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aQuarius Diet Challenge 2013: Simy Mathew – Video

Posted: October 2, 2013 at 4:46 am


aQuarius Diet Challenge 2013: Simy Mathew
aQuarius Diet Challenger Simy Mathew talks a bout her newly acquired passion for fitness Videography: Ryan Navarro.

By: AquariusMag

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Do Diets Really Just Make You Fatter? – Healthline

Posted: December 25, 2022 at 12:07 am

Dieting is a multibillion-dollar global industry.

However, theres no evidence people are becoming slimmer as a result.

In fact, the opposite seems to be true. Obesity has reached epidemic proportions worldwide.

About 13% of the worlds adult population has obesity, and this number increases to 35% in the United States (1, 2).

Interestingly, theres some evidence that weight loss diets dont work in the long term and may actually lead to weight gain.

As the obesity epidemic continues to grow, many people turn to calorie-restricted diets in an attempt to lose weight.

However, people with obesity arent the only ones dieting. Losing weight is a priority for many people who either have less weight or are slightly overweight, particularly women.

Many researchers believe this is related to having a poor body image, which is made worse by constant media exposure to slim models, celebrities, and athletes (3, 4).

The desire to be thinner can begin as early as grade school. In one study, more than 50% of girls ages 68 with less weight said that their ideal weight was lower than their actual weight (5).

Girls beliefs about dieting and weight are often learned from their mothers.

In one study, 90% of mothers reported they had dieted recently. Study results showed 5-year-old daughters of dieting mothers were twice as likely to already have thoughts about dieting, compared with daughters of non-dieting mothers (6).

The desire to be thin is very common in women and can begin as early as 5 years old. Early awareness of dieting is often due to a mothers dieting behavior.

Losing weight is big business worldwide.

In 2015, it was estimated that weight loss programs, products, and other therapies generated more than $150 billion in profits in the United States and Europe combined (7).

The global weight loss market is predicted to reach $246 billion by 2022 (8).

Not surprisingly, weight loss programs can be quite expensive for someone who wants to lose more than a few pounds.

One study found that the average cost to lose 11 pounds (5 kg) ranged from $755 for the Weight Watchers program to $2,730 for the medication orlistat (9).

Whats more, most people go on many diets during their lifetime.

When these multiple attempts are taken into consideration, some people end up spending thousands of dollars pursuing weight loss, often without long-term success.

The diet industry generates billions of dollars every year and is expected to continue to grow in response to peoples desire to lose weight.

Unfortunately, weight loss diets have a disappointing track record.

In one study, 3 years after participants concluded a weight loss program, only 12% had kept off at least 75% of the weight theyd lost, while 40% had gained back more weight than they had originally lost (10).

Another study found that 5 years after a group of women lost weight during a 6-month weight loss program, they weighed 7.9 pounds (3.6 kg) more than their starting weight on average (11).

Yet, another study found that only 19% of people were able to maintain a 10% weight loss for 5 years (12).

It also appears that weight regain occurs regardless of the type of diet used for weight loss, although some diets are linked to less regain than others.

For instance, in a study comparing three diets, people who followed a diet high in monounsaturated fat regained less weight than those who followed a low fat or control diet (13).

A group of researchers who reviewed 14 weight loss studies pointed out that in many cases, regain may be higher than reported because follow-up rates are very low and weights are often self-reported by phone or mail (14).

Research shows that the majority of people will gain back most of the weight they lose while dieting and will even end up weighing more than before.

Although a small percentage of people manage to lose weight and keep it off, most people regain all or a portion of the weight they lost, and some gain back even more.

Studies suggest that rather than achieving weight loss, most people who frequently diet end up gaining weight in the long term.

A 2013 review found that in 15 out of 20 studies of people without obesity, recent dieting behavior predicted weight gain over time (15).

One factor that contributes to regain in people with less weight is an increase in appetite hormones.

Your body boosts its production of these hunger-inducing hormones when it senses it has lost fat and muscle (16).

In addition, calorie restriction and loss of muscle mass may cause your bodys metabolism to slow down, making it easier to regain weight once you return to your usual eating pattern.

In one study, when men with less weight followed a diet providing 50% of their calorie needs for 3 weeks, they started burning 255 fewer calories each day (17).

Many women first go on a diet in their early teen or preteen years.

A lot of research shows that dieting during adolescence is associated with an increased risk of developing overweight, obesity, or disordered eating in the future (18).

A 2003 study found that teens who dieted were twice as likely to become overweight than non-dieting teens, regardless of their starting weight (19).

Although genetics play a large role in weight gain, studies on identical twins have shown that dieting behavior may be just as important (20, 21).

In a Finnish study that followed 2,000 sets of twins over 10 years, a twin who reported dieting even one time was twice as likely to gain weight compared with their non-dieting twin. Also, the risk increased with additional dieting attempts (21).

However, keep in mind that these observational studies dont prove that dieting causes weight gain.

People who tend to gain weight are more likely to go on a diet, which may be the reason why dieting behavior is associated with an increased risk of gaining weight and developing obesity.

Rather than producing lasting weight loss, dieting among people who dont have obesity is associated with an increased risk of gaining weight and developing obesity over time.

Fortunately, there are some alternatives to dieting that give you a better chance of avoiding or reversing weight gain.

Try shifting the focus from a dieting mentality to eating in a way that optimizes your health.

To start, choose nourishing foods that keep you satisfied and allow you to maintain good energy levels so you feel your best.

Eating mindfully is another helpful strategy. Slowing down, appreciating the eating experience, and listening to your bodys hunger and fullness cues can improve your relationship with food and may lead to weight loss (22, 23, 24).

Exercise can reduce stress and improve your overall health and sense of well-being.

Research suggests that at least 30 minutes of daily physical activity is particularly beneficial for weight maintenance (25, 26).

The best form of exercise is something you enjoy and can commit to doing long term.

Body mass index (BMI) is a measure of your weight in kilograms divided by the square of your height in meters. Its often used to help people determine their healthy weight range.

Researchers have challenged the usefulness of BMI for predicting health risk, as it doesnt account for differences in bone structure, age, gender, or muscle mass, or where a persons body fat is stored (27).

A BMI between 18.5 and 24.9 is classified as normal, while a BMI between 25 and 29.9 is considered overweight, and a BMI above 30 refers to having obesity.

However, its important to recognize that you can be healthy even if youre not at your ideal weight. Some people feel and perform best at a weight higher than whats considered a normal BMI.

Although many diets promise to help you achieve your dream body, the truth is that some people simply arent cut out to be very thin.

Studies suggest that being fit at a stable weight is healthier than losing and regaining weight through repeated cycles of dieting (28, 29, 30).

Accepting your current weight can lead to increased self-esteem and body confidence, along with avoiding the lifelong frustration of trying to achieve an unrealistic weight goal (31, 32).

Try to focus on being healthier instead of aiming for an ideal weight. Let weight loss follow as a natural side effect of a healthy lifestyle.

The desire to be thin often begins early in life, particularly among girls, and it can lead to chronic dieting and restrictive eating patterns.

This can do more harm than good. Contrary to popular opinion, permanent changes in lifestyle habits are needed.

Breaking the dieting cycle can help you develop a better relationship with food and maintain a healthier stable weight.

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Unhealthy Dietary Patterns and Risks of Incident Obesity | DMSO – Dove Medical Press

Posted: October 12, 2022 at 1:57 am

Introduction

Obesity is one of the important challenges in public health worldwide. It may cause damage to the function of human organs and systems and ultimately lead to other chronic non-communicable diseases (NCDs) including cardiovascular disease, type 2 diabetes, dyslipidemia, chronic kidney disease, osteoarthritis, and cancer.18 Over the last decades, the global prevalence of obesity has increased rapidly, approximately 11% of men and 15% of women were obese in the world.9 In 2015, the prevalence of overweight and obesity among Chinese adults were 41.3% and 15.7%, respectively.10 Obesity-related NCDs brought a huge economic burden in China, and obesity and overweight accounted for 11.1% of deaths associated with NCDs in 2019.11

The root cause of obesity is that the bodys energy intake is greater than the bodys energy expenditure, resulting in excess energy being stored in the form of fat although lots of risk factors for obesity were explored and identified including genetics, diet, physical exercise, and psychological factors in previous studies.11 Thus, dietary factors still play a key role in the process of developing obesity even though some previous findings were controversial over countries or populations.12,13

The traditional nutritional epidemiology researches generally explore relationships between one or several foods or nutrients and health outcomes. Recently, dietary patterns of the overall diet were occupied to assess the comprehensive effects of food or nutrients on human health, and they showed more effectively and precisely than traditional those.14 However, different dietary patterns varied widely over countries, races, and research methods.15 Previous studies showed that western and junk food dietary patterns increased energy intake and risk of obesity,16 while Mediterranean dietary pattern was considered to reduce triglyceride levels.17 Also, an association between Chinese traditional dietary pattern and obesity was reported in one research.18 However, most of previous studies were cross-sectional studies between dietary patterns and obesity,1820 and it was rare to explore prospective associations between dietary patterns and obesity with community population cohorts in China.

There were huge differences in food culture and diet behaviors over different regions, even in China, due to the geographical features and ethnic diversity.21 Thus, based on a prospective community-based population cohort in Guizhou province, this study aimed to explore associations between dietary patterns and incident obesity in Southwest China.

Data for this study were from the Guizhou Population Health Cohort Study (GPHCS), a prospective community-based cohort in Guizhou province, China.22 The baseline survey was conducted between November 2010 and December 2012, and it was followed up between December 2016 and June 2020. The inclusion criteria for subjects in this study included followings: (1) aged 18 years or above; (2) lived in these communities and had no plan to move; (3) completed the questionnaire and blood sample collection; (4) signed written informed consent before data collection. A total of 9280 participants were recruited at the baseline. Those who had obesity at baseline (n = 644), who lost to follow-up (n = 1045), and who had missing data (n = 1634) or incomplete dietary survey (n = 215) were excluded. Finally, the remaining 5742 participants were eligible for the analysis (Figure 1). This study was approved by the Institutional Review Board of Guizhou Province Centre for Disease Control and Prevention (No. S2017-02).

Figure 1 Flow chart of participants in this cohort study.

A structured questionnaire was done through a face-to-face interview by local trained health professionals. The baseline and follow-up questionnaire included demographic characteristics (age, sex, ethnicity, educational level, marriage status, and occupation), lifestyle (smoking status, alcohol use, and physical activity), history of chronic diseases, and dietary factors. Current smokers referred to smoking tobacco products including manufactured or locally produced in a month.23 Alcohol drinkers referred to drinking alcohol more than once every month within the last 12 months.22 Physical activity was defined as meeting WHO recommendations on physical activity according to the global physical activity questionnaire (GPAQ).24

Dietary data including frequencies and quantities of 16 food items (fermented bean curd, bean paste, pickles, oil, legumes, meat, fruits, milk, eggs, fish, potatoes, grains, vegetables, beverages, desserts, and fried food) consumed during the recent 12 months before the study recruitment were collected by a simplified Food Frequency Questionnaire (FFQ). Anthropometric measurements including height, body weight, and blood pressure were measured. BMI was calculated as body weight in kilograms divided by height in meters squared (kg/m2). Obesity was defined as BMI 30kg/m2 based on the WHO BMI classification standard.25

In this study, factor analysis with eigenvalues >1 and varimax rotation was occupied to aggregate 16 food items into factors with food patterns. Four factors that explained most of the variances were determined based on scree plots and their loadings for the initial food items. The factor-loading matrix for the four dietary patterns and their food or food groups is shown in Table S1. Factor 1, named high-salt and high-oil pattern, was characterized by a high factor load of fermented bean curd, bean paste, pickles, and oil. Factor 2, named western pattern, was characterized by a high factor load of legumes, meat, fruits, milk, eggs, fish, and potatoes. Factor 3, named grain-vegetable pattern, was characterized by a high factor load of grains and vegetables. Factor 4, named junk food pattern, was characterized by a high factor load of beverages, desserts, and fried food. A summary score for each pattern was then derived and categorized into quartiles (Quartile 025th, Q1; 26th-50th, Q2; 51st-75th, Q3; 76th-100th, Q4) for further analysis.

The Students t-test and the Chi-square test were used for continuous variables and categorical variables, respectively. Person-years (PYs) of follow-up were calculated from the date of enrolling the cohort until the date of diagnosis of obesity, death, or follow-up, whichever came first. Because physical activity violated the proportional hazards assumption, the multivariable Cox proportional hazards regression models stratified by physical activity were employed to determine the association between dietary patterns and incident obesity and to estimate hazard risk (HR), adjusted HR (aHR), and their 95% confidence intervals (CIs). Several variables were adjusted and controlled in the multivariable models: age (1829, 3064, 65 years), sex (male/female), Han Chinese (no/yes), education years (9/<9), current smokers (no/yes), alcohol drinkers (no/yes), diabetes mellitus (no/yes), hypertension (no/yes). Tests for linear trends across increasing quartiles of dietary pattern were performed by assigning median value to each quartile of dietary pattern. The sensitivity analysis was conducted after exclusion of participants with overweight at baseline. All statistical tests were two-sided and P < 0.05 was considered statistically significant. All analyses were performed in R software (Version 4.1.0; R Foundation for Statistical Computing, Vienna, Austria).

The baseline characteristics of participants are presented in Table 1. Of all subjects, the average age was 45.06 15.21 years old and more than half were women. Most of them were Han Chinese and had 9 education years or longer. The prevalence of current smoking and alcohol drinking was around one-third, while the proportion of physical activity was more than four-fifths. There were significant differences in education level, physical activity, current smokers, alcohol drinkers, hypertension, and diabetes between men and women (detailed in Table 1).

Table 1 Baseline Characteristics of Participants

As shown in Table 2, four dietary patterns statistically varied over different age groups and physical activity groups. Men (53.6%) had higher grain-vegetable pattern scores than women (46.4%). Han Chinese had more chances to have western pattern and junk food pattern. Participants with less than 9 education years had lower proportions of high-salt and high-oil pattern, western pattern, and junk food pattern. Those subjects with hypertension or diabetes tended to have high-salt and high-oil pattern and junk food pattern. There were also significant differences in high-salt and high-oil patterns and western pattern among participants who were current smokers or alcohol drinkers.

Table 2 Participants Characteristics According to Quartiles of Four Dietary Patterns

During the follow-up of 40,524.15 PYs, 427 new obesity cases were identified and the incidence rate of obesity was 10.54/1000PYs overall. There were significant sex differences in the incidence rate (9.36/1000PYs for men vs 11.64/1000PYs for women, p = 0.004). The incidence rate increased with age and the age-specific incidence rates of obesity are displayed over sex in Figure 2. Similar sex differences were observed among those aged 30 to 64 years old (p = 0.010) or elders (p = 0.031). Also, the highest incidence rate of obesity reached 12.27/1000PYs and 9.8/1000PYs in both women and men aged 30 to 64 years, respectively.

Figure 2 Age-specific Incidence rates of obesity for Chinese adults over sex.

Abbreviation: PYs, person years of follow-up.

Note: **P < 0.01.

In the Cox regression model stratified by physical activity, associations between dietary patterns and incident obesity are presented in Table 3. Participants in the higher quartile of junk food pattern score were more likely to develop obese with the HR (95% CI) of 1.54 (1.162.02) and 1.44 (1.091.89) for the third and fourth quartiles, respectively. After the adjustment for covariates, both aHRs in the Q3 and Q4 group of junk food pattern increased slightly and were still significant. Also, the risk of incident obesity significantly increased with the score of junk food pattern (p for trend = 0.040). In addition, subjects in the Q3 group of western pattern had a significantly higher risk of incident obesity (aHR: 1.33, 95% CI: 1.011.75) compared to those in the Q1 group, and there was a marginally raised trend in the risk of incident obesity as western pattern scores (p for trend = 0.087). It was not found that there were any significant associations between high-salt and high oil pattern or grain-vegetable pattern and incident obesity. No significant interactions were observed between dietary pattern and main covariates, either. In the sensitivity analysis, the main results remained robust after exclusion of participants with overweight at baseline (seen in Figure S1).

Table 3 Associations Between Baseline Dietary Patterns and Incident Obesity

The prevalence of obesity has been increasing dramatically worldwide. As a leading risk factor for obesity, unhealthy dietary has been prevalent in China. During the follow-up of 40,524.15 PYs, the incidence rate of obesity was estimated at 10.54/1000PYs in this study population overall with a significant sex difference. Also, the highest incidence rate of obesity reached at 12.27/1000PYs and 9.80/1000PYs in both women and men aged 3064 years, respectively. Those findings indicated that there was a high risk of developing obesity in this study population, especially for women, which called the development and implementation of specific intervention for the prevention and control of obesity.

In the present study, four major dietary patterns were identified and then associations between four dietary patterns and incident obesity were explored among adult residents in Southwest China. The junk food pattern consisted of high consumption of beverages, desserts, and fried food. Likewise, the western pattern was characterized by high consumption of legumes, meat, fruits, milk, eggs, fish, and potatoes. We found that junk food pattern and western pattern were positively associated with the increased risk of developing obesity, while no significant associations between high-oil and high-salt pattern, grain-vegetable pattern and incident obesity were observed in this study. The results were consistent with the South Asian consensus on Nutritional Medical Treatment of Diabesity, which advocated for a hypocaloric diet and reducing intake of carbohydrates and saturated fats.26 Meanwhile, among Iranian women, it was reported that a low-carbohydrate diet was not associated with overweight and obesity.27

In China, the consumption of junk food such as desserts, beverages, and fried food is on the rise since the 1980s.11 In this study, the contribution of junk food dietary pattern to a higher risk of obesity was demonstrated, which was consistent with a Mediterranean prospective cohort design with a median 6-year follow-up.28 Previous studies revealed that during the frying process, excessive fat and calories tended to increase, and trans-fatty acids related to the risk of weight gain29 were also prone to be generated.30 Furthermore, the junk food pattern has a high intake of beverages and sweets, and the positive associations of sugar-sweetened beverages (SSBs) to obesity were confirmed by Framingham Heart Study.31 A recent meta-analysis revealed that the consumption of SSBs increased waist circumference in adult populations.32 Also, a cross-sectional study33 indicated that fruit drink intake was significantly linked with a higher risk of obesity among women. In addition, added sweet or sugar foods were positively associated with BMI in the women.34 Excess sugar intake among sweets and desserts was a significant contributor to the development of overweight or obesity.35,36

Over the past decades, the socioeconomic level has changed dramatically in China, especially in the southwest region. The transition from the traditional dietary pattern characterized by a high intake of vegetables, grains, and legumes to the Western model had occurred.37,38 It was observed that western dietary pattern had a higher incident risk of obesity and there was a marginally raised trend in the incident risk of obesity as western pattern levels in this study. Several studies have demonstrated that Chinese who had a western dietary pattern were more likely to suffer from obesity.39,40 Some similar findings were also reported among children and adolescents.12,41,42 One of possible reasons might be that meat and meat products are rich in cholesterol and saturated fatty acids,43,44 which could increase the risk of suffering from obesity to a certain degree.45 However, Daneshzad et al46 demonstrated that there was no significant association between total meat consumption and obesity based on a meta-analysis of observational studies. Therefore, more prospective studies are needed to clarify the association between red meat and total meat, and obesity.

Moreover, given the topographical characteristics of the Guizhou region, a wide range of potato products, boiled, fried, or mashed, were widely consumed in the local area. As a staple food in the western world, potatoes, an energy-dense food, played a significant role in the western diet pattern, and contributed greater amounts of carbohydrates to the diet.47 Foods containing more starches and refined carbohydrates were positively associated with weight gain.48 A meta-analysis confirmed that weight change was positively associated with the consumption of potatoes (boiled or mashed potatoes, potato chips, and French fries).49 Halkjaer et al50 also reported that total potato intake was associated with the increase in waist circumstances in women. However, the evidence for a link between potato intake and the risk of obesity remains controversial.51,52

Based on this 10-year community population-based cohort in Southwest China,53 this study extended the evidence on the association between dietary patterns and incident obesity. Also, this study collected data through FFQ rather than 24h dietary recall to get long-term usual intake more accurately.41,54 However, there were some main limitations in the study. First, the outcome of obesity was only assessed by BMI and did not include those measures of central obesity such as waistline in this study, which may underestimate the incidence of obesity. Second, over several years of follow-up, the daily diet measured on baseline may be time-varying to bias our findings but we did not collect detailed diet information in the follow-up of this study. Third, Cox proportional hazards regression models were employed with the strata by physical activity to meet Proportional Hazards Assumption. In addition, some possible confounding factors such as medications, family history of obesity or genetic variants related to obesity were not collected in this study, which may bias the findings from this study. Our findings in this southwest Chinese population need to be confirmed or clarified by more prospective studies over different populations. For future studies, associations between diets and obesity measured by waistline or body composition should be explored, and genediet interactions on developing obesity should be considered, too.

In summary, there was a high risk of incident obesity among this Chinese community population of Southwest China. Also, four dietary patterns were identified in this community population of Southwest China, and junk food and western pattern increased risks of incident obesity. The findings provided new evidence for obesity prevention and control from the dietary perspective, especially for the Chinese population. Urgent intervention is called to be developed to promote a healthy dietary pattern and prevent the becoming obesity.

The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board (or Ethics Committee) of the center of disease control and prevention of Guizhou Province (No. S2017-02).

Written informed consent was obtained from all subjects before the data collection.

This work was supported by the Guizhou Province Science and Technology Support Program (Qiankehe [2018]2819).

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

The authors declare no conflicts of interest in this work.

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32. Ardeshirlarijani E, Jalilpiran Y, Daneshzad E, Larijani B, Namazi N, Azadbakht L. Association between sugar-sweetened beverages and waist circumference in adult populations: a meta-analysis of prospective cohort studies. Clinical Nutrition ESPEN. 2021;41:118125. doi:10.1016/j.clnesp.2020.10.014

33. Nikpartow N, Danyliw AD, Whiting SJ, Lim H, Vatanparast H. Fruit drink consumption is associated with overweight and obesity in Canadian women. Can J Public Health. 2012;103(3):178182. doi:10.1007/BF03403809

34. Deglaire A, Mjean C, Castetbon K, Kesse-Guyot E, Hercberg S, Schlich P. Associations between weight status and liking scores for sweet, salt and fat according to the gender in adults (The Nutrinet-Sant study). Eur J Clin Nutr. 2015;69(1):4046. doi:10.1038/ejcn.2014.139

35. Lampur A, Castetbon K, Deglaire A, et al. Associations between liking for fat, sweet or salt and obesity risk in French adults: a prospective cohort study. Int J Behav Nutr Phys Act. 2016;13:74. doi:10.1186/s12966-016-0406-6

36. Andres-Hernando A, Kuwabara M, Orlicky DJ, et al. Sugar causes obesity and metabolic syndrome in mice independently of sweet taste. Am J Physiol Endocrinol Metab. 2020;319(2):E276E290. doi:10.1152/ajpendo.00529.2019

37. Du SF, Wang HJ, Zhang B, Zhai FY, Popkin BM. China in the period of transition from scarcity and extensive undernutrition to emerging nutrition-related non-communicable diseases, 19491992. Obes Rev. 2014;15:815. doi:10.1111/obr.12122

38. Wilson AS, Koller KR, Ramaboli MC, et al. Diet and the human gut microbiome: an international review. Dig Dis Sci. 2020;65(3):723740. doi:10.1007/s10620-020-06112-w

39. Cao Y, Xu X, Shi Z. Trajectories of dietary patterns, sleep duration, and body mass index in China: a population-based longitudinal study from China Nutrition and Health Survey, 19912009. Nutrients. 2020;12(8):2245. doi:10.3390/nu12082245

40. Xu X, Byles J, Shi Z, McElduff P, Hall J. Dietary pattern transitions, and the associations with BMI, waist circumference, weight and hypertension in a 7-year follow-up among the older Chinese population: a longitudinal study. BMC Public Health. 2016;16:743. doi:10.1186/s12889-016-3425-y

41. Zhen S, Ma Y, Zhao Z, Yang X, Wen D. Dietary pattern is associated with obesity in Chinese children and adolescents: data from China Health and Nutrition Survey (CHNS). Nutr J. 2018;17(1):68. doi:10.1186/s12937-018-0372-8

42. Zhang J, Wang H, Wang Y, et al. Dietary patterns and their associations with childhood obesity in China. Br J Nutr. 2015;113(12):19781984. doi:10.1017/S0007114515001154

43. Laskowski W, Grska-Warsewicz H, Kulykovets O. Meat, meat products and seafood as sources of energy and nutrients in the average Polish diet. Nutrients. 2018;10(10):1412. doi:10.3390/nu10101412

44. Larsson SC, Virtamo J, Wolk A. Red meat consumption and risk of stroke in Swedish women. Stroke. 2011;42(2):324329. doi:10.1161/STROKEAHA.110.596510

45. Rouhani MH, Salehi-Abargouei A, Surkan PJ, Azadbakht L. Is there a relationship between red or processed meat intake and obesity? A systematic review and meta-analysis of observational studies. Obes Rev. 2014;15(9):740748. doi:10.1111/obr.12172

46. Daneshzad E, Askari M, Moradi M, et al. Red meat, overweight and obesity: a systematic review and meta-analysis of observational studies. Clinical Nutrition ESPEN. 2021;45:6674. doi:10.1016/j.clnesp.2021.07.028

47. King JC, Slavin JL. White potatoes, human health, and dietary guidance. Adv Nutr. 2013;4(3):393s401s. doi:10.3945/an.112.003525

48. Robertson TM, Alzaabi AZ, Robertson MD, Fielding BA. Starchy carbohydrates in a healthy diet: the role of the humble potato. Nutrients. 2018;10(11):1764. doi:10.3390/nu10111764

49. Mozaffarian D, Hao T, Rimm EB, Willett WC, Hu FB. Changes in diet and lifestyle and long-term weight gain in women and men. N Engl J Med. 2011;364(25):23922404. doi:10.1056/NEJMoa1014296

50. Halkjaer J, Tjnneland A, Overvad K, Srensen TI. Dietary predictors of 5-year changes in waist circumference. J Am Diet Assoc. 2009;109(8):13561366. doi:10.1016/j.jada.2009.05.015

51. Aljuraiban GS, Pertiwi K, Stamler J, et al. Potato consumption, by preparation method and meal quality, with blood pressure and body mass index: the INTERMAP study. Clin Nutr. 2020;39(10):30423048. doi:10.1016/j.clnu.2020.01.007

52. Linde JA, Utter J, Jeffery RW, Sherwood NE, Pronk NP, Boyle RG. Specific food intake, fat and fiber intake, and behavioral correlates of BMI among overweight and obese members of a managed care organization. Int J Behav Nutr Phys Act. 2006;3:42. doi:10.1186/1479-5868-3-42

53. Chen Y, Wang Y, Xu K, et al. Adiposity and long-term adiposity change are associated with incident diabetes: a prospective cohort study in Southwest China. Int J Environ Res Public Health. 2021;18(21):11481.

54. Moghames P, Hammami N, Hwalla N, et al. Validity and reliability of a food frequency questionnaire to estimate dietary intake among Lebanese children. Nutr J. 2016;15:4. doi:10.1186/s12937-015-0121-1

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Unhealthy Dietary Patterns and Risks of Incident Obesity | DMSO - Dove Medical Press

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Diet-related diseases pose a major risk for Covid-19. But the U.S. overlooks them. – POLITICO

Posted: November 6, 2021 at 1:51 am

Just a few days later, Boris Johnson gave a speech at the Conservative Party Conference alluding to his anti-obesity campaign by striking a personal chord: I had a very common underlying condition: My friends, I was too fat. The prime minister also mentioned hed since lost 26 pounds. He went on to outline a vision for the future of Britain that included a healthier population, with more biking and walking.

Stateside, the U.S. government was still not raising the alarm about the link between rampant metabolic disease and greater risk. It was never part of White House messaging on the virus and the suite of policies needed to respond to the crisis something that didnt change when President Joe Biden took the reins, either.

Its not central to the discussion at all, said Dan Glickman, who served as agriculture secretary during the Clinton administration and is now a senior fellow at the Bipartisan Policy Center.

"Its a gigantic gap in the discussion about how health care relates to Covid and how it relates to the prevention of disease.

Dan Glickman, former agriculture secretary during the Clinton administration

Glickman noted that the countrys leading voices on coronavirus, including Anthony Fauci, dont focus on underlying conditions and what could be done about them long term. Instead, the focus is solely on vaccines, which have been proven to be safe and effective.

They hardly ever talk about prevention, Glickman said. Its missing. Its a gigantic gap in the discussion about how health care relates to Covid and how it relates to the prevention of disease.

As the pandemic heads into its third year, the connection to diet-related diseases and the overall vulnerability of the American population is a theme that remains absent at the highest levels of government. The only high-level Biden administration official who routinely talks about the issue is Agriculture Secretary Tom Vilsack and he brings it up often.

Vilsack, whos serving in the role for a second time after eight years during the Obama administration, likes to point out in his speeches, for example, that the government now spends more treating diabetes than the entire budget of the USDA, which is about $150 billion.

In an interview with POLITICO, Vilsack noted that more than half of the $380 billion per year spent treating just cardiovascular disease, cancer and diabetes is now picked up by the government, including through programs like Medicare and Medicaid.

Agriculture Secretary Tom Vilsack speaks on rising food prices at a press briefing at the White House in September. | Kevin Dietsch/Getty Images

Ironically, if you could eliminate those costs you would be able to afford a $3.5 trillion Build Back Better bill [without pay-fors], he said.

It's a significant issue that requires elevation, Vilsack said. We're moving the dials that we can move at USDA. I think, however, it takes more than that. I think it takes multiple departments focused on this and multiple leaders saying this is an issue that requires some attention.

Dealing with diet-related diseases hasnt been top of mind in Congress, either. For example, theres a bipartisan bill to require Medicare to cover medications and more types of specialists to help treat obesity. The legislation has been introduced repeatedly since 2013, the year the American Medical Association formally recognized obesity as a disease, but has not gotten much traction even as major Covid aid bills have moved through Congress.

Fatima Cody Stanford, an obesity medicine physician scientist at Massachusetts General Hospital and Harvard Medical School who is a key advocate for the bill, said the pandemic has sparked much more interest among lawmakers and staff, but it hasnt yet translated into legislative action.

One of the biggest challenges, she said, is that most people still do not understand obesity is a complex disease, not something that can be blamed on or fixed by personal choices, and it often requires multidisciplinary treatment that many people do not have access to.

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Diet-related diseases pose a major risk for Covid-19. But the U.S. overlooks them. - POLITICO

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[Full text] A Bidirectional View of Migraine and Diet Relationship | NDT – Dove Medical Press

Posted: February 10, 2021 at 8:54 pm

Introduction

Interest in headache1 is potentially as old as recorded human history. With all the advancements in understanding and management of headaches over the years, headache in general has remained a major complaint for which patients feel an urge for a medical consult. Costs related to headaches are high and are classified as direct (medical care) and indirect costs (loss of productivity). Therefore, if headaches can be diagnosed correctly and earlier, and if they can be managed properly, the burden to patients and societies will be dramatically reduced.

Based on the latest version of the headache classification, migraine is a form of primary headaches,2 ranked among the most disabling medical conditions.3 Number four of the Trndelag Health Survey (HUNT4 study) revealed that 18.1% of the studied population had active migraine.4 Migraine is characterized by headache attacks and associated symptoms presented in a multiphasic nature,5 where both peripheral nervous system and central nervous systems are considered involved.5,6 The recurrent nature of migraine and the fact that it can be triggered,7 have provided a key feature to explore internal and external triggers and through those, to study the mechanisms underlying the disorder. This phenomenon has also presented a unique opportunity to modify triggering factorsthose that can be modifiedto reduce intensity of migraine and how often it occurs. This concept is attractive, as it has been found that lifestyle factors,8 such as diet,9 can trigger migraine, and lifestyle modifications,10 for example diet modifications, and nutraceutical interventions11 have collectively shown beneficial effects in patients with migraine. Considering these options is important, because despite remarkable advancement in understanding of the pathogenesis of migraine and targeting migraine by the novel therapeutic options,6 challenges remain related to sufficient efficacy, and desirable safety, and the fact that nonresponders are present.12 In addition, a number of individuals with migraine are continuously searching for natural and device- or drug-free interventions outside of the typical therapeutic options. In this line, functional medicine approach to manage migraine has been proposed as a potential tool. This approach considers individual's genetic, biochemical, and lifestyle factors to construct plans for personalized treatment. Functional medicine consists of timeline, matrix, and the therapeutic lifestyle factors (for example, sleep, exercise, diet, and stress). Within this framework, functional food can also be defined for migraine. Generally, a food is defined functional if it is satisfactorily demonstrated to affect beneficially one or more target functions in the body, beyond adequate nutritional effects in a way that is relevant either to an improved state of health and well-being and/or reduction of risk of disease.13 Functional food has been tested to identify if it can exert beneficial effects for several diseases, for example for metabolic syndrome.14 This syndrome consists of several metabolic disorders (eg, high levels of fasting glucose and obesity) and enhances the risks of other diseases, for example stroke, diabetes, and cardiovascular diseases.14 Interestingly, migraine has also been recognized as a disorder related to metabolic imbalance, and that highlights a potential for functional food for migraine.15 William Amery in 1982, provided the first evidence that the metabolism is linked to the pathogenesis of migraine.16 Recent studies investigating metabolic alterations in migraine have proposed that a mismatch seems to exist between brain energy sources and the consumption of the sources,17 and have linked this energy deficit to mitochondrial dysfunction in migraine.18 It is hypothesized that energy-reserve deficit alone or combined with an overload of sensory input could activate the trigeminovascular system in the cascade of pathophysiological events in migraine.18 Based on this, a metabolic treatment of migraine has been proposed.17,19

While identification of dietary triggers and dietary interventions for migraine prevention are profound in the literature, the concept of dietary choices, and pattern of diet in migraine patients have been investigated less.20,21 The idea that mechanisms underlying migraine pathogenesis might influence dietary choices is valuable, but has sporadically been discussed.20,21 Epidemiological findings have demonstrated that choice of diet by individuals with migraine is different compared with individuals without migraine. Potential reasons for such difference have been explained by several factors, for example, contribution of neurotransmitters such as serotonin and orexin, hormones, and state of aura.21 A potential bidirectional relationship (Figure 1), where migraine influences food intake, and consumed food affects the manifestations of migraine, needs further investigation. Within this framework, investigation of the gutbrain axis contribution seems highly valuable.21

Figure 1 A potential bidirectional relationship between migraine and diet.

In the following sections, some examples from the current literature are presented to highlight what we already know about the effects of diet on migraine and the effects of migraine on dietary choices, and what remains unknown to stimulate further research. Therefore, the purpose of this targeted review is not to provide a comprehensive systematic review of the current literature on the role of diet in migraine; since several excellent reviews are already available (eg,9,2226). PubMed, Cochrane Library, EMBASE, and Web of Science databases were searched for studies using keywords of diet, migraine, food, and lifestyle with the aim of providing the current overview, and a viewpoint to the potential future directions. The ultimate goal is to form testable scientific hypotheses for future investigation of the bidirectional relationship of migraine and diet.

Studies that have investigated whether and how the consumption of dietary components can influence the manifestations of migraine are abundant. The potential role of dietary triggers, contribution of the immune system, metabolic systems, and the gutbrain axis contribution are among the examples focused on the effect of diet on migraine. The other direction, where migraine might also influence the food intake, has been less investigated. Presence of aura,2729 some neurotransmitters involved in pathogenesis of migraine (eg, serotonin,30,31 and orexin32), hormones (eg insulin33), and level of adiocytokines34 have been proposed to influence the choice of diet by affected individuals in terms of content, pattern, and amount of food intake.21 Several familiar and unknown factors can potentially influence this bidirectional relationship. These include, but are not limited to, gender, age, and geographical locations.9,24,3537

A large number and diverse range of factors (eg, dietary factors) with a high degree of heterogeneity have been reported capable of triggering migraine.38 For example, stress has been shown to exacerbate migraine, and having or expecting a migraine can negatively affect stress level of affected individuals. Menstrual migraine is a typical example of the link between hormones and migraine. Sleep and migraine have also been found interrelated where sleep disturbances aggravate migraine. Other environmental factors such as intense light, strong odors and high altitude have also been reported to influence migraine.39 Consequently, long lists of recommendations exist for avoiding potential triggers or coping strategies in order to prevent migraine or subsiding its frequency and severity; hence, enhancing the quality of life in affected patients.40

A meta-analysis of available studies for headache triggers has summarized data from 27,122 participants from 85 articles published between 1958 and 2015, and has provided 420 triggers.41 86% of the included participants in this meta-analysis had the minimum of one trigger for their headaches. Findings from this study highlighted that stress was the most prevalent trigger.41 Heterogeneity, however, was high and intra- and interindividual variations among trigger frequency and potency were also profound.41 Knowledge of migraine triggers can help in improving the management, coping, and care for migraine; but studying migraine triggers is not challenge-free. Using smartphone-based dairy studies that use ecological momentary assessment systems, has presented fatigue, sensory sensitivity, negative affect, specific foods, menstruation, and yawning as the most frequent triggers of migraine.4244 Correct understanding of trigger perception has been discussed by Turner et al45 to highlight how important are the behavioral changes in response to a headache trigger that is perceived by patients as a precipitating factor. An example is the avoidance of bright light if the individual with migraine perceives it as a migraine trigger. This controlling avoidance behavior may influence the scope of individual activities, and can negatively influence the quality of life.40,46,47 Perhaps that is why coping strategies are prioritized to avoidance strategies, in general.47

Collectively, the current ultimate recommendation for individuals with migraine has pointed to the value of maintaining an appropriate and healthy lifestyle.48 Lifestyle can be defined as the controlled behavior and activities of a person and many activities, habits, and practices involve risk factors. The contribution of dietary factors within the lifestyle modification has been recognized; however, proposed beneficial changes in lifestyle, consider a broader spectrum to not only include dietary aspects, but also monitoring of exercise, sleep, and stress.49

It has been proposed that modification of lifestyle might prevent migraine, which in turn would decrease the burden to individual patients, and health-related costs.50 However, due to the complexity of migraine, as a multidimensional disorder, and also the complexity of designing studies to test how dietary factors can influence migraine,49 inconsistency exists in the literature, ranging from a limited importance of dietary modification for migraine to some promising effects. Cross-sectional studies have been important in providing an overview of potential triggers;51 however, if the goal is to prove (or falsify) that a causal or a bidirectional relationship exists in the dietmigraine interaction, prospective studies with proper control groups must be designed that are also longitudinal in nature. For example, age of onset is extremely important.51 A migraine patient passes through different phases in an age span, from pediatric to geriatric migraines, for example. Puberty has been shown linked with migraine and migraine that occurs before puberty differs from post-puberty migraine. Several factors such as alteration in lifestyle, habits, and hormonal levels have been proposed to shape this evolution from pre- to post-puberty. A recent study52 has investigated this evolution in a selected pre-pubertal patients who were diagnosed with migraine. Researchers in this study collected medical records, migraine manifestations, and lifestyle-related factors, at baseline and at the two-year follow-up. Nineteen patients (migraine with aura: 27.5%) were recruited. The results of this study demonstrated that migraine accompanying symptoms changed with a significantly higher prevalence of dizziness, vertigo, mood changes, confusion, and allodynia.52 Prodromal symptoms became more prevalent, where sleep disturbances and schedule changes showed a significant increase as migraine triggers. Interestingly, at baseline, food was triggered at 11% of cases, but after two years, it went down to zero. Another study on the participants aged above 16, has also identified the appearance of new triggers over time. For example, new factors, including pain in neck, consumption of alcohol, hormonal changes, and smoking were notified.53 These studies provide valuable information that migraine triggers show changes during puberty, and new triggers can appear together with changes in habits along with physical and lifestyle changes, which collectively highlight attention to a potential dynamic pathological process that deserves further investigation. These studies also present a valuable point that besides studying dietary factors other daily lifestyle features, for example how a patient sleeps, makes a workrest balance, and deals with stressful situations are important to observe and note, because these factors are often interrelated and can influence each other directly or through indirect interactions. Comorbid conditions, such as other neurological, psychological, or cardiovascular disorders are also important and influential, because patients, influenced by those conditions, might follow a special lifestyle, including certain diets.1 For example, those who are diabetic or have a heart disease may follow a vegan diet for its beneficial effects,54,55 and some migraine patients might be on a vegan diet for comorbidy or other reasons.

A systematic review from 202022 has summarized the findings from 43 studies that have investigated and reported dietary patterns (11 studies), triggers (20 studies), and dietary interventions (12 studies) in patients with migraine.22 Level of evidence was determined as low level, because the authors identified that >50% of the studies were cross-sectional or patient surveys. Caffeine and alcohol were found as major triggers that could increase migraine frequency.22 Several dietary interventions were also reviewed, for example, elimination diets, low-fat diet, and ketogenic diet that presented promising results in managing migraine.22 However, this review did not present a choice or a favorable, so-called migraine diet, due to lack of qualified and sufficient information.

Elimination diets can be based on a diary for identification of triggers, or based on tests for the IgG-positive food, both strategies to limit those triggers. When participants were tested for antibodies against 266 foods and individually eliminated those foods that they had positive tests for, a reduction of 29% in migraine days was found.56 This study was, however, a small cross-sectional study, with some limitations. Another study, which was designed as a randomized controlled trial, eliminated those foods from diets of migraine patients who participated and were positive for certain food-related antibodies. When headache days were determined after four weeks on the elimination diet, a 19% reduction was found.57

Dietary interventions have mostly been investigated in a small population with no proper control group, hence results are heterogeneous and a sharp conclusion cannot be made. For example, a diet high in carbohydrate and low in tryptophan was tested in a group of seven patients and showed beneficial to subside headaches. The authors proposed that the positive effect has been apparently due to a mixture of lower intake of food that could trigger headache and also elevated levels of serotonin following the tested diet.58

Dietary lipids were investigated afterwards, because it was proposed that a diet high in lipids could cause headache following a potential lowering of serotonin levels in plasma that might be a result of higher platelet aggregation.59 A diet with a very low level of lipids (~20 g per day), therefore, was proposed to prevent headaches.60 A randomized, crossover trial reported in 201561 that low lipid compared with moderate lipid dietary intake could subside occurrence of migraine and headache intensity. It has also been reported that the dietary approaches to stop hypertension (DASH) diet could diminish the intensity of headache and duration in migraine.62 This particularly points to the importance of migraine comorbidities, and how dietary factors can influence an overall well-being of the affected patient.

Supplementation by a diverse range of vitamins and minerals has been reported beneficial for migraine. For example, based on a review from 2018, vitamin D, vitamin B2, vitamin B12, magnesium, carnitine, and niacin have reduced frequency of magnesium, carnitine, and niacin have reduced frequency of migraines.63

Even though beneficial effects of these dietary interventions have been reported in the literature,22 one must consider that individual patients may require special needs that importantly points towards the concept of precision medicine in migraine.64 Including larger cohorts of patients and considering follow-ups of longer duration could help in properly examining the effect of dietary interventions, a point to be considered in the future investigations. In this line, patient adherence and age influence on diet choices and dietary patterns emphasize the value of long-term assessments. However, plan, design, and conduct of long-term studies are difficult and several intractable factors need to be considered and integrated into the assessments. At present, comparisons between studies remain difficult because age, gender, cultural, and religious variations among different studied populations have largely been ignored. Gender of affected individuals is an important factor to consider,51 because changes in hormonal concentrations, for example plasma estrogen concentrations, have shown an association with migraine.65 Alternatively, dietary intakes that can alter estrogen activity to a lower level have been shown beneficial for premenstrual symptoms.66 Therefore, low fat, high fiber, or vegan diets, might help some patients, for example those who have menstrual migraines. In fact, a study67 has tested this hypothesis, by investigating the effects of a four-week low-fat vegan diet in migraine. Overall, headache severity, headache days and frequency subsided, but this study has some limitations in design preventing drawing a sharp conclusion.67 Besides linking beneficial effects of a vegan diet to a low fat content, and lowering estrogen activity, several other mechanisms have been proposed, for example antioxidant and anti-inflammatory properties of plant-based food. Since an involvement of neurogenic inflammation in migraine68 has been suggested, this might be an explanation. In addition, dairy products (eg, cheese) and meat49 are not present in a vegan diet and these components have often been reported as migraine triggers in the literature.69,70 Therefore, absence of these components in a vegan diet might exert an anti-inflammatory effect against migraine.

Weight loss has been reported beneficial in migraine,71,72 although open questions remain in the field due to design and studied populations in the current literate. A proof of concept study in 2015 presented that weight loss could result in symptom improvement.73 Based on a pilot study published in 2019,11 enhancing the quality of diet and maintaining a healthy weight, could improve some clinical features of migraine. In this open, and nonrandomized study, women with migraine received an individualized diet plan, which was based on a professional nutritional diagnosis. This study was first to provide evidence that diet quality and maintaining a healthy weight are important,11 not the weight loss per se. This means that for underweight patients a weight gain might be the successful strategy, while for overweight patients, a weight reduction strategy would provide beneficial effects on migraine.11

Bond et al74 designed a study to test if two different strategies for weight loss would be comparable or different. Migraine patients who were overweight or obese women (a population considered to be most affected by obesityrelated migraine risks)35,75,76 were included and divided into two groups. One group received a behavioral weight loss (BWL) that included both exercise and diet, and the other group received educational instructions on migraine. Findings from this study showed that both groups benefited from a reduction in headaches following the two strategies and there was no significant difference between the groups. This study presented that independent of the type of strategy; strategies for weight loss might be beneficial for this special population.

According to a systematic review and meta-analysis77 that has summarized and compared two strategies for weight loss, it was revealed that independent of technique, weight loss could reduce headache severity, frequency, duration, and associated disabilities. Therefore, weight loss was highlighted as the critical factor, not the amount of weight reduction, or the strategies that were used to achieve the loss.77 In fact, the obesity and migraine link has been a matter of investigation for a while. The fundamental questions are, do people with migraine gain weight because of migraine related disability? Or does obesity lead to greater migraine frequency? In other words, which comes first, obesity or migraine. Results are mixed in the literature. Winter et al in 201278 found that among 19,162 middle-aged women, those with migraine had a significantly higher risk to shift towards being overweight or obese. The risk was not different for women with or without aura.78 Age plays a role in obesitymigraine interactions,79 because age affects the body mass index (BMI), distribution of body fat, hormones, and prevalence of migraine. Reported in 2020, the HUNT3 (the third population-based Nord-Trndelag Health Study)80 showed that a greater association exists between migraine and obesity in younger adults, ie, those >50 years old, still within the reproductive age. Therefore, one must consider that in the study by Winter et al,78 where middle-aged women were included, other risk factors might have played a role.

A meta-analysis81 of 12 studies, including data from 288,981, demonstrated that body composition is a critical factor. When pooled data were adjusted for age and sex in this analysis, an increase risk of migraine (27%) was identified in obese vs normal weight and was not lost even after multivariate adjustments. The risk was shown slightly elevated (13%) in underweight vs normal weight and again it was not changed even after application of multiple adjustments. Therefore, it seems based on these results, that obesity and being underweight could enhance risk of migraine.81 An increased risk of migraines in underweight and obese women vs normal weight was presented in 2015 by Ornello et al.82 However, pre-obese subjects did not show any increasing risk.82

Multiple underlying mechanisms for the impact of obesity on migraine have been proposed, one of which is a neurometabolic impact.18 This has been based on reports in the literature that metabolic factors can trigger migraine, for example, fasting/hypoglycemia, dehydration, stress, alcohol, and lack of sleep. These factors have been found linked to reduced brain energy levels in migraine patients. It has been proposed that these triggers could reduce mitochondrial function, ATP generation, cellular glucose transport, and lipid oxidation, promote neuroinflammation (neuronal and glial signaling modulation), and astrocytic signaling.18,19 These mechanisms are also linked to increased cortical excitability that has been proposed in migraine pathophysiology.83 The review by Gross et al18 in 2019, summarized the available literature on the metabolic changes in migraine and how those changes can contribute in pathophysiology and being potential targets for treatments. One important feature in this context is that nutritional intervention to improve nutrient metabolism, neuroinflammation, and oxidative stress, can eventually improve migraine.18 This has shed light on the concept of obesity and migraine. Observations have provided evidence that the hypothalamus which is the first station for detecting of changes in peripheral energy status, is involved in migraine pathogenesis.84 Interestingly, it has been found that hypothalamic astrocytes have distinct responses to nutrients, ie fatty acid and glucose metabolism coupling.85 In addition, it has been found that different brain cells utilize, store, and modify their response to lipids. L-carnitine, which transports fatty acids into the mitochondria, where those are oxidized to produce ATP, has shown efficacy in blunting migraine.86 In contrast, saturated high-fat diets leading to obesity, promote metabolic dysfunction, depressive like behavior, and neuroinflammation.87 This has led to applying a strategy in which targeting obesity could suppress neuroinflammation and consequently block the depressive symptoms. Interestingly, increased mood disorders have been seen in migraine patients, so these basic research findings are clarifying some underlying mechanisms that might share commonalities in obesity, migraine, and mental health.88

The concept that migraine might be a response to low brain energy level or uncompensated oxidative stress,89 has brought the ketogenic diet back into attention.90 This diet acts in a similar way to fasting, where ketone bodies are elevated and can be used as an alternative source of energy to correct abnormalities in glucose metabolism reported in migraine. Some reports, including a proof of concept study,73 have demonstrated beneficial effects of a ketogenic diet to reduce migraine frequency. Recently, an alternative method has been considered to apply exogenous ketogenic substances.91 This means to provoke nutritional ketosis with ketogenic substances, for example, beta-hydroxybutyrate (HB) salts.91 A recent review90 summarized the potential mechanisms underlying the effect of ketone bodies and presented those as signaling molecules that can interfere with pathways involved in migraine pathophysiology.90 For example, ketogenic substances can reverse mitochondrial dysfunction, subside oxidative stress, reduce cerebral excitability, or lower the inflammation.90 Even though an extensive amount of work has been done in animals, clinical research is lacking to validate the findings as if these protective effects of ketone bodies (KBs) would also be present in patients with migraine. Supplementation with HB without a strict dietary change is under investigation91 and could help provide evidence and address those open questions.

Diet-induced obesity has been shown to reduce brain fatty acid uptake.92,93 This has opened up a concept that obesity could enhance deficits in brain energy reserves and metabolism that characterize migraine. Within this concept, omega-3 fatty acid supplementation has shown antidepressive action and reduced migraine frequency.94 Fish oil supplementation in obese mice95 has shown reduction in metabolic and anxiodepressive effects of diet-induced obesity and related alterations in the composition of brain lipid. Further investigation is required in humans, as mood, food, and obesity have been found interrelated in a complex interaction.96 In addition, it is still not known whether a migraineobesity association is different in females and males, in different ages, and in different subtypes of migraine, considering mood disorders and emotional behaviors in humans.

As the evidence continues to accumulate, it is suggested that physicians recommend weight loss to their patients who have comorbid obesity. This is because weight loss has proven to improve sleep, mood, and other factors that increase susceptibility for having more frequent or severe migraine attacks. Lifestyle changes overlap with migraine and can be beneficial in migraine management, in particular when migraine is comorbid with other conditions, such as depression. There are lifestyle modification approaches for obesity. For example, according to Wadden et al,97 diet, exercise, and behavioral therapy were major determinants of lifestyle modification, where a reduced-calorie diet and a high level physical activity could yield a long-term weight loss.97 Based on a recent review,26 diets that promote weight loss, such as the ketogenic diet, and low-calorie diets, could be considered beneficial for those headache patients who are obese. In addition, lowering intake of omega-6 and intake of higher amount of omega-3 in this group can be advantageous. However, another review9 has emphasized that the net outcome depends on several factors, for example, age, gender, genetic predisposition, and environmental factors. Therefore, in order to provide evidence-based dietary recommendations for migraine, we need to consider these influential factors in study designs. In addition, the more we know about the mechanisms leading to migraine, the better we can investigate different factors, including dietary factors, which can interfere with those mechanisms. Future research is needed to provide evidence of whether diet can be a disease-modifying agent for migraine, and how. Considering the big picture, this would also enable personalized recommendations that - are in line with biopsychosocial considerations in targeting migraine.

In addition, one must consider that if comorbidities exist with migraine, dietary modification might be beneficial in controlling the condition. For example, several studies have highlighted a solid link between migraine and gastrointestinal diseases, in particular, irritable bowel syndrome (IBS). For review see Camara-Lemarroy et al.98

The gutbrain axis is a term to describe a potential two-way relationship between the gut and the brain. The gutbrain axis might potentially explain the existing link between IBS and migraine.98 Evidence is accumulating on the role of gutbrain axis in several neurological disorders, and migraine is not an exemption, where this has been reviewed in a recent review.99 However, we still do not know how the gut and the brain may interact in migraine.99 Several mechanisms have been proposed,100 for example, composition of gut microbiota, proinflammatory substances such as interleukins, neuropeptides (eg, calcitonin gene-related peptide; CGRP), hormones, and dietary components.101

In a recent metagenome-wide association study (MWAS),102 fecal samples of elderly women with migraine have been compared with matched controls to determine if gut microbiota is associated with migraine. Results showed that patients and controls are different in terms of diversity of species in the gut. Clostridium species (an unhealthy composition) were significantly higher in the migraine group. However, a healthy composition (eg, Faecalibacterium prausnitzii, Bifidobacterium adolescentis, and Methanobrevibacter smithii) were profound in controls. Patients also presented a diminished metabolic function of the gut compared with the controls.102 These findings may pave the way toward diagnosis, prognosis, and response to treatment strategies, or point to a novel therapeutic target. Based on the results,102 and to maintain healthy composition of the gut microbiota, proper probiotics have been suggested to correct dysbiosis in migraine patients. The concept of using probiotics for maintaining well-being is not new,103 however, identification of the role of probiotics in minimizing neuroinflammation, a mechanism proposed for migraine,104 has attracted attention toward the use of probiotics for alleviating migraine attacks.105,106 In patients with episodic and chronic migraine, a multispecies probiotic supplement has been investigated to identify a potential beneficial effect and profile of inflammatory markers.106 Findings revealed that probiotic supplementation could reduce the frequency and severity of migraine attacks. In addition, patients had a lower number of migraine days in the month and consumed a lower number of drugs to stop migraine headaches.106 According to the findings by Sensenig et al, mineral and vitamins added into a probiotic regimen for 12 weeks could result in a remarkable improvement in headache in 60% of migraine patients. Improvement in quality of life was reported by 80% of patients.107

Probiotic interventions as a prophylactic way to treat migraine have been summarized in a recent systematic review.108 Out of 68 screened studies, only two studies were analyzed, one with negative 109 and one with positive outcome106 in diminishing migraine frequency and intensity. The authors of this review108 have recommended points for inclusion and exclusion for the enrolment of patients, considerations for study design that can recruit standard and comparable methods, and proper control groups, within sufficient time.108 Microbiome analysis, pre- and postintervention, has also been encouraged.108

Another potential explanation for the existing link between gastrointestinal disorders and migraine is the gut permeability,110 where the leaking of lipopolysaccharides from the lumen into the blood can trigger a proinflammatory response,111 which is known to play a role in migraine pathogenesis.112 In a group of migraine patients diagnosed with comorbid IBS, probiotics combined with an elimination diet were tested.113 Sixty patients were randomized into three groups to receive the elimination diet, probiotics, or diet plus probiotics.113 The study results demonstrated that the combination method was superior for improving migraine comorbid with IBS.113

In addition to gut composition, which was found different in migraine patients, collected samples from the oral cavity of patients with migraine have demonstrated different composition from controls.114,115 Significantly higher nitrate, nitrite, and nitric oxide reductase genes were found in oral cavity samples of migraine patients. Interestingly, nitrates and food additives are reported among headache triggers, and nitric oxide pathway has been linked to migraine.116,117 Therefore, bacterial composition can be investigated in oral cavity and fecal samples in migraine and composition might reveal differences from controls.114

Identification of the CGRP role in migraine, has led to the development of new targets118 such as monoclonal antibodies that target CGRP itself, or its receptor, and also new oral gepants, antagonists of CGRP receptor.119 Evidence is limited as if dietary components could interfere with CGRP in migraine. Cady and Durham treated rats with cocoa-enriched diets for 14 days and investigated the expression of CGRP in the trigeminal ganglion cells, where they reported a significant decrease in the expression.120 In cell models, CGRP secretion has also been diminished after treating cells with petasin, which is the active component of butterbur, grape seed, and ginger extract.121,122

In relation to CGRP, a new study123 has demonstrated that when migraine patients with episodic migraine were supplemented with vitamin D, they had lower headache days and disability assessed on the migraine-related disability score (MIDAS) showed a significant improvement after 12weeks.123 Researchers in this study analyzed the serum levels of CGRP and presented that in the group on vitamin D supplementation, CGRP level was significantly lower.123 Based on the findings and correlational analysis, the authors have proposed that vitamin D might exert some of its effect through lowering of the CGRP levels.123 A larger study with a longer duration together with supportive basic research studies to look into underlying mechanisms of vitamin D in lowering CGRP and exertion of antinociceptive effect through this path, have been suggested.123

Considering beneficial effects of targeting CGRP with recent compounds,118,119 this line of investigation remains open to identify how dietary components or patterns might interact with expression and function of CGRP to interact with migraine manifestations.

Neurologists often encourage their patients with migraine to follow a consistent lifestyle. This is based on the observation that sudden changes in any lifestyle component may provoke migraine attacks. This includes several components, such as exercise, sleep, workrest cycles, diet, etc. However, evidence is still limited. In addition, the pattern of diet or habits of dietary choices might be equally as important as content of the diets. A cross-sectional study in 2015124 that used logistic regression, found that migraine is associated with low intake of food, regardless of the type of food.

A review125 on dietary consistency has presented the topic from three different views to migraine. The authors have proposed migraine as an illness, a disease, and a state of inflammation.125 Within this proposed framework, the authors looked at the relationship between diet and migraine as a function of changes in these three.125 Other researchers have considered migraine a brain disorder of maladaptive response and have described a feedforward allostatic cascade model that can lead to migraine.126 In this model specific stressors such anxiety, noise, food, odors, and bright light can be tested. Each of these factors can contribute to the allostatic load with a different magnitude, and factors can be summed over time. Therefore, the authors have proposed that modification of these effectors or stressors can help to intervene with the skewed allostatic load in migraine.126 Independent of the viewpoint to migraine, maintaining consistency in daily living is not easy and most likely requires education, monitoring, and support, and scientifically driven patterns.125

Studies are vast in the literature to examine dietary triggers for migraine and to lesser to examine dietary intervention. However, the question remains open as to whether certain dietary intake patterns are specific to migraine and whether migraine pathogenesis would influence dietary choices and patterns. In this line, it is important to identify if the subtypes of migraine can have an influence on the choices. For example, if the state of aura would lead patients with migraine to select a specific dietary component or patterns, while those choices might be different from those patients who do not have aura, and in comparison with migraine-free individuals. To address this side of the diet-migraine relationship, studies with proper control groups, such as nonheadache and nonmigraine control groups, and including subtypes of migraine (episodic, chronic, with and without aura) would allow for a proper evaluation. However, the evidence is very limited. Pattern of food intake has been investigated in one study,124 where a large population of middle-aged women was included. This study124 was designed based on a hypothesis that migraine patients and healthy individuals are different when it comes to food intake and food avoidance behavior, and that subtypes of migraine (eg, with and without aura) may influence these behaviors even further. This study124 demonstrated that a migraine-specific pattern of food intake existed that was different from healthy individuals. The only exception was alcohol consumption. In addition, and based on the presence or absence of aura in migraine subtypes, the choice of certain food items was influenced. Those items were, for example, chocolate, processed meats, dairy products, and wine.124 Interestingly, lower intake of dietary compounds known as migraine triggers was not evident. This led to an assumption that those food items might have been avoided by patients within a particular subtype of migraine.124 Further studies, however, are required to investigate this arm of migrainediet relationship. Epidemiological findings have demonstrated that choice of diet by individuals with migraine is different from individuals without migraine and the difference reflects on several nutritional metrics,21 for instance, diet quality,127 diet composition,128 dietary schedule,50 and amount of consumption in a wide range of different foods.23,124,129 We still do not know if mechanisms underlying migraine pathogenesis might influence dietary intake.20,21 Future studies are warranted to identify the patterns and potential underlying mechanisms and to examine if migraine type, migraine frequency, and food intake are interrelated. Besides, longitudinal studies are preferred to cross-sectional studies.

Migraine pain and related disturbances may influence individuals with migraine to select a convenient, simple, or easy choice in diet, which might differ from those without migraine that have a tendency for a more complex dietary pattern. The choice can reflect on the amount, quality, timing, and patterns of dietary intake. This might be due to the fact that the hypothalamus has been found activated in the premonitory phase of migraine, the time that food cravings often occur.28,130 Food cravings, for instance for chocolate, have been reported to present and have accounted for triggering migraine attacks while this might be a part of the onset.1 Interestingly, chocolate has been a matter of investigation as one of the migraine triggers.131 A recent systematic review132 has looked into 25 studies that evaluated if chocolate acts as a trigger in migraine, where 23 studies reported that chocolate could trigger migraine. There were also three provocative studies133135 that tested the triggering effect of chocolate compared with placebo, and neither of those could identify a significant outcome. Therefore, based on these findings, the authors of the systematic review concluded that evidence is still lacking to draw any recommendation for migraine patients about eating or avoiding chocolate.132

Neurotransmitter, hormone, and adipocytokine levels in migraine patients are different compared with controls that might also influence the desire for food, or food intake or even the metabolic control of the hypothalamus18,136 in affected patients. For example, orexin A, was elevated in headache phase,32 while serotonin levels were lower during the interictal phase.30,31 Higher insulin resistance and elevated adipocytokines such as leptin are also reported in migraine patients compared with controls.33,34

The choice of mealtime by migraine patients might also affect the meal intake and its properties. There is a gap here for understanding how migraine history would influence a preferred mealtime in an attempt to manage migraines proactively. Mealtime can influence the content of meal depending on the time, and hence plays a role in the bidirectional loop of migraine-diet. In fact, a study from 2016137 has looked into the pattern of regular lifestyle behavior for three elements of sleep, mealtime, and daily exercise in patients with episodic and chronic migraine. This is the first study of the combined three variables compared with previous studies138140 that considered each domain separately. Findings from this study137 demonstrated that all three elements (ie, regular mealtime, regular sleep, and daily exercise) were lower in frequency among migraine patients with chronic migraine compared with episodic migraine. Interestingly, regular mealtime was found as the element that was adopted the best by both groups of migraine patients.137 The authors, therefore, proposed that self-regulated behaviors, such as regular mealtimes, would be beneficial for the affected patients to control their migraine.137 It is interesting to investigate whether genetic or epigenetic factors64 can influence the choice of mealtime by patients with migraine and if this differs between episodic and chronic migraine.

A small number of patients have been seen anecdotally to respond to the paleo diet or variations of this diet. The rationale follows a theory that modern era diseases, for example, diabetes, heart disease, and obesity were absent in the Paleolithic era. Therefore, a clear diet could also help prevent migraine. This diet is known for weight loss, and it is free from refined and processed food, additives and preservatives.

The gutbrain axis that is a bidirectional path, might also affect dietary choices here. Interestingly, the gutbrain axis has been discussed in terms of psychological aspects,141 named as gutbrain psychology, which brings mind to the equation of the brain and gut relationship. Based on this synchronism of gut, brain, and mind, it has been proposed that the gut microbiota could affect normal mental processes and under pathological mental and neurological disorders.141 Whether this can influence choice of diet in migraine, or when migraine is co-existent with other psychological conditions, eg, stress and anxiety, needs further investigation. This also remains to be tested as if other factors, eg, gender of migraine patients can affect this (by, eg, hormones or psychology-related factors). Figure 2 is an overview of the gutbrain axis and potential players in the bidirectional relationship of migraine and diet.

Figure 2 A bidirectional relationship of the gut and brain, and different factors that can potentially influence migrainediet bidirectional relationship within this system. Green arrows are toward improvement of migraine headache, while red arrows reflect on negative impact. For a comprehensive review on the gutbrain axis and migraine headache, please see Arzani et al.99

Taken together, a potential bidirectional relationship, where migraine influences food intake, and consumed food affects the manifestations of migraine, needs further investigation. The question, therefore, remains open as to whether migraine can affect dietary choices and to what extent, and how dietary choices can influence migraine. In a broader spectrum, the allostatic model in migraine126 could potentially help studying the influence of migraine on food intake and the influence of dietary intake on migraine. Table 1 provides an overview of the main points mentioned earlier for the dietmigraine relationship and considerations for future studies.

Table 1 A Summary of Main Elements in Bidirectional Aspects of DietMigraine and MigraineDiet Relationship

Diet as a potential trigger for migraine has been discussed for some time. Identification of potential dietary triggers for migraine125 has mainly emerged via keeping dairies, avoidance behavior, or elimination diets to help managing migraine.142,143 Some triggers appear common among the migraine population, while others appear to be unique to individuals. Therefore, identification of personal food triggers in each individual seems valuable to assist with a better way of coping with migraine. No particular migraine diet exists yet to lean on a strong evidence, and hence the investigation of dietary patterns is needed to confirm efficacy before recommending for migraine prevention. Types of evidence, including level of effect are, therefore, expected from these interventions. For each, one must consider the burden of various diets for patients and if any potential side effects or safety issues may occur.20

Comorbidities are also important to consider, such as IBS and in this regard, studying the role of the gutbrain axis is encouraged. Migraine has been also associated with cardiovascular and psychological disorders. Therefore, studying dietary interventions that can be beneficial for comorbid conditions are valuable. Dietary recommendations for migraine may aid in immediate control, slow progression, or prevention of diet-related comorbidities (eg, obesity, diabetes, and cardiovascular diseases). These recommendations are often included in a broader lifestyle modification, including sleep hygiene, stress management, regular exercise, or smoking cessation. A focus on maintenance of a consistent healthy lifestyle, in addition to nonpharmacological and pharmacological management of migraines seems to be the key for most of migraine patients.20 Implementation of any lifestyle changes, including dietary factors, needs a careful evaluation and a clear communication to help both clinicians and patients to achieve expected and reasonable goals. Education, monitoring, and support are essential elements in particular in long-term interventions and follow-ups.20 Effect of migraine or its evolution over age and among the genders for dietary choices, and dietary pattern is not known.51 Pattern, quality, and amount of food can also be influenced by geographical locations, cultural, and religious factors. These factors must be considered and reported in future studies of any potential bidirectional relationship between migraine and diet.

The author reports no conflicts of interest in this work.

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Second virtual meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) – subgroup on Diet and Health – World Health Organization

Posted: September 21, 2020 at 3:54 pm

In response to a call from the 58th World Health Assembly (May 2005), the World Health Organization (WHO) established the Guidelines Review Committee (GRC) in 2007 with the purpose of developing and implementing procedures to ensure that WHO guidelines are developed in ways consistent with internationally recognized best practices, emphasizing the appropriate use of systematically reviewed available evidence. The robust guideline development process being implemented by WHO is described in detail in the WHO Handbook for guideline development (2014).

In accordance with the Organization-wide transformation in strengthening WHOs role in developing evidence-informed public health guidance, the Department of Nutrition for Health and Development (NHD) has strengthened its role and leadership in providing evidence-informed policy and programme guidance to Member States for promoting healthy diets and nutrition throughout the life course, in partnership with relevant internal departments and partners, and guided by the new WHO guideline development process. This normative mandate was reaffirmed through a request from the 63rdWorld Health Assembly (May 2010) to strengthen the evidence base on effective and safe nutrition actions to counteract the public health effects of the double burden of malnutrition, and to describe good practices for successful implementation. More recently WHOs commitment to strengthen its normative work was reiterated in the13thGeneral Programme of Work (2019 2023)was endorsed by the 71stWorld Health Assembly (May 2018). It states that Setting norms and standards is a unique function and strength of WHO and further noted that WHO will reinforce its science- and evidence-based normative work.

To implement the strengthening of evidence-informed nutrition guidance, NHD established in 2010 theWHO Nutrition Guidance Expert Advisory Group (NUGAG)guided by theWHO Steering Committee for Nutrition Guidelines Development, which includes representatives from all Departments in WHO with an interest in the provision of recommendations in promoting healthy diets and nutrition. Membership in NUGAG is usually for three to four years and NUGAG includes experts from various WHO Expert Advisory Panels as well as experts from a larger roster including those identified through open calls for experts, taking into consideration a balanced mix of genders, breadth in areas of expertise, and representation from all WHO Regions.

The NUGAG will provide advice to WHO on the following:

In 2010 2011, the NUGAG consisted of four subgroups: 1) micronutrients; 2) diet and health; 3) nutrition in life course and undernutrition; and 4) monitoring and evaluation. However, due to organizational changes implemented in NHD in January 2012 and in an effort to reduce the administrative burden of managing multiple subgroups, the number of NUGAG subgroups were reduced to two: 1) diet and health; and 2) nutrition actions which were subsequently renamed as the guideline development group (GDG) on nutrition actions. In 2018, the NUGAG Subgroup on Policy Actions was also established.

Updating of the dietary goals for the prevention of obesity and diet-related noncommunicable diseases (NCDs) has been the focus of the work of the NUGAG Subgroup on Diet and Health. After completing the work on updating the guidelines on sodium and potassium intakes (published in 2012) and on sugars intake (published in 2015), the NUGAG Subgroup on Diet and Health had been working on the updates of the WHO guidelines on the intake of total fat, saturated fatty acids, trans-fatty acids, polyunsaturated fatty acids, non-sugar sweeteners and carbohydrates including dietary fibre. The draft guidelines on saturated fatty acids and trans-fatty acids were completed, launched for public consultation in May 2018, and are currently being finalized for release in 2019. The draft guidelines on intake of total fat, polyunsaturated fatty acids including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), non-sugar sweeteners and carbohydrates are being prepared for public consultation in late 2019 early 2020. Over the past several years, the NUGAG Subgroup on Diet and Health also began reviewing the issues related to dietary patterns, in which interest and concern are growing as a result of rapidly changing food environments.

Updating of these dietary goals and developing guidance on dietary patterns are important elements of WHOs efforts in implementing the NCD agenda and achieving the triple billion targets set up by the 13th General Programme of Work (2019 2023), including one billion more people enjoying better health and well-being. This will also contribute to the implementation of the Political Declaration of the UN High-level Meeting on NCDs held in New York in September 2011 and the outcome document of the high-level meeting of the UN General Assembly on NCDs (A/RES/68/300) held in New York in July 2014 as well as the implementation of the NCD Action Plan for 2013 2020 which was adopted by the 66th World Health Assembly held in May 2013. Furthermore, it had also provided inputs to the work of the highlevel Commission on Ending Childhood Obesity established by the WHO Director-General in May 2014.

In November 2014, WHO organized, jointly with the Food and Agriculture Organization of the United Nations (FAO), the Second International Conference on Nutrition (ICN2). ICN2 adopted the Rome Declaration on Nutrition and the Framework for Action, which recommends a set of policy options and strategies to promote diversified, safe and healthy diets at all stages of life. Subsequently, the 136th Session of the WHO Executive Board (EB) held in January 2015 and the 68th World Health Assembly held in May 2015 endorsed the Rome Declaration and Framework for Action and called on Member States to implement the commitment of the Rome Declaration across multiple sectors, by expanding WHOs evidence-informed guidance.

Furthermore, in April 2016, the UN General Assembly (UNGA) declared a UN Decade of Action on Nutrition (2016-2025), recognizing the role of nutrition in achieving the 2030 Agenda on Sustainable Development and the Sustainable Development Goals (SDGs). The Decade calls for eradicating hunger and preventing all forms of malnutrition worldwide, particularly stunting, wasting, and overweight in children under five years of age; and anaemia in women and children among other micronutrient deficiencies; as well as for reversing the rising trends in overweight and obesity and reducing the burden of diet-related NCDs in all age groups. Therefore, the goal of the Decade is to increase action at the national, regional and global levels in order to achieve commitment of the Rome Declaration adopted at ICN2, through implementing policy options included in the Framework for Action and evidence-informed programme actions.

Updating of the dietary goals being carried out by the NUGAG Subgroup on Diet and Health contributes not only to the implementation of the ICN2 commitments but also to the achievement of the goals of the Decade. But further prompted by the increasing requests from various Member States for WHOs guidance on effective policy measures to develop enabling food environment for promoting healthy diets and nutrition, NHD initiated in 2017 the establishment ofthe WHO Nutrition Guidance Expert Advisory Group (NUGAG) Subgroup on Policy Actions, which works alongside the NUGAG Subgroup on Diet and Health.

The Safe, Healthy and Sustainable Diet Unit (CC Healthy Diets) of the new Department of Nutrition and Food Safety (NFS) established in the beginning of 2020 as part of the WHOs transformation process serves as the Secretariat of the NUGAG Subgroup on Diet and Health and also now the NUGAG Subgroup on Policy Actions. The NUGAG Subgroups are generally expected to meet annually, but due to the COVID-19 pandemic, it is very unlikely to hold any physical meetings, including those of the NUGAG during 2020. Therefore, it is planned to hold a series of virtual meetings to progress the work of the NUGAG on Diet and Health with a view to finalize pending guidelines. The first virtual meeting was held on 15 16 June 2020.

1. Finalize the recommendations on saturated fatty acid andtrans-fatty acid intake, including drafted rationale and remarks, taking into consideration:

2. Review and identity implications for future research, taking into account on-going research and any existing controversies; and

3. Review and identify challenges for implementation of the guidelines.

Theexpected outcome of the meeting is, therefore, to finalize the recommendations and accompanying rationale and remarks on saturated fatty acid andtrans -fatty acid intake.

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Second virtual meeting of the WHO Nutrition Guidance Expert Advisory Group (NUGAG) - subgroup on Diet and Health - World Health Organization

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Diet Shake Market is expected to double its market size in Upcoming Years | Key Players: Glanbia, 310 Nutrition, RSP Nutrition, Isagenix Worldwide,…

Posted: September 20, 2020 at 10:57 am

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Diet Shake Market is expected to double its market size in Upcoming Years | Key Players: Glanbia, 310 Nutrition, RSP Nutrition, Isagenix Worldwide,...

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Working on feed biosecurity with the ice block challenge – Pig Progress

Posted: September 7, 2020 at 7:51 pm

In the US, nobody needs to be told about the risk of viruses entering a farm through feed. Years of research have proved this for swine producers. But what can be done? Scientists have investigated the effect of additives on mitigating the transmission of viral diseases through feed. It is exciting that producers and veterinarians now have options for use in a feed biosecurity programme.

Results from a new collaborative study have recently been published in the journal Transboundary and Emerging Diseases, in which 15 commercial additives were tested to evaluate their effect on mitigating Senecavirus A (SVA), Porcine Epidemic Diarrhoea virus (PEDv) and Porcine Reproductive and Respiratory Syndrome virus (PRRSv) in contaminated feed. A wide range of organic substances were tested, from essential oils and monovalent or multivalent organic acids to short, medium and long-chain fatty acid blends and formaldehyde-based products.

In the study 15 commercial additives were tested to evaluate their effect on mitigating SVA, PEDv and PRRSv in feed. - Photo: Hans Prinsen

In 14 of the 15 additives tested, pigs on the supplemented diets had significantly greater average daily weight gain, significantly lower clinical signs and infection levels, as well as numerically lower mortality rates compared to the control pigs, says Dr Scott Dee, director of applied research at Pipestone Veterinary Services in Pipestone, MN, United States. Dr Dee conducted the study with several colleagues at Pipestone, Dr Megan C. Niederwerder at Kansas State University and Dr Aaron Singrey and Dr Eric Nelson at South Dakota State University (Dee is also an adjunct faculty member there).

It is important to note that the products tested in this study do not yet have label approval claiming efficacy against viruses

We concluded that these additives mitigated the effects of the three viruses we investigated in contaminated feed, resulting in improved health and performance compared to pigs fed non-mitigated diets, says Dr Dee. It is exciting that producers and veterinarians now have options for use in a feed biosecurity programme. However, it is important to note that the products tested in this study do not yet have label approval claiming efficacy against viruses. Many companies are collaborating with the FDA to move this forward.

The effects of several of these feed additives in combating African Swine Fever virus (ASFv) are currently being carried out by Dr Niederwerder at her lab facility, which is certified to handle this virus.

This study builds on findings (from the same group of researchers and others) that have demonstrated that these same pig viruses can survive in feed. The capability of livestock feed to transmit viral diseases was first proven scientifically by Pipestone in 2014 during the PEDv epidemic in North America. Since that time, various feed additives have been evaluated in lab settings for their effect on viral viability and infectivity in contaminated feed using bioassay piglet models, Dr Dee explains.

However, studies that involve the real-world conditions of commercial swine production were needed, with larger populations of pigs, realistic volumes of contaminated feed supplemented with selected additives and natural feeding behaviours.

Dr Dee and his colleagues used a new research model called an ice block challenge to insert equal concentrations of SVA, PEDv and PRRSv into feed treated or not treated with additives. The ice blocks were then manually dropped into designated feed bins and the pigs were allowed to consume the feed naturally.

The ice block of viruses and water which will be added to the feed. - Photo: Dr Scott Dee

PEDv broke out in the US in 2013, and its movement into Canada in 2014 was traced back to a contaminated feed ingredient. In subsequent years, members of the Canadian Pork Council worked with staff at the Canadian Food Inspection Agency (CFIA) to create national guidelines for the import and handling of feed ingredients that present high risks for viral diseases such as ASF, along with storage time and heat treatment recommendations for industry. Much of this was launched in the spring of 2019. Regarding what has been happening in this vein within the US, Dr Dee says the pork and feed industries there have worked very hard over the last few years and have been successful in making changes to biosecurity at feed mills.

There are strong industry programmes now in place, but I and others would like to see a national government-led pig virus disease prevention and control programme pertaining to feed, similar to what is happening in Canada, Dr Dee says. We need a national government-driven programme with additives approved by the Food and Drug Administration (FDA) and standard operating procedures for storage time, handling and so on.

We will hopefully be able to set short-, intermediate- and long-term goals to get a programme going

He adds, Weve had good leadership from industry, and we scientists are building a body of evidence on which a sound national programme can be based. A national Feed Risk Taskforce has been formed, and I sit on it with staff from the US Department of Agriculture; FDA; Swine Health Information Council; National Pork Producers Council; CFIA; members of the poultry, swine, cattle and feed industries, and others; and we are meeting this month (September 2020). We will hopefully be able to set short-, intermediate- and long-term goals to get a programme going and discuss future research directions.

Image showing ice block in feed (a tip is visible). - Photo: Dr Scott Dee

Dr Dee adds that, in the meantime, now that he and his colleagues have provided the industry with efficacy data, it is up to individual feed companies and producers to make mitigation decisions based on cost, mill specifications and so on. We have discovered there are lots of additive options for viruses of domestic interest, such as PRRSv, PEDv and SVA, he says, and we look forward to data from Dr Niederwerders lab regarding the effect of these products in combating foreign animal diseases.

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The Paleo Diet: Should Modern Humans Eat the Way Our Ancestors Did? – Discover Magazine

Posted: August 19, 2020 at 11:00 pm

Can you prevent weight gain and 21st-century health problems by eating the way our ancestors did?

Thats the premise behind the paleo diet, which takes inspiration from the Paleolithic era that spanned between 2.6 million to 12,000 years ago predating the advent of farming and animal domestication.

Some followers of the paleo diet believe that humans are genetically adapted to eat a certain way one thats closer to how early humans ate. This view is rooted in the evolutionary discordance hypothesis, which states that human evolution stopped around 50,000 years ago. In other words, our Stone Age bodies are not suited for our modern diets of convenience and carbs, and this mismatch is making us fat and sick.

While eating like a caveman or cavewoman isnt easy, making the paleo leap is purported to result in a number of health benefits from weight loss, to clearer skin, to improved mood, to better sleep. But like many health and wellness fads, researchers say paleos health benefits are likely too good to be true.

Unfortunately, scientists havent found much evidence that backs up the health benefits of the paleo diet beyond weight loss. Other claims havent been studied at all. But what research has uncovered is that it might be unhealthy for some people to follow a paleo diet, particularly among those concerned with heart and kidney health.

But theres another mammoth in the room: Even paleolithic people didnt eat paleo. Plenty of anthropological research has found that the popular diets interpretations of how Paleolithic-era humans ate are pretty inaccurate.

"[With] ancient diets, people just ate the foods available to them. With the current globalized food system, we now have access to more types of food, which makes that approach more complicated," says Colleen Rauchut Tewksbury, a senior research investigator and bariatric program manager at the University of Pennsylvania. She is also a spokeswoman for the Academy of Nutrition and Dietetics.

(Credit: Alexander Raths/Shutterstock.com)

According to Google Trends data, paleo was the most-searched diet in 2013. In recent years, diets like keto, intermittent fasting and the carnivore diet have kicked paleo out of the top rankings. But survey data from 2018 showed that roughly 3 million Americans were still following a version of the paleo diet.

It is also sometimes called the Paleolithic diet, Stone Age diet, hunter-gatherer diet or a caveman diet. Whole30, which is a 30-day regimen based on the paleo diet, has also become a popular way to supposedly reset the body after an indulgent holiday season.

But no matter what you call it, interest in adopting ancient diets isn't new. In the 1970s, an American gastroenterologist named Walter L. Voegtlin promoted a meat-centric Stone Age diet to achieve optimal health. Voegtlin is largely regarded as the pioneer of the modern paleo diet and was the first to write a book about it. But his ideas never gained widespread support, which perhaps is not a surprise considering some of Voegtlins extreme and unsavory views like encouraging the mass slaughter of dolphins and eugenics.

Since then, other purported health gurus helped to bring paleo out of the cave and into the mainstream. Primal eating feels at home in our current era of romanticizing health wisdom and habits of the past.

But before you keep sipping on bone broth, it might be a good idea to consider what real prehistoric people actually ate.

While people living in Paleolithic times would have painstakingly hunted and gathered their own food, modern-day followers of the diet can conveniently hop in their cars and zoom to the nearest grocery to find most paleo essentials on their shopping list. There, they can load up on all the meat, fish, eggs, fruits, non-starchy veggies and nuts they want. But dairy, legumes, grains, added sugars, alcohol, coffee and processed food should be avoided. Some versions of the paleo diet are stricter than others.

But a nuance the modern take on the diet doesn't take into account is that hunter-gatherers varied considerably in terms of the food they consumed. Different groups of early humans lived in vastly different climates and landscapes. People simply ate whatever was available to them, wherever that was.

Homo sapiens occupied every niche on the planet starting from [around] 100,000 years ago. We were highly adaptable, says Jennie Brand-Miller, a professor of nutrition at the University of Sydney. There were high-latitude hunter-gatherers who ate mostly animal foods and very little plant food and there was the opposite, [those who ate] a lot of plant-based food and only a little animal [protein].

Interestingly, there were no vegan hunter-gatherers, she says.

Meat-eating is often emphasized in anthropology simply because butchered animal bones are often better preserved and more likely to be discovered than evidence of plant-based meals. Based on whats been uncovered, early humans didnt appear to be terribly picky eaters. They probably ate insects. They didnt turn their nose up at elephant brains. They ate starchy tubers. They ate oats, processed by hand.

One things certain, though: Our ancestors most certainly did not eat bacon or chocolate. Those indulgences came on the food scene much later in history, yet are sometimes recommended in paleo diet literature. (But its pretty safe to say our paleo ancestors would have eaten bacon or chocolate, if given the chance.)

(Credit: Keith Homan/Shutterstock)

The idea that we should adopt a special diet because our genes are still stuck in the Stone Age isnt quite accurate.As cultures change through time, our genes change, too. Brand-Miller says there are a few genetic adaptations to modern diets that help illustrate this.

One of the best examples relates to milk and the prevalence of lactose intolerance. For most of our species history, the ability to digest milk after infancy didnt exist. Adults lacked lactase, the enzyme needed to break down lactose to simpler sugars that can be absorbed by the intestines. When people started domesticating cattle around 10,000 years ago, they started relying on dairy products as a food source. Over time, these groups evolved a genetic mutation for making lactase into adulthood. But because dairy wasnt a traditional part of diets everywhere, many descendants of these groups are missing this genetic mutation today.

People vary in their ability to process other foods as well, Brand-Miller says. People with genetic ties to regions that historically ate a high-starch diet tend to have more copies of the gene linked to higher production of salivary amylase an enzyme that breaks down carbs. That makes east Asians in particular more efficient at digesting starchy food. Likewise, Brand-Miller says fruit wasnt part of the traditional Arctic diet. So, its not surprising that a greater incidence of people with Inuit ancestry are deficient in sucrase, the enzyme that processes sucrose, a type of sugar.

But some people who dont have adequate levels of particular digestive enzymes can still consume small amounts of these foods without ill effects, Brand-Miller says. Aside from these differences, humans are generally well-adapted to eat almost anything put in front of them, which is perhaps one of the secrets to our species success.

People always have and probably always will eat a wide variety of foods depending on culture and what's available, says Melyssa Roy, a public health researcher at the University of Otago in New Zealand.

The health claims around the paleo diet are as controversial as the ancient menus themselves. Typically, the modern paleo diet is high in protein and low in carbohydrates. Paleo often gets a bad rap for being so restrictive, and it doesnt allow consumption of foods like legumes, whole grains and dairy products.

Nutrition has a lot of gray area, and many diets such as these leave little room for flexibility or individualization, says Rauchut Tewksbury.

Because paleo hasnt been studied extensively, the long-term benefits and potential risks are poorly understood. But if weight loss is your primary reason for considering the paleo diet, theres some evidence it works.

For instance, Roy and her colleagues compared the weight loss results of 250 overweight individuals following one of three diets: intermittent fasting, Mediterranean and paleo. After 12 months, all groups lost weight but paleo came in last. Paleo dieters lost 4 pounds on average, compared with a 6-pound loss on the Mediterranean diet, and nearly 9 pounds with intermittent fasting. In general, participants found it easiest to stick to the Mediterranean diet, which is an important part of sustaining weight loss over time.

But if quick weight loss is your goal the paleo diet has its merits.

"In the short term, lower carbohydrate paleo diets are associated with higher satiety and faster weight loss, Brand-Miller says.

A two-year randomized and controlled study followed 70 postmenopausal Swedish women who were obese. Some participants were assigned to a paleo diet that included lean meat, fish, eggs, vegetables, fruits, berries and nuts. Other participants were assigned to a diet in line with the Nordic Nutrition Recommendations (NNR), the joint dietary recommendations for northern European countries. The NNR incorporates less protein and fat, but more carbohydrates than the paleo diet.

Six months in, the paleo group lost more weight than those following the NNR. Paleo dieters lost 13 pounds on average compared with 5 pounds with NNR. But after 24 months, the difference in weight loss between the two diets was less pronounced. Both groups showed similar improvements in blood pressure and cholesterol. Interestingly, participants' triglyceride levels decreased more on the paleo diet. High levels of triglycerides a type of fat found in the blood have been linked to heart disease.

But that doesnt necessarily mean that the paleo diet is heart-healthy. Brand-Miller says several studies have linked low-carb diets to higher rates of death, especially from heart disease. To add to that, she says mouse studies have suggested high-carbohydrate diets increase longevity. Perhaps the reason is rooted in our microbiomes.

A study compared the bloodwork of 44 paleo dieters with 47 people following a diet based on Australian national health recommendations. Among paleo dieters, researchers found elevated levels of a compound called trimethylamine N-oxide, which is associated with heart problems. In their work, the researchers explained that high levels of this compound might be due to a lack of whole grains in the paleo diet. Bacteria in the gut produces trimethylamine N-oxide while digesting meat. But consuming whole grains increases production of beneficial gut bacteria, which seems to counter the harmful compound.

(Credit: WR.lili/Shutterstock)

Saturated fat might be another thing to worry about on the paleo diet. Dietary fats, in general, arent demonized today like they were in the '90s. But saturated fat isnt totally in the clear. Decades of research have linked the consumption of saturated fats to elevated levels of LDL cholesterol levels (the bad kind), which has been shown to increase the risk for heart disease.

The evidence is conflicting about whether high amounts of saturated fat are harmful in the context of this kind of diet. For some people, it may be better to avoid high amounts of animal fats, especially if they're still consuming a more standard diet. A strict paleo diet eliminates dairy, and there may be concerns around calcium intake, too, Roy says.

Diets that are high in protein have also been linked to kidney problems. Whether this applies to people with normally functioning kidneys hasn't been settled. Filtering excess protein from the blood can put additional stress on the organs, further decreasing their function among people with kidney problems.

But the idea that paleo must incorporate copious amounts of meat might be a bit of a misnomer to begin with.

[Paleo] is more about eating foods in their natural state, Roy says.

Brand-Miller says there are healthier approaches to paleo. For instance, incorporating plenty of fruits and vegetables even those that are packed with carbs. Plant-based foods can add nutrients, fiber, flavor and variety to diets.And, they'll help you live longer, too.

If the paleo diet gets anything right, it's the stance against processed food. Highly refined ultraprocessed foods now account for more than half of all calories consumed and 90 percent of added sugar intake in the U.S. which increases the risk of weight gain and several health conditions. But it's not a matter or paleo or bust.

Ultimately, the best way to eat for your health is the change you can keep up with. Most people know what they need to do: Limit calories, eat fruits, vegetables, whole grains and lean proteins. The challenge is how to do it, says Rauchut Tewksbury. There are lots of ways people can achieve this. The key is figuring out which is best for you as an individual that you can keep up with.

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‘I Did Keto For A Year Then Switched To A Higher-Carb DietAnd I Lost 135 Pounds In Less Than 2 Years’ – Women’s Health

Posted: July 3, 2020 at 12:46 am

My name is Katie Hopkins, and I am 24 years old. I am from Tallahassee, Florida, and I am an operations consultant for the state. I did keto for a year and then switched to a more standard way of eating and lost 135 pounds in less than two years.

I grew up being a super active person. I played sports all year round and never really had to worry about what I ate or how I was going to get my exercise for the day. But once I got to college and no longer had the daily exercise from sports, I started to put on weight.

I kept the same eating habits even though I was not doing anything to burn those calories anymore. And before I started my weight loss journey, my biggest issues were with portion control and not being able to truly commit to losing weight.

From 2013 to 2018, I gained about 100 pounds. At my heaviest weight was 333 pounds, and I was 22 at the time.

Courtesy of Katie Hopkins

I moved to be closer to family, but I also moved because I felt like I was stuck in a rut where I was. I felt like the change of scenery would really give me the push I needed to start my weight loss journey. I knew I needed to take control of my health, and this was the perfect way to do so.

I was tired of feeling tired all the time, wishing I looked different, and always feeling defeated. Once I made the move to Tallahassee, I had a complete mindset reset and said to myself, This is the time you actually do this. No quitting, no excuses. The only one keeping you from your goals is you.

Courtesy of Katie Hopkins

At the beginning of my weight loss journey, I chose to follow the keto diet. I chose it because I had seen so many success stories and people losing huge amounts of weight. I felt like it was the best choice for me at the time because it gave me a way to really focus on what I was putting into my body, and most of the foods that are keto-friendly, I already really liked.

I turned to YouTube for most of my keto info. I followed keto YouTubers for food ideas, reviews, and just support in general. I lost my first 100 pounds on keto.

Courtesy of Katie Hopkins

I felt like I got as much as I could out of keto and I was ready for a new challenge and way of eating. I now eat a higher-carb diet, as opposed to keto, which is high-fat and low-carb. I enjoy eating this way now because I dont feel quite as limited, especially going out to eat, as I did on keto. I have so many more healthy foods I can eat now.

Courtesy of Katie Hopkins

Courtesy of Katie Hopkins

While eating had always been a bit of a struggle for me, exercise was not. Now, I exercise a lot more. Now that I have control over my eating, exercise has become a bigger focus for me. I love it because it relieves stress, and I love pushing myself to get stronger and faster.

A typical week of exercise for me consists of two to three days of strength training and one to two days of running or another type of cardio. I also really enjoy lifting weights at the gym and improving my strength.

Courtesy of Katie Hopkins

Running used to be something I hated, but I have really come to love it. It makes me push myself hard. There is no better feeling for me than beating my fastest time or longest distance.

Courtesy of Katie Hopkins

These three changes helped me see the most noticeable results in my weight loss.

Courtesy of Katie Hopkins

I know the feeling of thinking it will never happen for you. I always thought I would always be bigger and that losing weight would never happen for me. But that kind of mindset is what kept me from even starting. Once I decided that no matter what, I was going to change my life, everything changed. It was like something finally clicked in my head.

Courtesy of Katie Hopkins

Losing weight has changed my life so much. I have learned to love myself again. Before, I felt like my weight defined me. I truly feel like losing weight has allowed me to become my true self. I am more confident than ever before, and I now have complete control over my health and happiness.

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'I Did Keto For A Year Then Switched To A Higher-Carb DietAnd I Lost 135 Pounds In Less Than 2 Years' - Women's Health

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