Diet Plan

Diet PlanDiet, Food & Fitness

Keto while pregnant


Keto diet during pregnancy

Keto diet also known as ketogenic diet, is a high fat, low carbohydrate, adequate protein diet, which has been gaining support as a lifestyle diet for weight maintenance 1 and body-building purposes in healthy adults 2. The “classic” ketogenic diet is a special high-fat, low-carbohydrate diet that helps to control seizures in some people with epilepsy. The ketogenic diet has been used for many years to treat children whose seizures are not responding to several different seizure medicines; however it is not usually used as a first-option treatment. There are now different forms of the keto diet and some less restrictive forms have been taken up by adults with epilepsy. The typical “classic” ketogenic diet, called the “long-chain triglyceride diet,” provides 3 to 4 grams of fat for every 1 gram of carbohydrate and protein. Keto diet is prescribed by a physician and carefully monitored by a dietitian.

The keto diet is a safe treatment for epilepsy in children. There are some possible side effects with long-term use, though, including:

  • Constipation
  • Kidney stones
  • Dehydration
  • High cholesterol levels in the blood
  • Slowed growth
  • Weak bones
  • Bone fractures

A person starting the ketogenic diet may feel sluggish for a few days after the diet is started. This can worsen if a child is sick at the same time as the diet is started. Make sure to encourage carbohydrate-free fluids during illnesses.

The increasing use of the keto diet or ketogenic diet particularly by women of child-bearing age, raises a question about its suitability during pregnancy. A keto diet during pregnancy results in alterations in embryonic organ growth. Such alterations may be associated with organ dysfunction and potentially behavioral changes in postnatal life 3. Prenatal and early postnatal exposure to a ketogenic diet also results in significant alterations to neonatal brain structure, and results in retarded physiological growth. These alterations could be accompanied by functional and behavioral changes in later postnatal life. Futhermore, keto diet while pregnant deleteriously affects maternal fertility and increases susceptibility to fatal ketoacidosis during lactation 4.

Studies on adult humans and rodents have shown that sparse carbohydrate and glucose availability initiates a process of ketogenesis that produces ketones, which all organs – including the brain – can use for energy 5. During pregnancy, since the embryo’s capability to carry out ketogenesis is very limited, it relies on ketone supply from maternal circulation. Ketone supply is modulated by the carriers Monocarboxylate Transporters 6. Studies using non-ketogenic gestational diets report that Monocarboxylate Transporter expression in the placenta decreases at the end of gestation 7, implying restricted ketone availability to the fetus. This observation seems contrary to other studies that reported an increase in ketone utilization enzymes within the brain during the second half of gestation 5. This increase in ketone utilization enzymes was speculated to facilitate lipid and myelin (white-matter) synthesis 8, implying greater availability would be favorable for the developing brain. A similar conclusion could be drawn from studies linking ketones and cerebral protein synthesis 9. Yet, while ketones may be important metabolic substrates, an excessive supply to fetal brain can also damage nucleotide bio-synthesis, impairing nucleic acid production and brain growth 10.

Not only can the keto diet lead to developmental delays in your baby but it can also cause nutritional deficiencies if done incorrectly, which can lead to serious problems for both pregnant women and their babies. Many people who follow the keto diet strictly don’t eat foods like fruits, nuts, beans, and many vegetables—sources of essential micronutrients necessary for the healthy development of your baby.

What is keto diet like?

The typical “classical” ketogenic diet, called the “long-chain triglyceride diet,” provides 3 to 4 grams of fat for every 1 gram of carbohydrate and protein. That is about 90% of calories from fat. Usually when the classic ketogenic diet is prescribed, the total calories are matched to the number of calories the person needs. For example, if a child is eating a 1500 calorie regular diet, it would be changed to a 1500 calorie ketogenic diet. For very young children only, the diet may be prescribed based on weight, for example 75 to 100 calories for each kilogram (2.2 pounds) of body weight. If it sounds complicated, it is! That’s why people need a dietician’s help when using this diet.

A ketogenic diet “ratio” is the ratio of fat to carbohydrate and protein grams combined.

  • A 4:1 ratio is more strict than a 3:1 ratio and is typically used for most children.
  • A 3:1 ratio is typically used for infants, adolescents, and children who require higher amounts of protein or carbohydrate for some other reason.

The kinds of foods that provide fat for the ketogenic diet are butter, heavy whipping cream, mayonnaise, and oils (e.g., canola or olive). Because the amount of carbohydrate and protein in the diet have to be restricted, it is very important to prepare meals carefully. No other sources of carbohydrates can be eaten.

The ketogenic diet is supervised by:

  • a dietician who monitors the child’s nutrition and can teach parents and the child what can and cannot be eaten
  • a neurologist who monitors medications and overall benefits.

Typically the keto diet is started in the hospital. The child traditionally begins by fasting (except for water) under close medical supervision for 18-24 hours. The diet is then started, either by slowly increasing the calories or the ratio. Most centers today do NOT start with a fasting period. The primary reason for admission in most centers is to monitor for any increase in seizures on the diet, ensure all medications are carbohydrate-free, and educate the families.

Is the keto diet safe while you’re pregnant?

No, pregnant women shouldn’t go keto diet.

Now that you know the keto diet might be off the table, what diet should you follow?

Healthy eating during pregnancy key points

  1. Healthy eating during pregnancy includes getting enough nutrients for you and your baby as well as knowing how much to eat.
  2. Eat food from different groups like grains, proteins, vegetables, fruits and dairy. Some foods from these groups are good sources for nutrients like folic acid, iron, calcium and Vitamin D, which are helpful for you and your baby.
  3. If you’re pregnant, thinking about getting pregnant or breastfeeding, eat 8 to 12 ounces each week of fish that are low in mercury.
  4. Talk to your health care provider about nutrients, eating a healthy amount of food and when you have any concerns about your diet

Healthy eating during pregnancy includes knowing how much to eat and what foods are healthy. It’s also finding a balance between getting enough nutrients for your baby’s growth and keeping a healthy weight for you and your baby’s health. Talk to your provider about how you can get the nutrients you need in your diet.

What nutrients do I need during pregnancy to keep my baby and me healthy?

During pregnancy, you can get a lot of nutrients from different sources or food groups such as grains, proteins, vegetables, fruits, and dairy. Other sources of nutrients are fats and vitamins and minerals.

Proteins help your body with muscle and tissue growth and also with your baby’s growth. Protein can be found in foods like:

  • Beef, pork, fish and poultry
  • Eggs
  • Milk, cheese and other dairy foods
  • Beans and peas
  • Nuts and Seeds
  • Soy products like tempeh and tofu

Carbohydrates are found in food like grains and they’re your body’s fuel to help you do your activities. . There are different types of carbohydrates. Foods can have a combination of all three types of carbohydrates.

Simple carbohydrates are broken down fast, spiking your blood sugar quickly. It’s best to limit foods high in simple carbohydrates like:

  • Table sugar
  • Certain breakfast cereals
  • Sugary desserts

Complex carbohydrates give longer lasting energy and can be found in:

  • Whole grain products, like bread, rice and pasta
  • Beans
  • Starchy vegetables like potatoes and corn

Fiber is also a type of complex carbohydrate and can be found in plant foods. Fiber can help with digestion. The following foods are good sources of fiber:

  • Vegetables such as cabbage, spinach, kale
  • Fruits like, berries, oranges, apples and peaches with the skin
  • Legumes such as chickpeas, black beans, lentils

Certain amounts of fat are also important for your body. During pregnancy, the fats you eat are a source of energy and help with your baby’s organs and the placenta. However, be careful not to eat too much saturated fat (such as butter, heavy cream and meats with high content of fat) and trans fat (often found in margarine, microwave popcorn, cookies and pastries made with vegetable shortening) because those can cause problems for your health.

Other nutrients that you need during pregnancy to keep yourself and your baby healthy include:

  • Folate or Folic acid. These can help prevent birth defects of the brain and spine in your baby, called neural tube defects. This can be found in enriched and fortified products (like bread, rice, cereals), leafy green vegetables, citrus fruits and beans and peas. Enriched and fortified means the nutrient was added to a food product.
  • Calcium. This strengthens bone and teeth for your baby and also helps your body stay healthy during pregnancy. Good sources of calcium are dairy products, broccoli and kale. Fortified cereals or juices may also be a good source.
  • Vitamin D. This is also helpful for building your baby’s bones and teeth. Good sources include fatty fish like salmon or fortified milk or orange juice.
  • Iron. This helps your body create more blood to help make sure your baby gets enough oxygen. Good sources of iron are meat products and beans. Your body can absorb iron more easily if you also get enough Vitamin C. Vitamin C can be found in orange juice, citrus fruits and strawberries.
  • Docosahexaenoic acid (DHA). This is a kind of fat call an omega-3 fatty acid. This is important for brain and eye development of your baby.
  • Iodine. This is a mineral that helps with your baby’s brain and nerve growth.

How much should you eat each day during pregnancy?

Most pregnant women need only about 300 extra calories per day during the last 6 months of pregnancy. A glass of skim milk two small crackers and a tablespoon of peanut butter have approximately 300 calories. The exact amount depends on your weight before pregnancy. If you’re underweight before pregnancy, you may need more calories. If you’re overweight before, you may need less. Talk to your doctor about what’s right for you.

Use this sample menu to plan healthy meals.

healthy pregnancy diet

Knowing how big each of these serving sizes is can be tricky. Here are some everyday items that can help:

  • 1 cup is about the size of a baseball.
  • 1/3 cup is about as much as you can fit in your hand (a rounded or full handful).
  • ½ cup is about the size of a tennis ball.
  • ¼ cup is about the size of a golf ball.
  • 1 tablespoon is about the size of ½ a ping pong ball.
  • 1 ounce of meat (chicken, pork, beef, fish, etc.) is about the size of two thumbs.
  • 3 ounces of meat is about the size of a deck of cards or the palm of your hand.
  • A small fruit (orange or apple) is about the size of a tennis ball.

Go to website ( to learn more about how to make healthy food choices during pregnancy. MyPlate shows the amounts and foods that you may want to eat at every trimester during your pregnancy. They break down food into five groups:

  1. Grains. These include bread, pasta, oatmeal, cereal and tortillas.
  2. Fruits. These can be fresh, frozen, canned or dried
  3. Vegetables. These can be raw, cooked, frozen, canned, dried or 100% vegetable juice.
  4. Dairy. These include milk and products made from milk like cheese, yogurt and ice cream. While pregnant, make sure you eat pasteurized dairy foods (this means it has gone through a heating process that makes it safer to eat) and try to choose fat-free or low-fat types.
  5. Protein Foods. These include meat, poultry, seafood, beans, peas, eggs, tofu, nuts and seeds.

Follow these MyPlate guidelines:

  • Make 1/2 of your plate fruits and vegetables.
  • Drink skim milk or 1% milk.
  • Make 1/4 of your plate grains. When you eat grains, try to use whole grains ½ of the time.
  • Make 1/4 of your plate protein. Use different sources of protein such as low mercury fish 2 or 3 times a week. See more information about fish in the section below. Choose lean meats and poultry.
  • Aim at eating less “empty” calories. This means the food has a lot of calories but not a lot of nutrients such as candy, chips, or sugary drinks.

Other ways to eat healthy and make sure you’re getting enough nutrients are:

  • Eat snacks that have good amounts of nutrients such as fruit, cereal and yogurt. Choose snacks that are low in fat and sugar.
  • You may find it easier to eat six smaller meals throughout the day. This can also be helpful later in pregnancy to avoid indigestion.
  • Drink six to eight glasses of water each day.
  • Take your prenatal vitamin every day. This is a multivitamin made just for pregnant women and can help you make sure you get enough folic acid and iron.
  • Make sure your whole meal fits on one plate. Don’t make huge portions.

Is it okay to eat fish when you’re pregnant?

Yes, as long as you eat the right kinds! Most fish are low in fat and high in protein and other nutrients your body needs like omega-3 fatty acids. Omega-3 fatty acids are important for brain development.

Some fish have mercury, a metal that can harm your baby. When you’re pregnant, it’s OK to eat fish as long as it’s low in mercury. And be careful to limit the amount. If you’re pregnant, thinking about getting pregnant or breastfeeding, eat 8 to 12 ounces each week of fish that are low in mercury like:

  • Shrimp
  • Salmon
  • Sardines
  • Catfish
  • Canned light tuna
  • Albacore (white) tuna — Don’t have more than 6 ounces of this tuna in 1 week.

Figure 1. Pregnancy and fish diet

Pregnancy and fish diet

How can I eat healthy if I am a vegetarian?

If you’re a vegetarian and pregnant, it’s possible to get the nutrients you need. Talk to your provider about how to get the nutrients you and your baby need during pregnancy. Some helpful tips are:

  • Make sure you get enough protein from sources like soy milk, tofu and beans. If you’re on a diet that allows for animal products, you can also eat eggs, milk and cheese.
  • Eat lots of foods that have good amounts of iron such as vegetables and legumes like spinach, white beans, kidney beans and chickpeas.
  • For calcium if you cannot have dairy foods, eat dark leafy greens, calcium-enriched tofu and other products enriched with calcium such as soy milk, rice milk or orange juice.
  • Some cereals and milk may also be fortified with vitamin B12.

What if I have other concerns about my diet?

Some women may be lactose intolerant, they can’t fully digest lactose in dairy products. Others are unable to eat things like gluten (found in wheat, barley and rye) due to Celiac disease. Your doctor can help you plan your diet or advise you take certain supplements. Other helpful tips for healthy eating are:

  • For lactose intolerant women, calcium can be found in other foods like seeds, nuts and soy. There are also lactose-free milks, cheeses and other dairy products.
  • For women with Celiac disease, many gluten-free options can be found in grocery stores and include a variety of fruits, vegetables, meats potatoes, poultry and beans.
  1. Foster GD, Wyatt HR, Hill JO, Markis AP, Rosenbaum DL, Brill C, Stein RI, Mohammed BS, Miller B, Rader DJ, Zamel B, Wadden TA, Tenhave T, Newcomb CW, Klein S. Weight and metabolic outcomes after 2 years on a low-carbohydrate versus low-fat diet: a randomized trial. Ann Intern Med. 2010;153(3):147–157. doi: 10.7326/0003-4819-153-3-201008030-00005
  2. McDonald L. The Ketogenic Diet: A Complete Guide for the Dieter and Practitioner. Lyle: McDonald; 1998.
  3. Sussman D, van Eede M, Wong MD, Adamson SL, Henkelman M. Effects of a ketogenic diet during pregnancy on embryonic growth in the mouse. BMC Pregnancy Childbirth. 2013;13:109. Published 2013 May 8. doi:10.1186/1471-2393-13-109
  4. Sussman D, Ellegood J, Henkelman M. A gestational ketogenic diet alters maternal metabolic status as well as offspring physiological growth and brain structure in the neonatal mouse. BMC Pregnancy Childbirth. 2013;13:198. Published 2013 Oct 29. doi:10.1186/1471-2393-13-198
  5. Robinson AM, Williamson DH. Physiological roles of ketone bodies as substrates and signals in mammalian tissues. Physiol Rev. 1980;60(1):143–187.
  6. Halestrap AP, Wilson MC. The monocarboxylate transporter family–role and regulation. IUBMB Life. 2012;64(2):109–119. doi: 10.1002/iub.572
  7. Nagai A, Takebe K, Nio-Kobayashi J, Takahashi-Iwanaga H, Iwanaga T. Cellular expression of the monocarboxylate transporter (MCT) family in the placenta of mice. Placenta. 2010;31(2):126–133. doi: 10.1016/j.placenta.2009.11.013
  8. Patel MS, Srinivasan M, Aalinkeel R. Metabolic programming by nutrition during early development. Indian J Exp Biol. 2000;38(9):849–855.
  9. Rudolf MC, Sherwin RS. Maternal ketosis and its effects on the fetus. Clin Endocrinol Metab. 1983;12(2):413–428. doi: 10.1016/S0300-595X(83)80049-8
  10. Jones CT, Rolph TP. Metabolism during fetal life: a functional assessment of metabolic development. Physiol Rev. 1985;65(2):357–430.
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Diet PlanDiet, Food & Fitness

Slimming World diet

slimming world diet

What is the Slimming World diet

The commercial weight management organization, Slimming World (and Rosemary Conley and Weight Watchers), meets the National Institute for Health and Care Excellence (NICE) best practice criteria 1  to be effective at 12 to 18 months – in helping adults adopt the lifestyle behavior changes needed to reduce weight, prevent weight gain and support long-term weight maintenance.

Slimming World’s weight loss plan encourages you to swap high-fat foods for low-fat foods that are naturally filling. You choose your food from a list of low-fat foods they call “Free Foods”, such as fruit, vegetables, pasta, potatoes, rice, lean meat, fish and eggs, which you can eat in unlimited amounts. There’s no calorie counting, no foods are banned, and you’re still allowed the occasional treat. You can get support from fellow slimmers at weekly group meetings and follow an exercise plan to become gradually more active. The plan is designed to help you lose about 1-2lb a week.

The organisation has an extensive community-based infrastructure of over 13,000 support groups held each week across the UK and Ireland, supporting ~800,000 members seeking to manage their weight and to develop healthy eating and lifestyle behaviors 2, 3. Groups are located in a variety of local venues at different times and days of the week, making the groups widely accessible for members of the community. Around 98 % of participants access the groups through self-referral and pay weekly (£4.95) to attend their chosen group. This is an open programme, with no fixed duration of membership. Participants can join, leave and re-join as they wish for any length of time as support groups are continuously available week-by-week through the year, to maximise attendance and engagement from members of the community.

The programme consist of a multi-component approach utilizing evidence-based behavior change techniques in the context of group support targeted to individual needs to help members to make healthier food choices and gradual increases in physical activity 4. Trained facilitator-led group support provides an environment, which avoids criticism, prescriptive control or judgment and facilitates sustainable health related behavior changes. The support system combines individual attention and group participation in a forum where members discuss experiences, identify their own patterns of behavior and, with the support of the group, develop new ways of overcoming barriers to change to support weight loss and maintenance of weight loss.

Evidence-based strategies and actions taken in the programme to promote and sustain weight loss include:

  • Self-regulation through a variety of techniques including:
    • (i) weekly recording of body weight,
    • (ii) use of diaries to self-monitor food, activity, feelings and emotions and energy density risk scaling tools to encourage participants to eat more healthily,
    • (iii) individualized motivation and group support for self-monitoring, goal setting, action plans, contingent reinforcement, and pre-planned strategies for relapse events 5.
  • Motivational components for dietary and physical activity change involving practices focused on improving intrinsic motivation and self-efficacy for physical activity and healthy eating 6.
  • Emotion regulation and stress management components through a non-judgemental, non-stigmatic and de-shaming environment of social support enabling shared experience with an emphasis on the importance of compassion and self-compassion 7.

Slimming World Diet reviews

Weight change and attendance

The characteristics and outcomes for higher attenders and lower attenders are given in Table 1. Mean weight change of all participants was −3.9 kg, percent weight change −4.4 %, BMI after 3 months was 31.2 kg/m2 and mean BMI change was −1.4 kg/m2. Mean attendance was 7.8 of a possible 14 sessions. Excluding all subjects who only attended one week and therefore recorded no weight change (n = 91,814), mean weight change was −4.2 kg, percent weight change −4.7 % (3.7), mean BMI change was −1.5 kg/m2 and mean attendance was 8.2 (4.0). 478,772 (35.3 %) of participants attended at least 75 % of sessions (higher attenders) and 877,333 (64.7 %) were classified as lower attenders. Mean attendance of higher attenders was 12.5 sessions and for lower attenders was 5.1 sessions. 37.6 % of the whole population and 75.7 % of the higher attenders lost at least 5 %, 23.1 % of higher attenders and 9.0 % of the whole population lost equal to or more than 10 % of their body weight over the 14 possible sessions.

Table 1 shows that higher attenders on average were slightly heavier (2.3 kg), older, (3.5 years) had a slightly higher BMI (0.9 kg/m2) and a similar height on enrolment to lower attenders 2. Higher attenders lost significantly more weight than lower attenders (6.8 versus 2.3 kg, respectively), during the 14-week period. The same patterns were evident for percent weight loss (7.5 versus 2.7 % respectively and for change in BMI (−2.5 versus −0.9 kg/m2 respectively).

Figure 1 shows the percentage of the whole population, higher attenders and lower attenders who achieved 5 % and ≥10 % weight loss by week 14. 75.7 % of higher attenders and 16.9 % of lower attenders achieved at least 5 % weight loss. 23.1 % of higher attenders lost at least 10 % of their initial body weight by the end of the referral period compared to 1.3 % of lower attenders.

Table 1. The characteristics and weight loss outcomes for higher attenders (n = 478,772) and lower attenders (n = 877,333). Higher attenders are defined as those who attended ≥75 % of the 14 sessions of the observation period. Lower attenders are those who attended ≤75 % of sessions

Higher attendersn = 478,772Lower attendersn = 877,333
Height (m)1.650.081.650.07
Weight (kg)89.91987.618.6
Age (years)44.613.841.113.3
Weight change (kg)–6.83.6–2.32.4
Weight change (%)–7.53.5–2.72.6
Attendance (wks)
Start BMI (kg/m2)33.26.332.36.2
End BMI (kg/m2)30.7631.46.2
BMI change (kg/m2)–2.51.3–0.90.9
[Source 2]

Figure 1. The percentage of the whole population, higher attenders and lower attenders who achieved 5 % and 10 % weight loss by the end of the 14 sessions of the observation period (n = 1,356,105)

slimming world diet weight loss percentage

[Source 2]

Men and women

Table 2 compares the characteristics and weight loss outcomes for men and women. Men were on average taller (0.14 m), older (2 years), heavier (26.2 kg) and had a higher BMI (3.2 kg/m2) on enrolment than women. Men tended to lose more weight than women both absolutely (2.7 kg) and as a percentage (1.4 %) of baseline body weight. Men attended to a slightly greater degree than women (0.8 sessions) and they had a greater BMI change (−0.7 kg/m2) than women over the 14 sessions of the observation period. There was a significant difference in the percentage of men and women classed as higher attenders (42.5 % versus 34.9 %, respectively).

A significantly higher percentage of men than women lost 5 % (51.1 % versus 36.9 %) and 10 % (18.3 % versus 8.6 %, respectively) of their baseline weight by the 14th session.

Table 2. The characteristics and weight loss outcomes for men (n = 67,139) and women (n = 1,288,966)

Menn = 67,139Womenn = 1,288,966
Height (m)1.780.071.640.07
Start weight (kg)113.321.887.117.7
Age (years)44.213.342.213.6
Weight change (kg)–6.55.3–3.83.4
Weight change (%)–5.74.4–4.33.7
Attendance (wks)
Start BMI (kg/m2)35.66.332.46.2
BMI at 3 months (kg/m2)33.56.1316.1
BMI change (kg/m2)–2.11.7–1.41.3
[Source 2]

Rates of weight change

The average rate of weight change over the 14-week time window, in kg/week for the total population was −0.28 kg/week. Analysis of variance showed that men lost weight at a significantly faster rate (−0.47 versus −0.27 kg/week or 0.41 versus 0.31 %, respectively) than women, both in absolute and percent terms. Higher attenders lost weight at a significantly faster rate than did lower attenders (−0.48 versus −0.17 kg/week). These patterns were also apparent for percent weight loss −0.53 versus 0.19 %, respectively.

Figure 2 shows that the rate of weight loss decreased as the process of weight reduction proceeded from the start to end of the observation period. The slope for the rate of weight loss was steeper during weeks 1 to 7 than weeks 8 to 14 for the whole population and for men compared to women.

Figure 2. Mean cumulative weight change for the whole study population (n = 1,356,105), women (n = 1,288,966) and men (n = 67,139) over the 14-sessions of the observation period

average weight loss on slimming world diet plan

[Source 2]

Weight change in different BMI groups

39.8 % of participants had a BMI <30 kg/m2, 30.8 % between 30–34.9 kg/m2, 17.3 % between 35–39.9 kg/m2 and 12.2 % had a start BMI ≥40 kg/m2. Absolute weight loss increased with increasing BMI category. Absolute weight changes were −3.1, −3.9, −4.5, and −5.4 kg for the BMI categories <30 kg/m2, 30–34.9 kg/m2, 35–39.9 kg/m2 and ≥40 kg/m2, respectively. However, percent weight change was similar in each BMI category at −4.2, −4.5, −4.5 and −4.4 % for BMI categories <30 kg/m2, 30–34.9 kg/m2, 35–39.9 kg/m2and ≥40 kg/m2, respectively. The significance of these comparisons reflects a small effect size but a very large sample size.

Prediction of weight loss

The greatest predictors of percent weight loss were gender (men losing more than women), number of attendances and percent weight lost in the first week 2. Height and start BMI had considerably smaller impacts on percent weight lost at 3 months although due to the very large sample size factors for height and BMI were significant at p < 0.001. Age, height, gender and starting BMI all explained a very small amount of the variance in percent weight lost. In the case of gender it should be borne in mind that men accounted for 5 % of the sample. Attendance accounted for 44 % of the total variance in percent weight lost at the end of the 3-month period. Percent weight lost during the first week of attendance was also an important predictor of total weight lost, accounting for 11.3 % of the variance.

Thus, considering that men accounted for only 5 % of the sample, the two key predictors of percent weight loss by the end of the 3 month period were attendance and percent weight lost in the first week. However, week 1 weight loss was also related to attendance, since adding week 1 weight loss into the stepwise model first increased the percent variance explained by the first week’s weight loss to 19.6 % and decreased the percent of the variance due to attendance to 35.6 %. Since week 1 loss is included in the total loss, some correlation is inevitable unless there is complete compensation in later weeks. Therefore, week 1 loss is positively correlated with subsequent loss up to 3 months. Those who lost more weight in week 1 tended to attend longer. Both models explained the same total amounts of variance in percent weight lost.


In the Slimming World weight management programme, no foods are banned, so meals offer balance and variety and are family-friendly. The portion size from each food group will vary depending on which plan you follow. The “Body Magic” booklet they provide gives ideas to help you raise your activity levels. Meeting as a group can provide valuable support. Slimming World diet’s group meetings encourage members to share successes, ideas and recipes with each other, but they may not appeal to everyone. While the meal plans may lack some flexibility, they are generally balanced. Higher levels of attendance led to levels of weight loss known to be associated with significant clinical benefits, which on this scale may have an impact on public health. However, without learning about calories and portion sizes, you may struggle to make healthy choices once you’ve left the programme.

Another interesting outcome from this study was that the percentage weight lost in the first week and attendance were the greatest predictors of weight loss. These effects has also been found in other studies 8, 9. Attendance is discussed above. The relationship between percent weight lost in the first week and end weight loss is less clear. It may be that those who lose a greater percent of baseline weight in the first week are more motivated (either before they attend or as a consequence of their experiences in the first week), they may have familiarized themselves with the eating and activity programme to a greater extent, are simply on a consistent trajectory of greater weight loss or a combination of these variables. What is known is that certain behavior change techniques are associated with better weight outcomes 10. Evidence also suggests that greater engagement with components of commercial programmes that promote these behaviour changes is associated with better weight outcomes 11. Improving personalisation of multicomponent programmes to better match behavior change techniques to the requirements of specific individuals is likely to further improve engagement and weight outcomes. This should be a research priority for implementing weight management solutions in the general population and may improve the capacity of models to predict weight outcomes for different groups of people.

Slimming World diet Pros:

In the present review mean weight loss was 3.9 kg, 37.7 % of the whole population and 75.7 % of the higher attenders lost ≥5 % during the first 3 months of their engagement in the Slimming World weight management programme. Twenty three percent of higher attenders and 9.0 % of the whole population lost ≥10 % of their body weight. These data have confirmed that there are two simple basic predictors (attendance and weight loss in the first week) of weight loss that together account for 55 % of the variability in weight lost during the study period, which would be valuable indicators of the likelihood a person will lose ~5 % of their initial body weight during that time. Weight management programmes should therefore work to enhance initial weight loss and attendance because regardless of age or starting weight, if a person is able to attend 11 or more sessions in a 3 month period and is supported and encouraged to achieve good weight losses in their first week, they are likely to be successful in beginning their weight loss journey.

Slimming World diet Cons:

Slimming World doesn’t educate you about calories. Without learning about calories and portion sizes, you may struggle to keep the weight off in the long term when you come off the programme.

  1. Weight management: lifestyle services for overweight or obese adults.
  2. Stubbs RJ, Morris L, Pallister C, Horgan G, Lavin JH. Weight outcomes audit in 1.3 million adults during their first 3 months’ attendance in a commercial weight management programme. BMC Public Health. 2015;15:882. doi:10.1186/s12889-015-2225-0.
  4. Stubbs RJ, Lavin JH. The challenges of implementing behaviour changes that lead to sustained weight management. Nutr Bull. 2013;38:5–22. doi: 10.1111/nbu.12002.
  5. Dombrowski SU, Sniehotta FF, Avenell A, Johnston M, MacLennan G, A-S V. Identifying active ingredients in complex behavioural interventions for obese adults with obesity-related co-morbidities or additional risk factors for co-morbidities: a systematic review. Health Psychol. 2012;6:7–32.
  6. Teixeira PJ, Silva MN, Mata J, Palmeira AL, Markland D. Motivation, self-determination, and long-term weight control. Int J Behav Nutr Phys Act. 2012;9:22. doi: 10.1186/1479-5868-9-22.
  7. Stubbs RJ, Gail C, Whybrow S, Gilbert P: The evolutionary inevitability of obesity in modern society: implications for behavioral solutions to weight control in the general population. In: Obesity and Weight Management: Challenges, Practices and Health Implications. edn. Edited by Martinez MP, Robinson H. Hauppauge NY 11788-3619 USA: Novo Publishing. 2012.
  8. Postrach E, Aspalter R, Elbelt U, Koller M, Longin R, Schulzke JD, Valentini L. Determinants of successful weight loss after using a commercial web-based weight reduction program for six months: cohort study. J Med Internet Res. 2013;15:e219. doi: 10.2196/jmir.2648.
  9. Hemmingsson E, Johansson K, Eriksson J, Sundstrom J, Neovius M, Marcus C. Weight loss and dropout during a commercial weight-loss program including a very-low-calorie diet, a low-calorie diet, or restricted normal food: observational cohort study. Am J Clin Nutr. 2012;96:953–961. doi: 10.3945/ajcn.112.038265.
  10. Hartmann-Boyce J, Johns DJ, Jebb SA, Aveyard P, Behavioural Weight Management Review G Effect of behavioural techniques and delivery mode on effectiveness of weight management: systematic review, meta-analysis and meta-regression. Obes Rev. 2014;15:598–609. doi: 10.1111/obr.12165.
  11. Neve MJ, Morgan PJ, Collins CE. Behavioural factors related with successful weight loss 15 months post-enrolment in a commercial web-based weight-loss programme. Public Health Nutr. 2012;15:1299–1309. doi: 10.1017/S1368980011003090.
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Diet PlanDiet, Food & Fitness

Rosemary Conley diet

Rosemary Conley Diet

What is the Rosemary Conley diet

Rosemary Conley’s “Eat Yourself Slim” Diet and Fitness Plans (a low fat diet combined with a weekly group exercise class) combine a low-fat, low-GI diet with regular exercise 1. You can follow her recipes or her various diets and fitness programmes. The Rosemary Conley’s diet recommends participants choose foods with less than a 4% fat content, with the exception of oily fish, porridge oats and lean meat. In contrast, protein energy increased by 4%, carbohydrate rose by 8%. There was no significant change in % energy derived from alcohol. Overall there was a fall of 37% in mean daily energy intake. Her online weight loss club has a range of tools and videos covering cooking classes, medical, psychological and nutritional advice, plus exercises for all fitness levels. There is also support and motivation from trained coaches. You learn about calorie counting and portion size, which can help you sustain your weight loss beyond the programme. The diets are designed to help you lose a stone in seven weeks and encourage lifestyle change. How long you stay on the plan depends on your weight loss goal.

Rosemary Conley Diet reviews

‘Diet Trials’ 2, a large UK multi-site unblinded randomized controlled study was designed to compare the relative efficacy of four commercial weight loss programmes on weight and body fat loss and the primary outcomes of this study have recently been published. The diets were chosen as being representative of the major different approaches to weight management available in the UK: the Slim-Fast Plan (a meal replacement approach), Weight Watchers Pure Points Programme (an energy controlled diet with weekly group meetings), Dr Atkins’ New Diet Revolution (a low carbohydrate eating plan) and Rosemary Conley’s “Eat Yourself Slim” Diet & Fitness Plan (a low fat diet combined with a weekly group exercise class). All diets resulted in significant loss of body fat and weight over six months. Groups did not differ significantly but loss of body fat and weight was greater in all groups compared with the control group 2. In an intention to treat analysis, average weight loss was 5.9 kg and average fat loss was 4.4 kg over six months 2. The Atkins diet resulted in significantly higher weight loss during the first four weeks, but by the end was no more or less effective than the other diets 2.

Macro and micro-nutrient composition of diet at baseline

At baseline the average % of energy from macronutrients comprised of 42% carbohydrate, 37% fat, 16% protein, 5% alcohol for the whole cohort. In terms of fat content, the average baseline diet contained 30.8 g saturated fat, 14.8 g polyunsaturated and 28.4 g monounsaturated fat. All micronutrient intakes exceeded their respective reference nutrient intake values with the exception of potassium where the average intake was 95% reference nutrient intake. There were no significant differences between the baseline diets in terms of macro, micro-nutrient or % energy derived from alcohol. Therefore, all data presented are changes for each diet group from baseline measurement.

Alteration in fat intake

Of interest in this analysis, is the effect of the different dietary programmes on the type and amount of fat intake and in particular differences between the low carbohydrate and low fat diets (Weight Watchers and Rosemary Conley). Change in dietary fat intake was calculated from baseline to 8 weeks in terms of absolute intake (g/day), see Figure ​1. This shows that although there was a proportional increase in % energy from fat in the Atkins dieters, there were no significant changes in absolute intake of fat per day or in the quantity of saturated fat consumed. It should be noted, the amount of saturated fat consumed fell significantly on all the other diets and also in the control group.

Figure 1. Change in fat (g/day) between baseline and 2 months for those following the Atkins, Weight Watchers, Rosemary Conley and Slimfast diets

changes in fat intake

WW= Weight Watchers; SF = Slim Fast; RC= Rosemary Conley

[Source 1]

Macronutrient changes

Alteration of energy intake across all diet groups was apparent over the study period with significant falls in total energy intake and energy intake/kg/body weight recorded. This was mirrored by analysis of the ‘plausible reporters’ sub-group which showed a significant reduction in energy intake (kJ/kg/day) between baseline and two months, with significant differences between control and all active diet groups. These falls in energy intake are substantiated by the physiological measures of weight loss. In summary, the mean weight losses (kg) over the 2 month study were as follows: Atkins 5.2 kg, Weight Watchers 4.7 kg, Slim-Fast 3.7 kg, Rosemary Conley 4.0 kg, Control 0.4 kg, with all diet groups being significantly greater than control but there were no differences between active diet groups.

Figure 2. Alteration in percentage of energy from macronutrients from baseline and after 8 weeks of dieting

Alteration in percentage of energy from macronutrients

WW= Weight Watchers; SF = Slim Fast; RC= Rosemary Conley

[Source 1]

Changes in micronutrients

Micronutrient intakes reported as a proportion of recommended daily intakes are summarized in Table 1 using data for completers only. All of the Atkins group were calculated without micronutrient supplementation and the recommended daily intakes for thiamin was calculated as 0.4 mg/4200 kj reported energy intake. At baseline, the only micronutrient consistently below recommended daily intakes was potassium, this showed a trend to drop further away from the recommended daily intakes in all diet groups over time. In this study, there were significant differences in iron intake between males and females at baseline. At baseline, men had an absolute iron intake (median 14.6 mg, range 5.7 – 27.1 mg/day) that was significantly higher than women (median 11.9 mg range 5.6 – 23 mg/day). Changes in intake of iron (mg/day) from baseline to two months demonstrated a significant effect of diet group for women only .

Changes within diet groups are summarised as follows:

Atkins group

There were significant falls in % recommended daily intake for folate, magnesium, calcium, iron and potassium and a significant increase in selenium.
Weight Watchers group

There were significant declines in % recommended daily intake for riboflavin, niacin, potassium, calcium, magnesium, iron and zinc.

Slimfast group

There was a significant decline for niacin and a rise in % recommended daily intake for zinc after 2 months.

Rosemary Conley group

There were significant decline in % recommended daily intake for magnesium, potassium and zinc.

Control group

There were no significant alterations in micronutrient % recommended daily intake in the control group.

Table 1. Micronutrient intake (mean % recommended daily intakes) and percentage change in recommended daily intakes over the 2 month study period by diet group for individuals with data recorded at baseline and at follow-up

AtkinsWt WatchersSlimfastRosemary ConleyControl
Baseline2 monthBaseline2 monthBaseline2 mnthoBaseline2 mBaseline2 m
Vitamin A
Vitamin C

[Source 1]

Dietary fiber and fruit and vegetable intake

Intake of dietary fiber was on average 17.7 g/day; with no diet group differences but gender differences were apparent with men consuming on average 3 g/day more dietary fibre than women. Baseline intake of non-starch polysaccharide was below the recommended intake of 18 g/day (mean intake 12.8 g/day).

The median number of fruit and vegetable portions consumed at baseline was 17 portions per week (2.4 portions per day). Only 12% of the entire cohort achieved the UK recommended intake of ≥ 5 fruit and vegetables portions per day at baseline. There were no between diet group differences in portions of fruit and vegetables eaten at baseline.

Only the Weight Watchers diet led to a significant increase of fruit and vegetables and this amounted to less than one portion per day (0.79 portions per day). There was a trend towards an increase in the Rosemary Conley group (0.53 portion increase); there were no significant shifts for the other diets tested. Although portions of fruit and vegetables eaten on the Atkins diet did not alter over time, there was a significant reduction in non-starch polysaccharide intake in the Atkins dieters. A repeated measures of non-starch polysaccharide intake from baseline to 2 months of all diet groups showed a significant effect of diet group and post hoc testing demonstrated a significant reduction in non-starch polysaccharide (12.8 g at baseline to 5.1 g at 2 months) for the Atkins group compared to all the other diets.

Weight and fat loss

Monthly weight loss by using all available data (Figure 3) was high initially but then slowed. Loss of body fat showed similar patterns (see Table 2). Mean weight loss was significantly higher in the Atkins group than in the other diet groups during the first four weeks: Atkins 4.4 kg (range 13.5 to 0.3 kg), Weight Watchers 2.86 kg (range 12.9 to – 0.9 kg), Slim-Fast 2.68 kg (range 9.4 to – 1.8 kg), and Rosemary Conley 3.17 kg (range 8.1 to – 2.0 kg). Furthermore, in the first two months, the greatest loss of body fat was also seen in the Atkins group; however, this loss was not significantly different from that seen in the Weight Watchers or Rosemary Conley groups, but it was significantly greater than that seen in the Slim-Fast group. Fat loss was significantly greater in all four diet groups than in the control group. Between two and six months, fat loss (kg and percentage) slowed down and the diets groups did not differ significantly. Between baseline and six months fat loss did not differ between diet groups, but fat loss in all diet groups was significantly greater than in the control group. All diets resulted in a reduction in waist circumference. Waist reduction (at six months) was highly correlated with total weight loss and moderately correlated with percentage of body fat lost.

Table 2. Mean baseline characteristics of participants in the BBC diet trials allocated to different diet regimens. Values are mean (SD)

CharacteristicAtkins diet (n=57)Weight Watchers (n=58)Slim-Fast (n=59)Rosemary Conley (n=58)Controls (n=61)
Age (years)40.9 (9.7)39.9 (10.9)38.9 (10.7)40.6 (10.3)40.8 (9.6)
Weight (kg)90.3 (12.7)88.8 (13.3)90.1 (14.1)89.8 (12.9)87.9 (13.5)
Body mass index (kg/m2)31.9 (2.2)31.2 (2.7)32.2 (3.0)31.6 (2.6)31.5 (2.9)
Body fat (kg)*35.7 (6.0)34.2 (6.9)35.6 (6.5)34.5 (7.6)33.4 (6.5)
Body fat (%)40.9 (6.6)39.7 (7.1)40.6 (6.5)39.6 (7.7)39.4 (6.8)
Waist circumference (cm)102 (10.6)100 (10.3)101 (11.5)100 (9.8)100 (10.1)
Blood pressure (mm Hg):
Systolic135 (15.1)127 (15.1)129 (17)130 (14.8)130 (16.1)
Diastolic83 (10.7)80 (10.7)81 (11.5)82 (10.3)81 (9.6)
Glucose (mmol/l)5.47 (0.5)5.46 (0.5)5.53 (0.6)5.6 (0.6)5.48 (0.5)
Total cholesterol (mmol/l)5.77 (0.9)5.58 (1.1)5.47 (1.1)5.63 (0.95)5.80 (1.1)
*Not measured in all participants: 57 for Weight Watchers, 56 for Rosemary Conley, 60 for controls.
Not measured in all participants: 56 for Atkins diet, 57 for Rosemary Conley, 59 for controls.
[Source 2]

Figure 3. Weight loss during the BBC diet trials

Weight loss during the BBC diet trials

[Source 2]

Table 3. Main outcome indicators in participants in the BBC diet trials allocated to different diet regimens

OutcomeAtkins diet (n=57)Weight Watchers (n=58)Slim-Fast (n=58)Rosemary Conley (n=58)Controls (n=61)
Weight loss (kg)
0-2 months5.2 (4.4)4.7 (3.2)3.7 (3.5)4.0 (3.3)0.4 (1.8)
2-6 months1.3 (3.1)2.2 (3.0)1.4 (2.8)2.4 (3.4)−0.9 (1.6)
0-6 months6.0 (6.4)6.6 (5.4)4.8 (5.6)6.3 (6.1)−0.6 (2.2)
Weight loss (%)
0-2 months5.5 (4.2)5.1 (3.5)3.8 (3.4)4.5 (3.6)0.4 (2.2)
2-6 months1.3 (3.1)2.4 (3.4)1.3 (2.9)2.7 (3.7)−1.2 (1.9)
0-6 months6.2 (6.2)7.3 (6.1)4.9 (5.5)7.0 (6.6)−0.6 (2.7)
Fat loss (kg)*
0-2 months3.5 (3.0)3.1 (2.4)2.3 (2.3)2.5 (2.1)0.2 (1.3)
2-6 months1.2 (2.3)2.0 (2.3)1.2 (2.6)2.1 (2.5)−0.5 (1.2)
0-6 months4.6 (4.8)5.0 (4.3)3.4 (4.3)4.5 (4.3)−0.3 (4.4)
Fat loss (%)
0-2 months1.9 (1.9)1.6 (1.9)1.0 (1.4)1.5 (1.5)0.1 (1.4)
2-6 months1.3 (1.9)2.0 (2.0)1.2 (2.4)2.1 (2.4)−0.0 (1.0)
0-6 months3.1 (3.3)3.6 (3.3)2.1 (2.9)3.4 (3.5)0.1 (1.6)
Reduction in waist circumference (cm)
0-2 months6.7 (6.1)5.5 (5.1)4.8 (4.6)4.5 (5.3)1.0 (4.0)
2-6 months2.4 (4.0)3.0 (3.5)2.1 (3.4)3.0 (4.2)−0.3 (2.4)
0-6 months8.1 (7.4)8.3 (7.0)6.4 (6.3)7.2 (7.2)0.8 (3.8)

For all variables reported, the control group was significantly different from all other groups (P<0.001).

*Not measured in all participants: 57 for Weight Watchers, 56 for Rosemary Conley, 60 for controls.
Pairwise comparison of group means with post hoc Tukey’s HSD (honestly significantly different) test found a significant difference between the Atkins and Slim-Fast groups.
[Source 2]

Analysis of diet programmes completers

A secondary analysis of data from participants who completed the trial shows the range of weight lost by these highly motivated participants, who probably adhered most strongly to the randomly allocated diets. Figure 4 shows the range of total weight lost; some participants lost more than 25 kg over the six month study period, whereas others gained weight. After six months all diets resulted in a clinically useful mean reduction in percentage body weight: Rosemary Conley 9.9%, Weight Watchers 9.0%, Atkins 8.9% and Slim-Fast 6.8% 2; no significant differences were seen between the diets but all were more successful than no diet (controls gained 0.95%, 3.3%). The proportion of participants who completed the trial and lost at least 10% of their body weight at six months was 46% for the Rosemary Conley group, 45% for the Atkins group, 36% for the Weight Watchers group, and 21% for the Slim-Fast group. These losses were achieved despite the random allocation of diets.

Figure 4. Absolute weight loss of participants who completed the BBC diet trials

Absolute weight loss of participants who completed the BBC diet trials

[Source 2]

Cardiac risk factors

The researchers found few significant differences in cardiac risk factors between the diets groups and the control group (Table 3). Initially, the fall in systolic pressure in the Atkins group was significantly greater than in the Slim-Fast group but not the other groups, probably because of the relatively greater initial weight loss in the Atkins group. Regression analysis showed that total weight loss over time had the greatest influence on systolic and diastolic pressure.

Glucose concentrations fell slightly over time; only in the Weight Watchers group was fasting glucose significantly lower than in the control group. In the first two months, a significant but small drop in total cholesterol was seen in all diet groups except for the Atkins group. By six months, cholesterol had fallen significantly compared with the control group only in the Weight Watchers group (by 0.55 mmol/l).

Table 4. Changes in cardiac risk factors in participants in the BBC diet trials allocated to different diet regimens. Values are mean (SD)

OutcomeAtkins diet (n=57)Weight Watchers (n=58)Slim-Fast (n=58)Rosemary Conley (n=58)Controls (n=61)
Fall in blood pressure
0-2 months:
Systolic5.7* (12.7)3.5 (9.6)0.5* (11.4)2.4 (11.2)3.3 (11.0)
Diastolic3.6 (8.4)4.1 (6.8)3.1 (7.8)2.8 (7.1)2.0 (7.0)
2-6 months:
Systolic1.3 (9.8)0.9 (10.3)2.9 (12.4)2.1 (9.2)−0.9 (8.3)
Diastolic1.1 (6.3)0.8 (6.7)−0.3 (8.6)1.0 (5.5)−0.4 (5.7)
0-6 months:
Systolic7.2 (11.6)4.1 (11.7)2.7 (10.7)4.5 (9.8)2.8 (11.6)
Diastolic4.9 (8.1)4.4 (8.6)2.5 (8.6)3.6 (6.0)1.6 (7.4)
Fall in total glucose (mmol/l)
0-2 months0.04 (0.4)0.14 (0.5)0.13 (0.5)0.15 (0.5)0.02 (0.4)
2-6 months0.13 (0.5)0.29 (0.6)0.12 (0.5)0.17 (0.5)0.13 (0.4)
0-6 months0.19 (0.5)0.46* (0.6)0.19 (0.6)0.27 (0.5)0.14* (0.5)
Fall in cholesterol (mmol/l)
0-2 months0.08 (0.7)0.44* (0.6)0.26* (0.6)0.35* (0.8)0.08 (0.5)
2-6 months0.19 (0.5)0.11 (0.5)0.07 (0.5)0.08 (0.6)0.24 (0.24)
0-6 months0.29 (0.8)0.55* (0.7)0.35 (0.6)0.5 (0.5)0.5* (0.18)
*Pairwise comparison of group means using post hoc Tukey’s HSD (honestly significantly different) test showed a significant difference in systolic blood pressure at 2 months between the Atkins and Slim-Fast groups; in the fall in glucose at 6 months between the control and Weight Watchers groups; in the fall in total cholesterol at 2 months between the Weight Watchers, Rosemary Conley, and Slim-Fast groups; and in the fall in total cholesterol at 6 months between the Weight Watchers and control groups.
[Source 2]

Compliance with the diets

Reported attendance at slimming clubs was similar at two months (Rosemary Conley 79%, Weight Watchers 66%) and six months (Rosemary Conley 47%, Weight Watchers 47%). Slim-Fast recommends 14 meal replacements each week; participants reported 10 each week at two months and eight at six months. With the Atkins diet, reported portions of carbohydrate foods fell from 40 each day at baseline to five at two months and seven at six months.

Withdrawal from diet programmes

Eighty three (28%) participants had withdrawn by six months (Table 5); 53 (64% of the total number) had withdrawn by week 8, and at this time only seven (8%) participants who withdrew had lost more than 5% of their body weight compared with 53 (25%) who completed the trial. Older participants were significantly more likely to complete than younger ones (mean age 41.6 v 36.8). No differences in diet, center or sex were found between participants who completed or withdrew. Withdrawal in the control group (21; 35%) was mostly because participants did not wish to delay dieting.

Table 5. Reasons for withdrawal from the diet

GroupDissatisfied with randomization

Could not tolerate diet

Dissatisfied with weight loss

Non-compliant or lost to follow-up



Total (% of initial cohort)

Atkins diet021600021502 (13)15 (36)
Weight Watchers010201240102 (13)9 (21)
Slim-Fast001603410115 (29)12 (29)
Rosemary Conley210112132406 (40)11 (26)
Controls212211305 (33)16 (35)
Total41621516911414120 (25)63 (29)

M=male, F=female.

[Source 2]

Follow-up at 12 months

At 12 months, 158 participants (54% of the original sample) returned data; 29 had originally been allocated to the Atkins diet, 33 to Weight Watchers, 33 to Slim-Fast, 35 to Rosemary Conley, and 28 to the control group. Dieting behaviour had changed considerably: only 58 (45%) were still keeping to their originally allocated diets (nine to Atkins, 20 to Weight Watchers, nine to Slim-Fast, 20 to Rosemary Conley). Twenty five (19%) had swapped dietary programmes and 47 (36%) were following their own diet or exercise plan. More participants in the unsupported programmes (Atkins diet and Slim-Fast) withdrew than in the supported programmes. Participants in the control group who had switched to dieting (mean weight loss 6.37 kg) also preferred group based approaches because just over half chose Weight Watchers.

Because so many participants changed diets (25% of men and 29% of women), we also analysed weight loss in participants who had maintained the diet to which they were initially allocated (Table 6). Statistical analysis is limited by sample size but indicates that weight rebound after the initial six months was higher in the unsupported programmes; however, all diets resulted in a clinically useful weight loss of around 10% after 12 months in participants who had persisted with the diet allocated.

Table 6. Mean weight loss for participants in the BBC diet trials who completed 12 months on the diet to which they were randomly allocated

Weight lossAtkins diet (n=9)Weight watchers (n=20)Slim-Fast (n=9)Rosemary Conley (n=20)
0-12 months:
Absolute weight loss (kg)9.0 (4.1)9.1 (6.2)10.7 (6.2)10.9 (4.1)
Weight loss (% of initial body weight)10.3 (4.7)10.3 (6.0)11.4 (5.9)13.1 (4.9)
6-12 months:
Absolute weight loss (kg)−1.5 (3.3)0.45 (3.6)−1.65 (3.1)1.2 (3.5)
[Source 2]


Clinically beneficial weight loss is possible through the 4 commercially available strategies (Weight Watchers, Slim-Fast, Rosemary Conley and Atkins) and reduced blood pressure and waist circumference accompany weight loss. The four different approaches were equally effective after six months 2. Reductions in weight and body fat were seen with the Atkins diet within the first eight weeks of dieting, so that the large weight changes seen with low carbohydrate diets are not caused by loss of body water alone. The Atkins diet had no detrimental effects on total cholesterol concentrations or renal function, although the overall safety of the diet was not tested 3.

No dietary differences were apparent at six months, but behavior from six to 12 months points towards an advantage of programmes based on group support.

The range of absolute weight loss in participants who completed the study was wide. However, the mean absolute weight loss of around 8 kg is comparable to other studies 4. Compliance with each diet varied greatly. Weight can be lost only by a sustained negative balance of energy, so the degree of adherence to a diet will predict success or failure if activity levels remain constant.

The need for a “quick fix” and the relative lack of interest that people show in achieving modest weight loss contribute to lack of adherence to most diets in the long term. People who had kept to their allocated diet lost about 10% of their weight, despite some weight rebound, but some regression to the mean effect was seen.

  • Overall, mean weight loss did not vary significantly between the 4 commercially available diet groups (Weight Watchers, Slim-Fast, Rosemary Conley and Atkins).
  • Clinically useful weight loss and fat loss can be achieved in adults who are motivated to follow commercial diets for a substantial period.
  • The Rosemary Conley’s diet and exercise plans offer a balanced approach to weight loss that teaches you about portion size, the importance of regular exercise and making healthier choices. The educational element is very useful for long-term weight management once you have left the programme.

Rosemary Conley’s diet Pros:

The programme is based around calories, with a focus on cutting fat. The “portion pots” – which are used to measure foods such as rice, cereal, pasta and baked beans – teach you about portion control. Physical activity is an integral part of the weight loss plan, with exercise videos suitable for all ages, sizes and abilities offered online.

Rosemary Conley (and Slimming World and Weight Watchers), meets the National Institute for Health and Care Excellence (NICE) best practice criteria 5 to be effective at 12 to 18 months – in helping adults adopt the lifestyle behavior changes needed to reduce weight, prevent weight gain and support long-term weight maintenance.

Rosemary Conley’s diet Cons:

Some low-fat products aren’t necessarily healthier, as they can still be high in sugar and calories. It’s unrealistic to expect people to go out with their portion pots, which means portion control may be tricky away from the home.

  1. Truby H, Hiscutt R, Herriot AM, et al. Commercial weight loss diets meet nutrient requirements in free living adults over 8 weeks: A randomised controlled weight loss trial. Nutrition Journal. 2008;7:25. doi:10.1186/1475-2891-7-25.
  2. Truby H, Baic S, deLooy A, et al. Randomised controlled trial of four commercial weight loss programmes in the UK: initial findings from the BBC “diet trials.” BMJ : British Medical Journal. 2006;332(7553):1309-1314. doi:10.1136/bmj.38833.411204.80.
  3. Safety of low-carbohydrate diets. Crowe TC. Obes Rev. 2005 Aug; 6(3):235-45.
  4. The efficacy of dietary fat vs. total energy restriction for weight loss. Harvey-Berino J. Obes Res. 1998 May; 6(3):202-7.
  5. Weight management: lifestyle services for overweight or obese adults.
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Diet PlanDiet, Food & Fitness

White tea

white tea

What is white tea

White tea is tea made from new growth buds and young leaves of the plant Camellia sinensis. White tea leaves are steamed and dried almost immediately after harvesting (sometimes before even leaving the fields) or fried to inactivate oxidation and then dried. Currently there is no generally accepted definition of white tea and very little international agreement; some sources use the term to refer to tea that is merely dried with no additional processing 1, some to tea made from the buds and immature tea leaves picked shortly before the buds have fully opened and allowed to wither and dry in natural sun, while others include tea buds and very young leaves which have been steamed or fired before drying. Most definitions agree, however, that white tea is not rolled or oxidized, resulting in a flavor characterized as “lighter” than green or traditional black teas.

White tea

  1. The Chinese position: white tea is defined by the sub-species it is manufactured from (Camellia sinensis var. khenghe baihao) and Camellia sinensis var. fudin bai hao) found only in Fujian province and with minimal processing following traditional guidelines. White tea is a seasonal crop (spring) with special sensory and health benefits.
  2. Other producing countries define white tea by plucking standard i.e. only the bud or first leaves that are plucked and dried with minimal processing. In this way the delicate white leaf hairs are left intact lending the appearance of ‘white tea’. It has to be noted that, if this definition would be generally accepted, it would exclude traditional Chinese white tea varieties such as Pai Mu Tan (White Peony).

So there are a few issues: firstly the appearance (liquor of white tea is very pale yellow in color, and mild tasting in cup) and secondly the manufacture (minimal processing, just drying, no “fermentation”).

There are health claims underway, such as:

  • (a) white tea is lower in caffeine than green tea,
  • (b) white tea is much higher in antioxidants, esp. catechins than green tea and
  • (c) white tea has a higher anti-mutagenicity action compared to green tea.

However, from compositional data available it can be stated that the first two claims are completely nonsense 1 (see Table 1 below). Currently there is a great marketing and public interest for white tea. As there is a high demand but low supply it has sometimes been suspected that more white tea is now sold than is grown!

In spite of its name, brewed white tea is pale yellow. Its name derives from the fine silvery-white hairs on the unopened buds of the tea plant, which give the plant a whitish appearance. The unopened buds are used for some types of white tea. All kinds of tea originate from Camellia sinensis, white tea is harvested primarily in China, mostly in the Fujian province, but more recently produced in Eastern Nepal, Taiwan, Northern Thailand, Galle (Southern Sri Lanka) and India.

Figure 1. Tea manufacture – major steps and corresponding types of tea

tea manufacturing process

[Source 1]

Table 1. White tea and green tea caffeine and polyphenols content

White TeaAverageGreen TeaAverage
Caffeine3.35-5.74 g/100 gram4.85 g/100 gram1.67-3.90 g/100 gram2.90 g/100 gram
Total Polyphenols16.23-25.95 g/100 gram21.54 g/100 gram13.7-24.7 g/100 gram19.18 g/100 gram
Total Catechins7.94-16.56 g/100 gram13.22 g/100 gram9.89-17 g/100 gram12.95 g/100 gram
Epigallocatechin-3-gallate (EGCG)
Flavonol glycosides *0.06-1.440.61 (1.25)0.64-2.021.1 (2.27)
* Data are calculated as aglycones, in parentheses as glycosides.
[Source 1]

Health benefits of white tea

Flavanol related compounds

Tea is a natural source of proanthocyanidins which does occur in green teas in relevant amounts. Green tea is relatively rich in proanthocyanidins and lower in bisflavanols, while black tea has higher amounts of bisflavanols. This is in tune with the observation of Hashimoto et al. 2 that especially the galloylated proanthocyanidins are degraded during the so-called fermentation. There are at least 16 proanthocyanidins present in tea 3. Not much information on the contribution of proanthocyanidins to the taste of tea beverages or to the health effects is currently available.

Tea contains both kaempferol and quercetin as well as flavanols or catechins up to 30% dry weight and other acids such as gallic acid, caffeic acid and coumaric acid 4. Flavonols (quercetin, kaempferol, and myricetin) are present in form of their O-glycosides. At least 14 different glycosides have been detected in tea 5. There are mono-, di- and triglycosides present in tea, among those often the quercetin 3-rhamno-glucoside in the highest concentration. Flavonol glycosides are interesting in terms of health benefits. According to the literature there are protective effects against coronary heart disease. Scharbert et al. 5 stated that the flavonol glycosides are responsible for the astringency in black tea and not theaflavins or catechins. The flavonol glycosides content is not very much affected by the enzyme transformation (fermentation).

Flavonoids are thought to prevent the formation of reactive oxygen species by inhibiting enzymes or chelating trace metals which can mediate free radical production as well as being free radical scavengers and upregulating genetic antioxidant defences 6. Catechins are powerful bioflavonoids and green tea has been shown in vivo and in vitro to have anti-inflammatory and antioxidant activity 7.

Phenolics in tea

All teas contain high quantities of several polyphenolic components, particularly epicatechin, epicatechin gallate, epigallocatechin, and the most abundant (constituting 65% of the total catechin content) and perhaps the most bioactive component, epigallocatechin-3-gallate (EGCG) 8. Other, such as epiafzelechin and its gallate as well as acetylated catechins have also been identified 9. Tea leaves that have been processed the least contain the most catechins. Tea’s polyphenols include flavanols, flavandiols, flavonoids, and phenolic acids; these compounds may account for up to 30% of the dry weight of the tea leaves according to the literature.

Figure 2. Chemical structure of the four major catechins present in tea

major catechins present in tea

Note: (a) (−)-Epicatechin (EC), (b) (−)-epigallocatechin (EGC), (c) (−)-epicatechin gallate (ECG), and (d) (−)-epigallocatechin gallate (EGCG).

[Source 10]

Epigallo-catechin-3-gallate (EGCG) is a complex molecule formed by a flavanol core (flavan-3-ols) structure with a gallocatechol group and a gallate ester 11. These two gallocatechol rings confer the potent antioxidant and chelating properties to epigallo-catechin-3-gallate (EGCG) 12. Each of the gallocatechol rings is capable of directly capturing free radicals from the environment with high efficiency 13. Previous studies have shown that epigallo-catechin-3-gallate (EGCG) possesses a stronger antioxidant capacity compared with the other green tea catechins and it is also demonstrated that epigallo-catechin-3-gallate (EGCG) is more efficient in radical scavenging than vitamins E and C 14.


Therapeutic Potential of Epigallo-catechin-3-gallate (EGCG)

For many years, the consumption of green tea has been associated with numerous health benefits 15. These properties can be directly linked with the polyphenol content of tea, more specifically with epigallo-catechin-3-gallate (EGCG). For this reason, the study of epigallo-catechin-3-gallate (EGCG) is of utmost importance because this compound seems to prevent and also be useful in the treatment of numerous diseases like cancer and cardiovascular and neurodegenerative diseases 16. Epigallo-catechin-3-gallate (EGCG) is a powerful antioxidant, anti-inflammatory, antibacterial, and antiviral agent and is capable of modulating some pathways, changing the metabolism of lipids 17.

Cancer Chemoprevention

Cancer is the end of several steps of cellular growth lesions, namely, hyperplasia, metaplasia, dysplasia, and neoplasia 18. Each of the presented conditions is a progression in the cancer formation, culminating in the malignant neoplasia known as cancer 19. Nowadays, most modern therapies currently available for treating cancer are very expensive and toxic and have low effectiveness in treating the disease 19. Therefore, it is urgent to investigate natural compounds like epigallocatechin-3-gallate (EGCG) derived from green tea for the prevention and treatment of cancer and other diseases 18. According to previous studies, epigallocatechin-3-gallate (EGCG) is a promising molecule in the prevention and treatment of cancer 20. Some anticancer properties of EGCG are attributed to its free radical scavenging properties, avoiding the damage of the cell structures induced by the free radicals 21. Besides being antioxidant, EGCG has the ability to bind and modulate the activity of several signaling molecules related to mitosis, survival, and cellular death, moderating the cellular responses present in cancer 22. Previous works demonstrated that EGCG is able to inhibit all of the processes involved in carcinogenesis: initiation, promotion, and progression 23. EGCG has the ability to bind to some proteins associated in molecular pathways that are misregulated in cancerous cells. Indeed, EGCG induces the suppression of two important transcription factors, tumor suppressor p53 and nuclear factor kappa-light-chain enhancer of activated B-cells (NF-kB), leading to regression of the tumors 24. To assist the growth of the tumor, new capillaries are needed to satisfy the oxygen and nutrient requirements of the cells 25. The growth process of new blood vessels is called angiogenesis 25. To promote formation of new capillaries, the tumor secretes signaling molecules to the surrounding tissues, especially vascular endothelial growth factor (VEGF). VEGF is directly influenced by the activity of hypoxia-inducible factor 1α (HIF-1α) and NF-kB factors, which are modulated by the presence of EGCG 25. For these reasons, EGCG is able to diminish tumor angiogenesis and stall growth 26. In addition, there is strong evidence that EGCG is capable of diminishing migration and metastasis formation of tumors 27. Previous studies report that EGCG promotes a reduction in the migration and metastasis formation of tumor cells with tumor size reduction, accomplishing a more reliable and efficient chemotherapy 28. Although the single use of EGCG in chemotherapy is unlikely due to its inefficacy in completely eliminating the disease, it would be very interesting to use EGCG as an adjuvant of the cytostatic drugs 29. This synergism that has been reported in numerous in vitro, in vivo, and preclinical studies may be useful to reduce the amount of the necessary cytostatic drugs, which will reduce the side effects 30. In addition, EGCG’s antioxidant and anti-inflammatory properties are also useful to protect against chemotherapy side effects. Finally, the health benefits of EGCG would be advantageous in enhancing the overall condition of the patients 24.

Cardiovascular Benefits

Cardiovascular diseases have a high incidence, mainly in the developed world due to a sedentary lifestyle, poor nutrition, and ambient factors 31. A diet rich in cholesterol, fat, and sugar can lead to coronary diseases like arteriosclerosis and ischemia 31. Recent studies showed that EGCG can enhance the capillary circulation dilating the capillaries, diminishing inflammation, and interfering with the lipid absorption and digestion 32. On the other hand, EGCG interferes directly with the lipid emulsion process in the lipid digestion 33. This is achieved by direct interference in the micelle formation and by inhibiting the phospholipase A2, with this enzyme being of high importance in the lipid digestion 33. The junction of the two processes can limit the absorption of lipids and consequently lower the amount of plasmatic lipids and cholesterol 33. In addition, EGCG can lower cholesterol even more, stimulating its excretion through the bile. Moreover, EGCG will further improve the lipid profile by enhancing the lipid metabolism 34. This catechin can also modulate the process of platelets formation, from macrophage recruiting to macrophage uptake of cholesterol 34. This effect is internally modulated in the macrophage and externally helped by the anti-inflammatory response caused by EGCG 35. Previous studies demonstrated that the administration of EGCG is capable of preventing the growth and also reducing the size of existing platelets. The action mechanism responsible for the anti-inflammatory property of EGCG is the direct inhibition of the phospholipase A2 35.

Neurodegenerative Diseases

The causes of neurodegenerative diseases like Parkinson’s disease and Alzheimer’s disease are still unknown, with various theories being proposed. Both diseases present clinical features, like the oxidative damage of neurons and accumulation of iron in specific brain areas 36. Another relevant aspect is the accumulation of misfolded proteins in deposits, such as the β-amyloid peptide in Alzheimer’s disease that interferes with the survival of the neurons, leading to premature apoptosis 36. Special interest has been assigned to the therapeutic role of antioxidants in such neurodegenerative diseases 37. The neuroprotective properties of the EGCG agent are related to its antioxidant, anti-inflammatory, and iron chelating properties 37. In addition, the blood-brain barrier is permeable to EGCG 38. The mechanism behind the passage of this hydrophilic compound through the blood-brain barrier remains unknown 38. In the literature, it is described that EGCG is more efficient in radical scavenging than vitamins C and E, with its iron chelating ability being useful to significantly improve the symptoms of these neurodegenerative diseases 39. According to what was mentioned above, EGCG is also a cellular modulator that interacts with various pathways. In neuronal cells, this catechin promotes cell survival responses and the inhibition of cell death signals, leading to an enhancement of neuronal health 40. Modifications in cell signaling also promote the nonamyloid α-secretase pathway, diminishing the production of Aβ-amyloid peptides 39.

Several research studies confirm that EGCG has neuroprotective properties in humans, promoting an enhancement of the degree of cognition after oral administration. These studies also confirm that EGCG induces an overall increase in the cerebral activity and calmness 41.

Infectious Diseases

Nowadays, the main strategy to fight viruses is immunization. Unfortunately, several viral infections lack one efficient vaccine, with the HIV infection being the most important. Nance et al. have shown strong HIV inhibition promoted by EGCG in cell cultures in a dose dependent manner 42. Moreover, Li et al. have also proven that EGCG inhibit reverse transcriptase and act synergistically with another reverse transcriptase inhibitor, namely, azidothymidine 43. Some studies also described that EGCG is capable of binding to CD4 cells, preventing the virus from anchoring and entering the host 42.

EGCG is also useful in the inhibition of other viruses, such as enterovirus 71, hepatitis C, adenovirus, herpes simplex virus, and influenza virus 44. One of the molecular targets that seem to be deregulated by the viral infection is the NF-kB and the MAP-kinases pathway 45. As a consequence, EGCG may induce an essential immune response, which helps to fight the viral infection. Concerning antibacterial and antifungal activities, EGCG seems to be less effective in combating infectious diseases caused by bacteria and fungi 46. The most relevant studies in the literature show that there may be some synergistic effects on EGCG association with antibiotics against multidrug-resistant strains, such as Staphylococcus aureus and Stenotrophomonas maltophilia 47. The antifungal activity of EGCG was also reported against human-pathogenic yeasts, such as Candida albicans. However, the mechanisms of action are still unclear 48.

Chronic Inflammatory Disorder

Inflammation is a body response to foreign structures to the human body and damage in the tissues 49. However, in chronic inflammatory disorders, this inflammatory response is continuously active leading to the destruction of healthy tissues causing all the above-mentioned symptoms. These conditions can be incurable and cause major discomfort to the patients 36. Rheumatoid arthritis is one chronic inflammatory disorder characterized by cellular infiltration and proliferation of the synovium, leading to the progressive destruction of the joints through the interaction between infiltrating cells and mediators 50. These injuries lead to chronic pain affecting the life quality of the patients 50. In this disease, the cartilage cells (i.e., chondrocytes) enter in apoptosis in response to oxidative stress and some inflammatory cytokines, interleukin (IL-1β) and tumor necrosis factor-α (TNF-α) 50. The same cytokines also lead to the increase of bone reabsorption and the differentiation of osteoclasts 50. In addition, IL-1β is capable of increasing the amounts of reactive oxygen species via overexpression of inducible nitric oxide synthase and increases the inflammation by overexpression of cyclooxygenase (COX-2) 51. The presence of IL-1β can also activate the expression of matrix metalloproteinases (MMPs) responsible for matrix degradation 51. TNF-α also plays an important role in bone turnover. In arthritis, there is overexpression of TNF-α, which is responsible for the differentiation and activity of osteoclasts. The long-term activation of these cells leads to bone erosion and fragility 52. The current treatment for arthritis is by the administration of methotrexate combined with analgesics and nonsteroidal anti-inflammatory drugs which can be proficient in most cases, but ineffective in some patients 53. Moreover, recent studies have shown that this treatment tends to lose efficacy over time 53. For this reason, new therapies are needed and EGCG may be a promising compound. In fact, EGCG has a high antioxidant activity and also capacity to decrease the inflammation response in the body 54. In cartilage cell cultures, EGCG showed marked inhibition of IL-1β inducible nitric oxide synthase COX-2 expression and activity 55. The expressions of both enzymes are mediated by NF-kB, which is also suppressed in the presence of EGCG 55.


Obesity is a medical condition characterized by excess accumulation of fat in the body in an extension that may have negative effects on the overall health condition and may lead to the development of diseases, such as diabetes and arteriosclerosis 56. The main treatment of obesity is lifestyle reeducation, including diet modification 57. However, in some cases, drugs and supplements are needed to help in the process of losing weight 57. As previously stated, EGCG interferes directly with the lipid digestion by the inhibition of the phospholipase A2 and interfering with the lipid/cholesterol emulsion in the gut 58. The lipid blocking capacity of EGCG can be highly relevant in the loss of weight and weight managing protocols. In addition, EGCG is capable of enhancing the lipid metabolism, leading to more caloric burn and consequent fat loss. EGCG can also interfere with the digestion of starch by inhibition of α-amylase 59. Besides that, the ingestion of EGCG during a weight loss program is very useful because its administration is strongly linked with circulation improvement, free radical scavenging, and mood enhancement 60.


EGCG has been associated with the prevention and reversion of diabetes mellitus through a number of effects, such as improvement of insulin secretion, regulation of glucose uptake, inhibition of insulin resistance, and enhancement of glucose tolerance and its role in oxidative stress and inflammation 61. However, these beneficial effects in diabetes are not regulated by a single mechanism, but still EGCG appears to act through multiple signaling pathways. Green tea intake has been reported to exert beneficial intestinal effects increasing the blood EGCG levels which in turn seem to inhibit cellular glucose uptake, improving its tolerance in vivo 61. Several studies demonstrated that EGCG significantly enhances glucose tolerance in rodents with type 2 diabetes mellitus 62. Another study suggested that EGCG increases glucose-stimulated insulin secretion in db/db mice, through its potent antioxidant effect 63. At the same time, EGCG induces tyrosine phosphorylation of insulin receptors, thereby mimicking insulin in H4IIE rat hepatoma cells [130]. In H4IIE cells, EGCG downregulates genes involved in gluconeogenesis and the synthesis of fatty acids, triacylglycerol, and cholesterol and glucokinase mRNA expression was upregulated in the liver of db/db mice in a dose dependent manner 64. Moreover, Cai et al. showed that EGCG improves the insulin secretory function in rat pancreatic β-cell lines under conditions of glucotoxicity through mediation of Akt signaling pathway 65. EGCG also revealed effects on fatty acid-induced insulin resistance in skeletal muscle, through the activation of protein kinase C (PKC) or c-Jun N-terminal kinase (JNK) signaling pathways 66. Furthermore, EGCG can also enhance AMPK/ACC cascade that blocks insulin receptor substrate-1 (IRS-1) serine phosphorylation, which is essential for the glucose uptake in response to insulin stimulus 67.


White tea and tea in general contains various bioactive phytochemicals – Epigallo-catechin-3-gallate (EGCG) and Flavonoids –  that could provide therapeutic effects.

However, more human clinial trials are needed in order to establish whether or not there is therapeutic effect of drinking tea (white, green, Oolong or black teas). Without such evidence, it will remain unclear whether these untested and unproven positive effects in test tube and animal studies are truly beneficial in humans. For now, there is insufficient evidence that tea oe white tea have any benefits in diabetes, metabolic syndrome, obesity or weight loss, cancer, infectious diseases, Alzheimer’s disease, Parkinson’s disease or cardiovascular diseases.

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  55. Singh R., Ahmed S., Islam N., Goldberg V. M., Haqqi T. M. Epigallocatechin-3-gallate inhibits interleukin-1β-induced expression of nitric oxide synthase and production of nitric oxide in human chondrocytes: Suppression of nuclear factor κB activation by degradation of the inhibitor of nuclear factor κB. Arthritis and Rheumatism. 2002;46(8):2079–2086. doi: 10.1002/art.10443
  56. Moon H.-S., Lee H.-G., Choi Y.-J., Kim T.-G., Cho C.-S. Proposed mechanisms of (−)-epigallocatechin-3-gallate for anti-obesity. Chemico-Biological Interactions. 2007;167(2):85–98. doi: 10.1016/j.cbi.2007.02.008
  57. Thielecke F., Boschmann M. The potential role of green tea catechins in the prevention of the metabolic syndrome—a review. Phytochemistry. 2009;70(1):11–24. doi: 10.1016/j.phytochem.2008.11.011
  58. Raederstorff D. G., Schlachter M. F., Elste V., Weber P. Effect of EGCG on lipid absorption and plasma lipid levels in rats. Journal of Nutritional Biochemistry. 2003;14(6):326–332. doi: 10.1016/S0955-2863(03)00054-8
  59. Forester S. C., Gu Y., Lambert J. D. Inhibition of starch digestion by the green tea polyphenol, (−)-epigallocatechin-3-gallate. Molecular Nutrition and Food Research. 2012;56(11):1647–1654. doi: 10.1002/mnfr.201200206
  60. Scholey A., Downey L. A., Ciorciari J., et al. Acute neurocognitive effects of epigallocatechin gallate (EGCG) Appetite. 2012;58(2):767–770. doi: 10.1016/j.appet.2011.11.016
  61. Park J.-H., Bae J.-H., Im S.-S., Song D.-K. Green tea and type 2 diabetes. Integrative Medicine Research. 2014;3(1):4–10.
  62. Wolfram S., Raederstorff D., Preller M., et al. Epigallocatechin gallate supplementation alleviates diabetes in rodents. Journal of Nutrition. 2006;136(10):2512–2518
  63. Ortsäter H., Grankvist N., Wolfram S., Kuehn N., Sjöholm Å. Diet supplementation with green tea extract epigallocatechin gallate prevents progression to glucose intolerance in db/db mice. Nutrition and Metabolism. 2012;9, article 11 doi: 10.1186/1743-7075-9-11.
  64. Wolfram S., Raederstorff D., Preller M., et al. Epigallocatechin gallate supplementation alleviates diabetes in rodents. Journal of Nutrition. 2006;136(10):2512–2518.
  65. Cai E. P., Lin J.-K. Epigallocatechin gallate (EGCG) and rutin suppress the glucotoxicity through activating IRS2 and AMPK signaling in rat pancreatic β cells. Journal of Agricultural and Food Chemistry. 2009;57(20):9817–9827. doi: 10.1021/jf902618v.
  66. Deng Y.-T., Chang T.-W., Lee M.-S., Lin J.-K. Suppression of free fatty acid-induced insulin resistance by phytopolyphenols in C2C12 mouse skeletal muscle cells. Journal of Agricultural and Food Chemistry. 2012;60(4):1059–1066. doi: 10.1021/jf204496f
  67. Dong Z. Effects of food factors on signal transduction pathways. BioFactors. 2000;12(1-4):17–28. doi: 10.1002/biof.5520120104
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Diet PlanDiet, Food & Fitness

Fodmap diet

fodmap diet

What is fodmap

FODMAP stands for “Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols“. A diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) – low FODMAP diet. Since ingestion of FODMAPs increases the delivery of readily fermentable substrates and water to the distal small intestine and colon—which results in luminal distention and gas—the reduction of FODMAPs in a patient’s diet may improve functional gastrointestinal symptoms 1.

These fermentable short-chain carbohydrates are prevalent in the diet.

  • Oligosaccharides: fructans and galactooligosaccharides (GOS)
  • Disaccharides: lactose
  • Monosaccharides: fructose
  • Polyols: sorbitol and mannitol

Researchers suggest that the small intestine does not absorb FODMAPs very well. They increase the amount of fluid in the bowel. They also create more gas. That’s because bacteria in the colon they are easily fermented by colonic bacteria. The increased fluid and gas in the bowel leads to bloating and changes in the speed with which food is digested. This results in gas, pain and diarrhea. Eating less of these types of carbohydrates should decrease these symptoms.

Foods that trigger IBS

So far, studies have shown that a low FODMAP diet has a beneficial effect in a majority of patients with Irritable Bowel Syndrome (IBS) symptoms 2. One study even found that 76% of Irritable Bowel Syndrome (IBS) patients following the diet reported improvement with their symptoms. Probiotics also have great potential in the management of Irritable Bowel Syndrome (IBS); however, it is still unclear which strains and doses are the most beneficial. Further research is needed on the effect of different fibers or combinations of fibers, in Irritable Bowel Syndrome (IBS).

What is Irritable bowel syndrome (IBS)

Irritable bowel syndrome (IBS) is a condition that affects the functioning of the bowel. The main symptoms are abdominal pain or discomfort that is often relieved by passing wind or faeces, stomach bloating, and chronic diarrhoea or constipation (or alternating between the two). Irritable bowel syndrome (IBS) sufferers may experience multiple symptoms of diarrhea, constipation, abdominal pain, abdominal distention, excessive flatulence, bloating, a continual urge to defecate, urgency to get to a toilet, incontinence, a sensation of incomplete evacuation, straining with a bowel movement, hard / lumpy stools, or even an inability to have a bowel movement at all.

There are several subtypes of IBS.

  • IBS-D: Diarrhea predominant
  • IBS-C: Constipation predominant
  • IBS-A or IBS-M: Alternating, or mixed, between constipation and diarrhea
  • IBS-PI: Post Infectious IBS
  • PDV-IBS: Post Diverticulitis IBS

These symptoms can be embarrassing, inconvenient and distressing. Fortunately, IBS does not cause permanent damage to the bowel and it does not cause other serious diseases like bowel cancer.

Irritable Bowel Syndrome is found predominantly in women in a 2:1 ratio versus men.

If you have IBS, then an episode can be triggered by an infection, stress, food intolerance or particular medicines.

The exact cause of IBS is unknown. It’s probably due to many factors, including the nerves in the bowel being more sensitive than usual (allowing the person to feel sensations they wouldn’t normally feel), abnormal contractions in the bowel, chronic inflammation of the bowel and psychological factors.

The main feature of IBS is abdominal pain associated with a change in bowel habits.

Symptoms to look for include:

  • recurring episodes of diarrhea or constipation
  • symptoms that alternate between diarrhea and constipation
  • bloating
  • pain or discomfort that is relieved by passing wind or going to the toilet
  • symptoms are more common in women and may be worse around menstruation or at times of stress.

IBS does not cause bleeding from the back passage.

Irritable bowel syndrome (IBS) is best defined by what it is NOT!

  • IBS is NOT an anatomical or structural defect.
  • IBS is NOT an identifiable physical or chemical disorder.
  • IBS is NOT a cancer and will not cause cancer.
  • IBS will NOT cause other gastrointestinal diseases.

Patients suffering from IBS should not be worried about it leading to other serious diseases. The major problem with IBS is not because it causes death or serious disease, but because it changes the quality of life for the patient.

Irritable bowel syndrome is not associated with serious medical consequences. People with IBS tend to live long and in some studies, somewhat longer than individuals who do not have IBS. IBS is not associated with other serious GI diseases, such as inflammatory bowel disease (Crohn’s disease or ulcerative colitis) or colon cancer. The presence of IBS does not put extra stress on the other organs in the body such as the heart, liver or kidneys. Overall the prognosis for irritable bowel syndrome is excellent.

A subset of Irritable Bowel Syndrome sufferers may have co-morbidities with other digestive health disorders namely; GERD (gastroesophageal reflux disease) / Heartburn, Dyspepsia, Chronic Constipation, Chronic Abdominal Pain, Fibromyalgia, Pelvic pain or perhaps Crohn’s Disease and Ulcerative Colitis, known collectively as Inflammatory Bowel Disease (IBD). For instance, 29% of gastroesophageal reflux disease (GERD) patients have Chronic Constipation. Diagnosis can shift from one motility disorder to another over time; however, co-morbidity in IBS may be due to a general amplification of symptom reporting and physician consultation rather than a direct association. A research study illustrated that patient education in diet, exercise, and stress management showed significant improvement in pain and symptoms at 1 and 6 months of treatment. An educational approach and appropriate use of medications should be components of a physician-based IBS treatment plan.

IBS is usually diagnosed based on your symptoms and your medical history. There is no medical test that can be used to confirm a diagnosis, although tests (such as a blood test or a colonoscopy) may be required to rule out other conditions.

Causes of Irritable Bowel Syndrome

There are many theories about what exactly causes IBS: problems with the nerves or muscles in the gut, an overgrowth of certain bacteria in the small intestine or a change in bacteria in the colon, an inability to digest certain foods, or stomach or bowel inflammation. Some people have symptoms every day, while others experience long symptom-free periods. IBS does not lead to serious disease, but it does significantly affect your quality of life.

While doctors don’t know what causes IBS, they do know that flare-ups are often triggered by food, caffeine, stress, carbonated drinks, artificial sugars, or infectious diarrhea. The more IBS episodes you have, the more sensitive your gut becomes to triggers.

How is IBS treated ?

It is important to have a doctor who will carefully explain your condition, answer your questions, and work with you to develop a management plan suitable for your individual needs.

Managing IBS may include one or all of the following:

  • reassurance that the symptoms are not due to cancer
  • changing your lifestyle and diet
  • reviewing medication that might aggravate diarrhea or constipation
  • a good healthy diet
  • dietary fiber.

Some people choose to take medicines to treat their symptoms when they flare up. These may include:

  • anti-diarrhoeal medicines
  • painkillers
  • constipation treatments
  • antispasmodics (to ease cramping)
  • antidepressants (which are used to treat pain and depression).

Physiotherapy can be helpful in some cases to teach you how to use your muscles to control your bowel function more effectively.

Your doctor will also work with you to discover if psychological issues like anxiety, depression or stress are a problem for you. In some cases it may be beneficial to see a psychologist or counsellor who can teach you strategies for dealing with these issues and for coping with IBS.

Changing your diet

In past years IBS was treated from the perspective that it was a “motility disorder”. The use of fiber supplementation to improve intestinal motility or movement was a common recommendation. While some studies have questioned whether fiber supplementation alone is helpful for the treatment of IBS and its symptoms, there are other good reasons to consume a high fiber diet. High fiber diets are associated with lower blood sugar, lower cholesterol as well as a lower tendency to form diverticula or outpouchings of the colon. Moreover, some patients with IBS report having a good result with a high fiber diet. Certainly every patient should include at least 25 grams of fiber in their diet every day.

There is no ‘one size fits all’ diet for IBS. However, dietary changes can often relieve IBS symptoms.

It may help to keep a food diary so you can identify any foods that make your symptoms worse.

It can also help to modify the amount and type of fiber in your diet:

  • If you have IBS with constipation, it can help to eat more soluble fiber and drink more water
  • If you have IBS with diarrhea, it can help to cut down on insoluble fiber.

In some cases, avoiding a particular food or food group might help – examples include gluten, caffeine, alcohol, spicy foods, high fat foods or foods that cause excessive bloating such as beans, lentils or certain vegetables.

Australian researchers have recently developed a special diet that may help control IBS symptoms in some people. It’s called the FODMAP diet, and it involves restricting your intake of certain dietary carbohydrates (sugars) that are poorly absorbed by the bowel.

Before making any major changes to your diet it is a good idea to talk to your doctor or a dietitian.

Low Fodmap Diet

FODMAP stands for Fermentable, Oligo-, Di-, Mono-saccharides And Polyols. FODMAPs are short-chain carbohydrates (sugars) that are highly fermentable (to ferment, is to go through a chemical change that results in alcohol) and poorly absorbed during digestion 3. The acronym FODMAPs was created to describe poorly absorbed, short-chain carbohydrates that can lead to excessive fluid and gas accumulation, resulting in bloating, abdominal pain, and distention (Figure 1).

The Low FODMAP diet was developed by researchers at Monash University more than five years ago, in Australia, by Susan Shepherd and Peter Gibson. This diet eliminates certain foods to improve the symptoms of functional gut disorders (FGD). Irritable bowel syndrome (IBS), a type of FGD, may be helped by this diet. IBS is the most commonly diagnosed gastrointestinal condition and over half of patients with IBS associate a trigger in their symptoms with eating a meal 4. The Monash team, led by Professor Peter Gibson, provided the first evidence that a Low FODMAP diet improves IBS symptoms. Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder affecting one in seven Australian adults and approximately 35 million Americans are impacted by IBS including many in Europe and many in Asian countries. IBS is characterised by chronic and relapsing symptoms; lower abdominal pain and discomfort, bloating, wind, distension and altered bowel habit (ranging from diarrhoea to constipation) but with no abnormal pathology. The diagnosis of IBS should be made by a medical practitioner.

FODMAPs are found in a wide variety of foods, including those containing lactose, fructose in excess of glucose, fructans, galacto-oligosaccharides, and polyols (sorbitol, mannitol, xylitol, and maltitol). All FODMAPs have poor absorption and rapid fermentation, and they are comprised of small, osmotically active molecules. FODMAPs are poorly absorbed for a number of reasons, including the absence of luminal enzymes capable of hydrolyzing the glycosidic bonds contained in carbohydrates, the absence or low activity of brush border enzymes (eg, lactase), or the presence of low-capacity epithelial transporters (fructose, glucose transporter 2 [GLUT-2], and glucose transporter 5 [GLUT-5]). Fructose, which is an important FODMAP in the Western diet, is absorbed across villous epithelium through low-capacity, carrier-mediated diffusion involving GLUT-5. The absorption of free fructose is markedly enhanced in the presence of glucose via GLUT-2. Therefore, if fructose is present in excess of glucose, the risk of fructose malabsorption is increased. In addition, some molecules, such as polyols, are too large for simple diffusion. The fermentation rate is determined by the chain length of the carbohydrate 5.

For example, oligosaccharides are rapidly fermented, compared to polysaccharides. Fermentation results in the production of carbon dioxide, hydrogen, and/or methane gas. Finally, small, osmotically active molecules draw more water and other liquid into the small bowel. Given these properties, a diet low in FODMAPs has become a potential therapy for IBS patients.

When FODMAPs reach the colon (large intestine), bacteria ferment these sugars, turning them into gas and chemicals. This stretches the walls of the colon, causing abdominal bloating, distension, and pain or cramping in many people. Other symptoms, such as diarrhea, constipation, and nausea, are also common side effects of FODMAP carbohydrates. Not everyone has the same reaction to FODMAPs. Ethnicity, genetics, and environmental factors (such as an individual’s microbiome, motility, immune system, and sensory system) may play a part in your body’s ability to tolerate these carbohydrates.

Figure 1. FODMAPs in your gut

FODMAPs diet in gut

Note: Ingested fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) are poorly absorbed in the small intestine. Their small molecular size results in an osmotic effect, drawing water (H20) through to the large intestine. FODMAPs are then fermented by colonic microflora, producing hydrogen (H2) and/or methane gas (CH4). The increase in fluid and gas leads to diarrhea, bloating, flatulence, abdominal pain, and distension.

[Source 1]

What symptoms may be associated with FODMAPS ?

As FODMAPs are poorly absorbed during the digestive process, they may pass to the large intestine (colon), where they are rapidly fermented by the bacteria that normally live in the colon. This makes chemicals called short chain fatty acids, as well as gas. This, in turn, leads to changes in the acidity and types of bacteria in the colon. The colon expands, which can lead to pain, bloating, and changes in bowel habits.

Diets rich in FODMAPs may increase symptoms in patients with functional gut disorders (FGD) or irritable bowel syndrome (IBS). However, the FODMAPs themselves are not the root of the problem. For that reason, patients may need to include other options to treat their symptoms. This may include medicine, exercise, meditation, hypnotherapy, etc.

When is a Low-FODMAP diet recommended ?

Despite limited data, implementation of a low-FODMAP diet should be considered in patients with IBS, particularly those in whom food is a trigger for symptoms.

Eliminating or restricting FODMAPs from the diet may greatly improve symptoms of functional gut disorders (FGD). In Australia, a Low-FODMAP diet is the main treatment for irritable bowel syndrome (IBS). It was adopted by their National Therapeutic Guidelines. The Low-FODMAP diet can be adjusted to meet personal food and lifestyle preferences. Following a personally developed Low-FODMAP plan does not cure IBS, but it may lead to drug-free management of symptoms and better quality of life. As with any diet, it is important to discuss with your doctor and working with a gastrointestinal trained dietician is also useful.

A number of studies suggest that limiting FODMAPs in the diet leads to improved symptoms in one-half to two-thirds of patients who follow this diet. Many patients see improvement in 1-2 weeks, though some may need to wait up to 4 weeks. Bloating and abdominal pain are the most likely symptoms to improve. Diarrhea is more likely to improve than constipation. If there is no improvement after 4 weeks, it is likely not worth continuing this diet.

A Low-FODMAP diet is not recommended for people without gastrointestinal symptoms. Also, if your IBS symptoms improve on the Low-FODMAP diet, you should eventually re-introduce FODMAPs, one at a time, to identify foods that trigger symptoms and those that do not. This will allow a more diverse diet. Keeping a personal food diary may help simplify this process

Implementation of a low-FODMAP diet is best done with the help of a dietician during a one-to-one consultation so that the dietician can understand the patient’s symptoms; this process also ensures that any diet modifications are individualized and still provide a balanced diet. A diet history should be taken to determine the composition of FODMAPs in an individuals diet. Education can then be tailored appropriately rather than focusing on FODMAPs that may never be consumed. Lists of food substitutions can help patients understand what they can and cannot eat (Table 1) 6. For good symptom control, individuals should restrict their total FODMAP load for 6-8 weeks. After this time, the diet may be modified to be less restrictive based on symptom response.

However, there are also several limitations to low-FODMAP diets. Most foods do not list their FODMAP content. In addition, the cutoff levels for FODMAP content are not clearly defined. When this diet was first examined, cutoff values were proposed based on foods that patients identified to be triggers for their symptoms. Foods and beverages with the following amounts of FODMAPs were considered to have risk for inducing symptoms: more than 0.5 g of fructose in excess of glucose per 100 g, more than 3 g of fructose in an average serving quantity regardless of glucose amount, and more than 0.2 g of fructans per serving 6. Although a low-FODMAP diet has been shown to be helpful in patients with IBS or other functional bowel disorders, further randomized controlled trials should be conducted.

Table 1. Foods High in Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols (FODMAPs) and Suitable Alternatives

FODMAPFoods high in FODMAPsSuitable alternatives low in FODMAPs
Excess fructoseFruits: apple, clingstone peach, mango, nashi pear, pear, sugar snap pea, tinned fruit in natural juice, watermelonFruits: banana, blueberry, cantaloupe, carambola, durian, grape, grapefruit, honeydew melon, kiwi, lemon, lime, orange, passion fruit, pawpaw, raspberry, strawberry, tangelo
Honey sweeteners: fructose, high-fructose corn syrupHoney substitutes: golden syrup, maple syrup
Large total fructose dose: concentrated fruit sources, large servings of fruit, dried fruit, fruit juiceSweeteners: any sweeteners except polyols
LactoseMilk: regular and low-fat cow, goat, and sheep milk; ice creamMilk: lactose-free milk, rice milk
Ice cream substitutes: gelato, sorbet
Yogurts: regular and low-fat yogurtsYogurts: lactose-free yogurts
Cheeses: soft and fresh cheesesCheeses: hard cheeses
Oligosaccharides (fructans and/or galactans)Vegetables: artichoke, asparagus, beetroot, broccoli, Brussels sprout, cabbage, fennel, garlic, leek, okra, onion, pea, shallotVegetables: bamboo shoot, bok choy, capsicum, carrot, celery, chives, choko, choy sum, corn, eggplant, green bean, lettuce, parsnip, pumpkin, silverbeet, spring onion (green part only)
Cereals: rye and wheat cereals when eaten in large amounts (eg, biscuit, bread, couscous, cracker, pasta)Onion/garlic substitutes: garlic-infused oil
Legumes: baked bean, chickpea, lentil, red kidney beanCereals: gluten-free and spelt bread/cereal products
Fruits: custard apple, persimmon, rambutan, watermelon, white peachFruit: tomato
PolyolsFruits: apple, apricot, avocado, cherry, longon, lychee, nashi pear, nectarine, peach, pear, plum, prune, watermelonFruits: banana, blueberry, cantaloupe, carambola, durian, grape, grapefruit, honeydew melon, kiwi, lemon, lime, orange, passion fruit, pawpaw, raspberry
Vegetables: cauliflower, mushroom, snow pea
Sweeteners: isomalt, maltitol, mannitol, sorbitol, xylitol, and other sweeteners ending in “-ol”Sweeteners: glucose, sugar (sucrose), other artificial sweeteners not ending in “-ol”
[Source 6]

FODMAP Food List

Table 2. FODMAP Food List




LactoseDairy whey and high-lactose containing milks such as cow, goat, sheep, chocolate, buttermilk, and condensed milk, and whipped cream. Ice cream, cow’s milk-based yogurt, brie, cottage cheese, ricotta, and sour cream.Gelato or sorbet (though watch fructose content) and lactose-free yogurts. Aged hard cheeses tend to be easier to tolerate. Cheddar, Colby, parmesan, and mozzarella. Greek yogurt.
Limit: Butter, margarine, sour cream, half and half, cream cheese, Swiss cheese, goat cheese, feta cheese, cheddar, parmesan, and mozzarella contain lactose, although at lower amounts.
Non-Dairy Milk Alternatives Soy milk contains galactans and should be avoided as well, coconut milk, soy products, hummus, beans, and lentils. Lactose- free or lactaid milk, rice milk, almond milk, almond butter, and cashew milk.
Fructose / Sweeteners Honey, agave, apples, cherries, dates, guava, honeydew melon, lychee, mandarin oranges, mangoes, peaches, pears, persimmons, star fruit, canned fruit in natural juices, dried fruits and less ripe fruits, corn syrup, high fructose sweeteners, coconut milk, fruit pastes (i.e. chutney, plum sauce, barbeque sauce, ketchup), rosé wine, port, and sherry Maple syrup, jams, marmalades, vegemite, table sugar, bananas, blackberries, blueberries, boysenberries, cranberries, grapefruit, kiwis, kumquats, lemons, limes, passion fruit, raspberries, and strawberries.
Limit: grapes, oranges, papaya, pineapple, and watermelon.
Starches Bread, pasta, semolina, flour tortillas, wheat-based bread and breadcrumbs. Wheat-based cereals, crackers, cookies, cakes, pasta, and pastries. Beer. Corn breads, gluten- free breads, pastas, cereals, as well as corn flakes, oatmeal, potato-based breads, rice-based noodles and breads, and wheat-free rye bread.
Fruit Grapes, mangoes, peaches, persimmon, pineapple, watermelon, and bananas. Grapefruit, lemons, limes, papaya, raspberries, strawberries, and blueberries.
Vegetables Artichokes, asparagus, beets, broccoli, Brussel sprouts, cabbage, chicory, garlic, leeks, lettuce, okra, onions, radicchio, scallions, shallots, snow peas, and zucchini. Bean sprouts, bell peppers, bok choy, carrots, celery, chives, cucumber, eggplant, potatoes, pumpkin, radishes, spinach, tomatoes, turnips, winter squash, and garlic-infused oil.
Galactans Plant based proteins such as beans, black-eyed peas, chick peas, kidney beans, lentils, lima beans, pinto beans, soy products, broccoli, Brussel sprouts, cabbage, green beans, and yellow beans. Eggs, nuts, quinoa, seeds, bean sprouts, bell peppers, bok choy, carrots, celery, chives, cucumbers, eggplant, potatoes, pumpkin, radish, spinach, and tomatoes.
Artificial Sweeteners Sorbitol, mannitol, isomaltose, malitol, xylitol, polydextrose, hydrogenated starch Aspartame, sucralose, saccharin. Commonly found in various gum and candy as well.
Fruit Apples, apricots, avocados, cherries, lychee, nectarines, peaches, pears, plums, and watermelon. Bananas, blueberries, grapefruit, kiwi, lemons, limes, passion fruit, raspberries, cantaloupe, honeydew, and strawberries
Vegetables Artichoke, asparagus, brussel sprouts, cabbage, cauliflower, green beans mushrooms, snow peas sprouts, and summer squash. Bean sprouts, bell peppers, bok choy, carrots, celery, chives, cucumbers, eggplant, kale, lettuce, potatoes, pumpkin, radishes, spinach, tomatoes, winter squash, yams, and zucchini.

Eat Less Of These Foods


  • Cow’s milk, yogurt, pudding, custard, ice cream, cottage cheese, ricotta cheese and mascarpone


  • Fruits, such as apples, pears, peaches, cherries, mangoes, pears and watermelon
  • Sweeteners, such as honey and agave nectar
  • Products with high fructose corn syrup


  • Vegetables, such as artichokes, asparagus, Brussels sprouts, broccoli, beetroot, garlic and onions
  • Grains such as wheat and rye
  • Added fiber, such as inulin

Oligosaccharides (fructans and/or galactans)

  • Chickpeas, lentils, kidney beans and soy products
  • Vegetables, such as broccoli


  • Fruits, such as apples, apricots, blackberries, cherries, nectarines, pears, peaches, plums and watermelon
  • Vegetables, such as cauliflower, mushrooms and snow peas
  • Sweeteners, such as sorbitol, mannitol, xylitol, maltitol and isomalt found in sugar-free gum and mints, and cough medicines and drops

Eat More Of These Foods

  • Dairy: Lactose-free milk, rice milk, almond milk, coconut milk, lactose-free yogurt; hard cheeses such as feta and brie
  • Fruit: Bananas, blueberries, cantaloupe, grapefruit, honeydew, kiwi, lemon, lime, oranges and strawberries
  • Vegetables: Bamboo shoots, bean sprouts, bok choy, carrots, chives, cucumbers, eggplant, ginger, lettuce, olives, parsnips, potatoes, spring onions and turnips
  • Protein: Beef, pork, chicken, fish, eggs and tofu
  • Nuts/seeds (limit to 10-15 each): Almonds, macadamia, peanuts, pine nuts and walnuts
  • Grain: Oat, oat bran, rice bran, gluten-free pasta, such as rice, corn, quinoa, white rice, corn flour and quinoa

The idea behind the low FODMAPs diet is to only limit the problematic foods in a category — not all of them. (After all, they do have health benefits.) You may tolerate some foods better than others.

Meet with a registered dietician if you are considering this diet. It’s important to make sure your eating plan is safe and healthy. He or she will have you eliminate FODMAPs from your diet. Then you gradually add the carbohydrates back in one at a time and monitor your symptoms. A food diary and symptom chart may be helpful tools.


A low-FODMAP diet appears to be effective for treatment of at least a subset of patients with IBS. FODMAPs likely induce symptoms in IBS patients due to luminal distention and visceral hypersensitivity. Some health professionals believe it’s too restrictive. Proponents of the diet report that people stick with it because of how it improves their quality of life. Whenever possible, implementation of a low-FODMAP diet should be done with the help of an experienced dietician.

However, more research is needed to determine which patients can benefit from a low-FODMAP diet and to quantify the FODMAP content of various foods, which will help patients follow this diet effectively.

  1. Magge S, Lembo A. Low-FODMAP Diet for Treatment of Irritable Bowel Syndrome. Gastroenterology & Hepatology. 2012;8(11):739-745.
  2. Irritable bowel syndrome and diet: where are we in 2018 ? Current Opinion in Clinical Nutrition & Metabolic Care: November 2017 – Volume 20 – Issue 6 – p 456–463.
  3. Low-FODMAP Diet. American College of Gastroenterology.
  4. Low FODMAP diet for Irritable Bowel Syndrome. Monash University.
  5. Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. Gibson PR, Shepherd SJ. J Gastroenterol Hepatol. 2010 Feb; 25(2):252-8.
  6. Gibson PR, Barrett JS. Clinical ramifications of malabsorption of fructose and other short-chain carbohydrates. Practical Gastroenterology. 2007;31:51–65.
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Diet PlanDiet, Food & Fitness

Anti inflammatory diet

anti inflammatory diet food list

What is an anti inflammatory diet ?

There are two distinct types of inflammation. The first type is inflammation resulting in acute pain. This can be considered classical inflammation. A second type of inflammation can be described as chronic low-level inflammation that is below the threshold of pain. This can be termed “silent inflammation” 1. Today we know the inflammatory process is a complex interaction of both the pro- and anti-inflammatory phases 2, 3. Inflammation acts as both a ‘friend and foe’: it is an essential component of immunosurveillance and host defence, yet a chronic low-grade inflammatory state is a pathological feature of a wide range of chronic conditions, such as the metabolic syndrome, non-alcoholic fatty liver disease (NAFLD), type 2 diabetes mellitus and cardiovascular disease (coronary heart disease) 4, 5. Although the association between inflammation and chronic conditions is widely recognised, the issue of causality and the degree to which inflammation contributes and serves as a risk factor for the development of disease remain unresolved.

Age is the leading risk factor for many devastating diseases such as acute and chronic neurodegenerative diseases, degenerative musculoskeletal diseases, cardiovascular diseases, type 2 diabetes, asthma, rheumatoid arthritis and inflammatory bowel disease 6. Increasing evidence suggests that systemic low grade inflammation is a contributing factor in age-related diseases like cancer, coronary artery disease, atherosclerosis, diabetes, Alzheimer’s disease and other neurodegenerative diseases or even aging in general 7, 8, 9, 10, 11. More recently with increasing obesity, type 2 diabetes and insulin resistance amongst the younger population, metabolic syndrome, a constellation of risk factors associated with high blood sugar, accumulation of fat around the waist, high blood pressure, obesity, dyslipidemia (high triglyceride, high blood cholesterol and low HDL”good” cholesterol) and cardiovascular risk 12, 13, is increasing to an epidemic prevalence. Type 2 diabetes and cardiovascular disease are widely recognized as conditions of chronic inflammation, characterized by subclinical elevations in circulating plasma concentrations of inflammatory proteins such as C-reactive protein (CRP) 14, plasminogen activator inhibitor type 1 (PAI-1), and fibrinogen 15, 16. There are several events that can turn on inflammatory responses. The most obvious is microbial invasion. Injuries and burns (both chemical and radiation) can also induce the most basic components of the inflammatory response. However, we are now beginning to understand how diet can also activate the same inflammatory responses induced by microbes. There is a great interest in identifying the best lifestyle approach for these patients to reduce the clinical and economical impact of inflammation and metabolic disorders.

It is very difficult to discuss a concept of silent inflammation if you cannot measure it, especially since there is no pain associated with it. It is only recently that new clinical markers of silent inflammation have emerged. The first of these clinical markers is high-sensitivity C-reactive protein (hs-CRP). High sensitivity serum C-reactive protein (hs-CRP), plasma interleukin 6 (IL-6), and tumor necrosis factor α receptor 2 (TNF-α-R2) are markers of systemic inflammation in the body, and have been associated with many chronic diseases, including coronary heart disease (coronary artery disease) 17, 18, 19, metabolic syndrome 20, diabetes mellitus 21, and cancer 22.

As inflammation has become increasingly recognized as having a role in cardiovascular disease and type 2 diabetes, there is reason to explore how diet relates to subclinical inflammation, because nutrition interventions could be used to modify inflammatory protein concentrations.

What foods cause inflammation in the body

Inflammation is the common link among the leading causes of death. Together, cardiovascular disease, cancer, and diabetes account for almost 70% of all deaths in the United States; these diseases share inflammation as a common link 23, 24. Dietary patterns high in refined starches, sugar, and saturated and trans-fatty acids, poor in natural antioxidants and fiber from fruits, vegetables, and whole grains, and poor in omega-3 fatty acids may cause an activation of the innate immune system, most likely by excessive production of proinflammatory cytokines associated with a reduced production of anti-inflammatory cytokines 25. Dietary strategies clearly influence inflammation, as documented through both prospective observational studies as well as randomized controlled feeding trials in which participants agree to eat only the food provided to them 23, 26. Studies have shown how various dietary components can modulate key pathways to inflammation including sympathetic activity, oxidative stress, transcription factor nuclear factor kappa B (NF-κB) activation, and proinflammatory cytokine production 27. Circulating markers of inflammation, such as C-reactive protein (CRP), tumor necrosis factor (TNF)-alpha, and some interleukins (IL-6, IL-18), correlate with propensity to develop coronary heart disease and heart attacks 28, 29, 30. Previous studies have also shown that depression is associated with upregulated inflammatory response, characterized by increased levels of pro-inflammatory cytokines and other acute-phase proteins 31.

Diets that promote inflammation are 23:

  • High in Refined Starches or Refined Carbs,
  • High in Sugar,
  • High in Saturated and Trans-fats,
  • High in Salt (sodium),
  • Alcohol,
  • Food Additives,
  • Low in omega-3 fatty acids,
  • Low in natural antioxidants,
  • Low in fiber from fruits,
  • Low in vegetables, and
  • Low in whole grains.

Dietary patterns high in refined starches, sugar, and saturated and trans-fatty acids, poor in natural antioxidants and fiber from fruits, vegetables, and whole grains, and poor in omega-3 fatty acids – aka the Average American Diet – may cause an activation of the innate immune system, most likely by an excessive production of proinflammatory cytokines associated with a reduced production of anti-inflammatory cytokines 32.

An Americanization of food habits has been recognized throughout the world, characterized by a high-energy diet, with increasing consumption of industrially processed foods. These foods usually contain large amounts of salt, simple sugars, saturated and trans fats, which food industries offer in response to consumers’ demands. Consequently, the intake of complex carbohydrates, fibres, fruits and vegetables has decreased. The energy and animal proteins consumed largely exceed World Health Organization recommendations, while, generally, a smaller variety of foods is being consumed.

  • Most Americans exceed the recommendations for added sugars, saturated fats, and sodium. Most people say that if there is a healthy choice on a menu they will take it. But observations and research show this is generally not the case. Instead, people tend to make choices based on how food tastes. Typically, the more sugar, salt and fat in the food, the more we will like it.
  • About three-fourths of the population has an eating pattern that is low in vegetables, fruits, dairy, and oils.
  • More than half of the population is meeting or exceeding total grain and total protein foods recommendations, but, are not meeting the recommendations for the subgroups within each of these food groups.

The typical eating patterns currently consumed by many in the United States do not align with the Healthy Dietary Guidelines. As shown in Figure 1, when compared to the healthy eating pattern:

  • About three-fourths of the population has an eating pattern that is low in vegetables, fruits, dairy, and oils.
  • Most Americans exceed the recommendations for added sugars, saturated fats, and sodium.

Figure 1. The Average American Diet containing foods that can cause inflammation

inflammatory diet

In addition, the eating patterns of many are too high in calories. Calorie intake over time, in comparison to calorie needs, is best evaluated by measuring body weight status. The high percentage of the population that is overweight or obese suggests that many in the United States over consume calories. More than two-thirds of all adults and nearly one-third of all children and youth in the United States are either overweight or obese.

The typical American diet is about 50% carbohydrate, 15% protein, and 35% fat. The Standard American Diet or “Western-style” dietary patterns with more red meat or processed meat, sugared drinks, sweets, refined carbohydrates, or potatoes-have been linked to obesity 33, 34, 35, 36.  The Average American (Western-style) dietary pattern is also linked to increased risk of heart disease, diabetes, and other chronic conditions.

Meal frequency and snacking have increased over the past 30 years in the U.S. 37 on average, children get 27 percent of their daily calories from snacks, primarily from desserts and sugary drinks, and increasingly from salty snacks and candy.

What Americans Eat: Top 10 sources of calories in the U.S. diet

  • Grain-based desserts (cakes, cookies, donuts, pies, crisps, cobblers, and granola bars)
  • Yeast breads
  • Chicken and chicken-mixed dishes
  • Soda, energy drinks, and sports drinks
  • Pizza
  • Alcoholic beverages
  • Pasta and pasta dishes
  • Mexican mixed dishes
  • Beef and beef-mixed dishes
  • Dairy desserts(Source: Report of the 2010 Dietary Guidelines Advisory Committee)

For the 20-30 year old the top sources of “Nutrition” are:

  1. Regular soft drinks 8.8% of total energy
  2. Pizza 5.1% of total energy
  3. Beer 3.9%
  4. Hamburgers and meat loaf 3.4%
  5. White bread 3.3%
  6. Cake, doughnuts and pastries 3.3%
  7. French fries and fried potatos 3.0%
  8. Potato chips, corn chips and popcorn 2.7%
  9. Rice 2.6%
  10. Cheese and cheese spread 2.5%

Since the above list of diets cause inflammation, therefore the main dietary strategy to reduce inflammation should include adequate omega-3 fatty acids intake, reduction of saturated and trans-fats, and consumption of a diet high in fruits, vegetables, nuts, and whole grains and low in refined grains. The whole diet approach seems particularly promising to reduce the inflammation associated with the metabolic syndrome (e.g. high “bad” triglyceride, low “good” HDL cholesterol, belly fat, high blood pressure, high blood sugar/insulin resistance). The choice of healthy sources of carbohydrate, fat, and protein, associated with regular physical activity and avoidance of smoking, is critical to fighting the war against chronic disease. Western dietary patterns warm up inflammation, while healthy dietary patterns cool it down.

Refined Starches or Refined Carbs Inflammatory Foods

The process of refining a food not only removes the fiber, but it also removes much of the food’s nutritional value, including B-complex vitamins, healthy oils and fat-soluble vitamins. Refined carbohydrates are plant-based foods that have the whole grain extracted during processing, where the fibers, starches, vitamins and minerals have been removed, leaving behind refined carbohydrates. Refined carbohydrates sources include bottled fruit juices, juice concentrates, white bread, pastries, sodas, donuts, cakes, cookies, sweets, chips and other highly processed or refined foods. These items contain easily digested carbohydrates that may contribute to weight gain, interfere with weight loss, and promote diabetes and heart disease 38.

Refined carbohydrates are composed of sugars (such as fructose and glucose) which have simple chemical structures composed of only one sugar (monosaccharides) or two sugars (disaccharides). Simple carbohydrates are easily and quickly utilized for energy by the body because of their simple chemical structure, often leading to a faster rise in blood sugar and insulin secretion from the pancreas – which can have negative health effects.

When it comes to carbohydrates, what’s most important is the type of carbohydrate you choose to eat because some sources are healthier than others. The amount of carbohydrate in the diet – high or low – is less important than the type of carbohydrate in the diet. For example, healthy, whole grains such as whole wheat bread, rye, barley and quinoa are better choices than highly refined white bread or French fries. For example, whole grain whole wheat flour.

Typically, foods with highly processed refined carbohydrates (eg, white bread) are digested at a much faster rate and have higher glycemic index (high GI) values than do more compact granules (low-starch gelatinization) and high amounts of viscose soluble fiber (eg, barley, oats, and rye) foods. These refined carbohydrates are more rapidly attacked by digestive enzymes due to grinding or milling that reduces particle size and removes most of the bran and the germ. Numerous epidemiologic studies have found that higher intake of refined carbohydrates (reflected by increased dietary Glycemic Load) is associated with greater risk of type 2 diabetes and heart disease, whereas higher consumption of whole grains protects against these conditions 39.

Table 1. List of refined carbs for more than 100 common foods with their glycemic index and glycemic load, per serving.

FOODGlycemic index (glucose = 100)Serving size (grams)Glycemic load per serving
Banana cake, made with sugar476014
Banana cake, made without sugar556012
Sponge cake, plain466317
Vanilla cake made from packet mix with vanilla frosting (Betty Crocker)4211124
Apple muffin, made with rolled oats and sugar446013
Apple muffin, made with rolled oats and without sugar48609
Waffles, Aunt Jemima®763510
Bagel, white, frozen727025
Baguette, white, plain953014
Coarse barley bread, 80% kernels34307
Hamburger bun61309
Kaiser roll733012
Pumpernickel bread56307
50% cracked wheat kernel bread583012
White wheat flour bread, average753011
Wonder® bread, average733010
Whole wheat bread, average69309
100% Whole Grain® bread (Natural Ovens)51307
Pita bread, white683010
Corn tortilla525012
Wheat tortilla30508
Coca Cola® (US formula)63250 mL16
Fanta®, orange soft drink68250 mL23
Lucozade®, original (sparkling glucose drink)95250 mL40
Apple juice, unsweetened41250 mL12
Cranberry juice cocktail (Ocean Spray®)68250 mL24
Gatorade, orange flavor (US formula)89250 mL13
Orange juice, unsweetened, average50250 mL12
Tomato juice, canned, no sugar added38250 mL4
All-Bran®, average44309
Coco Pops®, average773020
Cornflakes®, average813020
Cream of Wheat®6625017
Cream of Wheat®, Instant7425022
Muesli, average563010
Oatmeal, average5525013
Instant oatmeal, average7925021
Puffed wheat cereal803017
Raisin Bran®613012
Special K® (US formula)693014
Pearled barley, average2515011
Sweet corn on the cob486014
White rice, boiled, type non-specified7215029
Quick cooking white basmati6315026
Brown rice, steamed5015016
Parboiled Converted white rice (Uncle Ben’s®)3815014
Whole wheat kernels, average455015
Bulgur, average4715012
Graham crackers742513
Vanilla wafers772514
Rice cakes, average822517
Rye crisps, average642511
Soda crackers742512
Ice cream, regular, average62508
Ice cream, premium (Sara Lee®)38503
Milk, full-fat, average31250 mL4
Milk, skim, average31250 mL4
Reduced-fat yogurt with fruit, average3320011
Apple, average361205
Banana, raw, average4812011
Dates, dried, average426018
Grapes, black5912011
Oranges, raw, average451205
Peach, average421205
Peach, canned in light syrup521209
Pear, raw, average381204
Pear, canned in pear juice441205
Prunes, pitted296010
Baked beans401506
Black-eyed peas5015015
Black beans301507
Chickpeas, canned in brine421509
Navy beans, average3915012
Kidney beans, average341509
Soy beans, average151501
Cashews, salted22503
Macaroni, average5018024
Macaroni and Cheese (Kraft®)6418033
Spaghetti, white, boiled, average4618022
Spaghetti, white, boiled 20 min5818026
Spaghetti, whole-grain, boiled4218017
Corn chips, plain, salted425011
Fruit Roll-Ups®993024
M & M’s®, peanut33306
Microwave popcorn, plain, average65207
Potato chips, average565012
Pretzels, oven-baked833016
Snickers Bar®, average516018
Green peas54804
Carrots, average39802
Baked russet potato11115033
Boiled white potato, average8215021
Instant mashed potato, average8715017
Sweet potato, average7015022
Yam, average5415020
Hummus (chickpea salad dip)6300
Chicken nuggets, frozen, reheated in microwave oven 5 min461007
Pizza, plain baked dough, served with parmesan cheese and tomato sauce8010022
Pizza, Super Supreme (Pizza Hut®)361009
Honey, average612512

The complete list of the glycemic index and glycemic load for more than 1,000 foods can be found in the article “International tables of glycemic index and glycemic load values: 2008” by Fiona S. Atkinson, Kaye Foster-Powell, and Jennie C. Brand-Miller in the December 2008 issue of Diabetes Care, Vol. 31, number 12, pages 2281-2283 40.

List of refined carbs

Any foods that have been processed for quick consumption.

  • Foods made with refined or “white” flour also contain less fiber and protein than whole-grain products.
  • Snacks, such as crisps, sausage rolls, pies and pasties
  • Granola bars
  • Ice cream
  • Donuts
  • Cakes
  • Twinkies
  • Pastries
  • Canned fruits with added sugar or syrup
  • Sweets
  • Fruit drinks
  • Colas and carbonated sweetened beverages
  • Energy drinks
  • Sports drink
  • Jams
  • Crackers
  • Dressings
  • Sauces
  • Cookies
  • Fruit chews
  • Pizzas
  • Apple pies
  • Anything with added sugar.

Sugar by Any Other Name

You don’t always see the word “sugar” on a food label. It sometimes goes by another name, like these:

  • White sugar
  • Brown sugar
  • Raw sugar
  • Agave nectar
  • Brown rice syrup
  • Corn syrup
  • Corn syrup solids
  • Coconut sugar
  • Coconut palm sugar
  • High-fructose corn syrup
  • Invert sugar
  • Dextrose
  • Anhydrous dextrose
  • Crystal dextrose
  • Dextrin
  • Evaporated cane juice
  • Fructose sweetener
  • Liquid fructose
  • Glucose
  • Lactose
  • Honey
  • Malt syrup
  • Maple syrup
  • Molasses
  • Pancake syrup
  • Sucrose
  • Trehalose
  • Turbinado sugar

Watch out for items that list any form of sugar in the first few ingredients.

Anti inflammatory diet research

Whole grains are healthier than refined grains because the process of refining carbohydrates results in the elimination of much of the fiber, vitamins, minerals, phytonutrients, and essential fatty acids 23. Furthermore, refined starches and sugars can rapidly alter blood glucose and insulin levels 23 and postprandial hyperglycemia can increase production of free radicals as well as proinflammatory cytokines 41.

There is consistent evidence that consumption of whole grains is protective against incident type 2 diabetes and cardiovascular disease 42, 43. However, it is unclear how these protective effects are mediated. Dietary fiber intake may reduce the risk of these diseases by mediating the pro-inflammatory process 44, 45. Two mechanistic hypotheses have emerged. First, dietary fiber may decrease oxidation of glucose and lipids, while maintaining a healthy intestinal environment. Second, dietary fiber may prevent inflammation by altering adipocytokines in adipose tissue and increasing enterohepatic circulation of lipids and lipophilic compounds 46. The link between dietary fiber intake and reduced high sensitivity serum C-reactive protein (hs-CRP) has been observed in several recent studies, including two analyses using cross-sectional data from NHANES 1999–2000 47, 48, an analysis using a longitudinal cohort of 524 healthy adults 49 and a small clinical trial 50.

Various dietary components including long chain omega-3 fatty acids, antioxidant vitamins, plant flavonoids, prebiotics and probiotics have the potential to modulate predisposition to chronic inflammatory conditions. These components act through a variety of mechanisms including decreasing inflammatory mediator production through effects on cell signaling and gene expression (omega-3 fatty acids, vitamin E, plant flavonoids), reducing the production of damaging oxidants (vitamin E and other antioxidants), and promoting gut barrier function and anti-inflammatory responses (prebiotics and probiotics) 51. In a large Danish study 52 involving over 7000 men and women who were followed over 15 years (1982-1998). What that study found was that in both men and women who frequently consume wholemeal bread, vegetables, fruits, and fish, was associated with a better overall survival rate as well as better cardiovascular survival 52.

A low-fat diet (≤30% of total calories) is still considered by many physicians to be a healthy choice for both primary and secondary prevention of cardiovascular disease (coronary heart disease) 53. An unintended consequence of emphasizing low-fat diets may have been to promote unrestricted carbohydrate intake, which reduces high-density lipoprotein cholesterol (HDL “good” cholesterol) and raises triglyceride levels, exacerbating the metabolic manifestations of the insulin resistance syndrome, also known as the metabolic syndrome 54.

Three dietary strategies may help prevent coronary heart disease (coronary artery disease) 55:

  1. Increase consumption of omega-3 fatty acids from fish or plant sources;
  2. Substitute nonhydrogenated unsaturated fats for saturated and trans-fats; and
  3. Consume a diet high in fruits, vegetables, nuts, and whole grains and low in refined grains.

The effects of diet on coronary heart disease (coronary artery disease) can be mediated through multiple biologic pathways other than serum lipids, including oxidative stress, subclinical inflammation, endothelial dysfunction, insulin sensitivity, blood pressure, and thrombotic tendency 56.

Endothelial dysfunction is one of the mechanisms linking diet and the risk of cardiovascular disease 57, 58. This study 59 suggests a mechanism for the role of dietary patterns in the pathogenesis of cardiovascular disease. For example, women in the Nurses’ Health Study who ate a “American” diet (high in red and processed meats, sweets, desserts, French fries, and refined grains) had higher proinflammatory cytokines (C-reactive protein, Interleukin-6, E-selectin, soluble vascular cell adhesion molecule 1 and soluble intercellular adhesion molecule 1) than those with the “healthier” pattern, characterized by higher intakes of fruit, vegetables, legumes, fish, poultry, and whole grains 59. The levels of these mediators amplify the inflammatory response, are destructive and contribute to the clinical symptoms 51.

Arachidonic acid (AA) derived (omega-6) eicosanoids (primarily from refined vegetable oils such as corn, sunflower, and safflower) increase the production of proinflammatory cytokines IL-1, TNF-α, and IL-6, operating as precursors of the proinflammatory eicosanoids of the prostaglandin (PG)2-series 60. In contrast, the omega-3 (n-3) polyunsaturated fatty acids (PUFAs), found in fish, fish oil, walnuts, wheat germ, and some dietary supplements such as flax seed products can curb the production of Arachidonic acid (AA)-derived eicosanoids 61. The Omega-6 and Omega-3 polyunsaturated fatty acids (PUFAs) compete for the same metabolic pathways, and thus their balance is important 62. Accordingly, it is not surprising that both higher levels of Omega-3 polyunsaturated fatty acids (PUFAs) as well as lower Omega-6:Omega-3 ratios are associated with lower proinflammatory cytokine production 63.

Furthermore, in another study a healthy dietary pattern rich in fruit, vegetables and olive oil, such as the Mediterranean diet, is associated with lower levels of inflammatory markers, perhaps because of the anti-inflammatory properties of antioxidants 23.

The antioxidant properties of vegetables and fruits are thought to be one of the fundamental mechanisms underlying their anti-inflammatory dietary contributions 23. Oxidants such as superoxide radicals or hydrogen peroxide that are produced during the metabolism of food can activate the NF-κB pathway, promoting inflammation 64. Higher fruit and vegetable intakes are associated with lower oxidative stress and inflammation 64. In fact, some evidence suggests that the addition of antioxidants or vegetables may limit or even reverse proinflammatory responses to meals high in saturated fat 65.

To overcome silent inflammation requires an anti-inflammatory diet (with omega-3s and polyphenols). The most important aspect of such an anti-inflammatory diet is the stabilization of insulin and reduced intake of omega-6 fatty acids. The ultimate treatment lies in reestablishing hormonal and genetic balance to generate satiety instead of constant hunger. Anti-inflammatory nutrition with caloric restriction, should be considered as a form of gene silencing technology, in particular the silencing of the genes involved in the generation of silent inflammation. To this anti-inflammatory diet foundation supplemental omega-3 fatty acids at the level of 2–3 g of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) per day should be added. Finally, a diet rich in colorful, non-starchy vegetables would contribute adequate amounts of polyphenols to help not only to inhibit nuclear factor (NF)-κB (primary molecular target of inflammation) but also activate AMP kinase 66.

Table 2. Omega-3 Fatty Acid Foods EPA (Eicosapentaenoic acid) and DHA (Docosahexaenoic acid) – Fish and Seafood Sources


[Source 67]

Table 3. Other sources of Omega-3 Alpha-Linolenic Acid (ALA) – Non-Seafood Sources

Source of ALAALA content, g
Pumpkin seeds (1 tbsp)0.051
Olive oil (1 tbsp)0.103
Walnuts, black (1 tbsp)0.156
Soybean oil (1 tbsp)1.231
Rapeseed oil (1 tbsp)1.302
Walnut oil (1 tbsp)1.414
Flaxseeds (1 tbsp)2.350
Walnuts, English (1 tbsp)2.574
Flaxseed oil (1 tbsp)7.249
Almonds (100 g)0.4
Peanuts (100 g)0.003
Beans, navy, sprouted (100 g)0.3
Broccoli, raw (100 g)0.1
Lettuce, red leaf (100 g)0.1
Mustard (100 g)0.1
Purslane (100 g)0.4
Spinach (100 g)0.1
Seaweed, spirulina, dried (100 g)0.8
Beans, common, dry (100 g)0.6
Chickpeas, dry (100 g)0.1
Soybeans, dry (100 g)1.6
Oats, germ (100 g)1.4
Rice, bran (100 g)0.2
Wheat, germ (100 g)0.7
Avocados, California, raw (100 g)0.1
Raspberries, raw (100 g)0.1
Strawberries, raw (100 g)0.1
Novel sources of ALAALA content, g

Breads and pasta (100 g)0.1–1.6
Cereals (and granola bars) (55 g)1.0–4.9
Eggs (50 g or 1 egg)0.1–0.6
Processed meats (100 g)0.5
Salad dressing (14 g – 31 g)2.0–4.0
Margarine spreads (10 g – 100 g)0.3–1.0
Nutrition bars (50 g)0.1–2.2

Footnote: 1 tablespoon (tbsp) oil = 13.6 g; 1 tbsp seeds or nuts = 12.35 g.

[Source 68]

A traditional Mediterranean dietary pattern, which typically has a high ratio of monounsaturated (MUFA) and Omega-3 to Omega-6 polyunsaturated fatty acid (PUFAs) and supplies an abundance of fruits, vegetables, legumes, and grains, has been shown to have anti-inflammatory effects when compared with typical North American and Northern European dietary patterns in most observational and interventional studies 69.

The Mediterranean Diet is characterized by 70:

  1. An abundance of plant food (fruit, vegetables, breads, cereals, potatoes, beans, nuts, and seeds);
  2. Minimally processed, seasonally fresh, locally grown foods;
  3. Desserts comprised typically of fresh fruit daily and occasional sweets containing refined sugars or honey;
  4. Olive oil (high in polyunsaturated fat) as the principal source of fat;
  5. Daily dairy products (mainly cheese and yogurt) in low to moderate amounts;
  6. Fish and poultry in low to moderate amounts;
  7. Up to four eggs weekly;
  8. Red meat rarely; and
  9. Wine in low to moderate amounts with meals.

In studies involving people with chronic inflammatory bowel diseases (IBD) like Crohn’s disease and ulcerative colitis, the anti-Inflammatory diet (IBD-AID) has been used as an adjunct dietary therapy for the treatment of inflammatory bowel diseases (IBD) 71. The goal of the anti-Inflammatory diet (IBD-AID) is to assist with a decreased frequency and severity of flares, obtain and maintain remission in people with inflammatory bowel diseases (IBD). Dysbiosis, or altered bacterial flora, is one of the theories behind the development of anti-Inflammatory diet (IBD-AID), in that certain carbohydrates in the lumen of the gut provide pathogenic bacteria a substrate on which to proliferate 72, 73.

The anti-Inflammatory diet (IBD-AID) has five basic components:

  1. The first of which is the modification of certain carbohydrates, (including lactose, and refined or processed complex carbohydrates)
  2. The second places strong emphasis on the ingestion of pre- and probiotics (e.g.; soluble fiber, leeks, onions, and fermented foods) to help restore the balance of the intestinal flora 74, 75, 76
  3. The third distinguishes between saturated, trans, mono- and polyunsaturated fats 77, 78,
  4. The fourth encourages a review of the overall dietary pattern, detection of missing nutrients, and identification of intolerances.
  5. The last component modifies the textures of the foods (e.g.; blenderized, ground, or cooked) as needed (per patient symptomology) to improve absorption of nutrients and minimize intact fiber.

The phases indicated in Table 4 are examples of the modification of texture complexity, so that dietitian and patient can expand the diet as the patient’s tolerance and absorption improves. Some sensitivities common to many patients (not just those with IBD), are eased through supplementation of digestive enzymes or avoidance. A senior dietitian advised the patient and either family or spouse regarding the details of the diet during regular clinic visits. Patients taking supplements (probiotics, vitamin/minerals, omega-3 fatty acids) were advised to continue or discontinue, depending on the needs of the individual and the dietary intake 79.

The anti-Inflammatory diet (IBD-AID) consists of lean meats, poultry, fish, omega-3, eggs, particular sources of carbohydrate, select fruits and vegetables, nut and legume flours, limited aged cheeses (made with active cultures and enzymes), fresh cultured yogurt, kefir, miso and other cultured products (rich with certain probiotics) and honey. Prebiotics, in the form of soluble fiber (containing beta-glucans and inulin, such as bananas, oats, blended chicory root, and flax meal) are suggested. In addition, the patient is advised to begin at a texture phase of the diet matching with symptomology, starting with phase one if in an active flare. Many patients require foods to be softened and textures mechanically altered by pureeing the foods, and avoiding foods with stems and seeds when starting the diet (see phases 1–3 of Table 4), as intact fiber can be problematic for those with strictures and highly active mucosal inflammation. Some patients will require lifelong avoidance of intact fiber. Food irritants are not limited to intact fiber, but may include certain foods, processing agents and flavorings to which IBD patients may be reactive.

Table 4. The Anti-Inflammatory Diet (IBD-AID) Food Phase chart

Phase type

Phase I

Phase II

Phase III

Phase IV

Soft, well-cooked or cooked then pureed foods, no seeds Soft Textures: well-cooked or pureed foods, no seeds, choose floppy or tender foods May still need to avoid stems, choose floppy greens or other greens depending on individual tolerance If in remission with no strictures

Butternut Squash, Pumpkin, Sweet Potatoes, Onions

Carrots, Zucchini, Eggplant, Peas, Snow peas, Spaghetti squash, Green beans, Yellow beans, Microgreens (2 week old baby greens), Watercress, Arugula, Fresh flat leaf parsley and cilantro, Seaweed, Algae

Butter lettuce, Baby spinach, Peeled cucumber, Olives, Leeks Bok Choy, Bamboo shoots, Collard greens, Beet greens, Sweet peppers, Kale, Fennel bulb

Artichokes, Asparagus, Tomatoes, Lettuce, Brussels sprouts, Beets, Cabbage, Kohlrabi, Rhubarb, Pickles, Spring onions, Water chestnuts, Celery, Celeriac, Cauliflower, Broccoli, Radish, Green pepper, Hot pepper

Pureed vegetables: Mushrooms, Phase II vegetables (pureed)

Pureed vegetables: all except cruciferous

Pureed vegetables: all from Phase IV, Kimchi


Banana, Papaya, Avocado, Pawpaw

Watermelon (seedless), Mangoes, Honeydew, Cantaloupe, May need to be cooked: Peaches, Plums, Nectarines, Pears, (Phase III fruits are allowed if pureed and seeds are strained out)

Strawberries, Cranberries, Blueberries, Apricots, Cherries, Coconut, Lemons, Limes, Kiwi, Passion fruit, Blackberries, Raspberries, Pomegranate (May need to strain seeds from berries)

Grapes, Grapefruit, Oranges, Currants, Figs, Dates, Apples (best cooked), Pineapple, Prunes

Meats and fish

All fish (no bones), Sardines (small bones ok), Turkey and ground beef, Chicken, Eggs


Lean cuts of Beef, Lamb, Duck, Goose

Shrimp, Prawns, Lobster

Non dairy unsweetened

Coconut milk, Almond milk, Oat milk, Soy milk

Dairy, unsweetened

Yogurt, Kefir

Farmers cheese (dry curd cottage cheese), Cheddar cheese

Aged cheeses


Miso (refrigerated), Tofu, Olive oil, Canola oil, Flax oil, Hemp oil, Walnut oil, Coconut oil

Almond flour, Peanut flour, Soy flour, Sesame oil, Grapeseed oil, Walnut oil, Pureed nuts, Safflower oil, Sunflower oil

Whole nuts, Soybeans, Bean flours, Nut butters, Well-cooked lentils (pureed), Bean purees (e.g. hummus)

Whole beans and lentils


Ground flax or Chia Seeds (as tolerated)

Steel cut oats (well-cooked as oatmeal)

Rolled well-cooked oats


Basil, Sage, Oregano, Salt, Nutmeg, Cumin, Cinnamon, Turmeric, Saffron, Mint, Bay leaves, Tamari (wheat free soy sauce), Fenugreek tea, Fennel tea, Vanilla

Dill, Thyme, Rosemary Tarragon, Cilantro, Basil, Parsley

Mint, Ginger, Garlic (minced), Paprika, Chives, Daikon, Mustard

Wasabi, Tamarind, Horseradish, Fenugreek, Fennel


Stevia, Maple syrup, Honey (local), Unsweetened fruit juice

Lemon and lime juice

Misc.Capsule or liquid supplements, Cocoa powderBaking powder (no cornstarch), Baking soda, Unflavored gelatinGhee, Light mayonnaise, VinegarKetchup (sugar free), Hot sauce (sugar free)
[Source 71]

Chronic inflammatory processes contribute to the pathogenesis of many age-related diseases. In search of anti-inflammatory foods, researchers in the University of Wollongong, Australia, have systematically screened 115 variety of common dietary plants and mushrooms for their anti-inflammatory activity. Gunawardena and colleagues tested 115 commercially available plants and mushroom foods (including 115 identical samples heated with glucose) for their anti-inflammatory ability 80. The plant and mushroom samples were prepared by methods usually employed with food preparation, involving heating (i.e. ‘cooking’) and mechanical dispersion. Samples were prepared by blending in a food processor with water before heating in a microwave for 10 minutes under control conditions or including 1% glucose, to enhance Maillard reaction products. Using using the free radical nitric oxide (NO) and tumour necrosis factor–α (TNF-α) as pro-inflammatory markers, 10 foods demonstrated significant anti-inflammatory activity (see Table 5) 80. The activation of macrophages leads to secretion of inflammatory molecules such as the pro-inflammatory cytokine TNF-α and the free radical nitric oxide (NO), which play an important role in inflammation and nitroxidative stress in many age-related diseases, including Alzheimer’s disease 81.

Table 5. Anti-inflammatory foods

anti-inflammatory food list

[Source 80 ]

Seven of these food preparations, including lime zest, English breakfast tea, honey brown mushroom, button mushroom, oyster mushroom, cinnamon and cloves demonstrated potent anti-inflammatory activity with IC 50 values between 0.1 and 0.5 mg/ml. However, the most active food samples were onion, followed by oregano and red sweet potato exhibiting IC 50 values below 0.1 mg/ml. In addition, English breakfast tea leaves, oyster mushroom, onion, cinnamon and button mushroom preparations suppressed TNF-α production, exhibiting with IC 50 values below 0.5 mg/ml in RAW 264.7 macrophages 6.

Secondary screen using RAW 264.7 macrophages, NO and TNF-α as pro-inflammatory markers, of the 10 products, oyster mushroom and cinnamon, demonstrated the most significant anti-inflammatory activities (with IC 50 values below 0.1 mg/ml), followed by cloves, oregano, onion, English breakfast tea leaves and lime zest (see Table 2) 6. The commonly used drug for the management of inflammatory conditions are non-steroidal anti-inflammatory drugs (NSAIDs), which have several adverse effects especially gastric irritation leading to the formation of gastric ulcers 82. Two anti-inflammatory drugs, including prednisone and the non-steroidal anti-inflammatory drug (NSAID) ibuprofen were also tested in the same study assay systems. Ibuprofen was toxic to cells at concentrations of 1.63 ± 0.44 mM, and NO and TNF-α production were down-regulated at the same concentrations (Table 6).  Prednisone inhibited LPS + IFN-γ induced NO and TNF-α production with IC 50 values of 0.25 ± 0.09 mg/ml (Table 6).

Table 6. Anti-inflammatory foods re-tested in macrophages

anti-inflammatory food list re-tested in macrophages

[Source 80]

Onions have been shown to exhibit anti-inflammatory properties, e.g. downregulation of adipokine expression in the visceral adipose tissue of rats or attenuation of vascular inflammation and oxidative stress in fructose-fed rats 83, 84. Among the polyphenols in onions, quercetin was suggested to be the responsible anti-inflammatory ingredient, as evidenced by the downregulation of COX2 transcription in human lymphocytes 85. Furthermore, the anti-inflammatory activity of the onion has been
studied also in relation to the presence of thiosulfinates and cepaenes 86, 87.

Anti-inflammatory properties of cinnamon has been demonstrated for Cinnamomum osmophloem kaneh 88, 89, but less is known about the ‘true’ cinnamon of India, Cinnamomum zeylanicum. Some authors reported significant inhibitory effects of inflammatory signalling by the extracts of C. cassia 90. Sodium benzoate appears to be one of the active ingredients in cinnamon, since it inhibits LPS-induced expression of inducible NO synthase (iNOS), pro-inflammatory cytokines (TNF-α and IL-1 β) and surface markers for inflammatory activation such as CD11b, CD11c, and CD68 in mouse microglia 91. However, E-cinnamaldehyde and o-methoxycinnamaldehyde are responsible for most of the anti-inflammatory activity of cinnamon 92.

Clove (Syzygium aromaticum) extracts have been identified as having potent free radical (including superoxide anion) scavenging properties, and metal chelating activities, which may be due to the presence of flavonoids. Cloves contain considerable concentrations of eugenol, beta-caryophyllene, quercetin and kaempferol as well as rhamnetin and kaempferol and their glycosides 93.

Red sweet potato (Ipomoea batatas), a species rich in β-carotene and anthocyanins 94, has been demonstrated to have anti-inflammatory properties for the first time by this study 6.

Lime (Citrus aurantifolia) rich in flavonol glycosides, especially of kaempferol-type are known for their anti-oxidant properties 95, this study 6 is also the first to report on its anti-inflammatory activities.

A handful studies have shown the anti-inflammatory properties of the various mushroom species. For example, oyster mushroom concentrate was shown to suppress LPS-induced secretion of TNF-α, IL-6 and IL-12p40 in RAW264.7 macrophages and also suppressed PGE2 and NO by down-regulation of COX-2 and iNOS expression, respectively. Oyster mushroom concentrate also inhibited LPS-dependent DNA binding activity of AP-1 and NF-κ B in RAW264.7 cells 96. In mushrooms, water-soluble polysaccharides, especially the β-glucans, are most likely to be the substances responsible for the anti-inflammatory properties. For example, β-glucans isolated Pleurotus ostreatus were able to potentiate the anti-inflammatory effects of methotrexate in rat models of experimental arthritis or colitis 97, 98. A further potential anti-inflammatory compound in mushrooms could be ergothioneine, a sulfur containing amino acid that functions as an antioxidant and is present in mushrooms at a concentration of up to 2.0mg/g 99. In Acute Respiratory Distress Syndrome (ARDS), ergothioneine given intravenously 1h before or 18 h after cytokine (IL-1 and IFN-γ) insufflation, decreased lung injury and lung inflammation in cytokine insufflated rats 100.

The anti-inflammatory activity in these food samples survived ‘cooking’ and suggesting these foods may be useful in limiting inflammation in a variety of age-related inflammatory diseases 6. Furthermore, these foods could be a source for the discovery of novel anti-inflammatory drugs 6. However, validation of these foods containing anti-inflammatory properties will require further clinical trials in human subjects before any recommendation can be given for their use to treat inflammatory conditions.

Inflammatory bowel disease dietary guidelines

To help patients navigate their nutritional questions, the International Organization of Inflammatory Bowel Diseases recently reviewed the best current evidence to develop expert recommendations regarding dietary measures that might help to control and prevent relapse of inflammatory bowel disease 101. In particular, the International Organization of Inflammatory Bowel Diseases focused on the dietary components and additives that they felt were the most important to consider because they comprise a large proportion of the diets that inflammatory bowel disease patients may follow. Furthermore, the recent International Organization of Inflammatory Bowel Diseases guidelines are an excellent starting point for discussions between patients and their doctors about whether specific dietary changes might be helpful in reducing symptoms and risk of relapse of inflammatory bowel disease. However, all patients with inflammatory bowel disease (IBD) should work with their doctor or a nutritionist, who will conduct a nutritional assessment to check for malnutrition and provide advice to correct deficiencies if they are present.

The International Organization of Inflammatory Bowel Diseases recommendations were developed with the aim of reducing symptoms and inflammation 101. The ways in which altering the intake of particular foods may trigger or reduce inflammation are quite diverse, and the mechanisms are better understood for certain foods than others. For example, fruits and vegetables are generally higher in fiber, which is fermented by bacterial enzymes within the colon. This fermentation produces short-chain fatty acids (SCFAs) that provide beneficial effects to the cells lining the colon. Patients with active IBD have been observed to have decreased short-chain fatty acids, so increasing the intake of plant-based fiber may work, in part, by boosting the production of short-chain fatty acids. However, it is important to note disease-specific considerations that might be relevant to your particular situation. For example, about one-third of Crohn’s disease patients will develop an area of intestinal narrowing, called a stricture, within the first 10 years of diagnosis. Insoluble fiber can worsen symptoms and, in some cases, lead to intestinal blockage if a stricture is present. So, while increasing consumption of fruits and vegetable is generally beneficial for Crohn’s disease, patients with a stricture should limit their intake of insoluble fiber.

Table 7. The International Organization of Inflammatory Bowel Diseases guidelines

FoodIf you have Crohn’s diseaseIf you have ulcerative colitis
Fruitsincrease intakeinsufficient evidence
Vegetablesincrease intakeinsufficient evidence
Red/processed meatinsufficient evidencedecrease intake
Unpasteurized dairy productsbest to avoidbest to avoid
Dietary fatdecrease intake of saturated fats and avoid trans fatsdecrease consumption of myristic acid (palm, coconut, dairy fat), avoid trans fats, and increase intake of omega-3 (from marine fish but not dietary supplements)
Food additivesdecrease intake of maltodextrin-containing foodsdecrease intake of maltodextrin-containing foods
Thickenersdecrease intake of carboxymethylcellulosedecrease intake of carboxymethylcellulose
Carrageenan (a thickener extracted from seaweed)decrease intakedecrease intake
Titanium dioxide (a food colorant and preservative)decrease intakedecrease intake
Sulfites (flavor enhancer and preservative)decrease intakedecrease intake
[Source 101 ]

What are specific diets for inflammatory bowel disease?

A number of specific diets have been explored for inflammatory bowel disease (IBD), including the Mediterranean diet, specific carbohydrate diet, Crohn’s disease exclusion diet, autoimmune protocol diet, and a diet low in fermentable oligo-, di-, monosaccharides, and polyols (FODMAPs). Although the International Organization of Inflammatory Bowel Diseases group initially set out to evaluate some of these diets, they did not find enough high-quality trials that specifically studied them 101. Therefore, they limited their recommendations to individual dietary components. Stronger recommendations may be possible once additional trials of these dietary patterns become available. For the time being, patients are to monitor for correlations of specific foods to their symptoms. In some cases, patients may explore some of these specific diets to see if they help.

anti inflammatory diet

Anti inflammatory diet meal plan

By following the US Department of Health food guide, called ChooseMyPlate 102, you can make healthier food choices. The new US Department of Agriculture’s food guide 2015-2020 103 encourages you to eat more fruits and vegetables, whole grains, lean proteins, and low-fat dairy. Using the guide 103, you can learn what type of food you should eat and how much you should eat. You also learn why and how much you should exercise.

There are 5 major food groups that make up a healthy diet:

  1. Grains
  2. Vegetables
  3. Fruits
  4. Dairy
  5. Protein foods

You should eat foods from each group every day. How much food you should eat from each group depends on your age, gender, and how active you are.

ChooseMyPlate 102 makes specific recommendations for each type of food group.


  • Whole grains contain the entire grain. Processed grains have had the bran and germ removed. Be sure to read the ingredient list label and look for whole grains first on the list.
  • Foods with whole grains have more fiber and protein than food made with processed grains.
  • Examples of whole grains are breads and pastas made with whole-wheat flour, oatmeal, bulgur, faro, and cornmeal.
  • Examples of processed grains are white flour, white bread, and white rice.

Most children and adults should eat about 5 to 8 servings of grains a day (also called “ounce equivalents”). Children age 8 and younger need about 3 to 5 servings. At least half those servings should be whole grain. An example of one serving of grains includes:

  • 1 slice of bread
  • Half of a bagel
  • 1 cup (30 grams)of cereal
  • 1/2 cup (165 grams) cooked rice
  • 5 whole-wheat crackers
  • 1/2 cup (75 grams) cooked pasta

Eating whole grains can help improve your health by 104:

  • Reducing the risk of many chronic diseases.
  • Whole grains can help you lose weight. Portion size is still key. Because whole grains have more fiber and protein, they are more filling than refined grains, so you can eat less to get the same feeling of being full. But if you replace vegetables with starches, you’ll gain weight, even if you eat whole grain.
  • Whole grains can help you have regular bowel movements.

Ways to eat more whole grains:

  • Eat brown rice instead of white rice.
  • Use whole-grain pasta instead of regular pasta.
  • Replace part of white flour with wheat flour in recipes.
  • Replace white bread with whole-wheat bread.
  • Use oatmeal in recipes instead of bread crumbs.
  • Snack on air-popped popcorn instead of chips or cookies.


  • Vegetables can be raw, fresh, cooked, canned, frozen, dried, or dehydrated.
  • Vegetables are organized into 5 subgroups based on their nutrient content. The groups are dark-green vegetables, starchy vegetables, red and orange vegetables, beans and peas, and other vegetables.
  • Try to include vegetables from each group, try to make sure you aren’t only picking options from the “starchy” group.

Most children and adults should eat between 2 and 3 cups (200 to 300 grams) of vegetables a day. Children age 8 need about 1 to 1 1/2 cups (100 to 150 grams). Examples of a cup include:

  • Large ear of corn
  • Three 5-inch (13 centimeters) broccoli spears
  • 1 cup (100 grams) cooked vegetables
  • 2 cups (250 grams) of raw, leafy greens
  • 2 medium carrots
  • 1 cup (240 milliliters) 100% vegetable juice (carrot, tomato)

Eating vegetables can help improve your health in the following ways:

  • Lowers your risk of heart disease, obesity, and type 2 diabetes
  • Helps protect you against some cancers
  • Helps lower blood pressure
  • Reduces the risk of kidney stones
  • Helps reduce bone loss

Ways to eat more vegetables:

  • Keep plenty of frozen vegetables handy in your freezer.
  • Buy pre-washed salad and pre-chopped veggies to cut down on prep time.
  • Add veggies to soups and stews.
  • Add vegetables to spaghetti sauces.
  • Try veggie stir-fries.
  • Eat raw carrots, broccoli, or bell pepper strips dipped in hummus or ranch dressing as a snack.


  • Fruits can be fresh, canned, frozen, or dried.

Most adults need 1 1/2 to 2 cups (200 to 250 grams) of fruit a day. Children age 8 and younger need about 1 to 1 1/2 cups (120 to 200 grams). Examples of a cup include:

  • 1 small piece of fruit, such as an apple or pear
  • 8 large strawberries
  • 1/2 cup (130 grams) dried apricots or other dried fruit
  • 1 cup (240 milliliters) 100% fruit juice (orange, apple, grapefruit)
  • 1 cup (100 grams) cooked or canned fruit
  • 1 cup (250 grams) chopped fruit

Eating fruit can help improve your health, they may help to:

  • Lower your risk of heart disease, obesity, and type 2 diabetes
  • Protect you against some cancers
  • Lower blood pressure
  • Reduce the risk of kidney stones
  • Reduce bone loss

Ways to eat more fruit:

  • Put out a fruit bowl and keep it full of fruit.
  • Stock up on dried, frozen, or canned fruit, so you always have it available. Choose fruit that is canned in water or juice instead of syrup.
  • Buy pre-cut fruit in packages to cut down on prep time.
  • Try meat dishes with fruit, such as pork with apricots, lamb with figs, or chicken with mango.
  • Grill peaches, apples, or other firm fruit for a healthy, tasty dessert.
  • Try a smoothie made with chopped fruit and plain yogurt for breakfast.
  • Use dried fruit to add texture to trail mixes.


Protein foods include meat, poultry, seafood, beans and peas, eggs, processed soy products, nuts and nut butters, and seeds. Beans and peas are also part of the vegetable group.

  • Choose meats that are low in saturated fat and cholesterol, such as lean cuts of beef and chicken and turkey without skin.
  • Most adults need 5 to 6 1/2 servings of protein a day (also called “ounce equivalents”). Children age 8 and younger need about 2 to 4 servings.

Examples of a serving include:

  • 1 oz (28 grams) lean meat; like beef, pork, or lamb
  • 1 oz (28 grams) poultry; such as turkey or chicken
  • 1 large egg
  • 1/4 cup (50 grams) tofu
  • 1/2 cup (50 grams) cooked beans or lentils
  • 1 tablespoon (15 grams) peanut butter
  • 1/3 cup (35 grams) nuts

Eating lean protein can help improve your health:

  • Seafood high in omega-3 fats, such as salmon, sardines, or trout, can help prevent heart disease.
  • Peanuts and other nuts, such as almonds, walnuts, and pistachios, when eaten as part of a healthy diet, can help lower the risk of heart disease.
  • Lean meats and eggs are a good source of iron

Ways to include more lean protein in your diet:

  • Choose lean cuts of beef, which include sirloin, tenderloin, round, chuck, and shoulder or arm roasts and steaks.
  • Choose lean pork, which include tenderloin, loin, ham, and Canadian bacon.
  • Choose lean lamb, which includes tenderloin, chops, and leg.
  • Buy skinless chicken or turkey, or take the skin off.
  • Grill, roast, poach, or broil meats, poultry, and seafood instead of frying.
  • Trim all visible fat and drain off any fat when cooking.
  • Substitute peas, beans, or soy in place of meat at least once a week. Try bean chili, pea or bean soup, stir-fried tofu, rice and beans, or veggie burgers.
  • Include 8 ounces (225 grams) of cooked seafood a week


Most children and adults should get about 3 cups (720 milliliters) of dairy a day. Children age 2 to 8 need about 2 to 2 1/2 cups (480 to 600 milliliters). Examples of a cup include:

  • 1 cup (240 milliliters) milk
  • 1 regular container of yogurt
  • 1 1/2 ounces (45 grams) hard cheese (such as cheddar, mozzarella, Swiss, Parmesan)
  • 1/3 cup (40 grams) shredded cheese
  • 2 cups (450 grams) cottage cheese
  • 1 cup (250 grams) pudding made with milk or frozen yogurt
  • 1 cup (240 milliliters) calcium-fortified soymilk

Eating dairy food can improve your health:

  • Consuming dairy foods is important for improving bone health especially during childhood and adolescence, when bone mass is being built.
  • Dairy foods have vital nutrients including calcium, potassium, vitamin D, and protein.
  • The intake of dairy products is linked to reduced risk of cardiovascular disease, type 2 diabetes, and lower blood pressure in adults.
  • Low-fat or fat-free milk products provide little or no solid fat.

Ways to include low-fat foods from the dairy group in your diet:

  • Include milk or calcium-fortified soymilk (soy beverage) as a beverage at meals. Choose fat-free or low-fat milk.
  • Add fat-free or low-fat milk instead of water to oatmeal and hot cereals.
  • Use fat-free or low-fat milk when making condensed cream soups (such as cream of tomato).
  • Top casseroles, soups, stews, or vegetables with shredded reduced-fat or low-fat cheese.
  • Use lactose-free or lower lactose products if you have trouble digesting dairy products. Also, you can get more calcium from non-dairy sources such as fortified juices, canned fish, soy foods, and green leafy vegetables.


  • Oils are not a food group. However, they provide important nutrients and should be part of a healthy diet.
  • Fats such as butter and shortening are solid at room temperature. They contain high levels of saturated fats or trans fats. Eating a lot of these fats can increase your risk of heart disease.
  • Oils are liquid at room temperature. They contain monounsaturated and polyunsaturated fats. These types of fats are generally good for your heart.
  • Children and adults should get about 5 to 7 teaspoons (25 to 35 milliliters) of oil a day. Children age 8 and younger need about 3 to 4 teaspoons (15 to 20 milliliters) a day.
  • Choose oils such as olive, canola, sunflower, safflower, soybean, and corn oils.
  • Some foods are also high in healthy oils. They include avocados, some fish, olives, and nuts.


ChooseMyPlate 102 also provides information about how to lose excess weight:

  • You can use the online SuperTracker to learn what you currently eat and drink. By writing down what you eat and drink every day, you can see where you can make better choices.
  • You can use the Daily Food Plan to learn what to eat and drink. You just enter your height, weight, and age to get a personalized eating plan.
  • Use the SuperTracker to track your daily activity and food you eat, plus your weight.
  • If you have any specific health concerns, such as heart disease or diabetes, be sure to discuss any dietary changes with your doctor or registered dietitian first.

You also learn how to make better choices, such as:

  • Eating the right amount of calories to keep you at a healthy weight
  • Not overeating and avoiding big portions
  • Eating fewer foods with empty calories. These are foods high in sugar or fat with few vitamins or minerals.
  • Eating a balance of healthy foods from all 5 food groups
  • Making better choices when eating out at restaurants
  • Cooking at home more often, where you can control what goes into the foods you eat
  • Exercising 150 minutes a week
  • Decreasing your screen time in front of the TV or computer
  • Getting tips for increasing your activity level
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Diet PlanDiet, Food & Fitness

How to eat clean and lose weight

eat clean

What does it mean to eat clean ?

“How to eat clean ?” Many clinicians find themselves at a loss to answer this common question from patients. The difficulty of offering a simple answer is understandable. The overwhelming volume of data generated by food and nutrition researchers coupled with sometimes contradictory findings, the seeming flip-flops in recommendations, and the flood of misinformation in diet books and the media can make it seem as though explaining the essentials of healthy eating is akin to describing the intricacies of particle physics. That is unfortunate, because there are now enough solid evidence from reliable sources to weave simple but compelling recommendations about clean eating.

The fundamentals of eating clean encourage you to consume more whole foods — such as fruits, vegetables, lean proteins, whole grains and healthy fats — and limit highly processed snack foods, sweets and other packaged foods. An example of a meal containing all of these foods would be a spinach salad with grilled chicken, quinoa, avocado, walnuts and apple slices.

Clean eating isn’t black and white. There’s room for flexibility and modifications, and it doesn’t require avoiding any certain food groups — unless medically necessary.

Clean eating also doesn’t mean that all foods must be consumed in the raw state. Cooking, pasteurizing and preserving are okay.

Replacing meals with store-bought protein shakes or sugary smoothies and juices is not an example of clean eating.

Although research on nutrients such as fats, carbohydrates, and specific vitamins and minerals has been revealing, it has also generated some dead ends, along with myths and confusion about what constitutes clean eating. A key reason is because people eat food, not nutrients. Furthermore, humans tend to follow relatively repeatable dietary patterns. Although it is harder to study dietary patterns than it is to study nutrients, new research has shown how some dietary patterns are good for long-term health.

One dietary pattern that may harm long-term health is the typical Western diet—rich in red meat, highly processed grains, and sugar, and lacking in fruits, vegetables, whole grains, and fiber. A host of studies have emphasized that this type of dietary pattern promotes atherosclerosis and a variety of cardiovascular conditions, including heart attack and stroke, peripheral vascular disease, and heart failure 1, 2.

A clean eating plan gives your body the nutrients it needs every day while staying within your daily calorie goal for weight loss. A clean eating plan also will lower your risk for heart disease and other health conditions 3.

All food and beverage choices matter. Choose a healthy eating pattern at an appropriate calorie level to help achieve and maintain a healthy body weight, support nutrient adequacy, and reduce the risk of chronic disease. Over time, if you eat and drink more calories than your body uses or “burns off,” your body may store the extra energy, leading to weight gain.

According to the Dietary Guidelines for Americans 4, a clean eating is eating a diet that is healthy. A clean eating plan involves:

  • Emphasizes vegetables, fruits, whole grains, and fat-free or low-fat milk products.
  • Includes lean meats, poultry, fish, beans, eggs, and nuts.
  • Is low in saturated fats, trans fats, cholesterol, salt, and added sugars.
  • Grains, at least half of which are whole grains.
  • Controls portion sizes.
  • Balances the calories you take in from food and beverages with the calories burned through physical activity to maintain a healthy weight.
  • Consume less than 10 percent of calories per day from added sugars.
  • Consume less than 5-7 percent of calories per day from saturated fats.
  • Consume less than 2,300 milligrams (mg) per day of sodium (salt).
  • If alcohol is consumed, it should be consumed in moderation—up to one drink per day for women and up to two drinks per day for men—and only by adults of legal drinking age. It is not recommended that individuals begin drinking or drink more for any reason.

Here are some tips to help you meet the eat clean guidelines:

  • Eating fruits and vegetables of different colors gives your body a wide range of valuable nutrients.
  • A variety of vegetables from all of the subgroups—dark green, red and orange, legumes (beans and peas), starchy, and other.
  • Fruits, especially whole fruits.
  • Include foods that contain fiber such as fruits, vegetables, beans, and whole-grains.
  • Eat lean cuts of meat and poultry. Trim away excess fat and remove skin from poultry before cooking.
  • Limit calories from added sugars and saturated fats and reduce sodium intake. Consume an eating pattern low in added sugars, saturated fats, and sodium. Cut back on foods and beverages higher in these components to amounts that fit within healthy eating patterns.
  • Limiting highly processed, packaged foods with a long list of ingredients, most of which are not natural. Ingredients listed on the food label should mostly be foods that you recognize, such as whole-grain steel cut oats, dried apple, flaxseed and cinnamon. Limit ingredients that you can’t identify or can’t easily pronounce, such as carnauba wax, soy lecithin and artificial flavor.
  • Cutting back on foods with added salt, sugar or fat.
  • Avoiding foods that are drastically altered compared with their natural form, such as apple juice versus a whole apple, chicken nuggets versus a fresh chicken breast, or vegetable chips versus fresh vegetables. Sometimes processing can be a good thing for foods, such as pasteurization that makes eggs and dairy products safe for consumption. Also, frozen fruits and vegetables are okay because they are minimally processed and can sometimes contain more nutrients than fresh varieties since they are frozen at their peak.
  • Pay attention to portion sizes, especially at restaurants.
  • Smaller portions equal fewer calories.
  • Season your food with lemon juice, herbs, and spices, rather than using butter and salt.
  • Choose foods that are baked, broiled, braised, grilled, steamed, sautéed, or boiled, rather than fried.
  • Preparing and eating more foods at home. Start with simple meals to help you get into the habit, such as Greek yogurt and fresh berries for breakfast, or a whole-grain roasted turkey and avocado wrap with red pepper slices at lunch.
  • When eating out, select a dish from the menu, rather than getting your money’s worth at the all-you-can-eat buffet.

In the United States and other developed countries, the average adult can expect to live 80 years or more 5. With such longevity, it isn’t enough merely to consume the calories needed to sustain the body, build it, and repair it. The foods that supply these calories can influence the risk of developing chronic conditions, which range from heart disease and cancer to osteoporosis and age-related vision loss.

Although much remains to be learned about the role of specific nutrients in decreasing the risk of chronic disease, a large body of evidence supports the utility of healthy dietary patterns that emphasize whole-grain foods, legumes, vegetables, and fruits, and that limit refined starches, red meat, full-fat dairy products, and foods and beverages high in added sugars. Such diets have been associated with decreased risk of a variety of chronic diseases 6.

Diet, of course, is just one approach to preventing illness. Limiting caloric intake to maintain a healthy weight, exercising regularly, and not smoking are three other essential strategies. Compelling data from the Nurses’ Health Study show that women who followed a healthy lifestyle pattern that includes these four strategies were 80% less likely to develop cardiovascular disease over a 14-year period compared to all other women in the study 7. A companion study, the Health Professionals Follow-up Study, showed that similar healthy choices were beneficial in men, even among those who were taking medications to lower blood pressure or cholesterol 8.

Strong evidence shows that clean eating patterns are associated with a reduced risk of cardiovascular disease (coronary heart disease). Moderate evidence indicates that healthy eating patterns also are associated with a reduced risk of type 2 diabetes, certain types of cancers (such as colorectal and postmenopausal breast cancers), overweight, and obesity. Emerging evidence also suggests that relationships may exist between eating patterns and some neurocognitive disorders and congenital anomalies. Within this body of evidence, higher intakes of vegetables and fruits consistently have been identified as characteristics of healthy eating patterns; whole grains have been identified as well. Additionally, some evidence indicates that whole grain intake may reduce risk for coronary heart disease and is associated with lower body weight. Other characteristics of healthy eating patterns have been identified include fat-free or low-fat dairy, seafood, legumes, and nuts. Lower intakes of meats, including processed meats; processed poultry; sugar-sweetened foods, particularly beverages; and refined grains have often been identified as characteristics of healthy eating patterns.

Table 1. Elements of clean healthy eating

Choose healthy fats over unhealthy fats.
  • Avoid trans fats, which are generally found in commercially baked products and deep-fried restaurant food.
  • Limit intake of saturated fats, mostly from red meat, butter, milk, and other dairy products (under 8% of calories [17 grams*])
  • Emphasize polyunsaturated fats from olives and olive oil; canola, peanut, and other nut oils; almonds, cashews, peanuts, and other nuts and nut butters; avocados; sesame, pumpkin, and other seeds (10–15% of calories [22–27 grams*])
  • Emphasize polyunsaturated fats from vegetables oils such as corn, soybean, and safflower oils; walnuts; fatty fish such as salmon, herring, and anchovies (8–10% of calories [17–22 grams*])
Choose slowly digested carbohydrates over highly refined ones.Limit intake of sources of rapidly digested carbohydrates such as white flour, white rice, pastries, sugary drinks, and French fries. In their place, emphasize whole grains (such as brown rice, barley, bulgur, quinoa, and wheat berries), whole fruits and vegetables, beans, and nuts. Aim for at least 6 servings of whole grains a day. Choosing a whole-grain breakfast cereal and whole grain bread are excellent starts.
Pick the best protein packages by emphasizing plant sources of protein rather than animal sources.Adopting a “flexitarian” approach to protein has long-term health payoffs. Aim for at least half of protein from plants—beans, nuts, seeds, whole grains, fruits, and vegetables. Choose fish, eggs, poultry for most of the rest, with small amounts of red meat and dairy making up the balance. Aim for two servings of fish per week.**
Accentuate fruits and vegetables.Consider 5 servings of fruit and vegetables a daily minimum; 9 a day is even better. Eat for variety and color. Each day try to get at least one serving of a dark green leafy vegetable, a yellow or orange fruit or vegetable, a red fruit or vegetable, and a citrus fruit. Fresh is usually best, especially if it is local; frozen fruits and vegetables are nearly as good.
Opt for low-calorie hydration.Water is the best choice for hydration. Coffee and tea in moderation (with only a small amount of milk or sugar) are generally safe and healthful beverages. If milk is part of the diet, skim or low-fat milk is best. Avoid sugar-laden drinks such as sodas, fruits drinks, and sports drinks. Limit fresh juice to one small glass a day. Alcohol in moderation (no more than one drink a day for women) if at all.
Meet the daily recommendations for vitamins and minerals.Taking an RDA-level multivitamin-multimineral supplement each day that contains folic acid and 1,000 IU of vitamin D provides an inexpensive nutritional safety net. Many premenopausal women need extra iron, and some women need additional calcium.
Daily exerciseCalories expended are as important for good health as the quality and quantity of calories consumed. Current recommendations call for 30 minutes of physical activity such as brisk walking on most, if not all, days of the week.
*for a diet of 2,000 calories a day
**low-mercury choices are best, especially for women who are pregnant or breastfeeding
[Source 9]

Table 2. Elements of 2 healthy dietary patterns

Mediterranean- type diet
  • Fruits, vegetables, grains, beans, nuts, and seeds are eaten daily and make up the majority of food consumed.
  • Fat, much of it from olive oil, may account for up to 40% of daily calories.
  • Small portions of cheese or yogurt are usually eaten each day, along with a serving of fish, poultry, or eggs.
  • Red meat is consumed now and then.
  • Small amounts of red wine are typically taken with meals.

These diets are low in saturated fat and high in fiber.

DASH diet 10, 11*
  • Grains and grain products: 7–8 servings*, more than half of which are whole-grain foods
  • Fruits: 4–5 servings
  • Vegetables: 4–5 servings
  • Low-fat or non-fat dairy foods: 2–3 servings
  • Lean meats, fish, poultry: 2 servings or fewer
  • Nuts, seeds, and legumes: 4–5 servings per week
  • Added fats: 2–3 servings per day
  • Sweets: limited

The nutrient breakdown of the DASH diet was: total fat, 27% of calories; saturated fat, 6% of calories; cholesterol, 150 mg; protein, 18% of calories; carbohydrate, 55% of calories; fiber, 30 g; sodium, 2,300 mg; potassium, 4,700 mg; calcium, 1,250 mg; and magnesium, 500 mg

*In the DASH diet, servings listed are based on a diet of 2,000 calories per day.
[Source 9]
  • Mediterranean Diet

Traditional diets developed in countries surrounding the Mediterranean Sea have been linked with lower rates of heart disease and other chronic conditions. Such diets also appear to transplant well to foreign soil. Among the 166,012 women participating in the National Institutes of Health Diet and Health Study, those whose diets most closely matched a traditional Mediterranean diet had reduced risks of all-cause mortality, cardiovascular mortality and cancer mortality compared with those following a Western diet 12. A similar trend was observed for men. The impact was even greater among smokers. The Mediterranean diet has other health benefits as well, such as reduced risk of cancer, Parkinson’s disease, and Alzheimer’s disease 13. It has also been associated with control of asthma 14 and improvement in rheumatoid arthritis 15.

Although there is no single diet that can be called “the” Mediterranean diet, those worthy of the name are high in extra virgin olive oil; high in whole grain foods and fiber; and rich in fruits, vegetables, legumes, and nuts. Small portions of cheese and yogurt are eaten daily; fish is consumed in varying amounts; red meat, poultry, eggs, and sweets are consumed sparingly. Modest amounts of red wine complement meals, and regular physical activity is a part of daily life. An example of a Mediterranean-type diet can be found here The Mediterranean Diet

  • DASH Diet

In the 1990s, the National Heart, Lung, and Blood Institute sponsored a randomized, controlled trial called Dietary Approaches to Stop Hypertension (DASH) to see if certain changes in diet could lower blood pressure. The DASH diet emphasized fruits, vegetables, and low-fat dairy foods and limited red meat, saturated fats, and sweets. Compared with an average American diet, the DASH diet lowered participants’ systolic blood pressure by an average of 5.5 mm Hg and diastolic pressure by 3 mm Hg 10. A low-sodium DASH approach was even more effective; the results were comparable to those from trials of antihypertensive medications 11. The impact of the DASH diet goes beyond lowering blood pressure. It has since been shown to reduce weight 16, the risk of coronary heart disease and stroke 17 and the development of kidney stones 18. Details of the DASH diet can be found here What is the DASH Diet ?

Dietary Fat

Dietary fat is a terribly misunderstood and mistakenly maligned nutrient. Myths and messages that have persisted since the 1960s warn that “fat is bad.” That dangerous oversimplification has helped launch dozens of largely ineffective diets and the development of thousands of fat-free but calorie-laden foods. It has also helped fuel the twin epidemics of obesity and type 2 diabetes. The message “fat is bad” is problematic because there are four main types of dietary fat with dramatically different effects on health.

Trans fats from partially hydrogenated oils are undeniably bad for the cardiovascular system and the rest of the body. These largely man-made fats elevate harmful low-density lipoprotein (LDL) cholesterol, reduce protective high-density lipoprotein (HDL) cholesterol, stimulate inflammation, and cause a variety of other changes that damage arteries and impair cardiovascular health 19. Higher intake of trans fat has been associated with an increased risk for developing cardiovascular disease, type 2 diabetes, gall stones, dementia, and weight gain 19.

Saturated fats from red meat and dairy products increase harmful LDL, but also increase HDL. A moderate intake of saturated fat (under 7% of daily calories) is compatible with a healthy diet, whereas consumption of greater amounts has been associated with cardiovascular disease.

Monounsaturated and polyunsaturated fats from vegetable oils, seeds, nuts, whole grains, and fish—especially the polyunsaturated omega-3 fatty acids—are important components of a healthy diet and are also essential for cardiac health. Eating polyunsaturated fats in place of saturated and trans fats lowers harmful LDL, elevates protective HDL, improves sensitivity to insulin, and stabilizes heart rhythms 20.

Dietary fat per se is not associated with risk of chronic disease. In fact, diets that include up to 40% of calories from fat can be quite healthy if they are low in trans and saturated fat and emphasize polyunsaturated and monounsaturated fat 21. Although definitive data are not available on the optimal proportions of dietary fats, a low intake of trans and saturated fat and a higher intake of unsaturated fats reduce the risk of cardiovascular disease and diabetes.


In the United States, the reduction in the intake of dietary fat from 45% of calories in 1965 to approximately 34% today was accompanied by an increase in the intake of carbohydrates 22. These extra carbohydrates were largely in the form of highly processed grains. Processing removes fiber, healthful fats, and an array of vitamins, minerals, and phytonutrients, making processed grains such as white flour or white rice nutritionally impoverished compared with whole-grain versions. Consumption of a diet rich in highly processed grains is associated with an increase in triglycerides and a reduction in protective HDL cholesterol 23. These adverse responses may be aggravated in the context of insulin resistance, which often develops during pregnancy or as part of metabolic syndrome. The prevalence of insulin resistance and type 2 diabetes are both increasing in the United States and around the world.

The Glycemic Index

The glycemic response refers to the measurable increase in blood sugar after consuming carbohydrates. The greater the postprandial spike in glucose a food generates, the greater that food’s glycemic index. Highly refined grains cause a more rapid and a greater overall increase in blood sugar than less-refined whole grains 24. Greater glycemic responses are accompanied by increased plasma insulin levels, which are thought to be at the root of metabolic syndrome 25 and have also been implicated in ovulatory infertility in women 26. Diets with a high glycemic index or glycemic load (the product of dietary glycemic index and total carbohydrate intake) appear to increase the risks of type 2 diabetes and coronary artery disease, particularly among women who have some insulin resistance 27. The dramatic loss of fiber and micronutrients during the milling process may also contribute to these adverse effects of highly processed grains.

In contrast, whole grains and foods made from whole grains, along with fruits, vegetables, and beans, provide slowly digested carbohydrates that are rich in fiber, vitamins, minerals, and phytonutrients. A substantial body of evidence indicates that eating whole grains or cereals high in fiber, rather than highly refined grains, reduces the risk of cardiovascular disease14 and type 2 diabetes 28. Although reductions in the risk of colon cancer by diets rich in whole-grain fiber have been difficult to document, such a dietary pattern has been clearly associated with reductions in constipation and diverticular disease.


To the metabolic systems engaged in protein production and repair, it is immaterial whether amino acids come from animal or plant protein. However, protein is not consumed in isolation. Instead, it is packaged with a host of other nutrients. The quality and amount of fats, carbohydrates, sodium, and other nutrients in the “protein package” may influence long-term health. For example, results from the Nurses’ Health Study suggest that eating more protein from beans, nuts, seeds, and the like, while cutting back on easily digested carbohydrates reduces the risk of heart disease 29. In that study, eating more animal protein while cutting back on carbohydrates did not reduce heart disease risk, possibly because of the fats and other nutrients that come along (or don’t come along) with protein from animals.

Vegetables and fruits

“Eat more fruits and vegetables” is timeless advice that has the backing of a large body of evidence 30. Vegetables and fruits provide fiber, slowly digested carbohydrates, vitamins and minerals, and numerous phytonutrients that have been associated with protection against cardiovascular disease, aging-related vision loss due to cataract and macular degeneration, and maintenance of bowel function. The connection between vegetables and fruits and cancer is less well established. Although they do not have a blanket anticancer effect, fruits and vegetables may work against specific cancers, including esophageal, stomach, lung, and colorectal cancer 31.

Fruits and vegetables should be consumed in abundance, which means a minimum of five servings a day—and more is better. As few as 1 in 4 persons in the United States meet this guideline 32.


The ideal beverage provides 100% of what the body needs water—H2O—without any calories or additives. Water has all of those qualifications. From the tap, it costs a fraction of a penny per glass. After water, the two most commonly consumed beverages are tea and coffee. Both are remarkably safe beverages, and have been associated with reduced risks of type 2 diabetes 33, kidney stones and gallstones, and possibly heart disease and some types of cancer.

Two problematic beverages are sugar-sweetened drinks (sodas, fruit drinks, juices, sports drinks, etc.) and alcoholic drinks. One 12-ounce can of sugar-sweetened cola delivers 8–10 teaspoons of sugar, approximately 120–150 “empty” calories 34. Not surprisingly, daily consumption of sugary beverages has been associated with weight gain and increased risk of type 2 diabetes 35, heart disease 36, and gout 37. Alcohol in moderation (no more than one drink a day for women, 1–2 drinks a day for men) has been associated with reduced risks of cardiovascular disease and type 2 diabetes. On the other hand, even moderate drinking may increase the risk of breast cancer.

However, it is possible that a diet rich in folate may attenuate this risk. In the Nurses’ Health Study, the risk of breast cancer associated with alcohol intake was strongest among women with total folate intake less than 300 μg/d for alcohol intake ≥15 grams (g)/d vs <15 g/d which is the alcohol content of one “standard” drink. For women who consumed at least 300 μg/d of total folate, there was no increased risk of breast cancer associated with alcohol intake 38. Drinking alcohol during pregnancy is not recommended due to possible health hazards to the developing child.

Vitamins and minerals

An optimal diet generally provides all the vitamins, minerals, and other micronutrients needed for good health. However, many women in the U.S., and a very large percentage of poor women, do not follow optimal diets 39. Thus, for most women a daily multivitamin-multimineral supplement provides good insurance against nutritional deficiencies. Such supplements usually include extra iron, which is needed by the 9% to 11% of premenopausal women with iron deficiency 40.

The most firmly established benefit of vitamin supplements is that additional folic acid can reduce the risk of neural tube defects by approximately 70% 41. Current guidelines call for all women of childbearing age to take a daily supplement containing 400 to 800 micrograms (μg) of folic acid, or 4 milligrams (mg) for women with a child with a neural tube defect.

Calcium is important for the maintenance of bone strength. Precisely how much calcium is needed is a controversial question. World Health Organization guidelines recommend an intake of 400 mg/day. In the United Kingdom, 700 mg/day is considered adequate for women aged 19 years and older. In the United States, dietary guidelines recommend that adult women receive 1,500 mg of calcium daily 42, in large part by consuming 3 servings of low-fat or fat-free dairy products a day 43. A lower-calorie, no-fat option is to get calcium from supplements.

For maintaining bone strength, other factors—including physical activity and vitamin D—are as important, or more important, than calcium. There is mounting evidence that current recommendations for vitamin D (200–600 IU/day, depending on age) are too low, and that 1,000 IU/day provides better protection against fractures and possibly heart disease and some cancers 44 (see Vitamin D). Excess intake of preformed vitamin A (retinol) has been associated with an increased risk of hip fracture, possibly by competing with vitamin D 45. However, elevated risk is seen at intakes slightly higher than the current Dietary Reference Intake of 700 μg per day. Given this concern, a multivitamin that delivers much of its vitamin A as beta-carotene is preferred.

How much should you eat ?

How much you should eat depends on the total number of calories you need each day varies, depending on a number of factors, including the your genes, age, sex, height, weight, your build (muscular or athletic or average or overweight) and level of physical activity. In addition, a need to lose, maintain, or gain weight and other factors affect how many calories should be consuming. In general, men need more calories than women do, and younger adults need more calories than adults in midlife and older. At all ages, adults who are more physically active need to eat more calories than those who are less active.

What is a healthy weight ?

Body mass index (BMI) is one way to tell whether you are at a healthy weight, overweight, or obese. It measures your weight in relation to your height. A BMI of 18.5 to 24.9 is in the healthy range. A person with a BMI of 25 to 29.9 is considered overweight, and someone with a BMI of 30 or greater is considered obese.

  • To find out about your body mass index (BMI), you can use a FREE online BMI calculators from the Centers for Disease Control and Prevention (CDC) – for Adults 46 and for Children 47

Eat clean to lose weight

You Are What You Eat. Your Weight and Your Life is the Result of Your Habits.

To lose weight, most people need to reduce the number of calories they get from food and beverages (energy IN) and increase their physical activity (energy OUT).

For a weight loss of 1–1 ½ pounds per week, daily intake should be reduced by 500 to 750 calories. In general:

  • Eating plans that contain 1,200–1,500 calories each day will help most women lose weight safely.
  • Eating plans that contain 1,500–1,800 calories each day are suitable for men and for women who weigh more or who exercise regularly.

Very low calorie diets (VLCD) of fewer than 800 calories per day should not be used unless you are being monitored by your doctor.

Table 3. Estimated Calorie Needs per Day, by Age, Sex, and Physical Activity Level

76 and up2,0002,2002,400
76 and up1,6001,8002,000

Notes: Within each age and sex category, the low end of the range is for sedentary individuals; the high end of the range is for active individuals. Due to reductions in basal metabolic rate (resting energy requirement) that occur with aging, calorie needs generally decrease for adults as they age.

These are only estimates, and approximations of individual calorie needs can be aided with online tools such as those available at 48. To find out What and How Much To Eat, you can use a FREE, award-winning, state-of-the-art, online diet and activity tracking tool called SuperTracker 49 from the United States Department of Agriculture Center for Nutrition Policy and Promotion 49. This free application empowers you to build a healthier diet, manage weight, and reduce your risk of chronic diet-related diseases. You can use SuperTracker 49 to determine what and how much to eat; track foods, physical activities, and weight; and personalize with goal setting, virtual coaching, and journaling.

[a] Sedentary means that you do only light physical activity as part of your typical daily routine.

[b] Moderately Active means that you do physical activity equal to walking about 1.5 to 3 miles a day at 3 to 4 miles per hour, plus your typical daily routine.

[c] Active means a lifestyle that includes physical activity equivalent to walking more than 3 miles per day at 3 to 4 miles per hour, in addition to the activities of your typical daily routine.

[d] Estimates for females do not include women who are pregnant or breastfeeding.

[e] If you need to lose weight, eat fewer calories than you burn or increase your activity level to burn more calories than you eat.

[Source: Institute of Medicine. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington (DC): The National Academies Press; 2002. 50].

General guidance for achieving and maintaining a healthy body weight is provided below:

  • Children and adolescents are encouraged to maintain calorie balance to support normal growth and development without promoting excess weight gain. Children and adolescents who are overweight or obese should change their eating and physical activity behaviors to maintain or reduce their rate of weight gain while linear growth occurs, so that they can reduce body mass index (BMI) percentile toward a healthy range.
  • Before becoming pregnant, women are encouraged to achieve and maintain a healthy weight, and women who are pregnant are encouraged to gain weight within gestational weight gain guidelines 51.
  • Adults who are obese should change their eating and physical activity behaviors to prevent additional weight gain and/or promote weight loss. Adults who are overweight should not gain additional weight, and those with one or more cardiovascular risk factors (e.g., hypertension and hyperlipidemia) should change their eating and physical activity behaviors to lose weight. To lose weight, most people need to reduce the number of calories they get from foods and beverages and increase their physical activity. For a weight loss of 1 to 1½ pounds per week, daily intake should be reduced by 500 to 750 calories. Eating patterns that contain 1,200 to 1,500 calories each day can help most women lose weight safely, and eating patterns that contain 1,500 to 1,800 calories each day are suitable for most men for weight loss. In adults who are overweight or obese, if reduction in total calorie intake is achieved, a variety of eating patterns can produce weight loss, particularly in the first 6 months to 2 years 52; however, more research is needed on the health implications of consuming these eating patterns long-term.
  • Older adults, ages 65 years and older, who are overweight or obese are encouraged to prevent additional weight gain. Among older adults who are obese, particularly those with cardiovascular risk factors, intentional weight loss can be beneficial and result in improved quality of life and reduced risk of chronic diseases and associated disabilities.
  • Some foods — vegetables, nuts, fruits, and whole grains — were associated with less weight gain when consumption was actually increased. Obviously, such foods provide calories and cannot violate thermodynamic laws. Their associations with weight loss suggest that the increase in their consumption reduced the intake of other foods to a greater (caloric) extent, decreasing the overall amount of energy consumed. Higher fiber content and slower digestion of these foods would augment satiety, and their increased consumption would also displace other, more highly processed foods in the diet, providing plausible biologic mechanisms whereby persons who eat more fruits, nuts, vegetables, and whole grains would gain less weight over time 53.
  • You don’t have to give up all your favorite foods when you’re trying to lose weight. Small amounts of your favorite high-calorie foods may be part of your weight-loss plan. Just remember to keep track of the total calories you take in. To lose weight, you must burn more calories than you take in through food and beverages.
  • To find out What and How Much To Eat, you can use a FREE, award-winning, state-of-the-art, online diet and activity tracking tool called SuperTracker 49 from the United States Department of Agriculture Center for Nutrition Policy and Promotion 49. This free application empowers you to build a healthier diet, manage weight, and reduce your risk of chronic diet-related diseases. You can use SuperTracker 49 to determine what and how much to eat; track foods, physical activities, and weight; and personalize with goal setting, virtual coaching, and journaling.

SuperTracker website 49

  • To find out about how many calories you should eat to lose weight according to your weight, age, sex, height and physical activity, you can use a FREE online app Body Weight Planner 54
  • To find out about the 5 Food Groups you should have on your plate for a meal, you can use a FREE online app ChooseMyPlate 55

Almost any diet will result in weight loss, at least for a short time, if it helps the dieter take in fewer calories than she burns.

The truth is, almost any diet will work if it helps you take in fewer calories. Diets do this in two main ways:

  1. getting you to eat certain “good” foods and/or avoid “bad” ones.
  2. changing how you behave and the ways you think or feel about food.

Few dieters, however, are able to sustain weight-loss diets for long periods. Different palates, food preferences, family situations, and even genes mean that no single diet is right for everyone. What is needed is a dietary pattern that can be sustained for years, and that is as good for the heart, bones, brain, psyche, and taste buds as it is for the waistline. This diet should include plenty of choices and few restrictions or “special” foods. Data from randomized trials suggest that the nutrient makeup of a dietary pattern for weight loss matters far less than the number of calories it delivers.

In a head-to-head trial 56 of four diets loosely based on the Atkins, Ornish, and Mediterranean diets (low fat, average protein; low fat, high protein; high fat, average protein; and high fat, high protein respectively), participants lost an average of 13.2 pounds (6 kg) at 6 months, and had a 2-inch reduction in waist size, regardless of the diets they were following. At 12 months, most began to regain some weight 56. Among those who completed the trial, the amount of weight loss after 2 years was similar in participants assigned to a diet with 25% protein and those assigned to a diet with 15% protein (average of 4.5 and 3.6 kg, respectively), and was also the same in those assigned to a diet with 40% fat and those assigned to a diet with 20% fat (average of 3.9 and 4.1 kg, respectively). There was no effect of carbohydrate level on weight loss within the target range of 35% to 65% of calories from carbohydrate. The change in waist circumference was also similar across the diet groups. Feelings of hunger, satiety, and satisfaction with the diet were the same across the board, as were cholesterol levels and other markers of cardiovascular risk. It is important to note that these averages hide huge variations in weight loss, with some participants losing 30 pounds or more while others actually gained weight during the trial 56. This supports the idea that weight-loss strategies must be individualized. Group counseling was an aid to weight loss, suggesting that behavioral, psychological, and social factors are probably more important for weight loss than the mix of nutrients in a diet.

The best diet for losing weight is one that is good for all parts of your body, from your brain to your toes, and not just for your waistline. It is also one you can live with for a long time. In other words, a diet that offers plenty of good tasting and healthy choices, banishes few foods, and doesn’t require an extensive and expensive list of groceries or supplements.

In the most comprehensive review (meta-analysis) conducted to date, a team of researchers 57, analyse all available articles and randomised trials on all popular branded diets including macronutrient composition diets (low carbohydrate, low fat, high protein, high fat, etc.).

The branded diet programs being analysed were:

  • Atkins Diet
  • Biggest Loser Diet
  • DASH (Dietary Approaches to Stop Hypertension) Diet
  • Jenny Craig Diet
  • LEARN (Lifestyle, Exercise, Attitudes, Relationships and Nutrition) Diet
  • Mediterranean Diet
  • Nutrisystem Diet
  • Ornish Diet
  • Pritikin Diet
  • Rosemary Conley Diet
  • Slimming World Diet
  • South Beach Diet
  • Volumetrics Diet
  • Weight Watchers Diet
  • Zone Diet
  • Low Calorie Diet (LCD)
  • Very Low Calorie Diet (VLCD)
  • Low Carbohydrate
  • High Carbohydrate
  • Carb Counting
  • Low-glycemic index (Low GI)
  • Low-glycemic load (Low GL)
  • Low Fat
  • High Fat
  • Ketogenic
  • Scheduling (meals & meal pattern)
  • Meal replacement
  • Portfolio Diet
  • High Protein
  • Energy Density Diet
  • Portion Control Diet
  • TLC (Therapeutic Lifestyle Changes) Diet
  • Vegetarian Diet


  • Weight loss differences between individual brand named diets were small with likely little importance to those seeking weight loss. For example, the Atkins diet resulted in a 1.71 kg greater weight loss than the Zone diet at 6-month follow-up.
  • The largest and most significant weight loss was associated with low-carbohydrate diets (8.73 kg at 6-month follow-up and 7.25 kg at 12-month follow-up) and low-fat diets (7.99 kg at 6-month follow-up and 7.27 kg at 12-month follow-up) than no dietary intervention over a 12-month period.
  • Behavioral support and exercise enhanced weight loss.
  • There isn’t one “perfect” diet for everyone, owing to individual differences in genes and lifestyle.

This study supports the practice of recommending any diet that a person will adhere to in order to lose weight 58.

Unfortunately, most weight-loss diets are hard to stick to long enough to reach your weight goal. And some may not be healthy.

The sheer number of weight-loss plans can be overwhelming. There’s overlap, but most plans can be grouped into a few major categories.

In the review conducted by U.S. News & World Report with the help of a panel of 22 experts to make their choices to find the nation’s best overall diets for 2013 59. U.S. News evaluated and ranked the 38 diets, to be top-rated, a diet had to be relatively easy to follow, nutritious, safe, effective for weight loss and protective against diabetes and heart disease. The US government-endorsed Dietary Approaches to Stop Hypertension (DASH) diet took the number 1 spot, while the Mediterranean diet came in second and Mediterranean-DASH Intervention for Neurodegenerative Delay (MND) Diet came in 3rd. The Weight Watchers Diet came in 4th tie with Therapeutic Lifestyle Changes (TLC), Mayo Clinic Diet and The Flexitarian Diet (casual vegetarian) 59.

In addition to consuming a healthy eating pattern, individuals in the United States should meet the Physical Activity Guidelines for Americans 60. Regular physical activity is one of the most important things you can
do to improve your health. The Physical Activity Guidelines, released by the U.S. Department of Health and Human Services, provides a comprehensive set of recommendations for Americans on the amounts and types of physical activity needed each day. Adults need at least 150 minutes of moderate intensity physical activity and should perform muscle-strengthening exercises on 2 or more days each week. Youth ages 6 to 17 years need at least 60 minutes of physical activity per day, including aerobic, muscle-strengthening, and bone-strengthening activities. Establishing and maintaining a regular physical activity pattern can provide many health benefits. Strong evidence shows that regular physical activity helps people maintain a healthy weight, prevent excessive weight gain, and lose weight when combined with a healthy eating pattern lower in calories. Strong evidence also demonstrates that regular physical activity lowers the risk of early death, coronary heart disease, stroke, high blood pressure, adverse blood lipid profile, type 2 diabetes, breast and colon cancer, and metabolic syndrome; it also reduces depression and prevents falls. People can engage in regular physical activity in a variety of ways throughout the day and by choosing activities they enjoy.

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  60. U.S. Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. Washington (DC): U.S. Department of Health and Human Services; 2008. ODPHP Publication No. U0036. Available at:
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Diet PlanDiet, Food & Fitness

What is a yo yo diet ?



What is a yo yo diet

A Yo-yo diet is often called weight cycling, which is the repeated weight loss and regain of body weight on some particular diet. Repeated bouts of weight loss followed by regain forms a pattern known as weight cycling. Weight cycling or ‘yo-yo’ dieting is an inevitable process in human, because of subsequent weight loss and regain of body weight due to poor diet and irregular dieting. Human weight cycle (yo-yo dieting) is the major factor for causing global epidemic diseases in human beings 1. Research indicates that weight cycling, or “yo-yo dieting” is a common occurrence in overweight and obese populations. The long term negative health consequences of weight cycling are debated and it is unclear whether or not this weight change pattern poses a greater disease risk compared to obesity maintenance 2.

Every year, scores of millions of people – as diverse as obese and lean, teenagers and older adults, sedentary and elite athletes, commoners and celebrities – attempt to lose weight on some form of diet. People on the yo-yo diet or weight cycling can usually change their body weight from small weight loss and to small weight regains of 5-10 lbs per cycle, to large body weight changes in weight of 50 lbs. or more per cycle. The National Institutes of Health suggest that small weight cycles range from loss and regain of 2.3–4.5 kg, whereas a large cycle may be characterized by 23 kg or more 3. Weight regain is generally the rule, with one-third to two-thirds of the weight lost being regained within 1 year and almost all is regained within 5 years 4. With studies of the long-term outcomes showing that at least one-third of dieters regain more weight than they lost, together with prospective studies indicating that dieting during childhood and adolescence predicts future weight gain and obesity, there is concern as to whether dieting may paradoxically be promoting exactly the opposite of what it is intended to achieve.

It has been estimated 24% of American men and 38% of women are currently attempting to lose weight 5, 6, 7. When individuals with an obese body mass index (BMI) are considered, 65% of men and 68% of women are trying to lose weight, which is a fivefold increase compared to those within the normal BMI (18–24.9 kg/m2) range that are trying to lose weight 7. While successful weight loss is achieved, researchers have indicated that long-term maintenance of a reduced weight appears to be rare.

The probability of weight regain increases in the time following initial weight loss 8. Researchers believe this is due to the energy gap created during caloric restriction where decreased energy expenditure is paired with an increased drive to eat 8. Rodent studies have demonstrated that this gap persists regardless of the duration of weight reduction, which increases the probability of weight regain 9. This drive to eat causes a hyperphagic response when free access to food is allowed and when paired with suppressed lipid utilization, weight regain is often rapid and efficient 9, 8. While this finding was elucidated through use of a rodent model, human weight regain data supports this concept. One year after a modest weight loss (14.5% of body weight), Votruba et al. 10 reported that within a year of weight loss, 16 out of 28 women regained weight and had a 19% increase in body weight and a 26% increase in percent fat mass. Weiss 11 reported that by one year after a modest weight loss (10% of body weight), 33% of adult subjects regained all lost weight. Furthermore, they concluded that the odds of regaining were positively associated with the percentage of initial weight lost 11. Field et al. reported that approximately 55% of overweight and obese women who lost 10% of their body weight regained all lost weight within 4 years 12. In support of this finding, within 9 years of the initial weight loss (5% of body weight), 95% of women and 93% of men were unable to maintain the reduced body weight 13. Collectively, these studies suggest that while initial weight loss is possible, long-term maintenance is problematic, especially when large amounts of weight are lost or an individual is overweight or obese.

Some research links weight cycling or yo-yo dieting with certain health risks. To avoid potential risks, most experts recommend that obese adults adopt healthy eating and regular physical activity habits to achieve and maintain a healthier weight for life. Non-obese adults should try to maintain their weight through healthy eating and regular physical activity.

Links between yo-yo diet and increased body weight, hypertension and eating-disordered cognitions have been proposed, however, studies on the physical and/or psychological health risks associated with yo-yo diet have produced mixed results. Some studies report no relation between yo-yo diet and physical health 14, while others suggest that cycling increases health risks. Specifically, yo-yo diet has been associated with increased weight and central adiposity 15, 16, hypertension (high blood pressure) 16, 17 and type 2 diabetes 18.

Who are the demographic of yo-yo dieters

According to research yo-yo dieters and non-yo-yo dieters did not differ on demographic information including age, education, employment status, income, marriage, or medication use 19. See Table 1 for a list of all demographic information.

Survey data collected by Williamson and colleagues 7 indicated that 25% of men and 27% of women trying to lose weight have made long-term attempts (classified as trying for over 1 year or “always trying to lose weight”). It has also been shown that 7% of men and 10% of women can be classified as severe weight cyclers (intentionally lost at least 5 kg and regained at least three different times), while 11% of men and 19% of women are mild weight cyclers (lost and regained at least 5 kg on one or two occasions) 20. While these results were generated from a group of adults in Finland, the conclusion that 18% of men and 27% of women weight cycle is comparable to the prevalence described by Williamson et al. 7. These numbers are likely a conservative estimate of the prevalence of weight cycling, which may be even greater in the United States.

Table 1. Demographic information of Yo-yo dieters and Non-yo-yo dieters

      Yo-yo dieters     Non-yo-yo dieters
Education, ≥16 years52%50%
Full-time employment90%95%
Individual income, >$40,00067%65%
Hypertension classification, mm Hg
 Normal, <120/<8028%32%
 Pre-HTN, 120–139/80–8944%46%
 Stage 1 HTN, 140–159/90–9921%19%
 Stage 2 HTN, >160/>1006%4%
[Source 19]

Note: HTN = hypertension (high blood pressure)

Interestingly, more than half of yo-yo dieters had tried yo-yo diet more than three times. Yo-yo dieters weighed more, had a higher body mass index (BMI) and reported a higher peak weight compared to non-yo-yo dieters, despite reporting no differences in ideal weight.

Yo-yo dieters were more likely to binge eat and reported greater body image disturbance.

Yo-yo dieters reported significantly lower self-esteem for their appearance and greater body dissatisfaction and drive for thinness compared to non-yo-yo dieters, however, all self-esteem scores were within clinically normal limits 19. Average total self-esteem scores, symptoms of anxiety, and symptoms of depression were all clinically non-significant and did not differ between yo-yo dieters and non-yo-yo dieters, suggesting that the relationship between psychological health and yo-yo dieters may be limited to the domain of body image and eating 21, 22.

Does Weight Regain in Yo-yo Diet Disrupts Normal Physiology ?

The physiological changes associated with weight cycling, such as energy expenditure, metabolism and fuel utilization, have been documented using a rat model. MacLean and colleagues 23 have documented the physiological alterations occurring in obesity-prone rats that contribute to the rapid, efficient regain during relapse following weight loss and maintenance. Their focus has been on the energy gap created during a period of caloric restriction that is characterized by decreased energy expenditure and an increased drive to eat 23. They found that in addition to changes in energy intake, alterations in metabolic efficiency and fuel utilization (favoring carbohydrate oxidation) may significantly affect the propensity to regain weight 8. For instance, in the 16 weeks following moderate weight loss (14%), food efficiency was increased 10-fold upon the first day of a 56-day re-feeding in weight cycle rats compared to rats with established obesity. While this dramatic rise was reduced within several days, food efficiency remained elevated above levels in obese mice for the first 4 weeks of relapse 24. The most dramatic changes occurred during the first week of relapse, a time when nearly 40% of lost weight, which was primarily fat mass, was regained 24, 25. Researchers also noted that as the length of maintenance increased, the amount of weight regained upon relapse also increased. Furthermore, regain was accompanied by a 30% increase in adipocyte concentration per fat pad.

Based on the above literature, it is clear that weight gain during relapse appears to induce more rapid adipose tissue growth and hyperplasia due to metabolic shifts favoring lipid storage. Because adipose tissue is a metabolically active tissue, responsible for production of leptin, cytokines and adiponectin as well as responding to traditional hormone systems 26, it is possible that the consequences of weight gain during relapse may also differ from that of initial weight gain. In recent years, lay literature has asserted that weight cycling may be more detrimental to health than simply remaining overweight or obese 27, 28. Researchers have found associations between weight cycling and an overshoot of lipogenic enzyme, triglyceride and cholesterol levels in animals and increased risk of heart attack and stroke in humans 29, 30, 31, 32. However, other researchers noted no long term adverse effects on body composition, blood pressure, lipid profile or risk of developing type II diabetes 14, 33, 34, 35, 36 (13, 22, 37, 49, 56). Due to limited research in the area of weight cycling all of the negative consequences may not be known. Existing studies differ considerably in their research design, subject population used, duration of treatment, incorporation of exercise, magnitude and frequency of weight cycles. The lack of a universal definition of weight cycling is perhaps a great contributor to the variability within experimental design. This variability is discussed in greater detail in the following sections.

Evaluation of Weight Cycling: Human Models

Some existing scientific literature supports the theory that weight cycling increases disease risk (directly or indirectly) in humans. Wallner and colleagues 15 found that a history of weight cycling was associated with a more pronounced android fat distribution in women compared to those who were normal-weight or overweight without a history of weight cycling 15. It is possible that women who are prone to the accumulation of abdominal adiposity may be more likely to weight cycle for a more aesthetically desirable figure 37. Regardless of whether weight cycling causes the accumulation of android adiposity or vice versa, other researchers have found that a history of weight cycling was independently associated with an increased risk of developing hypertension 16 and clinically significant decreases in HDL-cholesterol in women 38. French et al. 30 and Vergnaud et al. 39 demonstrated associations between weight cycling and risk for heart attack and stroke, as well as the development of metabolic syndrome 39, 30. Blair et al. 29 studied men enrolled in the Multiple Risk Factor Intervention Trial who were at elevated risk for coronary heart disease due to smoking, hypertension and hypercholesterolemia, finding that greater weight variability over 4 years of follow up was associated to increase all-cause mortality.

In contrast to the preceding reports, several other researchers reported that weight cycling has no independent impact on health status. Prentice et al. found that weight cycling did not significantly alter body composition 35. However, unlike Wallner et al. 15, who asked for 4 years worth of weight history, this study was completed in only 18 weeks. It may be possible that any deleterious effects of weight cycling do not manifest immediately or that the magnitude of the weight loss was not sufficient to induce long-term change. Li et al. 34 studied obese patients, in a multi-disciplinary weight loss program, who had relapsed and re-entered. Multiple attempts at weight loss over 12 years showed no effect on the rate at which weight could be lost each time or on blood pressure or lipid profile; in fact, these measurements at baseline were significantly lower at the time of re-entry compared to the initial start for men and women. Initial blood pressure in men (134/88 mmHg) and women (126/82 mmHg) was recorded at the restart baseline at 129/85 mmHg and 121/78 mmHg, respectively. While no subjects were hypertensive, all values remained within the pre-hypertensive range. Furthermore, BP has been documented to fluctuate throughout the day 40. Triglyceride levels in men and women were reduced by 0.1 and 0.2 mmol/L between initial and restart baselines and cholesterol was reduced by 0.1 and 0.5 mmol/L, respectively. Women’s values were all within the normal/low risk range and men’s values remained in the borderline high range. Cholesterol values for both genders were all in the borderline high risk range. While deemed statistically significant, the differences between baselines may not be physiologically relevant as disease risk did not appear to change. Even though this study was longitudinal in nature, perhaps the use of regular exercise as part of the program acted as a confounding factor, as aerobic exercise is independently and positively correlated with decreases in blood pressure and cholesterol 41, 42.

A similar exercise effect was reported by Field et al. 14 where mild and severe weight cycling was strongly associated with weight gain and hypertension, controlling the statistical analysis for weight and weight gain greatly attenuated this correlation; however, the questionnaire data also revealed that severe weight cyclers exercised significantly more that non weight cyclers. Graci et al. 33 noted that weight cycling had no effect on cardiovascular disease risk factors; weight cycling throughout adulthood was not associated with changes in body composition, fat distribution blood pressure or insulin levels. One major difference in this study, compared to those with competing findings, was that Graci et al. 33 used morbidly obese subjects (BMI up to 69 kg/m2) and perhaps there is a less-pronounced response to weight cycling in this population because the subjects already have an elevated disease risk. Similar results by Wing et al. 43 and Jeffery et al. 44 may have been effected by the short duration of measurement period (2.5 years) or the failure to use appropriate blood pressure cuffs for obese patients 16. Field et al. 45 concluded that 4 years of weight cycling, prior to diagnosis of type 2 diabetes, was not predictive of disease development while Wannamethee et al. 46 and Mehta et al. 47 found that weight fluctuation does not directly increase risk of death.

There is only one published study that examined the effect weight variability has on pro-inflammatory or related factors. Yatsuya et al. 48 reported that Japanese men with a history of weight variability had an independently increased odds ratio of elevated C-Reactive Protein (CRP). One limitation of this study was that it was a cross-sectional design thus it was not possible to evaluate cause and effect, no information on intentionality of weight change and the cross-sectional design with a majority of subjects having final BMIs less than 25 kg/m2. This lack of literature suggests that in order to fully understand the possible effects of weight cycling, we must include examination of pro-inflammatory responses to this pattern.

Yo yo diet consequences on health

As obesity is becoming increasingly more prevalent in the United States, weight loss to reduce adipose tissue mass is strongly promoted as a means to decrease the disease risk associated with excess adiposity 49, 50. Unfortunately, the majority of individuals who lose weight are unlikely to maintain the reduced weight for an extended period of time 13, 10. Repeated periods of weight loss and regain form a pattern known as weight cycling or yo-yo dieting. Hill 51 indicates that popular and lay literature have asserted that weight cycling (i.e. “yo-yo dieting”) may increase the risk of developing cardiovascular disease or type II diabetes to a greater extent than remaining weight stable at an obese Body Mass Index (BMI; ≥30 kg/m2). The scientific literature is inconsistent regarding the long-term consequences of weight cycling. Because there is no universally-accepted definition of yo-yo dieting, differences in experimental design may have contributed to discrepancies in scientific outcomes.

Weight gain and obesity have significant implications concerning disease risk, which is believed to be mediated by an elevated level of systemic inflammation. Low-grade systemic inflammation is associated with obesity and it may serve as a link between adiposity and the development of cardiovascular disease and type 2 diabetes 52. The pro-inflammatory effects of yo-yo dieting have not been examined. Discerning a difference in disease risk between maintenance of obesity and yo-yo dieting is important and may provide insight concerning individual differences in disease progression. If yo-yo dieting is associated with an increased disease risk, continually recommending weight loss to those unable to maintain reduced weights may be a major public health issue.

  1. U.S. Department of Health and Human Services. Examining and elucidation of human weight cycle model adopting e-cell simulation system.
  2. STROHACKER K, CARPENTER KC, MCFARLIN BK. Consequences of Weight Cycling: An Increase in Disease Risk? International Journal of Exercise Science. 2009;2(3):191-201.
  3. Consequences of Weight Cycling: An Increase in Disease Risk ? Strohacker K, Carpenter KC, McFarlin BK. Int J Exerc Sci. 2009; 2(3):191-201.
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  7. Weight loss attempts in adults: goals, duration, and rate of weight loss. Williamson DF, Serdula MK, Anda RF, Levy A, Byers T. Am J Public Health. 1992 Sep; 82(9):1251-7.
  8. Metabolic adjustments with the development, treatment, and recurrence of obesity in obesity-prone rats. MacLean PS, Higgins JA, Johnson GC, Fleming-Elder BK, Peters JC, Hill JO. Am J Physiol Regul Integr Comp Physiol. 2004 Aug; 287(2):R288-97.
  9. Peripheral metabolic responses to prolonged weight reduction that promote rapid, efficient regain in obesity-prone rats. MacLean PS, Higgins JA, Jackman MR, Johnson GC, Fleming-Elder BK, Wyatt HR, Melanson EL, Hill JO. Am J Physiol Regul Integr Comp Physiol. 2006 Jun; 290(6):R1577-88.
  10. Pattern and cost of weight gain in previously obese women. Votruba SB, Blanc S, Schoeller DA. Am J Physiol Endocrinol Metab. 2002 Apr; 282(4):E923-30.
  11. Weight regain in U.S. adults who experienced substantial weight loss, 1999-2002. Weiss EC, Galuska DA, Kettel Khan L, Gillespie C, Serdula MK. Am J Prev Med. 2007 Jul; 33(1):34-40.
  12. Relationship of a large weight loss to long-term weight change among young and middle-aged US women. Field AE, Wing RR, Manson JE, Spiegelman DL, Willett WC. Int J Obes Relat Metab Disord. 2001 Aug; 25(8):1113-21.
  13. A descriptive study of weight loss maintenance: 6 and 15 year follow-up of initially overweight adults. Sarlio-Lähteenkorva S, Rissanen A, Kaprio J. Int J Obes Relat Metab Disord. 2000 Jan; 24(1):116-25.
  14. Weight cycling, weight gain, and risk of hypertension in women. Field AE, Byers T, Hunter DJ, Laird NM, Manson JE, Williamson DF, Willett WC, Colditz GA. Am J Epidemiol. 1999 Sep 15; 150(6):573-9.
  15. Body fat distribution of overweight females with a history of weight cycling. Wallner SJ, Luschnigg N, Schnedl WJ, Lahousen T, Sudi K, Crailsheim K, Möller R, Tafeit E, Horejsi R. Int J Obes Relat Metab Disord. 2004 Sep; 28(9):1143-8.
  16. Risk factors for hypertension in obese women. The role of weight cycling. Guagnano MT, Ballone E, Pace-Palitti V, Vecchia RD, D’Orazio N, Manigrasso MR, Merlitti D, Sensi S. Eur J Clin Nutr. 2000 Apr; 54(4):356-60.
  17. Weight fluctuations could increase blood pressure in android obese women. Guagnano MT, Pace-Palitti V, Carrabs C, Merlitti D, Sensi S. Clin Sci (Lond). 1999 Jun; 96(6):677-80.
  18. The association of lifetime weight and weight control patterns with diabetes among men and women in an adult community. Holbrook TL, Barrett-Connor E, Wingard DL. Int J Obes. 1989; 13(5):723-9.
  19. Osborn RL, Forys KL, Psota TL, Sbrocco T. Yo-Yo Dieting in African American Women: Weight Cycling and Health. Ethnicity & disease. 2011;21(3):274-280.
  20. Prevalence of weight cycling and its relation to health indicators in Finland. Lahti-Koski M, Männistö S, Pietinen P, Vartiainen E. Obes Res. 2005 Feb; 13(2):333-41.
  21. Weight cycling, psychological health, and binge eating in obese women. Venditti EM, Wing RR, Jakicic JM, Butler BA, Marcus MD. J Consult Clin Psychol. 1996 Apr; 64(2):400-5.
  22. Weight cycling in treatment-seeking obese persons: data from the QUOVADIS study. Marchesini G, Cuzzolaro M, Mannucci E, Dalle Grave R, Gennaro M, Tomasi F, Barantani EG, Melchionda N, QUOVADIS Study Group. Int J Obes Relat Metab Disord. 2004 Nov; 28(11):1456-62.
  23. Enhanced metabolic efficiency contributes to weight regain after weight loss in obesity-prone rats. MacLean PS, Higgins JA, Johnson GC, Fleming-Elder BK, Donahoo WT, Melanson EL, Hill JO. Am J Physiol Regul Integr Comp Physiol. 2004 Dec; 287(6):R1306-15.
  24. Peripheral metabolic responses to prolonged weight reduction that promote rapid, efficient regain in obesity-prone rats. MacLean PS, Higgins JA, Jackman MR, Johnson GC, Fleming-Elder BK, Wyatt HR, Melanson EL, Hill JO. Am J Physiol Regul Integr Comp Physiol. 2006 Jun; 290(6):R1577-88.
  25. Enhanced metabolic efficiency contributes to weight regain after weight loss in obesity-prone rats. MacLean PS, Higgins JA, Johnson GC, Fleming-Elder BK, Donahoo WT, Melanson EL, Hill JO. Am J Physiol Regul Integr Comp Physiol. 2004 Dec; 287(6):R1306-15.
  26. Adipose tissue as an endocrine organ. Kershaw EE, Flier JS. J Clin Endocrinol Metab. 2004 Jun; 89(6):2548-56.
  27. Does dieting make you fat ? Hill AJ. Br J Nutr. 2004 Aug; 92 Suppl 1:S15-8.
  28. Does weight cycling present a health risk ? Jeffery RW. Am J Clin Nutr. 1996 Mar; 63(3 Suppl):452S-455S.
  29. Body weight change, all-cause mortality, and cause-specific mortality in the Multiple Risk Factor Intervention Trial. Blair SN, Shaten J, Brownell K, Collins G, Lissner L. Ann Intern Med. 1993 Oct 1; 119(7 Pt 2):749-57.
  30. Weight variability and incident disease in older women: the Iowa Women’s Health Study. French SA, Folsom AR, Jeffery RW, Zheng W, Mink PJ, Baxter JE. Int J Obes Relat Metab Disord. 1997 Mar; 21(3):217-23.
  31. The effects of weight cycling on serum leptin levels and lipogenic enzyme activities in adipose tissue. Kochan Z, Karbowska J, Swierczynski J. J Physiol Pharmacol. 2006 Nov; 57 Suppl 6():115-27.
  32. Weight cycling-induced alteration in fatty acid metabolism. Sea MM, Fong WP, Huang Y, Chen ZY. Am J Physiol Regul Integr Comp Physiol. 2000 Sep; 279(3):R1145-55.
  33. Weight cycling and cardiovascular risk factors in obesity. Graci S, Izzo G, Savino S, Cattani L, Lezzi G, Berselli ME, Balzola F, Liuzzi A, Petroni ML. Int J Obes Relat Metab Disord. 2004 Jan; 28(1):65-71.
  34. Weight cycling in a very low-calorie diet programme has no effect on weight loss velocity, blood pressure and serum lipid profile. Li Z, Hong K, Wong E, Maxwell M, Heber D. Diabetes Obes Metab. 2007 May; 9(3):379-85.
  35. Effects of weight cycling on body composition. Prentice AM, Jebb SA, Goldberg GR, Coward WA, Murgatroyd PR, Poppitt SD, Cole TJ. Am J Clin Nutr. 1992 Jul; 56(1 Suppl):209S-216S.
  36. Repetitive weight loss and weight regain: effects on weight reduction, resting metabolic rate, and lipolytic activity before and after exercise and/or diet treatment. van Dale D, Saris WH. Am J Clin Nutr. 1989 Mar; 49(3):409-16.
  37. The effects of the ideal of female beauty on mood and body satisfaction. Pinhas L, Toner BB, Ali A, Garfinkel PE, Stuckless N. Int J Eat Disord. 1999 Mar; 25(2):223-6.
  38. Weight cycling and high-density lipoprotein cholesterol in women: evidence of an adverse effect: a report from the NHLBI-sponsored WISE study. Women’s Ischemia Syndrome Evaluation Study Group. Olson MB, Kelsey SF, Bittner V, Reis SE, Reichek N, Handberg EM, Merz CN. J Am Coll Cardiol. 2000 Nov 1; 36(5):1565-71.
  39. Weight fluctuations and risk for metabolic syndrome in an adult cohort. Vergnaud AC, Bertrais S, Oppert JM, Maillard-Teyssier L, Galan P, Hercberg S, Czernichow S. Int J Obes (Lond). 2008 Feb; 32(2):315-21.
  40. Effects of age and gender on ambulatory blood pressure and heart rate. Jaquet F, Goldstein IB, Shapiro D. J Hum Hypertens. 1998 Apr; 12(4):253-7.
  41. Effects of high- and low-intensity exercise training on aerobic capacity and blood lipids. Gaesser GA, Rich RG. Med Sci Sports Exerc. 1984 Jun; 16(3):269-74.
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  43. A prospective study of effects of weight cycling on cardiovascular risk factors. Wing RR, Jeffery RW, Hellerstedt WL. Arch Intern Med. 1995 Jul 10; 155(13):1416-22.
  44. Weight cycling and cardiovascular risk factors in obese men and women. Jeffery RW, Wing RR, French SA. Am J Clin Nutr. 1992 Mar; 55(3):641-4.
  45. Weight cycling and the risk of developing type 2 diabetes among adult women in the United States. Field AE, Manson JE, Laird N, Williamson DF, Willett WC, Colditz GA. Obes Res. 2004 Feb; 12(2):267-74.
  46. Weight change, weight fluctuation, and mortality. Wannamethee SG, Shaper AG, Walker M. Arch Intern Med. 2002 Dec 9-23; 162(22):2575-80.
  47. Mehta T, Smith DL, Muhammad J, Casazza K. Impact of weight cycling on risk of morbidity and mortality. Obesity reviews : an official journal of the International Association for the Study of Obesity. 2014;15(11):870-881. doi:10.1111/obr.12222.
  48. Association between weight fluctuation and fasting insulin concentration in Japanese men. Yatsuya H, Tamakoshi K, Yoshida T, Hori Y, Zhang H, Ishikawa M, Zhu S, Kondo T, Toyoshima H. Int J Obes Relat Metab Disord. 2003 Apr; 27(4):478-83.
  49. Promoting weight loss in type II diabetes. Brown SA, Upchurch S, Anding R, Winter M, Ramìrez G. Diabetes Care. 1996 Jun; 19(6):613-24.
  50. The beneficial effects of modest weight loss on cardiovascular risk factors. Van Gaal LF, Wauters MA, De Leeuw IH. Int J Obes Relat Metab Disord. 1997 Mar; 21 Suppl 1:S5-9.
  51. Does dieting make you fat ? Hill AJ. Br J Nutr. 2004 Aug; 92 Suppl 1():S15-8.
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Diet PlanDiet, Food & Fitness

What is the TLC diet ?


tlc diet plan

What is the TLC diet ?

The Therapeutic Lifestyle Changes Diet or the TLC Diet is a diet for people with high blood cholesterol 1. The TLC diet is low-saturated-fat, low-cholesterol eating plan that calls for less than 7 percent of calories from saturated fat and less than 200 mg of dietary cholesterol per day 2. The TLC diet recommends eating only enough calories to maintain a desirable weight and avoid weight gain. If your LDL “bad” cholesterol is not lowered enough by reducing your saturated fat and cholesterol intakes, the amount of soluble fiber in your diet can be increased. Certain food products that contain plant stanols or plant sterols (for example, cholesterol-lowering margarines) can also be added to the TLC diet to boost its LDL-lowering power.

The TLC Diet is one part of the three Therapeutic Lifestyle Changes Program (TLC Program) 1. The other 2 parts of the Therapeutic Lifestyle Changes Program are physical activity and weight management. Sometimes, medication also is needed 1. By staying on the TLC Program, you’ll be keeping that cholesterol drug at the lowest possible dose and as a bonus you’ll be getting a bigger reduction in your risk for heart disease.

TLC Program Estimates of LDL Reductions


LDL Reduction

Saturated fat

Decrease to less than 7% of calories


Dietary cholesterol

Decrease to less than 200 mg/day



Lose 10 pounds if overweight


Soluble fiber

Add 5–10 grams/day


Plant sterols/stanols

Add 2 grams/day




* Notice that this amount of LDL reduction from TLC Program compares well with many of the cholesterol-lowering drugs. (Source 1).

Risk factors that could increase your chance for developing myocardial infarction (heart attack) :

Major risk factors:

  • High serum cholesterol level
  • Hypertension
  • Diabetes mellitus
  • Cigarette smoking

Minor risk factors:

  • Increasing age
  • Male gender
  • Family history
  • Physical inactivity
  • Obesity
  • Excess alcohol consumption
  • Excess carbohydrates intake
  • Social deprivation
  • Competitive and stressful lifestyle with type A personality
  • Diets deficient in fresh vegetables, fruit and polyunsaturated fatty acids.

What is Fat

Fat is a nutrient that helps the body function in various ways: For example, it supplies the body with energy. It also helps other nutrients work. But the body needs only small amounts of fat, and too much of the saturated type will increase cholesterol in the blood.

There are different types of fat, and they have different effects on cholesterol and heart disease risk. Here’s a quick rundown (for
more, see the Truth About Fats):

  • Saturated fat. This fat is usually solid at room and refrigerator temperatures. It is found in greatest amounts in foods from animals, such as fatty cuts of meat, poultry with the skin, whole-milk dairy products, and lard, as well as in some vegetable oils, including coconut and palm oils. Studies show that too much saturated fat in the diet leads to higher LDL levels. Populations that tend to eat more saturated fat have higher cholesterol levels and more heart disease than those with lower intakes. Reducing the amount of saturated fat in your diet is a very effective way to lower LDL cholesterol.
  • Unsaturated fat. This fat is usually liquid at room and refrigerator temperatures. Unsaturated fat occurs in vegetable oils, most nuts, olives, avocados, and fatty fish, such as salmon. There are types of unsaturated fat—monounsaturated and polyunsaturated. When used instead of saturated fat, monounsaturated and polyunsaturated fats help lower blood cholesterol levels. Monounsaturated fat is found in greatest amounts in foods from plants, including olive, canola, sunflower, and peanut oils. Polyunsaturated fat is found in greatest amounts in foods from plants, including safflower, sunflower,
    corn, soybean, and cottonseed oils, and many kinds of nuts. A type of polyunsaturated fat is called omega-3 fatty acids, which are being studied to see if they help guard against heart disease. Good sources of omega-3 fatty acids are some fatty fish, such as salmon, tuna, and mackerel.
  • Trans Fat. Trans fat—or trans fatty acids—is found mostly in foods that have been hydrogenated. Hydrogenation is a process in which hydrogen is added to unsaturated fat to make it more stable and solid at room temperature and more saturated. Some trans fat also occurs naturally in animal fats, such as dairy products and some meats. Trans fat or trans fatty acids, it tends to raise blood cholesterol similarly to saturated fat. Main sources of trans fat are stick margarine, baked products such as crackers, cookies, doughnuts, and breads, and foods fried in hydrogenated shortening, such as french fries and chicken. Trans fat also may be in some unsuspected places, such as dietary supplements. Soft margarines (tub and liquid) and vegetable oil spreads have lower amounts of trans fat than hard margarines. Some margarines are now free of trans fat. A new Federal regulation requires the amount of trans fat in a
    product to be noted on the Nutrition Facts label of the food package by January 2006. Use the label to choose margarines and other food products that have
    the least amount of saturated fat and trans fat. If trans fat is not listed on a product’s Nutrition Facts label (see Light Margarine – Nutrition Label), check the ingredients list. Look for shortening or hydrogenated or partially hydrogenated vegetable oil—that often indicates the presence of trans fat.

how to read nutrition label

What is cholesterol ?

Cholesterol is a waxy, fat-like substance that occurs naturally in all parts of the body. Cholesterol isn’t just something that sits in your body like fat around your waist. Your bodies need cholesterol to make cell membranes, key hormones like testosterone and estrogen, the bile acids needed to digest and absorb fats and vitamin D. Cholesterol is so important to the body that the liver and intestines make it from scratch. However, cholesterol also is found in some of the foods you eat.

Cholesterol is carried through your bloodstream by carriers made of fat (lipid) and proteins. These are called – lipoproteins.

Two types of lipoproteins carry cholesterol to and from cells. One is low-density lipoprotein or LDL. The other is high-density lipoprotein or HDL. The amount of each type of cholesterol in your blood can be measured by a blood test.

  • Low density lipoprotein, or LDL, which also is called the “bad” cholesterol because it carries cholesterol to tissues, including the arteries. Most of the cholesterol in the blood is the LDL form. The higher the level of LDL cholesterol in the blood, the greater your risk for heart disease.
  • High density lipoprotein, or HDL, which also is called the “good” cholesterol because it takes cholesterol from tissues to the liver, which removes it from the body. A low level of HDL cholesterol increases your risk for heart disease.
  • Triglycerides are produced in the liver, are another type of fat found in the blood and in food. Causes of raised triglycerides are overweight/obesity, physical inactivity, cigarette smoking, excess alcohol intake, and a diet very high in carbohydrates (60 percent of calories or higher). Recent research indicates that triglyceride levels that are borderline high (150–199 mg/dL) or high (200–499 mg/dL) may increase your risk for heart disease. Levels of 500 mg/dL or more need to be lowered with medication to prevent the pancreas from becoming inflamed. A triglyceride level of 150 mg/dL or higher also is one of the risk factors of the metabolic syndrome or metabolic syndrome X 1. To reduce blood triglyceride levels: control your weight, be physically active, don’t smoke, limit alcohol intake, and limit simple sugars and sugar-sweetened beverages. Sometimes, medication also is needed.

Your body needs some cholesterol to work properly. But if you have too much of bad cholesterol (LDL and Triglycerides) in your blood, it can combine with other substances in the blood and stick to the walls of your arteries. This is called plaque. Plaque can narrow your arteries or even block them.

The plaque buildup in arteries that LDL cholesterol and triglycerides contribute to is known as atherosclerosis (“hardening of the arteries”). When plaque builds up, it can partly or entirely block the blood flow of an artery in the heart, brain, pelvis, legs, arms or kidneys. This can lead to coronary heart disease, angina (chest pain), carotid artery disease, peripheral artery disease and chronic kidney disease.

Atherosclerosis can also lead to a heart attack or stroke. That’s because a couple of things can happen where plaque occurs:

  • A piece of plaque may break off.
  • A blood clot (thrombus) may form on the uneven surface of plaque buildup.

If either of these travels through the body, ultimately lodging in an artery to the heart, it causes a heart attack. If lodged in an artery to, or in, the brain, a stroke results.

Over time, plaque hardens and narrows your coronary arteries. This limits the flow of oxygen-rich blood to the heart. Eventually, an area of plaque can rupture (break open). This causes a blood clot to form on the surface of the plaque. If the clot becomes large enough, it can mostly or completely block blood flow through a coronary artery. A heart attack occurs if the flow of oxygen-rich blood to a section of heart muscle is cut off. If blood flow isn’t restored quickly, the section of heart muscle begins to die. Without quick treatment, a heart attack can lead to serious problems or death.

Plaque also can build up in other arteries in your body, such as the arteries that bring oxygen-rich blood to your brain and limbs. This can lead to problems such as carotid artery disease, stroke, and peripheral artery disease.

Cholesterol and Coronary Artery Disease
Cholesterol and Coronary Artery Disease

Coronary heart disease is a condition in which plaque builds up inside the coronary (heart) arteries. Plaque is made up of cholesterol, fat, calcium, and other substances found in the blood. When plaque builds up in the arteries, the condition is called atherosclerosis.

Where does Cholesterol come from ?

Cholesterol comes from two sources. Your body (specifically your liver) makes all the cholesterol you need. The rest you get from foods from animals. For example, meat, poultry and full-fat dairy products contain cholesterol (called dietary cholesterol). More importantly, these foods are high in saturated and trans fat. That’s a problem because these fats cause your liver to make more cholesterol than it otherwise would. For some people, this added production means they go from a normal cholesterol level to one that’s unhealthy.

Cholesterol source
Cholesterol source

Some tropical oils, such as palm oil, palm kernel oil and coconut oil, also can trigger your liver to make more cholesterol. These oils are often found in baked goods.

The saturated and trans fats you eat may raise your blood cholesterol level. Having too much cholesterol in your blood may lead to increased
risk for heart disease and stroke. High levels of cholesterol in the blood can increase your risk of heart disease. Your cholesterol levels tend to rise as you get older. There are usually no signs or symptoms that you have high blood cholesterol, but it can be detected with a blood test. You are likely to have high cholesterol if members of your family have it, if you are overweight or if you eat a lot of fatty foods.

You can lower your cholesterol by exercising more and eating more fruits and vegetables. You also may need to take medicine to lower your cholesterol.

Why Is Cholesterol Important ?

Your blood cholesterol level has a lot to do with your chances of getting heart disease. High blood cholesterol is one of the major risk factors for heart disease. A risk factor is a condition that increases your chance of getting a disease. In fact, the higher your blood cholesterol level, the greater your risk for developing heart disease or having a heart attack. Heart disease is the number one killer of women and men in the United States. Each year, more than a million Americans have heart attacks, and about a half million people die from heart disease 3.

  • Cholesterol is a waxy, fat-like substance. Your body needs some cholesterol, but it can build up on the walls of your arteries and lead to heart disease and stroke when you have too much in your blood.
  • Having high blood cholesterol puts you at risk of heart disease, the leading cause of death in the United States.
  • You can have high cholesterol and not realize it. Most of the 65 million Americans with high cholesterol have no symptoms. So it’s important to have your blood cholesterol levels checked. All adults age 20 and older should have their cholesterol levels checked at least once every 5 years. If you have an elevated cholesterol, you’ll need to have it tested more often. Talk with your doctor to find out how often is best for you 1.
  • People with high cholesterol have about twice the risk of heart disease as people with lower levels.
  • 71 million American adults (33.5%) have high low-density lipoprotein (LDL), or “bad,” cholesterol.
  • Only 1 out of every 3 adults with high LDL cholesterol has the condition under control.
  • Less than half of adults with high LDL cholesterol get treatment.
  • Lowering your cholesterol can reduce your risk of having a heart attack, needing heart bypass surgery or angioplasty, and dying of heart disease.
  • Exercising, eating a healthy diet, and not smoking will help you prevent high cholesterol and reduce your levels.
  • High cholesterol has no symptoms, so many people don’t know that their cholesterol is too high. Your doctor can do a simple blood test to check your levels.
  • The National Cholesterol Education Program recommends that adults get their cholesterol checked every five years.

How Does Cholesterol Cause Heart Disease ?

When there is too much cholesterol (a fat-like substance) in your blood, it builds up in the walls of your arteries. Over time, this buildup causes “hardening of the arteries” so that arteries become narrowed and blood flow to the heart is slowed down or blocked. The blood carries oxygen to the heart, and if enough blood and oxygen cannot reach your heart, you may suffer chest pain. If the blood supply to a portion of the heart is completely cut off by a blockage, the result is a heart attack.

High blood cholesterol itself does not cause symptoms, so many people are unaware that their cholesterol level is too high. It is important to find out what your cholesterol numbers are because lowering cholesterol levels that are too high lessens the risk for developing heart disease and reduces the chance of a heart attack or dying of heart disease, even if you already have it. Cholesterol lowering is important for everyone–younger, middle age, and older adults; women and men; and people with or without heart disease.

Heart Attack (Myocardial infarction)

Myocardial infarction is a medical term, commonly known as a heart attack that occurs when a portion of the heart muscle (myocardium) is damaged because of sudden occlusion of one of the coronary arteries that supply the oxygen rich blood to the heart muscle 4.

An acute myocardial infarction (sudden heart attack) occurs by developing a thrombus also called blood clot in a coronary artery previously affected by atherosclerosis. Cholesterol deposition in the wall of the artery is the main mechanism of atherosclerosis. This deposited cholesterol ultimately forms a plaque in the wall of the artery called atherosclerotic plaque. Many years are required to establish a plaque. Sometimes atherosclerotic plaque may rupture or erode and can trigger clotting mechanism in the blood to form a blood clot. This blood clot impaired blood flow to heart muscle lasts long enough to damage myocardial cells.

Types of myocardial infarction:

Myocardial infarction is classified into two types;

  • ST-segment elevation myocardial infarction (STEMI):

It occurs by complete occlusion of a major coronary artery that produces an entire thickness damage of heart muscle. STEMI is also called transmural infarction due to its full thickness involvement. This entire thickness damage of heart muscle produces an ECG (electrocardiography) change of ST-segment elevation. It can be sub classified into anterior, antero-septal, posterior, inferior, lateral, high lateral or antero- lateral myocardial infarction (according to left ventricular wall damage), and RV type (according to right ventricular wall damage).

  • Non ST-segment elevation myocardial infarction (NSTEMI):

NSTEMI is usually due to complete occlusion of a minor coronary artery or partial occlusion of a major coronary artery that produces a partial thickness damage of heart muscle. Here, the damage of heart muscle is confined to the inner ⅓ rd – ⅔ rd of the left ventricular wall. For this reason, it is also called subendocardial infarction. ST-segment elevation in ECG is not developed in this myocardial infarction because of partial thickness damage of heart muscle. Here, this muscle damage is demonstrated by an elevation of cardiac markers (CK-MB or Troponin) in the blood.

Symptoms of myocardial infarction:

  • Chest pain: Chest pain is the cardinal symptom of acute myocardial infarction. Pain is constricting, choking, squeezing or heavy in character, develops gradually over several minutes, usually located in the center of the chest, but may radiate to neck, jaw, shoulder, back, and arms (most commonly left arm). Occasionally, pain may be felt only at the sites of radiation. In older patient patients or those with diabetes mellitus, painless myocardial infarction may occur (also called silent myocardial infarction). Pain conducting nerve fiber is degenerated (autonomic neuropathy) in old age and in diabetes.
  • Shortness of breath: It may develop due to ischemic left ventricular dysfunction or dynamic mitral regurgitation.
  • Nausea, vomiting, and sweating: Due to upset of autonomic nervous system.
  • Syncope (sudden loss of consciousness): Sometimes patients may present with syncope, usually due to an arrhythmia or severe hypotension.
  • Tachycardia (high pulse rate): Due to sympathetic nerve activation.
  • Bradycardia (low pulse rate): Patients with inferior myocardial infarction may present with bradycardia due to vagus nerve activation.
  • Cardiogenic shock: Some patients may present with shock due to impaired myocardial function.
    Diagnosis of myocardial infarction:

Many people develop chest pain that is not due to a myocardial infarction. Therefore, tests are usually done to confirm the diagnosis of a myocardial infarction.

These are:

(1) Electrocardiography (ECG)

ECG findings of STEMI are ST-segment elevation, pathological Q-wave formation and T-wave inversion. ST-segment elevation must be greater than 2 mm in chest leads (v1 – v6) or greater than 1 mm in limb leads (I, II, III, aVL and aVF). A new onset left bundle branch block (LBBB) in ECG is also considered as ST-segment elevation myocardial infarction. NSTEMI is usually associated with ST-segment depression or T-wave inversion in ECG.

(2) Cardiac markers

Cardiospecific isoenzyme CK-MB (creatine kinase myocardial band), and cardiospecific proteins troponin T and troponin I are rises in acute myocardial infarction. CK-MB starts to rise at 4-6 hours and falls to normal within 48-72 hours. Troponin T and troponin I start to rise at 4-6 hours and remain high for up to two weeks.

(3) Full blood count

Elevation of WBC count is usual. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) may elevate.

(4) Chest X-ray

It is done to assess for signs of lung edema.

(5) Echocardiography

Regional ventricular wall motion abnormalities on an echocardiogram are also suggestive of a myocardial infarction. It also assesses ventricular function and detects important complications.
Early complications of myocardial infarction :

Early complications of myocardial infarction are as followings:

(A) Arrhythmias: Many patients with myocardial infarction may develop following form of arrhythmia:

  • Ventricular fibrillation
  • Ventricular tachycardia
  • Ventricular ectopics
  • Accelerated idioventricular rhythm
  • Atrial fibrillation
  • Atrial tachycardia
  • Atrioventricular block
  • Sinus bradicardia

In majority of cases arrhythmia is transient. Rest, pain relief and correction of hypokalaemia may prevent them.

(B) Left ventricular failure: It is due to extensive myocardial infarction.

(C) Cardiogenic shock: It is due to left ventricular dysfunction.

(D) Percarditis – pericarditis develop on the second or third days after myocardial infarction. Patient may feel a different type of pain that tends to be worse or sometimes only feel on inspiration.

(E) Embolism: On the endocardial surface of infarcted heart muscle, thrombus often forms. This thrombus may lodge and lead to development of systemic embolism that occationally causes stroke or ischemic limp.

(F) Mitral regurgitation – it is due to papillary muscle infarction.

Late complications myocardial infarction:

(1) Post MI syndrome (Dressler’s syndrome): It usually occurs 1-3 weeks after myocardial infarction, and is characterized by fever, pericarditis and pleuritis, and is probably due to myocardial antigens released after infarction. Management is with NSAIDs, high dose aspirin or even corticosteroids.

(2) Left ventricular aneurysm: In myocardial infarction, part of the infarcted area of ventricle becomes dilate and moves paradoxically during systole. Ventricular aneurysm can be minimized by use of ACE inhibitor and beta-blocker.

Treatment of myocardial infarction:

A myocardial infarction requires immediate hospitalization and medical attention.

Basic treatment:

(1) Complete bed rest with continuous monitoring by ECG.

(2) Inhaled oxygen therapy.

(3) Aspirin and clopidogrel

A 300 mg tablet of aspirin is given orally as early as possible. It can be given intravenously to patients who cannot swallow or who are unconscious. Aspirin reduces the mortality rate of myocardial infarction by approximately 25%. In combination of aspirin, clopidogrel 300 mg should be given orally as early as possible. Small mortality benefit is seen in combination of aspirin and clopidogrel. Ticagrelor 150 mg orally may be given instead of clopidogrel. Aspirin, clopidogrel and ticagrelor all are antiplatelet drugs that prevent the aggregation of platelets within the blood vessels.

(4) Pain relief

Nitrate and opiate analgegic are used to relief pain. Nitrate act as a vasodilator and relief pain. Nitrate should first be given buccally or by sublingual (under tongue) spray. If the patient experiencing persistent ischemic chest pain after 3 doses given 5 minutes apart, then intravenous glyceryl trinitrate 0.6-1.2 mg/hour or isosorbide dinitrate 1-2 mg/hour can be given until pain relieved or systolic blood pressure falls to less than 100 mgHg. Intravenous opiate analgegic such as morphine 10 mg or diamorphine 5 mg is usually used for severe pain and may have to be repeated.

Treatment to restore blood supply in the occluded coronary artery (re-perfusion therapy):

The part of the heart muscle does not die immediately after occlusion of coronary artery. If blood supply is restored within a few hours, much of the affected area of the heart muscle will be saved from damaging. There are two therapies that can restore blood supply back through the occluded coronary artery:

(1) Primary percutaneous coronary intervention (PCI):

It is treatment of choice for ST-segment elevation myocardial infarction. It should be done within 120 minutes of symptoms starting. Where PCI is not available or primary PCI cannot be achieved within 120 minutes of diagnosis, thrombolytic therapy should be administered.

On the other hand, medium to high risk patients with non-ST segment elevation myocardial infarction should be considered for early coronary angiography and revascularization, either by PCI (percutaneous coronary intervention) or by CABG (coronary artery bypass grafting). Early medical treatment is appropriate in low risk patients, and coronary angiography and revascularization reserved for those who fail to settle with medical treatment. (By using grace score or timi score, patients with non-ST segment elevation myocardial infarction can be categorized into low, medium or high risk group).

(2) Thrombolytic therapy:

It is only indicated for ST-segment elevation myocardial infarction. It is also called clot-busting drug. Available clot-busting drugs are streptokinase, alteplase, tenecteplase and reteplase. These drugs break the blood clot within the coronary artery and clear lumen. It should be given within three hours of onset of chest pain but may be given in patients who present within 12 hours of pain. After 12 hours, thrombolytic therapy appears to be a little benefit and may be harmful. In non-ST segment elevation myocardial infarction, this therapy is totally harmful and should be avoided.

Antiplatelet therapy:

Aspirin 75 mg daily should be given indefinitely if there are no side effects occur. Clopidogrel 75 mg daily should be given orally in combination of aspirin. Both drugs inhibit platelet aggregation and prevent further occlusion. Ticagrelor 90 mg two times daily may be given instead of clopidegrol. Ticagrelor is more effective than clopidegrol. Patients who undergo percutaneous coronary intervention, glycoprotein IIb/IIIa receptor blocking drug such as tirofiban, abciximab, or eptifibatide are the best antiplatet drug.

Anticoagulant therapy:

Anticoagulant therapy is recommended in patients not receiving reperfusion therapy. This therapy prevents reinfarction, and reduces the risk of thromboembolic complications. Anticoagulation can be achieved by using unfractionated heparin, low molecular weight heparin or fractionated heparin (enoxaparin, dalteparin), or a pentasaccharide (fondaparinux). Comparatively low molecular weight heparin is more safety and efficacious than unfractionated heparin, and pentasaccharide is more safety and efficacious than low molecular weight heparin. The dose regimens are:

Enoxaparin: 1 mg/kg body weight two times daily usually for 8 days by subcutaneous injection.
Dalteparin: 120 units/kg body weight two times daily usually for 8 days by subcutaneous injection.
Fondaparinux: 2.5 mg daily usually for 8 days by subcutaneous injection.


Beta-blocker diminishes myocardial oxygen demand by reducing heart rate, blood pressure and myocardial contractility, and reduces chest pain and ventricular arrhythmias. Reduction in heart rate prolongs the diastolic period of the heart and may augment blood flow to the heart muscle. In patients not receiving thrombolytic therapy, early beta-blocker reduces in infarct size and mortality rate. In patients receiving thrombolytic therapy, recent trials have not found a mortality rate reduction, although recurrent ischemia and re-infarction rates were reduced. Oral beta-blocker atenolol 25-50 mg twice daily, metoprolol25-50 mg twice daily, or bisoprolol 5 mg once daily are usually adequate. Beta-blockers should be avoided if there is heart failure, heart block, hypotension, or bradycardia.


Oral or sublingual nitrate can be used if patients feel chest pain.


Irrespective of serum cholesterol level, all patients should receive statin such as atorvastatin, rosuvastatin, simvastatin or pitavastatin.

ACE (angiotensin converting enzyme) inhibitor or ARB (angiotensive receptor blocker):

An ACE inhibitor such as ramipril, enalapril, captopril, or lisinopril is started 1 or 2 days after myocardial infarction. ACE inhibitor therapy reduces ventricular remodeling, prevent the onset of heart failure, and reduce recurrent infarction. An ARB (valsartan, candesartan, losartan or olmesartan) is suitable alternative in patients intolerant of ACE inhibitor.


  • Restrict physical activities for four to six weeks – Death tissue of infarct area in heart muscle takes 4-6 weeks to be replaced with fibrous tissue.
  • Cessation of cigarette smoking.
  • Maintaining an ideal body weight.
  • Eating a Mediterranean style diet (diet rich in monounsaturated fatty acids and omega-3 fatty acids, but low in saturated fatty acids).
  • Achieving well control of high pressure and diabetes mellitus.
  • Taking regular exercise up to, but not beyond, the point of chest discomfort.
  • Continue secondary prevention drugs therapy including aspirin, clopidogrel, beta-blocker, ACE inhibitor, and statin.


What Do Your Cholesterol Numbers Mean ?

Everyone age 20 and older should have their cholesterol measured at least once every 5 years. It is best to have a blood test called a “lipoprotein profile” to find out your cholesterol numbers. This blood test is done after a 9- to 12-hour fast and gives information about your:

  • Total cholesterol
  • LDL (bad) cholesterol–the main source of cholesterol buildup and blockage in the arteries
  • HDL (good) cholesterol–helps keep cholesterol from building up in the arteries
  • Triglycerides–another form of fat in your blood

If it is not possible to get a lipoprotein profile done, knowing your total cholesterol and HDL cholesterol can give you a general idea about your cholesterol levels. If your total cholesterol is 200 mg/dL* or more or if your HDL is less than 40 mg/dL, you will need to have a lipoprotein profile done. See how your cholesterol numbers compare to the tables below.

Total Cholesterol LevelCategory
Less than 200 mg/dLDesirable
200-239 mg/dLBorderline High
240 mg/dL and aboveHigh

Note: Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood.

LDL Cholesterol LevelLDL-Cholesterol Category
Less than 100 mg/dLOptimal
100-129 mg/dLNear optimal/above optimal
130-159 mg/dLBorderline high
160-189 mg/dLHigh
190 mg/dL and aboveVery high


Desirable Cholesterol Levels
Total cholesterolLess than 200 mg/dL
LDL (“bad” cholesterol)Less than 100 mg/dL
HDL (“good” cholesterol)60 mg/dL or higher
TriglyceridesLess than 150 mg/dL

(Source 5).

Note: HDL (good) cholesterol protects against heart disease, so for HDL, higher numbers are better. A level less than 40 mg/dL is low and is considered a major risk factor because it increases your risk for developing heart disease. HDL levels of 60 mg/dL or more help to lower your risk for heart disease.

Triglycerides can also raise heart disease risk. Levels that are borderline high (150-199 mg/dL) or high (200 mg/dL or more) may need treatment in some people.

What Affects Cholesterol Levels ?

A variety of things can affect cholesterol levels. These are things you can do something about:

  • Diet. Saturated fat and cholesterol in the food you eat make your blood cholesterol level go up. Saturated fat is the main culprit, but cholesterol in foods also matters. Reducing the amount of saturated fat and cholesterol in your diet helps lower your blood cholesterol level.
  • Weight. Being overweight is a risk factor for heart disease. It also tends to increase your cholesterol. Losing weight can help lower your LDL and total cholesterol levels, as well as raise your HDL and lower your triglyceride levels.
  • Physical Activity. Not being physically active is a risk factor for heart disease. Regular physical activity can help lower LDL (bad) cholesterol and raise HDL (good) cholesterol levels. It also helps you lose weight. You should try to be physically active for 30 minutes on most, if not all, days.

Things you cannot do anything about also can affect cholesterol levels. These include:

  • Age and Gender. As women and men get older, their cholesterol levels rise. Before the age of menopause, women have lower total cholesterol levels than men of the same age. After the age of menopause, women’s LDL levels tend to rise.
  • Heredity. Your genes partly determine how much cholesterol your body makes. High blood cholesterol can run in families.


What Is Your Risk of Developing Heart Disease or Having a Heart Attack ?

In general, the higher your LDL level and the more risk factors you have (other than LDL), the greater your chances of developing heart disease or having a heart attack. Some people are at high risk for a heart attack because they already have heart disease. Other people are at high risk for developing heart disease because they have diabetes (which is a strong risk factor) or a combination of risk factors for heart disease. Follow these steps to find out your risk for developing heart disease.

Step 1: Check the tables below to see how many of the listed risk factors you have; these are the risk factors that affect your LDL cholesterol goal.


You can also go to the The American Heart Association and the American College of Cardiology website to download the online apps – Assessment of Cardiovascular Risk Calculator and additional Prevention Guideline Tools. You can go to this page 6 to download Apple iOs or Android versions of that tool.

Apple App:

Android App:

You can also use the online version of that Cardiovascular Risk Calculator and additional Prevention Guideline Tool available here 7:!/baseline-risk

And if you understand Excel spreadsheet, you can use their downloadable spreadsheet 8, which is a companion tool to the Assessment of Cardiovascular Risk Calculator and additional Prevention Guideline Tools – available here:

The spreadsheet enables health care providers and patients to estimate 10-year and lifetime risks for atherosclerotic cardiovascular disease, defined as coronary death or nonfatal myocardial infarction, or fatal or nonfatal stroke, based on the Pooled Cohort Equations and the work of Lloyd-Jones, et al., respectively. The information required to estimate atherosclerotic cardiovascular disease risk includes age, sex, race, total cholesterol, HDL cholesterol, systolic blood pressure, blood pressure lowering medication use, diabetes status, and smoking status.

Major Risk Factors That Affect Your LDL Cholesterol Goal

  • Cigarette smoking
  • High blood pressure (140/90 mmHg or higher or on blood pressure medication)
  • Low HDL cholesterol (less than 40 mg/dL)*
  • Family history of early heart disease (heart disease in father or brother before age 55; heart disease in mother or sister before age 65)
  • Age (men 45 years or older; women 55 years or older)

* If your HDL cholesterol is 60 mg/dL or higher, subtract 1 from your total count.

Even though obesity and physical inactivity are not counted in this list, they are conditions that need to be corrected.

Step 2: How many major risk factors do you have ?

If you have 2 or more risk factors in the table above, use the attached risk scoring tables (which include your cholesterol levels) to find your risk score. Risk score refers to the chance of having a heart attack in the next 10 years, given as a percentage. My risk score is ________%.

Step 3: Use your medical history, number of risk factors, and risk score to find your risk of developing heart disease or having a heart attack in the table below.

If You HaveYou Are in Category
Heart disease, diabetes, or risk score more than 20%*I. High Risk
2 or more risk factors and risk score 10-20%II. Next Highest Risk
2 or more risk factors and risk score less than 10%III. Moderate Risk
0 or 1 risk factorIV. Low-to-Moderate Risk

* Means that more than 20 of 100 people in this category will have a heart attack within 10 years.

My risk category is ______________________.

  • Example – Men:

A male person is 60 years of age, diabetic, smoker, his serum total cholesterol is 190 mg/dl and HDL cholesterol is 45 mg/dl, has blood pressure 120 mg Hg with drug treatment. His Framingham Risk Score would be 11 + 3 + 4 + 1 + 0 + 1 = 20. He is a high risk individual and has a more than 30% risk of developing cardiovascular disease such as myocardial infarction over the next 10 years.

  • Example – Women :

A female person is 65 years of age, diabetic, non-smoker, her serum total cholesterol is 220 mg/dl and HDL cholesterol is 40 mg/dl, has blood pressure 130 mg Hg without any treatment. Her Framingham Risk Score would be 10 + 4 + 0 + 3 + 1 + 1 = 19. She is a high risk individual and has a 24.8% risk of developing cardiovascular disease such as myocardial infarction over the next 10 years.

Estimate of 10-Year Risk for Men

Framingham Point Scores by Age Group


Framingham Point Scores by Age Group and Total Cholesterol

Total CholesterolAge 20-39Age 40-49Age 50-59Age 60-69Age 70-79

Framingham Point Scores by Age and Smoking Status

Age 20-39Age 40-49Age 50-59Age 60-69Age 70-79

Framingham Point Scores by HDL Level


Framingham Point Scores by Systolic Blood Pressure and Treatment Status

Systolic BPIf UntreatedIf Treated

10-Year Risk by Total Framingham Point Scores

Point Total10-Year Risk
< 0< 1%
17 or more30%

(Source: National Institutes of Health, National Heart, Lung and Blood Institute. Estimate of 10-Year Risk for Coronary Heart Disease Framingham Point Scores.   9).

How To Calculate Your Risk of Developing Cardiovascular Disease – Men

  • Example – Men:

A male person is 60 years of age, diabetic, smoker, his serum total cholesterol is 190 mg/dl and HDL cholesterol is 45 mg/dl, has blood pressure 120 mg Hg with drug treatment. His Framingham Risk Score would be 11 + 3 + 4 + 1 + 0 + 1 = 20. He is a high risk individual and has a more than 30% risk of developing cardiovascular disease such as myocardial infarction over the next 10 years.

Estimate of 10-Year Risk for Women

Framingham Point Scores by Age Group


Framingham Point Scores by Age Group and Total Cholesterol

Total CholesterolAge 20-39Age 40-49Age 50-59Age 60-69Age 70-79

Framingham Point Scores by Age and Smoking Status

Age 20-39Age 40-49Age 50-59Age 60-69Age 70-79

 Framingham Point Scores by HDL Level


Framingham Point Scores by Systolic Blood Pressure and Treatment Status

Systolic BPIf UntreatedIf Treated

10-Year Risk by Total Framingham Point Scores

Point Total10-Year Risk
< 9< 1%
25 or more30%

(Source: National Institutes of Health, National Heart, Lung and Blood Institute. Estimate of 10-Year Risk for Coronary Heart Disease Framingham Point Scores.   9).

How To Calculate Your Risk of Developing Cardiovascular Disease – Women

  • Example – Women :

A female person is 65 years of age, diabetic, non-smoker, her serum total cholesterol is 220 mg/dl and HDL cholesterol is 40 mg/dl, has blood pressure 130 mg Hg without any treatment. Her Framingham Risk Score would be 10 + 4 + 0 + 3 + 1 + 1 = 19. She is a high risk individual and has a 24.8% risk of developing cardiovascular disease such as myocardial infarction over the next 10 years.


What is the Framingham Risk Score ?

Framingham Risk Score is a scoring system used to assess an individual’s risk of developing cardiovascular disease over the next 10-years 10. It was first developed from the Framingham Heart Study in 1948 on residents of the town of Framingham, United States under the direction of the National Heart, Lung and Blood Institute and is now on its third generation of participants 11. It is gender-specific algorithm; scoring system is different for men and women. It is practical, clinically relevant and modestly accurate but its effectiveness seems somewhat limited in certain specific populations 11.

Framingham Risk Score not only estimate the cardiovascular risk but also guide for prevention of cardiovascular disease. Prevention can be achieved by modification of lifestyle and initiating the preventive drug therapy. It is important to be able to decide when to initiate lifestyle modification and preventive drug therapy.

Usually individuals with low to intermediate risk are recommended for lifestyle modification. Lifestyle modification including avoid cigarette smoking, perform regular exercise (minimum of 20 minutes, three times per week), intake healthy diet that contains less amount of saturated fat and rich in fresh fruits and vegetables, maintain an ideal body weight, and reduce alcohol consumption. Individuals with intermediate risk should monitor their risk profile every 6–12 months.

High risk individuals are recommended for both lifestyle modification and preventive drug therapy. Preventive drug therapy including statin intake to control cholesterol level, low dose aspirin to prevent thromboembolic manifestations, treatment for diabetes and treatment for high blood pressure (blood pressure should be treated to a target of 140/85 mmHg or lower in non-diabetic persons and 130/80 mmHg or lower in diabetic persons). High risk individuals should monitor their risk profile every 3–6 months.

Variables of Framingham Risk Score:

Six variables are used in Framingham Risk Score for assessment of cardiovascular risk:

1. Age of person

2. Diabetes

3. Smoking status

4. Total cholesterol – Total cholesterol is the sum of all cholesterol in our blood. Practically, it is estimated by summation of HDL cholesterol, LDL cholesterol and one fifth of triglyceride. Its optimal level is less than 200 mg/dl. The higher the level, the greater the risk for cardiovascular disease.

5. HDL (high density lipoprotein) cholesterol – This cholesterol is beneficial for us. High density lipoprotein carries excess cholesterol from the peripheral tissues to the liver for disposal from the body via bile. Its optimal level is 60 mg/dl or more that is considered as a protective against cardiovascular disease. Level less than 40 mg/dl greatly increase the risk of developing cardiovascular disease.

6. Systolic blood pressure – It is the first portion of blood pressure recording. For example, if a person’s recording is 130/80 mg Hg, the systolic blood pressure is 130 mg Hg.

What can you do if your Cholesterol Level is High ?

The main goal of cholesterol-lowering treatment is to lower your LDL level enough to reduce your risk of developing heart disease or having a heart attack. The higher your risk, the lower your LDL goal will be. To find your LDL goal, see the boxes below for your risk category. There are two main ways to lower your cholesterol:

  1. Therapeutic Lifestyle Changes (TLC)–includes a cholesterol-lowering diet (called the TLC diet), physical activity, and weight management. TLC is for anyone whose LDL is above goal.
  2. Drug Treatment–if cholesterol-lowering drugs are needed, they are used together with TLC treatment to help lower your LDL.

If you are in:

  • Category I, Highest Risk, your LDL goal is less than 100 mg/dL. you will need to begin the TLC diet to reduce your high risk even if your LDL is below 100 mg/dL. If your LDL is 100 or above, you will need to start drug treatment at the same time as the TLC diet. If your LDL is below 100 mg/dL, you may also need to start drug treatment together with the TLC diet if your doctor finds our risk is very high, for example if you had a recent heart attack or have both heart disease and diabetes.
  • Category II, Next Highest Risk, your LDL goal is less than 130 mg/dL. If your LDL is 130 mg/dL or above, you will need to begin treatment with the TLC diet. If your LDL is 130 mg/dL or more after 3 months on the TLC diet, you may need drug treatment along with the TLC diet. If your LDL is less than 130 mg/dL, you will need to follow the heart healthy diet for all Americans, which allows a little more saturated fat and cholesterol than the TLC diet.
  • Category III, Moderate Risk, your LDL goal is less than 130 mg/dL. If your LDL is 130 mg/dL or above, you will need to begin the TLC diet. If your LDL is 160 mg/dL or more after you have tried the TLC diet for 3 months, you may need drug treatment along with the TLC diet. If your LDL is less than 130 mg/dL, you will need to follow the heart healthy diet for all Americans.
  • Category IV, Low-to-Moderate Risk, your LDL goal is less than 160 mg/dL. If your LDL is 160 mg/dL or above, you will need to begin the TLC diet. If your LDL is still 160 mg/dL or more after 3 months on the TLC diet, you may need drug treatment along with the TLC diet to lower your LDL, especially if your LDL is 190 mg/dL or more. If your LDL is less than 160 mg/dL, you will need to follow the heart healthy diet for all Americans.

To reduce your risk for heart disease or keep it low, it is very important to control any other risk factors you may have such as high blood pressure and smoking.

Lowering Cholesterol With Therapeutic Lifestyle Changes (TLC) Program

TLC Program is a set of things you can do to help lower your LDL cholesterol. The 3 main parts of TLC Program are:

  • The TLC Diet. This is a low-saturated-fat, low-cholesterol eating plan that calls for less than 7 percent of calories from saturated fat and less than 200 mg of dietary cholesterol per day. Foods low in saturated fat include fat-free or 1percent dairy products, lean meats, fish, skinless poultry, whole grain foods, and fruits and vegetables. Look for soft margarines (liquid or tub varieties) that are low in saturated fat and contain little or no trans fat (another type of dietary fat that can raise your cholesterol level). Limit foods high in cholesterol such as liver and other organ meats, egg yolks, and full-fat dairy products.Good sources of soluble fiber include oats, certain fruits (such as oranges and pears) and vegetables (such as brussels sprouts and carrots), and dried peas and beans.The TLC diet recommends only enough calories to maintain a desirable weight and avoid weight gain. If your LDL is not lowered enough by reducing your saturated fat and cholesterol intakes, the amount of soluble fiber in your diet can be increased. Certain food products that contain plant stanols or plant sterols (for example, cholesterol-lowering margarines) can also be added to the TLC diet to boost its LDL-lowering power.
  • Weight Management. Losing weight if you are overweight can help lower LDL and is especially important for those with a cluster of risk factors that includes high triglyceride and/or low HDL levels and being overweight with a large waist measurement (more than 40 inches for men and more than 35 inches for women).
  • Physical Activity. Regular physical activity (30 minutes on most, if not all, days) is recommended for everyone. It can help raise HDL and lower LDL and is especially important for those with high triglyceride and/or low HDL levels who are overweight with a large waist measurement.

Treatment for high LDL cholesterol involves the TLC Program and if needed, drug therapy. But the cornerstone of your treatment is the TLC Program. Even if you need to take a cholesterol-lowering drug, following the program will assure that you take the lowest necessary dose. Further, the program does something
drug therapy doesn’t—it helps control other risk factors for heart disease too, such as high blood pressure, overweight/obesity, and diabetes, as well as the tendency of the blood to form clots.

The TLC Program uses four categories of heart disease risk to set LDL goals and treatment steps (see Steps 1-3 and the Boxes above). If you have heart disease or diabetes, then you are in category I, which has the highest risk. The higher your risk category, the more important it is to lower your LDL and control any other heart disease risk factors (including smoking and high blood pressure) you have. Further, the higher your risk category, the more you’ll benefit from taking action. But whatever your risk category, you will use the TLC approach as a basic part of your treatment.

The TLC Program is a step-by-step way to lower your LDL cholesterol—and your heart disease risk. You’ll start the program by following a heart healthy diet and becoming physically active, in addition to controlling other risk factors for heart disease such as smoking and high blood pressure. As you continue with the program, you and your doctor will review your progress toward reaching your LDL goal and, if needed, add other treatment options. Throughout the program, you may seek the advice of a dietitian or other health professional.

A typical TLC Program path to success would be:

First Doctor Visit—Start Lifestyle Changes

  • Reduce saturated fat, trans fat, and cholesterol.
  • Increase physical activity moderately.
  • If overweight, reduce calories—increase fiber-rich foods to help reduce calorie intake.
  • —Allow 6 weeks—

Second Doctor Visit—Check LDL and, If Needed, Add More Dietary Approaches

  • Reinforce reduction of saturated fat, trans fat, and cholesterol.
  • Add plant stanols/sterols.
  • Increase soluble fiber.
  • —Allow 6 weeks—

Third Doctor Visit—Check LDL and, If Needed, Add Drug Therapy

  • Start drug therapy for LDL lowering, if needed.
  • Focus on treatment of metabolic syndrome—reinforce weight management and physical activity.
  • —Every 4 to 6 months—

Keep Checking Progress

The TLC Diet Plan

The TLC diet calls for you to have:

  • Less than 7 percent of your daily calories from saturated fat.
  • Less than 200 mg a day of cholesterol.
  • 25–35 percent of daily calories from total fat (includes saturated fat calories)
  • Diet options you can use for more LDL lowering
    • 2 grams per day of plant stanols or sterols
    • 10–25 grams per day of soluble fiber
  • Only enough calories to reach or maintain a healthy weight
  • In addition, you should get at least 30 minutes of a moderate intensity physical activity, such as brisk walking, on most, and preferably all, days of the week.
  • Cholesterol

The cholesterol in your diet raises the cholesterol level in your blood—but not as much as saturated fat. However, the two often are found in the same foods. So by limiting your intake of foods rich in saturated fat, you’ll also help reduce your intake of cholesterol. Dietary cholesterol comes only from foods of animal origin,
such as liver and other organ meats; egg yolks (but not the whites, which have no cholesterol); shrimp; and whole milk dairy products, including butter, cream, and cheese. Keep your dietary cholesterol to less than 200 milligrams a day. Use the Nutrition Facts label on food products to help you choose items low in cholesterol.

  • Soluble Fiber

Fiber comes from plants. Your body can’t really digest it or absorb it into your bloodstream—your body isn’t nourished by it. But it is vital for your good health.
Foods high in fiber can help reduce your risk of heart disease. It’s also good for your digestive tract and for overall health. Further, eating foods rich in fiber can help you feel full on fewer calories, which makes it a good food choice if you need to lose weight.

There are two main types of fiber—insoluble and soluble (also called “viscous”). Both have health benefits but only soluble fiber reduces the risk of heart disease. It does that by helping to lower LDL cholesterol. The difference between the two types is how they go through the digestive tract. Insoluble fiber goes through it largely undissolved. It’s also called “roughage” and helps the colon function properly. It’s found in many whole-grain foods, fruits (with the skins), vegetables, and legumes (such as dry beans and peas).

Soluble fiber dissolves into a gel-like substance in the intestines. The substance helps to block cholesterol and fats from being absorbed through the wall of the intestines into the blood stream. Research shows that people who increased their soluble fiber intake by 5–10 grams each day had about a 5 percent drop in their LDL cholesterol. TLC diet recommends that you get at least 5–10 grams of soluble fiber a day—and, preferably, 10–25 grams a day, which will lower your LDL even more.

  • Plant Stanols and Sterols

Plant stanols and sterols occur naturally in small amounts in many plants. Those used in food products are taken from soybean and tall pine-tree oils. When combined with a small amount of canola oil, the product is used in various foods. As with soluble fiber, plant stanols and sterols help block the absorption of cholesterol from the digestive tract, which helps to lower LDL—without affecting HDL or triglycerides. Studies show that a daily intake of about 2 grams of either stanols or sterols reduces LDL cholesterol by about 5–15 percent—often within weeks.

Stanols and sterols are added to certain margarines and some other foods, such as a special type of orange juice. But remember that foods with stanols/sterols are not calorie-free. If you use these products, you may need to offset the calories by cutting back elsewhere.

  • Omega-3 Fatty Acids

Omega-3 fats are found in some fatty fish and in some plant sources, such as walnuts, canola and soybean oils, and flaxseed. They do not affect LDL levels but
may help protect the heart in other ways. In some studies, people who ate fish had a reduced death rate from heart disease. It is possible that this is related to the effects of omega-3 fats, which may help prevent blood clots from forming and inflammation from affecting artery walls. Omega-3 fats also may reduce the risk for heart rhythm problems and, at high doses, reduce triglyceride levels. Studies have suggested that omega-3 fats reduce the risk for heart attack and death from heart disease for those who already have heart disease. Based on what is now known, try to have about two fish meals every week. Fish high in omega-3 fats are salmon, tuna (even canned), and mackerel.

  • Sodium (salt)

Studies have found that reducing the amount of  sodium in your diet lowers blood pressure. High blood pressure is a major risk factor for heart disease. Sodium is one component of table salt (sodium chloride). But it’s found in other forms too. So read food labels. Some low fat foods are high in sodium—use the label to choose the lower sodium options. Vegetables and fruits are naturally low in sodium—and low in saturated fat and calories. Instead of using salt or added fat to make foods tastier, use spices and herbs.

All Americans should limit their sodium intake to no more than 2,300 milligrams of sodium (about 1 teaspoon of salt) a day—that includes all sodium consumed, whether added in cooking or at the table, or already present in food products. In fact, processed foods account for most of the salt and sodium Americans consume. You may be surprised at which products have sodium. They include soy sauce, seasoned salts, monosodium glutamate (MSG), baking soda, and some antacids. Be sure to read food labels to choose products lower in sodium. Fresh fruits and vegetables are naturally low in sodium.

  • Alcohol

You may have heard that moderate drinking reduces the risk for heart disease. Small amounts of alcohol may help protect some persons. However, drinking too much alcohol can have serious health consequences. It can damage the heart and liver, and contribute to both high blood pressure and high triglycerides. If you don’t drink now, don’t start. If you do drink, have no more than one drink a day for women and two a day for men. And don’t forget that alcohol has calories. If you need to lose weight, you will need to be especially careful about how many alcoholic beverages you drink.

Foods To Choose for TLC Diet

The TLC diet encourages you to choose a variety of nutritious and tasty foods. Choose fruits, vegetables, whole grains, low-fat or non-fat dairy products, fish, poultry without the skin, and, in moderate amounts, lean meats.

  • To find out What and How Much To Eat, you can use a FREE, award-winning, state-of-the-art, online diet and activity tracking tool called SuperTracker 12 from the United States Department of Agriculture Center for Nutrition Policy and Promotion 12. This free application empowers you to build a healthier diet, manage weight, and reduce your risk of chronic diet-related diseases. You can use SuperTracker 12 to determine what and how much to eat; track foods, physical activities, and weight; and personalize with goal setting, virtual coaching, and journaling.

SuperTracker website:

  • To find out about the 5 Food Groups you should have on your plate for a meal, you can use a FREE online app ChooseMyPlate 13


The TLC Diet calls for a variety of foods that are low in saturated fat, trans fat, and cholesterol but high in taste. It is not a deprivation diet. It can satisfy your taste buds as much as your heart.

Here’s the breakdown of the TLC diet by food groups:

  • Breads/Cereals/Grains 6 or more servings a day

Adjust to calorie needs. Foods in this group are high in complex carbohydrates and fiber. They are usually low in saturated fat, cholesterol, and total fat. Whole-grain breads and cereals, pasta, rice, potatoes, low-fat crackers, and low-fat cookies.

  • Vegetables/Dry Beans/Peas 3–5 servings a day

These are important sources of vitamins, fiber, and other nutrients. Dry beans/peas are fiber-rich and good sources of plant protein. Fresh, frozen, or canned—without added fat, sauce, or salt.

  • Fruits 2–4 servings a day

These are important sources of vitamins, fiber, and other nutrients. Fresh, frozen, canned, dried—without added sugar.

  • Dairy Products 2–3 servings a day—fat free or low fat (for example, 1% milk)

These foods provide as much or more calcium and protein than whole milk dairy products—but with little or no saturated fat. Fat-free or low-fat milk, buttermilk, yogurt, sour cream, cream cheese, low-fat cheese (with no more than 3 grams of fat per ounce, such as low-fat cottage cheese).

  • Eggs 2 or fewer yolks per week—including yolks in baked goods and in cooked or processed foods

Yolks are high in dietary cholesterol. Egg whites or egg substitutes have no cholesterol and less calories than whole eggs.

  • Meat/Poultry/Fish 5 or less ounces a day

Poultry without skin and fish are lower in saturated fat. Lean cuts of meat have less fat and are rich sources of protein and iron. Be sure to trim any fat from meat and remove skin from poultry before cooking. Lean cuts of beef include sirloin tip, round steak, and rump roast; extra lean hamburger; cold cuts made with lean meat or soy protein; lean cuts of pork are center cut ham, loin chops, and pork tenderloin. Strictly limit organ meats, such as brain, liver, and kidneys—they are high in cholesterol. Eat shrimp only occasionally—it is moderately high in cholesterol.

  • Fats/Oils

Amount depends on daily calorie level. Nuts are high in calories and fat, but have mostly unsaturated fat. Nuts can be eaten in moderation on the TLC diet—be sure the amount you eat fits your calorie intake. Unsaturated vegetable oils that are high in unsaturated fat (such as canola, corn, olive, safflower, and soybean); soft or liquid margarines (the first ingredient on the food label should be unsaturated liquid vegetable oil, rather than hydrogenated or partially hydrogenated
oil) and vegetable oil spreads; salad dressings; seeds; nuts. Choose products that are labeled “lowsaturated fat,” which equals 1 gram of saturated fat per serving.

  • Soluble fiber

Barley, oats, psyllium, apples, bananas, berries, citrus fruits, nectarines, peaches, pears, plums, prunes, broccoli, brussels sprouts, carrots, dry beans, peas, soy products (such as tofu, miso).

TLC Diet Menu

There are 4 kinds of menus:

  1. Traditional American style,
  2. Southern-style,
  3. Mexican American-style, and
  4. Asian American style foods.

Traditional American Cuisine 1,800 Calories


  • Oatmeal (1 cup)
  • Fat-free milk (1 cup)
  • Raisins (1/4 cup)
  • Honeydew melon (1 cup)
  • Orange juice, calcium fortified (1 cup)
  • Coffee (1 cup) with fat-free milk (2 Tbsp)


  • Roast beef sandwich
  • Whole-wheat bun (1 medium)
  • Roast beef, lean (2 oz)
  • Swiss cheese, low fat (1 oz slice)
  • Romaine lettuce (2 leaves)
  • Tomato (2 medium slices)
  • Mustard (2 tsp)
  • Pasta salad (1/2 cup)
  • Pasta noodles (1/4 cup)
  • Mixed vegetables (1/4 cup)
  • Olive oil (1 tsp)
  • Apple (1 medium)
  • Iced tea, unsweetened (1 cup)


  • Orange roughy (2 oz) cooked with olive oil (2 tsp)
  • Parmesan cheese (1 Tbsp)
  • Rice* (1 cup)
  • Soft margarine (1 tsp)
  • Broccoli (1/2 cup)
  • Soft margarine (1 tsp)
  • Strawberries (1 cup) topped with low-fat frozen yogurt (1/2 cup)
  • Water (1 cup)


  • Popcorn (2 cups) cooked with
  • canola oil (1 Tbsp)
  • Peaches, canned in water (1 cup)
  • Water (1 cup)

Southern Cuisine 1,800 Calories


  • Bran cereal (3/4 cup)
  • Banana (1 medium)
  • Fat-free milk (1 cup)
  • Biscuit, low sodium and made with canola oil (1 medium)
  • Jelly (1 Tbsp)
  • Soft margarine (1 tsp)
  • Honeydew melon (1/2 cup)
  • Coffee (1 cup) with fat-free milk (2 Tbsp)


  • Chicken breast (2 oz) cooked with canola oil (2 tsp)
  • Corn on the cob* (1 medium)
  • Soft margarine (1 tsp)
  • Collard greens (1/2 cup)
  • Chicken broth, low sodium (1 Tbsp)
  • Rice, cooked (1/2 cup)
  • Fruit cocktail, canned in water (1 cup)
  • Iced tea, unsweetened (1 cup)


  • Catfish (3 oz), coated with flour and baked with canola oil (1/2 Tbsp)
  • Sweet potato (1 medium)
  • Soft margarine (2 tsp)
  • Spinach (1/2 cup)
  • Vegetable broth, low sodium (2 Tbsp)
  • Corn muffin (1 medium), made with fat-free milk and egg substitute
  • Soft margarine (1 tsp)
  • Watermelon (1 cup)
  • Iced tea, unsweetened (1 cup)


  • Graham crackers (4 large)
  • Peanut butter, reduced fat, unsalted (1 Tbsp)
  • Fat-free milk (1/2 cup)

Mexican-American Cuisine 1,800 Calories


  • Bean Tortilla
  • Corn tortilla (1 medium)
  • Pinto beans (1/4 cup)
  • Onion (2 Tbsp), tomato, chopped (2 Tbsp)
  • Jalapeno pepper (1 medium)
  • Sauté with canola oil (1 tsp)
  • Papaya (1 medium)
  • Orange juice, calcium fortified (1 cup)
  • Coffee (1 cup) with fat-free milk (2 Tbsp)


  • Stir-fried Beef
  • Sirloin steak (2 oz)
  • Garlic, minced (1 tsp)
  • Onion, chopped (1/4 cup)
  • Tomato, chopped (1/4 cup)
  • Potato, diced (1/4 cup)
  • Salsa (1/4 cup)
  • Olive oil (11/2 tsp)
  • Mexican rice (1/2 cup)
  • Rice, cooked (1/2 cup)
  • Onion, chopped (2 Tbsp)
  • Tomato, chopped (2 Tbsp)
  • Jalapeno pepper (1 medium)
  • Carrots, diced (2 Tbsp)
  • Cilantro (1 Tbsp)
  • Olive oil (2 tsp)
  • Mango (1 medium)
  • Blended fruit drink (1 cup)
  • Fat free milk (1 cup)
  • Mango, diced (1/4 cup)
  • Banana, sliced (1/4 cup)
  • Water (1/4 cup)


  • Chicken fajita
  • Corn tortilla (1 medium)
  • Chicken breast, baked (2 oz)
  • Onion, chopped (2 Tbsp)
  • Green pepper, chopped (2 Tbsp)
  • Garlic, minced (1 tsp)
  • Salsa (11/2 Tbsp)
  • Canola oil (1 tsp)
  • Avocado salad
  • Romaine lettuce (1 cup)
  • Avocado slices, dark skin, California type (1/2 small)
  • Tomato, sliced (1/4 cup)
  • Onion, chopped (2 Tbsp)
  • Sour cream, low-fat (11/2 Tbsp)
  • Rice pudding with raisins (1/2 cup)
  • Water (1 cup)


  • Plain yogurt, fat-free, no sugar added (1 cup)
  • Mixed with peaches, canned in water (1/2 cup)
  • Water (1 cup)

Asian Cuisine 1,800 Calories


  • Scrambled egg whites (1/2 cup liquid egg substitute)
  • Cooked with fat-free cooking spray
  • English muffin (1 whole)
  • Soft margarine (2 tsp)
  • Jam (1 Tbsp)
  • Strawberries (1 cup)
  • Orange juice, calcium fortified (1 cup)
  • Coffee (1 cup) with fat-free milk (2 Tbsp)


  • Tofu Vegetable stir-fry
  • Tofu (3 oz)
  • Mushrooms (1/2 cup)
  • Onion (1/4 cup)
  • Carrots (1/2 cup)
  • Swiss chard (1/2 cup)
  • Garlic, minced (2 Tbsp)
  • Peanut oil (1 Tbsp)
  • Soy sauce, low sodium (21/2 tsp)
  • Rice, cooked (1/2 cup)
  • Orange (1 medium)
  • Green tea (1 cup)


  • Beef stir-fry
  • Beef tenderloin (3 oz)
  • Soybeans, cooked (1/4 cup)
  • Broccoli, cut in large pieces (1/2 cup)
  • Peanut oil (1 Tbsp)
  • Soy sauce, low sodium (2 tsp)
  • Rice, cooked (1/2 cup)
  • Watermelon (1 cup)
  • Almond cookie (1 cookie)
  • Fat-free milk (1 cup)


  • Chinese noodles, soft (1/2 cup)
  • Peanut oil (1 tsp)
  • Green tea (1 cup)

How to Make TLC Heart Healthy Meals

Eating heart healthy meals doesn’t mean giving up on taste. Here are some tips on how to make “health” a special ingredient in your recipes:

Cooking Methods

  • Use low-fat methods and remember not to add butter or high fat sauces—Bake, broil, microwave, roast, steam, poach, lightly stir fry or sauté in cooking spray, small amount of vegetable oil, or reduced sodium broth, grill seafood, chicken, or vegetables.
  • Use a nonstick (without added fat) or regular (with small amount of fat) pan.
  • Chill soups and stews for several hours and remove congealed fat.
  • Limit salt in preparing stews, soups, and other dishes—use spices and herbs to make dishes tasty.

Milk/Cream/Sour Cream

  • Cook with low-fat (1-percent fat) or fat-free types of milk or of evaporated milk, instead of whole milk or cream.
  • Instead of sour cream, blend 1 cup low-fat, unsalted cottage cheese with 1 tablespoon fat-free milk and 2 tablespoons lemon juice, or substitute fat-free or low-fat sour cream or yogurt.


  • Use a variety of herbs and spices in place of salt.
  • Use low-sodium bouillon and broths, instead of regular bouillons and broths.
  • Use a small amount of skinless smoked turkey breast instead of fatback to lower fat content but keep taste.
  • Use skinless chicken thighs, instead of neck bones.


  • Use cooking oil spray to lower fat and calories.
  • Use a small amount of vegetable oil, instead of lard, butter, or other fats that are hard at room temperature.
  • In general, diet margarines are not well suited for baking—instead, to cut saturated fat, use regular soft margarine made with vegetable oil.
  • Choose margarine that lists liquid vegetable oil as the first ingredient on the food label and is low in saturated fat and low in or free of trans fat.


  • In baking or cooking, use three egg whites and one egg yolk instead of two whole eggs, or two egg whites or 1/4 cup of egg substitute instead of one whole egg.

Meats and Poultry

  • Choose a lean cut of meat and remove any visible fat.
  • Remove skin from chicken and other poultry before cooking.
  • Try replacing beef with turkey in many recipes.

Sandwiches and Salads

  • In salads and sandwiches, use fat-free or low-fat dressing, yogurt, or mayonnaise, instead of regular versions.
  • To make a salad dressing, use equal parts water and vinegar, and half as much oil.
  • Garnish salads with fruits and vegetables.

Soups and Stews

  • Remove fat from homemade broths, soups, and stews by preparing them ahead and chilling them. Before reheating the dish, lift off the hardened fat that formed at the surface. If you don’t have time to chill the dish, float a few ice cubes on the surface of the warm liquid to harden the fat. Then remove and
    discard the fat.
  • Use cooking spray, water, or stock to sauté onion for flavoring stews, soups, and sauces.


  • To make muffins, quick breads, and biscuits, use no more than 1–2 tablespoons of fat for each cup of flour.
  • When making muffins or quick breads, use three ripe, very well-mashed bananas, instead of 1/2 cup butter or oil. Or substitute a cup of applesauce for a cup of butter, margarine, oil, or shortening—you’ll get less saturated fat and fewer calories.


  • To make a pie crust, use only 1/2 cup margarine for every 2 cups of flour.
  • For chocolate desserts, use 3 tablespoons of cocoa, instead of 1 ounce of baking chocolate. If fat is needed to replace that in chocolate, add 1 tablespoon or less of vegetable oil.
  • To make cakes and soft-drop cookies, use no more than 2 tablespoons of fat for each cup of flour.

TLC Diet Snacks and Treats

Eating the TLC way doesn’t mean depriving yourself of snacks and treats. Try these low-saturated fat munchies and desserts, but keep track of the calories:


  • Fresh or frozen fruits
  • Fresh vegetables
  • Pretzels
  • Popcorn (air popped or cooked in small amounts of vegetable oil and without added butter or salt)
  • Low-fat or fat-free crackers (such as animal crackers, fig and other fruit bars, ginger snaps, and molasses cookies)
  • Graham crackers
  • Rye crisp
  • Melba toast
  • Bread sticks
  • Bagels
  • English muffins
  • Ready-to-eat cereals
  • Desserts and sweets
  • Fresh or frozen fruits
  • Low-fat or fat-free fruit yogurt
  • Frozen low-fat or fat-free yogurt
  • Low-fat ice cream
  • Fruit ices
  • Sherbet
  • Angel food cake
  • Jello
  • Baked goods, such as cookies, cakes, and pies with pie crusts, made with unsaturated oil or soft margarines, egg whites or egg substitutes, and fat-free milk
  • Candies with little or no fat, such as hard candy, gumdrops, jelly beans, and candy corn.

What About Dessert ?

The TLC diet lets you have moderate amounts of sweets and low saturated  fat desserts.

Becoming Physically Active

Becoming physically active is another key part of the TLC Program —it’s a step that has many benefits. Lack of physical activity is a major risk factor for heart disease. It affects your risk of heart disease both on its own and by its effects on other major risk factors. Regular physical activity can help you manage your weight and, in that way, help lower your LDL. It also can help raise HDL and lower triglycerides, improve the fitness of your heart and lungs, and lower blood  pressure. And it can reduce your risk for developing diabetes or, if you already have the condition, lessen your need for insulin.

You don’t have to run marathons to become physically active. In fact, if you haven’t been active, the key to success is starting slowly and gradually increasing your effort. For instance, start by taking a walk during breaks at work and gradually lengthen your walks or increase your pace. If you have heart disease or high blood  pressure, or if you are a man over 40 or a woman over 50 who is planning to be very active, you

Regular physical activity is good for you in many ways in addition to helping you raise HDL and lower LDL:

  • Physical activity is good for your heart.
  • Your weight is much easier to control when you are active.
  • Physical activity can boost your ability to make other improvements in lifestyle such as diet changes.
  • You’ll feel and look better when you’re physically active.
  • You’ll feel more confident when you are active.
  • Physical activity is a great way to burn off steam and stress and helps you beat the blues.
  • You’ll have more energy.
  • You can share physical activities with friends and family.
  • Physical activity can be lots of fun.

Unless your doctor tells you otherwise, try to get at least 30 minutes of a moderate-intensity activity such as brisk walking on most, and preferably all, days of the week. You can do the activity all at once or break it up into shorter periods of at least 10 minutes each. Moderate-intensity activities include playing golf (walking the course, instead of riding in a cart), dancing, bowling, bicycling (5 miles in 30 minutes), as well as gardening and house cleaning. More intense activities include jogging, swimming, doing aerobics, or playing basketball, football, soccer, racquetball, or tennis.


A Handy Guide to Calories Burned in Common Activities

The table below lists the calories burned by doing dozens of activities listed by category (such as gym activities, training and sports activities, home repair etc.) for 30 minutes. Activities and exercises include walking (casual, race, and everything in between), swimming, jogging, yoga, and even watching TV and sleeping. In each category, activities are listed from least to most calories burned.

Calories burned in 30-minute activities
Gym Activities125-pound person155-pound person185-pound person
Weight Lifting: general90112133
Aerobics: water120149178
Stretching, Hatha Yoga120149178
Calisthenics: moderate135167200
Riders: general150186222
Aerobics: low impact165205244
Stair Step Machine: general180223266
Teaching aerobics180223266
Weight Lifting: vigorous180223266
Aerobics, Step: low impact210260311
Aerobics: high impact210260311
Bicycling, Stationary: moderate210260311
Rowing, Stationary: moderate210260311
Calisthenics: vigorous240298355
Circuit Training: general240298355
Rowing, Stationary: vigorous255316377
Elliptical Trainer: general270335400
Ski Machine: general285353422
Aerobics, Step: high impact300372444
Bicycling, Stationary: vigorous315391466
Training and Sport Activities
Dancing: slow, waltz, foxtrot90112133
Volleyball: non-competitive, general play90112133
Water Volleyball90112133
Archery: non-hunting105130155
Golf: using cart105130155
Hang Gliding105130155
Gymnastics: general120149178
Horseback Riding: general120149178
Tai Chi120149178
Volleyball: competitive, gymnasium play120149178
Walking: 3.5 mph (17 min/mi)120149178
Badminton: general135167200
Walking: 4 mph (15 min/mi)135167200
Softball: general play150186222
Walking: 4.5 mph (13 min/mi)150186222
Whitewater: rafting, kayaking150186222
Dancing: disco, ballroom, square165205244
Golf: carrying clubs165205244
Dancing: Fast, ballet, twist180223266
Hiking: cross-country180223266
Skiing: downhill180223266
Swimming: general180223266
Walk/Jog: jog <10 min.180223266
Water Skiing180223266
Basketball: wheelchair195242289
Race Walking195242289
Ice Skating: general210260311
Racquetball: casual, general210260311
Rollerblade Skating210260311
Scuba or skin diving210260311
Sledding, luge, toboggan210260311
Soccer: general210260311
Tennis: general210260311
Basketball: playing a game240298355
Bicycling: 12-13.9 mph240298355
Football: touch, flag, general240298355
Hockey: field & ice240298355
Rock Climbing: rappelling240298355
Running: 5 mph (12 min/mile)240298355
Running: pushing wheelchair, marathon wheeling240298355
Skiing: cross-country240298355
Snow Shoeing240298355
Swimming: backstroke240298355
Volleyball: beach240298355
Bicycling: BMX or mountain255316377
Boxing: sparring270335400
Football: competitive270335400
Running: 5.2 mph (11.5 min/mile)270335400
Running: cross-country270335400
Bicycling: 14-15.9 mph300372444
Martial Arts: judo, karate, kickbox300372444
Racquetball: competitive300372444
Rope Jumping300372444
Running: 6 mph (10 min/mile)300372444
Swimming: breaststroke300372444
Swimming: laps, vigorous300372444
Swimming: treading, vigorous300372444
Water Polo300372444
Rock Climbing: ascending330409488
Running: 6.7 mph (9 min/mile)330409488
Swimming: butterfly330409488
Swimming: crawl330409488
Bicycling: 16-19 mph360446533
Handball: general360446533
Running: 7.5 mph (8 min/mile)375465555
Running: 8.6 mph (7 min/mile)435539644
Bicycling: > 20 mph495614733
Running: 10 mph (6 min/mile)495614733
Outdoor Activities
Planting seedlings, shrubs120149178
Raking Lawn120149178
Sacking grass or leaves120149178
Gardening: general135167200
Mowing Lawn: push, power135167200
Operate Snow Blower: walking135167200
Plant trees135167200
Gardening: weeding139172205
Carrying & stacking wood150186222
Digging, spading dirt150186222
Laying sod / crushed rock150186222
Mowing Lawn: push, hand165205244
Chopping & splitting wood180223266
Shoveling Snow: by hand180223266
Home & Daily Life Activities
Watching TV232833
Reading: sitting344250
Standing in line384756
Child-care: bathing, feeding, etc.105130155
Food Shopping: with cart105130155
Moving: unpacking105130155
Playing w/kids: moderate effort120149178
Heavy Cleaning: wash car, windows135167200
Child games: hop-scotch, jacks, etc.150186222
Playing w/kids: vigorous effort150186222
Moving: household furniture180223266
Moving: carrying boxes210260311
Home Repair
Auto Repair90112133
Wiring and Plumbing90112133
Carpentry: refinish furniture135167200
Lay or remove carpet/tile135167200
Paint, paper, remodel: inside135167200
Cleaning rain gutters150186222
Hanging storm windows150186222
Paint house: outside150186222
Carpentry: outside180223266
Occupational Activities
Computer Work415161
Light Office Work455667
Sitting in Meetings496072
Desk Work536578
Sitting in Class536578
Truck Driving: sitting607489
Heavy Equip. Operator7593111
Police Officer7593111
Theater Work90112133
Carpentry Work105130155
Coaching Sports120149178
Masseur, standing120149178
Construction, general165205244
Coal Mining180223266
Horse Grooming180223266
Forestry, general240298355
Heavy Tools, not power240298355
Steel Mill: general240298355

(Source: Harvard Heart Letter 2004)

Maintaining a Healthy Weight

Being overweight or obese increases your chances for having high triglycerides, a low HDL, and a high LDL. You’re also more likely to develop high blood  pressure, diabetes, heart disease, some cancers, and other serious health problems. If you have excess weight around your waist, you’re more likely to develop the metabolic syndrome.

Losing your extra weight reduces these risks and improves your cholesterol and triglyceride levels. If you are overweight and have a high cholesterol, you’ll need to get your LDL and your weight under control by changing your diet and increasing your physical activity. At the start of the TLC program, your main focus will be on lowering LDL toward the goal level by making changes such as reducing saturated fat and calories and increasing fiber, which could also help you lose weight.

Finding out if you need to lose weight involves a two-step process:

  • First, your doctor may already have checked your body mass index, or BMI, which relates your weight to your height. A BMI of 18.5–24.9 indicates a normal weight; a BMI of 25–29.9 is overweight; while a BMI of 30 or higher is obese.

To find out about your body mass index (BMI), you can use a FREE online BMI calculators from the Centers for Disease Control and Prevention (CDC) – for Adults 14 and for Children 15

  • BMI Calculator Adults.
  • BMI Calculator Children.

To find out about how many calories you should eat to lose weight according to your weight, age, sex, height and physical activity, you can use a FREE online app Body Weight Planner 16

  • Body Weight Planner.


  • Second, your doctor may have taken your waist measurement. A waist measurement of 35 inches or more for women or 40 inches or more for men is one of the factors involved in the metabolic syndrome. It also indicates an increased risk of obesity-related conditions, such as heart disease. Check with your doctor and find out what a healthy weight is for you. If you need to lose pounds, do so gradually—a reasonable and safe weight loss is 1 to 2 pounds a week.  You don’t have to reach your ideal weight to reap health benefits. If you are overweight, losing even 10 percent of your current weight lowers your risk for
    heart disease and other health problems.
  1. National Institutes of Health, National Heart, Lung, and Blood Institute. YOUR GUIDE TO Lowering Your Cholesterol With TLC.
  2. National Institutes of Health, National Heart, Lung, and Blood Institute. High Blood Cholesterol: What You Need To Know.
  3. Centers for Disease Control and Prevention.Division for Heart Disease and Stroke Prevention. – Cholesterol Fact Sheet –
  4. Myocardial infarction.
  5. National Cholesterol Education Program. Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults.
  6. The American Heart Association and the American College of Cardiology. Assessment of Cardiovascular Risk Calculator.
  7. The American Heart Association and the American College of Cardiology. Assessment of Cardiovascular Risk Calculator.!/baseline-risk
  8. The American Heart Association and the American College of Cardiology. Assessment of Cardiovascular Risk Calculator Spreadsheet Companion.
  9. National Institutes of Health, National Heart, Lung and Blood Institute. Estimate of 10-Year Risk for Coronary Heart Disease Framingham Point Scores.
  10. NSTEMI. Framingham Risk Score.
  11. Framingham Heart Study.
  13. ChooseMyPlate.
  14. BMI Calculator Adults.
  15. BMI Calculator Children.
  16. Body Weight Planner.
read more
Diet PlanDiet, Food & Fitness

What is gluten free diet ?

gluten free diet

The Gluten Free Diet

Gluten free diet is a diet free of gluten. This is essentially a diet that removes all foods containing or contaminated with gluten. However, since gluten-containing whole grains contain fiber and nutrients including B vitamins, magnesium, and iron, it’s important to make up for these missing nutrients. Along with consuming naturally gluten-free foods in their whole form like fruits, vegetables, legumes, nuts, seeds, fish, eggs, and poultry, the following whole grains are also inherently gluten-free:

  • Quinoa
  • Brown, black, or red rice
  • Buckwheat
  • Amaranth
  • Millet
  • Corn
  • Sorghum
  • Teff
  • Oats (when not contaminated during growing/processing)

Gluten free diet is a diet that is critical in treating celiac disease and non-celiac gluten sensitivity and wheat allergy.  Gluten is a protein found naturally in wheat, barley, and rye that triggers an immune reaction if you have celiac disease, non-celiac gluten sensitivity and wheat allergy. Removing gluten from your diet will improve symptoms for most people, heal damage to your small intestine, and prevent further damage over time. While you may need to avoid certain gluten-foods, the good news is that many healthy, gluten-free foods and products are now available in grocery stores and restaurants, making it easier to stay gluten free.

It’s also key not to rely on processed gluten-free foods that may be high in calories, sugar, saturated fat, and sodium and low in nutrients, such as gluten-free cookies, chips, and other snack foods. Often, these foods are made with processed unfortified rice, tapioca, corn, or potato flours.

  • If you are concerned about celiac disease, you are strongly discouraged from starting a gluten-free diet without having had a firm diagnosis by your medical doctor. And if you change your diet to the gluten free diet, even for as little as a month, can complicate the diagnostic process. This is because all celiac disease blood tests require that you be on a gluten-containing diet to be accurate.

Interestingly, studies show that people who do not have celiac disease are the biggest purchasers of gluten-free products 1. Consumer surveys show that the top three reasons people select gluten-free foods are for “no reason,” because they are a “healthier option,” and for “digestive health” 2. For those who are not gluten-intolerant, there is no data to show a specific benefit in following a gluten-free diet, particularly if processed gluten-free products become the mainstay of the diet. In fact, research following patients with celiac disease who change to a gluten-free diet shows an increased risk of obesity and metabolic syndrome. This could be partly due to improved intestinal absorption, but speculation has also focused on the low nutritional quality of processed gluten-free foods that may contain refined sugars and saturated fats and have a higher glycemic index 3, 4.

What is Gluten

Gluten comes from the Latin word for ‘glue’ which gives dough the elastic property that holds gas when it rises. Bubbles of carbon dioxide are released from fermenting yeast, which become trapped by the visco-elastic protein, ensuring a light honeycombed texture for the dough 5. The elastic nature of gluten also holds particles of the dough together, preventing crumbling during rolling and shaping. Hence, gluten plays a vital role in the production of leavened baked goods.

Gluten is the name given to the protein found in some, but not all, grains:

  • Grains containing gluten – wheat (including wheat varieties like spelt, kamut, farro and durum, plus products like bulgar and semolina), barley, rye, triticale.
  • Gluten-free grains – corn, millet, rice, oats (uncontaminated), sorghum.
  • Gluten-free pseudo-cereals – amaranth, buckwheat, quinoa.

Gluten can be readily prepared by gently washing dough under a stream of running water. This removes the bulk of the soluble and particulate matter to leave a proteinaceous mass that retains its cohesiveness on stretching 6. Gluten is the term used to identify a mixture of proteins (prolamines) that occurs in the endosperm of wheat (gliadins) and other cereals such as barley (hordeins) and rye (secalins) 7. Gluten is found in wheat (wheatberries, durum, emmer, semolina, spelt, farina, farro, graham, KAMUT® khorasan wheat and einkorn), rye, barley and triticale – a cross between wheat and rye. Gluten helps foods maintain their shape, acting as a glue that holds food together. Gluten can be found in many types of foods, even ones that would not be expected.

Gluten is common in foods such as bread, pasta, cookies, and cakes. Many pre-packaged foods, lip balms and lipsticks, hair and skin products, toothpastes, vitamin and nutrient supplements, and, rarely, medicines, contain gluten.

Up to recently, the most common gluten-related disorders in children included only coeliac disease (celiac disease) and wheat allergy. To these, the entity known as non-coeliac gluten sensitivity has been added. The common feature among these gluten-associated disorders is their treatment: a gluten-free diet.

Gluten and Health Benefits

Gluten is most often associated with wheat and wheat-containing foods that are abundant in our food supply. Negative media attention on wheat and gluten has caused some people to doubt its place in a healthful diet. There is little published research to support these claims; in fact published research suggests the opposite.

In a 2017 study of over 100,000 participants without celiac disease, researchers found no association between long-term dietary gluten consumption and heart disease risk 8. In fact, the findings also suggested that non-celiac individuals who avoid gluten may increase their risk of heart disease, due to the potential for reduced consumption of whole grains.

  • Many studies have linked whole grain consumption with improved health outcomes. For example, groups with the highest intakes of whole grains including wheat (2-3 servings daily) compared with groups eating the lowest amounts (less than 2 servings daily) were found to have significantly lower rates of heart disease and stroke, development of type 2 diabetes, and deaths from all causes 9, 10, 11, 12.

Gluten may also act as a prebiotic, feeding the “good” bacteria in our bodies. Arabinoxylan oligosaccharide is a prebiotic carbohydrate derived from wheat bran that has been shown to stimulate the activity of bifidobacteria in the colon. These bacteria are normally found in a healthy human gut. Changes in their amount or activity have been associated with gastrointestinal diseases including inflammatory bowel disease, colorectal cancer, and irritable bowel syndrome 13, 14.

Gluten Containing Foods

1)Wheat is commonly found in:

  • breads
  • baked goods
  • soups
  • pasta
  • cereals
  • sauces
  • salad dressings
  • roux

Varieties and derivatives of wheat such as:

  • wheatberries
  • durum
  • emmer
  • semolina
  • spelt
  • farina
  • farro
  • graham
  • KAMUT® khorasan wheat
  • einkorn wheat

2) Barley is commonly found in:

  • malt (malted barley flour, malted milk and milkshakes, malt extract, malt syrup, malt flavoring, malt vinegar)
  • food coloring
  • soups
  • beer
  • Brewer’s Yeast

3) Rye is commonly found in:rye

  • rye bread, such as pumpernickel
  • rye beer
  • cereals

4) Triticale is a newer grain, specifically grown to have a similar quality as wheat, while being tolerant to a variety of growing conditions like rye. It can potentially be found in:

  • breads
  • pasta
  • cereals

5) Malt in various forms including: malted barley flour, malted milk or milkshakes, malt extract, malt syrup, malt flavoring, malt vinegar

6) Brewer’s Yeast

7) Wheat Starch that has not been processed to remove the presence of gluten to below 20ppm and adhere to the FDA Labeling Law. According to the FDA, if a food contains wheat starch, it may only be labeled gluten-free if that product has been processed to remove gluten, and tests to below 20 parts per million of gluten. With the enactment of this law on August 5th, 2014, individuals with celiac disease or gluten intolerance can be assured that a food containing wheat starch and labeled gluten-free contains no more than 20ppm of gluten. If a product labeled gluten-free contains wheat starch in the ingredient list, it must be followed by an asterisk explaining that the wheat has been processed sufficiently to adhere to the FDA requirements for gluten-free labeling.

Common Foods That Contain Gluten

  • Pastas: raviolis, dumplings, couscous, and gnocchi
  • Noodles: ramen, udon, soba (those made with only a percentage of buckwheat flour) chow mein, and egg noodles. (Note: rice noodles and mung bean noodles are gluten free)
  • Breads and Pastries: croissants, pita, naan, bagels, flatbreads, cornbread, potato bread, muffins, donuts, rolls
  • Crackers: pretzels, goldfish, graham crackers
  • Baked Goods: cakes, cookies, pie crusts, brownies
  • Cereal & Granola: corn flakes and rice puffs often contain malt extract/flavoring, granola often made with regular oats, not gluten-free oats
  • Breakfast Foods: pancakes, waffles, french toast, crepes, and biscuits.
  • Breading & Coating Mixes: panko breadcrumbs
  • Croutons: stuffings, dressings
  • Sauces & Gravies (many use wheat flour as a thickener): traditional soy sauce, cream sauces made with a roux
  • Flour tortillas
  • Beer (unless explicitly gluten-free) and any malt beverages (see “Distilled Beverages and Vinegars” below for more information on alcoholic beverages)
  • Brewer’s Yeast
  • Anything else that uses “wheat flour” as an ingredient

Distilled Beverages And Vinegars

Most distilled alcoholic beverages and vinegars are gluten-free. These distilled products do not contain any harmful gluten peptides even if they are made from gluten-containing grains. Research indicates that the gluten peptide is too large to carry over in the distillation process, leaving the resulting liquid gluten-free.

Wines and hard liquor/distilled beverages are gluten-free. However, beers, ales, lagers, malt beverages and malt vinegars that are made from gluten-containing grains are not distilled and therefore are not gluten-free. There are several brands of gluten-free beers available in the United States and abroad.

Foods That May Contain Gluten

  • Energy bars/granola bars – some bars may contain wheat as an ingredient, and most use oats that are not gluten-free
  • French fries – be careful of batter containing wheat flour or cross-contact from fryers
  • Potato chips – some potato chip seasonings may contain malt vinegar or wheat starch
  • Processed lunch meats
  • Candy and candy bars
  • Soup – pay special attention to cream-based soups, which have flour as a thickener. Many soups also contain barley
  • Multi-grain or “artisan” tortilla chips or tortillas that are not entirely corn-based may contain a wheat-based ingredient
  • Salad dressings and marinades – may contain malt vinegar, soy sauce, flour
  • Starch or dextrin if found on a meat or poultry product could be from any grain, including wheat
  • Brown rice syrup – may be made with barley enzymes
  • Meat substitutes made with seitan (wheat gluten) such as vegetarian burgers, vegetarian sausage, imitation bacon, imitation seafood (Note: tofu is gluten-free, but be cautious of soy sauce marinades and cross-contact when eating out, especially when the tofu is fried)
  • Soy sauce (though tamari made without wheat is gluten-free)
  • Self-basting poultry
  • Pre-seasoned meats
  • Cheesecake filling – some recipes include wheat flour
  • Eggs served at restaurants – some restaurants put pancake batter in their scrambled eggs and omelets, but on their own, eggs are naturally gluten-free

Other Items That Must Be Verified By Reading The Label Or Checking With The Manufacturer

  • Lipstick, lipgloss, and lip balm because they are unintentionally ingested
  • Communion wafers
  • Herbal or nutritional supplements
  • Drugs and over-the-counter medications (Learn about Gluten in Medication)
  • Vitamins and supplements (Learn about Vitamins and Supplements)
  • Play-dough: children may touch their mouths or eat after handling wheat-based play-dough. For a safer alternative, make homemade play-dough with gluten-free flour.

Gluten in Medication

The true chances of getting a medication that contains gluten is extremely small, but you should still eliminate all risks by evaluating the ingredients in your medications by reading the medicine labels 15.

Medications are composed of many ingredients, both inside and outside of the product. These ingredients, also known as excipients, include the active component, absorbents (which absorb water to allow the tablet to swell and disintegrate), protectants, binders, coloring agents, lubricators, and bulking agents (which allow some products to dissolve slowly as they travel throughout the intestinal tract). Excipients can be synthetic or from natural sources that are derived from either plants or animals. Excipients are considered inactive and safe for human use by the FDA, but can be a potential source for unwanted reactions.

  • Dr. Steve Plogsted (Associate Clinical Professor of Pharmacy, Ohio Northern University College of Pharmacy) maintains a website that provides information regarding gluten-free drugs 16. However, this site is for informational purposes only and may contain inaccuracies. Dr. Plogsted advises that, “All persons should interpret the information with caution and should seek medical advice when necessary.” 16

Vitamins & Supplements

Vitamin and mineral therapy can be used in addition to the standard gluten-free diet to hasten a patient’s recovery from nutritional deficiency. However, certain ingredients in vitamins and supplements – typically the inactive ingredients – can contain gluten, so extra care must be taken to avoid any gluten exposure 17.

People recently diagnosed with celiac disease are commonly deficient in fiber, iron, calcium, magnesium, zinc, folate, niacin, riboflavin, vitamin B12, and vitamin D, as well as in calories and protein. Deficiencies in copper and vitamin B6 are also possible, but less common. A study from 2002 by Bona et. al. indicated that the delay in puberty in children with celiac disease may partially be due to low amounts of B vitamins, iron, and folate.

However, after treatment with a strict gluten-free diet, most patients’ small intestines recover and are able to properly absorb nutrients again, and therefore do not require supplementation. For certain patients however, nutrient supplements may be beneficial.

It is also important to remember that “wheat-free” does not necessarily mean “gluten-free.” Be wary, as many products may appear to be gluten-free, but are not.

If In Doubt, Go Without !

When unable to verify ingredients for a food item or if the ingredient list is unavailable DO NOT EAT IT. Adopting a strict gluten-free diet is the only known treatment for those with gluten-related disorders.

Gluten Free Foods

The most cost-effective and healthy way to follow the gluten-free diet is to seek out these naturally gluten-free food groups, which include:

  • Fruits
  • Vegetables
  • Meat and poultry
  • Fish and seafood
  • Dairy
  • Eggs
  • Beans, legumes, and nuts
  • Gluten free grains e.g. rice, sorghum, millet and corn

There are many naturally gluten-free grains that you can enjoy in a variety of creative ways. Many of these grains can be found in your local grocery store, but some of the lesser-known grains may only be found in specialty or health food stores. It is not recommended to purchase grains from bulk bins because of the possibility for cross-contact with gluten.

The following grains and other starch-containing foods are naturally gluten-free:

  • Rice
  • Cassava
  • Corn (maize)
  • Soy
  • Potato
  • Tapioca
  • Beans
  • Sorghum
  • Quinoa
  • Millet
  • Buckwheat groats (also known as kasha)
  • Arrowroot
  • Amaranth
  • Teff
  • Flax
  • Chia
  • Yucca
  • Gluten-free oats
  • Nut flours

There has been some research that some naturally gluten-free grains may contain gluten from cross-contact with gluten-containing grains through harvesting and processing. If you are concerned about the safety of a grain, purchase only versions that are tested for the presence of gluten and contain less than 20 ppm.

Is a gluten-free diet safe if you don’t have celiac disease ?

In recent years, more people without celiac disease have adopted a gluten-free diet, believing that avoiding gluten is healthier or could help them lose weight. No current data suggests that the general public should maintain a gluten-free diet for weight loss or better health 18, 19.

A gluten-free diet isn’t always a healthy diet. For instance, a gluten-free diet may not provide enough of the nutrients, vitamins, and minerals the body needs, such as fiber, iron, and calcium. Some gluten-free products can be high in calories and sugar.

The composition of the gut microbiota is susceptible to the influence of the diet and, especially, to the quality and quantity of ingested carbohydrates 20, 21, 22. The reductions in polysaccharide intake associated with the gluten-free diet could explain the observed changes in the microbiota, since these dietary compounds usually reach the distal part of the colon partially undigested, and constitute one of the main energy sources for commensal components of the gut microbiota 23. The genome of these bacteria encodes many enzymes specialized in the utilization of non-digestible carbohydrates, which provide these bacterial groups a competitive advantage over potentially pathogenic bacteria to colonize the intestine 24, 25.

It also seems feasible that when the growth of beneficial bacteria is not supported due to a reduced supply of their main energy sources other bacterial groups, which can be opportunistic pathogens, can overgrowth leading to intestinal dysbiosis. Within the gut ecosystem, the microbiota acts as a metabolic organ whose survival and composition is determined by a dynamic process of selection and competition. In fact, intake of complex dietary carbohydrates (e.g., dietary fiber) has been shown to influence both microbial colonization and fermentation variables in the mammalian gut. Thus, high intake of dietary fiber resulted in a greater short-chain fatty acid concentration in (e.g., acetic and butyric acids), and lower Escherichia coli counts in piglet intestine, while an opposite trend was shown with low fiber intake 26.

In a small study 27 involving 10 healthy subjects (30.3 years-old), who were following a gluten-free diet over one month by replacing the gluten-containing foods they usually ate with certified gluten-free foods (with no more than 20 parts per million of gluten). Analyses of their fecal microbiota and dietary intakes, indicated that populations of generally regarded healthy bacteria decreased (Bifidobacterium, B. longum and Lactobacillus), while populations of potentially unhealthy bacteria increased parallel to reductions in the intake of polysaccharides (from 117 g to 63 g on average) after following the gluten-free diet. In particular, increases were detected in numbers of E. coli and total Enterobacteriaceae, which may include opportunistic pathogens 28. Although this preliminary study has limitations, including number of participants and the short duration of the intervention, the changes in the microbiota found in healthy subjects following a gluten-free diet, in particular the reductions in Bifidobacterium plus Lactobacillus populations relative to Gram-negative bacteria (Bacteroides and E. coli) were detected. These findings indicate that gluten-free diet may contribute to reducing beneficial bacterial counts and increasing enterobacterial counts, which are microbial features associated with the disease 29, 30 and, therefore, it would not favor completely the normalization of the gut ecosystem 27. This evidence suggests a disruption of the delicate balance between the host and its intestinal microbiota (dysbiosis), which might favor the overgrowth of opportunistic pathogens and weaken the host defences against infection and chronic inflammation via possible alterations in mucosal immunity 31.

If you think you might have celiac disease, don’t start avoiding gluten without first speaking with your doctor. If your doctor diagnoses you with celiac disease, he or she will put you on a gluten-free diet.

gluten free foods

When Gluten Is a Problem

What’s not great about gluten is that it can cause serious side effects in certain individuals. Some people react differently to gluten, where the body senses it as a toxin, causing one’s immune cells to overreact and attack it. If an unknowingly sensitive person continues to eat gluten, this creates a kind of battle ground resulting in inflammation. The side effects can range from mild (fatigue, bloating, alternating constipation and diarrhea) to severe (unintentional weight loss, malnutrition, intestinal damage) as seen in the autoimmune disorder celiac disease. Estimates suggest that 1 in 133 Americans has celiac disease, or about 1% of the population, but about 83% of them are undiagnosed or misdiagnosed with other conditions 32, 33. Research shows that people with celiac disease also have a slightly higher risk of osteoporosis and anemia (due to malabsorption of calcium and iron, respectively); infertility; nerve disorders; and in rare cases cancer 34. The good news is that removing gluten from the diet may reverse the damage. A gluten-free diet is the primary medical treatment for celiac disease. However, understanding and following a strict gluten-free diet can be challenging, possibly requiring the guidance of a registered dietitian to learn which foods contain gluten and to ensure that adequate nutrients are obtained from gluten-free alternatives. Other conditions that may require the reduction or elimination of gluten in the diet include:

  • Non-celiac gluten sensitivity, also referred to as gluten sensitive enteropathy or gluten intolerance—An intolerance to gluten with similar symptoms as seen with celiac disease, but without the accompanying elevated levels of antibodies and intestinal damage. There is not a diagnostic test for GSE but is determined by persistent symptoms and a negative diagnostic celiac test.
  • Wheat allergy—An allergy to one or more of the proteins (albumin, gluten, gliadin, globulin) found in wheat, diagnosed with positive immunoglobulin E blood tests and a food challenge. Compare this with celiac disease, which is a single intolerance to gluten. Symptoms range from mild to severe and may include swelling or itching of the mouth or throat, hives, itchy eyes, shortness of breath, nausea, diarrhea, cramps, and anaphylaxis. People who test negative for this condition may still have gluten sensitivity. This condition is most often seen in children, which most outgrow by adulthood.
  • Dermatitis herpetiformis—A skin rash that results from eating gluten. It is an autoimmune response that exhibits itself as a persistent red itchy skin rash that may produce blisters and bumps. Although people with celiac disease may have dermatitis herpetiformis, the reverse is not always true. Those with dermatitis herpetiformisoften do not have any digestive symptoms.

It is important to note that gluten is a problem only for those who react negatively to it. Most people can and have eaten gluten most of their lives, without any adverse side effects.

Gluten Related Disorders

Gluten-related disorders have gradually emerged as an epidemiologically relevant phenomenon with an estimated global prevalence around 5%. Celiac disease, wheat allergy and non-celiac gluten sensitivity represent different gluten-related disorders 35.

There are a number of definitions in use to define gluten related disorders. By and large, all of them encompass the same basic principles. For the purpose of this report, the following definitions have been chosen for these conditions – celiac disease, wheat allergy and Gluten Sensitivity (Non-Celiac Gluten Sensitivity).

Celiac Disease

Celiac disease (also known as coeliac disease, celiac sprue, non-tropical sprue, autoimmune enteropathy and gluten sensitive enteropathy) is an immune-mediated systemic disorder triggered by gluten and related prolamins present in wheat, barley, and rye that occur in genetically susceptible individuals who have the human leukocyte antigen (HLA)-DQ2 and/or HLA-DQ8 haplotypes. It is characterized by an inflammatory enteropathy with variable degrees of severity, a wide range of gastrointestinal and/or systemic complaints, and the presence of celiac-specific autoantibodies 36.

Celiac disease is triggered by eating foods containing gluten. Gluten is a protein found naturally in wheat, barley, and rye, and is common in foods such as bread, pasta, cookies, and cakes. Many pre-packaged foods, lip balms and lipsticks, hair and skin products, toothpastes, vitamin and nutrient supplements, and, rarely, medicines, contain gluten.

For more information about celiac disease see the post on What is celiac disease ?

When people with celiac disease eat gluten (a protein found in wheat, rye and barley), their body mounts an immune response that attacks the small intestine. These attacks lead to damage on the villi, small fingerlike projections that line the small intestine, that promote nutrient absorption. When the villi get damaged, nutrients cannot be absorbed properly into the body 37.

It is estimated to affect 1 -3 in 100 (1-3%) people worldwide, except for populations in which the HLA risk alleles (celiac disease genes) (HLA-DQ2 and/or DQ8) are rare such as in South East Asia 38, 39, 40, 41. Two and one-half million Americans are undiagnosed and are at risk for long-term health complications 37.

Celiac disease is also hereditary, meaning that it runs in families. People with a first-degree relative with celiac disease (parent, child, sibling) have a 1 in 10 risk of developing celiac disease 37. Furthermore, first-degree family members (parent, child, sibling) of patients with celiac disease have an increased risk for the disease, already at a young age, ranging from 5% to 30%, depending on their sex and HLA makeup 42, 43.

Celiac disease is different from gluten sensitivity or wheat allergy 44. If you have gluten sensitivity, you may have symptoms similar to those of celiac disease, such as abdominal pain and tiredness. Unlike celiac disease, gluten sensitivity does not damage the small intestine.

Wheat Allergy

Wheat allergy is a hypersensitivity reaction to wheat proteins mediated through immune mechanisms and involving mast cell activation. The immune response can be immunoglobulin E (IgE) mediated, non-IgE mediated, or a combination of both. Wheat allergy is most commonly a food allergy, but wheat can become a sensitizer when the exposure occurs through the skin or airways (baker’s asthma) 45, 18, 46.

In both wheat allergy and celiac disease, your body’s immune system reacts to wheat. However, some symptoms in wheat allergies, such as having itchy eyes or a hard time breathing, are different from celiac disease. Wheat allergy is an immunoglobulin E–mediated reaction to the insoluble gliadins, particularly ω-5 gliadin, the major allergen of wheat-dependent, exercise-induced anaphylaxis (“baker’s asthma”) 47. Usually, patients with wheat allergy are not allergic to other prolamines containing grains, such as rye or barley and their wheat-free diet is less restrictive than the strict gluten-free diet for patients with celiac disease. The symptoms of wheat allergy develop within minutes to hours after gluten ingestion and are typical for an immunoglobulin E–mediated allergy, including itching and swelling in the mouth, nose, eyes, and throat; rash and wheezing; and life-threatening anaphylaxis. The gastrointestinal manifestations of wheat allergy may be similar to those of coeliac disease, but wheat allergy does not cause (permanent) gastrointestinal damage 18. Those with wheat allergy also benefit from the gluten free diet, although these patients often do not need to restrict rye, barley, and oats from their diet 18.

Table 1. The clinical manifestations of gluten-related disorders are numerous and complex in nature and involve multiple organ systems. There is considerable overlap of symptoms between these conditions, which makes differentiation impossible on clinical grounds alone. (Source 48).

gluten related disorders symptoms

What is Gluten Sensitivity (Gluten Intolerance) or Non-Celiac Gluten Sensitivity

Gluten sensitivity is also known as non-celiac gluten sensitivity, is a clinical condition in which intestinal and extraintestinal symptoms are triggered by gluten ingestion, in the absence of celiac disease and wheat allergy 7. The symptoms usually occur soon after gluten ingestion, improving or disappearing within hours or a few days after gluten withdrawal and relapsing following its reintroduction 49. Ataxia and peripheral neuropathy are the most common neurological manifestations of gluten sensitivity. Myopathy is a less common and poorly characterized additional neurological manifestation of gluten sensitivity 50.

The prevalence of gluten sensitivity in the general population is unknown, but it has been estimated to be anywhere between 0.5% and 6% in different countries. No data on prevalence are available for the paediatric population, and the scarce data on children refer to gluten avoidance and not to Gluten sensitivity per se 51, 52. The disorder seems to be more common in girls and in young/middle-aged adults 51, 53.

Gluten sensitivity is a controversial subject, where patients who have neither celiac disease nor wheat allergy, have varying degrees of symptomatic improvement on the gluten free diet. Conditions in this category include dermatitis herpetiformis, irritable bowel syndrome (IBS), and neurologic diseases such as gluten-sensitive ataxia and autism 18, 53, 54. In children, gluten sensitivity tends to manifest with gastrointestinal symptoms, such as abdominal pain and chronic diarrhoea, whereas the systemic manifestations seem to be less frequent, the most common systemic symptom being tiredness 55. Unlike patients with coeliac disease, patients with gluten sensitivity do not appear to be at a higher risk for long-term complications such as nutrient deficiencies secondary to malabsorption. Patients with gluten sensitivity do not seem to have autoimmune comorbidities, as observed in coeliac disease, but allergy is more frequently seen in patients with gluten sensitivity 51, 53.

An association between gluten sensitivity and neuropsychiatric disorders, such as schizophrenia and autism spectrum disorders, has been suggested 56, 57. The conclusion of a Cochrane review including 2 small randomized controlled trials, however, is that there is no evidence for efficacy of gluten exclusion in these disorders 53, 58. The major effect of gluten in patients with gluten sensitivity is in the perception of their general well-being 59.

How is Gluten Sensitivity Diagnosed

The diagnosis of gluten sensitivity is based on exclusion of other gluten-related disorders, especially celiac disease and wheat allergy. Unfortunately, there are no biological markers specific to gluten sensitivity. The only antibodies observed in a retrospective study of adults with gluten sensitivity are immunoglobulin G and immunoglobulin A anti-gliadin antibodies (AGAs), which occur in, respectively, 56% and 8% of the patients compared with 80% and 75% in the population with celiac disease 60. It, however, has to be taken into account that anti-gliadin antibodies are also frequently present in the general population. The vast majority of patients with gluten sensitivity showed immunoglobulin G anti-gliadin antibodies disappearance after gluten withdrawal. Half of the patients with gluten sensitivity were HLA-DQ2 or -DQ8 positive, a prevalence only slightly higher than in the general population (30%–40%) 49, 53. A double-blind, placebo-controlled challenge has been suggested to confirm gluten sensitivity diagnosis. This is a complicated procedure to be performed in practice, given the difficulty in preparing the intervention products, the need for highly trained personnel, and high costs 61. An alternative is the open food challenge, but this is less reliable because of the important placebo effect. It is necessary to confirm the diagnosis of gluten sensitivity on a gluten-containing diet to avoid missing the diagnosis of true coeliac disease 62.

What Causes Gluten Sensitivity ?

The cause of gluten sensitivity is unknown. There is agreement among researchers that only minor histological alterations have been found in the small bowel mucosa of patients with gluten sensitivity, compatible with 0 (normal mucosa) or I (mild alterations) in Marsh classifications 51, 54, 63. On the contrary, there is discrepancy regarding intestinal permeability in gluten sensitivity, because some studies have reported normal permeability and others not, with increased permeability in a subgroup of HLA-DQ2/DQ8–positive patients 54, (Vazquez-Roque MI, Camilleri M, Smyrk T, et al. A controlled trial of gluten-free diet in patients with irritable bowel syndrome-diarrhea: effects on bowel frequency and intestinal function. Gastroenterology 2013; 144:903–911.()), 64.

Furthermore, gene expression analyses showed increased expression of Toll-like receptor 2 and reduced expression of the T-regulatory cell marker forkhead box P3 in patients with gluten sensitivity compared with those in patients with celiac disease, suggesting a role of innate immunity in the pathogenesis of gluten sensitivity. Contrary to coeliac disease, however, most studies show that adaptive immunity markers are not increased in patients with gluten sensitivity 64, 65.

Gluten Sensitivity Treatment

In general, gluten sensitivity, and celiac disease and wheat allergy, is treated with a gluten-free diet, but, considering the lack of knowledge about its gluten- (dose-)related character and about the permanent or transient nature of the condition, periodic reintroduction of gluten into the diet may be advised 49, 66.


Gluten free diet is a diet that is critical in treating celiac disease and non-celiac gluten sensitivity and wheat allergy.  Gluten is a protein found naturally in wheat, barley, and rye that triggers an immune reaction if you have celiac disease, non-celiac gluten sensitivity and wheat allergy.

If you are concerned about celiac disease, you are strongly discouraged from starting a gluten-free diet without having had a firm diagnosis by your medical doctor. And if you change your diet to the gluten free diet, even for as little as a month, can complicate the diagnostic process. This is because all celiac disease blood tests require that you be on a gluten-containing diet to be accurate.

Celiac disease and wheat allergy are two well-described gluten-related diseases with clear guidelines for diagnosis and treatment. Gluten sensitivity is a controversial entity with more questions than answers concerning its nature, diagnosis, and treatment 7. Researchers are still learning more about gluten sensitivity. If your health care provider thinks you have it, he or she may suggest that you stop eating gluten to see if your symptoms go away. However, you should first be tested to rule out celiac disease.

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