Overall diet quality key to heart health

 

A healthy, balanced dietary pattern, rather than one focused on individual nutrients or foods is key to maintaining heart health, according to a Scientific Statement issued by the American College of Cardiology and published in JACC, its flagship journal. Diets should include minimally processed plant-based foods and healthy fats and proteins, while limiting foods high in refined starches, added sugars, sodium or unhealthy fats, as well as highly processed foods of poor nutritional quality.

“Suboptimal diet is a key risk factor for cardiovascular disease (CVD), and diet and lifestyle modification is widely considered essential for both primary and secondary prevention,” said Frank B. Hu, MD, PhD, Professor and Chair of Department of Nutrition at Harvard T.H. Chan School of Public Health and Chair of the Scientific Statement. “However, the concept of a ‘heart-healthy’ diet has evolved over time from nutrient-centric approaches to more holistic, food- and pattern-based strategies that better reflect advances in the understanding of the complex relationship between diet and cardiometabolic health.”

Recently, guideline recommendations have shifted from individual nutrients to overall dietary patterns, with strong evidence supporting a variety of healthy dietary patterns, including the Mediterranean diet and dietary approaches to stop hypertension (DASH) diet. These patterns generally emphasize vegetables, fruits, whole grains, nuts, legumes, healthy protein sources, and unsaturated fats for lowering risk of CVD.

This Scientific Statement reviews current evidence on nutrition and cardiovascular health, including macronutrients, micronutrients, dietary patterns, ultra-processed foods and emerging nutrition-based interventions, and offers consensus recommendations on incorporating food and health into clinician/patient discussions on preventing and managing heart disease.

The consensus recommendations include:

• Diet and nutrition play a central role in preventing and managing cardiovascular kidney metabolic syndrome, which includes interconnected conditions such as CVD, diabetes, obesity and chronic kidney disease, with emphasis on plant-forward eating patterns, lower sodium intake and limiting highly processed foods of poor nutritional quality.
• Access to healthy foods, affordability and other social drivers of health significantly affect diet quality. Food security should be considered across four domains: availability, affordability, accessibility and utilization of nutritious foods.
• Cardiovascular risk is driven less by the percentage of carbohydrates, fats or protein consumed and more by overall nutrition quality, food sources and degree of processing.
• Current evidence supports replacing saturated fats with unsaturated fats, particularly from sources like liquid plant oils, nuts, seeds and fish, and prioritizing whole grains and other high-fiber food. Foods high in saturated fat, refined starches and added sugars should be limited.
• Make beverage choices that support cardiovascular health by prioritizing water and other unsweetened beverages and limiting sugar-sweetened beverages. Moderate consumption of coffee or tea can be part of a healthy dietary pattern. Alcohol consumption should generally be limited or avoided.
• GLP-1 receptor agonists can produce significant weight loss and cardiovascular benefits, but a nutrient-rich, high-quality diet remains important during treatment. Adequate intakes of protein, fiber, vitamins and minerals are essential for maintaining overall health and preventing nutritional deficiencies.
• “Food Is Medicine” programs that provide nutritious food as clinical interventions can improve diet quality, with growing evidence of benefits for clinical outcomes. Successful implementation will require integrating these programs into health care systems and developing sustainable approaches across diverse settings.

“Ultimately, heart-healthy eating is not about focusing on a single nutrient or food or following the latest dietary trend,” Hu said. “What matters most is the overall quality of the diet—a consistent pattern of healthy food choices that supports cardiometabolic health and is sustainable over time.”

Sugar amplifies damage done to gut health by antibiotics

 

Eating sweets while taking antibiotics may worsen the harm done by the drugs to the normal community of bacteria in the gut, a new study found.

The work centers on the intestinal microbiome, which harbors bacterial species that co-evolved with humans to live in the digestive tract, help digest food, and support the immune system. Antibiotics, among the most prescribed drugs globally, are known to eliminate helpful bacteria alongside harmful species, in some cases letting harmful ones dominate. 

The microbiome is more capable of resisting the buildup of harmful pathogens when natural species diversity is in place, but antibiotics reduce diversity in ways that make the gut more vulnerable to disease, the study authors said.

Led by researchers from NYU Langone Health, City of Hope, and Memorial Sloan Kettering, the study precisely tracked every food item in 9,419 meals eaten by 173 hospitalized cancer patients and then measured their gut microbiome changes. The team found an additional 21% reduction in alpha diversity, a measure of the variety of helpful bacterial species present, for every 100 grams of sugar consumed in the 48 hours before treatment.  

Publishing online Sept. 30 in the journal Nature, the work also showed how the combination of a sugary diet and antibiotic treatment caused blooms in patients of the bacterial species Enterococcus faecium, which has been linked to hard-to-treat infections. Experiments in mice confirmed this pattern, wherein exposure to the antibiotic biapenem and dietary sucrose drove a 16.3-fold increase in the Enterococcus population in the gut by day 3 of the study, and 33.4-fold higher burden by day 6.

“As we are learning how collateral damage of antibiotics to the microbiome are linked with long-term health problems, it’s important to identify factors that limit these unintended health risks,” said the study’s co-senior author Jonas Schluter, PhD, assistant professor in the Department of Microbiology at NYU Langone. “Our study, which used more than 9,000 recorded meals, suggests that modifying diet during and after antibiotics, specifically by reducing sweets intake, could help with that.”

The research team studied patients with blood cancers because they receive antibiotics frequently and precisely tracking food intake is feasible during hospitalization. The researchers recorded patient diets at every meal and collected microbiome samples daily, making the study among the largest and highest-resolution of its kind to date.

"The microbiome is emerging as an important factor in cancer care", said co-senior study author Marcel van den Brink, MD, PhD, chief physician executive at City of Hope. "For patients undergoing intensive treatments such as bone marrow transplantation, the healthy diversity of the gut microbiome can have important implications for outcomes. Studies like this help us better understand how everyday factors, including diet, may affect a delicate balance that influences how patients respond to treatment, recover and experience side effects."

Patients with blood cancers who undergo stem cell transplantation are typically hospitalized for several weeks, during which they receive both chemotherapy and antibiotics. During this time, they show drastic changes in nutrition as well as severe damage to their microbiomes. In these patients, harmful bacterial species like Enterococcus faecium often thrive because the rest of the gut ecosystem has been “destroyed.”

“Especially in blood cancer patients, microbiome injury is associated with worse outcomes, including higher overall mortality and infections,” said Jonathan Peled, co-senior author on the study and associate director of the Center for Hematological Malignancies at Memorial Sloan Kettering Cancer Center. “An important next step will be to design clinical trials to test whether short-term dietary changes can improve clinical outcomes in patients.”

“The new work identifies dietary sugars as an amplifier of antibiotic-induced microbiome disruption, probably because the potentially harmful bacteria that survive the antibiotics are benefiting from the dietary sugars that they can use to expand,” said study second author William Jogia, a PhD student in Dr. Schluter’s lab in the Institute for Systems Genetics. “While the findings suggest that reducing simple sugars may limit microbiome injury, whether sugar directly supports Enterococcus, weakens competing bacteria, or acts through another mechanism in patients remains to be seen.”

High-intensity walking can reverse frailty more effectively than casual-speed walking

 Interventions to reduce frailty and promote healthy aging are critical to improving quality of life and reducing disability in older adults. Walking is the most common form of exercise among older adults; however, the optimal walking intensity for prefrail and frail adults remains unclear. We conducted a cluster-randomized, assessor- and participant-blinded trial to determine whether high-intensity walking (HIW) improves frailty more than casual-speed walking (CSW). Fourteen retirement communities were randomized to either HIW or CSW using a modified minimal sufficient balance randomization scheme. We recruited 165 prefrail and frail adults aged ≥60 years, of whom 105 were included in the analytic cohort. Participants were able to ambulate at least 10 feet with moderate assistance or less.  This cluster-randomized trial demonstrates that high-intensity walking can reverse frailty more effectively than casual-speed walking due to increased physiologic stimuli during more intensive activity.

Full study

Digital menstrual tracking risks creating more harm than benefit

 

Digital menstrual tracking risks creating more harm than benefit and requires greater scrutiny, warn experts in The BMJ today. 

Widely promoted to women and girls on social media and by tech firms, menstrual tracking apps and other “femtech” tools claim to scientifically analyse personal data to improve health, wellbeing, and performance based on a user's menstrual cycle. 

But Katharine Lee and colleagues argue that neither menstrual tracking nor "cycle syncing" - adjusting diet and exercise according to menstrual cycle phases - have been convincingly shown to improve health or other performance measures. 

And they say the slick marketing of digital menstrual cycle tracking apps and the scientifically suspect practice of cycle syncing “require critical interrogation and resistance.”

For example, decades of sports science research shows no overall effect of menstrual cycle phase on performance, injury risk, or health, and any effects found have been trivial and highly individualised. Research on phased based dietary interventions to reduce menstrual cycle symptoms or improve performance is also generally inconclusive, highly individualised, or speculative.

Even if menstrual phase corresponded with fluctuations in health, performance, or vulnerability to injury in individuals, simple digital tracking technologies cannot reliably predict such variation, they explain.

Aside from their weak evidence base, digital cycle tracking technologies also come with serious risks, they write, including wasted time and labour, unwanted surveillance, risks to health data privacy, and may distract from or even threaten efforts to advance women’s health.

“These apps have the potential for widespread impact on the wellbeing of women and girls. Yet, the evidence that these digital tools can actually help in the management of menstrual conditions, boost health, and provide insights into exercise and nutritional needs is lacking,” they warn.

Suggestions to address the risks of digital tracking include strengthening protections for consumer and employee data, improving user awareness of how data are used, and advising clinicians to recommend apps to patients only when they meet stringent standards.

Others have emphasised the need to regulate misleading marketing and resist the commercial co-option of feminist activist rhetoric.

Tailoring health communications approaches to the social media environments where users encounter cycle syncing content may offer an opportunity to build the public’s trust in more credible sources and counteract misleading narratives about hormones and health, they note.

Meanwhile, health practitioners, regulators, and the general public must be aware of and work to address the risks of these consumer technologies on women’s health, they conclude.

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Journal

The BMJ

DOI

10.1136/bmj-2026-100858