Review of the week’s plant-based nutrition news 4th October 2020

A short review this week with studies on coffee and alcohol consumption, the best diet for musculoskeletal pain, a report on the state of the food system in the UK and a flashback to a study from 2015 on hypertension.

COFFEE AND ADVANCED COLORECTAL CANCER: Coffee consumption is generally considered a healthy beverage to consume as part of a healthy diet (except in pregnancy), with 3–4 cups a day associated with no harm but some potential health benefits, certainly at a population level. The most consistent benefits for cancer are seen for prevention of liver and endometrial cancer. Less data is available for the consumption of coffee for those with an established diagnosis of cancer. This paper investigated whether coffee consumption is associated with improved survival in patients with advanced or metastatic colorectal cancer. The study included 1171 patients with untreated locally advanced or metastatic colorectal cancer with a median follow-up of 5.4 years, during which time 93% of the patients had died or experienced disease progression. The results showed that for every 1 cup of coffee consumed per day, there was a 5% and 7% reduction in risk of disease progression and death, respectively. For those consuming at least 4 cups of coffee per day, there was a 22% and 36% reduced risk of disease progression and death, respectively. The results were similar for both caffeinated and decaffeinated coffee suggesting that the abundant polyphenols rather than the caffeine are responsible for the observed benefits.

Although this is an interesting observation and will reassure the those of us that consume coffee regularly, the key to a healthy diet for cancer in my view is to concentrate on a healthy overall diet pattern as close to 100% plant-based as possible and including as must variety as possible. Studies have shown that those consuming the most whole plant-foods and least animal-derived foods before and after a diagnosis of colorectal cancer have improved survival.

NUTRITIONAL FACTORS AND MUSCULOSKELETAL PAIN: Musculoskeletal pain, particularly back pain, significantly impacts quality of life for many people. In the UK, lower back pain is the top cause of disability. Most rely on pharmaceutical pain killers for musculoskeletal pain, but what about the impact of nutrition? This systematic review examined the association between dietary patterns, the components of patients’ diet and chronic musculoskeletal pain. 12 eligible articles were included consisting of nine experimental and three observational studies. Four main approaches were used to investigate the association between dietary patterns and chronic musculoskeletal pain: (1) the effects of a specific dietary pattern intervention on pain in patients with chronic musculoskeletal pain; (2) comparing the dietary patterns and nutritional intakes of patients having chronic musculoskeletal pain with those of healthy, pain free-controls; (3) comparing dietary patterns and nutrient intakes of patients with chronic musculoskeletal pain with standard dietary reference intake values; and (4) analysing the dietary patterns of patients with chronic musculoskeletal pain cross-sectionally and investigating the association between pain severity and food/nutrient intake.

The positive findings with benefits for pain included a vegan, but not vegetarian diet, for fibromyalgia and rheumatoid arthritis, weight loss diets for osteoarthritis, a vegetarian diet for general musculoskeletal pain and a FODMAP diet for fibromyalgia. Healthy eating patterns were associated with improvements in pain and four out of nine studies examining dietary change used a vegetarian or vegan diet. Higher intakes of protein, fat, sugar and calories, more typical of the Western diet pattern, were associated with increased pain. In overweight and obese individuals with osteoarthritis, higher pain scores were associated with greater intakes of calories, sugar and fat with benefits found for calorie restricted diets. The study also showed that among patients with chronic musculoskeletal pain, intake of certain nutrients, including vitamins and micronutrients, were more often below the dietary reference values and less than the nutritional intake of healthy, pain-free people. The authors of this study conclude ‘On the basis of the available literature, there is some evidence that plant-based dietary patterns such as vegetarian and vegan diets might have pain-relieving effects on chronic musculoskeletal pain. This effect might arise from the anti-inflammatory characteristics of the plant-based dietary patterns’

So its seems from the available literature plant-based diet patterns, including vegetarian and vegan diets, can improve pain in those with musculoskeletal pain. What’s there to lose? Especially since these same diet patterns also help reduce the risk of cardiovascular disease, type 2 diabetes, overweight and obesity without the risk of side-effects.

NO SAFE LIMIT OF ALCOHOL DURING PREGNANCY: This is the largest study to examine the impact of alcohol consumption in pregnancy and included 9,719 childre aged 9 to 10.9 years from the Adolescent Brain Cognitive Development Study. The researchers investigated whether any alcohol consumption in pregnancy was related to psychological, behavioural, neural and cognitive differences in these children. 25% of the children had been exposed to alcohol in utero. Children who were exposed to low levels of alcohol at any time during pregnancy experienced more psychological/emotional problems and behavioural problems than unexposed children. With greater intakes of alcohol (approx 36 drinks in the first 6–7 weeks of pregnancy), there was a 25% increased likelihood of an attention deficit hyperactivity disorder. Heavier alcohol use during early pregnancy was also associated with rule breaking behaviour and aggression. There were differences observed in brain volume and surface area amongst the children exposed to alcohol, which may contribute to the psychological and behavioural problems. In general, there was a dose-response with the greater the exposure to alcohol in pregnancy the greater the incidence of behavioural and psychological problems. Even low consumption, 16 drinks, in the first few weeks of pregnancy followed by abstinence was associated with negative outcomes in the children. Based on these results, its best to advise abstinence of alcohol from conception and throughout pregnancy.

CONSUMPTION OF ANIMAL FLESH AND RISK OF HYPERTENSION: This was a new study to me highlighted in a talk by Dr Shivam Joshi this week for the PBHP UK webinar series. Hypertension is the leading risk factor for chronic illness globally, significantly increasing the risk of cardiovascular disease, renal failure and dementia. Diet and lifestyle choices are intimately related to the risk of developing hypertension and we have known for a long while that vegetarian and vegan diet patterns are associated with a significantly lower risk of developing hypertension and is very effective for treating hypertension, especially if salt intake is also minimised. The DASH diet, designed to treat hypertension and modelled around the vegetarian diet, has been shown to be very effective for treatment. Yet the diet allows for consumption of animal foods in an attempt to be ‘more acceptable’. However, according to this paper from 2015, virtually all foods derived from animal flesh contribute to the developement of hypertension.

This large study including nearly 200,000 men and women from 3 prospective cohort studies; Nurses’ Health Study I and II and the Health Professionals Follow-up Study with 2,936,359 person-years of follow-up. The results showed that when comparing those consuming less than one serving of per month compared to one or more servings per day, there was an increased risk of hypertension with the conusmption of processed and unprocessed red meat (30% increase), poultry (22%) and seafood (5% although confidence intervals crossed 1). Seafood was associated with an increased risk of hypertension in 2 of the 3 cohorts. Consumption of any animal flesh ≥1 serving/day was associated with a 30% increased risk of hypertension risk. The risk was independent of other risk factors. Replacing one serving of total (processed and unprocessed) meat or poultry with one serving seafood was associated with an increased risk of developing hypertension in men but not women. The authors conclude ‘Long-term intake of meat and poultry were associated with increased risk of hypertension. …we found a weak but significant trend towards an increased risk of hypertension with increasing seafood consumption’.

These data call into question the conventional advise that suggests poultry and seafood are ‘healthy food’ choices to make. If you want to avoid hypertension and the need for medication, the scientific data suggests avoiding the consumption of all animal flesh is the best choice to make.

THE BROKEN FOOD SYSTEM IN THE UK: This report is well worth reading, albeit rather depressing. It should be a call to action for health professionals to demand better from Government and policy makers. Our food system is indeed broken as explained in this new report from the Food Foundation. The report used 10 metrics to assess the UK’s food system; advertising, places to buy food, affordability of a healthy diet, products with too much sugar, products with too little veg, wages, food prices, child growth and obesity and diabetes. The headline findings including the following; 1) The poorest 20% of UK households would need to spend 39% of their disposable income on food to meet Eatwell Guide costs. This compares to just 8% for the richest 20%. 2) Advertising spend on fruit and vegetables has increased since 2017, but remains low, with just 2.9% of ad spend on food and drink going towards fruit and vegetables. This is compared to 11% on soft drinks, 18% on confectionary and 17% on sweet and savory snacks. 3) Forty five local authorities in England have seen more than a 5% increase in the proportion of food outlets that are fast food takeaways. 4) 16% of workers in the food sector earn the minimum wage compared to 7% of workers across the UK. 5) More healthy foods are three times as expensive as less healthy foods per calorie, with the cost of more healthy foods diverging from less healthy foods over the past four years. 6) Regarding products with too much sugar, the situation has started to improve, with the proportion of children’s cereals with a high sugar content decreasing by 12 percentage points between 2019 and 2020. 7) For products with vegetables, 24% of ready meals were vegetarian or plant-based in 2020 — a 33% increase since 2018. 8) Obesity among children continues to be greater amongst the most deprived communities compared to the least deprived. 9) Children in deprived communities are more than 1 cm shorter on average than children in wealthy communities by the time they reach age 11. 10) Diabetes-related amputations have increased by 18% in four years.

The conclusions are stark and require immediate action. ‘This trajectory illustrates the fate of children born in 2020 if the government and businesses do not act now to ensure that everybody is able to secure nutritious food. Children born this year will be at a high risk of obesity and several diet-related chronic diseases throughout their lives. By 2085, nearly 1 in 5 people will have heart disease and more than 1 in 5 people will have type 2 diabetes if we do not change UK diets. As we know, the poorest people are disproportionately more likely to suffer from these conditions. But this is preventable. Government and industry should heed these warning signs of a broken system, as illustrated by the metrics in this report, and act now so that everyone is able to benefit from healthy and sustainable diets. COVID-19 has highlighted the fragility both of our health and of the UK’s food and health systems, but it has also created an unprecedented opportunity to change things for the better as society and businesses start to rebuild. If action is not taken, and soon, the situation will continue to deteriorate.’

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