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Vegetarian and Vegan Diet in Fibromyalgia: A Systematic Review.
Nadal-Nicolás, Y, Miralles-Amorós, L, Martínez-Olcina, M, Sánchez-Ortega, M, Mora, J, Martínez-Rodríguez, A
International journal of environmental research and public health. 2021;18(9)
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Fibromyalgia (FM) is a chronic non-degenerative disease of unknown etiology without effective medical treatment that mostly affects women. The aim of this study was to evaluate the efficacy of mainly plant-based diets in patients with FM compared to omnivorous diets. A secondary aim was to examine the main effects of these diets on patients’ symptoms and the improvement in their quality of life. This study is a systemic review of six studies (n = 4 clinical trials and n = 2 observational cohort studies). The selected studies included 157 FM patients in both the intervention and control groups, and more than 117 were women. Results indicate that a mainly plant-based diet improves biochemical parameters and body inflammation; body weight, sleep quality, quality of life, pain at rest as well as other symptoms of FM and their impact on health. Authors conclude that even though their findings are promising further well-designed clinical trials are needed to consolidate these dietary recommendations in FM patient.
Abstract
Fibromyalgia (FM) is a chronic non-degenerative disease characterized by the presence of multiple symptoms such as chronic pain, which negatively influence the quality of life of sufferers, most of whom are women. Currently, there is no effective treatment to limit the impact of these symptoms. The aim of this research is to review the scientific evidence on the effect of following a vegetarian or vegan diet on fibromyalgia patients. A systematic review included the original articles that answered the research question. These articles were in 2021 in the PubMed, Web of Science and Scopus databases. The research used the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. No time restriction was applied, and grey literature was not included. The evaluation of the methodological quality of the articles was carried out using the following different scales: STROBE (strengthening the reporting of observational studies in epidemiology), PEDro (Physiotherapy Evidence Database), and MMAT (Mixed Methods Appraisal Tool) scales. A total of 88 studies were analyzed, of which 6 investigations were included in this systematic review (n = 4 clinical trials and n = 2 cohort studies). These investigations show significant improvements in biochemical parameters, quality of life, quality of sleep, pain at rest and general health status when following mainly plant-based dietary patterns. In conclusion, these findings are promising but interpretation of the findings is limited due to the methodological quality of the studies. Well-designed clinical trials are needed to consolidate these dietary recommendations in FM patients.
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Mobile Apps to Improve Medication Adherence in Cardiovascular Disease: Systematic Review and Meta-analysis.
Al-Arkee, S, Mason, J, Lane, DA, Fabritz, L, Chua, W, Haque, MS, Jalal, Z
Journal of medical Internet research. 2021;23(5):e24190
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A long-term use of cardiovascular medications significantly reduces the risk of morbidity and mortality, but their full therapeutic potential cannot be achieved if patients are nonadherent. Developing interventions to tackle medication nonadherence is important for improving health outcomes. The aim of this study was to evaluate the effectiveness of app-based interventions on medication adherence in patients with cardiovascular disease (CVD). This study is a systemic review and meta-analysis of 16 randomised controlled trials. The apps used were all different for each study and were developed by different organizations: 8 were academic or government institutions, whereas others were commercial organizations. Results show that a total of 9 trials showed a statistically significant improvement in medication adherence in the intervention arm. Furthermore, the apps used had mixed functionality, including reminders, education or both, however, overall, user engagement and usability were rated positively, demonstrating interest in the concept. Authors conclude that it is difficult to make strong, unrestricted recommendations for practice, especially with the methodological limitations of the trials included in this study. However, mobile apps may enhance medication adherence as part of a package of care.
Abstract
BACKGROUND Adherence rates of preventative medication for cardiovascular disease (CVD) have been reported as 57%, and approximately 9% of all CVD events in Europe are attributable to poor medication adherence. Mobile health technologies, particularly mobile apps, have the potential to improve medication adherence and clinical outcomes. OBJECTIVE The objective of this study is to assess the effects of mobile health care apps on medication adherence and health-related outcomes in patients with CVD. This study also evaluates apps' functionality and usability and the involvement of health care professionals in their use. METHODS Electronic databases (MEDLINE [Ovid], PubMed Central, Cochrane Library, CINAHL Plus, PsycINFO [Ovid], Embase [Ovid], and Google Scholar) were searched for randomized controlled trials (RCTs) to investigate app-based interventions aimed at improving medication adherence in patients with CVD. RCTs published in English from inception to January 2020 were reviewed. The Cochrane risk of bias tool was used to assess the included studies. Meta-analysis was performed for clinical outcomes and medication adherence, with meta-regression analysis used to evaluate the impact of app intervention duration on medication adherence. RESULTS This study included 16 RCTs published within the last 6 years. In total, 12 RCTs reported medication adherence as the primary outcome, which is the most commonly self-reported adherence. The duration of the interventions ranged from 1 to 12 months, and sample sizes ranged from 24 to 412. Medication adherence rates showed statistically significant improvements in 9 RCTs when compared with the control, and meta-analysis of the 6 RCTs reporting continuous data showed a significant overall effect in favor of the app intervention (mean difference 0.90, 95% CI 0.03-1.78) with a high statistical heterogeneity (I2=93.32%). Moreover, 9 RCTs assessed clinical outcomes and reported an improvement in systolic blood pressure, diastolic blood pressure, total cholesterol, and low-density lipoprotein cholesterol levels in the intervention arm. Meta-analysis of these clinical outcomes from 6 RCTs favored app interventions, but none were significant. In the 7 trials evaluating app usability, all were found to be acceptable. There was a great variation in the app characteristics. A total of 10 RCTs involved health care professionals, mainly physicians and nurses, in the app-based interventions. The apps had mixed functionality: 2 used education, 7 delivered reminders, and 7 provided reminders in combination with educational support. CONCLUSIONS Apps tended to increase medication adherence, but interventions varied widely in design, content, and delivery. Apps have an acceptable degree of usability; yet the app characteristics conferring usability and effectiveness are ill-defined. Future large-scale studies should focus on identifying the essential active components of successful apps. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42019121385; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=121385.
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Effects of Plant-Based Diets on Outcomes Related to Glucose Metabolism: A Systematic Review.
Johannesen, CO, Dale, HF, Jensen, C, Lied, GA
Diabetes, metabolic syndrome and obesity : targets and therapy. 2020;13:2811-2822
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Research indicates that a reduction in the intake of animal products and an increase in plant-based foods have several positive health outcomes. The aim of this study was to evaluate the effect of a plant-based diet on outcomes related to glucose metabolism. This study is a systemic review of nine randomised controlled trials which focused on subjects with overweight/obesity, type 2 diabetes mellitus, or cardiovascular disease. Overall, the results of this study were inconsistent overall. Findings show that: - five of the nine studies (56%) showed that the plant-based intervention significantly improved markers of glycaemic control from baseline to end point. - four studies (44%) showed a significant improvement in markers of glycaemic control in the intervention group that differed from the control intervention. Additionally, they also did not reveal any significant improvements of a plant-based intervention on outcomes related to glucose metabolism. Authors outline that no clear conclusion regarding effects of different plant-based diets can be drawn based on the current findings.
Abstract
According to the rising prevalence of obesity and metabolic disorders leading to impaired glucose metabolism, effective strategies to prevent and/or delay the onset of disease are of great need. A plant-based diet has been suggested as an effective lifestyle change that may reduce the degree of obesity and improve outcomes related to glucose metabolism. This systematic review aimed to evaluate the effect of a plant-based diet on outcomes related to glucose metabolism. A literature search was conducted in the database PubMed until January 30, 2020. Randomized controlled trials investigating the effect of a plant-based dietary intervention on outcomes related to glucose metabolism in human subjects compared to an omnivorous diet were eligible for inclusion. Of 65 publications identified, nine trials on subjects with overweight/obesity, type 2 diabetes mellitus, or cardiovascular disease were included. Five studies reported that the plant-based intervention significantly improved markers of glycemic control from baseline to end point, of which four revealed a significant improvement in the intervention group compared to the control intervention. The remaining four studies did not observe a significant effect of a plant-based intervention on outcomes related to glucose metabolism. Our findings suggest that a shift to a plant-based diet may lead to favorable effects on glycemic control in individuals diagnosed with type 2 diabetes mellitus and/or obesity. The data were however somewhat conflicting, and the included trials reported results based on different intervention diets and study populations. Overall, no clear conclusions regarding effects of different plant-based diets can be drawn based on the current findings alone.
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Optimum nutritional strategies for cardiovascular disease prevention and rehabilitation (BACPR).
Butler, T, Kerley, CP, Altieri, N, Alvarez, J, Green, J, Hinchliffe, J, Stanford, D, Paterson, K
Heart (British Cardiac Society). 2020;106(10):724-731
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There are multiple modifiable risk factors for cardiovascular disease (CVD), many of which are modifiable via changes in diet and physical activity. The aim of this study was to review the area of cardiovascular nutrition and provide recommendations for practitioners to help patients make healthy eating decisions. This review highlighted the complexities of nutrition. Thus, improving diet quality post-myocardial infarction is associated with a reduction in risk for all-cause mortality, with evidence to suggest it is the whole diet, rather than individual components, that drives this association. One of the dietary patterns mostly associated with cardiovascular health is the ‘Mediterranean’ diet. Various studies suggest that it is linked with lower all-cause mortality in both primary and secondary prevention of CVD. Additionally, the DASH diet is also associated with decreased incidence of stroke, CVD, coronary heart disease, diabetes, in addition to improvements in cardiovascular. Improvement in patients’ cardiovascular outcomes can result from providing patients with food-based advice. However, it is important that the health practitioners dispensing this information have an understanding of nutritional science and an appreciation for the patients’ comorbidities. Authors conclude that nutritional advice needs to be patient-focused, flexible, and should be adapted to each individual with CVD and their other comorbidities.
Abstract
Nutrition has a central role in both primary and secondary prevention of cardiovascular disease yet only relatively recently has food been regarded as a treatment, rather than as an adjunct to established medical and pharmacotherapy. As a field of research, nutrition science is constantly evolving making it difficult for patients and practitioners to ascertain best practice. This is compounded further by the inherent difficulties in performing double-blind randomised controlled trials. This paper covers dietary patterns that are associated with improved cardiovascular outcomes, including the Mediterranean Diet but also low-carbohydrate diets and the potential issues encountered with their implementation. We suggest there must be a refocus away from macronutrients and consideration of whole foods when advising individuals. This approach is fundamental to practice, as clinical guidelines have focused on macronutrients without necessarily considering their source, and ultimately people consume foods containing multiple nutrients. The inclusion of food-based recommendations aids the practitioner to help the patient make genuine and meaningful changes in their diet. We advocate that the cardioprotective diet constructed around the traditional Mediterranean eating pattern (based around vegetables and fruits, nuts, legumes, and unrefined cereals, with modest amounts of fish and shellfish, and fermented dairy products) is still important. However, there are other approaches that can be tried, including low-carbohydrate diets. We encourage practitioners to adopt a flexible dietary approach, being mindful of patient preferences and other comorbidities that may necessitate deviations away from established advice, and advocate for more dietitians in this field to guide the multi-professional team.
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Non-Systematic Review of Diet and Nutritional Risk Factors of Cardiovascular Disease in Obesity.
Rychter, AM, Ratajczak, AE, Zawada, A, Dobrowolska, A, Krela-Kaźmierczak, I
Nutrients. 2020;12(3)
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Nutrition is a major factor influencing obesity associated heart disease risk, however many people with this disease do not follow nutritional recommendations. This review of 155 studies aimed to summarise dietary aspects of heart disease prevention. The paper began by outlining the role of obesity through the development of other disorders that contribute to heart disease, such as type 2 diabetes, high blood pressure and blood sugar imbalance. The quantity and distribution of fat tissue also can contribute to heart disease risk, especially if it is located within the heart or around the major organs of the body. Dietary factors which can increase heart disease risk were described as an increased intake of processed foods, sugar, salt and certain fats and low intakes of fruit, vegetables, fibre, whole grains, beans and nuts. The Mediterranean diet, the dietary approaches to stop hypertension (DASH) diet, plant-based diets, the portfolio dietary pattern and low carbohydrate diets were all reviewed and although mixed results were stated for low carbohydrate diets, most of the diets reviewed reported improved heart disease outcomes. The role of intestinal microbiota in heart disease were also reviewed and the influence of a poor diet was implicated in imbalanced gut microbiota and the development of heart disease. It was concluded that an unhealthy diet can contribute to heart disease and that dietary patterns such as the Mediterranean diet and plant-based diets may be favourable for its management. This study could be used by healthcare professionals to individualise dietary recommendations for patients with heart disease or who are at risk of it.
Abstract
Although cardiovascular disease and its risk factors have been widely studied and new methods of diagnosis and treatment have been developed and implemented, the morbidity and mortality levels are still rising-cardiovascular disease is responsible for more than four million deaths each year in Europe alone. Even though nutrition is classified as one of the main and changeable risk factors, the quality of the diet in the majority of people does not follow the recommendations essential for prevention of obesity and cardiovascular disease. It demonstrates the need for better nutritional education in cardiovascular disease prevention and treatment, and the need to emphasize dietary components most relevant in cardiovascular disease. In our non-systematic review, we summarize the most recent knowledge about nutritional risk and prevention in cardiovascular disease and obesity.
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Menopause-Associated Lipid Metabolic Disorders and Foods Beneficial for Postmenopausal Women.
Ko, SH, Kim, HS
Nutrients. 2020;12(1)
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Menopause is the absence of menstruation due to the loss of ovarian activity with ageing. During this transition period, changes in hormones, primarily the decline in the oestrogen estradiol, give rise to altered lipid metabolism. An unfavourable lipid profile presents a risk for metabolic disorders, such as cardiovascular diseases and type 2 diabetes. Post-menopausal changes also lead to shifts in body fat and fat distribution, resulting in an increased tendency for central fat accumulation and obesity. Obesity is associated with insulin resistance. This susceptibility for weight accumulation is possibly also driven by the age-associated decline in skeletal muscle, which reduces metabolic energy expenditure. This review summarizes the physiology of menopause and postmenopause and the consequential impact on lipid metabolism. In addition, there is a discussion of dietary recommendations, nutritional and plant-derived compounds that could support the management of menopause associated changes in lipid levels, metabolic risk factors and obesity. The recommendations discussed include traditional healthy diets and low-calorie diets, with attention drawn to adequate protein intake. Furthermore, the role of probiotics, nutritional and plant-sourced constituents are considered, including Vitamin D, Omega-3 fatty acids, antioxidants like Vitamin A, β-carotene, Vitamin C and E, genistein, resveratrol, flavonoids, indoles and capsaicin. The authors advocate sourcing these compounds from a varied whole-foods diet, which would minimize nutrient interactions and absorption issues that can occur with supplementation. This review may be of interest to those supporting the nutritional needs of menopausal and post-menopausal women, that are experiencing or are at risk of experiencing metabolic disorders.
Abstract
Menopause is clinically diagnosed as a condition when a woman has not menstruated for one year. During the menopausal transition period, there is an emergence of various lipid metabolic disorders due to hormonal changes, such as decreased levels of estrogens and increased levels of circulating androgens; these may lead to the development of metabolic syndromes including cardiovascular diseases and type 2 diabetes. Dysregulation of lipid metabolism affects the body fat mass, fat-free mass, fatty acid metabolism, and various aspects of energy metabolism, such as basal metabolic ratio, adiposity, and obesity. Moreover, menopause is also associated with alterations in the levels of various lipids circulating in the blood, such as lipoproteins, apolipoproteins, low-density lipoproteins (LDLs), high-density lipoproteins (HDL) and triacylglycerol (TG). Alterations in lipid metabolism and excessive adipose tissue play a key role in the synthesis of excess fatty acids, adipocytokines, proinflammatory cytokines, and reactive oxygen species, which cause lipid peroxidation and result in the development of insulin resistance, abdominal adiposity, and dyslipidemia. This review discusses dietary recommendations and beneficial compounds, such as vitamin D, omega-3 fatty acids, antioxidants, phytochemicals-and their food sources-to aid the management of abnormal lipid metabolism in postmenopausal women.
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Timing of Breakfast, Lunch, and Dinner. Effects on Obesity and Metabolic Risk.
Lopez-Minguez, J, Gómez-Abellán, P, Garaulet, M
Nutrients. 2019;11(11)
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Timing of food intake is an emerging factor that may predict the success of weight loss therapies. The aim of this review is to explore the timing of the three main meals of the day, breakfast, lunch and dinner, and the impact that eating during the biological night can have on metabolism, glucose tolerance, and obesity-related factors. The review shows that the timing of food intake is an external synchronizer and plays a crucial role in obesity and weight loss treatment. Breakfast skipping is causally linked to obesity and late lunch (after 3 p.m.) hinders weight loss, mainly in those carriers of a genetic variant in Perilipin. Furthermore, a late lunch has a deleterious effect on microbiota diversity and composition whereas late dinner (within two hours before bedtime) decreases glucose tolerance. Authors conclude that modifying food-timing may be a potential tool to decrease obesity and metabolic risk.
Abstract
(1) Background: Eating is fundamental to survival. Animals choose when to eat depending on food availability. The timing of eating can synchronize different organs and tissues that are related to food digestion, absorption, or metabolism, such as the stomach, gut, liver, pancreas, or adipose tissue. Studies performed in experimental animal models suggest that food intake is a major external synchronizer of peripheral clocks. Therefore, the timing of eating may be decisive in fat accumulation and mobilization and affect the effectiveness of weight loss treatments. (2) Results: We will review multiple studies about the timing of the three main meals of the day, breakfast, lunch and dinner, and its potential impact on metabolism, glucose tolerance, and obesity-related factors. We will also delve into several mechanisms that may be implicated in the obesogenic effect of eating late. Conclusion: Unusual eating time can produce a disruption in the circadian system that might lead to unhealthy consequences.
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Plant-Based Diets for Cardiovascular Safety and Performance in Endurance Sports.
Barnard, ND, Goldman, DM, Loomis, JF, Kahleova, H, Levin, SM, Neabore, S, Batts, TC
Nutrients. 2019;11(1)
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Studies suggest that endurance athletes are at higher risk of some types of heart disease. This review looked at the ability of plant-based diets to reduce risk and affect athletic performance. The authors found evidence that plant-based diets are associated with beneficial effects on health, such as reducing body fat, blood pressure, cholesterol, oxidative stress and inflammation. The authors of this review argue that there is a sound scientific basis for recommending plant-based diets to endurance athletes.
Abstract
Studies suggest that endurance athletes are at higher-than-average risk for atherosclerosis and myocardial damage. The ability of plant-based regimens to reduce risk and affect performance was reviewed. The effect of plant-based diets on cardiovascular risk factors, particularly plasma lipid concentrations, body weight, and blood pressure, and, as part of a healthful lifestyle, reversing existing atherosclerotic lesions, may provide a substantial measure of cardiovascular protection. In addition, plant-based diets may offer performance advantages. They have consistently been shown to reduce body fat, leading to a leaner body composition. Because plants are typically high in carbohydrate, they foster effective glycogen storage. By reducing blood viscosity and improving arterial flexibility and endothelial function, they may be expected to improve vascular flow and tissue oxygenation. Because many vegetables, fruits, and other plant-based foods are rich in antioxidants, they help reduce oxidative stress. Diets emphasizing plant foods have also been shown to reduce indicators of inflammation. These features of plant-based diets may present safety and performance advantages for endurance athletes. The purpose of this review was to explore the role of nutrition in providing cardioprotection, with a focus on plant-based diets previously shown to provide cardiac benefits.
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Intermittent Fasting in Cardiovascular Disorders-An Overview.
Malinowski, B, Zalewska, K, Węsierska, A, Sokołowska, MM, Socha, M, Liczner, G, Pawlak-Osińska, K, Wiciński, M
Nutrients. 2019;11(3)
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Intermittent fasting (IF) is an eating pattern that cycles between periods of fasting and eating. IF has gained popularity in recent years with people wanting to lose weight, and it may have many long-term health benefits. In this review, the authors looked at human and animal studies using variations of IF including time restricted eating (TRE), where eating is confined within a specific window during the day (for example 8 hours eating and 16 hours fasting), and alternate day fasting (ADF), where a day of eating normally is alternated with a day of either fasting entirely, or significant calorie restriction. The authors found that IF is related to many beneficial effects on the cardiovascular system, involving atherosclerosis progression, benefits for diabetes mellitus type 2 such as improved glucose metabolism and insulin sensitivity, lowering of blood pressure, and other cardiovascular risk factors (such as lipid profile and inflammation). It is currently unclear whether the benefits of IF are solely due to weight loss or other mechanisms. The success of every type of diet depends on compliance, and IF seems to be as easy or easier to follow than more traditional diets for many people. Fasting is not recommended for people with hormonal imbalances, pregnant and breastfeeding women, and diabetics. People with eating disorders and underweight people are also not recommended to use the intermittent fasting diet. In recent years, the IF diet and its varieties have become increasingly popular. This diet not only serves to reduce body weight but seems to have other long-term health benefits. However, individuals’ current health and situation should be considered before commencing the IF diet.
Abstract
Intermittent fasting is a form of time restricted eating (typically 16 h fasting and 8 h eating), which has gained popularity in recent years and shows promise as a possible new paradigm in the approach to weight loss and the reduction of inflammation, and has many potential long term health benefits. In this review, the authors will incorporate many aspects of fasting, mainly focusing on its effects on the cardiovascular system, involving atherosclerosis progression, benefits for diabetes mellitus type 2, lowering of blood pressure, and exploring other cardiovascular risk factors (such as lipid profile and inflammation).
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Dietary Flaxseed as a Strategy for Improving Human Health.
Parikh, M, Maddaford, TG, Austria, JA, Aliani, M, Netticadan, T, Pierce, GN
Nutrients. 2019;11(5)
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Flaxseed is a rich source of the omega-3 fatty acid, alpha-linolenic acid, lignans and fibre. Four common forms of flaxseed include whole flaxseed, ground flaxseed, flaxseed oil, partially defatted flaxseed meal and flax “milk”. The aim of this review was to provide a broad summary of the highlights of the research that have supported the growth of flaxseed as a commodity with significance in the fields of health and medicine. Research shows that: - flaxseed supplementation reduced blood glucose in subjects with type 2 diabetes and lowered blood glucose in subjects with prediabetes. - flaxseeds are used extensively in animal studies to treat a variety of cancers namely breast cancer. - dietary flaxseed may also improve aspects of brain function during conditions of neural disease. - dietary flaxseed may also exhibit a protective effect against menopausal symptoms. - flaxseed supplementation in the diet may alter the bacterial flora in the intestines of animals. Authors conclude that supplementation of the diet with milled flaxseed has many healthy benefits to the body.
Abstract
Flaxseed is a rich source of the omega-3 fatty acid, alpha linolenic acid, the lignan secoisolariciresinol diglucoside and fiber. These compounds provide bioactivity of value to the health of animals and humans through their anti-inflammatory action, anti-oxidative capacity and lipid modulating properties. The characteristics of ingesting flaxseed or its bioactive components are discussed in this article. The benefits of administering flaxseed or the individual bioactive components on health and disease are also discussed in this review. Specifically, the current evidence on the benefits or limitations of dietary flaxseed in a variety of cardiovascular diseases, cancer, gastro-intestinal health and brain development and function, as well as hormonal status in menopausal women, are comprehensive topics for discussion.