Dietary Quality

Healthy Unrefined foods

Eating more unrefined foods is an important strategy in the prevention of chronic disease, management of chronic conditions and promotion of overall health.

Nutrition is a key pillar of lifestyle medicine along with regular physical activity, restorative sleep, stress management, avoidance of risky substances, and a positive social connection.

Health Risk of poor diet

1 in 5 deaths globally (11 million in total) were associated with poor diet.

This study looked at dietary intakes across 195 countries and quantified the burden of disease (population attributable fraction) that could be attributed to deaths related to cardiovascular disease, cancer, or type 2 diabetes, as well as the impact of diet on ill health (as disability-adjusted life years or DALYs)

Poor diet quality is a leading and preventable cause of adverse health and chronic disease. Globally, we are facing a “double burden” of conventional malnutrition from insufficient calories or nutrients (both macro and micro nutrients) as well as poor nutrition due to overconsumption of sugar, fat, and salt, often leading to obesity, type 2 diabetes, cardiovascular diseases, and cancer. In the U.S., poor diet quality is driving chronic disease as six in ten Americans live with at least one chronic disease.

The overall dietary patterns influences human health and disease and directly affects quality-of-life throughout the lifespan. Current food trends towards a Western-Style diet of animal and processed foods, including excess calories, added sweeteners, saturated fats, coupled with the underconsumption of whole grains, legumes, fruits and vegetables, contribute to the rising levels of chronic conditions and obesity. Food systems to support diet quality have the potential to nurture human health and address disease conditions. Harvard’s seminal 2020 EAT-Lancet Commision on Food, Planet and Health states that “unhealthy diets pose a greater risk to morbidity and mortality than does unsafe sex, alcohol, drug and tobacco use combined.

measuring diet quality

Assessment of diet quality is essential to developing effective strategies and public policies to address malnutrition and achieve global nutrition safety. A clear example of this can be found in the U.N. Sustainable Development Goals, Measuring diet quality must depend on reliable dietary metrics developed to capture diet components such as quality, adequacy and diversity.

children’s nutrition

American children over consume added sugar intake, which may be contributing to the current obesity epidemic. American children also regularly consume fast food, which results in higher total energy and reduces diet quality. Dietary patterns should include Potassium-rich foods, alternatives to red and processed meat, whole grains, and avoidance of solid fats and sweetened beverages.

weight management

42.4% of American adults have obesity (30+BMI). The estimated annual medical cost of obesity in the United States was $147 billion US dollars in 2008; the medical cost for people who have obesity was $1429 higher than those of normal weight.

Obesity is a complex disease state involving excessive adipose tissue. Overweight and obesity are prominent risk factors for developing metabolic syndrome, heart disease, diabetes, and certain cancers. Findings from large-scale epidemiological studies indicate that plant-based diets maintain healthy weight and reduce both prevalence and incidence of over weight and obesity. The American Medical Association designated obesity a disease in 2013. As a result, the idea that obesity is caused by insufficient will power, lack of discipline, and bad personal choices has transformed the public discourse around the condition and reframed it as a disease around the condition and reframed it as a disease that increases other health complications and conditions.

Emerging research on the effects of the obesogenic food environment driven by the addictive qualities of refined sugar, salt, and fat, coupled with prevalent sedentary behavior indicates the importance of considering broader environmental conditions when addressing overweight and obesity.

type 2 diabetes

34.2 Million Americans

The prevalence of diabetes is rising in the United States and world wide, and is a major concern. There is an urgent need to curb this rapidly rising incidence.

diabetes

Diabetes Mellitus is a group of metabolic disorders in which either the pancreas does not produce enough insulin to regulate blood glucose, or the body cannot use insulin effectively. This results in hyperglycemia. Chronic hyperglycemia leads to damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels. Diabetes is diagnosed when the hemoglobin A1C (HbA1c) is 6.5% (48 mmol/mol) or higher, and 5.7-6.4% (39-46 mmol/mol) is considered prediabetes.

Diabetes mellitus is a global health problem with a worldwide prevalence of 88% and is associated with multiple comorbidities and high healthcare costs. The Center of Disease Control reports that 10.5% of the US population have diabetes and 34.5% have prediabetes.

Many of those with diabetes are undiagnosed. (26.9 million people diagnosed and 7.3 million un-or under diagnosed.)

Of the different types of diabetes categorized, the most common is type 2, in which the body produces insufficient insulin or cannot us it effectively. The focus of this report is T2D, as this condition is lifestyle-driven, and its causes are largely modifiable, particularly with diet.

Diet as a modifiable lifestyle factor plays an important role in treating diabetes. The American Diabetes Association (ADA) recommends an individualized medical nutrition therapy for glycemic and lipid management.

Pathophysiology of cvd

CVD begins with progressive endothelial injury, inflammatory oxidative stress, diminution of nitric oxide production, from cell formation, and development of plaques that may rupture to cause myocardial infarction (MI) or stroke. Heart attacks and strokes are usually acute events caused by blockages that prevent blood from flowing to the heart or brain. The most common reason for this is a build up of deposits made up of fat, cholesterol, calcium, and other substances on the inner wall of the blood vessels that supply the heart or brain. Diet has long been implicated in the pathophysiology of CVD with excess amounts of added oils, dairy, meat, fowl, fish, and sugary foods. Insufficient micronutrient density and disproportioned macronutrients are also studied variables. These foods can injure or impair endothelial function after each ingestion, making food choices a major, if not the major, cause of coronary artery disease. Most CVD can be prevented by addressing behavioral risk factors such as unhealthy diet and obesity, physical inactivity, tobacco use, and harmful alcohol use.

inflammation

Inflammation as it relates to atherosclerosis and CVD, is a complex and highly regulated interaction between many cellular and molecular mechanisms. There are multiple sources of inflammation, some modifiable and others non-modifiable. Smoking, dyslipidemia, diabetes, obesity, perivascular fat deposition, reactive oxygen species, diet, and gut microbiome have been shown to contribute to arterial inflammation, and increased risk of CVD. Diet plays a significant role in inflammation and cardiovascular risk.

trimethyl n-oxide (Tmao)

DIetary nutrient intake and its metabolism by the gut microbiome have recently been associated with CVD risk.In particular, TMAO, a metabolite of gut microbiota,is a predictor of incident CVD events. L-carnitine, an abundant nutrient in re meat, accelerates atherosclerosis in mice via gut microbiota-dependent formation of trimethylamine (TMA) and (TMAO). This production happens via a multi step pathway involving an atherogenic intermediate y-butyrobetaine (yBB). The contribution of yBB in gut microbiota-dependent IL-caitine metabolism in humans is still being studied. However, studies with oral d3-L-carnitine or d9-yBB before versus after antibiotic exposure reveal that gut microbiota contributes to the initial 2 steps in a meta organismal L carnitine — yBB — TMA — TMAO pathway in subjects.

The gut flora processes dietary carnitine into TMA (trimethylamine), which the liver converts into TMAO. Elevated levels of TMOA have been shown to be associated with increased risk of coronary artery disease, myocardial infarction, stroke, and death. Fasting levels of TMAO have been shown to predict atherosclerotic burden and extent of coronary artery disease. Similar pronostic utility of TMAO has been demonstrated in individuals with diabetes, peripheral arterial disease, and congestive heart failure. These findings are independent of traditional cardiovascular risk factors and have been validated in 2 systematic reviews and meta-analysis. Based on these observations.

reproductive cancers

Ovarian cancer is the deadliest cancer of the female reproductive organs, outpacing all other forms of gynecological cancer.

Reproductive cancers are typically those originating in the reproductive organs of the pelvic area, but also include the breast, as breast cancer is sometimes considered a reproductive cancer. Risk factors for reproductive cancers include both unmodifiable (sex, age, genetic) and modifiable lifestyle factors such as diet. These factors apply to all reproductive cancers, though the most common reproductive cancers include breast, endometrial, prostate;and testicular cancers. Currently accepted recommendations for cancer prevention includes focusing on achieving a healthy weight, increasing physical activity, and consuming a diet rich in whole grains, vegetables, fruit, and beans.

autoimmune disease

Collectively, Autoimmune diseases affect more than 24 million people in the U.S.

An additional 8 million people have autoantibodies, blood molecules that indicate a person’s chance of developing autoimmune disease.

Healthy immune function is necessary to fight against viruses and diseases, yet when the immune system is poorly regulated, healthy cells can become the target of the immune system’s powerful defenses. Such is the case with autoimmune diseases which encompass type 1 diabetes, inflammatory bowel diseases, rheumatoid arthritis, and nervous system diseases like multiple sclerosis, among many others. Autoimmune conditions are becoming increasingly common in the United States and are currently among the most common disease categories affecting millions of Americans each year. One potential reason for the increase in autoimmune diseases is the risk of obesity, which can interfere with the body’s ability to regulate immune responses such as inflammation. Diet has strong associations with obesity, inflammation, and the immune system, and there are now ample evidence indicating that diets high in plant foods (e.g., fruits, vegetables, whole grains, legumes, nuts, and seeds) have beneficial effects on weight loss, markers of inflammation, and systems associated with autoimmune diseases. Unlike traditional pharmaceutical treatments that can be costly and produce unpleasant side effects, treatments that can be costly and produce unpleasant side effects, treatments involving dietary changes are cost effective, can be safe, and have a strong potential to improve multiple health outcomes beyond the targeted autoimmune diseases. With these benefits in mind,clinicians can consider health dietary patterns as a component of the current treatment regimens for patients with autoimmune disease.

autoimmune disease in context

Autoimmune disease, or autoimmune inflammatory (AI) disease, refers to some 80 to 100 or more related diseases that occur as a result of an overreactive immune system. There may be more added as research indicates disorders fit this distinction. Here, the body attacks healthy cells, tissues, or organs that it mistakes for foreign bodies, which results in the production of antibodies and creates a chronic inflammatory state. With so many potentially autoimmune-related diseases, prevalence and incidence rates are difficult to calculate. The National Institutes of Health (NIH) estimates that 23.5 million Americans are currently affected by autoimmune diseases, while the American Autoimmune Related Diseases Association (AARDA) estimates a much higher 50 million.

GLobally, it is thought that roughly 4% of the world’s population is affected by at least one of the autoimmune diseases, and the prevalence of these conditions continues to rise. Different autoimmune diseases affect different organ systems. In people with type 1 diabetes, for instance, the endocrine system is attacked which inhibits hormonal production of insulin. In Crohn’s disease and other inflammatory bowel diseases, the digestive system is targeted. It is the musculoskeletal system under attack in rheumatoid arthritis, autoimmune conditions affecting the central nervous system (e.g., multiple sclerosis). Autoimmune diseases also affect certain populations disproportionately. In the United States, 78% of autoimmune cases occurred in women, in a 2004 report from Centers for Disease Control and Prevention (CDC), women of African, Hispanic, Asian, and Native American descent have been more likely to develop lupus, for example, than caucasian women. And African American females have also been shown to develop this disease at a younger age than caucasians. Autoimmune diseases are recognized as having a genetic basis and tend to cluster in families, but individual family members may experience different autoimmune diseases. While genetics are implicated in the development of many autoimmune diseases, T regulatory cells seem to play a central role in autoimmune dysfunction related to pro-inflammatory cytokine secretion, and circumstantial evidence links certain autoimmune dysfunctions to preceding infections.

telomeres and aging

Telomeres, the DNA-protein complexes at chromosome ends, protects genome from degradation and interchromosomal fusion. Telomeres shorten with age and progressive telomere shortening leads to senescence and/or apoptosis. SHorter telomeres have also been implicated in genomic instability and oncogenesis. Older people with shorter telomeres have 3 to 8 times increase risk to die from heart disease and infectious diseases, respectively.

Telomeres play a central role in cell fate and aging by adjusting the cellular response to stress and growth stimulation on the basis of previous cell division and DNA damage. At least a few hundred nucleotides of telomere reats must”cap” each chromosome end to avoid activation of DNA repair pathways. Repair of critically short or “uncapped” telomeres by telomerase or recombination is limited in most somatic cells and apoptosis or cellular senescence is triggered when too many “uncapped” telomeres accumulate. The chance of the latter increases as the length is set and maintained in cells of the germline which typically express high levels of telomerase. In somatic cells, telomere length is very heterogeneous by typically declines with age, posing a barrier to tumor growth but also contributing to loss of cells with age. Loss of (stem) cells via telomere cells, a process facilitated by the genome instability and aneuploidy triggered by dysfunctional telomeres.

Lifestyle Changes May Lengthen Telomeres

A small pilot study shows for the first time that changes in diet, exercise, stress management and social support may result in longer telomeres. the parts of chromosomes that affect aging.

Learn more about a Personalized Aging Well System to Increase Your Telomeres

obesity

The Obesity Medical Association defines obesity as a chronic, progressive, relapses, and treat the multi-factorial neurobehavioral disease where in an increase in body fat promotes adipose tissue dysfunction and abnormal fat-mass physical forces, resulting in adverse metabolic, biomechanical, and psychosocial health consequences. Obesity and overweight are defined with cutoffs for body mass index (BMI kg/mr), the standard calculation to estimate adipose tissue, which is also frequently used to predict chronic disease risk.

Obesity is often divided into subcategories:

• Class 1 : BMI of 30 to 35

• Class 2 : BMI of 35 to 40

• Class 3 : BMI of 40 or higher

Obesity treatment is multi-model and, depending on BMI cut-offs, may include medication and surgery, endoscopic procedures, and very low-calorie diets. Lifestyle Medicine and Behavioral Therapy are the foundation of obesity treatment. The United States Preventive Services Task Force recommends intensive, multicomponent behavioral intervention for all individuals with obesity.

cardiovascular disease

One person dies every 36 seconds in the US from Cardiovascular Disease.

Heart disease is the leading cause of death for men, women, and people of most racial and ethnic groups in the United States. Almost 655,000 Americans die from heart disease each year- that’s 1 in every 4 deaths.

The burden of cardiovascular disease (CVD) is increasing globally and continues to be the leading cause of death worldwide, responsible for roughly one in four deaths in the US alone. Modifiable lifestyle risk factors are associated with most acute myocardial infarctions, including many dietary risk factors which include red and processed meat, saturated fat, refined carbohydrates, excess sodium, and inadequate fiber. Populations consuming diets centered on whole plant foods have better cardiovascular risk profiles and lower rates of cardiac events and mortality. Lifestyle Medicine practitioners can best support cardiac health in patients by encouraging adoption and maintenance of whole foods, predominantly plant based.

cardiovascular disease in context

Cardiovascular disease (CVD) is a group of heart and blood vessel disorders that include coronary heart disease, cerebrovascular disease, rheumatic heart disease, and other circulatory conditions, including heart failure, arrhythmias, and stroke. The most common cause of CVD ischemic heart disease (IHD), often developed by atherosclerotic narrowing of the coronary arteries. Over the past fifty years there has been a significant drop in CVD-related mortality. However, despite substantial advances over the past decade in all areas of cardiovascular medicine, CDV remains the leading cause of death across the world.

As outlined in the most recent Global Burden of Cardiovascular Disease data, the risk factors for CVD and the associated burden of heart disease continue to rise in low- to middle income nations. In addition to conventional risk factors (hypertension, smoking, diabetes, obesity, hyperlipidemia, chronic kidney disease), psychological factors and social determinants of health play a significant role. Food insecurity as a social determinant of health is an important factor contributing to CVD burden. At a population level, 90% of the attributable cardiovascular risk is modifiable through lifestyle changes.

Diet-induced risk is an important contributor to CVD risk. Atherosclerosis has been shown to be associated with dietary intake of red and processed meat, saturated fat, and refined carbohydrate. Globally, the diet-induced risk is primarily due to increased consumption of sodium and low intake of whole grains & fruits, as well as over consumption of ultra processed foods. The cost of healthcare and lost productivity due to CVD in the U.S. is in excess of $300 billion per year, and suboptimal diet has been shown to be contributing over 18% of this spending.

chronic kidney disease

14% of American Population

More than 661,000 Americans have kidney failure. Of these 468,000 individuals are on dialysis, and roughly 193,000 live with a functioning kidney transplant.

Largely plant based diets may delay progression and help to control common chronic conditions that are often associated with CKD, including type 2 diabetes, cardiovascular disease, hypertension, obesity, and kidney stones, improving multiple comorbidities simultaneously. Provided the potassium levels are monitored, plant-based diets pose minimal to no risk for CKD patients and may delay or avoid the need for dialysis.

chronic kidney disease in context

Chronic kidney disease describes the gradual loss of renal function: the filtering of wastes, toxins, and excess fluids from blood to be excreted in the urine. Electrolytes and wastes accumulate until kidney function is significantly impaired, often with few symptoms in the early stages of the disease.

As one of the top ten leading causes of premature death, CKD affects more than one in seven American adults or 15% or 37 million people. Most (90%) do not know they have it. Diabetes and high blood pressure are common comorbidities and the leading causes of End-Stage Renal Disease (ESRD), which is also associated with all-cause mortality. Other risk factors include obesity, older age, glomerulonephritis (diseases that damage the kidneys filtering units), inherited diseases such as polycystic kidney disease, malformations at birth, lupus or other immune diseases, and obstructions such as kidney stones or an enlarged prostate, as well as repeated urinary tract infections.

Treatment of chronic renal failure can be challenging since individuals may not feel ill or present symptoms until advanced stages. Comorbidities may be recognized and treated first without consideration of renal risk, and though recommendations to follow a healthy diet may be offered to keep CKD from worsening, there is much confusion over what constitutes a healthy diet, even among practitioners.

reproductive cancers in context

Cancer is characterized by uncontrolled cell growth and proliferation, and it is the second leading cause of death in the U.S. Cancer types are typically named for the organs or tissues of origin. For women, reproductive cancers include cervical, ovarian,endometrial (uterine), vaaginal, vulvar, and breast cancers of which only cervical has an early detection screening test. Although breast is most common reproductive cancer among women, ovarian is the deadliest, with a 5 year survival rate of only 44%, as early detection is difficult. Only 15% are diagnosed in stage 1, where the survival rate is 92%. More than 20,000 cases in the U.S. were diagnosed in 2020. For men, reproductive cancers primarily include testicular, penile, and prostate cancers. Survival rates for the last two male cancers are 98% and 95%, respectively.

causes and risk factors

According to the American Cancer Society, common causes of cancer include smoking and tobacco usage, diet and physical activity, exposure to the sun and other types of radiation as well as certain viruses and other infections. While some risk factors are unmodifiable (sex, age, or genetics), other risk factors are potentially modifiable.

These are primarily related to lifestyle and include smoking, drinking alcohol, dietary intake, and physical activity. Dietary risk factors include consumption of red and processed meat, and underconsumption of fruits and vegetables, dietary fiber, and dietary calcium.

prevention and early detection

According to the World Cancer Research Fund and the American Institute for Cancer Research (WCRF/WICR), an estimated 30-50% of all cancer cases are preventable through healthy lifestyles and avoidance of carcinogens, pollution, and long-term infections. In addition to the avoidance of tobacco, the 2018 WCRF/AICR recommendations for cancer prevention focus on evidence-based modifiable lifestyle factors, including healthy weight, physical activity, and consuming a diet rich in whole grains, vegetables, fruits and beans. Recommendations discourage using supplements for cancer prevention and state to limit fast foods high in fat, starches, or sugars, red and processed meat, sugar-sweetened drinks, and alcohol. Finally, mothers are recommended to breastfeed their babies of possible, and those diagnosed with cancer are encouraged to follow the recommendations above.

diet and autoimmune diseases

Research reveals that environmental factors and diet play a predominant role in the manifestation of these diseases. For instance, there is a higher prevalence of autoimmune diseases in Western societies where Western lifestyles may contribute to autoimmunity through modern cleanliness and sterilization practices that have reduced exposure to beneficial pathogens. Western dietary practices are also implicated in autoimmunity, as they are characterized by high intakes of energy, cholesterol, protein, saturated fat, added sugar, and salt with low intakes of fiber and antioxidants. Such a diet is associated with increased risk of autoimmune diseases through directly increasing inflammation and indirectly increasing insulin resistance and obesity. Non-Western countries that previously experienced relatively lower rates of autoimmune diseases, like Japan and India are now seeing increase of incidence which may be associated with changing environmental and lifestyle factors such as diet. Though there is limited evidence that autoimmune diseases are directly linked to dietary factors.

longevity

93,927 persons age 100 and older in the U.S. in 2018

Over the past 10 years, the population of American age 65 and older has increased from 38.8 million in 2008 to 52.4 million in 2018 (a 35% increase) and is projected to reach 94.7 million in 2060.

As a number of centenarians increases globally due to improved living standards and access to quality healthcare, efforts to improve quality of life from modified health behaviors become even more relevant for the lifestyle medicine (LM) practitioners.

Medical and health professionals have two fundamental purposes; to sustain life and to relieve suffering. If they are successful, the net effect is an increase in human longevity and quality of life. Recent research indicates that genetic predisposition likely accounts for only 15-30% of longevity, for instance, the Danish Twin Study established that only 20% of the average person’s lifespan is dictated by genetics. Some research suggests a much lower estimation of under 10%. Environmental and lifestyle influences play a large role in determining life span. In 202, life expectancy from birth was 78.9 years of total U.S. population. In 1860 it was 39.4 years and had risen over the past 160 years largely due to the dramatic decrease in infant and child mortality rates in the late 19th and early 20th centuries. Additionally, medical advancements, fewer wars, and organized efforts to control the spread of infectious disease, including widespread water and sanitation infrastructure and improved living standards, all contributing to longer lifespans. Today in developed countries, non-communicable diseases (NCDs) are collectively the major cause of death, most of which are lifestyle-related. Though both social inequities and COVID-19 pandemic have made the continued rise more uncertain, life expectancy has roughly tripled over the course of human history. However, since 1970, the main driver of these gains in industrialized countries has been a reduction in death rates from cardiovascular disease and cancer, particularly among older adults and largely due to medical interventions.