Diet and Obesity in US - Dr. Low Dog · Pesticide and ADHD • Pyrethroidpesticides cause...
Transcript of Diet and Obesity in US - Dr. Low Dog · Pesticide and ADHD • Pyrethroidpesticides cause...
1/27/17
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“TheNutritionPrescription”
Tieraona Low Dog, MDFellowship Director
Academy of IntegrativeHealth & Medicine
Author of “Fortify Your Life”“Healthy At Home” and
“Life Is Your Best Medicine”
www.DrLowDog.com
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“TheFoodYouEatCanBeEither:
TheSafest&
MostPowerfulFormOfMedicine
-or-
TheSlowestFormOfPoison.”
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DietandObesityinUS
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Nutritioninthe21st Century
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“ Let your food be your medicine and your medicine be your food.”
—Hippocrates
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WHORecommendsLimitingSugarConsumptionTo25g/d
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Sugarsaddedtofoods,aswellasthosefoundnaturallyinhoney,syrups,fruitjuicesandfruitconcentrates.Notinfreshproduce.
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Low(<=55)
Low(<=10) 11-19
56-69 High(>=70)
High(>=20)
GlycemicIndex(GI)
GlycemicLoad(GL)
0
0
20
10 20 30 40 50 60
6040 80 100
GlycemicIndex&GlycemicLoadRatingChart
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InfluencesonGlycemicLoadofFoods
• Amountofprocessing(increasessurfacearea)
• Fibercontent(decreasesGL)• Fatcontentandproteinslow
stomachemptyingandlowertheglycemicload
• Many“fat-free” foodsarehighGLandcontributetoobesity
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GlycemicLoad
IndividualFoodPortion
Low 0-10
Moderate 11-19
High 20+
WholeDay
Low <80
Moderate 80-120
High >120
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Food ServingSize Glycemic Load
Grapefruit ½large 3
Apple 1medium 6
Banana 1large 14
Raisins 1smallbox 20
Watermelon 1cup 8
Carrots 1large 5
Orange 1medium 6
Sweet potato 1cup 17
Bakedpotato 1medium 28
Frenchfries 1mediumserving 26
Snickers 1bar 35
Reese’scup 1miniature 2
Whitetablewine 5ounces 1
Redtablewine 5ounces 1
Grapejuice 6ounces 12
GlycemicLoad
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Food ServingSize Glycemic Load
Asparagus ½cup 2
Broccoli 1cup 4
Greenbeans 1cup 3
Tomato 1medium 2
SubwaysandwichTurkeybreast
6inch 17
Butterpecan icecream 5.5ounces(small) 22
Vanillaicecreamcone 4.5ounces (small) 19
Potatochips,fatfree 1bag(8ounces) 49
Tortillachips,whitecorn 3.5ounces 38
Eggo oatwaffles 1serving 13
Maplesyrup 4Tbsp 39
Egg,hardboiled 1 2
Applejuice 8ounce 6
GlycemicLoad
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Food Serving Size Glycemic Load
Spaghetti 1cup 38
Brown rice 1cup 23
Whiterice 1cup 33
Whitebread 1slice 10
Wholegrainbread 1slice 5
Bagel,cinnamonraisin 13.5inch 24
Pumpernickel bread 1slice 6
Macaroniandcheese 1cupprepared 31
Chocolatedoughnut 1doughnut(80g) 25
Glazeddoughnut 1doughnut(80g) 12
Kellogg’sFrostedFlakes ¾cup 20
Kellogg’sSpecial K 1cup 14
PostBranFlakes ¾cup 12
PostRaisin Bran 1cup 25
GlycemicLoad
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PicturesofLow/HighGIMeals&Snacks
GI = 60 GL = 48 GI = 42 GL = 31
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PicturesofLow/HighGIMeals&Snacks
GI = 80 GL = 32 GI = 61 GL = 12
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RealityCheck
• It is not practical to try to “count” glycemic load, in part because it will vary based upon portion size and other components in the meal.
• The take home message: cut back on processed, refined , sugary foods and drinks.
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Resources
• The New Glucose Revolution by Jennie Brand-Miller, PhD
• The Glycemic Load Diet by Rob Thompson MD
• The Glycemic Load Diet Cookbook by R. Thompson
• The Easy GL Diet Handbook by Fedon Lindberg MD
• The 150 Healthiest 15-Minutes Recipes on Earth by Jonny Bowden, PhD
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SugarSubstitutes/Non-CaloricSweeteners
• Aspartame(Equal&Nutrasweet)• Sucralose(Splenda)• Saccharin(Sweet‘NLow,SweetTwin)• Acesulfame K(Sunett,SweetOne)• Stevia(Truvia,PureVia,SunCrystals)
– FromSteviarebaudiana leaves• MonkFruit(Nectresse)
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SugarAlcohols
• Erythritol• Hydrogenatedstarchhydrolysate• Isomalt• Lactitol• Maltitol• Mannitol• Sorbitol
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NaturalSweeteners
• Agavenectar• Datesugar• Fruitjuiceconcentrates• Honey• Maplesyrup• Molasses• Canesugar
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GlutenandCeliac
• Glutenisthenameforthestorageproteinsfoundinwheat,barley,ryeandrelatedcerealgrains– triticale,speltandkamut.
• Inpatientswithceliacdisease,astrictgluten-freedietistheonlytreatment.
• Expertsestimatethatabout1%ofAmericanshaveceliacdisease.
• Thecondition,causedbyanabnormalimmuneresponsetogluten,candamagetheliningofthesmallintestine.
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SymptomsofCeliac• Recurringbloating,gas,orabdominalpain• Chronicdiarrheaorconstipationorboth(canpresentlikeIBS)• Pale,foul-smellingstool• Unexplainedanemia• Boneorjointpain• Behaviorchanges/depression/irritability• VitaminKDeficiency• Fatigue,weaknessorlackofenergy• Delayedgrowthoronsetofpuberty• Failuretothrive(ininfants)• Missedmenstrualperiods,infertilitymale&female,miscarriage• Cankersoresinsidethemouth• Toothdiscolorationorlossofenamel
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GlutenSensitivity
• Notmuchisknownaboutthisconditionexcept:– Peopledonottestpositiveforceliacdisease.– Arenotallergictogluten.– Theyreportfeelingsickaftereatingordrinkingproductsthatcontaingluten.
• Manygluten-freefoodscontainricestarch,cornstarch,tapiocastarch,potatostarchandguargumasasubstituteforflour.Inotherwords,alotofthesefoodsarenotparticularly“wholesome.”
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PesticideExposureandADHD
• UsingdatafromNHANES– childrenwithtypicallevelsofpesticideexposurefromeating pesticide-treatedfruits/vegetableshavehigherrisk ofdevelopingADHD.
• Childrenages8-15withhigherurinarylevelsofdimethylalkylphosphate (DMAP)hadtwicetheoddsofADHDwhencomparedwithchildrenwithloworundetectablelevels.
KuehnBM.JAMA.2010Jul7;304(1):27-8.Bouchard,etal.Pediatrics.2010Jun;125(6):e1270-7.
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PesticideandADHD
• Pyrethroid pesticidescauseabnormalitiesindopaminesystemandproduceADHDphenotypeinanimalmodels.
• 687children(8-15yearsofage)evaluated.Thosewithurinary3-PBAabovelimitofdetectionwere2xmorelikelytohaveADHDcomparedwiththosebelowLOD.
• Hyperactive-impulsivesymptomsincreasedby50%forevery10-foldincreasein3-PBAlevels;changeininattentionwasnotsignificant.
Wagner-SchumanM,etal.EnvironHealth2015;May28;14:44.
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Eatinganorganicdietforoneweeksignificantlyreducedpesticideexposureinadults.Meantotalorganophosphatemetaboliteswere89%lowerthanwhenparticipantswereeatingconventionalfoods.Similarresultshavebeenshowninchildren.
OatesL,etal.EnvironRes2014;132:105-11BradmanA,etal.EnvironHealthPerspect2015;123(10):1086-93
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http://www.ewg.org/foodnews/
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Does Eating Fat Give You Heart Disease?
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SaturatedFatDebate
• Threelargemetaanalyses(21studies,12studies,and76studies)haveallfailedtoshowanysignificantevidencethatsaturatedfatincreasestheriskforheartdisease.
• Italsohasfailedtofindanysignificantevidencethatincreasingpolyunsaturatedfatsanddecreasingsaturatedfatslowersheartrisk.
• Adviceforverylowfatdietsnotsupportedbyevidence.
Siri-Tarino,Amer JClin Nutr 2010;91(3):535–46.Schwingshacki L,etal.BMJOpen2014;4(4):e004487.ChowdhuryR,etal.AnnInternMed2014;160(6):398-406
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Eggs
• Provide essential fatty acids, proteins, choline, vitamins A and B12 , selenium, and other critical nutrients at levels above or comparable to those found in other animal-source foods.
• Meta-analysis suggests that egg consumption is not associated with the risk of CVD and cardiac mortality in the general population.
• New dietary guidelines do not limit dietary cholesterol.
ShinJY,etal.AmJClin Nutr 2013;98(1):146-59
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Choline• RelatedtoB-vitamins.Necessaryforsynthesisofcellmembranes,productionofVLDL,precursorACh
• Suboptimalintakeofcholinein95%pregnantwomeninBoston.Lowintakeé riskofNTD
• HighermaternalcholineintakealtersgenemethylationandexpressionofplacentalCRH,keyregulatorinstressresponse.Baby’sintelligence,memory,andpossiblymoodregulationmaybedamagedpermanentlyifmotherischolinedeficient
• RDA:450mg/dBreastfeeding:550mg/dJiangX,etal.FASEBJ.2012;26(8):3563–3574.Brunst KJ,etal.PublicHealthNutr 2014;17(9):1960-70.
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CholineandCognition
• Prospectivestudyinvolving154healthymother-infantpairsconductedinVancouver,Canada(72%white,15%Asian).AllwomenweretakingPNV.
• Maternalbloodcollectedat16and36weeksgestationandinfantneurodevelopmentassessedat18monthsagefor154mother-infantpairs.Babieswereallsingletonsandfull-term.
• Significantpositiveassociationsfoundbetweeninfantcognitivetestscoresandmaternalplasmafreecholine(p=0.009)andastrongtrendtowardsgrossmotordevelopment.
WuBT,etal.PLoS One2012;7(8):e43448.
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CholineinFoods:http://naldc.nal.usda.gov/download/47335/PDF
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• Studiesshowdairyproductsarebeneficialinmusclebuilding,loweringbloodpressure,preventingtoothdecay,diabetes,colorectalcancer,andobesity.
Tunick MH,etal.JAgric FoodChem 2014;Nov19
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MilkandButter
• Formoderatemilkusers,normalmilkat4%fatisnobigdeal andcontainsfatsolublevitaminsremovedinmakinglowfatmilk.Thesaturatedfattyacidsinmilkaremostlytheshorterchainformsthatdonoteffectcholesterolmetabolism.
• Systematicreviewandmeta-analysissuggestrelativelysmallorneutraloverallassociationsofbutterwithmortality,CVD,anddiabetes.Thesefindingsdonotsupportaneedformajoremphasisindietaryguidelinesoneitherincreasingordecreasingbutterconsumption.
Pimpin L,etal.PLoS One2016;11(6):30158118LiangJ,etal.Crit RevFoodSci Nutr 2016;Dec21
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Dietary Fat and CancerSystematic Review
• No associations were found for prostate, esophageal, gastric, renal cell, bladder, lung, skin, or postmenopausal breast cancer by the total intake or types of dietary fat.
• There may be an association between total dietary fat and premenopausal breast cancer.
• Ovarian cancer there was limited-suggestive evidence for a positive association with intake of saturated fats.
SchwabU,etal.FoodNutr Res2014;10;58.doi:10.3402/fnr.v58.25145.
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Omega3FattyAcidsfromPlantsandAnimals
Darkgreenvegetables,walnuts,freshlygroundflaxseedsandotherplantfoods.
ALA
Coldwaterfish,fishoil,freshseaweed,cleananimalfoodslikefreerangechicken,eggs,andgrassfedbeef.
DHA EPA
ConvertstoConvertsto
IntermediateMoleculesSuppliesSupplies
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ImageFrom:FabianCJ,etal.BreastCancerRes2015;2015;17(1):6
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Resolution Biology
• Inflammation always considered a passive process.• Newer research shows that resolution of self-limited acute
inflammation is an active, programmed response.• Omega 3 fatty acids produce specialized pro-resolving
mediators (SPM) – resolvins, protectins and maresins.
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Serhan CN,ChiangN.Curr Opin Pharmacol 2013;13(4):632-40.
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Cardiovascular HealthOnthebasisof19cohortstudiesoffree-livingpopulationsglobally,biomarkerconcentrationsofseafoodandplant-derivedω-3fattyacidsareassociatedwithamodestlylowerincidenceoffatalCHD.
PrediMed studyfoundthatdietaryALA,suppliedmainlybywalnutsandoliveoil,relatesinverselytoall-causemortality,whereasprotectionfromcardiacmortalitywaslimitedtofish-derivedlong-chainn-3polyunsaturatedfattyacids.
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DelGobbo LC,etal.JAMAInternMed2016;176(8):1155-66.
Sala-VilaA,etal.JAmHeartAssoc 2016;Jan26;5(1).pii:e002543.
KnowYour“O”
• TheOmega-3IndexindicatesthepercentageofEPA+DHAinredbloodcellfattyacids.
• CanadiangovernmentfoundthatthemeanOmega-3IndexlevelofCanadiansaged20-79was4.5%.– Levelshigherforwomen,olderadults,Asiansandothernon-whiteCanadians,omega-3
supplementusers,andfishconsumers;levelslowerforsmokersandpeoplewhowereobese.
• Fewerthan3%ofadultshadlevelsassociatedwithlowCHDrisk;43%hadlevelsassociatedwithhighrisk.
Langlois K,etal.HealthRep2015;Nov18;26(11):3-11
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Omega3andHTN
• Omega-3fattyacidsdecreasetheproductionofvasoconstrictoreicosanoids,reduceACEactivityandangiotensinIIformation,andenhanceendothelialnitricoxideproductionandactivatetheparasympatheticnervoussystem.
• Metaanalysisfoundthatmarineomega3sleadstosmallbutsignificantreductioninSBPand≥2grams/dreducesDBP.
• DHA>EPAforbloodpressureloweringeffects.MillerPE,etal.AmJHypertens 2014;27(7):885-96.
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Omega 3 Fatty Acids – Bone/Muscle
• In animal studies, marine omega 3 attenuates bone loss associated with estrogen loss; EPA enhances calcium absorption, reduces calcium excretion and increases calcium deposition in bone.
• Marine omega 3 acids tend to have positive effects on bone if ingested for ≥ 18 months and given along with calcium.
• Omega-3fattyacidsstimulatemuscleproteinsynthesisinolderadultsandmaybeusefulforthepreventionandtreatmentofsarcopenia.
Fernandes G, et al. Prostaglandins Leukot Essent Fatty Acids. 2003;68(6):361-372 Orchard TS, et al. Br J Nutr. 2012;107:S253-S260
Smith GI, et al. Am J Clin Nutr 2011; 93(2):402–412
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Pregnancy
• MaternalDHAintakeduringpregnancyandlactationcanprolonghighriskpregnancies,increasebirthweight,headcircumference;enhancevisualacuity,handandeyeco-ordination,attention,andinformationprocessing.
• Systematicreviewfoundriskofearlypretermdeliveryreducedby58%andanypretermdeliveryby17%withtheEPA/DHAsupplementation.
MorseNL.Nutrients2012;4(7):799-840Kar S,etal.Eur JObstet Gynecol Reprod Biol 2016;198:40-6
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Omega3andProstateCancer?
• SELECTtrialraisedconcernsaboutpotentiallinkbetweenomega3sandincreasedprostatecancer/aggressivecancer.
• EuropeanFoodSafety(EFSA)concluded,“thereisnoevidenceforaroleofEPAand/orDHAintakeinthedevelopmentofprostatecancer.”
• Also,“supplementalintakeofEPAandDHAcombinedatdosesupto5g/ddoesnotgiverisetosafetyconcernsforadults.”
EFSAJournal10(7):doi:10.2903/j.efsa.2012.2815
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SeafoodCalculatorwww.ewg.org/research/ewg-s-consumer-guide-seafood/seafood-calculator
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OliveOil• CornerstoneofMediterraneandiet.Richinantioxidants,particularlyvitaminE.
• Oleocanthal mimicseffectofibuprofeninreducinginflammation.
• Protectsagainstheartdisease;lowerstotalbloodcholesterol,LDL-C,triglycerides;improvesHDL.
• NursesHealthStudyfoundthatgreateradherencetoMediterraneandietwasassociatedwithlongertelomeres(healthandlongevity).
Hemaez A,etal.Arterioscler Thromb Vasc Biol 2014;34(9):2115-9.Crous-Bou M,etal.BMJ2014;349:g6674
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Avocado
• Avocados second only to olives for level of monounsaturated fat.
• Randomized, crossover trial of 45 overweight/obese participants found inclusion of one avocado per day was superior to low-fat or moderate fat diet high in oleic acid for lowering cholesterol.
• Only avocado group had significantly decreased LDL particle number, small dense LDL-C and ratio of LDL/HDL.
Wang L, et al. J Am Heart Assoc 2015; 4(1). pii: e001355.
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Protein
• FromtheGreekwordprotos, “first.”• Usedtobuildnewcells,maintaintissues(e.g.,muscles,innerbone,hair,nails),createenzymes,makehemoglobintocarryoxygen,lipoproteinstotransportcholesterol;presentininnerandoutermembraneofeverylivingcell.
• Sourcesincludemeat,poultry,seafood,beansandpeas,eggs,soyproducts,nuts,nutbutters,andseeds.
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WCRF/AICRRecommendationstoReduceCancerRisk
• Limitconsumptionofredmeats(beef,pork,lamb)andavoidprocessedmeats.
• ThereisNOquestionthatregularconsumptionofprocessedreadmeatsincreasesriskofcolorectalcancer.
Kmietowicz Z.BMJ2015;351:h5729
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WeAren’tEatingWhatWeAteInTheStoneAge
HEALTHYPROTEINSOURCES• Soyandotherlegumes(lentils,beans,etc.)• Quinoa• Nutsandseeds• Lowmercurycoldwaterfish• Organicpoultry• Grassfedbeef,pork,lamb• Wildgame• Milkanddairywithouthormones• Omega3enrichedeggs
Roughly8gramsofproteinper20poundsofbodyweightisgenerallyrecommended
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SodiumRecommendations?
• InMay2013,InstituteofMedicinefoundlimitedevidencelinkingassociationbetweenlowsodiumintake(1500-2300mg/d)andimprovedhealthoutcomesinthosewithdiabetes,kidneydisease,heartdisease,hypertensionorborderlinehypertension;those51yearsofageandolder;orAfricanAmericans(NationalResearchCouncil).
• However,averageAmericanconsumes3400mg/dsodium.Toomuch!Useiodizedsalt.
Sodium Intake in Populations: Assessment of Evidence. Washington, DC: The National Academies Press, 2013.
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TraditionalAsianDiet
• LittlequestionmanypeopleinAsiancountrieshavelowratesofdiabetes,heartdiseaseandcancer.
• Thereisnoone“Asian”diet butsomegeneralizationsthatcanbemade.
• TraditionalChinesedietshavebeenexploredthroughtheChina-Cornell-Oxfordproject.Thislong-termstudyisdiscussedatlengthintherecentfilmForksoverKnives,whichpromotesbetterhealththroughaplant-baseddiet.
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Willcox DC,etal.JAmColl Nutr 2009;28(S)_500-516
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OkinawanDietaryPattern
• Highconsumptionofvegetables• Highconsumptionoflegumes(mostlysoy)• Moderateconsumptionfishproducts• Lowconsumptionmeatandmeatproducts• Lowconsumptionofdairyproducts• Moderatealcoholconsumption• Lowcaloricintake• EmphasisonlowGLcarbohydrates
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FlexitarianorVegetarianDiets
• Reviewof25studiesofflexitariandietsfoundemergingevidencesuggestiveofbenefitsforbodyweight,improvedmarkersofmetabolichealth,bloodpressure,andreducedriskoftype2diabetes.
• Vegetariandietshaveverybeneficialeffectsonlipids.
DerbyshireEJ.FrontNutr 2017;Jan 6;3:55WangF,etal.JAmHeartAssoc 2015;4(10):e002408