A review of the week’s plant-based nutrition news 6th September 2020

This week I cover UK guidance on nutrition and cardiovascular health, impact of diet on diabetes risk, Parkinson’s disease and converting livestock farming to a profitable, climate smart solution.

POST-COVID-19 NUTRITION FOR CARDIOVASCULAR HEAlTH: Cardiovascular disease (CVD) remains the most common cause of death globally for both men and women. Those with CVD have a higher risk of adverse outcomes from infection with the pandemic coronavirus that causes COVID-19. If this coronovirus is going to be with us for the foreseeable future we need to improve cardiovascular health. Diet and nutrition are key to maintaing cardiovascular health as highlighted in my review from last week. The key dietary factors responsible for CVD are diets high in salt (reflecting conusmption of processed and pre-packaged foods) and low in whole plant foods (whole grains, fruits, vegetables, legumes, nuts and seeds). The UK diet currently ranks as one of the worst, with more than 50% of foods consumed classified as ultra-processed.

This joint statement from the British Association for Cardiovascular Prevention and Rehabilitation (BACPR), the British Dietetic Association (BDA) and the Public Health Nutrition Specialist Group (PHNSG) is therefore welcome. The statement acknowledges that the pandemic has affected our food choices in many ways. The good aspects are that more people are cooking at home with increased purchases of fruits and vegetables. However, there is also increased purchasing of ultraprocessed snack foods with many gaining weight during lockdown and a significant proportion losing weight due to lack of food and hence at further risk of malnutrtition.

The recommendations have good and less good aspects to it. There is emphasis on the consumption of whole foods including fruits, vegetables and whole grains with further advice to increase fibre intake. There are strong recommendations to reduce the consumption of processed and ultra-processed foods that have added salt, sugar and fat (whether plant-based or not). Curbing the increased alcohol consumption during the pandemic is also highlighted. The less good aspects are that high quality protein consumption, which is particularly important for elders at risk of frailty and sacropenia, is still being associated with animal-derived foods and plant sources of protein are mentioned but not emphasised enough. This is despite the fact that eating plant protein in favour of animal protein is associated with healthier aging. and lower risk of CVD. For those with type 2 diabetes a lower carbohydrate diet is suggested and here the better recommendation is made to replace with plant-based protein and fats. Nonetheless, we know that if consuming high quality carbohydrates there is no requirement to reduce intake, even in those with type 2 diabetes, and lower carbohydrate diets may be associated with increased risk of CVD, cancer and risk of death. There is no connection made between diet choice, sustainability and climate health. Here we know there are benefits for replacing animal protein with plant-based protein and replacing dairy with non-dairy alteratives. The latter is essential if we want guidelines to be inclusive of those communities, usually Black and Asian, that are more likely to be lactose intolerant.

PROCESSED AND RED MEAT CONSUMPTION IS ASSOCIATED WITH RISK OF TYPE 2 DIABETES: Type 2 diabetes is a disease predominately related to diet and lifestyle and is preventable in the majority of cases. This week the NHS in the UK has committed to helping those with type 2 diabetes reverse their disease through the use of calorie reduced meal replacement shakes. Those with type 2 diabetes for less than 6 years will be eligible. This is a welcomed step given that type 2 diabetes, especially when poorly controlled, is also a significant risk factor for higher mortality from COVID-19. However, you might not be surprised to hear that I am disappointed that a whole food plant-based diet has not been more widely adopted by the NHS as a means for reversing type 2 diabetes. This approach would be a more sustainable and a healthier way to lose weight (the key to reversing diabetes for most people) than artificial meal replacements. The American College of Lifestyle Medicine have recently published a statement on diabetes remission supporting a whole food plant-based approach.

Food choices throughout life are key to preventing type 2 diabetes and the study highlighted is a new analysis from the EPIC study, which included 11,741 individuals with type 2 diabetes and a sub-cohort of 15,450 participants without diabetes from 8 European countries followed for a median of 12.3 years. It examined the impact of replacing red and processed meat with poultry, fish, eggs, legumes, cheese, cereals, yogurt, milk, and nuts on the risk of developing type 2 diabetes. The study found a 10% reduction in type 2 diabetes risk by replacing one serving/day of red and processed meat with either cheese, yogurt or nuts and an 8% reduction in risk by replacing one serving/day of red and processed meat with cereals. Replacement with poultry, fish, milk, eggs, or legumes was not shown to have an impact on diabetes risk.

These data support results of previous studies that show limiting or avoiding red and processed meat is beneficial for prevention of type 2 diabetes. The interesting findings from this paper are that cheese and yogurt consumption, both fermented foods, seemed to provide benefit, which may relate to the positive impacts of fermented foods on the gut microbiome and also explain why milk consumption did not have a positive impact. However, remember there are several plant-based sources of fermented foods. In addition, the lack of benefit of legumes is unexpected given previous studies have reported a reduced risk of diabetes with increased consumption, with a particular benefit for soya consumption. The reason may be that in this cohort legume consumption was pretty low — median of 4–5g per day (range 0–24g). One cooked tin of beans is 400g! In addition, its worth noting that the study was not able to differentiate between the intake of refined and whole grains whereas previous studies have shown benefits for whole grain consumption and diabetes risk.

EAT A PLANT-BASED DIET TO PREVENT WEIGHT GAIN AND TYPE 2 DIABETES: This study highlights the benefits of a plant-based diet pattern for prevention of type 2 diabetes. The CARDIA study included 2500 participants. It found that shifting to a more plant-centred diet over a 20 year period reduced the risk of type 2 diabetes by half during the 9 year follow-period. The best quality plant-focused diet reduced the risk by 70%! At the same time there was significantly less chance of gaining weight. The mostly healthy foods were fruits, vegetables, legumes, nuts/seeds and vegetable oils. An increased intake of meat over time was associated with a significant increase, in the order of 2–3 fold, in risk of type 2 diabetes.

We know from the two main studies that have examined the health of vegetarians and vegans — Adventist Health Study-2 and the EPIC-Oxford study that risk of overweight and type 2 diabetes is greatly reduced — in the order of 40-50% reduction — in those eating a vegetarian or vegan diet when compared to omnivores. The healthier the diet with the most emphasis on whole plant foods the better.

So the take home from these two studies on type 2 diabetes is that most foods are better choices than red and processed meat when it comes to type 2 diabetes prevention with a great deal of evidence supporting a plant-predominate diet

DIET PATTERN AND PARKINSON’S DISEASE: Parkinson’s disease (PD) is a debilitating and progressive neurological disorder. The onset is preceded by a prodromal period of around 10 years when patients experience subtle symptoms. Diet is recognised as a factor associated with the risk of developing PD with dairy consumption increasing the risk and nutrient/polyphenol dense foods such as fruits, vegetables, tea, coffee, wine and omega-3 fats being protective. Healthy diet patterns such as the Mediterranean diet have been associated with a lower risk of PD.

The current paper examines the impact of the Mediterranean diet and adherence to the Alternate Health Eating Index on the prevalence of prodromal features of PD, including constipation, disordered sleep, reduced smell, excessive day time sleepiness, impaired colour vision, depressive symptoms and body pain. The study included 47.679 participants from the Nurses Health Study and the Health Professionals Follow-up Study followed for 30 years. Adherance to the healthy diet patterns was associated with a significantly reduced incidence of 3 or more prodomal symptoms, particularly consipation, excessive daytime sleepiness and depressive symptoms. The foods most associated with reduction in these symptoms were vegetables, nuts and moderate alcohol consumption. It is thought that healthy diet patterns high in fibre promote gut health and hence protect against disorders of the brain and also act by reducing inflammation and oxidative stress, both mechanims implicated in neurodegeneration. What now needs to be determined is whether these healthy diet patterns, if adhered to overtime, can prevent the onset of PD.

SWITCHING SHEEP PASTURE TO FORESTS — A PROFITABLE STRATEGY FOR LIVESTOCK FARMERS: I am increasingly including aspects of food production and farming in my reviews given its enormous impact on planetary health. We need to support livestock farmers to use their land to help mitigate the impacts of climate change, which will inevitably involve changing to no-till crop farming or re-wilding. Currently, however, livestock farmers in Europe continue to receive billions of pounds in subsides to maintain current farming practice. This is despite the fact the international community is called for the adoption of a plant-based foods system.

This paper from the UK examines whether diverting European subsidies into the restoration of trees on abandoned farmland could be a cost-effective way of using the land to store carbon and thus help mitigate the impact of climate change. The study focussed on sheep farmers who without the current subsidies would not be able to make a profit. The analysis showed conversion of sheep pasture to forest and subsides instead given for tree planting and carbon sequestration could be a financially viable model for livestock farmers. The authors state that ‘At present, subsidies in Europe sustain the uneconomic and environmentally detrimental livestock industry….The morality of subsidising farming practices that cause high greenhouse gas emissions in Europe, whilst spending billions annually on protecting forest carbon in less developed nations to slow climate change is questionable’. They conclude ‘The ultimate cost-benefit analysis depends on whether the cultural and social value placed on pastoral livestock production outweighs the global costs of climate change’.

There are organisations actively trying to support livestock farmers to change to an industry that is profitable and better for the environment. The organisation Refarmd is working with farmers to make the transition from cows’ milk to the production of plant-based drinks, and at the same time convert their farmland into animal sanctuaries. We also need Governments and policy makers to support such transitions.

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