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9/19/19 FAD and FAD diets She went through that 14 Mediterranean Diet, Low Fat Diet, Low Carb Diet, day diet, But all she lost Ketogenic Diet, Other Diet was 2 weeks Kavita Poddar – PhD, RD, CD Clinical Nutritionist Heart and Vascular Clinic Outline Recognizing a FAD diet No Billed • Quick-Fix permanent Recognizing FAD diet Cure alls changes • Why do people go for FAD diets? Limit food Scientific • Popular diet trends choices Expensive Jargons and supplements terms • What works? Evidence – Fact vs. FAD vs. Fiction Testimonials Simple Dramatic Conclusions Statements • Supporting your patients to make heart Critical and from Complex Skeptical of studies healthy choices Scientific Community 1 9/19/19 Why FAD Diets? Types of Diet Martin CB, Herrick KA, Sarafrazi N, Ogden CL. Attempts to Lose Weight Among Adults in the United States, 2013-2016. NCHS Data Brief. 2018 Jul;(313):1-8. Coconut oil Intermittent Fasting Varying Obesity (2015–2016) (Hales levels of CM, Carroll MD, Fryar CD, Ogden CL Prevalence of Obesity Among Adults Macros and Youth: United States, 2015- 2016. NCHS Data Brief. 2017 Oct;(288):1-8 Types of Diet Low-Carb Diets – Key to weight loss? Diets at different levels of Macronutrients Sugar Buster’s, Zone (<45%) >70% Carbs; Carb Addict’s <10% Fat; >65% Carbs; 15% Protein Diet (<30%) 45 -65% <20% Fat; 15% Protein Example Atkin’s, Keto, Carbs; 25- Dean Ornish <45% Carbs; 35% Fat; 15- Example Protein power <30% Fat; 20% Protein Pritkin <30% Carbs; ~30% >40% Fat; (<20 gm/day) <20% Carbs; Protein Example >20-<30% Jenny Craig, >60% Fat; Protein Example – >20% Nutrisystem, Zone, Sugar Weight Protein Example – Buster’s Carb Watchers, Example Addict’s Diet DASH, USDA, Atkin’s, Keto, AHA Protein Power 2 9/19/19 Low Carb Diets – The Premise Low Carb Diets – Are they safe? Roehl K, Sewak SL. Practice Paper of the Academy of Nutrition and Dietetics: Classic and Modified Ketogenic Diets for Treatment of Epilepsy. J Acad Nutr Diet. 2017 Aug;117(8):1279-1292. Paoli A, Grimaldi K, Toniolo L, Canato M, Bianco A, Fratter A. Nutrition and acne: therapeutic potential of ketogenic diets. Skin Pharmacol Physiol. 2012;25(3):111-7. Low-fat/Very low-fat diets Balanced Macronutrient Composition Commercial Example Jenny Craig Nutrisystem Weight Watchers Promote slow and steady rate of WL •Add physical activity •Behavior changes •Calorie deficit •Allow for greater range of Non food choices Commercial •Nutritional adequate Example American Heart Association, DASH, US Healthy Eating Limit guidelines Sodium, Saturated fats, refined carbs Based on sound scientific principles 3 9/19/19 Intermittent Fasting Intermittent Fasting Is the wait worth the weight? Premise Patterson RE, Laughlin GA,MattsonLaCroix MP, AZ,LongoHartman SJ,VD,NatarajanHarvie M. L, ImpactSenger CM,of intermittentMartínez ME, fastingVillaseñoron A,healthSears and DD, diseaseMarinac CR, Gallo LC.processes. Intermittent Ageing Res FastingRev. 2017and Oct;39:46Human Metabolic-58. He alth. J Acad Nutr Diet. 2015 Aug;115(8):1203-12. Patterson RE, Laughlin GA, LaCroix AZ, Hartman SJ, Natarajan L, Senger CM, Martínez ME, Villaseñor A, Sears DD, Marinac CR, Gallo LC. Intermittent Fasting and Human Metabolic Health. J Acad Nutr Diet. 2015 Aug;115(8):1203-12. Coconut oil ↑ Energy Expenditure Medium Chain ↑ Satiety ↑ Thermogenesis Scientific Evaluation of Claims Triglycerides Reduce Food intake • Coconut oil • 90% Saturated Fat • 4% MCT • 47.7% Lauric Acid • MCT oil ≠ Coconut oil 4 9/19/19 Dietary Approaches Weight-loss achieved and weight-loss pattern Associated with weight loss Average Weight loss • Maximum at 6 months = 4 to 12 kgs • Smaller losses maintained up to 2 years Slow weight regain is common Any evidence based diet that restricts certain • Weight loss at 1 year = 4-10 kgs types of food in order to create energy deficit • Weight loss at 2 years = 3 - 4 kgs by reduced food intake Average Calorie intake/day Strength of Evidence - High • 1200-1500kcals/day women • 1500-1800kcals/day men • OR create Calorie deficit of 750-500kcals/day Strength of Evidence - High 2013 Guidelines Reference 2013 Guidelines Reference CVD risk parameters CVD risk parameters (In presence of weight-loss) Strength of Evidence - High • Low-fat high carb diet: – Greater reductions in LDL-C – Lesser reductions in TG – Lesser increase in HDL-C Reduces BP, ↓ TG, BG, Greater improves LDL-C, A1C and weight HDL-C, further reduces TG and • Low- carb high fat diet: diabetes reduction BG and need for medications – Lesser reductions in LDL-C – Greater reductions in TG – Greater increase in HDL-C 2013 Guidelines Reference 2013 Guidelines Reference 5 9/19/19 Macronutrient Manipulation Diets Mediterranean Vs. DASH diet Summary - FACT BP: BP: • Reduced BP by 6–7/2–3 mm Hg • When food was supplied to adults with • Effective Diet and Lifestyle Interventions (Compared to minimal advice to BP 120–159/80–95 mm Hg, the DASH consume a low-fat dietary pattern) Diet, when compared to a typical – Promote behavior changes • Adherence to a MED pattern was American diet of the 1990s, lowered BP associated with lower BP (2–3/1–2 mm by 5–6/3 mm Hg. – Support adherence to a calorie-restricted diet Hg) – Observational – healthy young – Strength of Evidence: High – adults Lipids Nutrient dense (Macro and micronutrient – Strength of Evidence: Low • When food was supplied to adults with composition) Lipids: a total cholesterol level <260 mg/dL, – • Compared to minimal or no dietary LDL–C <160 mg/dL, the DASH Diet, Provide greater food choices advice resulted in no consistent effect when compared to a typical American on plasma LDL–C, HDL–C, and TG, in diet of the 1990s, lowered LDL–C by 11 part due to substantial differences and mg/dL, HDL–C by 4 mg/dL, & had no limitations in the studies. effect on TG – Strength of Evidence: Low – Strength of Evidence: High AHA/ACC – Mostly recommends DASH diet for prevention. 2013 Guidelines Reference Intermittent Fasting Intermittent Fasting Weight loss and CVD parameters American Heart Association Intermittent fasting – (13 trials, 2-8 week duration) • Irregular patterns appear less favorable for • 1.3% - 8% weight loss • Seems to improve metabolic parameters achieving healthy cardio-metabolic profile • No comparison groups • Intentional Eating with mindful attention to Alternate day fasting – 3 studies – Comparison group • Weight loss comparable to the CER (Continuous energy restriction) group timing and frequency of eating occasions • Reduction in blood glucose and insulin could lead to healthier lifestyle and cardio • Intense hunger reported Modified alternate-day fasting metabolic risk management • 3.2% (12 wk) compared to control group • 8% (8 wk) weight loss in absence of comparison group • Limited and mixed evidence for ↓ insulin and improved lipids St-Onge MP et al. Meal Timing and Frequency: Implications for Cardiovascular Disease Patterson RE, Laughlin GA, LaCroix AZ, Hartman SJ, Natarajan L, Senger CM, Martínez ME, Villaseñor A, Sears DD, Marinac CR, Gallo LC. Intermittent Fasting and Human Metabolic Health. J Acad Nutr Prevention: A Scientific Statement From the American Heart Association. Diet. 2015 Aug;115(8):1203-12. Circulation. 2017 Feb 28;135(9) 6 9/19/19 Intermittent Fasting Intermittent Fasting GAPS Summary - FAD Promising non-pharmacologic approach to improving health at the population Unknown level with multiple public health benefits • Optimal fasting regimen (length of fasting interval, fasting # of days per week, degree of energy restriction, diet behaviors on non-fasting days) • Prolonged nightly fasting in humans and impact on health – does it show sustained improvements More research needed • Randomized trials of longer duration (free living adults) in diverse population including the more vulnerable population • Behavior and metabolic changes are sustainable • Impact on overall energy intake, sleep, energy expenditure Patterson RE, Laughlin GA, LaCroix AZ, Hartman SJ, Natarajan L, Senger CM, Martínez ME, Villaseñor A, Sears DD, Marinac CR, Gallo LC. Intermittent Patterson RE, Laughlin GA, LaCroix AZ, Hartman SJ, Natarajan L, Senger CM, Martínez ME, Villaseñor A, Sears DD, Marinac CR, Gallo LC. Intermittent Fasting and Human Metabolic Health. J Acad Nutr Fasting and Human Metabolic Health. J Acad Nutr Diet. 2015 Aug;115(8):1203-12. Diet. 2015 Aug;115(8):1203-12. Coconut oil Coconut oil Weight loss Cardio-metabolic parameters • Studies conducted with MCT oil show that: – Doses of ~ 20-25 g may have an effect on satiety and body • Lauric, myristic weight (by increasing expenditure and thermogenesis) palmitic and • Dose as low as 3-5 g showed some benefits in very few studies stearic acids are the most common • Studies conducted with coconut oil show no beneficial types of saturated impact on weight loss fatty acids in – Significant amount of coconut oil would be required to obtain coconut oil. Mensink RP. Effects of Saturated Fatty sufficient amounts of medium chain triglycerides for weight Acids on Serum Lipids and Lipoproteins: loss A Systematic Review and Regression Analysis. Geneva, Switzerland: World • Studies comparing coconut oil and MCT as a Health Organization; 2016. comparator are needed Clegg ME. They say coconut oil can aid weight loss, but can it really? Eur J Clin Nutr. 2017 Oct;71(10):1139-1143. 7 9/19/19 Coconut oil Coconut oil Cardio-metabolic parameters Summary - Fiction Support For • Prevention and treatment of atopic dermatitis • May prevent hair damage d/t protein loss during grooming processes and UV exposure • Impacts LDL cholesterol negatively Support Against • Prevention or treatment of Alzheimer’s Replacing carbs with individual Saturated fats – increases HDL cholesterol disease, bone loss, or glycemic control and Mensink RP. Effects of Saturated Fatty Acids on Serum Lipids and Lipoproteins: A Systematic Review and Regression Analysis. Geneva, Switzerland: World Health Organization; 2016. weight loss Wallace TC. Health Effects of Coconut Oil- A Narrative Review of Current Evidence. J Am Coll Nutr.
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