A review of the weeks plant-based nutrition news 3rd November 2019

Lifestylemedicine.org

AMERICAN COLLEGE OF LIFESTYLE MEDICINE ANNUAL CONFERENCE (ACLM): This week was the ACLM annual conference, which I had the privilege of attending. The ACLM was founded in 2004 and has gone from strength to strength. There is now a global network of lifestyle medicine organsiations around the world advocating for lifestyle approaches to prevent, treat and even reverse chronic disease. 1500 health professionals came together in Orlando, FL, to hear the latest evidence for lifestyle medicine. Speakers were world class, including Elizabeth Blackburn, noble prize winning scientist, who is an authority on telemores and co-discovered the enzyme telomerase. Here book, the Telomere Effect, is well worth reading. You will not be surprised to learn that healthy lifestyles benefit our telomeres. Valter Longo, an authority on longevity research, spoke about the ability of a fasting mimicking diet to benefit disease prevention and even treatment. His book, the longevity diet, is also excellent.

The most inspiring aspect of the conference was the consistent endorsement of a predominately whole food plant-based diet, which is one of the ACLM’s pillars of lifestyle medicine. This is because a diet centred around whole plant foods, that minimises animal-derived and processed foods, is evidence based with large numbers of studies demonstrating its benefit for disease prevention, treatment and even reversal. All the food at the conference was whole food plant-based and the nutrition speakers, including Dean Ornish, Michelle McMacken, Brenda Davis, Scott Stoll, Michael Greger, are all using plant-based nutrition in their clinical practice. The conference app had the information shown below on the ACLM’s position statement on diet and nutrition for both adults and children.

A NEW LIFESTYLE MEDICINE CLINIC IN SCOTLAND: On returning from the ACLM conference, I had the pleasure of connecting with Dr Laura Freeman and I am totally inspired by her passion. She has recently returned from Canada where she has been practicing lifestyle medicine as a family physician for a number of years. Now she is bringing that experience to Scotland.

Dr Laura Freeman is providing an alternate way of health and healing. Many of us do not want to use medications to treat chronic disease. Through lifestyle medicine, other options are available, which can reduce the reliance on medication and the best part is that it is risk and side-effect free.

There is now a qualification in lifestyle medicine and Dr Freeman has this diploma and is also certified in the CHIP health programme .

Dr Laura Freeman, MBChB, MRCGP, CCFP, Dip IBLM/BSLM

A UK trained GP, Dr Laura Freeman is now working as a certified Lifestyle Medicine Physician and CHIP Facilitator.

Private Lifestyle Medicine clinics based in Glasgow and Edinburgh.

Email: drlauramichelefreeman@gmail.com
Insta: @drlaurafreeman

WHICH FOODS ARE BEST OF HUMAN AND PLANETARY HEALTH?: This study published in PNAS this week explored the multiple human health and environmental impacts of 15 different food groups: chicken, dairy, eggs, fish, fruits, legumes, nuts, olive oil (used as an indicator for vegetable oils high in unsaturated fatty acids), potatoes, processed red meat, refined grain cereals, sugar-sweetened beverages, unprocessed red meat, vegetables, and whole grain cereals. The impact of these foods was assessed based on 5 health outcomes — coronary heart disease, type II diabetes, stroke, and colorectal cancers, accounting for 40% of global mortality — and 5 environmental outcomes — GHG emissions, land use, scarcity-weighted water use, and 2 forms of nutrient pollution — acidification and eutrophication.

What the study found was that the same dietary changes that could help reduce the risk of diet-related noncommunicable diseases could also help meet international sustainability goals. The foods associated with improved health (whole grain cereals, fruits, vegetables, legumes, nuts, olive oil, and fish), all except fish have among the lowest environmental impacts, and fish has markedly lower impacts than red meats and processed meats. Foods associated with the largest negative environmental impacts — unprocessed and processed red meat — are consistently associated with the largest increases in disease risk. Thus, dietary transitions toward greater consumption of healthier foods would generally improve environmental sustainability.

Fish consumption appears to have benefits for human health but is negatively impacting our oceans. Nearly 90% of the world’s marine fish stocks are now fully exploited, overexploited or depleted. Is fish consumption necessary for all? I would suggest that in parts of the world where whole plant foods are readily available, fish consumption is NOT necessary for health. However there may be parts of the world where fish consumption is a staple and 10–12% of the worlds population depend on fisheries and aquaculture for their livelihood. In these areas we should be looking for alternate solutions for food and income generation. For the UK a whole food plant-based diet should be the aim for all citizens.

DAIRY AND HEALTH: The science on dairy consumption is difficult to navigate. Some studies show benefits for health and others that dairy consumption has either a neutral or even negative effect. Don’t get me wrong. I am NOT suddenly advocating dairy consumption, I am just reporting the science. In many ethnic groups around the world, dairy consumption is not even possible as the majority are lactose intolerant, given that milk consumption was not expected or necessary after weaning.

This week in the American Journal of Clinical Nutrition, 3 large studies from prospective cohorts have been published examining the effect of dairy consumption on type 2 diabetes and mortality.

1. This study evaluated the association between dairy fat intake and risk of type 2 diabetes and also examined the effect of isocalorically replacing dairy fat with other macronutrients. The study followed 41,808 men in the Health Professionals Follow-Up Study, 65,929 women in the Nurses’ Health Study and 89,565 women in the Nurse’ Health Study II. The results showed that dairy fat was not associated with risk of type 2 diabetes when compared with calories from carbohydrates. Replacing 5% of calories from dairy fat with other sources of animal fat or carbohydrate from refined grains was associated with a 17% and a 4% higher risk of type 2 diabetes, respectively. Conversely, a 5% calorie replacement with carbohydrate from whole grains was associated with a 7% lower risk of type 2 diabetes.
2. This study evaluated the association of long-term changes in dairy product consumption with subsequent risk of type 2 diabetes in 34,224 men in the Health Professionals Follow-Up Study, 76,531 women in the Nurses’ Health Study and 81,597 women in the Nurses’ Health Study II. The results showed that decreasing total dairy intake by >1.0 serving/d over a 4-y period was associated with an 11% higher risk of type 2 diabetes in the subsequent 4 years compared with maintaining a relatively stable consumption. Increasing yogurt consumption by >0.5 serving/d was associated with an 11% lower type 2 diabetes risk, whereas increasing cheese consumption by >0.5 serving/d was associated with a 9% higher risk compared with maintaining stable intakes. Substituting 1 serving/d of yogurt or reduced-fat milk for cheese was associated with a 16% or 12% lower type 2 diabetes risk, respectively. Therefore, the study suggests that substituting yogurt or reduced-fat milk for cheese is associated with a lower risk of type 2 diabetes.
3. This study investigated associations of consumption of various dairy products with mortality in the Italian cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC)–Italy study. The consumption of milk, yogurt, cheese, butter, and dairy calcium consumption was correlated with mortality for cancer, cardiovascular disease, and all causes. After a median follow-up of 14.9 y, 2468 deaths were identified in 45,009 participants: 59% from cancer and 19% from cardiovascular disease. No significant association of consumption of any dairy product with mortality was found in the fully adjusted models. A 25% reduction in risk of all-cause mortality was found for milk intake from 160 to 120 g/d but not for the highest (>200 g/d) category of intake compared with nonconsumption. Therefore, the conclusion was that there is no evidence of a dose–response association between milk consumption and mortality and also no association of consumption of other dairy products investigated with mortality.

So what can we take away from there studies? When examining the health effect of a particular food, we always have to ask ‘instead of what?’ Food is not eaten in isolation, so the impact of the rest of the diet is very important and can make a food look good, bad or neutral. For dairy, we can say that its consumption is better than eating red and processed meat but worse than eating whole grains, for example. High fat dairy foods, including cheese consumption, are often associated with other less healthy behaviours, such as physicial inacticity, smoking, eating less fruits and vegetables. Thus, high fat dairy consumption often appears detrimental. The converse is also true, low fat dairy and yogurt is more often consumed by more health conscious people. In many studies, yogurt consumption has been shown to be beneficial to health, probably due to the benefits to the gut microbiome. The lack of dose -response effect in the Italian study does question the true benefit to health seen at the lower levels of consumption.

My interpretation: Dairy consumption in population studies in general show a neutral effect on health. There are certainly more beneficial foods to be eating — whole plant foods — and less beneficial foods — red and processed foods. Dairy consumption is NOT necessary and this is supported by international dietary recommendations, including the Eat-Lancet commission and the Health Canada dietary guidelines. In fact replacement of dairy milk with soya milk may have additional benefits for certain conditions such as breast and prostate cancer prevention. For other diseases, dairy consumption can have detrimental effects, such as increasing the risk of prostate cancer, acne and non-Hodgkin lymphoma. There are better ways to improve the health of the gut microbiome, largely by eating fibre rich whole plant foods. Dairy production is not sustainable for planetary health and given that a large proportion of the worlds population is lactose intolerant, dairy consumption should not be encouraged.

BLUEBERRIES AND CARDIOMETABOLIC HEALTH: I missed this study back in May 2019. A randomised study of blueberries! We know that blueberry consumption is beneficial to health but randomised studies are few. This is the longest randomised study to date, examing the effect of 6-months of blueberry intake on insulin resistance and cardiometabolic function in people with metabolic syndrome. The double-blind, randomised study included 115 adults, median age of 63 years and a median body mass index of 31. Participants were fed 2 dietarily achievable blueberry intakes (equivalent to 1/2 and 1 cup/d (75/150 g)) in the form of a milled, freeze-dried powder and compared with matched placebo. The outcome measures included insulin resistance, flow-mediated dilatation, systemic arterial stiffness, lipoprotein status, nitric oxide (NO)-related metabolite assay and anthocyanin metabolism. An equivalent daily intake of 1 cup (but not 1/2 cup) of blueberries improved endothelial function, systemic arterial stiffness and nitric oxide bioactivity. Some, but not all, measures of lipid status improved. There was no effect on measures of insulin resistance. The authors state that is this the first study to show sustained improvements in vascular function, lipid status, and underlying nitric oxide bioactivity following 1 cup blueberries/d. The effect size is predicted to result in a 12–15% reduction in cardiovascular risk.

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