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BNP – The Best Test for A Failing Heart!

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BNP – The Best Test for A Failing Heart! 

Ronald Grisanti D.C., D.A.B.C.O., D.A.C.B.N., M.S.

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As a reader of YMD News you have learned that elevated fibrinogen, hsCRP, a CT heart scan and homocysteine are among the many known risk factors for progressive heart disease.

It now turns out that there is a blood test that is an even a better indicator than any of these, especially if they are all normal. The test is simple and inexpensive and readily available and reliably shows the level of cardiovascular risk you are at.

For one, this test can show if you need bypass surgery or an implantable defibrillator, and whether even without any symptoms, if you are headed for heart failure.
What is so sad is even the most prestigious medical facilities like Cleveland, Mayo, Johns Hopkins, Harvard, etc. as well as from practitioners who claim to practice alternative, state-of-the-art or advanced medicine rarely if ever check this life-saving test.
start quote Levels over 500 of BNP can predict risk of heart attack 5-8-fold within the next four years.end quote

The test? BNP.

It stands for brain natriuretic peptidemainly because it was first discovered in the brain over 10 years ago. It is actually a hormone made in the ventricles of the heart which is the main pumping muscle of the heart.
It is a well-established marker for the diagnosis of heart failure and a predictor of death in people who have stable coronary disease with no symptoms and are told that they are “doing just fine”

What is most important is there are no drugs that can fix it, only nutrients.

Research shows that people with a level of over 400 are eight times more likely to die in the next 1-5 years than folks with levels under 100 ng/liter.

As noted above, the test is commonly used to diagnose heart failure,  however, it turns out BNP can show if the heart is suffering from ischemia (not enough oxygen delivered to the heart muscle) even though the patient may not be experiencing angina or chest pain or arrhythmia or have any signs of it on EKG, echocardiogram, etc.

No other test comes this close to being as useful a crystal ball since it predicts long and short-term death, independent of other conventional test.

Additional studies show that having a level just over 80 pg/mL of BNP can raise the incidence of death in the next year 5-fold.

And others have confirmed that levels over 500 of BNP can predict risk of heart attack 5-8-fold within the next four years. And rememer this is independent of any other studies, x-rays or blood tests. Remember, these are in people who think they are “stable” and have been told by their cardiologist that they are “doing just fine”.

Even though this crystal ball test has been known for quite a while, cardiologists in general do not use it because (1) first there is no drug to correct it. And the (2) second reason they don’t use it is because they are not trained in the molecular biochemistry of healing/repairing what is causing the problem in the first place.

References:
  • Doust JA, et al, A systematic review of the diagnostic accuracy of natriuretic peptides for heart failure, Arch Intern Med 164:1978-84, 2004
  • Rogers Sherry, Total Wellness, Prestige Publishing, April 2013
  • Mega JL, et al, B-type of natriuretic peptide at presentation and prognosis in patients with ST-segment elevation myocardial infarction: an ENTIRE-TIMI-23 substudy, JAm Coll Cardiol 44:335-9, 2004
  • James SK, et al, N-terminal pro-brain natriuretic peptide and other risk markers for the separate prediction of mortality and subsequent myocardial infarction in patients with unstable coronary artery disease: a Global Utilization of Strategies To Open Occluded Arteries (GUSTO)-IV substudy, Circulation 108:275-81, 2003
  • Kragelund C, et al, N-terminal pro–B-type natriuretic peptide and long-term mortality in stable coronary heart disease, New Engl J Med 352:666-75, 2005
  • Omland T, et al, B-type natriuretic peptide and long-term survival in patients with stable coronary artery disease, Am J Cardiol, 95:24-8, 2005
  • Schnabel R, et al, Analysis of N-terminal-pro-brain natriuretic peptide and C-reactive protein for risk stratification in stable and unstable coronary artery disease: results from the AtheroGene study, Eur Heart J 26:241-9, 2005
  • Schnabel R, et al, B-type natriuretic peptide and the risk of cardiovascular events and death in patients with stable angina: results from the Athero-Gene study, JAm Coll Cardiol 47:552-8, 2006
  • Wang TJ, et al, Plasma natriuretic peptide levels and the risk of cardio-vascular effects and death, New Engl JMed 350:655-63, 2004
  • Kistorp C, et al, N-terminal pro-brain natriuretic peptide, C-reactive protein, and urinary albumin levels as predictors of mortality and cardiovascular events in older adults, JAm Med Assoc, 293:1609-16, 2005
  • Marz W, et al, N-terminal pro-B type natriuretic peptide predicts total and cardiovascular mortality in individuals with or without stable coronary artery disease: the Ludwigshafen Risk and Cardiovascular Health Study, Clin Chem 53; 6:1075-83, 2007
  • Goetze JP, et al, Increased cardiac BNP expression associated with myocardial ischemia, FASEB J 1106; 17:1105-7, 2003
  • D’Souza SP, et al, B-type natriuretic peptide: a good omen in myocardial ischemia? Heart 89:707-9, 2003
  • Ribeiro AL, Natriuretic peptides in acute myocardial infarction, Brit Med J 338:1154-5, 2009
    Tapanainen JM, et al, Natriuretic peptides as predictors of non-sudden and sudden cardiac death after acute myocardial infarction in the betablocking era, JAm CottCar*iol43; 5:757-63, 2004   
  • Oremus M, et al, A systematic review of BNP is a predictor of prognosis in persons with coronary artery disease, Clin Biochem 41:260-5, 2008
  • Bibbins-Domingo K, et al, N-terminal fragment of the prohormone brain-type natriuretic peptide (NT-proBNP), cardiovascular events, and mortality in patients with stable coronary heart disease, JAm Med Assoc 297:169-76, 2007
  • Morrow DA, NACB Writing Group, National Academy of Clinical Bio-chemistry laboratory medicine practice guidelines: clinical characteristics and utilization of biochemical markers in acute coronary syndromes, Circulation 115: e356-75, 2007
  • Weidemann A, et al, Hypoxia, via stabilization of the hypoxia-inducible factor HI F-1 alpha, is a direct and sufficient stimulus for brain-type natriuretic peptide induction, Biochem J, 409:233-42, 2008

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Chiropractic Adjustments Improve Lower Limb Strength

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Chiropractic Adjustments Improve Lower Limb Strength

by Dr. David Graber, Council on Technique & Clinical Excellence Chair

Can Chiropractic adjustments improve athletic performance


A recent study suggests that they can.  Published in the European Journal of Applied Physiology, a single session of spinal manipulation increased muscle strength and corticospinal excitability to ankle plantar flexor (Soleus) muscles in elite Taekwondo athletes. The increased maximum voluntary contraction force lasted for 30 minutes, and the corticospinal excitability increase persisted for at least 60 minutes.

The spinal manipulations were performed by a licensed chiropractor who assessed the function of the entire spine and both sacroiliac joints for segmental dysfunction and performed spinal manipulation where he found it was indicated. The clinical indicators for segmental dysfunction include joint tenderness, restricted intersegmental range of motion, asymmetric intervertebral muscle tension, and abnormal or blocked joint play and end-feel of a joint.

Christiansen, T.L., Niazi, I.K., Holt, K. et al. Eur J Appl Physiol (2018).

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Dr. Lane’s Thoughts X

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1.  I was married before my wonderful wife to a woman who more closely matched my background.  She was Jewish andeducated, working in the school system of a major NJ city.  While we had problems that led to a divorce soon after we married, the most odd part of being together was her father – an Israeli loudmouth with unfiltered opinions about everything.  


He simply felt that if you invited him to your home it was because you wanted to hear his opinions and if you went to his house it was because you wanted to hear his opinions.  Everyone was a prisoner of his conservative views on other races, Israel (his homeland), the military, and his very strange recollection about his life which seemed to encompass  every major events in the USA and Israel for the previous 55 years – if it happened, he was there and he did everything.


And what did he have opinions about?  Mostly “coloreds” [for those not from the USA, this is an ancient term to refer to black people.  Only people over 70 years old would ever want to speak like this], where he felt they all lived (Newark, NJ)  and their impact on his local town’s economy (very negative since he felt that his taxes paid for black people’s welfare in another city where he did not live).  He never saw people advancing or the world changing for the better; this is despite spending 33 years as a public school teacher in a city in New Jersey


I was always amused about how he stated that he previously spoke Italian because he lived in Ethiopia.  He spoke no Italian that we knew of and the last time Ethiopia had a population of Italian speakers in was 1945-46 when they were occupied by the Axis forces in World War 2.  This timeframe was roughly the time of my ex-FIL’s birth.  I guess the Israeli army may have been stationed there in the late 1960s but it is doubtful that he had any reason to learn Italian.


My ex-FIL has a condition that psychologists refer to Munchausen Syndrome – factitious disorder imposed on self is associated with severe emotional difficulties. This is a condition named after Baron Munchausen who was a an 18th century German officer who was known for embellishing the stories of his life and experiences—is the most severe type of factitious disorder.  In many cases it can lead to your children being diagnosed as depressives or with social phobias.  I would think that it would lead to embaressment due to explaining to others about your atypical exaggeration and embellishment of your life and activities.  Kids see through other kids’ parents because they have nothing at stake in helping to maintain the pretense.  


People who suffer from this condition also need to dominate conversations and to use any group as a captive audience for the outlandish stories.


It was probably, also, the excessive time my ex-wife had us visiting with her parents that factored into the doom of our marriage.  There is a limit to how much time you want to spend with a bigoted know-it-all and this guy had us there many times a month for every Jewish holiday, and every family celebration – meaning 2-3 times a week.  That sounds nice on the surface but became overbearing as married life sunk in for myex- wife and me.


You need those first years to establish your marriage with each other, not to establish your slavish relationship with in-laws who should not be a major factor in your lives.


In addition, he and my ex-MIL would mock my professional credentials and my profession as a chiropractor referring to me as “not a REAL doctor” which meant a medication-writing MD or DO.  Tolerating this barrage was a part of my married life but when it was combined with the twice-weekly visits (that could not be avoided) I cringed every time my wife would tell me about our next obligation to see them.


My divorce decree specifically mentioned that I was never to write about her by name or mention her psycho-medical issues.  I think it is clear that I have not done that except in the vaguest terms.  I feel sympathy for her that even at an advancing age she still lives under the thumb (or fear) of her father and his mental problems.


For the last 2 yearsI have been married to another woman whose parents celebrate me as a blessing to their family.  They also live in another country and don’t speak English.  Even my wife’s ex-husband is a part of our family life and often comes over for events around their daughters and for family holidays like Thanksgiving and Christmas.


2) Once of the worst problems to live with emotionally is being poor.  I am talking about being part of the “working poor” who make money but never enough to be comfortable.  It is a sickening feeling to not be able to treat your friends to coffees, contribute to a good cause, or share in other peoples’ experiences with a contribution.  You are considered “cheap” but it is the inhumane life of having to make choices between buying health insurance each month or meeting your car payment.  


It is hard to be judged as being “unworthy” by someone you are interested in because your job doesn’t pay well enough or you are unable to find employment despite training and degrees.  Life goes on and you are trying to get some kind of hold on something worthwhile that uses your skill set.


It drains your soul, empties your humanity, and robs your sense of self.


I knew plenty of people who were “pretend” poor – they had low-paying jobs but parents who paid for all of their expenses from a car and insurance to rent or home purchase.  On paper they made $14K but they lived the life of a person making $60K.  They qualified for low-income health insurance, subsidies for heat and other utilities, and low-income loans.  They saw no problem in accepting these handouts meant for people in much more desperate situations.


People making a (barely-sufficient) $20K were not eligible for these same subsidies and probably had jobs that were much more demanding with stricter rules to follow.


As an aside, did you know that Walmart gives out employment applications along with forms for applying for Medicaid and food stamps since they know that the people they hire will never be eligible for company-sponsored health insurance due to insufficient hours at minimum wage.


3)  Everyone wants an incredible revelation about weight control; they want a thunderous moment where science and discovery come together to create the answer to getting and maintaining a healthy weight.  There is nothing like that and there never will be.  Sorry.


What there is out there will eb summed up here.


Food choices


Portion control


Exercise.


If you can’t control for one of these then you have to do more of the other two.


If you can’t exercise much then you need to make better food choices and eat less.


If you can’t control what you can find to eat because you are never home to make healthy food then you need to eat less of the food you find or find lower-calorie choices when you can.


If you can’t control your portion size or find time to exercise then you need to choose better food.


I am a normal human male who has used this formula with success.  You can also. 😊


4) Our president Trump is not only a shameless egomaniac but surrounds himself solely with people who agree with him.  His hiring practices seem to indicate loyalty is his only criteria for his staff.  Ignorance and the shameless disregard of facts and information is an acceptable means to keep your job as long as you display strict loyalty.  The American people pay for these people to work with Trump.


5) The replacement of reading by video has cost the American people any semblence of coherent conversational skills along with the loss of any knowledge of sentence structure or syntax.  Poor communication skills can only lead to misunderstanding (ask anyone who is learning to talk in a different language – the right word has to be said the right way or antagonism will occur).


6) If I have no written about it enough – I love working with patient population of federal license holders who need medical exams.  This means CDL holders (truckers and bus drivers mostly), pilots, railroad workers, andheavy machinery operators.  These are the heart of the USA and the decent people who reflect the real America that the rest of the world may never see.

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Is it more difficult for an older person to lose weight? (NYT 2/1/2018)

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Is it more difficult for an older person to lose weight?
A. Yes, unfortunately. Although it is possible to lose weight at any age, several factors make it harder to lose weight with age.
Even those who remain active lose muscle mass every decade beginning in their 30s, research suggests, replacing it with fat. Muscles use up more calories than fat, so less muscle means a slower metabolism and the need for fewer calories, said Dr. Medha Munshi, a geriatrician and endocrinologist at Beth Israel Deaconess Medical Center in Boston.
Declining levels of the sex hormones estrogen and testosterone, which typically start around the early 50s for women, with the onset of menopause, and somewhat later for men, compound the effect, said Dr. Munshi, who also directs the Joslin Diabetes Center’s geriatric diabetes programs.
People may also pay in late-middle age for weight they gained and lost in earlier decades, said Dr. Leslie Cho, an interventional cardiologist at the Cleveland Clinic. Weight gain changes metabolism, she said. A 60-year-old who now weighs 200 pounds but once weighed 300, for example, will need far fewer calories per day than someone of the same age and size who was never so overweight. Losing those fat cells, she explained, tricks the body into thinking it is starving and needs to hold on more tightly to calories consumed. “You do have to eat less to maintain that weight if you’ve been heavy,” said Dr. Cho, who also directs the Cleveland Clinic’s Women’s Cardiovascular Center.
Older people also tend to have more aches and pains and to be more sedentary, engaging in fewer physical activities.

Instead of obsessing about a number on a scale, Dr. Cho suggests that older people focus on general fitness. “It’s not about losing weight,” she said. “It’s about maintaining weight loss, but also about healthy eating and lifestyle.”
Adding muscle through weight training can also help speed up metabolism, or at least compensate somewhat for its decline, Dr. Munshi said. She tells her older patients that “you need it now more than you needed it at 25.” Eating more protein — but not more calories — may also help build or sustain muscle, she said. And she noted that many of her oldest patients end up underweight because they’ve lost their appetite along with their sense of smell, so food doesn’t seem appealing anymore.

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Increasing Intake of Vitamin D May Ease Irritable Bowel Syndrome: 4 Vitamin D Rich Foods

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Increasing Intake of Vitamin D May Ease Irritable Bowel Syndrome: 4 Vitamin D Rich Foods 


Facing trouble with your bowel movement? Regular consumption of Vitamin D could help ease irritable bowel syndrome says a study. Irritable bowel syndrome or IBS is fast emerging to be one of the most common disorders faced by the urban settlements


IBS is an intestinal disorder causing pain in the stomach, gas, diarrhea and constipation.The chronic and relapsing and functional disorder of the gastrointestinal (GI) tract not only takes a toll on your bowel movement but your daily life. 

Low Vitamin D status is common among the IBS population, revealed the  researchers on basis of previous evidence. 


Lack of vitamin D has also been linked to the risk of colorectal cancer and inflammatory bowel disease.


According to researchers upping the intake of Vitamin D may help soothe those who have been suffering from the condition. Eating Vitamin D supplements may help ease symptoms which can include abdominal pain, bloating, diarrhea and constipation, the paper noted. 
Vitamin D was also shown to have the most benefit on quality of life in IBS patients, the study showed.


“It is evident from the findings that all people with IBS should have their Vitamin D levels tested and a large majority of them would benefit from supplements,” said lead Bernard Corfe, from the University of Sheffield.


“IBS is a poorly understood condition which impacts severely on the quality of life of sufferers.There is no single known cause and likewise no single known cure,” Corfe added, in a paper published in the European Journal of Clinical Nutrition.

For the study, the team reviewed seven studies: four observational studies and three randomised controlled trials on the relation between Vitamin D and IBS.


Vitamin D refers to a group of several different forms of this vitamin. It is also popularly known as the sunshine vitamin. Since exposure to sun is one of the best sources of Vitamin D. Vitamin D is essential for general well-being, including bone health, immune function, mental health as well as gut health. 


In addition to supplements you can also have your dose of natural sources of Vitamin D in these foods. 

1. Mushrooms: Some studies suggest that including mushrooms in your diet four times a week may shoot up your Vitamin D levels. Mushrooms can naturally produce Vitamin D when exposed to sunlight.

2. Soy milk: Soy milk is a plant-based milk produced by soaking dry soybeans and grinding them with water. While it contains the same amount of protein as regular cow’s milk it boasts of high Vitamin D, Vitamin C and iron.

3. Fatty fishAll kinds of fish are high on Vitamin D. Typically oily or fatty fish contain more Vitamin D than less oily fish. Try salmon, mackerel, eel or tuna. 

4. EggsSince the vitamin D in an egg comes from its yolk, it’s important to use the whole egg–not just the whites. 

There are very few natural food sources of Vitamin D, so make the most of them.

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Breastfeeding May Halve Diabetes Risk in Women

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Breastfeeding May Halve Diabetes Risk in Women

Women who breastfed for at least 6 months across all births reduced their risk for type 2 diabetes throughout their childbearing years by almost half compared with those who did not breastfeed, a 30-year study has found.
“We found a very strong association between breastfeeding duration and lower risk of developing diabetes, even after accounting for all possible confounding risk factors,” lead author Erica P. Gunderson, PhD, senior research scientist at the Kaiser Permanente Division of Research in Oakland, California, said in a news release.
“The incidence of diabetes decreased in a graded manner as breastfeeding duration increased, regardless of race, gestational diabetes, lifestyle behaviors, body size, and other metabolic risk factors measured before pregnancy, implying the possibility that the underlying mechanism may be biological,” she explained.
Dr Gunderson and colleagues published their findings online January 16 in JAMA Internal Medicine.

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High Lipoprotein(A) Is Often the Culprit in “Young” Heart Attacks

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High Lipoprotein(A) Is Often the Culprit in “Young” Heart Attacks

While doctors routinely test for other lipoproteins like HDL and LDL cholesterol, few test for lipoprotein(a) [ lp(a)]a fatty particle in the blood, which can triple the risk of having a heart attack or stroke at an early age. 

For most people, lp(a) is nothing to worry about. Levels are strongly determined by genetics and the majority of people produce very little of it.
But up to one in five Americans have perilously high levels of it in their blood. Studies show that diet and exercise have almost no impact on lp(a), and cholesterol-lowering drugs only modestly lower it.

“People don’t know about it, physicians don’t know about it, and we have to get an education program out there, but that’s expensive,” said Dr. Henry N. Ginsberg, the Irving Professor of Medicine at Columbia University and a leading expert on lp(a). “I would say that somewhere between 15 to 20 percent of the population would clearly benefit from knowing that this is their problem.”

Lp(a) was discovered in 1963 by a Norwegian scientist, Kare Berg, who noticed that it was especially common among people with coronary heart disease. No one knows precisely what purpose lp(a) serves in the body, though some scientists speculate that it may have a beneficial role such as helping to repair injured cells or preventing infections by binding to pathogens in the blood.

But the downside of excessive lp(a) is clear: It accelerates the formation of plaque in the arteries, and it promotes blood clots.

Studies suggest that the threshold for high lp(a) begins around 30 milligrams per deciliter of blood. Heart disease risk jumps for those in the 80th percentile, with lp(a) levels above 60, and climbs sharply for the 5 percent of the population with lp(a) levels between 150 and 300, according to Dr. Ginsberg at Columbia. “Those people can be disasters in terms of cardiovascular risk,” he said.

Yet many people at high risk do not fit the typical profile of a person with heart disease. Sandra Revill Tremulis was a health-conscious medical device executive who moonlighted as an aerobics instructor, followed a strict diet, and maintained 16 percent body fat, equivalent to that of an elite athlete. Her LDL and total cholesterol levels were low, and at age 39, her Framingham risk score, which gauges heart disease risk, put her odds of having a heart attack in her 40s at just 1 percent.

“Only a small percentage of physicians know about this,” she said. “The biggest challenge for patients is finding knowledgeable physicians who know about this and can help them.”

Dr. Lloyd-Jones at Northwestern said that testing for lp(a) should be considered for people with early-onset cardiovascular disease — which means younger than age 50 for men and age 60 for women — or a strong family history of it. Since high lp(a) is hereditary, those who have it often have a parent, sibling or grandparent who suffered a premature heart attack or stroke. When one person has it, it’s important to test other family members too.

Two medications, niacin and a class of drugs known as PCSK9 inhibitors, have been shown to modestly reduce lp(a) levels. But niacin, a B vitamin, has many side effects, and PCSK9 inhibitors, which are not approved for lp(a) lowering, are not usually covered by insurance for that purpose and can cost as much as $14,000 a year.

At least one drug company, Ionis Pharmaceuticals, is developing a drug specifically to combat lp(a), but the drug is still in mid-stage testing and it could be years before it reaches the market.

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Oleg Frank, MD: A Good Doctor to see in Newark, NJ

I have been asked to suggest a good doctor in Newark, NJ that my patients can see if they do not have insurance.  


I recommend Dr. Oleg Frank (yes, he speaks Russian but he has lived in the USA since he was 3 years old)


Oleg Frank, MD
40 Ferry Street
Newark, NJ 07105


973-344-4470


This is the only doctor that I send my patients to where the patient THANKS ME for suggesting him!  That almost never happens with anything else I do!

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BEST DIETS: U.S. News and World Report

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BEST DIETS: U.S. News and World Report

The best overall diets include the Flexitarian diet, Weight Watchers, MIND diet, TLC diet and Volumetrics.
The theme you can see here is that DASH and Mediterranean are the best diets overall!
The Flexitarian diet is a mostly meatless plan that emphasizes plant-based foods. Weight Watchers focuses on healthy eating, with point values assigned to foods and a daily point limit. TLC stands for therapeutic changes for high cholesterol; followers exercise more and lower saturated fat. The MIND diet combines parts of the DASH and Mediterranean diets and aims to improve brain health.
Best commercial diets: Winners include Weight Watchers and Jenny Craig for first and second. Jenny Craig provides low-calorie packaged foods and consultant support. The Flat Belly diet and Nutritarian tied for third. The Flat Belly plan focuses on eating healthy, with monounsaturated fats such as from olive oil and nuts and setting a 1,600-calorie daily limit. The Nutritarian diet emphasizes a plant-based plan with ”anti-cancer super foods.”
Best weight loss diets: Winners were Weight Watchers, Volumetrics, Jenny Craig, Vegan, and Flexitarian. Volumetrics focuses on eating foods that fill you up, such as broth-based soups, fruits, and non-starchy vegetables such as tomatoes and mushrooms.
Best fast weight loss diets: Winners are the HMR diet, Weight Watchers, Biggest Loser, Medifast, SlimFast and Volumetrics. The HMR diet is a low-calorie plan with meal replacement shakes that focuses on fruits and vegetables. The Biggest Loser includes eating regular meals with lean protein, fruits, and vegetables and keeping a food journal. Medifast starts with five meal replacements a day and one meal, with more meals phased in as weight is lost. SlimFast is a program of meal replacement shakes.
Best diets for healthy eating: Winners: DASH, Mediterranean, Flexitarian, TLC, Mayo Clinic, MIND, Volumetrics, and Weight Watchers. The Mayo Clinic diet focuses on healthy lifelong eating.
Easiest to follow: Mediterranean, Flexitarian, Weight Watchers, DASH, and MIND.
Best for diabetes: After the two first-place winners, DASH and Mediterranean, came the Flexitarian, Mayo Clinic, Vegan, Volumetrics, and Weight Watchers diets.
Best for heart disease: DASH claimed the top spot, followed by Mediterranean and Ornish (tie for second) and TLC. Flexitarian, MIND, and Vegan tied for the fifth spot. The Ornish diet ranks foods from healthiest to most indulgent, encouraging followers to emphasize the foods from the healthiest group.
Best plant-based diets: The top five are the Mediterranean, Flexitarian, Ornish, Vegetarian, and Traditional Asian diets. The Traditional Asian plan includes low-fat eating with little red meat and plenty of fresh fruits, fish, and vegetables.

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