heart health

Are Easter Eggs Bad For You?

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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.

 

 

 

Which Diets Are Best In 2023?

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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.

Which Supplements Are Good For Your Heart?

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How Should You Interpret This Study? 

Author: Dr. Stephen Chaney 

strong heartFebruary is Heart Health month. So, it is fitting that we ask, “What is the status of heart health in this country?” The American Heart Association just published an update of heart health statistics through 2019 (CW Tsao et al, Circulation, 145: e153-e639, 2022). And the statistics aren’t encouraging. [Note: The American Heart Association only reported statistics through 2019 because the COVID-19 pandemic significantly skewed the statistics in 2020 and 2021].

The Good News is that between 2009 and 2019:

  • All heart disease deaths have decreased by 25%.
  • Heart attack deaths have decreased by 6.6%.
  • Stroke deaths have decreased by 6%.

The Bad News is that:

  • Heart disease is still the leading cause of death in this country.
  • Someone dies from a heart attack every 40 seconds.
  • Someone dies from a stroke every 3 minutes.

Diet, exercise, and weight control play a major role in reducing the risk of heart disease. Best of all, they have no side effects. They represent a risk-free approach that each of us can control.

But is there something else? Could supplements play a role? Are supplements hype or hope for a healthy heart?

All the Dr. Strangeloves in the nutrition space have their favorite heart health supplements. They claim their supplements will single-handedly abolish heart disease (and help you leap tall buildings in a single bound).

On the other hand, many doctors will tell you these supplements are a waste of money. They don’t work. They just drain your wallet.

It’s so confusing. Who should you believe? Fortunately, a recent study (P An et al, Journal of the American College of Cardiology, 80: 2269-2285, 2022) has separated the hype from the hope and tells us which “heart-healthy” supplements work, and which don’t.

How Was This Study Done?

Clinical StudyThis was a major clinical study carried out by researchers from the China Agricultural University and Brown University in the US. It was a meta-analysis, which means it combined the data from many published clinical trials.

The investigators searched three major databases of clinical trials to identify:

  • 884 randomized, placebo-controlled clinical studies…
  • Of 27 types of micronutrients…
  • With a total of 883,627 patients…
  • Looking at the effectiveness of micronutrient supplementation lasting an average of 3 years on either…
    • Cardiovascular risk factors like blood pressure, total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides…or…
    • Cardiovascular outcomes such as coronary heart disease (CHD), heart attacks, strokes, and deaths due to cardiovascular disease (CVD) and all causes.

[Note: Coronary heart disease (CHD) refers to build up of plaque in the coronary arteries (the arteries leading to the heart). It is often referred to as heart disease and can lead to heart attacks (myocardial infarction). Cardiovascular disease (CVD) is a more inclusive term that includes coronary heart disease, stroke, congenital heart defects, and peripheral artery disease.]

The investigators also included an analysis of the quality of the data in each of the clinical studies and rated the evidence of each of their findings as high quality, moderate quality, or low quality.

Which Supplements Are Good For Your Heart?

The top 3 heart-healthy supplements in this study were:

Omega-3s And Heart DiseaseOmega-3 Fatty Acids:

  • Increased HDL cholesterol and decreased triglycerides, both favorable risk factors for heart health.
  • Deceased risk of heart attacks by 15%, all CHD events by 14%, and CVD deaths by 7% (see definitions of CHD and CVD above).
  • The median dose of omega-3 fatty acids in these studies was 1.8 g/day.
  • The evidence was moderate quality for all these findings.

Folic Acid:

  • Decreased LDL cholesterol (moderate quality evidence) and decreased blood pressure and total cholesterol (low quality evidence).
  • Decreased stroke risk by 16% (moderate quality evidence).

Coenzyme Q10:

  • Decreased triglycerides (high quality evidence) and reduced blood pressure (low quality evidence).
  • Decreased the risk of all-cause mortality by 32% (moderate quality evidence).
  • These studies were performed with patients diagnosed with heart failure. Coenzyme Q10 is often recommended for these patients, so the studies were likely performed to test the efficacy of this treatment.

There were three micronutrients (vitamin C, vitamin E, and vitamin D) that did not appear to affect heart disease outcomes.

Finally, as reported in previous studies, β-carotene increased the risk of stroke, CVD mortality, and all-cause mortality.

In terms of the question I asked at the beginning of this article, this study concluded that:

  • Omega-3, folic acid, and coenzyme Q10 supplements represent hope for a healthy heart.
  • Vitamin C, vitamin E, and vitamin D supplements represent hype for a healthy heart.
  • β-carotene supplements represent danger for a healthy heart.

But these conclusions just scratch the surface. To put them into perspective we need to dig a bit deeper.

How Should You Interpret This Study?

Question MarkIn evaluating the significance of these findings there are two things to keep in mind.

#1: This study is a meta-analysis and meta-analyses have both strengths and weaknesses.

The strength of meta-analyses is that by combining multiple clinical studies they can end up with a database containing 100s of thousands of subjects. This allows them to do two things:

  • It allows the meta-analysis to detect statistically significant effects that might be too small to detect in an individual study.
  • It allows the meta-analysis to detect the average effect of all the clinical studies it includes.

The weakness of meta-analyses is that the design of individual studies included in the analysis varies greatly. The individual studies vary in things like dose, duration, type of subjects included in the study, and much more.

This is why this study rated most of their conclusions as backed by moderate- or low-quality evidence. [Note: The fact that the authors evaluated the quality of evidence is a strength of this study. Most meta-analyses just report their conclusions without telling you how strong the evidence behind those conclusions is.]

#2: Most clinical studies of supplements (including those included in this meta-analysis) have two significant weaknesses.

  • Most studies do not measure the nutritional status of their subjects prior to adding the supplement. If their nutritional status for a particular nutrient was already optimal, there is no reason to expect more of that nutrient to provide any benefit.
  • Most studies measure the effect of a supplement on a cross-section of the population without asking who would be most likely to benefit.

You would almost never design a clinical study that way if you were evaluating the effectiveness of a potential drug. So, why would you design clinical studies of supplements that way?

With these considerations in mind, let me provide some perspective on the conclusions of this study.

Coenzyme Q10:

This meta-analysis found that coenzyme Q10 significantly reduced all-cause mortality in patients with heart failure. This is consistent with multiple clinical studies and a recent Cochrane Collaboration review.

Does coenzyme Q10 have any heart health benefits for people without congestive heart failure? There is no direct evidence that it does, but let me offer an analogy with statin drugs.

Statin drugs are very effective at reducing heart attacks in high-risk patients. But they have no detectable effect on heart attacks in low-risk patients. However, this has not stopped the medical profession from recommending statins for millions of low-risk patients. The rationale is that if they are so clearly beneficial in high-risk patients, they are “probably” beneficial in low-risk patients.

I would argue a similar rationale should apply to supplements like coenzyme Q10.

Omega-3s:

This study found that omega-3 reduced both heart attacks and the risk of dying from heart disease. Most previous meta-analyses of omega-3s and heart disease have come to the same conclusion. However, some meta-analyses have failed to find any heart health benefits of omega-3s. Unfortunately, this has allowed both proponents and opponents of omega-3 use for heart health to quote studies supporting their viewpoint.

However, there is one meta-analysis that stands out from all the others. A group of 17 scientists from across the globe collaborated in developing a “best practices” experimental design protocol for assessing the effect of omega-3 supplementation on heart health. They conducted their clinical studies independently, and when their data (from 42,000 subjects) were pooled, the results showed that omega-3 supplementation decreased:

  • Premature death from all causes by 16%.
  • Premature death from heart disease by 19%.
  • Premature death from cancer by 15%.
  • Premature death from causes other than heart disease and cancer by 18%.

This study eliminates the limitations of previous meta-analyses. That makes it much stronger than the other meta-analyses. And these results are consistent with the current meta-analysis.

Omega-3s have long been recognized as essential nutrients. It is past time to set Daily Value (DV) recommendations for omega-3s. Based on the recommendations of other experts in the field, I think the DV should be set at 500-1,000 mg/day. I take more than that, but this would represent a good minimum recommendation for heart health.

folic acidFolic acid:

As with omega-3s, this meta-analysis reported a positive effect of folic acid on heart health. But many other studies have come up empty. Why is that?

It may be because, between food fortification and multivitamin use, many Americans already have sufficient blood levels of folic acid. For example, one study reported that 70% of the subjects in their study had optimal levels of folates in their blood. And that study also reported:

  • Subjects with adequate levels of folates in their blood received no additional benefit from folic acid supplementation.
  • However, for subjects with inadequate blood folate levels, folic acid supplementation decreased their risk of heart disease by ~15%.

We see this pattern over and over in supplement studies. Supplement opponents interpret these studies as showing that supplements are worthless. But a better interpretation is that supplements benefit those who need them.

The problem is that we don’t know our blood levels of essential nutrients. We don’t know which nutrients we need, and which we don’t. That’s why I like to think of supplements as “insurance” against the effects of an imperfect diet.

Vitamins E and D:

The situation with vitamins E and D is similar. This meta-analysis found no heart health benefit of either vitamin E or D. That is because the clinical studies included in the meta-analysis asked whether vitamin E or vitamin D improved heart health for everyone in the study.

Previous studies focusing on patients with low blood levels of these nutrients and/or at high risk of heart disease have shown some benefits of both vitamins at reducing heart disease risk.

So, for folic acid, vitamin E, and vitamin D (and possibly vitamin C) the take-home message should be:

  • Ignore all the Dr. Strangeloves telling you that these vitamins are “magic bullets” that will dramatically reduce your risk of heart disease.
  • Ignore the naysayers who tell you they are worthless.
  • Use supplementation wisely to make sure you have the recommended intake of these and other essential nutrients.

β-carotene:

This meta-analysis reported that β-carotene increased the risk of heart disease. This is not a new finding. Multiple previous studies have come to the same conclusion.

And we know why this is. There are many naturally occurring carotenoids, and they each have unique heart health benefits. A high dose β-carotene supplement interferes with the absorption of the other carotenoids. You are creating a deficiency of other heart-healthy carotenoids.

If you are not getting lots of colorful fruits and vegetables from your diet, my recommendation is to choose a supplement with all the naturally occurring carotenoids in balance – not a pure β-carotene supplement.

The Bottom Line 

The Dr. Strangeloves in the nutrition space all have their favorite heart health supplements. They claim their supplements will single-handedly abolish heart disease (and help you leap tall buildings in a single bound).

On the other hand, many doctors will tell you these supplements are a waste of money. They don’t work. They just drain your wallet.

It’s so confusing. Who should you believe? Fortunately, a recent study has separated the hype from the hope and tells us which “heart-healthy” supplements work, and which don’t.

This study was a meta-analysis of 884 clinical studies with 883,627 participants. It reported:

  • Omega-3 supplementation deceased risk of heart attacks by 15% and all cardiovascular deaths by 7%.
  • Folic acid supplementation decreased stroke risk by 16%.
  • Coenzyme Q10 supplementation decreased the risk of all-cause mortality in patients with heart failure by 32%.
  • Vitamin C, vitamin E, vitamin D did not appear to affect heart disease outcomes.
  • β-carotene increased the risk of stroke, CVD mortality, and all-cause mortality.

For more details 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.

What Is The Truth About Low Carb Diets?

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Why Is The Cochrane Collaboration The Gold Standard?

Author: Dr. Stephen Chaney 

low carb dietAtkins, South Beach, Whole30, Low Carb, high Fat, Low Carb Paleo, and Keto. Low carb diets come in many forms. But they have these general characteristics:

  • They restrict carbohydrate intake to <40% of calories.
  • They restrict grains, cereals, legumes, and other carbohydrate foods such as dairy, fruits, and some vegetables.
  • They replace these foods with foods higher in fat and protein such as meats, eggs, cheese, butter, cream, and oils.
  • When recommended for weight loss, they generally restrict calories.

What about the science? Dr. Strangelove and his friends tell you that low carb diets are better for weight loss, blood sugar control, and are more heart healthy than other diets. But these claims are controversial.

Why is that? I have discussed this in previous issues of “Health Tips From The Professor”. Here is the short version.

  • Most studies on the benefits of low carb diets compare them with the typical American diet.
    • The typical American diet is high in fat, sugar and refined flour, and highly processed foods. Anything is better than the typical American diet.
  • Most low carb diets are whole food diets.
    • Any time you replace sodas and highly processed foods with whole foods you will lose weight and improve your health.
  • Most low carb diets are highly structured. There are rules for which foods to avoid, which foods to eat, and often additional rules to follow.
    • Any highly structured diet causes you to focus on what you eat. When you do that, you lose weight. When you lose weight, your health parameters improve.
    • As I have noted before, short term weight loss and improvement in health parameters are virtually identical for the very low carb keto diet and the very low-fat vegan diet.

With all this uncertainty you are probably wondering, “What is the truth about low carb diets?”

A recent study by the Cochrane Collaboration (CE Naude et al, Cochrane Database of Systematic Reviews, 28 January 2022) was designed to answer this question.

The Cochrane Collaboration is considered the gold standard of evidence-based medicine. To help you understand why this is, I will repeat a summary of how the Cochrane Collaboration approaches clinical studies that I shared two weeks ago.

Why Is The Cochrane Collaboration The Gold Standard?

ghost bustersWho you gonna call? It’s not Ghostbusters. It’s not Dr. Strangelove’s health blog. It’s a group called the Cochrane Collaboration.

The Cochrane Collaboration consists of 30,000 volunteer scientific experts from across the globe whose sole mission is to analyze the scientific literature and publish reviews of health claims so that health professionals, patients, and policy makers can make evidence-based choices about health interventions.

In one sense, Cochrane reviews are what is called a “meta-analysis”, in which data from numerous studies are grouped together so that a statistically significant conclusion can be reached. However, Cochrane Collaboration reviews differ from most meta-analyses found in the scientific literature in a very significant way.

Many published meta-analyses simply report “statistically significant” conclusions. However, statistics can be misleading. As Mark Twain said: “There are lies. There are damn lies. And then there are statistics”.

The Cochrane Collaboration also reports statistically significant conclusions from their meta-analyses. However, they carefully consider the quality of each individual study in their analysis. They look at possible sources of bias. They look at the design and size of the studies. Finally, they ask whether the conclusions are consistent from one study to the next. They clearly define the quality of evidence that backs up each of their conclusions as follows:

  • High-quality evidence. Further research is unlikely to change their conclusion. This is generally reserved for conclusions backed by multiple high-quality studies that have all come to the same conclusion. These are the recommendations that are most often adopted into medical practice.
  • Moderate-quality evidence. This conclusion is very likely to be true, but further research could have an impact on it.
  • Low-quality evidence. Further research is needed and could alter the conclusion. They are not judging whether the conclusion is true or false. They are simply saying more research is needed to reach a definite conclusion.

This is why their reviews are considered the gold standard of evidence-based medicine. If you are of a certain age, you may remember that TV commercial “When EF Hutton talks, people listen.” It is the same with the Cochrane Collaboration. When they talk, health professionals listen.

How Was The Study Done?

Clinical StudyThe authors of this Cochrane Collaboration Report included 61 published clinical trials that randomized participants into two groups.

  • The first group was put on a low carbohydrate diet (carbohydrates = <40% of calories).
  • The second group was put on a “normal carbohydrate” diet (carbohydrates = 45-65% of calories, as recommended by the USDA and most health authorities).
    • The normal carbohydrate diet was matched with the low carbohydrate diet in terms of caloric restriction.
    • Both diets were designed by dietitians and were generally whole food diets.

The participants in these studies:

  • Were middle-aged.
  • Were overweight or obese.
  • Did not have diagnosed heart disease or cancer.
  • May have diagnosed type-2 diabetes. Some studies selected participants that had diagnosed type 2 diabetes. Other studies excluded those patients.

The studies were of 3 types:

  • Short-term: Participants in these studies followed their assigned diets for 3 to <12 months.
  • Long-term: Participants in these studies followed their assigned diets for >12 to 24 months.
  • Short-term with maintenance: Participants in these studies followed their assigned diets for 3 months followed by a 9-month maintenance phase.

What Is The Truth About Low Carb Diets?

The TruthAll the studies included in the Cochrane Collaboration’s meta-analysis randomly assigned overweight participants to a low carbohydrate diet (carbohydrates = <40% of calories) or to a “normal carbohydrate” diet (carbohydrates = 45-65% of calories) with the same degree of caloric restriction.

If low carb diets have any benefit in terms of weight loss, improving blood sugar control, or reducing heart disease risk, these are the kind of studies that are required to validate that claim.

This is what the Cochrane Collaboration’s meta-analysis showed.

When they analyzed studies done with overweight participants without type 2 diabetes:

  • Weight loss was not significantly different between low carb and normal carb diets in short-term studies (3 to <12 months), long-term studies (>12 to 24 months), and short-term studies followed by a 9-month maintenance period.
  • There was also no significant difference in the effect of low carb and normal carb diets on the reduction in diastolic blood pressure and LDL cholesterol.

Since diabetics have trouble controlling blood sugar, you might expect that type 2 diabetics would respond better to low carb diets. However, when they analyzed studies done with overweight participants who had type 2 diabetes:

  • Weight loss was also not significantly different on low carb and normal carb diets.
  • There was no significant difference in the effect of low carb and normal carb diets on the reduction in diastolic blood pressure, LDL cholesterol, and hemoglobin A1c, a measure of blood sugar control.

Of course, the reason Cochrane Collaboration analyses are so valuable is they also analyze the strength of the studies that were included in their analysis.

You may remember in my article two weeks ago, I reported on the Cochrane Collaboration’s report supporting the claim that omega-3 supplementation reduces pre-term births. In that report they said that the studies included in their analysis were high quality. Therefore, they said their report was definitive and no more studies were needed.

This analysis was different. The authors of this Cochrane Collaboration report said that the published studies on this topic were of moderate quality. This means their conclusion is very likely to be true, but further research could have an impact on it.

What Does This Study Mean For You?

confusionIf you are a bit confused by the preceding section, I understand. That was a lot of information to take in. Let me give you the Cliff Notes version.

In short, this Cochrane Collaboration Report concluded:

  • Low carb diets (<40% of calories from carbohydrates) are no better than diets with normal carbohydrate content (45-65% of calories from carbohydrates) with respect to weight loss, reduction in heart disease risk factors, and blood sugar control. Dr. Strangelove has been misleading you again.
  • This finding is equally true for people with and without type 2 diabetes. This calls into question the claim that people with type 2 diabetes will do better on a low carb diet.
  • The published studies on this topic were of moderate quality. This means their conclusion is very likely to be true, but further research could have an impact on it.

If you are thinking this study can’t be true because low carb diets work for you, that is because you are comparing low carb diets to your customary diet, probably the typical American diet.

  • Remember that any whole food diet that eliminates sodas and processed foods and restricts the foods you eat will cause you to lose weight. Whole food keto and vegan diets work equally well short-term compared to the typical American diet.
  • And any diet that allows you to lose weight improves heart health parameters and blood sugar control.

If you are thinking about the blogs, books, and videos you have seen extolling the virtues of low carb diets, remember that the Dr. Strangeloves of the world only select studies comparing low carb diets to the typical American diet to support their claims.

  • The studies included in this Cochrane Collaboration report randomly assigned participants to the low carb and normal carb diets and followed them for 3 to 24 months.
    • Both diets were whole food diets designed by dietitians.
    • Both diets reduced caloric intake to the same extent.

What about the claims that low carb diets are better for your long-term health? There are very few studies on that topic. Here are two:

  • At the 6.4-year mark a recent study reported that the group with the lowest carbohydrate intake had an increased risk of premature death – 32% for overall mortality, 50% for cardiovascular mortality, 51% for cerebrovascular mortality, and 36% for cancer mortality. I will analyze this study in a future issue of “Health Tips From The Professor”.
  • At the 20-year mark a series of studies reported that:
    • Women consuming a meat-based low carb diet for 20 years gained just as much weight and had just as high risk of heart disease and diabetes as women consuming a high carbohydrate, low fat diet.
    • However, women consuming a plant-based low carb diet for 20 years gained less weight and had reduced risk of developing heart disease and diabetes as women consuming a high carbohydrate, low fat diet.

My recommendation is to avoid low-carb diets. They have no short-term benefits when compared to a healthy diet that does not eliminate food groups. And they may be bad for you in the long run. Your best bet is a whole food diet that includes all food groups but eliminates sodas, sweets, and processed foods.

However, if you are committed to a low carb diet, my recommendation is to choose the low-carb version of the Mediterranean diet. It is likely to be healthy long term.

The Bottom Line 

The Cochrane Collaboration, the gold standard of evidence-based medicine, recently issued a report that evaluated the claims made for low carb diets.

All the studies analyzed in the Cochrane Collaboration’s report randomly assigned overweight participants to a low carbohydrate diet (carbohydrates = <40% of calories) or to a “normal carbohydrate” diet (carbohydrates = 45-65% of calories) with the same degree of caloric restriction.

If low carb diets have any benefit in terms of weight loss, improving blood sugar control, or reducing heart disease risk, these are the kind of studies that are required to validate that claim.

The Cochrane Collaboration Report concluded:

  • Low carb diets (<40% of calories from carbohydrates) are no better than diets with normal carbohydrate content (45-65% of calories from carbohydrates) with respect to weight loss, reduction in heart disease risk factors, and blood sugar control.
  • This is equally true for people with and without type 2 diabetes.
  • The published studies on this topic were of moderate quality. This means their conclusion is very likely to be true, but further research could have an impact on it.

My recommendation is to avoid low carb diets. They have no short-term benefits when compared to a healthy diet that does not eliminate food groups. And they may be bad for you in the long run. Your best bet is a whole food diet that includes all food groups but eliminates sodas, sweets, and processed foods.

However, if you are committed to a low carb diet, my recommendation is to choose the low carb version of the Mediterranean diet. It is likely to be healthy long term.

For more details on the 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.

Eating Of The Green

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Why Is Eating Green Good For Your Heart? 

Author: Dr. Stephen Chaney

You may be one of the millions of Americans who celebrated St. Patrick’s Day a couple of weeks ago. If so, you may have sung the famous Irish folk song “The Wearing of the Green”. If you are Irish, that song has special meaning for you. However, when I hear that song, I think of “Eating of the Green.”

And when I think of eating green, I don’t mean that everything we eat should be green. I am thinking of whole fruits and vegetables in a variety of colors. We have known for years that fruits and vegetables are good for our health. Consumption of fruits and vegetables is associated a lower risk of high blood pressure, heart disease, cancer, inflammatory diseases, and much more.

For today’s health tip, I am going to focus on heart health and an unexpected explanation for how fruits and vegetables reduce our risk of heart disease.

Why Is Eating Green Good For Your Heart?

health benefits of beetroot juiceWe have assumed that whole fruits and vegetables lower our risk of heart disease because they are low in saturated fats and provide heart-healthy nutrients, phytonutrients, and fiber. All of that is true. But could there be more?

Recent research has suggested that the nitrates found naturally in fruits and vegetables may also play a role in protecting our hearts. Here is what recent research shows:

  • The nitrates from fruits and vegetables are converted to nitrite by bacteria in our mouth and intestines.
    • Fruits and vegetables account for 80% of the nitrate in our diet. The rest comes from a variety of sources including the nitrate added as a preservative to processed meats.
    • Although all fruits and vegetables contain nitrates, the best sources are green leafy vegetables and beetroot. [Beet greens are delicious and also a good source of nitrate, but beetroot is the part of the beet we usually consume.]
  • Nitrite is absorbed from our intestine and converted to nitric oxide by a variety of enzymes in our tissues.
  • Both reactions require antioxidants like vitamin C, which are also found in fruits and vegetables.

Nitric oxide has several heart healthy benefits. For example:

  • It helps reduce inflammation in the lining of blood vessels. Inflammation stimulates atherosclerosis, blood clot formation, and is associated with an increased risk of heart disease.
  • It relaxes the smooth muscle cells that surround our blood vessels. This makes the blood vessels more flexible and helps reduce blood pressure.
  • It prevents smooth muscle cells from proliferating, which prevents them from invading and constricting our arteries. This, in turn, has the potential to reduce the risk of atherosclerosis.
  • It prevents platelet aggregation. This, in turn, has the potential to reduce the risk of heart attack and stroke due to blood clots that block the flow of blood to our heart or brain.

It is well established that nitrates from fruits and vegetables reduce blood pressure. More importantly, they can help slow the gradual increase in blood pressure as we age.

However, few studies have asked whether this reduction in blood pressure translates into improved cardiovascular outcomes. This study (CP Bondonno et al, European Journal of Epidemiology, 36: 813-825, 2021) was designed to answer that question.

How Was This Study Done?

Clinical StudyThis study made use of data from the Danish Diet, Cancer, and Health Program. That program enrolled 53,150 participants from Copenhagen and Aarhus between 1993 and 1997 and followed them for an average of 21 years. None of the participants had a diagnosis of cancer or heart disease at the beginning of the study.

Other characteristics of the participants at the time they were enrolled in the study were:

  • 46% male
  • Average age = 56
  • BMI = 26 (>20% overweight)
  • Average systolic blood pressure = 140 mg Hg
  • Average diastolic blood pressure = 84 mg Hg

At the beginning of the study, participants filled out a 192-item food frequency questionnaire that assessed their average intake of various food and beverage items over the previous 12 months. The vegetable nitrate content of their diets was analyzed using a comprehensive database of the nitrate content of 178 vegetables. For those vegetables not consumed raw, the nitrate content was reduced by 50% to account for the nitrate loss during cooking.

Blood pressure was measured at the beginning of the study. Data on the incidence (first diagnosis) of heart disease during the study was obtained from the Danish National Patient Registry. Data were collected on diagnosis of the following heart health parameters:

  • Cardiovascular disease (all diseases of the circulatory system).
  • Ischemic heart disease (lack of sufficient blood flow to the heart). The symptoms of ischemic heart disease range from angina to myocardial infarction (heart attack).
  • Ischemic stroke (lack of sufficient blood flow to the brain).
  • Hemorrhagic stroke (bleeding in brain).
  • Heart failure.
  • Peripheral artery disease (lack of sufficient blood flow to the extremities).

Is Nitrate From Vegetables Good For Your Heart?

strong heartIntake of nitrate from vegetables ranged from 18 mg/day (<1/3 serving of nitrate-rich vegetables per day) to 168 mg (almost 3 servings of nitrate-rich vegetables per day). The participants were grouped into quintiles based on their vegetable nitrate intake. When the group with the highest vegetable nitrate intake was compared to the group with the lowest vegetable nitrate intake:

  • Systolic blood pressure was reduced by 2.58 mg Hg.
  • Diastolic blood pressure was reduced by 1.38 mg Hg.
  • Risk of cardiovascular disease was reduced by 14%.
  • Risk of ischemic heart disease (angina and heart attack) was reduced by 13%.
  • Risk of ischemic stroke (stroke caused by lack of blood flow to the brain) was reduced by 14%.
  • Risk of heart failure was reduced by 17%.
  • Risk of peripheral artery disease was reduced by 31%.
  • Risk of hemorrhagic stroke (bleeding in the brain) was not significantly reduced.

Two other observations were of interest:

  • Blood pressure and risk of peripheral artery disease decreased with increasing vegetable nitrate intake in a relatively linear fashion. However, the other parameters of heart disease plateaued at a modest intake of vegetable nitrate intake (around one cup of nitrate-rich vegetables per day). This suggests that as little as one serving of nitrate-rich vegetables a day is enough to provide some heart health benefits.
  • Only about 21.9% of the improvement in heart health could be explained by the decrease in blood pressure. This is not surprising when you consider the other beneficial effects of nitric oxide described above.

The authors concluded, “Consumption of at least ~60 mg/day of vegetable nitrate (~ one serving of green leafy vegetables or beets) may mitigate risk of cardiovascular disease.”

Are Nitrates Good For You Or Bad For You?

questionsYou are probably thinking, “Wait a minute. I thought nitrates and nitrites were supposed to be bad for me. Which is it? Are nitrates good for me or bad for me?”

It turns out that nitrates and nitrites are kind of like Dr. Jekyll and Mr. Hyde. They can be either good or bad. It depends on the food they are in and your overall diet.

Remember the beginning of this article when I said that the conversion of nitrates to nitric oxide depended on the presence of antioxidants? Vegetables are great sources of antioxidants. So, when we get our nitrate from vegetables, most of it is converted to nitric oxide. And, as I discussed above, nitric oxide is good for us.

However, when nitrates and nitrites are added to processed meats as a preservative, the story is much different. Processed meats have zero antioxidants. And the protein in the meats is broken down to amino acids in our intestine. The amino acids combine with nitrate to form nitrosamines, which are cancer-causing chemicals. Nitrosamines are bad for us.

Of course, we don’t eat individual foods by themselves. We eat them in the context of a meal. If you eat small amounts of nitrate-preserved processed meats in the context of a meal with antioxidant-rich fruits and vegetables, some of the nitrate will be converted to nitric oxide rather than nitrosamines. The processed meat won’t be as bad for you.

Eating Of The Green

spinachYour mother was right. You should eat your fruits and vegetables!

  • The USDA recommends at least 3 servings of vegetables and 2 servings of fruit a day.
  • Based on this study, at least one of those servings should be nitrate-rich vegetables like green leafy vegetables and beets.
  • If you don’t like any of those, radishes, turnips, watercress, Bok choy, Chinese cabbage, kohlrabi, chicory leaf, onion, and fresh garlic are also excellent sources of nitrate.
  • The good news is that you may not need to eat green leafy vegetables and beets with every meal. If this study is correct, one serving per day may have heart health benefits. That means you can enjoy a wide variety of fresh fruits and vegetables as you try to meet the USDA recommendations.

Finally, if you don’t like any of those foods, you may be asking, “Can’t I just take a nitrate supplement?”

  • For blood pressure, there are dozens of clinical trials, and the answer seems to be yes – especially when the nitrate comes from vegetable sources and the supplement also contains an antioxidant like vitamin C.
  • For heart health benefits, the answer is likely to be yes, but clinical trials to confirm that would take decades. Double blind, placebo-controlled trials of that duration are not feasible, so we will never know for sure.
  • Moreover, you would not be getting all the other health benefits of a diet full of fresh fruits and vegetables. Supplementation has its benefits, but it is not meant to replace a healthy diet.

The Bottom Line

We have known for years that fruits and vegetables are good for our hearts. We have assumed that was because whole fruits and vegetables are low in saturated fats and provide heart-healthy nutrients, phytonutrients, and fiber. But could there be more?

It is well established that nitrates from fruits and vegetables reduce blood pressure. More importantly, they can help slow the gradual increase in blood pressure as we age.

However, few studies have asked whether this reduction in blood pressure translates into improved cardiovascular outcomes. A recent study was designed to answer that question.

When the study compared people with the highest vegetable nitrate intake to people with the lowest vegetable nitrate intake:

  • Blood pressure was significantly reduced.
  • The risk of cardiovascular disease was reduced by 14%.
  • Risk of ischemic heart disease (angina and heart attack) was reduced by 13%.
  • Risk of ischemic stroke (stroke caused by lack of blood flow to the brain) was reduced by 14%.
  • Risk of heart failure was reduced by 17%.
  • Risk of peripheral artery disease was reduced by 31%.
  • Blood pressure and risk of peripheral artery disease decreased with increasing vegetable nitrate intake in a relatively linear fashion.
  • However, the other parameters of heart disease plateaued at a modest intake of vegetable nitrate intake (around one cup of nitrate-rich vegetables per day). This suggests that as little as one serving of nitrate-rich vegetables a day is enough to provide some heart health benefits.

The authors concluded, “Consumption of at least ~60 mg/day of vegetable nitrate (~ one serving of green leafy vegetables or beets) may mitigate risk of cardiovascular disease.”

Of course, you may have heard that nitrates and nitrites are bad for you. I discuss that in the article above.

For more details about 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.

Which Diets Are Best In 2022?

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Which Diet Should You Choose?

Author: Dr. Stephen Chaney

Emoticon-BadMany of you started 2022 with goals of losing weight and/or improving your health. In many cases, that involved choosing a new diet. That was only a month 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 2022”. For the full report, click on this link.

How Was This Report Created?

Expert PanelUS News & World Report recruited panel of 27 nationally recognized experts in diet, nutrition, obesity, food psychology, diabetes, and heart disease to review the 40 most popular diets.  The panel is 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 nine sets of Best Diets rankings:

  • Best Diets Overall combines panelists’ ratings in all seven categories. However, all categories were not equally weighted. Short-term and long-term weight loss were combined, with long-term ratings getting twice the weight. Why? A diet’s true test is whether it can be sustained for years. And safety was double counted because no diet should be dangerous.
  • Best Commercial Diets uses the same approach to rank 15 structured diet programs that require a participation fee or promote the use of branded food or nutritional products.
  • Best Weight-Loss Diets was generated by combining short-term and long-term weight-loss ratings, weighting both equally. Some dieters want to drop pounds fast, while others, looking years ahead, are aiming for slow and steady. Equal weighting accepts both goals as worthy.
  • Best Diabetes Diets is based on averaged diabetes ratings.
  • Best Heart-Healthy Diets uses averaged heart-health ratings.
  • 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 judgments about each diet’s taste appeal, ease of initial adjustment, ability to keep dieters from feeling hungry and imposition of special requirements.
  • Best Plant-Based Diets uses the same approach as Best Diets Overall to rank 12 plans that emphasize minimally processed foods from plants.
  • Best Fast Weight-Loss Diets is based on short-term weight-loss ratings.

Which Diets Are Best In 2022?

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 5 and bottom 5 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.]

Best Diets Overall 

The Top 5: 

#1: Mediterranean Diet. The Mediterranean diet has been ranked #1 for 5 consecutive years.

#2: 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.)

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

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

#5: The TLC Diet (This diet was designed by the NIH to promote heart health.)

The Bottom 5: 

#36: Whole 30 Diet (A whole food, restrictive diet, designed for a 30-day jump start to weight loss. It was not designed for long-term use).

#37: Modified Keto Diet (A slightly less restrictive version of the Keto Diet).

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

#39: Dukan Diet (High protein, low carb, low fat diet).

#40: GAPS Diet (A diet designed to improve gut health).

Best Weight-Loss Diets

The Top 5: Weight Loss

#1: Flexitarian Diet

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

#3: Vegan Diet (A diet that only allows plant foods).

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

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

The Bottom 5: 

#36: Fertility Diet (A diet designed to improve fertility, but the experts were skeptical that it would increase your chances of becoming pregnant)

#37: Whole 30 Diet

#38: Alkaline Diet (A diet designed to make your blood more alkaline, but the experts were skeptical about that claim)

#39: AIP Diet (A diet designed for people with autoimmune diseases)

#40: GAPS Diet

Best Diabetes Diets

The Top 5: 

#1: Mediterranean Diet

#2: Flexitarian Diet

#3: Vegan Diet

#4: Mayo Clinic Diet

#5: DASH Diet

The Bottom 5: 

#36: Alkaline Diet

#37: Dukan Diet

#38: GAPS Diet

#39: Sirtfood Diet (a very low calorie, fad diet that emphasizes plant foods rich in sirtuins)

#40: Whole 30 Diet

Best Heart-Healthy Diets 

strong heartThe Top 5: 

#1: Mediterranean Diet

#2: Ornish Diet

#3: DASH Diet

#4: Flexitarian Diet

#5: TLC Diet

#6: Vegan Diet

The Bottom 5: 

#36: Keto Diet

#37: AIP Diet

#38: Whole 30 Diet

#39: Modified Keto Diet

#40: Dukan Diet

Best Diets for Healthy Eating

The Top 5: 

#1: Mediterranean Diet

#2: DASH Diet

#3: Flexitarian Diet

#4: MIND Diet

#5: TLC Diet

The Bottom 5: 

#36: Raw Food Diet

#37: Atkins Diet

#38: Dukan Diet

#39: Modified Keto Diet

#40: Keto Diet 

Easiest Diets to Follow

The Top 5: Easy

#1: Mediterranean Diet

#2: Flexitarian Diet

#3: Fertility Diet

#4: MIND Diet

#5: DASH Diet

The Bottom 5: 

#36: Modified Keto Diet

#37: Keto Diet

#38: Whole 30 Diet

#39: GAPS Diet

#40: Raw Foods Diet 

Best Fast Weight-Loss Diets

The Top 5 (Excluding Commercial Diets): 

#1: Atkins Diet

#2: Biggest Loser Diet

#3: Keto Diet

#4: Raw Food Diet

#5: Vegan Diet

The Bottom 5 

#36: Dr. Weil’s Anti-Inflammatory Diet

#37: The Fertility Diet

#38: AIP Diet

#39: Alkaline Diet

#40: Gaps Diet

Which Diets Are Best For Rapid Weight Loss?

Happy woman on scaleThere are 3 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. The top 5 diets are very different. For example, the keto and vegan diets are polar opposites, yet they both are in the top 5 for rapid weight loss.

  • The Atkins and keto diets are meat heavy, low carb diets. They restrict fruits, some vegetables, grains, and most legumes.
  • The Biggest Loser diet relies on restrictive meal plan and exercise programs.
  • The restrictions of the raw food diet are obvious.
  • The vegan diet is a very low-fat diet that eliminates meat, dairy, eggs, and animal fats.
  • I did not include commercial diets that rated high on this list, but they are all restrictive in one way or another.

2) We should ask what happens when we get tired of restrictive diets and add back some of your favorite foods.

  • If you lose weight on a vegan diet and add back some of your favorite foods, you might end up with a semi-vegetarian diet. This is a healthy diet that can help you maintain your weight loss.
  • If you lose weight on the Atkins or keto diets and add back some of your favorite foods, you end up with the typical American diet – one that is high in both fat and carbs. This is not a recipe for long-term success.

3) Don’t pay too much attention to the bottom 5 diets. None of them were designed with weight loss in mind.

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.

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.

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) In case you were wondering, intermittent fasting ranked 26-30 and the Paleo diet ranked 26-33 on most of the list – not the worst diets, but a long way from the best. If you have a favorite diet I didn’t mention, check the US News website to find where it is ranked.

6) 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.

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 2022”.

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

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

  • If you are looking for rapid weight loss, any whole food restrictive diet will do.
  • We should ask what happens when we get tired of restrictive diets and add back some of our favorite foods.
  • Long term weight loss is possible if you transition to a healthy diet after you have lost the weight.

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

  • Choose a diet that fits your needs.
  • Choose diets that are healthy and associated with long term weight loss.
  • Choose diets that are easy to follow.
  • Choose diets that fit your lifestyle and dietary preferences.
  • 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, 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.

Is It Too Late To Change Your Diet?

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You Can Improve Your Health At Any Age

Author: Dr. Stephen Chaney

Fast Food ExamplesIf you are like most Americans, your dietary preferences as an adult are based on the foods your family ate while you were growing up.

  • Your favorite foods…
  • Your comfort foods…
  • The foods you always avoid…

…are based on your family heritage, not on your genes. And if you are like most Americans, your diet isn’t healthy.

  • It’s high in fat and cholesterol…
  • It’s high in sugar and refined carbohydrates…
  • It’s high in processed foods…
  • It’s low in whole, unprocessed foods…
  • It’s high in calories, so your waistline keeps growing.

You know your diet isn’t healthy, but you keep coasting along through your 30’s and 40’s until…the unthinkable happens. You are diagnosed with a deadly disease, like heart disease, high blood pressure, or diabetes, and your doctor says that unless you change your diet, you are doomed to a short unhealthy life. You have reached a fork in Food Choicesthe road.

Changing the diet you grew up with, the diet you love, is a daunting task. It’s tempting to think, “Why bother…

  • It’s probably too late to change my diet…
  • The damage has already been done…
  • I can’t reverse it now.”

If this scenario describes you or someone you love, you aren’t alone. There are millions of Americans just like you. You want to know whether changing your diet is worth the trouble. You want to know whether it is too late, or whether you can still change your health for the better.

Most clinical studies don’t answer this question. Most clinical studies do a diet assessment at the beginning of the study and look at health outcomes 20 or 30 years later. If they do more than one diet assessment during the study, the purpose of these assessments is to show that most people stick to the same diet throughout the study.

These studies measure the effect of habitual diets on health outcomes. They tell you that good diets lead to good health outcomes, and bad diets lead to bad health outcomes. But they don’t tell you whether changing your diet from bad to good in your 30’s or 40’s can have a significant effect on your health.

Fortunately, a recent study has answered this question. This study (Y Choi et al, Journal of The American Heart Association, 10e020718, 2021) started with people in their mid-20s. It looked at whether changing their diet from bad to good in their 30s and 40s had any effect on their risk of developing heart disease in their 50s and 60s.

How Was This Study Done?

Clinical StudyThe data for this study were obtained from the CARDIA study (Coronary Artery Risk Development in Young Adults). The study enrolled 4946 young adults (average age = 25, 55% female and 45% male, 50% black and 50% white) and followed them for 32 years (average age of participants at the end of the study = 57).

Diet was assessed by a trained interviewer at year 0, year 7 (average age of participants = 32), and year 20 (average age of participants = 45).

Adherence of the participants to a healthy, plant-centered diet was assessed using an analytical tool called APDQS that divided the foods eaten by the participants into 3 groups based on their known influence on heart disease:

1) Beneficial.

    • These foods included fruit, avocado, beans/legumes, green vegetables, yellow vegetables, tomatoes, other vegetables, nuts and seeds, soy products, whole grains, vegetable oil, fatty fish, lean fish, poultry, moderate alcohol, coffee, tea, and low-fat milk/cheese/yogurt.
    • This is what the investigators considered a plant-centered diet. It encompasses diets ranging from vegan to Mediterranean and DASH.

2) Adverse.

    • These foods included fried potatoes, refined grain desserts, salty snacks, pastries, sweets, high-fat red meats, processed meats, organ meats, fried fish/poultry, sauces, soft drinks, whole fat milk/cheese/yogurt, and butter.
    • This could be considered a typical American diet.

3) Neutral.

    • These foods included potatoes, refined grains, margarine, chocolate, meal replacements, pickled foods, lean meats, shellfish, eggs, soups, and fruit juices.
    • These foods are not the healthiest, but the evidence that they have a negative effect on health disease risk is inconclusive.

The participants were divided into 5 quintiles based on adherence to a plant-centered diet, with quintile 1 having the lowest adherence and quintile 5 having the highest adherence to a plant-centered diet.

The effect of diet on heart disease was measured in two ways:

1) The dietary data from years 0, 7 and 20 were averaged and the effect of average adherence to a plant-centered diet on the risk of developing heart disease by the time the participants were 57 was measured. This is similar to the design of most other studies looking at the effect of diet and heart disease.

2) The effect of an improvement in adherence to a plant-centered diet between ages of 32 and 45 on the risk of developing heart disease by age 57 was also measured. This is what makes this study unique. Basically, the investigators were asking if you could eat a bad diet for 30 years or more and still reduce your risk of heart disease by switching to a good diet by the age of 45. That is the question that millions of American are asking themselves right now.

Is It Too Late To Change Your Diet?

Heart Healthy DietAs I described above this study asked two distinct questions:

1) What effect does your habitual diet have on your risk of developing heart disease?

For this portion of the study, the investigators averaged the dietary data collected in years 0, 7, and 20 of the study and ranked the participants diet from 1 to 5 based on their adherence to a plant-centered diet. When they compared the group with best adherence (group 5) with the group with worst adherence (group 1):

    • Adherence to a plant-centered diet reduced their risk of developing heart disease by 48%.
    • This is consistent with previous studies looking at the beneficial effects of plant-centered diets on heart disease.

2) What effect does changing your diet from bad to good when you are in your 30s or 40s have on your risk of developing heart disease? 

For this portion of the study, the investigators compared the dietary data collected at years 7 and 20 (corresponding to average ages 32 and 45 for the participants) and ranked the participants from 1 to 5 based on improved adherence to a plant-centered diet. When they compared the group with best improvement in adherence (group 5) with the group with worst improvement in adherence (group 1):

    • Improved adherence to a plant-centered diet reduced the risk of developing heart disease by 39%.
    • This answers the questions I posed at the beginning of this article. In short, it is never too late to change your diet for the better.

The authors concluded, “In summary, our study shows that long-term consumption of a nutritionally rich plant-centered diet is associated with a lower risk of heart disease. Furthermore, increased [adherence to a] plant-centered diet in young adulthood is associated with a lower subsequent risk of heart disease throughout middle age, independent of the earlier diet quality” [In short, they are saying that changing to a more plant-centered diet in your 30s and 40s reduces your risk of heart disease.]

You Can Improve Your Health At Any Age

I titled this section, “You Can Improve Your Health At Any Age” for a reason. I wanted to make the point that it is never too late to change your diet, and your health, for the better.

Yes, I realize that the study I described above only shows:

  • The effect of changing to a more plant-centered diet in your 30s and 40s.
  • The benefit of changing to a more plant-centered diet on heart disease outcomes.

However, we have ample evidence that changing to a more plant-based diet at any age is likely to reduce the risk of many diseases. For example:

  • There are multiple reports in the literature of people in their 60s and 70s who had a health scare, changed to a more plant-centered diet, and dramatically improved their health.

While neither type of study can be considered definitive by itself, together they suggest it is never too late to change your diet for the better.

But what changes should you make? As I said above, anything from Vegan to Mediterranean or DASH fits the definition of a plant-centered diet (something I have previously referred to as a primarily plant-based diet).

You could choose the plant-centered diet that best fits your preferences and lifestyle and read books or go online to find details and recipes that will help you transition to that diet…or you could simply:

  • Eat more fruit, avocado, beans/legumes, green vegetables, yellow vegetables, tomatoes, other vegetables, nuts and seeds, soy products, whole grains, vegetable oil, fatty fish, lean fish, poultry, moderate alcohol, coffee, tea, and low-fat milk/cheese/yogurt.
  • Eat less fried potatoes, refined grain desserts, salty snacks, pastries, sweets, high-fat red meats, processed meats, organ meats, fried fish/poultry, sauces, soft drinks, whole fat milk/cheese/yogurt, and butter.
  • Eat these foods in moderation: potatoes, refined grains, margarine, chocolate, meal replacements, pickled foods, lean meats, shellfish, eggs, soups, and fruit juices.

The Bottom Line

If you are like most Americans, you know your diet is unhealthy. But it is the diet you grew up with. It’s the diet you love. So, you keep eating it anyway.

Then you have a wake-up call. You find yourself in your doctor’s office, and your doctor is advising you to change your diet. But giving up the diet you love is difficult, and you wonder if it is worth it. Can you really improve your health significantly by changing your diet now, or is it too late? Has the damage already been done?

Fortunately, a recent study has answered these questions. This study started with people in their mid-20s. And it looked at whether changing their diet from bad to good in their 30s and 40s had any effect on their health in their 50s and 60s. This is what the study found.

  • Improved adherence to a plant-centered diet in their 30s and 40s reduced their risk of developing heart disease in their 50s and 60s by 39%.

While this study was very specific in terms of age and disease, I have discussed in the article above why changing to a more plant-based diet at any age is likely to reduce your risk of multiple diseases. In short, it is never too late to change your diet, and your health, for the better.

For more details about this study and how to change your diet for the better, 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.

Is Nitrate From Vegetables Good For Your Heart?

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Are Nitrates Good For You Or Bad For You? 

Author: Dr. Stephen Chaney

health benefits of beetroot juiceWe have known for years that fruits and vegetables are good for our hearts. We have assumed that was because whole fruits and vegetables are low in saturated fats and provide heart-healthy nutrients, phytonutrients, and fiber. But could there be more?

Recent research has suggested that the nitrates found naturally in fruits and vegetables may also play a role in protecting our hearts. Here is what recent research shows:

  • The nitrates from fruits and vegetables are converted to nitrite by bacteria in our mouth and intestines.
    • Fruits and vegetables account for 80% of the nitrate in our diet. The rest comes from a variety of sources including the nitrate added as a preservative to processed meats.
    • Although all fruits and vegetables contain nitrates, the best sources are green leafy vegetables and beetroot. [Beet greens are delicious and also a good source of nitrate, but beetroot is the part of the beet we usually consume.]
  • Nitrite is absorbed from our intestine and converted to nitric oxide by a variety of enzymes in our tissues.
  • Both reactions require antioxidants like vitamin C, which are also found in fruits and vegetables.

Nitric oxide has several heart healthy benefits. For example:

  • It helps reduce inflammation in the lining of blood vessels. Inflammation stimulates atherosclerosis, blood clot formation, and is associated with an increased risk of heart disease.
  • It relaxes the smooth muscle cells that surround our blood vessels. This makes the blood vessels more flexible and helps reduce blood pressure.
  • It prevents smooth muscle cells from proliferating, which prevents them from invading and constricting our arteries. This, in turn, has the potential to reduce the risk of atherosclerosis.
  • It prevents platelet aggregation. This, in turn, has the potential to reduce the risk of heart attack and stroke due to blood clots that block the flow of blood to our heart or brain.

It is well established that nitrates from fruits and vegetables reduce blood pressure. More importantly, they can help slow the gradual increase in blood pressure as we age.

However, few studies have asked whether this reduction in blood pressure translates into improved cardiovascular outcomes. This study (CP Bondonno et al, European Journal of Epidemiology, doi.org/10.1007/s10654-021-00747-3) was designed to answer that question.

How Was This Study Done?

Clinical StudyThis study made use of data from the Danish Diet, Cancer, and Health Program. That program enrolled 53,150 participants from Copenhagen and Aarhus between 1993 and 1997 and followed them for an average of 21 years. None of the participants had a diagnosis of cancer or heart disease at the beginning of the study.

Other characteristics of the participants at the time they were enrolled in the study were:

  • 46% male
  • Average age = 56
  • BMI = 26 (20% overweight)
  • Average systolic blood pressure = 140 mg Hg
  • Average diastolic blood pressure = 84 mg Hg

At the beginning of the study, participants filled out a 192-item food frequency questionnaire that assessed their average intake of various food and beverage items over the previous 12 months. The vegetable nitrate content of their diets was analyzed using a comprehensive database of the nitrate content of 178 vegetables. For those vegetables not consumed raw, the nitrate content was reduced by 50% to account for the nitrate loss during cooking.

Blood pressure was measured at the beginning of the study. Data on the incidence (first diagnosis) of heart disease during the study was obtained from the Danish National Patient Registry. Data were collected on diagnosis of the following heart health parameters:

  • Cardiovascular disease (all diseases of the circulatory system).
  • Ischemic heart disease (lack of sufficient blood flow to the heart). The symptoms of ischemic heart disease range from angina to myocardial infarction (heart attack).
  • Ischemic stroke (lack of sufficient blood flow to the brain).
  • Hemorrhagic stroke (bleeding in brain).
  • Heart failure.
  • Peripheral artery disease (lack of sufficient blood flow to the extremities).

Is Nitrate From Vegetables Good For Your Heart?

strong heartIntake of nitrate from vegetables ranged from 18 mg/day (<1/3 serving of nitrate-rich vegetables per day) to 168 mg (almost 3 servings of nitrate-rich vegetables per day). The participants were grouped into quintiles based on their vegetable nitrate intake. When the group with the highest vegetable nitrate intake was compared to the group with the lowest vegetable nitrate intake:

  • Systolic blood pressure was reduced by 2.58 mg Hg.
  • Diastolic blood pressure was reduced by 1.38 mg Hg.
  • Risk of cardiovascular disease was reduced by 14%.
  • Risk of ischemic heart disease (angina and heart attack) was reduced by 13%.
  • Risk of ischemic stroke (stroke caused by lack of blood flow to the brain) was reduced by 14%.
  • Risk of heart failure was reduced by 17%.
  • Risk of peripheral artery disease was reduced by 31%.
  • Risk of hemorrhagic stroke (bleeding in the brain) was not significantly reduced.

Two other observations were of interest:

  • Blood pressure and risk of peripheral artery disease decreased with increasing vegetable nitrate intake in a relatively linear fashion. However, the other parameters of heart disease plateaued at a modest intake of vegetable nitrate intake (around one cup of nitrate-rich vegetables per day). This suggests that as little as one serving of nitrate-rich vegetables a day is enough to provide some heart health benefits.
  • Only about 21.9% of the improvement in heart health could be explained by the decrease in blood pressure. This is not surprising when you consider the other beneficial effects of nitric oxide described above.

The authors concluded, “Consumption of at least ~60 mg/day of vegetable nitrate (~ one serving of green leafy vegetables or beets) may mitigate risk of cardiovascular disease.”

Are Nitrates Good For You Or Bad For You?

ConfusionYou are probably thinking, “Wait a minute. I thought nitrates and nitrites were supposed to be bad for me. Which is it? Are nitrates good for me or bad for me?”

It turns out that nitrates and nitrites are kind of like Dr. Jekyll and Mr. Hyde. They can be either good or bad. It depends on the food they are in and your overall diet.

Remember the beginning of this article when I said that the conversion of nitrates to nitric oxide depended on the presence of antioxidants? Vegetables are great sources of antioxidants. So, when we get our nitrate from vegetables, most of it is converted to nitric oxide. And, as I discussed above, nitric oxide is good for us.

However, when nitrates and nitrites are added to processed meats as a preservative, the story is much different. Processed meats have zero antioxidants. And the protein in the meats is broken down to amino acids in our intestine. The amino acids combine with nitrate to form nitrosamines, which are cancer-causing chemicals. Nitrosamines are bad for us.

Of course, we don’t eat individual foods by themselves. We eat them in the context of a meal. If you eat small amounts of nitrate-preserved processed meats in the context of a meal with antioxidant-rich fruits and vegetables, some of the nitrate will be converted to nitric oxide rather than nitrosamines. The processed meat won’t be as bad for you.

What Does This Study Mean For You?

spinachYour mother was right. You should eat your fruits and vegetables!

  • The USDA recommends at least 3 servings of vegetables and 2 servings of fruit a day.
  • Based on this study, at least one of those servings should be nitrate-rich vegetables like green leafy vegetables and beets.
  • If you don’t like any of those, radishes, turnips, watercress, Bok choy, Chinese cabbage, kohlrabi, chicory leaf, onion, and fresh garlic are also excellent sources of nitrate.
  • The good news is that you may not need to eat green leafy vegetables and beets with every meal. If this study is correct, one serving per day may have heart health benefits. That means you can enjoy a wide variety of fresh fruits and vegetables as you try to meet the USDA recommendations.

Finally, if you don’t like any of those foods, you may be asking, “Can’t I just take a nitrate supplement?”

  • For blood pressure, there are dozens of clinical trials, and the answer seems to be yes – especially when the nitrate comes from vegetable sources and the supplement also contains an antioxidant like vitamin C.
  • For heart health benefits, the answer is likely to be yes, but clinical trials to confirm that would take decades. Double blind, placebo-controlled trials of that duration are not feasible, so we will never know for sure.
  • Moreover, you would not be getting all the other health benefits of a diet full of fresh fruits and vegetables. Supplementation has its benefits, but it is not meant to replace a healthy diet.

The Bottom Line

We have known for years that fruits and vegetables are good for our hearts. We have assumed that was because whole fruits and vegetables are low in saturated fats and provide heart-healthy nutrients, phytonutrients, and fiber. But could there be more?

It is well established that nitrates from fruits and vegetables reduce blood pressure. More importantly, they can help slow the gradual increase in blood pressure as we age.

However, few studies have asked whether this reduction in blood pressure translates into improved cardiovascular outcomes. A recent study was designed to answer that question.

When the study compared people with the highest vegetable nitrate intake to people with the lowest vegetable nitrate intake:

  • Blood pressure was significantly reduced.
  • The risk of cardiovascular disease was reduced by 14%.
  • Risk of ischemic heart disease (angina and heart attack) was reduced by 13%.
  • Risk of ischemic stroke (stroke caused by lack of blood flow to the brain) was reduced by 14%.
  • Risk of heart failure was reduced by 17%.
  • Risk of peripheral artery disease was reduced by 31%.
  • Blood pressure and risk of peripheral artery disease decreased with increasing vegetable nitrate intake in a relatively linear fashion.
  • However, the other parameters of heart disease plateaued at a modest intake of vegetable nitrate intake (around one cup of nitrate-rich vegetables per day). This suggests that as little as one serving of nitrate-rich vegetables a day is enough to provide some heart health benefits.

The authors concluded, “Consumption of at least ~60 mg/day of vegetable nitrate (~ one serving of green leafy vegetables or beets) may mitigate risk of cardiovascular disease.”

Of course, you may have heard that nitrates and nitrites are bad for you. I discuss that in the article above.

For more details about this study, information about vegetable nitrate supplements, and what this study 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.

Which Diet Is Best For Your Heart?

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Why Are Dietary Studies So Confusing? 

Author: Dr. Stephen Chaney

heart diseaseYou are concerned about your heart.

  • Perhaps it is because of genetics. Everyone on one side of your family tree had their first heart attack in their mid-forties.
  • Perhaps it is because your doctor has warned you that your heart is a ticking time bomb. Unless you make some drastic changes, you will die of a heart attack in the near future.
  • Perhaps you already have some symptoms of heart disease, and you are scared.

You want to make some changes. You want to protect your heart. What should you do?

The short answer is that a holistic approach is best, and I will share the American Heart Association recommendations below. But let’s start by asking what you should eat. There are two important questions:

#1: Which diet is best for your heart?

  • A whole food vegan diet, the Mediterranean diet, and the DASH diet are all strong contenders for the best heart healthy diet.
  • But there are many other diets that claim to be heart healthy. Some enthusiasts even claim the Paleo and keto diets are heart healthy.
  • The problem is that few studies have compared these diets against each other. That makes it difficult to settle the question of which diet is best for your heart.

#2: Which protein source is best for your heart – plant protein, fish, poultry, or red meat?

  • Plant and fish protein are both strong contenders for the most heart healthy protein.
  • Poultry has the reputation of being more heart healthy than red meat. But this has become controversial. Some recent studies suggest poultry is no better than red meat in terms of heart health.

Fortunately, a recent study (F Petermann-Rocha et al, European Heart Journal, 42: 1136-1143, 2021) has made this comparison. It compared vegetarians, fish eaters, poultry eaters, and red meat eaters for the risk of developing heart disease.

How Was This Study Done?

Clinical StudyThis study made use of data from the UK Biobank program. The UK Biobank program recruited over 500,000 participants (ages 37-73) from England, Wales, and Scotland between 2006 and 2010 and followed them for an average of 8.5 years.

At entry into the program, each participant filled out a touchscreen questionnaire, had physical measurements taken, and provided biological samples.

Dietary intake was assessed based on the touchscreen questionnaire and the average of 5 24-hour dietary recalls. The participants were divided into four groups based on this dietary analysis:

  • Vegetarians (All participants in the study consumed cheese and eggs, so this group would more accurately be described as lacto-ovo-vegetarians).
  • Fish eaters.
  • Poultry eaters.
  • Red meat eaters.

Over the next ~8.5 years, each group was compared with respect to the following heart health parameters:

  • Risk of developing cardiovascular disease (all diseases of the circulatory system).
  • Risk of developing ischemic heart disease (lack of sufficient blood flow to the heart. The most common symptom of ischemic heart disease is angina).
  • Risk of having a myocardial infarction (commonly referred to as a heart attack).
  • Risk of having a stroke.
  • Risk of developing heart failure.

Which Diet Is Best For Your Heart?

The study compared vegetarians, fish eaters, and poultry eaters with red meat eaters with respect to each of the heart disease parameters listed above. The results were:

  • When fish eaters were compared with meat eaters, they had:
    • 7% lower risk of cardiovascular diseases of all types.
    • 21% lower risk of ischemic heart disease (angina).
    • 30% lower risk of myocardial infarction (heart attack).
    • 21% lower risk of stroke.
    • 22% lower risk of heart failure.
  • When vegetarians were compared with meat eaters, they had:
    • 9% lower risk of cardiovascular diseases of all types.
    • Lower, but statistically non-significant, risk of other heart disease parameters.
  • When poultry eaters were compared with meat eaters there were no significant differences in heart disease outcomes.

The authors concluded, “Eating fish rather than meat or poultry was associated with a lower risk of adverse cardiovascular outcomes…supporting its role as a healthy diet that should be encouraged. Vegetarianism was only associated with a lower risk of cardiovascular disease incidence.”

Why Are Dietary Studies So Confusing?

confusionSo, you are probably thinking, “Are diets with fish protein really more heart healthy than diets with plant protein?”

Fish have a lot going for them. They are an excellent source of heart healthy omega-3 fats. And, when substituted for red meat protein, they decrease intake of saturated fats.”

But plant protein has a lot going for it as well. Numerous studies have shown that vegetarian diets are more heart healthy than the typical American diet. And only plant-based diets have been shown to reverse atherosclerosis.

So, why are dietary studies so confusing? The problem is that diets are complex. They have many moving parts. When we focus on one aspect of a diet, we are ignoring the rest of the diet. The food we have focused on may be healthy. But if it is paired with unhealthy foods, the overall diet can still be unhealthy.

The current study is a perfect example of that principle:

  • The participants represented a cross section of the British population. All the “diets” were high in sugar, sugary drinks, saturated fat, and processed meals bought from the supermarket. None of them were optimal.
  • In addition to consuming cheese and eggs, “vegetarians” consumed more crisps, slices of pizza, and smoothie drinks than meat-eaters. [In case you were wondering, the English refer to small thin salty snacks like potato chips as crisps. They reserve the term chips for what we call French Fries.]
  • “Vegetarians” also consumed a lot of highly processed vegetarian alternatives designed to taste like other meat products.
  • On the other hand, fish eaters consumed more fruits and vegetables than meat-eaters. It wasn’t just the fish that made this diet more heart healthy.

In other words, the “vegetarian diet” in this study was not nearly as healthy as the whole food vegetarian diets that have previously been shown to be heart healthy. And the “fish-eaters diet” was healthier than the “meat-eaters diet” because of both the fish and the extra fruits and vegetables these people were consuming.

In the words of the authors, “…As a group, vegetarians consumed more unhealthy foods, such as crisps, than meat eaters. Therefore, vegetarians should not be considered a homogeneous group, and avoidance of meat will not be sufficient to reduce health risk if the overall diet is not healthy.”

My summary:

  • Whole food plant-based diets (the true definition of vegetarianism) are very heart healthy. [Note: The diet in this study was lacto-ovo-vegetarian rather than a true vegetarian diet. However, recent studies have suggested that addition of small amounts of dairy and eggs to a vegetarian diet may make them more heart healthy rather than less heart healthy.]
  • Primarily plant-based diets with fish as the main protein source (otherwise known as pescatarian diets) are also very heart healthy.
  • If you want a healthy heart, choose the one that best fits your preferences and your lifestyle.

A Holistic Approach: The American Heart Association Recommendations

Doctor With Patient

  • If you smoke, stop.
  • Choose good nutrition.
    • Choose a diet that emphasizes vegetables, fruits, whole grains, low-fat dairy products, poultry, fish, legumes, non-tropical vegetable oils, and nuts.
    • Choose a diet that limits sweets, sugar-sweetened beverages, and red meats.
    • Reduce high blood cholesterol and triglycerides.
    • Reduce your intake of saturated fat, trans fat and cholesterol.
  • Lower High Blood Pressure.
  • Be physically active every day.
    • Aim for at least 150 minutes per week of moderate-intensity physical activity per week.
  • Aim for a healthy weight.
  • Manage diabetes.
  • Reduce stress.
  • Limit alcohol.
  • Have a regular physical checkup.

The Bottom Line

A recent study in the United Kingdom compared vegetarians, fish eaters, poultry eaters, and red meat eaters for the risk of developing heart disease and the risk of dying from heart disease. The results were:

  • When fish eaters were compared with meat eaters, they had:
    • 7% lower risk of cardiovascular diseases of all types.
    • 21% lower risk of ischemic heart disease (angina).
    • 30% lower risk of myocardial infarction (heart attack).
    • 21% lower risk of stroke.
    • 22% lower risk of heart failure.
  • When vegetarians were compared with meat eaters, they had:
    • 9% lower risk of cardiovascular diseases of all types.
    • Lower, but statistically non-significant, risk of other heart disease parameters.
  • When poultry eaters were compared with meat eaters there were no significant differences in heart disease outcomes.

The authors concluded, “Eating fish rather than meat or poultry was associated with a lower risk of adverse cardiovascular outcomes…supporting its role as a healthy diet that should be encouraged. Vegetarianism was only associated with a lower risk of cardiovascular disease incidence.”

However, the “vegetarian diet” in this study was not nearly as healthy as the whole food vegetarian diets that have previously been shown to be heart healthy. And the “fish-eaters diet” was healthier than the “meat-eaters diet” because of both the fish and the extra fruits and vegetables this group of people were consuming.

In the words of the authors, “…As a group, vegetarians consumed more unhealthy foods, such as crisps [potato chips], than meat eaters. Therefore, vegetarians should not be considered a homogeneous group, and avoidance of meat will not be sufficient to reduce health risk if the overall diet is not healthy.”

My summary:

  • Whole food plant-based diets (the true definition of vegetarianism) are very heart healthy.
  • Primarily plant-based diets with fish as the main protein source (otherwise known as pescatarian diets) are also very heart healthy.
  • If you want a healthy heart, choose the one that best fits your preferences and your lifestyle.

For more details about 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.

Which Diets Are Best In 2021?

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Which Diet Should You Choose?

Emoticon-BadMany of you started 2021 with goals of losing weight and/or improving your health. In many cases, that involved choosing a new diet. That was only 2 months 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 2021”. For the full report, click on this link.

How Was This Report Created?

Expert PanelUS News & World Report recruited panel of 25 nationally recognized experts in diet, nutrition, obesity, food psychology, diabetes, and heart disease to review the 39 most popular diets.  They rated 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 nine sets of Best Diets rankings:

  • Best Diets Overall combines panelists’ ratings in all seven categories. However, all categories were not equally weighted. Short-term and long-term weight loss were combined, with long-term ratings getting twice the weight. Why? A diet’s true test is whether it can be sustained for years. And safety was double counted because no diet should be dangerous.
  • Best Commercial Diets uses the same approach to rank 15 structured diet programs that require a participation fee or promote the use of branded food or nutritional products.
  • Best Weight-Loss Diets was generated by combining short-term and long-term weight-loss ratings, weighting both equally. Some dieters want to drop pounds fast, while others, looking years ahead, are aiming for slow and steady. Equal weighting accepts both goals as worthy.
  • Best Diabetes Diets is based on averaged diabetes ratings.
  • Best Heart-Healthy Diets uses averaged heart-health ratings.
  • 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 judgments about each diet’s taste appeal, ease of initial adjustment, ability to keep dieters from feeling hungry and imposition of special requirements.
  • Best Plant-Based Diets uses the same approach as Best Diets Overall to rank 12 plans that emphasize minimally processed foods from plants.
  • Best Fast Weight-Loss Diets is based on short-term weight-loss ratings.

Which Diets Are Best In 2021?

The word WInner in white letters surrounded by a burst of colorful stars in 3d

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 5 and bottom 5 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.]

Best Diets Overall 

The Top 5: 

#1: Mediterranean Diet

#2: 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.)

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

#4: Mayo Clinic Diet

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

The Bottom 5: 

#35: Modified Keto Diet

#36: Whole 30 Diet

#37: GAPS Diet (A diet designed to improve gut health).

#38: Keto Diet

#39: Dukan Diet

Best Weight-Loss DietsWeight Loss

The Top 5: 

#1: Flexitarian Diet

#2: Vegan Diet

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

#4: Mayo Clinic Diet

#5: Ornish Diet

The Bottom 5: 

#35: Fertility Diet

#36: Whole 30 Diet

#37: Alkaline Diet

#38: AIP Diet (A diet designed for people with autoimmune diseases)

#39: GAPS Diet

Best Diabetes Diets

The Top 5: 

#1: Flexitarian Diet

#2: Mediterranean Diet

#3: DASH Diet

#4: Mayo Clinic Diet

#5: Vegan Diet

The Bottom 5: 

#35: The Fast Diet

#36: AIP Diet

#37: GAPS Diet

#38: Whole 30 Diet (A diet designed for people with autoimmune diseases)

#39: Dukan Diet

strong heartBest Heart-Healthy Diets 

The Top 5: 

#1: DASH Diet

#2: Mediterranean Diet

#3: Ornish Diet (A diet based on the caloric density of foods).

#4: Flexitarian Diet

#5: Vegan Diet

The Bottom 5: 

#35: Keto Diet

#36: AIP Diet

#37: Whole 30 Diet

#38: Modified Keto Diet

#39: GAPS Diet

Best Diets for Healthy Eating

The Top 5: 

#1: DASH Diet

#2: Mediterranean Diet

#3: Flexitarian Diet

#4: TLC Diet (A diet designed to promote heart health)

#5: MIND Diet

The Bottom 5: 

#35: Atkins Diet

#36: Raw Food Diet

#37: Modified Keto Diet

#38: Dukan Diet

#39: Keto Diet 

Easiest Diets to FollowEasy

The Top 5: 

#1: Mediterranean Diet

#2: Flexitarian Diet

#3: MIND Diet

#4: DASH Diet

#5: Fertility Diet

The Bottom 5: 

#35: Keto Diet and Modified Keto Diet (tie)

#36: Whole 30 Diet

#37: Dukan Diet

#38: GAPS Diet

#39: Raw Foods Diet 

Best Fast Weight-Loss Diets

The Top 5 (Excluding Commercial Diets): 

#1: Atkins Diet

#2: Biggest Loser Diet

#3: Keto Diet

#4: Raw Food Diet

#5: Volumetrics Diet

Which Diets Are Best For Rapid Weight Loss?

Happy woman on scaleLet me start with some general principles:

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

  • The Atkins and keto diets are meat heavy, low carb diets. They restrict fruits, some vegetables, grains, and most legumes.
  • The Biggest Loser diet relies on restrictive meal plan and exercise programs.
  • The restrictions of the raw food diet are obvious.
  • The volumetrics diet restricts foods with high caloric density.
  • The vegan diet, which ranks #7 on this list, is a very low fat diet that eliminates meat, dairy, eggs, and animal fats.
  • I did not include commercial diets that rated high on this list, but they are all restrictive in one way or another.

#2: Restrictive diets ultimately fail.

  • The truth is 90-95% of people who lose weight quickly on a restrictive diet regain most of that weight in the next two years. The pounds come back and often bring their friends along as well. Many people regain more weight than they lost. This is the famous “Yo-Yo Effect”.
  • If dieters paid for one of the commercial diets, they may as well have burned their money.
  • When I talk with people about weight loss, many of them tell me the Atkins diet is the only one they can lose weight on. That would be impressive if they were at a healthy weight, but most are not. They are overweight. I am starting to see the same thing from overweight people who have used the keto diet to lose weight and have regained their weight.

#3: We should ask what happens when we get tired of restrictive diets and add back some of your favorite foods.

  • If you lose weight on a vegan diet and add back some of your favorite foods, you might end up with a semi-vegetarian diet. This is a healthy diet that can help you maintain your weight loss.
  • If you lose weight on the Atkins or keto diets and add back some of your favorite foods, you end up with the typical American diet – one that is high in both fat and carbs. This is not a recipe for long-term success.
  • Long term weight loss is possible if you transition to a healthy diet after you have lost the weight. In a recent article in “Health Tips From The Professor” I wrote about an organization called the National Weight Control Registry. These are people who have been successful at keeping the weight off. For purposes of this discussion, two points are important.
  • They lost weight on every possible diet.
  • They kept the weight off by following a healthy reduced calorie, low fat diet. (For what else they did, click here).

Which Diet Should You Choose?

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

  • 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.
  • 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.
  • Choose diets that are easy to follow. The less-restrictive primarily plant-based diets top this list – diets like Mediterranean, DASH, MIND, and flexitarian.
  • 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.
  • 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. Teose 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.

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 2021”.

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

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

  • If you are looking for rapid weight loss, any whole food restrictive diet will do.
  • Restrictive diets ultimately fail.
  • We should ask what happens when we get tired of restrictive diets and add back some of our favorite foods.
  • Long term weight loss is possible if you transition to a healthy diet after you have lost the weight.

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

  • Choose a diet that fits your needs.
  • Choose diets that are healthy and associated with long term weight loss.
  • Choose diets that are easy to follow.
  • Choose diets that fit your lifestyle and dietary preferences.
  • 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, 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