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Weight Management & Nutrition

 

 

Exercise and weight loss

Work in progress!

 

Mythbusting?https://www.acsm.org/all-blog-posts/acsm-blog/acsm-blog/2020/02/13/mythbusting-weight-loss

The top four weight loss myths?(by?Renee J. Rogers?)

  • Myth 1: The need to choose Diet over Exercise: Weight Loss = 80% diet + 20% Exercise. ?Eat Less and Move More? is the general recommendation used to describe the likely more complicated relationship between lifestyle weight loss behaviors: diet and exercise. If we focus only on diet by cutting calories, we will lose fat mass and muscle mass at the same time. For this reason it is important to combine diet with exercise. The latter helps us to keep the weight off, especially if we do high level of physical activity?(upwards of 225-250 min/week).
  • Myth 2: I Exercise, so I get to Eat more. Let?s be honest, some people definitely choose to use exercise as a way to burn more calories so they have ?more room? for food later. If your goal is to lose weight, this method doesn?t work.
  • Myth 3: Burning Calories through Exercise means High-Intensity Workouts and Long Session at the Gym. The reality is that moderate-to-vigorous intensity exercise is recommended, and we want to work towards burning as many calories as possible through accumulating physical activity minutes. Achieving that volume can be done in a variety of ways (no one exercise mode is perfect).

Research shows that?it is not just about the intense workout?that happens in the gym. A study of 260 adults participating in a weight management program found that after 18 months, those that had greater amounts of light-intensity activity beyond structured moderate-vigorous exercise lost more weight.

All physical activity burns calories. More intensity equals greater caloric burn, but more overall?volume, even at lower intensities and durations can add up too. Consider building physical activity into the entire lifestyle not just at the gym, to maximize overall volume. Activity programming should be designed to balance burning calories with individualized strategies that keep the person ?moving more and sitting less? through their entire day. Even a?one-minute activity break?can be a move in the right direction.

  • Myth 4: Everything has to Change Immediately.

Stacking Behaviors:?Everyone is different, so determining what the person feels more comfortable to start with (diet or exercise) may be a positive strategy. The end goal should be Diet + Exercise.

Start slow and go slow:?Extreme changes are often not fun and not sustainable. ?We have to build a foundation for maintaining positive eating and activity habits for the long term.

Make a plan:?We need to set short term goals that strategically introduce the next positive layer of weight loss behavior.

How to use fat as your main fuel

In order to use fat (Free Fatty Acids ? FFA) as your main fuel, you need to exercise at low intensity (e.g. cycling, walking) so the body has the capacity to mobilize and oxidize fat. Fat combustion almost totally powers exercise?at 25% of aerobic capacity.?If you walk or cycle, at 1 hour you use 70% of carbohydrate? and 30% of fat, at 2 hours 60% of carbohydrate? and 40% of fat, at 3 hours 40% of carbohydrate? and 60% of fat, and at 4 hours 20% of carbohydrate? and 80% of fat (Generalized percentage contribution of macronutrient catabolism in relation to oxygen consumption of the leg muscles during prolonged exercise, e.g. cycling ? figure 2.9,?name of the book?).

As you can see?exercise intensity?and?duration?affect Fat Oxidation. You need to walk or cycle for more than 3 hours if you want to use fat as your main fuel. That?s boring!!! but don?t worry, there is another way. You need to increase your?metabolism. The only way to increase your metabolism is resistance training ( weight lifting) in order to build up your fat-free mass (muscles). More muscles = higher metabolism at rest = more calories to burn.

Endurance training?(running, cycling, rowing, etc?) has a lot of beneficial effects on your heart health, cardiorespiratory function, endurance fitness, and physical well-being. However, it is important to realize that muscles are the engines of our bodies. If the engine is bigger, we burn more calories.

(BUILD MUSCLE, IMPROVE HEALTH BENEFITS ASSOCIATED WITH?RESISTANCE?EXERCISE, 2015 acsm)?Bear in mind that adults who do not perform?resistance?exercise?lose almost 5 lbs of muscle every decade before age 50 years and up to 10 lbs of muscle every decade after age 50 years. Age-related muscle loss causes a cascade of physiological problems, including bone?loss,?metabolic rate?reduction,?fat?gain, diabetes, metabolic syndrome, heart disease, and all-cause mortality.

Resting metabolism: At rest, every pound of untrained muscle uses between 5 and 6 calories per day for protein breakdown and synthesis. However, every pound of resistance-trained muscle uses approximately 9 calories per day for more extensive protein breakdown and repair processes. ?A single?strength training?session can increase resting energy expenditure by 5% to 9% for 3 days after the workout. Many other studies have shown approximately a 7% increase in resting?metabolic rate?after several weeks of resistance training.

Body fat:?Most?strength training?studies that have shown significant increases in lean weight (?1.0 lbs/month) also have demonstrated concurrent decreases in fat weight (almost 1.5 lbs/month).?Resistance exercise?also has been effective for reducing intra-abdominal fat in older men and women.

ACSM (The American College of Sports Medicine) Resistance training recommendations:

  • 2-4 sets x 8-12 reps each for the major muscle groups;
  • 70% ? 80% of maximum resistance (8-12 reps);
  • performing 8 to 10 multijoint exercises;
  • two or three nonconsecutive days per week

(High intensity circuit training is good ??https://journals.lww.com/acsm-healthfitness/Fulltext/2013/05000/HIGH_INTENSITY_CIRCUIT_TRAINING_USING_BODY_WEIGHT_.5.aspx)?Another option if you don?t have time to go to the gym or like at the moment you are stuck at home due to covid19:?high-intensity?circuit training?(HICT)?using body weight as resistance.

HICT can be a fast and efficient way to lose excess body weight and body fat (5,12,17,18). When resistance training exercises using multiple large muscles are used with very little rest between sets, they can elicit aerobic and metabolic benefits? (2,6,12). Research has found that these metabolic benefits can be present for up to 72 hours after a high-intensity exercise bout has been completed (7).

  • Number of exercises 9-12
  • A 30-second exercise bout
  • Rest Between Exercise Bouts 30? (6)

  • Total exercise time at least 20 min ? ACSM guidelines (3)

HICT SAMPLE PROGRAM: The following is an example of a 12-station HICT program. Exercises are performed for 30 seconds, with 10 seconds of transition time between bouts. Total time for the entire circuit workout is approximately 7 minutes. The circuit can be repeated 2 to 3 times.

  1. Jumping jacks Total body
  2. Wall sit Lower body
  3. Push-up Upper body
  4. Abdominal crunch Core
  5. Step-up onto chair Total body
  6. Squat Lower body
  7. Triceps dip on chair Upper body
  8. Plank Core
  9. High knees/running in place Total body
  10. Lunge Lower body
  11. Push-up and rotation Upper body
  12. Side plank Core

 

My conclusion:

 

 

References:

Mythbusting?https://www.acsm.org/all-blog-posts/acsm-blog/acsm?blog/2020/02/13/mythbusting-weight-loss;

What is the best Diet?

What is the secret to lose weight???Read and write better with Vanessa

 

 

 

 

 

 

As you know there are too many diets out there, the Paleo Diet, the Vegan Diet, the Dukan Diet, the Atkins Diet, the Zone Diet, the 5:2 Diet, the Mediterranean Diet, etc?

Every year someone creates a new Diet and people follow it, hoping that this one will work.

Maybe the diet works but people see a diet as a restriction and because of that, they won?t stick for long. Most of them will lose weight but soon or later will put weight back on again.

People don?t have to see a diet as a restriction, otherwise you associate it with a negative thought and it won?t last. It is like waking up every morning and going to do a job that you don?t like (most people do). Negative thoughts are no good for your mind (e.g. less happier, more stressed, get angry easlily..). You have to see your diet as a good change and associate it with something positive. You have to because it should become your new habit that will last not until you lose your weight but for a long term (all your life ).

I won?t go into details about diets, I will focus more on the evidence behind them.

The Paleo Diet

The paleo diet includes food which was available to humans during the Paleolithic era. We talk about vegetables, fruits, nuts, roots, meat and excludes foods such as dairy products, grains, sugar, legumes, processed oils, salt, alcohol, and coffee. A?traditional Paleolithic diet?contains an estimated 35% of energy from fats, 35% of energy from carbohydrates, and 30% of energy from proteins. Therefore, the Paleolithic diet typically resembles a low-carbohydrate diet.

What does the evidence say?

A study by?Mellburg et al ?, showed no long-term differences between participants on the Palaeolithic diet and those on the control at 24 months.

A study by?Ma?gorzata Jamka et al ?, compared the effect of the Paleolithic diet with other types of diets on glucose and insulin homeostasis (equilibrium) in subjects with altered glucose metabolism (diabetes, or metabolic syndrome). It showed that the Paleolithic diet did not differ from other types of diets commonly perceived as healthy with regard to effects on glucose and insulin homeostasis in subjects with altered glucose metabolism.

The Paleolithic diet may assist in controlling weight and waist circumference and in the management of chronic diseases? ??Ehrica V A de Menezes et al ?.

A Genoni et al?4?compared the Paleolithic diet to the Australian Guide to Healthy Eating (AGHE) in terms of compliance, palatability and feasibility. ?The Paleolithic group reported a significantly greater number of events of diarrhoea, costs associated with grocery shopping, and belief that the diet was not healthy. Further studies are required to assess longer term feasibility.

A study by?Kristine A Whalen et al.?5??suggests? that diets that are more Paleolithic- or Mediterranean-like may be associated with lower risk of all-cause, cardiovascular-specific, cancer-specific, and other noninjury or accident-specific mortality.

Result: is it better to write results for each diet or write just 1 result at the end?

The Vegan Diet

The vegan excludes animal-derived foods, such as eggs, meat, fish, poultry, cheese, and other dairy products. Instead, a vegan diet includes plant foods like fruits, vegetables, grains, nuts, seeds, and legumes.

What does the evidence say?

A study by?G Sebastiani et al.?6 ?examined the Vegan Diet during Pregnancy.? The study reported that Vegans are at risk of nutritional deficiencies, but if the adequate intake of nutrients is upheld, pregnancy outcomes are similar to those reported in the omnivorous population.

There is robust evidence for short- to moderate-term beneficial effects of vegan diet (duration ? 24 months) on weight status, energy metabolism and systemic inflammation in healthy participants, obese and type-2 diabetes patients (7).

Is a vegan diet detrimental to endurance and muscle strength? A?study??8?assessed 56 healthy young lean physically active women, who were classified as vegan (n?=?28) or omnivore (n?=?28). All volunteers followed either a vegan or an omnivore diet for at least 2 years. The results suggest that a vegan diet does not seem to be detrimental to endurance and muscle strength in healthy young lean women. In fact, the study showed that submaximal endurance might be better in vegans compared with omnivores. Therefore, these findings contradict the popular belief of the general population.?The generalisability of this results is limited due to the small sample size.

A study? by?M Dinu et al.??9?reports a significant protective effect of a vegetarian diet versus the incidence and/or mortality from ischemic heart disease and incidence from total cancer. Vegan diet conferred a significant reduced risk of incidence from total cancer. Overall the study reported significant reduced levels of body mass index, total cholesterol, LDL-cholesterol, and glucose levels in vegetarians and vegans versus omnivores.

Result:?

 

The Dukan Diet

It is a high-protein low-carbohydrate diet. The diet is based on the theory that eating a lot of protein can help people lose weight. This is because:

  • Protein makes you feel full and satisfied, which helps you to eat less
  • Digesting protein uses more energy, so the body burns a few more calories
  • High protein foods tend to be lower in calories. It contains only 4 calories per gram compared to fat, which has 9 calories per gram.

There are 4 phases of the Dukan Diet: Attack Phase, Cruise Phase, Consolidation Phase, and Stabilisation Phase.

What does the evidence say?

A study by?J Wyka et al.?10?carried out in Poland in 2015, assessed dietary consumption in 51 women adopting the Dukan-diet.

  • Women?s average weight reduction after 8-10 weeks of dieting was approximately 15 kilograms.
  • Many nutritional abnormalities were found in women on the high protein Dukan-diet. Adopting this diet in the long-term may pose health threats through acquiring kidney and liver disease, osteoporosis and cardiovascular disease.
  • Women taking up high protein diets demonstrated deficient calorific intake which was responsible for the lowering of body mass.
  • The women?s diet had low contents of carbohydrate, calcium, iron, potassium, vitamin C and folates but excessive amounts of protein, phosphorus, sodium along with vitamins A and D.
  • Adopting a high protein diet in the long term may be harmful to health.
  • However further research is needed to confirm or refuse these results, since the study investigated a small number of individuals.

In 2011 the British Dietetic Association claimed that The Dukan Diet has no solid evidence behind it (11).

Dukan diet may increase the risk of?kidney stone formation?12?due to high-proteine intake.

Whereas diets high in protein have considerable beneficial effects on satiety and weight control, which is of great interest to e.g. obese individuals, there are some caveats to high protein diets such as increased acid load to the kidneys or high fat content of animal proteins. Awareness of these caveats enables individuals choosing to consume a high-protein diet to get the most benefit from it (13).

A?study??14??highlighted that a higher protein intake appears to confer some weight-loss benefit after 64 weeks.

Rapid weight loss can be motivating, but it?s unsustainable and unhealthy. The Dukan diet isn?t nutritionally balanced, which is acknowledged by the fact you need a vitamin supplement and a fibre top-up in the form of oat bran (15).

Further research is needed to confirm or refuse these results, since most of these studies investigated a small number of individuals. (check with vanessa).

The Atkins Diet

It is a low-carbohydrate diet. The Atkins diet promises to turn your body into a fat-burning machine. The theory is that by starving yourself of carbohydrates, your body will start burning fat for energy. The Atkins diet contains an estimated 55%-70% of energy from fats, 20%-30% of energy from protein, and 5%-15% of energy from carbs.

What does the evidence say?

In the Atkins diet, the body burns fat as its main fuel. This process produces ketosis and therefore increases levels of acetone, acetola and glycotoxin methylglyoxal (MG), which may cause blood vessel and tissue damage. In the study by?B J K Beisswenger et al.??16?the rise in MG appears to be related to the presence of ketosis and not necessarily to the amount of weight loss. The long-term implications of the elevation of MG while on the Atkins diet are not known. Very-low-carbohydrate diets could lead to significant health problems in the future.

A study conducted by?D S Ludwig et al.?17?reports that Ketogenic diets appear to be more effective than low-fat diets for treatment of obesity and diabetes. In addition to the reductions in blood glucose and insulin achievable through carbohydrate restriction, chronic ketosis might confer unique metabolic benefits of relevance to cancer, neurodegenerative conditions, and other diseases associated with insulin resistance. Based on available evidence, a well-formulated ketogenic diet does not appear to have major safety concerns for the general public and can be considered a first-line approach for obesity and diabetes. High-quality clinical trials of ketogenic diets will be needed to assess important questions about their long-term effects and full potential in clinical medicine.

Atkins diets asserts that it is important to have a balanced intake of all three categories of fats: monounsaturated (e.g. olive oil), polyunsaturated (e.g. fish, nuts)? and saturated (e.g. butter). As a percentage of total fat consumed this comes out to?30% saturated, 40% monounsaturated, and about 22% polyunsaturated (www.Atkins.com).?Dietary Guidelines for Americans 2015-2020?advise to consume less than?10%?of calories per day from?saturated fats, due to eating too much can increase the risk of heart disease.

Is therefore saturated fat really unhealthy?

A study conducted by?P W Siri-Tarino?18??showed that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of coronary heart diseaseor (CHD) or cardiovascular disease (CVD).

A?study??19?carried out on data obtained in 1,141 obese patients, showed the low-carbohydrate diet (LCD) to be associated with significant decreases in body weight, body mass index, abdominal circumference, systolic blood pressure, diastolic blood pressure, plasma triglycerides, fasting plasma glucose, glycated haemoglobin, plasma insulin and plasma C-reactive protein, as well as an increase in high-density lipoprotein cholesterol.

Results:

The Zone Diet

The Zone Diet emphasizes low-carbohydrate consumption. The Zone is a 40% carbohydrate, 30% protein and 30% fat eating plan that advocates only sparing use of grains and starches. The precise 0.75 protein to carbohydrate ratio required with each meal is promoted to reduce the insulin to glucagon ratio, which purportedly affects eicosanoid metabolism (e.g. prostaglandins)? and ultimately produces a cascade of biological events leading to a reduction in chronic disease risk, enhanced immunity, maximal physical and mental performance, increased longevity and permanent weight loss.

Eat small, frequent meals during the day, every 4?6 hours after a meal or 2?2.5 hours after a snack, whether hungry or not.

What does the evidence say?

A study by?M L Dansinger et al.??20?showed?that the Zone diet as well as the Atkins, Ornish and Weight Watchers resulted in modest weight loss and cardiac risk factor reductions. Cardiac risk factor reductions were associated with weight loss regardless of diet type. This study has several limitations and further research is needed to confirm or refuse these results.

There is presently little scientific support for the connections made between diet, endocrinology and eicosanoid metabolism (e.g. prostaglandins) . ?In fact, a?review??21?of the literature suggests that there are scientific contradictions in the Zone Diet hypothesis that cast unquestionable doubt on its potential efficacy.

Results:

5:2 Diet?(or intermittent fasting diet?)

The 5:2 diet is based on a principle known as intermittent fasting (IF), where you eat normally for 5 days a week and fast on the other 2.

What does the evidence say?

A study conducted by?K Ganesan et al.??22?found that intermittent fasting was effective for short-term weight loss among normal weight, overweight and obese people. Obesity and overweight is an international health crisis, and interventions such as alternate day fasting (ADF) are needed to help people to achieve weight loss.

Another study carried out by?L Harris et al.??23?showed that intermittent energy restriction may be an effective strategy for the treatment of overweight and obesity. Meta-analyses (a statistical analysis that combines the results of multiple scientific studies) revealed that both intermittent energy restriction (IER) and continuous energy restriction (CER) resulted in similar weight loss, therefore, IER is as effective as CER for short term weight loss in overweight and obese adults.

This study conducted by??R de Cabo et al.??24??reported that preclinical studies and clinical trials in humans and animals, have shown that intermittent fasting has broad-spectrum benefits for many health conditions, such as obesity, diabetes mellitus, cardiovascular disease, cancers, and neurologic disorders.

A study by?M P Mattson et al.25??showed that intermittent fasting (IF) can protect against the metabolic syndrome and associated disorders including diabetes and cardiovascular disease in humans.

A study by?A Parvaresh et al.?26?suggests that modified alternate-day fasting diet may be a more effective option in managing body weight, waist circumference, systolic blood pressure, and fasting plasma glucose, compared with common calorie restriction.

Results:

The Mediterranean Diet

The Mediterranean Diet in general, it?s high in vegetables, fruits, legumes, nuts, beans, cereals, grains, fish, and unsaturated fats such as olive oil. It usually includes a low intake of meat and dairy foods. ?A rough estimate of the calorie breakdown of a Mediterranean diet is 40-50% from carbs, 35-40% from fat, 15-20% from protein ??Show to Vanessa.

What does the science say?

A study conducted by?R Estruch et al.27?reported that among persons at high cardiovascular risk, a Mediterranean diet supplemented with extra-virgin olive oil or nuts reduced the incidence of major cardiovascular events.

Adherence to a Mediterranean diet is associated with a significant improvement in health status, as seen by a reduction in mortality from cardiovascular diseases, incidence of or mortality from cancer, and incidence of Parkinson?s disease and Alzheimer?s disease (28).

The lower risk of cardiovascular diseases events with Mediterranean diet intake may be accounted for by known factors related to inflammation, glucose metabolism and insulin resistance, BMI (body mass index), blood pressure, and lipids (in particular HDL and VLDL). Despite this, a sizeable proportion of the potential benefit of Mediterranean diet intake with cardiovascular diseases risk reduction remains unexplained and requires future investigation into additional mechanisms (29).

Women who consumed the most components of the Mediterranean diet had significantly higher fat-free mass and leg muscle power than those who consumed the least. The findings in a study conducted by?E Kalaiditi et al.??30?emphasize the role for the Mediterranean diet in the prevention of? age-related loss of skeletal muscle (Sarcopenia).

A review conducted by?K Reese et al.31?concluded that, despite the large number of included trials, there is still uncertainty regarding the effects of a Mediterranean style diet on cardiovascular disease occurrence and risk factors in people both with and without cardiovascular disease already.

Another review carried out by?J G Mancini et al.?32?assessed the Mediterranean diet and its efficacy for weight loss at 1 year in overweight or obese individuals, compared to a Low fat diet, a Low-carbohydrate diet, and The American Diabetes Association diet. The findings suggested that the Mediterranean diet results in similar weight loss and cardiovascular risk factor level reduction as comparator diets in overweight or obese individuals trying to lose weight.

Results:

My conclusion on all diets:

I want to conclude with this systematic?review?33?published in 2020 which assessed the effectiveness of dietary?macronutrient patterns?(usual diet, dietary advice, low fat, low carbohydrate, moderate macronutrients) and popular named diet (Mediterranean, Low fat, Jenny Craig, Dietary advice, Dash, Biggest Loser, Atkins, Zone, Weight Watchers, Volumetrics, Usual diet, South Beach, Slimming World, Rosemary Conley, Portfolio, Paleolithic, Ornish) programmes for weight loss and cardiovascular risk factor improvement among adults who are overweight or obese.

Conclusions: Compared with usual diet, moderate certainty evidence supports modest weight loss and substantial reductions in systolic and diastolic blood pressure for low carbohydrate (eg, Atkins, Zone), low fat (eg, Ornish), and moderate macronutrient (eg, DASH, Mediterranean) diets at six but not 12 months. Differences between diets are, however, generally trivial to small.

 

Table 1. The ?big-five? components of the healthy lifestyle, with contributions of the various components to give protection from risk of death, with and the proposed mechanisms of action. Note that the missing 21% is probably stress related. (Write at the end ? Lifestyle and diet, 2014 cvj Africa).

 

Eat less, when you finish a meal you still need to feel a bit hungry. Eat 3 per day is enough. Do not eat 5.

Drink less alcohol , 1 gr= 9Kcal

Mention Tim Noakes and peter brukner

 

References:

  1. Cutting Through the Paleo Hype: The Evidence for the Palaeolithic Diet, Christopher E Pitt 2016;
  2. The Effect of the Paleolithic Diet vs. Healthy Diets on Glucose and Insulin Homeostasis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials, 2020;
  3. Influence of Paleolithic diet on anthropometric markers in chronic diseases: systematic review and meta-analysis, 2019;
  4. Compliance, Palatability and Feasibility of PALEOLITHIC and Australian Guide to Healthy Eating Diets in Healthy Women: A 4-Week Dietary Intervention, 2016;
  5. Paleolithic and Mediterranean Diet Pattern Scores Are Inversely Associated with All-Cause and Cause-Specific Mortality in Adults, 2017;

  6. The Effects of Vegetarian and Vegan Diet during Pregnancy on the Health of Mothers and Offspring, 2019;
  7. The effects of plant-based diets on the body and the brain: a systematic review, 2019;
  8. Is a vegan diet detrimental to endurance and muscle strength?, 2020;
  9. Vegetarian, Vegan Diets and Multiple Health Outcomes: A Systematic Review With Meta Analysis of Observational Studies, 2017;
  10. Assessment of Food Intakes for Women Adopting the High Protein Dukan Diet, 2015;
  11. https://www.telegraph.co.uk/news/health/news/8893919/Dukan-diet-not-based-on-science.html
  12. Fad diets and their effect on urinary stone formation, 2014;
  13. A High-Protein Diet for Reducing Body Fat: Mechanisms and Possible Caveats, 2014;
  14. Long-term effects of a high-protein weight-loss diet, 2008;
  15. http://www.nhs.uk/live-well/healthy-weight/top-diets-review;
  16. Ketosis Leads to Increased Methylglyoxal Production on the Atkins Diet, 2005;
  17. The Ketogenic Diet: Evidence for Optimism but High-Quality Research Needed, 2020;
  18. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease, 2010;
  19. Systematic review and meta-analysis of clinical trials of the effects of low carbohydrate diets on cardiovascular risk factors, 2012;
  20. Comparison of the Atkins, Ornish, Weight Watchers, and Zone Diets for Weight Loss and Heart Disease Risk ReductionA Randomized Trial, 2005;
  21. The Zone Diet Phenomenon: A Closer Look at the Science Behind the Claims, 2003;
  22. Intermittent Fasting: The Choice for a Healthier Lifestyle, 2018;
  23. Intermittent fasting interventions for treatment of overweight and obesity in adults: a systematic review and meta-analysis, 2018;
  24. Effects of Intermittent Fasting on Health, Aging, and Disease, 2019;
  25. Impact of intermittent fasting on health and disease processes, 2017;
  26. Modified alternate-day fasting vs. calorie restriction in the treatment of patients with metabolic syndrome: A randomized clinical trial, 2019;
  27. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet, nejm 2013;
  28. Adherence to Mediterranean diet and health status: meta-analysis, bmj 2008;
  29. Assessment of Risk Factors and Biomarkers Associated With Risk of Cardiovascular Disease Among Women Consuming a Mediterranean Diet, 2018;

  30. Measurements of Skeletal Muscle Mass and Power Are Positively Related to a Mediterranean Dietary Pattern in Women, 2016;
  31. Mediterranean-style diet for the primary and secondary prevention of cardiovascular disease, 2019 Cochrane;
  32. Systematic Review of the Mediterranean Diet for Long-Term Weight Loss, 2016;
  33. Comparison of dietary macronutrient patterns of 14 popular named dietary programmes for weight and cardiovascular risk factor reduction in adults: systematic review and network meta-analysis of randomised trials, 2020.

 

 

 

 


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