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Cardiometabolic Effects of Omnivorous vs Vegan Diets in Identical Twins: A Randomized Clinical Trial.
Landry, MJ, Ward, CP, Cunanan, KM, Durand, LR, Perelman, D, Robinson, JL, Hennings, T, Koh, L, Dant, C, Zeitlin, A, et al
JAMA network open. 2023;6(11):e2344457
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A vegan dietary pattern is typically lower in energy density but higher in fibre, vitamins, minerals, and phytonutrients compared with other dietary patterns. However, sometimes a vegan dietary pattern can limit specific nutrients, such as vitamin B12, iron, and calcium. In addition, a poorly formulated vegan diet can include low-quality plant foods, such as refined carbohydrates and added sugars. The aim of this study was to compare the cardiometabolic effects of a healthy vegan diet with a healthy omnivorous diet, exposing both groups to vegetables, legumes, fruits, whole grains, nuts, and seeds. This study was a single-site, parallel-group, dietary intervention randomised clinical trial which randomised healthy, adult identical twins to a healthy vegan or omnivorous diet for 8 weeks. Results showed that: - low-density lipoprotein was significantly lower for twins receiving the vegan diet compared with twins receiving the omnivorous diet. - insulin levels and weight were also significantly lower among the twins on the vegan diet from baseline to 8 weeks. - vegan-diet participants had total lower protein intake as a percentage of calories, lower dietary satisfaction, lower intake of dietary cholesterol, but higher intake of vegetable servings and intake of dietary iron. - vegans had lower intake of vitamin B12, yet serum vitamin B12 levels were not statistically different than omnivores at 8 weeks. Authors concluded that their findings show cardiometabolic advantages for the healthy vegan vs the healthy omnivorous diet among healthy, adult identical twins. Thus, clinicians may consider recommending plant-based diets to reduce cardiometabolic risk factors, as well as aligning with environmental benefits.
Abstract
IMPORTANCE Increasing evidence suggests that, compared with an omnivorous diet, a vegan diet confers potential cardiovascular benefits from improved diet quality (ie, higher consumption of vegetables, legumes, fruits, whole grains, nuts, and seeds). OBJECTIVE To compare the effects of a healthy vegan vs healthy omnivorous diet on cardiometabolic measures during an 8-week intervention. DESIGN, SETTING, AND PARTICIPANTS This single-center, population-based randomized clinical trial of 22 pairs of twins (N = 44) randomized participants to a vegan or omnivorous diet (1 twin per diet). Participant enrollment began March 28, 2022, and continued through May 5, 2022. The date of final follow-up data collection was July 20, 2022. This 8-week, open-label, parallel, dietary randomized clinical trial compared the health impact of a vegan diet vs an omnivorous diet in identical twins. Primary analysis included all available data. INTERVENTION Twin pairs were randomized to follow a healthy vegan diet or a healthy omnivorous diet for 8 weeks. Diet-specific meals were provided via a meal delivery service from baseline through week 4, and from weeks 5 to 8 participants prepared their own diet-appropriate meals and snacks. MAIN OUTCOMES AND MEASURES The primary outcome was difference in low-density lipoprotein cholesterol concentration from baseline to end point (week 8). Secondary outcome measures were changes in cardiometabolic factors (plasma lipids, glucose, and insulin levels and serum trimethylamine N-oxide level), plasma vitamin B12 level, and body weight. Exploratory measures were adherence to study diets, ease or difficulty in following the diets, participant energy levels, and sense of well-being. RESULTS A total of 22 pairs (N = 44) of twins (34 [77.3%] female; mean [SD] age, 39.6 [12.7] years; mean [SD] body mass index, 25.9 [4.7]) were enrolled in the study. After 8 weeks, compared with twins randomized to an omnivorous diet, the twins randomized to the vegan diet experienced significant mean (SD) decreases in low-density lipoprotein cholesterol concentration (-13.9 [5.8] mg/dL; 95% CI, -25.3 to -2.4 mg/dL), fasting insulin level (-2.9 [1.3] μIU/mL; 95% CI, -5.3 to -0.4 μIU/mL), and body weight (-1.9 [0.7] kg; 95% CI, -3.3 to -0.6 kg). CONCLUSIONS AND RELEVANCE In this randomized clinical trial of the cardiometabolic effects of omnivorous vs vegan diets in identical twins, the healthy vegan diet led to improved cardiometabolic outcomes compared with a healthy omnivorous diet. Clinicians can consider this dietary approach as a healthy alternative for their patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05297825.
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Micronutrients, Phytonutrients, and Mental Health
As the pioneer and global leader of Functional Medicine, the Institute of Functional Medicine leads and catalyses the efforts of a large and expanding Functional Medicine ecosystem, including providers, educators, payers, industry leaders, regulators, and influencers.
2022
Abstract
The IFM provides some food for thought around the topic of micronutrient deficiency in the population today and how this is having a detrimental impact on our mental health. The many avenues of micronutrient depletion are explored including stress and the link between the coronavirus pandemic and the rise in mental health issues across the globe. They shine a spotlight specifically on magnesium and B vitamins where low levels have been linked to increased risk of depression, plus the importance of anti-inflammatory dietary phytonutrients and antioxidants such as vitamins A, C, D and E which have been associated with reduced levels of stress, anxiety and depression. Besides the evidence for a varied and nutrient dense diet, we are reminded that strategies for managing stress should also be considered with respect to both the direct impact on our mental and physical health, and the risk of micronutrient depletion.
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The Functional Medicine Approach to COVID-19: Nutrition and Lifestyle Practices for Strengthening Host Defense.
Minich, DM, Hanaway, PJ
Integrative medicine (Encinitas, Calif.). 2020;19(Suppl 1):54-62
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Lifestyle interventions can be an effective means to help patients regain their locus of control during times of uncertainty like those experienced in a pandemic. The study is a review about emerging research focusing on nutrition and lifestyle practices for strengthening host defense. Research indicates that there are three mechanisms that may be involved in the ability of food-derived compounds to reduce viral infection and severity: a. balancing inflammatory pathways, b. reducing oxidative stress and increasing antioxidant levels, and c. harmonizing the gut microbiome. Clinical recommendations focus mainly on nutrition, stress reduction/management, sleep quality and quantity, physical activity programme and social factors/connections. Authors conclude by emphasising that the findings of this study are only intended to identify lifestyle practices that may boost the immune system as they have not been proven effective against COVID-19.
Abstract
The developing symptoms of COVID-19, as well as the progression of illness and fatality, are a clearly a function of the overall health status of the individual. Complex, chronic diseases such as obesity, hypertension, and diabetes are directly correlated with risk of disease severity and mortality. We explore lifestyle interventions that have specifically been demonstrated to strengthen host defense, reduce the probability and mitigate the severity of viral infection. Lifestyle interventions, from a Functional Medicine perspective, include nutrition, sleep, exercise, stress reduction, and connection. These factors, when in balance, provide a foundation for optimal health and immune function.
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Blueberries Improve Pain, Gait Performance, and Inflammation in Individuals with Symptomatic Knee Osteoarthritis.
Du, C, Smith, A, Avalos, M, South, S, Crabtree, K, Wang, W, Kwon, YH, Vijayagopal, P, Juma, S
Nutrients. 2019;11(2)
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Osteoarthritis (OA) is the most common joint disorder in the world. Inflammation is one of the major drivers of the progression of OA, which typically involves progressive loss of the structure and function of joint cartilage. Polyphenols, which are compounds found in plant foods such as spices, tea, dark chocolate and dark-coloured berries, have been studied for their anti-inflammatory properties. Blueberries are high in dietary polyphenols, so researchers proposed that the regular consumption of blueberries may help improve OA. The purpose of this randomised, double-blind trial was to examine the effect of freeze-dried whole blueberries on pain, inflammation and walking ability in people with knee OA. A group of adults aged 45 to 79 with knee OA, consumed either 40g freeze-dried blueberry powder or maltodextrin powder (placebo) daily for four months. Blood draws and assessment of pain and walking were conducted at baseline, two months, and four months. Pain, stiffness, and difficulty to perform daily activities improved significantly in the blueberry treatment group, with no change in the placebo group. Some measures of walking ability improved in the blueberry group. No statistically significant changes were observed in blood levels of inflammatory markers in either of the groups. However, an increasing trend for interleukin (IL)-13 concentration and a decreasing trend in monocyte chemoattractant protein-1 (MCP-1) concentration were seen in the blueberry group. The findings of this study suggest that daily incorporation of whole blueberries may reduce pain, stiffness, and difficulty to perform daily activities, while improving walking ability, and would therefore improve quality of life in individuals with knee OA.
Abstract
Osteoarthritis (OA) is the most common joint disorder in the world and is the most frequent cause of walking related disability among older adults in the US, which brings a significant economic burden and reduces quality of life. The initiation and development of OA typically involves degeneration or progressive loss of the structure and function of articular cartilage. Inflammation is one of the major drives of the progression of OA. Dietary polyphenols have been studied for their anti-inflammatory properties and potential anabolic effects on the cartilage cells. Blueberries are widely consumed and are high in dietary polyphenols, therefore regular consumption of blueberries may help improve OA. The purpose of the present study was to examine the effect of freeze dried whole blueberries on pain, gait performance, and inflammation in individuals with symptomatic knee OA. In a randomized, double-blind trial, adults age 45 to 79 with symptomatic knee OA, were randomized to either consume 40 g freeze-dried blueberry powder (n = 33) or placebo powder (n = 30) daily for four months. Blood draws and assessment of pain and gait were conducted at baseline, two months, and four months. Western Ontario McMaster Osteoarthritis Index (WOMAC) questionnaires were used to assess pain and GAITRite® electronic walkway was used to evaluate gait spatiotemporal parameters. WOMAC total score and sub-groups, including pain, stiffness, and difficulty to perform daily activities decreased significantly in the blueberry treatment group (p < 0.05), but improvement of WOMAC total score and difficulty to perform daily activities were not observed in the placebo group. Normal walking pace single support percentage for both limbs increased (p = or < 0.007), while double support percentage for both limbs decreased in the blueberry treatment group (p = or < 0.003). No significant changes were observed in plasma concentrations of tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6, IL-10, IL-13, matrix metalloproteinases (MMP)-3, MMP-13, and monocyte chemoattractant protein-1 (MCP-1) in both treatment groups. However, an increasing trend for IL-13 concentration and a decreasing trend in MCP-1 concentration were noted in the blueberry group. The findings of this study suggest that daily incorporation of whole blueberries may reduce pain, stiffness, and difficulty to perform daily activities, while improving gait performance, and would therefore improve quality of life in individuals with symptomatic knee OA.
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Bridging the Reciprocal Gap between Sleep and Fruit and Vegetable Consumption: A Review of the Evidence, Potential Mechanisms, Implications, and Directions for Future Work.
Noorwali, E, Hardie, L, Cade, J
Nutrients. 2019;11(6)
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Both sleep disruption and a low intake of fruit and vegetables (FV) are associated with higher rates of premature death and chronic disease. This review looked at previous studies in order to determine whether there is a link between sleep and FV consumption. A recent meta-analysis found that shorter sleep duration is consistently associated with low fruit and vegetable intake in children, but in adults the association is less clear. Studies looking at the effect of sleep on FV intake had variable results. Tart cherries and kiwi fruits were the most commonly studied fruits for their effect on sleep measures. Observational studies tended to find that both short- and long-sleepers tend to eat less FV than those that sleep for 7-8 hours. A lot of evidence shows that people who go to sleep later (‘owls’) tend to consume unhealthier diets with lower intakes of FV than people who go to bed earlier (‘larks’). The researchers also looked at potential mechanisms for the association between sleep and FV intake. Polyphenols in FV may influence sleep by increasing neurotransmitters via the gut-brain axis, improving energy metabolism and through alterations in circadian rhythms and the CLOCK genes. Ways in which disrupted sleep may affect FV consumption included changes in hunger hormones, emotional stress and impaired decision making. With further research, interactions between sleep measures and FV consumption may be clarified and potentially reduce the burden of chronic diseases and premature deaths.
Abstract
A substantial burden of disease and mortality globally is attributable to both sleep disruption and low intakes of fruit and vegetable (FV) and there is increasing mechanistic and epidemiological evidence to support a reciprocal relationship between the two. This review provides an overview of experimental and observational studies assessing the relations between sleep and FV consumption from 52 human adult studies. Experimental studies are currently limited and show inconsistent results. Observational studies support a non-linear association with adults sleeping the recommended 7-9 hours/day having the highest intakes of FV. The potential mechanisms linking sleep and FV consumption are highlighted. Disrupted sleep influences FV consumption through homeostatic and non-homeostatic mechanisms. Conversely, FV consumption may influence sleep through polyphenol content via several potential pathways. Few human experimental studies have examined the effects of FV items and their polyphenols on sleep and there is a need for more studies to address this. An appreciation of the relationship between sleep and FV consumption may help optimize sleep and FV consumption and may reduce the burden of chronic diseases. This review provides implications for public health and directions for future work.
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Phytochemicals in Skin Cancer Prevention and Treatment: An Updated Review.
Ng, CY, Yen, H, Hsiao, HY, Su, SC
International journal of molecular sciences. 2018;19(4)
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This 2018 review discusses the anti-oxidative, anti-inflammatory, anti-proliferative, and anti-angiogenic effects of phytochemicals for the management of skin cancer. Melanoma and non-melanoma skin cancers are caused by cellular DNA damage, and as the skin is the body’s largest organ, it is most exposed to environmental stimulus. There are several promising phytochemicals in cancer chemoprevention including Epigallocatechin-3-gallate, resveratrol, curcumin, proanthocyanidins, silymarin, apigenin, capsaicin, genistein, indole-3-carbinol, and luteolin. Additionally, Gingerol has been applied topically to improve chemical stability in the skin. Caffeic Acid Phenethyl Ester (CAPE) is derived from bee propolis was shown to inhibit skin papilloma in animal studies. Capsaicin from red chillies induced apoptosis (cell death) in melanoma cells. Curcumin has been shown to modify numerous inflammatory markers including C-reactive protein and COX-2 whilst topically can promote remarkable symptomatic relief and reduce external cancer lesion size. Caffeic Acid exerts a protective effect towards skin cancer migration and invasion. EGCG has been shown to sensitize melanoma cells to inhibit growth, promote cell death and decrease cell proliferation. Genistein from soy has been shown to exert anti-angiogenesis properties, reduce tumour proliferation and metastasis. Resveratrol has a synergistic effect with other phytochemicals to suppress tumours. What all the studies reviewed show is the potential for phytochemicals in cancer treatment. They are widely available, cost effective and highly tolerated. They appear to have anti-carcinogenic effects through regulation of multiple different signalling pathways which help alter the typical progression of skin cancer.
Abstract
Skin is the largest human organ, our protection against various environmental assaults and noxious agents. Accumulation of these stress events may lead to the formation of skin cancers, including both melanoma and non-melanoma skin cancers. Although modern targeted therapies have ameliorated the management of cutaneous malignancies, a safer, more affordable, and more effective strategy for chemoprevention and treatment is clearly needed for the improvement of skin cancer care. Phytochemicals are biologically active compounds derived from plants and herbal products. These agents appear to be beneficial in the battle against cancer as they exert anti-carcinogenic effects and are widely available, highly tolerated, and cost-effective. Evidence has indicated that the anti-carcinogenic properties of phytochemicals are due to their anti-oxidative, anti-inflammatory, anti-proliferative, and anti-angiogenic effects. In this review, we discuss the preventive potential, therapeutic effects, bioavailability, and structure-activity relationship of these selected phytochemicals for the management of skin cancers. The knowledge compiled here will provide clues for future investigations on novel oncostatic phytochemicals and additional anti-skin cancer mechanisms.
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Cardiovascular Health Benefits of Specific Vegetable Types: A Narrative Review.
Blekkenhorst, LC, Sim, M, Bondonno, CP, Bondonno, NP, Ward, NC, Prince, RL, Devine, A, Lewis, JR, Hodgson, JM
Nutrients. 2018;10(5)
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Diets high in vegetables are linked with a lower incidence of chronic disease. Some vegetables may have much larger health benefits in comparison to others, and therefore dietary guidelines could be developed to include targeted advice on consuming specific types of vegetables with the greatest health benefits. This review of observational studies focused on the cardiovascular health benefits of specific vegetable types. Vegetables discussed in this review were grouped into the following types: leafy green, cruciferous, alliums, yellow-orange-red and legumes. These vegetables contain many nutrients and phytochemicals that have been proposed to have benefits for cardiovascular health. The authors looked at the results from nearly 100 observational studies. Most of the studies were carried out on older adults; some were focussed on a single gender (male or female), and some were mixed. Follow up periods in the studies ranged from 3 years to 28 years. Most of the studies relied on food frequency questionnaires (FFQs) to estimate vegetable consumption, and many did not define the size of a vegetable portion in grams. The percentage of studies demonstrating significant benefits of vegetable consumption on CVD ranged from 25% for legumes to 43% for leafy greens. The strongest beneficial effects on CVD risk were seen for leafy green and cruciferous vegetables. The authors concluded that the evidence in this review suggests intake of leafy green and cruciferous vegetables may confer strong cardiovascular health benefits. Increasing vegetable intake, with a focus on leafy green and cruciferous vegetables may provide the greatest benefits.
Expert Review
Conflicts of interest:
Educator for various organizations, such as Institute for Functional Medicine, American Academy for Anti-Aging Medicine
Take Home Message:
- Green leafy vegetables and cruciferous vegetables were found to most impactful for cardiovascular health.
Evidence Category:
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A: Meta-analyses, position-stands, randomized-controlled trials (RCTs)
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B: Systematic reviews including RCTs of limited number
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C: Non-randomized trials, observational studies, narrative reviews
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D: Case-reports, evidence-based clinical findings
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E: Opinion piece, other
Summary Review:
This review highlights the role of specific types of vegetables based on color and nutrients for cardiovascular health benefit.
Clinical practice applications:
The authors investigated whether some vegetable types were more relevant for cardiovascular-related issues than others. Based on their review of the scientific literature, green, leafy vegetables and cruciferous vegetables were found to be most impactful.
Considerations for future research:
This review suggests that more research is needed to understand how certain plant foods, vegetables, and phytochemicals may be functionally important for certain organ systems.
Abstract
Adequate vegetable consumption is one of the cornerstones of a healthy diet. The recommendation to increase vegetable intake is part of most dietary guidelines. Despite widespread and long-running public health messages to increase vegetable intake, similar to other countries worldwide, less than 1 in 10 adult Australians manage to meet target advice. Dietary guidelines are predominantly based on studies linking diets high in vegetables with lower risk of chronic diseases. Identifying vegetables with the strongest health benefits and incorporating these into dietary recommendations may enhance public health initiatives around vegetable intake. These enhanced public health initiatives would be targeted at reducing the risk of chronic diseases, such as cardiovascular diseases (CVD). Specific vegetable types contain high levels of particular nutrients and phytochemicals linked with cardiovascular health benefits. However, it is not clear if increasing intake of these specific vegetable types will result in larger benefits on risk of chronic diseases. This review presents an overview of the evidence for the relationships of specific types of vegetables, including leafy green, cruciferous, allium, yellow-orange-red and legumes, with subclinical and clinical CVD outcomes in observational epidemiological studies.
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Vegetable Diversity, Injurious Falls, and Fracture Risk in Older Women: A Prospective Cohort Study.
Sim, M, Blekkenhorst, LC, Lewis, JR, Bondonno, CP, Devine, A, Zhu, K, Woodman, RJ, Prince, RL, Hodgson, JM
Nutrients. 2018;10(8)
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Vegetables contain a variety of nutrients and phytochemicals, with a range of health benefits. Previous research has linked higher vegetable consumption in older populations with a lower risk of falls. The importance of vegetable diversity (number of different vegetables consumed) for the risk of falling and fractures is unclear. The objective of this study was to examine the relationship between vegetable diversity with falls and fractures leading to hospitalisation in a prospective cohort of Australian women aged 70 years or over. Vegetable diversity was quantified by assessing the number of different vegetables consumed daily. Vegetable intake was estimated using a food frequency questionnaire at baseline in 1998. Over 14.5 years, injurious falls and fractures were captured using health records. Over 14.5 years of follow-up 39.7% of participants experienced an injurious fall. The percentage of women who experienced an injurious fall in the low (≤3/day), moderate (4/day) and high (≥5/day) vegetable diversity groups were 42.6%, 40.2%, and 36.6%, respectively. For each additional vegetable consumed, there was an 8% reduction in the risk of falls and a 9% reduction in the risk of fractures. The largest benefit of higher vegetable diversity were observed in the one third of women with the lowest vegetable intake (<2.2 servings/day). The authors concluded that increasing vegetable diversity, especially in older women with low vegetable intake, may be an effective way to reduce injurious fall and fracture risk.
Abstract
The importance of vegetable diversity for the risk of falling and fractures is unclear. Our objective was to examine the relationship between vegetable diversity with injurious falling and fractures leading to hospitalization in a prospective cohort of older Australian women (n = 1429, ≥70 years). Vegetable diversity was quantified by assessing the number of different vegetables consumed daily. Vegetable intake (75 g servings/day) was estimated using a validated food frequency questionnaire at baseline (1998). Over 14.5 years, injurious falls (events = 568, 39.7%), and fractures (events = 404, 28.3%) were captured using linked health records. In multivariable-adjusted Cox regression models, women with greater vegetable diversity (per increase in one different vegetable/day) had lower relative hazards for falls (8%; p = 0.02) and fractures (9%; p = 0.03). A significant interaction between daily vegetable diversity (number/day) and total vegetable intake (75 g servings/day) was observed for falls (pinteraction = 0.03) and fractures (pinteraction < 0.001). The largest benefit of higher vegetable diversity were observed in the one third of women with the lowest vegetable intake (<2.2 servings/day; falls HR 0.83 95% CI (0.71⁻0.98); fractures HR 0.74 95% CI (0.62⁻0.89)). Increasing vegetable diversity especially in older women with low vegetable intake may be an effective way to reduce injurious fall and fracture risk.
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Elderberry Supplementation Reduces Cold Duration and Symptoms in Air-Travellers: A Randomized, Double-Blind Placebo-Controlled Clinical Trial.
Tiralongo, E, Wee, SS, Lea, RA
Nutrients. 2016;8(4):182
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Long-haul air travel increases the occurrence of respiratory illnesses such as the common cold. Elderberries have anti-bacterial and anti-viral properties and previous studies have shown that an elderberry extract can reduce the duration and severity of cold and flu symptoms. This randomised controlled trial aimed to identify whether capsules containing a standardised elderberry extract are effective in preventing respiratory symptoms in travellers on long-haul flights. 325 healthy adults volunteered for the study. Participants were split into two groups: one group was given capsules each containing 300mg of Elderberry extract, and the other group was given placebo capsules. For both groups, participants were given 2 capsules a day for 10 days leading up to travelling, and 3 capsules a day during travel and for four to five days after reaching their destination. Participants completed health surveys 10 days and two days before travelling, and then again five days after. They also kept a daily diary of cold symptoms. Participants in both the placebo and elderberry group tended to experience an increase in respiratory symptoms after travelling. The elderberry group experienced less colds than the placebo group, although the difference was not statistically significant. Elderberry supplementation did however result in a reduction in symptoms, and shortened the cold duration by approximately two days compared to the placebo. The authors recommend that more clinical research with high quality elderberry preparations is carried out to better understand the health benefits of this traditional medicine.
Abstract
Intercontinental air travel can be stressful, especially for respiratory health. Elderberries have been used traditionally, and in some observational and clinical studies, as supportive agents against the common cold and influenza. This randomized, double-blind placebo-controlled clinical trial of 312 economy class passengers travelling from Australia to an overseas destination aimed to investigate if a standardised membrane filtered elderberry (Sambucus nigra L.) extract has beneficial effects on physical, especially respiratory, and mental health. Cold episodes, cold duration and symptoms were noted in a daily diary and assessed using the Jackson score. Participants also completed three surveys containing questions regarding upper respiratory symptoms (WURSS-21) and quality of life (SF-12) at baseline, just before travel and at 4-days after travel. Most cold episodes occurred in the placebo group (17 vs. 12), however the difference was not significant (p = 0.4). Placebo group participants had a significantly longer duration of cold episode days (117 vs. 57, p = 0.02) and the average symptom score over these days was also significantly higher (583 vs. 247, p = 0.05). These data suggest a significant reduction of cold duration and severity in air travelers. More research is warranted to confirm this effect and to evaluate elderberry's physical and mental health benefits.