Heart in Diabetes

Heart in Diabetes


Taub PR. Contemporary diets in the prevention of cardiovascular disease. Presented at: Heart in Diabetes Annual Meeting; Sept. 10-12, 2021 (hybrid meeting).

Disclosures: Taub reports no relevant financial disclosures.
September 11, 2021
3 min read

Plant-based diets, time-restricted eating provide cardiometabolic benefits


Taub PR. Contemporary diets in the prevention of cardiovascular disease. Presented at: Heart in Diabetes Annual Meeting; Sept. 10-12, 2021 (hybrid meeting).

Disclosures: Taub reports no relevant financial disclosures.
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Eating a balanced, plant-based diet and practicing time-restricted eating can provide cardiometabolic benefits and may reduce the risk for cardiovascular disease, according to a speaker at the Heart in Diabetes CME Conference.

Pam R. Taub, MD, FACC, founder and director of Step Family Cardiac Wellness and Rehabilitation Center and professor of medicine at UC San Diego Health, discussed the importance of evidence-based diet recommendations with an emphasis on eating nutrient-dense whole foods and time-restricted eating with an overnight fasting interval.

“The problem with diet, it’s an area where there are a lot of claims without substantiated science to back it up,” Taub told Healio. “It’s important that we are focused on giving our patients evidence-based recommendations.”

Importance of balanced diet

Taub noted there is a variety of evidence-based diets that have their own unique characteristics. However, many of these diets also share common features. Using the Barnard, Pritikin, Ornish and Esselstyn diets as an example, Taub said all four center on fruits, vegetables, whole grains and legumes and avoid foods with added sugars. She advised health care professionals to focus on these common features.

“The cornerstone of one’s diet should be plant-based with vegetables and fruits, and avoidance of processed foods and red meats,” Taub said. “For carbohydrates, whole grains are a good way to obtain them.”

Eating a balanced diet is also key. Taub said multiple food groups should be incorporated into an eating pattern rather than focusing on a single food group. Evidence suggests the Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets provide the most CVD prevention, but health care professionals should allow a diet to be tailored based on a person’s cultural background.

The number of calories a person consumes will vary based on several factors, including age, sex and physical activity level. Generally, a diet should include 1,500 kcal to 2,000 kcal per day, with a focus on nutrient-dense foods.

Benefits of time-restricted eating

Timing of eating is also an element of a healthy diet. Taub said the term “intermittent fasting” is typically used to describe any type of fasting, such as alternate-day fasting, fasting for 2 days of the week or periodic fasting. These types of fasting are different, however, and some do not have evidence-based benefits.

Studies suggest one type of intermittent fasting may provide several cardiometabolic benefits. For a study published in Cell Metabolism in 2019, Taub and colleagues enrolled adults with metabolic syndrome to engage in a 10-hour time-restricted eating window for 12 weeks. In the study, time-restricted eating was associated with reductions in body weight, blood pressure, cholesterol and HbA1c. Participants also improved their sleep quality with time-restricted eating.

“Because you’re aligning eating with your body’s circadian rhythm, it makes good physiological sense, and there aren’t side effects or adverse events that we’ve seen in our studies on time-restricted eating,” Taub said.

When it comes to determining how long an eating window should be, Taub recommended identifying an eating pattern that can be sustained long term. Time-restricted eating can be incorporated around a person’s lifestyle and adjusted to where they can be comfortable while also receiving health benefits.

“There’s a lot of flexibility around these eating windows,” Taub said. “It’s not that you’re locked into a 10-hour eating window each day, you can modify it based on your schedule.”

Fasting may reduce the risk for CVD based on changes in trimethylamine N-oxide (TMAO) levels. Studies indicated that people with high TMAO levels have an increased risk for major adverse CV events. Animal-based diets have also been associated with higher TMAO levels, whereas plant-based diets lower TMAO. Taub said fasting may lead to further reductions in TMAO.

“There are some preliminary studies looking at what fasting can do to TMAO levels,” Taub said. “Small studies need to be evaluated in larger cohorts, but with fasting, there seems to be a decrease in TMAO levels, suggesting that fasting is having some beneficial impacts on a biomarker that is associated with CV risk.”