Plant-Based Eating Patterns and their Association with Exercise Performance and Chronic Disease. Are there any Nutritional Risks?

Jesse Oswald • March 27, 2024

Key Points

  • Plant-based diets are dietary patterns emphasizing higher intakes of plant foods and are low or completely void of animal foods.
  • Plant-based diets have been linked to lower risk for chronic diseases, including cardiovascular disease, type 2 diabetes, obesity, and some cancers.
  • If appropriately planned, plant-based diets can be nutritionally adequate and safe for athletes and specific population groups, such as pregnant and breastfeeding women and the elderly.

 

As their name reveals, plant-based diets (PB) mainly or only comprise plant foods, such as grains, legumes, nuts, seeds, vegetables, and fruits, excluding foods from animals, including dairy, meat, poultry, fish, and seafood. They vary in restrictiveness, from avoiding only red meat to avoiding animal products entirely. For example, a strict vegan will not consume anything from an animal, including honey and gelatin.


The proportion of the population reporting following a PB diet continues to increase, with approximately 5-10% in developed countries reporting following some PB.


Whether to include animal-derived protein in the diet may relate to concerns about physical health, environmental sustainability, socioeconomic considerations, ethics related to the worker or animal welfare, or religious convictions, among other motivations.


There are many subcategories under the plant-based umbrella term, including the following:

  • Lacto-ovo-vegetarian is primarily plant-based, including dairy products and eggs, excluding animal flesh (meat, poultry, fish).
  • Vegan is strictly plant-based, excluding all animal products, from red meat and eggs to honey and gelatin.
  • Pescatarian allows fish and seafood consumption, excluding red meat, chicken, dairy, and eggs.
  • Flexitarian is primarily plant-based, occasionally including red meat, poultry, dairy, or fish.

These subcategories are the main directions of PB diets. Still, they are not exhaustive since each ramifies to additional subcategories, such as Lacto-vegetarians, ovo-vegetarians, vegans who follow a raw or fruit diet, and people who abide by a macrobiotic diet.

The Environmental Benefits of PB Diets

There is a considerable variation in the ecological footprint of animal-based products, with beef being especially detrimental to the environment compared to other products such as pork, chicken, or eggs. An increasing body of evidence suggests that the production of plant foods tends to be less resource-intensive and environmentally destructive for several reasons, mainly due to lower levels of greenhouse gas emissions (GHGs) compared to raising animals for human consumption.


The Academy of Nutrition and Dietetics advocated that ‘’PB diets are more environmentally sustainable than diets rich in animal products because they use fewer natural resources and are associated with much less environmental damage.’’ Following a PB diet is often considered the most effective strategy for systemically reducing GHGs and agricultural land use related to food production and consumption, thus decreasing environmental impact.



A review study concluded that adopting lacto-ovo-vegetarian diets could reduce GHG emissions by 35%, land use by 42%, and freshwater use by 28%. Furthermore, a 25% reduction in meat consumption and a transition to a PB diet would minimize the impact of agricultural land expansion on the ecosystem's biodiversity and carbon dioxide emissions. Altogether, embracing a PB eating pattern, especially in developed countries, could be an effective strategy for reducing the food system’s environmental degradation and our use of the earth’s resources.

The Role of PB Diets in Health and Disease

PB diets are considered nutritionally upgraded, compared to omnivorous diets, since they contain less saturated fat and cholesterol and more folate dietary fibre, antioxidants, phytochemicals, and carotenoids.


Several studies have shown that plant-based dietary patterns are linked to a lower risk of cardiovascular disease (CVD) and cardiovascular disease mortality. Specifically, vegetarians are 32% less likely to develop coronary heart disease (CHD) than meat eaters. Moreover, PB diets have been shown to reverse atherosclerosis in individuals with established CVD. They also reduce systolic and diastolic blood pressure and enhance insulin sensitivity, thus reducing the risk of type 2 diabetes and improving glycemic control in individuals with diabetes. Based on systematic reviews of randomized clinical trials, vegetarians tend to have a lower body mass index (BMI) and waist circumference, hence decreased obesity risk, reduced incidence of specific cancers, and lower all-cause mortality.

One study showed that adopting a low-fat vegan diet in post-menopausal women resulted in a mean weight loss of 5.8kg in 14 weeks, significantly greater than the control diet.


PB diets might act through multiple pathways in terms of their proposed health effects, including improvements in the lipid profile of vegetarians/vegans, including decreases in total cholesterol, LDL cholesterol, and triglycerides, reduced visceral fat, enhanced oxidative stress and inflammation markers, and reduced glycosylated hemoglobin (HbA1c).


However, these positive health outcomes stem from healthful plant food sources rich in dietary fibre, such as whole grains, fruits, vegetables, legumes, nuts, and plant protein, such as soy. PB diets can also be unhealthful, containing high amounts of refined carbohydrates, sugar, and highly processed mock meats. Therefore, an unhealthy PB diet may be equally compounding to an omnivorous diet in terms of their risk in health outcomes.



Besides the metabolic benefits of healthful PB diets, there is evidence that they may be associated with a lower risk of chronic kidney disease (CKD). Specifically, a recent study found that when one serving of red and/or processed meat was replaced with plant proteins, the risk of CKD was significantly lower. It was also demonstrated that a healthful PB diet, emphasizing fruits, vegetables, whole grains, nuts, legumes, coffee, and tea, was associated with a slower GFR, the optimal marker to measure kidney function decline. However, the protective effect was lost when healthy plant foods were replaced with poor plant-based food choices, such as commercial fruit juice, refined grains, and sweets.

Considerations for Athletes Consuming a PB Diet

PB diets can meet the needs of athletes at all levels, from recreational to elite athletes. However, if not appropriately planned, a PB diet may provide insufficient amounts of certain macro- and micro-nutrients. Thus, depending on food preferences, athletes need to ensure adequate intake of nutrients found less abundantly in PB diets or less well absorbed from plants than animal sources. Nutrition recommendations should consider each athlete’s training volume (intensity and frequency), sport, season, performance goals, and food preferences.



➢   Energy intake

Dietary fibre, abundant in PB diets, slows digestion, increases feelings of satiety, and decreases total daily energy intake. While such characteristics benefit overall health, they could make meeting the energy requirements of elite sports challenging. Especially endurance running athletes should be conscious not to overconsume dietary fibre during competition since they have been correlated with gastrointestinal disturbances. To ensure adequate energy is consumed, athletes should monitor their weight and be aware of involuntary or sizeable degrees of weight loss. Some strategies for PB athletes to ensure adequate intake include eating five to eight meals and snacks daily, decreasing high-fibre foods, and choosing energy-dense food choices, such as nuts and seeds, nut and seed butter, avocados, dried fruits, hummus, and granola.


➢   Protein intake

Branched-chain amino acids (BCAAs), leucine, isoleucine, and valine, are particularly important for promoting muscle protein synthesis (MPS). Although they are more concentrated in animal-based protein than plant-based protein, intervention studies utilizing either a whey protein or a soy protein supplement in conjunction with resistance training yield negligible differences between groups regarding muscle gain.


Nevertheless, some athletes may struggle to meet their protein needs from PB foods if their caloric requirements are exceptionally high. As mentioned before, a PB diet tends to be very filling due to the high fibre content. Therefore, athletes may find it challenging to consume enough protein from plant food sources to support optimal muscle protein synthesis. Some studies suggest increasing the amount of protein consumed at each meal and consuming it evenly throughout the day. It is also recommended to mix plant-based protein sources, including soy foods, legumes, nuts, seeds, quinoa, and other grains, to ensure a more balanced amino acid profile of all essential amino acids and support most training needs.


Recent work has also shown that distributing protein consumption throughout the day and including a pre-sleep protein feeding promotes MPS overnight, especially when preceded by resistance training.


The American College of Sports Medicine recommends that athletes consume 1.2-1.7g/kg/day and, during times of energy restriction, to promote muscle mass retention, to consume up to 2.0g/kg/day. If an athlete still struggles to meet protein recommendations, a soy protein supplement may be particularly adjuvant due to its high leucine content.


➢   Omega-3 fatty acids

Most studies indicate that plasma levels of EPA and DHA are lower in PB athletes than omnivores. Hence, athletes looking to optimize their performance may need to ensure they achieve optimal intake levels from the omega-3 fatty acids, EPA, and DHA, primarily found in fatty fish, hence may be lacking in such diets. As a result, supplementation with an algal DHA supplement may improve muscle adaptation, energy metabolism, muscle recovery, and injury prevention.


➢   Iron

Although iron is found abundantly in a PB diet, the bioavailability of iron in plant food sources (non-heme iron) is less than that found in animal sources (heme iron). In combination with the increased iron needs in athletes, especially females and endurance, this may result in lower ferritin levels and iron deficiency, which needs to be treated with an iron supplement so that exercise performance will not be compromised. To maximize their body’s non-heme iron absorption, individuals are suggested to pair plants' iron food sources, such as whole grains, legumes, nuts, seeds, dried fruits, green leafy vegetables, and iron-fortified cereals, with a vitamin C source, such as lemon, citrus fruits, peppers, tomatoes, and strawberries. They are also recommended to cook acidic foods, such as tomatoes in cast-iron skillets, avoid the simultaneous consumption of iron-rich foods with calcium supplements and beverages rich in tannins, such as coffee, tea, and cocoa, as well as avoid exercise within two hours of consumption.


➢   Zinc

Research has shown that athletes with insufficient dietary zinc intake may negatively impact exercise performance regarding strength and endurance. However, PB athletes tend to have normal Zinc levels; hence supplementation is unnecessary. Vegetarian food sources for zinc include whole grains, legumes, tofu, tempeh, nuts, and seeds. However, the high phytate content of these foods decreases zinc absorption. Some practical food preparation techniques to increase zinc bioavailability include soaking and sprouting beans, grains, nuts, seeds, and leavening bread.


➢   Calcium

A well-planned PB diet provides sufficient calcium for the athlete to meet the recommended daily intakes. However, vegans especially consume substantially less calcium than other vegetarians and omnivores. Therefore, athletes with inadequate calcium intake should consistently use calcium-fortified foods, such as fortified breakfast cereals, fortified fruit juices, and fortified plant-based milk, or at least take a calcium supplement. Moreover, phytic and oxalic acids in plant-based calcium food sources inhibit calcium absorption. Hence, food choices with good absorption calcium rates include beans, almonds, tahini, dried figs, soy products, and low-oxalate vegetables such as kale, broccoli, Chinese cabbage, and bok choy. Boiling can also reduce oxalate content in high-oxalate vegetables like spinach and Swiss chard.


➢   Vitamin D

Athletes following a PB diet may be at greater risk for inadequate vitamin D levels due to limited PB sources of vitamin D (fatty fish, fish oils, and egg yolk are the richest nutritional sources), particularly if they do not achieve sufficient sun exposure (10-30 minutes between 10 a.m. and 3 p.m.) and/or have darker skin. Since vitamin D is vital for athletes due to its role in immune function, inflammatory modulation, and exercise performance, plausible deficiencies should be addressed. Fortified plant-based milk, fortified orange juice, fortified margarine, and fortified breakfast cereals provide modest amounts of vitamin D for PB athletes. Therefore, supplementation may be needed to achieve an adequate vitamin D status, depending on dietary intake and sunlight exposure, hence a healthy bone mineral density.


➢   Vitamin B12

Vitamin B12 is solely found in animal products and, therefore, requires supplementation. Notably, the mean dietary intake of vitamin B12 for vegan athletes falls well below the recommended allowance; hence, supplementation is obligatory. Lacto-ovo-vegetarians, on the other hand, may be marginally normal, depending on the use of dairy products. Marginal amounts may also be available through nutritional yeast, fortified cereals, fortified vegan meat analogs, and plant-based milk, such as soy, almond, oat, etc., but such sources will not provide sufficient intake. In addition to detrimental health effects, such as megaloblastic anemia and fatigue, vitamin B12 deficiency is associated with lower creatine biosynthesis, which, along with the low creatine intake through plant-based foods, may eventually impair exercise performance. Therefore, all vegans should check their B12 status annually as a good preventative measure.


➢   Creatine

Creatine supplementation may optimize short-duration, high-intensity, and resistance exercise performance in athletes following a PB diet. Creatine supplementation may also benefit cognitive function and concussion recovery, especially for athletes in team skill-based sports.

 

PB Diets and Exercise Performance

Carbohydrates are the primary energy source during moderate and high-intensity aerobic exercise. Compared to other dietary patterns, the high concentration of carbohydrates typically found in a PB diet has been reported to increase muscle glycogen concentration, improving endurance performance.


Although regular exercise reduces the risks for many chronic diseases, such as obesity, type 2 diabetes, and CVD, intense exercise performed by elite athletes can elicit an inflammatory response and increase oxidative stress, leading to muscle fatigue and delayed-onset muscle soreness syndrome (DOMS). Since muscle glycogen levels are directly correlated with time to fatigue in moderate (60-80% VO2 max) intensity exercise, optimizing glycogen levels may delay fatigue in endurance and team sports. Furthermore, since phytochemicals such as polyphenols and antioxidants reduce inflammation and oxidative stress, PB diets abundant in these compounds have been considered superior for performance than animal-based dietary patterns.


Nevertheless, the limited evidence available suggests that PB diets neither hinder nor aid exercise performance in terms of strength, aerobic power (VO2 max), or power performance. Additional research is needed to determine whether such diets improve exercise performance and/or accelerate recovery.

Potential Nutritional Risks Associated with PB Diets

Although PB diets can have many health benefits, as described above, a major criticism is the risk of nutrient deficiencies related to long-term use, particularly the more strict forms of PB diets, such as veganism. This notion is intensified for sensitive life cycle stages, such as childhood and adolescence, pregnancy, lactation, and older adulthood.


Pregnant women who adhere to vegan diets are at higher risk of protein deficiency, especially in the second and third trimesters of pregnancy. Hence, 25g of additional protein is recommended, including 2 ½ cups of soy milk and 1 ½ cups of lentils daily. So, if protein consumption is adequate, PB dietary patterns have no difference regarding infant birth weight compared with omnivorous mothers.

PB dietary patterns are associated with a reduced risk of excessive weight gain, gestational diabetes mellitus, hypertensive disorders during pregnancy, and preterm birth. Pregnant and lactating vegetarians who are well-supplemented with vitamin B12 and the omega-3 fatty acid DHA derived from microalgae and also have sufficient sun exposure (see above) and a well-balanced diet by consuming a variety of nutrient-dense and fortified plant foods can effectively meet their energy and nutrient needs.


Vegetarian children and adolescents generally meet their protein needs when their diets contain adequate energy and a variety of plant protein sources. Other than vitamin B12, which needs to be consumed through fortified foods and/or supplement, especially in vegans, deficiencies of other micronutrients are rarely seen when well-balanced PB diets are consumed.

The same applies to older adults consuming PB diets, with extra attention for possible vitamin D and calcium deficiencies, which, when present, should be corrected through the reinforced consumption of fortified foods and/or supplements.


A systematic review involving 37,134 subjects found vegetarians and vegans had lower bone mineral density at the femoral neck and lumbar spine than omnivores. The effect was greater in vegans, who also had higher fracture rates. Another review concluded that the balance between protective factors in PB diets and potential nutrient shortfalls might leave vegetarians, especially vegans, at increased risk of bone loss and fractures.


A meta-analysis found that vitamin B12 deficiency was associated with stroke, Alzheimer’s disease, vascular dementia, and Parkinson’s disease. Similar health damages may arise from iron insufficiency, another commonly assumed risk for plant-based dieters.

Although protein is abundant in PB diets, the amino acid profile in plants is often suboptimal compared to animal-based sources, particularly in BCAAs. However, the Academy of Nutrition and Dietetics has reported that consuming a wide variety of PB protein sources and adequate energy intake is sufficient to meet the required intakes of all essential amino acids.



Like any diet, the nutrition quality of a PB diet lies on the spectrum from a minimally nutritious diet based on nutrient-poor, processed foods to a maximally healthy diet rich in whole food sources. Therefore, when appropriately planned, a PB diet consisting of minimally processed and fortified foods can be nutritionally adequate and safe for all age groups and physiological conditions, including childhood, adolescence, pregnancy, lactation, and older adulthood. Particular attention should be given to calcium, iron, omega-3 fatty acids, vitamin D, and especially vitamin B12, the only micronutrient that may be missing entirely from a vegan diet unless supplemented.

Key Takeaways

Plant-based diets are eating patterns that more or less, depending on the subcategory, encompass the consumption of plant foods, such as fruits, vegetables, grains, legumes, nuts, and seeds, while avoiding the inclusion of animal or animal-derived products, such as dairy, eggs, and honey.


Well-planned and nutrient-dense PB diets, especially the pescatarian and lacto-ovo-vegetarian subcategories, can be adopted by individuals who seek to improve their overall health, particularly in terms of body weight, blood pressure, lipid, and metabolic profile, and cancer risk.


Plant-based diets are potentially nutritionally adequate and safe for all population groups, from athletes to lactating women and children, provided they are appropriately planned and well-balanced.



Anyone following a plant-based diet who thinks they cannot meet their macro- and/or micro-nutrient needs or have already established nutritional deficiencies should work with a registered dietitian to assist them, let alone athletes whose exercise performance strongly relies on that.

An Ounce of Prevention - Hyperion Health Blog

A woman is helping an older woman do exercises on an exercise ball in a gym.

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By Jesse Oswald • January 29, 2025
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Predicting Medical Costs with VO2max

By Jesse Oswald • January 20, 2025
Highlights Healthcare expenses are skyrocketing, with consumers and employers facing the significant brunt. Identifying those likely to get sick is critical as our resource-strapped healthcare system should focus on those likely to become the most significant burden to the system. VO2 max is a crucial longevity indicator that can also accurately predict healthcare expenses. The rampant chronic disease epidemic and the resulting surge in medical expenses is one of the most dire problems of modern societies, probably only second to climate change. Healthcare inflation is on a meteoric rise, and for those with limited or no healthcare coverage, a medical emergency is the equivalent of personal bankruptcy. A dire problem for employers In the US, employers and consumers who face rising health insurance premiums and astronomical out-of-pocket medical expenses feel the brunt of rising healthcare costs. Such is the problem that even large, well-capitalized corporations choose to send employees overseas for specific medical procedures since the cost of traveling and treatment in a foreign country is lower than the cost of care in the US. Another startling example is the infamous "northern caravan," a term that describes people with diabetes in the northern states who travel to Canada to secure their insulin supply. According to McKinsey , a survey conducted among over 300 employers highlighted that the average increase in the cost of health benefits over the past three years has been within the range of 6 to 7 percent. This survey also indicated that any rate increases exceeding 4 to 5 percent were deemed unsustainable. Interestingly, 95 percent of the surveyed employers expressed willingness to contemplate reducing benefits if costs surged by 4 percent or more. The primary cost-control measures that these employers indicated they might explore included elevating the portion of premium costs covered by employees and a potential transition to high-deductible health plans. Why is Breath Analysis relevant? Vis-a-vis this problem, the early and accurate estimation of who will get sick and how much they will cost is as critical as the treatment itself. The reason is that no other method of accurately identifying at-risk populations exists; it helps focus our scarce prevention resources and attention on those most in need. Breath analysis, AKA VO2max or metabolic testing, is an assessment that reveals two key biomarkers that provide significant predictive value for one's likelihood of developing costly chronic conditions. These two biomarkers are VO2max and the Respiratory Exchange Ratio. In this article, we will dive into VO2max to understand why it's a critical reflection of our overall health and, consequently, a window into our future healthcare spend. What is VO2max? Let's start with the basics. What is VO2max? VO2 max is the maximum amount of oxygen the human body can absorb. It is measured in terms of milliliters of oxygen consumed per kilogram of body weight. The below formula below indicates how VO2max is calculated: The numerator indicates the volume of oxygen your heart, lungs, and cells can absorb, expressed in milliliters per minute. The denominator indicates the weight of the individual represented in kilograms. 
There are many different types of fats in this picture.

Dietary Fat: An Essential Dietary Component Rather than the root of all Nutritional Health Issues

By Jesse Oswald • January 13, 2025
Key points A total fat intake between 20-35% ensures sufficient intake of essential fatty acids and fat-soluble vitamins Omega-6 PUFAs are primarily found in vegetable oils, while omega-3 PUFAs are primarily found in fatty fish and fish oils Both omega-3 PUFAs and MUFAs have established benefits for cardiovascular disease TFAs are the only dietary lipids that have a strong positive relationship with cardiovascular disease Omega-3 PUFA supplementation increases the beneficial bacteria of the human microbiome Over the last three decades, there has been a great revolution against fat due to its suspected association with several nutritional health issues, especially cardiovascular disease. There was a tremendous amount of evidence that indicated dietary cholesterol and saturated fat as the main culprits of cardiovascular disease, thus morbidity and mortality. It was when all the low-fat and no-fat dairy products started to launch, promising even complete substitution of the cholesterol-lowering heart medication if these products were exclusively consumed. Let’s start from the beginning. Dietary fat intake can vary significantly and still meet energy and nutrient needs. International guidelines suggest a total fat intake between 20% and 35% of the daily caloric consumption. This range ensures sufficient intake of essential fatty acids and fat-soluble vitamins. Not only does the quantity of the ingested fat matter, but most importantly, its quality. Some dietary fats have beneficial effects, with a significant role in maintaining good health, while others may threaten it. Which are, after all, the dietary fats? Dietary fats is a rather heterogeneous group of organic compounds, including four main types of fat, which are elaborately described in the following sections of this article. Polyunsaturated fatty acids (PUFAs) Polyunsaturated fatty acids (PUFAs) have two or more carbon-carbon double bonds. Omega-6 PUFAs and omega-3 PUFAs are the main types of PUFAs and are classified according to the location of the first unsaturated bond (sixth and third carbon atom, respectively). Alpha-Linolenic acid (ALA), docosahexaenoic acid (DHA), docosapentaenoic acid (DPA), and eicosapentaenoic acid (EPA) are the most important omega-3 PUFAs. ALA is an essential fatty acid that can only be obtained from diet and can be converted into EPA and then to DHA, but the rate of this conversion is finite, approximately 7.0%–21% for EPA and 0.01%–1% for DHA. In the same way, the most important omega-6 PUFAs are linoleic acid (LA) and arachidonic acid (ARA). LA is an essential fatty acid that, in order to give rise to ARA, needs to be ingested through the diet as the human body cannot synthesize it. The recommended intake for total PUFA ranges between 5% and 10% of the total energy intake, while a total omega-3 PUFA intake of 0.5%–2% and a total omega-6 PUFA intake of 2.5%-5% is suggested. A dietary ratio of omega−6/omega−3 PUFA is recommended to be 1:1–2:1 to balance their competing roles and achieve health benefits. Omega-6 and omega-3 PUFAs Omega-6 PUFAs, in the form of LA, are plentiful in most crop seeds and vegetable oils, such as canola, soybean, corn, and sunflower oils. In contrast to omega-6 PUFAs, omega-3 PUFAs are obtained from a limited range of dietary sources. Flax, chia, and perilla seeds are rich in ALA, with significant amounts also detected in green leafy vegetables. The consumption of fatty fish, such as salmon, sardines, tuna, trout, and herring, provides high amounts of EPA and DHA. Besides fish and their oils, small amounts of omega-3 PUFAs are also detected in red meat like beef, lamb, and mutton. All the above dietary sources provide EPA, DPA, DHA, LA, and ARA in different amounts, and their intake is necessary for normal physiological function. PUFAs play a critical role in many chronic diseases, affecting human cells by regulating inflammation, immune response, and angiogenesis. Omega-3 PUFAs’ role against hypertriglyceridemia has been clarified, and research indicates that systematically consuming oily fish can contribute to general heart protection. Supplementation with omega-3 PUFAs could potentially lower the risk of several cardiovascular outcomes, but the evidence is stronger for individuals with established coronary heart disease. Moreover, adequate EPA and DHA levels are necessary for brain anatomy, metabolism, and function. Although the mechanisms underlying omega-3 PUFAs' cardioprotective effects are still poorly understood, several studies have been conducted in this direction. Unfortunately, that does not hold true for their omega-6 counterparts, for which controversial emerging data tend to show anti-inflammatory behavior that needs to be further studied. Monounsaturated fatty acids (MUFAs) In contrast to PUFAs, monounsaturated fatty acids (MUFAs) are easily produced by the liver in response to the ingestion of carbohydrates. The main MUFA is oleic acid, found in plant sources, such as olive oil, olives, avocado, nuts, and seeds, while minimal amounts are also present in meat, eggs, and dairy products. Specific guidelines around MUFAs’ dietary consumption do not exist. Therefore, MUFAs are recommended to cover the remaining fat intake requirements to reach the total daily fat intake goal. A growing body of research shows that dietary MUFAs reduce or prevent the risk of metabolic syndrome, cardiovascular disease (CVD), and hypertension by positively affecting insulin sensitivity, blood lipid levels, and blood pressure, respectively. Moreover, olive oil contains several bioactive substances, possessing anti-tumor, anti-inflammatory, and antioxidant qualities. According to a meta-analysis, consuming olive oil was linked to a lower risk of developing any sort of cancer, especially breast cancer and cancer of the digestive system. Another study found that an isocaloric replacement of 5% of the energy from saturated fatty acids (SFAs) with plant MUFAs led to an 11% drop in cancer mortality over a 16-year follow-up period. Therefore, including MUFAs in the everyday diet offers multifaceted benefits in chronic disease prevention and management, including cancer and general health promotion.  Saturated fatty acids (SFAs) Saturated fatty acids (SFAs) form a heterogeneous group of fatty acids that contain only carbon-to-carbon single bonds. Whole-fat dairy, (unprocessed) red meat, milk chocolate, coconut, and palm kernel oil are all SFA-rich foods. These fatty acids have distinct physical and chemical profiles and varying effects on serum lipids and lipoproteins. Stearic, palmitic, myristic, and lauric acids are the principal SFAs found in most natural human diets. Dietary practice and guidelines recommend limiting SFA intake to <10% of the total energy (E%), while the American Heart Association suggests an even lower intake of <7 E% because total saturated fat consumption and LDL-C levels are positively correlated. However, the role of SFAs in CVDs is quite complex, and the evidence is heterogeneous. In a recent study with a 10.6-year follow-up period, which included 195,658 participants, there was no proof that consuming SFAs was linked to developing CVD while replacing saturated fat with polyunsaturated fat was linked to an increased risk of CVD. Moreover, according to 6 systematic reviews and meta-analyses, cardiovascular outcomes and total mortality were not significantly impacted by substituting saturated fat with polyunsaturated fat. Even if these analyses were to be challenged, due to heterogenous evidence, the possible reduction in CVD risk associated with replacing SFAs with PUFAs in several studies may not necessarily be an outcome of SFAs’ negative effect but rather a potential positive benefit of PUFAs. Regarding SFAs' effect on different types of cancers, associations of their intake with an increased risk of prostate and breast cancer have been indicated. Conversely, a meta-analysis showed no link between SFA intake and a higher risk of colon cancer; similarly, consuming MUFAs, PUFAs, or total fat did not affect colon cancer risk. Hence, the role of SFA consumption in preventing, promoting, or having a neutral role in serious chronic diseases has not been fully elucidated yet. Trans fatty acids (TFAs) Trans fatty acids (TFAs) are created industrially by partially hydrogenating liquid plant oils or can be naturally derived from ruminant-based meat and dairy products. TFAs are highly found in commercial baked goods, biscuits, cakes, fried foods, etc. Guidelines regarding TFAs are stringent and limit TFA intake to <1% of energy or as low as possible. In 2015, the US Food and Drug Administration declared that industrial TFAs are no longer generally recognized as safe and should be eliminated from the food supply as their consumption is strongly linked to various CVD risk factors. Specifically, TFA intake raises triglycerides and increases inflammation, endothelial dysfunction, and hepatic fat synthesis, leading to a significantly increased risk of coronary heart disease (CHD). A meta-analysis suggested that increased TFA intake led to an increase in total and LDL-cholesterol and a decrease in HDL-cholesterol concentrations. Data also indicates that TFAs may influence carcinogenesis through inflammatory pathways, but the reported data are debatable. A recent study investigated the effects of all types of dietary fat intake on CVD risk. While PUFA, MUFA, and SFA intake were not linked to higher CVD risk, dietary TFA intake showed a strong association with CVD risk. Analysis indicated PUFA intake and CVD risk were inversely correlated, and the relative risk of CVD was reduced by 5% in studies with a 10-year follow-up. Dietary lipids and the human microbiome Dietary lipids also affect human microbiota composition. Studies have identified a close association between the human microbiome and metabolic diseases, including obesity and type 2 diabetes. Diets with a high omega-6 PUFA, SFA, and TFA intake increase the amount of many detrimental bacteria in the microbiome and reduce the amount of the beneficial ones, altering the microbiota composition and inducing inflammation via the secretion of pro-inflammatory cytokines. These bacteria may disrupt the gut barrier function, allowing lipopolysaccharides (LPS) translocation, which are bacterial toxins. This condition is linked to metabolic perturbations such as dyslipidemia, insulin resistance, non-alcoholic fatty liver disease (NAFLD), and CVD. On the contrary, omega-3 PUFA (EPA and DHA) supplementation increases beneficial bacteria and limits harmful ones, enhancing intestinal barrier functioning and preventing LPS translocation and its implications. Omega-3 PUFA supplementation has also been studied as a means of mental health disorders management, but the evidence is still controversial. A possible protective impact of fish consumption on depression has been suggested by various studies, as well as a possible protective effect of dietary PUFAs on moderate cognitive impairment. A recent review of meta-analyses indicated that omega-3 PUFA supplementation might have potential value in mental health disorders, but data credibility is still weak. Dietary lipids and obesity Last but not least, obesity and its management is another field that dietary lipids intake seems to impact with their mechanisms. A diet high in PUFA has been shown to lower the total mass of subcutaneous white adipose tissue (the predominant fat type in human bodies), reduce blood lipid levels, and improve insulin sensitivity. In a study comparing PUFA and MUFA isocaloric intake, PUFA was more advantageous and lowered visceral adiposity in patients with central obesity. By stimulating brown adipose tissue, which aids energy expenditure through its elevated thermogenic activity, omega-3 PUFAs seem to elicit these positive effects in fat tissue, thus being useful in preventing and/or managing obesity. Another related study compared PUFA to SFA overfeeding in dietary surplus conditions that aimed to increase weight by 3%. While SFA overfeeding led to weight gain, primarily through the expansion of the visceral adipose tissue, PUFA overfeeding also led to weight gain, but because of a greater expansion of lean tissue mass. To sum up, dietary fats are an essential part of the human diet with many important physiologic functions, including cell function, hormone production, energy, and nutrient absorption. Moreover, dietary fat consumption is associated with positive outcomes in regard to cardiovascular disease, metabolic syndrome, cancer, and depression. Therefore, there is no reason to demonize this valuable dietary component, incriminating it for irrelevant adverse health outcomes, primarily weight loss failure and obesity. References 1. Astrup A, Magkos F, Bier DM, Brenna JT, de Oliveira Otto MC, Hill JO, King JC, Mente A, Ordovas JM, Volek JS, Yusuf S, Krauss RM. Saturated fats and health: A reassessment and proposal for food-based recommendations: JACC State-of-the-Art review. J Am Coll Cardiol. 2020;76(7):844-857. DOI: 10.1016/j.jacc.2020.05.077 2. Bojková B, Winklewski PJ, Wszedybyl-Winlewska M. Dietary fat and cancer-Which is good, which is bad, and the body of evidence. Int J Mol Sci. 2020;21(11):4114. DOI: 10.3390/ijms21114114 3. Custers, Emma EM, Kiliaan, Amanda J. Dietary lipids from body to brain. Prog Lipid Res. 2022;85:101144. DOI: 10.1016/j.plipres.2021.101144 4. de Souza RJ, Mente A, Maroleanu A, Cozma AI, Ha V, Kishibe T, Uleryk E, Budylowski P, Schünemann H, Beyene J, Anand SS. 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