Reduction of Carbohydrate Intake Improves Type 2 Diabetics’ Ability to Regulate Blood Sugar

The Danish National Institute of Public Health estimates that the number of Danes diagnosed with type 2 diabetes will have doubled to no less than 430,000 in 2030. Nutritional therapy is important to treat the disease optimally, but the recommendations are unclear. According to the Danish Health Authority, up to 85% of newly diagnosed patients with type 2 diabetes are overweight, and they are typically advised to follow a diet focused on weight loss: containing less calories than they burn, low fat content and a high content of carbohydrates with a low ‘glycaemic index’ (which indicates how quickly a food affects blood sugar levels).

Reduced carbohydrate content – increase in protein and fat

A central aspect in the treatment of type 2 diabetes is the patient’s ability to regulate their blood sugar levels, and new research now indicates that a diet with a reduced carbohydrate content and an increased share of protein and fat improves the patient’s ability to regulate his or her blood sugar levels compared with the conventional dietary recommendations. In addition, it reduces liver fat content and also has a beneficial effect on fat metabolism in type 2 diabetics.

“The purpose of our study was to investigate the effects of the diet without ‘interference’ from a weight loss. For that reason, the patients were asked to maintain their weight. Our study confirms the assumption that a diet with a reduced carbohydrate content can improve patients’ ability to regulate their blood sugar levels – without the patients concurrently losing weight,” explains Senior Consultant, DMSc Thure Krarup, MD, from the Department of Endocrinology at Bispebjerg Hospital. He continues: “Our findings are important, because we’ve removed weight loss from the equation. Previous studies have provided contradictory conclusions, and weight loss has complicated interpretations in a number of these studies.”

New dietary recommendations for type 2 diabetics in future

Based on the growing body of evidence, we might rethink the dietary recommendations for patients with type 2 diabetes, stresses Thure Krarup:

“The study shows that by reducing the share of carbohydrates in the diet and increasing the share of protein and fat, you can both treat high blood sugar and reduce liver fat content. Further intensive research is needed in order to optimise our dietary recommendations for patients with type 2 diabetes,” says Thure Krarup, stressing that the findings should be confirmed in large-scale, long-term controlled trials.

The findings of the study have been published in the article “A carbohydrate-reduced high-protein diet improves HbA1c and liver fat content in weight stable subjects with type 2 diabetes: a randomized controlled trial” in the renowned scientific journal ‘Diabetologia’.

Summary: What did the study show?

  • A diet with a reduced carbohydrate content, high protein content and moderately increased fat content improves glycaemic control (the ability to regulate blood sugar) by reducing blood sugar after meals and ‘long-term blood sugar’ (measured by ‘HbA1c’, which is a blood test used to measure the average blood sugar level over approximately the past two months).
  • A diet with a reduced carbohydrate content, a high protein content and a moderately increased fat content reduces liver fat content.
  • A diet with a reduced carbohydrate content may be beneficial to patients with type 2 diabetes – even if it does not lead to weight loss.

Source: University of Copenhagen


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To Track Carbs, Tap Into the Glycemic Index and Glycemic Load

Len Canter wrote . . . . . . . . .

Rather than just counting carbs, you might want to get familiar with the glycemic index and the glycemic load, numeric weighting systems that rank carb-based foods based on how much they raise blood sugar.

While monitoring these indicators might be especially helpful for those with diabetes, they also can be useful tools to keep others from developing diabetes and even lower the risk of heart disease, especially for women and for people who are overweight.

The glycemic index is the better known of the two. It’s a measure of the blood glucose-raising potential of carbohydrate foods compared to a reference food, like pure glucose or a slice of white bread.

The glycemic load goes one step further. It takes into account both the types of carbs in a food and the amount of carbs in a serving. The lower a food’s glycemic load, the less it affects blood sugar and insulin levels.

A food’s glycemic load gives you a more exact measurement than the glycemic index alone because even though most healthy foods are both low-glycemic index and low-glycemic load, a few higher glycemic index foods — like bananas, pineapples and watermelon — actually have low-to-moderate glycemic loads and can fit into many diets. That’s important because those three fruits in particular deliver many important nutrients.

Lowering the glycemic load of your diet happens naturally when you increase your intake of whole grains, nuts, legumes, fruits and non-starchy vegetables, and decrease foods like potatoes, white bread and sugary treats.

Using the glycemic indexes will help you refine your choices as you take steps to improve your diet.

Source: HealthDay

How Much Carb is Best for Your Health?

Kathleen Doheny wrote . . . . . . . .

Carbohydrate confusion is rampant, and the latest research isn’t helping to clear it up.

Carbs have been vilified as the culprit behind weight gain in several trendy diets like Keto and Whole 30. But the headlines about one recent study were enough to unnerve even the most dedicated low-carb fan: ” ‘Low-Carb’ Diet May Up Odds for an Early Death” was one of the scarier ones.

But another recent study by Harvard researchers found a higher chance of premature death in both low-carb eaters and high-carb eaters.

These conflicting findings point to a larger problem with carb research, experts say. Carbohydrate studies are plentiful, but agreement about the best way to eat carbs — and how much of them we need on a daily basis — is rare.

“The confusion is major at this stage,” says Connie Diekman, director of university nutrition at Washington University in St. Louis and former president of the Academy of Nutrition and Dietetics. “People don’t know what carbs are, how much they need.”

So, what should you do about carbs — go low, high, or stay in the middle? What’s healthy and what’s moderate carbohydrate intake anyway? And which amount of carbs will help you lose weight and live longer? Or is that an impossible dream?

Low-Carb Diets

The newest study, presented at a meeting of European cardiologists in August, looked at a U.S. sample of nearly 25,000 people. It found that the low-carb eaters had a 32% higher chance of dying from any cause during a follow-up of over 6 years. The risk of death from heart disease, when looked at separately, was 51% higher, stroke, 50%, and cancer, 35%. They evaluated other studies to confirm their findings.

But experts not involved in the research took some issues with the study. It offered no clear-cut definition of low-carb; nor did the researchers have information about why people ate low-carb diets.

What are Good and Bad Carbohydrates?

Cutting back on carbs? Maybe you don’t have to deny yourself that slice of whole-grain bread.

“You don’t know if it’s a select group of individuals who chose to go on a low-carb diet for health reasons,” for instance, says Alice Lichtenstein, Gershoff professor of nutrition science and policy at Tufts University’s Jean Mayer USDA Human Nutrition Research Center on Aging.

Another new study on carbohydrates from Harvard found that middle-of-the-roaders who kept their carbohydrate intake to 50% or 55% of total calories were the likeliest to live the longest. Those researchers evaluated dietary records completed by more than 15,000 U.S. adults, ages 45 to 64, between 1987 and 1989. During the 25-year follow-up, they found that the moderate carb eaters, staying at 50% to 55%, were less likely to die than both the low-carb eaters (in this study, less than 40%) and the high-carb eaters (in this study, more than 70%).

The researchers then combined their results with the results of seven other studies, including more than 432,000 people. They got the same results, finding moderate-carb eaters likely to live longer than low-carb or high-carb eaters.

In addition, they found that low-carb diets with protein and fat from animals, such as from beef, pork, and chicken, were linked with a higher risk of death than those that favored plant-derived protein and fat, such as from vegetables, nuts, peanut butter, and whole grains.

Previous studies have produced conflicting findings. Some have found that low-carb diets promote weight loss and can help heart health. But other studies have found that low-carb eating could boost the risk of heart disease, cancer, and earlier death.

Carbs Defined

While researchers continue to sort out exactly how many of our daily calories should come from carbs, experts say most of us could use a bit more information on carbohydrates, starting with: What exactly is a carb?

Some carbs occur naturally — such as those in fruits, vegetables, milk, nuts, grains, seeds, and legumes. Other carbs are added to processed foods in the form of starch or extra sugars.

Sugar, the simplest carbohydrate form, is in fruits, vegetables, milk, and milk products. Starch is a complex carb found in grains, vegetables, and cooked dry beans and peas. Fiber, also a complex carbohydrate, is in fruits, vegetables, whole grains, and dry cooked beans and peas.

Our bodies convert carbohydrates into sugar or glucose as foods are digested. Glucose is a main source of fuel for our body, including the brain.

While carbs often get blamed for weight gain, they aren’t all bad. Besides providing energy, carb-containing foods such as whole grains and dietary fiber can lower the chance of heart and blood vessel disease, according to experts at the Mayo Clinic. Fiber may also lower the risk of obesity and type 2 diabetes and help your digestion. Eating healthy carbs from fruits, vegetables, and whole grains is also linked with weight control.

“Carbohydrates are your body’s energy , but what is important is which ones you choose and the quantity. That word moderation, which we all hate to hear, is important,” says Diekman.

Defining Low, Moderate, High

Further confusing the issue is the definition of a low-carb diet. But most people term diets that allow 25% to 30% of calories from carbs as low-carb, says Stephen Phinney, MD, PhD, chief medical officer at Virta Health, which offers a very low-carb treatment to reverse diabetes.

So if you eat 2,000 calories a day, a diet of 25% carbs would mean eating 500 calories from carbs, or about 125 grams. The keto diet, as it’s known, is even lower, with ketosis (the state at which your body is fueled mainly by fat and ketones) occurring when you eat 50 grams of carbohydrates a day or less.

Moderate, in general, is 45% to 65% of total calories from carbs.

And high is often defined as more than 70% of total calories from carbs.

The ‘Party Line’ On Carbs

The Dietary Guidelines for Americans recommends eating a moderate amount of carbs — about 45% to 65% of your total daily calories. If you eat 2,000 calories a day, your carbs on this moderate plan should total about 900 to 1,300 calories, or about 225 to 325 grams a day. (A slice of whole wheat bread has 12 grams or more of carbs; a single 6-inch pancake, 30.)

Depending on which expert or which study you refer to, opinions differ about the benefits of low-carb versus higher-carb diets, and why moderation is the best course.

A low-carb diet can definitely benefit children with seizures, says Phinney, who’s a professor emeritus of medicine at the University of California, Davis. It can also help reverse type 2 diabetes. “This is dangerous to do on your own without expert medical supervision,” he says, especially if people are being weaned from their diabetes medications.

Eating a small amount of carbs doubles the body’s ability to burn fat during high-intensity exercise, Phinney says. Very lean and high-performing athletes, such as runners in 50- and 100-mile events, can run totally on body fat stores if they eat a very low-carb diet, improving performance, he says.

Phinney says he is not aware that the low-carb trend has gained traction among elite athletes who run shorter distances, such as the 26.2-mile marathon or the 13.1-mile half-marathon. But he has heard from many recreational runners who compete at these distances and shorter ones who follow the keto diet and find it improves their times. And he suspects the very low-carb diet may also be catching on with elite athletes besides runners.

What about very low-carb eating for your average healthy person without seizure issues or diabetes? “I wouldn’t advocate it for someone who doesn’t have a tangible benefit,” Phinney says.

If losing body fat is your aim, cutting dietary fat lowers body fat more than restricting carbs, according to a National Institutes of Health study. Kevin Hall, PhD, an NIH senior investigator and lead author, studied 19 men and women who were obese but free of diabetes. Before trying each of two diet types, they ate a diet of 50% of total calories from carbs, 35% from fat, and 15% from protein. Then they reduced total calories by 30% — while on the low-carb plan they reduced carbs by 60%; while on the low-fat diet they reduced fat by 85%.

The reduced-fat diet was better than the reduced-carb diet at increasing fat burning, which led to body fat lossExperts agree that some carbs are better than others. Choose the least refined carbs — think whole grains, brown rice — says Lichtenstein.

Aim for the moderate range and don’t focus only on carbs. “You have to think about the whole diet,” she says. The fat you eat should be healthy, such as from liquid vegetable oils. Protein should be lean. Within each category, choose the healthiest option, Lichtenstein says.

Follow these tips from Lichtenstein and Diekman to boost your diet’s content of ”better” carbs, fats, and protein:

  • Choose less-refined carbs — whole wheat pasta over regular, whole grain hamburger buns over non-whole grain, Lichtenstein says. Grain foods such as pasta, whole grain cereals and breads, quinoa, lentils, and beans are also good fiber sources, Diekman says. Plus, they provide a good base for eating more vegetables.
  • Aim to get most of your carbs from fruits, vegetables, and grain foods, Diekman says, with the rest from dairy foods such as milk and yogurt.
  • For fats, choose liquid vegetable oils, nuts, and seeds, Lichtenstein says.
  • For protein, go for lean meats, nonfat dairy, and plant-based protein, Lichtenstein suggests.

Deciding how many of your daily calories should come from carbs isn’t an easy decision, but one thing is sure: Although more research about the optimal balance of carbs is on the horizon, it may help you with your decision, or it could complicate it even more.

Source: WebMD

Moderate Carbohydrate Intake May be Best for Health

Low-carb diets that replace carbohydrates with proteins and fats from plant sources associated with lower risk of mortality compared to those that replace carbohydrates with proteins and fat from animal sources.

Eating carbohydrates in moderation seems to be optimal for health and longevity, suggests new research published in The Lancet Public Health journal.

The observational study of more than 15,400 people from the Atherosclerosis Risk in Communities Study (ARIC) in the USA found that diets both low (70% energy) in carbohydrates were linked with an increase in mortality, while moderate consumers of carbohydrates (50-55% of energy) had the lowest risk of mortality.

The primary findings, confirmed in a meta-analysis of studies on carbohydrate intake including more than 432,000 people from over 20 countries, also suggest that not all low-carbohydrate diets appear equal–eating more animal-based proteins and fats from foods like beef, lamb, pork, chicken and cheese instead of carbohydrate was associated with a greater risk of mortality. Alternatively, eating more plant-based proteins and fats from foods such as vegetables, legumes, and nuts was linked to lower mortality.

“We need to look really carefully at what are the healthy compounds in diets that provide protection”, says Dr Sara Seidelmann, Clinical and Research Fellow in Cardiovascular Medicine from Brigham and Women’s Hospital, Boston, USA who led the research.

“Low-carb diets that replace carbohydrates with protein or fat are gaining widespread popularity as a health and weight loss strategy. However, our data suggests that animal-based low carbohydrate diets, which are prevalent in North America and Europe, might be associated with shorter overall life span and should be discouraged. Instead, if one chooses to follow a low carbohydrate diet, then exchanging carbohydrates for more plant-based fats and proteins might actually promote healthy ageing in the long term.”[1]

Previous randomised trials have shown low carbohydrate diets are beneficial for short-term weight loss and improve cardiometabolic risk. However, the long-term impact of carbohydrate restriction on mortality is controversial with prospective research so far producing conflicting results. What’s more, earlier studies have not addressed the source or quality of proteins and fats consumed in low-carb diets.

To address this uncertainty, researchers began by studying 15,428 adults aged 45-64 years from diverse socioeconomic backgrounds from four US communities (Forsyth County, NC; Jackson, MS; Minneapolis, MN; and Washington County, MD) enrolled in the ARIC cohort between 1987 and 1989. All participants reported consuming 600-4200 kcal per day for men and 500-3600 kcal per day for women, and participants with extreme (high or low) caloric intake were excluded from the analysis.

At the start of the study and again 6 years later, participants completed a dietary questionnaire on the types of food and beverages they consumed, what portion size and how often, which the researchers used to estimate the cumulative average of calories they derived from carbohydrates, fats, and protein.

The researchers assessed the association between overall carbohydrate intake (categorised by quantiles) and all cause-mortality after adjusting for age, sex, race, total energy intake, education, exercise, income level, smoking, and diabetes. During a median follow-up of 25 years, 6283 people died.

Results showed a U-shape association between overall carbohydrate intake and life expectancy, with low (less than 40% of calories from carbohydrates) and high (more than 70%) intake of carbohydrates associated with a higher risk of mortality compared with moderate intake (50-55% of calories).

The researchers estimated that from age 50, the average life expectancy was an additional 33 years for those with moderate carbohydrate intake–4 years longer than those with very low carbohydrate consumption (29 years), and 1 year longer compared to those with high carbohydrate consumption (32 years). However, the authors highlight that since diets were only measured at the start of the trial and 6 years later, dietary patterns could change over 25 years, which might make the reported effect of carbohydrate consumption on lifespan less certain.

In the next step of the study, the authors performed a meta-analysis of data from eight prospective cohorts (including ARIC) involving data from 432,179 people in North American, European, and Asian countries. This revealed similar trends, with participants whose overall diets were high and low in carbohydrates having a shorter life expectancy than those with moderate consumption (figure 2).

As Seidelmann explains, “A midrange of carbohydrate intake might be considered moderate in North America and Europe where average consumption is about 50% but low in other regions, such as Asia, where the average diet consists of over 60% carbohydrates.” [1]

In further analyses examining whether the source of proteins and fats favoured in low-carbohydrate diets–plant-based or animal-based–was associated with length of life, researchers found that replacing carbohydrates with protein and fat from animal sources was associated with a higher risk of mortality than moderate carbohydrate intake. In contrast, replacing carbohydrates with plant-based foods was linked to a lower risk of mortality (table 3).

“These findings bring together several strands that have been controversial. Too much and too little carbohydrate can be harmful but what counts most is the type of fat, protein, and carbohydrate,” says Walter Willett, Professor of Epidemiology and Nutrition at Harvard T. H. Chan School of Public Health and co-author of the study. [1]

The findings show observational associations rather than cause and effect. Considering evidence from other studies, the authors speculate that Western-type diets that heavily restrict carbohydrates often result in lower intake of vegetables, fruit, and grains and lead to greater consumption of animal proteins and fats–some of which have been implicated in stimulating inflammatory pathways, biological ageing, and oxidative stress–and could be a contributing factor to the increased risk of mortality. Whilst high carbohydrate diets (common in Asian and less economically advantaged nations) tend to be high in refined carbohydrates such as white rice, may also contribute to a chronically high glycaemic load and worse metabolic outcomes.

“This work provides the most comprehensive study of carbohydrate intake that has been done to date, and helps us better understand the relationship between the specific components of diet and long term health”, says Dr Scott Solomon, The Edward D Frohlich Distinguished Chair at Brigham and Women’s Hospital and Professor of Medicine at Harvard Medical School, and senior author on the paper. “While a randomized trial has not been performed to compare the longer term effects of different types of low carbohydrate diets, these data suggest that shifting towards a more plant-based consumption is likely to help attenuate major morbid disease.”[1]

The authors note some limitations including that dietary patterns were based on self-reported data, which might not accurately represent participants’ food consumption; and that their conclusions about animal-based sources of fat and protein might have less generalisability to Asian populations which tend to have diets high in carbohydrates, but often consume fish rather than meat. Finally, given the relatively small number of individuals following plant-based low-carb diets, further research is needed.

Writing in a linked Comment, Dr Andrew Mente and Dr Salim Yusuf from McMaster University, Hamilton, Canada say, “Such differences in risk associated with extreme differences in intake of a nutrient are plausible, but observational studies cannot completely exclude residual confounders when the apparent differences are so modest. Based on first principles, a U-shaped association is logical between most essential nutrients versus health outcomes. Essential nutrients should be consumed above a minimal level to avoid deficiency and below a maximal level to avoid toxicity. This approach maintains physiological processes and health (ie, a so-called sweet spot). Although carbohydrates are technically not an essential nutrient (unlike protein and fats), a certain amount is probably required to meet short-term energy demands during physical activity and to maintain fat and protein intakes within their respective sweet spots. On the basis of these principles, moderate intake of carbohydrate (eg, roughly 50% of energy) is likely to be more appropriate for the general population than are very low or very high intakes.”

Source: EurekAlert!

International Study: Moderate Consumption of Fats and Carbohydrates Best for Health

Research with more than 135,000 people across five continents has shown that a diet which includes a moderate intake of fat and fruits and vegetables, and avoidance of high carbohydrates, is associated with lower risk of death.

To be specific about moderate, the lowest risk of death was in those people who consume three to four servings (or a total of 375 to 500 grams) of fruits, vegetables and legumes a day, with little additional benefit from more.

As well, contrary to popular belief, consuming a higher amount of fat (about 35 per cent of energy) is associated with a lower risk of death compared to lower intakes. However, a diet high in carbohydrates (of more than 60 per cent of energy) is related to higher mortality, although not with the risk of cardiovascular disease.

These are the top messages of two reports published Tuesday (Aug. 29) in The Lancet, both produced from a major global study led by researchers at the Population Health Research Institute (PHRI) of McMaster University and Hamilton Health Sciences. The reports were also presented on Tuesday (Aug. 29) at the Congress of the European Society of Cardiology in Barcelona, Spain.

The data are from the Prospective Urban Rural Epidemiology (PURE) study which followed more than 135,000 people from 18 low-income, middle-income and high-income countries. The study asked people about their diet and followed them for an average of seven and half years.

The research on dietary fats found that they are not associated with major cardiovascular disease, but higher fat consumption was associated with lower mortality; this was seen for all major types of fats (saturated fats, polyunsaturated fats and mono unsaturated fats), with saturated fats being associated with lower stroke risk.

Total fat and individual types of fat were not associated with risk of heart attacks or death due to cardiovascular disease.

The researchers point out that, while this may appear surprising to some, these new results are consistent with several observational studies and randomized controlled trials conducted in Western countries during the last two decades.

The large new study, when viewed in the context of most previous studies, questions the conventional beliefs about dietary fats and clinical outcomes, says Mahshid Dehghan, the lead author for the study and an investigator at PHRI.

“A decrease in fat intake automatically led to an increase in carbohydrate consumption and our findings may explain why certain populations such as South Asians, who do not consume much fat but consume a lot of carbohydrates, have higher mortality rates,” she said.

Dehghan pointed out that dietary guidelines have focused for decades on reducing total fat to below 30 per cent of daily caloric intake and saturated fat to below 10 per cent of caloric intake. This is based on the idea that reducing saturated fat should reduce the risk of cardiovascular disease, but did not take into account how saturated fat is replaced in the diet.

She added that the current guidelines were developed about four decades ago using data from some Western countries where fat was more than 40 per cent or 45 per cent of caloric intake and saturated fat intakes were more than 20 per cent. The consumption of these are now much lower in North America and Europe (31 per cent and 11 per cent respectively).

The second paper from the PURE study assessed fruit, vegetable and legume consumption and related them to deaths, heart disease and strokes.

The study found current fruit, vegetable and legume intake globally is between three to four servings per day, but most dietary guidelines recommend a minimum of five daily servings. Given that fruits and vegetables are relatively expensive in most middle-income and low-income countries, this level of consumption is unaffordable for most people in many regions of the world such as South Asia, China, Southeast Asia and Africa, where the levels of their consumption is much lower than in Western countries.

“Our study found the lowest risk of death in those who consumed three to four servings or the equivalent to 375 to 500 grams of fruits, vegetables and legumes per day, with little additional benefit for intake beyond that range,” said Victoria Miller, a McMaster doctoral student and lead author of the paper. “Additionally, fruit intake was more strongly associated with benefit than vegetables.

“The PURE study includes populations from geographic regions which have not been studied before, and the diversity of populations adds considerable strength that these foods reduce disease risk.”

Previous research has shown that eating fruits, vegetables and legumes decrease the risk of cardiovascular disease and deaths, but most studies were conducted mainly in North America and Europe with a few from other parts of the world.

“Raw vegetable intake was more strongly associated with a lower risk of death compared to cooked vegetable intake, but raw vegetables are rarely eaten in South Asia, Africa and Southeast Asia,” Miller said. “Dietary guidelines do not differentiate between the benefits of raw versus cooked vegetables — our results indicate that recommendations should emphasize raw vegetable intake over cooked.”

Legumes include beans, black beans, lentils, peas, chickpeas and black-eyed peas and are frequently eaten as an alternative to meat or some grains and starches such as pasta and white bread.

“Legumes are commonly consumed by many populations in South Asia, Africa and Latin America. Eating even one serving per day decreases the risk of cardiovascular disease and death. Legumes are not commonly consumed outside these geographic regions, so increased consumption among populations in Europe or North America may be favourable,” said Miller.

In a third study, published concurrently by The Lancet Diabetes and Endocrinology, the same researchers looked at the impact of fats and carbohydrates on blood lipids and blood pressure.

They found that LDL (so-called ‘bad’ cholesterol) is not reliable in predicting effects of saturated fat on future cardiovascular events. Instead, the ratio of Apolipoprotein B (ApoB) and Apolipoprotein A1 (ApoA1), or organizing proteins in the blood, give the best indication of the impact of saturated fat on cardiovascular risk.

Andrew Mente, an investigator at PHRI and an associate professor of the Department of Health Research Methods, Evidence and Impact at McMaster, is an author on the three studies.

“The findings of these studies are robust, globally applicable and provide evidence to inform nutrition policies. This is relevant because in some parts of the world nutritional inadequacy is a problem, whereas in other parts of the world nutritional excesses may be the problem,” he said.

“Most people in the world consume three to four servings of fruits, vegetables and legumes a day. This target is likely more affordable and achievable, especially in low and middle-income countries where the costs of fruits and vegetables are relatively high.”

“Moderation in most aspects of diet is to be preferred, as opposed to very low or very high intakes of most nutrients,” said Salim Yusuf, principal investigator of the study and the director of the PHRI.

Source: McMaster University


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