals, including fruits and vegetables during the day, and one large meal at night.

This meal’s style is that you don’t need to follow a structured fasting plan; instead, you skip one to two meals when you don’t feel hungry or have time to eat.

Which method is better than others?

There is no evidence of superiority among different methods. Therefore, you should use whatever way is convenient for you.

However, if you decide to try intermittent fasting, be mindful of food quality. Ensure you eat healthy food and avoid junk food during the eating period as much as possible.

What are the side effects?

The most common one is hunger. Moreover, you may also feel tired, not able to think, and weak. It may take some time for your body to adjust to the new meal schedule.

Suppose you have underlying medical conditions such as diabetes, eating disorders, pregnancy, gastroesophageal reflux, and women with menstrual disorders. In that case, you should talk to your physician before you start doing intermittent fasting.

References

Western Diet

The diet is characterized by high intakes of processed meat, red meat, fried foods, high-fat dairy products, eggs, pre-packaged foods, butter, added sugar products, and low intakes of Fish, fruits, vegetables, whole grains, nuts, and seeds.

Western Diet and Potential Health Implication

Earlier studies reported support the association between a western diet and increased risk of coronary artery disease, diabetes, cholesterol problem and cancer. [1,2] Moreover, prolonged consumption of western style calories rich diet could even evoke a state of chronic metabolic inflammation, which could contribute to multiple health problems including obesity-associated metabolic syndrome, type 2 diabetes mellitus, non-alcoholic fatty liver disease, cardiovascular diseases, Alzheimer’s disease as well as certain cancers (i.e., colon cancer, pancreatic cancer, and breast cancer). [3]

Therefore, researchers are trying to define certain dietary intake patterns with metabolic activity resulting in oxidative stress, insulin resistance, and lipid dysregulation. In the latest study done by Chandler PD and colleagues, they attempted to map out metabolic signatures between two dietary patterns; western vs prudent dietary pattern. Prudent dietary pattern is mostly consisted of fresh fruit, vegetables, grilled Fish and salad. 2199 Women’s Health Initiative (WHI) participants were included. The finding was positive association of oxidative stress and abnormal lipid metabolism, resulting chronic inflammation, with western diet whereas prudent dietary pattern was not. [4]

References

What is the best diet type in daily life?

Although there are multiple research trials regarding correlation with dietary patterns and cardiovascular events, hard endpoints-based trials are, however, still limited. Nevertheless, choosing a healthy diet is not very hard as you think. Mediterranean and plant-based diets are known to be good healthy foods available. As there are multiple food options available, it is paramount to emphasize the type of food you eat, rather than following a specific type of diet.

The healthy diet mostly should include the following:

Plenty of vegetable fruits and whole grains (i.e. whole oats, whole wheat, whole-grain rye, buckwheat, Bulgur Wheat, Millet, Whole Barley, Quinoa, Brown Rice, Corn, Pop Corn)
Low-fat and non-fat dairy
Skinless poultry, Fish
Beans and legumes
Vegetable oils
Nuts and seeds

We should limit fat, trans fat, sodium (less than 23,00mg per day), sugar-sweetened beverages, processed meats, and alcohol in moderation. Remember how many calories you should eat everyday although it depends on multiple factors including age, gender, and daily physical activity.

References

1. Colilla S, Crow A, Petkun W, Singer DE, Simon T, Liu X. Estimates of current and future incidence and prevalence of atrial fibrillation in the U.S. adult population. Am J Cardiol. 2013;112:1142–1147. doi: 10.1016/j.amjcard.2013.05.063.

2. Pathak RK, Middeldorp ME, Meredith M, Mehta AB, Mahajan R, Wong CX, Twomey D, Elliott AD, Kalman JM, Abhayaratna WP, Lau DH, Sanders P. Long-Term Effect of Goal-Directed Weight Management in an Atrial Fibrillation Cohort: A Long-Term Follow-Up Study (LEGACY). J Am Coll Cardiol. 2015 May 26;65(20):2159-69. doi: 10.1016/j.jacc.2015.03.002. Epub 2015 Mar 16. PMID: 25792361.

3. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22(8):983–8.

4. Heart Rhythm Society. (2019). Complications from Atrial Fibrillation. Accessed May 9, 2019.

References

1. Diabetes Diet. Retrieved January 22, 2021, from https://www.diabetesfoodhub.org.

References

1. Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Dennison Himmelfarb, C., ... & Wright, J. T. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology, 71(19), e127-e248.

References

1. Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, et al. Heart disease and stroke statistics—2020 update: a report from the American Heart Association. Circulation. 2020;141(9):e139–e596.

2. Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, Fleisher LA, Fowkes FG, Hamburg NM, Kinlay S, Lookstein R, Misra S, Mureebe L, Olin JW, Patel RA, Regensteiner JG, Schanzer A, Shishehbor MH, Stewart KJ, Treat-Jacobson D, Walsh ME. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017 Mar 21;135(12):e686-e725. doi: 10.1161/CIR.0000000000000470. Epub 2016 Nov 13. Erratum in: Circulation. 2017 Mar 21;135(12 ):e790. PMID: 27840332; PMCID: PMC5479414.

References

1. Kleindorfer DO, Miller R, Moomaw CJ, Alwell K, Broderick JP, Khoury J, Woo D, Flaherty ML, Zakaria T, Kissela BM. Designing a message for public education regarding stroke: does FAST capture enough stroke? Stroke. 2007 Oct;38(10):2864-8. doi: 10.1161/STROKEAHA.107.484329. Epub 2007 Aug 30. PMID: 17761926.

References

1. Fryar CD, Chen T-C, Li X. Prevalence of uncontrolled risk factors for cardiovascular disease: United States, 1999–2010 pdf icon[PDF-494K]. NCHS data brief, no. 103. Hyattsville, MD: National Center for Health Statistics; 2012. Accessed May 9, 2019.

2. U.S. Department of Health and Human Services (USDHHS). A Report of the Surgeon General: How Tobacco Smoke Causes Disease: What It Means to You (Consumer Booklet). Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2010.

3. U.S. Department of Health and Human Services (USDHHS). The Health Consequences of Smoking: What It Means to You (Consumer Booklet). Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2004.

4. U.S. Department of Health and Human Services (USDHHS). How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2010.

References

1. Humalda, J. K., & Navis, G. (2014). Dietary sodium restriction: a neglected therapeutic opportunity in chronic kidney disease. Current opinion in nephrology and hypertension, 23(6), 533.

2. Garofalo C, Borrelli S, Provenzano M, et al. Dietary Salt Restriction in Chronic Kidney Disease: A Meta-Analysis of Randomized Clinical Trials. Nutrients. 2018;10(6):732. Published 2018 Jun 6. doi:10.3390/nu10060732

3. Kovesdy CP. Management of hyperkalaemia in chronic kidney disease. Nat Rev Nephrol. 2014;10(11):653-662. doi:10.1038/nrneph.2014.168

4. González-Parra E, Gracia-Iguacel C, Egido J, Ortiz A. Phosphorus and nutrition in chronic kidney disease. Int J Nephrol. 2012;2012:597605. doi:10.1155/2012/597605

References

1. Ng M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384:766–781. doi: 10.1016/S0140-6736(14)60460-8. 

2. Ford ES, Li C, Zhao G, Tsai J. Trends in obesity and abdominal obesity among adults in the United States from 1999 to 2008. Int. J. Obes. 2011;35:736–743. doi: 10.1038/ijo.2010.186.

3. Blackburn GL, Wollner S, Heymsfield SB. Lifestyle interventions for the treatment of class III obesity: a primary target for nutrition medicine in the obesity epidemic. Am. J. Clin. Nutr. 2010;91:289S–292S. doi: 10.3945/ajcn.2009.28473D.

4. World Health Organisation (WHO). Dietary Reference Intakes for Energy, Carbohydrate, Fibre, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids (Macronutrients); WHO Technical Report Series 935; World Health Organisation (WHO): Geneva, Switzerland, 2007

References

1. Centers for Disease Control and Prevention. Underlying Cause of Death, 1999–2018. CDC WONDER Online Database. Atlanta, GA: Centers for Disease Control and Prevention; 2018. Accessed March 12, 2020.

2. Fryar CD, Chen T-C, Li X. Prevalence of uncontrolled risk factors for cardiovascular disease: United States, 1999–2010. NCHS data brief, no. 103. Hyattsville, MD: National Center for Health Statistics; 2012. Accessed May 9, 2019.

3. Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, et al. Heart disease and stroke statistics—2019 update: a report from the American Heart Association external icon. Circulation. 2019;139(10):e56–528.  

References

2. Centers for Disease Control and Prevention (CDC). Hypertension Cascade: Hypertension Prevalence, Treatment and Control Estimates Among US Adults Aged 18 Years and Older Applying the Criteria From the American College of Cardiology and American Heart Association's 2017 Hypertension Guideline—NHANES 2013–2016external icon. Atlanta, GA: US Department of Health and Human Services; 2019.

3. Sacks, F. M., Svetkey, L. P., Vollmer, W. M., Appel, L. J., Bray, G. A., Harsha, D., ... & Karanja, N. (2001). Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. New England journal of medicine, 344(1), 3-10.  

4. Cook NR, Cutler JA, Obarzanek E, et al. Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP). BMJ 2007;334:885-8.

5. Shenoy SF, Poston WS, Reeves RS, Kazaks AG, Holt RR, Keen CL, Chen HJ, Haddock CK, Winters BL, Khoo CS, Foreyt JP. Weight loss in individuals with metabolic syndrome given DASH diet counseling when provided a low sodium vegetable juice: a randomized controlled trial. Nutr J. 2010 Feb 23;9:8. doi: 10.1186/1475-2891-9-8. PMID: 20178625; PMCID: PMC2841082.

6. Blumenthal JA, Babyak MA, Hinderliter A, Watkins LL, Craighead L, Lin PH, Caccia C, Johnson J, Waugh R, Sherwood A. Effects of the DASH diet alone and in combination with exercise and weight loss on blood pressure and cardiovascular biomarkers in men and women with high blood pressure: the ENCORE study. Arch Intern Med. 2010 Jan 25;170(2):126-35. doi: 10.1001/archinternmed.2009.470. PMID: 20101007; PMCID: PMC3633078.

7. Onvani S, Haghighatdoost F, Azadbakht L. Dietary approach to stop hypertension (DASH): diet components may be related to lower prevalence of different kinds of cancer: A review on the related documents. J Res Med Sci. 2015 Jul;20(7):707-13. doi: 10.4103/1735-1995.166233. PMID: 26622263; PMCID: PMC4638076.

8. Asghari G, Yuzbashian E, Mirmiran P, Hooshmand F, Najafi R, Azizi F. Dietary Approaches to Stop Hypertension (DASH) Dietary Pattern Is Associated with Reduced Incidence of Metabolic Syndrome in Children and Adolescents. J Pediatr. 2016 Jul;174:178-184.e1. doi: 10.1016/j.jpeds.2016.03.077. Epub 2016 May 5. PMID: 27156186.

9. Shirani F, Salehi-Abargouei A, Azadbakht L. Effects of Dietary Approaches to Stop Hypertension (DASH) diet on some risk for developing type 2 diabetes: a systematic review and meta-analysis on controlled clinical trials. Nutrition. 2013 Jul-Aug;29(7-8):939-47. doi: 10.1016/j.nut.2012.12.021. Epub 2013 Mar 6. PMID: 23473733.

10. Salehi-Abargouei A, Maghsoudi Z, Shirani F, Azadbakht L. Effects of Dietary Approaches to Stop Hypertension (DASH)-style diet on fatal or nonfatal cardiovascular diseases--incidence: a systematic review and meta-analysis on observational prospective studies. Nutrition. 2013 Apr;29(4):611-8. doi: 10.1016/j.nut.2012.12.018. PMID: 23466047.

11. Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, Himmelfarb CD, Khera A, Lloyd-Jones D, McEvoy JW, Michos ED, Miedema MD, Muñoz D, Smith SC Jr, Virani SS, Williams KA Sr, Yeboah J, Ziaeian B. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019 Sep 10;140(11):e596-e646. doi: 10.1161/CIR.0000000000000678. Epub 2019 Mar 17. Erratum in: Circulation. 2019 Sep 10;140(11):e649-e650. Erratum in: Circulation. 2020 Jan 28;141(4):e60. Erratum in: Circulation. 2020 Apr 21;141(16):e774. PMID: 30879355; PMCID: PMC7734661.

12. Top 10 Dash Diet Tips. Available at: http://dashdiet.org/dash-diettips. html. Accessed January 6, 2019.

References

1. Sutton, E. F., Beyl, R., Early, K. S., Cefalu, W. T., Ravussin, E., & Peterson, C. M. (2018). Early time-restricted feeding improves insulin sensitivity, blood pressure, and oxidative stress even without weight loss in men with prediabetes. Cell metabolism, 27(6), 1212-1221.

2. de Cabo, Rafael, and Mark P. Mattson. "Effects of intermittent fasting on health, aging, and disease." New England Journal of Medicine 381, no. 26 (2019): 2541-2551.

References

1. Heidemann C, Schulze MB, Franco OH, van Dam RM, Mantzoros CS, Hu FB. Dietary patterns and risk of mortality from cardiovascular disease, cancer, and all causes in a prospective cohort of women. Circulation 2008;118(3):230–7.

2. Wu K, Hu FB, Fuchs C, Rimm EB, Willett WC, Giovannucci E. Dietary patterns and risk of colon cancer and adenoma in a cohort of men (United States). Cancer Causes Control 2004;15(9): 853–62.

3. Christ A, Lauterbach M, Latz E. Western Diet and the Immune System: An Inflammatory Connection. Immunity. 2019 Nov 19;51(5):794-811. doi: 10.1016/j.immuni.2019.09.020. PMID: 31747581.  

4. Chandler PD, Balasubramanian R, Paynter N, Giulianini F, Fung T, Tinker LF, Snetselaar L, Liu S, Eaton C, Tobias DK, Tabung FK, Manson JE, Giovannucci EL, Clish C, Rexrode KM. Metabolic signatures associated with Western and Prudent dietary patterns in women. Am J Clin Nutr. 2020 Aug 1;112(2):268-283. doi: 10.1093/ajcn/nqaa131. PMID: 32520313; PMCID: PMC7398790.

References

1. Bueno N.B., de Melo I.S., de Oliveira S.L., da Rocha Ataide T. Very-low-carbohydrate ketogenic diet v. Low-fat diet for long-term weight loss: A meta-analysis of randomised controlled trials. Br. J. Nutr. 2013;110:1178–1187. doi: 10.1017/S0007114513000548.

2. Johnstone A.M., Horgan G.W., Murison S.D., Bremner D.M., Lobley G.E. Effects of a high-protein ketogenic diet on hunger, appetite, and weight loss in obese men feeding ad libitum. Amer. J. Clin. Nutr. 2008;87:44–55.

3. Cahill G.F., Jr. Fuel metabolism in starvation. Annu. Rev. Nutr. 2006;26:1–22. doi:10.1146/annurev.nutr.26.061505.111258. 

4. Goss, A. M., Gower, B., Soleymani, T., Stewart, M., Pendergrass, M., Lockhart, M., Krantz, O., Dowla, S., Bush, N., Garr Barry, V., & Fontaine, K. R. (2020). Effects of weight loss during a very low carbohydrate diet on specific adipose tissue depots and insulin sensitivity in older adults with obesity: a randomized clinical trial. Nutrition & metabolism, 17, 64. https://doi.org/10.1186/s12986-020-00481-9

5. Paoli A., Rubini A., Volek J.S., Grimaldi K.A. Beyond weight loss: A review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. Eur. J. Clin. Nutr. 2013;67:789–796. doi: 10.1038/ejcn.2013.116.

6. Volek J.S., Sharman M.J., Forsythe C.E. Modification of lipoproteins by very low-carbohydrate diets. J. Nutr. 2005;135:1339–1342.

7. Boden G, Sargrad K, Homko C, Mozzoli M, Stein TP. Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes. Ann Intern Med. 2005 Mar 15;142(6):403-11. doi: 10.7326/0003-4819-142-6-200503150-00006. PMID: 15767618.

8. Walton CM, Perry K, Hart RH, Berry SL, Bikman BT. Improvement in Glycemic and Lipid Profiles in Type 2 Diabetics with a 90-Day Ketogenic Diet. J Diabetes Res. 2019 Aug 14;2019:8681959. doi: 10.1155/2019/8681959. PMID: 31485454; PMCID: PMC6710763.

9. Westman, E. C., Yancy, W. S., Jr, Mavropoulos, J. C., Marquart, M., & McDuffie, J. R. (2008). The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus. Nutrition & metabolism, 5, 36. https://doi.org/10.1186/1743-7075-5-36

10. Weber, D. D., Aminazdeh-Gohari, S., & Kofler, B. (2018). Ketogenic diet in cancer therapy. Aging, 10(2), 164–165. https://doi.org/10.18632/aging.101382

11. Rusek, M., Pluta, R., Ułamek-Kozioł, M., & Czuczwar, S. J. (2019). Ketogenic Diet in Alzheimer's Disease. International journal of molecular sciences, 20(16), 3892. https://doi.org/10.3390/ijms20163892

12. Phillips, M., Murtagh, D., Gilbertson, L. J., Asztely, F., & Lynch, C. (2018). Low-fat versus ketogenic diet in Parkinson's disease: A pilot randomized controlled trial. Movement disorders : official journal of the Movement Disorder Society, 33(8), 1306–1314.

13. Ułamek-Kozioł, M., Czuczwar, S. J., Januszewski, S., & Pluta, R. (2019). Ketogenic Diet and Epilepsy. Nutrients, 11(10), 2510. https://doi.org/10.3390/nu11102510

References

1. Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F, Gómez-Gracia E, Ruiz-Gutiérrez V, Fiol M, Lapetra J, Lamuela-Raventos RM, Serra-Majem L, Pintó X, Basora J, Muñoz MA, Sorlí JV, Martínez JA, Fitó M, Gea A, Hernán MA, Martínez-González MA; PREDIMED Study Investigators. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts. N Engl J Med. 2018 Jun 21;378(25):e34. doi: 10.1056/NEJMoa1800389. Epub 2018 Jun 13. PMID: 29897866.

2. Kris-Etherton, P., Eckel, R. H., Howard, B. V., St. Jeor, S., & Bazzarre, T. L. (2001). Lyon diet heart study: benefits of a Mediterranean-Style, National Cholesterol Education Program/American Heart Association Step I dietary pattern on cardiovascular disease. Circulation, 103(13), 1823-1825.

3. Agnoli, C., Sieri, S., Ricceri, F., Giraudo, M. T., Masala, G., Assedi, M., ... & Krogh, V. (2018). Adherence to a Mediterranean diet and long-term changes in weight and waist circumference in the EPIC-Italy cohort. Nutrition & diabetes, 8(1), 1-10.

4. Mancini JG, Filion KB, Atallah R, Eisenberg MJ. Systematic Review of the Mediterranean Diet for Long-Term Weight Loss. Am J Med. 2016 Apr;129(4):407-415.e4. doi: 10.1016/j.amjmed.2015.11.028. Epub 2015 Dec 22. PMID: 26721635.

5. Ford, C., Chang, S., Vitolins, M., Fenton, J., Howard, B., Rhee, J., . . . Frazier-Wood, A. (2017). Evaluation of diet pattern and weight gain in postmenopausal women enrolled in the Women's Health Initiative Observational Study. British Journal of Nutrition, 117(8), 1189-1197. doi:10.1017/S0007114517000952

6. Salas-Salvadó, J., Bulló, M., Babio, N., Martínez-González, M. Á., Ibarrola-Jurado, N., Basora, J., Estruch, R., Covas, M. I., Corella, D., Arós, F., Ruiz-Gutiérrez, V., Ros, E., & PREDIMED Study Investigators (2011). Reduction in the incidence of type 2 diabetes with the Mediterranean diet: results of the PREDIMED-Reus nutrition intervention randomized trial. Diabetes care, 34(1), 14–19. https://doi.org/10.2337/dc10-1288

7. Esposito K, Maiorino MI, Di Palo C, Giugliano D; Campanian Postprandial Hyperglycemia Study Group. Adherence to a Mediterranean diet and glycaemic control in Type 2 diabetes mellitus. Diabet Med. 2009 Sep;26(9):900-7. doi: 10.1111/j.1464-5491.2009.02798.x. PMID: 19719711.

8. Sureda, A., Bibiloni, M., Julibert, A., Bouzas, C., Argelich, E., Llompart, I., Pons, A., & Tur, J. A. (2018). Adherence to the Mediterranean Diet and Inflammatory Markers. Nutrients, 10(1), 62. https://doi.org/10.3390/nu10010062

9. Casas, R., Urpi-Sardà, M., Sacanella, E., Arranz, S., Corella, D., Castañer, O., Lamuela-Raventós, R. M., Salas-Salvadó, J., Lapetra, J., Portillo, M. P., & Estruch, R. (2017). Anti-Inflammatory Effects of the Mediterranean Diet in the Early and Late Stages of Atheroma Plaque Development. Mediators of inflammation, 2017, 3674390. https://doi.org/10.1155/2017/3674390

References

1. Huang T, Yang B, Zheng J, Li G, Wahlqvist ML, Li D. Cardiovascular Disease Mortality and Cancer Incidence in Vegetarians: A Meta-Analysis and Systematic Review. Ann Nutr Metab. 2012; 60(4):233–40. [PubMed: 22677895]

2. Martinez-Gonzalez MA, Sanchez-Tainta A, Corella D, Salas-Salvado J, Ros E, Aros F, et al. A provegetarian food pattern and reduction in total mortality in the Prevencion con Dieta Mediterranea (PREDIMED) study. Am J Clin Nutr. 2014 Jul; 100(Suppl 1):320S–8S. [PubMed: 24871477]

3. Huang C, Huang J, Tian Y, Yang X, Gu D. Sugar sweetened beverages consumption and risk of coronary heart disease: a meta-analysis of prospective studies. Atherosclerosis. 2014 May; 234(1):11–6. [PubMed: 24583500]

4. Hu EA, Pan A, Malik V, Sun Q. White rice consumption and risk of type 2 diabetes: meta-analysis and systematic review. BMJ. 2012 Mar 15.344:e1454. [PubMed: 22422870]

5. Satija A, Bhupathiraju SN, Spiegelman D, Chiuve SE, Manson JE, Willett W, Rexrode KM, Rimm EB, Hu FB. Healthful and Unhealthful Plant-Based Diets and the Risk of Coronary Heart Disease in U.S. Adults. J Am Coll Cardiol. 2017 Jul 25;70(4):411-422. doi: 10.1016/j.jacc.2017.05.047. PMID: 28728684; PMCID: PMC5555375.

6. Lofvenborg JE, Andersson T, Carlsson PO, et al. Sweetened beverage intake and risk of latent autoimmune diabetes in adults (LADA) and type 2 diabetes. Eur J Endocrinol 2016;175:605-14.

7. Yang Q, Zhang Z, Gregg EW, Flanders WD, Merritt R, Hu FB. Added sugar intake and cardiovascular diseases mortality among US adults. JAMA Intern Med 2014;174:516-24.

8. Gluba-Brzozka A, Franczyk B, Rysz J. Vegetarian Diet in Chronic Kidney Disease-A Friend or Foe. Nutrients 2017;9.

9. Ornish D, Scherwitz LW, Billings JH, Brown SE, Gould KL, Merritt TA, Sparler S, Armstrong WT, Ports TA, Kirkeeide RL, Hogeboom C, Brand RJ. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. 1998 Dec 16;280(23):2001-7. doi: 10.1001/jama.280.23.2001. Erratum in: JAMA 1999 Apr 21;281(15):1380. PMID: 9863851.

10. Yokoyama Y, Nishimura K, Barnard ND, Takegami M, Watanabe M, Sekikawa A, Okamura T, Miyamoto Y. Vegetarian diets and blood pressure: a meta-analysis. JAMA Intern Med. 2014 Apr;174(4):577-87. doi: 10.1001/jamainternmed.2013.14547. PMID: 24566947.

11.Jenkins DJ, Kendall CW, Marchie A, Jenkins AL, Augustin LS, Ludwig DS, Barnard ND, Anderson JW. Type 2 diabetes and the vegetarian diet. Am J Clin Nutr. 2003 Sep;78(3 Suppl):610S-616S. doi: 10.1093/ajcn/78.3.610S. PMID: 12936955.

12. McMacken M, Shah S. A plant-based diet for the prevention and treatment of type 2 diabetes. J Geriatr Cardiol. 2017 May;14(5):342-354. doi: 10.11909/j.issn.1671-5411.2017.05.009. PMID: 28630614; PMCID: PMC5466941.

13. Pawlak, R. (2017). Vegetarian diets in the prevention and management of diabetes and its complications. Diabetes Spectrum, 30(2), 82-88.

14. Spencer EA, Appleby PN, Davey GK, Key TJ. Diet and body mass index in 38000 EPIC-Oxford meat-eaters, fish-eaters, vegetarians and vegans. Int J Obes Relat Metab Disord. 2003 Jun;27(6):728-34. doi: 10.1038/sj.ijo.0802300. PMID: 12833118.

References

1. Kiage JN, Merrill PD, Robinson CJ, et al. Intake of trans fat and all cause mortality in the Reasons for Geographical and Racial Differences in Stroke (REGARDS) cohort. Am J Clin Nutr. 2013;97:1121–8.

2. Hall, K.D., et al. (2015). Calorie for calorie, dietary fat restriction results in more body fat loss than carbohydrate restriction in people with obesity. Cell Metabolism, 22(3), 427-436. Retrieved from http://www.cell.com/cell-metabolism/abstract/S1550-4131(15)00350-2

3. Howard, B.V., et al. (2006). Low-fat dietary pattern and weight change over 7 years. Journal of the American Medical Association, 295(1), 39-49. Retrieved from http://jama.jamanetwork.com/article.aspx?articleid=202138

4. Dehghan M, Mente A, Zhang X, et al. Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study. Lancet 2017; 390: 2050–62.

5. Seidelmann SB, Claggett B, Cheng S, Henglin M, Shah A, Steffen LM, Folsom AR, Rimm EB, Willett WC, Solomon SD. Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis. Lancet Public Health. 2018 Sep;3(9):e419-e428. doi: 10.1016/S2468-2667(18)30135-X. Epub 2018 Aug 17. PMID: 30122560; PMCID: PMC6339822.

References

1. Weir HK, Anderson RN, Coleman King SM, et al. Heart disease and cancer deaths—trends and projections in the United States, 1969–2020. Prev Chronic Dis. 2016;13:E157.

2. US Department of Agriculture, Agricultural Research Service, Beltsirlle Human Nutrition Centre, Food Surveys Research Group (Beltsirlle, MD) https://www.ars.usda.gov/

3. Atkins RC. Dr. Atkins' new diet revolution. 1st Quill edn. New York: Quill; 2002.

4. St Jeor ST, Howard BV, Prewitt TE, Bovee V, Bazzarre T, Eckel RH, Nutrition Committee of the Council on Nutrition PA, Metabolism of the American Heart A Dietary protein and weight reduction: a statement for healthcare professionals from the Nutrition Committee of the Council on Nutrition, Physical Activity, and Metabolism of the American Heart Association. Circulation. 2001;104:1869–1874. doi: 10.1161/hc4001.096152.

5. Soenen S, Bonomi AG, Lemmens SG, Scholte J, Thijssen MA, van Berkum F, Westerterp-Plantenga MS. Relatively high-protein or ‘low-carb’ energy-restricted diets for body weight loss and body weight maintenance? Physiol Behav. 2012;107:374–380. doi: 10.1016/j.physbeh.2012.08.004. https://www.ncbi.nlm.nih.gov/pubmed/22935440

6. USDA dietary guidelines 2015-2020. (https://health.gov/our-work/food-nutrition/2015-2020-dietary-guidelines/guidelines/appendix-7)

7. Noto H, Goto A, Tsujimoto T, Noda M. Low-carbohydrate diets and all-cause mortality: a systematic review and meta-analysis of observational studies. PLoS One. 2013;8(1):e55030. doi:10.1371/journal.pone.0055030. Epub 2013 Jan 25. Erratum in: PLoS One. 2019 Feb 7;14(2):e0212203. PMID: 23372809; PMCID: PMC3555979.

8. Foster GD, Wyatt HR, Hill JO, McGuckin BG, Brill C, Mohammed BS et al. (2003). A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med 348, 2082–2090.

9. Trichopoulou, A., Psaltopoulou, T., Orfanos, P., Hsieh, C. C., & Trichopoulos, D. (2007). Low-carbohydrate–high-protein diet and long-term survival in a general population cohort. European journal of clinical nutrition, 61(5), 575-581.

10. Seidelmann SB, Claggett B, Cheng S, Henglin M, Shah A, Steffen LM, Folsom AR, Rimm EB, Willett WC, Solomon SD. Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis. Lancet Public Health. 2018 Sep;3(9):e419-e428. doi: 10.1016/S2468-2667(18)30135-X. Epub 2018 Aug 17. PMID: 30122560; PMCID: PMC6339822.

11. Knight, E. L., Stampfer, M. J., Hankinson, S. E., Spiegelman, D., & Curhan, G. C. (2003). The impact of protein intake on renal function decline in women with normal renal function or mild renal insufficiency. Annals of internal medicine, 138(6), 460-467.

References

1. Bertelli AA, Das DK. Grapes, wines, resveratrol, and heart health. J Cardiovasc Pharmacol. 2009 Dec;54(6):468-76. doi: 10.1097/FJC.0b013e3181bfaff3. PMID: 19770673.

2. Waterhouse AL. Wine phenolics. Ann N Y Acad Sci. 2002 May;957:21-36. doi: 10.1111/j.1749-6632.2002.tb02903.x. PMID: 12074959.

3. Bertelli, Alberto A A MD, PhD*; Das, Dipak K PhD, ScD, FAHA† Grapes, Wines, Resveratrol, and Heart Health, Journal of Cardiovascular Pharmacology: December 2009 - Volume 54 - Issue 6 - p 468-476 doi: 10.1097/FJC.0b013e3181bfaff3

4. Micallef M, Lexis L, Lewandowski P. Red wine consumption increases antioxidant status and decreases oxidative stress in the circulation of both young and old humans. Nutr J. 2007 Sep 24;6:27. doi: 10.1186/1475-2891-6-27. PMID: 17888186; PMCID: PMC2039729.

5. Chiva-Blanch G, Urpi-Sarda M, Ros E, Arranz S, Valderas-Martínez P, Casas R, Sacanella E, Llorach R, Lamuela-Raventos RM, Andres-Lacueva C, Estruch R. Dealcoholized red wine decreases systolic and diastolic blood pressure and increases plasma nitric oxide: short communication. Circ Res. 2012 Sep 28;111(8):1065-8. doi: 10.1161/CIRCRESAHA.112.275636. Epub 2012 Sep 6. PMID: 22955728.

6. Mukamal KJ, Ascherio A, Mittleman MA, Conigrave KM, Camargo CA Jr, Kawachi I, Stampfer MJ, Willett WC, Rimm EB. Alcohol and risk for ischemic stroke in men: the role of drinking patterns and usual beverage. Ann Intern Med. 2005 Jan 4;142(1):11-9. doi: 10.7326/0003-4819-142-1-200501040-00007. PMID: 15630105.

7. Arranz S, Chiva-Blanch G, Valderas-Martínez P, Medina-Remón A, Lamuela-Raventós RM, Estruch R. Wine, beer, alcohol and polyphenols on cardiovascular disease and cancer. Nutrients. 2012 Jul;4(7):759-81. doi: 10.3390/nu4070759. Epub 2012 Jul 10. PMID: 22852062; PMCID: PMC3407993.

8. Yang X, Li X, Ren J. From French Paradox to cancer treatment: anti-cancer activities and mechanisms of resveratrol. Anticancer Agents Med Chem. 2014;14(6):806-25. doi: 10.2174/1871520614666140521121722. PMID: 24851878.

9. Ruitenberg A, van Swieten JC, Witteman JC, Mehta KM, van Duijn CM, Hofman A, Breteler MM. Alcohol consumption and risk of dementia: the Rotterdam Study. Lancet. 2002 Jan 26;359(9303):281-6. doi: 10.1016/S0140-6736(02)07493-7. PMID: 11830193.

10. Gea A, Beunza JJ, Estruch R, Sánchez-Villegas A, Salas-Salvadó J, Buil-Cosiales P, Gómez-Gracia E, Covas MI, Corella D, Fiol M, Arós F, Lapetra J, Lamuela-Raventós RM, Wärnberg J, Pintó X, Serra-Majem L, Martínez-González MA; PREDIMED GROUP. Alcohol intake, wine consumption and the development of depression: the PREDIMED study. BMC Med. 2013 Aug 30;11:192. doi: 10.1186/1741-7015-11-192. PMID: 23988010; PMCID: PMC3765610.

11. Hodge AM, English DR, O'Dea K, Giles GG. Alcohol intake, consumption pattern and beverage type, and the risk of Type 2 diabetes. Diabet Med. 2006 Jun;23(6):690-7. doi: 10.1111/j.1464-5491.2006.01864.x. PMID: 16759314.

12. Chiva-Blanch G, Urpi-Sarda M, Ros E, Valderas-Martinez P, Casas R, Arranz S, Guillén M, Lamuela-Raventós RM, Llorach R, Andres-Lacueva C, Estruch R. Effects of red wine polyphenols and alcohol on glucose metabolism and the lipid profile: a randomized clinical trial. Clin Nutr. 2013 Apr;32(2):200-6. doi: 10.1016/j.clnu.2012.08.022. Epub 2012 Sep 3. PMID: 22999066.

References

1. Sender, R., Fuchs, S., & Milo, R. (2016). Revised estimates for the number of human and bacteria cells in the body. PLoS biology, 14(8), e1002533.

2. Hill, Colin, et al. "Expert consensus document: The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic." Nature reviews Gastroenterology & hepatology 11.8 (2014): 506.

3. Quigley EM. Gut bacteria in health and disease. Gastroenterol Hepatol (NY). 2013;9(9):560-569.

4. Rowland, I., Gibson, G., Heinken, A. et al. Gut microbiota functions: metabolism of nutrients and other food components. Eur J Nutr 57, 1–24 (2018). https://doi.org/10.1007/s00394-017-1445-8

5. Lei YM, Nair L, Alegre ML. The interplay between the intestinal microbiota and the immune system. Clin Res Hepatol Gastroenterol. 2015 Feb;39(1):9-19. doi: 10.1016/j.clinre.2014.10.008. Epub 2014 Nov 11. PMID: 25481240; PMCID: PMC4423786.

6. Tuohy KM, Fava F, Viola R. 'The way to a man's heart is through his gut microbiota'--dietary pro- and prebiotics for the management of cardiovascular risk. Proc Nutr Soc. 2014 May;73(2):172-85. doi: 10.1017/S0029665113003911. Epub 2014 Feb 4. PMID: 24495527.

7. Dale, Hanna Fjeldheim, et al. "Probiotics in irritable bowel syndrome: an up-to-date systematic review." Nutrients 11.9 (2019): 2048.

8. Blaabjerg S, Artzi DM, Aabenhus R. Probiotics for the Prevention of Antibiotic-Associated Diarrhea in Outpatients-A Systematic Review and Meta-Analysis. Antibiotics (Basel). 2017 Oct 12;6(4):21. doi: 10.3390/antibiotics6040021. PMID: 29023420; PMCID: PMC5745464.

9. Almeida, Alexandre, et al. "A new genomic blueprint of the human gut microbiota." Nature 568.7753 (2019): 499-504.

10. Rondanelli, Mariangela, et al. "Using probiotics in clinical practice: where are we now? A review of existing meta-analyses." Gut microbes 8.6 (2017): 521-543.

References

Neha K, Haider MR, Pathak A, Yar MS. Medicinal prospects of antioxidants: A review. Eur J Med Chem. 2019;178:687-704. doi:10.1016/j.ejmech.2019.06.010
Silva SAME, Michniak-Kohn B, Leonardi GR. An overview about oxidation in clinical practice of skin aging. An Bras Dermatol. 2017;92(3):367-374. doi:10.1590/abd1806-4841.20175481
Carlsen, Monica H et al. “The total antioxidant content of more than 3100 foods, beverages, spices, herbs and supplements used worldwide.” Nutrition journal vol. 9 3. 22 Jan. 2010, doi:10.1186/1475-2891-9-3
Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, Gluud C. Mortality in randomized trials of antioxidant supplements for primary and secondary prevention: systematic review and meta-analysis. JAMA. 2007 Feb 28;297(8):842-57. doi: 10.1001/jama.297.8.842. Erratum in: JAMA. 2008 Feb 20;299(7):765-6. PMID: 17327526.
Grodstein F, Kang JH, Glynn RJ, Cook NR, Gaziano JM. A randomized trial of beta carotene supplementation and cognitive function in men: the Physicians’ Health Study II. Archives of internal medicine. 2007 Nov 12;167(20):2184-90.

References

Dietary Guidelines for Americans 2020-2025. Retrieved from https://www.dietaryguidelines.gov
Fung TT, Hu FB, Pereira MA, et al. Whole-grain intake and the risk of type 2 diabetes: a prospective study in men. Am J Clin Nutr. 2002;76:535-40.
Liu S, Willett WC, Stampfer MJ, et al. A prospective study of dietary glycemic load, carbohydrate intake, and risk of coronary heart disease in US women. Am J Clin Nutr. 2000;71:1455-61.
Farvid MS, Eliassen AH, Cho E, Liao X, Chen WY, Willett WC. Dietary fiber intake in young adults and breast cancer risk. Pediatrics 2016: 137(3).
Pereira MA, O’Reilly E, Augustsson K, et al. Dietary fiber and risk of coronary heart disease: a pooled analysis of cohort studies. Arch Intern Med. 2004;164:370-6.

References

CDC Health Alert Network: Severe Pulmonary Disease Associated with Using E-Cigarette Products https://emergency.cdc.gov/han/han00421.asp (Accessed on September 23, 2019).
Electronic cigarette explosion/burn and poisoning related emergency department visits, 2018-2019. Rossheim ME, McDonald KK, Soule EK, Gimm GW, Livingston MD, Barnett TE, Jernigan DH, Thombs DL . Am J Emerg Med. 2020;38(12):2637. Epub 2020 Aug 16.
Effect of e-Cigarettes Plus Counseling vs Counseling Alone on Smoking Cessation: A Randomized Clinical Trial. Eisenberg MJ, Hébert-Losier A, Windle SB, Greenspoon T, Brandys T, Fülöp T, Nguyen T, Elkouri S, Montigny M, Wilderman I, Bertrand OF, Bostwick JA, Abrahamson J, Lacasse Y, Pakhale S, Cabaussel J, Filion KB, E3 Investigators. JAMA. 2020;324(18):1844.
E-cigarette versus nicotine inhaler: comparing the perceptions and experiences of inhaled nicotine devices. Steinberg MB, Zimmermann MH, Delnevo CD, Lewis MJ, Shukla P, Coups EJ, Foulds J. J Gen Intern Med. 2014 Nov;29(11):1444-50. Epub 2014 May 15.
U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.
U.S. Department of Health and Human Services. The Health Consequences of Smoking: What It Means to You. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004.
Meier MH, Caspi A, Ambler A, et al. Persistent cannabis users show neuropsychological decline from childhood to midlife. Proc Natl Acad Sci USA. 2012;109(40):E2657-E2664. doi:10.1073/pnas.1206820109.

TOP Antioxidant-Rich Foods

Avocado
Artichokes
Apricots
Berries
Beans
Broccoli
Carrots
Capsicum
Coffee
Dark Chocolate
Green Tea
Garlic
Grapes and Grapefruit
Kale
Kiwi
Mango
Nuts
Oranges
Onion
Poultry
Parsley
Pumpkin
Red Wine
Red Cabbage
Strawberries
Spinach
Seafood
Tea

Foods that contain Omega-3 FA

The American Heart Association recommends eating two servings of fish (particularly fatty fish) per week. A serving is 3.5 ounces cooked or about a cup of flaked fish.

Common fish and seafood products rich in Omega-3 [5]

Seafood	Serving Size	Omega-3 FA (mg/serving)
Anchovy	2.0 oz	1,200
Catfish (farmed)	5.0 oz	253
Clams	3.0 oz	241
Cod (Atlantic)	6.3 oz	284
Crab	3.0 oz	351
Fish sticks (frozen)	3.2 oz	193
Halibut	5.6 oz	740
Lobster	3.0 oz	71
Mahi mahi	5.6 oz	221
Mussels	3.0 oz	665
Oysters	3.0 oz	585
Pollock (Alaskan)	2.1 oz	281
Salmon (wild)	6.0 oz	1,774
Salmon (farmed)	6.0 oz	4,504
Sardines	2.0 oz	556
Scallops	3.0 oz	310
Shrimp	3.0 oz	267
Swordfish	3.7 oz	868
Trout	2.2 oz	581
Tuna (albacore)	3.0 oz	733
Tuna (light, skipjack)	3.0 oz	228