August 31, 202212:28 PM ET

ALLISON AUBREYTwitter

The U.S. food system makes junk food plentiful and cheap. Eating a diet based on whole foods like fresh fruit and vegetables can promote health – but can also strain a tight grocery budget. Food leaders are looking for ways to improve how Americans eat.

FREDERIC J. BROWN/AFP via Getty Images

The data are stark: the typical American diet is shortening the lives of many Americans. Diet-related deaths outrank deaths from smoking, and about half of U.S. deaths from heart disease – nearly 900 deaths a day – are linked to poor diet. The pandemic highlighted the problem, with much worse outcomes for people with obesity and other diet-related diseases.

“We’re really in a nutrition crisis in this country.” says Dariush Mozaffarian, a cardiologist and dean of the Friedman School of Nutrition Science and Policy at Tufts University

Now, there’s growing momentum to tackle this problem. The Biden administration will hold the White House Conference on Hunger, Nutrition, and Health on September 28th, and will announce a new national strategy. This comes more than 50 years after a landmark White House conference which helped launch today’s major federal food assistance programs.

“The 1969 conference was transformative,” Mozaffarian says. The programs it ushered in, like the WIC program, have helped feed millions of low-income families.

But this hasn’t been enough to solve the dual problems of food insecurity and diet-related disease. Food policy leaders say it’s time to think anew and build on what we’ve learned. The U.S. can’t “fix” hunger by just feeding people cheap, high-calorie, processed foods – the food that’s so abundant in our food supply, they say. Instead, it’s got to find ways to nourish people with healthy, nutrient-dense foods.

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“There’s a lot of enthusiasm and thinking about food more broadly and how we can fix this crisis,” Mozaffarian told NPR. He’s co-chair of an independent task force that includes doctors, chefs, food policy and business experts, as well as farming and health advocates, who are helping form the agenda at upcoming the White House conference.

In a new report, they’ve proposed a wide-ranging set of recommendations to end hunger, advance nutrition and improve health. Here are seven big ideas they’re excited about.

Nutrition advocates say SNAP and WIC benefits, which give low-income families money for groceries, could be designed to incentivize buying more fresh produce.

Justin Sullivan/Getty Images

1. Treat food as medicine

There’s a growing movement to integrate food and nutrition into health care, by providing healthy meals and groceries to patients to help prevent or manage diet-related illness.The task force wants to see this kind of work expand.

“We should pay for food-based interventions that are effective,” Mozaffarian says.

For example, there’s mounting evidence that providing prescriptions for fruit and vegetables can spur people to eat better and manage weight and blood sugar. The idea is for health care systems or insurers to provide or pay for healthy groceries, combined with nutrition education, to help patients change their eating habits. It is being piloted around the country.

“Produce prescription programs help improve diet quality and food security,” says task force member Dr. Hilary Seligman, a food insecurity expert and professor of medicine at University of California, San Francisco, noting that they can help with diet-related diseases like high blood pressure and diabetes.

Another idea is to offer medically tailored meals aimed at helping people who are already sick reverse chronic disease. Currently the federal government is running pilot programs that let Medicaid or Medicare pay for the meals in several states.

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2. Focus on quality of calories, not just quantity

The U.S. food supply is awash in cheap calories. And when you’re on a tight budget or relying on benefits like SNAP (food stamps), processed foods like chips and soda can set you back less than fresh produce. Of course, eating processed foods also contributes to cardiovascular disease, stroke, diabetes and other chronic illnesses, warns Nancy Brown, CEO of the American Heart Association.

Brown says federal food assistance programs have helped to address hunger. “However, many U.S. food policies and programs focus on improving access to sufficient quantities of food,” she says. Instead, it’s time to modernize these policies and focus on the quality of food, “so people have access to enough nutritious food.”

The task force wants to see food programs redesigned to nudge people towards healthier options. The report points to the GusNIP nutrition incentive program – which, in select communities – gives SNAP participants more money to buy fruit and vegetables. It’s a similar concept to the Double Bucks program which doubles the value of SNAP benefits when used to buy produce at farmers markets and other venues.

“It is important to scale up these efforts to ensure that everyone has access to healthy food options,” says task force member Angela Odoms-Young, a nutrition professor at Cornell University.

The task force recommends that Congress establish a nationwide produce incentive program for all SNAP participants. “These types of programs can help promote equity,” Odoms-Young says, noting that people of color disproportionately suffer from chronic illnesses.

To nudge people to eat more fruits and vegetables, one idea is to expand access to programs that give SNAP beneficiaries more money when they buy produce at places like farmer’s markets.

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3. Expand access to dietary and lifestyle counseling

The Affordable Care Act mandates that diet counseling be covered by insurers as a preventive care benefit for those at higher risk of chronic disease. The exact details of who is eligible for which services are left up to an advisory group of doctors and health care providers, as well as insurers, and many patients who would benefit may not have access to this service.

“The vast majority of Americans should be getting preventative behavioral lifestyle treatment,” Mozaffarian says. Too often, he says, doctors prescribe drugs for conditions before recommending or trying lifestyle changes. “Doctors go right to the drug,” he says. “I think that’s a big problem.”

The task force recommends that Congress expand Medicare and Medicaid coverage for medical nutrition therapy to people with high blood pressure, prediabetes, celiac disease, HIV/AIDS, cancer and other diet-related conditions. It also calls for expanded coverage of cooking classes and nutrition assistance, as well as coverage of the Diabetes Prevention Program, delivered by telehealth. This behavior-change program has been shown to be more effective than medicine in reducing the onset of Type 2 diabetes among people at high risk.

4. Support food entrepreneurs

People who start food businesses can help nourish their communities and create jobs. The task force calls on the federal government to pass policies that boost new healthy food enterprises, including providing new loans and grants to food and nutrition-related companies centered on health, equity, and sustainability. The idea is to focus especially on businesses owned by people of color and other marginalized groups.

“We don’t need more businesses creating diabetes and obesity,” says Tambra Raye Stevenson, who runs Wanda, a non-profit group that aims to build a pipeline and platform for a million Black women and girls to become local food leaders. “We need entrepreneurs that provide teaching kitchens, community gardens, healthy food retails, wellness studios, nutrition services, healthy consumer products, and urban agricultural centers,” she says.

She points to food entrepreneurs like Amanda Stephenson who opened a specialty food market in an underserved neighborhood in Washington, DC, Fresh Food Factory, and Mary Blackford of Market 7 who is planning a food hall that features Black-owned food and lifestyle businesses. “They are our food she-roes making a positive impact and providing healthy food access for our children and other women,” says Stevenson.

In the lead up to next month’s White House conference, groups like Food Tank, a food think tank, have organized listening sessions with food researchers and entrepreneurs. “For food to be more accessible and affordable, we need entrepreneurs that use science and technology,” says Danielle Nierenberg of Food Tank. She points to innovators like Journey Foods which is helping entrepreneurs bring nutritious foods and snacks to market.

5. Increase the number of new farmers growing healthy foods using regenerative farming techniques

If all Americans began to eat the recommended amounts of fruits and vegetables each day, there would be shortages. That’s because corn and soybeans are grown on most cropland in the U.S.. Now, there’s growing recognition of the need for more specialty crops – including fruits, vegetables, and nuts.

The task force recommends that Congress create a Farmer Corps to support new farmers, building on the Beginning Farmers and Ranchers Development Program. The idea is to provide new farmers with paid internships and apprenticeships to learn about sustainable farming, and funding to cover a living wage and housing. It also is pushing for loans to go to farmers growing with sustainable practices.

Growing the same crop, season after season, as many farmers do, can make lands less productive over time, and deplete nutrients from the soil.”The unfortunate reality is that today we subsidize conventional practices that degrade the soil,”says David Montgomery, a professor at the University of Washington and the author of What Your Food Atewho attended a listening session.

“What we need to sustain agriculture is to incentivize restoring healthy soils and train more farmers to be successful doing that,” he says.

6. Make school meals free for all students

School meals have been a fixture in U.S. schools ever since President Harry Truman signed the National School Lunch Act back in 1946. For decades, the federal government has reimbursed schools for meals they serve, and low-income students can qualify for free or reduced priced meals. Research has shown that low-income children who participate have better health.

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Yet, many families who are eligible for free or reduced-priced meals may not receive them, sometimes due to the paperwork, bureaucracy or stigma of participating or enrolling. Amid the pandemic, school meals have been offered for free to all students. Now, the task force says this should be a permanent change.

“Without access to free meals at school, many children go without food at all during the day, and many more do not have access to the nutritious foods they need to thrive,’ says Seligman, of UC, San Francisco. She notes that school meals help not only with kids’ nutrition, but they also reduce absenteeism and improve academic outcomes.

7. Establish a federal ‘food czar’

In order to turn ideas like these into action, the task force recommends the creation of a new role in the federal government, a national director of food and nutrition, a food czar figure, if you will. The new director would help streamline and coordinate the many disparate efforts already underway. The U.S. government spends more than $150 billion each year on food and nutrition related programs, and the health care system also spends billions on treatment of diet related diseases.

“This spending is fragmented across 200 separate actions and 21 different departments and agencies without harmonization or synergy,” the task force concludes. Now, they conclude, it’s time for a new approach.

END

What Is a Whole Food, Plant-Based Diet?

By Nelson Huber-Disla

August 8, 2018 — Updated October 20th, 2021

There’s no denying that public interest in health and nutrition has grown considerably. But many are still unsure what makes up a whole food, plant-based diet (WFPB). Are you one of them? Do you ever feel steeped in competing information on topics like these? Well, you certainly aren’t alone.

A WFPB diet doesn’t include any meat, poultry, fish, dairy, or eggs. It’s not, however, the same as a vegan diet, which is defined only by what it eliminates. A WFPB diet is defined also by what it emphasizes: a large variety of whole foods.

The term “whole” in WFPB describes foods that are minimally processed. This includes as many whole grains, fruits, vegetables, and legumes as you want. It also includes, in moderation: nuts, seeds, avocados, natural sweeteners, and certain soy or wheat products that don’t contain added fat (e.g., tofu).

The term “whole” in WFPB describes foods that are minimally processed.

Heavily processed foods, on the other hand, are not included in a WFPB diet. This means avoiding highly refined grain products (e.g., white rice, white flour), foods containing added sugars or artificial sweeteners (e.g., confectioners sugar, high fructose corn syrup), and foods containing added fat. Yes, even olive oil.

Earn your plant-based nutrition certificate

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And that’s it, in less than 10 sentences. You need little else.

You don’t need a calculator to count calories or carbs. There’s no need to avoid cooked foods. Convenience isn’t your enemy. You’re allowed frozen fruits and vegetables, as well as their canned counterparts (just make sure to find low-sodium options). Blandness is not a prerequisite. You’re encouraged to experiment with as many spices as you’d like. And finally, contrary to popular belief, a WFPB diet won’t break your budget. Many of your trusty staples (think beans and potatoes) are among the most affordable foods in the grocery store. This diet doesn’t require specialty items hidden in the health food section. It requires no pails of agave or carts of cashews.

Many eventually give up the “diet” label, in favor of “lifestyle.” Perhaps that’s because our popular notion of dieting has become so warped and confusing. It implies a struggle, frames each meal as a challenge to overcome. A WFPB lifestyle is different. It’s not a short-term punishment charged by guilt. It’s simply a return to whole foods, rich flavors, and natural health.

Go for green, use caution with orange and stay away from red.

For a more comprehensive list of foods and explanation, check out our Whole Food, Plant-Based Diet Guide.

For inspiration, browse our expansive recipe list.

Cognitive decline is linked to ultraprocessed food, a study finds. Ultraprocessed foods typically include flavourings, colourings, emulsifiers and other cosmetic additives. (Cesar Carroll/EyeEm/Adobe Stock/CNN)

• Sandee LaMotte

• CNN
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Published Aug. 1, 2022 1:06 p.m. ADT

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Eating ultraprocessed foods for more than 20% of your daily calorie intake every day could set you on the road to cognitive decline, a new study revealed.

We all know eating ultraprocessed foods that make our lives easier — such as prepackaged soups, sauces, frozen pizza and ready-to-eat meals — isn’t good for our health. Nor is gobbling up all the pleasure foods that we love so much: hot dogs, sausages, burgers, french fries, sodas, cookies, cakes, candies, doughnuts and ice cream, to name just a few.

Studies have found they can raise our risk of obesity, heart and circulation problems, diabetes and cancer. They may even shorten our lives.

Now, a new study has revealed eating more ultraprocessed foods may contribute to overall cognitive decline, including the areas of the brain involved in executive functioning — the ability to process information and make decisions.

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In fact, men and women who ate the most ultraprocessed foods had a 28% faster rate of global cognitive decline and a 25% faster rate of executive function decline compared with people who ate the least amount of overly processed food, the study found.

“While in need of further study and replication, the new results are quite compelling and emphasize the critical role for proper nutrition in preserving and promoting brain health and reducing risk for brain diseases as we get older,” said Rudy Tanzi, professor of neurology at Harvard Medical School and director of the genetics and aging research unit at Massachusetts General Hospital in Boston. He was not involved in the study.

Tanzi, who has written about ultraprocessed foods in his book “The Healing Self: A Revolutionary New Plan to Supercharge Your Immunity and Stay Well for Life,” said the key problem with ultraprocessed foods is that “they are usually very high in sugar, salt and fat, all of which promote systemic inflammation, perhaps the most major threat to healthy aging in the body and brain.

“Meanwhile, since they are convenient as a quick meal, they also replace eating food that is high in plant fiber that is important for maintaining the health and balance of the trillions of bacteria in your gut microbiome,” he added, “which is particularly important for brain health and reducing risk of age-related brain diseases like Alzheimer’s disease.”

IT’S NOT A LOT OF CALORIES

The study, presented Monday at the 2022 Alzheimer’s Association International Conference in San Diego, followed over 10,000 Brazilians for up to 10 years. Just over half of the study participants were women, White or college educated, while the average age was 51.

Cognitive testing, which included immediate and delayed word recall, word recognition and verbal fluency were performed at the beginning and end of the study, and participants were asked about their diet.

“In Brazil, ultraprocessed foods make up 25% to 30% of total calorie intake. We have McDonald’s, Burger King and we eat a lot of chocolate and white bread. It’s not very different, unfortunately, from many other Western countries,” said coauthor Dr. Claudia Suemoto, an assistant professor in the division of geriatrics at the University of São Paulo Medical School.

“Fifty-eight percent of the calories consumed by United States citizens, 56.8% of the calories consumed by British citizens, and 48% of the calories consumed by Canadians come from ultraprocessed foods,” Suemoto said.

Ultraprocessed foods are defined as “industrial formulations of food substances (oils, fats, sugars, starch, and protein isolates) that contain little or no whole foods and typically include flavorings, colorings, emulsifiers, and other cosmetic additives,” according to the study.

“People who consumed more than 20% of daily calories from processed foods had a 28% faster decline in global cognition and a 25% faster decline in executive functioning compared to people who ate less than 20%,” said study coauthor Natalia Gonçalves, a researcher in the department of pathology at the University of São Paulo Medical School.

For a person who eats 2,000 calories a day, 20% would equal 400 or more calories — for comparison, a small order of fries and regular cheeseburger from McDonalds contains a total of 530 calories.

Those in the study who ate the most ultraprocessed foods were “more likely to be younger, women, White, had higher education and income, and were more likely to have never smoked, and less likely to be current alcohol consumers,” the study found.

“People need to know they should cook more and prepare their own food from scratch. I know. We say we don’t have time but it really doesn’t take that much time,” Suemoto said.

“And it’s worth it because you’re going to protect your heart and guard your brain from dementia or Alzheimer’s disease,” she added. “That’s the take-home message: Stop buying things that are superprocessed.”

Randomized Controlled Trials of Beans | NutritionFacts.org

Written By Michael Greger M.D. FACLM on May 19, 2022

Image Credit: Unsplash. This image has been modified.

Do legumes—beans, chickpeas, split peas, and lentils—work only to prevent disease, or can they help treat and reverse it as well?

Legumes—all kinds of beans, chickpeas, split peas, and lentils—are “an excellent source of many essential nutrients, including vitamins, minerals, fibers, antioxidants, and other bioactive compounds,” and not just an excellent source, but they are perhaps the single cheapest source, as you can see at 0:19 in my video Benefits of Beans for Peripheral Vascular Disease. Indeed, in terms of nutrition density per penny, the four that really pull away from the pack are pinto beans, lentils, black beans, and kidney beans.

What’s more, all of that nutritional quality may have beneficial effects on excess body weight, insulin resistance, high cholesterol, inflammation, and oxidative stress—all major cardiovascular risk factors. So, do men and women who eat more beans tend to have less heart disease? Yes, which “suggests that increasing legume intake may be an important part of a dietary approach to the primary prevention of CHD [coronary heart disease] in the general population.” But, wait. Maybe those eating more bean burritos are just eating fewer beef burritos? The researchers took that into account and controlled for the intakes of meat, fruits, and vegetables, as well as smoking and exercise habits, yet, even still, the bean eaters appeared to be protected, as you can see at 1:05 in my video.

In the study, the group in the highest category were eating legumes four or more times a week. In my Daily Dozen, I recommend people eat legumes three times a day! In Costa Rica, researchers were able to find enough people eating beans every day, so even after controlling for many of the same factors, like intake of saturated fat and cholesterol, they found that just a single daily serving of beans was associated with a 38 percent reduction in the risk of heart attack. What’s more, you may actually get to live longer, too. Researchers found bean eaters had an 8 percent lower all-cause mortality, again after adjusting for other dietary factors. You can’t control for everything, though. You can’t prove cause and effect until you put it to the test.  

Randomized controlled interventional trials have found that dietary bean intake does significantly reduce bad LDL cholesterol levels. In fact, we’ve known that for more than half a century, dating back to 1962. You can see what happens at 2:11 in my videowhen you measure cholesterol levels at baseline, add beans to the diet, and then remove beans from the diet. The cholesterol content in blood serum goes down and back up.

Beans also “have a low glycemic index and saturated fat content, and are high in fiber, potassium, and plant protein, each of which independently confers BP- [blood pressure-] lowering effects. Whether there is sufficient evidence to emphasize dietary pulses [beans] alone to lower BP, however, is unclear.” Therefore, what we need is a systematic review and meta-analysis of controlled feeding trials, and we got just that. What did the researchers find? Beans do indeed lower blood pressure no matter where you start out.

Beans may be able to prevent artery disease, but what about reversing it? Can the daily consumption of beans (other than soybeans) reverse vascular impairment due to peripheral artery disease? “Peripheral artery disease (PAD) results from a decrease in blood flow to the limbs due to the presence of atherosclerotic plaque.” We know that soybeans may help, but what about other beans? Researchers had 26 individuals with peripheral artery disease consume one daily serving of a combination of beans, split peas, lentils, and chickpeas for eight weeks.

PAD is essentially diagnosed and followed with the ankle-brachial index, which is just the ratio of blood pressure at your ankle compared to your arm. Once it dips below 0.9, that means there must be some kind of clogs in the blood flow to the lower body. But, when you eat some beans, you may get a significant increase. In fact, the bump was enough to push 4 of 26 participants up into the normal range after only eight weeks eating some beans. Now, the study didn’t have a control group, but people with PAD tend to get worse, not better. “A legume-rich diet can elicit major improvements in arterial function,” concluded the researchers.

It meant a lot to me to be able to cover peripheral artery disease. If you remember my personal story, that’s one of the conditions that plagued my grandmother and one of the reasons she was confined in a wheelchair. She had been waiting to die—until she was saved by evidence-based nutrition, which inspired me to do for everyone’s family what Nathan Pritikin did for mine.

For more on central artery disease, see How Not to Die from Heart Disease, and the scores of other videos I have on heart disease.

KEY TAKEAWAYS

• Legumes (beans, chickpeas, split peas, and lentils) are not only an excellent source of many essential nutrients, such as vitamins, minerals, fiber, and antioxidants, but they may also be the single cheapest source.
• When it comes to nutrition density per penny, the stand-outs are pinto beans, lentils, black beans, and kidney beans.
• Eating legumes have been shown to have beneficial effects on major cardiovascular risk factors, including excess body weight, insulin resistance, high cholesterol, inflammation, and oxidative stress, even after controlling for intakes of meat, fruits, and vegetables, and exercise and smoking habits.
• My Daily Dozen recommends a minimum of three servings of legumes a day.
• Researchers have found that a single daily serving of beans is associated with a 38 percent lower risk of heart attack and bean eaters have an 8 percent lower all-cause mortality, again after adjusting for other dietary factors.
• Dietary bean intake significantly reduces so-called bad LDL cholesterol levels, and the low glycemic index and saturated fat content of beans, along with being high in fiber, potassium, and plant protein, each independently confers blood pressure-lowering effects.
• Beans may not only be able to prevent artery disease, but reverse it, too, and researchers have concluded, “A legume-rich diet can elicit major improvements in arterial function.”

What else can beans do? See:

What’s this “Daily Dozen” I mentioned? That’s from my book How Not to Die. SeeHow Not to Die: An Animated Summary. There are also two different treatments you can check out: Flashback Friday: Dr. Greger’s Daily Dozen Checklist and the more fanciful Dr. Greger’s Daily Dozen Checklist.

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:

NYC’s trans-fat ban has actually started saving lives
By Danika Fears April 12, 2017 | 4:25pm | Updated
Modal Trigger NYC’s trans-fat ban has actually started saving lives
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It looks as if Nanny Bloom­berg was right all along.

New York City’s ban on trans fats appears to be working out just as the former mayor had hoped, with research suggesting that people are healthier in places that forbid the heart-clogging oils.

Hospitals in New York counties with trans-fat bans saw a 6 percent drop in heart attacks and strokes three years after the laws went into effect, as compared with areas without restrictions, according to a new report in JAMA Cardiology.

That means there were 43 fewer heart attacks and strokes per 100,000 people, according to researcher Dr. Eric Brandt, a Yale University cardiology fellow.

Under the Bloomberg administration, the Big Apple in 2006 banned trans fats in restaurants, which often used the grease for french fries and other dishes.

The city’s restrictions applied to food purchased outside of stores, such as at restaurants, street vendors and bakeries.

The ban was originally scoffed at by some who feared the flavor of some foods might be ruined.

But, unlike Mike Bloomberg’s attempted crackdown on sugary drinks, the trans-fat ban was soon accepted by the public. Years later, few complain about it. In 2015 the FDA announced it would spread the trans-fat prohibition nationwide, starting in 2018.

Brandt said this is the first study to confirm public health has been improved by the ban.

“New York City was progressive and they enacted restrictions on trans fats, but no one looked to see if this made measurable changes to outcomes,” he said.

“There has been a lot of looking into whether trans fats are harmful. Here we find on a population level that when we restrict them, it benefits society by reducing heart attacks and strokes.”

Researchers conducting the study compared data on people hospitalized between 2002 and 2013 for heart attacks or strokes in counties that did restrict trans fats with data for counties that did not.

November 14, 2016 Categories: Heart News, Scientific Conferences & Meetings

Study Highlights:

Postmenopausal women who follow a high-protein diet could be at higher risk of heart failure, especially if most of their protein comes from meat.
Researchers combined dietary self-reports with biomarkers to determine actual dietary protein intake as self-reporting alone is often inaccurate.
Embargoed until 8 a.m. CT/ 9 a.m. ET, Monday, Nov. 14, 2016

NEW ORLEANS, Nov. 14, 2016 — Women over the age of 50 who follow a high-protein diet could be at higher risk for heart failure, especially if much of their protein comes from meat, according to preliminary research presented at the American Heart Association’s Scientific Sessions 2016.

Researchers evaluated the self-reported daily diets of 103,878 women between the ages of 50 and 79 years, from 1993 to 1998. A total of 1,711 women developed heart failure over the study period. The rate of heart failure for women with higher total dietary protein intake was significantly higher compared to the women who ate less protein daily or got more of their protein from vegetables.

While women who ate higher amounts of vegetable protein appeared to have less heart failure, the association was not significant when adjusted for body mass.

“Higher calibrated total dietary protein intake appears to be associated with substantially increased heart failure risk while vegetable protein intake appears to be protective, although additional studies are needed to further explore this potential association,” said Mohamad Firas Barbour, M.D., study author and internist at the Alpert Medical School of Brown University, Memorial Hospital of Rhode Island, in Pawtucket.

The findings were true regardless of age, race or ethnicity, level of education, or if the women had high blood pressure (2.9 percent), diabetes (8.3 percent), coronary artery disease (7.1 percent), anemia (3.4 percent), or atrial fibrillation (4.9 percent).

The subjects were all participants in the Women’s Health Initiative, an ongoing, long-term national dietary survey investigating strategies for reducing heart disease, breast and colorectal cancer, and osteoporosis.

Researchers said other studies have found a link between increased protein from meat and cardiovascular risk in women.

“Our findings should be interpreted with caution, but it appears that following a high-protein diet may increase heart failure risk,” Barbour