People affected by pathologies may not do the fasting mimicking diet, unless they have the prior approval of their specialized doctor. In the case of serious or relatively serious illnesses (cancer, diabetes, or cardiovascular, autoimmune, or neurodegenerative diseases), it is important to seek permission and approval from a disease specialist as well as from a dietitian with expertise in the fasting mimicking diet or in therapeutic fasting. The use of the fasting mimicking diet for disease treatment should for the moment be limited to clinical trials unless the doctor determines that there are no viable options and the patient cannot wait until the conclusion of appropriate clinical trials and FDA (US Food and Drug Administration), and similar agencies in other countries, approval.

Talk to your cardiologist about adopting components of the Esselstyn, Ornish, Walford, and Longevity diets, combined with new information emerging from clinical and epidemiological studies. For more specifics on all the below guidelines.

• No: red meat, poultry, or other meats
• No: dairy
• Yes: fish
• Yes: large amounts of vegetables (best if organic)
• Yes: legumes, including beans, lentils, garbanzo beans, peas (best if organic)
• Yes: whole grains, including pasta and bread, but less than 100 grams per day
• Yes: fruits, but only one or two a day (e.g., one apple or orange, two handfuls of blueberries, blackberries, or strawberries)
• Yes: olive oil (about 80 grams per day)
• Yes: nuts (about 30 grams a day of walnuts, almonds, or hazelnuts)
• Limit all eating to eleven to twelve hours a day (e.g., between 8 a.m. and 7 or 8 p.m. only)
• Limit meals to twice a day plus a low-sugar, high-fiber snack with fewer than 100 calories, if you are above BMI 25
• Limit sugar to less than 10 grams per day
• Eat approximately 0.31 to 0.36 grams of protein per pound of body weight per day. If you weigh 130 pounds, that comes to about 40 to 47 grams of protein per day, of which 30 grams should be consumed in a single meal to maximize muscle synthesis
• Exercise as directed.

The diet Professor Longo’s proposes differs from the Ornish diet in that it allows high levels of fat from fish, olive oil, and nuts. However, it does not go as far as the Barcelona study’s diet fat allowance, which permits close to one liter of olive oil per week. Because the Barcelona study diet clearly protects against cardiovascular disease, the diet presented by Professor Longo is a compromise that factors in decades of work and evidence produced by Ornish, Esselstyn, and others indicating that very low-fat intake may be preferable while also considering more recent studies suggesting that there is little evidence that a decreased consumption of olive oil and nuts will produce a beneficial effect.

Talk to your doctor about using the dietary treatments described here as an integrative strategy.

Undergo periodic fasting mimicking diet. Remind your doctor that hypertension medications should not be taken with fasting mimicking diet unless it is clear that your blood pressure will remain within the normal range.

Because the dietary interventions have not yet been tested in large randomized clinical trials for the treatment of cardiovascular disease, they should be used only in support of standard-of-care therapy. Our early results are certainly promising enough that you and your doctor should bear them in mind as we continue to work toward larger trials and FDA approval.