Popular Diets Wendy Dahl, PhD Associate Professor and Extension Specialist UF/IFAS Food Science & Human Nutrition Dept. [email protected] 1 Webinar Team Wendy Dahl, Ph.D. Julie England, M.S.,CFCS Associate Professor and Extension Specialist Seminole County FCS & Food Wendy Wood Lynch, M.S. UF/IFAS Food Science & Human Nutrition Depart. Systems Extension Agent Putnam County FCS Extension Agent [email protected] [email protected] [email protected] 2 Saturday Evening Post September 22nd 1934 • Walking is becoming a lost art! - one car for every 5 people! • Perpendicular diet – limiting to one, two or a few foods • Horizontal diet – a variety of foods – but less • A 18-day Hollywood Diet ‘What day are you on?’ 3 4 It’s not just about weight loss, but also perceived health benefits. Are we destined to repeat history? 5 Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017 www.thelancet.com Published online April 3, 2019 http://dx.doi.org/10.1016/S0140-6736(19)30041-8 6 Mediterranean Dietary Pattern Associated with decreased chronic disease risk: Olive oil ↓ Cardiovascular disease (Grosso et al. 2015) Fruit ↓ High blood pressure (Nissensohn et al. 2016) ↓ Metabolic syndrome (Godos et al. 2017) Vegetables ↓ Cancers (Schwingshackl & Hoffman 2015) Whole grains ↓ Type 2 Diabetes (Jannasch et al. 2017) Nuts and seeds ↓ Cognition (Solfrizzi et al. 2017) Legumes/pulses Some evidence for lower central obesity Fish and lean meats (Bendall et al. 2018) but weight loss requires eating less Limiting red meat, butter, *Also effective for managing chronic disease sweetened beverages, e.g. diabetes sweets pastries, etc. 7 Raw Foods Diet: What do the proponents say? • Claims for improving health, preventing development of chronic disease, and promoting weight loss. • Claims that cooking foods above 118° F will destroy beneficial enzymes and nutrients. • Recommended preparation methods include juicing, blending, dehydrating, sprouting, cutting, chopping, and slicing. J Nutr. 2005;135(10):2372-2378. 8 Raw Foods Diet: What foods are allowed? • Raw fruits and vegetables • Raw seeds and nuts • Unpasteurized milk • Sprouted grains and beans • Cold-pressed extra-virgin olive oil • Raw virgin coconut oil • Raw fish, raw eggs and raw meats 9 Raw Foods Diet: What does the science say? • Health benefits associated with • Decreased digestibility will lead to less consuming fruits and vegetables (but provision of calories, protein and also including cooked) other nutrients and possible weight • A host of human enzymes for optimal loss and malnutrition. digestion – enzymes in raw foods not needed • Yes, some of vitamins are destroyed with cooking but cooking also improves digestibility (e.g. protein) and bioavailability (e.g. lycopene in tomato sauce) 10 Raw Foods Diet: What are the pros and cons? Pros Cons • Promotes high intake of fruits • High risk of foodborne illness and vegetables with raw meat, eggs, fish and • High in fiber milk but also with sprouting • Includes minimally processed • Anti-nutrients in some raw foods foods (e.g. legumes) • May be lower in calories • Restrictive, lots of preparation • Undernutrition is possible 11 Alkaline Diet: What do the proponents say? • Eating foods such as meat, dairy and refined foods produce acids leading to disease • Eating fruits and certain vegetables alkalizes the body • Hydration is critical – expensive alkaline water needed 12 Alkaline Diet: What does the science say? • To stay in acid-base balance, we need healthy kidneys and healthy lungs • In health, we can’t and shouldn’t try to change the body pH • Fruits and vegetables are health enhancing for a variety of reasons. • In the extreme - overall very poor quality diet lacking in fruits and vegetables and lots of excess protein, there may be imbalance (Institute of Medicine 2004) 13 Normal serum pH 7.35-7.45 Acid-base Balance Respiratory regulatory Kidney [metabolic] control regulatory control • Change in respiration • Control of rate bicarbonate • Depth of breathing • Phosphate, sulfate • Release or retention of and ammonium buffers CO2 J Environ Public Health 2012; doi: 10.1155/2012/727630 16 What can go wrong with acid-base balance? • Respiratory Acidosis • Respiratory Alkalosis – Hypoventilation (↓ breathing) – Hyperventilation (rapid leads to retention of CO2 and ↑ breathing) leads to loss of CO2 acid • Metabolic Acidosis • Metabolic Alkalosis – Loss of bicarbonate or excess – Vomiting production of acid (e.g. chronic kidney disease, diabetic – Low blood potassium ketoacidosis, lactic acidosis) – Excessive use of antacids (i.e. – Diarrhea – most common cause calcium carbonate) Diet alone does not cause acidosis or alkalosis – except in extremes and in high risk individuals. 17 Alkaline Diet: Pros and Cons Pros Cons • Increased fruit and vegetable • Exclusion of so-called “acidic” intake foods may lead to nutrient inadequacies (protein, iron, calcium etc.) • Very high intakes of oxalate- containing vegetables (e.g. spinach) may be risky for some individuals. J Ren Nutr 2018 May;28(3):215-220. 18 Paleo Diet: What do the proponents say? • Claim that we need to eat as human hunters and gatherers might have eaten during the Paleolithic era > 10,000 years ago before the introduction of agriculture. • Claim our bodies are mismatched with the modern diet. • Promoted for weight management and overall health. 19 Paleo Diet: What foods are allowed? Allowed Not allowed • Lean meats (grass fed) • Cereal grains • Fish/seafood • Legumes • Fresh vegetables and fruit • Dairy • Nuts and Seeds • Potatoes • Eggs • Refined oils, processed • Healthful oils foods, refined sugar and salt 20 Paleo Diet: What does the science say? • Evidence that the Paleolithic diet has favorable effects on cardiovascular disease risk factors: weight status, lipid profile, blood pressure, and inflammatory markers. • “…the evidence is not conclusive and more well-designed trials are still needed.” Adv Nutr. 2019 Apr 30. pii: nmz007. doi: 10.1093/advances/nmz007 21 Paleo Diet: Pros and Cons Pros Cons Depending on food choice… • No dairy (calcium, vitamin D) • Higher fiber • No whole grains and health • Low sodium benefits • Higher antioxidants • Long-term effects? • Cost and sustainability 22 Ketogenic Diet: What do the proponents say? • Claims related to weight loss, diabetes, polycystic ovary syndrome, acne, neurological diseases, cancer and decreased respiratory and cardiovascular disease risk factors. • All due to shifting the energy source from glucose to ketone… European Journal of Clinical Nutrition (2013) 67, 789–796 23 Ketogenic Diet: What foods are allowed? Very high fat, very low carbohydrate, and moderate protein. • Oils, butter, mayonnaise, and cream • Cheese, nuts, meats, poultry, fish, shellfish, eggs • Green leafy vegetables Foods with higher amounts of carbohydrates such as grains, fruit, root vegetables, and legumes are restricted. A meal of heavy whipping cream, mayonnaise, meat, a green vegetable, dill pickle, and MCT oil – how does that sound? 24 Ketogenic Diet: What does the science say? • Glucose from carbohydrate-containing foods and stored glucose is normally used for energy • During starvation or on a diet with very low carbohydrate, ketones are produced from fat for fuel in 3-4 days or so – state of ‘ketosis’. • Evidence for the treatment of intractable epilepsy – speculative/no strong evidence for other neurological diseases. • Chronic disease management? Risk factors vs. disease risk e.g. blood glucose European Journal of Clinical Nutrition (2013) 67, 789–796 25 Ketogenic Diet: Pros and Cons Pros Cons • May be metabolic changes that • Very unpalatable diet help to promote weight loss and • Unknown long-term risks improvements in certain health • Low in fiber – ↑ health risks indicators in the short term. • Low in certain nutrients – deficiencies possible • Fatigue, poor mood, constipation and other reported side effects European Journal of Clinical Nutrition (2013) 67, 789–796 26 FODMAPS Diet: What do the proponents say? • FODMAPS = Fermentable, Oligo, Di- Monosaccharides and Polyols • Claims that undigested sugars lead to diarrhea and gastrointestinal symptoms • Recommend an elimination diet and reintroduction while monitoring symptoms *These fermentable carbohydrates naturally found in foods are prebiotic! Enhance beneficial bacteria. 27 FODMAPS Diet: What foods are restricted? • Vegetables: onions, garlic, asparagus, mushrooms, green peas • Pit fruits (e.g. cherries), apples, pears, watermelon • Dairy with lactose • Protein: Legumes, some processed meats • High fructose corn syrup, honey, sugar alcohols. • Grains: wheat/rye/barley (fructans) https://www.monashfodmap.com/about-fodmap-and-ibs/high-and-low-fodmap-foods/ 28 FODMAPS Diet: What does the science say? Fiber and Resistant Starch Proteins, peptides & Oligosaccharides & sugars (FODMAPS) amino acids Microbiota - Fermentation More bacteria Short chain Gases Other products fatty acids FODMAPS Diet: What are the pros and cons? Pros Cons • Not meant for weight loss – no • Possible nutrient inadequacies evidence to date • Promotes disordered eating? • Reduced distension/bloating and • Unfavorable gut microbiota – therefore less symptoms in health effects unknown people with irritable bowel syndrome 30 Gluten Free: What do the proponents say? • Prescribed for individuals with celiac disease and increasingly for non-celiac gluten sensitivity • Some are promoting the diet X for weight loss or just an overall “healthier diet” 31 Gluten Free: