Emphasizing whole foods is probably the biggest key to a healthy lifestyle.
Obesity has been trending upward for the past forty or so years, more than doubling since the ‘70s, and scientists are still unsure as to why. We never seem to be short on trendy diets, newly discovered “superfoods,” and medical procedures all claiming to help us live longer, or fight the obesity epidemic that has affected over 40 percent of Americans.
To help figure it out, researchers are looking to our hunter-gatherer ancestors, known for excellent metabolic health as well as their relative lack of chronic diseases and obesity. A recent study, published in the Obesity Reviews journal, analyzed diets, lifestyles, and physical activity levels of hundreds of modern hunter-gatherer societies whose diets more closely resemble those of our ancient predecessors than the Standard American Diet of today.
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After analyzing hundreds of these people groups, researchers found a surprising amount of variety—none of which led any group to be healthier, overall, than another. For instance, some societies consume 80 percent of their daily calories from carbohydrates, while others are mostly carnivorous.
There were some commonalities, however: Findings showed almost all of the societies consume a mix of meat, fish, and plant-based foods and clearly do not eat any processed or packaged products. Surprisingly, most of these societies regularly consume sugar (mostly in the form of honey). But one of the biggest differences is that on average, they consume much more fiber than most Americans.
Contrary to popular belief, longevity among these small-scale populations is actually about the same as in our industrialized world. While people in these groups may suffer some diseases that modern science has cured, they are largely free from obesity and many chronic diseases that are highly prevalent in the US. Researchers noted obesity in these people groups is less than five percent.
These hunter-gatherers are also much more active but expend similar amounts of energy to people in more modern societies. The study notes this means we should start viewing exercise as a more natural part of a healthy lifestyle instead of an exhausting attempt to burn calories for weight loss.
Interested in learning more about how exercise impacts overall health?
The study also noted if any one from these indigenous people groups moved to an industrialized society or if one of these people groups adopted dietary habits of industrialized societies, they eventually developed the same chronic diseases. Researchers noted based on this fact, as well as the variance of diets but similarly low rates of obesity and chronic disease, we can assume the health of hunter-gatherer societies is more impacted by environment than genetics.
So where do we go from here?
Conclusions from this study point us to no specific diet at all, but rather a prescription to move our bodies more and swap processed foods for whole ones. Researchers encouraged exercising more than just the recommended 150 minutes a week, but choosing lower or more moderate-intensity workouts could be more attainable and beneficial for overall health. They also noted modern processed foods are engineered for flavor and repeated consumption, making them easy foods to overconsume, and therefore, they should be eaten less of. New Year’s resolutions, anyone?
Reducing processed food intake starts by getting in the kitchen. Whether you prefer to meal prep on the weekends or shop for groceries several times a week for fresh and fast dinners, controlling what (and how much of it) goes into your meals is a great step in achieving overall health.
What's the Perfect Diet? Research Suggests There Just Isn’t One - Recipes
What are the causes of high triglycerides? What are the best foods and diet to lower triglycerides naturally? And why is lowering triglycerides naturally so important in the first place?
The answers to these questions and how to lower triglycerides naturally may surprise you.
For years high cholesterol has gotten most of the press, but many researchers now believe that high triglyceride levels may be the most significant indicator of both heart disease and stroke - no matter what your total cholesterol level is.
High Triglycerides Research
- First of all, a recent study published in the American Journal of Clinical Nutrition found, if your triglycerides are high, you have two to three times the risk of heart disease and stroke - even if you have low cholesterol. [Vol. 86: 943-49]
- Secondly, drugs for lowering triglycerides have serious side effects. That's why the American Heart Association recommends medications should only be considered after every natural avenue for lowering triglycerides has been exhausted.
- And number three, a good diet to lower triglycerides has been shown to cut your risk of stroke and sudden cardiac death by nearly half.
How to Lower Triglycerides
First of all, it's important to know the causes of high triglycerides.
Since triglycerides are forms of fats, you might think that less fat in the diet would be the most significant step in lowering triglycerides. But it's not. The main culprit is sugar!
That's right, the most important foods to avoid for high triglycerides are the refined carbohydrate foods that are high on the the glycemic index food list. Sugar is the reason that even a little alcohol has been shown to create large increases in blood plasma triglycerides.
- Increase high fiber foods.
- If you smoke or drink, quit.
- Replace bad fat with good fat.
- Lower fat calories to 20% to 30%.
- Eat more from the vegetables list.
- Choose healthy high protein foods.
- Switch to only healthy carbohydrates.
- Reduce calories on a low glycemic diet
- Add regular exercise and weight training.
- And achieve healthy permanent weight loss.
One of the best heart healthy foods you can add to your diet is cold water fish - at least three times a week. This one change can reduce your triglycerides significantly.
According to research and the AHA (American Heart Association), the DHA, DPA and EPA fatty acids found in salmon and other fatty fish, not only decrease triglycerides, but they can also cut your risk of stroke and sudden cardiac death by more than 44%.
What's more, omega 3 fish oil has been shown to reduce irregular heartbeat, blood clotting, hardening of the arteries, overall cholesterol and to lower blood pressure naturally.
The AHA and others recommend everyone with heart concerns or issues take daily fish oil capsules with balanced DHA, DPA and EPA, no matter how much fish they eat.
Other Fish Oil Health Benefits
And a healthier heart isn't the only benefit. Good quality fish oil has been shown to help prevent and relieve arthritis, cancer, diabetes, emphysema, ADHD and depression - just to name a few.
For best results, check out my highest fish oil recommendation at the omega 3 website.
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Note: The information contained on this website is not intended to be prescriptive. Any attempt to diagnose or treat an illness should come under the direction of a physician who is familiar with nutritional therapy.
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What is Diet Soda?
Diet soda is a zero-calorie, sugar-free version of a carbonated beverages. For example: to give the diet soda its classic sweet taste, Diet Coke contains aspartame and Splenda, both of which are artificial sweeteners, which contain no actual sugar or calories.
That said, artificial sweeteners can be between 200 to 600 times sweeter than table sugar, says Schapiro. So while diet soda is calorie[ and sugar-free, it can still taste sugary.
2 more tips:
Consider your meal times. When you eat is as important. “Don’t skip meals, or you will get hungry and tend to overeat later,” Zumpano says.
“Eating late at night is associated with elevated sugar levels in people with prediabetes, so we recommend you make lunch your largest meal and eat nothing starting three hours before bed.”
Make it easy on yourself. If you follow these guidelines, your blood sugar levels should drop, along with your weight. But making changes to lifelong eating habits can be difficult.
If you need help understanding exactly what you should and should not eat, take a close look at a Mediterranean-style diet. Following this type of eating plan is likely to put your blood sugar levels back on track. “There are plenty of books, articles and recipes for this healthy eating plan,” says Zumpano.
Beyond pure nutrition, there are other barriers to narrowing one's diet to a single food
The thing that makes potatoes special is that for a starchy food, they have an unusual amount of protein, and that includes a wide variety of amino acids, says Jackson. Still, even eating 3kg (6.6lbs) of potatoes a day would only get up to about two-thirds of the recommended amount for someone of Taylor's size.
Potatoes also don't have the recommended amount of fat, and though Taylor included sweet potatoes, garnering him vitamins A and E, iron, and calcium, Jackson noted that B vitamins and zinc and other minerals would be in short supply. But he seems to have gotten through his year relatively unscathed. In fact, he lost quite a bit of weight.
As an aside, potatoes have a habit of coming up in these kinds of conversations. Some years ago a reader wrote to The Chicago Reader advice column, The Straight Dope, asked whether it was true you could live on just potatoes and milk. After all, it's been said that before the Irish Potato Famine, people there were living almost solely on potatoes. Cecil Adams, the erstwhile columnist, claims to have run the numbers with his assistant and found that a whole lot of potatoes and milk would get you most of what you need – with the exception of the mineral molybdenum. But you can get all you need of that by also eating a bit of oatmeal.
Avocados are packed with nutrients - but not as many as potatoes (Credit: iStock)
Hearing this, Jackson laughs. “Oh, that's our diet – that's the Scottish diet from a hundred years ago. That fits right in. Potatoes, milk, and oatmeal, with some kale in there, too.”
But beyond pure nutrition, there are other barriers to narrowing one's diet to a single food. Humans have built-in mechanisms to avoid just such a situation (probably because it eventually leads to malnutrition) – specifically, a phenomenon called sensory-specific satiety: The more you eat of one thing, the less you can stomach it. “I call this the pudding scenario,” says Jackson, “where you go out for a meal and you're stuffed, you couldn't manage another bite. And then someone brings out a pudding and you can manage a few more calories.” There's the danger that eating the same thing day after day for a long time would make it more difficult to eat enough of it to keep you going. (Three kilos of avocado a day, anyone?)
Ketogenic diet: Is the ultimate low-carb diet good for you?
Recently, many of my patients have been asking about a ketogenic diet. Is a ketogenic diet safe? Would you recommend it? Despite the recent hype, a ketogenic diet is not something new. In medicine, we have been using it for almost 100 years to treat drug-resistant epilepsy, especially in children. In the 1970s, Dr. Atkins popularized his very-low-carbohydrate diet for weight loss that began with a very strict two-week ketogenic phase. Over the years, other fad diets incorporated a similar approach for weight loss.
What is a ketogenic (keto) diet?
In essence, it is a diet that causes the body to release ketones into the bloodstream. Most cells prefer to use blood sugar, which comes from carbohydrates, as the body&rsquos main source of energy. In the absence of circulating blood sugar from food, we start breaking down stored fat into molecules called ketone bodies (the process is called ketosis). Once you reach ketosis, most cells will use ketone bodies to generate energy until we start eating carbohydrates again. The shift, from using circulating glucose to breaking down stored fat as a source of energy, usually happens over two to four days of eating fewer than 20 to 50 grams of carbohydrates per day. Keep in mind that this is a highly individualized process, and some people need a more restricted diet to start producing enough ketones.
Because it lacks carbohydrates, a ketogenic diet is rich in proteins and fats. It typically includes plenty of meats, eggs, processed meats, sausages, cheeses, fish, nuts, butter, oils, seeds, and fibrous vegetables. Because it is so restrictive, it is really hard to follow over the long run. Carbohydrates normally account for at least 50% of the typical American diet. One of the main criticisms of this diet is that many people tend to eat too much protein and poor-quality fats from processed foods, with very few fruits and vegetables. Patients with kidney disease need to be cautious because this diet could worsen their condition. Additionally, some patients may feel a little tired in the beginning, while some may have bad breath, nausea, vomiting, constipation, and sleep problems.
Is a ketogenic diet healthy?
We have solid evidence showing that a ketogenic diet reduces seizures in children, sometimes as effectively as medication. Because of these neuroprotective effects, questions have been raised about the possible benefits for other brain disorders such as Parkinson&rsquos, Alzheimer&rsquos, multiple sclerosis, sleep disorders, autism, and even brain cancer. However, there are no human studies to support recommending ketosis to treat these conditions.
Weight loss is the primary reason my patients use the ketogenic diet. Previous research shows good evidence of a faster weight loss when patients go on a ketogenic or very low carbohydrate diet compared to participants on a more traditional low-fat diet, or even a Mediterranean diet. However, that difference in weight loss seems to disappear over time.
A ketogenic diet also has been shown to improve blood sugar control for patients with type 2 diabetes, at least in the short term. There is even more controversy when we consider the effect on cholesterol levels. A few studies show some patients have increase in cholesterol levels in the beginning, only to see cholesterol fall a few months later. However, there is no long-term research analyzing its effects over time on diabetes and high cholesterol.
Key takeaways from a ketogenic diet review?
A ketogenic diet could be an interesting alternative to treat certain conditions and may accelerate weight loss. But it is hard to follow, and it can be heavy on red meat and other fatty, processed, and salty foods that are notoriously unhealthy. We also do not know much about its long-term effects, probably because it&rsquos so hard to stick with that people can&rsquot eat this way for a long time. It is also important to remember that "yo-yo diets" that lead to rapid weight loss fluctuation are associated with increased mortality. Instead of engaging in the next popular diet that would last only a few weeks to months (for most people that includes a ketogenic diet), try to embrace change that is sustainable over the long term. A balanced, unprocessed diet, rich in very colorful fruits and vegetables, lean meats, fish, whole grains, nuts, seeds, olive oil, and lots of water seems to have the best evidence for a long, healthier, vibrant life.
Brands make a lot of money by putting "health" claims on their products &mdash some of which are totally legit, while others seem redundant (produce has always been gluten-free, for example). We derive better health from food, not simply from the individual nutrients that food contains.
Fresh food is wonderful for all of the obvious reasons, but often we forget about items that are just as nutritious in their preserved state. Canned or frozen veggies, fruit, and lower-sodium beans, lentils, chickpeas and peas all retain their peak nutritional quality and cost a lot less. Focus on eating more real, whole food that's as close to its natural, original version as possible. A combo of marketing and processing is what makes fresh oranges into fresh orange juice, so consider that when you check labels for sneaky, added sources of sugar, saturated fat, or sodium.
Is There an Optimal Diet for Humans?
A study of modern hunter-gatherer groups found that they exhibit generally excellent metabolic health while consuming a wide range of diets.
Nutrition experts have long debated whether there is an optimal diet that humans evolved to eat. But a study published this month adds a twist. It found that there is likely no single natural diet that is best for human health.
The research, published in the journal Obesity Reviews, looked at the diets, habits and physical activity levels of hundreds of modern hunter-gatherer groups and small-scale societies, whose lifestyles are similar to those of ancient populations. They found that they all exhibit generally excellent metabolic health while consuming a wide range of diets.
Some get up to 80 percent of their calories from carbohydrates. Others eat mostly meat. But there were some broad strokes: Almost all of them eat a mix of meat, fish and plants, consuming foods that are generally packed with nutrients. In general, they eat a lot more fiber than the average American. Most of their carbohydrates come from vegetables and starchy plants with a low glycemic index, meaning they do not lead to rapid spikes in blood sugar. But it is also not uncommon for hunter-gatherers to eat sugar, which they consume primarily in the form of honey.
The findings suggest that there is no one “true” diet for humans, who “can be very healthy on a wide range of diets,” said the lead author of the study, Herman Pontzer, an associate professor of evolutionary anthropology at Duke University. “We know that because we see a wide range of diets in these very healthy populations.”
One thing hunter-gatherer populations have in common is a very high level of physical activity. Many walk between five and 10 miles a day. Yet paradoxically they do not have higher energy expenditure levels than the average American office worker. That suggests that health authorities should consider recommending exercise primarily as a way to improve metabolic health, but not necessarily as a calorie-burning antidote to obesity, the authors said.
From a public health perspective, modern hunter-gatherers may be most remarkable for their relative lack of chronic diseases like heart disease, hypertension and cancer. Obesity rates are low. They have very high levels of cardiorespiratory fitness, even in old age. And Type 2 diabetes and metabolic dysfunction are hardly ever seen.
Life in hunter-gatherer societies, however, is not easy. Infant mortality rates are high because of infectious disease. Deaths from accidents, gastrointestinal illness and acute infections are common. But those who survive to adulthood often reach old age relatively free from degenerative diseases that are the norm in industrialized nations. They are typically fit and active until the end, suggesting that there is something about their way of life that allows them to age healthfully.
“Few of us would want to trade places with them. Their lives are still tough,” Dr. Pontzer said. “But the things they get sick from are things we know how to deal with, and the things they don’t get sick from are the things we struggle to deal with.”
It is possible that genetics and other factors unrelated to lifestyle protect them from chronic disease. But studies show that when people born into hunter-gatherer societies move to large cities and adopt Western lifestyles, they develop high rates of obesity and metabolic disease just like everyone else. Michael Gurven, an anthropologist at the University of California, Santa Barbara, has done extensive research on the Tsimane, a Bolivian population that lives a subsistence lifestyle of hunting, gathering, fishing and farming.
The Tsimane get most of their calories from complex carbohydrates high in fiber like plantain, corn, cassava, rice and bananas, supplemented with wild game and fish. Dr. Gurven has published detailed studies showing that they have exceptional cardiovascular health and almost no diabetes. Yet Dr. Gurven has seen several cases of Tsimane people developing and dying from Type 2 diabetes after leaving their villages and moving to the nearby town of San Borja, where they took sedentary office jobs and gave up their traditional diet.
“They changed from their traditional diet to eating in town where everything is fried,” he said. “They started eating fried chicken and rice and drinking Coca-Cola. Some of these folks can see a pretty rapid change in health.”
For the new study, Dr. Pontzer and his colleagues analyzed data on hunter-gatherers and other small-scale societies across the globe, from South America to Africa and Australia. They looked at detailed dietary assessments of fossil and archaeological records to get a sense of what early humans ate. And they included new data collected from the Hadza, a community of people who spend their days hunting and foraging in northern Tanzania, much as their ancestors have for tens of thousands of years. The Hadza consume what some call “the oldest diet.” Dr. Pontzer has spent time with them and long studied their health.
In a typical day, the Hadza set out in groups early in the morning to hunt and forage in the savanna. The women traverse hilly terrain to collect wild berries and dig up tubers resembling fibrous sweet potatoes. Getting them is not easy, Dr. Pontzer said: The women use sticks to dig up the tubers, in some cases while carrying infants on their backs. The men head out to hunt animals, often killing small ones but, about once a month, something big like a zebra, warthog or gazelle. On days when their hunts come up short, they head over to beehives and collect honey, which is one of their favorite foods, accounting for at least 15 percent of the calories in their diet.
“On any given day in a Hadza camp, there is almost always honey, a little meat and tubers,” Dr. Pontzer said.
The amount of daily calories the Hadza consume is similar to that of the average American. But they rely on a fairly small number of foods. And notably they do not have potato chips, candy bars, ice cream and other ultra-processed foods that combine large amounts of fat and simple carbs — foods that are engineered to be irresistible even when we are not hungry.
The lack of novelty and variety in hunter-gatherer diets may be part of the reason they do not overeat and become obese. Studies show, for example, that the greater the variety of food choices in front of us, the longer it takes to feel full, a phenomenon known as sensory specific satiety.
“It’s the reason you always have room for dessert at a restaurant even when you’re full,” Dr. Pontzer said. “Even though you’ve had a savory meal and you can’t eat one more bite of steak, you’re still interested in the cheesecake because it’s sweet and that button hasn’t been worn out in your brain yet.”
Why You Shouldn't Try This Diet
As a rule of thumb, losing 1 to 2 pounds a week is the safest way to slim down. A low-calorie fad diet like the 3-Day Mayo Clinic Diet or the Grapefruit Diet will only cause short-term weight loss, as these eating plans mostly cause a loss of water and muscle mass, not fat loss, according to the American Academy of Family Physicians.
The 3-Day Diet is so food-restrictive it would be difficult to stay on it long-term. And there's a very good chance a dieter will gain back the weight he or she lost, and possibly more.
"When diets are so restrictive, not only will they cause nutrient deficiencies, but they're also not sustainable. If a diet promises something that's too good to be true, chances are you won't be able to maintain the weight loss," says Zeratsky.
Following a high-protein, low-carb diet long-term not only results in nutrient deficiencies but also other negative side effects. The Mayo Clinic warns that high protein consumption can lead to bad breath, headache and constipation. What's more, some high-protein diets, when they include foods like red meat and full-fat dairy, may boost the risk of heart disease.
And consider this: New research suggests it's not the type of macronutrient diet you follow (such as one emphasizing protein, carbohydrates or unsaturated fats) that makes a difference in reducing the risk of heart disease rather, it's the healthy foods you eat.
An August 2019 study, published in the International Journal of Cardiology, involved 164 adults with high blood pressure or hypertension who were split into three groups that followed different diets. Each diet was rich in fruits and veggies, lean meats and fiber. Ultimately, all three diets reduced heart injury and inflammation in people with risk factors for heart disease. Emphasizing one macronutrient or another was less important than eating an overall healthy diet.
Additionally, forsaking an entire food group, like carbohydrates, can have repercussions. Your body uses carbs as fuel to keep it going. A low-carb diet decreases insulin levels, which forces your body to burn stored fat for energy (since you're not getting any energy from your food). That can cause weight loss, but it also causes fatigue, according to the Mayo Clinic.
What Is the Flexitarian Diet?
If you’re looking for a healthy diet that doesn’t involve counting calories, super strict rules and allows you to enjoy meat from time to time – look no further than the flexitarian diet.
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In its simplest definition, the flexitarian diet is a combination of the words “flexible” and “vegetarian.” It’s a cross between full vegan and vegetarian with the ability to enjoy animal products every so often.
Registered dietitian Kate Patton, MEd, RD, CSSD, LD, explains the ins and outs of this eating style.
What to know about the flexitarian diet
The flexitarian diet is listed on U.S. News Best Diet Rankings as the #2 Best Diet Overall (falling just behind the Mediterranean diet). It’s ranked high because it’s a simple, healthy, straight forward way of eating.
The flexitarian diet is essentially a flexible alternative to being a vegetarian. So you’re still focusing on fruits, veggies, whole grains, legumes and nuts, but you occasionally still enjoy meat.
So if vegetarianism never fully appealed to you because you love a good burger, the flexitarian diet might just be for you. (Still, it’s worth noting that this diet does focus on decreasing your overall meat consumption.)
“I think people are attracted to this diet because you can be a little bit more flexible on it,” says Patton. “Most diets imply a start and stop and the weight can creep back on, but the flexitarian diet places a large emphasis on eating a mostly plant-based diet, which is always recommended for long-term weight loss.”
What are the guidelines around meat with the flexitarian diet?
As the name suggests, this diet is flexible, but there are guidelines around how much (and why types) of meat you should be eating. Depending on your commitment level, you could be consuming between 9 and 28 ounces of meat a week while following this eating style. But that’s the beauty of this way of eating – you choose how much you want to cut down.
There are three basic stages of this eating pattern when it comes to decreasing meat:
When someone is first starting out on the flexitarian diet, it’s recommended to forgo meat two days a week. In the beginning stage you should keep your overall meat consumption to no more than 28 ounces a week for the five days you do consume it.
As a reminder, a card-deck sized portion of chicken or steak is about 3 ounces.
As you move through the diet and get used to eating more fruits and vegetables, focus on following a full vegetarian diet three to four days a week. Don’t consume more than 18 ounces of meat during the rest of the week.
Follow a vegetarian diet for five of the seven days in a week. On the two days you do consume meat, do not eat more than 9 total ounces.
Types of meat to eat
Remember, the overall goal of the flexitarian diet is to eat more nutritious plant foods and less meat. When you do incorporate meat into your diet, choose organic, free-range, pasture-raised or grass-fed beef, chicken or turkey. And always choose leaner cuts to minimize extra animal fat.
Since the flexitarian diet isn’t truly vegan or vegetarian, you can decide yourself if you want to incorporate fish. Just be sure to choose wild-caught varieties. “When it comes to protein, your main focus should be on getting the majority of your protein from plants instead of animals,” says Patton.
What are the risks and benefits of eating a flexitarian diet?
Dietitians will always recommend a way of eating that focuses on fruits and vegetables. The flexitarian diet does just that. Because of this, there are several benefits to this eating style, including:
- Decreased risk of heart disease.
- Weight loss.
- Decreased risk of Type 2 diabetes or management of pre-diabetes.
- It may help prevent cancer.
- It’s good for the environment since you are decreasing your meat consumption and reducing your carbon footprint.
Even with all of the benefits of this eating pattern, there are still risks for certain people. Cutting back on meat consumption can lead to some nutrient deficiencies like vitamin B12, zinc and calcium.
Also, some people who suffer from IBS might not do well with a heavily plant-based diet. If you have digestive issues, Patton recommends knowing which fruits and veggies you can tolerate.
Foods to eat on the flexitarian diet
“You should always aim to eat the least processed, most natural form of foods,” explains Patton. “You don’t need to worry about counting calories on the flexitarian diet because if you’re eating plant-based foods that comes from the ground, it’s not processed and it’s going to be in its most natural form.”
The flexitarian diet is made to be inclusive, but you do want to limit animal protein (including seafood) and processed foods and beverages. Here’s what to add to your shopping cart.
- Plant proteins (beans such as black, kidney or navy, edamame, chickpeas, lentils, tofu).
- Whole grains (brown rice, oats, barley , quinoa). (although dairy milk is OK in moderation).
- Dairy (cheese, yogurt or dairy alternatives).
- Nuts, nut butters, seeds and healthy fats.
- Oils, herbs and spices.
- Meat and poultry (lean cuts of beef, chicken breast, turkey breast).
- Fish (salmon, tilapia, cod, shrimp).
- Anything with added sugar or refined carbohydrates.
“Focusing on plant-based foods and not eating as much meat can be really hard for some people,” says Patton. “But nowadays you can find great bean-based burgers, canned bean and lentil soup and bean based pastas to start off, but eventually it’s even better to make your own home made versions. Don’t be afraid to get adventurous with this diet!”
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy