see also:

• healthy living and diets
• foods as toxins
• FODMAPs and the low FODMAP diet
• salt / sodium in food products
• honey
• 2019 Lancet commission into best diet for health and environment
• 2024: Underrated aspects of a true Mediterranean diet: understanding traditional features for worldwide application of a “Planeterranean” diet

• whilst we are currently in an period of an obesity epidemic in much of the world, there is a growing proportion who are starving and food shortages are likely to become a global issue, especially for quality protein.
• a significant sustainability issue is the impact of various foods upon the environment and also for animal welfare
• the apparently never ending changing recommendations for what is healthy and what is not also adds to the confusion of what should people be eating.
• for those with socio-economic challenges, cost per g of quality protein or cost per calorie of energy become important factors as well as the availability of micro-nutrients such as essential fats and vitamins
  • the ability for some small communities to create longer lasting foods during times of plenty may also be a survival factor hence the evolution of the making of cheese, processed meats, fruit preserves, etc.
• diet and the the GIT microbiome and health:
  • long-term diet is strongly associated with the gut microbiome composition
  • those who eat plenty of protein and animal fats have predominantly beneficial Bacteroides bacteria, while for those who consume more plant-based foods the Prevotella species ¹⁾
    • Prevotella made up 53% of the gut bacteria in West African children but were absent in age-matched European children ²⁾
  • it seems Bacteroides dominant gut microbiome results in lower inflammatory bowel disease (IBD), Crohn's disease, osteoporosis, asthma, perhaps colorectal cancer but increased risk of obesity, insulin resistance and dyslipidaemia

• there is still much debate about optimal timing of food intake, fasting durations, etc
• it seems daily 16hr fasting with food consumed only within an 8 hour window each day results in 91% increased cardiovascular mortality ³⁾

• balanced amino acid intake
  • 20 main types of amino acids are required as the building blocks for making protein as well as to make other important compounds such as creatine, peptide hormones, and some neurotransmitters.
  • 9 of these are “essential amino acids” in mammals as mammals cannot synthesize them:
    • histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine
  • a further 6 “conditionally essential” as in prematurity, high catabolic states or severe liver disease:
    • arginine, cysteine, glycine, glutamine, proline, and tyrosine
    • cystine and tyrosine may become essential in premature infants or those with severe liver disease
    • cystine can replace approximately 30% of the requirement for methionine, and tyrosine about 50% of the requirement for phenylalanine
    • arginine may not able to be produced in sufficient amounts to meet growth needs of childhood and deficiency may impact the urea cycle function
  • a continuous daily dietary supply of all the essential AAs is required to replace losses, and unlike other macro nutrients such as carbohydrates and fats, we do not have a store of amino acids apart from a small amount of changes to tissue protein turnover rates - unless we start breaking down muscle - and that is not a great idea!
    • daily obligatory nitrogen losses in adults averages ~50 mg of nitrogen per kilogram body weight daily - it is greater than this for children and lactating women
    • adults need a minimum ~14mg/kg body weight of each of these essential AAs each day (adolescents 2-5x this much, infants 5-10x this much)
    • a protein meal's value as a source of AAs will be determined by the amount of the limiting AA it contains and which can be digested
      • if one of the essential amino acids is not available in the required quantities, protein synthesis will be inhibited, irrespective of the availability of the other amino acids
      • examples of limiting AAs in various foods⁴⁾:
        • lysine: wheat, oats, maize, rice, peanuts, spirulina
        • methionine & cystine: beans, peas, mycoprotein, soy
        • tryptophan: beef
        • histidine: whey
        • no limiting AA: cow's milk, eggs, casein, quinoa
        • “complete proteins”: cow's milk, eggs, whey, beef, casein, quinoa, soy
    • any daily excess intake is not stored but degraded and the nitrogen excreted as urea, while the residual ketoacids are converted to carbohydrates or fats - the only way to create stores of amino acids is through muscle building
      • muscle protein turnover accounts for 30% of the total protein turnover in the young adult, but only 20% of that in the elderly as the elderly have less muscle mass
  • all food proteins (except gelatin) contain each of these 20 AAs although the amounts of each vary
    • highly digestible, high-quality protein sources include egg, meat, milk, or fish and recommended daily allowance of these is 0.75g/kg body weight for young adult males
    • pregnant women and lactating women have higher requirements (human milk contains 1.1-1.3g/100mL and thus an additional 15g/d is required to meet this⁵⁾)
  • it seems likely that mammals have a satiety mechanism which keeps us hungry until sufficient daily protein intake has occurred - this may result in over-eating if we have a very low protein diet - however, once this level is met, further protein intake does not appear to change satiety levels as other mechanisms come into play, otherwise in high protein diets, we would end up energy starving ourselves. The amino acid leucine has also been shown to play a key role in regulating insulin action in the body, with 2-3g of leucine in a meal helping to bind insulin receptors.
  • data from the Australian Health Survey found that only 14 per cent of Australian adults reach their recommended 2.5 serves of high-quality protein each day
  • recommended good quality protein intakes for adults to reduce loss of muscle mass and minimise development of frailty due to poor muscle mass
    • 1.2-1.6g per kilo of body weight of protein each day, or upwards of 100-140g eaten in small portions throughout the day - NOT as a 500g steak meal!
    • optimal intakes for an adult appears to occur at amounts of just 25-30g of good quality protein, or the equivalent in just 100g of lean chicken or beef, or two eggs, or a tin of tuna or salmon PER MEAL. Dairy products are also a good source.
    • do not consume more than 2-3g of protein per kilogram per day for any extended period of time as this can cause other issues.
      • high circulating levels of trimethylamine N-oxide or TMAO (due to high intakes of some beans, mushrooms or animal proteins including eggs, milk, fish, meat, or, changes to gut flora - as it is mainly formed from nutritional substrates from the metabolism of phosphatidylcholine/choline, carnitine, betaine, dimethylglycine, and ergothioneine by intestinal microflora in the colon) has been associated with cardiovascular disease, hypertension, stroke and increased mortality ⁶⁾
• essential vitamins and minerals
  • sodium
    • an adequate daily sodium is important to help maintain sodium equilibrium in the body
    • Western diets tend to have far too much sodium
    • too much sodium acutely may be lethal, too much over a longer period increases risk of fluid retention and hypertension
  • potassium
    • an adequate daily potassium is important to help maintain sodium equilibrium in the body and helps negate the hypertensive effects of dietary sodium excesses
    • key potassium foods are bananas, broccoli, spinach, sweet potatoes, avocados, beans and lentils
    • potassium intake must be reduced in those with end stage kidney disease
  • magnesium
    • adults need at least 300mg/d and perhaps 550mg/d is optimal
    • foods high in magnesium include leafy green vegetables, legumes, nuts, seeds and wholegrains
    • there appears to be a strong link between low magnesium levels (<18mg/L) and high amounts of a genotoxic amino acid called homocysteine (esp. if also have low B12 and folate levels) making people more susceptible to Alzheimer's and Parkinson's disease, gastrointestinal diseases, a range of cancers, and diabetes ⁷⁾
    • there appears to be a protective effect of higher dietary magnesium (550mg/day) on reducing brain aging, reduction in brain size and dementia ⁸⁾
• choline:
  • we need to consume 400-500 mg of choline per day to support cell regeneration, gene expression regulation, and for sending signals between neurons
  • choline is transported into the brain via a protein called FLVCR2 ⁹⁾
  • choline-rich foods include eggs, vegetables, meat, nuts and beans
• creatine
  • our bodies produce abut 1g/d but needs an additional 2-4g/d depending on muscle activity
  • main dietary sources are red meat and fish like salmon but even these only provide ~2g per kg of meat and that is far too much meat in the diet per day
  • hence some suggest supplementation in non-pregnant adults if warranted and beneficial, while performance athletes often aim for 5-10g/d as supplements but these doses will cause water retention and bloating (and diarrhoea at higher doses) and may be an issue for those taking diuretics or who have hypertension, bipolar disorder, kidney or liver problems
• energy

• polyphenols are a a primary group of phytochemicals found in plant-based foods (especially particularly abundant in nuts, fruits, vegetables, tea, and red wine) and many can act as powerful scavengers, protect cells from oxidative stress, reducing the risk of age-related diseases such as heart diseases, cancer, and neurodegenerative diseases
• polyphenols can modulate immune system function by inhibiting NF-κB and MAPK/ERK pathways, inhibiting toll-like receptors (TLRs) and pro-inflammatory gene expression, suppressing the enzymes related to the production of ROS, and up-regulating other endogenous antioxidant enzymes
• various polyphenols have been reported to slow ageing and have a range of other beneficial effects ¹⁰⁾
• a large 2025 study suggests those with the highest variety of dietary flavonoids had a 14% lower risk of all-cause mortality, a 10% lower risk of cardiovascular disease, and a 20% lower risk of type 2 diabetes mellitus incidence ¹¹⁾
• bioavailability of polyphenols in the gastrointestinal tract is relatively low, mainly accumulating in the large intestine and being metabolized by the gut microbiota
• flavonoids can be further classified into subclasses such as flavones, flavanols (flavan-3-ols), isoflavones, flavanones, anthocyanins, and chalcone
• Ellagic Acid (EA)
  • found in fruits and nuts, especially pomegranates, raspberries, and walnuts
  • EA can be converted to urolithin-A (UA) in the gut via the gut microbiota. UA is a novel natural chemical that has been proven to stimulate mitophagy both in vitro and in animals following administration and has a favorable safety profile. It has been proposed that the longevity beneficial effects of EA are mediated through its metabolite UA.
• Gallic Acid (GA)
  • present in various plants, such as tea, pomegranate, grapes, and nuts
  • broad spectrum of antioxidant, anti-inflammatory, antibacterial, antiviral, and antitumor properties
• Rutin
  • a flavonoid also known as quercetin-3-O-rutinoside and vitamin P, possesses relatively stable physicochemical properties and is widely distributed in citrus fruits and buckwheat seeds
• Quercetin
  • found in a variety of fruits and vegetables, such as onions, apples, berries, and broccoli
  • a potent antioxidant with anti-aging properties that scavenge free radicals and shield cells from oxidative stress-related cell damage
• Fisetin
  • a unique antioxidant flavonoid which may cros the blood brain barrier and mostly present in strawberries and other fruits and vegetables
  • not only has direct antioxidant activity, but it also increases glutathione levels, the primary antioxidant in cells
• Anthocyanins
  • a type of natural pigment in a wide range of foods, particularly berries such as black, blue, and raspberries
  • has powerful antioxidative effects

• “non-digestible dietary components that promote the growth and activity of beneficial bacteria in the gastrointestinal system”
• Prebiotic supplementation has been shown to increase mineral absorption, reduce inflammation, support metabolism, and reduce the risk of colorectal, laryngeal, and gastric cancers.
• examples:
  • lactulose
  • lactosucrose
  • oligofructose
  • insulin
  • fructo-oligosaccharides (FOSs) such as kestose, nystose, and 1 F-β-fructofuranosylnystose, and galacto-oligosaccharides (GOSs) such as raffinose and stachyose, promote the growth of Bifidobacteria and Lactobacilli
    • FOSs seem to be mostly abundant in cereal products, with wheat bran containing the highest amounts of kestose and nystose, whereas and whole-meal rye flour exhibited higher levels of 1 F-β-fructofuranosylnystose.
    • amongst tested cereals, legumes, nuts and fruitd, wheat bran and whole-meal rye cereals, as well as root vegetables, were identified as the richest sources of prebiotic FOSs ¹²⁾

• black beans appear to reduce IL-6 levels in pre-diabetics in an early 2025 study ¹³⁾
• chickpeas appear to reduce cholesterol levels in pre-diabetics in an early 2025 study ¹⁴⁾
• mangoes - 2 serves a day may reduce cholesterol and BP in post-menopausal women ¹⁵⁾
• plant based foods containing phytosterol-a may reduce risk of heart disease, diabetes, lower LDL cholesterol and may improve gut microbiome - a 2025 showed those who benefited most consumed about 4-5 servings of vegetables, 2-3 servings of fruit, two servings of whole grains and half a serving of nuts per day ¹⁶⁾
• almonds are rich in vitamin E, polyphenols, and monounsaturated fats
  • eating over 60g/day appears to produce significant improvements in specific key biomarkers, particularly those indicative of cellular damage (MDA and 8-OHdG)¹⁷⁾
  • just ensure they are not bitter - as eating 50 bitter almonds in adults may cause fatal cyanide poisoning
• ginseng ¹⁸⁾
  • ginsenosides appear to have anti-inflammatory and anti-neoplastic properties
  • insenosides Rg1 and Rb1 regulate cytokine production by inhibiting pro-inflammatory factors like TNF-α and IL-6 while promoting anti-inflammatory IL-10.
  • ginseng enhances natural killer (NK) cell activity via the TLR4/MyD88 pathway, and is reported to increase cytotoxicity by two- to threefold
  • ginsenoside Rh2 suppresses the PI3K/AKT pathway in prostate cancer, reducing tumor proliferation and invasion
  • ginsenoside Rg3 and Compound K exhibit neuroprotective effects and ameliorate cancer-related fatigue by activating AMPK signaling
  • some ginsenosides appear to have antidepressant and neuroprotective properties which may help those with chronic fatigue
  • polysaccharides in ginseng, such as arabinogalactan, activate macrophage receptors and promote hematopoietic recovery
• coffee
  • 2 cups a day (preferably early in the day to avoid caffeine's effects on sleep) appears to be beneficial, higher intake may have increasing adverse effects
  • coffee's bioactive compounds, particularly caffeine, polyphenols, and diterpenes, exert antioxidant, anti-inflammatory, antifibrotic, gut microbiome-modulating, and epigenetic-regulating effects, thereby slowing the progression of liver damage and reducing the risk of cirrhosis and liver cancer, but this beneficial effect apparently requires at least 3 cups per day ¹⁹⁾

• various national bodies have created healthy eating scoring systems - some of these have been perverted by major companies and profiteering leading to mistrust by consumers, while many are based upon older schools of thought
• European Consumer Organisation NutriScore system
  • https://www.beuc.eu/sites/default/files/publications/beuc-x-2019-051_nutri-score_factsheet.pdf
  • this is biased for societies where obesity is an issue and may not be useful in areas or times where food is scarce
  • it is calculated taking into account both the nutrients to limit (calories, saturated fat, sugars and salt) and those elements to favour (fibre, proteins, nuts, fruit and vegetables).
• The Lancet 2019 - 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017:
  • most of our health burden from diet in terms of excess mortality and disability is due to:
    • high salt intake
    • low wholegrain intake
    • low fruit intake
• UK 2023 study on diets and longevity:²⁰⁾
  • longevity-associated dietary pattern had moderate intakes of whole grains, fruit, fish and white meat; a high intake of milk and dairy, vegetables, nuts and legumes; a relatively low intake of eggs, red meat and sugar-sweetened beverages; and a low intake of refined grains and processed meat and switching from unhealthy to healthy diet could add 10 years of life expectancy

• eggs provide high-quality protein (~6g per egg), B vitamins, choline, and several essential nutrients
• whole eggs are one of the most affordable and highest-quality sources of complete protein available
• there is no clear evidence that even higher than usual egg consumption is associated with higher cardiovascular mortality ²¹⁾
• for most healthy adults, eating eggs regularly 1-6 times per week is associated with a lower risk of cardiovascular disease-related death
• the cholesterol in egg yolks is not a problem for most people, but some people are “hyper-responders” (eg. with APoE4 gene) and it will raise their LDL cholesterol if eating more than 2 eggs a day although this effect is variable and may lessen over time
• most guidelines generally recommend:
  • maximum of 7 eggs per week for adults with normal cholesterol, and up to 2 eggs per day for older adults with normal cholesterol
  • for those with high cholesterol, diabetes, or other risk factors for heart disease, it is generally advised to limit egg intake to 4–5 eggs per week
• egg whites:
  • 18 calories vs 74 for whole eggs
  • have just over half the protein of a whole egg and the protein contains all 9 of the essential AAs in good amounts
  • have zero fat and cholesterol whereas whole egg has 5g fat (mainly saturated fats) and 69% of daily dietary allowance of cholesterol
  • has no vitamin A, B12 or D and no choline and much less selenium whereas a whole egg has significant amounts of each of these
  • has 2/3rds the vitamin B2 of a whole egg
  • high daily intakes of egg whites are favoured by body builders as they are are low in calories, carbohydrates, fat, and cholesterol, but high in protein, however, they provide fewer nutrients compared with whole eggs.
  • eating large amounts of raw egg whites may reduce the absorption of the water-soluble vitamin biotin as they contain the protein avidin.
  • eating raw egg whites or raw eggs also in icreases risk of Salmonella

• prolonged fasting overnight is generally regarded as an important health measure
• shift work or late night snacks are generally associated with poor health, increased diabetes risk, and increased cancer risks

• may have beneficial effects
• some people develop adverse effects from prolonged fasts such as dizziness, hypoglycaemia, increased falls risk, etc
• some people have any beneficial effects obliterated by binge eating prior or after such fasts
• can modulate immune responses
  • the brain’s perception of hunger or fullness, rather than actual eating or caloric restriction, is enough to drive changes in the body’s immune cells, and in mice, the perception of hunger reduced circulating inflammatory monocytes ²²⁾

• there are various factors which may impact the environment including:
  • greenhouse gas emissions
  • scarcity weighted water use
  • land use
  • aquatic eutrophication potential
• foods that have particularly high environmental impacts in descending order based upon weight alone, include:
  • dried beef products such as biltong and beef jerky
  • beef, lamb (these have 3x impact of other meats, fish, nuts, etc)
  • other meats including fish
  • cheese (you need 100L milk to make 11kg cheese!)
  • nuts, dried fruits and nutrient powders
  • chocolate, coffee, tea
• foods with the lowest environmental impacts include sugary drinks but these have poor nutrition value
• see also:
  • https://www.pnas.org/doi/10.1073/pnas.2120584119#sec-1
• it would make better sense to scale the environmental impacts per 100g of quality protein given this is what will be most needed in the diet

• processed foods, particularly those marketed as “low fat”, generally have poor quality carbohydrates, low nutrients and often are high in sodium
  • a study in rats in 2021 showed that even after only 4 weeks of eating processed food, rats gained excess weight, but more worryingly the older cohort of rats developed inflammatory changes in the hippocampus and amygdala suggesting a role in dementia - this latter effect appeared to be prevented by supplementing their processed food diet with DHA ²³⁾
• processed meats have additional issues to high sodium and meat contents as they usually have high levels of carcinogenic chemicals such as nitrates and nitrites which are converted to nitrosamines
  • WHO states eating only 50g/day of processed meat such as 6 slices of bacon or one hot dog would increase lifetime risk of colorectal cancer (bowel cancer) from 5% to 6%
  • cooking meats at high temperatures such as on BBQs also increases carcinogenic chemicals such as heterocyclic amines (HCAs) and polycyclic aromatic hydrocarbons (PAHs)
• a 2024 study suggests eating two 85g serves of processed red meat (bacon, hot dogs, bolgna, etc) per week increases dementia risk by 13% compared to eating less than 3 servings per month ²⁴⁾
• ultra-processed foods (UPFs)
  • are defined as industrial formulations with five or more ingredients, often including additives, sugars, oils, fats, salt, and preservatives and they often lack dietary fiber.
  • they also tend to be high in saturated fat, which can increase the risk of developing cardiovascular disease (CVD)
  • processing methods which can cause harm:
    • the Maillard reaction improves sensory attributes like color, flavor, and texture; however, Maillard reaction products can potentially function as prooxidants and carcinogens
    • Extrusion can lead to lipid oxidation, followed by the degradation of unsaturated fatty acids and the formation of free radicals.
    • Hydrogenation, which is typically used when making margarine, can increase low-density lipoprotein (LDL) cholesterol levels.
  • adverse effects on the gut microbiome
    • consumption of UPFs may lead to the proliferation of pro-inflammatory microbial strains and reduced microbial α-diversity in the gut.
    • reduced production of short-chain fatty acids (SCFAs) and other protective gastrointestinal metabolites
    • emulsifiers used in UPFs can prevent the proliferation of beneficial bacteria with anti-inflammatory properties, which can increase gut permeability and bacterial translocation into the bloodstream
    • higher levels of potentially harmful bacteria in the microbiome, some of which include Granulicatella, Blautia, Carnobacteriaceae, and Bacteroidaceae.
    • lower levels of Roseburia and Lachnospira, both of which produce SCFAs
    • lower levels of Akkermansia muciniphila which improve insulin levels, sensitivity, and weight control
    • alterations in the gut microbiome which can collectively lead to systemic inflammation and oxidative stress
    • a greater ratio of Firmicutes to Bacteroidetes influences the development of type 2 diabetes.
    • loss of anti-inflammatory bacteria, reduced microbiome diversity, and increased pathobionts ( Bacteroides fragilis, Fusobacterium nucleatum, and Parvimonas micra appear to be pro-carcinogenic) increase the risk of colorectal cancer (bowel cancer)
  • increases hs-CRP and inflammation ²⁵⁾

• short-term exposure to high-fat diets can reduce the production of interleukin-22 (IL-22), a crucial protein that helps control gut inflammation
  • a 2025 study showed it took only two days of consuming high-fat foods for mice to lose their IL-22 stores and have an impaired gut function by impairing intestinal group 3 innate lymphoid cells (ILC3s) and their capacity to produce IL-22,²⁶⁾
  • unsaturated fats, like those found in nuts and avocados, do the opposite and boost IL-22 production
• high-fat diets can lead to low levels of Eubacterium rectale, Bacteroides, Verrucomicrobia, Bifidobacterium, and Clostridium coccoides, as well as greater proliferation of Firmicutes, Proteobacteria, and pro-inflammatory cytokines.

• intake of unprocessed red meat or processed red meat has been associated with increased cardiovascular and cancer mortality, although studies give different results, especially for different ethnicities and for gender and causality has not be proven ²⁷⁾, ²⁸⁾
• “the health and nutrition impacts of beef can range from detrimental to beneficial, depending on the context in which it is consumed: studies in high-income and high-consuming contexts indicate that increasing consumption of red meat would negatively affect health outcomes, whereas red meat consumption (and, more broadly, animal-based foods) in food-insecure contexts can be integral to nutrition security”²⁹⁾
  • it seems dietary trans-vaccenic acid (from milk, lamb or beef) reprograms CD8+ T cells and improves anti-tumour immunity ³⁰⁾
• proposed mechanisms of causality for worse health outcomes eating red meat include:
  • red meat is rich in saturated fatty acids, which have been associated with dyslipidemia, particularly elevated low-density lipoprotein (LDL)
  • red meat intake has been associated with increased levels of inflammatory and oxidative stress markers such as C-reactive protein (CRP) and gamma-glutamyl transferase (GGT) and chronic inflammation may be a causal agent in atherosclerosis and colorectal cancers (perhaps 6% risk instead of 5%) - this may be due to low grade tick-induced mammalian red meat allergy (MMA)
  • Heme iron in red and processed red meats has been associated with higher risk of type 2 diabetes and cardiovascular diseases
  • red meat is rich in L-carnitine, and recent research found that L-carnitine metabolism by intestinal microbiota elevates the level of a metabolite known as trimethylamine-N-oxide (TMAO), which was linked with a higher risk of cardiovascular diseases, particularly atherosclerosis
  • large amounts of sodium are used in some meat processing; high intakes of sodium are associated with elevated blood pressure
  • processed meats are often high in nitrates which are converted to potentially carcinogenic nitrosamines in the stomach
    • ham, bacon, salami are classified by WHO as known carcinogens
• there is also the environmental sustainability argument against eating red meat ³¹⁾
  • beef cattle contribute to high levels of greenhouse gas production (perhaps around 2-3% of emissions) however, lettuce has 3x the GHG emissions of bacon, and fruit has the largest water and energy footprint per calorie.
  • red meat is not a sustainable diet for the increasingly economically rich and highly populated developing world, although cattle may be able to create a protein source from farming lands not suitable for cropping and they can graze cropping residues, whiled insecticides and herbicides used in cropping may be causing far more harm than good to our environment and ecologic systems
• most of the increase in caloric intake from 1970 to 2014 has been due to intake of over-processed grains, caloric sweeteners, salads and cooking oils, and poultry while that from red meat has fallen 30%
• but then red meat may be less associated with GIT cancers (GC) than poultry:
  • a 2025 study of 4,869 participants³²⁾ appears to show:
    • “Poultry consumption above 300 g/week is associated with a statistically significant increased mortality risk both from all causes and from GCs.”

• a way of eating based on the traditional dietary patterns of people who live in countries bordering the Mediterranean Sea, such as Greece, Italy, and Spain.
• it emphasizes plant-based foods, including vegetables, fruits, whole grains, legumes, nuts, and seeds, with olive oil as the primary source of fat.
• fish and poultry are more common than red meat, and dairy products, eggs, and red wine are consumed in moderation.
• encourages limiting processed foods, added sugars, and saturated fats.
• it appears to reduce risk of heart disease, lower risk of type 2 diabetes, improved mental health and cognitive function, increased longevity, and may help with weight management.

• Dietary Approaches to Stop Hypertension (DASH) diet, is a dietary pattern designed to help lower high blood pressure and reduce the risk of heart disease.
• emphasizes the consumption of fruits, vegetables, whole grains, low-fat dairy, and lean protein while limiting sodium, saturated fat, and added sugars.

• developed in 2015 as a proposed healthy diet for achieving better cognitive outcomes
• it is a hybrid of the Mediterranean and DASH diets, incorporating what they believe are the most neuroprotective components of these diets, including berries, nuts, leafy greens, and whole grains, while limiting intake of foods believed to be associated with cognitive decline, such as red meat and pastries
• see also https://www.news-medical.net/health/The-MIND-Diet-Explained-Foods-That-Fight-Cognitive-Decline.aspx

• usually used for the short term Mx of irritable bowel syndrome by reducing Fermentable Oligo-saccharides, Disaccharides, Mono-saccharides And Polyols such as fructans, fructose, lactose, and galactans
• see FODMAPs and the low FODMAP diet

• ketogenic diets are characterized by a higher intake of fats, moderate intake of proteins, and lower consumption of carbohydrates.
• a classic KD has a 4:1 ratio of fats to non-fats based on molecular mass.
• the low dietary carbohydrate maintains the predominant oxidation of fatty acids, mimicking the state of starvation that involves ketogenesis in the liver
• these have been proposed to reduce risks of diabetes, inflammatory bowel disease (IBD), and even bipolar disorders
• they have been used to treat intractable epilepsy in adults and children
• they may have neuroprotective effects with implications for Parkinson’s disease, Alzheimer’s disease, glioma, and migraine
• a proportion of those who undertake such diets develop elevated LDL-C and ApoB levels despite otherwise healthy metabolic marker levels including low triglycerides, high HDL, low blood pressure, low insulin resistance, and low body mass index, and these people are said to have the Lean Mass Hyper-Responders (LMHRs) phenotype. It would appear the raised cholesterol levels in this group may not increase cardiovascular risk.³³⁾
• however, in the first few weeks, those starting the diet may develop “keto flu”:³⁴⁾
  • clinical features:
    • symptoms occur within two to three days of KD initiation and resolve within two to four weeks, with minimal or no intervention
    • occurs in approx 40% of people starting a KD compared to 8% of those starting a low fat diet
    • fatigue, brain fog, lethargy, lightheadedness, headache, mood changes, halitosis, muscle cramps, reduced exercise capacity, diarrhea, and constipation
    • other potential symptoms include hypoglycemia (mainly paeds), kidney stones (2.5-4%), acidosis, prurigo pigmentosa (a rare skin rash linked to ketosis), emesis, and nausea
  • pathophysiology:
    • thought to be driven by mechanisms such as natriuresis (excessive sodium excretion), hypovolemia (low blood volume), reduced energy substrate availability during the metabolic shift from glucose to ketones, and changes in gut microbiome diversity

• a low-carbohydrate ketogenic diet that restricts carbohydrate intake to promote weight loss and overall health and as such will increase ketosis
• emphasizes eating more protein and fat while limiting carbohydrates, particularly refined carbs like sugar, white flour, and processed foods.
• encourages the consumption of protein-rich foods like meat, poultry, and seafood, along with healthy fats like those found in avocados, nuts, and olive oil
• discourages highly processed foods, sugary drinks, baked goods, pasta, rice, bread, and starchy vegetables like corn and potatoes
• the diet is structured in phases, with the initial phase being the most restrictive in terms of carbohydrate intake

• these diets eliminate meats while vegans also exclude animal by-products such as eggs, dairy, honey, etc.
• the avoidance of red meat as well as the higher dietary fibre intakes appear to have strong evidence for health benefits
• there are also ethical reasons many have for a non-animal diet as well as climate warming mitigation goals by theoretically reducing methane emissions from cows
• they are potentially more affordable although high quality vegetarian and vegan foods such as berries, avocado, quality nuts, etc can be expensive and missing out on these may negate many of the benefits
• the studies of vegetarians vs meat eaters often do not allow for the general non-dietary healthy life choices of many vegetarians such as exercise, yoga, etc.
• a few of the main negatives are:
  • the complexity involved in ensuring an adequate well balanced, regular amino acid intake to ensure protein is not broken down from muscle resulting in long term sarcopenia / generalised muscle wasting and frailty
    • to get the same amount of protein in a 4oz steak (181 calories, 0 carbs, 4.5g fat) you’d need to eat 12 oz of kidney beans plus a cup of rice, which equals 638 calories, and 122g of carbs and 0.6g fat. To get the 30g of protein from almonds, you would need to consume a little over 1 cup of chopped almonds, which is over 850 calories and 75g of fat
    • protein and fat intake are probably the main dietary components that cause satiation.
    • animal proteins (e.g., whey), rich in essential amino acids, particularly leucine, have gained popularity for their role in inducing muscle protein synthesis
    • single-source plant proteins, such as soy, potato, pea, and cocoa, do not positively impact hormonal balance, muscle protein synthesis, and biochemical indices
    • blended, well-formulated plant source (eg. from combinations of pea, rice, and canola) intakes ≥30 g/day protein containing 2.5 – 3 g/day leucine have the potential to produce muscle protein synthesis effects in young athletic adults almost as effective as animal whey ³⁵⁾
  • ensuring an adequate calcium intake to prevent osteoporosis - dairy foods are one of the best food sources of calcium
  • ensuring adequate vitamin B12 (cobalamin) intakes to avoid anaemia, neuropathies and cognitive decline - unlike many animals humans cannot make their own B12 and the main sources are from animal foods as plants do not produce it
    • B12 deficiency can cause permanent neurologic damage to developing infants and is most common in vegetarians and vegans
    • a small 4oz serving of beef contains 95% of the daily requirements for B12
  • ensuring adequate iron intakes (most iron in non-animal foods have a poor bio-availability) to avoid iron deficiency anaemia
    • heme iron in red meat is the best, most bioavailable source of iron
  • avoiding excessive intakes of certain vegetables such as soy products which may potentially increase risk of breast cancer due to their pro-oestrogenic actions
  • a strict non-animal diet would seem to go against the evolutionary priorities that made Homo sapiens the dominant species - a predatory, hunting species designed to be omnivores rather than animals which had to spend most of their days grazing to gain adequate sustenance, and thus a return to vegetarianism could have long term adverse gut microbiome, health and cognitive impacts
    • in evolutionary terms, we are predatory omnivores (eyes face forwards as for predators, teeth are designed for both meat and grain eating, body mechanics and heat regulation designed to chase down prey, large brain to assist in survival even in extreme environments with minimal food and water opportunities), our bodies were meant to digest animal fats and proteins, and we naturally produce acids and bile to break down protein quite easily. Protein provides the building blocks of our bodies, and animal sources are the most complete protein sources because they contain all of the amino acids we need for optimal health.
  • a large study published in 2023 failed to show any mortality benefit of vegan or vegetarian diets ³⁶⁾
  • in summary, vegetarian diets are associated with poorer protein intake (hence poorer muscle bulk and higher risk of frailty), iron deficiency and B12 deficiency, poorer health (higher incidences of some cancers, allergies, and mental health disorders), a higher need for health care, and poorer quality of life.