Episodios
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In this episode, we will discuss a wide variety of landmark clinical trials regarding food and nutrition. Specifically, we will investigate how certain dietary patterns reduce the likelihood of health outcomes like cardiovascular disease, obesity, and diabetes, as well as a detailed discussion of the risk factors associated with these illnesses including the Lipoprotein insulin resistance score or LPIR, blood pressure, inflammation, cholesterol, lipoproteins, and more.
References:
Schatzkin A, et al. Lack of effect of a low-fat, high-fiber diet on the recurrence of colorectal adenomas. Polyp Prevention Trial Study Group. N Engl J Med. 2000;342(16):1149-1155. Barnes LL, et al. Trial of the MIND Diet for Prevention of Cognitive Decline in Older Persons. N Engl J Med. 2023;389(7):602-611. Dugani SB, et al. Association of Lipid, Inflammatory, and Metabolic Biomarkers With Age at Onset for Incident Coronary Heart Disease in Women. JAMA Cardiol. 2021;6(4):437-447. Fernández-Friera L, et al. Normal LDL-Cholesterol Levels Are Associated With Subclinical Atherosclerosis in the Absence of Risk Factors [published correction appears in J Am Coll Cardiol. 2018 Feb 6;71(5):588-589. doi: 10.1016/j.jacc.2017.12.042]. J Am Coll Cardiol. 2017;70(24):2979-2991. Estruch R, et al. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts. N Engl J Med. 2018;378(25):e34. Basterra-Gortari FJ, et al. Effects of a Mediterranean Eating Plan on the Need for Glucose-Lowering Medications in Participants With Type 2 Diabetes: A Subgroup Analysis of the PREDIMED Trial. Diabetes Care. 2019;42(8):1390-1397. Shai I, Schwarzfuchs D, et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet [published correction appears in N Engl J Med. 2009 Dec 31;361(27):2681]. N Engl J Med. 2008;359(3):229-241. Currenti W, et al. Comparative Evaluation of a Low-Carbohydrate Diet and a Mediterranean Diet in Overweight/Obese Patients with Type 2 Diabetes Mellitus: A 16-Week Intervention Study. Nutrients. 2023;16(1):95. Published 2023 Dec 27. Gardner CD, et al. Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial [published correction appears in JAMA. 2007 Jul 11;298(2):178]. JAMA. 2007;297(9):969-977. Ebbeling CB, et al. Effects of a low-carbohydrate diet on insulin-resistant dyslipoproteinemia-a randomized controlled feeding trial [published correction appears in Am J Clin Nutr. 2022 Jan 11;115(1):310. Landry MJ, Ward CP, et al. Cardiometabolic Effects of Omnivorous vs Vegan Diets in Identical Twins: A Randomized Clinical Trial [published correction appears in JAMA Netw Open. 2023 Dec 1;6(12):e2350422. Hallberg SJ, McKenzie AL, et al. Effectiveness and Safety of a Novel Care Model for the Management of Type 2 Diabetes at 1 Year: An Open-Label, Non-Randomized, Controlled Study [published correction appears in Diabetes Ther. 2018 Apr;9(2):613-621. doi: 10.1007/s13300-018-0386-4]. Diabetes Ther. 2018;9(2):583-612. O'Connor LE, et al. Effects of Total Red Meat Intake on Glycemic Control and Inflammatory Biomarkers: A Meta-Analysis of Randomized Controlled Trials. Adv Nutr. 2021;12(1):115-127. Hooper L, et al. Reduction in saturated fat intake for cardiovascular disease. Cochrane Database Syst Rev. 2020. Lytrivi M, et al. Impact of saturated compared with unsaturated dietary fat on insulin sensitivity, pancreatic β-cell function and glucose tolerance: a systematic review and meta-analysis of randomized, controlled trials. Am J Clin Nutr. 2023. Hall KD, et al. Ultra-Processed Diets Cause Excess Calorie Intake and Weight Gain: An Inpatient Randomized Controlled Trial of Ad Libitum Food Intake.Cell Metab. 2019. Lustig RH, et al. Isocaloric fructose restriction and metabolic improvement in children with obesity and metabolic syndrome. Obesity (Silver Spring). 2016. -
In this episode, we will take a deep dive into the biomarkers, lab values, and other tools that we can use to measure, quantify, and predict the risk of death, disease, and many preventable medical illness. This includes cardiovascular disease, certain cancers, dementia, infertility, and more.
Centers for Disease Control and Prevention. National Center for Health Statistics. Leading Causes of Death.
https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm
Cancer is a Preventable Disease that Requires Major Lifestyle Changes
Anand P, Kunnumakkara AB, Sundaram C, et al. Cancer is a preventable disease that requires major lifestyle changes [published correction appears in Pharm Res. 2008 Sep;25(9):2200. Kunnumakara, Ajaikumar B. Pharm Res. 2008;25(9):2097-2116. doi:10.1007/s11095-008-9661-9
World Health Organization: Between 30% and 50% of cancer deaths could be prevented by modifying or avoiding key risk factors
https://www.who.int/health-topics/cancer
The American Cancer Society states that 60% of uterine cancers are attributed to excess body weight
https://www.cancer.org/research/acs-research-news/more-than-4-in-10-cancers-and-cancer-deaths-linked-to-modifiable-risk-factors.html
Wu S, Zhu W, Thompson P, Hannun YA. Evaluating intrinsic and non-intrinsic cancer risk factors. Nat Commun. 2018;9(1):3490. Published 2018 Aug 28. doi:10.1038/s41467-018-05467-z
International Agency for Research on Cancer acknowledged that there was sufficient evidence to suggest that avoiding benign overweight obese was protective against at least 13 different cancers
Lauby-Secretan B, Scoccianti C, Loomis D, et al. Body Fatness and Cancer--Viewpoint of the IARC Working Group. N Engl J Med. 2016;375(8):794-798. doi:10.1056/NEJMsr1606602
LPIR score is a useful predictor of future type 2 diabetes even in patients with a normal Hemoglobin A1c
Harada PHN, Demler OV, Dugani SB, et al. Lipoprotein insulin resistance score and risk of incident diabetes during extended follow-up of 20 years: The Women's Health Study. J Clin Lipidol. 2017;11(5):1257-1267.e2. doi:10.1016/j.jacl.2017.06.008
According to the Centers for Disease Control and Prevention (CDC), approximately 70% of the sodium Americans consume comes from packaged, processed foods
https://www.cdc.gov/chronicdisease/resources/publications/factsheets/nutrition.htm
Approximately 70-90% of total body cholesterol is found within the cell
Maxfield FR, Wüstner D. Intracellular cholesterol transport. J Clin Invest. 2002;110(7):891-898. doi:10.1172/JCI16500
Lipoprotein(a) Is Markedly More Atherogenic Than LDL: An Apolipoprotein B-Based Genetic Analysis
Björnson E, Adiels M, Taskinen MR, et al. Lipoprotein(a) Is Markedly More Atherogenic Than LDL: An Apolipoprotein B-Based Genetic Analysis. J Am Coll Cardiol. 2024;83(3):385-395. doi:10.1016/j.jacc.2023.10.039
Association of Triglyceride-Lowering LPL Variants and LDL-C–Lowering LDLR Variants With Risk of Coronary Heart Disease
Ference BA, Kastelein JJP, Ray KK, et al. Association of Triglyceride-Lowering LPL Variants and LDL-C–Lowering LDLR Variants With Risk of Coronary Heart Disease. JAMA. 2019;321(4):364–373. doi:10.1001/jama.2018.20045
Elevated remnant cholesterol causes both low-grade inflammation and ischemic heart disease
Varbo A, Benn M, Tybjærg-Hansen A, Nordestgaard BG. Elevated remnant cholesterol causes both low-grade inflammation and ischemic heart disease, whereas elevated low-density lipoprotein cholesterol causes ischemic heart disease without inflammation. Circulation. 2013;128(12):1298-1309. doi:10.1161/CIRCULATIONAHA.113.003008
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In today’s episode, we will investigate and review the fundamentals of scientific nutrition so that you can more easily and confidently navigate and comprehend the myriad of dietary trends, media headlines, and conflicting nutritional recommendations that we are exposed to in our everyday lives. At the end of this episode, I hope for you to have a stronger understanding of how science can be used to study food, nutrition, and health, with particular attention to the various dietary study designs, and the relative strengths, weaknesses, and limitations of each.
www.KevinForeyMD.com
2014 Cochrane Review: Dietary salt Reduction and cardiovascular outcomes
Adler AJ, Taylor F, Martin N, Gottlieb S, Taylor RS, Ebrahim S. Reduced dietary salt for the prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2014, Issue 12. Art. No.: CD009217. DOI: 10.1002/14651858.CD009217.pub3
2020 Cochrane Review: The effect of a low salt diet on blood pressure
Graudal NA, Hubeck-Graudal T, Jurgens G. Effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride. Cochrane Database of Systematic Reviews 2020, Issue 12. Art. No.: CD004022. DOI: 10.1002/14651858.CD004022.pub5.
Negligible effect of dietary cholesterol of serum cholesterol and lipoproteins.
Fernandez ML. Dietary cholesterol provided by eggs and plasma lipoproteins in healthy populations. Curr Opin Clin Nutr Metab Care. 2006;9(1):8-12. doi:10.1097/01.mco.0000171152.51034.bf.
The PREDIMED study, a landmark trial focusing on the effects of the Mediterranean diet on cardiovascular outcomes and risk factors.
Estruch R, Ros E, Salas-Salvadó J, et al. Primary prevention of cardiovascular disease with a Mediterranean diet [retracted in: N Engl J Med. 2018 Jun 21;378(25):2441-2442]. N Engl J Med. 2013;368(14):1279-1290. doi:10.1056/NEJMoa1200303.
The PURE prospective cohort study demonstrating a higher risk of total mortality associated with high carbohydrate intake, and lower total mortality associated with low carbohydrate intake.
Dehghan M, Mente A, Zhang X, et al. Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study. Lancet. 2017;390(10107):2050-2062. doi:10.1016/S0140-6736(17)32252-3.
A subsequent prospective cohort study published in the Lancet Public Health, demonstrating higher mortality in individuals consuming low carbohydrate dietary patterns.
Seidelmann SB, Claggett B, Cheng S, et al. Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis. Lancet Public Health. 2018;3(9):e419-e428. doi:10.1016/S2468-2667(18)30135-X
Prospective cohort studying examining organic food consumption and the incidence of cancer in women in the United Kingdom
Bradbury KE, Balkwill A, Spencer EA, et al. Organic food consumption and the incidence of cancer in a large prospective study of women in the United Kingdom. Br J Cancer. 2014;110(9):2321-2326. doi:10.1038/bjc.2014.148
Negative trial of the MIND Diet for prevention of cognitive decline in patients with a family history of dementia
Barnes LL, Dhana K, Liu X, et al. Trial of the MIND Diet for Prevention of Cognitive Decline in Older Persons. N Engl J Med. 2023;389(7):602-611. doi:10.1056/NEJMoa2302368.
Comparison of a healthy “low-carbohydrate” and low-fat diet regarding weight loss
Gardner CD, Trepanowski JF, Del Gobbo LC, et al. Effect of Low-Fat vs Low-Carbohydrate Diet on 12-Month Weight Loss in Overweight Adults and the Association With Genotype Pattern or Insulin Secretion: The DIETFITS Randomized Clinical Trial [published correction appears in JAMA. 2018 Apr 3;319(13):1386] [published correction appears in JAMA. 2018 Apr 24;319(16):1728]. JAMA. 2018;319(7):667-679. doi:10.1001/jama.2018.0245
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The intention of this podcast is to promote greater awareness and understanding of food, nutrition, physical activity, and other day-to-day considerations regarding health and wellness. I've titled this podcast The Simple Path to Health because becoming a healthier you can in fact be really simple. Meanwhile, there is so much information out there that it also can be very overwhelming and confusing. Instead, my goal is to keep things practical, easy to understand, and applicable to you, the everyday individual.
www.KevinForeyMD.com
Prevalence of insulin resistance among adolescents and young adults, including insulin resistance among those with a normal body weight.
Andes LJ, Cheng YJ, Rolka DB, Gregg EW, Imperatore G. Prevalence of Prediabetes Among Adolescents and Young Adults in the United States, 2005-2016. JAMA Pediatr. 2020;174(2):e194498. doi:10.1001/jamapediatrics.2019.4498
Prospective cohort study of premature cardiovascular disease, which demonstrated insulin resistance and metabolic syndrome as two of the strongest risk-factors.
Dugani SB, Moorthy MV, Li C, et al. Association of Lipid, Inflammatory, and Metabolic Biomarkers With Age at Onset for Incident Coronary Heart Disease in Women. JAMA Cardiol. 2021;6(4):437-447. doi:10.1001/jamacardio.2020.7073
Conflicts of interest among members of the 2020 US Dietary Guidelines for America.
Mialon M, Serodio P, Crosbie E, Teicholz N, Naik A, Carriedo A. Conflicts of interest for members of the U.S. 2020 Dietary Guidelines Advisory Committee. Public Health Nutr. Published online March 21, 2022. doi:10.1017/S1368980022000672
Historical example of financial conflicts of interest among the medical research community.
Kearns CE, Schmidt LA, Glantz SA. Sugar Industry and Coronary Heart Disease Research: A Historical Analysis of Internal Industry Documents. JAMA Intern Med. 2016;176(11):1680-1685. doi:10.1001/jamainternmed.2016.5394
Financial conflict of interest involving Coca Cola at the University of Colorado.Olinger, David. CU Nutrition Expert Accepts $550,000 from Coca-Cola for Obesity Campaign, The Denver Post, 6 June 2016.
Dietary Guidelines for Americans, 1985.
https://health.gov/sites/default/files/2019-10/1985thin.pdf
Randomized controlled trial of fruit-rich diet on liver health, insulin, resistance, and lipid panel in patients with fatty liver disease.
Alami F, Alizadeh M, Shateri K. The effect of a fruit-rich diet on liver biomarkers, insulin resistance, and lipid profile in patients with non-alcoholic fatty liver disease: a randomized clinical trial. Scand J Gastroenterol. 2022;57(10):1238-1249. doi:10.1080/00365521.2022.2071109
Isocaloric carbohydrate replacement trial in children with Metabolic Syndrome.
Lustig RH, Mulligan K, Noworolski SM, et al. Isocaloric fructose restriction and metabolic improvement in children with obesity and metabolic syndrome. Obesity (Silver Spring). 2016;24(2):453-460. doi:10.1002/oby.21371
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