DASH diet

Is It Too Late To Save Your Mind?

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What Does A Brain Healthy Diet Look Like?

Author: Dr. Stephen Chaney 

Memory loss due to Dementia and Alzheimer’s disease with the medical icon of a tree in the shape of a human head and brain losing leaves.

Age-related cognitive decline is increasing at an alarming rate. For example:

  • Newly diagnosed cases of Alzheimer’s disease in Americans over 65 reached 6.5 million in 2022.
  • That’s expected to double by 2060.

We have known for years that a whole food, primarily plant-based diet significantly reduces the risk of cognitive decline and Alzheimer’s.

But in our 20s and 30s we tend to ignore that advice. We feel immortal. Aging is something that affects our grandparents – not us.

When we reach our 40s and 50s reality kicks in. Some of our parents, aunts, and uncles start to show symptoms of cognitive decline. Some of our grandparents are suffering from dementia and Alzheimer’s. Maybe we aren’t immortal.

We start to think about changing to a healthier diet and lifestyle. But then the troubling thoughts creep in. “Is it too late? Should I have made those changes in my 20s? Has that ship already sailed?”

A recent study (Y Song et al, Alzheimer’s & Dementia, 2023) was designed to answer that question

How Was This Study Done?

clinical studyThe authors used data from the New York University Women’s Health Study. They studied 5116 women (average age = 46) who enrolled in the study between 1985 and 1991 and were followed for an average of 33 years (average age at the end of the study = 79).

At the beginning of the study, each participant filled out a questionnaire about demographics (age, gender, ethnicity, income, education, and marital status), physical activity, reproductive history, cancer history, and medication use. They also filled out a food frequency questionnaire.

Using the foods reported in the food frequency questionnaires, the scientist rated each woman with respect to adherence to the DASH diet. The women were then separated into quartiles based on their adherence to the DASH diet.

The participants filled out follow-up questionnaires every 3-5 years. Those who did not return the questionnaires were contacted by phone. The last two follow-up questionnaires included a survey of subjective cognitive complaints (SCCs) such as:

  • Recent changes in the ability to remember things.
  • Difficulty remembering recent events.
  • Difficulty remembering a short list of items, such as a shopping list.
  • Difficulty understanding or following spoken instructions.
  • Difficulty following a group conversation or a plot in a TV program.
  • Difficulty navigating familiar streets.

Previous studies have shown that the SCCs survey is an accurate predictor of future dementia and Alzheimer’s.

Finally, the scientists looked at the correlation between adherence to the DASH diet at age 46 with the number of subjective cognitive complaints at age 79.

Is It Too Late To Save Your Mind?

This is what the authors reported:

  • There was an inverse association between adherence to foods in the DASH diet (which was called “DASH adherence” by the authors of this study) at age 46 and subjective cognitive complaints (SCCs) at age 79.
  • Women in the highest quartile of DASH adherence at age 46 had a 17% reduction in 2 or more SCCs at age 79.
  • Every quartile increase in DASH adherence increased the risk of 2 or more SCCs by 7%.

The most frequently reported SCCs were:

  • Recent changes in the ability to remember things (40%).
  • Difficulty remembering a short list of items (19%).
  • Difficulty remembering recent events (17%).

When they looked at the effect of different foods on SCCs (subjective cognitive complaints):

  • Consumption of sweets, red meat, and processed meats were associated with an increased risk of SCCs, with sweets having the largest effect.
  • Consumption of fruits, vegetables excluding potatoes, legumes and nuts were associated with a decreased risk of SCCs at age 79, with fruits having the largest effect.

There were two other findings of interest:

  • The effect of DASH adherence was stronger for Black women than for White women.
  • The protective effect of DASH adherence was stronger in women with no previous history of cancer.

The authors concluded, “We found that a higher level of adherence to the DASH diet in mid-life was associated with lower SCCs later in life among women. These findings suggest that improvements in diet quality in mid-life…may have a role in maintaining an optimal subjective cognition among women…”

What Does This Study Mean For You? 

Questioning WomanLet me start by putting this study into perspective:

  • The strength of this study is that it has the longest follow-up period (33 years) and most diverse population of any study on this topic.
  • It is consistent with several previous studies with shorter follow-up periods, including the Nurses Health Study which also looked at the effect of DASH adherence at mid-life on SCCs later in life.
  • Several studies have shown that the Mediterranean diet protects against cognitive decline. And one recent study showed that mid-life adherence to the Mediterranean diet also offers similar protection against late-life cognitive decline in men.
    • This suggests that any whole food, primarily plant-based eating pattern, is likely to offer similar benefits. That is important because most of us find it easier to focus on foods rather than rigid diets.
  • Three studies that just compared DASH adherence and SCCs when subjects were already in their 60s to 90s, found no protective effect of DASH adherence.
    • This suggests that if we wait until old age and are already starting to experience mental decline, switching to a healthier diet may not be as beneficial for protecting our mind as we would like it to be. However, I would never advise anyone to just throw up their hands and say, “I might as well eat what I like and die happy.” That’s because:
      • Healthy dietary patterns have a multitude of health benefits. Cognitive benefits are just the tip of the iceberg.
      • Statistics report averages, and none of us are average. Some people will experience much better cognitive benefits than others by switching to a healthier diet, even if they wait until their “golden years” to do so.
  • There aren’t any clinical studies looking at adherence to a healthy diet in our 20s or 30s and cognitive outcomes in our 70s. The time span is just too great for clinical studies.
    • So, while we can confidently say, “It’s not too late to save your mind” by switching to a healthier diet pattern like DASH or Mediterranean in middle age, there are no clinical studies showing we might get even better results if we started eating healthy in our 20s or 30s. However, logic tells us that is a likely outcome.
  • This and most studies on this topic have been done with women. That’s because two thirds of Alzheimer’s patients are women.
    • However, the few studies that have been done with men have reported similar results. So, guys, this affects us too.
  • Finally, the fact that DASH adherence was more effective in women who have not had a cancer diagnosis is interesting.
    • In my opinion this is likely because many cancer treatments leave residual “brain fog” and increase the risk of cognitive decline as we age. As someone who spent his life in cancer research, I consider a healthy diet and healthy lifestyle vitally important in helping the body recover from the ravages of cancer treatment.

What Does A Brain-Healthy Diet Look Like? 

According to the most recent US News & World Health ratings of the best diets in various categories, the top 4 diets for brain health are:

  • MIND diet (The MIND diet combines the best of the Mediterranean and DASH diets with an emphasis on brain healthy foods such as berries.)
  • Mediterranean diet.
  • Flexitarian diet (a flexible version of a semi-vegetarian diet).
  • DASH diet.

My Comments:

  • All four diets are whole food, primarily plant-based diets.
  • Although the MIND diet was specifically designed for brain health, it does not perform significantly better than the Mediterranean and DASH diets in slowing cognitive decline.

Of course, most people prefer to think in terms of foods rather than diets. In terms of brain-healthy foods, a recent Harvard Health Review suggests these are the foods we should emphasize for brain health:

  • Green Leafy Vegetables: Kale, spinach, broccoli, and collards are rich in brain-healthy nutrients like vitamin K, lutein, folate, and beta-carotene.
  • Fatty Fish: Salmon, trout, sardines, and mackerel provide omega-3 fatty acids, which are crucial for brain function and for reducing dementia risk.
  • Berries: Blueberries, strawberries, and blackberries contain antioxidants that have been shown to delay cognitive decline.
  • Nuts and Seeds: Walnuts are high in omega-3 fatty acids (ALA), while others provide vitamin E.
  • Healthy Fats: Olive oil is recommended as the primary cooking fat.
  • Whole Grains and Legumes: Oats, quinoa, beans, and lentils provide a steady, slow release of glucose for brain energy. Plus, their fiber supports the growth of friendly bacteria that produce brain-healthy nutrients (This is sometimes referred to as the gut-brain axis).
  • Other Foods: Avocados (monounsaturated fats), beets (nitrates for blood flow), and cocoa (flavonoids) are beneficial.

The Bottom Line 

A recent study showed that adherence to a healthy eating pattern like the DASH diet at middle age can help protect our brain from cognitive decline 30 years later.

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

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

_______________________________________________________________________________

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

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

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

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

 _______________________________________________________________________

About The Author 

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years.

Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”.

Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com.

For the past 54 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

Can You Cut Your Risk Of Heart Disease By 90%?

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The Effect Of Ultra-Processed Foods On Heart Disease Risk
 

Author: Dr. Stephen Chaney

strong heartHeart disease is a killer. It continues to be the leading cause of death – both worldwide and in industrialized countries like the United States and the European Union. When we look at heart disease trends, it is a good news – bad news situation.

  • The good news is that heart disease deaths are continuing to decline in adults over 70.
    • The decline among senior citizens is attributed to improved treatment of heart disease and more seniors following heart-healthy diets.
  • The bad news is that heart disease deaths are starting to increase in younger adults, something I reported in an earlier issue of “Health Tips From the Professor.”
    • The reason for the rise in heart disease deaths in young people is less clear. However, the obesity epidemic, junk and convenience foods, and the popularity of fad diets all likely play a role.

Everyone has a magic diet to reduce the risk of heart disease. The American Heart Association tells us to avoid fats, especially saturated fats. Vegans tell us to avoid animal protein. Paleo and Keto enthusiasts tell us carbs are the problem.

But what if we eliminated junk and convenience food AND switched to a really healthy diet? How much would that reduce heart disease risk? A recent study (Y Willett et al, The American Journal of Medicine, in press, 2026) looked at the first part of that question. It looked at the effect of ultra-processed food (what we call junk and convenience foods) consumption on the risk of developing heart disease.

How Was This Study Done?

Clinical StudyThe scientists analyzed data from 4787 participants in the most recently published (2021 to 2023) National Health and Nutrition Examination Survey (NHANES). The average age of participants in the survey was 55 years, with 56% of them being women.

All the participants in this study had completed a dietary survey of everything they ate over the last two days. They also reported whether they had ever experienced a heart attack or stroke.

Ultra-processed foods were defined as foods that are industrially modified and loaded with added fats, sugars, starches, salts, and chemical additives.

The percentage of ultra-processed foods in their diet was calculated, and the participants were divided into quartiles based on the percentage of ultra-processed foods they consumed.

Participants with the highest quartile of ultra-processed food consumption were compared to those in the lowest quartile with respect to the risk of cardiovascular disease (self-reported heart attack or stroke). The data were corrected for age, sex, race, ethnicity, smoking status, and income.

The Effect Of Ultra-Processed Foods On Heart Disease Risk

Fast Food DangersThe results were striking:

  • The participants in the highest quartile for ultra-processed food consumption had a 47% higher risk of heart disease compared to those in the lowest quartile for ultra-processed food consumption.

The authors concluded, “Adults who consumed the highest amount of ultra-processed foods had a statistically significant 47% increased risk of heart disease. Large scale randomized trials are needed, but in the meantime, health care providers should advise patients to decrease consumption of ultra-processed foods in addition to adopting other therapeutic lifestyle changes and adjunctive drug therapies of proven benefit.”

The authors recognized the difficulty of making those changes in a world where ultra-processed foods are ubiquitous and cheap.

However, they drew parallels to tobacco use in this country. They said, “Just as it took decades for the dangers of smoking to become widely accepted, reducing reliance on ultra-processed foods may take time. This is partly due to the influence of large multinational companies that dominate the food market. In addition, many people face limited access to healthier food options.”

They went on to say, “Addressing ultra-processed foods isn’t just about individual choices – it’s about creating environments where the healthy option is the easy option.”

Can You Cut Your Risk Of Heart Disease By 90%?

The short answer is, “probably not”. But you can reduce the risk of heart disease by a lot – and probably by a lot more than 47%.

That’s because this study did not look at what the participants were replacing the ultra-processed foods with. Some participants may have replaced them with whole food, primarily plant-based diets. Others may have replaced ultra-processed foods with whole food, meat-based diets high in saturated fats.

So, let’s look at the other side of the equation – how much you can reduce your risk of heart disease by eating a healthier diet. In a recent issue of “Health Tips From The Professor”, I reviewed a meta-analysis published in 2022 that looked at 99 clinical studies with tens of thousands of participants that measured the associations between foods or food groups and heart disease risk.

That study reported that:

  • Processed Meat: A single serving of processed meat increased heart disease risk by 27% to 44%.
  • Red Meat: Unprocessed red meat increased heart disease risk by as much as 27% – but only at ≥3 servings per day. The results with lower intakes were inconsistent – some studies showed increased risk, but others did not.
  • Poultry, Eggs, and Dairy Foods: They did not appear to affect heart disease risk.
  • Fish: Two to four servings per week of fatty fish decreased heart disease risk by around 12%.
  • Fruit: Two servings per day of fruit reduced heart disease risk by 21-32%.Vegan Foods
  • Vegetables: Two servings of vegetables per day reduced heart disease risk by 18-21%.
  • Legumes (beans and peas): Four servings per week reduced the risk of heart disease by around 14%.
  • Nuts: One serving (a handful) per day reduced the risk of heart disease by around 25%. 
  • Whole Grains: Two servings of whole grains per day reduced the risk of heart disease by 25%-34%.
  • Overall: When heart-healthy foods were consumed as part of the Mediterranean diet heart disease risk was reduced by 47%. Similar overall reductions in heart disease risk are likely with other heart-healthy diets like DASH, MIND, Flexitarian (flexible semi-vegetarian), and vegan diets.

In summary:

  • The first study shows that eliminating ultra-processed foods (junk and convenience foods) from your diet can decrease heart disease risk by 47% – but doesn’t tell us what the ultra-processed foods were replaced with. And it would take a much larger study to determine which food swaps were most effective at reducing heart disease risk.
  • The second study was a meta-analysis that told us that eating more fish and plant foods in the context of a heart-healthy diet can decrease your risk of heart disease by 47% – but doesn’t tell us what those healthy foods were replacing. And many of the individual studies included in the meta-analysis were conducted when ultra-processed food consumption was much less than it is today.

It would be tempting to add 47% plus 47% and conclude that eliminating ultra-processed food consumption and replacing ultra-processed foods with heart-healthy foods could decrease your risk of heart disease by 94%. But it’s not that simple. There are too many unanswered questions from these studies.

But it is safe to say that if we eliminated ultra-processed foods AND replaced them with heart-healthy foods in the context of a heart-healthy diet, we should be able to reduce our heart disease risk by more than 47% – perhaps much more.

What Do These Studies Mean For You?

There are two important lessons from these studies:

#1: Eliminating ultra-processed foods from your diet will significantly decrease your risk of heart disease.

And it isn’t just heart disease. Other recent studies have shown that eliminating ultra-processed foods from your diet helps you:

  • Control your weight (It is perhaps the most important lifestyle change to make if you want to maintain GLP-1-aided weight loss).
  • Reduce your risk of cancer.
  • Reduce your risk of diabetes.
  • Reduce your risk of inflammatory diseases.
  • Reduce anxiety and depression.
  • Increase your healthspan (your healthy years).

In short, ultra-processed foods are killers.

#2: Replacing ultra-processed foods with heart-healthy foods (fruits, vegetables, legumes, nuts, whole grains, and fish) in the context of a healthy diet (Mediterranean, DASH, MIND, Flexitarian, and vegan, for example) is likely to decrease your risk of heart disease even more.

  • And if your diet consists of mostly heart-healthy foods, you can add moderate amounts of heart-neutral foods (poultry, eggs, and dairy).
  • And the latest evidence suggests that you can even add small amounts of red meat in the context of a heart-healthy diet (As I have said in previous issues of “Health Tips From the Professor”, plant foods contain the antidotes to all the bad things about red meat.)

Finally, you might ask why I emphasize both heart-healthy foods and heart-healthy diets. There are two reasons:

  • Most of us think in terms of foods rather than diets.
  • The food industry is only too happy to provide us with ultra-processed foods for “heart-healthy” diets like the vegan and Mediterranean diet.

The Bottom Line

Two recent studies have shown how each of us can dramatically reduce our risk of heart disease.

  • The first study showed that eliminating ultra-processed foods from our diet can significantly decrease our heart disease risk – but didn’t tell us what the ultra-processed foods were replaced with.
  • The second study showed that eating more heart-healthy foods in the context of a heart-healthy diet can significantly decrease our risk of heart disease – but didn’t tell us what those healthy foods were replacing.

Taken together, those studies show us a clear path for dramatically decreasing our heart disease risk.

For more details about these studies and what they mean for you, read the article above.

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

 _____________________________________________________________________________

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

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

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

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

_______________________________________________________________________

About The Author 

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years.  Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”.

Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com.

For the past 45 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

 

Do Eggs Prevent Cognitive Decline?

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Are Eggs Brain Food?

Author: Dr. Stephen Chaney 

VillainFor much of the past 10 or 20 years, eggs have villainized. We were told that their high cholesterol levels would clog our arteries and increase our risk of heart attack and stroke.

We were told to eat egg whites, egg substitutes (even though egg substitutes were a witch’s brew of chemicals), or avoid eggs altogether.

But in recent years, the ground has shifted.

  • Cholesterol is no longer viewed as the demon it once was. It is now thought of as more of a bit player in a cast of dozens of factors contributing to increased risk of heart disease and stroke.

And when it comes to increased risk of heart disease, the AHA (American Heart Association) position on egg consumption and heart disease risk has shifted dramatically. They now recommend:

  • “Healthy adults can eat up to one whole egg per day as part of a heart-healthy diet.”
  • Diet context is very important. The AHA recommends:
    • “Eggs should not be paired with high-saturated fat foods like bacon, sausage, or butter. Instead, they should be poached, soft-boiled, or cooked in healthy fats like olive oil.”
    • I would add that recent studies have shown that if you are consuming a whole-food, primarily plant-based diet, consuming one or two eggs per day actually decreases your risk of heart disease.
  • Your body’s ability to regulate cholesterol levels is also important. For that reason, the AHA recommends:
    • “Individuals with diabetes, high blood cholesterol, or existing heart disease should be more cautious…limiting yolk consumption to 4 per week…[I would add obesity to this list].”

For more information on the studies behind these recommendations, go to https://www.chaneyhealth.com/healthtips/ and put eggs in the search box.

Are Eggs Brain Food?

There are lots of reasons to think of eggs as brain food. The authors of the study I am about to share observed:

  • “Eggs are a good source of protein (6.29 gram/medium egg), which has been linked to improved memory and reaction time in healthy young adults and reduced risk of cognitive impairment in older adults.”
  • “Egg protein is a good source of the essential amino acid tryptophan (77 mg per egg), which is converted to the neurotransmitter serotonin, involved in decision-making and memory.”
  • “Egg yolks are a good source of choline (150 mg per egg), which is a precursor to acetylcholine, a neurotransmitter involved in memory and learning. The authors went on to say, “Choline intake between 187 mg and 399 mg per day has consistently been associated with improved cognitive performance for both healthy younger and older adults.
  • “Egg yolks are also a good source of phospholipids (3.3 gm per egg), which are an important part of nerve membranes. Phospholipids modulate neurotransmitter receptors and have been linked to enhanced reaction time in healthy middle-aged men.”
  • “Egg yolks are a good source of DHA (between 25 to 50 mg DHA for commercially produced eggs and 100-150 mg of DHA for pasture-raised eggs) which has been associated with a lower risk of dementia.”

In short, there are lots of reasons to think that eggs might be good for the brain and might reduce the risk of age-related cognitive decline.

So, the authors of this study (N Sultan et al, Journal of Nutrition, Health, and Aging, 29, 100696, 2025) decided to conduct a systematic review of existing studies to evaluate the association between whole egg consumption and cognitive decline in healthy adults.

How Was The Study Done?

clinical studyThe authors set out to create a systematic review of studies looking at the effect of egg consumption on cognitive decline in older adults. This was not an easy undertaking because:

  • Most published studies in this area have looked at the effect of diets (e.g. MIND or Mediterranean diets) on cognitive decline rather than the effect of individual foods.
  • There are many ways to measure cognitive function, and no two studies used the same measures of cognitive function.

The authors utilized the top 5 databases of clinical studies and identified 10 studies with a total of >38,000 participants that investigated the effect of whole egg consumption on cognitive outcomes in healthy, older adults (average age = 68, 50% female).

Because the studies used different measures of cognitive function, the outcomes were divided into the following cognitive domains:

  • Global cognitive functioning.
  • Language functioning.
  • Verbal learning.
  • Memory.
  • Processing speed.
  • Decision-making.
  • Attention.
  • Executive function.
  • Risk-taking.
  • Reaction time.
  • Visuospacial ability.
  • Orientation.
  • Cognitive flexibility.
  • Interoception.

From these individual domains an overall cognitive function score was derived.

Do Eggs Prevent Cognitive Decline?

Memory loss due to Dementia and Alzheimer’s disease with the medical icon of a tree in the shape of a human head and brain losing leaves.

This is what the authors reported:

  • Two studies reported a reduced risk of dementia or cognitive impairment associated with moderate egg consumption (0.5-1 egg per day).
  • One study reported increased risk at high intake levels (> 1 egg per day).
  • Several studies showed improvements in memory, verbal fluency, and/or processing speed with moderate, but not high, egg intake.

The authors concluded, “This systematic review identified preliminary observational evidence that moderate habitual egg consumption may be associated with better cognitive performance, particularly in memory and verbal fluency domains, and reduced risk of cognitive impairment in adults without chronic disease…Further rigorous studies are required to determine whether egg consumption contributes to cognitive resilience and to clarify dose-response relationships. These efforts will help determine whether eggs can be recommended as part of evidence-based dietary strategies to support cognitive function in aging populations.”

As the authors said, this is not a definitive study. It is a preliminary study that lays the groundwork for future definitive studies. As someone who had dozens of publicly funded grants during my research career, I can tell you that publications like this are important, because they can be used to support requests for public funding of future research projects on that topic.

What kind of future research projects would be definitive? The authors said:

  • “Further rigorous studies are required to determine whether egg consumption contributes to cognitive resilience [as we age] and to clarify dose-response relationships.” Ideally these studies would:
    • Be designed to test the dose-response relationship.
    • Use similar measurement of cognitive function, so the study results would be easy to compare.
    • Look at diet context. For example, do eggs have the same cognitive benefits in whole food, primarily plant-based diets and diets that are high in saturated fats and processed foods?
    • Look at the effect of health status. Cholesterol build up can block arteries leading to the brain. Studies on heart health have shown eggs may not be beneficial for people who already have elevated cholesterol, diabetes, and arterial disease.

What Does This Study Mean For You? 

questionsHere are my thoughts:

  • As I outlined above, there are lots of reasons to think of eggs as brain food.
  • Moderate egg consumption may help protect against cognitive decline as we age. The current data are suggestive, but not definitive.
  • The American Heart Association now says that moderate egg consumption can be part of a heart-healthy diet. So, the major reason for avoiding eggs has been removed.
  • Egg consumption is likely to be most beneficial as part of a whole food, primarily plant-based diet. When I grew up Alabama a normal breakfast was eggs cooked in butter, sausage, grits and “red-eye gravy” (gravy made from ham fat). To say that it was probably not a brain-healthy way to eat eggs would be an understatement.
  • If you are already struggling with high cholesterol, diabetes and arterial disease, you should probably consult your doctor before increasing your egg consumption.

What Does A Brain-Healthy Diet Look Like? 

According to the most recent US News & World Health ratings of the best diets in various categories, the top 4 diets for brain health are:

  • MIND diet (The MIND diet combines the best of the Mediterranean and DASH diets with an emphasis on brain healthy foods such as berries.)
  • Mediterranean diet.
  • Flexitarian diet (a flexible version of a semi-vegetarian diet).
  • DASH diet.

My Comments:

  • All four diets are whole food, primarily plant-based diets.
  • Although the MIND diet was specifically designed for brain health, it does not perform significantly better than the Mediterranean and DASH diets in slowing cognitive decline.

Of course, most people prefer to think in terms of foods rather than diets. In terms of brain-healthy foods, a recent Harvard Health Review suggests these are the foods we should emphasize for brain health:

  • Green Leafy Vegetables: Kale, spinach, broccoli, and collards are rich in brain-healthy nutrients like vitamin K, lutein, folate, and beta-carotene.
  • Fatty Fish: Salmon, trout, sardines, and mackerel provide omega-3 fatty acids, which are crucial for brain function and for reducing dementia risk.
  • Berries: Blueberries, strawberries, and blackberries contain antioxidants that have been shown to delay cognitive decline.
  • Nuts and Seeds: Walnuts are high in omega-3 fatty acids (ALA), while others provide vitamin E.
  • Healthy Fats: Olive oil is recommended as the primary cooking fat.
  • Whole Grains and Legumes: Oats, quinoa, beans, and lentils provide a steady, slow release of glucose for brain energy. Plus, their fiber supports the growth of friendly bacteria that produce brain-healthy nutrients (This is sometimes referred to as the gut-brain axis).
  • Other Foods: Avocados (monounsaturated fats), beets (nitrates for blood flow), and cocoa (flavonoids) are beneficial.

My Comment:

  • Based on their nutrient content and studies like this one, I would add eggs (consumed in moderation) to the list.

The Bottom Line 

There are lots of reasons to think of eggs as brain food. A recent study suggests that moderate egg consumption may help slow cognitive decline as we age.

For more information on this study and what a brain-healthy diet looks like, read the article above.

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

_____________________________________________________________________________

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

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

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

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

___________________________________________________________________________

About The Author 

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years.

Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”.

Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com.

For the past 54 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

 

 

Which Diets Were Best In 2025?

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Which Diet Should You Choose For Good Health?

Author: Dr. Stephen Chaney

Question MarkMany of you started 2026 with goals of losing weight and/or improving your health. In many cases, that involved choosing a new diet.

And for many of you the “bloom” has already gone off the new diet you started so enthusiastically January 1st.

  • 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 January 1st…
  • 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. For 15 consecutive years US News & World Report has invited a panel of experts with different points of view to evaluate popular diets. They then combined the input from all the experts into rankings of the diets in various categories.

They did not rank diets this year but said that little has changed since their last rankings in 2025.

If you are still searching for your ideal diet, I will summarize the US News & World Report’s “Best Diets In 2026”. For the full report, click on this link.

How Was This Report Created?

Scientists-ConversingUS News & World Report recruited panel of 69 nationally recognized experts in diet, nutrition, obesity, food psychology, diabetes, and heart disease to review the most popular diets. This year they reviewed 38 diets in 21 different categories based on the most common reasons for choosing a specific diet.

Of course, fad diets come and go. Each year they drop diets that are no longer popular and add ones that are either new or have recently surged in popularity.

The panel rated diets based on:

  • Nutritional Completeness: The best diets include a variety of nutrient-dense foods that provide essential carbohydrates, protein, healthy fats, vitamins, and minerals.
  • Health Benefits and Risks: These diets are evidenced-based, promote health benefits, reduce disease risks, and focus on high-fiber, nutrient-rich, and antioxidant-packed foods.
  • Proven and Sustainable: These diets are supported by a large body of evidence that they protect against chronic disease and promote a long, healthy life. These diets also provide clear guidelines on what to eat more of and what to eat less of while allowing flexibility to suit personal preferences, including flavors, cultural cuisines and budget. Because these diets are adaptable, they are more sustainable in the long run and less likely to promote a rigid eating approach.

US News & World Report converted the experts’ ratings to scores 5 (highest) to 1 (lowest). They then used these scores to construct 21 categories of Best Diets rankings. I have included the following 8 categories in this Health Tips Blog.

  • 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 plans emphasizing minimally processed foods from plants that were included in this year’s ratings.
  • Best Healthy Weight-Loss Diet ratings were generated by combining the safety of the weight loss program 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 Inflammation were diets of whole, minimally processed foods like vegetables, fruits, whole grains, healthy fats, nuts, seeds, beans, fatty fish and lean proteins that have been shown to decrease inflammation. 
  • 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.

Which Diets Were Worst In 2025?

Emoticon-BadI did not include the worst diets in each category I listed below, but the US News & World Report article gave clear guidelines on what to avoid when choosing a healthy diet. In their words:

  • Avoid processed foods and sugary snacks: Sure, they taste great, but these can leave you with energy crashes and cravings that lead to overeating.
  • Watch out for “diet” foods: Just because something says “low-fat” or “diet” doesn’t mean it’s healthy. These foods often have added sugars or artificial ingredients. It is worth checking the label.
  • Skip extreme restrictions: Cutting out entire food groups or drastically slashing calories might work short term, but it’s hard to stick with and usually leads to burnout or regaining weight.
  • Focus on progress, not perfection: The best weight-loss strategies are about balance and flexibility, not rigid rules. Life happens, so it’s better to aim for consistency over time than to stick to an overly strict plan you can’t keep up with.
  • Focus on lifestyle change, not a quick fix: Healthy weight loss isn’t about quick fixes. It’s about building a lifestyle you enjoy and change sustain. Small changes, like adding more veggies to your meals or choosing water rather than sodas, may not seem like much, but they add up to lasting results over time.
  • Consistency over time beats perfection: An occasional slice of cake or pizza with friends won’t ruin your progress.

Which Diets Were Best In 2025?

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. Below I have listed the top 5 diets in each of the 8 categories I have chosen (If your favorite diet is not on the list and you would like to see where it is ranked, you will need to subscribe to US News & World Report).

Finally, I have excluded commercial diets from this review. I have focused on whole food diets based on foods you can easily find in your local grocery store or farmer’s market.

Best Diets Overall

The best overall diets were:

#1: Mediterranean Diet. The Mediterranean diet has been ranked #1 for 10 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 (A combination of the Mediterranean and DASH diets with foods selected that support brain health).

#5: The Mayo Clinic Diet (A 12-week program based on evidence-based behavioral science to establish life-long healthy eating habits).

Best Plant-Based Diets 

plant-based diets vegetablesThe top diets in this category were:

#1: Flexitarian Diet.

#2: Mediterranean Diet.

#3: Vegan Diet (a plant-based diet that eliminates all animal products).

#4: MIND Diet

#5: Ornish Diet (A low-fat, plant-based diet designed by Dr. Dean Ornish as part of a heart-healthy lifestyle program that has successfully reversed atherosclerotic buildup in some patients).

Best Healthy Weight-Loss Diets

The top diets in this category are proven. They are associated with lower weight and a reduced risk of chronic Weight Lossdiseases in long-term clinical studies. The top diets are:

#1: Mediterranean Diet

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

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

#4: Flexitarian Diet.

#5: DASH Diet.

Best Fast Weight-Loss Diets

weight lossOnce again, the report emphasized the dangers of quick weight loss diets. If you choose one of these diets to achieve a quick weight loss goal, the authors recommend you use these diets as a stepping stone toward a healthier lifestyle rather than a final solution.

Here are the rapid weight loss ratings:

#1: Keto Diet (A very low carb, high fat diet designed to produce ketosis in your body).

#2: South Beach Diet (A low carb, high protein approach to weight loss).

#3 Atkins Diet (The grandfather of the keto diet).

#4: Volumetrics Diet.

#5: Keyto Diet (A low-carb version of the Mediterranean diet).

Best Diabetes Diets

The key criteria for the best diabetes diets were that they were well-balanced, healthy diets that were designed to Diabetes and healthy diekeep glucose levels within the normal range throughout the day.

They are whole food diets that cut back on added sugars and refined carbs. The top diets in this category are: 

#1: Mediterranean Diet

#2: Flexitarian Diet

#3: MIND Diet

#4: DASH Diet.

#5: Mayo Clinic Diet.

#7: Vegan Diet.

Best Heart-Healthy Diets

strong heartThe top diets in this category were:

#1: DASH Diet

#2: Mediterranean Diet

#3: MIND Diet.

#4: Vegan Diet.

#5: Flexitarian Diet.

#6: TLC Diet. (The TLC (Therapeutic Lifestyle Change) diet was designed by the NIH to lower LDL cholesterol levels naturally.

Best Diets for Inflammation

The top diets in this category are:Flames

#1: Mediterranean Diet.

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

#3: Flexitarian Diet.

#4: DASH Diet.

#5: MIND Diet.

#7: Vegan Diet.

Easiest Diets to Follow

EasyThe authors of this report considered easy diets to be ones that:

  • Fit into your lifestyle, letting you enjoy indulgences while still being wholesome and nutritious – whether you’re eating out or at home. They focus on building long-term habits, not quick fixes, making them easier to stick with daily.
  • Focus on filling, tasty meals instead of strict restrictions.

They only listed four diets that were healthy, based on whole foods that were readily available, offered easy to follow recipes, and fit the criteria listed above.

#1: Mediterranean Diet (For those who enjoy Mediterranean foods).

#2: Flexitarian Diet (For those who enjoy flexible, semi-vegetarian meals).

#3: DASH Diet (For those who prefer American foods).

#4: MIND Diet (For those who could go either Mediterranean or American and are concerned with brain health).

Which Diet Should You Choose For Weight Loss?

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

  • In previous year’s evaluations 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.
  • 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.

2) If you are looking for healthy weight loss or just a healthy diet, the Mediterranean diet tops the list year after year, followed closely by the DASH, MIND, and flexitarian diets.

  • They are all whole food, primarily plant-based diets, that are backed by dozens of clinical studies showing that they are associated with a healthy weight and low risk of chronic disease long term.

Of course, GLP-1 drugs are the “elephant in the room” when we talk about weight loss. GLP-1 drugs work, but:

  • They are associated with concerning side effects such as:
    • Anxiety, depression, and suicidal thoughts. This is particularly concerning for anyone who has a tendency for anxiety or depression.
    • Muscle loss. This is particularly concerning for seniors who are already prone to age-related muscle loss.
    • Rarer side effects include increased risk of pancreatitis, kidney problems, and some cancers.
  • Unless they are coupled with dietary and lifestyle changes, their effects are temporary. The weight comes roaring back as soon as they are discontinued.
    • This is a concern because of their expense and side effects. Long-term use of these drugs:
      • Increases the cost of healthcare which increases health insurance costs for all of us (a topic which is in the news lately).
      • Increase the risk of side effects.

Which Diet Should You Choose For Good Health?

Food ChoicesWith rapid weight loss out of the way, let’s get back to the question, “Which Diet Should You Choose For Good Health?”

The Mediterranean diet tops the list year after year, followed closely by the DASH, MIND, and Flexitarian diets. But how do you choose between them? 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. 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.

4) 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 America’s favorite foods such as 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 according to individual health goals. In the article above I summarize the US News & World Report’s “Best Diets In 2025”.

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

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

  • If you are looking for rapid weight loss, any whole food restrictive diet will do. The Keto diet tops this list but ranks near the bottom of the healthy diet categories.
  • If you are looking for healthy, long-term weight loss the Mediterranean diets tops the list followed by the Volumetrics, Mayo Clinic, Flexitarian, and DASH diets.

#2: Which diet should you choose for good health? Once again, the Mediterranean diet tops the list followed by the DASH, Flexitarian, MIND, and Mayo Clinic diets. The Vegan diet is the top 10 of most healthy diet lists, while the keto diet is near the bottom.

For more details on 2026 US News & World Report on Best Diets and my advice on how to choose a healthy 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.

_______________________________________________________________________________

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

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

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

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

 _______________________________________________________________________

About The Author 

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years.

Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”.

Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com.

For the past 54 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

 

 

What Diet Is Best For Healthy Aging?

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What About Primarily Meat-Based Diets?

Author: Dr. Stephen Chaney

Pinochio

It’s so confusing. Everyone claims they have clinical proof that their diet is the best. You will be healthier and live longer.

But the diets are so different. They range from vegan to keto. They can’t all be equally healthy. What is the truth?

To answer that question, we first need to understand how the proponents of each diet can claim theirs is the perfect diet for health and longevity. It’s because they base their claims on:

  • Short-term studies. Most of their claims are based on studies that range from a few weeks to a few months. You need 20- or 30-year studies to measure the effects of a particular diet on health outcomes.
  • Biological markers (Things like cholesterol and triglyceride levels, blood sugar control, and/or inflammation). Biological markers can predict possible health outcomes. But without long-term studies on actual health outcomes, you don’t know whether those predictions are accurate.
  • Comparisons with the typical American diet. Any diet looks good compared with the American diet.
  • Elimination of highly processed foods. While these diets emphasize different foods, they are all whole food diets. Again, any diet that eliminates processed foods is an improvement.
    • It doesn’t matter whether you restrict calories, restrict certain foods or food groups, or restrict the time you allow yourself to eat. You unconsciously eat less.
    • And when you eat less, you lose weight.
    • And when you lose weight, your cholesterol and triglyceride levels fall, your blood sugar control improves, and inflammation decreases.
    • That’s why short-term weight loss and improvement in biological markers are virtually identical with vegan and keto diets. Those diets are as different as any two diets could be. But they are both highly restrictive diets.

The take-home lesson is clear. Don’t be confused by claims based on short-term studies. What you should look for is:

  • Long-term studies (20 years or more)…
  • that look at the effect of diet on health outcomes, and…
  • do not compare their diet with the typical American diet.

When I first reviewed this topic 8 years ago, I could only find a few studies that met these criteria:

  • One study showed that people consuming primarily plant-based diets weighed less than people who consumed primarily meat-based diets for 20 years or more.
  • Other studies showed that people consuming primarily plant-based diets had a reduced risk of diabetes and heart disease compared to people consuming primarily meat-based diets for 20 years or more.

These are valuable observations, but they are limited. That’s why I was so excited when I came across a recent 30-year study (A-J Tessier et al, Nature Medicine, volume 31, pages 1644-1652, 2025) looking at the effect of 9 different diets on longevity and health outcomes. In short, this study looked at the effect of different diets on healthy aging.

How Was This Study Done?

Clinical StudyThe authors of this study used data from 105,015 participants in the Nurses’ Health Study (NHS) and Health Professionals Follow Up Study (HPFS). Both studies enrolled participants in 1986 and followed them through 2016. In short, they were both 30-year studies. Participants with preexisting chronic diseases were excluded from the study.

  • Lifestyle factors and medical histories were assessed every two years.
  • A detailed dietary assessment was conducted every four years. The assessments measured the intake of 152 foods. Food intakes were averaged over the duration of the study for each participant.

[Note: This study did not measure how the diets of participants changed between 1986 and 2016, although that is an interesting question. Perhaps a future study is planned.]

Based on the foods eaten, the diets of the participants were evaluated for adherence to 9 dietary patterns, which I have described in more detail below.

[Note: To be clear, the participants were not trying to follow these diets. They ate what they ate, and the investigators subsequently compared their dietary pattern with various healthy diets.]

For each of the diets included in this study, participants were divided into quintiles based on how closely their food intake adhered to the recommendations for that diet. Then the highest quintile was compared to the lowest quintile to determine how well that diet predicted “healthy aging” after a 30-year follow-up.

The term “healthy aging” was based on 5 criteria:

  • Longevity – achieving an age of 70 or more.
  • Absence of the top 11 major chronic diseases (cancer, diabetes, myocardial infarction (heart attack), coronary artery disease, congestive heart failure, stroke, Parkinson’s disease, multiple sclerosis, and ALS).
  • No impairment of cognitive function.
  • No impairment of physical health.
  • No mental health issues.

In other words, these were not just individuals who survived 70 years or more. They survived and thrived. They were enjoying their golden years because they still had good health and excellent quality of life.

Diets Included In This Study

The diets included in this study were:

  • AHEI – Alternative Healthy Eating Index (A scoring system developed by Harvard researchers to measure overall diet quality based on its ability to predict lower risks of heart attacks, strokes, and diabetes).
  • aMed – Alternative Mediterranean Diet Index (The aMed diet index differs from the original Med index by separating fruits and nuts into different groups, eliminating dairy, emphasizing whole grains, and excluding red and processed meats in favor of chicken and fish).
  • DASH – Dietary Approaches to Stop Hypertension (The name speaks for itself. But I also sometimes refer to this diet as “the Americanized version of the Mediterranean diet’ because it features foods more familiar to Americans. For example, it allows more red meat options than most of the other diets in this list.
  • MIND – Mediterranean-Dash intervention for Neurogenerative Delay (It is a dietary pattern designed to reduce the risk of Alzheimer’s disease and other forms of dementia. It combines elements of the Mediterranean and DASH diets but differs from both by emphasizing berries as a major fruit source, among other things.)
  • hPDI – Healthy Plant-Based Diet Index (It is a scoring system that measures adherence to a diet rich in healthy plant-based foods and lower consumption of less-healthy plant foods and animal foods.)
  • PHDI – Planetary Health Diet Index (It emphasizes foods (primarily plant foods) that are healthy and are good for the environment. Of the diets on this list, it is the most restrictive and closest to a vegan diet)
  • EDIH – Empirical Dietary Index For Hyperinsulinemia (It is a scoring system that measures the potential of a diet to cause chronically high insulin levels, which is associated with type 2 diabetes and certain cancers.)
  • EDIP – Empirical Dietary Inflammation Pattern (It is a scoring system that measures the inflammatory potential of a diet.)
  • UPF – Consumption of Ultraprocessed Foods (Since recent studies have shown that most Americans get between 55 and 70% of their calories from ultraprocessed foods, this is fast becoming a measure of the typical American diet.)

Note: Except for the UPF diet, these are all whole food, primarily plant-based diets.

What Diet Is Best For Healthy Aging?

Here are the results of the study (drum roll, please):

  • Of the 105,015 participants in this study, only 9.3% achieved healthy aging.
  • Adherence to any of the 8 healthy diets improved the probability of achieving healthy aging.
  • The odds of achieving healthy aging ranged from 1.45 for the Healthy Plant-Based Diet to 1.86 for the Alternative Healthy Eating Index.
  • If you were to pick one winner, it would be the Alternative Healthy Eating Index. And if you were to define healthy aging as achieving an age of 75 or more with the other 4 criteria, the odds increase to 2.24 (more than double) for the Alternative Healthy Eating Index.
  • As you might expect, adherence to a diet high in ultraprocessed foods had the opposite effect. It decreased the odds of achieving healthy aging by 32%.

When you look at each of the criteria for healthy aging individually, the results were a bit more nuanced:

  • For survival to 70+ years, the Alternative Healthy Eating Index and the Planetary Health Diet Index were tied. Both increased the odds of survival by more than 2-fold.
  • The Alternative Healthy Eating Index and the Planetary Health Diet Index were also tied for surviving to 70 with intake cognitive health and intact physical function.
  • The Empirical Dietary Index For Hyperinsulinemia edged out the Alternative Healthy Eating Index for freedom from 11 chronic diseases.

The effect of healthy diets on the odds of achieving healthy aging is independent from BMI, smoking, and physical activity. This means that:

  • The effects of healthy diets on healthy aging were not because people consuming healthy diets weighed less, smoked less, or exercised more.
  • Even if some of your lifestyle choices are suboptimal, choosing a healthy diet will increase your odds of surviving and thriving.

Finally, the study looked at the effects of individual foods on healthy aging. The results were:

  • Higher intakes of fruits, vegetables, whole grains, unsaturated fats, nuts, legumes, and low-fat dairy products increase your odds of healthy aging.
  • Higher intakes of trans fats, sodium, sugary beverages, and red or processed meats decrease your odds of achieving healthy aging.

The effects of these foods on healthy aging aren’t novel. They are consistent with dozens of other studies that have looked at the effect of individual foods on long-term health outcomes. In fact, the diets included in this study were chosen because they included foods that positively affect health outcomes and minimize foods that negatively affect health outcomes.

What About Primarily Meat-Based Diets?

the paleo dietI have good friends who advocate for primarily meat-based diets such as keto, paleo, and carnivore. I’m sure they are going to say, “This study is a sham. It only included primarily plant-based diets, so, of course, it is only going to show benefits for primarily plant-based diets.” I can hear their their questions now:

  • Why didn’t this study include any of the primarily meat-based diets? My answer is: “All the popular meat-based diets exclude one or more of the food groups associated with health and longevity and emphasize one or more of the food groups associated with a shorter, less healthy life. And these food associations are consistent among multiple long-term studies looking at the effect of various foods on health outcomes. 

The authors could have constructed a similar index for each of the popular meat-based diets. But they would have been the inverse of the plant-based diet indices because the foods included and excluded from plant-based and meat-based diets are opposite. Therefore, just like the UPF index, they would have been associated with a decreased probability of achieving healthy aging.”

  • Why did the scientists designing this study ignore the proven health benefits of primarily meat-based diets? My answer is: “The “proven benefits” of primarily meat-based diets are based on short-term studies showing the effects of those diets on biological markers. Long-term studies looking at health outcomes are lacking.”
  • But modern primarily meat-based diets are a special case because they limit carbohydrates and cause ketosis. Why weren’t they included in the study? My answer is: “The Atkins diet limits carbohydrates and causes ketosis. It has been around for more than 50 years. And, to my knowledge, there are no studies showing it is beneficial long term. If the Atkins diet cannot be shown to have long-term health benefits, it is unlikely that modern diets that mimic it are healthy long term.

What Does This Study Mean For You?

confusionThe answer is clear. If you want to survive and thrive in your 70s and beyond, choose a whole food, primarily plant-based diet.

If you want the absolute best diet, follow the Alternative Healthy Eating Index recommendations. There are many online resources to guide you.

However, any whole food, primarily plant-based diet will do. The ones with the most online resources are the Mediterranean, DASH, and MIND diets. Choose the one that best fits your food preferences and lifestyle.

If you want to go more vegetarian, the Healthy Plant-Based Diet is a bit easier than a strict vegan diet.

If you are concerned about the environment, the Planetary Diet is best for you.

If you have specific health issues like hypertension, diabetes, or inflammation, there are diets designed just for you.

And if following structured diets is not your style, just:

  • Eat more fruits, vegetables, whole grains, unsaturated fats, nuts, legumes, and low-fat dairy products.
  • Eat less trans fats, sodium, sugary beverages, and red or processed meats, and ultraprocessed foods.

Finally, even if some of your lifestyle choices are suboptimal, this study shows choosing a healthy diet will increase your odds of surviving to your 70s and thriving.

The Bottom Line

A recent 30-year study looked at the effect of 8 whole food, primarily plant-based diets on healthy aging defined as:

  • Achieving an age of 70 or more.
  • The absence of the top 11 major chronic diseases.
  • No impairment of cognitive function.
  • No impairment of physical health.
  • No mental health issues.

The key findings were:

  • Adherence to any of 8 whole food, primarily plant-based diets improved the probability of achieving healthy aging.
  • The odds of achieving healthy aging ranged from 1.45 for the Healthy Plant-Based Diet to 1.86 for the Alternative Healthy Eating Index.

For more information on this study, why primarily meat-based diets were not considered healthy enough to be included in this study, 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.

 ____________________________________________________________________________

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

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

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

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

 _______________________________________________________________________

About The Author 

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

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com.

For the past 53 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

 

 

The Low Carb Myth

by

The “Goldilocks Effect”

Author: Dr. Stephen Chaney

low carb dietThe low carb wars rage on. Low carb enthusiasts claim that low-carb diets are healthy. And they claim the lower you go, the healthier you will be. Let me start with some definitions:

  • The typical American diet is high carb. It gets about 55% of its calories from carbohydrates. [Note: The Mediterranean and DASH diets also get about 55% of their calories from carbohydrates. I’ll talk more about that later.]
  • Moderate carb diets get 26-46% of their calories from carbohydrates. Examples include the low carb Mediterranean diet and the Paleo, South Beach, and Zone diets.
  • Low carb diets get <26% of their calories from carbohydrates. The Atkins diet is the classic example of a low carb diet.
  • Very low carb diets get <10% of their calories from carbohydrates. Examples are the Keto and Carnivore diets.

And I don’t need to tell you that the Keto and Carnivore diets are receiving a lot of favorable press lately.

But some health experts warn that low carb and very low carb diets may be dangerous. For example, several studies have reported that low carb diets increase the risk of mortality (shorten lifespan).

As a consumer you are probably confused by the conflicting claims. Are low carb diets healthy, or is this another myth? In this issue of “Health Tips From the Professor” I am going to discuss two very large studies that came to opposite conclusions.

Both were what we call meta-analysis studies. Simply put, that means they combine the data from several smaller studies to obtain more statistically reliable data. But as Mark Twain said, “There are lies. There are damn lies. And then there are statistics.”

The first study, called the Prospective Urban Rural Epidemiology (PURE) study, was published a few years ago. It included data from 135,335 participants from 18 countries across 5 continents. That’s a very large study, and normally we expect very large studies to be accurate.

It showed a linear relationship between carbohydrate intake and mortality. Simply put, the more carbohydrate people consumed, the greater their risk of premature death. The results from the PURE study had low carb enthusiasts doing a victory lap and claiming it was time to rewrite nutritional guidelines to favor low carb diets.

SkepticWhenever controversies like this arise, reputable scientists are motivated to take another look at the question. They understand that all studies have their weaknesses and biases. So, they look at previous studies very carefully and try to design a study that eliminates the weaknesses and biases of those studies. Their goal is to design a stronger study that reconciles the differences between the previous studies.

And this study had two glaring weaknesses.

  • The percent carbohydrate intake ranged from 40% to 80%. It showed that a moderate carbohydrate intake might be healthier than a high carbohydrate intake, but it provided no information about low carb or very low carb diets.
  • The data was primarily from Asian countries. It was not clear whether it was relevant to the kind of diets consumed in North America and Europe.

A second study published a year later (SB Seidelmann et al, The Lancet, doi.org/10.1016/S2468-2667(18)30135-X) eliminated these weaknesses and resolved the conflicting data.

How Was The Second Study Done?

clinical studyThis study was performed in two parts. This first part drew on data from the Atherosclerosis Risk in Communities (ARIC) study. That study enrolled 15,428 men and women, aged 45-64, from four US communities between 1987 and 1989. This group was followed for an average of 25 years, during which time 6283 people died.

Carbohydrate intake was calculated based on food frequency questionnaires administered when participants enrolled in the study and again 6 years later. The study evaluated the association between carbohydrate intake and mortality.

The second part was a meta-analysis that combined the data from the ARIC study with all major clinical studies since 2007 that measured carbohydrate intake and mortality and lasted 5 years or more. The total number of participants included in this meta-analysis was 432,179, and it included data from previous studies that claimed low carbohydrate intake was associated with decreased mortality.

The Low Carb Myth

The results from the ARIC study were:

GravestoneThe relationship between mortality and carbohydrate intake was a U-shaped curve.

    • The lowest risk of death was observed with a moderate carbohydrate intake (50-55%). This is the intake recommended by current nutrition guidelines.
    • The highest risk of death was observed with a low carbohydrate intake (<20%).
    • The risk of death also increased with very high carbohydrate intake (>70%).
  • When the investigators used the mortality data to estimate life expectancy, they predicted a 50-year-old participant would have a projected life expectancy of:
    • 33.1 years if they had a moderate intake of carbohydrates.
    • 4 years less if they had a very low carbohydrate intake.
    • 1.1 year less if they had a very high carbohydrate intake.
  • And the risk associated with low carbohydrate intake was affected by what the carbohydrate was replaced with.
    • When carbohydrates were replaced with animal protein and animal fat there was an increased risk of mortality on a low-carb diet.

The animal-based low-carb diet contained more beef, pork, lamb, chicken, and fish. It was also higher in saturated fat.which low carb diets are healthy

    • When carbohydrates were replaced with plant protein and plant fats, there was a decreased risk of mortality on a low-carb diet. The plant-based low-carb diet contained more nuts, peanut butter, dark or whole grain breads, chocolate, and white bread. It was also higher in polyunsaturated fats.
  • The effect of carbohydrate intake on mortality was virtually the same for all-cause mortality, cardiovascular mortality, and non-cardiovascular mortality.
  • There was no significant effect of carbohydrate intake on long-term weight gain (another myth busted).

The results from the dueling meta-analyses were actually very similar in some respects. When the data from all studies were combined:

  • Very high carbohydrate diets were associated with increased mortality.
  • Meat-based low-carb diets increased mortality, and plant-based low-carb diets decreased mortality.
  • The results were the same for total mortality, cardiovascular mortality, and non-cardiovascular mortality.

The authors concluded: “Our findings suggest a negative long-term association between life-expectancy and both low carbohydrate and high carbohydrate diets…These data also provide further evidence that animal-based low carbohydrate diets should be discouraged.

Alternatively, when restricting carbohydrate intake, replacement of carbohydrates with predominantly plant-based fats and proteins could be considered as a long-term approach to healthy aging.”

Simply put, that means if a low carb diet works best for you, it is healthier to replace the carbs with plant-based fats and protein rather than animal-based fats and protein.

The “Goldilocks Effect”

Goldilocks EffectThis study also resolved the discrepancies between previous studies. The authors pointed out that the PURE study relied heavily on data from Asian and developing countries, and the average carbohydrate intake is very different in Europe and the US than in Asian and developing countries.

  • In the US and Europe mean carbohydrate intake is about 50% of calories and it ranges from 25% to 70% of calories. With that range of carbohydrate intake, it is possible to observe the increase in mortality associated with both very low and very high carbohydrate intakes.
  • The US and European countries are affluent, which means that low carb enthusiasts can also afford diets high in animal protein.
  • In contrast, white rice is a staple in Asian countries, and protein is a garnish rather than a main course. Consequently, overall carbohydrate intake is greater in Asian countries and very few Asians eat a truly low carbohydrate diet.
  • High protein foods tend to be more expensive than high carbohydrate foods. Thus, very few people in developing countries can afford to follow a very low carbohydrate diet, and overall carbohydrate intake also tends to be higher in those countries.

Therefore, in Asian and developing countries the average carbohydrate intake is greater (~61%) than in the US and Europe (~50%), and the range of carbohydrate intake is from 45% to 80% of calories instead of 25% to 70%. With this range of intake, it is only possible to see the increase in mortality associated with very high carbohydrate intake.ARIC Study

In fact, when the authors of the current study overlaid the data from the PURE study with their ARIC data, there was an almost perfect fit. The only difference was that their ARIC data covered both low and high carbohydrate intake while the PURE study touted by low carb enthusiasts only covered moderate to high carbohydrate intake.

[I have given you my rendition of the graph on the right. If you would like to see the data yourself, look at the paper.]

Basically, low carb advocates are telling you that diets with carbohydrate intakes of 26% or less are healthy based on studies that did not include carbohydrate intakes below 40%. That is misleading. The studies they quote are incapable of detecting the risks of low carbohydrate diets.

In short, the ARIC study finally answered the question, “How much carbohydrate should we be eating if we desire a long and healthy life?” The answer is “Enough”.

I call this “The Goldilocks Effect”. You may remember “Goldilocks And The Three Bears”. One bed was too hard. One bed was too soft. But one bed was “just right”. One bowl of porridge was too hot. One was two cold. But one was “just right”.

According to this study, the same is true for carbohydrate intake. High carbohydrate intake is unhealthy. Low carbohydrate intake is unhealthy. But moderate carbohydrate intake is “just right”.

What Does This Study Mean For You?

QuestionsThere are several important take-home lessons from this study:

1) All major studies agree that very high carbohydrate intake is unhealthy. In part, that reflects the fact that diets with high carbohydrate intake are likely to be high in sodas and sugary junk foods. It may also reflect the fact that diets which are high in carbohydrates are often low in plant protein or healthy fats or both.

2) All studies that cover the full range of carbohydrate intake agree that low and very low carbohydrate diets are also unhealthy. They shorten the life expectancy of a 50-year-old by about 4 years.

3) The studies quoted by low carb enthusiasts to support their claim that low-carb and very low carb diets are healthy don’t include carbohydrate intakes below 40%. That means their claims are misleading. The studies they quote are incapable of detecting the risks of low carbohydrate diets. Their claims are a myth.

4) Not all high carb diets are created equally. As I noted above, the Mediterranean and DASH diets are just as high in carbohydrates as the typical American diet, but their carbohydrates come from whole fruits and vegetables, whole grains, beans, nuts, and seeds. And multiple studies show that both diets are much healthier than the typical American diet.

5) Not all low carb diets are created equally. Meat-based low-carb diets decrease life expectancy compared to the typical American diets while plant-based low carb diets increase life expectancy.

6) The health risks of meat-based low-carb diets may be due to the saturated fat content or the heavy reliance on red meat. However, the risks are just as likely to be due to the foods these diets leave out – typically fruits, whole grains, legumes, and some vegetables.

7) Proponents of low-carb diets assume that you can make up for the missing nutrients by just taking multivitamins. However, each food group also provides a unique combination of phytonutrients and fibers. The fibers, in turn, influence your microbiome. Simply put, whenever you leave out whole food groups, you put your health at risk.

The Bottom Line

The low-carb wars are raging. Several studies have reported that low carb diets increase risk of mortality (shorten lifespan). However, a study published a few years ago came to the opposite conclusion. That study had low carb enthusiasts doing a victory lap and claiming it is time to rewrite nutritional guidelines to favor low-carb diets.

However, a study published a year later resolves the conflicting data and finally answers the question: “How much carbohydrate should we be eating if we desire a long and healthy life?” The answer is “Enough”.

I call this “The Goldilocks Effect”. According to this study, high carbohydrate intake is unhealthy. Low carbohydrate intake is unhealthy. But moderate carbohydrate intake is “just right”.

Specifically, this study reported:

  • Moderate carbohydrate intake (50-55%) is healthiest. This is the carbohydrate intake found in healthy diets like the Mediterranean and DASH diets, and is the intake recommended by current nutritional guidelines.
  • All major studies agree that very high carbohydrate intake (60-70%) is unhealthy. It shortens the life expectancy of a 50-year-old by about a year.
  • All studies that cover the full range of carbohydrate intake agree that low carbohydrate intake (<26%) is also unhealthy. It shortens the life expectancy of a 50-year-old by about 4 years.
  • The studies quoted by low carb enthusiasts to support their claim that low-carb diets are healthy don’t include carbohydrate intakes below 40%. That means their claims are misleading. The studies they quote are incapable of detecting the risks of low carbohydrate diets.
  • Meat-based low-carb diets decrease life expectancy while plant-based low carb diets increase life expectancy. This is consistent with the results of previous studies.

The authors concluded: “Our findings suggest a negative long-term association between life-expectancy and both low carbohydrate and high carbohydrate diets…These data also provide further evidence that animal-based low carbohydrate diets should be discouraged.”

Simply put, the latest study means that the supposed benefits of low carb diets are a myth.

For more details, read the article above.

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

___________________________________________________________________________

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

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

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

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

 ______________________________________________________________________

About The Author 

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

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com.

For the past 53 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

Are All Plant-Based Diets Healthy?

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Why Are Plant-Based Diets Healthy?

Author: Dr. Stephen Chaney

Unless you are like Rip van Winkle and have been asleep for the past 30 years, you have probably heard that plant-based diets are good for you. In fact, that advice is sound. It is based on multiple long-term studies.

But you may still be hesitant to make the switch. You are probably wondering if you have to be a vegan purist to benefit from a plant-based diet. If so, you are wondering whether you can make that drastic a change in your diet. Or, you may have already decided “that is a bridge too far” and don’t want to even consider it.

So, one important question is, “Do you have to go vegan to benefit from a plant-based diet?”

On the other hand, “Big Food, Inc” has made it easier than ever to switch to more “plant-based” eating. After all, sugar comes from plants. And highly processed grains come from plants. Add a few chemicals and you can come up with an endless supply of highly processed plant-based foods.

So, another important question is, “Can a diet of highly processed plant-based foods be as healthy as a diet of whole, unprocessed plant-foods?”

The study (Y. Wang et al., Nutrition Journal, 22: 46, 2023) I am reviewing today was designed to answer these two questions. It also represents the first meta-analysis to combine data from studies on the effects of plant-based diets on diabetes, heart disease, cancer, and mortality into a single study.

How Was The Study Done?

clinical studyThe investigators performed a meta-analysis of 76 studies with 2,230,443 participants that looked at the associations of plant-based dietary patterns and the incidence of type 2 diabetes, cardiovascular disease, cancer, and mortality among adults 18 years or older.

The characteristics of study participants ranged from:

  • 25 to 87 years old.
  • BMI of 20 to 30.

And the duration of the studies within the meta-analysis ranged from 2 to 36 years.

The adherence to plant-based diets was defined as higher consumption of plant-based foods and lower consumption or exclusion of animal-based foods.

The meta-analysis also included studies looking at the effect of changing from a more animal-based to a more plant-based dietary pattern.

The meta-analysis included studies looking at the benefit of vegan and vegetarian diets. In terms of participants these studies represented just over 50% of the data in the meta-analysis. So, this meta-analysis was ideally positioned to determine whether vegan and vegetarian diets were more beneficial than other primarily plant-based dietary patterns that included some animal foods.

The methodology used to classify diets as primarily plant-based varied from study to study. But in each case the study participants were divided into quartiles ranging from consuming the most plant-based diet to consuming the least plant-based diet.

The study then compared study participants with the highest adherence to plant-based diets to those with the lowest adherence to plant-based diets with respect to type 2 diabetes, cardiovascular disease, cancer, and mortality.

Finally, the study also compared adherence to healthy plant-based dietary patterns (whole or minimally processed fruits, vegetables, whole grains, beans, nuts, and seeds) to unhealthy plant-based dietary patterns (foods and drinks with added sugar, highly processed plant foods, and starchy vegetables).

Are Plant-Based Diets Healthy?

When comparing highest to lowest adherence to plant-based dietary patterns the risk of:

  • Type-2 diabetes was reduced by 18%.
  • Cardiovascular disease was reduced by 10%.
  • Cancer was reduced by 12%.
  • Mortality was reduced by 16%.

In short, all the news was good for primarily plant-based dietary patterns.

Are All Plant-Based Diets Healthy?

Increased adherence to a healthy plant-based dietary pattern (That term is defined in the methods section above) was associated with an even better reduction in disease risk. For example:

  • Type-2 diabetes was reduced by 21%.
  • Cardiovascular disease was reduced by 15%.
  • Cancer was reduced by 13%.
  • Mortality was reduced by 14%, which was statistically indistinguishable from the reduction in mortality associated with all plant-based dietary patterns above.

Factory FarmIn contrast, increased adherence to an unhealthy plant-based dietary pattern was associated with increased risks of disease. For example:

  • The risk of type 2 diabetes increased by 8%.
  • The risk of cardiovascular disease increased by 14%.
  • The risk of cancer increased by 7%.
  • The risk of mortality increased by 16%.

In short, plant-based dietary patterns consisting of whole or minimally processed plant foods are good for you. Plant-based dietary patterns consisting of highly processed plant foods are not.

Are Vegan and Vegetarian Diets More Beneficial Than Other Plant-Based Dietary Patterns?

Mediterranean Diet FoodsTwenty seven of the studies within this meta-analysis compared vegetarian or vegan dietary patterns with animal-based dietary patterns. These studies had 1,343,967 participants, which amounts to 57% of the participants in the meta-analysis.

Thus, this meta-analysis was well positioned to determine relative benefits of vegan and vegetarian diets compared to other primarily plant-based dietary patterns that include some animal foods. The investigators reported that:

  • The risk reduction for type 2 diabetes was greater in studies with vegan and vegetarian diets than in studies with other primarily plant-based diets.
  • No other statistically significant benefits were observed for vegan and vegetarian diets compared to other primarily plant-based diets.

In short, you don’t need to become a vegan to experience the health benefits of a plant-based diet.

In contrast, increased adherence to an unhealthy plant-based dietary pattern was associated with increased risks of disease. For example:

  • The risk of type 2 diabetes increased by 8%.
  • The risk of cardiovascular disease increased by 14%.
  • The risk of cancer increased by 7%.
  • The risk of mortality increased by 16%.

In short, plant-based dietary patterns consisting of whole or minimally processed plant foods are good for you. Plant-based dietary patterns consisting of highly processed plant foods are not.

What If You Change From An Animal-Based To A Plant-Based Diet?

Food ChoicesIf you have been consuming an animal-based diet for years, you may be wondering whether it is too late to change. Has the damage already been done?

Six studies within this meta-analysis examined the effect of changing from an animal-based diet to a plant-based diet on type 2 diabetes and mortality. Changing to a more plant-based dietary pattern:

  • Reduced diabetes by 17% and mortality by 5%.

In short, it’s never too late to switch to a more plant-based dietary pattern.

Why Are Plant-Based Diets Healthy?

The short answer is that we don’t know for sure, but the authors mentioned several popular hypotheses.

  • Obesity is a risk factor for type 2 diabetes, cardiovascular disease, and certain types of cancer. And studies have shown that people consuming plant-based diets tend to weigh less.
  • The increased fiber content and higher ratio of polyunsaturated fats to saturated fats lower cholesterol levels and improve blood lipid profiles, which are associated with a lower risk of cardiovascular disease.
  • Plant-based diets are anti-inflammatory, which reduces the risk of all three diseases.
  • Plant foods are rich in polyphenols and other phytonutrients that are associated with reduced risk of cardiovascular disease, lower blood pressure, and improvements in insulin sensitivity.
  • Plant foods are metabolized by gut bacteria to metabolites that are associated with reduced risk of type 2 diabetes and cardiovascular disease.
  • Plant foods support healthy gut bacteria associated with a reduced risk of several diseases.
  • Finally, plant-based dietary patterns are associated with no or reduced consumption of red and processed meats, which increase the risk of type 2 diabetes, cardiovascular disease, and certain types of cancer.

For a more detailed discussion read the article).

What Does This Study Mean For You?

The authors of this study concluded, “Higher adherence to plant-based dietary patterns, especially from healthy sources, may be universally beneficial for the primary prevention of type 2 diabetes, cardiovascular disease, cancer, and mortality. The current study provides further evidence in support of current recommendations that emphasize consuming high-quality plant-based foods for achieving optimal health.”

“Future studies are needed to elucidate…mechanistic pathways linking plant-based diets with multiple disease outcomes.”

I would just like to emphasize a few points:

  • These are all association studies. It takes decades for diseases like diabetes, heart disease, and cancer to develop. So, it is impossible to confirm these findings with double blind, placebo-controlled studies. However, when you have 76 studies with over 2 million participants all pointing to the same conclusion, it is hard to ignore the findings.
  • The good news is that you don’t have to become a vegan to experience these benefits. There are many healthy primarily plant-based diets available. Choose the one that best fits your food preferences and lifestyle.
  • Be aware that whatever diet you choose, Big Food Inc is only too happy to provide you with highly processed foods that fit that dietary pattern. Don’t fall for that trap. Stick with whole or minimally processed plant foods.
  • If your current diet isn’t the best, it is never too late to switch to a healthier primarily plant-based diet.

The Bottom Line

A recent meta-analysis of 76 studies with 2,230,443 participants looked at the associations of plant-based dietary patterns and the incidence of type 2 diabetes, cardiovascular disease, cancer, and mortality among adults 18 years or older.

The authors of the study concluded, “Higher adherence to plant-based dietary patterns, especially from healthy sources, may be universally beneficial for the primary prevention of type 2 diabetes, cardiovascular disease, cancer, and mortality. The current study provides further evidence in support of current recommendations that emphasize consuminh high-quality plant-based foods for achieving optimal health.”

Other key points from the study are:

  • These are all association studies. It takes decades for diseases like diabetes, heart disease, and cancer to develop. So, it is impossible to confirm these findings with double blind, placebo-controlled studies. However, when you have 76 studies with over 2 million participants all pointing to the same conclusion, it is hard to ignore the findings.
  • The good news is that you don’t have to become a vegan to experience these benefits. There are many healthy primarily plant-based diets available. Choose the one that best fits your food preferences and lifestyle.
  • Be aware that whatever diet you choose, Big Food Inc is only too happy to provide you with highly processed foods that fit that dietary pattern. Don’t fall for that trap. Stick with whole or minimally processed plant foods.
  • If your current diet isn’t the best, it is never too late to switch to a healthier primarily plant-based diet.

For more details about how the authors came to these conclusions and what they mean for you, read the article above.

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

_______________________________________________________________________________

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

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

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

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

 ______________________________________________________________________

About The Author 

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

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com.

For the past 45 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

Which Diets Are Best For The Planet?

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Which Diets Are Best For Your Health?

Author: Dr. Stephen Chaney

HotIs it hot enough yet? I’m not going to take a stand in the global warming debate. But I will say this summer has been extraordinarily hot – even for North Carolina.

So, what can we do about it? I will list some options below. But with “tongue in cheek” I will give voice to both sides of each option.

  • We can elect politicians of our choice and hope they have the wisdom to balance reductions in global warming with the energy needs of our country – but there has been little evidence of that wisdom from either end of the political spectrum.
  • We can purchase electric cars – despite their cost, limited range, and long refueling times.
  • We can recycle – even though most of what we recycle ends up in regular trash.
  • We can turn up our thermostats in summer and down in winter – and choose to swelter in summer and shiver in winter.
  • We can change our diet – but wait. Could this be a win no matter what our views are on climate change? Could the same diets that are better for the planet also be better for our health?

That is the hypothesis today’s study (K. O’Malley et al, The American Journal of Clinical Nutrition, 117: 701-708, 2023) set out to test.

How Was The Study Done?

clinical studyThe investigators analyzed 24-hour dietary recall data from 16,412 participants from the 2005 – 2010 NHANES survey. NHANES (National Health and Nutrition Examination Survey) is an ongoing, nationally representative, survey to measure the health and nutrition status of the US population. This investigation used data collected between 2005 and 2010.

The dietary data were used to categorize the intake of individual participants into different diets as follows:

  • Vegan – plant foods only.
  • Vegetarian – includes eggs and dairy but excludes meat.
  • Pescatarian – includes fish as the major source of meat.
  • Paleo – excludes grains, legumes, and dairy.
  • Keto – excludes grains, legumes, fruits, and starchy vegetables.
  • Omnivore – Any diet not included in the categories above.

The omnivore diet was further divided to identify people following the DASH and Mediterranean diets.

The environmental impact of each diet was calculated based on the amount of CO2 and methane produced in the production of the foods included in the diet.

The impact on our health of each diet was calculated based on the Alternative Healthy Eating Index.

  • The Healthy Eating Index was first developed in 1995 as tool to gauge how well a diet followed the Dietary Guidelines for Americans established by the Department of Health & Human Services and the USDA.
  • The Alternative Healthy Eating Index was first developed in 2002 to include a wider range of foods and to better predict the effect of diet on chronic diseases based on clinical studies of health outcomes.
  • Each of these indices are regularly updated as more data become available.

Which Diets Are Best For the Planet?

I have put the data in a graphical format, so it is easier to visualize.The vertical axis is greenhouse gas emissions expressed as kg of CO2 equivalents per 1,000 calories (The term CO2 equivalents is used because cows and sheep produce methane which is a much more potent greenhouse gas than CO2). Lower is better.

On the horizontal axis the diets from left to right are vegan, vegetarian, pescatarian, paleo, keto, omnivore, DASH, and Mediterranean. The diets with the least greenhouse gas emissions are shown in green (the greener the better), and the diets with the most greenhouse gas emissions are shown in orange and red.

Which Diets Are Best For Your Health?

Once again, I have chosen a graphical representation.

The vertical axis is the Alternative Healthy Eating Index. In this case, higher is better.

The color score is the same as above. However, I would note that:

  • Fish is the main animal protein source in the pescatarian diet. I suspect that the vegan and vegetarian diets would score just as high as the pescatarian diet in the Alternative Healthy Eating Index if an omega-3 supplement was taken along with the diets.
  • The Alternative Healthy Eating Index is weighted heavily on clinical studies showing that a particular diet reduces the risk of heart disease, diabetes, and/or cancer. That is likely why the DASH diet ranks so high. It was designed to decrease the risk of hypertension. Because of that there have been dozens of studies showing it reduces the risk of strokes and heart attacks.

The available evidence suggests that the Mediterranean diet is just as effective as the DASH diet at reducing the risk of strokes, heart attacks, and diabetes. But we do not yet have as many studies looking at the effect of the Mediterranean diet on those diseases. Based on the currently available evidence, I consider the Mediterranean diet to be just as healthy as the DASH diet.

Finally, I would like to point out the obvious. This and other studies show that the same diets that are good for the planet are good for our health.

For example, the authors estimated:

  • For any given day, if a third of omnivores in the United States switched to a vegetarian diet, it would be equivalent to eliminating 340 million passenger miles in gas-powered vehicles.
  • If this change were implemented year-round, it would amount to almost 5% of the reductions in greenhouse gas emissions needed to meet the original US targets in the Paris accords.
  • For those omnivores who made the switch to a vegetarian diet, it would improve diet quality by 6%.

Of course, if all omnivores in the United States switched to a vegetarian diet, these percentages would be tripled, but that is wildly unrealistic.

What Does This Study Mean For You?

Planetary DietThe take home lesson from this study is clear.

If your primary concern is climate change, choose the planet-healthy diet that best fits your food preferences and lifestyle. [The ones with the lowest greenhouse gas emissions are shown in green in the first graph above – the greener, the better.] Any of these diets will also be good for your health.

If your primary concern is health, choose the healthy diet that best fits your food preferences and lifestyle. [The ones with the highest Alternate Healthy Eating Index are shown in green in the second graph above – the greener, the better.] Any of these diets will also be good for the planet.

 

The Bottom Line

A recent study compared 8 popular diets (vegan, vegetarian, pescatarian, paleo, keto, omnivore, DASH, and Mediterranean) with respect to their impact on the environment and on your health.

The results were clear-cut. The diets that were best for the planet were best for your health and vice-versa.

For example, the authors estimated:

  • For any given day, if a third of omnivores in the United States switched to a vegetarian diet, it would be equivalent to eliminating 340 million passenger miles in gas-powered vehicles.
  • If this change were implemented year-round, it would amount to almost 5% of the reductions in greenhouse gas emissions needed to meet the original US targets in the Paris accords.
  • For those omnivores who made the switch to a vegetarian diet, it would improve diet quality by 6%.

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.

 ______________________________________________________________________________

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

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

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

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

 About The Author 

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

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com.

For the past 45 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

 

Which Diets Are Heart Healthy?

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What Does A Heart Healthy Diet Look Like?

Author: Dr. Stephen Chaney 

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

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

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

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

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

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

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

Why Are Americans Confused About Diet And Heart Disease Risk?

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

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

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

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

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

And, the words of the authors,

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

What Does A Heart Healthy Diet Look Like?

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

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

Here are my comments on these guidelines:

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

Which Diets Are Heart Healthy?

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

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

Here are the results:

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

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

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

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

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

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

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

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

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

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

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

The Bottom Line 

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

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

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

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

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

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

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

____________________________________________________________________________

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

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

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

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

Is Whole Fat Dairy Healthy?

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Is It Dairy Or Diet?

Author: Dr. Stephen Chaney 

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

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

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

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

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

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

How Was This Study Done?

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

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

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

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

This is different from most other healthy diet recommendations.

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

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

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

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

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

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

Is Whole Fat Dairy Healthy?

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

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

 

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

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

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

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

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

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

2) You don’t have to be perfect.

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

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

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

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

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

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

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

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

Is It Dairy Or Diet?

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

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

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

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

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

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

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

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

On the other hand,

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

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

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

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

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

The Bottom Line 

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

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

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

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

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

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

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

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

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

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

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

_________________________________________________________________________

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

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

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

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

Health Tips From The Professor