The "South Bronx Paradise Diet," also known as "The South Bronx Parasite Diet," is a controversial dietary approach that gained notoriety through its appearance in the Aqua Teen Hunger Force episode "Diet." This article delves into the diet's portrayal in the media, its potential risks, and the broader context of nutrition and dietary patterns in relation to health, particularly in the context of peripheral artery disease (PAD).
The Aqua Teen Hunger Force Depiction
In the Aqua Teen Hunger Force episode, Carl adopts the "South Bronx Paradise Diet" in an attempt to lose weight. Meatwad, also seeking to slim down, is encouraged by Frylock to pursue a balanced diet and exercise. The episode satirizes extreme dieting trends, portraying the "South Bronx Paradise Diet" as a dangerous and unconventional method.
Carl's diet involves consuming special energy bars that Frylock later discovers contain organisms, revealing the diet's true name: "The South Bronx Parasite Diet." As Carl continues the diet, he becomes increasingly skinny and exhibits bizarre behavior, such as crawling on the ceiling and eating flies, indicating the detrimental effects of the parasites consuming his insides.
The episode highlights the absurdity and potential dangers of fad diets, cautioning against blindly following dietary advice without understanding the underlying principles and potential consequences.
Dietary Risk Factors and Peripheral Artery Disease (PAD)
Dietary risk factors play a crucial role in the prevention and progression of atherosclerosis and PAD, a condition affecting the arteries of the lower limbs. PAD shares a common etiology with coronary artery and cerebrovascular disease. Nutrition, defined as the process of taking in food and using it for growth, metabolism, and repair, has a significant impact on PAD.
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A comprehensive review of numerous articles and studies reveals the interplay between nutrition and the development/progression of PAD. The review analyzes the interaction between nutrition and PAD predictors, summarizing the relationship between PAD, dietary risk factors, and outcomes. It also examines the role of well-studied diets like the Mediterranean diet, vegetarian/vegan diets, low-carbohydrate ketogenic diets, and intermittent fasting, as well as prevalent eating behaviors such as emotional and binge eating, night eating and sleeping disorders, anorexia, bulimia, skipping meals, home cooking, and fast/ultra-processed food consumption. The review further analyzes the interplay between PAD and nutritional status, nutrients, dietary patterns, and eating habits.
Dietary patterns and eating disorders can affect the development and progression of PAD, as well as its disabling complications, including major adverse cardiovascular events (MACE) and major adverse limb events (MALE).
The Global Impact of Diet and Cardiovascular Disease
With a global population of approximately 7.85 billion people and a growth rate of 1.05% per year, the average population increase is estimated at 81 million people yearly. Cardiovascular disease (CVD) is the leading cause of death globally, resulting in approximately 17.9 million deaths annually.
Healthy diets can play an essential role in preventing and/or delaying major atherosclerotic complications. Diets high in sodium yet low in whole grains, nuts, seeds, vegetables, omega-3 fatty acids, and fruits have recently been identified as the main dietary risk factors responsible for 10 million deaths from CVD and 207 million cardiovascular diseases worldwide.
Analyzing Risk Factors for PAD
A narrative review analyzes the risk factors for PAD as they relate to nutrition, food, diet, and eating behaviors. The review encompasses a vast collection of articles and studies, providing a comprehensive overview of the topic.
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Atherosclerosis is a chronic, progressive disease that affects the main arterial beds, including the coronary, carotid, and peripheral arterial trees. The involvement of the lower limb vessels defines PAD, and patients with this condition are often complex and fragile given their significant cardiovascular risk. An important aspect of PAD is the study of the risk factors underlying the disease and influencing patient outcomes.
Non-dietary risk factors of PAD include obesity, smoking, diabetes mellitus, chronic kidney disease, hypertension, dyslipidemia, and systemic inflammation. Each of these is prevalent in patients with PAD and plays a fundamental role in the disease progression. Smoking cessation and the control of serum glucose levels are primary goals for these patients to reduce oxidative vascular damage due to tobacco use or glucose toxicity. Arterial calcification can be ameliorated by slowing the deterioration of renal function, which is responsible for the disturbance of calcium-phosphorus metabolism. "Residual risk" involving systemic inflammation should also be considered with regard to cardiovascular risk. Prevention against oxidative stress and the control of immune dysregulation are most effective in counteracting any subclinical inflammatory process.
The Epidemic of Chronic Diseases and Suboptimal Eating Behaviors
An epidemic of chronic diseases related to suboptimal eating behaviors and inadequate nutrition has dramatically affected the mortality and morbidity of the global population. A significant number of patients die due to the consequences of inappropriate diets on health, regardless of traditional cardiovascular risk factors. Cardiovascular disease is the leading cause of death and morbidity attributable to poor nutrition, accounting for a substantial number of deaths and disability-adjusted life years each year.
Among those comorbidities related to dietary habits, several of the main risk factors for PAD suggest an interaction between nutrition, predictors of atherosclerosis, and the development of PAD. There is a high prevalence of dietary risk factors in those suffering from chronic disease and exposed to multiple atherosclerotic risk factors. The most recognized dietary risk factors for overall mortality and morbidity, highly associated with atherosclerotic complications, are high sodium consumption, low intake of whole grains and fruit, as well as high intake of sugar (especially sugary drinks), red and processed meats, and trans fats. Other nutritional aspects that parallel cardiovascular risk include processes related to food manufacturing (processing, production, distribution, cooking), poor access to healthy food, insufficient supply of seeds, vegetables, omega-3 fatty acids, and the adoption of unhealthy eating behaviors.
Well-Studied Diets and Their Impact on PAD Risk Factors
A dietary scheme is a balanced composition of macro- and micronutrients that provides adequate caloric intake and benefits metabolism. Each diet has characteristics that can be tailored to the patient’s personal needs and comorbidities. The relationship between various common and well-studied diets (Mediterranean diet, vegetarian and vegan diet, low-carbohydrates ketogenic diet, intermittent fasting) and the main risk factors of PAD (diabetes mellitus, obesity, hypertension, dyslipidemia, chronic kidney disease, inflammatory status) has been evaluated. Current knowledge on each dietary model in relation to the selected risk factors and predictors of PAD are described, listing several pros and cons of each on patient comorbidity.
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The Mediterranean Diet (MD)
The Mediterranean diet (MD) has received particular scientific interest in recent years as it induces a significant reduction in CV risk via a balanced composition of macronutrients (carbohydrates, proteins, and fats). The most important characteristics of the MD are: (1) the moderate consumption of lean meat and fish with a minimum intake of red or processed meat, (2) the avoidance of sugary drinks, (3) a moderate intake of salt and dairy products (especially cheese and yogurt), and (4) an abundance of vegetables, seeds, legumes (e.g., lentils and beans), fruit, cereals, and whole grains (e.g., unprocessed maize, millet, oats, wheat, and brown rice).
Unlike a Western diet, the MD reduces the consumption of saturated fats (almost avoiding products such as butter) by including foods rich in unsaturated fats (mono- and polyunsaturated) such as olive oil, nuts, and seeds, used as main courses or cooking ingredients. Extra virgin olive oil and red wine, rich in polyphenols, tocopherols, and phytosterols, provide anti-inflammatory characteristics and valuable cardiovascular protection properties, such that they are considered pillars of the MD.
The MD also includes appropriate eating and non-eating behaviors that may ameliorate the ongoing obesity and diabetes pandemic. The Mediterranean lifestyle and eating habits are effective solutions to the harmful consequences of a “Westernization” of life, including incorrect eating behaviors and physical inactivity, that are responsible for the higher prevalence of chronic diseases, especially diabetes and obesity.
The MD counteracts weight gain by changing intestinal microbiota (e.g., the Firmicutes/Bacteroidetes ratio), increasing energy expenditure via the thermogenesis of brown adipose tissue, and inducing lipolysis. The healthy composition of nutrients in the MD is key to decreasing the incidence of diabetes and obesity. The MD includes a large variety of plant-based foods, polyunsaturated fats, fruits, whole grain products, fish, and fiber together with a reduced intake of processed and red meats, refined sugars, and saturated fats. Weight loss is also facilitated through the regulation of satiety promoted by the consumption of products rich in short-chain fatty acids that induce the production of incretin and the associated control of blood sugar and insulin sensitivity. Furthermore, the improvement of insulin resistance can be explained by a lower intake of carbohydrates with a high glycemic index and an increase in the intake of monounsaturated acids, essential and branched-chain amino acids that favor glucose control, preventing the development and progression of diabetes.
The MD has documented beneficial effects on hypertension. The reduction in saturated fats replaced by olive oil or mixed nuts in the MD results in a significant reduction in blood pressure. Stricter adherence to the MD has been shown to have additional benefit in the prevention and treatment of hypertension along with the traditional pharmacological treatment. In addition to a reduction in blood pressure and the overall risk of mortality/morbidity, the MD may reduce arterial stiffness and endothelial dysfunction, known conditions related to atherosclerosis. Nutrients included in the diet may alter various molecular processes that slow down the vessel degeneration observed in atherosclerosis.
The MD is included in the therapeutic recommendations of the non-pharmacological management of atherosclerotic disease since the heterogeneous composition of nutrients and the quality of foods found in the MD play an important role in the regulation of lipid metabolism with a documented reduction in the overall CV risk. It is an effective dietary strategy in the prevention of dyslipidemia and could prove to be a successful approach to achieve the recommended therapeutic goals for cholesterol. The diet has a direct effect on the serum lipid profile with a reduction in levels of cholesterol, triglycerides, and atherogenic apolipoproteins along with an increase in serum HDL-c. The abundance of plant-derived foods, olive oil, and nuts, along with a low intake of processed foods, dairy products, and red meats are examples of MD recommendations that have lipid-lowering effects with a consequent reduction in atherosclerosis, especially in patients with comorbidities. Additionally, the low consumption of foods rich in saturated fats espoused by the MD results in a decreased endogenous production of cholesterol.
The MD also offers a wide choice of foods that directly lower cholesterol levels such as the polyunsaturated fats of vegetable origin, olive oil, seeds, nuts, vegetables, and fruit. Complex carbohydrates and fibers (such as cereals and whole meal pasta) are low glycemic index foods that contribute to intestinal fermentation, modulate insulin production, and lead to a greater synthesis of short-chain fatty acids with a consequent reduction in serum cholesterol levels. Phytosterols are plant-based fats, similar to cholesterol. These molecules compete with the intestinal absorption of cholesterol which favors its elimination, directly improving the cardiovascular risk by favorably influencing the lipid profile.
Currently, the heterogeneous inter-individual response to dietary patterns is a new topic of interest and the promising results on dyslipidemia observed in people with a strong family history of hypercholesterolemia suggests a possible epigenetic regulation of lipid metabolism by the MD. Long-term adherence and the early adoption of the diet, especially from preschool life, exert the most significant effects on health, cardiovascular protection, and the lipid profile, confirming the importance of precocious nutritional strategies for primary prevention.
Chronic kidney disease is characterized by an irreversible and progressive decline in kidney function, which determines a profound modification of cardiometabolic homeostasis. Renal failure is responsible for the accumulation of various uremic toxins derived from the intestine…