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15 Heart healthy food items to add to your daily diet – PINKVILLA

Posted: October 12, 2022 at 1:58 am

When it comes to the health of your heart, your diet plays a primary role. In fact, right from the management of your blood pressure to proving prime protection from a number of heart diseases, your diet can do it all. Healthy eating choices and eating patterns can not only give your heart a necessary health boost, but they can also help you fit into a smaller pair of jeans and keep your skin healthy and young. Studies show the reason behind approximately one-third of the deaths worldwide is because of heart disease alone. Interestingly, just the addition of certain heart healthy food items to add to your daily diet can make all the difference. In fact, there are certain common food items that can impact blood pressure, cholesterol levels, triglycerides, and inflammation.

Understanding Heart Health

Did you know the heart of a healthy adult beats over 2 billion times in an average lifetime? During which it works to push more than millions of gallons of blood to all the parts of the body. The consistent flow of blood transports oxygen, hormones, and several crucial elements to all the parts of the body. In fact, if the heart stops working, all the essential bodily functions simply fail and the body breaks down. Despite the constant workload that never ends, the heart is steadfast and dependable.

However, in the absence of heart-healthy habits, which include lack of heart healthy food, absence of exercise, and unhealthy habits like smoking, and drinking the heart stumbles and in worse cases even breaks down. This absence of heart-healthy habits makes you more prone to several big and small heart diseases including high blood pressure and even heart attack.

Heart attack

One of the major problems that come with bad heart health is atherosclerosis. Atherosclerosis is nothing but the accumulation of cholesterol inside your already thin arteries. This accumulation limits the normal blood flow through the arteries, which can lead to a life-threatening heart attack or stroke.

Although with age the functioning of the heart gradually slows down, however, it is important to understand unhealthy habits can make your heart age faster. With healthy lifestyle changes, you can not only reduce the chances of getting a heart attack you can achieve an overall better immunity. But the question remains on how to incorporate heart-healthy habits.

How to incorporate Heart-Healthy eating habits?

Despite being one of the leading causes of death in the United States, heart attacks are totally avoidable. All you need to do is incorporate a few heart-healthy habits. When it comes to heart-healthy living, you have a chance to make healthy choices at every point of your life. Right from taking the stairs to eating broccoli, every little action plays a very important role.

While there are many factors in how you can minimize the chances of getting heart disease, your diet is the most important. With heart-healthy eating habits, you can consciously add heart healthy food items to add to your daily diet including certain fruits and vegetables and minimize the intake of saturated fats and sugars. Ahead, find a carefully curated list of 15heart healthy food items for the soundness of your heart.

Here is a list of 15heart healthy food items to maximize your heart health:

1. Green leafy vegetables

When it comes to heart healthy food items to add to your daily diet green vegetables definitely top the list. It is well established that green leafy vegetables are an excellent source of vitamins, minerals, and even antioxidants. Whenever you have a chance to incorporate kale, spinach, and collard greens into your diet, please say yes. Not only are they a great source of vitamin K, but they are also one of the best heart healthy foods out there. Research shows, green vegetables promote improved blood flow through your arteries and even a enable healthy blood clotting process which reduces the risk of heart diseases. Moreover, green veggies are also rich in dietary nitrates, which help in the management of blood pressure, arterial stiffness, and overall cell function.

2. Tomatoes

Another vegetable that works as well as green vegetables to protect the heart is a tomato. Tomatoes are one of the best heart healthy foods that are rich in lycopene. Lycopene is a natural plant-based pigment filled with antioxidant properties. These antioxidant-rich properties work to neutralize damaging free radicals that prevent and protect from any oxidative damage or inflammation thereby protecting from heart diseases. Lycopene is also linked to reducing the risk of heart attack and even stroke. Incorporation of tomatoes into your daily diet can help you manage blood pressure, blood lipids, and even endothelial function. Studies reveal tomatoes are known to increase the levels of HDL or good cholesterol. HDL further works to eliminate any excess cholesterol or plaque from arteries which promotes better flow of blood thereby protecting the heart from heart diseases and stroke.

3. Whole grains

Whole grains are another heart healthy food items that you must add to your daily diet to promote a healthy heart. Germ, endosperm, and bran are all nutrient-rich parts of any grain. Top whole grains you must incorporate into your diet include:

whole wheat

While the consumption of refined carbohydrates might increase the risk of heart disease, the consumption of whole grains actually works to protect the heart. Studies claim that incorporating more whole grains into your diet can definitely work to benefit your heart and improve overall heart health while reducing the risk of heart disease. In addition to that, it also works to prevent as well as manage hypertension. So the next time you go grocery shopping, make sure you buy whole grains, you get products with the labels whole grain or whole wheat. When it comes to labels like wheat flour or even multigrain you must read the label to confirm if they are whole grains.

4. Avocados

Avocados are another one of several heart healthy food items out there. Avocados are one of the best sources of monounsaturated fats which are incredibly heart healthy. They are known to effectively reduce the levels of cholesterol hence lowering the risk of heart disease. Studies reveal that avocados reduce the incorporation of LDL or bad cholesterol, which lowers the risk of heart disease. Also, multiple studies also claim that avocados exhibit lipid-lowering and cardioprotective properties. They are rich in potassium which works to benefit the heart. Avocados help in reducing the risk of high blood pressure, high cholesterol, metabolic syndrome, and even stroke.

5. Berries

Berries, including strawberries, blueberries, raspberries, and even blackberries are one of the best categories of heart healthy food items. Filled with the essential nutrients and antioxidants for the body, berries work to nourish as well as protect the body against oxidative stress as well as inflammation. Not just that, studies show berries specifically strawberries help in the improvement of insulin resistance and management of LDL also known as bad cholesterol.

Another study about blueberries reveals that the incorporation of blueberries in your diet can improve the functioning of cells lining the blood vessels. This helps in controlling blood pressure and promotes healthy blood clotting. Almost all kinds of berries work to reduce LDL or bad cholesterol and help in the maintenance of systolic blood pressure, body mass index, and inflammation. When you have a bad sugar craving or simply need a snack, berries cab definitely be that low-calorie but delicious dessert. Another food for healthy heart might include fruits like cherries and oranges for the heart.

6. Fatty fish & fish oil

Studies claim that fatty fish like salmon, sardines, tuna, and mackerel are rich in omega-3 fatty acids that are flooded with heart-health benefits. Omega-3 fatty acids derived from fatty fish play a crucial role in protecting the heart from developing any heart disease. Moreover, it also reduces the risk of arrhythmias and CVD events. Studies claim that the consumption of fish for an extended period of time can reduce cholesterol levels and help in the management of blood triglycerides, blood sugar levels, and blood pressure. Another study proved the positive relationship between the consumption of fish and the risk reduction of cardiovascular diseases and depression. It even works to increase overall longevity. Another way to incorporate the benefits of fish is by incorporating fish oil which ensures the daily dose of omega-3 fatty acids. Apart from fish oils, fish oil supplements are also food healthy for the heart, they also work to deliver benefits like reduction of blood triglycerides, improvement of arterial function, and management of blood pressure. Similar benefits can also be incorporated through omega-3 supplements like krill oil or algal oil.

7. Beans

Beans are one of the best heart healthy food options out there. They are rich in resistant starch, which helps in the digestion process. Resistant starch in beans also works to benefit the gut. Several studies claim that adding beans and legumes to the daily diet can reduce the risk of heart disease by reducing levels of blood triglycerides and LDL or bad cholesterol. Beans also help in the management of blood pressure and inflammation which again reduces the risk of heart disease. Add beans to your daily routine if you want to incorporate a diet for a healthy heart.

8. Dark chocolate

Another exciting food item that actually helps in improving heart health is dark chocolate. When incorporated in moderation, dark chocolates can incorporate a healthy dose of antioxidants including flavonoids, that work to promote better heart health. Studies claim that consuming less than 5-6 servings of unsweetened dark chocolate per week reduces the risk of coronary heart disease, stroke, and even diabetes. However, when eaten in huge amounts chocolates can be harmful because of their sugar and calorie content. Make sure you pick good quality dark chocolate with at least 70 percent cocoa content. Moderate consumption of dark chocolate is also known to reduce the risk of plaque accumulation thereby reducing the risk of heart disease.

9. Green tea

Green tea has always been linked to innumerable health benefits. Right from boosting a fat-burning metabolism to improving insulin sensitivity, green tea is no less than a magic drink. Green tea is flooded with polyphenols and catechins. They serve as antioxidants that prevent all kinds of cell damage while reducing inflammation. Studies prove green tea works to protect the soundness of your heart. Research shows green tea promotes leptin and reduces LDL or bad cholesterol which works to help with obesity. Another study claims, green tea works to reduce blood pressure triglycerides, and even LDLs. Matcha green tea also seems to have multiple benefits for the heart. All kinds of green tea-infused snack or green tea as a beverage works as one of the best heart healthy food options.

10. Almonds

Almonds are another nutrient-rich healthy snack that works to benefit the heart. They are rich in all kinds of vitamins and minerals and work to promote heart-healthy monounsaturated fats and fiber. These work to protect against heart disease. Research claims eating almonds regularly can even work to reduce cholesterol levels. It even reduces belly fat along with the levels of LDL or bad cholesterol thereby reducing the risk of heart disease. In addition to that, studies show almonds increase the levels of HDL or good cholesterol. This in turn reduces any plaque buildup while clearing your arteries to promote better blood flow. Almonds are rich in nutrients and calories as well. However, when consumed in moderation it is known to deliver fiber and monounsaturated fats which reduces cholesterol as well as belly fat.

11. Walnuts

If you have been looking for heart healthy food items, walnuts are another snack you can definitely incorporate into your daily diet. They are flooded with fiber and micronutrients including magnesium, copper, and manganese. Just a few servings of walnuts can help in the protection against several heart diseases. Studies show several tree nuts including walnuts work to prevent cardiovascular diseases when incorporated into the daily diet. Research shows that walnuts also decrease LDL or bad cholesterol in the body and help in the maintenance of blood pressure.

12. Seeds

Another one of the best heart healthy food items that you must consider adding to your diet are certain kinds of seeds including, chia seeds, flaxseeds, and hemp seeds. Not only are they rich in heart-healthy nutrients like omega-3 fatty acids they promote the incorporation of fiber. Studies claim the incorporation of seeds into your diet can effectively minimize risk factors like blood pressure, inflammation, cholesterol, and triglycerides that might lead to a heart attack. Hemp seeds are rich in arginine which is an amino acid that works to promote lower blood pressure levels and reduces inflammatory markers. This reduces the risk of heart disease. Another example of a heart-healthy seed is flaxseed which also helps in blood pressure and cholesterol management. This proves flaxseed minimizes the risk of cardiovascular disease as well as cancer. Also, it also helps in minimizing the risk of diabetes and certain gastrointestinal conditions. When it comes to seeds chia seeds are another health healthy food item that potentially works to lower blood triglyceride levels while boosting the levels of beneficial HDL or good cholesterol.

13. Olive oil

A staple in Mediterranean diets, olive oil is one of the most documented heart healthy food items out there. Packed with antioxidants, olive oil is known to relieve all kinds of inflammation while decreasing the risk of chronic diseases. Studies have shown olive oil is rich in monounsaturated fatty acids that work to improve heart health. Another study shows olive oil works to effectively lower the risk of acquiring heart disease. Moreover, olive oil is rich in oleic acid as well as antioxidants that help in the prevention as well as treatment of hypertension. Olive oil can easily be substituted with your cooking oil and can even be added to salads and sauces.

14. Edamame

Immature soybean popularly known as edamame thats used in several Asian dishes is another one of the most effective heart healthy food items. Just like any other soy product, edamame is filled with soy isoflavones which is a flavonoids. It helps in lowering cholesterol levels and works to improve heart health. Soy protein also reduces the risk of developing cardiovascular diseases. When combined with a better lifestyle and more dietary changes, it can even reduce cholesterol levels which works to reduce the risk of heart ailments. Studies show soy protein works to manage blood lipids, which reduces the risk of cardiovascular disease. Along with that, edamame is rich in dietary fiber and antioxidants as well. Tofu is another soy-rich snack thats good for the heart.

15. Garlic

It is well established that garlic has plenty of health care benefits. In fact, it is one of the best home remedies to treat a number of problems. Research shows garlic is flooded with medicinal properties one of which is the improvement of heart health. Garlic is rich in compounds known as allicin which is one of the most therapeutic compounds. Studies show garlic extract works as well as a standard prescription drug for the reduction of blood pressure. Another study shows that garlic works to reduce cholesterol and LDL which makes it beneficial for patients with high cholesterol. Studies also reveal garlic works to reduce any sort of platelet buildup, which reduces the risk of blood clots and even stroke. When consumed raw garlic is the most beneficial.

When it comes to incorporating a heart-healthy diet there are a number of heart healthy food items out there. Diet is one of the most important factors that significantly affect health. What you consume on a regular basis can impact every aspect of your health including heart health. Also, there are certain diet plans like the DASH diet that help in the management of heart health. However, before you incorporate any major changes in diet, it is important to consult your healthcare professional. If you wouldn't like to incorporate a whole new diet, With a little moderation and healthy food choices you can manage to control your blood pressure, inflammation, cholesterol levels, and even triglycerides. While the above-mentioned food list for a healthy heart or heart-healthy snacks is incredibly healthy when you combine them with healthy habits and better lifestyle changes, the risk of heart disease practically goes away. Not just that, a healthy heart diet, regular exercise, and a little moderation in diet can help naturally improve your overall health which will be visible in the form of better skin, better fitness, and overall better immunity.

Note: If you are medically diagnosed with any heart disease, these dietary recommendations cannot substitute for your medications. In fact, you must consult your healthcare professional before you incorporate any major changes in your diet.

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A Comprehensive Review on the Effects of Vegetarian Diets on Coronary Heart Disease – Cureus

Posted: October 4, 2022 at 2:07 am

Coronary heart disease (CHD) is the leading cause of morbidity and mortality in the United States (US) and worldwide.According to estimates, 85.6 million Americans have cardiovascular disease (CVD), and the number is continuing to rise [1]. Healthy lifestyle choices may reduce the risk of myocardial infarction by more than 80% with nutrition playing a key role [2].

The refusal to eat meat (red meat, poultry, seafood, and the flesh of any other animal) is known as vegetarianism [3]. Vegetarians may be classified as vegans, pesco-vegetarians, lacto-vegetarians, lacto-ovo-vegetarians, and flexitarians [4,5]. Vegans avoid using or eating any animal products [4,5]. Pesco-vegetarians consume fish and other seafood [4,5]. Lacto-vegetarians eat dairy products; lacto-ovo-vegetarians eat dairy products and eggs [4,5]. Flexitarians occasionally or even once a week eat meat [4,5]. A plant-based diet is low in cholesterol, fat, animal products, salt, and sugar[6]. By way of dietary advice, well-planned vegetarian diets should be promoted as having advantages for preventing and reversing atherosclerosis and lowering risk factors for CVD [2].

Growing research points to health benefits and possible cardiovascular advantages of plant-based diets and eating habits that prioritize plant-based foods while reducing animal products [7]. Many studies have discovered that plant-based diets, particularly those abundant in high-quality plant foods including whole grains, fruits, vegetables, and nuts, are linked to a decreased risk of cardiovascular events and intermediate-risk factors [7,8]. The objective of this review is to determine the association between a vegetarian diet and CHD.

Over time, a lot of studies have been carried out on the prevalence of CHDs and various factors that predispose people of different races and ages to these diseases. Various modifications have been implicated over time in reducing the incidence and prevalence of these diseases. One of these is the application of a vegetarian diet.

Search Strategy

This review article was conducted using the scale for the assessment of non-systematic review articles (SANRA). We searched two databases: EMBASE (Excerpta Medica database) and PubMed (MEDLINE) using specific search terms. Search terms used were vegetarian diet AND ischemic heart disease AND cardiovascular disease. We searched for recent articles; hence, we used articles written from 2012 to 2022.

Inclusion Criteria

Original articles in the English language, from 2012 to 2022, related to the study's objectivewere included.

Exclusion Criteria

Review and commentary articles, articles older than 10 years, and articles not written in English language were excluded.

Our data search returned a total of 287 articles. These were screened for relevance to the objective, which resulted in six articles (Figure 1). Four of the six articles were observational studies and the other two were randomized studies. The articles reviewed provided the effects of vegetarian diet on CHD. The articles also revealed that adherence to a plant-based diet was inversely related to the incidence of heart failure risk and that vegetarian diet is beneficial for secondary prevention of CAD via modulation of lipid profile, reduction in BMI, and patients having a high concentration of plasma antioxidants micronutrients in their system. Also, it was seen that consumption of a plant-centered diet starting in young adulthood is associated with a lower risk of CVD by middle age (Table 1).

In a randomized cross-over study by Djekic et al., it was discovered that subjects with ischemic heart disease (IHD) experienced a reduction in oxidized low-density lipoprotein cholesterol (LDL-C) after being placed on avegetarian dietfor four weeks [9]. There was also a reduction in their cardiometabolic risk factors compared to their counterparts on an isocaloric meat diet (meat diet of the same calorie) [9]. This reduction in oxidized LDL-C has been attributed to the presence of a particular baseline gut microbiota rich in several genera of the families Ruminococcaceae and Barnesiellaceae in these individuals [9]. These gut microbes play important roles in the clearance of intestinal infections and immunomodulation [14]. Ordinarily, the conversion of LDL-C to its oxidized form enhances the formation of fatty streaks and the formation of atherosclerotic plaques [15]. People who suffer from IHD have a reasonably high level of oxidized LDL-C than people free from IHD [14]. Thus, even when on medical therapy, a vegetarian diethelp lowers the level of oxidized LDL-C in people with IHD. This was confirmed when four weeks of a vegetarian diet lowered the level of oxidized LDL-C in subjects with IHDwith a meat diet, who were also being treated with percutaneous coronary intervention (PCI) [9].Furthermore, coronary artery disease(CAD) patients on standard medical therapy, who were placed on a four-week vegetarian dietshowed a favorable and significant impact on plasma lipids, particularly sphingomyelins (SMs), alkyl phosphatidylcholine (O-PC), phosphatidylcholine (PC), and triglycerides (TGs) compared to isocaloric meat diet. Additionally, data from high-throughput lipidomics connected a vegetarian diet to the presence of long-chain polyunsaturated TGs in high concentrations and the absence of lipotoxic lipids such TGs with saturated fatty acyl chains [16]. According to another study, CAD patients had lower amounts of unsaturated TGs in their epicardial adipose tissue than persons without the condition[17].Generally, vegetarian diet improves plasma lipid profile by reducing the level of lipotoxic lipids species.

In another prospective cohort study conducted by Choi et al., a plant-centered over the long term was linked to a 52% decreased risk of incident CVD in people who were tracked since young adulthood [11]. Additionally, a 13-year rise in the quality of a plant-based diet was linked to a 61% decreased risk of CVD occurrences in the next 12-year period [11]. However, since there are other risk factors relevant to the incidence of CVDs, the timing and length of exposure to these risk factors may differ in how this illness manifests in adults. As a result, an assessment in middle or advanced age may not provide a comprehensive view of the whole spectrum of illness development in adulthood. This study demonstrated a link between a higher quality plant-based diet starting in early adulthood and a decreased risk of CVDs in adulthood[11]. Social parameters like race and educational background were also found to be mediators of the relationship between a plant-based diet and CVD incidence. A proposed mechanism of how a plant-based diet may reduce CVDs incidents is the trapping of free radicals which leads to a reduction in reactive oxygen molecules thereby preventing tissue damage. This successful endeavor has been linked to substances like phenolics, carotenoids, tocopherols, and ascorbic acid, which are plentiful in nuts and seeds, fruits, vegetables, and whole grains[18].

In a randomized controlled studyusing low-fat food plant-based diet in a community for obesity, IHD, or diabetes done by Wright et al., a reduction in BMI, cholesterol, and other risk factors was achieved [10]. The dietary approach included whole grains, legumes, vegetables, and fruits [10]. Participants were advised to eat until satiation and no restriction on total energy intake was placed. Participants were asked to not count calories. A diet chart was provided to participants outlining which foods to consume, limit, or avoid. Starches such as potatoes, sweet potato, bread, cereals, and pasta were also encouraged to satisfy their appetite and they were asked to avoid refined oils (e.g. olive or coconut oil), animal products (meat, fish, eggs, and dairy product, high-fat plant foods such as nuts and avocados, and highly processed foods. Participants were encouraged to minimize sugar, salt, and caffeinated beverages [10]. Daily vitamin B12(methylcobalamin) supplements (50g) were also provided for participants.This study was said to have had better weight reduction in six and 12 months compared to studies that do not impose calorie restrictions and frequent activity requirements.Participants in this study were focused on a whole food plant-based diet and this was attributed to the low energy density in the food consumed [10].

Shah et al, contrasted the effects of the American Heart Association's (AHA) recommended diet on CHD with those of a vegan dietin a prospective study design [1]. In patients with established CHD receiving medical treatment that followed guidelines, this research showed a considerably higher decrease in highly-sensitive C-reactive protein (hs-CRP) with a vegan diet compared to the AHA's diet recommendation. A risk indicator for serious negative cardiovascular outcomes in CHD is hs-CRP [19]. However, there was no significant difference in the degree of weight loss and waist circumference[1]. In a study of 46 patients with CHD who were assigned to a one-month vegan diet regimen with prepared meals and stress management, it was established that there was a resulting decrease in plasma cholesterol [20].Astudy analyzed the outcomes of the MultiSite Cardiac Lifestyle Intervention Program [19] and encompassed 56 CHD patients and 75 patients at risk for CHDs using a low-fat, plant-based diet, exercise, whole foods, stress management, and group support sessions. Over the course of the three months of this intervention, it was seen that waist-hip ratio, CRPs, BMI, insulin concentration, and lipid profile all decreased.

Navarro et al. demonstrated that a vegetarian diet is associated with decreased concentration of myeloperoxidase (MPO), metalloproteinase (MMP-9 and MMP-2), and tissue inhibitor of MMP (TIMP-1)/MMP-9 ratio when compared with omnivores in apparently healthy individuals [12]. The reduced concentration of these cardiovascular biomarkers has been linked to a high intake of fruits and vegetables with a reduced concentration of circulating neutrophils and leucocytes in vegetarians compared to omnivores. In metabolic syndrome and diabetes, there is an associated high concentration of leucocytes, which is also associated with high activity of MMP, cardiovascular dysfunction, and remodeling [12]. This study reiterates the association between a high intake of vegetarian meals and its associated reduced biomarkers of CVDs.

Cengiz1 et al., were able to elaborate on the general fact that a vegetarian diet reduces the risk of CVDs, a fact related to low saturated fat and cholesterol content [21]. Soy protein contains isoflavones and polyphenols, which are bioactive compounds that have been implicated in the reduction of low-density lipoprotein (LDL) levels which is important in atherosclerosis pathogenesis [22]. Studies on Isoflavones have shown that this compound is responsible for arterial vasodilation and the reduction of serum cholesterol in animal models [23]. It also inhibits atherosclerosis in postmenopausal monkeys [23]. It has been shown that vegetarian diets lower blood pressure and deaths from CHD and stroke decline when blood pressure levels drop [21].

According to Kahleova et al., the advantages of a vegetarian diet include lowering CVD risk factors and benefits in preventing atherosclerosis[2]. Blood vessels are lined with the endothelium, which helps in regulating angiogenesis and vascular tone as well as preventing leucocyte adhesion. Various adverse factors have been implicated in abnormal endothelial function; some of these are sedentary lifestyle, western diet type, hypertension, and inflammation. In a nutshell, a diet rich in meat has been associated with compromised endothelial function while high fruit and vegetable intake is associated with improved endothelial function [24]. As a matter of fact, the compromised endothelial function has been noted to improve with a vegetarian diet. Apart from CRP, other inflammatory biomarkers like interleukin-6 and soluble intercellular adhesion molecule-1 have been shown to reduce in the serum with plant based-diet [25]. These inflammatory biomarkers have been implicated in various CVDs, thus, plant based-diet plays a positive role in reversing the pathophysiology of these diseases. Increased level of trimethylamine N-oxide (TMAO) has also been associated with the risk of myocardial infarction, stroke, or even death [26].An organic substance produced by the gut bacteria is called TMAO and is a culprit which promotes atherosclerosis through the accumulation of cholesterol in foam cells [26]. Dietary phosphatidylcholine and carnitine, which are plentiful in a variety of food sources, such as eggs, dairy products, and red meat, are then used in its hepatic metabolism of it. Vegetarians' gut microbiome generates less triethylamine, which is the precursor of TMAO, thus, a consequential reduction in the incidence of CVDs [27].

This review demonstrated its strength in its ability to explore the effects of a vegetarian diet on CHD.Across all selected articles, the impact of the reduction in the risk factors associated with CHD was also demonstrated. The limitations observed include the following: studies conducted in clinical settings could have observer bias because of the possible influence of the researcher's expectations. Also, the causal relationship between a vegetarian diet and CHD could not be appreciated in the included articles that were observational studies.Another limitation was the attrition effect, as most of the patients were lost to follow-up and they may be underreporting dietary intake among participants. There is a need to use a population size that reflects the effects of a vegetarian diet on CHD across race, sex, and socioeconomic classification.

An increase in sensitization and education efforts is imperative to ensure that people are appropriately informed about this great option to improve their quality of life significantly. Beyond education, however, is the issue of accessibility. Good quality, organic whole foods are very expensive and most times outside the budget range of most families, and these disparities are even more glaring when you examine them by racial demographics.Working on subsidizing the prices of good quality foods to improve accessibility in addition to education will go a long way towards encouraging more people to adopt a vegetarian or vegan diet.

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Office of Dietary Supplements (ODS)

Posted: September 10, 2022 at 2:11 am

Introduction

This fact sheet provides information on weight-loss dietary supplements*, including summaries of research on the safety and efficacy of several of the most commonly used ingredients in these products.

More than two-third of adults and almost one-third of children and adolescents in the United States are overweight or have obesity [1,2]. Forty-five percent of Americans who are overweight and 67% of those with obesity are trying to lose weight [3].

Health experts agree that making lifestyle changesincluding following a healthy dietary pattern, reducing caloric intake, and engaging in physical activityis the basis for achieving long-term weight loss [4-7]. But because making diet and lifestyle changes can be difficult, many people turn to dietary supplements promoted for weight loss in the hope that these products will help them more easily achieve their weight-loss goals.

Approximately 15% of U.S. adults have used a weight-loss dietary supplement at some point in their lives; more women report use (21%) than men (10%) [8]. Americans spend about $2.1 billion a year on weight-loss dietary supplements in pill form (e.g., tablets, capsules, and softgels) [9], and one of the top 20 reasons why people take dietary supplements is to lose weight [10].

Dietary supplements promoted for weight loss encompass a wide variety of products and come in a variety of forms, including capsules, tablets, liquids, powders, and bars [11]. Manufacturers market these products with various claims, including that these products reduce macronutrient absorption, appetite, body fat, and weight and increase metabolism and thermogenesis. Weight-loss products can contain dozens of ingredients, and some contain more than 90 [11]. Common ingredients in these supplements include botanicals (herbs and other plant components), dietary fiber, caffeine, and minerals.

In its report on dietary supplements for weight loss, the U.S. Government Accountability Office concluded that "little is known about whether weight loss supplements are effective, but some supplements have been associated with the potential for physical harm" [12]. Many weight-loss supplements are costly, and some of these products ingredients can interact or interfere with certain medications. So it is important to consider what is knownand not knownabout each ingredient in any dietary supplement before using it.

People who are considering using weight-loss supplements should talk with their healthcare provider to discuss these products' potential benefits and risks. This is especially important for those who have medical conditions, including high blood pressure, diabetes, and liver or heart disease. Yet, according to a large national survey, less than one-third of U.S. adults who use weight-loss dietary supplements discuss this use with a healthcare professional [8].

*Dietary supplements are labeled with a Supplement Facts panel and do not include meal replacement shakes or prescription or over-the-counter medications.

The U.S. Food and Drug Administration (FDA) regulates dietary supplements, including those promoted for weight loss [13]. Like other dietary supplements, weight-loss supplements differ from over-the-counter or prescription medications in that the FDA does not classify them as drugs. Unlike drugs, dietary supplements do not require premarket review or approval by the FDA. Supplement manufacturers are responsible for determining that their products are safe and their label claims are truthful and not misleading. If the FDA finds a supplement to be unsafe, it may take enforcement action to remove the product from the market or ask the manufacturer to recall the product. The FDA and the Federal Trade Commission can also take regulatory actions against manufacturers that make unsubstantiated weight-loss claims about their products. The FDA does not permit dietary supplements to contain pharmaceutical ingredients, and manufacturers may not promote dietary supplements to diagnose, treat, cure, or prevent any disease [13].

For more information about dietary supplement regulation, see the Office of Dietary Supplements (ODS) publication, Dietary Supplements: What You Need to Know.

Weight-loss dietary supplements contain a wide variety of ingredients. Not surprisingly, the amount of scientific information available on these ingredients varies considerably. In some cases, evidence of their purported benefits consists of limited data from animal and laboratory studies, rather than data from human clinical trials. In other cases, studies supporting a given ingredients use are small, of short duration, and/or of poor quality, limiting the strength of the findings. In almost all cases, additional research is needed to fully understand the safety and/or efficacy of a particular ingredient [3].

Complicating the interpretation of many study results is the fact that most weight-loss dietary supplements contain multiple ingredients, making it difficult to isolate the effects of each ingredient and predict the effects of the combination. Evidence may exist for just one of the ingredients in a finished product, and no evidence may be available for an ingredient when it is combined with other ingredients. Furthermore, dosages and amounts of active components vary widely among weight-loss supplements, and a products composition is not always fully described in published studies [14]. Studies might also use different and sometimes inappropriate assessment techniques to measure the effectiveness of a given treatment. All of these factors can make it difficult to compare the results of one study with those of another.

Table 1 briefly summarizes the findings discussed in more detail in this fact sheet on the safety and efficacy of the most common ingredients of weight-loss dietary supplements. These ingredients are listed and discussed in the table and text in alphabetical order. Dosage information is provided when it is available. However, because ingredients might not be standardized and many products contain proprietary blends of ingredients, the active compounds and their amounts might not be comparable among products [15].

Research findings: Possible modest reduction in body weight and waist circumference

Reported adverse effects: Headache, difficulty sleeping, flatulence, and gas

Research findings: No effect on body weight

Reported adverse effects: Flatulence

Research findings: Possible increase in resting metabolic rate and energy expenditure; inconclusive effects on weight loss

Reported adverse effects: Chest pain, anxiety, headache, musculoskeletal complaints, and increased blood pressure and heart rate

Research findings: Possible modest effect on body weight or decreased weight gain over time

Reported adverse effects: Nervousness, jitteriness, vomiting, and tachycardia

Research findings: No effect on body weight, weight loss, or prevention of weight gain based on clinical trials

Reported adverse effects: Constipation, kidney stones, and interference with zinc and iron absorption at intakes above 2,0002,500 mg for adults

Research findings: Might reduce energy intake but no effect on body weight

Reported adverse effects: Gastrointestinal distress, increased insulin levels, and decreased high-density lipoprotein (HDL) levels

Research findings: Possible modest reduction in body weight

Reported adverse effects: Nausea, vomiting, diarrhea, abdominal cramps, and a fishy body odor; might increase trimethylamine N-oxide (TMAO) levels, which are linked to greater cardiovascular disease risk

Research findings: Minimal effect on body weight

Reported adverse effects: Flatulence, bloating, constipation, indigestion, nausea, and heartburn

Research findings: Minimal effect on body weight and body fat

Reported adverse effects: Headache, watery stools, constipation, weakness, vertigo, nausea, vomiting, and urticaria (hives)

Research findings: No effect on body weight

Reported adverse effects: More frequent bowel movements, loose stools

Research findings: Minimal effect on body weight and body fat

Reported adverse effects: Abdominal discomfort and pain, constipation, diarrhea, loose stools, dyspepsia, and (possibly) adverse effects on blood lipids and glucose homeostasis

Research findings: Insufficient research to draw firm conclusions

Reported adverse effects: None known

Research findings: Little to no effect on body weight

Reported adverse effects: Headache, nausea, upper respiratory tract symptoms, gastrointestinal symptoms, mania, and liver damage

Research findings: Little to no effect on body weight

Reported adverse effects: Loose stools, flatulence, diarrhea, constipation, and abdominal discomfort

Research findings: Possible modest effect on body weight

Reported adverse effects: Headache and urinary tract infections

Research findings: Possible modest effect on body weight

Reported adverse effects (for green tea extract): Constipation, abdominal discomfort, nausea, increased blood pressure, and liver damage

Research findings: No effect on body weight

Reported adverse effects: Abdominal pain, flatulence, diarrhea, nausea, and cramps

Research findings: No effect on energy intake or body weight based on one study

Reported adverse effects: Headache, dizziness, nausea, and vomiting

Research findings: Inconsistent effects on body fat, waist and hip circumference, and body weight

Reported adverse effects: Gastrointestinal symptoms, such as gas

Research findings: Possible minimal effect on body weight and body fat

Reported adverse effects: Diarrhea, gas, bloating, and (possibly) decreased HDL levels

Research findings: Insufficient research to draw firm conclusions

Reported adverse effects: None known

Research findings: No effect on body weight

Reported adverse effects: Anorexia, weight loss, polyuria, heart arrhythmias, and increased calcium levels leading to vascular and tissue calcification

Research findings: Possible modest effect on body weight and body fat

Reported adverse effects: Headache, soft stools, flatulence, and constipation

Research findings: No effect on body weight; insufficient research to draw firm conclusions

Reported adverse effects: Headache, anxiety, agitation, hypertension, and tachycardia, myocardial infarction, cardiac failure, and death

African Mango [Irvingia gabonensis (Aubry-Lecomte ex ORorke) Baill.]

African mango, or Irvingia gabonensis, is a fruit-bearing tree that is native to western and central Africa [16]. Irvingia gabonensis seed kernel extract has been proposed to promote weight loss by inhibiting adipogenesis, as demonstrated in vitro [17]. In addition, a proprietary extract of Irvingia gabonensis, IGOB131, reduces serum levels of leptin [18], a hormone that is positively correlated with body weight and percentage body fat [19]. IGOB131 might also reduce total cholesterol and low-density lipoprotein (LDL) levels [18].

Efficacy: Studies have examined the effects of Irvingia gabonensis on weight loss to only a limited extent in humans. A clinical trial conducted in Cameroon randomized 102 adults with overweight or obesity (body mass index [BMI] >25) to receive either 150 mg IGOB131 or placebo 3060 minutes before lunch and dinner (300 mg total daily dose) for 10 weeks [18]. Participants who received the extract had significantly lower body weight, body fat, and waist circumference at the end of the trial than those taking a placebo. This trial, along with two others, was included in a 2013 systematic review whose authors reported that Irvingia gabonensis extract causes statistically significant reductions in body weight and waist circumference [19]. The authors noted, however, that the trials included in the review used different study methodologies, small samples, short intervention periods, and varying daily doses of Irvingia gabonensis extract (300 mg to 3,150 mg); in addition, the trials were all conducted by the same authors. Additional trials with larger samples and diverse populations are needed to determine whether Irvingia gabonensis extract is effective for weight loss [19].

Safety: Irvingia gabonensis extract appears to be well tolerated. No adverse effects have been found in rats at doses up to 2,500 mg/kg body weight per day [20], but its safety has not been rigorously studied in humans. Most reported adverse effects are mild, including headache, difficulty sleeping, flatulence and gas [19]. However, Irvingia gabonensis has been associated with renal failure in a patient with chronic kidney disease [21].

Beta-Glucans

Beta-glucans are glucose polysaccharides found in bacteria, yeasts, fungi, and cereal grains (such as oats and barley). As soluble dietary fibers, beta-glucans are proposed to increase satiety and gastrointestinal transit time and to slow glucose absorption [16]. Consumption of beta-glucans from barley has been shown to reduce energy intake and appetite in humans [22].

Efficacy: Several studies have investigated the effects of beta-glucans on blood lipids, blood pressure, and insulin resistance, with weight loss as a secondary outcome. In one of these studies, 66 women who were overweight followed a low-calorie diet (designed to produce a 0.5 kg/week weight loss) for 3 months that was supplemented with 56 g/day beta-glucan (from oat bran), 89 g/day beta-glucan, or no beta-glucan (control) [23]. At the end of the trial, all groups lost weight and had a smaller waist circumference, but there were no significant differences between groups. Similarly, other trials have found that 310 g/day beta-glucans for 412 weeks does not have a significant effect on weight loss [16].

Safety: Beta-glucans appear to be well tolerated. Reported adverse effects include increased flatulence, but not changes in stool consistency, stool frequency, or bloating [24].

Bitter Orange [(Citrus aurantium L.); zhi qiao]

Bitter orange is the common name for the botanical Citrus aurantium. The fruit of this plant is a source of p-synephrine (often referred to simply as synephrine) and other protoalkaloids [25- 28]. As alpha-adrenergic agonists, synephrine alkaloids can mimic the action of epinephrine and norepinephrine. However, the extent to which bitter orange and synephrine cause similar cardiovascular and central-nervous-system effects to epinephrine and norepinephrine (e.g., increased heart rate and blood pressure) is not clear [25-27].

Studies suggest that bitter orange increases energy expenditure and lipolysis and that it acts as a mild appetite suppressant [25,27]. After the FDA banned the use of ephedrine alkaloids in dietary supplements in 2004 [see section on ephedra (m hung)], manufacturers replaced ephedra with bitter orange in many products; thus, bitter orange became known as an ephedra substitute [29]. Although synephrine has some structural similarities to ephedrine, it has different pharmacological properties [27,30].

Efficacy: Several small human studies have examined whether bitter orange is effective for weight loss [30]. Interpreting the results of these studies is complicated by the fact that bitter orange is almost always combined with other ingredients in weight-loss supplements.

In one study, 20 healthy adults who were overweight (BMI >25) took a product containing 975 mg bitter orange extract (6% synephrine alkaloids), 528 mg caffeine, and 900 mg St. Johns wort; a placebo; or nothing (control) each day for 6 weeks [31]. All participants also took part in a circuit-training exercise program and were counseled to consume 1,800 kcal/day. At the end of the study, participants taking the combination bitter orange product had a significantly greater reduction in percent body fat and fat mass and a greater increase in basal metabolic rate than those in the placebo and control groups. Participants in all groups lost weight, but the authors did not report whether the mean reduction in body weight in the treatment group (1.4 kg) was significantly greater than that in the placebo group (0.9 kg) or control group (0.4 kg) [32].

In another study, 8 healthy people with overweight or obesity (BMI 2540) received counseling to follow a 1,2001,500 kcal/day diet and were randomized to take either an herbal supplement containing bitter orange (18 mg synephrine/day) and other ingredients, including guarana extract as a source of caffeine (396 mg caffeine/day), or placebo [33]. The peak rise in resting metabolic rate at baseline was significantly higher in participants taking the herbal supplement than those in the placebo group, but the difference was not significant at the end of the 8-week study. Participants taking the herbal supplement had a significant increase in mean body weight (1.13 kg) compared with those taking a placebo (0.09 kg) at the end of the study. However, this increase in body weight did not significantly affect body fat and lean tissue levels or waist circumference. The authors noted that the weight gain might have occurred by chance because the trial was insufficiently powered to detect this small difference.

The authors of a 2012 review of 23 small human clinical studies involving a total of 360 participants concluded that synephrine increases resting metabolic rate and energy expenditure [30]. The authors of an earlier review of animal studies, clinical trials, physiologic studies, and case reports concluded that synephrine alkaloids have a suggestion of some benefit to weight loss, but the available data are very limited and cannot be considered conclusive [25]. Similarly, a 2011 systematic review of four weight loss trials (including the two described above) concluded that the evidence of efficacy for bitter orange/synephrine is contradictory and weak [34]. According to all of these reviews, longer-term clinical trials with rigorous designs and large samples are needed to determine the value of bitter orange for weight loss.

Safety: Products containing bitter orange may have significant safety concerns. Reported adverse effects include chest pain, headache, anxiety, elevated heart rate, musculoskeletal complaints, ventricular fibrillation, ischemic stroke, myocardial infarction, and death [34,35]. However, many of the products with these effects contain multiple herbal ingredients, and the role of bitter orange in these adverse effects cannot be isolated. Some studies indicate that bitter orange and synephrineas bitter orange extract or pure synephrineraise blood pressure and heart rate, but other studies show that they do not have these effects [25-27,31,36-39]. For example, a single dose of 900 mg bitter orange standardized to 6% (54 mg) synephrine significantly increased heart rate as well as systolic and diastolic blood pressure for up to 5 hours compared to placebo in 15 healthy men and women [38]. However, in an 8-week clinical trial in 80 healthy, resistance-trained adult men, a dietary supplement containing bitter orange extract (providing 20 mg synephrine/day), 284 mg caffeine, and other ingredients did not increase resting heart rate, systolic or diastolic blood pressure, or reported side effects at 4 and 8 weeks compared to placebo or the same supplement formulation without synephrine [40]. Some researchers have suggested that synephrine might not act directly as a cardiovascular stimulant [27,37,39]. Instead, caffeine, other stimulants in multicomponent formulations, and other constituents of bitter orange or adulterants (such as m-synephrine, which is not naturally present in bitter orange) might be responsible for its observed effects.

Caffeine, Including Caffeine from Guarana, Kola Nut, Yerba Mat, or Other Herbs

Many dietary supplements promoted for weight loss contain added caffeine or an herbal sourcesuch as guarana (Paullinia cupana), kola (or cola) nut (Cola nitida), and yerba mat (Ilex paraguariensis)that naturally contains caffeine. Green tea and other forms of tea also contain caffeine (see section on green tea). Some weight-loss supplement labels do not declare the amount of caffeine in the product and only list the herbal ingredients. As a result, consumers might not be aware that the presence of certain herbs means that a product contains caffeine and possibly other stimulants [41].

Caffeine is a methylxanthine that stimulates the central nervous system, heart, and skeletal muscles. It also increases gastric and colonic activity and acts as a diuretic [42,43]. Caffeine has a half-life of about 6 hours; blood levels increase within 1545 minutes of consumption, and they peak at around 60 minutes [44]. Caffeine increases thermogenesis in a linear, dose-dependent fashion in humans [45]. A 100 mg dose of caffeine, for example, increased energy expenditure by a mean of 9.2 kcal/hr more than placebo in healthy humans, and this effect lasted for three hours or more. Caffeine might also contribute to weight loss by increasing fat oxidation through sympathetic activation of the central nervous system and by increasing fluid loss [41,45]. Habitual use of caffeine however, leads to caffeine tolerance and a diminishment of these effects [41,43].

Efficacy: Caffeine increases energy expenditure and fat oxidation [44]. However, the extent to which these effects affect weight loss is less clear, partly because clinical trials examining the effects of caffeine on weight loss have all been short and have used combination products. In one study, 167 participants with overweight or obesity (BMI 2540) took a supplement containing kola nut (192 mg/day caffeine) and ma huang (90 mg/day ephedrine) or placebo [46]. Participants were counseled to eat a normal diet except for limiting dietary fat to 30% of calories and to exercise moderately. After 6 months, those in the treatment group lost significantly more weight (mean weight loss 5.3 kg) than those in the placebo group (2.6 kg) and had significantly greater body fat reduction. A product containing caffeine plus glucosyl hesperidin (G-hesperidin, a flavonone glycoside found mainly in citrus fruits) reduced abdominal fat and BMI in a clinical trial in Japan [47]. In this study, 75 healthy men and women who were overweight (BMI 2430) received one of five treatments daily for 12 weeks while maintaining their regular lifestyle and eating habits. The five treatments were placebo and four formulations of 0, 25, 50, or 75 mg caffeine plus 500 mg G-hesperidin. The 75 mg caffeine plus G-hesperidin significantly reduced BMI by a mean of 0.56 vs. 0.02 for placebo. The 50 or 75 mg caffeine plus G-hesperidin also significantly reduced abdominal fat compared to placebo, whereas the G-hesperidin alone or with only 25 mg caffeine did not significantly affect BMI or abdominal fat. These findings indicate that the higher doses of caffeine might be responsible for the observed effects.

In another study, 47 adults who were overweight (BMI 2630) were randomized to take a combination product containing 336 mg yerba mat (11.5% caffeine), 285 mg guarana (36% caffeine), and 108 mg damiana (a botanical extract that contains essential oils, resins, and tannins but not caffeine) or placebo 15 minutes before each main meal for 45 days while maintaining their normal eating habits [48]. At the end of the study, participants taking the herbal product lost a mean of 5.1 kg compared to 0.3 kg for those taking the placebo.

Data from a 12-year prospective observational study provide some insight into the long-term association between caffeine intake and body weight [49]. In this study, researchers followed 18,417 healthy men and 39,740 healthy women enrolled in either the Nurses Health Study or the Health Professionals Follow-Up Study. On average, participants gained some weight during the study, but men who increased their caffeine intake during the 12 years of follow-up gained a mean of 0.43 kg less than those who decreased their caffeine consumption. For women, the corresponding mean difference in weight gain was 0.35 kg less. In a cross-sectional study, German adults who had lost weight and maintained the weight loss (n = 494) reported significantly higher consumption of coffee and other caffeinated beverages (mean intake 3.83 cups/day) than the general population (n = 2,129, mean intake 3.35 cups/day), suggesting that caffeine might help with weight loss maintenance [50]. However, further research is needed to confirm this finding.

Safety: For healthy adults, the FDA and the European Food Safety Authority (EFSA) state that up to 400 mg/day caffeine does not pose safety concerns [51,52], whereas the American Medical Association recommends a limit of 500 mg/day [53]. For comparison, an 8-ounce cup of brewed coffee contains about 85100 mg caffeine . The FDA and EFSA have not set a safe level of intake for children, but the American Medical Association recommends that adolescents consume no more than 100 mg/day, and the American Academy of Pediatrics discourages children and adolescents from consuming caffeine and other stimulants [51-54].

Caffeine can cause sleep disturbances and feelings of nervousness, jitteriness, and shakiness. Caffeine can be toxic at doses of 15 mg/kg (about 1,000 mg for a 150-lb adult), causing nausea, vomiting, tachycardia, seizures, and cerebral edema [42]. Doses above 150 mg/kg (about 10,000 mg for a 150-lb adult) can be fatal. Combining caffeine with other stimulants, such as bitter orange and ephedrine, can potentiate these adverse effects. According to an analysis, 47% of calls to the California Poison Control System in 2006 reporting adverse effects or toxicities potentially caused by dietary supplements involved products containing caffeine [55]

Calcium

Calcium is an essential mineral that is stored in the bones and teeth, where it supports their structure and function. Calcium is required for vascular contraction and vasodilation, muscle function, nerve transmission, intracellular signaling, and hormonal secretion [56]. The Recommended Dietary Allowance (average daily level of intake sufficient to meet the nutrient needs of 9798% of healthy individuals) for calcium ranges from 1,000 to 1,300 mg/day for children and adults aged 4 years and older.

Several studies have correlated higher calcium intakes with lower body weight or less weight gain over time [57-61]. Two explanations have been proposed. First, high calcium intakes might reduce calcium concentrations in fat cells by decreasing the production of parathyroid hormone and the active form of vitamin D. Decreased intracellular calcium concentrations, in turn, might increase fat breakdown and discourage fat accumulation in these cells [59]. Second, calcium from food or supplements might bind to small amounts of dietary fat in the digestive tract and prevent absorption of this fat [59,62,63]. Dairy products, in particular, might contain additional components that have even greater effects on body weight than their calcium content alone would suggest [60,64-67]. For example, protein and other components of dairy products might modulate appetite-regulating hormones [61].

Efficacy: A 2014 randomized crossover trial in 15 healthy young men found that diets high in milk or cheese (supplying a total of 1,700 mg/day calcium) significantly increased fecal fat excretion compared to a control diet that supplied 500 mg calcium/day [68]. However, the results from clinical trials examining the effects of calcium on body weight have been largely negative. For example, supplementation with 1,500 mg/day calcium (from calcium carbonate) was investigated in 340 adults with overweight or obesity (BMI 25) with mean baseline calcium intakes of 878 mg/day (treatment group) and 887 mg/day (placebo group) [69]. Compared to placebo, calcium supplementation for 2 years had no clinically significant effects on weight.

The authors of four reviews of published studies on the effects of calcium from supplements or dairy products on weight management reached similar conclusions [70-73]. These reviews include a 2009 evidence report from the Agency for Healthcare Research and Quality whose authors concluded that, overall, clinical trial results do not support an effect of calcium supplementation on weight [70]. In addition, a 2015 meta-analysis of 41 randomized controlled trials found no benefit of calcium supplementation or increased dairy food consumption for body weight or body fat [73]. A 2016 meta-analysis of 33 randomized trials and longitudinal studies lasting 12 weeks to 6 years found that calcium from foods or supplements had no overall effect on body weight [74]. However, in subgroup analyses, calcium did reduce body weight in some groups, including children, adolescents, adult men, premenopausal women, women older than 60, and people with normal BMI [74]. Overall, the results from clinical trials do not support a clear link between higher calcium intakes and lower body weight, prevention of weight gain, or weight loss.

Safety: The Tolerable Upper Intake Level (UL; maximum daily intake unlikely to cause adverse health effects) for calcium established by the Institute of Medicine of the National Academies (now the Academy of Medicine at the National Academies of Sciences, Engineering, and Medicine) is 2,500 mg/day for adults aged 1950 years and 2,000 mg for adults aged 51 and older [56]. High intakes of calcium can cause constipation and might interfere with the absorption of iron and zinc, although this effect is not well established. High intakes of calcium from supplements, but not foods, have been associated with an increased risk of kidney stones [56,75-77].

Capsaicin and Other Capsaicinoids

Capsaicinoids give chili peppers their characteristic pungent flavor. Capsaicin is the most abundant and well-studied capsaicinoid [78]. Capsaicin and other capsaicinoids have been proposed to have anti-obesity effects via their ability to increase energy expenditure and lipid oxidation, attenuate postprandial insulin response, increase satiety, and reduce appetite and energy intake [78-82]. Other research suggests that capsaicin increases satiety by inducing gastrointestinal distress (e.g., pain, burning sensation, nausea, and bloating, which could all reduce the desire to eat) rather than by releasing satiety hormones [82].

Efficacy: Most research on capsaicin and other capsaicinoids focuses on their effects on energy intake and appetite, rather than body weight. A meta-analysis of eight randomized, placebo-controlled clinical trials evaluated the effects of capsaicinoids on ad libitum energy intake in a total of 191 participants who had a normal body weight or were moderately overweight [78]. Doses of capsaicinoids ranged from 0.2 mg in a single meal to 33 mg/day for 4 weeks (via chili powder, chili-containing foods, or chili capsules). Overall, consuming capsaicinoids significantly reduced energy intake by a mean of 74 kcal per meal; body weight was not assessed, so the impact of this calorie reduction on weight loss cannot be quantified. The authors noted that the results suggest that at least 2 mg capsaicinoids are needed to reduce calorie intake but that the studies were very heterogeneous.

A 2017 clinical trial compared 2 mg/day and 4 mg/day capsaicinoid supplements for 12 weeks in 77 adults who were overweight [83]. At the end of the trial, participants receiving 4 mg/day capsaicinoids reported a mean intake of 252 fewer calories per day than those receiving placebo and a mean of 140 fewer calories per day than those receiving 2 mg/day capsaicinoids. However, the calorie reductions did not significantly affect body weight at either 6 weeks or 12 weeks.

Safety: Supplementation with 4 mg/day capsaicinoids can cause gastrointestinal distress [83]. It might also increase serum insulin and reduce high-density lipoprotein (HDL) cholesterol levels. Otherwise, capsaicin and other capsaicinoids appear to be safe. Research is underway to reduce the pungency and "chili taste" associated with capsaicin while retaining its potential biological effects [81].

Carnitine

Carnitine is the generic term for several compounds, including L-carnitine itself, several acylcarnitines (e.g., acetyl-L-carnitine), and propionyl-L-carnitine. It is composed of the amino acids lysine and methionine [84]. Carnitine is naturally present in animal products such as meat, fish, poultry, and milk and dairy products; small amounts are present in some plant foods. Humans synthesize carnitine from its constituent amino acids, so dietary carnitine intake is not necessary. Almost all cells of the body contain carnitine, which transports fatty acids into the mitochondria and acts as a cofactor for fatty acid beta-oxidation [85]. Because of these effects, carnitine has been proposed as a weight-loss agent.

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An online survey of dietary quality during complementary feeding; associations with maternal feeding self-efficacy and adherence to dietary…

Posted: September 10, 2022 at 2:04 am

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Spyreli E, McKinley MC, Dean M. Parental considerations during complementary feeding in higher income countries: a systematic review of qualitative evidence. Public Health Nutr. 2021;20:131.

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5 Surprising Effects of Eating Soy, Say Dietitians Eat This Not That – Eat This, Not That

Posted: September 2, 2022 at 2:05 am

When you hear the word "soybeans," the first things that may come to mind are all the health claims you remember from years ago. Wasn't there talk about soy causing "man-boobs?" And what about those possible links to breast cancer, thyroid disease, and dementia? But those claims have not been clinically substantiated, according to experts at Harvard T.H. Chan School of Public Health.

"Soy is probably the most controversial nutrition topic out there," says Kathryn Piper, RD, LD, a registered dietitian and founder of The Age-Defying Dietitian. "The different outcomes in the research are most likely related to the variations in how soy is studied."

Soy can be safely consumed several times a week especially when eaten as an alternative to red and processed meats, say dietitians we spoke with.

"Numerous studies support the safety of 25 grams of soy protein per day," says Piper. "Soy is nutrient-dense, providing protein, fiber, calcium, and B vitamins and it appears to have a positive impact on those with heart disease and diabetes and women in menopause."

Let's consider the potential benefits of eating more soy. Read on, and for more, don't miss4 Surprising Effects of Cottage Cheese.

Soy is a rich source of protein, which is critical for repairing and building muscle. And as we've reported many times, muscle is metabolically active. The more muscle you have, the more calories you burn and the less fat you're likely to carry on your frame.

Protein is also satiating, keeping you feeling full longer and fighting cravings for sugary carbohydrates. "Soy may play a positive role on insulin resistance, fatty acid metabolism, and other hormonal, cellular, or molecular changes associated with weight gain," says medical review board member Lauren Manaker, MS, RDN, a registered dietitian nutritionist and founder of Nutrition Now Counseling.

A study in the International Journal of Medical Sciences that looked at soy's impact on obese people found that consuming dietary soy protein regularly reduced body weight, fat mass, and cholesterol levels.

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While a diet rich in soy protein may help you lose weight and take some strain off your heart, there are other circulatory perks to gain from eating soy and soy products. "Soy can help lower cholesterol and reduce your risk of cardiovascular disease," says Eatthis.com medical review board member Toby Amidor, MS, RD, author of Diabetes Create Your Plate Meal Prep Cookbook. She cites a 2019 meta-analysis published in the Journal of Nutrition, which found that soy protein reduced low-density lipoprotein, the so-called "bad" cholesterol, by 3 to 4% in adults.6254a4d1642c605c54bf1cab17d50f1e

RELATED:The Best Proteins for Lowering Cholesterol, Says Dietitian

Two other conditions play a key role in heart disease, heart attacks, and strokes that eating more soy may alleviatehigh blood pressure and inflammation, says Amidor.

Chronic low-grade inflammation is a condition where the immune system cells consistently flood the body due to poor diet, smoking, alcohol abuse, and other lifestyle factors. This covert assault may damage tissues, such as the linings of arteries, which can trigger another silent killerhigh blood pressure.

Both inflammation and high blood pressure may cause plaques to develop in arteries that can break off and trigger blood clots that initiate heart attacks and strokes. Two recent studies suggest supplementing the diet with soy protein may reduce blood pressure and chronic inflammation.

As you get older, your risk of osteoporosis increases. Half of all adults over 50, some 54 million Americans (including men), are at risk of breaking a bone due to low bone density, according to the National Osteoporosis Foundation. Eating more soy may help protect you from fractures.

"The isoflavones in soy foods are linked to improved bone mineral density and preventing osteoporosis-related bone loss, regardless of your weight," says Manaker. Isoflavones are a type of phytoestrogen, a plant-derived compound that's found in more abundance in soybeans and soy products than in any other food.

RELATED:#1 Best Supplement for Strong Bones After 50, Says Dietitian

High levels of estrogen have been associated with breast cancer. For that reason, women with breast cancer on hormone therapy were once told to avoid eating soy products. However, moderate soy consumptionup to two servings of tofu, soy milk, or edamame dailydoes not increase the risk of breast cancer, according to the Mayo Clinic. And eating soy products may actually have a protective effect, according to a large study in the journal Cancer, which found that isoflavone, the major phytoestrogen in soy, was associated with reduced mortality from not just breast cancer but all causes.

Other research published in 2022 by the American Association for Cancer Research found that soy might protect young girls from developing breast cancer later in life, says Amidor. The study looked at the diets of 329 girls from puberty until 2 years after first menstruation and found an inverse association between soy consumption and absolute fibroglandular volume, which is indicative of a lower risk of breast cancer.

Jeff Csatari

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Patriots Trent Brown switched to a pescatarian diet to meet weight goals this offseason – Boston.com

Posted: August 9, 2022 at 2:14 am

PatriotsDavon Godchaux was greeted with a lot of appreciation on Thursday. John Tlumacki/Globe Staff

When Trent Brown re-signed with the Patriots this offseason, the team included an interesting bonus to help motivate the offensive tackle.

The Patriots included $1.5 million ($750,000 each season) in bonuses tied to Browns weight in the two-year, $22 million contract he signed in March. While the 385 and 375-pound weight goals Brown had to meet over the offseason might seem easy, the veteran has struggled with his weight in recent years. The 6-foot-8 Brown reportedly saw his weight go up to 400 pounds during the 2020 season while playing with the Raiders.

With a lot of money on the line, Brown looked noticeably slimmer during the first two weeks of Patriots training camp. He revealed to GQs Christopher Carson that he switched to a strict pescatarian diet over the offseason, which has helped him lose 20 pounds from the 380 pounds he previously weighed.

Brown told Carson that the diet change wasnt too difficult because hes eaten food that fits within a pescatarian diet since he entered the league in 2015.

I just had to cut some other things out, Brown said. Instead of having bacon or sausage at breakfastwhen I do eat breakfastit would probably be a piece of salmon or striped bass with my spinach scramble. It was really a pretty smooth transition. Thats probably why Im tired of eating salmon now. Ive been eating salmon and stir fry every day for [expletive] seven years.

In addition to going full pescatarian, Brown told Carson that he drinks a green juice for breakfast and two gallons of water every day. He credited the high amount of water he drinks to help suppress his appetite.

Brown also said that there is some pressure to keep his weight down because of the incentives. However, he feels confident in sticking to his regimen.

With the regular season approaching, Brown said told Carson his calf is feeling good after missing the better part of nine games last season due to a calf injury. The weight loss also has him feeling different and he has a goal to reach by the end of the preseason.

I think dropping 20 pounds definitely goes a long way as far as mobility and helping the way my body moves, Brown said. Ive always been an explosive guy, but I feel like Im that much quicker and lighter on my feet now. My cardiovascular health is definitely better with just not carrying the extra 20 pounds around. By the end of camp I hope to be at around 355. That would be greatit will give myself some leeway between my weight goal and their weight goal for me, so I wont have to be strict as hell on myself throughout the season.

The first $300,000 in bonuses tied to Browns weight came during the offseason. Brown had to weigh 385 pounds or less on the first day of the teams offseason program to earn $150,000. He had to weigh under 375 pounds on June 1 and under 365 pounds on July 15 to earn an extra $150,000.

Brown can earn $25,000 each week during the regular season if he weighs under 365 pounds, which can go up to $425,000 if he meets it every week.

In an interview with the Boston Heralds Karen Guregian on Thursday, Brown said he definitely put in the work during the offseason, so Im expecting to reap the benefits.

I still feel like Im the best tackle to play this game, and I feel like I can be one of the best to ever play.Im out to prove it, Brown said. So here we go. Day by day. Brick by brick.

I approached each day of this offseason, wanting to come in and be the player I know I can be, Brown added. I know I have a responsibility leading this team. Thats how Im approaching each day. I think everyone is appreciative of that. Im appreciative of everyone around me thats working just as hard to help steer this bus in the right direction.

Despite his weight concerns and calf injury, Brown had a strong 2021 season. He allowed just one sack over the 489 snaps he played. Pro Football Focus gave Brown a 78.7 overall grade and an 81.2 pass-blocking grade, which wouldve ranked 21st and 13th, respectively, if he played enough snaps to qualify last season.

Brown exclusively played right tackle last season but is switching back to left tackle, where he played during the Patriots 2018 Super Bowl-winning season.

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What Is the Asian Diet? Potential Health Benefits, Food List, Meal Plan, and More – Everyday Health

Posted: August 1, 2022 at 2:15 am

One of the big benefits of the Asian diet is that youre likely to get more antioxidants than in a Western diet. Youre certainly getting a lot more nutrients than the food label captures, Dr. Li says. Antioxidants are substances that protect your cells from damage caused by free radicals. Free radicals molecules that are created when your body breaks down food or youre exposed to cigarette smoke may play a role in heart disease, cancer, and other chronic diseases, notes Mayo Clinic. In this way, a diet high in antioxidants may protect overall health.

As many antioxidants double as pigments, the natural color of your food is one way to tell what types of antioxidants youre getting. For example, pink and red fruits like tomatoes and pink grapefruit typically have lycopene as their primary antioxidant, Li says. Animal and test-tube studies suggest that lycopene may lower your risk of cancer and heart disease, though more research is needed, according to areview published in August 2020 in the journal Antioxidants.

Unsweetened tea is a staple of the Asian diet, and is a big reason why the diet is thought to stave off chronic diseases, Supan says. Any tea is going to be packed with a good amount of antioxidants. Teas are especially rich in a type of polyphenol known as flavonols, which have been shown to help lower blood pressure and cholesterol, according to areview published in September 2017 in Nutrition Bulletin.

Here are some more Asian diet benefits that research has uncovered.

Following a traditional Asian diet may extend benefits that lower your risk of type 2 diabetes. In a past randomized clinical trial, both Asian Americans and Caucasian Americans at risk of type 2 diabetes lowered their insulin resistance (a hallmark of type 2 diabetes) after following a rigorously controlled traditional Asian diet for 16 weeks. Those who switched back to a traditional Western diet for eight weeks after an eight-week stint on the Asian diet not only gained weight (up to 2 pounds [lb]), but they also increased their insulin resistance.

The Asian diet may help prevent diabetes because it emphasizes many foods that the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) recommends to keep blood sugar under control: whole grains, vegetables, fruits, beans and legumes, and healthy fats. It also limits foods that tend to spike blood sugar and increase your risk of diabetes-related complications like heart disease and stroke, which include sweets, processed foods, sweetened beverages, and animal fats.

The Asian diet may also help control type 2 diabetes, but you may need to pay close attention to your portion sizes, especially when it comes to whole grains, Supan says.

For astudy published August 2018 in the European Journal of Clinical Nutrition, researchers compared the eating patterns of more than 12,000 men from seven countries (United States, Finland, the Netherlands, Italy, Greece, Croatia and Serbia, and Japan) to see if there was an association between diet and death from cardiovascular disease.

They discovered a similar eating pattern between the Mediterranean group and the Japanese group: both favored seafood and vegetables and minimized their consumption of animal foods and animal fat. The Mediterranean and Japanese groups also had significantly lower risks of death from heart diseasethan the other groups.

One reason for this heart-health benefit may be the key role that fish plays in many Asian diets, particularly in coastal regions, Li says. Fish contains omega-3 fatty acids, a group of healthy fats that can help lower your risk of heart disease, heart failure, and stroke, according to theAmerican Heart Association (AHA). In an analysis of four international studies published March 2021 in JAMA Internal Medicine, researchers revealed that two servings of fish per week which is the frequency suggested in the Asian diet food pyramid is associated with a lower risk of heart attack, stroke, and death among people with heart disease.

According to Li, Asian diets typically include a lot of fermented foods like tempeh, miso, and kimchi. These foods are rich sources of probiotics, which are good bacteria that are beneficial to your gut.

Mainly, probiotics maintain a healthy balance between good and bad bacteria in your body, helping support immune function and control inflammation, notes theCleveland Clinic. They may also treat and prevent diarrhea, irritable bowel syndrome, ulcerative colitis, and H. pylori (the cause of ulcers), according toHarvard Health.

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Diet Review: MIND Diet | The Nutrition Source | Harvard TH Chan School of Public Health – HSPH News

Posted: July 16, 2022 at 1:57 am

Finding yourself confused by the seemingly endless promotion of weight-loss strategies and diet plans?In this series, we take a look at some popular dietsand review the research behind them.

The Mediterranean-DASH Diet Intervention for Neurodegenerative Delay, or MIND diet, targets the health of the aging brain. Dementia is the sixth leading cause of death in the United States, driving many people to search for ways to prevent cognitive decline. In 2015, Dr. Martha Clare Morris and colleagues at Rush University Medical Center and the Harvard Chan School of Public Health published two papers introducing the MIND diet. [1,2] Both the Mediterranean and DASH diets had already been associated with preservation of cognitive function, presumably through their protective effects against cardiovascular disease, which in turn preserved brain health.

The research team followed a group of older adults for up to 10 years from the Rush Memory and Aging Project (MAP), a study of residents free of dementia at the time of enrollment. They were recruited from more than 40 retirement communities and senior public housing units in the Chicago area. More than 1,000 participants filled out annual dietary questionnaires for nine years and had two cognitive assessments. A MIND diet score was developed to identify foods and nutrients, along with daily serving sizes, related to protection against dementia and cognitive decline. The results of the study produced fifteen dietary components that were classified as either brain healthy or as unhealthy. Participants with the highest MIND diet scores had a significantly slower rate of cognitive decline compared with those with the lowest scores. [1] The effects of the MIND diet on cognition showed greater effects than either the Mediterranean or the DASH diet alone.

The purpose of the research was to see if the MIND diet, partially based on the Mediterranean and DASH diets, could directly prevent the onset or slow the progression of dementia. All three diets highlight plant-based foods and limit the intake of animal and high saturated fat foods.

The MIND diet specifically showcases 15 dietary components, including 10 brain healthy foods and five unhealthy food items. The healthy items are green leafy vegetables, vegetables other than green leafy types, berries, nuts, olive oil, whole grains, fish, poultry, beans, and wine (one glass daily). The unhealthy items are higher in saturated and trans fat and include red meat (including beef, pork, lamb, and products made from these meats), butter and stick margarine, cheese, pastries and sweets, and fried foodespecially fast-food fried items.

The MIND diet guidelines suggest including:

The unhealthy foods are limited to pastries and sweets less than 5 servings a week, red meat and red meat products less than 4 times a week, cheese and fried foods less than once a week, and butter/stick margarine less than 1 tablespoon a day.

This sample meal plan is roughly 2000 calories, the recommended intake for an average person. If you have higher calorie needs, you may add an additional snack or two; if you have lower calorie needs, you may remove a snack. If you have more specific nutritional needs or would like assistance in creating additional meal plans, consult with a registered dietitian.

Breakfast: 1 cup cooked steel-cut oats mixed with 2 tablespoons slivered almonds, cup fresh or frozen blueberries, sprinkle of cinnamon

Snack: 1 medium orange

Lunch:

Snack: cup unsalted mixed nuts

Dinner:

The MIND diet contains foods rich in certain vitamins, carotenoids, and flavonoids that are believed to protect the brain by reducing oxidative stress and inflammation. Researchers found a 53% lower rate of Alzheimers disease for those with the highest MIND scores. Even those participants who had moderate MIND scores showed a 35% lower rate compared with those with the lowest MIND scores. [2] The results didnt change even after adjusting for factors associated with dementia including healthy lifestyle behaviors, cardiovascular-related conditions (e.g., high blood pressure, stroke, diabetes), depression, and obesity, supporting the conclusion that the MIND diet was associated with the preservation of cognitive function.

Although the aim of the MIND diet was on brain health, it may also benefit heart health, diabetes, and certain cancers because it includes components of the Mediterranean and DASH diets, which have been shown to lower the risk of these diseases.

Additional published studies and ongoing trials review the potential benefits of the MIND diet:

The MIND diet can be a healthful eating plan that incorporates dietary patterns from the Mediterranean and DASH, both of which have suggested benefits in preventing and improving cardiovascular disease and diabetes, and supporting healthy aging. When used in conjunction with a balanced plate guide, the diet may also promote healthy weight loss if desired. More research needs to be done to extend the MIND studies in other populations, and clinical trials are ongoing to prove that the MIND diet reduces cognitive decline that occurs with aging.

The contents of this website are for educational purposes and are not intended to offer personal medical advice. You should seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The Nutrition Source does not recommend or endorse any products.

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The #1 Best Chocolate for Weight Loss, Says Dietitian Eat This Not That – Eat This, Not That

Posted: July 8, 2022 at 2:00 am

When you're on your weight loss journey, it can sometimes be difficult to focus on eating solely healthy foods. However, just because you're watching what you eat, does not mean that you can't enjoy a small indulgence now and then. Chocolate, in particular, is a delectable sweet treat that you can enjoy in moderationeven when you're trying to lose weight.

There are various types to choose from, so when deciding on which will coincide with your weight loss efforts, how do you know which chocolate to choose from? Well, according to Lisa Young, PhD, RDN, author of Finally Full, Finally Slim, a nutritionist in private practice, and a member of our Medical Expert Board, the #1 best chocolate to eat for weight loss is your favorite type!

"The best chocolate to eat for weight loss is the one you most enjoy," says Dr. Young.

This doesn't mean that all chocolates are healthy. Dr. Young believes that the dark variety is the healthiest as far as chocolates go. This is because dark chocolate contains the highest levels of antioxidants, including polyphenols, flavonols, and catechins, out of all types of chocolate. These antioxidants may help protect the cells in your body against free radicals that can lead to heart disease and cancer. They may also reduce inflammation and regulate blood pressure.

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However, for sustainable weight loss, Dr. Young advises treats to her clients and recommends that they pick something they love.

Treating yourself to your favorite foods actually may help aid in weight loss. This is because you are not depriving yourself of what you love, which otherwise may lead to quitting your diet or binge-eating unhealthy foods. Instead, you are focusing more on portion control and becoming more conscious of what you're eating.

In fact, according to the Mayo Clinic, it is possible to eat your favorite foods and still lose weight. Aside from portioning out your snack, the clinic recommends savoring the flavor. Many times, especially when we're hungry, we tend to inhale our food. The food is quickly gone, and not only did you not eat it slow enough to feel satisfied, but you also didn't taste the food.

Instead, try eating your chocolate slowly. The Mayo Clinic suggests sitting down with your chocolate and taking one small bite at a time. Then, keep each bite in your mouth for a few moments before swallowing. Lastly, notice the rich flavors, creamy textures, and overall sweetness. This allows you to actually enjoy what you're eating. Being mindful is going to help you slow down and not overindulge.6254a4d1642c605c54bf1cab17d50f1e

"So, pick the chocolate that gives you the most pleasure and stick with no more than a 1-ounce portion to help keep your calories in check," advises Dr. Young.

Kayla Garritano

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Dietary Inflammation Index and Mental System Diseases | JIR – Dove Medical Press

Posted: December 19, 2021 at 1:46 am

Introduction

In recent decades, the prevalence of mental health disorders has been increasing and is a major public health problem. The current worldwide prevalence of depression is estimated at 350 million.1,2 According to the World Health Organization, more than a quarter of European adults have experienced psychological disorders. Data from the Global Burden of Disease Study highlights the significant contribution of mental health and depression to the global burden of non-communicable diseases, including years of disability.3 Therefore, it is important to determine new preventive measures or strategies to reduce the development of the disease. Multi-factor processes, most likely to involve biological, social, genetic, and environmental factors, contribute to the individuals mental health and well-being.4,5 There is increasing attention to the possible contribution of modifiable lifestyle behaviors (such as habitual dietary intake) to the development of common mental health disorders. In addition, the emerging field of nutritional psychiatry no longer focuses on specific nutrients or foods but turns its attention to the relationship between eating patterns and mental health.6,7

Healthy eating patterns, such as the Norwegian and Mediterranean diets, which are characterized by a high intake of fruits, vegetables, whole grains, fish, and lean meat, are associated with a lower likelihood of depression.810 On the contrary, it is reported that people with unhealthy or Western-style diets have an increased risk of depression, which is typically characterized by a large consumption of energy-dense, high-fat and high-sugar products, processed and red meat, refined grains, and alcohol. However, meta-analysis and systematic reviews have not yet provided confirmation, partly because of the limited number of studies. Eating patterns and diet quality are also related to well-being, anxiety, and stress, which suggests that the biological mechanisms that underpin the health-related diet go beyond depressive symptoms. Inflammation has been proposed as the basis of the mechanism linking diet to mental health.11,12 There is increasing evidence that depression is related to increased concentrations of pro-inflammatory cytokines. Although high heterogeneity was observed in earlier meta-analyses, a recent meta-analysis (MDD) of cytokines and chemokines in major depression confirmed that concentrations of tumor necrosis factor A (TNF-A) and interleukin-6 (IL-6), as well as other cytokines and chemokines, were significantly elevated in MDD patients. At present, relevant studies have reported that there is an association between the inflammatory potential of habitual diet and mental health, but the specific mechanism has not yet reached a consistent conclusion.1315 Lucas et al reported Eating patterns related to circulating levels of C-reactive protein (CRP), IL-6, and TNF- receptor 2 were determined, and their relationship with depression risk was examined among participants in the Nurses Health Study.1618 They reported a 3040% increase in the risk of depression, depending on the definition, comparing the highest and lowest quintiles (that is, the most pro-inflammatory versus the most anti-inflammatory).19 In recent years, the Dietary Inflammatory Index (DII) has been developed to characterize an individuals continuous diet from maximum anti-inflammatory to pro-inflammatory. So far, DII has been associated with CRP, IL-6, and TNF-a. To date, only three studies have examined the relationship between DII and depression; all have reported that those with the most pro-inflammatory diets have an increased risk of depression.20

One candidate mechanism for motivation-related disorders in major depression is inflammation. Now, a large amount of literature shows that compared with the control group, some patients with depression have increased expression of inflammatory proteins and genes in peripheral tissues and cerebrospinal fluid (CSF), and increased peripheral blood acute phase proteins, chemokines, and adhesion molecules. A meta-analysis of these documents has determined that the most reliable inflammatory biomarkers for depression are the increase in peripheral blood inflammatory cytokines tumor necrosis factor (TNF) and interleukin (IL)-6 and the increase in acute phase protein C-reactive protein. Finally, compared with the general population, in the list of common symptoms, non-depressed individuals with primary immune diseases showed a significantly higher incidence of anhedonia symptoms.2123

Patients with depression show a wide range of clinical manifestations, including cognitive and autonomic symptoms. Importantly, these symptoms may differ in their biological causes, and deconstructing depression into specific symptoms may provide valuable insights into underlying neurobiology. A study has conducted a narrative review of the existing literature (21 studies) to clarify whether the link between depression and inflammation has specific symptoms. Overall, there is evidence that there is an association between neurovegetative symptoms of depression and inflammation, independent of cognitive symptoms. This is not the case with cognitive symptoms and inflammation. There is also some evidence that there are gender differences in the direction of the relationship between depression and inflammation.24 At the same time, a meta-analysis of 22 studies showed that CRP and IL-6 inflammatory cytokine levels are significantly positively correlated with the risk of concurrent depression. At the same time, inflammation (measured by CRP or IL-6) can predict future depression. This suggests that there may be a two-way relationship between depression and pro-inflammatory states.25 Another review identified the cross-sectional and longitudinal associations of two inflammatory markers, C-reactive protein (CRP) and interleukin 6 (IL-6), and depression in the elderly. The results show that there is a cross-sectional and longitudinal relationship between CRP and IL-6 and depression in the elderly. In longitudinal studies, inflammation causes depression, rather than inflammation.26

Elevated biomarkers of systemic inflammation have been reported in individuals with cognitive decline; however, most of the literature involves cross-sectional analyses with mixed results. A study investigating the etiology of this association conducted a meta-analysis of prospective studies examining the association between baseline interleukin-6 (IL-6), an established marker of peripheral inflammation, and the risk of cognitive decline at follow-up in adults without dementia. At the same time, mindfulness-based intervention (MBI) has a positive impact on the mental health of different populations. One study examined the effects of MBI on a psychiatric biomarker used to summarize the effects of low-grade inflammation. The results showed that MBI showed a low but significant effect on health outcomes associated with low-grade inflammatory biomarkers.22

The Dietary Approach to Stopping Hypertension (DASH) is based on seven components, with the four highest intakes considered ideal (vegetables, fruits, whole grains, and legumes) and three components, with avoidance or minimum intakes, considered ideal (conversion and red meat, sweet drinks, and sodium). The minimum value of each section is 1, the maximum value is 5, and the middle value is graded proportionately.27,28 The scores for all components are added up to a DASH total score ranging from 5 to 40, with higher scores indicating a healthier diet.29

There is increasing evidence that there is a link between depression and high blood pressure. Unhealthy lifestyle habits, such as high-energy intake and poor diet, smoking and drinking, and lack of physical exercise, are all risk factors for depression and high blood pressure. In addition, depression and hypertension are related to the imbalance of redox activity signaling and increased immune-inflammatory response.30,31 These diseases may lead to excessive activation of the hypothalamic-pituitary-adrenal axis, leading to increased secretion of corticotropin-releasing factor, corticotropin, and cortisol. These known risk factors are increased blood pressure and depressive symptoms. Oxidative stress and mild inflammation may also cause autonomic nervous system dysfunction, including increased sympathetic nerve activity and decreased parasympathetic nerve activity, and promote high blood pressure and depression.32 In addition, due to the role of endothelial cells in the production of brain-derived neurotrophic factors, endothelial dysfunction is considered a risk factor for depression. Endothelial dysfunction is also a risk factor for high blood pressure because it may lead to an increase in blood pressure and the vascular endothelium may acquire pro-inflammatory properties.33

The Diet to Stop High Blood Pressure (DASH) diet plan, which includes following a diet rich in fruits, vegetables, and low-fat dairy products, as well as low in SFA and red meat, is effective in reducing inflammatory markers and cardiovascular risk factors, including blood pressure And blood lipids. In addition, it has been reported that there is a negative correlation between adherence to a DASH diet and diabetes or CVD. Since hypertension and depression have many common risk factors, and because of the potential benefits of the DASH diet for diabetes, CVD, and low-grade inflammation, it is determined that the dietary treatment of hypertension may be related to the risk of depression.34,35

Adhering to the DASH diet can not only reduce the risk of CRC and CRA in men and women but also reduce the risk of renal function decline and all-cause mortality.36 There is evidence that the protective properties of the DASH diet may be partly due to its inverse relationship with visceral obesity.37 Some studies have provided evidence that the Dietary Approaches to Stop Hypertension (DASH) diet is associated with reduced levels of oxidative stress and inflammation, and may provide effective means for chronic disease prevention.38 Compared with the conventional diet, adherence to the DASH diet can effectively improve the circulating serum inflammatory biomarkers in adults and promote the formation of a systemic anti-inflammatory environment, at the same time, it can also reduce the risk of aggregate metabolism in elderly women. Consequently, it may be a valuable strategy to inhibit the inflammatory process.39,40 DASH diet can significantly increase GSH and reduce MDA levels. In addition, there is a trend to improve TAC, NO, and f2-is prostaglandins by sticking to the DASH diet.41 Intake of the DASH diet for 8 weeks in NAFLD patients has significant effects on body weight, BMI, ALT, ALP, triglycerides, insulin metabolism markers, inflammation markers, glutathione, and malondialdehyde.42 Whilst, DASH diet in pregnant women with GDM has a beneficial effect on FPG, serum insulin levels, HOMA-IR score, plasma TAC, and total GSH levels.43

The Alternative Healthy Eating Index 2010 (AHEI-2010) is based on 11 ingredients, of which six are considered ideal for maximum intake (vegetables, fruits, whole grains, nuts and legumes, long-chain omega-3 fats (DHA and EPA), and polyunsaturated fatty acids) and one is considered ideal for moderate intake (alcohol). Four ingredients to avoid or minimize are considered ideal (sugar-sweetened beverages and fruit juices, red and processed meats, trans fats, and sodium). The minimum value of each section is 0, the maximum value is 10, and the middle value is graded proportionately. The scores for all the components are added to produce an aHEI-2010 overall score, which ranges from 0 to 110, with a higher score indicating a healthier diet.44,45

Prospective studies have shown that, as measured by the Alternative Healthy Eating Index (AHEI), adherence to a healthy eating pattern is associated with a lower risk of recurrence of depressive symptoms in women, but not in men. This favorable association is attributed to the components of AHEI, including vegetables, fruits, and the ratio of PUFA/SFA. In addition, it is reported that according to the Healthy Eating Index (HEI)-2005 measurement, African Americans and white adults living in Baltimore have a higher quality of their diet and fewer symptoms of depression.46,47 Similar findings have been reported in the National Health and Nutrition Examination Survey, where a higher HEI is associated with a lower risk of depression in adults. The results of the meta-analysis of observational studies also revealed a significant negative correlation between healthy eating patterns (determined by factor analysis) and depression risk.48,49

Several possible mechanisms may explain the negative correlation between AHEI-2010 and depression. This association is caused by the cumulative effect of all the components of AHEI-2010, not by individual nutrients or food groups. The high content of folic acid, B vitamins, and antioxidants in a healthy diet may reduce the damage of oxidative stress to neurons. Due to the relationship between high levels of inflammatory biomarkers and depressive symptoms, the anti-inflammatory properties of the foods contained in AHEI have been shown to reduce the concentration of monoamines. In addition, the high levels of PUFA and n-3 fatty acids present in oily fish and other components of AHEI are other possible mechanisms.5052

The Relative Mediterranean Diet Score (rMED) described by Buckland et al estimates compliance with MD and is based on 9 ideal or bad dietary components. In terms of health, the ideal ingredients include grains, vegetables (excluding potatoes), beans, fruits and nuts, fresh fish, olive oil, and moderate alcohol consumption. In turn, undesirable ingredients include meat and dairy products. Each ingredient (except alcohol) is expressed in grams per 1000 kcal per day and is divided into gender-specific tertiles. Values between 0 and 2 are assigned to each tertile of the ideal component.53,54 For unwanted ingredients, the scores are reversed. For alcohol consumption, if the alcohol consumption is in the range of 525 g/day for women and 1050 g/day for men, 2 points are allocated; otherwise, it is recorded as 0 points. rMED is the sum of all 9 components. The total score ranges from 0 points (non-compliance) to 18 points (complete compliance).55

MD is characterized by high consumption of olive oil, whole grains, and plant food, low in saturated fat and sugar intake, and moderate consumption of fish, dairy products, and red wine, is considered to be one of the best models of a healthy diet because it has several cardiovascular diseases, cancer, diabetes, metabolic syndrome, inflammation and oxidative stress, and the beneficial effects of overall mortality rates. In particular, recent evidence suggests that inflammation and oxidative stress may constitute potential pathways for a potential link between diet and depression. This is supported by several studies that report a significant association between the inflammatory potential of diet and depression or depressive symptoms.56,57

Many possible approaches have been proposed to explain the link between diet and depression, including inflammation, oxidative stress, and regulation of neurotransmitter synthesis. Epidemiological studies report a negative correlation between MD compliance and inflammation and oxidative stress marker levels. Specifically, inflammation is the result of an imbalance between pro-inflammatory and anti-inflammatory mediators. In the brain, pro-inflammatory cytokines, such as IL-6 and TNF-, affect almost all pathways involved in the pathophysiology of depression, such as changes in neurotransmitter expression, neuroendocrine function, and synaptic plasticity.58,59

Certain Mediterranean diet components may affect preclinical vascular changes through potential new mechanisms. These changes may be related to cardiovascular risk by reducing endothelial oxidative stress, reducing inflammation, and enhancing endothelial function.60 Furthermore, greater adherence to the Mediterranean diet, especially its fish composition is related to lower CRP blood concentration.61 MedDiet has similar effects on inflammation in men and women. In addition, the variability of MedDiets anti-inflammatory effects may be partly due to the individuals overall inflammatory state; however, this observation seems to be more specific to men.62 In addition, the understanding of how nutrition affects the prevention and/or treatment of neurodegenerative diseases has also been greatly developed in recent years. The protective effect of the Mediterranean diet (MD) in preventing neurodegenerative diseases has been reported in many studies. The distinctive feature of the Mediterranean diet is the moderate intake of red wine and extra virgin olive oil, both of which are rich in polyphenolic compounds, such as resveratrol, oleuropein, hydroxytyrosol, and its derivatives. In vitro studies have shown They have neuroprotective properties, including anti-inflammatory effects on microglia.63

DII is an inflammatory index developed and verified by a researcher at the University of South Carolina in Columbia to evaluate the inflammatory potential of an individuals diet to understand the inflammatory impact of diet on human health. The purpose of creating the inflammation index is to provide a tool to classify an individuals diet from the most anti-inflammatory to the most pro-inflammatory continuity. The original DII was derived from the results of articles evaluating the effects of specific foods and ingredients on specific inflammatory markers published from 1950 to 2007. Each food and ingredient was assigned a score and multiplied by the actual food intake parameters of the individual to produce a The overall score summarizes a persons diet from the maximum anti-inflammatory to the maximum pro-inflammatory degree. Specific markers are IL-1, IL-4, IL-6, IL-10, TNF- and CRP. In 2014, South Carolina researchers improved the original DII scoring for peer-reviewed journals updated from 2007 to 2010; the improved scoring system has been applied to 45 food parameters, including whole foods, nutrition, and other biologically active compounds, from all over the world Eleven food consumption data sets were determined, and the entire diet was considered, not just individual nutrition or food, and a comprehensive database was established to represent various diets of different populations in different regions of the world, which can be applied globally. The DII includes micronutrients, micronutrients, and other common dietary components, such as flavonoids and caffeine. It is a new tool for evaluating the potential of dietary inflammation and can be applied to any population that has collected dietary data. DII can be obtained through 24-hour diet recall interviews or food record data. Food parameters can increase or decrease inflammatory potential through pro-inflammatory and anti-inflammatory markers; according to the influence of food parameters on inflammation, significantly increase IL-1, IL-6, TNF- or CRP, or decrease IL-4 or IL-10 Give +1, it is a pro-inflammatory effect; significantly reduce IL-1, IL-6, TNF- or CRP, or increase the -1 given by IL-4 or IL-10, which is an anti-inflammatory effect; if food If the parameter does not produce any significant changes in inflammation markers, 0 is assigned.6466

The steps to establish a personal DII are as follows. The calculation of DII is based on dietary intake data and then linked to a representative database, which provides a reliable mean and standard deviation for 45 food parameters, and calculates the Z score of each persons food parameter, to balance the right bias Influence, the Z value is converted to the central percentile. The calculation of food-specific inflammation score is first weighted according to the research design and research type. These weighted valuesare used to calculate the pro-inflammatory component of each food parameter: a. Divide the number of weighted pro-inflammatory articles by the total number of weighted articles, b. Subtract the anti-inflammatory score from the pro-inflammatory score, and choose 236 as the critical point, that is, the median of the total number of weighted articles of all food parameters, to represent an optimal and robust literature library, all with weighted articles 236 Food parameters are assigned to the full value of the score. Adjust the foods and ingredients with weighted foods <236 as follows: divide the weighted foods by 236; then multiply the scores by the food parameter-specific original inflammatory effect score to obtain the food parameter-specific overall inflammatory effect score. Multiply the central percentile value of each food parameter by its respective overall food parameter specific inflammatory effect score to obtain the food parameter specific DII score. Add up all food parameter-specific DII scores to obtain personal DII scores.67

Chronic low-grade inflammation has complex and multifocal endogenous and exogenous causes, and diet has always been considered an important factor in regulating inflammation. A healthy diet (such as a Mediterranean diet, rich in fruits and vegetables) is usually associated with lower levels of inflammation, and a Western diet (such as high fat and simple carbohydrates) is associated with higher levels of inflammatory markers, which can cause inflammation in the immune system.68,69 Belongs to the inflammatory diet. Studies have shown that the Western diet can change the intestinal microbial ecosystem and promote the occurrence and development of chronic inflammation. A study on cardiovascular risk showed that complement components C3, CPR, IL-6, TNF-, WBC, and neutrophil/lymphocyte ratio (NLR) are all increased in people with higher DII scores, and NLR is a sign of systemic inflammation. A meta-analysis on the relationship between DII and the risk of prostate cancer showed that a pro-inflammatory diet can lead to increased cell proliferation, inflammation, and oxidative stress, leading to prostate cancer. The possible mechanism is the promotion of foods such as butter, meat, and candy. An inflammatory diet increases systemic inflammation and causes insulin resistance, leading to an increase in insulin levels. Insulin levels play a role in the occurrence of prostate cancer by stimulating cell proliferation and apoptosis.70,71 A study in the United States showed that adherence to a pro-inflammatory diet including cholesterol and saturated fat has independent positive correlations with inflammation markers of white blood cells, IL-6, and homocysteine, and intake of high sugar, saturated fat, and other pro-inflammatory foods It promotes inflammation, which may increase the risk of various chronic diseases. On the other hand, the intake of the Mediterranean diet (including whole grains, fish, fruits and green vegetables, olive oil, etc.) is associated with lower levels of inflammation and is an anti-inflammatory diet. Adherence to the Mediterranean diet is associated with lower CRP, platelets, and WBC has anti-inflammatory effects and has a protective effect on cardiovascular diseases.72,73

Mental health disorders are more common in women than in men. According to reports, there are gender differences in depression and anxiety, including the age of onset and duration of symptoms, social adaptation, and long-term outcome. Current work shows that there are associations between the potential for dietary inflammation and depressive symptoms, anxiety, and mental health, and these associations are particularly evident in female participants. Although some earlier studies have also reported associations between female depression risk, these are female-only cohorts, and the dietary inflammation potential is determined by two different methods (dietary inflammation pattern and DII). The examination of the Nurses Health Research showed that by definition, comparing the highest and lowest quintiles of dietary inflammation patterns (that is, the most pro-inflammatory versus the most anti-inflammatory), the risk of depression increased by 3040%.74,75 The Australian Longitudinal Study of Womens Health (n = 6438) conducted a 12-year follow-up of middle-aged women and found that people with diet in the top quartile of DII had a 20% lower risk of depression than those in the lowest quartile of DII. To date, only two other studies have investigated the relationship between DII scores and the risk of depression in both sexes.76 In a Spanish cohort study of college graduates (n=15,093), male and female participants reported similar increases in depression risk (OR 1.53 and 1.46, respectively). Consistent with our findings are the latest data from the Whitehall II study, which also revealed a sex-specific association between DII and recurrence of depressive symptoms.77 In a longitudinal analysis of middle-aged men and women (average follow-up age of 60 years), women with the highest DII scores (ie, most pro-inflammatory diets) were almost 3 times more likely to develop recurrent depressive symptoms, even after adjustment After a wide range of confounding factors. No association was observed among male study participants. Compared with the Mitchelstown and Whitehall II cohorts (average age of about 60 years), the Spanish cohort (average age of one-fifth of the DII is 3640 years) may at least partly explain this difference in reporting specific gender relations Time. Further research is necessary to unravel the relationship between gender diet and depression.78,79

Several studies have assessed the relationship between diet and the inflammatory potential of overweight or obesity. Higher DII scores indicate a diet that is more conducive to inflammation and are associated with higher BMI, waist circumference, waist-to-height ratio, and increased risk of cardiovascular disease and cancer. A cross-sectional study of the University of Minas Gerais cohort also showed that the prevalence of obesity increased with the DII score. In addition, a longitudinal study of a Mediterranean cohort also showed that higher DII scores were associated with increased annual mean weight change and incidence of overweight and obesity at 10 years of follow-up. Our findings are consistent with these previous studies that higher DII scores are associated with an increased risk of obesity, while lower DII scores are associated with a lower risk of obesity.8082

A large cross-sectional study showed that in individuals with high cardiovascular risk, there is a direct correlation between DII and BMI and abdominal obesity. A recent meta-analysis of 12 prospective studies reported that subjects with the highest DII quartile had higher BMI levels. A meta-analysis of another observational study showed that there is a significant positive correlation between DII and obesity and BMI. On the other hand, some previous studies have shown that DII is negatively correlated with obesity, or has nothing to do with body weight, BMI, fat mass, and abdominal obesity.83 These controversies may be partly due to differences in the study population, metabolic disorders, BMI cut-off values, age, gender, and socioeconomic status, dietary supplements, and the number of foods and nutrients included in the DII calculation. It may also be related to reported deviations that are known to vary with weight status.81,84

DII provides a quantitative assessment of the potential for dietary inflammation. Current research results show that, compared with obese individuals, a normal-weight diet is more pro-inflammatory and manifests as a higher DII score. However, E-DII did not differ significantly among the three study groups. As mentioned earlier, this may be due to differences in total energy intake using FFQ, which are taken into account when scoring E-DII or energy-related reporting deviations.85,86 A follow-up cohort study showed that there is a direct link between DII and annual weight gain and overweight and obesity in normal-weight individuals. There seems to be a two-way relationship between obesity and inflammation. Body fat mass induces inflammation, which can lead to obesity and weight gain. In addition, a positive correlation was observed between the DII score and circulating leptin (as a pro-inflammatory fat-derived peptide), which underscores the potential role of dietary inflammatory features on adipose tissue inflammation. Chronic inflammation is one of the key mechanisms explaining obesity-related complications.87,88

In the field of obesity, BMI is the most common and convenient obesity classification index. The significance of using BMI is far-reaching because it can give an accurate cut-off point to define the number of people with different weights, and then tell us the prevalence of obesity. Obesity is defined as the excessive accumulation of body fat, and this excess fat is usually considered an indicator of poor health, which in turn constitutes a series of risk factors for diseases, including diabetes, ischemic heart disease, hyperlipidemia, Sleep apnea, arthritis, and others.89

Adipose tissue is not only a storage organ for triglycerides, but also studies have shown the role of white adipose tissue as a producer of certain biologically active substances called adipokines.90

In mammals, white adipose tissue (WAT) stores and releases lipids, while brown adipose tissue (BAT) oxidizes lipids to promote thermogenesis. In obese individuals, WAT undergoes profound changes; it enlarges, becomes dysfunctional, and develops into a state of low-grade inflammation.91 Adipose tissue is the source of pro-inflammatory activity, so it is called obesity-related inflammatory activity.92 Withal, adipose tissue itself is an endocrine organ that can secrete a variety of body fluid mediators, such as adipokines, which can induce or reduce inflammation and oxidative stress.93 Some studies have provided evidence that rodent models have demonstrated that fat inflammation pathways play an important role in diet and obesity-related metabolic disorders, and mRNA microarrays and secretion profiles of human adipose tissue and fat cells have identified similar inflammatory pathways in the obesity Inflammation pathway activated by endotoxin.94

Studies have shown that there is a correlation between dietary inflammatory index and age, and aging is also closely related to elevated systemic inflammation markers. It is important to pay attention to how to measure these indicators in the context of dietary intervention. The levels of acute-phase response factor c-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor (TNF) in the blood of the elderly tend to increase during the aging process. In the National Health and Nutrition Examination Survey (NHANES III), chronically elevated protein in the acute phase is a risk indicator of high mortality. The mortality rate of patients with elevated serum CRP over the age of 60 is 2.7 times higher than that of patients below this threshold (0.30 mg/dl).95,96

Chronic inflammation is a persistent, low-level non-specific body inflammation state. Studies have shown that chronic inflammation is related to cancer, diabetes, and cardiovascular diseases.97 In addition, studies have shown that the occurrence of old age frailty is accompanied by changes in an inflammatory state. Inflammatory factors induce cell senescence through oxidative stress, cell apoptosis, cell cycle arrest, and other pathways, causing tissue, organ, and system damage, which greatly increases the risk of debilitating or age-related chronic diseases.98 A large number of studies have proved that diet plays an important regulatory role in chronic inflammation. Different dietary patterns and dietary ingredients will produce different inflammatory effects. Aging is also a contributing factor to inflammation caused by diet. The underlying mechanism remains to be studied, but it can be simply assumed that old age is related to a more unhealthy and unbalanced diet, which may lead to higher DII scores in the elderly population. Human aging is accompanied by changes that may impair food acquisition, digestion, and metabolism. Many conditions, such as disability, acute and chronic diseases, may affect the nutritional status of elderly patients. There is convincing evidence that diet changes with age, which may promote inflammation, which may help increase or maintain obesity, especially abdominal obesity, in most people who are overweight or obese.99101

Inflammation is a key component of the innate immune systems ability to clear infections and repair injured tissues. Inflammation is caused by the release of pro-inflammatory cytokines from innate immune cells. In addition to the effects on the periphery, cytokines can also communicate with the brain and cause a series of emotional, cognitive, and behavioral changes collectively referred to as disease behavior.102,103 Of particular relevance to this review is that peripheral inflammation has been shown to induce depression-like behaviors in animal models, including decreased exploratory, novelty, and social behavior, decreased food intake; and sleep disorders. These disease behaviors are considered an adaptive response designed to reduce the spread of infection and promote healing. However, long-term inflammatory signaling, such as when the inflammatory response is maintained by continuous psychosocial stress, may have adverse effects, including the risk of depression and other mental illnesses.104

Research conducted in the past few decades has clarified the mechanism by which peripheral inflammation can enter the brain to affect neural processes related to depression, including neuroplasticity, neurotransmitter systems, and neuroendocrine functions. For example, inflammatory cytokines can alter neuroplasticity by reducing the expression of the brain-derived neuroprotective hormone BDNF. Inflammation can also cause changes in the dopaminergic system, which is related to depression. A single injection of high doses of LPS (5 mg/kg) can cause the degeneration of the dopaminergic system in the brain, especially in the substantia nigra and striatum.105107 In addition, the use of IFN- for chronic treatment in non-human primates leads to a decrease in the synthesis and availability of dopamine in the striatum, which is related to a reduction in sucrose consumption that depends on effort. A large number of experimental studies conducted in rodents have shown that the release of dopamine and the reduction of dopamine receptor binding are closely related to the defects of reward motivation behavior in depression.108

In addition to the effect on dopamine, inflammation can also affect the serotonin system through changes in tryptophan metabolism. Under normal, healthy conditions, approximately 5% of tryptophan is metabolized to serotonin, and 95% of tryptophan is metabolized through the kynurenine pathway. The metabolism of tryptophan through the kynurenine pathway can be converted into neurotoxic 3-hydroxykynurenine (OHK) and quinolinic acid (QUIN) or neuroprotective kynurenine.109,110 The way tryptophan is metabolized depends on the presence of indoleamine-2,3-dioxygenase (IDO). In preclinical models, the use of LPS to activate inflammation increases the activity of IDO, thereby assigning more tryptophan metabolism to the kynurenine pathway instead of serotonin synthesis, ultimately leading to serotonin deficiency. In preclinical models, LPS-induced depressive behavior is mediated by IDO activation. It is worth noting that inflammation and IDO both affect glutamate metabolism, which may also play a role in depression.111

In addition, inflammation has a powerful effect on the neuroendocrine system. Inflammatory cytokines may indirectly up-regulate glucocorticoids in the body by interfering with the functional ability of glucocorticoid receptors, leading to the continuous synthesis of corticotropin-releasing hormone (CRH) and the continuous activation of the HPA axis, which have long been associated with the pathogenesis of depression-related. This process can be self-sustaining because long-term elevated glucocorticoids can stimulate the production of neuroinflammation by activating microglia (resident immune cells in the brain).112

Diet affects inflammation, but there are currently few studies on how diet affects inflammation markers. One theory is that a pro-inflammatory diet can increase the levels of inflammatory cytokines by affecting oxidative stress and immune mechanisms. Related studies have shown that macrophages will produce free radicals and release them into tissues after ingesting a pro-inflammatory diet. Free radicals promote cell oxidative stress. Excess free radicals are usually associated with increased inflammation, that is, pro-inflammatory diets can cause inflammation in the blood. The release of sex factors is enhanced, causing inflammation. Research by Barrera et al showed that Western diet can cause postprandial hyperglycemia and hyperlipidemia, and through non-enzymatic glycosylation and glucose-induced NADH: NAD ratio imbalance mechanism to generate reactive oxygen species to increase inflammation and oxidative stress and mediate Expression of inflammatory factors CRP, IL-6, IL-1. Increasingly, the diet is the main medium for the function of the microbiota of the gastrointestinal tract.113,114 A German study showed that in mice fed a pro-inflammatory diet, the integrity of the intestinal immune cell barrier can be disturbed or lost, that is, through different mechanisms to cause intestinal cytotoxic effects, inhibit adenosine monophosphate-activated protein kinase, and Causes the production of mitochondrial reactive oxygen species, activates the mouse NLRP3 inflammasome, and mediates the release of IL-1, that is, diet can directly and indirectly (through the intestinal microbiota) provide a rich source of biologically active substances, and produce local and systemic effects on immune function. Influence and mediate the development of inflammatory response. At the same time, the anti-inflammatory diet, the Mediterranean diet, can reduce the release of pro-inflammatory factors by reducing the proportion of Gram-negative bacteria in the intestine, improving the intestinal barrier function, and reducing endotoxins, thereby reducing metabolic endotoxemia, inflammation, and The subsequent occurrence of metabolic diseases.115,116

The DII/E-DII is a summary measure for assessing the inflammatory potential of the diet. The construct validity of the DII and E-DII has been determined against inflammatory biomarkers in several different populations. Overall, these validated results support the notion that diet plays an essential role in modifying inflammation. Diets can be either pro-inflammatory or antiinflammatory, depending on the hormonal responses they generate.117 A pro-inflammatory diet may increase the chronic, persistent activation of the immune system, which leads to low-grade inflammation. Activation of immune cells, especially polymorphonuclear leukocytes, leads to overproduction of reactive oxygen species (ROS) resulting in oxidative stress. It is not well understood how oxidative stress leads to the development of depression. However, the most likely hypothesis is that the brain neuronal cells are vulnerable to oxidative stress due to their requirement of higher oxygen consumption and consequent generation of ROS, as well as a relatively weak antioxidant defense. ROS activates inflammasomes such as NLRP3 (NOD-, LRR and pyrin domain-containing protein 3), a cytoplasmic protein complex that modulates innate immune function by activating caspase-1, which increases pro-inflammatory cytokines such as IL1b.118,119 ROS also can regulate inflammatory processes by activation of transcription factors, including nuclear factor-kappa B (NF-kb) and activator protein-1 (AP-1) that lead to increased expression of proinflammatory cytokines. Conversely, these cytokines either: 1) stimulate indoleamine 2,3-dioxygenase (IDO) to convert tryptophan to kynurenine which is transformed into the neurotoxic quinolinic acid; or 2) exert an effect on the hypothalamic-pituitary-adrenal (HPA) axis which is linked to a reduction in hippocampal volumes, impaired neuronal plasticity, and decreased neurochemical functioning, resulting in DepS.120,121

Another potential mechanism through which diet may influence DepS includes the brain-gut-microbiota axis, a bilateral communication network between the intestine and brain. The intestinal microbiota and diet play an essential role in these gut-brain interactions and be involved in the pathogenesis of psychiatric disorders, including depression. Depression is associated with an altered gut microbiota composition, richness, and diversity.122,123 First, the neurotransmitter serotonin may have antidepressant and anxiolytic effects. Tryptophan, the main precursor of serotonin, is predominantly produced (>90%) by the gut microbiota. It is evident that the consumption of probiotics, specifically, Lactobacillus spp. and Bifidobacterium spp., affect mood by influencing serotonin levels. Second, in some preclinical studies in mice, consumption of a typical Western diet (high in animal protein and fat, low in fiber) led to a marked decrease in the numbers of total bacteria and a proportional reduction of beneficial Bifidobacterium or Eubacterium species leading to diet-induced dysbiosis. This phenomenon results in increased permeability of the intestinal mucosa, also known as leaky gut, which may increase the immune response and chronic neuroinflammation. This, in turn, stimulates pro-inflammatory cytokine production, which occurs when bacterial components such as lipopolysaccharides from the bacterial cell wall binding to circulating macrophages or monocytes.124126

A growing body of evidence supports the potential use of dietary interventions as adjunctive treatments for mental disorders. This review identified many ways that diet may affect mental health. These include pathways that regulate inflammation, oxidative stress, mitochondrial dysfunction, gut microbiota, tryptophan-kynurenine metabolism, HPA axis, neurogenesis and BDNF, epigenetics, and obesity (Figure 1). However, we do acknowledge that there are many other potential mechanisms involved in the pathophysiology of depression. These mechanisms are not mentioned in this article, but all of them can further reduce the risk of depression through dietary interventions, such as dietary effects on leptin, adiponectin, and mitochondrial biosynthesis. Research highlights the potential of restricting pro-inflammatory diets and/or supporting anti-inflammatory diets in reducing the risk of depression. However, more prospective longitudinal studies and improved methods are needed to confirm the current findings.

Figure 1 The possible main mechanism of dietary inflammatory index and depression.

Community Cohort Study on Specialized Nervous System Diseases (No.2017YFC0907701).

The authors report no conflicts of interest in this work.

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