Intermittent fasting and blood pressure

Though it depends on what you’re hoping to accomplish (and it’s not safe for everyone), it’s beneficial to limit your food intake, in general. “By every measure, eating less is better,” Dr. Bruemmer says. Evolution has equipped us with the unique ability to store energy for periods of deprivation. However, in today’s work food, and mostly unhealthy food, is available all around us. Across all species, including worms, flies, rodents, dogs, monkeys, and human, very few intervention have ever been shown to prolong life. However, in all these species, fasting and eating less is clearly one of them.

Below, he answers questions about fasting and offers some tips for exploring it.

Contents

Can eating less strengthen your heart?

Research shows that fasting can help lower blood pressure, reduce cholesterol, control diabetes and reduce weight.

“Four of the major risks for heart disease are high blood pressure and cholesterol, diabetes and weight, so there’s a secondary impact,” Dr. Bruemmer says. “If we reduce those, we can reduce the risk of heart disease.”

One word of caution, though: Fasting can lead to an electrolyte imbalance. This can make the heart unstable and prone to arrhythmias.

“So whenever we prescribe certain diets, including a very low calorie diet and protein-sparing modified fast diet, these require medical supervision, and we check blood tests monthly and prescribe potassium supplementation to prevent electrolyte imbalance from occurring,” Dr. Bruemmer says.

Some studies also show that fasting may help prevent cancer or increase the effectiveness of chemotherapy treatment.

However, much of the research on fasting is in preliminary stages. “We have a lot more to learn about fasting,” he says.

Is fasting a good way to lose weight?

Although it offers health benefits — including reduced heart disease and weight loss — it’s not really the best way to lose weight, Dr. Bruemmer says. While fasting helps you drop pounds quickly, it doesn’t help you stay in shape.

“For long-term weight loss, it’s not terrific,” he says. “The only time we really recommend fasting for weight is if someone needs rapid weight loss, for instance, for surgery.”

When is fasting not a good idea?

Fasting is not safe for everyone — so consult your physician before you begin.

Those who should not fast include:

  • Women who are pregnant or breastfeeding
  • Children and teenagers
  • People who have type 1 diabetes
  • Those who have eating disorders

Fasting may also have a negative impact on people with other medical problems. Your doctor can help determine whether it is right for you, Dr. Bruemmer says.

What should you know about fasting before you begin? 3 tips

1. There are different methods of fasting.

Some people fast for eight hours, 24 hours or longer. Others cut way back on calories for a certain number of days each week or month.

The popular “5, 2” plan involves two days of caloric reduction each week. You eat two meals (totaling about 500 calories) on fasting days. On non-fasting days, you follow a healthy diet, but you don’t restrict calories.

2. Meal planning is essential.

“You want to make sure you have adequate nutrition before and after the fast,” Dr. Bruemmer says. And when you’re consuming less overall, it’s important to make sure your nutrition is sound when you do eat.

Healthy foods to eat before a fast include:

  • Fruits and vegetables (these are helpful for hydration)
  • Foods high in lean protein, like chicken or fish.
  • Low-fat yogurt.

Avoid foods that are high in sodium or which may cause bloating, such as canned soup and pizza.

3. Afterward, break your fast slowly.

Don’t suddenly start eating everything in sight when you’re done fasting.

“You don’t want to shock the system,” Dr. Bruemmer says.

Instead, it’s best to start by snacking on a few dates or other dried fruit, for instance. Then take a break, and then eat fruit and other light foods at first.

“Whether doing a fast for lifestyle or religious reasons, it’s always wise to talk to your doctor first,” Dr. Bruemmer says.

More Information

Center for CardioMetabolic Health

Take a look at the Recent articles

Abstract

Objective: To observe the effect of Weekend Fasting Therapy on blood pressure in overweight or obese patients with hypertension.

Methods: The 90 patients who met the obesity/overweight and hypertension diagnostic criteria were randomized and assigned into the Control group (CT), Weekend fasting group (WF) and Weekend fasting and Standardized dinner group (WFSD). Body mass Index (BMI) and blood pressure were measured before and after treatment.

Results: After 6 weeks of treatment, significantly reduced in BMI, systolic blood pressure and diastolic blood pressure in WF group and WFSD group (P<0.05) but were not observed in CT group. BMI, blood pressure reduction, the standard and effective rate of blood pressure were more significantly changed whenever between WF group and control group (P<0.05), or between WFSD group and control group (P<0.05). But there was no significant differences between WF group and WFSD group. Blood pressure reduction were no correlated with the body weight, BMI, waist circumference, hip circumference, waist-to-hip ratio in WF group and WFSD group.

Conclusions: Weekend fasting therapy can reduce the blood pressure and lose weight in overweight or obese patients with hypertension.

Key words

Weekend fasting, obesity, hypertension

Introduction

Hypertension is one of the most common cardiovascular diseases. As people’s living standards improve and dietary patterns change, overweight and obesity have become a global trend . It has been confirmed that overweight and obesity are important risk factors for inducing hypertension. Relative to the normal population, the incidence of obese people may increase by 2 to 6 times . A prospective study by Fleming showed that both systolic and diastolic blood pressures increased significantly with an increase in BMI. For every 4.5 kg of body weight gain, systolic blood pressure increased by 4.4 mm Hg and diastolic blood pressure increased by 4.2 mm Hg . Due to excessive intake of high-calorie, high-fat foods at dinner, coupled with less exercise at night, excessive heat is converted into fat stored in the body, and a large amount of blood lipids are deposited on the blood vessel wall, causing atherosclerosis, thus the risk of hypertension is increased.

Fasting therapy, as a medically valuable medical practice, has been highly recognized worldwide . The definition of this therapy refers to a diet therapy that prevents the treatment of certain diseases, except for the right amount of drinking water and extremely low-calorie supply, in a limited time . A series of experimental studies and clinical observations have confirmed the weight-loss effect of this therapy on obese patients , and the antihypertensive effect on patients with hypertension . In addition, weight loss and a healthy lifestyle caused by fasting will produce long-lasting antihypertensive effects .

Fasting methods are divided into intermittent fasting (IF) and periodic fasting (PF). Intermittent fasting includes fasting every other day or fasting twice a week. According to the working rules and eating habits of Chinese people, the intermittent fasting is arranged on the weekend, which means fasting on Saturday and Sunday, that is, “weekend fasting”. Fasting on Saturday and Sunday’s leisure time can both achieve the goal of treatment for the disease and avoid the harm caused by overeating on Saturday and Sunday.

In this experiment, the effects of weekend fasting therapy on blood pressure of overweight/obese patients with hypertension were studied through different dietary interventions. The effectiveness of the therapy was explored, and a new method for clinical prevention and treatment of hypertension was provided.

Materials and Methods

The subjects were all the patients from the First Affiliated Hospital of Sun Yatsen University who were eligible for hypertensive patients with overweight/obesity. The diagnostic criteria were: (1) overweight and/or obesity: BMI ≥ 24.0 kg/m2, waist circumference for male ≥ 85 cm and female ≥ 80cm ; (2) Patients diagnosed with hypertension and are being treated . Exclusion criteria: acute malignant hypertension and hypertensive crisis; patients with secondary hypertension; abnormalities functions in heart, liver and kidney; age below 18 or over 70; pregnant women and lactating women, women with pregnancy plan within 1 year; patients with malignant tumors and blood diseases; patients with active tuberculosis; patients with ulcers and severe gastric bleeding; anorexia or excessive weight loss or malnutrition; unable to cooperate with treatment, with poor compliance. The study was approved by the Ethics Committee of the First Affiliated Hospital of Sun Yatsen University, and the research process complied with the Helsinki Declaration . All subjects signed informed consent.

90 eligible patients were selected and divided into Weekend fasting group (WF), Weekend fasting and standardized dinner group (WFSD) and control group according to the random number table method CT).

Study Method

Weekend fasting therapy is divided into three stages: buffer period, fasting period and free diet period. The first stage: buffer period (1 day), the main purpose is to gradually control the amount of food, to transitional eliminate the psychological hunger. On the day of buffer period, eat 1500g of fruit, drink about 2-3L of mineral water, and advise the subjects to perform aerobic exercise (such as walking slowly), record the amount of exercise and time, and avoid heavy physical exercise. The second stage: fasting period (2 days), at this stage, patients are prohibited from eating food. On the first day of fasting, dissolve 15-30 grams of Xuan Ming powder into 500ml warm water to make the intestines clean. At this stage, sodium bicarbonate tablets were orally administered three times a day, 1.0 g (2 tablets) at a time; the glucurolactone tablets for 3 times, once 0.2 g (2 tablets). In addition, the subject is recommended to drink more than 3 liters of mineral water per day. Encourage the subject to have aerobic exercise. The amount of exercise and time can be recorded according to the individual’s physical strength. Avoid heavy physical exercise and avoid activities that require a high concentration of energy (such as driving a vehicle). Stage 3: During the free diet (4 days), subjects were allowed to eat freely, but it is still recommended to avoid overeating. The weekend fasting + standardized dinner group (WFSD group) eats 1 bag of low-calorie nutritious meals per night (each containing 7.9g protein, 2.8g fat and 22g starch, multivitamins and minerals, for total 200Kcal calories).

The above three stages need to be repeated 6 times, which will be recorded as a course of treatment; at least every two weeks, the researchers monitor their weight, blood pressure, heart rate, waist circumference and hip circumference. Drink tea, alcohol, coffee and other drinks were prohibited during treatment.

Grouping plan

  1. The WF group undergo fasting therapy in accordance with standardized weekend fasting therapy procedures;
  2. The WFSD group uses a standardized dinner instead of a daily dinner from Monday to Friday, except for fasting on weekends;
  3. The normal diet of the CT group, without intervention, continued to follow the previous blood pressure reduction program;

Observation indicators

Main indicators: systolic blood pressure and diastolic blood pressure changes. Secondary indicators: weight, BMI, waist circumference, hip circumference, waist to hip ratio.

Efficacy Criteria

Compliance with blood pressure: According to the 2010 edition of the Guidelines for Prevention and Treatment of Hypertension in China, Bp<140/90mmHg is used as the standard value.

Rate of compliance = number of blood pressure standards after taking the drug / total number of cases in the group

Efficacy indicators:

Effective: After the reduction or treatment, the drug reduction standard has not been reached, but Bp≤130/85mmHg

Invalid: Bp>130/85mmHg

Drug reduction standard: Bp≤120/80mmHg or after treatment, refer to the 2002 Guidelines for Clinical Research of New Drugs in Traditional Chinese Medicine which achieve significant or effective effect.

Significant effect, the diastolic blood pressure decreased by ≥10 mm Hg after treatment and fell to the normal range; or the diastolic blood pressure did not fall to normal, but it has decreased by more than 20 mm Hg, one of the two indicators reached will be regarded as the Significant effect.

Effective effect Although the diastolic blood pressure drop after effective treatment has not reached 10 mm Hg, it has dropped to the normal range; or decreased by 10-19 mm Hg. If it is systolic hypertension, the systolic blood pressure drops by ≥ 30 mm Hg.

Effectiveness = number of valid cases / total number of cases in the group

Principle of reducing medicine (adjusted according to blood pressure):

  • If you take more than 2 kinds of antihypertensive drugs, deactivate one of them
  • If you take 1 antihypertensive drug, the dose is halved
  • If the blood pressure is completely normal, you do not need to take the medicine

Measurement method Blood pressure:

The subjects were quietly rested for 10 minutes. The blood pressure of the right hand was measured by a mercury sphygmomanometer. The upper arm of the study object was level with the heart, the palms were laid flat, the legs were closed and the whole body was relaxed, and the cuff was under the airbag. The edge is 2-3 cm above the elbow. The first sound of Korotkoff is systolic blood pressure (SBP), and the fifth sound is diastolic blood pressure (DBP). The measurement is performed twice continuously, each time interval is 10min, and the average value is taken. If the difference between the two measurement results is large (more than 5mmHg), then measure again . Body weight: use a regularly calibrated TANITA MC-180 body fat meter to measure. After urinating in the morning on an empty stomach, the subjects took off their shoes, only wore thin clothes, stepped on the weighing plate, and waited for 5 seconds before leaving the weighing plate. The staff reads the numbers on the display and weighs exactly 0.1kg. Waist circumference : After emptying the abdominal urination, the subject was erect, and the feet were separated by 30-40 cm. An inelastic, minimum scale of 1 mm was placed on the anterior superior iliac spine and connected to the lower edge of the twelfth bone. The midpoint (usually the natural narrowest part of the waist), around the abdomen in the horizontal direction, makes it close and does not oppress the skin, measuring the waist at the end of normal exhalation, the reading is accurate to 1mm. Hip circumference: After urinating in the morning on an empty stomach, the legs are erected upright, the arms are naturally drooping, and the tape measure is placed horizontally on the pubic symphysis and the most prominent part of the gluteus maximus. The reading is accurate to 1 mm.

Statistical methods

Normal distribution measurement data are expressed as mean ± standard deviation (X̅± S). Comparison of measurement data between groups is performed by one-way analysis of variance or Kruskal-Wallis method. The pairwise test is used to compare the differences between groups. Comparisons between groups were made using the LSD-t test or the Bonferroni method. The count data was expressed as a percentage, and the comparison between groups was performed by 2 tests; the correlation between the two variables was Pearson-related or Spearman rank correlation; the data was statistically processed using SPSS 19.0, and all statistical tests were performed using a two-sided test with a value less than 0.05. There will be a significant difference in the statistical test when P value is less than 0.05.

Results

General Information

There were no significant differences in age, body weight, body mass index, systolic blood pressure, diastolic blood pressure, waist circumference, hip circumference, and waist-to-hip ratio between the three groups (P>0.05), which were comparable (Table 1).

Table 1. Comparison of basic characteristics of three groups ( ± S)

n=30;1mmHg≈0.133KPa;WF-weekend fasting group;WFSD- weekend fasting + standardized dinner group;CT- normal diet group;BMI- body Mass Index;SBP- systolic blood pressure;DBP- diastolic blood pressure

Effects on blood pressure, weight, waist circumference and hip circumference of patients

Through observation, the systolic blood pressure and diastolic blood pressure in the WF group and the WFSD group were significantly lower than before, and the difference was statistically significant (P<0.05). However, there was no significant change in the control group before and after treatment. By comparison between groups, it was found that the three groups had significant differences in blood pressure (P<0.05). Compared with CT group, the changes of systolic blood pressure and diastolic blood pressure in WF group and WFSD group were significantly lower than those in CT group, the difference was statistically significant (P<0.05), but there was no significant difference between WF group and WFSD group (Table 2).

Table 2. Effects of three groups of patients on blood pressure before and after treatment ( ± S)

Compared with the same group before treatment, *P<0.05;Compare with CT group,#P<0.05

Through observation, the body weight and BMI of the WF group and the WFSD group were significantly lower than before, and the difference was statistically significant (P<0.05), but there was no significant change before and after treatment in the control group. Through comparison between groups, it was found that the three groups had significant differences in body weight and BMI (P<0.05). Compared with the CT group, the changes in body weight and BMI of the WF group and the WFSD group were significantly lower than those of the CT group, and the difference was statistically significant (P<0.05), but there was no significant difference between the WF group and the WFSD group (Table 3).

Table 3. Effects of three groups of patients on body weight and BMI before and after treatment ( ± S)

Compared with the same group before treatment, *P<0.05;compare with CT group #P<0.05

Through observation, the waist circumference, hip circumference and waist-to-hip ratio of the WF group and the WFSD group were significantly lower than the previous ones, and the difference was statistically significant (P<0.05). However, there was no significant change before and after treatment in the control group. Through comparison between groups, it was found that there were significant differences in the effects of waist circumference, hip circumference and waist-to-hip ratio among the three groups (P<0.05). Compared with the CT group, the changes of waist circumference, hip circumference and waist-hip ratio in the WF group and the WFSD group were significantly lower than those in the CT group, and the difference was statistically significant (P<0.05), but there was no difference between the WF group and the WFSD group. Significant differences (Table 4).

Table 4. Effect of waist circumference, hip circumference and waist-to-hip ratio before and after treatment in three groups of patients ( ± S)

Compared with the same group before treatment,*P<0.05;compare with CT group #P<0.05

The compliance rate and efficiency of blood pressure after treatment

Three groups of blood pressure compliance rates were conductedtest (=15.771, P<0.05), indicating significant differences between the three groups. Comparing any two groups, it can be seen that the blood pressure compliance rate of WF group and WFSD group is significantly higher than that of CT group (P<0.05); however, there is no significant difference between WF group and WFSD group (Table 5).

Three groups of blood pressure effectiveness were conductedtest (=21.667, P<0.01), indicating significant differences between the three groups. Comparing any two groups, it can be seen that the blood pressure reduction efficiency of WF group and WFSD group is significantly higher than that of CT group (P<0.01); however, there is no significant difference between WF group and WFSD group (Table 5).

Table 5. Blood Pressure Compliance Rate and Efficiency of Three groups of patients

Compare with CT Group,*P<0.05,##P<0.01

Correlation analysis between blood pressure changes and changes in body weight, BMI, waist circumference, hip circumference and waist-hip ratio

The correlation between blood pressure changes and body weight, BMI, waist circumference, hip circumference and waist-to-hip ratio in WF group and WFSD group was analyzed. It was found that there was no statistically significant correlation between blood pressure changes and the above indicators (P>0.05) (Table 6).

Table 6. Correlation coefficient between blood pressure change and body weight, BMI, waist circumference, hip circumference, waist-hip ratio (value of r)

Group

Index

Weight

BMI

Waist circumference

Hip circumference

Waist to hip ratio

WF

Systolic blood pressure

Diastolic blood pressure

WFSD

Systolic blood pressure

Diastolic blood pressure

#P<0.05

Discussion

Hypertension is a major problem worldwide. In 2013, the World Health Organization took the prevention and control of hypertension for the first time as the theme of World Health Day, emphasizing the need to improve the control rate and treatment rate of hypertension. Overweight and obesity, as important risk factors for the onset of hypertension, are increasingly attracting human attention. Fasting therapy reduces weight loss and reduces the risk of cardiovascular disease associated with obesity by limiting the total daily calorie intake.

One of the characteristics of obese patients with hypertension is endothelial dysfunction . By secreting nitric oxide and endothelin, the vascular endothelium is involved in the regulation of blood pressure. When vascular endothelial function is impaired, it releases less nitric oxide, increases endothelin, contracts small blood vessels, and increases peripheral resistance, which increases blood pressure. Previous studies have confirmed that a low-calorie diet can improve endothelial function in obese hypertensive patients . Our previous study by the research team also confirmed that vascular endothelin can be significantly decreased after fasting, and nitric oxide is significantly increased, thereby lowering blood pressure . Caloric restriction can increase nitric oxide synthesis by activating AMP-activated protein kinase, phosphatidylinositol 3-kinase, and protein kinase B . Caloric restriction also promotes the synthesis of adiponectin, down-regulating gene expression of renin-angiotensin converting enzyme and renin type 1A receptor, thereby lowering blood pressure . In addition, during fasting, the plasma osmotic pressure decreases, the stimulation of osmotic pressure receptors is reduced, the release of vasopressin is reduced, the re-absorption of water in the distal convoluted tubules and collecting tubes is reduced, the amount of urination is increased, and blood pressure is lowered by reducing blood volume.

By analyzing the correlation between blood pressure changes and changes in body weight, BMI, waist circumference, hip circumference, and waist-to-hip ratio, there is no significant correlation between changes in blood pressure and changes in the above indicators, suggesting that fasting therapy has an independent antihypertensive effect. This indicates that fasting therapy can not only reduce the risk factors of cardiovascular disease, but also lower blood pressure by improving vascular endothelial function, promoting adiponectin synthesis and lowering plasma osmotic pressure, thereby delaying the process of atherosclerosis and reducing damage to the target organ.

The results of this study show that although taking antihypertensive drugs alone can reduce the blood pressure of patients with hypertension, but not all of them meet the standard; while performing weekend fasting for 6 weeks on the basis of taking antihypertensive drugs, not only can reduce the weight of patients, but also improve the compliance rate and efficiency of blood pressure control, and even achieve the purpose of reducing medicine. This suggests that caloric restriction contributes to a further reduction in blood pressure in hypertensive patients. The results of this study are consistent with previous experimental studies and clinical observations of caloric restriction on weight loss in obese patients and antihypertensive effects in patients with hypertension .

In clinical observation, we found that although there was no significant difference between the WFSD group and the WF group in terms of pressure reduction amplitude, blood pressure reduction efficiency, compliance rate and general indicators, it had a better trend than the WF group. Therefore, considering the WFSD group may have a better effect on the buck. The test results may be related to the small number of samples in this study and the poor compliance of patients in the dining package.

The shortcoming of this study is that most of the patients collected were mild and moderate hypertensive patients, while there were fewer cases of severe hypertension and hypertensive emergencies. Therefore, this study is more important for the treatment of overweight/obesity with mild to moderate hypertension. Combined with the current situation in China, the majority of patients with hypertension are mild and moderate hypertension (90%), and mild hypertension accounts for more than 60% . Fasting therapy has a benign antihypertensive effect , and its decompression amplitude is closely related to the basal blood pressure value but has no excessive reduction effect on normal blood pressure. Therefore, this therapy is safe and suitable for most people with high blood pressure.

Conclusion

At present, when selecting antihypertensive drugs, the first-line drugs recommended according to the international treatment guidelines are combined with cardiovascular risk factors and complications of patients, and individualized programs are selected. For patients with overweight/obesity and hypertension, this study provides new treatment ideas and guidelines that is to combine antihypertensive drugs with weekend fasting, which can reduce weight, lower blood pressure, and reduce the amount and type of medication, delay the progression of atherosclerosis, reduce target organ damage, and also reduce adverse drug reactions, reduce the economic burden of patients, thereby achieving the best therapeutic effect. At the same time, weekend fasting is suitable for the characteristics of Chinese office workers. It is easier to be accepted by the public to perform fasting during the leisure time on Saturday and Sunday. Moreover, this method is easy to operate, safe and low in cost, which is worthy for clinical promotion and application.

Fund Project

Shenzhen Health and Family Planning System Research Project (SZSW2018001); Shenzhen Health and Family Planning System Research Project (SZLY2018002).

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Tipping the scales at 233 pounds, Charles Joy realized he needed to make some changes.

The 28-year-old Louisville, Kentucky, native already had tried many diet plans to varying degrees of success. In 2013, he lost more than 100 pounds through exercise and diet. But afterward, his weight slowly began to creep back up.

In 2017, Joy decided to try time-restricted eating, consuming all his meals within an eight-to 10-hour window each day. The pounds melted away. Today, he weighs 183 pounds.

“It’s working much better, because it’s so flexible,” Joy said. “With calorie restriction, you have to plan out everything, and I was never satisfied. Now I don’t even think about food until the afternoon.”

Time-restricted eating is one variation of a hot diet trend that also includes intermittent fasting. According to Krista Varady, an associate professor of nutrition at the University of Illinois at Chicago, there are several types of intermittent fasting, including one meal per day, the 5/2 method, which involves five feast days and two days with restricted calories, and alternate-day fasting.

Fasting is nothing new. For a month every year, practicing Muslims celebrate Ramadan by fasting from sunrise to sunset, and it’s a part of many other major religious traditions. But is it healthy and effective to restrict eating or fast on a regular basis?

It can be, said Varady, who said she has run more than a dozen clinical trials on alternate-day fasting and one on time-restricted eating.

In a 2017 JAMA Internal Medicine trial, Varady and her colleagues showed alternate-day fasting was just as effective as daily calorie restriction for losing weight and maintaining the loss.

“With alternate-day fasting, people typically lose 3 to 8 percent of their body weight over three to 12 months,” Varady said. And it can work with both low- and high-fat diets.

Weight loss is not the only benefit. In a 2009 study, most of the study participants also saw reductions in the so-called “bad” LDL cholesterol and in blood pressure. Other studies show decreases in insulin resistance, which is associated with an increased risk of Type 2 diabetes. And diabetes is a risk factor for heart disease.

Alternate-day fasting works, at least in part, because people wind up consuming less food overall.

But those who use time-restricted eating can lose weight without restricting caloric intake, said Dr. Satchidananda Panda, a professor and researcher at the Salk Institute for Biological Studies in La Jolla, California. He also wrote a book about time-restricted eating.

“The science and the benefits of time-restricted eating are very different from those of other forms of fasting,” Panda said.

According to Panda, time-restricted eating is based on the science of circadian rhythms, which control every hormone.

In a 2012 study, Panda and his team split mice into two groups. One ate all the sugary, fatty foods they wanted during a 24-hour period. The other group had the same sorts of foods but were only allowed to eat during an eight-hour daily window. Both groups consumed the same number of calories, but the mice that ate round-the-clock became fat and sick while those on a time-restricted diet did not.

Panda also has shown that fruit flies placed on a time-restricted eating plan have hearts that appear to be 20 to 30 percent younger than their age would suggest. Fruit fly hearts and human hearts are similar, so Panda believes it’s reasonable to conclude humans might benefit in the same way.

“It works by slightly reducing ATP producing proteins of mitochondria in the heart and keeping the mitochondria healthy, which reduces oxidative stress,” Panda said, noting that time-restricted eating gives the body time to repair itself. “Most of our studies are showing that the effect is on multiple organs and on the central nervous system. It’s a positive feedback loop.”

Panda hopes to continue his research, and find out whether the health benefits seen in animal studies hold true for humans. Data collected from his smartphone app, myCircadianClock, could be key. The app helps people track when they eat, sleep, exercise and take supplements and medications.

“We send them push notifications asking them what improvement they are seeing,” Panda said.

In most of Panda’s studies, people eat their first meal between 8 a.m. and 10 a.m. but Charles Joy typically waits until 4 p.m. to break his fast. Joy’s doctor initially was concerned by the diet, but Joy felt vindicated by his low cholesterol and blood pressure readings. He has no plans to change things up anytime soon.

“I’ve been obese and super-unhealthy pretty much my entire life, the biggest guy in school,” Joy said. “This feels great, and I want to keep it going as long as I can.”

If you have questions or comments about this story, please email [email protected]

Research Article
The effect of intermittent fasting on blood pressure variability in patients with newly diagnosed hypertension or prehypertension

Intermittent fasting is a phenomenon which can be observed in most humans. The effect of intermittent fasting on blood pressure variability (BPV) has not previously been investigated. The purpose of this study was to assess the effect of fasting on blood pressure (BP) (with office, home, central, and ambulatory blood pressure monitoring ) and on BPV. Sixty individuals were included in the study. Office, home, ABPM, and central BP measurements were performed before and during intermittent fasting. Standard deviation and coefficient variation were used for office and home BPV measurement, while the smoothness index was used to calculate ABPM variability. Patients’ BP and BPV values before and during intermittent fasting were then compared. Intermittent fasting resulted in a significant decrease in office BP values and ABPM measurements but caused no significant change in home and central BP measurements. Twenty-four hour urinary sodium excretion decreased. Smoothness values obtained from ABPM measurements were low; in other words, BPV was greater. BPV was higher in patients who woke up to eat before sunrise, but BPV was low in patients with high body mass index. Intermittent fasting produced a significant decrease in BP values in terms of office and ABPM measurements in this study but caused no significant change in central BP and home measurements. We also identified an increase in BPV during intermittent fasting, particularly in patients who rose before sunrise.

(mrs/Moment, Getty Images)

Regular fasting is associated with lower rates of heart failure and a longer life span, according to two new studies.

Researchers sought to shed new light on the centuries-old debate about how fasting affects health. Recent studies have shown it contributes to reductions in blood pressure, “bad” LDL cholesterol and insulin resistance, a condition that can raise blood sugar. A 2017 study showed alternate-day fasting was as effective as daily calorie restriction for losing weight and keeping the pounds off.

The new studies focused on data from patients evaluated for heart disease in Utah and other Rocky Mountain states. The research included hundreds of members of The Church of Jesus Christ of Latter-day Saints, also known as Mormons, who typically fast one Sunday each month, for up to 24 hours.

In the first study, researchers zeroed in on how fasting impacts life span. About 2,000 people who had undergone a cardiac catheterization procedure were followed for an average of 4.4 years, including 389 “routine fasters” who had been fasting regularly for at least five years.

After adjusting for various factors, researchers discovered the routine fasters had a 45% lower mortality rate than the non-fasters during the follow-up period.

“It’s very interesting … it’s a more profound effect than we anticipated,” said researcher Dr. Benjamin Horne, who recently presented the preliminary findings at the American Heart Association’s Scientific Sessions.

Horne also was involved in the second fasting study, which used the same patient data to see how routine fasting affects heart failure and heart attacks. After adjusting for various factors, there was no significant difference in heart attacks, but routine fasters had a 71% lower rate of developing heart failure than non-fasters.

“That’s a huge difference, and frankly, it was a little unexpected,” said Horne, director of cardiovascular and genetic epidemiology at Intermountain Medical Center in Salt Lake City, Utah.

Krista Varady, an associate professor of nutrition at the University of Illinois at Chicago, called it “an important study that hasn’t been done before. There’s a lot of short-term clinical trials for intermittent fasting, but we definitely don’t have any long-term data in humans looking at whether it can prevent things like heart failure.”

Varady, who was not involved in the research, said the study was limited by the fact that most of the fasters were Latter-day Saints.

“They lead a very different lifestyle compared to the average American,” she said. “For instance, they don’t smoke, don’t drink alcohol and are slightly more physically active. It just makes sense they’re going to live longer and have a lower chance of heart disease.”

Even though researchers adjusted for some of those factors, she said “it is very difficult to tease apart the effects of fasting versus an otherwise healthy lifestyle in this population, despite the use of statistical corrections.”

A number of hot diet trends encourage people to restrict their eating to a window of 8 to 12 hours and fasting the remaining 12 to 16 hours. But participants in the two new studies fasted even more hours each day, over the course of an average of 42.2 years, Horne said.

“We think that long-term fasting of about one day, once a month, over a period of decades is making the body activate those beneficial mechanisms for a few hours each day between dinner and breakfast when it usually wouldn’t. … Those hours build up over long periods of time and provide the benefits,” he said.

The research was limited by being an observational study that doesn’t prove cause and effect, Horne said. He’d like to see future studies that explore why fasting seems to protect against heart failure, and he also called for a large study on the psychological benefits of fasting.

“Some people who’ve started fasting say they unexpectedly feel they have more self-control over their appetite,” he said. “Potentially, there’s a direct result between fasting and the strengthening of the mind so people are able to eat a better diet.”

Varady called for future studies that follow people who restrict eating in a variety of ways – such time-restrictive fasters and alternate-day fasters. “This is a nice first step, but we need to do long-term research on different people doing different types of fasting.”

Find more news from Scientific Sessions.

If you have questions or comments about this story, please email [email protected]

Will Smith says he fasted for 10 days and no longer needed a blood-pressure medication he’d been taking for a decade

  • Will Smith tried a 10-day fasting regimen to break his cycle of unhealthy eating, he said on an episode of the Facebook Watch series “Red Table Talk.”
  • The 50-year-old actor said the disciplined fasting plan lowered his blood pressure enough to where he stopped taking a medication he’d been on for 10 years.
  • A cardiologist said blood pressure was one factor in many concerns for good heart health and longevity. He recommends a balanced lifestyle instead of fasting.
  • Visit INSIDER’s homepage for more.

After getting into a routine of drinking vodka for lunch and eating enough carbs that his family started calling him “pudge muffin,” Will Smith decided to call an emergency family meeting about his eating habits.

In an episode of the Facebook Watch series “Red Table Talk,” the 50-year-old actor announced he tried a 10-day fasting regimen to reset his relationship to food and improve his health.

It’s unclear what exactly Smith’s fasting plan involved, since people use the term to describe everything from a liquids-only diet to limiting foods to certain times of day to abstaining from eating and drinking entirely. The actor said, however, that after four days he measured his blood pressure and noticed it had lowered — so significantly, in fact, that he stopped taking a blood-pressure medication he had relied on for a decade.

Read more: Skipping a few meals with intermittent fasting may help people avoid cancer, diabetes, and heart disease

“I had the epiphany that I don’t know anything about food,” Smith said in the episode. “I couldn’t believe that I got to 50 years old without knowing you literally are what you eat.”

Fasting can lower blood pressure, but that’s not the only indicator of heart health

Blood pressure is a measure of how much force it takes to pump blood through the body. It’s related to the elasticity of your circulatory system — stiffer vessels require your heart to work harder to pump blood, explained Dr. Joshua Yamamoto, a cardiologist and medical director at the Foxhall Foundation.

“Blood pressure is a number, not a disease,” Yamamoto told Insider in an email. “What matters is whether or not we maintain good blood flow to every part of the body, and do we overwork the heart.”

The problem with high blood pressure is that it puts more strain on the heart muscle, which can cause an irregular heartbeat (arrhythmia), heart failure, or clotting that can lead to stroke.

It’s true that fasting can lower blood pressure, Yamamoto said, but so can starvation and dehydration, neither of which are healthy. It’s important to consider blood pressure in context of overall health, he said.

“The question is, ‘Can fasting decrease brain damage and heart damage in the long run?”” Yamamoto said. “The answer to that question is — probably not.”

Things that are proved to lower blood pressure in the long term include eating a healthy, balanced diet with lots of fresh vegetables and fruit, getting plenty of exercise, managing stress, limiting alcohol consumption, and avoiding tobacco and nicotine products.

It’s not yet clear how fasting works in the long term, but the type of fasting is important

There’s good evidence that some forms of fasting can reduce some people’s chances of developing long-term health issues like diabetes, heart disease, and multiple sclerosis.

Intermittent fasting refers to limiting meals to within a set time period. A popular variation is the 8:16 fast — eating all your daily meals within an eight-hour period and fasting the other 16 hours of the day. Practitioners of this method may choose to eat between 9 a.m. and 5 p.m. or between noon and 8 p.m., for example.

Dr. Miriam Merad, the director of the Precision Immunology Institute at Mount Sinai School of Medicine, previously told Insider that there’s promising evidence that fasting had a huge number of health benefits, most likely by reducing inflammation.

“Maybe eating two times a day would be entirely sufficient and very beneficial, in fact, in terms of health,” Merad said.

However, she added, “if you start fasting for too long you destroy your immune system.”

“You become very susceptible to infection,” she said. “So fasting is not a trivial thing. It’s good to fast, but you cannot starve yourself.”

She also cautioned that fasting should always be supervised by a doctor, dietitian, or other professional. And fasting isn’t for everyone — it can be harmful to be people who are pregnant or who have history of disordered eating.

Ultimately, more research needs to be done to show the long-term health effects of fasting.

  • A simple ‘polypill’ taken every day can cut the risk of heart attack in half, but some doctors are still hesitant to recommend it
  • High blood pressure could make your brain shrink over time, according to new research
  • There’s more evidence that fasting may make you healthier, and it comes from studying Ramadan observers.

How to normalize your blood pressure

Elevated blood pressure is a common health issue today. Almost a third of U.S. adults have high blood pressure – perhaps you or someone in your family does?1 High blood pressure isn’t necessarily something you can feel, but it increases the risk of serious conditions such as strokes and heart attacks.

The good news is that you can improve your blood pressure by way of simple lifestyle changes.

The usual treatment for elevated blood pressure today is medication. In some cases this is often reasonable. But what if you could achieve perfect blood pressure without pills or side-effects – with improved health and weight as welcome side-bonuses, instead?

For more background information on blood pressure, see our evidence based guides What is normal blood pressure and High blood pressure- What you need to know

This guide will build upon those and show you how to normalize your blood pressure naturally.

Contents

  1. Who needs blood pressure medication?
  2. Causes of blood pressure
  3. Five ways to lower your blood pressure

1. When should hypertension be medicated?

As detailed in our previous blood pressure guides, the most recent update to the AHA hypertension guidelines created a much more aggressive definition of elevated blood pressure. Systolic pressure between 120-129 and diastolic above 80, formerly in the normal range, is now considered “elevated blood pressure.” A systolic pressure between 130-139 and diastolic 80-89 is now stage 1 hypertension, and a systolic greater than 140 or diastolic greater than 90 is now stage 2 hypertension.

But does this mean everyone with a diagnosis of hypertension needs medications?

To their credit, the guidelines recommend lifestyle therapy for stage 1 hypertension, but they do recommend immediate medications for stage 2 and above. We would argue that just about everyone, except at the extreme levels, deserves a dedicated trial of lifestyle intervention before committing to medical therapy with potential adverse effects.

Observational studies suggest having lower blood pressure correlates with fewer cardiovascular events and longer life.2 This, however, is different than saying drug therapy to achieve lower levels is universally beneficial. Instead, it shows that having naturally low blood pressure is beneficial. Naturally low. That can be achieved through healthy lifestyles.

If your blood pressure is elevated, however, there are circumstances where medications may be helpful.

If it is severely elevated (over 160 systolic or over 100 in diastolic), medication in addition to lifestyle interventions is likely wise. If you have other risk factors for heart disease (like smoking or diabetes), starting medication may be beneficial even for a lower elevation in blood pressure (over 140/90).3

Up until recently there was a lack of convincing evidence that medication improves the health of otherwise healthy people with mildly elevated blood pressure (140-159 systolic and/or 90-99 diastolic).4 This meant it was unclear whether it was worth risking the side effects of the medication if all you have is a mild elevation in the absence of other cardiovascular risk factors.

A new large study, however, showed that people over age 50 with hypertension and additional cardiovascular risk factors lived longer and reduced the risk of heart disease if they used multiple medications to lower their systolic blood pressure all the way to 120.5 Unfortunately this benefit comes with significantly increased risk of side effects including the risk of falls, kidney disease and loss of consciousness.6

Would these results translate to “real-world” practice? One study suggests potentially not. This study was an extensive chart review of over 38,000 patients at low risk for heart disease who had stage two hypertension (blood pressure between 149/90 and 159/99) and were treated with blood pressure medications. Over an average follow-up time of almost six years, they found no reduction in the risk of cardiovascular disease events or risk of death with medication use. They did, however, find an increased risk for low blood pressure, fainting, and acute kidney injury among those treated with medications.7

In the end, it appears that the data are not as conclusive as guidelines may suggest. That is why we suggest working with your doctor to try lifestyle interventions before medications if it is safe.

Patients with diabetes

The data is also inconsistent for patients with diabetes. Guidelines from the AHA and ACC treat diabetics the same as the high risk population and recommend medical treatment for blood pressure above 130/80.8

However, the ACCORD trial as well as a meta-analysis of RCTs suggest aggressive treatment to this level does not reduce cardiovascular events but may increase significant adverse events.9Thus, the latest recommendations from the American Diabetes Association) set the target blood pressure for those with diabetes at 140/90.

Keep in mind, however, that these were drug intervention trials. While treating with drugs to lower BP further my not benefit diabetics, we can hypothesize that lifestyle interventions would. After all, medications come with side effects and risks that most lifestyle interventions do not.

To summarize, the following are approximate limits for the levels of blood pressure at which there is little debate that medication are appropriate:

  • Otherwise healthy individuals: Over 160/100
  • Diabetics/people with heart disease: Over 140/90
  • Over age 50 with other CVD risk factors who have not improved their BP with lifestyle interventions: Over 140/90

With that said, current guidelines recommend much more aggressive medication therapy for blood pressure despite conflicting outcome results, especially for those at lower risk of cardiovascular disease.

We feel the evidence supports that stage 1 hypertension and stage 2 in otherwise healthy individuals are best treated with lifestyle interventions. These lifestyle changes should target the underlying causes of high blood pressure and decrease the risk of long term complications. The use of medications should be individualized based on response to lifestyle changes, individual preference, and cardiovascular other risk factors.

2. Reasons for high blood pressure

There are several less common causes of high blood pressure comprising about 10% of all cases (such as kidney or adrenal disorders, certain medications or supplements, etc.).10 Therefore, anyone with a new diagnosis of hypertension should see their healthcare provider for an initial evaluation to ensure there isn’t a reversible or dangerous cause of their elevated blood pressure.

However, the overwhelmingly most common type of elevated blood pressure is the kind that doesn’t have an underlying medical cause, so-called primary or essential hypertension. In these cases it can also be part of what’s called “metabolic syndrome”, also known as the disease of the Western world:11

The above health problems are grouped together because they often appear as a cluster of symptoms in one individual. People with elevated blood pressure often carry extra weight around their belly, and they’re also likely to be at risk for high blood sugar and type 2 diabetes.

The good news is: if you can get to the root cause, you can often improve all these markers with one simple lifestyle change.12

Read more about causes of hypertension in our guide on high blood pressure

The common cause

As described in our guide on high blood pressure, it is difficult to find one solitary cause for hypertension. Age, obesity, sedentary lifestyle, smoking and others all increase the risk for hypertension.13

However, when it comes to the metabolic syndrome, many believe the main cause is eating more high-calorie, high-carbohydrate foods than the body can handle.14 The end result is increased insulin levels with increasing insulin resistance.

High insulin and high blood pressure

Insulin is the main fat-storing hormone in the body, and too much insulin can therefore lead to becoming overweight in the long run. What’s more, elevated insulin levels can lead to the accumulation of fluid and salt in the body which increases blood pressure.15

In addition, high levels of insulin can thicken the tissue around blood vessels (the so-called smooth muscle), which also may contribute to an elevated blood pressure.

Therefore, it makes sense that interventions aimed at reducing insulin levels will greatly improve hypertension and metabolic syndrome.

3. Lifestyle changes for a healthier blood pressure

There are several possible lifestyle changes you can make to lower your blood pressure, five of which we list below. The first one is likely the most important since it eliminates the most common cause of high blood pressure:

1. Cure the Western disease with low-carb nutrition

Multiple studies on low-carbohydrate diets show improved blood pressure even when compared to other diets.16

For example, one study demonstrated that a low-carb diet improved blood pressure more than a low-fat diet plus the weight loss drug Orlistat.17 In addition, a review of multiple randomized controlled trials concluded that low-carb diets were more effective than low-fat diets for weight loss and reducing blood pressure and other cardiovascular risk factors.18

As a bonus, low-carb nutrition not only improves blood pressure, but it also improves all five markers of the metabolic syndrome.19

This not only works in scientific studies but also in real life with numerous anecdotal reports of success.

A low-carb diet for beginners

2. To salt or not to salt

Eating less salt may lower your blood pressure a little. Research has shown that this effect is, however, small for most people in the long term.20

Despite various trials showing a slight reduction of blood pressure with lower sodium diets, we lack contemporary evidence that less salt in our food will affect the risk of heart disease or death. This was shown in a recent meta-study of all RCTs on the subject.21 In addition, it’s unclear if sodium reduction is as important as increasing potassium.22 Since potassium comes from whole foods, such and veggies and avocados, it’s possible that a diet with higher sodium minimally-processed-foods would still have a beneficial effect on blood pressure.

Since much of the salt we ingest comes from fast food, ready-made meals, bread and soft drinks, low-carb diets automatically lower salt intake as these foods are avoided. Furthermore, the hormonal effects of LCHF make it easier for the body to dispose of excess salt through urine; this can explain the slight lowering of blood pressure.23

Last, large observational trials such as the PURE study, suggest the healthiest population eats a moderate amount of sodium, with higher risk seen at extremely high and low levels of sodium intake.24

With all the conflicting evidence, it’s unclear whether you will become healthier by eating less salt or not. However, if you stick to a low carb diet, you should be able to enjoy salt in moderation (4-7 grams of sodium per day) without excess risk.25

More about salt and health

3. Eliminate other things which increase blood pressure

Blood pressure can sometimes be lowered simply by avoiding the things that drive it up. Here are a few common causes of elevated blood pressure:26

  • Common painkillers (so-called non-steroidal anti-inflammatory drugs, NSAID), can increase your blood pressure by inhibiting the production of salt in your kidneys. This includes over-the-counter pills such as Ipren, Ibumetin, Ibuprofen, Diklofenak and Naproxen as well as the prescription drug Celebra. Painkillers with the active substance paracetamol are better for your blood pressure.
  • Cortisone pills, such as Prednisolon
  • Birth control pills (for some people this may be an issue, you may want to discuss other options with your health care provider)
  • Coffee (caffeine)
  • Alcohol in large amounts
  • Nicotine (smoking, other forms of tobacco) can give dramatic short-lived rises in blood pressure of 15-20 units
  • Drugs such as amphetamine and cocaine
  • Licorice in large amounts

This doesn’t mean it’s imperative to abstain from coffee or alcohol completely; however, if you are a big “user” it may be wise to decrease your intake. On the other hand, it’s always a good idea to completely stop smoking: kicking a smoking habit is excellent for your health in general, not just your blood pressure.

4. Exercise

Regular exercise has been shown to increase blood pressure acutely, but to also somewhat lower blood pressure long-term.27 And, if nothing else, at least you’ll be burning carbohydrate and therefore increasing your carb tolerance.

5. Intermittent fasting

Variable definitions of intermittent fasting and lack of consistent scientific protocols limits the literature on fasting. However, some studies show intermittent fasting is associated with reduced systolic blood pressure.28

This makes sense from a mechanistic perspective as intermittent fasting can reduce insulin and improve weight loss, both of which can improve blood pressure.29

Read more about intermittent fasting and time restricted eating in our medically reviewed guides.

Follow up your blood pressure

When making lifestyle changes, it is helpful to follow your blood pressure regularly. This can be done at your doctor’s office, or even better on your own with the DIY instruments.

Conclusion:

Although the definitions of elevated blood pressure have changed recently, the approach likely remains the same. We should focus on the lifestyle interventions that reverse the root cause of hypertension, and in doing so, also address the metabolic diseases that accompany it. Medications still have a place for severely elevated pressure or pressure that does not improve with lifestyle interventions. However, if we can reverse the underlying cause, that is a much more powerful intervention than masking the symptom.

16:8 Diet, a Form of Intermittent Fasting, May Help You Lose Weight, Study Suggests

To lose weight and boost your overall health, intermittent fasting may hold the key to success. The authors of the research, which was published in the June 2018 issue of Nutrition and Healthy Aging, say their results support prior data that time-restricted eating may improve health markers in various ways.

Unlike previous research, the study specifically focused on participants who are obese. Twenty-three individuals, who on average were age 45 and had a body mass index (BMI) of 35, were included. For 12 weeks, the participants were instructed to eat anything they wanted, but only between the hours of 10 a.m. and 6 p.m. Outside of those hours, they were told to consume only water or calorie-free beverages such as black tea or coffee. The diet is called “16:8,” which refers to the number of hours you fast versus the number of hours you eat.

“The most surprising result we found is even though we told them they could eat whatever they wanted, they had a natural calorie restriction of about 350 calories per day ,” says the lead study author, Kelsey Gabel, RD, a PhD candidate at the University of Illinois at Chicago. Put differently, although researchers didn’t tell participants on the 16:8 diet to limit their caloric intake, on average, they ended up taking in about 350 calories less per day simply by restricting the window of time during which they ate.

RELATED: The Weight-Loss Programs to Try and the Fad Diets to Skip if You Want Results

Participants also shed 3 percent of their body weight and had a 7 percent drop in systolic blood pressure. Fat mass, insulin resistance, and cholesterol were also measured, but these markers didn’t vary between the 16:8 diet group and the control group.

“I think the is something people can do for the long term,” says Gabel. “When people stopped eating all day, I think they became more in tune with their feeding and hunger cues, and stopped eating when they weren’t hungry.”

Another small study, published May 10, 2018, in the journal Cell Metabolism found that early time-restricted feeding lowers the desire to eat in the evening and may also improve health, even if the person doesn’t lose weight.

Who Shouldn’t Try Fasting Diets Like 16:8?

Ali Miller, RD, CDE, an integrative dietitian who was not involved in the study but uses the diet (during a different time window, 12 p.m. to 8 p.m.) in her Houston-based virtual practice, agrees with Gabel that 16:8 is more of a lifestyle change than a temporary diet. But she warns that some people who are considering this lifestyle should proceed with caution.

“If someone is on a very high carbohydrate diet going into the 16:8 approach, they will have higher insulin levels, so they will likely be a candidate for hypoglycemia (low blood sugar),” says Miller. “Same with diabetics who are unmanaged or on high medication, and people who are on diuretic drugs.”

The 16:8 approach is not necessarily off-limits for those individuals, she says, but she recommends they work with a health practitioner for medical monitoring to reduce their medication and maintain the lifestyle.

RELATED: Is Intermittent Fasting Safe for People With Diabetes?

Although the current study findings are promising, especially for individuals hoping to lose weight or lower blood pressure without counting calories, it’s important to be aware of the small sample size. Another limitation of this research is that the subjects’ dietary intake and adherence to the set time frame were self-reported, which means the calorie deficit noted in the paper could be inaccurate.

In the future, Gabel wants to further explore the optimal time frame for the feeding window. People are more insulin resistant as the day goes on, so she’s curious if it’d be more beneficial to have the eating window closer to wake-up time. She’s also interested in finding out whether, if the food window is decreased, patients lose more weight, or perhaps adhere to the diet less closely.

RELATED: What a Fasting Diet Can and Can’t Do for Your Health

Reality is not so kind. Two studies of real-world eaters shed light on which healthy eating strategies actually work in the real world.

  • Skip Paleo. A study in the American Journal of Clinical Nutrition followed 250 people for a year with minimal professional support, allowing them to opt into a Mediterranean food plan, intermittent fasting (two days a week of eating 500-600 calories), or a Paleo plan with a bit of dairy, legumes, and grains. At the end of a year, the Paleo plan had by far the lowest adherence, with just a third sticking to it, and the lowest weight loss, at 4.6 pounds. The Paleo eaters also showed no improvements in blood pressure or blood sugar levels.
  • Intermittent fasting works best. It’s maintainable: 54% of people were still fasting twice a week after a whole year, losing an average of 11.2 pounds, and showing lowered blood pressure.
  • Mediterranean is also a smart choice. Take note: The Mediterranean eaters had the highest adherence rate, at 57%, and lost an average of 10.1 pounds, with improvements in both blood pressure and blood sugar levels.
  • You will not eat healthfully at a restaurant. A study in the Journal of Nutrition of 35,000 people over a 13-year period found that if you walk into a restaurant, your chances of adhering to your healthy eating plan are zero. Specifically, just 0.1% of restaurant meals were of ideal nutritional and dietary quality—and the 1 in 1,000 is probably not gonna be you. On average, Americans get over 20% of their calories from eating out.

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