Patient case (clinical description): A 66-year-old woman comes to the office due to joint pain in the hands and periodic morning stiffness that lasts less than 15 minutes.  The pain is moderately severe and worsens with daily activity. The patient used Tylenol with minimal relief.  Past medical history is notable for hypertension and hypercholesteremia.  Physical examination shows firm nodules over the distal interphalangeal joints, bilaterally. The patient has pain in her knees as well. The knees are stiff in the morning for less than 30 minutes and become worse with climbing stairs. She has some sensation of bone friction during activity. X-ray shows narrowing of the joint space, subchondral bone sclerosis and osteophyte formation along the joints.

Patient's own account: I'm a 66-year-old woman and I went to my doctor's office because of a bloody joint pain in my hands that has been lasting for a while. The pain comes and go in the morning usually. I feel like a stiffness that last less than 15 minutes. The pain is moderately severe but it gets worse when I'm using my hands. I used Tylenol which helped a little. Apart from that, I suffer from hypertension and high cholesterol. The doctor made me notice that I have bumps around both of my hand joints. I also suffer from my knees and they are also stiff in the morning for around 30 min. It's even worse when I climb up the stairs! I also feel like my bones are rubbing against each other when I'm moving. The X-ray showed that I have narrow joint space, I have sclerosis, and abnormal growths of bone along my joints.

Clinical trial: The MHERO Study (Michigan's Hypertension, Diabetes, and Obesity Education Research Online)

Eligibility criteria:
Inclusion Criteria:

          1. BMI of 25-50

          2. Diagnosis pre-hypertension or hypertension (within the past 6 months) and current
             resting systolic blood pressure > 130 mmHg.

          3. Diagnosis of either prediabetes or type 2 diabetes, defined as:

               1. HbA1c of at least 5.7% or

               2. Two-hour glucose tolerance test >140 mg/dL

          4. Aged 21-70 years old

          5. Access to the internet and text messaging

          6. Ability to engage in light physical activity

          7. Sufficient control over their food intake to adhere to study diets

          8. Willingness to regularly monitor blood pressure, glucose, dietary intake, and body
             weight over 4-month trial

          9. Participation in the trial approved by primary care provider, along with agreement to
             work with the participant and our research team to manage medication changes

        Exclusion Criteria:

          1. Non-English speaking

          2. Current use of insulin, Dilantin, lithium, and warfarin

          3. Inability to complete baseline measurements

          4. Severe renal or hepatic insufficiency

          5. Cardiovascular dysfunction, including diagnosis of:

               1. Congestive heart failure

               2. Angina

               3. Arrhythmias

               4. Cardiomyopathy

               5. Valvular heart disease

          6. Uncontrolled psychiatric disorder

          7. Consumes >30 alcoholic drinks per week

          8. Currently undergoing chemotherapy

          9. Pregnant or planning to get pregnant in the next 12 months

         10. Breastfeeding or less than 6 months' post-partum

         11. Planned weight loss surgery or similar surgery performed previously

         12. Vegan or vegetarian

         13. Currently enrolled in a weight loss program or take weight loss supplements (that are
             not willing to be stopped before enrolling)

         14. Expecting to move out of the area within 12 months

         15. Any other medical condition that may make either diet dangerous as determined by the
             study medical team.
No condition on gender to be admitted to the trial.
No healthy subjects accepted to join the trial.
Subject must be at least 21 Years old.
Subject must be at most 70 Years

Eligibility (NLI label): Entailment