Copyright

Nutrition Guide for Clinicians, 3rd Edition

©2022, Physicians Committee for Responsible Medicine. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means—print, electronic, or recording—without prior written permission from the publisher, except for quotations in critical articles and reviews.

Unbound™ software platform © 2000-2022 Unbound Medicine, Inc. All rights reserved.

Editors

Editor-in-Chief

Neal D. Barnard, MD, FACC

Medical Authors

Angela Eakin, MD, MS
Manuel Calcagno, MD
Stephen Neabore, MD
Emily Kasmar, AGPCNP-BC
James F. Loomis, MD
Caroline Trapp, DNP, ANP- BC, CDE, FAANP
Meghan A. Jardine, MS, MBA, RDN, LD, CDE
Karen Smith, RD, CDE
Maggie Neola, RD
Susan Levin, MS, RD
Matt Ruscigno, RD
Rick Weissinger, MS, RD

Managing Editors

Doug Hall
Rosendo Flores

Medical Reviewers

Gagan Anand, MD
Gurneet K. Anand, ND, MS
Kristen Babinski, MD, PhD
Daniel M. Berinstein, MD
Andrea Boggild, MSc, MD, DTMH, FRCPC
Christie Cobb, MD
Shelly Delplanche, MD
Alan Desmond, MD
Daniel El-Bogdadi, MD, FACR
Joanne Evans, Med, RN, APRN
Jack Flyer, MD
Kerry Foley, MD
Daniel A. Forman, DO
Andrew Freeman, MD, FACC, FACP
Kristi Funk, MD
Eduardo Garcia Lirio, MD
Kristen N. Ganjoo, MD
Brooke Goldner, MD
Manuel O. Gonzalez, MD
Meagan Gray, MD
Nilofer Khan Habibullah, MA, MD
Hesham Hazin, MD
Frederick Hendricks, MD, MPH, FACS
Anna Herby, RD, CDE/CDCES
Natasa Janicic, MD, PhD
Hana Kahleova, MD, PhD
Jamie Kane, MD
Neha Kumar, DO, MPH
Daniel Z. Lieberman, MD
Vanessa Mendez, MD
Michael Persky, MD
Caren Pichardo, MD
Paul Porras, MD
Vanita Rahman, MD
Ramya Ramakrishnan, MD
Kavita Rajasekhar, MD
Jasmol Sardana, DO
Achyut Sompura, MD
David Spence, CM, MD, FRCPC, FAHA
Saray Stancic, MD
Asha Subramanian, MD, MPH
Patricia Tager, MD
Jordan Taillon, MD, MPH
Alison Tierney, MS, RD
Patricia Centron Vinales, MD
Angus B. Worthing, MD, FACP, FACR
Maureen Wang, MD, FACC
Susan L. Zito, DO

Dedication

Thank you to Jennifer Winchester, MD; Sergio Ramirez Salazar, MD; Pamela Ferguson, RD; Brent Jaster, MD; Scott Kahan, MD; Michael Keevican; Laura Anderson; Reina Pohl, MPH.; Lee Crosby, RD; and Craig Ziskin for their contributions to this work.

Sponsors

Platinum Sponsors

The Moxie Foundation
Ron Allison, MD
Ted Barnett, MD
Garth Davis, MD
Daran Haber, MD
Alexandra Haessler, MD
Adina W. Mercer, MD
Ana M. Negrón, MD
Rebecca Nessel, MD

Gold Sponsors

Seth D. Ammerman, MD
Zarin Azar, MD
Christie Beck, MD
Jason Beck, MD
David J. Chizek, MD
Susan M. Diaz, MD
Robert S. Egerman, MD
Robert O. Ford, MD
Joel Fuhrman, MD
Arthur W. Giebel, MD
Harald Giebel, MD
Beverly Giebel, MD
Herb Giebel, MD
Marvin Jumes, MD
Sarah Keating, MD
Saima Khawaja, MD
Kind Heart Institute
Benjamin H. Lau, MD
Melissa K. Li, MD
Rich McLellan, MDR.
Jason Newsom, MD
Rhoda Ruttenberg, MD
Mark Taylor, MD
Mary Thomas, MD
Harold Vonk, MD

Silver Sponsors

Drew A. Brodsky, MD
Fiquet H. Duckworth, MD
Sally Fisher, MD
Donald D. Forrester, MD
Elizabeth Forrester, PhD
Keith Hanson, MD
Eva Lai Henry, M.D.
Vivian Houng, MD
M. Walter Johnson, MD
Albert Lui, MD
John McDougall, MD
Sakiliba Mines, MD
Michelle Montemayor, MD
Mary O’Connell, MD
Karl Ordelheide, MD
Susan E. Ritter, MD
Robert Rowen, MD
Michelle Spring, MD
Terri Su, MD
Sudhir Nayer, MD
Diane Tanenbaum, MD
Jim Tipton, MD, and Susan Tipton, MSPH
Gayle Tyerman, MD
Kenton Wang, DO
Glenn L. Wiltse, MD
Michal Young, MD

Bronze Sponsors

Charles Aronberg, MD
Ellen Alkon, MD
Rasika Amarasekera, MD
Robin R. Bellina, MD
Kym Boyman, MD, FACOG
Drew A. Brodsky, MD
Kathy Burnard
Jeffrey Cao, MD
Aparna Chandrasekaran, MD
Mrs. Carla Cohen
Marjorie Cramer, MD
Horacio Rubén Vicente D’Agostino, MD, FACR, FSIR
Lynne L. Fagan, MD
Harold H. Fain, MD, MPH
Subhas Ganguli, MD
Kristen Ganjoo, MD
Chris Goeser, DC, MD
Sophie Gosselin, MD, and Daniel Morris
Jonathan Grill
Michael F. Grisante, MD
George Guthrie, MD
Colleen Harrison
Robin Hermes, MD
Leslie Herzog
Bey-Yu Hilgart, MD
Vivian Houng, MD
M. Walter Johnson, MD
Divya-Devi Joshi, MD
Matthew Kingsbauer, DO
Henry Kuharic, MD
Rukmini Komarlu, MD
Junghae Helen Kwon, MD
David C. Law, MD
Sophie Suk Fong Leung, MD
Albert Lui, MD
Arthur Milholland, MD
Ernest C. Miller, MD
Mark C. Niblack, MD
Susan J. Nissen, MD
Edwin A. Noyes, MD
Eric Ossowski, MD
Al Puerini, MD
Michael Rabinoff, DO, PhD
Elaine M. Rancatore, DO
Vicki L. Reid, MD
Sonny Saggar, MD
Gregory Saunders, MD
Cynthia Anna Schandl, MD
Fredric Schroeder, MD
Gary Silverman, MD
Samara Solan, MD
Mona Sigal, MD
Ravi Singh, MD
Erica Springer
Cindy Steele, MD
George Terwilliger, MD
Ronald Turco, MD
Gordon Wheat, MD
Glenn L. Wiltse, MD
Kevin Woods, MD
Shannon Wright MD, PhD
Michal Young, MD

About PCRM

The Physicians Committee is leading a revolution in medicine - putting a new focus on health and compassion. The organization combines the clout and expertise of more than 12,000 physicians with the dedicated actions of more than 175,000 members across the United States and around the world.

Preface

Important Notice to Reader

This book summarizes information on the role of nutrition in health and illness. Readers should be aware that knowledge of nutrition and medicine is constantly evolving. They are encouraged to check the most current information on preventive and therapeutic measures. It is clinicians’ responsibility, relying on their experience and knowledge of their patients, to determine the best plan of care. The authors, editors, and publisher accept no liability for any injury arising out of the use of material contained herein, and make no warranty, expressed or implied, with respect to the contents of this publication.

Notices and Disclaimers

Nutrition Guide for Clinicians (the "Content") is a publication of Physicians Committee for Responsible Medicine ("PUBLISHER") and copyright © 2022, by PUBLISHER.

All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means—print, electronic, or recording—without prior written permission from the publisher, except for quotations in critical articles and reviews.

The Unbound™ software platform is copyright © 2000-2022 Unbound Medicine, Inc. All rights reserved.

The user is receiving only a limited right to use the Content and Unbound Platform (jointly referred to as the "Service") for user’s own internal or personal use. The user may not reproduce, forward, modify, create derivative works based upon, transmit, distribute, disseminate, sell, publish or sublicense the Service or in any way commingle the Service with other third party content, without PUBLISHER’s or Unbound Medicine’s consent.

Disclaimer of Warranties

THE SERVICE IS PROVIDED ON AN "AS IS" BASIS. NEITHER PUBLISHER, UNBOUND MEDICINE NOR ITS LICENSORS MAKE ANY GUARANTEES OR WARRANTIES OF ANY KIND, EITHER EXPRESS OR IMPLIED, INCLUDING, BUT NOT LIMITED TO, IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE OR USE AS TO THE SERVICE OR THE INFORMATION THEREIN OR ANY WARRANTIES AS TO THE ACCURACY, COMPLETENESS, CURRENTNESS, OR RESULTS TO BE OBTAINED FROM, ACCESSING OR USING THE SERVICE, OR ANY MATERIAL REFERENCED IN SUCH SERVICE OR ANY INFORMATION ENTERED INTO THE SERVICE BY USERS OR OTHER PERSONS AND/OR ANY MATERIAL AVAILABLE ON OR THAT CAN BE ACCESSED THROUGH THE SERVICE (INCLUDING VIA ANY HYPERLINK OR OTHERWISE) OR AS TO NON-INFRINGEMENT OF THIRD PARTY RIGHTS. ANY WARRANTIES OF ANY KIND, WHETHER EXPRESS OR IMPLIED, ARE DISCLAIMED. ANY MATERIAL OR DATA OBTAINED THROUGH USE OF THE SERVICE IS AT YOUR OWN DISCRETION AND RISK AND USER UNDERSTANDS THAT IT WILL BE SOLELY RESPONSIBLE FOR ANY RESULTING DAMAGE TO ITS COMPUTER SYSTEM OR LOSS OF DATA.

Disclaimers

MEDICINE IS AN EVER-CHANGING SCIENCE. AS NEW RESEARCH AND CLINICAL EXPERIENCE BROADEN OUT KNOWLEDGE, CHANGES IN TREATMENT AND DRUG THERAPY ARE REQUIRED. IN VIEW OF THE POSSIBILITY OF HUMAN ERROR OR CHANGES IN MEDICAL SCIENCES, NEITHER PUBLISHER, UNBOUND MEDICINE NOR ITS LICENSORS WARRANTS THAT THE INFORMATION CONTAINED IN THE SERVICE IS IN EVERY RESPECT ACCURATE OR COMPLETE, AND THEY ARE NOT RESPONSIBLE FOR ANY ERRORS OR OMISSIONS OR THE RESULTS OBTAINED FROM THE USE OF SUCH INFORMATION. USERS ARE ENCOURAGED TO CONFIRM THE INFORMATION CONTAINED IN THE SERVICE WITH OTHER SOURCES. FOR EXAMPLE, AND IN PARTICULAR, USERS ARE ADVISED TO CHECK THE PRODUCT INFORMATION SHEET INCLUDED IN THE PACKAGE OF EACH DRUG THEY PLAN TO ADMINISTER TO BE CERTAIN THAT THE INFORMATION CONTAINED IN THE PUBLISHER CONTENT IS ACCURATE AND THAT CHANGES HAVE NOT BEEN MADE IN THE RECOMMENDED DOSE OR IN THE CONTRAINDICATIONS FOR ADMINISTRATION. THIS RECOMMENDATION IS PARTICULARLY IMPORTANT IN CONNECTION WITH NEW OR INFREQUENTLY USED DRUGS. NEITHER PUBLISHER NOR ITS LICENSORS SHALL BE LIABLE TO SUBSCRIBER OR TO ANY USER OR ANYONE ELSE FOR ANY INACCURACY, DELAY, INTERRUPTION IN SERVICE, ERROR OR OMISSION, REGARDLESS OF CAUSE, OR FOR ANY DAMAGES RESULTING THEREFROM.

Limitation of Liability

IN NO EVENT WILL PUBLISHER, UNBOUND MEDICINE OR ITS LICENSORS, BE LIABLE FOR ANY INDIRECT, SPECIAL OR CONSEQUENTIAL DAMAGES, INCLUDING BUT NOT LIMITED TO, LOST TIME, LOST MONEY, LOST PROFITS OR GOOD WILL, WHETHER IN CONTRACT, TORT, STRICT LIABILITY OR OTHERWISE, AND WHETHER OR NOT SUCH DAMAGES ARE FORESEEN OR UNFORESEEN ARISING FROM OR RELATING TO: (i) YOUR USE OF THE SERVICE OR USE OF THE SERVICE THROUGH YOUR ACCOUNT BY ANYONE ELSE; (ii) THE COST OF PROCUREMENT OF SUBSTITUTE DATA, INFORMATION OR SERVICES; (iii) UNAUTHORIZED ACCESS TO OR ALTERATION OF YOUR TRANSMISSIONS OR DATA; OR (iv) ANY OTHER MATTER RELATING TO THE SERVICE. UNBOUND’S TOTAL CUMULATIVE LIABILITY TO YOU AND ANYONE WHO USES THE SERVICE THROUGH YOUR ACCOUNT, FOR ANY AND ALL CLAIMS UNDER ANY THEORY OF LAW, WILL NOT EXCEED THE UNUSED PORTION OF FEES PAID FOR THE SERVICE. IF, NOTWITHSTANDING THE OTHER TERMS OF THIS AGREEMENT, UNBOUND SHOULD HAVE ANY LIABILITY TO YOU OR ANY THIRD PARTY FOR ANY LOSS, HARM OR DAMAGE, YOU AND UNBOUND AGREE THAT SUCH LIABILITY SHALL UNDER NO CIRCUMSTANCES EXCEED THE LESSER OF $1,000 OR THE FEES YOU PAID US DURING THE THREE (3) MONTHS IMMEDIATELY PRECEDING THE DAY THE ACT OR OMISSION OCCURRED THAT GAVE RISE TO YOUR CLAIM. YOU AND UNBOUND AGREE THAT THE FOREGOING LIMITATION OF LIABILITY IS AN AGREED ALLOCATION OF RISK BETWEEN YOU AND US AND REFLECTS THE FEES, IF ANY, UNBOUND CHARGE YOU TO USE THE SITE AND THE SERVICES. YOU ACKNOWLEDGE THAT ABSENT YOUR AGREEMENT TO THIS LIMITATION OF LIABILITY, UNBOUND WOULD NOT PROVIDE THE SITE OR SERVICES TO YOU.