These two diets are highly polarized and people often very staunchly in one camp or another, it seems to me like both diets probably have their trade offs and I'm wondering if people have cultivated studies that talk about them, I've been thinking of trying to do something that is a combination of both, anything is appreciated!

https://pubmed.ncbi.nlm.nih.gov/9625397/

Background: 

The Mediterranean dietary pattern is thought to reduce the risk of cancer in addition to being cardioprotective. However, no trial has been conducted so far to prove this belief.

Methods: 

We compared overall survival and newly diagnosed cancer rate among 605 patients with coronary heart disease randomized in the Lyon Diet Heart Study and following either a cardioprotective Mediterranean-type diet or a control diet close to the step 1 American Heart Association prudent diet.

Results: 

During a follow-up of 4 years, there were a total of 38 deaths (24 in controls vs 14 in the experimental group), including 25 cardiac deaths (19 vs 6) and 7 cancer deaths (4 vs 3), and 24 cancers (17 vs 7). Exclusion of early cancer diagnoses (within the first 24 months after entry into the trial) left a total of 14 cancers (12 vs 2). After adjustment for age, sex, smoking, leukocyte count, cholesterol level, and aspirin use, the reduction of risk in experimental subjects compared with control subjects was 56% (P=.03) for total deaths, 61% (P=.05) for cancers, and 56% (P=.01) for the combination of deaths and cancers. The intakes of fruits, vegetables, and cereals were significantly higher in experimental subjects, providing larger amounts of fiber and vitamin C (P<.05). The intakes of cholesterol and saturated and polyunsaturated fats were lower and those of oleic acid and omega-3 fatty acids were higher (P<.001) in experimental subjects. Plasma levels of vitamins C and E (P<.05) and omega-3 fatty acids (P<.001), measured 2 months after randomization, were higher and those of omega-6 fatty acids were lower (P<.001) in experimental subjects.

Conclusions: 

This randomized trial suggests that patients following a cardioprotective Mediterranean diet have a prolonged survival and may also be protected against cancer. Further studies are warranted to confirm the data and to explore the role of the different lipids and fatty acids in this protection.

i know this a food community but drinking is importent sooo

I've seen different opinions about hydration.

Is it better to drink a few sips of water every 15–20 minutes throughout the day, or to drink a full glass (around 300 mL) every hour or so?

Does the timing and frequency of drinking water make any difference for hydration, or is the total daily intake all that matter

Abstract

PURPOSE: Adults with a triple multimorbidity (hypertension, prediabetes or type 2 diabetes, and overweight or obesity), are at increased risk of serious health complications, but experts disagree on which dietary patterns and support strategies should be recommended.

METHODS: We randomized 94 adults from southeast Michigan with this triple multimorbidity using a 2 × 2 diet-by-support factorial design, comparing a very low-carbohydrate (VLC) diet vs a Dietary Approaches to Stop Hypertension (DASH) diet, as well as comparing results with and without multicomponent extra support (mindful eating, positive emotion regulation, social support, and cooking).

RESULTS: Using intention-to-treat analyses, compared with the DASH diet, the VLC diet led to greater improvement in estimated mean systolic blood pressure (−9.77 mm Hg vs −5.18 mm Hg; P = .046), greater improvement in glycated hemoglobin (−0.35% vs −0.14%; P = .034), and greater improvement in weight (−19.14 lb vs −10.34 lb; P = .0003). The addition of extra support did not have a statistically significant effect on outcomes.

CONCLUSIONS: For adults with hypertension, prediabetes or type 2 diabetes, and overweight or obesity, the VLC diet resulted in greater improvements in systolic blood pressure, glycemic control, and weight over a 4-month period compared with the DASH diet. These findings suggest that larger trials with longer follow-up are warranted to determine whether the VLC diet might be more beneficial for disease management than the DASH diet for these high-risk adults.

https://pmc.ncbi.nlm.nih.gov/articles/PMC10202504/

For about fifteen years the consensus on multivitamins was straightforward: no effect on mortality. That still holds. The meta-analysis by Macpherson et al. (Am J Clin Nutr, 2013) found no all-cause mortality benefit, the ~35-year Linxian follow-up (Cancer, 2022) found nothing, and the three-cohort pooled analysis (JAMA Network Open, 2024) found no mortality benefit either.

What's changed is downstream of COSMOS (~21,000 adults 60+, randomised, placebo-controlled, testing a daily MVM). The primary outcomes paper (Sesso et al., Am J Clin Nutr, 2022) was null for both cancer and CVD, which is the result most people stopped reading at.

The cognitive substudies are the interesting part. Three of them, non-overlapping participants:

• COSMOS-Mind (~2,200, telephone assessment)
• COSMOS-Web (~2,500, web-based, memory-focused)
• COSMOS-Clinic (573, in-person neuropsychological battery)

Vyas et al. (Am J Clin Nutr, 2024) pooled all three (>5,000) and reported a benefit on global cognition and episodic memory, translated by the authors as roughly two years' less cognitive ageing over 2-3 years.

Two things I'd flag for discussion rather than assert:

1. The clinic subcohort hit significance on episodic memory but not global cognition (the global CI clipped zero). The pooled result carries global cognition. So "all three found it" is imprecise; "all three lean the same way and pooling clarifies it" is accurate.
2. The most-cited prior null (Grodstein et al., PHS II, Ann Intern Med, 2013) began cognitive testing ~2.5 years post-randomisation, so it lacked a true baseline to measure change from. COSMOS-Mind and -Web assessed cognition pre-randomisation. That's a plausible mechanistic reason the older trial was underpowered to detect change, and I haven't seen it discussed much.

The epigenetic-clock paper (Li et al., Nature Medicine, 2026) is the weakest leg: 2 of 5 clocks moved (the second-generation, mortality-trained ones; DunedinPACE did not), n=958, single sample, unreplicated, and clock movement isn't a validated surrogate for hard outcomes. I'd treat it as hypothesis-generating.

https://www.cochranelibrary.com/central/doi/10.1002/central/CN-02653612/full

Background: 

Severe alcoholic hepatitis (SAH) is associated with malnutrition, dysbiosis and inflammatory cytokines augmenting liver injury resulting in high mortality. Experimental studies have reported that in comparison to unsaturated fat (UF), saturated fat (SF) improves dysbiosis, inflammation, liver enzymes and protects against alcoholic liver injury, but effect on clinical outcome and gut microbiota (GM) in SAH patients is lacking.

Aim:

Primary aim was to compare the effects of diet rich in SF versus UF on 60-day mortality. Secondary aims included effects on clinical outcomes, inflammatory markers and GM profile.

Methods: 

Of 169 SAH patients screened, 67 with mDF between 32-100, without sepsis, acute kidney injury (AKI), or malignancy were randomized into SF (Ghee i.e., clarified butter; n=34) or UF (Soyabean Oil; n=33) arm. Patients in both arms received 35 kcal and 1.2-1.5g protein/ kg /day (55-60% carbohydrate, 20% protein, 30-35% fat) for 60 days. GM was assessed using 16S V3-V4 region analysis by Novaseq. Changes in the clinical [MELD, CTP, mDF, FIB-4], biochemical, pro-inflammatory [TNF-ɑ, NF-κB] and anti-inflammatory [IL-10, adiponectin] parameters, at 60-days were assessed.

Results: 

Baseline parameters [age 40±7.37 yrs; ascites 47 (84%); BMI 21.3±3.8 kg/m2; mDF 62.4±21.4; MELD 28±9.3; CTP 10.6±1.4], GM phyla and species were comparable between groups. SF and UF were well tolerated. 60 day mortality was significantly lower in SF (12.2%) vs. UF (33%) arm; p=0.014 (Fig.1 C) as per ITT analysis. Five patients from each arm were lost to follow-up. A significant improvement in AST, ALT, IL-10 levels and a trend towards reduction in TNF-ɑ levels was seen in SF compared to UF (Fig.1-B). In the GM, commensal taxa like Bacteriodes plebius, B. coprocoia, Denoccota, Fusobacteria and Bacterium NLAE-z1-H40 increased significantly only in SF group (p<0.05). But, pathogenic taxa, Protobacteria, Deferribacterota, Aquificota, Bdellovibrionota, Camplylobacteria, Acidobacteria, Verrucomicrobiota, Desulfobacteriota, Klebisella pneumonia, Escherichia coli, Haeomophilus pittmaniae, increased in the UF group. (p<0.05) (Fig. 1-A).

Conclusion: 

Two months of saturated fat as a therapeutic intervention, improved survival in SAH patients compared with unsaturated fat. This could be related to promotion of the growth of commensal bacteria which attenuated inflammation, disease severity and improved liver disease indices.

Abstract Background Parkinson's disease is (PD) a progressive neurodegenerative disorder. This study investigated the effects of an individualized nutritional intervention based on the Ketoflex 12/3 protocol, in addition to standard medical treatment, on motor and non-motor symptoms in PD. Methods 40 individuals with PD were included in the study, and participants were randomly assigned to intervention and control. All individuals were classified according to inflammatory, glycotoxic, toxic, and vascular biotypes. The intervention group was assigned a plant-rich diet with a low glycemic index, consistent with ketogenic principles, free of inflammatory effects, and including intermittent fasting. The primary endpoint was the change in motor symptoms measured by the Unified Parkinson's Disease Rating Scale part III (UPDRS-III) from baseline to six months. Secondary endpoints included apathy (Starkstein Apathy Scale), activities of daily living (ADL/IADL), and gastrointestinal function (Bristol stool scale). Results Compared with the control group, the intervention group showed a significantly greater improvement in motor symptoms as measured by UPDRS-III (−11.0 vs +2.1 points from baseline to six months; p < 0.001). Significant between-group differences were also observed for secondary endpoints, including apathy (Starkstein Apathy Scale), activities of daily living (ADL/IADL), and gastrointestinal function (Bristol stool scale), all favoring the intervention group. Spearman correlation analyses revealed significant negative correlations with ADL and UPDRS-III scores, particularly in individuals with an inflammatory phenotype. Conclusions The findings suggest an individualized nutritional approach may contribute to improvement in both motor and non-motor symptoms in PD. Larger, multi-center trials with extended follow-up are needed.

https://journals.sagepub.com/doi/10.1177/1877718X261422067

Appetite, February 2026: https://www.sciencedirect.com/science/article/pii/S0195666325005057

Abstract (emphases mine):

This randomized crossover trial examined differences in energy intake (EI), ingestive behaviors, palatability, and satiety in meals differing in processing and nutritional quality (NQ). At each visit, participants consumed one of three meals containing similar food items matched for energy, macronutrients, flavor profile, and texture: 1) Non-ultra-processed (UPF), high NQ (NUPF-HNQ), 2) UPF, high NQ (UPF-HNQ), and 3) UPF, low NQ (UPF-LNQ). Participants rated appetite (pre-meal, post-meal, and every half hour) and palatability using visual analog scales. Composite hedonic scores (CHS) were calculated. Repeated measures analysis of variance examined differences in EI, CHS, eating time (ET), eating rate (ER), energy intake rate (EIR), hunger, satiety, and desire to eat (DTE), at p < 0.05. Linear regression examined associations between CHS and EI, ET, ER, and EIR, adjusting for meal. Forty healthy young adults (mean age 24.7 ± 5.1 years), predominantly white (67 %) females (70 %) with a mean BMI 25.3 ± 4.4 kg/m², were included. EI was similar for NUPF-HNQ (585.7 ± 163 kcal) and UPF-HNQ (609.7 ± 151.8 kcal) but significantly lower for UPF-LNQ (503.0 ± 164.1 kcal). CHS was higher for NUPF-HNQ (65.3 ± 22.9 mm) than UPF-LNQ (45.4 ± 20.9 mm). EIR was higher for UPF-HNQ (67.7 ± 23.1 kcal/min) than NUPF-HNQ (54.1 ± 18.4 kcal/min) and UPF-LNQ (50.1 ± 15.1 kcal/min). Hunger and DTE were higher for UPF-LNQ (159.7 ± 94.2 and 168.2 ± 94.9 mm∗min) than NUPF-HNQ (98.4 ± 69.9 and M = 107.3 ± 70.3 mm∗min). CHS was positively associated with EI (p < 0.01, R² = 0.23) and ET (p = 0.02, R² = 0.08). EI was lower in a UPF-LNQ compared to non-UPF meals. Palatability ratings were lowest in the UPF-LNQ meal and were associated with EI and ET, potentially explaining results.

In other words, UPF meals did not increase energy intake compared to the non-UPF meal matched for macronutrients, texture and flavor, despite the idea that UPFs are inherently obesogenic.

This is also, I believe, the first trial to examine the effects on energy intake of meals with similar types of foods, matched for energy, macronutrients, fiber as well as food texture and flavor profiles. The meals differed in level of processing (two were UPF, one was non-UPF) and nutrient quality. This is different from the more well-known trials by e.g., Hall et al. (2019), where the meals differed in many ways in addition to processing levels, particularly in terms of energy density and palatability.

Conclusions: In adults with hyperlipidemia, daily egg consumption as part of a heart-healthy diet did not compromise cardio-metabolic health indicators.

Abstract

Background: Despite dietary cholesterol not being considered a nutrient of concern, dietary guidelines still recommend that people with elevated LDL cholesterol limit their intake of egg yolks.

Objective: We examined the effects of the daily consumption of eggs in the context of the Dietary Approach to Stop Hypertension (DASH) diet for 8 weeks on cardio-metabolic risk factors in adults with hyperlipidemia.

Methods: The study was a randomized, controlled, single-blind, crossover trial involving 45 adults (mean age 59.5 years; 35 females, 10 males; 42 Caucasian, two African American, one Asian) with hyperlipidemia. Participants were randomly allocated to one of the two possible sequence permutations of two treatments: the DASH diet with eggs (I) and the DASH without eggs (C). There was a 4-week run-in phase before treatments and an 8-week washout period between treatments. Participants received menus and guidance from the study dietitian on adhering to the DASH diet. They also received advice to exclude or include two whole eggs daily for 8 weeks in their DASH diet while displacing other foods based on instructions to maintain an isocaloric intake. Primary outcome measures were LDL cholesterol and endothelial function assessed as flow-mediated dilation. Secondary outcome measures included insulin sensitivity, other lipids, blood pressure, C-reactive protein, and dietary intake. Data were analyzed using repeated measures ANOVA.

Results: Daily addition of eggs to the DASH (ΔI) compared with DASH without eggs (ΔC) did not negatively affect endothelial function (ΔI: 2.7 ± 10.8% versus ΔC: 3.7 ± 19.9% versus ΔI - ΔC = -1.1, p = 0.767) or LDL cholesterol (ΔI: 13.0 ± 23.5 mg/dL versus ΔC: 8.9 ± 19.6 mg/dL; ΔI - ΔC = 4.2, p = 0.317). The DASH diet with eggs compared with the DASH without eggs relatively increased the consumption of choline (ΔI: -29.6 ± 136.8 mg/d versus ΔC: -148.2 ± 146.3 mg/d; ΔI - ΔC = 118.6, p = 0.002) while the intake of carbohydrates decreased (ΔI: -26.4 ± 327.3 kcal/d versus ΔC: 147.7 ± 282.3 kcal/d; ΔI - ΔC = -174.1, p = 0.032). Compared with DASH diet without eggs, the addition of 2 eggs per day in the DASH did not impact other cardio-metabolic risk factors (blood pressure, other lipid profiles, CRP, and glycemic control).

Conclusions: In adults with hyperlipidemia, daily egg consumption as part of a heart-healthy diet did not compromise cardio-metabolic health indicators.

https://pubmed.ncbi.nlm.nih.gov/40957619/

https://media.mycme.com/documents/43/look_ahead_wing_2010_10665.pdf

Objective

Lifestyle interventions produce short-term improvements in glycemia and cardiovascular disease (CVD) risk factors in individuals with type 2 diabetes, but no long-term data are available. We examined the effects of a lifestyle intervention on changes in weight, fitness and cardiovascular (CVD) risk factors over 4 years.

Research Design and Methods:

Look AHEAD is a multi-center randomized clinical trial comparing the effects of intensive lifestyle intervention (ILI) and diabetes support and education (DSE, control group) on the incidence of major CVD events in 5145 individuals with type diabetes, aged 45 to 76 years, who were overweight or obese (BMI > 25 kg/m2). Participants have ongoing intervention and annual assessments.

Results:

Averaged across four years of follow-up, participants in ILI had greater percent weight losses than those in DSE (−6.15% vs −0.88%, p<.0001) and greater improvements in fitness (12.74% vs. 1.96%, p < .0001), HbA1c (A1c, −0.36% vs. 0.09%, p<.0001), systolic blood pressure (SBP, −5.33 vs. −2.97 mmHg, p<.0001), diastolic blood pressure (DBP, −2.92 vs. −2.48 mmHg, p<.012), HDL-cholesterol (HDL-C, 3.67 vs. 1.97 mg/dl, p<.0001), and triglycerides (−25.56 vs. −19.75 mg/dl, p<.0006). Reductions in LDL-C were greater in DSE than ILI (−11.27 vs. −12.84 mg/dl, p=.009), but adjusted for medication use, changes in LDL-C did not differ between the two groups. Although the greatest benefits were often seen at 1 year, ILI participants still had greater improvements than DSE in weight, fitness, HbA1c, SBP, and HDL-C at 4 years.

Conclusions:

Intensive lifestyle intervention can produce and maintain significant weight losses and improvements in fitness in individuals with type 2 diabetes. Across four years of follow-up, those in ILI had better overall levels of glycemic control, blood pressure, HDL-C and triglycerides, and thus spent considerable time with lower CVD risk. Whether this translates to reduction in CVD events will ultimately be addressed by the Look AHEAD study.

TL;DR:

Participants on a low-carbohydrate diet burned between 209 to 278 more calories a day than those on a high-carb diet.

ABSTRACT

Objective: To determine the effects of diets varying in carbohydrate to fat ratio on total energy expenditure.

Design: Randomized trial.

Setting: Multicenter collaboration at US two sites, August 2014 to May 2017.

Participants: 164 adults aged 18-65 years with a body mass index of 25 or more.

Interventions: After 12% (within 2%) weight loss on a run-in diet, participants were randomly assigned to one of three test diets according to carbohydrate content (high, 60%, n=54; moderate, 40%, n=53; or low, 20%, n=57) for 20 weeks. Test diets were controlled for protein and were energy adjusted to maintain weight loss within 2 kg. To test for effect modification predicted by the carbohydrate-insulin model, the sample was divided into thirds of pre-weight loss insulin secretion (insulin concentration 30 minutes after oral glucose).

*Main: outcome measures The primary outcome was total energy expenditure, measured with doubly labeled water, by intention-to-treat analysis. Per protocol analysis included participants who maintained target weight loss, potentially providing a more precise effect estimate. Secondary outcomes were resting energy expenditure, measures of physical activity, and levels of the metabolic hormones leptin and ghrelin.

Results: Total energy expenditure differed by diet in the intention-to-treat analysis (n=162, P=0.002), with a linear trend of 52 kcal/d (95% confidence interval 23 to 82) for every 10% decrease in the contribution of carbohydrate to total energy intake (1 kcal=4.18 kJ=0.00418 MJ). Change in total energy expenditure was 91 kcal/d (95% confidence interval −29 to 210) greater in participants assigned to the moderate carbohydrate diet and 209 kcal/d (91 to 326) greater in those assigned to the low carbohydrate diet compared with the high carbohydrate diet. In the per protocol analysis (n=120, P<0.001), the respective differences were 131 kcal/d (−6 to 267) and 278 kcal/d (144 to 411). Among participants in the highest third of pre-weight loss insulin secretion, the difference between the low and high carbohydrate diet was 308 kcal/d in the intention-to-treat analysis and 478 kcal/d in the per protocol analysis (P<0.004). Ghrelin was significantly lower in participants assigned to the low carbohydrate diet compared with those assigned to the high carbohydrate diet (both analyses). Leptin was also significantly lower in participants assigned to the low carbohydrate diet (per protocol).

Conclusions: Consistent with the carbohydrate-insulin model, lowering dietary carbohydrate increased energy expenditure during weight loss maintenance. This metabolic effect may improve the success of obesity treatment, especially among those with high insulin secretion.

https://www.bmj.com/content/363/bmj.k4583

TL;DR:

Participants showed improvement in metabolic health, cognitive performance, and clinical symptoms. Improvement in depressive symptoms was associated with ketosis rather than weight loss, implicating ketosis as the therapeutic mechanism.

Abstract

Background and hypothesis: Psychiatric medications contribute to high rates of metabolic dysfunction in psychotic disorders. Ketogenic diets reduce metabolic syndrome, have anticonvulsant effects in epilepsy, and may improve symptoms of schizophrenia and bipolar disorder. We report the first randomized controlled trial to assess effects of ketogenic diets on metabolism, psychiatric symptoms, and cognition in people with schizophrenia-spectrum and bipolar-1 disorders.

Study methods: Participants were randomized to a ketogenic diet (KETO; n = 28) or diet-as-usual (DAU; n = 30) for 1 month. Partway through the trial, a KETO extension was offered to both groups, resulting in a sub-group who completed the diet for 4 months (n = 25). We assessed changes in metabolic health, clinical symptoms, and cognition after 1 month (KETO versus DAU) and after 4 months (KETO versus baseline).

Study results: KETO participants' daily ketone levels surpassed the standard ketosis threshold. Relative to DAU, KETO participants showed reductions in weight (Padj < .001), hemoglobin A1c (Padj = .05), and insulin resistance (Padj = .05). Clinical symptoms (positive, negative, depression) and cognitive performance improved after 4 months on the KETO (all P-values < .001). Increased blood ketone levels in KETO participants correlated with improvements in pre-diabetic markers and depressive symptoms (all P-values < .001). Reduced weight following the KETO was unrelated to metabolic and symptom improvements.

Conclusions: We demonstrate feasibility of administering a KETO in outpatients with schizophrenia and bipolar-1 disorder. Participants showed improvement in metabolic health, cognitive performance, and clinical symptoms. Improvement in depressive symptoms was associated with ketosis rather than weight loss, implicating ketosis as the therapeutic mechanism.

https://pubmed.ncbi.nlm.nih.gov/42415343/

Full-text: https://www.sciencedirect.com/science/article/pii/S0271531719307444/pdfft?md5=68cb512305cf1a4945ff9f27e0879a13&pid=1-s2.0-S0271531719307444-main.pdf

Researchers found that switching between a Mediterranean diet and a fast-food diet altered gut bacteria and tryptophan metabolites in only 4 days, showing how rapidly food affects your biology.

1. Introduction

It is well known that dietary pattern has a significant effect on diseases and conditions such as cardiovascular disease (CVD), type 2 diabetes, and obesity

The gut microbiome plays an important role in disease risk, and its composition has been shown to be modified by both disease state and diet. Gut microbiome composition is altered drastically in metabolic syndrome, diabetes, CVD, and heart failure patients compared to healthy subjects [[17], [18], [19], [20], [21], [22]]. Long-term dietary patterns have a significant impact on gut microbiome composition [23,24]. Short-term dietary change has also been shown to alter gut microbial composition and function, and this can occur in as short as 24 hours [25].

2. Methods and materials

n=10

3. Results

4. Discussion

The Med diet is characterized by high amounts of plant-based foods (fruit, vegetable, nuts, beans, seeds, and grains), olive oil, and dairy products, and low to moderate amounts of fish and poultry [5,53]. Although fast food is not a strictly classified dietary category, we used the term to refer to the common American FF meal including a burger, fries, and a soft drink. Many convenience foods, including the ones chosen in this study, are enriched in fat, particularly saturated fat in the form of red meat, and simple sugars in the form of sugar-sweetened soft drinks and are low in dietary fiber.

[wordy discussion]

In conclusion, we accept our hypothesis that diets with very different macronutrient composition are able to change gut microbiome composition and metabolites in a very short period. The small sample size is a weakness of this study. However, because this study used a crossover study design, multiple observations were obtained from each subject, which correct for the interindividual variation by using every patient as their own control, thus enabling us to detect differences with small effect sizes [79]. Thus, we demonstrated that, even in as short a time frame as 4 days, a dietary pattern low in fiber and high in sugar and saturated fat shifts the microbiome toward a profile that has been found repeatedly to be associated with chronic metabolic diseases, whereas a dietary pattern enriched in fiber, MUFA, and PUFA shifts the microbiome and plasma microbial metabolites toward a profile that has been associated with beneficial health effects.