What Can Twins Tell Us About Diet?

What Are The Pros And Cons Of Twin Studies? 

Author: Dr. Stephen Chaney 

Why is the advice on healthy diets so confusing? One blog claims the vegan diet is best. Another says it is the keto diet is best. The Mediterranean diet is popular, but other experts claim the DASH or MIND diet might be better. Blogs champion diets ranging from the familiar to downright weird.

If you try to keep up with the science, it seems like the science is constantly changing. Each week you see headlines saying the latest study shows diet “X” is best – and “X” keeps changing. Why is that? Why do studies on healthy diets keep coming up with conflicting conclusions?

I have discussed the strengths and weaknesses of clinical studies and why they provide conflicting results in detail in previous issues of “Health Tips From the Professor”. However, one factor I have not discussed in detail is the effect of genetics on how we utilize foods, something called nutrigenomics.

Simply put, we are all genetically different. The way we utilize foods is different. The effect that foods have on our bodies is different. I have touched on that briefly in a previous article discussing individual difference in blood sugar response to various foods. But that is just one of many examples.

We do not yet know enough about gene-nutrient interactions to use genomic data to accurately predict which diets are best. Again, I have covered that topic in a previous issue of “Health Tips From the Professor”. However, we do know that genetic differences have a big influence on which diet is best for us. And most clinical studies on diets do not even attempt to take genetic differences into account.

That is where twin studies come in. Identical twins (monozygotic twins) have an identical genetic makeup and usually have an identical environment until they become adults. So, when I saw an identical twin study (MJ Landry et al, JAMA Network Open, 6(11):e2344457, 2023) comparing a vegan diet (only plant foods) with an omnivorous diet (both animal and plant foods), I wanted to review it and share it with you.

How Was The Study Done? 

Clinical StudyIdentical twins were recruited from the Stanford Twin Registry. Twenty-two identical twin pairs were chosen for this study. Their characteristics were average age = 40, BMI = 26% (moderately overweight), sex = 77% female, ethnicity = 73% white, followed by an approximately equal representation of Asian, black, multiracial, and Pacific Islander.

One unanticipated characteristic of this group of twins was that 70% of them still lived together and cooked together, so their environment was also very similar.

One twin of each pair was put on a healthy vegan diet and the other on a healthy omnivorous diet for 8 weeks. Both diets were designed by dietitians. The diets emphasized fruits, vegetables, and whole grains while limiting added sugars and refined grains.

Both diets were healthier than the diets the twins were eating prior to the study. Finally, the participants were not told how much to eat, and were not instructed to lose weight.

For the first four weeks the participants were provided with all their meals by a nationwide food delivery company. The participants were also provided with training on purchasing and preparing healthy foods for their diet. This prepared them for the last 4 weeks of the study in which they purchased and prepared their own meals.

Participants visited the Stanford Clinical and Translational Science Research Unit at the beginning of the study and at the end of weeks 4 and 8 for weight measurement and a fasting blood draw.

Adherence to the diets was measured by a series of unannounced interviews to administer a 24-hour dietary recall questionnaire. These were scheduled for the weeks they visited the clinic.

What Can Twins Tell Us About Diet? 

TwinsEven though the sample size was small, there were three statistically significant results.

  • LDL-cholesterol was reduced by 12% for the twin on the vegan diet, while it remained unchanged for the twin on the omnivorous diet.
  • The fasting insulin level was reduced by 21% for the twin on the vegan diet, while it remained unchanged for the twin on the omnivorous diet. This suggests the twin on the vegan diet was experiencing improved blood sugar control after just 8 weeks.
  • The twin on the vegan diet lost 4 pounds in 8 weeks, while weight remained the same for the twin on the omnivorous diet. This occurred even though neither twin was instructed to eat less nor to lose weight. It is most likely a consequence of the lower caloric density of the vegan diet (See my discussion of caloric density in last week’s issue of “Health Tips From the Professor”.
  • The changes in LDL-cholesterol and fasting insulin were remarkable because none of the twins in this study had elevated LDL-cholesterol or problems with blood sugar control at the beginning of the study.

The authors of this study concluded, “In this randomized clinical trial of the cardiometabolic effects of omnivorous vs vegan diets in identical twins, the healthy vegan diet led to improved cardiometabolic outcomes compared with a healthy omnivorous diet. Clinicians can consider this dietary approach as a healthy alternative for their patients.”

[Let me decipher the term cardiometabolic for you. The decrease in LDL-cholesterol is associated with heart health – the cardio portion of the term. The decrease in fasting insulin is associated with decreased risk of diabetes. Since diabetes is considered a metabolic disease, this is the metabolic portion of the term.]

Were There Any Downsides To The Vegan Diet? 

thumbs down symbolThis study also highlighted two well-known limitations of vegan diets.

  • Although the differences were not statistically significant, the authors expressed concern that vitamin B12 intake was less for twins on the vegan diet than twins on the omnivorous diet even though the vegan diet was designed by dietitians.

The authors noted that B12 deficiency among vegans is well known, and said, “Long-term vegans are typically encouraged to take a cyanocobalamin (vitamin B12) supplement.

  • Although both groups had excellent adherence to their assigned diets, those assigned to the vegan diet expressed a lower satisfaction with the diet, which suggests long-term adherence to the diet after the study ended was unlikely.

The authors said, “Although our findings suggest that vegan diets offer a protective cardiometabolic advantage compared with a healthy omnivorous diet, excluding all meats and/or dairy products may not be necessary because research suggests that cardiometabolic benefits can be achieved with modest reduction in animal foods and increases in healthy plant-based foods compared with typical diets.”

“We believe that lower dietary satisfaction in the vegan group may have been attributable to the strictness of the vegan diet…Some people may find a less restrictive diet preferable for LDL-cholesterol-lowering effects.”

I concur.

What Are The Pros And Cons Of Twin Studies? 

pros and consThe Pros are obvious. Most dietary studies cannot take genetic differences into account and have difficulty accounting for environmental differences. In this study genetics was identical for each twin pair and their environment was very similar. It offers a unique advantage over other studies.

But the strength of this study is also its greatest weakness. Because the general population is genetically and environmentally diverse, it is difficult to extrapolate the results to the general population.

If this were the only study to show cardiometabolic benefits of a plant-based diet, it would simply be an interesting observation.

  • But there are several studies showing that the vegan diet is associated with lower weight and reduced risk of heart disease and diabetes.
  • And there are dozens of studies showing that primarily plant-based omnivorous diets reduce the risk of heart disease and diabetes.

This study is fully consistent with those studies.

The Bottom Line 

A recent study put identical twins on either a healthy vegan diet (only plant foods) or a healthy omnivorous diet (both animal and plant foods) for 8 weeks. At the end of 8 weeks:

  • LDL-cholesterol was reduced by 12% for the twin on the vegan diet, while it remained unchanged for the twin on the omnivorous diet.
  • The fasting insulin level was reduced by 21% for the twin on the vegan diet, while it remained unchanged for the twin on the omnivorous diet. This suggests the twin on the vegan diet was experiencing improved blood sugar control after just 8 weeks.
  • The twin on the vegan diet lost 4 pounds in 8 weeks, while weight remained the same for the twin on the omnivorous diet. This occurred even though neither twin was instructed to eat less or to lose weight. It is most likely a consequence of the lower caloric density of the vegan diet.
  • The changes in LDL-cholesterol and fasting insulin were remarkable because none of the twins in this study had elevated LDL-cholesterol or problems with blood sugar control at the beginning of the study.

The authors of this study concluded, “In this randomized clinical trial of the cardiometabolic effects of omnivorous vs vegan diets in identical twins, the healthy vegan diet led to improved cardiometabolic outcomes compared with a healthy omnivorous diet. Clinicians can consider this dietary approach as a healthy alternative for their patients.”

For more information on the pros and cons of this study and what it means for you, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

 _____________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

_______________________________________________________________________

 About The Author

Dr. Steve ChaneyDr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years.  Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”. Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

For the past 35 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

Do Produce Prescriptions Improve Health?

What Are The Pros And Cons Of Produce Prescriptions?

Author: Dr. Stephen Chaney 

Can you imagine a world in which doctors asked their patients how many fruits and vegetables they were eating rather than how many drugs they were taking? Can you imagine a world in which doctors advised their patients to try a healthier diet before they put them on drugs?

Unfortunately, that world doesn’t exist currently and is unlikely to exist in the foreseeable future.

But what if there were another approach to encourage healthier eating? And what if it made a meaningful impact on people’s health?

There is such an approach, and it’s called a “produce prescription”.

“What are produce prescriptions?”, you might ask. Simply put, produce prescriptions are government programs that provide lower-income Americans with food insecurity extra income that can only be spent on fresh fruits and vegetables.

And it isn’t a lot of extra income. Previous studies have shown that lower-income Americans only need an extra $63 to $78/month to afford the recommended 3-5 servings of fresh fruits and vegetables a day.

But do produce prescriptions work? Do they significantly improve the diet and health of lower-income Americans who participate in programs offering produce prescriptions?

These are the questions that the authors of the current study (K Hager et al, Circulation: Cardiovascular Quality And Outcomes; 16:e009520, 2023) set out to answer.

How Was The Study Done?

clinical studyThe authors evaluated the results from 9 pilot produce prescription studies that were administered at 22 sites in 12 states between 2014 and 2020. These pilot studies were generally funded as experimental programs through Medicare and SNAP.

The pilot programs enrolled:

  • Adults at risk for poor cardiometabolic health (at risk for both heart disease and diabetes). The enrollment criteria included being overweight or obese and having either diabetes or elevated blood pressure.
  • Children who were overweight or obese.
  • People recruited from health centers serving predominantly low-income neighborhoods who were food insecure.

The authors of the study only included pilot studies that collected data on food intake and measured at least 1 biomarker of improved health (BMI (a measure of obesity), HbA1c (a measure of blood sugar control) and blood pressure).

The income incentive to purchase more fruits and vegetables varied from state to state but averaged $63/month.

With these criteria the study included 1817 children and 2064 adults.

The adults:

  • Averaged 54.4 years old.
  • Were 70.7% female, 29.8% non-Hispanic White, 45.1% non-Hispanic Black, 21.4% Hispanic, 3.6% other.

The children:

  • Averaged 9.2 years old.
  • Were 51.4% female, 9.2% non-Hispanic White, 13.1% non-Hispanic Black, 75.5% Hispanic, 2.3% other.

Overall:

  • 3% of families enrolled in the program experienced food insecurity.
  • 7% of families enrolled in the program were involved in SNAP.

Finally, the programs lasted an average of 6 months.

Do Produce Prescriptions Improve Health?

The results were encouraging:

  • At the beginning of the study fruit and vegetable intake was 2.7 cups/day for adults and 3.4 cups/day for children.
  • By the end of the study fruit and vegetable intake increased by 0.85 cups/day for adults and 0.26 cups/day for children.

Note: It is unfortunate that the authors chose to report fruit and vegetable consumption as cups/day because most of us think in terms of servings per day and the relationship between servings and cups varies with each fruit and vegetable. For example, one cup represents:

  • One serving of raw spinach.
  • Two servings of cooked spinach.
  • Two servings of most fruits.
  • One serving of bananas.

I could go on, but you get the point.

  • So, perhaps a better way to think about these results would be to say both adults and children in these low-income households were eating around 3.6 cups/day of fruit and vegetable intake – a 31% increase for adults and a 7.6% increase for children.
  • Another way of thinking about it would be to say that produce prescription programs got both adults and children in food-insecure households up to a healthier 3.6 cups/day of fruits and vegetables.

As for other outcomes:

  • Food insecurity dropped by one third for families participating in these programs.
  • The families reported that they felt healthier.
  • BMI (a measure of overweight and obesity) decreased for both adults and children.
  • HbA1c (a measure of blood sugar control) and blood pressure decreased in adults with cardiometabolic disease (heart disease and diabetes) at the beginning of the programs.

In the words of the authors, “In this large, multisite evaluation, produce prescriptions were associated with significant improvements in fruit and vegetable intake, food security, and health status for adults and children, and clinically relevant improvements in glycated hemoglobin (HbA1c), blood pressure, and BMI for adults with poor cardiometabolic health.”

What Are The Pros And Cons Of Produce Prescriptions?

pros and consThe pros are obvious.

Food insecurity in low-income neighborhoods is a major problem. In the words of the authors:

  • “Food insecurity is strongly associated with poor health outcomes and higher health care costs.
  • Food-insecure individuals under use medications and choose cheaper, unhealthful foods due to costs.
  • [There are] stark disparities in household food insecurity…by race/ethnicity, with 7.1% of White, non-Hispanic households experiencing food insecurity compared with 21.7% of Black, non-Hispanic households, and 17.2% of Hispanic households.”

The authors do not claim that food insecurity is the only cause of health disparities in this country, but a simple program that reduces food insecurity and improves health outcomes is an obvious plus.

But there are cons as well.

  • While the results of these programs were statistically and clinically significant, they were relatively modest. In the words of the authors, “Produce prescriptions may need to be of longer duration or combined with additional components…”
  • Most Americans have the income to buy more fruits and vegetables but chose not to. Programs like this can reduce health disparities but are unlikely to improve the health of the American population as a whole.
  • There was no mention of the cost of implementing this program nationwide in the article, but that is likely to be a major stumbling block.

Unfortunately, government agencies never think of replacing old programs that don’t work with new programs that do work. They only think of adding the cost of the new program to their current budget.

Unfortunately, once you start talking about programs that increase government spending, they become political footballs. Because of this many beneficial programs end up in the dustbin of history.

The Bottom Line 

Food insecurity among low-income households is a major cause of health disparities in this country. Several states across the country have piloted an idea called produce prescription programs. Simply put, these programs provide high-risk families who have food insecurity and poor health with a monthly stipend that can only be used to purchase fresh fruits and vegetables from grocery stores and farmers markets.

A recent study evaluated the effectiveness of these pilot programs and found the produce prescription programs:

  • Improved fruit and vegetable intake for the families who participated in the programs.

In addition:

  • Food insecurity dropped by one third for families participating in these programs.
  • The families reported that they felt healthier.
  • BMI (a measure of overweight and obesity) decreased for both adults and children.
  • HbA1c (a measure of blood sugar control) and blood pressure decreased in adults with cardiometabolic disease (heart disease and diabetes) at the beginning of the programs.

In the words of the authors, “In this large, multisite evaluation, produce prescriptions were associated with significant improvements in fruit and vegetable intake, food security, and health status for adults and children, and clinically relevant improvements in glycated hemoglobin (HbA1c), blood pressure, and BMI for adults with poor cardiometabolic health.”

For more information on this study and a summary of the pros and cons of produce prescription programs, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

____________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

Which Diets Are Heart Healthy?

What Does A Heart Healthy Diet Look Like?

Author: Dr. Stephen Chaney 

heart attacksHeart disease is a big deal. According to the CDC, “Heart disease is the leading cause of death for men, women, and people of most racial and ethnic groups in the United States. One person dies every 33 seconds in the United States from cardiovascular disease. About 695,000 people in the United States died from heart disease in 2021 – that’s 1 in every 5 deaths”.

This doesn’t have to happen. According to the Cleveland Clinic, “90 percent of heart disease is preventable through healthier diet, regular exercise, and not smoking”. For this issue of “Health Tips From the Professor”, I will focus on the role of diet on heart health.

The problem is many Americans are confused. They don’t know what a heart-healthy diet is. There is so much conflicting information on the internet.

Fortunately, the American Heart Association has stepped in to clear up the confusion.

In 2021 they reviewed hundreds of clinical studies and published “Evidence-Based Dietary Guidance to Promote Cardiovascular Health”.

And recently they have published a comprehensive review (CD Gardner et al, Circulation, 147: 1715-1730, 2023) of how well popular diets align with their 2021 dietary guidelines.

I will cover both publications below. But first I want to address why Americans are so confused about which diets reduce heart disease risk.

Why Are Americans Confused About Diet And Heart Disease Risk?

I should start by addressing the “elephant in the room”.

  • As I discussed in last week’s “Health Tips From the Professor” article, Big Food Inc has seduced us. They have developed an unending supply of highly processed foods that are cheap, convenient, easy to prepare, and fulfill all our cravings. These foods are not heart-healthy, but they make up 73% of our food supply.

The Institute of Medicine, the scientific body that sets dietary standards, states that a wide range of macronutrient intakes are consistent with healthy diets. Specifically, they recommend carbohydrate intake at 45% to 65%, fat intake at 20% to 35%, and protein intake at 10% to 35% of total calories. (Of course, they are referring to healthy carbohydrates, fats, and proteins.)

The authors of this article pointed to several reasons why Americans have been misled about heart-healthy diets.

  • Many of the most popular diets fall outside of the “Acceptable Macronutrient Range”.
  • Many popular diets exclude heart-healthy food groups.

And, the words of the authors,

  • “Further contributing to consumer misunderstanding is the proliferation of diet books, [and] blogs [by] clinicians with limited understanding of what the dietary patterns entail and the evidence base for promoting cardiometabolic health.” I call these the Dr. Strangeloves of our world.

What Does A Heart Healthy Diet Look Like?

Let me start by sharing the American Heart Association’s 10 “Evidence-Based Dietary Guidelines to Promote Cardiovascular Health.

#1: Adjust energy intake and expenditure to achieve and maintain a healthy body weight
#2: Eat plenty of vegetables and fruits; choose a wide variety
#3: Choose foods made mostly with whole grains rather than refined grains
#4: Choose healthy sources of protein
Mostly from plants (beans, other legumes, and nuts)
Fish and seafood
Low-fat or fat-free dairy products instead of full-fat dairy products
If meat or poultry are desired, choose lean cuts and avoid processed forms
#5. Use liquid plant oils (olive, safflower, corn) rather than animal fats (butter and lard) and tropical oils (coconut and palm kernel)
#6. Use minimally processed foods instead of highly processed foods
#7: Minimize intake of beverages and foods with added sugars
#8: Choose and prepare foods with little or no salt
#9: If you do not drink alcohol, do not start; if you choose to drink alcohol, limit intake
#10: Adhere to this guidance regardless of where food is prepared or consumed

Here are my comments on these guidelines:

  • If you have been reading my “Health Tips From the Professor” blog for a while, you probably realize that these aren’t just guidelines to promote heart health. These guidelines also reduce the risk of diabetes, cancer, inflammatory diseases, and much more.
  • If you have read my post on coconut oil, you will know that I have a minor disagreement with the AHA recommendation to avoid it. There is no long-term evidence that coconut oil is bad for the heart. But there is also no long-term evidence that it is good for the heart. My recommendation is to use it sparingly.
  • And you probably know there has been considerable discussion recently about whether full fat dairy is actually bad for the heart. In my most recent review of the topic, I concluded that if full fat dairy is heart healthy, it is only in the context of a primarily plant-based diet and may only be true for fermented dairy foods like unpasteurized yogurt and kefir.
  • Finally, guideline 10 may need some translation. Basically, this guideline is just asking how easy it is to follow the diet when you are away from home.

Which Diets Are Heart Healthy?

confusionIn evaluating how well diets adhered to the American Heart Association guidelines the authors ignored item 1 (energy intake) because most of the diets they evaluated did not provide any guidelines on how many calories should be consumed.

Each diet was given a score between 0 (Fail) and 1 (A+) for each of the other 9 guidelines by a panel of experts. The points for all 9 guidelines were added up, giving each diet a rating of 0 (worst) to 9 (best). Finally, a score of 9 was assigned 100%, so each diet could be given a percentage score for adherence to heart-healthy guidelines.

Here are the results:

Tier 1 diets (the most heart healthy diets) received scores of 86% to 100%. Going from highest (100%) to lowest (86%), these diets were:

  • DASH, Nordic, Mediterranean, Pescetarian (vegetarian diets that allow fish), and Ovo-Lacto Vegetarian (vegetarian diets that allow dairy, eggs, or both).
  • You will notice that these are all primarily plant-based diets.

Tier 2 diets were Vegan and other low-fat diets (TLC, Volumetrics). They both received scores of 78%.

  • The Vegan diet received 0 points for category 10 (ease of following the diet when eating out). It was also downgraded in category 7 for not having clear guidance for the use of salt when preparing foods.
  • The other low-fat diets were downgraded in categories 7, 10, and 5 (use of tropical oils).

Tier 3 diets received scores of 64% to 72%. They included very-low fat diets (<10% fat, very strict vegan diets) and low-carb diets (Zone, South Beach, Low-Glycemic Index).

  • They received 0 points for category 10 and were downgraded for eliminating heart-healthy food groups (liquid plant oils for the very low-fat diets, and fruits, vegetables, whole grains, and plant proteins for the low-carb diets).

Tier 4 diets (the least heart healthy diets) were the Paleo diet with a score of 53% and very low-carb diets (Atkins and Ketogenic) with a score of 31%.

  • The Paleo diet received 0 points for categories 10, 3 (choose whole grains), and 5 (using liquid plant oils rather than animal fats or tropical oils). It was also downgraded for lack of healthy plant-based protein sources.
  • The very low-carb diets were the least heart healthy. They received 0 points for categories 2 (eat plenty of fruits and vegetables), 3 (choose whole grains), 3 (healthy protein sources), 5 (use liquid plant oils instead of animal fats), 7 (minimize salt consumption), and 10 (ease of following the diet away from home).

The authors concluded, “Numerous [dietary] patterns [are] strongly aligned with 2021 American Heart Association Dietary Guidance (ie, Mediterranean, DASH, pescetarian, vegetarian) [and] can be adopted to reflect personal and cultural preferences and budgetary constraints.

Thus, optimal cardiovascular health would be best supported by developing a food environment that supports adherence to these patterns wherever food is prepared or consumed.”

Given our current food environment that last statement is wildly optimistic. But at least you have the information needed to make the best food choices for you and your family

The Bottom Line 

In 2021 the American Heart Association published 10 guidelines for evaluating heart-healthy diets. A recent study looked at how well popular diets adhered to those guidelines. The authors separated the diets into four categories (tiers) based on how heart-healthy they were. The results were not surprising:

  • Tier 1 diets (the most heart healthy diets) were DASH, Nordic, Mediterranean, Pescetarian (vegetarian diets that allow fish), and Ovo-Lacto Vegetarian (vegetarian diets that allow dairy, eggs, or both).
  • Tier 2 diets were Vegan and other low-fat diets (TLC, Volumetrics).
  • Tier 3 diets included very-low fat diets (<10% fat, very strict vegan diets) and low-carb diets (Zone, South Beach, Low-Glycemic Index).
  • Tier 4 diets (the least heart healthy diets) were the Paleo diet and very low-carb diets (Atkins and Ketogenic).

The authors concluded, “Numerous [dietary] patterns [are] strongly aligned with 2021 American Heart Association Dietary Guidance (ie, Mediterranean, DASH, pescetarian, vegetarian) [and] can be adopted to reflect personal and cultural preferences and budgetary constraints.

Thus, optimal cardiovascular health would be best supported by developing a food environment that supports adherence to these patterns wherever food is prepared or consumed.”

Given our current food environment that last statement is wildly optimistic. But at least you have the information needed to make the best food choices for you and your family.

For more information on this study, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

____________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

Is Whole Fat Dairy Healthy?

Is It Dairy Or Diet?

Author: Dr. Stephen Chaney 

CheesesFor years we have been told to select low fat dairy foods. But recent headlines claim, “That’s nonsense. Whole fat dairy foods are healthy.” Are those headlines true?

In previous issues of “Health Tips From the Professor” I have kept you abreast of recent studies suggesting that whole fat dairy foods may not be as bad for us as we thought. I also cautioned you that the headlines may not have accurately represented the studies they described.

Headlines have to be simple. But truth is often more nuanced. If we believed the current headlines, we might be asking ourselves questions like, “Should we ditch the current health guidelines recommending low-fat dairy foods? Are foods like ice cream, sour cream, and cheddar cheese actually be good for us?

To answer these questions, I will look at the study (A Mente et al, European Heart Journal, 44, 2560-2579, 2023) behind the current headlines and put the study into perspective.

Spoiler alert: If I could summarize the study findings in two sentences, they would be, “Whole fat dairy can be part of a healthy diet. But can it be part of an unhealthy diet?”

Stay tuned. I will discuss the science behind that statement below.

How Was This Study Done?

clinical studyThis study started with data collected from the Prospective Urban Rural Epidemiology (PURE) study. The PURE study is an ongoing study correlating diet, lifestyle, and environmental effects on health outcomes. It has enrolled 166,762 individuals, age 35-70, from 21 low-, middle-, and high-income countries on 5 continents.

Habitual food intake was determined using country-specific food frequency questionnaires at the time participants joined the study. Participants (166,762) from the PURE study who had complete dietary information were included in this study and were followed for an average of 9.3 years.

Based on preliminary analysis of data from the PURE study, the authors developed their version of a healthy diet, which they call the PURE diet. Like most other healthy diets, the PURE diet emphasizes fruits, vegetables, legumes, nuts, and fish. However:

  • Based on studies suggesting that whole fat dairy foods can be part of a healthy diet, the PURE diet includes whole fat dairy foods.

This is different from most other healthy diet recommendations.

They went on to develop what they referred to as the PURE healthy diet score by:

  • Determining the median intake for each of the 6 food groups included in their PURE diet (fruits, vegetables, legumes, nuts, fish, and whole fat dairy).
  • Assigning each participant in the study a score of 0 or 1 depending on whether their intake for that food group was below or above the median intake.
  • Adding up the points. Since 6 food groups were included in the PURE diet, this means that each participant in the study was assigned a PURE diet score ranging from 0-6.

Once they had developed a PURE diet score, they expanded their data by including five additional large independent studies that included people from 70 countries. The combined data from all six studies amounted to 245,597 people from 80 countries. Of the people included in the data analysis:

  • 21% came from high income countries.
  • 60% came from middle income countries.
  • 19% came from low-income countries.

This is very similar to the global population distribution. This is a strength of this study because it allowed them to ask whether the PURE diet score worked as well in low-income countries as in high-income countries.

Finally, they correlated the PURE diet score with outcomes like all-cause mortality, heart attack, and stroke.

Is Whole Fat Dairy Healthy?

QuestionsThe authors of this study divided the participants of all 6 studies into quintiles based on their PURE diet score and compared those in the highest quintile (PURE score of ≥ 5) with those in the lowest quintile (PURE score of ≤ 1).

The people in the highest quintile were eating on average 5 servings/day of fruits and vegetables, 0.5 servings/day of legumes, 1.2 servings/day of nuts, 0.3 servings/day of fish, 2 servings/day of dairy (of which 1.4 servings/day was whole fat dairy), 0.5 servings/day of unprocessed red meat, and 0.3 servings/day of poultry.

 

The people in the lowest quintile ate significantly less fruits, vegetables, nuts, fish, and dairy; and slightly less legumes, unprocessed red meat, and poultry than those in the highest quintile.

However, they consumed significantly more refined wheat foods and white rice. This study did not track consumption of highly processed foods, but the high consumption of white flour leads me to suspect they ate a lot more highly processed food.

With that in mind, when the authors compared people with the highest PURE diet scores to those with the lowest PURE diet scores:

  • All-cause mortality was reduced by 30%.
  • Cardiovascular disease was reduced by 18%.
  • Heart attacks were reduced by 14%.
  • Strokes were reduced by 19%.
  • The PURE healthy eating score was slightly better at predicting health outcomes than the Mediterranean, DASH, and HEI (Healthy Eating Index) scores. But the differences were small. So, I still recommend choosing the healthy diet that best fits your preferred foods and your lifestyle.
  • The PURE healthy eating score was significantly better at predicting health outcomes than the Planetary diet score. I will discuss the nutritional inadequacy of “sustainable diets” like the Planetary diet in next week’s “Health Tips From the Professor” article.

Because of the size and design of this study, they were able to make three interesting observations.

  1. The PURE, Mediterranean, DASH, and HEI diet scores were predictive of health outcomes in every country across the globe. You no longer have to wonder if what works in the United States will work in low-income countries and in countries with very different food preferences. Previous studies have not been able to make that claim.

2) You don’t have to be perfect.

    • A 20% increase (one quintile) in PURE score was associated with a 6% lower risk of major cardiovascular events and an 8% lower risk of mortality. In other words, even small improvements in your diet may improve your health outcomes.
    • The health benefits of the PURE diet started to plateau at a score of 3 (with 6 being the highest score). The authors concluded that most of the health benefits were associated with a modestly higher consumption of healthy foods compared to little or no consumption of healthy foods.

Simply put, that means the health benefits gained by going from a moderately healthy diet to a very healthy diet are not as great as the health benefits gained by going from a poor diet to a moderately healthy diet.

[Note: There are still improvements in health outcomes when you go from a moderately healthy diet to a very healthy diet.  My recommendation: “You don’t need to achieve perfection, but you shouldn’t accept mediocrity”.]

3) The PURE diet score was more predictive of health outcomes in some countries than in others.

    • The PURE diet score was more predictive of health outcomes in low-income countries. The authors felt that was because low-income countries started with average PURE scores of 2.1, whereas higher-income countries started with average PURE scores of 3.5.

The authors felt this was another example getting more “bang for the buck” by going from a poor diet to a moderately healthy diet than from a moderately healthy diet to a very healthy diet. (Remember, the health benefits associated with improving PURE diet scores start to plateau at a PURE score of 3.

    • The difference in benefits for low-income countries compared to high-income countries was observed for the Mediterranean, DASH, and HEI diet scores. So, it is probably safe to say for any healthy diet you don’t need to be perfect. You just need to be better.

The authors concluded, “A diet composed of higher amounts of fruit, vegetables, nuts, legumes, fish, and whole fat dairy is associated with a lower risk of cardiovascular disease and mortality in all world regions, especially in countries with lower income where consumption of these foods is low.”

Is It Dairy Or Diet?

CheesesThe headlines are telling us that recommendations to choose low-fat dairy products are out of date. They say there is no reason to fear whole fat dairy foods. They are good for you. Bring on the ice cream, sour cream, cream cheese, and high fat hard cheeses!

As usual, there is a kernel of truth in the headlines, but headlines have to be simple. And the latest headlines are an oversimplification of what the studies actually show. Let me provide perspective to the headlines by asking two questions.

#1: Is it dairy or diet? A major weakness of this and similar studies is that they fail to consider diet context. What do I mean by that? Let’s dig a little deeper into this study.

  • Let’s start with a description of the PURE diet. It is a diet that emphasizes fruits, vegetables, legumes, nuts, and fish. In other words, it is a primarily plant-based diet.
  • Although the authors keep referring to the diet as one that includes whole fat dairy. It would be more accurate to say that it includes dairy, which was 30% low-fat and 70% whole fat.
  • The authors said that removal of any one food group from this combination reduced the predictive power of the PURE diet. In other words, the beneficial effect of 70% whole fat dairy is best seen in the context of a primarily plant-based diet.
  • The PURE diet was most effective at predicting health outcomes in low-income countries where a significant percent of the population consumes a primarily plant-based diet because meats are expensive.

So, a more accurate description of this study would be it shows that a mixture of low-fat and whole-fat dairy foods are a healthy addition to a primarily plant-based diet. But that is too complicated for a headline.

#2: If whole fat dairy can be part of a healthy diet, can it also be part of an unhealthy diet?

To answer that question let’s compare the potential effects of whole fat dairy on a primarily plant-based diet compared to the typical American or European diet.

  • Milk and other dairy foods are excellent sources of calcium, vitamin B12, and iodine and good sources of protein, vitamin D, choline, zinc, and selenium – nutrients that are often low or missing in plant-based diet. And this is true whether the dairy foods are low-fat or whole fat.
  • Primarily plant-based diets tend to be low in saturated fat, so the potential negative effects of adding a small amount of saturated fat to the diet may be outweighed by the beneficial effects of the nutrients dairy foods provide.

On the other hand,

  • The typical American or European diet provides plenty of protein and vitamin B12 and significantly more choline, vitamin D, iodine, and zinc than a plant-based diet. The added nutrients from adding dairy foods to this kind of diet is still beneficial, but the benefits are not as great as adding dairy foods to a primarily plant-based diet.
  • If you read the American Heart Association statement on saturated fats, it does not say that any amount of saturated fat is bad for you. In fact, small amounts of saturated fats play some beneficial roles in our bodies. The American Heart Association says, “Eating too much saturated fat can raise the level of LDL cholesterol in your blood…[which] increases your risk of heart disease and stroke.”
  • Here is where the problem lies. The typical American or European diet already contains too much saturated fat. Whole fat dairy just adds to that excess.

So, the most accurate description of this study would be it shows that a mixture of low-fat and whole-fat dairy foods are a healthy addition to a primarily plant-based diet but may not be a healthy addition to the typical American diet. But that is way too complicated for a headline.

You are probably wondering what this means for you. Here are my recommendations.

If you eat like most Americans, you should continue to follow the current health guidelines to choose low-fat dairy foods.

If you happen to be among the few Americans who eat a primarily plant-based diet, you will probably benefit by adding a mixture of low-fat and whole fat dairy foods to your diet.

The Bottom Line 

Once again, the headlines are telling us that recommendations to choose low-fat dairy products are out of date. The articles say there is no reason to fear whole fat dairy foods. They are good for you. Bring on the ice cream, sour cream, cream cheese, and high fat hard cheeses!

As usual, there is a kernel of truth in the headlines, but headlines have to be simple. And the latest headlines are an oversimplification of what the studies actually show. In this post I looked at the study behind the most recent headlines and provided perspective to the headlines by asking two questions.

#1: Is it dairy or diet? A major weakness of this and similar studies is that they fail to consider diet context.

When you consider diet context a more accurate description of this study would be it shows that a mixture of low-fat and whole-fat dairy foods are a healthy addition to a primarily plant-based diet. But that is too complicated for a headline.

#2: If whole fat dairy can be part of a healthy diet, can it also be part of an unhealthy diet?

When you consider that question the most accurate description of this study would be it shows that a mixture of low-fat and whole-fat dairy foods are a healthy addition to a primarily plant-based diet but may not be a healthy addition to the typical American diet. But that is way too complicated for a headline.

You are probably wondering what this means for you. Here are my recommendations.

If you eat like most Americans, you should continue to follow the current health guidelines to choose low-fat dairy foods.

If you happen to be among the few Americans who eat a primarily plant-based diet, you will probably benefit by adding a mixture of low-fat and whole fat dairy foods to your diet.

For more information on this study, and the science behind my summary of the study, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

_________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

Does The Mediterranean Diet Improve Pregnancy Outcomes?

Is The Mediterranean Diet Overrated?

Author: Dr. Stephen Chaney

healthy pregnancyYou may have noticed that certain celebrities are singled out for fame and acclaim, while others of equal talent and accomplishment are virtually ignored.

The same thing occurs in the scientific realm. At present, the Mediterranean diet is the darling of the diet world. Study after study is designed to test the benefits of the Mediterranean diet while other excellent diets are ignored. I will discuss this phenomenon and ask whether the Mediterranean diet is overrated at the end of this article. But let’s start at the beginning.

Multiple studies have shown that the Mediterranean diet is associated with lower risk of heart disease, diabetes, and high blood pressure. Some studies suggest it is associated with lower risk of kidney disease and Alzheimer’s disease.

Studies also suggest that the Mediterranean diet is associated with an increase in lifespan (how long you live) and healthspan (how long you enjoy good health). In other words, these studies suggest that following a Mediterranean diet adds years to your life and life to your years.

Most of these studies have been done with men. However, there are enough studies with women to be confident that the beneficial effects of the Mediterranean diet on disease risk and lifespan apply to women as well as to men.

But what about pregnancy? Does the Mediterranean diet support a healthy pregnancy? Here the data are less clear. Three studies have been published showing that pregnant women who follow the Mediterranean diet are less likely to experience gestational diabetes (diabetes during pregnancy).

But what about other adverse pregnancy outcomes that can affect the health of both the mother and her baby such as:

  • Gestational hypertension (high blood pressure during pregnancy).
  • Preeclampsia (high blood pressure and protein in the urine that occurs late in pregnancy. It may be associated with liver and/or kidney damage).
  • Eclampsia (a severe form of preeclampsia where the mother also has seizures).
  • Preterm birth (birth prior to 37 weeks).
  • Low birth weight infant.

This study (N Makarem et al, JAMA Network Open. 5(12): e2248165, 2022) was designed to look at the effect of the Mediterranean diet on all seven of these adverse pregnancy outcomes.

How Was This Study Done?

Clinical StudyThe data for this analysis came from a large clinical trial called the Nulliparous Pregnancy (first time pregnancy) Outcomes Study. The study enrolled 7798 women in their first trimester of pregnancy from 8 medical centers across the country. The women were racially, ethnically, and geographically diverse.

Diet around the time of conception was assessed with a food frequency questionnaire administered at the mother’s first visit to the clinic (usually around 6-13 weeks after conception). The participants were asked to indicate their usual intake of 120 foods and beverages during the past 3 months. In other words, the participants were asked to indicate their diet prior to conception through early pregnancy.

Adherence to the Mediterranean diet was assessed using something called the aMed or Alternative Mediterranean Diet Score (a version of the Mediterranean diet that considers US food preferences). Each participant was assigned one point for:

  • Above average intake of vegetables, fruits, nuts, whole grains, legumes, fish, and the ratio of monounsaturated fat to saturated fat.
  • Below average intake of red meat and processed meats.

Alcohol intake was a bit more complicated:

  • Participants were given 1 point for one 12-ounce can of beer, 5 ounces of wine, or 1.5 ounces of liquor and 0 points for consumption above or below that amount.

The points for all these dietary components were added up to give an aMed score of 0-9, with 9 representing the best adherence to the Americanized version of the Mediterranean diet.

Does The Mediterranean Diet Improve Pregnancy Outcomes?

Mediterranean Diet FoodsThe authors started out by dividing the pregnant moms into thirds according to adherence to an Americanized Mediterranean diet based their aMed score. When they compared those in the top third (aMed scores of 6-9) with those in the lowest third (aMed scores of 0-3) the risk of developing:

  • Any adverse pregnancy outcome was reduced by 21%.
  • Preeclampsia or eclampsia were reduced by 28%.
  • Gestational diabetes was reduced by 37%.
  • Other adverse pregnancy outcomes were not statistically different.

Next, they asked whether stricter adherence to the Mediterranean diet would be even more beneficial. To do this New Parentsthey divided the pregnant moms into fifths. When they compared those in the top fifth (aMed scores of 7-9) with those in the lowest fifth (aMed scores of 0-2) the risk of developing:

  • Any adverse pregnancy outcome was still reduced by 20%, but…
    • Preeclampsia and eclampsia were reduced by 35%.
    • Gestational diabetes was reduced by 54%.
    • Other adverse pregnancy outcomes were not statistically different.

When they broke the results down into participant subgroups:

  • The effect of the Mediterranean diet on any adverse pregnancy outcomes was not affected by prepregnancy BMI (a measure of obesity), race, or ethnicity.
  • However, it was significantly affected by age. Any adverse pregnancy outcome was reduced by:
    • 48% in women over 35.
    • 15% in women younger than 35.

The authors concluded, “We demonstrate that a Mediterranean diet pattern is associated with lower risk of developing any APO [adverse pregnancy outcome] and multiple individual APOs in US women…Our findings add to the growing body of evidence that the Mediterranean diet pattern may play an important role in preserving the health of women across the lifespan, including during pregnancy.”

Is The Mediterranean Diet Overrated?

At the beginning of this article, I posed the question, “Is the Mediterranean diet overrated?” When the authors broke the results down by food group, it suggested the answer may be, “Yes”.

The reduction in any adverse pregnancy outcome was associated with:

  • Above average consumption of vegetables, fruits, legumes, and fish.

The reduction in preeclampsia and eclampsia was associated with:

  • Above average consumption of vegetables, fruits, and fish.

The reduction in gestational diabetes was associated with:

  • Above average consumption of vegetables, and…
  • Below average consumption of red meat and processed meats.

If you are saying to yourself, “Wait a minute. Doesn’t this pattern of food consumption describe almost any whole food, primarily plant-based diet”, you would be correct. In theory, this pattern of food consumption is also consistent with the DASH diet, Mind diet, Scandinavian diet, flexitarian diet, pesco-vegetarian diet, and semi vegetarian diet, just to name a few.

In my opinion there is nothing about this study that restricts beneficial pregnancy outcomes to the Mediterranean diet. However, I do have a few caveats about that statement.

  • A good prenatal supplement is a good idea to make sure you are getting the vitamins and minerals required for a successful pregnancy. However, as I have described in a previous article finding a good prenatal supplement may not be as easy as it should be.
  • Choline is important for a healthy pregnancy, and it is missing in many prenatal supplements. While choline is found in many plant foods, the best sources of choline are fish, poultry, eggs, and dairy. You want to be sure to include some of these in your diet and/or look for a prenatal supplement containing at least 200 mg of choline.
  • The long chain omega-3s DHA and EPA are important for a healthy pregnancy and are also missing or present in inadequate amounts in many prenatal supplements.
  • The best dietary sources of DHA and EPA are cold water fish like salmon, tuna, sardines, and herring. That means:
    • If you are following the DASH diet or something similar, you will want to substitute fish for red meat.
    • A pesco-vegetarian diet is probably a better choice for you than a semi-vegetarian because it focuses on fish as the main protein source in place of poultry and red meat.
    • If you are not a big fish lover, you should consider an omega-3 supplement supplying at least 250 mg of long chain omega-3s with most of it as DHA.

What Does This Study Mean For You?

Questioning WomanLet me close by putting a few things into perspective.

1) When I said that the Mediterranean diet may be overrated, I did not mean it wasn’t an excellent diet. I simply mean it is probably not any better than other whole food, primarily plant-based diets (with the caveats I listed above).

2) The pregnancy benefits of the Mediterranean diet (and other healthy diets) are related to the overall health of the mother. A good prenatal supplement is still important to assure adequate amounts of all the nutrients essential for a healthy pregnancy.

  • For example, the authors pointed out that most women do not change their dietary habits when they become pregnant, and that their pregnancy is more likely to be successful if they are in good health at the time of conception.

3) Most diets of women of childbearing age do not provide adequate amounts of choline and omega-3s, so it is important to choose a prenatal supplement program that provides adequate amounts of choline and omega-3s.

4) Adequate calories and protein are also important for a healthy pregnancy.

  • Pregnancy is not the time to lose weight, even if you are overweight.
  • A vegan diet may not provide enough protein unless it has been designed by a dietitian.
  • You should discuss your current diet with your health care provider, and they may refer you to a dietitian if necessary.

The Bottom Line 

The Mediterranean Diet is currently the darling of the nutrition world. Yes, numerous studies have shown that people consuming the Mediterranean diet are healthier and live longer. But we find ourselves in a situation where study after study is being designed to look for other benefits of the Mediterranean diet while equally healthy diets are being ignored.

The study discussed in this article is a perfect example. It was designed to determine whether adherence to the Mediterranean diet prior to and during pregnancy reduced the risk of experiencing adverse outcomes during pregnancy – outcomes that could affect the health of the mother and her baby.

The answer to that question was, “Yes”. Adherence to the Mediterranean diet reduced the risk of:

  • Any adverse outcome during pregnancy by 20%.
  • Preeclampsia and eclampsia by 35%.
  • Gestational diabetes by 54%.

And the risk reduction was even greater for women over 35.

However, when the investigators looked at the foods responsible for the reduction in adverse pregnancy outcomes, it appears likely that any whole food, primarily plant-based diet would provide the same results.

In short, this study showed that adherence to the Mediterranean diet improves pregnancy outcomes. The authors chose to focus on the Mediterranean diet because of its popularity. But their data show it is likely that other whole food, primarily plant-based diets would be equally beneficial.

For more information on this study and what it means for you, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

___________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

Are Easter Eggs Bad For You?

Clearing Up The Eggfusion 

Author: Dr. Stephen Chaney

The Easter Bunny will be here soon bringing beautifully decorated eggs for all the children. But wait. Aren’t eggs bad for us? Should we really be encouraging our kids to eat Easter eggs? Maybe we should encourage them to eat Easter candy instead (just kidding).

What is the truth about eggs on our health? Perhaps it’s time for the professor to clear up the “eggfusion” (That’s short for egg confusion). Let me start with a brief historical summary:

  • First there were the warnings that eggs were bad for your heart because egg yolks contained cholesterol, and cholesterol was to be avoided at all costs.
  • Then experts decided that dietary cholesterol wasn’t all that bad for you. It was saturated fats, obesity, and lack of exercise that raised “bad” (LDL) cholesterol levels in your bloodstream.
  • That was followed by several US studies suggesting that eggs in moderation (one per day) did not affect your risk of heart disease.
  • Then a major study claimed that an egg a day actually lowered your risk of heart disease.

Now, the most recent headlines claim that eggs increase your risk of heart disease, and you should avoid them. No wonder you are experiencing eggfusion. Let me review the latest study and put it into perspective by comparing it to previous studies. Let me clear up the eggfusion.

But let me warn you. This is a bit complex, as the truth often is. When I try to explain the contradictions between major studies on egg consumption and heart health, I think the best analogy might be the tale of the blind men trying to tell what an elephant was like by touching different parts of the elephant. None of them could provide an accurate description because none of them could see the whole elephant.

We need to look at the “whole elephant” to see what these studies missed.

How Was The Study Done?

Heart Disease StudyThis study (WW Zhong et al, JAMA, 321: djw322, 2017) combined the data from 6 clinical trials in the United States that assessed dietary intake and measured cardiovascular health outcomes. In all, these studies included 29,615 adults who were followed for an average of 17.5 years.

The diet of the participants was assessed upon entry into each of the clinical trials. The primary variables derived from the dietary information were cholesterol and egg consumption. Diet was not assessed at later times in these studies.

The primary outcomes measured were heart disease and all-cause mortality. In this study heart disease was an umbrella term that included fatal and non-fatal heart attacks, stroke, heart failure, and death from other heart-related causes.

Do Eggs Increase Heart Disease Risk?

heart attacksHere are the main findings from this study.

  • Each additional half an egg consumed per day (which is equivalent to 3-4 eggs per week) was associated with a:
    • 6% increased risk of heart disease. While that doesn’t sound like much, the increased risk was over 13% for one egg per day and almost 27% for two eggs per day.
  • The increased heart disease risk associated with one half egg per day was greater for:
    • Women (13% increase) than men (3% increase).
    • People who already had high blood cholesterol (7% increase), not people who already had low cholesterol levels (0% increase). This suggests that the effect of eggs on heart disease risk primarily affects people who are already having trouble controlling their blood cholesterol levels – either due to genetics or due to diet & lifestyle.

Of course, the question is whether it was the eggs that increased the risk of heart disease or was it something else in the diet. This study attempted to answer that question by systematically subtracting out other variables that affect heart disease risk to see whether that correction eliminated the association between egg consumption and heart disease risk. When this was done:

  • The association between egg consumption and heart disease risk disappeared after correcting for dietary cholesterol intake.
  • The association between egg consumption and heart disease risk remained significant after correcting for other components of the diet, such as fats, animal protein, fiber, sodium, or overall “diet quality”. There were 3 main measures of diet quality.
    • The Med diet score measures how closely the diet resembles the Mediterranean diet.
    • The DASH diet score measures how closely the diet resembles the DASH diet.
    • The Healthy Eating Index (HEI) measures how closely the diet aligns with the USDA Dietary Guidelines For Americans. Basically, the HEI recommends a whole food diet containing foods from all 5 food groups with a heavy emphasis on fruits, vegetables, whole grains, and legumes. It also recommends limiting saturated and trans fats, added sugars, and sodium.

In simple terms the authors concluded that the effect of eggs on heart disease risk was primarily due to their cholesterol content and was not influenced by other components of the overall diet. [I will revisit this conclusion latter.]

What Are The Strengths And Weaknesses Of The Study?

SkepticThe strengths are obvious. This was a very large study (29,615 participants) and the people enrolled in the study were followed for a long time (an average of 17.5 years). The primary variables in the study (cholesterol consumption, egg consumption, heart disease, and all-cause mortality) were accurately measured in each of the clinical trials included in the study.

However, there were some significant weaknesses as well:

  • Cholesterol and egg consumption were only measured by a single dietary survey when people entered the study. This study assumes they did not change over the course of the study. That is very unlikely. Both cholesterol intake and egg consumption in the US population have waxed and waned over the years, in part due to variations in dietary guidelines.
  • The measurements of diet quality used were based on US and European food preferences. That is significant because the only studies showing that egg consumption lowers heart disease risk were performed in China and Japan, where the diet is closer to semi-vegetarian than to US or European diets.

Are Easter Eggs Bad For You?

thumbs down symbolThis is very large, well designed study that combines the data from 6 clinical trials spanning the years 1974 to 2013.

The strongest conclusions from the study are:

  • In the context of a Western diet (the US diet) egg consumption slightly increases your risk developing heart disease. The increased risk is ~6% for 3-4 eggs/week, ~13% for 1 egg per day, and ~27% for two eggs per day.
  • The increased risk of heart disease appears to be almost entirely due to the cholesterol content of eggs.

The significance of this study needs to be weighed in the context of:

  • Recent studies in the US and Europe showing eggs do not increase heart disease risk.
  • Studies in China and Japan (where the diets can best be described as semi-vegetarian) showing that eggs decrease heart disease risk.

The significance of this study also needs to be weighed in the context of:

  • Studies showing that obesity, saturated fat, and physical inactivity have bigger effects on serum cholesterol levels and heart disease risk than dietary cholesterol from foods like eggs.

What Did This Study Miss?

EggsIf, as this study suggests, the effect of eggs on heart disease risk is due to their cholesterol content, this study (and most previous studies) missed a very important point. The effect of dietary cholesterol on blood cholesterol levels is not strongly affected by the overall composition of the diet. It is affected by the composition of the diet at the time foods containing dietary cholesterol are eaten.

  • The kind of fiber found in certain fruits, vegetables, whole grains, and legumes bind to dietary cholesterol, preventing it from being absorbed as it passes through the intestine.
  • Certain phytonutrients in plant foods affect how dietary cholesterol is utilized by the body.
  • However, to blunt the effect of dietary cholesterol on blood cholesterol levels the fiber and phytonutrient-containing foods must be consumed at the same meal.

Simply put, if your breakfast consists of eggs, sausage, biscuits, and hash browns, the cholesterol in the eggs will likely increase your blood cholesterol level, which in turn increases your risk of heart disease. This will occur even if you eat lots of fruits, vegetables, whole grains, and legumes with your other meals.

If, on the other hand, your breakfast consists of eggs and fiber-rich plant foods like oatmeal and beans, the cholesterol in the eggs will likely have a much smaller effect on your blood cholesterol levels and your heart disease risk.

The fact that previous studies have not looked at what foods were consumed along with the eggs may explain some of the variation in their conclusions about the effect of egg consumption on heart disease risk.

The Professor’s Story

professor owlLet me share my story with you. About 25 years ago, my doctor told me that my cholesterol levels were getting high and wanted to put me on statins. I didn’t take a stain, and I didn’t stop eating eggs for breakfast. I changed breakfast.

Now I soft boil my eggs or fry them in olive oil. I eat them along with oatmeal, which contains a fiber that binds cholesterol, and walnuts, which contain omega-3s and phytonutrients that lower blood cholesterol. I also include whatever fruit is in season. Finally, I take a supplement providing 2 grams of plant stanols and sterols, which blocks cholesterol absorption from the intestine.

My blood cholesterol levels have been low ever since. I have not had to take statins, and I get to enjoy the taste and health benefits of an egg any time I want to. Of course, what worked for me may not work for you. The effect of dietary cholesterol on blood cholesterol levels is also affected by genetics, weight, and fitness, just to name the top three.

Are Easter Eggs Good For You?

thumbs upOnce you get past the cholesterol problem, eggs are a very healthy food.

  1. Studies have shown that egg protein results in improved blood sugar control, better satiety (feeling of fullness), and reduced subsequent food intake in healthy and overweight individuals. In layman’s terms that means egg protein can help you achieve and maintain a healthy weight.

2) Egg yolks are a good source of lutein and zeaxanthin. We think of lutein and zeaxanthin as good for eye health. They also play an important role in protecting against oxidation, inflammation, and atherosclerosis.

3) Egg yolks also contain choline. We think of choline as good for brain and nerves. But, choline and other phospholipids in the yolk also raise HDL levels and enhance HDL function.

4) Eggs are a good source of vitamin A, vitamin D, vitamin B12, riboflavin, selenium and iron.

5) Eggs contain almost twice as much monounsaturated and polyunsaturated fats as saturated fats.

Clearing Up The “Eggfusion”

egg confusion

  1. The latest study suggests that eggs may increase your risk of heart disease, and this is due to their cholesterol content.

2) This study needs to be considered in the context of recent studies in the US showing that egg consumption did not increase heart disease risk and studies in China and Japan showing that egg consumption lowered heart disease risk.

3) It is also important to consider that egg consumption in China and Japan is in the context of a semi-vegetarian diet. This suggests that diet plays a role in determining the effect of egg consumption on heart disease risk.

4) However, if you take this study at face value, there are two things you can do to reduce your risk of heart disease:

  • Reduce dietary cholesterol by avoiding eggs or using egg whites.
    • Eat eggs in moderation along with fiber- and phytonutrient-rich plant foods that negate the effect of dietary cholesterol on blood cholesterol levels. I recommend oatmeal or beans, nuts or seeds, and fiber rich fruits and vegetables. These should be consumed at the same meal to minimize the effect of the cholesterol in the eggs on blood cholesterol levels. As for Easter eggs, they are a perfect addition to a green salad.
    • Eggs are a very healthy food, so I recommend the second option if possible. Get your blood cholesterol levels measured to determine which approach works best for you.

5) Finally, we need to recognize that egg consumption plays a relatively minor role in determining heart disease risk. Other factors play a much larger role in influencing heart disease risk. For example:

    • Smoking, obesity, inactivity, saturated and trans fats significantly increase your risk of heart disease.
    • Omega-3s, antioxidants, and a primarily plant-based diet like the Mediterranean diet significantly decrease your risk of heart disease.

If we wish to reduce our risk of heart disease, this is where we should focus most of our attention. We can minimize the effect of egg consumption on heart disease risk by changing the foods we eat with the eggs. For more information on how to reduce your risk of heart disease, read my books, “Slaying The Food Myths” and “Slaying The Supplement Myths”.

The Bottom Line

1) The latest study suggests that eggs increase your risk of heart disease because of their cholesterol content.

2) This was a very large study. It combined the data from 6 clinical trials spanning the years 1974 to 2013. It followed 29,615 people for an average of 17.5 years. However, it has two significant weaknesses:

  • It only determined cholesterol intake and egg consumption at the time people entered the clinical trials. Both cholesterol intake and egg consumption have waxed and waned considerably over the years covered by these clinical trials.
  • It did not measure what foods were consumed along with the eggs. Foods consumed along with eggs have a strong influence on how much the cholesterol in the eggs influences blood cholesterol levels, which, in turn, influences the effect eggs have on heart disease risk.

3) This study also needs to be considered in the context of recent studies in the US showing that egg consumption did not increase heart disease risk and studies in China and Japan showing that egg consumption lowered heart disease risk.

4) However, if you take this study at face value, there are two things you can do to reduce your risk of heart disease:

  • Reduce dietary cholesterol by avoiding eggs or using egg whites.
  • Eat eggs in moderation along with fiber- and phytonutrient-rich plant foods that negate the effect of dietary cholesterol on blood cholesterol levels. I recommend oatmeal or beans, nuts or seeds, and fiber rich fruits and vegetables. These should be consumed at the same meal to minimize the effect of the cholesterol in the eggs on blood cholesterol levels. As for Easter eggs, they are a perfect addition to a green salad.
  • Eggs are a very healthy food, so I recommend the second option if possible. Get your blood cholesterol levels measured to determine which approach works best for you.

5) Finally, we need to recognize that egg consumption plays a relatively minor role in determining heart disease risk. Other factors play a much larger role in influencing heart disease risk. For example:

  • Smoking, obesity, inactivity, saturated and trans fats significantly increase your risk of heart disease.
  • Omega-3s, antioxidants, and a primarily plant-based diet like the Mediterranean diet significantly decrease your risk of heart disease.

For more information on how to reduce your risk of heart disease, read my books, “Slaying The Food Myths” and “Slaying The Supplement Myths”.

For more details and to learn what the professor does about egg consumption, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

 

 

 

Can You Create Your Personal Fountain Of Youth?

Can A Healthy Lifestyle Improve Your Healthspan?

Author: Dr. Stephen Chaney

Fountain Of YouthEver since Ponce de Leon led an expedition to the Florida coast in 1513, we have been searching for the mythical “Fountain Of Youth”. What does that myth mean?

Supposedly, just by immersing yourself in that fountain you would be made younger. You would experience all the exuberance and health you enjoyed when you were young. There have been many snake oil remedies over the years that have promised that. They were all frauds.

But what if you had it in your power to live longer and to retain your youthful health for most of those extra years. The ability to live healthier longer is something that scientists call “healthspan”. But you can think of it as your personal “Fountain Of Youth”.

Now comes the important question, “Can a healthy lifestyle improve your healthspan?” We know a healthy lifestyle is good for us. Most of us know what a healthy lifestyle is. But it’s so hard. Is it worth it? Will it actually increase our lifespan? Will it increase our healthspan?

Today I am sharing two studies from the prestigious Harvard T.H. Chan School of Public Health that answer those questions.

How Were The Studies Done?

clinical studyThese studies started by combining the data from two major clinical trials:

  • The Nurse’s Health Study, which ran from 1980 to 2014.
  • The Health Professional’s Follow-Up Study, which ran from 1986-2014.

These two clinical trials enrolled 78,865 women and 42,354 men and followed them for an average of 34 years. During this time there were 42,167 deaths. All the participants were free of heart disease, type 2 diabetes, and cancer at the time they were enrolled. Furthermore, the design of these clinical trials was extraordinary.

  • A detailed food frequency questionnaire was administered every 2-4 years. This allowed the investigators to calculate cumulative averages of all dietary variables.
  • Participants also filled out questionnaires that captured information on disease diagnosis every 2 years with follow-up rates >90%. This allowed the investigators to measure the onset of disease for each participant during the study. More importantly, 34 years is long enough to measure the onset of diseases like heart disease, diabetes, and cancer – diseases that require decades to develop.
    • The questionnaires also captured information on medicines taken and lifestyle characteristics such as body weight, exercise, smoking and alcohol use.
  • For analysis of diet quality, the investigators use something called the “Alternative Healthy Eating Index”. [The original Healthy Eating Index was developed about 10 years ago based on the 2010 “Dietary Guidelines for Americans”. Those guidelines have since been updated, and the “Alternative Healthy Eating Index” is based on the updated guidelines.] You can calculate your own Alternative Healthy Eating Index below, so you can see what is involved.
  • Finally, the investigators included five lifestyle-related factors – diet, smoking, physical activity, alcohol consumption, and BMI (a measure of obesity) – in their estimation of a healthy lifestyle. Based on the best available evidence, they defined “low-risk” in each of these categories. Study participants were assigned 1 point for each low-risk category they achieved. Simply put, if they were low risk in all 5 categories, they received a score of 5. If they were low risk in none of the categories, they received a score of 0.
  • Low risk for each of these categories was defined as follows:
    • Low risk for a healthy diet was defined as those who scored in the top 40% in the Alternative Healthy Eating Index.
    • Low risk for smoking was defined as never smoking.
    • Low risk for physical activity was defined as 30 minutes/day of moderate or vigorous activities.
    • Low risk for alcohol was defined as 0.5-1 drinks/day for women and 0.5-2 drinks/day for men.
    • Low risk for weight was defined as a BMI in the healthy range (18.5-24.9 kg/m2).

Can A Healthy Lifestyle Improve Your Healthspan?

Older Couple Running Along BeachThe investigators compared participants who scored as low risk in all 5 categories with participants who scored as low risk in 0 categories (which would be typical for many Americans). For simplicity, I will refer to people who scored as low risk in 5 categories as having a “healthy lifestyle” and those who scored as low risk in 0 categories as having an “unhealthy lifestyle”.

The results of the first study were:

  • Women who had had a healthy lifestyle lived 14 years longer than women with an unhealthy lifestyle (estimated life expectancy of 93 versus 79).
  • Men who had a healthy lifestyle lived 12 years longer than men with an unhealthy lifestyle (estimated life expectancy was 87 versus 75).
  • It was not necessary to achieve a perfect lifestyle. Life expectancy increased in a linear fashion for each low-risk lifestyle behavior achieved.

The authors of the study concluded: “Adopting a healthy lifestyle could substantially reduce premature mortality and prolong life expectancy in US adults. Our findings suggest that the gap in life expectancy between the US and other developed countries could be narrowed by improving lifestyle factors.”

The results of the second study were:

  • Women who had a healthy lifestyle lived 11 years longer free of diabetes, heart disease, and cancer than women who had an unhealthy lifestyle (estimated disease-free life expectancy of 85 years versus 74 years).
  • Men who had a healthy lifestyle lived 8 years longer free of diabetes, heart disease, and cancer than men who had an unhealthy lifestyle (estimated disease-free life expectancy of 81 years versus 73 years).
  • Again, disease-free life expectancy increased in a linear fashion for each low-risk lifestyle behavior achieved.

The authors concluded: “Adherence to a healthy lifestyle at mid-life [They started their analysis at age 50] is associated with a longer life expectancy free of major chronic diseases. Our findings suggest that promotion of a healthy lifestyle would help reduce healthcare burdens through lowering the risk of developing multiple chronic diseases, including cancer, cardiovascular disease, and diabetes, and extending disease-free life expectancy.”

Can You Create Your Personal Fountain Of Youth?

questionsI posed the question at the beginning of this article, “Can you create your personal Fountain Of Youth”?” These two studies showed that you can improve both your life expectancy and your disease-free life expectancy by simply changing your lifestyle. So, the answer to the original question appears to be, “Yes, you can improve your healthspan. You can create your personal “Fountain of Youth.”

However, as a nation we appear to be moving in the wrong direction. The percentage of US adults adhering to a healthy lifestyle has decreased from 15% in 1988-1992 to 8% in 2001-2006.

Finally, I know you have some questions, and I have answers.

Question: What about supplementation? Will it also improve my healthspan?

Answer: When the investigators analyzed the data, they found that those with the healthiest lifestyles were also more likely to be taking a multivitamin. So, they attempted to statistically eliminate any effect of supplement use on the outcomes. That means these studies cannot answer that question.

However, if you calculate your Alternate Healthy Eating Index below, you will see that most of us fall short of perfection. Supplementation can fill in the gaps.

Question: I cannot imagine myself reaching perfection in all 5 lifestyle categories? Should I even try to achieve low risk in one or two categories?

Answer: The good news is that there was a linear increase in both life expectancy and disease-free life expectancy as people went from low-risk in one category to low-risk in all 5 categories. I would encourage you to try and achieve low risk status in as many categories as possible, but very few of us, including me, achieve perfection in all 5 categories.

Question: I am past 50 already. Is it too late for me to improve my healthspan?

Answer: Diet and some of the other lifestyle behaviors were remarkably constant over 34 years in both the Nurse’s Health Study and the Health Professional’s Follow-Up Study. That means that the lifespan and healthspan benefits reported in these studies probably resulted from adhering to a healthy lifestyle for most of their adult years.

However, it is never too late to start improving your lifestyle. You may not achieve the full benefits described in these studies, but you still can add years and disease-free years to your life.

How To Calculate Your Alternative Healthy Eating Index 

You can calculate your own Alternative Healthy Eating Index score by simply adding up the points you score for each food category below.

Vegetables

Count 2 points for each serving you eat per day (up to 5 servings).

One serving = 1 cup green leafy vegetables or ½ cup for all other vegetables.

Do not count white potatoes or processed vegetables like French fries or kale chips.

Fruits

Count 2½ points for each serving you eat per day (up to 4 servings).

One serving = 1 piece of fruit or ½ cup of berries.

          (do not count fruit juice or fruit incorporated into desserts or pastries). 

Whole Grains

Count 2 points for each serving you eat per day (up to 5 servings).

One serving = ½ cup whole-grain rice, bulgur and other whole grains, cereal, and pasta or 1 slice of bread.

(For processed foods like pasta and bread, the label must say 100% whole grain).

Sugary Drinks and Fruit Juice

Count 10 points if you drink 0 servings per week.

Count 5 points for 3-4 servings per week (½ serving per day).

Count 0 points for 7 or more servings per week (≥1 serving per day).

One serving = 8 oz. fruit juice, sugary soda, sweetened tea, coffee drink, energy drink, or sports drink.

Nuts and Beans

Count 10 points if you eat 7 or more servings per week (≥1 serving per day).

Count 5 points for 3-4 servings per week (½ serving per day).

Count 0 points for 0 servings per week.

One serving = 1 oz. nuts or seeds, 1 Tbs. peanut butter, ½ cup beans, 3½ oz. tofu.

Red and Processed Meat

Count 10 points if you eat 0 servings per week.

Count 7 points for 3-4 servings per week (½ serving per day).

Count 3 points for 3 servings per week (1 serving per day).

Count 0 points for ≥1½ servings per day.

One serving = 1½ oz. processed meats (bacon, ham, sausage, hot dogs, deli meat)

          Or 4 oz. red meat (steak, hamburger, pork chops, lamb chops, etc.)

Seafood

Count 10 points if you eat 2 servings per week.

Count 5 points for 1 serving per week.

Count 0 points for 0 servings per week.

1 serving = 4 oz.

Now that you have your total, the scoring system is:

  • 41 or higher is excellent
  • 37-40 is good
  • 33-36 is average (remember that it is average to be sick in this country)
  • 28-32 is below average
  • Below 28 is poor

Finally, for the purposes of these two studies, a score of 37 or higher was considered low risk.

The Bottom Line 

Two recent studies have developed a healthy lifestyle score based on diet, exercise, body weight, smoking, and alcohol use. When they compared the effect of lifestyle on both lifespan (life expectancy) and healthspan (disease-free life expectancy), they reported:

  • Women who had had a healthy lifestyle lived 14 years longer than women with an unhealthy lifestyle.
  • Men who had a healthy lifestyle lived 12 years longer than men with an unhealthy lifestyle.
  • Women who had a healthy lifestyle lived 11 years longer free of diabetes, heart disease, and cancer than women had an unhealthy lifestyle.
  • Men who had a healthy lifestyle lived 8 years longer free of diabetes, heart disease, and cancer than men who had an unhealthy lifestyle.
  • It is not necessary to achieve a perfect lifestyle. Lifespan and healthspan increased in a linear fashion for each low-risk lifestyle behavior (diet, exercise, body weight, smoking, and alcohol use) achieved.
  • These studies did not evaluate whether supplement use also affects healthspan.
    • However, if you calculate your diet with the Alternate Healthy Eating Index they used (see above), you will see that most of us fall short of perfection. Supplementation can fill in the gaps.

The authors concluded: “Our findings suggest that promotion of a healthy lifestyle would help reduce healthcare burdens through lowering the risk of developing multiple chronic diseases, including cancer, cardiovascular disease, and diabetes, and extending disease-free life expectancy.”

For more details, including how to calculate your Alternative Healthy Eating Index, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Which Diets Are Best In 2023?

Which Diet Should You Choose?

Author: Dr. Stephen Chaney

Emoticon-BadMany of you started 2023 with goals of losing weight and/or improving your health. In many cases, that involved choosing a new diet. That was only 6 weeks ago, but it probably feels like an eternity.

For many of you the “bloom” has gone off the new diet you started so enthusiastically in January.

  • Perhaps the diet isn’t working as well as advertised…
  • Perhaps the diet is too restrictive. You are finding it hard to stick with…
  • Perhaps you are always hungry or constantly fighting food cravings…
  • Perhaps you are starting to wonder whether there is a better diet than the one you chose in January…
  • Perhaps you are wondering whether the diet you chose is the wrong one for you…

If you are rethinking your diet, you might want to know which diets the experts recommend. Unfortunately, that’s not as easy as it sounds. The diet world has become just as divided as the political world.

Fortunately, you have an impartial resource. Each year US News & World Report invites a panel of experts with different points of view to evaluate popular diets. They then combine the input from all the experts into rankings of the diets in various categories.

If you are still searching for your ideal diet, I will summarize the US News & World Report’s “Best Diets In 2023”. For the full report, click on this link.

How Was This Report Created?

Expert PanelUS News & World Report recruited a panel of 30 nationally recognized experts in diet, nutrition, obesity, food psychology, diabetes, and heart disease to review the 24 most popular diets.

The diets evaluated are not the same each year. Last year they evaluated the top 40 most popular diets. This year they only reviewed the top 24.

That means some good diets were left off the list. For example, the vegan diet is very healthy, but it is also very restrictive. Very few people follow a pure vegan diet, so it didn’t make the top 24 most popular. However, this year’s list did include several primarily plant-based diets that are more popular with the general public.

The panel is also not the same each year. Some experts are rotated off the panel, and others are added. The experts rate each diet in seven categories:

  • How easy it is to follow.
  • Its ability to produce short-term weight loss.
  • Its ability to produce long-term weight loss.
  • its nutritional completeness.
  • Its safety.
  • Its potential for preventing and managing diabetes.
  • Its potential for preventing and managing heart disease.

They converted the experts’ ratings to scores 5 (highest) to 1 (lowest). They then used these scores to construct eleven sets of Best Diets rankings:

  • Best Diets Overall ranks diets on several different parameters, including whether all food groups are included in the diet, the availability of the foods needed to be on the diet and the use of additional vitamins or supplements. They considered if the diet was evidence-based and adaptable to meet cultural, religious, or other personal preferences. In addition, the criteria also included evaluation of the prep and planning time required for the diet and the effectiveness of the diet for someone who wants to get and stay healthy.
  • Best Plant-Based Diets used the same approach as Best Diets Overall to rank the eight plans emphasizing minimally processed foods from plants that were included in this year’s ratings.
  • Best Commercial Diet ratings used the same approach to rank 15 commercial diet programs that require a participation fee or promote the use of branded food or nutritional products.
  • Best Long-Term Weight-Loss Diet ratings were generated by combining the safety of the rate of weight loss promoted and the likelihood of the plan to result in successful long-term weight loss and maintenance of weight loss.
  • Best Fast Weight-Loss Diets were scored on their effectiveness for someone who wants to lose weight in three months or less.
  • Best Diabetes Diet ratings were calculated equally from the effectiveness of the diet for someone who wants to lower risk factors for diabetes, the nutritional quality of the diet, and research evidence-based support for the diet.
  • Best Heart-Healthy Diet ratings were calculated equally from the effectiveness of the diet for someone who wants to lower risk factors for hypertension and other forms of heart disease, the nutritional quality of the diet, and evidence-based support for the diet.
  • Best Diets for Bone and Joint Health were calculated equally on the effectiveness of the diet for someone who wants to lower their risk factors for inflammation and improve bone and joint health, as well as the nutritional quality and research evidence-based support for the diet.
  • Best Diets for Healthy Eating combines nutritional completeness and safety ratings, giving twice the weight to safety. A healthy diet should provide sufficient calories and not fall seriously short on important nutrients or entire food groups.
  • Easiest Diets to Follow represents panelists’ averaged scores for the relevant lifestyle questions, including whether all food groups are included and if the recommended foods are readily available at the average supermarket.
  • Best Family-Friendly Diets were calculated equally on their adaptability for the whole family, including cultural, religious, and personal preferences, the time required to plan and prep, nutritional value and access to food at any supermarket.

Which Diets Are Best In 2023?

Are you ready? If this were an awards program, I would be saying “Envelop please” and would open the envelop slowly to build suspense.

However, I am not going to do that. Here are the top 3 and bottom 3 diets in each category (If you would like to see where your favorite diet ranked, click on this link.

[Note: I excluded commercial diets from this review. (I have a brief discussion of commercial diets below). If you notice a number missing in my summaries, it is because I eliminated one or more commercial diet from my summary.]

Best Diets Overall 

The Top 3: 

#1: Mediterranean Diet. The Mediterranean diet has been ranked #1 for 6 consecutive years.

#2 (tie): DASH Diet (This diet was designed to keep blood pressure under control, but you can also think of it as an Americanized version of the Mediterranean diet.)

#2 (tie): Flexitarian Diet (A flexible semi-vegetarian diet).

The Bottom 3: 

#20: Keto Diet (A high protein, high fat, very low carb diet designed to achieve ketosis).

#21: Atkins Diet (The granddaddy of the high animal protein, low carb, high fat diets).

#24: Raw Food Diet (A diet based on eating foods that have not been cooked or processed).

Best Plant-Based Diets Overall 

The Top 3: 

#1: Mediterranean Diet.

#2: Flexitarian Diet.

#3: MIND Diet (This diet is a combination of Mediterranean and DASH but is specifically designed to reduce cognitive decline as we age.)

The Bottom 3: 

Since only 8 diets were included in this category, even the bottom 3 are pretty good diets, so I did not include a “list of shame” in this category.

Best Long-Term Weight-Loss DietsWeight Loss

The Top 3: 

#1: DASH Diet

#2 (tie): Volumetrics Diet (A diet based on the caloric density of foods).

#2 (tie): Mayo Clinic Diet (A diet designed to establish lifelong healthy eating habits).

The Bottom 3: 

#22 (tie): Keto Diet.

#22 (tie): Atkins Diet.

#24: Raw Food Diet.

Best Fast Weight-Loss Diets

The Top 3: 

#1: Keto Diet

#2: Atkins Diet

#7 (tie): Mayo Clinic Diet

#7 (tie): South Beach Diet

#7 (tie): Volumetrics Diet

The Bottom 3: 

The diets at the bottom of this list were designed for health and weight maintenance rather than rapid weight loss, so I did not include a “list of shame” in this category.

Best Diabetes Diets

The Top 3: 

#1: DASH Diet

#2: Mediterranean Diet

#3: Flexitarian Diet

The Bottom 3: 

#20: Atkins Diet

#21: Paleo Diet (A diet based on what our paleolithic ancestors presumably ate. It restricts grains and dairy and is heavily meat-based).

#22: Raw Food Diet.

Best Heart-Healthy Diets

Healthy HeartThe Top 3: 

#1: DASH Diet

#2: Mediterranean Diet

#3 (tie): Ornish Diet (A whole food, semi-vegetarian diet designed to promote heart health).

#3 (tie): Flexitarian Diet

The Bottom 3: 

#22 (tie): Raw Foods Diet

#22 (tie): Paleo Diet

#24: Keto Diet

Best Diets for Bone and Joint Health 

The Top 3: 

#1 (tie): DASH Diet

#1 (tie): Mediterranean Diet

#3: Flexitarian Diet

The Bottom 3: 

#21 (tie): Raw Foods Diet

#21 (tie): Paleo Diet

#22: Atkins Diet 

#23: Keto Diet 

Best Diets for Healthy Eating

The Top 3: 

#1: Mediterranean Diet

#2: DASH Diet

#3: Flexitarian Diet

The Bottom 3: 

#22: Keto Diet

#23: Atkins Diet

#24: Raw Foods Diet

Easiest Diets to FollowEasy

The Top 3: 

#1 (tie): Flexitarian Diet

#1 (tie): TLC Diet (This diet was designed by the NIH to reduce cholesterol levels and promote heart health.)

#3 (tie): Mediterranean Diet

#3 (tie): DASH Diet

The Bottom 3: 

#19: Atkins Diet

#20: Keto Diet

#22: Raw Foods Diet

Which Diets Are Best For Rapid Weight Loss?

Happy woman on scaleThere are 2 take-home lessons from the rapid weight loss category:

  1. If you are looking for rapid weight loss, any whole food restrictive diet will do.
    • Last year’s diet analysis included the vegan diet, and both vegan and keto diets ranked near the top of the rapid weight loss category. Keto and vegan diets are both very restrictive, but they are polar opposites in terms of the foods they allow and restrict.
      • The keto diet is a meat heavy, very low carb diet. It restricts fruits, some vegetables, grains, and most legumes.
      • The vegan diet is a very low-fat diet that eliminates meat, dairy, eggs, and animal fats.
    • The Atkins and keto diets toppled this year’s rapid weight loss list, but they were joined by the Mayo Clinic, South Beach, and volumetrics diets. Those diets are also restrictive, but, like the vegan diet, they are very different from the Atkins and keto diets.
    • I did not include commercial diets that rated high on this list, but they are all restrictive in one way or another.

2) Whole food, very low carb diets like Atkins and keto are good for rapid weight loss, but they rank near the bottom of the list for every healthy diet category.

    • If you choose to lose weight on the Atkins or keto diets, switch to a healthier diet once you reach your desired weight loss.

Which Diet Should You Choose?

Food ChoicesWith rapid weight loss out of the way, let’s get back to the question, “Which Diet Should You Choose?” My recommendations are:

1) Choose a diet that fits your needs. That is one of the things I like best about the US News & World Report ratings. The diets are categorized. If your main concern is diabetes, choose one of the top diets in that category. If your main concern is heart health… You get the point.

2) Choose diets that are healthy and associated with long term weight loss. If that is your goal, you will notice that primarily plant-based diets top these lists. Meat-based, low carb diets like Atkins and keto are near the bottom of the lists.

  • “Why is that?”, you might ask? The answer is simple. And it’s not that all 30 experts were prejudiced against low carb diets. It’s that the major primarily plant-based diets like Mediterranean, DASH, and flexitarian are backed by long-term clinical studies showing they are healthy and significantly reduce the risk of diabetes, heart disease, and other chronic diseases.
  • On the other hand, there are no long-term studies showing the Atkins and keto diets are healthy long term. And since the Atkins diet has been around for more than 50 years, the lack of clinical evidence that it is healthy long term is damming.

3) Choose diets that are easy to follow. The less-restrictive primarily plant-based diets top this list – diets like Mediterranean, DASH, MIND, and flexitarian. They are also at or near the top of almost every diet category.

4) Choose diets that fit your lifestyle and dietary preferences. For example, if you don’t like fish and olive oil, you will probably do much better with the DASH or flexitarian diet than with the Mediterranean diet.

5) Finally, focus on what you have to gain, rather than on foods you have to give up.

  • On the minus side, none of the diets include sodas, junk foods, and highly processed foods. These foods should go on your “No-No” list. Sweets should be occasional treats and only as part of a healthy meal. Meat, especially red meat, should become a garnish rather than a main course.
  • On the plus side, primarily plant-based diets offer a cornucopia of delicious plant foods you probably didn’t even know existed. Plus, for any of the top-rated plant-based diets, there are websites and books full of mouth-watering recipes. Be adventurous.

What About Commercial Diets?

I chose not to review commercial diets by name, but let me make a few observations.

  • If you look at the gaps in my lists, it should be apparent that several commercial diets rank near the top for fast weight loss, but near the bottom on most healthy diet lists.
  • I do not recommend commercial diets that rely on ready-to-eat, low-calorie, highly processed versions “of your favorite foods”.
    • These pre-packaged meals are expensive. Unless you are a millionaire, you won’t be able to afford these meals for the rest of your life.
    • These pre-packaged meals are not teaching you healthy eating habits that will allow you to keep the weight off.
  • If you wish to spend your hard-earned dollars on a commercial diet, choose a diet that:
    • Relies on whole foods from all 5 food groups.
    • Teaches and provides support for the type of lifestyle change that leads to permanent weight loss.
  • Meal replacement shakes can play a role in healthy weight loss if:
    • They are high quality and use natural ingredients as much as possible.
    • They are part of a holistic lifestyle change program.

The Bottom Line 

For many of you the “bloom” has gone off the new diet you started so enthusiastically in January. If you are rethinking your diet, you might want to know which diets the experts recommend. Unfortunately, that’s not as easy as it sounds. The diet world has become just as divided as the political world.

Fortunately, you have an impartial resource. Each year US News & World Report invites a panel of experts with different points of view to evaluate popular diets. They then combine the input from all the experts into rankings of the diets in various categories. In the article above I summarize the US News & World Report’s “Best Diets In 2023”.

There are probably two questions at the top of your list.

#1: Which diets are best for rapid weight loss? Here are 2 general principles:

  1. If you are looking for rapid weight loss, any whole food restrictive diet will do.

2) If you choose to lose weight on the Atkins or keto diets, switch to a healthier diet once you reach your desired weight loss. Atkins and keto diets are good for rapid weight loss, but they rank near the bottom of the list for every healthy diet category.

#2: Which diet should you choose? Here the principles are:

  1. Choose a diet that fits your needs.

2) Choose diets that are healthy and associated with long term weight loss.

3) Choose diets that are easy to follow.

4) Choose diets that fit your lifestyle and dietary preferences.

5) Finally, focus on what you have to gain, rather than on foods you have to give up.

For more details on the diet that is best for you and my thoughts on commercial diets, read the article above.

Can Lifestyle Overcome Bad Genes?

Lifestyle, Genetics, And Dementia Risk 

Author: Dr. Stephen Chaney 

Cognitive-DeclineAlzheimer’s disease and other forms of dementia are among the most feared diseases of aging. What use is it to have a healthy body, a loving family, and a successful career if you can’t remember any of it? You should be able to enjoy your Golden years, not see them slip through your fingers.

If you have a family history of dementia or have sent your DNA off for testing and learned you are genetically predisposed to dementia, you are probably worried.

Perhaps the scariest thing about Alzheimer’s is that the medical community has no answers. There are no drugs to prevent or cure Alzheimer’s and brain transplants are out of the question. Some medical professionals will tell you nothing can be done, but is that true?

Before I answer that question let me share a fictional story because it provides a clue. In 1997, when I was still a relatively young scientist, I saw a film called GAATACA. [If you are looking for an entertaining film to watch, it is still available on some streaming services.]

This film envisioned a future society in which parents had their sperm and eggs sequenced so that their children would be genetically perfect. In that society the term “love child” had been redefined as a child who had been conceived without prior DNA sequencing.

The hero of this film was, of course, a love child. He was born with a genetic predisposition for heart disease. He was considered inferior, a second-class citizen of this future world.

Without giving away the plot of the film (I don’t want to spoil the enjoyment for you if you are thinking of watching it), he overcame his genetic inferiority. With a strict regimen of diet and physical fitness he became stronger and healthier than many of his genetically perfect peers.

This is when I first began to realize that our genes do not have to determine our destiny. We have the power to overcome bad genetics. We also have the power to undermine good genetics.

With that in mind, let’s return to Alzheimer’s. Studies have suggested that a healthy lifestyle can help reduce your risk of developing Alzheimer’s and other forms of dementia. But what about genetics? Will a healthy lifestyle only reduce your risk of dementia if your genetic risk is low, or will it be equally effective when your genetic risk is high? Can lifestyle overcome genetics?

The current study (A Tin et al, Neurology, 99: e154-e163, 2022) was designed to answer these questions.

How Was This Study Done?

clinical studyThis study included 11,561 participants from the Atherosclerosis Risk In Communities (ARIC) study. The ARIC study recruited middle-aged adults (average age of 54) from both urban and rural areas of the United States and followed them for 26 years. The participants were 57% female and 53% white.

Simply put, the study was designed to look at the effect of a healthy lifestyle on the genetic risk of developing dementia.

A healthy lifestyle was defined based on something called “Life’s Simple 7” (LS7) score.

  • The LS7 score was developed by the American Heart Association to define the effect of lifestyle on the risk of developing heart disease. However, it works equally well for defining the effect of lifestyle on risk of developing dementia.
  • The LS7 score consists of 7 modifiable health factors.
    • The factors are diet, physical activity, BMI (a measure of obesity), smoking, total cholesterol, blood pressure, and fasting blood glucose.
  • The data for deriving the LS7 scores were derived from data gathered from each participant when they enrolled in the ARIC study.
    • Diet was assessed by a 66-item food frequency questionnaire.
    • Physical activity and smoking were assessed in separate questionnaires.
    • BMI, blood pressure, total cholesterol, and fasting blood glucose were measured during a visit to a designated clinic at the beginning of the study.
  • Each modifiable health factor was separated into 3 categories (ideal, intermediate, and poor) and the highest score was assigned to the ideal category. The LS7 score was the sum of the scores from all 7 modifiable health factors.

Genetic risk of developing dementia was defined based on something called “The Genetic Risk Score” (GRS).

  • We have known for years that individuals of European descent who have the APOE ɛ4 gene variant have a 2 to 5-fold increased lifetime risk of developing dementia.
  • In recent years scientists have discovered several additional gene variants that increase the risk of dementia.
  • These have been combined with APOE ɛ4 to create a Genetic Risk Score for dementia.
  • The Genetic Risk Score for each participant was determined by DNA sequencing at the beginning of the study, with the highest score indicating the greatest risk for developing dementia.

The onset and severity of dementia were determined based on 7 clinic visits during the study.

  • Questionnaires were administered at each visit to assess self-reported dementia symptoms.
  • Cognitive tests were administered at visits 2 and 4.
  • Detailed cognitive and functional assessments were conducted at visits 5, 6, and 7.
  • The data were reviewed by an expert committee of physicians and neuropsychologists to determine dementia status.

Lifestyle, Genetics, And Dementia Risk

DNA TestingAt the end of the 26-year study:

  • When participants with the highest Genetic Risk Scores were compared to those with the lowest Genetic Risk Scores:
    • European American participants were 2.7-fold more likely to develop dementia.
    • African American participants were 1.55-fold more likely to develop dementia.
  • When participants with the highest LS7 (healthy lifestyle) scores were compared to those with the lowest LS7 scores:
    • European American participants were 40% less likely to develop dementia.
    • African American participants were 17% less likely to develop dementia.
    • A healthy lifestyle decreased the risk of developing dementia to a comparable extent at all levels of genetic risk for dementia.

The authors concluded, “Higher LS7 scores [a measure of a healthy lifestyle] are largely associated with a lower risk of incident dementia across strata of genetic risk [at all levels of genetic risk], supporting the use of LS7 [a healthy lifestyle] for maintaining brain health and offsetting genetic risk. More studies with larger study populations are needed…”

I should briefly comment on why African Americans were less responsive to both genetic risk and a healthy lifestyle than European Americans. The reasons for these discrepancies are not known, but:

  • There are socioeconomic factors and health disparities that increase the risk of dementia that are not included in the LS7 score.
  • A recent study has identified genetic risk factors for dementia that are unique to African Americans that are not included in the genetic risk score used in this study.

Can Lifestyle Overcome Bad Genes?

Dr. James Watson, who was co-discoverer of the DNA double helix and was heavily involved in the sequencing of the human genome, asked that he not be told about his risk of developing Alzheimer’s when his own DNA was sequenced in the early 2000’s. His reasoning was, “Why know the risk if you can’t change it?”

If the study I discussed today is true, you can modify the risk. Your genes don’t have to be your destiny. But is it true?

There is good reason to believe it might be true. Multiple studies have shown that each of the health factors included in LS7 score reduce the risk of developing dementia. However, most of those studies have not looked at the interaction between a healthy lifestyle and genetic risk.

Fortunately, there is another recent study that looked at the interaction between a healthy lifestyle and genetic risk of developing dementia.

  • This study used a different database (The UK Biobank study which enrolled 500,000 participants) and different criteria for defining a healthy lifestyle (diet, physical activity, smoking, and alcohol use).

However, the conclusions of this study were very similar:

  • People at high genetic risk were almost twice as likely to develop dementia as those at low genetic risk.
  • A healthy lifestyle decreased the risk of developing dementia by about 40% for both people at high genetic risk and for people at low genetic risk.

But this study went one step further than the study I discussed in this article. The British study reported that:

  • People at low genetic risk and an unhealthy lifestyle (the typical American) were just as likely to develop dementia as people at high genetic risk and a healthy lifestyle.

In other words, bad genetics does not doom you to Alzheimer’s and dementia. A healthy lifestyle can cut your risk almost in half. Conversely, good genetics is not a “Get Out of Jail Free” card. You can squander the advantage of good genetics with an unhealthy lifestyle.

And, just like the hero of the movie I discuss at the beginning of this article, a healthy lifestyle may be able to overcome bad genes and make you just as healthy (with respect to the risk of developing dementia) as people with good genes and an unhealthy lifestyle – which includes most Americans.

The Bottom Line 

Alzheimer’s disease and other forms of dementia are among the most feared diseases of aging. What use is it to have a healthy body, a loving family, and a successful career if you can’t remember any of it?

If you have a family history of dementia or have sent your DNA off for testing and learned you are genetically predisposed to dementia, you are probably worried.

Perhaps the scariest thing about Alzheimer’s is that the medical community has no answers. There are no drugs to prevent or cure Alzheimer’s and brain transplants are out of the question. Some medical professionals will tell you nothing can be done, but is that true?

Studies have suggested that a healthy lifestyle can help reduce your risk of developing Alzheimer’s and other forms of dementia. But what about genetics? Will a healthy lifestyle only reduce your risk of dementia if your genetic risk is low, or will it be equally effective when your genetic risk is high? Can lifestyle overcome genetics?

A recent study was designed to answer these questions. It found:

  • When participants with the highest Genetic Risk Scores were compared to those with the lowest Genetic Risk Scores:
    • They were 1.5 to 2.7-fold more likely to develop dementia.
  • When participants with the highest LS7 (healthy lifestyle) scores were compared to those with the lowest LS7 scores:
    • They were 17% to 40% less likely to develop dementia.
  • A healthy lifestyle decreased the risk of developing dementia to a comparable extent at all levels of genetic risk for dementia.

The authors concluded, “Higher LS7 scores [a measure of a healthy lifestyle] are largely associated with a lower risk of incident dementia across strata of genetic risk [at all levels of genetic risk], supporting the use of LS7 [a healthy lifestyle] for maintaining brain health and offsetting genetic risk. More studies with larger study populations are needed…”

This, and other studies discussed in this issue of “Health Tips For The Professor” suggest that your genes don’t have to determine your destiny. You can overcome bad genes with a healthy lifestyle.

For more details on this study, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Tips For Successful Weight Loss

Which Diet Is Best?

Author: Dr. Stephen Chaney

It’s the beginning of January. Weight loss season has just launched again. Like millions of Americans, you have probably set a goal to eat healthier, lose weight, or both. But which diet is best? Vegan, Paleo, Keto, 360, Intermittent Fasting, low-carb, low fat – the list is endless.

And then there are the commercial diets: Meal replacements, low calorie processed foods, prepared meals delivered to your door – just to name a few of the categories.

You can choose to count calories, focus on portion sizes, or keep a food journal.

And, if you really want to live dangerously, you can try the latest diet pills that claim to curb your appetite and rev up your metabolism.

The advertisements for all these diets sound so convincing. They give you scientific-sounding mumbo jumbo to explain why they work. Then they talk about clinical studies they say prove their diet works.

If you are like most Americans, you have already tried several of these diets. They worked for a while, but the pounds came back – and brought their friends with them.

But, as the saying goes, “Hope springs eternal in the human breast”. Surely some diet you haven’t tried yet will work for you.

There are such diets. But they will require effort. They will require a change of mindset. There is no magic wand that will chase the extra pounds away forever.

If you are searching for the perfect diet to start the new year, let me be your guide. Here are:

  • 4 tips on mistakes to avoid and…
  • 6 tips on what to look for…
  • 7 tips for making weight loss permanent…

…when you are choosing the best diet for you.

Mistakes To Avoid When Choosing The Best Diet

Avoid1. Endorsements

Endorsements by your favorite athlete or public person are paid for. They don’t necessarily represent their opinion. Nor do they assure you that they follow that diet or use that diet supplement.

Endorsements by Dr. Strangelove and his buddies can be equally misleading. They usually tell you that the medical establishment has been lying to you, and they have discovered the “secret” to permanent weight loss and the “Fountain of Youth”.

Recommendations of the medical and scientific communities usually represent a consensus statement by the top experts in their field. I would choose their advice over Dr. Strangelove’s opinion any day.

2) Testimonials

Most of the testimonials you see online or in print are either paid for or are fake.

Testimonials by your friends can be equally misleading. We are all different. What works for your friend or for your trainer may not work for you.

For example, some of us do better on low-carb diets, and others do better on low fat diets.

[Note: Some DNA testing companies claim they can sequence your DNA and tell you which diet is best. However, as I reported in a recent article in “Health Tips From The Professor”, independent studies show that DNA testing is of no use in predicting whether low-carb or low-fat diets are better for you.]

3) Diets Based on “Magic” Or “Forbidden” Foods or Food Groups.

I have often said we have 5 food groups for a reason. Each food group provides a unique blend of nutrients and phytonutrients. And each plant food group provides a unique blend of fibers that support the growth of different types of friendly gut bacteria.

The bottom line is that each of us does better with some foods than others, but there are no “magic” or “forbidden” foods that apply to everyone.

Magic4) “Magic” Diets.

I have written perhaps the first diet book, “Slaying The Food Myths”, that doesn’t feature a “magic” diet that is going to make the pounds melt away and allow you to live to 100. Instead, I recommend a variety of healthy diets and suggest you choose the one that fits you best.

However, I understand the allure of “magic” diets. Dr. Strangelove claims the diet will be effortless. He gives you some scientific-sounding mumbo-jumbo to convince you the diet is scientifically sound. Then he cites some clinical studies showing the diet will cause you to lose weight and will improve your health parameters (things like cholesterol, triglycerides, blood sugar, and blood pressure). It sounds so convincing.

Before you fall for Dr. Strangelove’s latest “magic” diet, let me share two things that may blow your mind:

  • The studies are all short-term (usually 3 months or less).
  • When you rely on short-term studies, the very low-fat Vegan diet and very low-carb Keto diet give you virtually identical weight loss and improvement in health parameters!

Those two diets are as different as any two diets could be. That means we can forget all the scientific-sounding mumbo-jumbo as to why each of those diets work. Instead, we should ask what these two diets have in common.

The answer is simple:

#1: The clinical studies are comparing “magic” diets to the typical American diet. Anything is better than the typical American diet! It is high in sugar, refined carbohydrates, saturated fat, and highly processed foods. No wonder the “magic” diets look so good.

#2: The diets are whole food diets. Anytime you eliminate sodas, fast foods, and highly processed foods, you will lose weight.

#3: The diets eliminate one or more food groups. Whenever you eliminate some of your favorite foods from your diet, you tend to lose weight without thinking about it. I call this the cream cheese and bagel phenomenon.

  • If you are following a low-fat diet, it sounds great to say you can eat all the bagels you want. But without cream cheese to go with the bagels, you tend to eat fewer bagels.
  • If you are following a low-carb diet, it sounds great to say you can eat as much cream cheese as you want, but without bagels to go with your cream cheese, you tend to eat less cream cheese.

#4: Because they eliminate many of your favorite foods, “magic” diets make you focus on what you eat. Whenever you focus on what you eat, you tend to lose weight. That is why food journals and calorie counters are effective.

#5: Finally, whenever you lose weight, your health parameters (cholesterol, triglycerides, blood sugar, and blood pressure) improve.

Tips For Successful Weight Loss

SkepticWhat should you look for in choosing a healthy weight loss diet? Here are my top 6 tips.

1. Choose whole food diets. Avoid sodas, fast foods, and highly processed foods.

2) Choose primarily plant-based diets. These can range from Vegan through semi-vegetarian, Mediterranean, DASH, and Nordic. All are healthy diets. I have discussed the evidence for this recommendation in my book “Slaying The Food Myths”. Here is a brief summary.

When we look at long term (10-20 year) studies:

  • Vegetarians weigh less and are healthier than people consuming the typical American diet.
  • People consuming semi-vegetarian, Mediterranean, and DASH diets are healthier than people consuming the typical American diet.

When we look at low-carb diets:

  • People consuming plant-based low-carb diets weigh less and are healthier than people consuming the typical American diet.
  • People consuming meat-based low-carb diets are just as fat and unhealthy as people consuming the typical American diet.
  • The Atkins low-carb diet has been around for more than 50 years, and there is no evidence it is healthy long-term.

3) Choose diets that include a variety of foods from all 5 food groups. I have discussed the rationale for that recommendation above.

4) Choose diets that consider meat as a garnish, not a main course.

5) Choose diets that feature healthy carbs and healthy fats rather than low-carb or low-fat diets.

6) Think lifestyle, not diet. If you choose a restrictive diet so you can achieve quick weight loss, you will probably be just as fat and unhealthy next December 31st as you are this year. Instead, choose diets that teach healthy eating and lifestyle changes that you can make a permanent part of your life.

Tips For Keeping The Weight Off

You know the brutal truth. Around 95% of dieters regain everything they lost and then some within a few years. You have probably gone through one or more cycles of weight loss and regain yourself – something called “yo-yo dieting”. You may even be asking yourself if it is worth bothering to try to lose weight this year.

Rather focusing on the negative statistics of weight loss, let’s look at the good news. There are people who lose the weight and keep it off. What do they do?

There is an organization called the National Weight Control Registry that has enrolled more than 10,000 people who have lost weight and kept it off. The people in this group lost weight on almost every diet imaginable. However, here is the important statistic: On average people in this group have lost 66 pounds and kept it off for at least 5 years.

The National Weight Control Registry has kept track of what they have done to keep the weight off. Here is what they do that you may not be doing:

1. They consume a reduced calorie, whole food diet.

2) They get lots of exercise (around 1 hour/day).

3) They have internalized their eating patterns. In short, this is no longer a diet. It has become a permanent part of their lifestyle. This is the way they eat without even thinking about it.

4) They monitor their weight regularly. When they gain a few pounds, they modify their diet until they are back at their target weight.

5) They eat breakfast on a regular basis.

6) They watch less than 10 hours of TV/week.

7) They are consistent (no planned cheat days).

Which Diet Is Best?

Now it is time to get back to the question you are asking right now, “Which diet is best?” I have covered a lot of ground in this article. Let me summarize it for you.

If you are thinking about popular diets:

  • Primarily plant-based diets ranging from Vegan to Mediterranean and Dash are associated with a healthier weight and better health long term.
    • If want to lose weight quickly, you may want to start with the more restrictive plant-based diets, like Vegan, Ornish, Pritikin or semi-vegetarian.
    • If you do better with a low-carb diet, my recommendation is the lower-carb version of the Mediterranean diet called Med-Plus. It is a whole food version of the Mediterranean diet that minimizes added sugar and refined grains (I will be talking more about it in next week’s “Health Tips From the Professor”).
    • If your primary goal is rapid weight loss, you could also start with one of the healthier of the restrictive low-carb diets, like the Paleo or the 360 diet. I do not recommend the Keto diet.
  • No matter what diet you start with, plan to transition to the primarily plant-based diet that best fits your lifestyle and food preferences. This is the diet you will want to stick with to maintain your weight loss and achieve better health long term.
  • Plan on permanent lifestyle change rather than a short-term diet. Otherwise, you are just wasting your time.
  • Eat whole foods. Big Food keeps up with America’s favorite diets and is only too happy to sell you highly processed foods that match your favorite diet. Avoid those like the plague.

If you are thinking about commercial diets featuring meal replacement products:

  • Look for meal replacement products that:
    • Do not contain artificial sweeteners, flavors, or preservatives.
    • Use non-GMO protein. A non-GMO certification for the other ingredients is not necessary. For a more detailed explanation of when non-GMO certification is important and when it is unnecessary, see my article in “Health Tips From the Professor”.
    • Have stringent quality controls in place to assure purity. “Organic” and/or “non-GMO” on the label do not assure purity.
  • Look for programs that can provide clinical studies showing their diet plan is effective for weight loss and for keeping the weight off. Many programs have short-term clinical studies showing they are effective for weight loss, but very few have longer-term studies showing the weight stays off.
  • Finally, look for programs that teach permanent lifestyle change. This should include guidance on exercise and healthy eating.

I do not recommend most commercial diets that feature prepared low-calorie foods “shipped right to your door” as a major part of their program. The foods are highly processed. Plus, they include all your favorite unhealthy foods as part of the program. Even if they include lifestyle change as part of their program, they are undermining their message with the foods they are providing you.

I would be remiss if I didn’t mention that Weight Watchers is highly recommended by most experts in the field. Weight Watchers emphasizes journaling and counting calories, which is a plus because it makes you focus on what you are eating. They also have a good lifestyle program and support that can help you transition to permanent lifestyle change if you are willing to put in the effort. However, I don’t recommend their prepared low-calorie foods. They are no better than foods provided by the other commercial diet programs.

The Bottom Line 

Weight loss season is upon us. If you plan to lose weight and/or adopt a healthier diet this year, you are probably asking, “Which Diet Is Best?” In this issue of “Health Tips From The Professor” I give you:

  • 4 tips on mistakes to avoid when selecting the diet that is best for you.
  • 6 tips on how to choose the best diet.
  • 5 tips on what to look for when selecting a diet featuring meal replacement products.
  • 7 tips on how to keep the weight off.

Then I put all this information together to help you choose the best diet, the best meal replacement product, and/or the best commercial diet program.

For more details read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Health Tips From The Professor