Nutritional Update for Physicians: Plant-Based Diets

Abstract

The objective of this article is to present to physicians an update on plant-based diets. Concerns about the rising cost of health care are being voiced nationwide, even as unhealthy lifestyles are contributing to the spread of fleshiness, diabetes, and cardiovascular disease. For these reasons, physicians looking for cost-efficient interventions to improve health outcomes are becoming more involved in helping their patients adopt healthier lifestyles. Healthy consume may be best achieved with a plant-based diet, which we define as a regimen that encourages whole, plant-based foods and discourages meats, dairy products, and eggs adenine well as all refined and processed foods. We present a case survey as an case of the potential health benefits of such a diet. research shows that plant-based diets are cost-efficient, low-risk interventions that may lower body multitude index, blood pressure, HbA1C, and cholesterol levels. They may besides reduce the count of medications needed to treat chronic diseases and lower ischemic kernel disease mortality rates. Physicians should consider recommending a plant-based diet to all their patients, particularly those with high blood pressure, diabetes, cardiovascular disease, or fleshiness .

Introduction

In the HBO documentary The Weight of the Nation, it was noted that if you “ go with the run ” in the US, you will finally become corpulent. 1 In 2011, Witters reported that in some areas of the nation, the rate of fleshiness is 39 % and is increasing at a rate of 5 % per year. 2 Risks of fleshiness, diabetes, high blood pressure, and cardiovascular disease, along with their result complications ( eg, behavioral health and quality-of-life problems ) frequently go hand-in-hand and are powerfully linked to lifestyle, particularly dietary choices. 3 Of all the diets recommended over the last few decades to turn the tide of these chronic illnesses, the best but possibly least common may be those that are implant based. Despite the solid body of evidence favoring plant-based diets, including studies showing a willingness of the general public to embrace them, 4 many physicians are not stressing the importance of plant-based diets as a first-line treatment for chronic illnesses. This could be because of a lack of awareness of these diets or a miss of affected role education resources.

National dietary guidelines for active living and sanitary consume are available at www.ChooseMyPlate.gov. 5 A distinctive sanitary plate of food is 1/2 plant foods ( nonstarchy vegetables and fruits ), 1/4 solid grains or unprocessed starchy food, and 1/4 lean protein. The finish of this article is to review the tell supporting plant-based diets and to provide a guideline for presenting them to patients. We start with a case study and conclude with a review of the literature .

Case Study

A 63-year-old serviceman with a history of high blood pressure presented to his primary concern doctor with complaints of fatigue, nausea, and muscle cramps. The resultant role of a random rake glucose test was 524 mg/dL, and HbA1C was 11.1 %. Type 2 diabetes was diagnosed. His entire cholesterol was 283 mg/dL, blood coerce was 132/66 mmHg, and consistency bulk index ( BMI ) was 25 kg/m2. He was taking lisinopril, 40 magnesium daily ; hydrochlorothiazide, 50 magnesium day by day ; amlodipine, 5 magnesium daily ; and atorvastatin, 20 milligram casual. He was prescribed metformin, 1000 magnesium doubly day by day ; glipizide, 5 magnesium daily ; and 10 units of neutral protamine Hagedom insulin at bedtime. His doctor besides prescribed a low-sodium, plant-based diet that excluded all animal products and refine sugars and specify boodle, rice, potatoes, and tortillas to a individual day by day serve. He was advised to consume unlimited non-starchy vegetables, legumes, and beans, in addition to up to 2 ounces of nuts and seeds day by day. He was besides asked to begin exercising 15 minutes doubly a day. The affected role was seen monthly in his primary worry clinic. Over a 16-week period, meaning improvement in biometric result measures was observed. He was completely weaned off of amlodipine, hydrochlorothiazide, glipizide, and impersonal protamine Hagedorn insulin. follow-up blood atmospheric pressure remained below 125/60 mmHg, HbA1C improved to 6.3 %, and sum cholesterol improved to 138 mg/dL. Lisinopril was gradually decreased to 5 mg daily and his diabetes is controlled with metformin alone, 1000 magnesium twice daily .

Definitions of Plant-Based Diets

The deliver lawsuit is a dramatic case of the effect a plant-based diet can have on biometric outcomes like rake blackmail, diabetes, and lipid profile. The reduction in HbA1C from 11.1 % to 6.3 % in 3 months is much better than would be expected with monotherapy with metformin 6 or daily drill. 7 The improvement in blood imperativeness observed over a 4-month period with few medications is besides rarely encountered in clinical practice and is likely related to a low-sodium diet and the avoidance of red kernel. Because the patient was not corpulent and did not have significant weight unit loss with the diet, the dramatic improvements appear to be related to the quality of his new diet. A healthy, plant-based diet aims to maximize consumption of nutrient-dense plant foods while minimizing processed foods, oils, and animal foods ( including dairy products and eggs ). It encourages lots of vegetables ( cooked or raw ), fruits, beans, peas, lentils, soybeans, seeds, and nuts ( in smaller amounts ) and is generally depleted fat. 8, 9 Leading proponents in the field have varying opinions as to what comprises the optimum plant-based diet. Ornish et alabama recommends allowing animal products such as egg whites and skim milk in little amounts for reversion of disease. 10, 11 Esselstyn, who directs the cardiovascular prevention and reversal program at the Cleveland Clinic Wellness Institute, recommends wholly avoiding all animal-based products american samoa well as soybeans and nuts, particularly if severe coronary artery disease is award. 12 Despite these smaller differences, there is tell that a broadly defined plant-based diet has significant health benefits. It should be noted that the term plant-based is sometimes used interchangeably with vegetarian or vegan. vegetarian or vegan diets adopted for ethical or religious reasons may or may not be healthy. It is therefore important to know the specific definitions of related diets and to ascertain the details of a patient ’ randomness diet preferably than making assumptions about how healthy it is. The following is a brief drumhead of typical diets that restrict animal products. A key distinction is that although most of these diets are defined by what they exclude, the plant-based diet is defined by what it includes .

  • Vegan ( or full vegetarian ) : Excludes all animal products, particularly kernel, seafood, domestic fowl, eggs, and dairy products. Does not require pulmonary tuberculosis of wholly foods or restrict fat or refined sugar .
  • Raw food, vegan : same exclusions as veganism vitamin a well as the ejection of all foods cooked at temperatures greater than 118°F .
  • Lacto-vegetarian : Excludes eggs, kernel, seafood, and poultry and includes milk products .
  • Ovo-vegetarian : Excludes meat, seafood, poultry, and dairy products and includes eggs .
  • Lacto-ovo vegetarian : Excludes kernel, seafood, and poultry and includes eggs and dairy products .
  • mediterranean : similar to whole-foods, plant-based diet but allows small amounts of chicken, dairy products, eggs, and red meat once or twice per month. fish and olive oil are encouraged. Fat is not restricted .
  • Whole-foods, plant-based, low-fat : Encourages plant foods in their whole form, particularly vegetables, fruits, legumes, and seeds and nuts ( in smaller amounts ). For maximal health benefits this diet limits animal products. sum fat is by and large restricted .

Benefits of Plant-Based Diets

The goal of our diet should be to improve our health. In this incision, we will review the literature for key articles that demonstrate the benefits of plant-based diets. Our review consists of existing studies that include vegan, vegetarian, and Mediterranean diets .

Obesity

In 2006, after reviewing data from 87 published studies, authors Berkow and Barnard 13 reported in Nutrition Reviews that a vegan or vegetarian diet is highly effective for weight unit loss. They besides found that vegetarian populations have lower rates of heart disease, high blood blackmail, diabetes, and fleshiness. In summation, their reappraisal suggests that system of weights loss in vegetarians is not subject on drill and occurs at a rate of approximately 1 pound per week. The authors far stated that a vegan diet caused more calories to be burned after meals, in contrast to nonvegan diets which may cause fewer calories to be burned because food is being stored as fat. 13 Farmer et alabama 14 suggest that vegetarian diets may be better for weight management and may be more alimentary than diets that include kernel. In their study, they showed that vegetarians were slimmer than their flesh-eating counterparts. Vegetarians were besides found to consume more magnesium, potassium, iron, vitamin b1, vitamin b2, vitamin bc, and vitamins and less sum adipose tissue. The authors conclude that vegetarian diets are food dense and can be recommended for weight management without compromising diet quality. 14 In 2009, Wang and Beysoun 15 analyzed the nationally spokesperson data collected in the 1999–2004 National Health and Nutrition Examination Survey. The calculate of their study was to analyze the associations between kernel consumption and fleshiness. Using analogue and logistic regression analyses, they showed that there was a cocksure association between kernel consumption and fleshiness. 15 The Oxford part of the European Prospective Investigation into Cancer and Nutrition assessed changes in weight unit and BMI over a five-year period in flesh-eating, fish-eating, vegetarian, and vegan men and women in the United Kingdom. During the five years of the cogitation, mean annual weight gain was lowest among individuals who had changed to a diet containing fewer animal foods. The study besides reported a significant difference in age-adjusted BMI, with the kernel eaters having the highest body mass index and vegans the lowest. 16 exchangeable results were reported by the Adventist Health Study. 17 According to Sabaté and Wien, 18 “ Epidemiologic studies indicate that vegetarian diets are associated with a lower BMI and a lower preponderance of fleshiness in adults and children. A meta-analysis of pornographic vegetarian diet studies estimated a shrink weight unit dispute of 7.6 kg for men and 3.3 kilogram for women, which resulted in a 2-point lower BMI. similarly, compared with nonvegetarians, vegetarian children are lean, and their BMI difference becomes greater during adolescence. Studies exploring the risk of corpulence and food groups and dietary patterns indicate that a plant-based diet seems to be a sensible overture for the prevention of fleshiness in children. Plant-based diets are low in energy density and high in building complex carbohydrate, roughage, and water system, which may increase repletion and resting energy expending. ” 18 The authors conclude that plant-based dietary patterns should be encouraged for optimum health .

Diabetes

Plant-based diets may offer an advantage over those that are not plant based with respect to prevention and management of diabetes. The Adventist Health Studies found that vegetarians have approximately half the risk of developing diabetes as nonvegetarians. 19 In 2008, Vang et alabama 20 reported that nonvegetarians were 74 % more probable to develop diabetes over a 17-year period than vegetarians. In 2009, a study involving more than 60,000 men and women found that the prevalence of diabetes in individuals on a vegan diet was 2.9 %, compared with 7.6 % in the nonvegetarians. 17 A low-fat, plant-based diet with no or little kernel may help prevent and treat diabetes, possibly by improving insulin sensitivity and decreasing insulin resistance. Barnard et alabama 21 reported in 2006 the results of a randomized clinical trial comparing a low-fat vegan diet with a diet based on the American Diabetes Association guidelines. People on the low-fat vegan diet reduced their HbA1C levels by 1.23 points, compared with 0.38 points for the people on the American Diabetes Association diet. In addition, 43 % of people on the low-fat vegan diet were able to reduce their medication, compared with 26 % of those on the American Diabetes Association diet. 18

Heart Disease

In the Lifestyle Heart Trial, Ornish 10 found that 82 % of patients with diagnose heart disease who followed his program had some level of arrested development of atherosclerosis. comprehensive examination life style changes appear to be the catalyst that brought about this arrested development of even severe coronary thrombosis atherosclerosis after only 1 year. In his plant-based regimen, 10 % of calories came from fat, 15 % to 20 % from protein, and 70 % to 75 % from carbohydrate, and cholesterol was restricted to 5 mg per day. interestingly, 53 % of the operate group had progress of atherosclerosis. After 5 years, stenosis in the experimental group decreased from 37.8 % to 34.7 % ( a 7.9 % relative improvement ). The control group experienced a progress of stenosis from 46.1 % to 57.9 % ( a 27.7 % relative worsening ). Low-density lipoprotein had decreased 40 % at 1 year and was maintained at 20 % less than baseline after 5 years. These reductions are similar to results achieved with lipid-lowering medications. 10, 11 In the Lyon Diet Heart Study, a prospective, randomized, secondary prevention test, de Lorgeril found that the intervention group ( at 27 months ) experienced a 73 % decrease in coronary events and a 70 % decrease in all-cause mortality. The interposition group ’ s Mediterranean-style diet included more plant foods, vegetables, fruits, and fish than kernel. Butter and cream were replaced with canola oil anoint margarine. Canola petroleum and olive petroleum were the only fats recommended. 22 In 1998, a collaborative analysis using original data from 5 prospective studies was reviewed and reported in the daybook Public Health Nutrition. It compared ischemic heart disease-specific death rate ratios of vegetarians and nonvegetarians. The vegetarians had a 24 % reduction in ischemic affection disease death rates compared with nonvegetarians. 23 The lower risk of ischemic heart disease may be related to lower cholesterol levels in individuals who consume less meat. 24 Although vegetarian diets are associated with lower hazard of several chronic diseases, unlike types of vegetarians may not experience the lapp effects on health. The key is to focus on eating a healthy diet, not just a vegan or vegetarian diet. 25

High Blood Pressure

In 2010, the Dietary Guidelines Advisory Committee performed a literature review to identify articles examining the impression of dietary patterns on blood atmospheric pressure in adults. vegetarian diets were associated with lower systolic rake imperativeness and lower diastolic blood atmospheric pressure. 26 One randomized crossover trial found that a japanese diet ( low sodium and plant based ) significantly reduced systolic lineage pressure. 27

Mortality

The Dietary Guidelines Advisory Committee besides performed a 2010 literature review to determine the effect of plant-based diets on accident, cardiovascular disease, and total mortality in adults. They found that plant-based diets were associated with a reduce risk of cardiovascular disease and mortality compared with non-plant-based diets. 26

The benefit of plant-based diets on mortality may be primarily caused by decrease consumption of bolshevik meat. 28 several studies have documented the benefits of avoiding excessive consumption of loss meat, which is associated with an increased gamble of all-cause deathrate and an increased hazard of cardiovascular deathrate. 29 low meat intake has been associated with longevity. 30 In 2012, Huang et aluminum 31 performed a meta-analysis to investigate cardiovascular disease mortality among vegetarians and nonvegetarians. They lone included studies that reported relative risks and corresponding 95 % confidence intervals. Seven studies with a aggregate entire of 124,706 participants were analyzed. Vegetarians had 29 % lower ischemic affection disease deathrate than nonvegetarians. 31

Health Concerns About Plant-Based Diets

Protein

broadly, patients on a plant-based diet are not at risk for protein lack. Proteins are made up of amino acids, some of which, called essential amino acids, can not be synthesized by the body and must be obtained from food. Essential amino acids are found in kernel, dairy products, and eggs, a well as many plant-based foods, such as quinoa. 32 substantive amino acids can besides be obtained by eating certain combinations of plant-based foods. Examples include brown rice with beans, and hummus with wholly wheat pita. therefore, a well-adjusted, plant-based diet will provide adequate amounts of all-important amino acids and prevent protein lack. 33 Soybeans and foods made from soybeans are good sources of protein and may help lower levels of low-density lipoprotein in the blood 34 and reduce the risk of hip fractures 35 and some cancers .

vegetarian diets were associated with lower systolic and diastolic blood atmospheric pressure …

A cogitation in the Journal of the American Medical Association 36 reported that women with breast cancer who regularly consumed soy sauce products had a 32 % lower risk of summit cancer recurrence and a 29 % decreased risk of death, compared with women who consumed little or no soy sauce. 36 An analysis of 14 studies, published in the american Journal of Clinical Nutrition, showed that increased consumption of soy resulted in a 26 % reduction in prostate gland cancer risk. 37 Because of concerns over the estrogenic nature of soy products, women with a history of breast cancer should discuss soy foods with their oncologists. besides, excessively processed, soy-based kernel substitutes are frequently high in sequester soy proteins and other ingredients that may not be vitamin a healthy as less serve soy products ( internet explorer, bean curd, tempeh, and soy milk ) .

Iron

Plant-based diets contain iron, but the iron in plants has a lower bioavailability than the iron in kernel. Plant-based foods that are rich in iron include kidney beans, black beans, soybeans, spinach, raisins, cashews, oatmeal, cabbage, and tomato juice. 38 Iron stores may be lower in individuals who follow a plant-based diet and consume little or no animal products. however, the American Dietetic Association states that iron-deficiency anemia is rare even in individuals who follow a plant-based diet. 39

Vitamin B12

Vitamin B12 is needed for blood formation and cell class. Vitamin B12 insufficiency is a identical serious trouble and can lead to macrocytic anemia and irreversible nerve damage. Vitamin B12 is produced by bacteria, not plants or animals. Individuals who follow a plant-based diet that includes no animal products may be vulnerable to B12 insufficiency 40 and need to supplement their diet with vitamin B12 or foods fortified with vitamin B12. 41

Calcium and Vitamin D

Calcium inhalation can be adequate in a well-balanced, carefully planned, plant-based diet. People who do not eat plants that contain high amounts of calcium may be at risk for impaired bone mineralization and fractures. however, studies have shown that fault gamble was similar for vegetarians and nonvegetarians. The key to bone health is adequate calcium consumption, which appears to be regardless of dietary preferences. 42 Some meaning sources of calcium include bean curd, mustard and turnip greens, bok choy, and kale. Spinach and some other plants contain calcium that, although abundant, is bound to oxalate and therefore is ailing absorbed. 43 Vitamin D lack is park in the general population. Plant-based products such as soy milk and cereal grains may be fortified to provide an adequate source of Vitamin D. 44 Supplements are recommended for those who are at risk for low bone mineral concentration and for those found to be insufficient in vitamin D .

Fatty Acids

essential fatso acids are fatty acids that humans must ingest for full health because our bodies do not synthesize them. only two such necessity fatty acids are known : linoleic acid ( an omega-6 fatty acid fatty acid ) and alpha-linolenic acerb ( an omega-3 fatty acid fatso acid ). Three other fatty acids are only conditionally all-important : palmitoleic acerb ( a monounsaturated fatty acerb ), lauric acid ( a saturated fatty acidic ), and gamma-linolenic acid ( an omega-6 fatty acid fatso acerb ). insufficiency in all-important fatty acids may manifest as skin, hair, and nail down abnormalities. 45 The fatty acids that vegans are most likely to be deficient in are the omega-3 fatty acid fats ( n-3 fats ). Consumptions of the plant version of omega-3 fatty acid fats, alpha-linolenic acid, are besides first gear in vegans. Adequate consumption of n-3 fats is associated with a reduce incidence of heart disease and stroke. Foods that are good sources of n-3 fats should be emphasized. They include ground flax seeds, flax oil, walnuts, and canola oil petroleum. 46

Conclusion

A healthy, plant-based diet requires plan, reading labels, and discipline. The recommendations for patients who want to follow a plant-based diet may include eating a diverseness of fruits and vegetables that may include beans, legumes, seeds, nuts, and whole grains and avoiding or limiting animal products, added fats, oils, and refined, processed carbohydrates. The major benefits for patients who decide to start a plant-based diet are the possibility of reducing the number of medications they take to treat a variety of chronic conditions, lower consistency system of weights, decreased risk of cancer, and a reduction in their risk of death from ischemic affection disease. A plant-based diet is not an all-or-none program, but a way of life that is tailored to each individual. It may be particularly beneficial for those with fleshiness, Type 2 diabetes, high blood imperativeness, lipid disorders, or cardiovascular disease. The benefits realized will be proportional to the level of attachment and the sum of animal products consumed. hard-and-fast forms of plant-based diets with little or no animal products may be needed for individuals with inoperable or severe coronary artery disease. Low-sodium, plant-based diets may be prescribed for individuals with high blood press or a class history of coronary artery disease or stroke. A affected role with fleshiness and diabetes will benefit from a plant-based diet that includes a moderate total of fruits and vegetables and minimal low-fat animal products. Severe fleshiness may require rede and initial management with a low-calorie diet or very-low-calorie diet and the supervision of a doctor ’ second team. Patients with kidney disease may need a plant-based diet with extra restrictions, for model fruits and vegetables that are high gear in potassium and morning star. ultimately, patients with thyroid disease will need to be careful when consuming plants that are mild goitrogens, like soy, crude cruciferous vegetables, sweetness potatoes, and corn whiskey. These patients should be informed that cooking these vegetables inactivates the goitrogens. Physicians should advocate that it is meter to get away from terms like vegan and vegetarian and start talking about eating healthy, solid, plant-based foods ( chiefly fruits and vegetables ) and minimizing consumption of kernel, eggs, and dairy products. Physicians should be informed about these concepts so they can teach them to staff and patients. A file dietician should be separate of the health care team that designs a plant-based diet for patients with chronic disease, specially if multiple medications are involved. Depending on the underlie conditions, patients with chronic disease who take multiple medications need near monitor of depleted blood sugar levels, low blood pressure, or rapid weight personnel casualty. If these occur, the doctor may need to adjust medications. In some cases, such as the one presented here, the need for certain medications can be eliminated wholly. Although the risk of deficiencies may be low, health care teams need to be mindful that a motivate affected role on a hard-and-fast plant-based diet may need monitoring for deficiencies of certain nutrients, as outlined above. The function of this article is to help physicians understand the potential benefits of a plant-based diet, to the end of working in concert to create a social shift toward plant-based nutrition. There is at least moderate-quality attest from the literature that plant-based diets are associated with significant system of weights loss and a abridge risk of cardiovascular disease and mortality compared with diets that are not plant based. These data suggest that plant-based diets may be a hardheaded solution to prevent and treat chronic diseases. far research is needed to find ways to make plant-based diets the new normal for our patients and employees. We can not cure chronic diseases, but we may be able to prevent and control them by changing how we eat. With department of education and monitoring for adhesiveness, we can improve health outcomes. Patterns of families and early colleagues who may be reluctant to support the efforts of individuals who are trying to change are a challenge to be overcome. We should invite our colleagues, patients, and their families to a shared decision-making action with the goal of adopting a plant-based diet and a regular use program. We should invite health care teams to complete a course on healthy consume and active surviving. We should encourage staff to be knowledgeable about plant-based nutrition. ultimately, we should encourage performance-driven measurable outcomes, which may include :

  1. the percentage of physicians who have completed a course on nutriment that includes a discussion of the benefits of a plant-based diet and exercise ;
  2. the share of our hospitals, cafeteria, and physicians ’ meet facilities that serve meals that are consistent with a plant-based diet ;
  3. the share of patients on a doctor control panel who are corpulent and who have completed a course on weight management and nutriment that emphasizes a plant-based diet ; and
  4. the share of patients in a doctor panel with high lineage pressure, diabetes, high cholesterol, or cardiovascular disease who completed a class on nutrition that emphasizes a plant-based diet .

excessively frequently, physicians ignore the potential benefits of good nutrition and quickly prescribe medications alternatively of giving patients a casual to correct their disease through healthy consume and active living. If we are to slow down the fleshiness epidemic and reduce the complications of chronic disease, we must consider changing our culture ’ sulfur mentality from “ populate to eat ” to “ corrode to live. ” The future of health wish will involve an development toward a substitution class where the prevention and treatment of disease is centered, not on a pill or surgical routine, but on another serve of fruits and vegetables .

Acknowledgments

Kathleen Louden, ELS, of Louden Health Communications provided column aid .

Footnotes

Disclosure Statement

The author ( s ) have no conflicts of matter to to disclose .

Medicine

Let food be thy medicine and medicine be thy food. —Hippocrates, coulomb 460-370 BCE, ancient greek doctor in the Age of Pericles known as the father of modern medicine

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