Study Finds Plant-Based Diet Can Reduce Cardiovascular Death by 40% Interview with:
“Vegetarian Skewers” by Geoff Peters is licensed under CC BY 2.0Hana Kahleova, M.D., Ph.D.
Director of clinical research
Physicians Committee for Responsible Medicine
Washington, DC 20016 What is the background for this study? What are the main findings? 

Response: In this study, my research team and I reviewed multiple clinical trials and observational studies to determine the links between diet and cardiovascular disease (CVD) risk. We found that a healthy diet can reduce the risk of heart attack by more than 80 percent—something no drug has ever accomplished.

We also found strong and consistent evidence that plant-based dietary patterns (with few or no animal products and rich in fruits, vegetables, grains, and legumes) can prevent and even reverse atherosclerosis and decrease other markers of CVD risk, including blood pressure, cholesterol, and weight. We found that a plant-based diet can reduce the risk of death from cardiovascular disease by about 40 percent overall.  Continue reading

No Link Found Between Autism and Maternal Fish Ingested During Pregnancy Interview with:
“Fish” by Dhruvaraj S is licensed under CC BY 2.0Dr Caroline M Taylor
Wellcome Trust Research Fellow
Centre for Child and Adolescent Health
Bristol Medical School, University of Bristol
Oakfield House, Oakfield Grove, Bristol What is the background for this study?

Response: Mercury is a toxic metal that is widespread in the environment. In pregnancy, mercury in the mother’ bloodstream is transferred through the placenta to the fetus, where is can affect development of the nervous system. Mercury from vaccines has been the focus of attention particularly in regard to a link with autism in children. However, the amount of mercury used in the vaccines is small in comparison with mercury from the diet and atmospheric pollution, and in the EU at least, childhood vaccines no longer contain this preservative. The fear that mercury is linked to autism has persisted, despite increasing evidence that this is not the case.

The aim of our study was to look at mercury from the diet rather than vaccines – specifically from fish – in pregnant women. We measured the women’s mercury levels in their blood and asked them about how much fish they ate. We then followed up their children for 9 years and recorded how many of them had autism diagnosed within that time. We also measured how many of them had autist traits by measuring their social and communication difficulties.  The data were part of the Children of the 90s study (Avon Longitudinal Study of Parents and Children – ALSPAC), which is based in Bristol, UK.

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Preterm Infants Need Optimized Nutrition For Maximal Brain Growth Interview with:
Katherine Ottolini MD, lead study author

Children’s National Health System and

Catherine Limperopoulos, Ph.D., senior study author

Dr. Limperopoulos

Catherine Limperopoulos, Ph.D., senior study author and
Director of Developing Brain Research Laboratory
Children’s National Health System What is the background for this study? What are the main findings?

Response: Nutrition is an important modifiable factor for brain development in premature infants, however few studies have evaluated the impact of nutritional interventions in the neonatal intensive care unit (NICU) on structural brain development in very premature infants using advanced, quantitative MRI techniques.

The goal of this study was to utilize quantitative MRI to evaluate the impact of macronutrient (carbohydrate, protein, fat) and energy intake throughout the duration of the NICU stay on brain volumes and white matter development in very premature infants at term-equivalent age (TEA).

We prospectively enrolled 68 very low birthweight infants (< 1500g) admitted to Children’s NICU within the first 7 days of life. We found significant negative associations between cumulative macronutrient and energy intake on both the brain’s white matter microstructural development (in the superior cerebellar peduncle, corpus callosum) and regional brain volumetric growth (cortical gray matter and cerebellum).

In contrast, when evaluating average nutritional intake, we found significant associations between lipid and energy intake and regional brain volumes in the cortical gray matter, brainstem and cerebellum.  Continue reading

Not All Calories Affect Health Equally Interview with:
“Soda” by Jannes Pockele is licensed under CC BY 2.0Kimber L. Stanhope, Ph.D., M.S., R.D.
Research Nutritional Biologist
Department of Molecular Biosciences: SVM
University of California, Davis What are the main findings of this study?

Response: Sugar-sweetened beverages increase risk factors for cardiometabolic disease compared with calorically-equal amounts of starch.

We are not the first group of experts to reach this conclusion. The Nutrition and Chronic Diseases Expert Group reached a similar conclusion last year (Micha, 2017). Yet very different conclusions/opinions are being still being published by other researchers. (Latest example: Archer E., In Defense of Sugar: A Critique of Diet-Centrism. Progress in Cardiovascular Disease, May 1, 2018).

These conflicting conclusions confuse the public and undermine the implementation of public health policies, such as soda taxes and warning labels, that could help to slow the epidemics of obesity and cardiometabolic disease. We hope that the careful review of the evidence and the discussion of issues that can lead to conflicting opinions in nutrition research in this paper will help to clarify this issue.

Consumption of polyunsaturated (n-6) fats, such as those found in some vegetable oils, seeds, and nuts, lowers disease risk when compared with equal amounts of saturated fats.

It is important to note however, that the effects of saturated fat can vary depending on the type of food. Dairy foods such as cheese and yogurts, which can be high in saturated fats, have been associated with reduced cardiometabolic risk.

The non-caloric sweetener aspartame does not promote weight gain in adults.

Aspartame is the most extensively studied of the non-caloric sweeteners. None of the dietary intervention studies that have investigated the effects of aspartame consumption have shown it promotes body weight gain.

This includes studies in which the adult research participants consumed aspartame for 6 months, 1 year or 3 years.

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Can a Dozen Eggs Per Week Be Safely Part of Overall Healthy Diet? Interview with:
“Eggs” by John Morgan is licensed under CC BY 2.0Nick Fuller PhD
Charles Perkins Centre Research Program Director
University of Sydney What is the background for this study? What are the main findings?

Response: There is a disparity in research findings between epidemiological studies and randomised controlled trials in those with type 2 diabetes mellitus. A lot of the research showing that a high egg consumption (6 or more eggs per week) is detrimental to a person’s health was conducted at a time when we were told to avoid eggs. People that were eating a high egg diet during that time were also likely to have other poor eating habits, such as one high in saturated fat and low in wholegrain carbohydrates. These studies did not control for such confounding factors.

As a result of this disparity in findings between epidemiological and controlled studies this has resulted in differing guidelines for recommended egg intake between countries.

To address a lack of randomised controlled trials in this field we conducted a large study over 12-months to assess the effect of a high egg consumption (12 eggs per week) on heart disease and diabetes risk factors in a group of people at high risk of cardiovascular heart disease – diagnosed with pre-diabetes or type 2 diabetes mellitus. 140 people were randomised to a high egg diet (12 eggs per week) or a low egg diet (less than 2 eggs per week) and advised on the principles of a healthy diet. For example, including plenty of wholegrain and low glycemic index carbohydrate sources and swapping sources of saturated fat (e.g. butter) for sources of poly and mono-unsaturated fat (e.g. avocado or olive oil). They followed their respective high or low egg diet for 12 months and over the time we measured a comprehensive list of risk factors for heart disease and type 2 diabetes.

Both the low and high egg groups had the same improvements in the health at the end of the 12 months and the high egg diet did not result in an increased risk of cardiovascular disease.

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Middle Eastern Diet Linked To Improved Microbiome in Liver Patients Interview with:

“Turkish Food” by Garry Knight is licensed under CC BY 2.0Jasmohan S. Bajaj, M.D.
Associate Professor
Department of Internal Medicine
Division of Gastroenterology
Virginia Commonwealth University What is the background for this study? What are the main findings?

Response: Altered gut microbiota composition can occur due to diseases and due to changes in the dietary practices. The interaction between these two and their linkage with clinical outcomes in liver diseases, such as cirrhosis is not clear from an international standpoint.

In this study we enrolled healthy subjects, and patients with cirrhosis who were either early or advanced in their process from USA and Turkey. We found that the Turkish subjects, who followed a Middle-eastern diet rich in vegetables and fermented milk products, had high microbial diversity, which was in turn associated with lower hospitalizations over 3 months. There was also an additional beneficial effect of coffee and tea intake. This protection persisted even when the clinical factors were accounted for. Continue reading

Small Intestinal Microbiome Adjusts To Dietary Fats and Sugar Interview with:

Eugene B. Chang, MD Martin Boyer Professor of Medicine Knapp Center for Biomedical Discovery University of Chicago Chicago, IL  60637

Dr. Chang

Eugene B. Chang, MD
Martin Boyer Professor of Medicine
Knapp Center for Biomedical Discovery
University of Chicago
Chicago, IL  60637 and

Kristina Martinez-Guryn, Ph.D., R.D. Assistant Professor  Biomedical Sciences Program Midwestern University Downers Grove, IL.

Dr. Martinez-Guryn

Kristina Martinez-Guryn, Ph.D., R.D.
Assistant Professor 
Biomedical Sciences Program
Midwestern University
Downers Grove IL What is the background for this study? What are the main findings?

Dr. Martinez-Guryn: The original goal of this study was to understand why mice devoid of all microorganisms (germ free mice) are protected from diet-induced obesity. We demonstrate that these mice display severely impaired lipid absorption even when fed a high fat diet.

Dr. Chang: We found that many of the processes of dietary lipid digestion and absorption are dependent on and modulated by the gut microbiome which itself responds to dietary cues to adjust the small intestine’s ability and capacity to handle dietary lipids appropriately. This interplay is important for general health, but the findings are also relevant to conditions of overnutrition (obesity, metabolic syndrome) and undernutrition (starvation, environmental enteropathy).  In conditions of overnutrition, high fat, simple sugar, low fiber foods typical of western diets promote small intestinal microbes (which have been largely neglected by the scientific community) that promote fat digestion and absorption. This increases our capacity to assimilate dietary fats which can contribute to the overnutrition problem.  In conditions of undernutrition, these types of gut microbes are lost or minimally represented.  Thus, when nutritional repletion is started, the gut’s ability to upregulate its capacity for dietary lipid digestion and absorption is compromised.

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Dietary Fiber Promotes Beneficial Bacteria, Improving Glucose Control in Diabetes Interview with:

Liping Zhao PhD, Professor Department of Biochemistry and Microbiology School of Environmental and Biological Sciences Rutgers University-New Brunswick NJ

Dr. Zhao

Liping Zhao PhD, Professor
Department of Biochemistry and Microbiology
School of Environmental and Biological Sciences
Rutgers University-New Brunswick NJ What is the background for this study?

Response: Microbes in the human gut (collectively known as the gut microbiota) provide many functions that are important for human health. A notable example is that some gut bacteria are able to ferment non-digestible carbohydrates in our diet, e.g. dietary fibers, to produce short-chain fatty acids (SCFAs). These SCFAs nourish our gut epithelial cells, reduce inflammation, and play a role in appetite control. Deficiency of SCFAs has been associated with many diseases including type 2 diabetes. Many gut bacteria have the genes (and therefore the capacity) to produce SCFAs from carbohydrate fermentation. However, we know little about how these bacteria, as individual strains and as a group, actually respond to an increased supply of carbohydrates. This is key to improve clinical efficacy of dietary fiber interventions to improve human health. Continue reading

How Much DASH Diet is Required To Reduce Uric Acid? Interview with:
“Blood Pressure” by Bernard Goldbach is licensed under CC BY 2.0Stephen P. Juraschek, MD, PhD

Instructor of Medicine
Beth Israel Deaconess Medical Center/Harvard Medical School What is the background for this study? What are the main findings?

Response: Recent evidence suggests that the DASH diet is associated with lower uric acid levels and lower risk of gout. Furthermore, a secondary analysis of the DASH trial showed that complete replacement of a typical American diet with the DASH diet lowered uric acid levels. However, it is unknown if partial replacement of a typical American diet with DASH foods might lower uric acid.

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Sugar Compound In Food Products May Have Encouraged Growth of Dangerous C. diff Bacteria Interview with:

Professor Robert Britton PhD Therapeutic Microbiology Laboratory Department of Molecular Virology and Microbiology Alkek Center for Metagenomics and Microbiome Research Baylor College of Medicine

Prof. Britton

Professor Robert Britton PhD
Therapeutic Microbiology Laboratory
Department of Molecular Virology and Microbiology
Alkek Center for Metagenomics and Microbiome Research
Baylor College of Medicine Interview: How would you summarise your findings?

Response: As a brief summary of our work, certain strains of Clostridium difficile have emerged in the past 20 years that have resulted in epidemics worldwide, leading to C. difficile becoming one of the most common causes of hospital acquired infections.  Two ribotypes of C. difficile, RT027 and RT078, emerged as key epidemic ribotypes associated with increased disease prevalence and increased mortality in patients.  We found that both of these ribotypes have acquired the ability to consume the disaccharide trehalose by two completely independent mechanisms.  We further show that trehalose enhances disease severity of C. difficile infection in a manner that requires C. difficile to metabolize trehalose in mice.  We also show that trehalose is present in the distal intestine of mice and humans in concentrations that the RT027 ribotype can metabolize.  Because RT027 and RT078 strains were present in clinics at least 10-20 years prior to their becoming epidemic isolates, we looked where people would acquire trehalose in the diet.

In 2000 the FDA approved trehalose for human consumption (EFSA did so in 2001) and based on the GRAS report from the FDA the amount of trehalose predicted to be consumed once released on the market would vastly increase what people get naturally from the diet.  Our data support that these two ribotypes increased in prevalence due to a change in the human diet.

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Older, Frail and Physically Inactive Adults At Risk of Multivitamin Deficiency Interview with:
“vitamins” by Colin Mutchler is licensed under CC BY 2.0
Priv.-Doz. Dr. Barbara Thorand 
Helmholtz Zentrum München
German Research Center for Environmental Health
Institute of Epidemiology II
Neuherberg, Germany What is the background for this study?

Response: Micronutrients, which include vitamins, minerals (e.g. calcium) and trace elements (e.g. iron), are essential nutrients that are required in minute amounts by the organism for proper growth and good health. Results from the last German National Nutrition Survey (NVS II)* uncovered a high prevalence of insufficient dietary intake of micronutrients in older adults aged 65 years and over in Germany. By means of blood analyses, our study has confirmed these critical results. This is a highly relevant issue, particularly in light of our growing aging population and the high societal relevance of successful healthy aging.

*Max Rubner-Institut: Nationale Verzehrsstudie II, Ergebnisbericht Teil 2 (2008). Die Bundesweite Befragung zur Ernährung von Jugendlichen und Erwachsenen.

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Frequent Take-Out Food Linked To Increased Cholesterol and Obesity in Children Interview with:

Dr. Angela S Donin Population Health Research Institute, St George’s University of London, London, UK

Dr. Donin

Dr. Angela S Donin
Population Health Research InstituteSt George’s
University of London
London, UK What is the background for this study? What are the main findings?

Response: There are increasing numbers of takeaway outlets, particularly in deprived neighbourhoods. This is driving an increase in consumption of takeaway meals, which previous evidence has shown is linked to higher risks of heart disease, type 2 diabetes and obesity. Little is known about the dietary and health impact of high consumption of takeaway foods in children.

This research found children who regularly ate takeaway meals had higher body fat and cholesterol compared to children who rarely ate take away meals, they also had overall poorer diet quality.

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Vast Majority of Adults Do Not Consume Enough Fruit and Vegetables Interview with:

Seung Hee Lee-Kwan, PhD Epidemiologist, Division of Nutrition, Physical Activity, and Obesity Centers for Disease Control and Prevention (CDC).

Dr. Seung Hee Lee-Kwan

Seung Hee Lee-Kwan, PhD
Epidemiologist, Division of Nutrition, Physical Activity, and Obesity
Centers for Disease Control and Prevention (CDC).

Seung Hee Lee-Kwan has a PhD in International Health at Johns Hopkins Bloomberg School of Public Health. Her previous work focused community-based interventions that aimed to promote healthy eating. Dr. Lee-Kwan’s current work at CDC is on fruits and vegetable surveillance, and research of health behaviors and environmental factors associated with obesity. What is the background for this study?

Response: The purpose of the study was to update a 2013 report that estimated how many people in each state are meeting fruit and vegetable intake recommendations with the latest data from 2015. These estimates looked at the percent of adults meeting the intake recommendations by age, sex, race/ethnicity, and income-to-poverty ratio for the 50 states and District of Columbia (DC).

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Aside From Pregnancy, 3-4 Cups of Coffee Per Day Has Likely Health Benefits Interview with:
“Coffee” by Treacle Tart is licensed under CC BY 2.0Robin Poole
Specialty registrar in public health
Academic Unit of Primary Care and Population Sciences
Faculty of Medicine
University of Southampton What is the background for this study?

Response: Worldwide, over two billion cups of coffee are consumed every day. Since such a lot of coffee is consumed it is important to understand whether this is beneficial or harmful to our health. Evidence to date has been mixed and this tends to vary between different outcomes.

Coffee is a complex mixture of many bioactive compounds including caffeine, chlorogenic acids, and diterpenes. Laboratory experiments have previously highlighted the potential for coffee to have anti-oxidant, anti-inflammatory, anti-fibrotic and anti-cancer effects.

Our research group is interested in liver conditions and we were aware of studies suggesting beneficial associations between drinking coffee and liver disease. We went on to conduct two meta-analyses and concluded that coffee drinking was beneficially associated with both liver cirrhosis and liver cancer.

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Eating a Mostly Plant Based Diet Linked To Lower Risk of Heart Failure Interview with:
“Fresh Food” by Sonny Side Up! is licensed under CC BY 2.0


Dr. Kyla M Lara
Icahn School of Medicine at Mount Sinai
 What is the background for this study? What are the main findings?

Response: This was the first study to evaluate whether dietary patterns of black and white adults living in the United States were associated with developing heart failure. We’re hearing a lot in the news about specific diets like low-fat, high protein, low carb, and other diets that decrease cardiovascular risk. We would love it, as physicians, if we could prescribe a specific diet to limit cardiovascular risk in our patients. I’m really excited about our study because instead of examining patterns of what we already know are healthy, we looked at foods people were regularly consuming in the United States and developed dietary patterns from this. This study is similar to other work we have done with stroke and heart attack.

We used data from the NIH funded REGARDS study, also known as the Reasons for Geographic and Racial Differences in Stroke. More than 30,000 white and African-American adults were recruited from 2003-2007. From this group, we studied over 18,000 adults who successfully completed a dietary assessment called the Food Frequency Questionnaire. This was a really great group to study because people who live in this particular geographic area of the Southeastern United States, also known as the stroke belt, suffer from a higher risk of death from stroke. It’s extremely important for us to better understand the major risk factors that contribute to this and also cardiovascular disease.

We used statistical techniques to derive 5 dietary patterns based on the types of foods participants tended to eat.
• Convenience – Mexican and Chinese food, mixed dishes (both meat and bean)
• Sweets – added fats, bread, chocolate, desserts, sweet breakfast foods
• Southern – added fats, fried food, organ and processed meat, fatty milk
• Alcohol/Salads – beer, wine, liquor, green leafy vegetables, salad dressings, nuts and seeds, coffee
• Plant Based- fruit, vegetables, fruit juice, cereal, fish, poultry

Each participant received a score for each pattern that reflected how closely their diet resembled that dietary pattern. This approach reflects the real world and how people eat.

Over the 3135 days (8.6 years) of median follow up, 594 participants were hospitalized for incident HF. Greatest adherence to the plant-based dietary pattern during the study period was associated with a 28% risk reduction of developing heart failure.
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