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Which diet will give you the best weight-loss results? Will these results be sustainable over the long term and will any harm be done in the process?
This topic has caused intense debate and no medical condition has generated as many proposed solutions as obesity. In essence, the terms ‘diet’, ‘meal-plan’ and ‘eating style’ all boil down to an attempt to help you eat in a more structured, healthy manner and reduce the total amount of calories you consume. In the metric world these are measured in Kilojoules (KJ). Hundreds of different diets are available and opposing opinions are quite common. Not surprisingly, for anyone without a degree in dietetics, this topic can become somewhat overwhelming.
How can the C.A.P.E meal-plan help you lose weight?
With the C.A.P.E meal-plan our aim is to assist you with successful and perhaps even enhanced weight-loss, both over the short and long term, as well as to improve your general health. We believe that by optimising certain metabolic, biochemical and hormonal pathways that collectively influence body fat regulation within the extreme complexity of human biochemistry, better weight-loss results can be achieved. We also believe that this can be done without exposing yourself to any health risks and by helping you make better food choices, actually improve your health. In designing this diet, we have incorporated several modern dietetic concepts in one simplified platform.
What are the modern trends in dietetic science?
Although not all opinion leaders with an interest in obesity-related diseases are in agreement with every novel concept, there are an increasing number of researchers who suggest that some of the conventional opinions that several mainstream dietetic regulatory and advisory boards have been suggesting should be reviewed.
This has also been our personal experience at the Medical Nutritional Institute, gained from working with a large number of overweight and obese patients in pharmacy clinics, corporate health, diabetic prevention and weight-loss programmes. In addition, with several other scientific research projects, many new discoveries relating to other factors that also play an important role in body-fat accumulation and overall health have been made.
These include new information on how certain plant molecules called polyphenols positively influence our health and help regulate body-fat accumulation. Another new concept relates to the active role that trillions of micro-organisms living within our intestines play and how they help determine how our body either stores or burns fat.
What are the basic principles behind the C.A.P.E meal-plan?
As a healthcare organisation, we developed the C.A.P.E meal-plan over a decade ago and have been using it in a clinical setting since then. The acronym C.A.P.E stands for Carbohydrate Adjusted, Protein Enriched. The principals we adopted in the original meal-plan have been reaffirmed by recent research. This updated version offers you a simplified programme which incorporates the following principles:
- A general shift towards food quality rather than quantity which includes consuming fewer processed vegetable oils and foods, and where possible, eating foods in their natural form.
- Adjusted macronutrient composition can shift your metabolic rate from your default setting, which is predominantly fat storing, to a more active fat burning metabolic orientation. This is specifically so in the case of higher protein, lower carbohydrate diets.
- Certain eating styles and supplements help you optimise your blood sugar and blood insulin levels and therefore help you to control your appetite far better.
- As we have advocated, diets should be more focussed on alleviating insulin resistance, a medical condition that leads to the development of metabolic syndrome, a condition that poses a significantly increased cardio-vascular risk in itself, than lowering your dietary intake of fat. This change of opinion is based on new findings collected through several recent studies that indicate that saturated fat does not threaten our health to the extent that was generally accepted in the past.
- The regular intake of plant based foods. These are high in healthy substances such as fibre and molecules called polyphenols. These not only offer you a wide variety of health benefits, but also actively help you lose weight. This was documented in a large study involving over 124,000 men and women over 24 years. We believe that you should be able to eat as many vegetables which have negligible amounts of carbohydrate as you like. Fruits on the other hand, while still high in these molecules, are also loaded with sugar, and so should not be eaten excessively.
- Optimising the delicate balance of the microbiome, the large colony of bacteria that lives in our intestines. Whilst investigation is ongoing, it is now clear that the microorganisms living inside obese and naturally slim individuals differ significantly, and research suggests that a shift in the composition of the microbiome will likely have a weight-loss benefit. This can be done by eating plant foods high in fibre and polyphenols, as well as reducing your total carbohydrate intake and improving the quality of your choices.
How does the C.A.P.E meal-plan work?
The C.A.P.E meal-plan stimulates your body to burn more fat whilst simultaneously reducing the production and storage of fat. This is achieved by not only limiting the total amount of calories that you consume on a daily basis, but also minimising your intake of energy-dense carbohydrates. Protein consumption is encouraged at every meal for the reasons explained below.
Total fat intake is still restricted, whilst the increased intake of omega 3 fat in the form of oily fish, olive oil, flaxseed or nuts is encouraged. The advantage of this approach is that protein is metabolically processed immediately and not generally stored under normal conditions. Protein also increases your metabolic rate through a process called thermogenesis. In addition, several studies have shown that higher protein consumption helps to control hunger.
Over four decades ago researchers started to propose that a high-protein diet would enhance weight-loss results. Not surprisingly, since this idea was so radically different from traditional thinking, the concept was initially rejected by the orthodox dietetic fraternity. Some early criticism was based on opinions regarding the potential detrimental effects of higher protein intake on blood cholesterol levels, kidney function, blood pressure and osteoporosis. In recent years, however, numerous high quality academic studies have examined the effects of protein-enriched diets on energy expenditure, energy intake and actual weight loss, compared to diets containing less protein, debunking many of the concerns regarding the side effects associated with a higher protein intake.
The C.A.P.E meal-plan also puts emphasis on the regular intake of a variety of certain plant food sources, due to the numerous benefits that plant derived chemicals have been shown to have on the human body. It is well known that plants are an essential source of micronutrients such as vitamins and minerals.
However, the actual reason you should eat certain plants is not to derive vitamins and minerals alone, since many of these are also available in protein sources, but to ingest several other unique plant based molecules, collectively called polyphenols as well as to increase the fibre content of the diet. These polyphenols can only be obtained from plants, and research suggests that they can improve our immune system, prevent overeating by regulating our appetite, suppress excess fat storage, regulate metabolism, alleviate chronic diseases, and allow us to feel healthier and more energetic each day.
What is thermogenesis and why does it matter?
‘Thermogenesis’, or the ‘thermic effect’ of food, is the amount of energy required for the digestion, absorption and disposal of nutrients and their waste products after a meal. In other words, it is the energy that is burnt in the body’s metabolic furnace to process and nutritionally assimilate food. Since obesity is known to be a disorder of energy imbalance, any strategy that will increase energy expenditure over the long term immediately becomes attractive.
Thermogenesis is influenced by the composition of different food groups. In general, the typical thermic effect of protein is 20 – 30 % of energy consumed, whilst for carbohydrates this number is much lower at 5 – 10 %, and only 0 – 3 % for fats1. Protein therefore has the highest metabolic energy requirement of the three macronutrients, resulting in an increased resting metabolism and less energy available for storage2,3. What this means in real terms is that although you might eat the same calorific amount of protein as carbohydrate, you actually retain less at the end of the day. Researchers from Harvard Medical School reviewed 15 studies on the topic and found that in all studies protein had a greater thermic effect than either carbohydrate or fat4.
On average, it was estimated that the usual difference between a high and low protein diet was 126 KJ a day. Although this may not seem that much, the cumulative effect, if sustained over a year, becomes a 45 990 KJ deficit, significant for anyone struggling to control their weight.
The importance of hunger control (satiety)
Battling hunger all day will prove a real uphill struggle for anyone trying to shed some weight. It is therefore important to prevent hunger by regulating levels of satiety, the sensation of being sufficiently “filled with food”. Several studies have compared the effect of a protein-enriched diet on hunger levels2,5. In almost all studies it was found that protein significantly reduces hunger by increasing satiety levels in comparison to at least one other macronutrient (carbohydrate or fat). Increased protein also helped to reduce food consumption at subsequent meals.
Total weight-loss – the crux of the matter!
The most effective way to lose weight is still through total calorific restriction6, in other words, you need to eat less, especially if you generally tend to overeat. However, your food choice and the ratios of the macronutrients carbohydrate, protein and fat are for various biochemical and hormonal reasons important, and may help you eat less even if it doesn’t feel like it.
Several studies have now convincingly established that a higher protein intake leads to greater weight-loss over both the short and long term5. The type of weight lost is also more favourable – it is fat rather than muscle7, which is lost in higher carbohydrate diets.
Kidney function – should you worry about it?
There have been some concerns that a protein-enriched diet will have a negative effect on kidney function. This was based on the medical principle that protein intake needs to be reduced in individuals with poor kidney function. However, several studies have found no evidence that an increased protein intake has a negative effect on normal kidney function5.
What about total fat content?
Several new studies have indicated that unsaturated, low fat diets, in preference to saturated fat, do not offer the perceived cardiovascular benefit that was generally assumed in the past8,9. Highly processed vegetable based fats and oils in the form of spreads, oils and margarine are therefore no longer considered safer alternatives to butter, ghee, coconut oil or lard, and in some cases are suggested to even prove more harmful due to their high concentration of trans-fats10.
Dietary focus is therefore not centred on the concept of avoiding foods that contain fat in preference to eating highly processed food that offer a low-fat option. This new evidence is good news for those who want to lose weight by increasing their protein intake. Since many sources of animal protein contain saturated fat, a reduced concern with saturated fat allows for a far greater range of dietary choices.
Food that contains slightly more fat, especially saturated fat, also tastes better, since many crucial natural flavours are fatty molecules and therefore only fat soluble. Without them, food can taste rather bland. Many plant based molecules are also fat soluble, and so their uptake into the body is improved if eaten with some kind of fat. We do not, however suggest an excessive amount of fat, as high fat intake will definitely lead to weight gain.
The bottom line is that an eating plan will only work if the foods we eat are as delicious and as satisfying as those we ate which led to obesity. Bland diets are hardly sustainable over the long term.
Blood cholesterol, cardiovascular and osteoporosis risk
An area of controversy has been the effect of a higher protein intake on blood cholesterol levels, and thereby cardiovascular risk. While more research is still needed in this area, it appears from the analysis of many new studies that a higher protein intake does not elevate blood cholesterol levels. Other studies have demonstrated that the exchange of protein for carbohydrate may in fact be beneficial for blood cholesterol levels11.
Another concern has been the development of osteoporosis. A review of 61 studies conducted over the past 30 years found that protein intake does not have a negative effect on bone health12. The Framingham Osteoporosis Study actually found that protein had a positive impact on bone health. Other papers have corroborated this effect5.
The opinion that an increased saturated fat intake leads to elevated blood cholesterol and heart disease is a topic of some debate, but it appears that the risk is less, although not absent9. It is our personal opinion that it often does, based on our own research on individuals consuming a high fat diet. We are therefore NOT in favour of the recommendation that you can consume as much fat as you want on the condition that you reduce your carbohydrate intake to a minimum.
Increased fat intake may increase blood cholesterol and triglyceride levels, which the majority of advisory healthcare bodies still believe causes cardiovascular disease, in spite of the fact that some individuals claim the opposite. In addition, while carbohydrate has essentially been given a free run in terms of cardiovascular health, new evidence shows that it may in fact promote disease8,10.
It is suggested that where fat is supplemented, except in high temperature cooking (where saturated fat is better), it should be mono or polyunsaturated9,10 (found mostly in nuts, seeds and fish, especially olive oil). Recent evidence suggests that saturated fats derived from dairy are less harmful than previously accepted8.
The bottom line is that our bodies have a highly efficient system to store fat and consuming excess fat may therefore lead to weight gain. We therefore suggest that your fats come from “real food sources”, which can be described as food that is unprocessed and in its natural form, preferably be unsaturated (not trans) and that fat is not deliberately added or consumed excessively.
What are polyphenols and how do they benefit our health?
Polyphenols are a diverse group of naturally produced chemicals made by plants. The major categories of polyphenols are: i) non-flavonoids, ii) flavonoids, and iii) tannins. These are further divided into sub-classes (table 1). Some well-known polyphenols include resveratrol from red wine and ellagitannins from tea. These chemicals contribute to the aroma, taste and colour of plants. Due to their diverse structures, polyphenols serve many biological functions, including acting as signalling molecules, antioxidants and assisting with the prevention of infections.
With the recent decline in eating whole, raw, and unprocessed foods, especially plants, we are often missing out on providing our bodies with chemicals which they have relied on for most of human history, and in turn are neglecting our health. At the cellular level, many biochemical processes are similar and shared between humans and plants, and so many chemicals will perform the same or similar functions in us as they do in plants. This is good, as plants are the most chemically diverse organism on our planet, meaning that we have thousands upon thousands of compounds available which may help us improve our health.
How do polyphenols affect weight-loss?
Two recent, large scale studies, conducted on over 124,000 individuals for up to 24 years, provide strong evidence that the consumption of certain low-carbohydrate containing plants is associated with better weight management because of the presence of a range of polyphenols. The first suggests that weight gain is prevented by a greater amount of non-starchy fruit and vegetables, especially berries, apples, pears, soy, cauliflower, and green leafy vegetables13.
A follow up study focussed specifically on which polyphenols were responsible for these effects14. They found that weight change was most affected by two classes of polyphenols, namely anthocyanins and flavonoids. Plants which contain a large amount of anthocyanins are usually dark red in colour, and include blackberries, red pepper and red grapes, strawberries, raspberries and cherries. Flavonoids also form the biochemical basis for plant pigmentation, especially of flowers, and may be yellow, red or blue.
However, flavonoids are also abundantly present in green leaves, of which green tea will be a good example, and white fruits or vegetables like apples and onions. An important note is that there are often more and unique polyphenols in the coloured portion or skins of fruits and vegetables, and therefore peeling should be avoided.
Polyphenols regulate fat storage in the body and improve health in a number of ways. Many are antioxidants, which prevent dangerous by-products of metabolism from damaging cells and DNA, and even act to increase the body’s natural antioxidant capabilities15. They also reduce inflammation16, appetite, the uptake of calories and modulate blood glucose levels15,17.
In addition, plant bioactive compounds may increase thermogenesis and energy expenditure16. These compounds also directly moderate fat storage through reducing the number of fat cells and increasing fat breakdown15. Polyphenols can also influence fat and protein absorption and digestibility18, reducing nutrient uptake and slowing digestion.
The fact that various polyphenols have different effects, and often are more effective in combination, means that the best strategy is to consume a large amount of diverse plant species. Even a single serving per day of many of these fruits and vegetables may provide valuable amounts of polyphenols14, especially if consumed raw. Additionally, many polyphenols are fat soluble and so it is best to eat them with some fat to improve absorption in the gut and availability in the body18.
Why is fibre important?
Besides filling you up without adding calories, fibre offers many other health benefits, including combatting cardiovascular disease and cancer19, metabolic syndrome20 and improving digestion21. The strongest medical evidence for the health benefits of fibre relate to a reduction in cardiovascular disease, where cholesterol and other blood lipid levels are better controlled, and blood pressure is reduced21,22. In terms of metabolic syndrome, fibre leads to an improvement in blood sugar control and a reduction in body weight21. The evidence is also strong that type 2 diabetes may be prevented by fibre intake23,24.
Fibre may also aid in controlling appetite and satiety25. This is primarily through creating the illusion that you are eating more than you actually are, as fibre has very little nutritional value in humans. Fibre does however provide a food source to the microbiome (the good bacteria which live in our gut) which research is showing is the key to weight and disease management.
Fibre also increases the time food takes to be digested, and slow glucose uptake from the gut, further preventing large spikes in glucose and insulin resistance. Higher fibre will therefore result in eating less, and thereby prevent weight gain or aid in weight loss, as has been shown in a number of studies26 27.
You should have at least 20 to 35 grams of fibre a day, which you can get from fruit, vegetables, whole grains, and supplements. As with polyphenols, there is often more fibre in the skins of fruits and vegetables.
What role do the micro-organisms in our intestine play in our health?
A recent finding is that our metabolic well-being, likelihood for chronic diseases, immunity, and numerous other biological functions is not entirely in our own body’s hands. Without us being aware, a large proportion of our biochemical functions are controlled by living micro-organisms, such as bacteria and yeasts, living within our own intestines.
Collectively, all these different micro-organisms are called the microbiome. The gut microbiome is crucial for digestion and nutrition, and can metabolise normally un-digestible nutrients to more available forms, synthesize novel nutrients, and contribute to signalling pathways which control hunger, nutrient uptake, and the efficiency of energy use28,29.
Our diets, genetics and our exposure to other humans, especially family members, are the major factors determining what our microbiome consists of. This is important as the specific ratios and types of different micro-organisms in our gut may determine our likelihood to gain or lose weight, and develop a number of chronic diseases including allergies30.
How does the microbiome influence our body fat percentage?
New research suggests that the microbiome may be one of the biggest determinants of variability among humans in the specific effects of nutrients on disease and weight gain31. Some of the most compelling evidence is the fact that the microbiomes of lean and overweight individuals differ significantly32. Additionally, it has been found that people with a “lean” microbiome are less efficient at processing and absorbing energy, and so can eat more while still keeping weight off33.
Research has indicated that the microbiome is involved in the development of a number of chronic diseases, including cardiovascular disease34-36, cancer37, rheumatoid arthritis38, as well as metabolic syndrome related disease39, 40 including inflammatory disease, insulin resistance, diabetes and obesity.
The most effective way to improve our microbiome health is through diet41, on which its composition is highly dependent42-44. In terms of improving microbiome health, it is generally accepted that lower carbohydrate, high fibre, plant based diets are best. Dietary fibre plays a large role in producing a healthy gut microbiome. Fibre and a number of other plant based chemicals are able to selectively alter the gut microbiome toward a healthier state, and are collectively termed prebiotics21.
It is also thought that oils rich in omega-3 are able to contribute to a healthier gut microbiome, partially explaining their anti-inflammatory and health promoting effects30,45. Microbiome composition can change rapidly, within days, but longer adherence to a diet is required to ensure long term and stable change, perhaps explaining why it is so difficult to keep weight off once it is lost 46.
How important is fluid?
An adequate intake of water is essential for proper bowel function, fat oxidation and weight-loss. In addition to its well-known health benefits, water has been shown to have a number of beneficial effects on weight loss47-49. These include increasing resting metabolism (especially if the water is cold)50,51 and satiety, and decreasing calorific intake through both appetite reduction if consumed before meals and reduced consumption of sugary beverages.52-55
Generally, it is accepted that you should drink at least 2 litres of water a day, and that having 500 ml of this 30 minutes before a meal should both increase resting metabolism and reduce appetite. Additionally, thirst may often be associated with hunger, so drink a glass of water and wait half an hour before having a snack. Water should therefore be consciously consumed in preference to any other fluid. Avoid all fruit juices as well as soft drinks and sweetened beverages such as sodas.
In addition, also avoid all sports drinks, energy drinks, flavoured waters and all vitamin waters. These products all contain large quantities of sugar, fructose and other carbohydrates, often under various deliberately misleading technical guises. Tea, coffee and cocoa with milk is fine at meal times but eliminate milk and sugar between meals. Tea and coffee are also rich sources of polyphenols. Herbal & Rooibos teas can be consumed as a water substitute during colder days provided they have NO milk or sugar added to them.
Note that this is not true for flavoured Ceylon & Green teas since they contain caffeine which can cause dehydration through stimulation of the kidneys and urine production.
Can I have any sugar?
No. It is important that all forms of refined sugars such as table sugar, fructose, syrup and honey must be excluded from you diet. This includes sweets, ice cream, desserts, chocolate, sweet sauces, “diabetic chocolates and sweets”, etc.
What about sugar substitutes and artificial sweeteners?
Whilst artificial sweeteners (e.g. aspartame, phenylalanine, sucralose, stevia and xylitol) were generally considered to be good sugar substitutes in the past, new research has indicated that they all have a negative impact on the microbiome and may therefore lead to excess body fat accumulation. Research has also shown that simply a sweet taste has the power to trigger an appetite or craving for sweet foods. It is therefore our advice to best avoid these artificial chemicals.
Condiments are a good idea
Bland food is terribly boring, so please don’t deprive yourself for no scientifically justifiable reason. Put some effort and planning into your meals. Spices, herbs, pepper, garlic, pickles, gherkins and chilli are excellent ways of ensuring that you have a pleasurable culinary experience. This advice does not extend to condiments such as tomato sauce and chutney, which are often high in sugar and salt.
Most spices are also plant based, and therefore contain valuable phytochemicals which further add value to any meal. Spices known to be especially beneficial include turmeric, ginger, cinnamon, black pepper and chillies. Sticking with current advice on cardiovascular health, however, excessive amounts of salt should be avoided.
Can I have alcohol?
Yes, but do keep in mind that alcohol is so rich in energy value that you can run a car on it! You will therefore need to limit your alcohol consumption if you want to obtain the best weight-loss results. Limit your alcohol intake to (five) 5 units per week for men and (four) 4 for women. (1 Unit = 120 ml Wine, 50 ml Dessert wine, 200 ml Beer, 280 ml Lite Beer, 1 Tot Distilled Liquor, 20 ml Cream-Based liqueur)
How can AntaGolin assist me?
AntaGolin, designed to combat insulin resistance, will help to optimise your metabolism and blood insulin levels, thereby helping to control your body fat. The product is plant-derived and rich in several health-beneficial molecules including polyphenols such as tannins and flavones, which actively helps alleviate insulin resistance. AntaGolin is also beneficial to pre-diabetic and type 2 diabetic individuals. An independent study done at Scion Clinical Research indicated that the use of AntaGolin demonstrated a reduction in insulin resistance between the placebo and active groups.
Specifically, AntaGolin contains barberry root extract (rich in berberine), banaba leaf extract, and inositol. Berberine has been shown to reduce blood sugar levels and promote fat loss, while banaba leaf extract is known to lower blood glucose levels and inhibit the uptake of carbohydrates and the formation of fat cells. Inositol improves insulin sensitivity.
What can I do to decrease my chance of cardiovascular disease?
The C.A.P.E meal-plan is designed to incorporate all proven trends in terms of improving cardiovascular health, and so following this diet alone should improve your longevity. Supplements aimed at improving blood cholesterol may also be helpful. RyChol is designed to stabilise blood cholesterol and triglyceride levels by targeting multiple biological pathways.
A blend of plant based ingredients, including polyphenols, target unique pathways involved in cardiovascular disease. Specifically, plant sterols mimic cholesterol, preventing its absorption, barberry root extract (rich in berberine) aids in the clearance of cholesterol through the liver, and apple polyphenols aid in reducing the absorption of fat and therefore triglycerides.
What else can I do to ensure success?
Weight-loss does not happen overnight. It requires perseverance and motivation, which is dependent on many factors, including mood and stress levels. These are not static processes and it is difficult to maintain optimism, self-control and emotional tranquillity. We all deal with difficult people and situations on a daily basis and become drained by our numerous responsibilities. Mood plays a dominant role in our lives.
Being in a good mood makes us feel better and become more optimistic and enthusiastic about life with all its responsibilities. It also strengthens our level of commitment and determination. Numerous negative emotions, like stress and frustration, have the opposite effect, tending to derail us and make us abandon our goals. This is when appetite control becomes a real uphill struggle.
For this reason, we recommend the use of NeuroVance, designed to reduce your response to stress and enhance brain function during times of stress, greater workloads, concentration difficulties and mood-related symptoms. NeuroVance contains two plant based chemicals, roseroot extract and inositol, as well as magnesium and zinc.
Roseroot extract has been associated with improved concentration and awareness, and has a of number components including polyphenols. Inositol is known to reduce stress and improve emotional wellbeing, while zinc and magnesium are required for optimal brain function.
1. Westerterp-Plantenga M, Nieuwenhuizen A, Tome D, et al. Dietary protein, weight loss, and weight maintenance. Annual Review of Nutrition 2009;29:21-41.
2. Leidy HJ, Clifton PM, Astrup A, et al. The role of protein in weight loss and maintenance. The American Journal of Clinical Nutrition 2015;101(6):1320S-29S.
3. Westerterp-Plantenga MS, Lemmens SG, Westerterp KR. Dietary protein–its role in satiety, energetics, weight loss and health. British Journal of Nutrition 2012;108(S2):S105-S12.
4. Halton TL, Hu FB. The effects of high protein diets on thermogenesis, satiety and weight loss: a critical review. Journal of the American College of Nutrition 2004;23(5):373-85.
5. Cuenca-Sánchez M, Navas-Carrillo D, Orenes-Piñero E. Controversies surrounding high-protein diet intake: satiating effect and kidney and bone health. Advances in Nutrition: An International Review Journal 2015;6(3):260-66.
6. Ramage S, Farmer A, Apps Eccles K, et al. Healthy strategies for successful weight loss and weight maintenance: a systematic review. Applied Physiology, Nutrition, and Metabolism 2013;39(1):1-20.
7. Clifton PM, Condo D, Keogh JB. Long term weight maintenance after advice to consume low carbohydrate, higher protein diets–a systematic review and meta analysis. Nutrition, Metabolism and Cardiovascular Diseases 2014;24(3):224-35.
8. Siri-Tarino PW, Chiu S, Bergeron N, et al. Saturated fats versus polyunsaturated fats versus carbohydrates for cardiovascular disease prevention and treatment. Annual Review of Nutrition 2015;35:517.
9. Hooper L, Martin N, Abdelhamid A, et al. Reduction in saturated fat intake for cardiovascular disease. The Cochrane Library 2015.
10. Nettleton JA, Lovegrove JA, Mensink R, et al. Dietary Fatty Acids: Is it Time to Change the Recommendations. Annals of Nutrition and Metabolism 2016;68(4):249-57.
11. Yancy WS, Olsen MK, Guyton JR, et al. A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia: a randomized, controlled trial. Annals of Internal Medicine 2004;140(10):769-77.
12. Darling AL, Millward DJ, Torgerson DJ, et al. Dietary protein and bone health: a systematic review and meta-analysis. The American Journal of Clinical Nutrition 2009:ajcn. 27799.
13. Bertoia ML, Mukamal KJ, Cahill LE, et al. Changes in intake of fruits and vegetables and weight change in United States men and women followed for up to 24 years: analysis from three prospective cohort studies. PLoS Med 2015;12(9):e1001878.
14. Bertoia ML, Rimm EB, Mukamal KJ, et al. Dietary flavonoid intake and weight maintenance: three prospective cohorts of 124 086 US men and women followed for up to 24 years. BMJ 2016;352:i17.
15. Wang S, Moustaid-Moussa N, Chen L, et al. Novel insights of dietary polyphenols and obesity. The Journal of Nutritional Biochemistry 2014;25(1):1-18.
16. Siriwardhana N, Kalupahana NS, Cekanova M, et al. Modulation of adipose tissue inflammation by bioactive food compounds. The Journal of Nutritional Biochemistry 2013;24(4):613-23.
17. Esfahani A, Wong JM, Truan J, et al. Health effects of mixed fruit and vegetable concentrates: a systematic review of the clinical interventions. Journal of the American College of Nutrition 2011;30(5):285-94.
18. Jakobek L. Interactions of polyphenols with carbohydrates, lipids and proteins. Food Chemistry 2015;175:556-67.
19. Liu L, Wang S, Liu J. Fiber consumption and all-cause, cardiovascular, and cancer mortalities: A systematic review and meta-analysis of cohort studies. Molecular Nutrition & Food research 2015;59(1):139-46.
20. Yokoyama Y, Barnard ND, Levin SM, et al. Vegetarian diets and glycemic control in diabetes: a systematic review and meta-analysis. Cardiovascular Ciagnosis and Therapy 2014;4(5):373-82.
21. Slavin J. Fiber and prebiotics: mechanisms and health benefits. Nutrients 2013;5(4):1417-35.
22. Slavin J. Position of the American Dietetic Association: health implications of dietary fiber. Journal of the American Dietetic Association 2008;108(10):1716-31.
23. Hopping BN, Erber E, Grandinetti A, et al. Dietary fiber, magnesium, and glycemic load alter risk of type 2 diabetes in a multiethnic cohort in Hawaii. The Journal of Nutrition 2009:jn. 109.112441.
24. Meyer KA, Kushi LH, Jacobs DR, et al. Carbohydrates, dietary fiber, and incident type 2 diabetes in older women. The American Journal of Clinical Nutrition 2000;71(4):921-30.
25. Slavin J, Green H. Dietary fibre and satiety. Nutrition Bulletin 2007;32(s1):32-42.
26. Tucker LA, Thomas KS. Increasing total fiber intake reduces risk of weight and fat gains in women. The Journal of Nutrition 2009;139(3):576-81.
27. Howarth NC, Saltzman E, Roberts SB. Dietary fiber and weight regulation. Nutrition reviews 2001;59(5):129-39.
28. Shreiner AB, Kao JY, Young VB. The gut microbiome in health and in disease. Current Opinion in Gastroenterology 2015;31(1):69.
29. Lozupone CA, Stombaugh JI, Gordon JI, et al. Diversity, stability and resilience of the human gut microbiota. Nature 2012;489(7415):220-30.
30. Shader RI. Some reflections on the microbiome and obesity. Clinical Therapeutics 2015;37(5):925-27.
31. Zmora N, Zeevi D, Korem T, et al. Taking it personally: personalized utilization of the human microbiome in health and disease. Cell Host & Microbe 2016;19(1):12-20.
32. Ley RE. Obesity and the human microbiome. Current Opinion in Gastroenterology 2010;26(1):5-11.
33. Jumpertz R, Le DS, Turnbaugh PJ, et al. Energy-balance studies reveal associations between gut microbes, caloric load, and nutrient absorption in humans. The American Journal of Clinical Nutrition 2011;94(1):58-65.
34. Wang Z, Klipfell E, Bennett BJ, et al. Gut flora metabolism of phosphatidylcholine promotes cardiovascular disease. Nature 2011;472(7341):57-63.
35. Tang WW, Wang Z, Levison BS, et al. Intestinal microbial metabolism of phosphatidylcholine and cardiovascular risk. New England Journal of Medicine 2013;368(17):1575-84.
36. Koeth RA, Wang Z, Levison BS, et al. Intestinal microbiota metabolism of L-carnitine, a nutrient in red meat, promotes atherosclerosis. Nature Medicine 2013;19(5):576-85.
37. Kostic AD, Chun E, Robertson L, et al. Fusobacterium nucleatum potentiates intestinal tumorigenesis and modulates the tumor-immune microenvironment. Cell Host & Microbe 2013;14(2):207-15.
38. Taneja V. Arthritis susceptibility and the gut microbiome. FEBS letters 2014;588(22):4244-49.
39. Baothman OA, Zamzami MA, Taher I, et al. The role of Gut Microbiota in the development of obesity and Diabetes. Lipids in Health and Disease 2016;15(1):1.
40. Ejtahed H-S, Soroush A-R, Angoorani P, et al. Gut Microbiota as a Target in the Pathogenesis of Metabolic Disorders: A New Approach to Novel Therapeutic Agents. Hormone and Metabolic Research 2016;48(06):349-58.
41. Hartstra AV, Bouter KE, Bäckhed F, et al. Insights into the role of the microbiome in obesity and type 2 diabetes. Diabetes Care 2015;38(1):159-65.
42. Ley RE, Turnbaugh PJ, Klein S, et al. Microbial ecology: human gut microbes associated with obesity. Nature 2006;444(7122):1022-23.
43. Wu GD, Chen J, Hoffmann C, et al. Linking long-term dietary patterns with gut microbial enterotypes. Science 2011;334(6052):105-08.
44. Cotillard A, Kennedy SP, Kong LC, et al. Dietary intervention impact on gut microbial gene richness. Nature 2013;500(7464):585-88.
45. Mani V, Hollis JH, Gabler NK. Dietary oil composition differentially modulates intestinal endotoxin transport and postprandial endotoxemia. Nutrition & Metabolism 2013;10(1):1.
46. Remely M, Tesar I, Hippe B, et al. Gut microbiota composition correlates with changes in body fat content due to weight loss. Beneficial Microbes 2015;6(4):431-39.
47. Vij VAK, Joshi AS. Effect of excessive water intake on body weight, body mass index, body fat, and appetite of overweight female participants. Journal of Natural Science, Biology, and Medicine 2014;5(2):340