A pharmacist's perspective on health and metabolic disease
Happy New Year!
I hope everyone had refreshing holiday break. I was fortunate to get away for about a month in the New Zealand back-country. For about 18 days in two trips there was no alcohol, electricity, wifi or LED lights and lots of low intensity exercise (if you count carrying a 16kg backpack up steep hills low-intensity). It was a good way to recharge the mental batteries.
Coming back to work, the EAT-Lancet plant based diet plan has shown up in my in-box. If you have not already seen this report it has good intentions – poor nutrition is a significant driver in many disease states, and there are many concerns as to how to make global food supply sustainable. So this report is the first in a series commissioned by a leading medical journal, The Lancet.
Both Zoe and Marty analyzed the nutrient density of the recommended diet from the table below and found it lacking.
Zoe discusses the lack of vitamins and minerals from this diet, particularly iron and vitamin B12, while Marty discusses overall nutritional density. Georgia looks at lots of different inconsistencies with the report, including the challenges of using epidemiological data and the biases behind the report. I recommend you read their summaries as well.
My (additional) concerns:
Is this a diet to prevent disease, or one that should be used in an already unhealthy person? They discuss using it for “generally healthy people”. About 20 years ago at least 50% of people with normal glucose tolerance had unhealthy insulin levels. These days, it is probably a lot worse. Will this diet help or hinder? (My money is on the latter) So what proportion of the population should be eating this diet, and what should everybody else (e.g. the majority) be eating?
Is the amount of protein adequate? At 15% of total calories, protein allowance is at the lower end of the WHO recommended scale of 15-25% of diet. Also, most of the recommended protein sources are poorer quality. Nuts and legumes may be reasonable sources of protein, but these authors acknowledge that animal protein is superior in quality. Ensuring that all essential amino acids acids are consumed is essential to health.
Should we be concerned about protein:calorie malnutrition? This is a state where the person consumes adequate calories, but insufficient protein. It leads to poor wound healing, impaired immune systems and stunted growth in children. It is estimated that globally, there are about 75 million vegetarians by choice, but 1450 million vegetarians by poverty – these people would choose to eat meat if they could afford it. These people probably also have significant health challenges due to malnutrition – even if they consume adequate calories.
Older adults and young children are among groups that need more protein in order to stay healthy. Older adults often struggle to consume sufficient protein through meat sources already. I’m concerned for this group, especially as many of them will slavishly follow health advice when they (incorrectly) think it applys to them.
I’ll accept that a well-balanced whole-food vegetarian diet can be healthy, but not many people actually follow a well-balanced whole-food diet – vegetarian or otherwise – if my observations of supermarket trolleys are anything to go by. Will reducing meat make it worse?
Can we compensate with supplements? Maybe, if you are rich and sufficiently educated to ensure you have an adequate (not excessive) amount. Many women, despite eating meat need an iron supplement – then need treatment to manage the resulting constipation. In New Zealand, a country that traditionally consumes a reasonable amount of meat, we already have significant challenges on our hospital system due to low meat consumption resulting in iron deficiency. Recommending a whole-scale reduction in eating meat will only place further burden on our health system, especially in our older, or otherwise, vulnerable populations.
Many vitamin/mineral combinations lack micronutrients and in many cases we don’t know what are the additional benefits of consuming these trace elements from real foods. I often talk about the benefits of phytonutrients when recommending people get their vitamin C from fruits and veggies in winter – rather than a tablet (even if that tablet contains bioflavinoids and rosehip extracts). How do we know if there is something in meat products that is equivalent to bioflavinoids. Supplements should only be used if the diet is inadequate, so why recommend an inadequate diet?
Also, these supplements are expensive, whether they are bought directly, or receiveed on prescription. If on prescription, there are costs (time or money) involved in seeing the doctor. If people struggle to see the doctor now, for infections or other serious conditions, I seriously doubt that they will see supplements as necessary.
Many people WILL assume that the diet recommended for health will contain all necessary elements for good health.
Why were sweeteners included? It is freely acknowledged sweeteners have no nutritional value, except for giving energy. So why on earth put them as part of a “healthy diet”? Could this not have been acknowledged and another food with high nutritional density be included.
The only “Special Considerations” this diet considered were young children, adolescent girls and pregnancy. What about people with any of the non-communicable diseases. Diets to keep people healthy should not be the same as diets to support a return to health.
What can we do? One of the big concerns for most people is that meat production is challenging to the environment. If not done well, I’d agree with that. So what can we do about it? There are a couple of things that can be done without giving up meat.
1) Check the amount of meat you are eating. Excessive consumption is not necessary.
2) Eat nose-to-tail. Don’t waste the meat. Eat the tail, organs, skin, feet and not just the choice cuts. Some cuts are quite tough, yes. Invest in a slow cooker.
But overall, be critical of the information that comes out. Consider biases and limitations. Then decide what is right for you and for your health.
Roast Lamb for dinner tonight, probably about 30g worth of protein.