Plant based nutrition hms2011


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  • Most commonly performed voluntary physiologic act…if it can influence our health for good or ill then we want to know how and where
  • Water soluble vitamin stored in the liver as unique among vitamins in that it contains a metal ion, cobalt. Deficiency---pernicious anemia……absence if intrinsic factor 0.1% lost per day ?
  • --Fraser et al. Archives of IM: 2001:161;1645-1652
  • --Am J Clin Nutr. 1999 Sep;70(3 Suppl):532S-538S.
  • Plant based nutrition hms2011

    1. 1. A presentation for HarvardMedical Students Lunch and Learn 01/25/2011 Stephan Esser MD
    2. 2. Plant Based Nutrition Exploring the Myths Engaging the Science Stephan Esser USPTA, MD
    3. 3. Disclosures
    4. 4. Goals• What are we meant for?• Why it’s Important?• Review Basic Definitions• Explore some Myths• Engage the Science• Recommendations for self/family/friends
    5. 5. What are we meant for?• Evolution or Creation• Anatomy• Physiology
    6. 6. Anatomy• Grinding/Reciprocating Molar Teeth• Absence of Claws• Opposable Thumbs• Vision: color vs B&W• Colonic Shape: – Convoluted vs Smooth• Long Intestines – 12 times the length of our torsos (about 30 feet). – 3 times the length of its torso.
    7. 7. Physiology• Absence of Uricase – Present in vertebrates• Weak Stomach Acid – 3-4 – 1-2• Vitamin Requirements – Vit. C
    8. 8. Why it Matters• Eating – Universal – Uniquely Modifiable• Opportunity for Influence – Modifiable risk factor • 20-30% Cancer Risk WHO • Obesity, CAD, HTN, HLD, Stroke, T2D Etc.
    9. 9. Definitions• Carnivore: – flesh-eating mammals that include dogs, foxes, bears, raccoons, and cats• Omnivore: – One consuming both plant and animal matter
    10. 10. Definitions• Vegetarian: – No flesh-foods – Pescatarians: fish – Ovo-Lactotarians: dairy and eggs• Vegan – No “animal” products – Nothing with a “face or a mother”
    11. 11. The Quandry
    12. 12. Food Basics……• Is it safe? – Death, Morbidity – Deficiency• Does it Alter Mortality/Morbidity?• Is it Therapeutic?
    13. 13. Safety• Sufficiency of: – Calories – Vitamins/Minerals • Vit. B12, D, Omega 3,Calcium, Zinc, Selenium• Risk of: – Protein Deficiency – Anemia – Neurologic Deficits – Osteoporosis
    14. 14. Nutrition Concerns and Health Effects of Vegetarian Diets Volume 109, Issue 7, Pages 1266-1282 (July 2009 Nutr Clin Pract December 7, 2010 vol. 25 no. 6 613-620It is the position of the American Dietetic Association that appropriately planned vegetarian diets, including total vegetarian or vegan diets, are healthful, nutritionally adequate, and may provide health benefits in the prevention and treatment of certain diseases. Well- planned vegetarian diets are appropriate for individuals during all stages of the life cycle, including pregnancy, lactation, infancy, childhood, and adolescence, and for athletes. A vegetarian diet is defined as one that does not include meat (including fowl) or seafood, or products containing those foods. This article reviews the current data related to key nutrients for vegetarians including protein, n-3 fatty acids, iron, zinc, iodine, calcium, and vitamins D and B-12. A vegetarian diet can meet current recommendations for all of these nutrients. In some cases, supplements or fortified foods can provide useful amounts of important nutrients. An evidence-based review showed that vegetarian diets can be nutritionally adequate in pregnancy and result in positive maternal and infant health outcomes. The results of an evidence-based review showed that a vegetarian diet is associated with a lower risk of death from ischemic heart disease. Vegetarians also appear to have lower low-density lipoprotein cholesterol levels, lower blood pressure, and lower rates of hypertension and type 2 diabetes than nonvegetarians. Furthermore, vegetarians tend to have a lower body mass index and lower overall cancer rates. Features of a vegetarian diet that may reduce risk of chronic disease include lower intakes of saturated fat and cholesterol and higher intakes of fruits, vegetables, whole grains, nuts, soy products, fiber, and phytochemicals. The variability of dietary practices among vegetarians makes individual assessment of dietary adequacy essential. In addition to assessing dietary adequacy, food and nutrition professionals can also play key roles in educating vegetarians about sources of specific nutrients, food purchase and preparation, and dietary modifications to meet their needs.
    15. 15. Content and bioavailability of trace elements in vegetarian diets Am J Clin Nutr May 1994 vol. 59 no. 5 1223S-1232SDespite the apparent lower bioavailability of zinc, copper, manganese, and selenium invegetarian diets because of the high contentsof phytic acid and/or dietary fiber and the low content of flesh foods in the diet, the trace element status of most adult vegetarians appears to be adequate.
    16. 16. B12• Water soluble• Stored in liver: enterohepatic re-circulation• Function: -DNA synthesis – Red cell production – Myelin synthesis – Immune function – Psychiatric health• Blood Levels – MMA
    17. 17. B12• VITAMIN B12 DEFICIENCY AS A WORLDWIDE PROBLEM Nutrition: Annual Review of Nutrition Vol. 24: 299-326• Vitamin B12 (cobalamin) deficiency in elderly patients CMAJ • August 3, 2004; 171 (3). doi:10.1503/cmaj.1031155. (20%)• Vitamin B12 Deficiency Due to a Strictly Vegetarian Diet in Adolescence CLIN PEDIATR December 1987 vol. 26 no. 12 662-663• Reversible Subacute Combined Degeneration of the Spinal Cord in a 14-Year-Old Due to a Strict Vegan Diet CLIN PEDIATR July 1, 2001 40: 413-415
    18. 18. B12 Deficiency• Strict Vegan: – 3-10 yrs to exhaust body stores• Other Causes:• Bacterial overgrowth in part of the small intestine• Malabsorption• Inflammatory bowel disease• Fish tapeworm infection• Post-Surgical short gut syndrome• Drugs such as antacids and metformin• Lack of intrinsic factor• Decreased stomach acidity• Consider repletion at – 1000-2000mcg/ day
    19. 19. Vitamin D• ADEK• Vitamin or Neuro-hormone?• Functions: – Osseous balance – Mood – Cardiovascular Health – Pain – Anti-oxidation – Immune function –?
    20. 20. Mushrooms½ cup = 2 IU
    21. 21. Omega 3• ALA/ EPA / DHA• Function – Inflammation – Cardiovascular Health – Mood – Neuro-development
    22. 22. Protein• Adequate• Clinically relevant deficiency is extremely rare• WHO 5%, 10-15% of total calories• May benefit from  – Elderly/Adolescent – Pregnancy/Lactating – Athletes
    23. 23. General Health Is there any evidence that Plant-based nutritionalters morbidity or mortality?
    24. 24. Dietary habits and mortality in 11 000 vegetariansand health conscious people: results of a 17 year follow up BMJ 1996; 313 : 775 (Published 28 September 1996) Results: 2064 (19%) subjects smoked, 4627 (43%) were vegetarian, 6699 (62%) ate wholemeal bread daily, 2948 (27%) ate bran cereals daily, 4091 (38%) ate nuts or dried fruit daily, 8304 (77%) ate fresh fruit daily, and 4105 (38%) ate raw salad daily. After a mean of 16.8 years follow up there were 1343 deaths before age 80. Overall the cohort had a mortality about half that of the general population. Within the cohort, daily consumption of fresh fruit was associated with significantly reduced mortality from ischaemic heart disease (rate ratio adjusted for smoking 0.76 (95% confidence interval 0.60 to 0.97)), cerebrovascular disease (0.68 (0.47 to 0.98)), and for all causes combined (0.79 (0.70 to 0.90)).
    25. 25. Vegetarian diets: what do we know of their effects on common chronic diseases? Am J Clin Nutr May 2009 vol. 89 no. 5 1607S-1612S There is convincing evidence that vegetarians have lower rates of coronary heart disease, largely explained by low LDL cholesterol, probable lower rates of hypertension and diabetes mellitus, and lower prevalence of obesity. Overall, their cancer rates appear to be moderately lower than others living in the same communities, and life expectancy appears to be greater.
    26. 26. Hypertension
    27. 27. 90 77.3 80 70.8 65.4 64.6 Percent of Population 70 60 53.2 54.1 50 38.8 38.4 40 30 24.4 16.2 20 12.2 6.6 10 0 20-34 35-44 45-54 55-64 65-74 75+ Men WomenPrevalence of high blood pressure in Adults age 20 and older, by age and sex (NHANES: 2003-2006). Source: NCHS and NHLBI.
    28. 28. BLOOD-PRESSURE-LOWERING EFFECT OF A VEGETARIAN DIET: CONTROLLED TRIAL IN NORMOTENSIVE SUBJECTS The Lancet, Volume 321, Issue 8314, Pages 5-10I.Rouse59 healthy, omnivorous subjects aged 25-63 years were randomly allocated to a control group, which ate an omnivorous diet for 14 weeks, or to one of two experimental groups, whose members ate an omnivorous diet for the first 2 weeks and a lacto-ovo-vegetarian diet for one of two 6-week experimental periods. Mean systolic and diastolic blood pressures did not change in the control group but fell significantly in both experimental groups during the vegetarian diet and rose significantly in the experimental group which reverted to the omnivorous diet. Adjustment of the blood-pressure changes for age, obesity, heart rate, weight change, and blood pressure before dietary change indicated a diet-related fall of some 5-6 mm Hg systolic and 2-3 mm Hg diastolic. Although the nutrient(s) causing these blood-pressure changes are unknown, the effects were apparently not mediated by changes in sodium or potassium intake
    29. 29. • BLOOD PRESSURE IN VEGETARIANS – Am. J. Epidemiol. (1974) 100 (5): 390-398.• Vegetarian diet in mild hypertension: a randomised controlled trial. – 58 subjects aged 30-64 with mild untreated hypertension were allocated either to a control group eating a typical omnivorous diet or to one of two groups eating an ovolactovegetarian diet for one of two six week periods. A fall in systolic blood pressure of the order of 5 mm Hg occurred during the vegetarian diet periods, with a corresponding rise on resuming a meat diet.
    30. 30. Cholesterol• The Effect of Vegetarian Diets on Plasma Lipid and Platelet Levels Arch Intern Med. 1986;146(6):1193-1197
    31. 31. Rapid reduction of serum cholesterol andblood pressure by a twelve-day, very low fat, strictly vegetarian diet. J Am Coll Nutr. 1995 Oct;14(5):491-6. During this short time period, cardiac risk factors improved: there was an average reduction of total serum cholesterol of 11% (p < 0.001), of bloodpressure of 6% (p < 0.001) and a weight loss of 2.5 kg for men and 1 kg for women.
    32. 32. Food Portion Cholesterol/mg Vegetables Unlimited 0 Fruits “ “ 0 Nuts “ “ 0 Seed “ “ 0 Grains “ “ 0Milk (non-fat) 100g 2Milk (whole) 100g 10 Butter 1 Tbs 31 Beef 100g 61 Salmon 100g 55 Chicken 100g 65 Shrimp 100g 126 Lobster 100g 127 Egg 100g 372
    33. 33. Diabetes
    34. 34. “Without preventive action, 1 in 3 children born in2000 will develop diabetes in their lifetime.” (HHS)
    35. 35. Diabetes• Does a vegetarian diet reduce the occurrence of diabetes? American Journal of Public Health, Vol. 75, Issue 5 507-512 – 25,698 adult White Seventh-day Adventists identified in 1960 followed for 21 years – vegetarians had a substantially lower risk than non-vegetarians of diabetes as an underlying or contributing cause of death• Fruit and Vegetable Consumption and Diabetes Mellitus Incidence among U.S. Adults Preventive Medicine Vol 32 Iss 1 January 2001. Pages 33-39 – Appr. 10, 000 participants, highest fruit and vegetable consumption = lowest risk of T2D• Dietary Patterns and the Incidence of Type 2 Diabetes Am. J. Epidemiol. (2005) 161 (3): 219-227. – 4,000 Finnish en and women, followed 23 years – Highest consumption of fruits/vegetables in prudent diet resulted in decreased risk
    36. 36. A Low-Fat Vegan Diet Improves Glycemic Control and Cardiovascular Risk Factors in a Randomized Clinical Trial in Individuals With Type 2 Diabetes Diabetes Care August 2006 vol. 29 no. 8 1777-1783 – 100 people randomized vegan vs ADA diet 22 weeks – 43% VG 26% ADA reduced diabetes medications. – HbA1c (A1C)  0.96 points VG 0.56 points in the ADA group – Excluding those who changed medications, A1C fell 1.23 points in the vegan group compared with 0.38 points in the ADA group – Body weight  6.5 kg VG and 3.1 kg ADA – LDL cholesterol  21.2% in the vegan group and 10.7% in the ADA group (P = 0.02). – urinary albumin reductions 15.9 mg/24h VG than in the ADA group 10.9 mg/24 h
    37. 37. A low-fat vegan diet and a conventional diabetes diet in the treatment of type 2 diabetes: a randomized, controlled, 74-wk clinical trial Clin Nutr May 2009 vol. 89 no. 5 1588S-1596SWeight loss was significant within each diet group but not significantly different between groups (−4.4 kg in the vegan group and −3.0 kg in the conventional diet group, P = 0.25) and related significantly to Hb A1c changes (r = 0.50, P = 0.001). Hb A1c changes from baseline to 74 wk or last available values were −0.34 and −0.14 for vegan and conventional diets, respectively (P = 0.43). Hb A1c changes from baseline to last available value or last value before any medication adjustment were −0.40 and 0.01 for vegan and conventional diets, respectively (P = 0.03). In analyses before alterations in lipid-lowering medications, total cholesterol decreased by 20.4 and 6.8 mg/dL in the vegan and conventional diet groups, respectively (P = 0.01); LDL cholesterol decreased by 13.5 and 3.4 mg/dL in the vegan and conventional groups, respectively (P = 0.03).Conclusions: Both diets were associated with sustained reductions in weight and plasma lipid concentrations. In an analysis controlling for medication changes, a low-fat vegan diet appeared to improve glycemia and plasma lipids more than did conventional diabetes diet recommendations. Whether the observed differences provide clinical benefit for the macro- or microvascular complications of diabetes remains to be established.
    38. 38. Toward Improved Management of NIDDM: A Randomized, Controlled, Pilot Intervention Using a Low-fat, Vegetarian Diet Preventive Medicine, Volume 29, Number 2, August 1999 , pp. 87-91(5)28% mean reduction in fasting serum glucose of the experimental group, from 10.7 to 7.75 mmol/L (195 to 141 mg/dl), was significantly greater than the 12% decrease, from 9.86 to 8.64 mmol/L (179 to 157 mg/dl), for the control group (P < 0.05). The mean weight loss was 7.2 kg in the experimental group, compared to 3.8 kg for the control group (P < 0.005).
    39. 39. The calorically restricted low-fat nutrient-dense diet in Biosphere 2 significantly lowers blood glucose, total leukocyte count, cholesterol, and blood pressure in humans PNAS December 1, 1992 vol. 89 no. 23 11533-11537• Biosphere 2 is a 3.15-acre space containing an ecosystem that is energetically open (sunlight, electric power, and heat) but materially closed, with air, water, and organic material being recycled. Since September 1991, eight subjects (four women and four men) have been sealed inside, living on food crops grown within. Their diet, low in calories (average, 1780 kcal/day; 1 kcal = 4.184 kJ), low in fat (10% of calories), and nutrient-dense, conforms to that which in numerous animal experiments has promoted health, retarded aging, and extended maximum life span. We report here medical data on the eight subjects, comparing preclosure data with data through 6 months of closure. Significant changes included: (i) weight, 74 to 62 kg (men) and 61 to 54 kg (women); (ii) mean systolic/diastolic blood pressure (eight subjects), 109/74 to 89/58 mmHg (1 mmHg = 133 Pa); (iii) total serum cholesterol, from 191 +/- 11 to 123 +/- 9 mg/dl (mean +/- SD; 36% mean reduction), and high density lipoprotein, from 62 +/- 8 to 38 +/- 5 (risk ratio unchanged); (iv) triglyceride, 139 to 96 mg/dl (men) and 78 to 114 mg/dl (women); (v) fasting glucose, 92 to 74 mg/dl; (vi) leukocyte count, 6.7 to 4.7 x 10(9) cells per liter. We conclude that drastic reductions in cholesterol and blood pressure may be instituted in normal individuals in Western countries by application of a carefully chosen diet and that a low-calorie nutrient-dense regime shows physiologic features in humans similar to those in other animal species.
    40. 40. Vegetarian diet: panacea for modern lifestyle diseases? QJM (1999) 92 (9): 531-544.doi: 10.1093/qjmed/92.9.531There are few adverse effects, mainly increased intestinal gas production and a small risk of vitamin B12 deficiency.
    41. 41. Other Reasons• Food and Agriculture Organization of the United Nations – Livestock use 30% of the Earth’s Land Surface – Produce 18% of greenhouse gases• 70+ % of antibiotics used in US are for livestock• 80+% of all wheat, corn, rye and oats for livestock• Cruelty/Abuse etc• Loss of Ocean Species/Pollution of waterways – –
    42. 42. Take Homes• Plant Based Diets: – Are Safe when adequately planned – Minimal, readily addressed ‘risk’ – Have Therapeutic Benefit • Obesity • Heart Disease 78% Health Care Expenditures are consumed by • High Blood Pressure of chronic disease the management • High Cholesterol Holman, H. JAMA 2004 Sep 1; 292:1057-1059 • Type 2 Diabetes
    43. 43. Points to Consider• Repletion in “at Risk” Populations – B12 – Vitamin D• Supplementation – Consider Omega 3’s
    44. 44. Knowledge = Responsibility• Do it!• Have fun with it!• Celebrate Colors, Flavors!• Achieve your best health!• Share it and Inspire Others!
    45. 45. Thank You!
    46. 46.
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