Introduction
Research in nutrition often focuses on individual food constituents or supplements. However, the concept of "food synergy" suggests that the coordinated biological constituents in whole foods may offer more effective health benefits than isolated nutrients. This article explores the principles of nutritional synergy, examines evidence-based dietary strategies for weight management, and discusses the integration of medical nutrition therapy (MNT) with mobile health interventions.
The Concept of Food Synergy
Food synergy posits that the interactions between constituents in foods are significant. The action of the food matrix (the composite of naturally occurring food components) on human biological systems is greater than or different from the corresponding actions of the individual food components. This significance depends on the balance between constituents within the food, their survival during digestion, and their biological activity at the cellular level. The food synergy concept supports dietary variety and nutrient-rich food choices.
Whole Foods vs. Isolated Nutrients
Whole foods often demonstrate superior effects compared to their isolated constituents. Foods with high quantities of unsaturated fats, such as nuts, have high amounts of compounds with antioxidant properties, which protect against the instability of these fats. A diet consisting solely of purified nutrients, without the coordination inherent in food, may not lead to optimal health.
The Importance of Food Matrix
The food matrix, composed of naturally occurring food components, has a greater or different impact on human biological systems compared to individual components. We do not have complete knowledge of food composition, and some effects may result from unidentified or underappreciated components. Organisms have coordinated constituents, determined by the cell as the central integrator. Isolated constituents formed outside of normal biological processes are not integrated.
The Role of Dietary Patterns
Observational studies show a strong link between dietary patterns like the Mediterranean diet and reduced rates of chronic diseases. The viability of the food synergy concept is bolstered by the lack of effect of many isolated compounds shown in clinical trials. To attain ideal health benefits, the combination of food components needs to address their interactions within the food and with the human system.
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Evidence-Based Dietary Strategies for Weight Management
Weight management depends on complex factors such as the amount and type of food eaten, and the timing of meals. An energy deficit is the most important factor in weight loss.
Calorie Restriction and Macronutrient Composition
A low-calorie diet (1,000-1,500 calories per day) with a low fat or carbohydrate content is often recommended. Deficits of 500-750 calories per day have been used for weight loss. In some cases, a very-low-calorie diet (VLCD) providing <800 kcal a day may be used for a short period under medical monitoring. Some macronutrient composition-based diets, such as the ketogenic diet or high-protein diet, could be considered in some cases.
Low-Calorie Diets
Low-calorie diets typically restrict fats or carbohydrates. The 2018 DIETFITS study found no significant differences in weight loss between low-fat and low-carbohydrate diets. However, meal planning and preparation take effort, and weight-loss maintenance requires a sustained low-calorie diet.
Very-Low-Calorie Diets (VLCD)
Traditionally, a VLCD is not recommended for routine weight management and should only be used in limited circumstances along with medical monitoring. A recent review suggested that a VLCD used in combination with behavioral programs can provide greater long-term weight loss than behavioral programs alone, and that it is tolerable and has few adverse effects. A VLCD with meal replacement is effective for achieving diabetes remission in individuals with obesity lasting for at least 2 years. Another form of the VLCD-the very-low-calorie ketogenic diet (VLCKD)-has been proposed as a promising option for significant weight loss in a short duration of time and stability for 2 years. The VLCKD consists of very-low-calorie (<700-800 kcal/day) and low-carbohydrate (<30-50 g/day) intake along with adequate protein consumption (equivalent to 0.8-1.2 g/day/kg of ideal body weight) for a short period, followed by a gradual switch to a low-calorie diet.
Meal Replacements
Meal replacements include products marketed as soups, shakes, and bars, and portion-controlled, ready-made meals. Meal replacements are used instead of “normal” food for one or more meals to reduce the daily calorie intake.
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Macronutrient-Focused Diets
Low-Carbohydrate Diets
A low-carb diet is defined as a carbohydrate intake below the lower boundary of the macronutrient distribution range for healthy adults (45%-65% of total daily energy) and encompasses a range of carbohydrate intake from 50-130 g/day or 10%-45% total energy from carbohydrates. With carbohydrate intake <10% (or <20-50 g/day), nutritional ketosis can occur, resulting in a ketogenic diet.
Ketogenic Diets
Ketogenic diets can suppress hunger during calorie restriction and may have some therapeutic effects on T2DM, polycystic ovary syndrome, and cardiovascular and neurological diseases. In one study, the ketogenic diet showed mixed effects on LDL-C level and was not superior to other dietary interventions for weight loss.
High-Protein Diets
A high-protein diet has been popularized as a promising tool for weight loss because it improves satiety and decreases fat mass. Dietary guidelines for adults recommend protein intake of 46-56 g or 0.8 g/kg of ideal body weight per day. If dietary protein consumption exceeds 0.8 g/kg/day, it is considered a high-protein diet. Usually, a high-protein diet refers to an increased protein intake to 30% of the total daily calories or 1-1.2 g/kg of the ideal body weight per day.
Other Dietary Approaches
Mediterranean Diet
The Mediterranean diet involves high intake of fruits and vegetables, poultry, fish, and dairy products, and little to no consumption of red meat. The effectiveness of the Mediterranean diet for weight loss and preventing cardiovascular disease is supported by sufficient evidence. Its benefits may extend to the reduction in cancer risk and significant reduction in digestive cancer risk. Adherence to a Mediterranean diet may improve cognitive function and decrease the risk of dementia, although the evidence supporting this association is weak to moderate. One systematic review of the Mediterranean diet for long-term weight loss reported similar results to other diets despite greater weight loss than with a low-fat diet after 12 months.
Paleolithic (Paleo) Diet
The Paleolithic (Paleo) diet, also known as the hunter-gatherer diet, suggests that our bodies have not evolved to handle highly processed foods. This diet follows the nutritional patterns of early humans who lived in the Paleolithic era. This diet advises consuming lean meat, fish, vegetables, fruits, and nuts while avoiding grains, dairy products, processed foods, and added sugar and salt.
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Low-Glycemic Index (GI) Diet
The glycemic index (GI) is a measurement system that ranks foods according to effect on blood glucose level. A low-GI diet emphasizes exchanging high-GI foods for low-GI alternatives. Nothing is strictly forbidden with the low-GI diet, but high-GI foods such as white bread, bagels, cereals, mashed potatoes, pasta, and noodles should be replaced by low-GI foods.
New Nordic Diet
The new Nordic diet is based on unprocessed whole grains, high-fiber vegetables, fish, low-fat dairy foods, lean meat of all types (beef, pork, lamb), beans and lentils, fruit, dense breads, tofu, and skinless poultry. This diet recommends more calories from plant foods and fewer from meat and more foods from the sea, lakes, and the wild countryside. It is based on whole and minimally processed foods and is high in both fiber and omega-3 fats.
Vegetarian Diet
Vegetarian diets can lower the risk of ischemic heart disease, T2DM, and cancer. Vegetarian diets can reduce blood pressure, lipid profiles, and inflammatory biomarkers and improve glycemic control and other cardiometabolic risk factors. This diet excludes meat, fish, and poultry, but there are many variations of the diet, including lactovegetarians and lacto-ovo-vegetarians.
DASH Diet
The Dietary Approaches to Stop Hypertension (DASH) diet was originally developed to lower blood pressure without medication, but it is now considered one of the healthiest eating patterns. The DASH plan includes many vegetables, fruits, and grains with an emphasis on whole grains. Low-fat or non-fat dairy foods, pulses, nuts, seeds, lean meats, poultry, and seafood are also allowed. The key features of DASH are low cholesterol and saturated fats; lots of magnesium, calcium, fiber, and potassium; and little to no red meat and sugar.
Portfolio Diet
The Portfolio diet is a vegan plan that emphasizes a “portfolio” of foods or food components that lower cholesterol. The diet recommends daily consumption of 2 g of plant sterols, 50 g of nuts, 10-25 g of soluble fibers from plant foods, and 50 g of soy protein; meat, poultry, seafood, dairy, and eggs are not allowed.
Meal Timing and Intermittent Fasting
Meal timing is also an important factor in weight management, and higher-calorie breakfasts in combination with overnight fasting may help to prevent obesity.
Intermittent Fasting
Intermittent fasting involves regular periods with no or very limited calorie intake. Intermittent fasting focuses on the time window of eating instead of calorie calculations or macronutrient composition, helping people to restrict food intake without having to count calories and to avoid late-night snacking.
Meal Timing and Circadian Rhythms
Alterations in circadian rhythms produce biochemical, physiological, and behavioral circadian rhythm disruptions. Eating late can cause circadian disruption, resulting in production of free cortisol, changes in daily rhythms of body temperature, decreased resting energy expenditure, and decreased glucose tolerance. Thus, timing of meals could have serious implications not only for weight management, but also for development of cardiovascular disease.
Healthy Food Habits for Weight Loss
There are certain healthy food habits that just might give you a slight weight loss edge. Some foods and beverages have what's called food synergy. What that means is that certain components in these foods and drinks (like minerals, vitamins and phytochemicals, fiber, and fats) interact with each other to boost health benefits. And sometimes, those benefits may include aiding weight loss.
Whole Grains
Whole grains have plenty of nutritional synergy between their different components and may be part of America's weight loss solution. Women who ate three or more servings of whole-grain foods a day had significantly lower BMIs than those eating less than one serving a day. Women whose diets included the most whole grains were half as likely to gain a lot of weight over a 12-year period as another group that ate the least whole grains. Oats, one of the most illustrious of whole grains, have shown they slow the emptying of the stomach into the small intestine -- and thus may help you feel fuller longer. Eating more whole grains may actually lead to less VAT fat (visceral adipose tissue).
Fruits and Vegetables
Fruits and vegetables have more water, fiber, and key nutrients -- but fewer calories than typical fast food and junk food. This makes them one of the best ways to lower your diet's "energy density" and increase "nutrient density". Eating a less calorie dense diet that includes lots of fruits and vegetables helps make meals more satisfying, while cutting calories. Eating more fruits and veggies along with cutting down on fat is a particularly smart strategy.
Vegetarian Meals
People following vegetarian diets tend to weigh less than meat-eaters. Switching to a low-fat vegan diet (one that includes no animal products) could result in a loss of about a pound a week, even without extra exercise or limits on calories. Even going partially meatless can help.
Low-Fat Dairy or Soy Milk
A healthy diet that includes 2-3 servings a day of low-fat or nonfat dairy may help promote weight loss, perhaps even in the midsection. High-calcium, low-calorie diets have been shown to help reduce body fat and preserve muscle mass, but some experts suspect that other components in dairy foods may also contribute to this effect. There is synergy between two components found in most low-fat dairy foods -- calcium and vitamin D -- when it comes to helping reduce the risk of colon cancer, preserve bone mass, and ease symptoms of PMS as part of a low-fat diet.
Green Tea
Some research indicates that green tea may trigger weight loss by stimulating the body to burn calories and mildly decrease body fat, possibly through catechins, a type of phytochemical. The phytochemicals in tea have a half-life of a few hours, so have one cup now, and another later in the day to get the biggest benefit.
Medical Nutrition Therapy (MNT) and Mobile Health Interventions
Medical nutrition therapy (MNT) is an evidence-based treatment where a registered dietitian provides personalized nutrition and lifestyle guidance to patients. MNT has been demonstrated to be effective for weight loss and managing chronic diseases in patients with obesity. With the rise of telehealth, MNT has gained popularity as an accessible alternative to traditional in-person care.
Effectiveness of MNT with a Companion Mobile App
A retrospective cohort study evaluated the effectiveness of an MNT program with a companion mobile app (Nourish) on weight loss among adults with overweight and obesity. The study included 3951 participants with a baseline BMI≥30 kg/m² or a BMI between 27-30 kg/m² with diabetes or prediabetes. Over a median follow-up of 2.2 months, 17% of participants achieved at least 5% weight loss. The mean weight change was -4.5 pounds, corresponding to a mean percent weight change of -2%. Longer follow-up time between weights and a higher number of completed appointments (≥5 appointments) were significantly associated with a significantly higher likelihood of achieving at least 5% weight loss. Participants who were most engaged, based on appointment frequency and app usage, were more likely to achieve at least 5% weight loss compared with those who were less engaged.
Benefits of Telehealth MNT
MNT delivered via telehealth has the potential to improve access and convenience of MNT and to help achieve clinical goals. Emerging research has validated the potential of MNT delivered via telehealth to deliver on the AHA mission by improving access, and in fact, has resulted in better engagement and adherence resulting from the increased convenience of telehealth. The emergence of telehealth is especially important for rural populations, who face unique challenges, such as limited access to health care providers and greater distances to fresh food sources.
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