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Study population

The study was approved by ethics committees in both Sheba Hospital in Israel (No. 5484) and the First-affiliated hospital of Sun Yat-Sen (SYS) University in China (No.[2021]GH1457; No.[2019]GH0367; No.[2017]073), and the research complies with all relevant ethical regulations. This study was conducted in Guangdong province in Southern China and Israel (Jan 2019 to April 2021). Several populations were analyzed (Fig.1). In China, newly diagnosed and treatment-nave CD patients were included, along with healthy urban residents of Guangzhou, a modernized metropolitan community with a population of 16 million, and healthy residents of Shaoguan district, a rural underdeveloped community 300km north of Guangzhou. Participants were asked about the amount of time they spent in an urban environment in the last year (How long have you stayed in a city in the last year?) with answers including less than 10%, 1050%, and above 50%. Newly diagnosed CD patients and healthy controls from Israel were included as another layer of a Westernized control cohort. CD diagnoses of all patients were harmonized and based on clinical history, physical examination, laboratory work, radiological findings, and endoscopic and histological features as previously established in the European Crohns and Colitis Organization consensus statement36. Written informed consent was obtained from all participants.

Data regarding enrolled subjects were recorded in a structured manner that included demographic, clinical, laboratory, endoscopic, and pathological features for the indicated group and participants (Fig.1). Laboratory tests included C-reactive protein (CRP). Endoscopic evaluations included gut segmental involvement. Stool specimens were collected into a collection tube at least 3 weeks following any antibiotic treatment. Stool samples were aliquoted and frozen immediately in 80C. Ileal biopsies were gathered during diagnostic colonoscopy and stored in RNAlater and frozen at 80C. Due to COVID-19 outbreak limitations, samples were processed locally within each country of origin. Samples from both cohorts were analyzed using a similar bioinformatic pipeline; direct comparisons between groups were performed within each country of origin.

Patients from both cohorts underwent environmental and dietary exposure surveys. Gender was determined based on self-report. For environmental exposure, we used the questionnaire developed by the International Organization of IBD (IOIBD), with some modifications. The questionnaire consists of 87 questions covering 25 different topics proposed to be environmental risk factors for CD. Although it was not formally validated by the IOIBD, this questionnaire has been previously used in epidemiological studies investigating triggers of IBD37,38, including one conducted in South-East Asia and China39. IOIBD questions relate to five main different areas: (1) Childhood factors up to 20 years including breastfeeding, appendectomy, tonsillectomy, eczema, vaccinations (tuberculosis, pertussis, measles, rubella, diphtheria, tetanus, polio), childhood infections (measles, pertussis, rubella, chickenpox, mumps, scarlet fever) and pet ownership; (2) food habits including daily, weekly or less frequent consumption of fruit, vegetables, egg, cereal, bread, coffee, tea, juice, sugar, and fast food; (3) smoking habits (current smoker, non-smoker, ex-smoker); (4) sanitary conditions such as the availability of in-house water tap, hot water tap or flush toilet; and (5) others factors including daily physical activity, the oral contraceptive pill and stressful events before diagnosis. We also included in the IOIBD questionnaire items about antibiotic use before and after the age of 15 years, use of toothpaste, and the presence of amalgam teeth filling during childhood or later in life. In addition, we added a specific question specifying the amount of time spent in an urban environment in the last year with answers including less than 10%, 1050%, and above 50%. Although the IOIBD questionnaire explores the role of diet before the diagnosis of IBD, we added an additional comprehensive FFQ (Food frequency questionnaire), conducted by a trained dietician. This tool included over 600 food items, with an FFQ list that prioritized the foods/beverages accounting for at least 80% of the total energy intake and the between-person variance in previously collected dietary intake data from the adult Israeli population40,41. Personnel from both Sheba and SYS were similarly trained in the dietary interview method and the equivalent FFQ was used after translation to Chinese and adaptation to the Chinese diet. In Israel, a computerized FFQ version was used that automatically computes the average daily nutrient content of an individual patients diet including macro and micronutrients, and food item servings. In China, the data were extracted manually and the portion of a specific food, and micro and micronutrient consumption were summarized. Data regarding exposures and diet are summarized in Supplementary Dataset1. The Sheba FFQ output included 62 features, while the SYS one included 28 features.

Principal component analysis (PCA) was performed to summarize variation in Israel and China FFQ data, separately, using R prcomp function with data scaled and centered. FFQ components were correlated to PC1 and PC2 values using Spearmans correlation, and the top 10 FFQ features by maximal Spearmans rho correlation to PC1 or PC2, with p0.05, are shown to highlight the main components affecting variance in dietary intake. Spearmans correlation was calculated between all FFQ component pairs, separately for Israel, China rural, and China urban and CD. Correlation heatmaps were generated showing Spearmans rho values, clustered using R hclust function with Euclidian distances.

At the Sheba site (Israel), fecal42,43,44 and biopsy7,8,9,10 DNA extraction, and PCR amplification of the variable region 4 (V4) of the 16S rRNA gene using Illumina adapted universal primers 515F/806R was conducted using the direct PCR protocol [Extract-N-Amp Plant PCR kit (Sigma-Aldrich, Inc.)]42,43,44. At the SYS site (China), fecal DNA samples were extracted using the OMEGA Soil DNA Kit (Omega Bio-Tek, Norcross, GA, USA) following the manufacturers instructions. PCRs of the variable region 4 (V4) of the 16S rRNA were conducted and amplicons were pooled in equimolar concentrations into a composite sample that was size selected (300500bp) using agarose gel to reduce non-specific products from host DNA. Sequencing was performed on the Illumina MiSeq platform at Sheba or the NovaSeq platform at Shanghai Personal Biotechnology Co., Ltd (Shanghai, China). Samples from both cohorts were analyzed independently using a similar bioinformatic pipeline. Reads were processed in a data curation pipeline implemented in QIIME 2 version 2021.445,46. Reads were demultiplexed according to sample-specific barcodes. Quality control was performed by truncating reads after three consecutive Phred scores lower than 20. Reads with ambiguous base calls or shorter than 150bp after quality truncation were discarded. Amplicon sequence variants (ASVs) detection was performed using Deblur47, and duplicate samples from different runs were joined, resulting in 323 samples with a median of 55,844 reads/sample (IQR 50,43562,947) for China, and 158 samples with a median of 23,595 reads/sample (IQR 13,54936,505) for Israel. ASVs present in less than 1% of the samples were removed. Additionally, candidate contaminant ASVs were filtered using dbBact14 by removing ASVs with the f-score mean for (water, soil, mus musculus) higher than homo sapiens, resulting in 1668/3642 ASVs for China and 1290/2838 ASVs for Israel after filtering. ASV taxonomic classification was assigned using a naive Bayes fitted classifier, trained on the August 2013 Greengenes database. Taxonomy assigned by 16S is indicated by the specific ASV number, and the sequence associated with each ASV number is indicated in Supplementary Dataset2 and in the relevant supplementary datasets. All samples were rarefied to 33k reads for and diversity analysis for China samples, and 4k reads for Israel samples, to avoid read number effects. Faiths phylogenetic diversity48 was used as a measure of within sample diversity, and Unweighted UniFrac was used as a measure of between sample -diversity49, using a phylogenetic tree generated by SAT-enabled phylogenetic placement (SEPP)50. The resulting distance matrix was used to perform a Principal Coordinates Analysis (PCoA). Heatmaps were generated using Calour version 2018.10.1 with default parameters51.

PERMANOVA: quantifications of variance were calculated using PERMANOVA with the adonis function in the R package Vegan52, on the rarefied Unweighted UniFrac distance values. The total variance explained by each variable was calculated while accounting for age and gender in the model (except for when looking at the contribution of age and gender, when only age or gender can be controlled for). PERMANOVA was calculated independently for each group (China CD, urban, rural-urban and rural, and Israel CD and control) and for each questionnaire and FFQ component. Multivariate Association with Linear Models (MaAsLin2) was used with R package version 1.8.0, to test for specific differentially abundant ASVs between: rural and rural-urban samples controlling for age and gender, China CD and urban controls controlling for age and gender, and Israel CD and controls, using both stool and biopsy samples, controlling for age, gender, sample type (stool or biopsy) and patient ID as the random variable. MaAsLin2 was also used to identify ASVs correlated with dietary consumption of fat, iron, and protein separately, within all China controls, controlling for age, gender and group (urban, rural-urban or urban). A false discovery rate (FDR) cutoff of 0.25 was used for all MaAsLin2 analysis53, and FDR cutoff of 0.1 is indicated.

Rural and Health indices: per-sample health index was calculated as previously described11. Briefly, a set of ASVs that were significantly increased or decreased across multiple human diseases compared to controls was identified. Using these ASVs bacteria, for each sample the log of the ratio of health-associated bacteria (98) to disease-associated bacteria (32), following rank transforming the samples, was calculated and defined as the health index (with higher values indicating a better health-associated microbiome). A similar approach was used to define a rural index for each sample, as follows: Using an independent dataset of rural and urban Chinese samples5, we identified 76 and 42 ASVs significantly higher/lower in the rural community respectively (using a rank-mean test with dsFDR<0.154, implemented in Calour51). The rural index was then calculated for each SOURCE sample as the log of the ratio of the rank-transformed frequencies of the ASVs from the rural and urban ASVs. Age matching between sample groups was performed by binning ages into 10 year bins, and equalizing the number of samples in each age bin between the two sample groups by randomly dropping samples.

dbBact term enrichment analysis: significantly enriched dbBact14 ontology terms between two ASV sets (e.g., higher/lower in rural community or positively/negatively correlated with dietary factor) were identified using the dbBact-calour plugin. Briefly, dbBact contains annotations linking ASVs to ontology-based terms, based on manual analysis of over 1000 amplicon experiments. For the current experiment analysis, for each term, a dbBact annotation-based score is calculated for each ASV, and the distribution of the score across the two ASV groups is compared to random permutations (of ASV group labels), using a permutation-based rank-mean test with dsFDR multiple hypothesis correction. For the term-specific Venn diagrams, the number of ASVs associated with the term in at least one dbBact experiment is shown for each ASV group, with the central (gray) circle showing the total number of ASVs in dbBact associated with the term. The study was conducted and is currently reported according to the STORMS guidelines55 (information in Supplementary Dataset1).

For samples from the Sheba site, DNA was purified using the PowerMag Soil DNA isolation kit (MoBio) optimized for the Tecan automated platform. DNA was diluted to 1.5ng, and Illumina libraries were prepared using Nextera DNA library preparation kit, Ref# 15028211; by Tecan Freedom Evo 200 robot device. Nextera DNA Unique Dual Indexes Sets AD from IDT were used for library preparation. Library concentration was measured using the iQuantTM dsDNA HS Assay Kit, ABP biosciences (Cat# AP-N011), and library size was quantified by automated electrophoresis nucleic acid QC -Tape-Station system. Libraries were sequenced by a NextSeq 500 device with IlluminaNS 500/550 High Output V2 75 cycle kit, Cat# FC-404-2005. SYS samples site, the extracted DNA was processed to construct metagenome shotgun sequencing libraries with insert sizes of 400bp by using Illumina TruSeq Nano DNA LT Library Preparation Kit. Each library was sequenced by the Illumina HiSeq X-ten platform (Illumina, USA) with PE150 strategy at Personal Biotechnology Co., Ltd. (Shanghai, China). Samples from both cohorts were analyzed independently using a similar pipeline (https://github.com/biobakery). Reads were first decontaminated and trimmed using KneadData v0.12.0, then samples under 7M reads PE (or 3.5M SE) were excluded. The average number of reads after the quality control process was 52,508,783.72 (11,833,357.89) PE and 8,773,250.37 (2,135,013.94) SE for the Chinese and Israeli cohorts respectively. Taxonomic profiles were generated using MetPhaln v4.0.056, from which the functional profiles were generated using HUMAnN v3.657. Default parameters were used for all modules, besides defining concatanating PE reads using the -cat-final-output parameter in KneadData. Taxonomic and functional features were filtered out if they didnt have abundance greater than 0.01% in at least 10% of the samples.

For the Sheba samples (n=37), extraction solution (ES: 75% methanol and 25% water and six internal standards) was mixed with fecal smear, sonicated for 10min, centrifuged at 14,000g for 10min at 4C, and stored at 80C until submission for LC-MS metabolomics analysis. LC-MS analysis was conducted as described58. Briefly, Dionex Ultimate ultra-high-performance liquid chromatography (UPLC) system coupled to Orbitrap Q-Exactive Mass Spectrometer (Thermo Fisher Scientific) was used. The resolution was set to 35,000 at a 200 mass/charge ratio (m/z) with electrospray ionization and polarity switching mode to enable both positive and negative ions across a mass range of 671000m/z. The UPLC setup consisted of ZIC-pHILIC column (SeQuant; 150mm2.1mm, 5m; Merck). Stool extracts were injected, and the compounds were separated with mobile phase gradient, starting at 20% aqueous (20mM ammonium carbonate adjusted to pH 9.2 with 0.1% of 25% ammonium hydroxide) and 80% organic (acetonitrile) and terminated with 20% acetonitrile. Flow rate and column temperature were maintained at 0.2ml/min and 45C, respectively, for a total run time of 27min. All metabolites were detected using mass accuracy below 5ppm. Thermo Xcalibur 4.1 was used for data acquisition. Peak areas of metabolites were determined using MZmine2.5359 by using the exact mass of the singly charged ions (m/z) and the retention time of metabolites was predetermined on the pHILIC column by analyzing an in-house mass spectrometry metabolite library that was built by running commercially available standards. Thermo TraceFinderTM 4.1 software was used for validation, by comparing the peak areas of the internal standards determined by both software. A total of 405 of 545 of the predefined metabolites library passed the threshold of peak intensity and were included in the analyses.

For the SYS samples, a targeted metabolomic analysis using a Q300 kit (Metabo-Profile, Shanghai, China) was performed. Lyophilized samples (~5mg) were mixed with 25l of water and homogenized with zirconium oxide beads for 3min. One hundred twenty l of methanol containing internal standard was added and then homogenized for another 3min, centrifuged at 18,000g for 20min, and 20l of supernatant was transferred to a 96-well plate. The plate was sealed and incubated at 30C for 60min, after which 330l of ice-cold 50% methanol solution was added to dilute the sample. Then the plate was stored at 20C for 20min, followed by 4000g centrifugation at 4C for 30min. One hundred thirty-five l of supernatant was transferred to a new 96-well plate with 10l internal standards in each well. A liquid chromatography coupled to tandem mass spectrometry (UPLC-MS/MS) system (ACQUITY UPLC-Xevo TQ-S, Waters Corp., Milford, MA, USA) was used to quantitate all targeted metabolites. To diminish analytical bias within the entire analytical process, the samples were analyzed in duplicates that were randomly analyzed. The quality control (QC) samples, internal standard calibrators, and blank samples were analyzed across the entire sample set. The raw data files generated by UPLC-MS/MS were processed using the MassLynx software (v4.1, Waters, Milford, MA, USA) to perform peak integration, calibration, and quantitation for each metabolite. A total of 185 of 305 metabolites passed the threshold of peak intensity and were included in the analyses.

Ninety-two metabolites overlapped between the 185 SYS dataset and the 405 in the Sheba cohort, and these were used to test correlations as independent validation. Overall, the normalized metabolite levels (each metabolite value was divided by the sum of total metabolites value per sample) were used for all downstream analyses in both Sheba and SYS cohorts.

Principal coordinates analysis (PCoA) was performed on the metabolomics data using Canberra distances as a measure of between sample -diversity. Multivariate Association with Linear Models (MaAsLin2) was used with R package version 1.8.0, to test for specific differentially abundant metabolites between China rural and rural-urban samples controlling for age and gender, and for China CD and urban controls controlling for age and gender, using FDR cutoff of 0.25.

At the Sheba site, RNA and DNA were isolated from terminal ileum (TI) biopsies obtained during diagnostic colonoscopy using the Qiagen AllPrep RNA/DNA Mini Kit. PolyA-RNA selection, fragmentation, cDNA synthesis, adapter ligation, TruSeq RNA sample library preparation (Illumina, San Diego, CA), and paired-end 75bp sequencing were performed. Median reads depth was ~ 39M (3146M IQR) in Sheba. Samples were sequenced at the NIH -supported Cincinnati Childrens Hospital Research Foundation Digestive Health Center. At the SYS site, mRNA was purified from total RNA using poly-T oligo-attached magnetic beads. The strand-specific cDNA sequencing libraries were generated using NEBNext UltraTM Directional RNA Library Prep Kit for Illumina (NEB, USA), and index codes were added. Samples were purified (AMPure XP system) and clustering of the index-coded samples was performed on a cBot Cluster Generation System using HiSeq 4000 PE Cluster Kit (Illumina, NEB, USA). After cluster generation, the stranded, poly-A selected libraries were sequenced on an Illumina NovaSeq 6000 platform by Novogene Bioinformation Technology. One hundred fifty bp paired-end reads were generated to a median depth of 42.3M (39.946.6M IQR) reads for China samples, and 38.2M (3238.2M IQR) reads for Israel samples. Reads were quantified by kallisto60 version 42.5 using Gencode v24 as the reference genome. Kallisto output files were summarized to gene level using R package tximport version 1.22.061. Protein coding genes with Transcripts per Million (TPM) values above 1 in at least 20% of the samples were used in downstream analysis.

Weighted gene co-expression network analysis (WGCNA) to identify modules of co-expressed genes25,62 was implemented utilizing R WGCNA package version 1.72-1, using the Sheba cohort as described63,64. The analysis was performed on TI transcriptomics data. WGCNA was implemented for the identification of co-expressed gene clusters; we used pairwise correlations between gene expression profiles and the signed hybrid version of WGCNA. Similarities of gene co-expression are converted to adjacency values (power adjacency function), with a parameter of 12. Average linkage hierarchical clustering on TOM-based dissimilarities is implemented to detect modules of strongly correlated genes across samples. For each module, the first principal component, referred to as the eigengene, was considered to be the module representative. A module summarized the expression levels of all the genes in a given module. Included parameters were cluster sensitivity parameter (deepSplit) of 2 to identify balanced gene modules, a minimum number of genes in a module (minModuleSize) was set to 30 genes, maxBlockSize was set to 20,000 to include all genes in one block. The same modules of co-expressed genes were applied to the SYS transcriptomics dataset. We focused on modules significantly associated with disease, with p0.05 in at least one of the two cohorts. Nine out of 14 modules were associated with disease. Module eigengenes were additionally correlated (Students asymptotic p value) to dietary factors, and to fecal metabolites. Metabolomics data was log-scaled and cleaned, with zeroes replaced by a fifth of the lowest value per metabolite, and values with over 4 standard deviations from the mean were trimmed to 4 standard deviations from the mean, to avoid extreme values driving correlations. BenjaminiHochberg FDR correction was applied separately to diet and metabolomics results. Correlations with FDR0.25 were considered significant. This module eigengenes correlation analysis was performed independently for the Sheba and SYS datasets. ToppGene65 and ToppCluster software were used to perform Gene Set Enrichment Analyses (GSEA) of the protein-coding genes within the modules in the WGCNA TI analysis.

For each of the Sheba TI transcriptomics WGCNA disease-associated modules, we defined modules associated with metabolites as fecal metabolites with significant correlation (FDR0.25) to that module eigengene. An exact binomial test was used to test the consistency of metabolites correlation to TI WGCNA modules, between all samples and CD samples only in the Sheba cohort. For the 416 significant module-metabolites correlation calculated using all samples, a correlation was considered consistent if it changed in the same direction in CD samples, looking at Spearmans rho. 406 out of 416 correlations were consistent. The probability of success was calculated as pall*pcd+(1pall)*(1pcd), with pall representing the percentage of positive correlations in all samples, and pcd representing the percentage of positive correlations in CD samples, to account for the unbalanced positive to negative correlations ratio. HAllA (Hierarchical All-against-All significance testing) version 0.8.20 was used to identify potential correlations between these modules associated metabolites and Israeli FFQ components, stool 16S ASVs, and stool metagenomics (MGX species, pathways, and ECs). HAllA was used with Spearman correlation and FDR cutoff of 0.25.

We applied sparse Partial Least Squares (sPLS) regression between pairs of omics19 including -metagenomics (species, pathways, and ECs), stool metabolomic, and host TI transcriptomics (using disease-related WGCNA modules PC1 values). This method aims to maximize the shared variation between a pair of omics while accounting for the sparsity in the data. As a measure of the identified shared variation, we calculated the Spearman correlation between the first components of each omic. Significance was evaluated by generating 100 permutations of the feature table, and counting the number of permutations that yielded a higher correlation value than the one calculated for the original data. DIABLO20 (Data Integration Analysis for Biomarker discovery using Latent variable approaches for Omics studies) was used to simultaneously maximize the shared variation between each omics and differentiate between the health conditions. To uncover the relationship between the omics features and the disease state, we focused on the 10 loadings with the highest correlation to the first and second components. Both sPLS regression and DIABLO were calculated using the MixOmics package66. According to the recommendations in the MixOmics package, the number of components was chosen by a minimal balanced error rate using the centroid distance method. In addition, HAllA version 0.8.20 was used to identify potential correlations between China rural and rural-urban metabolites, FFQ components, and stool 16S ASVs, using Spearman correlation and FDR cutoff of 0.25.

Statistics used for transcriptomics, microbiome, and metabolomics were performed in R, and details are under these specific sections. Overall, Pearsons chi-square test or Fishers exact test was used for categorical variables, Spearmans rank correlation was used for continuous variables, and the MannWhitney U test for categorical variables, with BenjaminiHochberg Procedure for FDR correction using 0.1 or 0.25 as indicated.

Further information on research design is available in theNature Portfolio Reporting Summary linked to this article.

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Diet-omics in the Study of Urban and Rural Crohn disease Evolution (SOURCE) cohort - Nature.com

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Five fruit and veg a day may just keep prostate and colorectal cancer at bay, according to new research.

A review of dozens of separate studies, published in the International Journal of Cancer, found that healthy diets with a rich variety of plant-based foods were associated with a lower risk of mortality from colorectal cancer, while unhealthy diets and intake of sugary drinks were linked to a higher risk of mortality.

In another study of 2,062 men diagnosed with prostate cancer, those with the highest intake of plant foods had a lower risk of prostate cancer progression compared with those who ate fewer plant-based foods. These findings were published in JAMA Network Open.

As part of their meta-analysis, the researchers from the International Agency for Research on Cancer and the World Health Organization analyzed 5 randomized controlled trials (RCTs) and 35 observational studies, which, in total, comprised of 30,242 individuals with colorectal cancer, 8,700 of whom died during the course of the study, 2,100 of which due to colorectal cancer.

Individuals living off Mediterranean and plant-based diets had lower risk of mortality than those eating unhealthy, Western diets. As for specific foods, whole grains and coffee (caffeinated or decaffeinated) were particularly noted for their link to lower risk of death. Sugary and artificially-sweetened drinks, on the other hand, were associated with worse cancer outcomes.

This comprehensive and rigorous review of the current state of evidence offers useful guidance on some of the diet and lifestyle factors that could improve cancer survival, and potentially help people living with and beyond cancer enjoy longer, healthier lives, said Dr. Helen Croker, assistant director of research and policy at World Cancer Research Fund International and co-author of the review.

At the same time, it shows a clear need for more well-designed intervention and cohort studies to support the development of robust recommendations for colorectal cancer patients and health professionals. As we are seeing an increase of people diagnosed with colorectal cancer at younger ages, it is more important than ever that health advice is based on high-quality research.

As part of the JAMA Network Open study, 2,062 men with biopsy-proven, nonmetastatic prostate cancer were enrolled across the US between 19992018 and asked to complete a diet and lifestyle questionnaire.

Between this first round of assessments and the follow-up appointments which, on average, occurred 6.5 years later 190 of the mens cancers progressed and 61 died.

The researchers observed that the men who regularly ate more plant-based foods had a 47% lower risk of cancer progression.

Compared with men who ate fewer plants, men with high plant-intake scores typically ate 1.9 additional servings of vegetables, 1.6 additional servings of fruit, 0.9 more servings of whole grains, 1.0 less serving of dairy, 0.4 less servings of animal fat, slightly less egg and marginally less meat.

Although such high plant-based index scores werent associated with a reduced risk of progression overall, such an ultra-green diet was associated with a 55% lower risk of cancer progression among 680 individuals with more advanced cancers.

The researchers from the University of California, San Francisco, concluded that plant-based diets may help keep prostate cancer progress at bay, although they say future research and replication of their findings are needed.

References: Tsilidis K, Markozannes G, Becerra-Toms N, et al. Post-diagnosis adiposity, physical activity, sedentary behaviour, dietary factors, supplement use and colorectal cancer prognosis: Global Cancer Update Programme (CUP Global) summary of evidence grading. Internat. Journ. of Canc. 2024. Doi: 10.1002/ijc.34904

Liu VN, Van Blarigan EL, Zhang L, et al. Plant-Based Diets and Disease Progression in Men With Prostate Cancer. JAMA Netw Open. 2024. doi:10.1001/jamanetworkopen.2024.9053

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Plant-Based Diet Can Reduce Severity of Colorectal and Prostate Cancer - Technology Networks

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For patients withprostate cancer, a primary concern is that the disease may progress to an advanced stage that becomes life-threatening. New findings show that eating a diet rich in fresh fruits, vegetables, and grains may significantly lower the chances of prostate cancer spreading.

[1]

Consuming a primarily plant-based diet may be associated with better prostate cancerspecific outcomes, adding to a list of other numerous health benefits, including a reduction in diabetes, cardiovascular disease, and overall mortality, says lead authorVivian Liu, a clinical researcher affiliated with the department of epidemiology and biostatistics at the University of California in San Francisco. Making small changes in ones diet to eat more plant-based foods and less animal-based food each day is beneficial and the more [plants] you eat, the better.

RELATED: 9 Scientific Benefits of Following a Plant-Based Diet

The investigation involved more than 2,000 men who at study start were 65 years old on average and had a diagnosis of nonmetastatic prostate cancer meaning it had not yet spread to other parts of the body. Participants each completed a comprehensive diet and lifestyle questionnaire that provided a detailed picture of their eating habits.

Over an average of 6.5 years, 190 participants experienced cancer progression and 61 died from prostate cancerspecific causes. Based on analysis of this data, Liu and her team determined that those who consumed the highest amounts of plant-based foods had a 47 percent lower risk of prostate cancer spreading compared with men who consumed the lowest amounts of plant-based foods.

Liu said that the results also point to an inverse relationship between plant-based consumption and dying prematurely, although information was insufficient to make a meaningful estimate as to a percent reduction in mortality risk.

In relation to the lowest level of plant-based consumption, the highest level meant eating 1.9 more portions of vegetables, 1.6 additional servings of fruit, and 0.9 more servings of whole grains every day.

To get a sense of what this means in real-life terms, a standard serving of fruit may be one medium apple, banana, orange, or pear. A half-cup of brown rice is considered a single serving of grains, while a single portion of vegetables may be a half-cup cooked or 1 cup raw broccoli, carrots, and the like.

Those eating high quantities of plant-based foods were also eating lower amounts of animal-based foods on average, one less serving of dairy (such as a cup of milk or two slices of cheese), slightly fewer eggs, and marginally less meat.

According toNatasha Gupta, MD, a research assistant professor in the department of urology at NYU Grossman School of Medicine in New York City, these results add to a growing body of literature highlighting the benefits of plant-based diets in terms of a reduced prostate cancer risk, as well as improved quality of life.

[2]

As to why a plant-based diet is beneficial, Gupta highlights that fruits and vegetables are rich in substances like phytochemicals and antioxidants, which may prevent harmful cellular changes.

On the other hand, animal-based foods like processed meat and red meat are known carcinogens according to theWorld Health Organization, and dairy has been linked to worse prostate cancer outcomes, says Gupta, who was not involved in this study. A plant-based dietary pattern naturally shifts away from these harmful foods to more helpful foods.

[3]

While about 6 in 10 prostate cancers are diagnosed in men who are age 65 and up, Liu stresses that dietary changes can still make a difference in this older population.

It's not too late, she says. You don't have to make a 180-degree change to your diet. Just focus on small changes to eat more plant-based foods and less animal-based food each day. Greater consumption of plant-based food after a prostate cancer diagnosis has also recently been associated with better quality of life, including sexual function, urinary function, and vitality so its a win on many levels.

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Prostate Cancer May Spread More Slowly With a Plant-Based Diet - Everyday Health

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Athletes need to replenish their energy, and the number of calories they need can be difficult to fit in.

British number one padel tennis player Tia Norton explains that her replenishment routine was influenced by some, perhaps, surprising advice from nutritionist. One of the things that I've taken away from it is eating a full fat diet is actually much, much better for performance. So I'm not cutting out full fat milk, bacon, cheese etc. Since I have incorporated full fat into my diet, I'm enjoying it much more because I'm not having to restrict myself.

Fruit, including the fast-digesting carb of bananas, is a handy pre-training snack and one that can be also used for a quick sugar injection during many sporting activities.

However, the kinds of energy-boosting snacks and drinks that are targeted at the average gym-goer are sometimes pushing your sweet tooth according to Matt Gardner, head of nutrition at Virgin Active. He feels that they should be used when people are caught short and cant find an alternative.

Producer Nina meets a group of people involved in Bite Back, a youth activist organisation campaigning against junk food. They tell her that the range of junk food available in sports shops is staggering and includes a rainbow of energy drinks, many of which boast that they contain electrolytes and B vitamins, but dont say as much about the amount of ultra-processed products, chemicals and sugar within.

Many of the protein bars are essentially chocolate bars; meanwhile some of the products were just chocolate but labelled with slogans like "I Love Football", "Man of the Match" and "Game On" to promote an association with sport.

Alice, one of the Bite Back activists believes that junk food has become the cultural wallpaper. She adds: We could do 24 hours of sport every single day of the week, and that still wouldn't be enough to combat the flood of junk food that's just constantly pumped towards us.

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BBC Radio 4 - The Food Programme - Seven things we learned about nutrition for sport. - BBC

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Whether she's donning an armoured suit in Edge of Tomorrow, travelling in on a wire for Mary Poppins or bossing a fight scene in her new movie, The Fall Guy, Emily Blunt's career requires her to be in great shape and luckily, she has a brilliant long-time personal trainer, Monique Eastwood, to help her hit any strength and fitness goals.

Monique and Emily have worked together for almost ten years, after the former slid her CV across the production desk of Edge of Tomorrow, and ever since Emily (along with the likes of

But what is the Pilates and dance-inspired Eastwood Movement Method that Emily Blunt loves and what does her workout routine actually look like? What self-care hacks does she use for keeping in the best shape whilst on set? And what do we know about the actor's eating habits?

We chatted to Emily's PT to learn more (oh! and PS: whilst it's always fun to nosey at what celebs get up to in the gym and to cherry-pick bits to jazz up your own routine, it's worth saying that every body shape and size is worthy of love and respect... and that two people could follow the exact same plan and emerge looking totally different. Which is something to celebrate!).

Now, without further ado, here's what we know about Emily's fitness regime and diet...

When her schedule permits, Emily works out 4 to 5 times a week with Monique (for about an hour at a time) but even when things get a little crazy schedule-wise and she's on the road, Emily stays committed to moving her body (and she also continued to work out during both of her pregnancies).

"She is so consistent, and disciplined. If she's on a film or doing press, it's very different and I'm on call when she needs me," the PT reveals. "We'll meet in a hotel for half an hour, or an hour, and just work out wherever we can. And if not, because her timezone doesn't fit with mine, Emily uses the Eastwood Fit app. She knows how to do my methods, so it doesn't matter where she is really."

In a recent BBC interview with her The Fall Guy co-star, Ryan Gosling, Emily even joked that she "squeezed in a half hour of Pilates" whilst everyone else on their promotional tour was taking a nap.

Given Monique's dance background, the workouts she creates for Emily are often inspired by similar movements. If you think about a squat for instance, you likely imagine it's just an up and down movement but Monique says "with me, being a ballerina, I don't want to just go up and down. I want to get into all the muscles in the pelvis and the legs, and get your brain to work simultaneously as the body moves".

She continues, "So I'll go from a side lunge, into a squat into a leg kick that way the inner thigh muscles are stimulated, as are the pelvic muscles and glutes." It's also about developing a brain-body connection, Monique adds, as your brain has to think about shifting the body from the left, to the centre, to the right.

Emily also has her own Reformer Pilates machine at home, Monique says. "She has a Reformer machine at her house, so when she's home it's a lot easier to programme in what I'm going to do with her."

In preparation for The Fall Guy, Emily made sure to prioritise stretch and recovery, as well as her usual mix of HIIT and strength sessions. "In the movie there's a scene where Emily runs and the energy is quite intense. She had to look agile and have that lean, long, strong powerful body," Monique says. "We maintained her with the typical mix [of workouts], along with more explosive movements and stretching... But you need that recovery day, otherwise it's just too much for your your cell rejuvenation."

Doing linked movements is also a great way of switching on your core, says Emily's trainer. "It's activating your core without even thinking; dancers don't do hundreds of sit-ups, we are just moving in different directions, and that's how our bodies becomes toned and controlled. Learning that control as you move gives you that poise, agility and graceful movement."

It helps her on set too. "I do a couple of fights," Emily revealed when discussing her new movie. "I adore a fight scene, and I'm very game. But [as for the kind of stunts that] Ryan did Im like, 'nope!' That thing he did off the top of that building? I was like, 'That's a solid no for me'."

On the cardio front, Emily isn't shy about getting stuck into a HIIT (high intensity interval training) class with Monique. "My HIIT classes are cardio bursts, we do jumping up and down, but I'm quite careful with what I do to bring your heart rate up. I don't do burpees because of backs and landing on your toes, I'm careful about how I jump people and I really want you to feel it in the pelvis, to get the strength from the right muscles, rather than your knees wobbling all over the place as you jump."

Monique adds that she also encourages those who are capable to add in weights as well, "that way you really get your heart rate up".

Life is all about balance, right? And that means the odd slice of cake or a margarita is still very much on the table, explains Monique. "I would say that the 90% of our days and our lives are geared around health, discipline and being nutritious, but we have a margarita together too, because that's what normal people do!" Apparently Emily also has a mean carrot cake recipe that she's happy to share, featuring maple syrup.

Emily's potatoes are so famed, her recipe even went viral back in 2020. Chatting to cook Ina Garten about her love of a roast, the actor said: "The usual routine is that you start at around 2pm and it goes on until 7. It is a long meal. You do not rush through it. It is wine-fuelled I couldn't believe it when everyone loved the roast potatoes I did on your show because I was like, 'Have people never had these before?' This was like a staple of my diet."

If you struggle to sleep, maybe it's time to give Emily's favourite breathing techniques a go before bed a trick she learnt from Monique. "There's a breath pattern I do that helps her to get to sleep sometimes, it's part of my Power/Stretch class," the expert explains. "A lot of yogis do it, where you breathe in for four, hold the breath for four, and then let go for four or let go for eight.

"When Em is doing lots of press or she's busy, rushing around, you can imagine [that leads to] elevated cortisol, so it's really important to bring that breath pattern in to help calm the parasympathetic nervous system down."

Monique Eastwood is an A-list trainer to stars including Emily Blunt, Stanley Tucci and Anne Hathaway. She is also the founder of the Eastwood Movement Method and Eastwood Fit App.

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Emily Blunt's workout and diet: how she trained for The Fall Guy - Cosmopolitan UK

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Well, eventually.

At first, when the doctor recommended Sale cut out gluten and make other dietary changes, he was not having it.

The doctor was like, Hey man, this is the deal, Sale said. And I said no. Im like, Im not gonna do it. I was like, Youre full of it, man. Im not doing it. And hes like, All right, go for it. And I want to say, maybe a few weeks later, I come back with my tail tucked between my legs. It was bothering me, so I was like, I gotta do something. I cant live on Advil every freaking day.

So he tried the gluten-free diet. He began eating more cooked foods instead of process foods. He tried to prioritize sleep. And hes now taking more vitamins A, B, C, fish oil, magnesium to aid his health.

With the changes, the achiness in his body subsided. He still dealt with injuries in the couple of years that followed, but those had more to do, Sale said, with just baseball being baseball.

Just try to do what I can, Sale, now 35, told The Atlanta Journal-Constitution in the visiting dugout at Dodger Stadium. Im not here saving the world. Its not like Im doing anything wild or crazy. I knew it was something that I could do better, my wife has a lot of knowledge in it and helped me out a lot with it, and its not gonna hurt. And not for nothing, its not impossible to do now because most places have (gluten-free) options. And you can always eat green beans with a chicken breast or a piece of beef a piece of steak, whatever and youll be good.

Gluten is the term for the proteins found in wheat, rye, barley and triticale the last of which is a mix between wheat and rye. In other words: No McDonalds, no Taco Bell, no Pizza Hut, etc. And no beer.

At the grocery store, certain snacks might come with the gluten free label. But at a restaurant, where cross-contamination can occur, eating gluten-free can be difficult.

Switching to a gluten-free diet is tough because gluten is hidden in so many foods you wouldnt think about a condiment, for example. Gluten isnt only bread. But it also has been a rough adjustment because, well, places like McDonalds and Taco Bell taste great.

I used to be very bad about my diet, Sale said. Read articles about me when I was younger. I was eating 20 bags of chips on the plane, McDonalds and Taco Bell a couple times a week. It was not good. If there was one thing that I definitely couldve done better throughout my career, it was that. And then obviously having to deal with all this (injury) stuff over the last few years, I had enough time to look into it and kind of get on a better diet and get on a better schedule, and stuff like that.

Brianne Sale has always been on the healthier side, Chris said. But over the past five or six years, he added, shes dialed in. She takes health classes. The Sales have an office in their home, and Brianne often spends time there doing research.

Chris continues to accept these changes from a few years ago. And over this past offseason, Brianne added another resource for Chris: The couple began subscribing to Elevated Eats, which customizes meal prep for athletes. Chris got another blood test, and the company used that panel to create a diet with appropriate meal options.

Its easier for me to do as Im told, you know? Sale said. Like, Hey Chris, eat this today, eat this today, take these at night, drink this in the morning. Thats so easy for me! Very much like my catchers. Throw this pitch here. OK, cool. Throw this pitch here now. All right, cool. Its being able to just kind of wake up and literally grab it out of the refrigerator, put it in the oven for 10 minutes at 350 (degrees), and then I got food to eat. Pretty simple, you know?

And Sales view on sleep reflects his maturity. How does improved sleep show up on the mound? Its difficult to pinpoint. But it cannot be a negative.

I can sleep 10 hours the night before a start and go out there and stink. You know what I mean? Sale said. And we can have a late-night flight into a city and I get four hours of sleep and go out there and have a good game. And vice versa, right? Its not really one thing, specifically. Its just everything combined. You gotta put good fuel in your body, and you have to recover. Sleeping is the best way to recover. You can do all the machines, you can take pills, you can do whatever, but sleeping is the best, natural way for your body to rest, recover and get back to where you need to go. Just putting more emphasis on that.

Sale isnt necessarily gluten intolerant, he said. He just stays away from it. If Sale ate a pizza right now, he wouldnt feel bad. He wouldnt get a stomach ache or get sick.

Its more cumulative for him. If I were to do that for a couple weeks, then Id start feeling like crap, he said. So he stays away from it. He likened it to someone cutting out sugars.

Sugars taste really good, right? he said. Like, eating Oreos is awesome, and ice cream is great. But if someone is like, Ah, Im gonna eat less sugar, its just always gonna be better for you.

Knock on wood, but it seems the changes Sale made in mid-to-late 2020 have helped him. And after a few years of injuries, Sale in 2023 spent time on the injured list, but started 20 games for the first time since 2019.

In six starts this season, Sale has posted a 3.44 ERA. He has 42 strikeouts in 36-2/3 innings. Hes looked like his old self again, knock on wood. His stuff has, for the most part, been nasty.

And Sale, with a fiery competitiveness and tons of experience, is a positive influence for his teammates. He can teach them a lot. Or they can simply watch as he sets an example.

Well, its the greatest thing when you have somebody like that you can watch and ask questions to, Braves manager Brian Snitker said. A guy thats had the success that he has, and how he goes about it and his approach, and all that guys always learn from each other, I think, and its good when you have guys like that.

Sales gluten-free diet has worked too well not to continue doing it. Its just healthier, he said. So hell keep staying away from it.

With maybe one exception.

But I gotta have In-N-Out while Im out here, Sale said, referencing the popular West Coast burger chain. Im gonna have two double-doubles and then Im back on the grind.

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Behind Braves pitcher Chris Sale's improved diet and why he made the changes - The Atlanta Journal Constitution

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This 24-year-old man adores food. He eats special meals during celebrations and enjoys eating new foods during his travels. In addition, he eats a balanced diet. He acknowledged that some need to eliminate certain foods from their diet and is respectful and understanding of other peoples preferences.

He makes sure to have vegetarian options for his vegetarian friends, halal food for his Muslim friends, and foods without beef for his Buddhist friends. When he began a relationship with Z, 20, he thought there wouldnt be any problems in regard to food since hes accustomed to many different dietary restrictions.

Z doesnt eat bread, rice, or noodles (not just gluten-free, just in general), any red meat, dairy, potatoes, sweet potatoes, too much oil, spices, added sugars, artificial sweeteners, and anything with flour, he said.

She doesnt consume any foods that could be labeled as unhealthy' or frozen foods. Z refuses to eat food if its been in the fridge for two days or so. All she eats is steamed chicken, raw seafood, steamed veggies, and fruit.

Since Z wont eat rice or noodles, they cant eat Chinese, Japanese, or Korean food. She eliminated potatoes, rice, bread, and pasta, which rules out Italian, French, and American food. Her refusal to consume flour or spices means they cant have South Asian food.

They cant eat ice cream or frozen yogurt since Z doesnt allow herself to have anything with sugar, artificial sweetener, or dairy. This rule she follows also eliminates cake and nearly all other desserts.

She has refused to eat stir-fried vegetables because they were cooked with too much oil and refused to eat acai because there was peanut butter drizzled on top, he explained.

Luckily, she doesnt enforce her dietary restrictions on him and allows him to eat whatever he likes. When they go out to eat, and she doesnt see anything on the menu that shes comfortable eating, she drinks water while he eats.

Its tough to find restaurants where Z will eat because she wont eat if the meals go slightly against her dietary rules. Whenever hes attempted to take her to vegan or vegetarian places, she usually tells him theres nothing on the menu she enjoys.

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He's Thinking Of Dumping His Girlfriend Because She Follows An Extremely Strict Diet Of Only Steamed Chicken ... - Chip Chick

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The Mediterranean diet has well-established

A study published in the European Journal of Clinical Nutrition looked at the cardiovascular advantages of the Mediterranean diet. Researchers analyzed data spanning 20 years and found that people who consistently followed a Mediterranean-style diet had a lower risk of developing hypertension (high blood pressure) than those who did not adhere to the diet as closely.

The study occurred in 2002 through 2022, and involved 3,042 participants who were not hypertensive at the beginning. The researchers collected a variety of information on the participants at the start, including glucose and cholesterol levels, body weight, and blood pressure. To see how closely the participants followed the Mediterranean diet at the beginning of the study, they were assigned a MedDietscore based on eating the following food groups: fruits, vegetables, whole grains, potatoes, legumes, fish, and olive oil. Over 20 years, researchers followed up with the participants to assess their MedDietScore and to check for the development of hypertension, high cholesterol, type 2 diabetes, and cardiovascular disease.

The study found that participants who closely adhered to the Mediterranean diet had the lowest risk of developing hypertension. The group with the highest MedDietScore, who followed the Mediterranean diet the best, had a hypertension incidence rate of 8.7%. In comparison, participants in the group who had the lowest MedDietScoreand therefore followed the diet less closelyhad hypertension rates of 35.5% by the end of the study.

Researchers also wanted to evaluate how following the diet consistently impacted hypertension risk. They found that those who were closely adhering to the Mediterranean diet regularly exhibited a 46.5% lower 20-year hypertension risk compared to those who were frequently not following the diet.

So what about the Mediterranean diet makes it great for regulating blood pressure and optimizing heart health? The answer may lie in a specific nutrient. Typically, meal patterns that include potassium-rich foods (like fruits, vegetables, and legumes) are beneficial for keeping your blood pressure in check, says Melissa Prest, D.C.N., R.D.N., national media spokesperson for the Academy of Nutrition and Dietetics and member of the Prevention Medical Review Board. The Mediterranean diet is a great example of a meal pattern that includes these foods and is lower in saturated fat and sugar.

When following a Mediterranean diet, youll generally get plenty of veggies and fruits that offer dietary fiber, potassium, and magnesium, all of which are associated with healthy blood pressure, adds Jackie Newgent, R.D.N., C.D.N., chef, nutritionist, and author of The Plant-Based Diabetes Cookbook. Plus, youll be able to enjoy liberal use of olive oil, which is also linked to lowered blood pressure.

Compared to a standard American diet, people following a Mediterranean diet are consuming more minimally processed foods, plant foods, fiber, and healthy fats, explains Prest. This mix is important when eating to maintain normal blood pressure. If you are at risk for high blood pressure and want to adopt Mediterranean diet principles, consider adding fruits and vegetables to most meals and snacks, mix up your protein by choosing plant proteins more often, and savor sweets and red meat as an occasional treat, Prest advises.

We know that the Mediterranean diet is often recommended for overall heart health, but this new research specifically shows the benefits of following the eating pattern in those with high blood pressure. This study showed that long-term adoption of the Mediterranean diet has a big impact on reducing high blood pressure risk, says Prest. Newgent agrees that its not about a quick-fix diet, and these results suggest that following the eating pattern long-term is advised for better heart health.

In general, people with high blood pressure can benefit from following a Mediterranean-style diet with the addition of consuming less salt and alcohol, advises Prest. With that said, if someone needs to avoid food like nuts, for instance, or curb a nutrient such as potassium, thats prevalent on a Mediterranean diet, they may simply need to follow a modified, personalized version of it, says Newgent. Also, if there are health concerns, like low blood pressure, work with a registered dietitian nutritionist to help you tweak the diet to address those concerns, says Prest.

Madeleine, Preventions assistant editor, has a history with health writing from her experience as an editorial assistant at WebMD, and from her personal research at university. She graduated from the University of Michigan with a degree in biopsychology, cognition, and neuroscienceand she helps strategize for success across Preventions social media platforms.

Read more from the original source:
Study: Mediterranean Diet Tied to Lower Hypertension Risk - Prevention Magazine

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From the outside, Okinawa looks like paradise. But this Japanese island with stunning white sand, crystal clear water, and mangrove jungles has been through a lot. In 1945, the immensely bloody Battle of Okinawa brought devastation to the shores of this picturesque island. But to this day, the environment and the people remain resilient. In fact, Okinawa might just be home to the most resilient people in the world. The island is renowned for having one of the highest concentrations of centenarians on Earth, and, it turns out, this might have a lot to do with diet, as well as resistance to the Western influence that has tried to penetrate the Okinawan way of life since the end of World War II.

jump to the recipes

After the Battle of Okinawa, the island was placed under American administration. This period brought with it many changes, including exposure to a new way of eating. There was an increase in the consumption of foods that were distinctly American, such as refined sugars and fats. But still, many aspects of the traditional Okinawan diet remained. And those who stuck to this way of eating, it seems, have reaped some serious health benefits.

Okinawa is a designated Blue Zone, which means it is a longevity hotspot. In the US, heart disease and cancer are two of the leading causes of death. But in Okinawa, there are six to 12 times fewer heart disease deaths, two to three times fewer colon cancer deaths, and seven times fewer prostate cancer deaths, reports the official Blue Zones organization. The risk of dying from breast cancer is also 5.5 times lower.

The island of Okinawa | Pexels

RELATED: More Than Just Pickles: Fermented Food to Eat for Gut Health

According to the Blue Zones, there are likely a few factors behind this. Okinawans move naturally and regularly, they have a purpose and a faith, they have strong social connections, they have effective ways to destress, and they only eat until they are 80 percent full. In fact, in Okinawa, people often say the mantra Hara hachi bu before they eat, which is a reminder not to overdo it when tucking into a meal.

On top of all of this, Okinawans eat a heck of a lot of plants, which are rich in vitamins, minerals, antioxidants, and fiber. In fact, less than one percent of their diet involves meat. Most of their daily intake comes from vegetables, beans, and fruit. As youll know if youve seen the recent Netflix documentary on the Blue Zones, habit is seen across the four other official longevity hotspots (yes, there are more!) in Loma Linda, California; Sardinia, Italy; Ikaria, Greece; and Nicoya, Costa Rica.

In Okinawa, people eat a wide range of different plant-based, whole foods. But below, weve picked a few of our favorite staples from the island, and highlighted their benefits and some of our go-to recipe ideas, too.

Hannah Kaminsky

Purple sweet potatoes are particularly popular in Okinawa. They get their color from anthocyanins, which are potent antioxidants that help protect cells from potentially disease-causing damage created by free radicals. Orange sweet potatoes, on the other hand, get their color from beta-carotene, another powerful antioxidant that supports immune function, vision health, and skin health. Both types of sweet potato are a good source of fiber, vitamin C, and potassium. Try it in a recipe: Vegan Sweet Potato Chili

Okinawa is an island, so it makes sense that the people who live there would make good use of seaweed. And it just so happens that marine algae is a great source of nutrients (its particularly high in iodine!) and antioxidants, too. Its also rich in soluble fiber, which can help to lower cholesterol, and in turn, support heart health. Try it in a recipe: Vegan Maple-Glazed Tofu Musubi

Another popular food in Okinawa is tofu, which is not only an excellent source of plant-based protein, but its also low in fat and rich in nutrients, like fiber, calcium, iron, and magnesium. Tofu also contains phytoestrogens, called isoflavones, which, according to some research, may help to inhibit the growth of cancer cells. Try it in a recipe: Quick and Easy Vegan Tofu Caprese

Yummy Addiction

Bitter melon, also known as bitter gourd or goya in Japan, is rich in vitamins, fiber, and antioxidants, but its also renowned for its potential to help regulate blood sugar. In fact, it contains compounds like charantin, polypeptide-p, and vicine, which have been shown to have anti-diabetic properties. Try it in a recipe: Coconut Bitter Melon Curry with Tofu

Daikon radish is a common ingredient across Japan. Because its high in fiber, its beneficial for digestive health, but research suggests its also anti-inflammatory. It also contains compounds like glucosinolates, which may support liver function and enhance the bodys natural detoxification processes. Try it in a recipe: Japanese-Inspired Rainbow Salad

Carrots are, of course, an excellent source of vitamin C, but they have many other benefits, too. They also contain beta-carotene, as well as vitamin K1, vitamin B6, potassium, and biotin. And theyre also a great source of dietary fiber, too. Try it in a recipe: Vegan Carrot Lox Toast With Herbed Cheese

Erin Scott

Millet is grown in Okinawa, so its no surprise its a dietary staple there. The grain is incredibly nutritious, and is particularly high in carbohydrates, fiber, protein, and B vitamins, as well as minerals like magnesium, manganese, and iron. It also contains antioxidants such as phenolic compounds and flavonoids, too. Try it in a recipe: Vegan Mixed Grain Vegetable Paella

Amy Angelo

Okinawan people consume turmeric in many different waysit can be eaten or drunk in tea, for example. But however its consumed, this bright yellow spice is always teeming with nutrients. For example, curcumin, the active compound in turmeric, has particularly potent anti-inflammatory properties, and its also a powerful antioxidant, too. Try it in a recipe: Vegan Carrot Ginger Turmeric Soup

Charlotte is a writer and editor based in sunny Southsea on England's southern coast.

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Eat Like a Blue Zoner With These 8 Foods Inspired by the Okinawan Diet - VegNews

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Joey Fatone is back on tour. Not with the boys of NSYNC, with whom Fatone reunited with recently for a song on Justin Timberlake's album, but with AJ McLean. Yes, that AJ McLean, of the Backstreet Boys, who were notoriously held up as the rivals to Fatone's NSYNC throughout the 90s. For the record, any member of either boy band would deny there was ever such a rivalry, chalking it up to a fabricated lie by the media to sell tabloids. Watching Fatone belt out Backstreet Boys bops or McLean doing NSYNC choreo during their A Legendary Night tour, which runs through July 2024, ought to fully put that notion to bed.

During a month-long hiatus from hitting the stage, the 47-year-old is keeping busy. He's been bopping around the country, and for horse racing season, he'll be hitting up Louisville on May 4 as a partner of Skrewball Whiskey. GQ caught up with Fatone a few hours before he was scheduled to head to yet another event, taking a call from his barber chair, mid-haircut, to chat the Fastest Two Minutes in Sports, his non-existent workout, and pre- and post-show routines.

For Real-Life Diet, GQ talks to athletes, celebrities, and other high performers about their diet, exercise routines, and pursuit of wellness. Keep in mind that what works for them might not necessarily be healthy for you.

GQ: Besides your haircut, what's going on, Joey?

Joey Fatone: Been doing a bunch of stuff with AJ from Backstreet Boys, doing that tourwrapping that up. I'm actually headed to Arizona [tomorrow] for a charity event, and that's why I'm running around getting a haircut. It's fight night for cancer, so it's been great. Everything's been really really good. Then I'm headed to the Kentucky Derby, so I've been having a lot of fun, but I can't complain.

Can you tell us how this partnership with Skrewball came about?

I go to the Kentucky Derby every year, so with the big horse race, of course, you know, me, I'm always wearing crazy things. So it's kind of like, I'm already kind of unusual, and so we're saying screw the usual for Skrewball.

How has your relationship with alcohol changed over the years?

Definitely less. As you get older, you can't bounce back like you used to back in the day. I've always been responsible, and I think my relationship with alcohol has definitely diminished. Nowadays [drinking] is more of a celebratory thing or a I'm on a vacation kind of thing. If you do drink, obviously, it's always that key: Drink responsibly.

You've managed to stay incredibly spry over the years. I'm curious how you've managed to stay that way, especially since you're back on tour.

Oh, gosh. I gotta pace myself. Back in the day, I'd be able to drink and then go out and then do a show next day. But I don't have a voice if I drink like that. I can't drink at all on tour. If I'm not working, I can throw a couple back.

I'm curious about your workout routine. What are you doing to stay fit?

I've been a lazy ass; I will not sugarcoat anything. I did a thing for AirSculpt, the company that's like a less-invasive lipo. I hate working out. I know that I am going to have to, but in a sense, my cardio is doing the show. It really kicked my ass the very first day that I did the show with AJ. What we do with the show is very energetic. We are running around the stage all the time, singing each other's songs. It's blast; it's a lot of fun. But it's helped me get my stamina back. The first two, three shows, I was in bad shape. I was sore; I was tired. As I'm getting older I know I need to start doing stuff. But I've gotten in the grove before. I've done CrossFit, I've done the two-a-day workouts; I've run marathons. It's just not for me. My workout is nonexistent at the moment.

I can't believe you're telling me you've run marathons, and now you're saying you're done with cardio.

I've done some crazy shit. At Disney, I've done the [Goofys Race and a Half Challenge, where you run a half marathon one day and then a full marathon the next] and the Dopey [Challenge, where you run a 5K, 10K, half marathon, and full marathon across four days.] I won't do that again.

Sounds like you should get back into running.

I know! It hurts. Oh my gosh. I did the run-walk Jeff Galloway method. It just helps you so you're not killing yourself when you're running constantly.

Do you follow any diets right now?

Just eating healthy, you know? However, man, I'm Italian. I like my pasta, but you know, you got it tone it down. I'm trying to eat my best: good fats, low carbs.

What's your favorite thing to eat?

I love everything, man. Oh, gosh. I love Greek salads. I remember I was in Greece when I was doing My Big Fat Greek Wedding, and in two months, I lost a bunch of weight because I was just eating chicken and saladsreally fresh and healthy.

What do you like what do you eat before you go on stage?

Something light usually. I'll have a Caesar salad, but if I'm tired of that, I'll have a steak or a little bit of meat. I try not to eat too much because I don't want to jump around and be like, Oh I feel like crap. Usually I'll eat something bigger after the show.

How do you hype yourself up before hitting the stage?

I gotta get in the zone. I stretch out a little bit and be kind of zenbe quiet like the calm before the storm.

Do you and AJ meditate together?

We have a prayer. Actually all the band and everyone, we say a prayer right before the show. It's funny because we've been doing that for years. It's amazing because AJ set the prayer up and it's very similar to what we did even back in the day with NSYNC.

What does your post-show routine look like?

I want to just chill and relax. I need a couple of moments to be alone by myself for a minute. I take the time to go over what went wrong, what went right, what was goodthose kinds of things. But other than that, it's chill.

Is there anything new you've learned about AJ since you started the tour?

He's a great entertainer, man. He's really good at [changing things up] on the fly. A lot of people can't do that. You see a lot of bands that come out and they're so scripted, where everything's just very set. He's really good at flying off the cuffif we have to wing something or play something else, he's always down for it. And that's the cool thing with our show, it's very off the cuff. Again, it's all about screwing things. Say screw it, let's have some fun.

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The Real-Life Diet of Joey Fatone, Who Ran Marathons and Decided They Were Not for Him - GQ

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