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From Fad to Fact: Evaluating the Impact of Emerging Diets on the Prevention of Cardiovascular Disease

      Abstract

      Cardiovascular disease remains one of the most prevalent and preventable chronic conditions worldwide. Diet modification is the foundation of cardiovascular disease prevention. Several dietary approaches have emerged to promote better cardiovascular health. The rapid dissemination of anecdotal and observational data through the internet and social media has caused confusion amongst providers and patients. The aim of this comprehensive review is to present objective insights into 2 of today's most popular fad diets: ketogenic diet and intermittent fasting. We will evaluate the performance of these diets based on their impact on cardiovascular risk factors.

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      References

        • Joseph P
        • Leong D
        • McKee M
        • et al.
        Reducing the global burden of cardiovascular disease, part 1.
        Circ Res. 2017; 121: 677-694
        • Stewart J
        • Manmathan G
        • Wilkinson P
        Primary prevention of cardiovascular disease: a review of contemporary guidance and literature.
        JRSM Cardiovasc Dis. 2017; 6 (2048004016687211)
        • Zampelas A
        • Magriplis E
        Dietary patterns and risk of cardiovascular diseases: a review of the evidence.
        Proc Nutr Soc. 2020; 79: 68-75
        • Kahleova H
        • Levin S
        • Barnard N
        Cardio-metabolic benefits of plant-based diets.
        Nutrients. 2017; 9: 848
        • Tonstad S
        • Butler T
        • Yan R
        • Fraser GE
        Type of vegetarian diet, body weight, and prevalence of type 2 diabetes.
        Diabetes Care. 2009; 32: 791-796
        • Kahleova H
        • Levin S
        • Barnard ND
        Vegetarian dietary patterns and cardiovascular disease.
        Prog Cardiovasc Dis. 2018; 61: 54-61
        • Yokoyama Y
        • Barnard ND
        • Levin SM
        • Watanabe M
        Vegetarian diets and glycemic control in diabetes: a systematic review and meta-analysis.
        Cardiovasc Diagn Ther. 2014; 4: 373-382
        • Yokoyama Y
        • Nishimura K
        • Barnard ND
        • et al.
        Vegetarian diets and blood pressure: a meta-analysis.
        JAMA Intern Med. 2014; 174: 577-587
        • Kastorini C-M
        • Milionis HJ
        • Esposito K
        • Giugliano D
        • Goudevenos JA
        • Panagiotakos DB
        The effect of Mediterranean Diet on metabolic syndrome and its components.
        J Am Coll Cardiol. 2011; 57: 1299-1313
        • Sherling DH
        • Perumareddi P
        • Hennekens CH
        Metabolic Syndrome.
        J Cardiovasc Pharmacol Ther. 2017; 22: 365-367
        • Westman EC
        • Mavropoulos J
        • Yancy WS
        • Volek JS
        A review of low-carbohydrate ketogenic diets.
        Curr Atheroscler Rep. 2003; 5: 476-483
        • Paoli A
        Ketogenic diet for obesity: friend or foe?.
        Int J Environ Res Public Health. 2014; 11: 2092-2107
        • Gomez-Arbelaez D
        • Bellido D
        • Castro AI
        • et al.
        Body composition changes after very low-calorie-ketogenic diet in obesity evaluated by three standardized methods.
        J Clin Endocrinol Metab. 2017; 102: 488-498
        • Moreno B
        • Bellido D
        • Sajoux I
        • et al.
        Comparison of a very low-calorie-ketogenic diet with a standard low-calorie diet in the treatment of obesity.
        Endocrine. 2014; 47: 793-805
        • Castellana M
        • Conte E
        • Cignarelli A
        • et al.
        Efficacy and safety of very low calorie ketogenic diet (VLCKD) in patients with overweight and obesity: a systematic review and meta-analysis.
        Rev Endocr Metab Disord. 2020; 21: 5-16
        • Paoli A
        • Bianco A
        • Grimaldi K
        • Lodi A
        • Bosco G
        Long term successful weight loss with a combination biphasic ketogenic Mediterranean Diet and Mediterranean Diet maintenance protocol.
        Nutrients. 2013; 5: 5205-5217
        • Gibson AA
        • Seimon RV
        • Lee CMY
        • et al.
        Do ketogenic diets really suppress appetite? A systematic review and meta-analysis.
        Obes Rev. 2015; 16: 64-76
        • Deemer SE
        • Plaisance EP
        • Martins C
        Impact of ketosis on appetite regulation—a review.
        Nutr Res. 2020; 77: 1-11
        • Dashti HM
        • Al-Zaid NS
        • Mathew TC
        • et al.
        Long term effects of ketogenic diet in obese subjects with high cholesterol level.
        Mol Cell Biochem. 2006; 286: 1-9
        • Cicero AFG
        • Benelli M
        • Brancaleoni M
        • Dainelli G
        • Merlini D
        • Negri R
        Middle and long-term impact of a very low-carbohydrate ketogenic diet on cardiometabolic factors: a multi-center, cross-sectional, clinical study.
        High Blood Press Cardiovasc Prev. 2015; 22: 389-394
        • Kephart WC
        • Pledge CD
        • Roberson PA
        • et al.
        The three-month effects of a ketogenic diet on body composition, blood parameters, and performance metrics in CrossFit trainees: a pilot study.
        Sports (Basel). 2018; 6: 1
        • Kwiterovich PO
        • Vining EPG
        • Pyzik P
        • Skolasky R
        • Freeman JM
        Effect of a high-fat ketogenic diet on plasma levels of lipids, lipoproteins, and apolipoproteins in children.
        JAMA. 2003; 290: 912-920
        • Bueno NB
        • De Melo ISV
        • De Oliveira SL
        • Da Rocha Ataide T
        Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials.
        Br J Nutr. 2013; 110: 1178-1187
        • Retterstøl K
        • Svendsen M
        • Narverud I
        • Holven KB
        Effect of low carbohydrate high fat diet on LDL cholesterol and gene expression in normal-weight, young adults: a randomized controlled study.
        Atherosclerosis. 2018; 279: 52-61
        • Gjuladin-Hellon T
        • Davies IG
        • Penson P
        • Amiri Baghbadorani R
        Effects of carbohydrate-restricted diets on low-density lipoprotein cholesterol levels in overweight and obese adults: a systematic review and meta-analysis.
        Nutr Rev. 2019; 77: 161-180
        • Sharman MJ
        • Kraemer WJ
        • Love DM
        • et al.
        A ketogenic diet favorably affects serum biomarkers for cardiovascular disease in normal-weight men.
        J Nutr. 2002; 132: 1879-1885
        • Volek JS
        • Phinney SD
        • Forsythe CE
        • et al.
        Carbohydrate restriction has a more favorable impact on the metabolic syndrome than a low fat diet.
        Lipids. 2009; 44: 297-309
        • Santos FL
        • Esteves SS
        • da Costa Pereira A
        • Yancy Jr, WS
        • Nunes JP
        Systematic review and meta-analysis of clinical trials of the effects of low carbohydrate diets on cardiovascular risk factors.
        Obes Rev. 2012; 13: 1048-1066
        • Mobbs CV
        • Mastaitis J
        • Isoda F
        • Poplawski M
        Treatment of diabetes and diabetic complications with a ketogenic diet.
        J Child Neurol. 2013; 28: 1009-1014
        • Kosinski C
        • Jornayvaz F
        Effects of ketogenic diets on cardiovascular risk factors: evidence from animal and human studies.
        Nutrients. 2017; 9: 517
        • Dashti HM
        • Mathew TC
        • Khadada M
        • et al.
        Beneficial effects of ketogenic diet in obese diabetic subjects.
        Mol Cell Biochem. 2007; 302: 249-256
        • Hussain TA
        • Mathew TC
        • Dashti AA
        • Asfar S
        • Al-Zaid N
        • Dashti HM
        Effect of low-calorie versus low-carbohydrate ketogenic diet in type 2 diabetes.
        Nutrition. 2012; 28: 1016-1021
        • Yancy Jr, WS
        • Foy M
        • Chalecki AM
        • Vernon MC
        • Westman EC
        A low-carbohydrate, ketogenic diet to treat type 2 diabetes.
        Nutr Metab (Lond). 2005; 2: 34
        • Myette-Côté É
        • Durrer C
        • Neudorf H
        • et al.
        Short-term low-carbohydrate high-fat diet with or without post-meal walks on glycemic control and inflammation in type 2 diabetes: a randomized trial.
        Am J Physiol Regul Integr Comp Physiol. 2018; 315: R1210-R1219
        • Westman EC
        • Yancy WS
        • Mavropoulos JC
        • Marquart M
        • McDuffie JR
        The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus.
        Nutr Metab. 2008; 5: 36
        • Cotter DG
        • Schugar RC
        • Crawford PA
        Ketone body metabolism and cardiovascular disease.
        Am J Physiol Heart Circ Physiol. 2013; 304: H1060-H1076
        • Filippatos TD
        • Liontos A
        • Papakitsou I
        • Elisaf MS
        SGLT2 inhibitors and cardioprotection: a matter of debate and multiple hypotheses.
        Postgrad Med. 2019; 131: 82-88
        • Mudaliar S
        • Alloju S
        • Henry RR
        Can a shift in fuel energetics explain the beneficial cardiorenal outcomes in the EMPA-REG OUTCOME study? A unifying hypothesis.
        Diabetes Care. 2016; 39: 1115-1122
        • Appel LJ
        • Sacks FM
        • Carey VJ
        • et al.
        Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids.
        JAMA. 2005; 294: 2455
        • Jornayvaz FR
        • Jurczak MJ
        • Lee H-Y
        • et al.
        A high-fat, ketogenic diet causes hepatic insulin resistance in mice, despite increasing energy expenditure and preventing weight gain.
        Am J Physiol Endocrinol Metab. 2010; 299: E808-E815
        • Grandl G
        • Straub L
        • Rudigier C
        • et al.
        Short-term feeding of a ketogenic diet induces more severe hepatic insulin resistance than an obesogenic high-fat diet.
        J Physiol. 2018; 596: 4597-4609
        • Kinzig KP
        • Honors MA
        • Hargrave SL
        Insulin sensitivity and glucose tolerance are altered by maintenance on a ketogenic diet.
        Endocrinology. 2010; 151: 3105-3114
        • Zhuang X
        • Zhang S
        • Zhou H
        • Du Z
        • Liao X
        U-shaped relationship between carbohydrate intake proportion and incident atrial fibrillation.
        J Am Coll Cardiol. 2019; 73: 4
        • Best TH
        • Franz DN
        • Gilbert DL
        • Nelson DP
        • Epstein MR
        Cardiac complications in pediatric patients on the ketogenic diet.
        Neurology. 2000; 54: 2328-2330
        • Rosenbaum M
        • Hall KD
        • Guo J
        • et al.
        Glucose and lipid homeostasis and inflammation in humans following an isocaloric ketogenic diet.
        Obesity (Silver Spring). 2019; 27: 971-981
        • Garbow JR
        • Doherty JM
        • Schugar RC
        • et al.
        Hepatic steatosis, inflammation, and ER stress in mice maintained long term on a very low-carbohydrate ketogenic diet.
        Am J Physiol Gastrointest Liver Physiol. 2011; 300: G956-G967
        • Aykan NF
        Red meat and colorectal cancer.
        Oncol Rev. 2015; 9: 288
        • Haring B
        • Selvin E
        • Liang M
        • et al.
        Dietary protein sources and risk for incident chronic kidney disease: results from the Atherosclerosis Risk in Communities (ARIC) study.
        J Ren Nutr. 2017; 27: 233-242
        • Patterson RE
        • Laughlin GA
        • Lacroix AZ
        • et al.
        Intermittent fasting and human metabolic health.
        J Acad Nutr Diet. 2015; 115: 1203-1212
        • Huang W
        • Ramsey KM
        • Marcheva B
        • Bass J
        Circadian rhythms, sleep, and metabolism.
        J Clin Invest. 2011; 121: 2133-2141
        • Manoogian ENC
        • Panda S
        Circadian rhythms, time-restricted feeding, and healthy aging.
        Ageing Res Rev. 2017; 39: 59-67
        • Melkani GC
        • Panda S
        Time-restricted feeding for prevention and treatment of cardiometabolic disorders.
        J Physiol. 2017; 595: 3691-3700
        • Longo VD
        • Panda S
        Fasting, circadian rhythms, and time-restricted feeding in healthy lifespan.
        Cell Metab. 2016; 23: 1048-1059
        • Moro T
        • Tinsley G
        • Bianco A
        • et al.
        Effects of eight weeks of time-restricted feeding (16/8) on basal metabolism, maximal strength, body composition, inflammation, and cardiovascular risk factors in resistance-trained males.
        J Transl Med. 2016; 14: 290
        • Carlson O
        • Martin B
        • Stote KS
        • et al.
        Impact of reduced meal frequency without caloric restriction on glucose regulation in healthy, normal-weight middle-aged men and women.
        Metabolism. 2007; 56: 1729-1734
        • Sadeghirad B
        • Motaghipisheh S
        • Kolahdooz F
        • Zahedi MJ
        • Haghdoost AA
        Islamic fasting and weight loss: a systematic review and meta-analysis.
        Public Health Nutr. 2014; 17: 396-406
        • Patterson RE
        • Sears DD
        Metabolic effects of intermittent fasting.
        Annu Rev Nutr. 2017; 37: 371-393
        • Stote KS
        • Baer DJ
        • Spears K
        • et al.
        A controlled trial of reduced meal frequency without caloric restriction in healthy, normal-weight, middle-aged adults.
        Am J Clin Nutr. 2007; 85: 981-988
        • Gabel K
        • Hoddy KK
        • Haggerty N
        • et al.
        Effects of 8-hour time restricted feeding on body weight and metabolic disease risk factors in obese adults: a pilot study.
        Nutr Healthy Aging. 2018; 4: 345-353
        • Wilkinson MJ
        • Manoogian ENC
        • Zadourian A
        • et al.
        Ten-hour time-restricted eating reduces weight, blood pressure, and atherogenic lipids in patients with metabolic syndrome.
        Cell Metab. 2020; 31: 92-104.e105
        • Harris L
        • Hamilton S
        • Azevedo LB
        • et al.
        Intermittent fasting interventions for treatment of overweight and obesity in adults.
        JBI Database System Rev Implement Rep. 2018; 16: 507-547
        • Heilbronn LK
        • Smith SR
        • Martin CK
        • Anton SD
        • Ravussin E
        Alternate-day fasting in nonobese subjects: effects on body weight, body composition, and energy metabolism.
        Am J Clin Nutr. 2005; 81: 69-73
        • Kim RY
        • Lee JH
        • Oh Y
        • Sung HK
        • Kim KH
        Assessment of the metabolic effects of isocaloric 2:1 intermittent fasting in mice.
        J Vis Exp. 2019; https://doi.org/10.3791/60174
        • Johnstone A
        Fasting for weight loss: an effective strategy or latest dieting trend?.
        Int J Obes. 2015; 39: 727-733
        • Malinowski B
        • Zalewska K
        • Węsierska A
        • et al.
        Intermittent fasting in cardiovascular disorders—an overview.
        Nutrients. 2019; 11: 673
        • Varady KA
        • Bhutani S
        • Klempel MC
        • et al.
        Alternate day fasting for weight loss in normal weight and overweight subjects: a randomized controlled trial.
        Nutr J. 2013; 12: 146
        • Tinsley GM
        • La Bounty PM
        Effects of intermittent fasting on body composition and clinical health markers in humans.
        Nutr Rev. 2015; 73: 661-674
        • Nematy M
        • Alinezhad-Namaghi M
        • Rashed MM
        • et al.
        Effects of Ramadan fasting on cardiovascular risk factors: a prospective observational study.
        Nutr J. 2012; 11: 69
        • Horne BD
        • Muhlestein JB
        • Anderson JL
        Health effects of intermittent fasting: hormesis or harm? A systematic review.
        Am J Clin Nutr. 2015; 102: 464-470
        • Heitor OS
        • Macedo RCO
        Impact of intermittent fasting on the lipid profile: assessment associated with diet and weight loss.
        Clin Nutr ESPEN. 2018; 24: 14-21
        • Rothschild J
        • Hoddy KK
        • Jambazian P
        • Varady KA
        Time-restricted feeding and risk of metabolic disease: a review of human and animal studies.
        Nutr Rev. 2014; 72: 308-318
        • Horne BD
        • Muhlestein JB
        • Lappe DL
        • et al.
        Randomized cross-over trial of short-term water-only fasting: metabolic and cardiovascular consequences.
        Nutr Metab Cardiovasc Dis. 2013; 23: 1050-1057
        • Al-Shafei AIM
        Ramadan fasting ameliorates arterial pulse pressure and lipid profile, and alleviates oxidative stress in hypertensive patients.
        Blood Press. 2014; 23: 160-167
        • Sutton EF
        • Beyl R
        • Early KS
        • Cefalu WT
        • Ravussin E
        • Peterson CM
        Early time-restricted feeding improves insulin sensitivity, blood pressure, and oxidative stress even without weight loss in men with prediabetes.
        Cell Metab. 2018; 27: 1212-1221.e3
        • Varady KA
        • Bhutani S
        • Church EC
        • Klempel MC
        Short-term modified alternate-day fasting: a novel dietary strategy for weight loss and cardioprotection in obese adults.
        Am J Clin Nutr. 2009; 90: 1138-1143
        • Horne BD
        • Muhlestein JB
        • May HT
        • et al.
        Relation of routine, periodic fasting to risk of diabetes mellitus, and coronary artery disease in patients undergoing coronary angiography.
        Am J Cardiol. 2012; 109: 1558-1562
        • Barnosky AR
        • Hoddy KK
        • Unterman TG
        • Varady KA
        Intermittent fasting vs daily calorie restriction for type 2 diabetes prevention: a review of human findings.
        Transl Res. 2014; 164: 302-311
        • Varady KA
        Impact of intermittent fasting on glucose homeostasis.
        Curr Opin Clin Nutr Metab Care. 2016; 19: 300-302
        • Catenacci VA
        • Pan Z
        • Ostendorf D
        • et al.
        A randomized pilot study comparing zero-calorie alternate-day fasting to daily caloric restriction in adults with obesity.
        Obesity. 2016; 24: 1874-1883
        • Mattson M
        • Wan R
        Beneficial effects of intermittent fasting and caloric restriction on the cardiovascular and cerebrovascular systems.
        J Nutr Biochem. 2005; 16: 129-137
        • Horne BD
        • May HT
        • Anderson JL
        • et al.
        Usefulness of routine periodic fasting to lower risk of coronary artery disease in patients undergoing coronary angiography.
        Am J Cardiol. 2008; 102: 814-819
        • Aksungar FB
        • Topkaya AE
        • Akyildiz M
        Interleukin-6, C-reactive protein and biochemical parameters during prolonged intermittent fasting.
        Ann Nutr Metab. 2007; 51: 88-95
        • Raveendran A
        • Zargar A
        Diabetes control during Ramadan fasting.
        Cleve Clin J Med. 2017; 84: 352-356
        • De Cabo R
        • Mattson MP
        Effects of intermittent fasting on health, aging, and disease.
        N Engl J Med. 2019; 381: 2541-2551
        • Anton SD
        • Moehl K
        • Donahoo WT
        • et al.
        Flipping the metabolic switch: understanding and applying the health benefits of fasting.
        Obesity. 2018; 26: 254-268
        • Mattson MP
        • Moehl K
        • Ghena N
        • Schmaedick M
        • Cheng A
        Intermittent metabolic switching, neuroplasticity and brain health.
        Nat Rev Neurosci. 2018; 19: 63-80