Review of the plant-based nutrition and lifestyle medicine news June 2024

This month brings us sobering facts about the health of our children, whilst also providing hope that plant-based lifestyle medicine can benefit conditions such as type 2 diabetes and dementia.

A Neglected Generation: Reversing the decline in children’s health

This report from the Food Foundation highlights the critical state of children’s health in England, emphasising that childhood nutrition been neglected and inadequately addressed by policymakers.

Key Issues Identified:

1. Increase in Calorie-Dense Diet-Related Conditions:
   • Obesity and type 2 diabetes have seen alarming increases.
   • Poor-quality diets and undernutrition also contribute significantly to children’s health issues, sometimes co-existing with obesity.
2. Nutritional Quality and Socio-Economic Influences:
   • The nutritional quality of food and wider socio-economic factors are crucial in determining children’s health.
   • Essential nutrients are often lacking in children’s diets, particularly among those from lower-income families.
3. Preventability of Health Problems:
   • Many health issues highlighted are preventable if children have access to healthy food.
   • There is a need to protect children from ultra-processed, sugary, and salty foods.
4. Environmental Challenges:
   • High levels of poverty and aggressive junk food marketing make it challenging for families to provide healthy meals.
   • The cost-of-living crisis has worsened these challenges.

Children’s Health Trajectory and Statistics:

• Height Decline: The average height of five-year-olds has been declining since 2013, with children in the UK being shorter on average than those in most other high-income countries.
• Obesity Increase: Obesity among 10-11 year-olds has increased by 30% since 2006.
• Type 2 Diabetes Increase: There has been a 22% increase in type 2 diabetes among under-25s over the past five years.
• Decreased Health Quality: Babies born today are expected to enjoy a year less of good health compared to those born a decade ago.

Challenges and Recommendations:

• Addressing Inequalities: Efforts to improve children’s health must focus on reducing inequalities and ensuring all children have access to nutritious food.
• Policy Failures: Despite numerous government strategies, no significant progress has been made in addressing childhood obesity and other diet-related health issues.
• Comprehensive Approach Needed: A radical overhaul of the food system is required, focusing on affordability and availability of healthy foods, and addressing socio-economic and commercial determinants of health.

This is a call to action for the next Government and an opportunity for policymakers to commit to a better food future, ensuring all children can thrive and grow up healthy.

Nearly 1.8 billion adults at risk of disease from not doing enough physical activity

The WHO reports on a new study published in The Lancet Global Health journal. We know that regular physical activity reduces the risk of many chronic conditions, both physical and mental health. Physical activity also improves quality of life and plays a key role in the management of many chronic conditions alongside a whole person, lifestyle medicine approach. Yet this new analysis shows the extent and rising prevalence of physical inactivity globally. 31% of adults in 2022 did not meet recommended levels of physical activity guidelines. If the trend continues, levels of inactivity are projected to further rise to 35% by 2030 leaving us way off track to meet global targets to reduce physical inactivity. Significant country-based differences are noted with additional sex and age differences, such that women and people older than 60 years are the least physically active.

The quote in the article is spot on “Promoting physical activity goes beyond promoting individual lifestyle choice – it will require a whole-of-society approach and creating environments that make it easier and safer for everyone to be more active in ways they enjoy  to reap the many health benefits of regular physical activity,”. As lifestyle medicine advocates we need to role model but also lobby for a more inclusive approach to embedding physical activity within healthcare and society as a whole.

One healthcare-led global initiative that is being adopted by lifestyle medicine advocates in the UK is Walk with A Doc. Watch our video capturing the inspirational Walk with a Doc group in Wolverhampton.

Plant-Based Dietary Patterns and Incident Diabetes in the Atherosclerosis Risk in Communities (ARIC) Study

A major benefit of consuming a plant-based diet is the lower risk of type 2 diabetes. This is in part due to the association between plant-based diets and lower body weight. But there are additional factors relating to the consumption of healthy nutrients found in plants and the lower intake of the harmful nutrients found in animals foods. Earlier this year, a large analysis of the UK biobank cohort once again demonstrated the ability of a healthy plant-based diet to significantly lower the risk of type 2 diabetes through a variety of mechanisms.

This new paper analysed data from the Atherosclerosis Risk in Communities (ARIC) study and included 11,965 participants who had completed a food frequency questionnaire (FFQ) at baseline and followed for a median of 22 years. The researchers used the plant-based dietary index to score FFQ data and categorised participants into those following healthy or unhealthy plant-based diets.

The results showed that participants most adherent to a healthy plant-based diet reduced their risk of type 2 diabetes by 15%. Although this sounds like rather a modest impact compared to previously reported data, its worth noting that even those consuming the most plant-based foods were only eating 11 portions of vegetables, 4 portions of nuts and 5 portions of legumes per week whilst still consuming 8 portions of meat per week. Thus, even modest shifts to eating more plants is beneficial for diabetes prevention. This study is useful in that it included black participants, who are often not well represented in dietary studies.

Along side the article, a useful commentary was provided, which highlights the consistency of data regarding the role of plant-based diets for diabetes prevention.

Association of a Low-Carbohydrate High-Fat Diet With Plasma Lipid Levels and Cardiovascular Risk

Despite the evidence supporting plant-based diets there seems to be continued promotion of a low-carbohydrate dietary approach for prevention and management of type 2 diabetes. Yet more and more evidence is accumulating that when low-carb diets emphasise animal sources of protein and fat, this is detrimental to long term health with increased risks of cardiovascular disease, certain cancers and premature death.

This is just the latest study of many to highlight the dangers of an animal-based low-carb diet. Researchers examined data from the UK Biobank. A low-carb high fat (LCHF) diet was defined as one consisting of no more than 25% of total daily energy or calories from carbohydrates and more than 45% of total daily calories from fat. The primary endpoint was the impact of LCHF diet on serum lipid levels; and the secondary endpoint was to investigate the association between LCHF dietary patterns and incident major adverse cardiovascular events.

A total of 70,684 participants completed a one-time self-reported 24-hour diet questionnaire and had blood drawn to check their lipid panels.  Of these participants, 305 were identified as consuming an LCHF diet, mean age 53 and mostly women (73.3%). They were matched by age and sex with 1,220 individuals who reported consuming a standard diet. The results showed that, compared with those consuming a standard diet, individuals consuming an LCHF diet had significantly higher levels of LDL-cholesterol and apolipoprotein B.  Furthermore, after an average follow-up of 11.8 years, those on an LCHF diet had a more than two-fold higher risk of experiencing incident major adverse cardiac events (MACE; defined as the composite of angina, myocardial infarction, coronary artery disease, ischaemic stroke, peripheral arterial disease, or coronary/carotid revascularisation), even after adjusting for other risk factors.

Of course this type of observational study has limitations and cannot establish causality between LCHF diet and an increased risk of major cardiac events.  Additionally, the participants provided dietary information at only one time point, which may limit the interpretation of the study findings.  Nevertheless, given that low-carb diets remain popular, the results should act as a note of caution. If low-carb diets are preferred, they should focus on replacing carbohydrates with plant sources of fat and protein.

Implications of food ultra-processing on cardiovascular risk considering plant origin foods: an analysis of the UK Biobank cohort

Please don’t get drawn into the debate on ultra-processed foods (UPFs) and the suggestion that shifting to a plant-based diet will lead to increased consumption and thus negative health outcomes. This is a narrative being pushed by those with vested interested to stop the urgent and needed transition away from animal-source foods, often reported as ‘natural’.

The study highlighted led to numerous inaccurate headlines suggesting that plant-based foods, including meat alternatives, were responsible for the increased risk of cardiovascular disease associated with UPF consumption. Luckily, many reputable sources have brought balance to the conversation and there is no need for me to write further on this. Only to say that not all UPFs are created equal. There is a big difference between supermarket-bought wholemeal bread and a donut. Most of the negative health outcomes are driven by processed meat, sugar sweetened beverages and cakes/pastries/biscuits/crisps. When plant-based milks and meat alternatives have been investigated as separate groups of UPFs, there does not appear to be a negative impact on health outcomes and in fact, according to a new review paper, plant-based meat alternatives may have considerable benefits for cardiovascular health compared to meat. Even within the category of plant-based meat alternatives there is a great variation between products, but the evidence suggests that if carefully selected, some plant-based meat alternatives have the potential to be healthier and nutrient-rich alternatives to animal-source foods and of course have the additional benefit of a smaller environmental footprint.

Effects of intensive lifestyle changes on the progression of mild cognitive impairment or early dementia due to Alzheimer’s disease: a randomized, controlled clinical trial

The study we have been waiting for has finally been report. It is the latest research from Dr Dean Ornish and colleagues using his intensive lifestyle medicine intervention in people with early stages of Alzheimers disease (AD).

This was a multicentre, randomised, controlled phase 2 trial with a 1:1 randomisation. It included participants with mild cognitive impairment (MCI) or early dementia due to AD. The experimental group underwent a 20-week intensive multi-domain lifestyle intervention, while the control group received usual care and were placed on a wait-list. Primary Outcomes: Changes in cognitive and functional tests including Clinical Global Impression of Change (CGIC), Alzheimer’s Disease Assessment Scale-Cognitive Subscale (ADAS-Cog), Clinical Dementia Rating–Sum of Boxes (CDR-SB), and Clinical Dementia Rating Global (CDR-G) Secondary Outcomes: Plasma Aβ42/40 ratio, other biomarkers, and the correlation between lifestyle changes and the degree of change in these measures.

The lifestyle interventions included a 100% whole food plant-based diet with food delivered to the participants and their spouse/study partner; exercise with 30 minutes of walking a day and mild strength training exercises at least three times per week; stress management with meditation, gentle yoga-based poses, stretching, progressive relaxation, breathing exercises, and imagery for a total of one hour per day; Group support with participants and their spouses/study partners participating in a support group one hour/session, three days/week. To reinforce this lifestyle intervention, each patient and their spouse or study partner met three times/week, four hours/session via Zoom: one hour of supervised exercise (aerobic + strength training), one hour of stress management practices (stretching, breathing, meditation, imagery), one hour of a support group, one hour lecture on lifestyle.

A large number of supplements were used in the intervention group including, omega-3 fatty acids and curcumin, multivitamin and minerals, co-enzyme Q10, vitamin C, vitamin B12, magnesium, Hericium erinaceus, Super Bifido Plus Probiotic.

Results

• Participants: 51 patients enrolled with a mean age of 73.5. Baseline characteristics were similar between the two groups. Two participants in the intervention group withdrew from the study.
• Primary Outcomes:
  • CGIC: Significant improvement in the intervention group (p = 0.001).
  • CDR-SB: Less progression in the intervention group (p = 0.032).
  • CDR Global: Significant improvement in the intervention group (p = 0.037).
  • ADAS-Cog: Borderline significant improvement in the intervention group (p = 0.053).
• Secondary Outcomes:
  • Plasma Aβ42/40 ratio: Increased in the intervention group and decreased in the control group (p = 0.003).
  • Lifestyle Correlation: Significant correlation between lifestyle changes and both cognitive function improvement and plasma Aβ42/40 ratio changes.
  • Microbiome: Improved significantly only in the intervention group (p < 0.0001).

Although not everyone in the intervention group showed improvements, when compared with the control group, none of the participants showed improvement in the various parameters, but similar numbers remained stable compared to the intervention group and more showed worsening of the disease. Like with all Dr Dean Ornish’s studies, the more adherent participants were to the lifestyle interventions, the greater the observed benefits

The authors conclude that comprehensive lifestyle changes, including diet, exercise, stress management, and social support, can significantly improve cognition and function in patients with MCI or early dementia due to AD after 20 weeks. This suggests that intensive lifestyle interventions can be beneficial for individuals already diagnosed with early stages of AD.

This study is a huge contribution to the field of lifestyle medicine and provides hope to many with early stages of dementia with a intervention that has no side-effects and can also benefit overall physical and mental health and wellbeing. However, I was a little disappointed that the study was small (albeit able to detect statistically significant differences between groups) and quite short term (20 weeks) and hope that participants will be followed for longer. In addition, I was surprised by the extensive use of supplementation. It is also disappointing that there is no way of teasing out which aspect of the lifestyle intervention is responsible for the greatest clinical impact. May be that does not matter, since all aspects are known to benefit health. We certainly cannot extrapolate these data to say that a vegan diet benefits people with early dementia, since we can not be certain of its impact in isolation.

As always, Dr Gil Carvalho has a useful summary of the study

 

Planetary Health Diet Index and risk of total and cause-specific mortality in three prospective cohorts

Back in 2019, the Eat Lancet commission published a key document outlining the composition of an evidence-based dietary pattern that would not only support human health but keep the food system within planetary boundaries. Known as the Planetary Health Diet, it is composed of at least 85% whole foods, whilst minimising animal-sourced and ultra-processed foods. Most animal foods are not considered essential within this dietary pattern.

This new study from the same group of researchers shows, in a large observational data set, that people who adhere the closest to this way of eating have significantly improved health outcomes and lower environmental impacts. The results showed that this type of diet pattern centred around fruits, vegetables, whole grains, beans, nuts and seeds reduced the risk of premature death by 30% with significant advantages for our major killers – heart and lung diseases and cancer.

In addition, there were significant environmental benefits, including 29% lower greenhouse gas emissions, 21% lower fertilizer needs, and 51% lower cropland use.

With the dire warnings from the recent Bonn Climate Change Conference and the ever increasing burden of chronic diseases, we appear to have an intervention that improves both aspects. We are fortunate that we do not have to compromise between individual and planetary health. The same type of diet is good for both. Read the Harvard University press release about the study.

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