Author: Alicia

  • From guidelines to greener plates: Australia’s necessary dietary shift

    From guidelines to greener plates: Australia’s necessary dietary shift

    Sustainable diets emerge as an area of ‘very high priority’ for the Australian Dietary Guidelines review. DFN welcomes this focus and anticipates a future with more plants on every plate.

    Cleared land

    As the Australian Dietary Guidelines (ADGs) undergo review, the National Health and Medical Research Council (NHMRC) has placed significant emphasis on exploring sustainable diets, establishing a working group to solely tackle this topic.

    But what exactly constitutes a sustainable diet? According to the Food and Agriculture Organization (FAO), it encompasses diets with minimal environmental impact, ensuring food and nutrition security for both current and future generations. These diets prioritise biodiversity and ecosystems, respect cultural diversity, and are accessible and affordable to all. Let’s explore how plant-forward diets align with these principles.

    Reduce greenhouse gas emissions

    Food contributes to roughly one quarter of global GHG emissions. Livestock – animals raised for meat, dairy, eggs and seafood production – contribute a staggering 31% to this figure, and this is before accounting for additional factors such as land use or supply chain emissions from crop production for animal feed.

    A 2016 study led by Marco Springman identified that a global switch to a vegan diet could reduce food-related greenhouse gas emissions by as much as two thirds.

    Locally the data shows we are not headed in the right direction when it comes to livestock emissions. The latest Australian GHG emissions quarterly update (Dec 2022) shows that emissions from agriculture have risen as a result of increases in livestock numbers and crop production.

    A global switch to a vegan diet could reduce food-related greenhouse gas emissions by as much as two thirds.

    Save lives

    The same 2016 study also highlighted moving to diets with fewer animal-sourced foods would have major health benefits, up to 8 million lives could be saved globally by 2050. More than half of these avoided deaths would be attributed to red meat consumption and 24–35% due to increased fruit and vegetable consumption.

    Not surprisingly Australia ranks among the world’s top meat-consuming countries, with an average annual consumption of 89.6 kg per person in 2019. Australia’s leading health issues, like heart disease, stroke, and diabetes, all have direct links to poor nutrition.

    Plant-based diets, including total vegetarian or vegan diets, are recognised in the current Australian Dietary Guidelines as healthy and nutritionally adequate for all stages of life. Nutrient-dense plant-based diets are a central pillar of a healthy lifestyle, helping to prevent many of the chronic conditions that impair quality of life as we age.

    Healthcare

    Maximise public funds

    The Australian Institute of Health and Wellbeing (AIHW) identified ‘overweight and obesity’ as the number one risk factor contributing the highest cost to Australia’s health system, at $4.3billion, not accounting for other costs such as reduced productivity.

    Imagine what could be achieved, from a dietary perspective alone, if even a portion of this money was directed to strengthening and building new partnerships with all levels of government, the private sector, community-based organisations, and families to ensure consistent and equitable access to healthy, safe, affordable foods for all.

    Prioritising biodiversity

    Three quarters of global deforestation is driven by agriculture, beef production is responsible for a whopping 41% of that. 

    A 2020 WWF report on deforestation identified Australia as the only country in the developed world to appear on the list, clearing for cattle pasture was the primary driver.

    Almost 75% of Australia is rangelands, suitable for livestock farming but this does not mean deforestation and land clearing is not rife. 680,688 hectares (the size of Ireland) of woody vegetation were cleared in Queensland alone in 2018-19, mostly for agriculture. Much of this was ‘likely or known’ koala habitat cleared for activity linked to grazing cattle for beef in Queensland alone; they are now endangered.

    A brief word on soy; there is no doubt that soy is being grown in harmful ways across the globe but the biggest reason for the surge in its production (it has increased 15 times in the past 50 years), is to feed livestock. More than three-quarters (77%) of global soy is fed to livestock for meat and dairy production.

    680,688 hectares (the size of Ireland) of woody vegetation were cleared in Queensland alone in 2018-19, mostly for agriculture.

    Easing the household financial strain

    Food and non-alcoholic beverages continue to put pressure on Australian households. Local and international studies indicate diets that include more plants provide more cost savings than those heavy in animal products. A simple example is a homemade curry where 500g of lamb is swapped out for chickpeas – this one meal alone could save about $12 for a family of four. The other benefit is the proliferation of many frozen and canned plant-based foods that reduce food waste and are accessible for the majority of Australians.

    Soy

    Australia must take action

    The global syndemic of obesity, undernutrition, and climate change affects most people in every country and region worldwide. In high-income countries like Australia, where many of us are in a fortunate position to have choices when it comes to our diet, we have an important role to play. 

    Shifts to plant foods correlate consistently and robustly with higher overall diet quality for human health. These same shifts are key for planetary health – which underpins all human health – they are a prerequisite to remaining below the 1.5°c warming threshold set by the 2015 Paris Climate Agreement, and securing a safe operating space for humanity

    Doctors For Nutrition praises the NHMRC for addressing the urgent need to promote diets that are healthy and have low environmental impacts. We look forward to seeing sustainability woven through the revised Australian Dietary Guidelines when the final updates are published in 2026.

    Have you seen the news?

    On Sunday evening 25 February 2024, Dr. Heleen Haitjema, co-founder and board director of DFN, joined a debate on the new Sky News ‘The Jury’ program, and provided her expert opinion on the pressing need to decrease red meat consumption to counteract the damaging environmental and climate consequences of meat production. 

    Watch the recording here

  • Free yourself from gluten fear

    Free yourself from gluten fear

    The gluten-free market is booming. Is it time you got on board? Should you be worried about gluten? Article first published in Vegan and Plant Based Living Magazine New Zealand.

    Sourdough bread

    Gluten, a protein found in wheat, barley, rye, and potentially oats, is a common ingredient in many foods. It is naturally occurring but can be added to provide flavour and an irresistible texture to tasty foods like bread, pasta, and baked goods. It also acts as a binding agent in processed foods, giving them shape.

    Sometimes it may also be lurking in unexpected places, such as herbs, nutritional supplements and even your toothpaste.

    Is this very common protein something we need to avoid?

    Friend or faux

    Globally the gluten-free market is worth more than AU$30 billion and rapidly growing. More and more people are ‘going gluten-free’ for health reasons, convinced that gluten-free products are a healthier choice. However, in reality it may be quite the opposite.

    For the small percentage of us (about 1%) diagnosed with coeliac disease, there is no question that a strict gluten-free diet is the only option. Coeliac disease is an autoimmune disorder, not a food allergy, where the immune system mistakenly attacks the lining of the small intestine when gluten is present, leading to damage, inflammation, and nutrient malabsorption. Blood tests and a small bowel biopsy are required to confirm diagnosis.

    In addition to coeliac disease, an estimated 3% of us may suffer from non-coeliac gluten sensitivity (NCGS). NCGS can be harder to diagnose because there are no specific biomarkers, and the symptoms overlap with many other gastrointestinal issues. Diagnosis requires a supervised elimination diet.

    If you’ve worked with your healthcare professional and ruled out coeliac disease or NCGS but feel better when you go gluten-free, there may be a couple of very good explanations.

    Firstly, a large number of foods containing gluten are processed. Think breads, pasta, pizza, cereals and processed meats – the list goes on. Dr Will Bulsiewicz, US-based Gastroenterologist, explains: “That is one of the main reasons people may feel better when they go gluten-free … they are eliminating many ultra-processed foods from their diet”.

    Secondly, for a small number of people, the problem isn’t gluten itself but rather fermentable carbohydrates (known as FODMAPs) often found in gluten containing foods, specifically fructans.

    For those individuals, fructans are not well-absorbed in the small intestine and can ferment in the large intestine, causing digestive issues. Cutting out gluten-containing foods alone alone will not solve gut issues; it also requires removing other high-fructan-containing foods like watermelon, broccoli, and cashews. Diagnosis and treatment requires working with a registered dietitian to follow a low-FODMAP diet and subsequent reintroduction.

    Wholesome variety for happy tummies

    For the vast majority of us there is no good reason to remove gluten from our diets; in fact, we are doing ourselves a disservice.

    Some gluten-free options can be highly processed, contain less protein, lack fibre and have higher levels of salt and saturated fats, compared to their gluten-containing counterparts.

    Some gluten-free options can be highly processed, contain less protein, lack fibre and have higher levels of salt and saturated fats, compared to their gluten-containing counterparts.

    The inflammatory effects of gluten are often sighted as a reason people cut it out. This is true for people with coeliac disease but for most of us it’s the opposite – gluten-containing foods, specifically whole grains, have been associated with reducing inflammation.

    The power of a variety of whole grains also benefits our heart health. In 2017, a study of over 100,000 participants found that people without coeliac disease who restricted gluten intake had an increased risk of heart disease (one of the leading causes of death in Australia and New Zealand) compared with those with a higher gluten intake. Why? You guessed it, a lower consumption of whole grains.

    Moreover, gluten has been shown to act as a prebiotic, feeding the “good” bacteria in our microbiome and keeping the bad guys at bay. For example, a prebiotic carbohydrate derived from wheat bran, stimulates the activity of the probiotic bifidobacteria in our colon. This important probiotic helps digest fibre, prevents infections, and produces compounds, such as B vitamins and healthy fatty acids.

    Cost is also a consideration. Gluten-free foods are often more expensive than similar foods containing gluten, sometimes costing twice as much. This can make following a gluten-free diet expensive if you have no medical reason to do so.

    The final verdict – seek a proper diagnosis before eliminating gluten. If you think you are one of the small percentage negatively impacted by gluten, it is crucial to be assessed by a health professional before making any dietary changes.

    This is undoubtedly one of those times to heed the wise words of your mother and consider, “if everyone else was to jump off a bridge, would you?”.

    A diverse diet, filled with a variety of whole grains, supports a healthy heart, reduces inflammation and promotes a thriving gut microbiome. Your body will thank you with every delicious bite.


    This article is republished with permission from Vegan & Plant Based Living.

    Healthy Gut
  • Doctors For Nutrition 2023: Year In Review

    Doctors For Nutrition 2023: Year In Review

    At the end of another fulfilling year, we evaluate our achievements and look forward to maximising our impact in the exciting year ahead.

    In 2023, resilience prevailed amidst national and international challenges, sparking shifts in priorities. Growing environmental concerns, and economic strains fueled a push towards plant-based choices.

    Weather-related events such as wide-spread flooding, bush fires and a peak in average temperatures highlighted the need for sustainability. The ongoing cost-of-living crisis prompted many of us to seek out ‘savvy sustenance’: getting back to basics with nourishing and budget-friendly meals. We continued to spend more time at home than ever before, in Australia roughly 40% of us now work remotely, growing interest in healthy home cooking.

    The 2023 Year In Review

    Doctors For Nutrition set the tone for 2023 within our own community by hosting Australasia’s only whole food plant-based nutrition conference. We gathered over 250 like-minded people in Melbourne to showcase both the long-established and the latest research on the leading lifestyle factor to influence health outcomes: our diet. The momentum of this cornerstone event continued throughout the year with many conversations and connections growing.

    During the rest of year we fast-tracked hundreds of GPs, medical students and health professionals, teaching them how to improve patient outcomes through plant-based nutrition, via our Prescribing Nutrition course.

    We continued to inform many thousands of people across the healthcare sector and wider community through educational webinars, resources, mainstream and social media. We also spoke face-to-face with health professionals and medical students.

    Finally we wrapped up 2023 with the Doctors Health Challenge — helping health professionals to better understand and assist their patients in implementing lifestyle changes by making those changes themselves!

    See details of the year’s achievements in the snapshots below, and read on to discover what’s in store for 2024.

    Nutrition in Healthcare

    Over 250 delegates, the majority of whom were healthcare professionals, gathered in-person or virtually. Those joining face-to-face gathered in Australia’s cultural capital, Melbourne. The conference ran over two full days and we were joined by 24 local and international experts. Delegates learnt about the role of a whole food plant-based approach to eating in the prevention, management and reversal of numerous chronic disease conditions.

    A key focus of the event was providing practical tools and techniques to support delegates in transitioning to a whole food plant-based diet themselves or helping their patients to do so. Interactive sessions facilitated real-time responses to the most popular questions from the crowd.

    Outside of the main academic program there were many other opportunities in which to partake: chances to get moving including a mindfulness session, a run and a guided walk.

    Explore a brief recap on the academic sessions throughout the two days and learn how you can access the full recordings.

    Growing our reach

    Growing our reach 2023

    In 2023 we:

    • Built our e-list to 7,770 subscribers; gaining an average of 77 new subscribers every month.
    • Had over 35,000 active users on our website; with our recipe collection and our NIHC23 conference pages proving highly popular.
    • Provided free resources to our community. There were 2,676 downloads from our website.
    • Added 9 new plant-friendly clinicians to our website.
    • Hit 20,000 social follows, an average of 304 new subscribers every month.
    • Began our new bi-monthly e-newsletter — a newsletter keeping our audience abreast of news, views and insights across the plant-based community.
    • Continued providing our expert-opinion across a range of magazines, newspapers, radio, podcasts and websites.

    Prescribing Nutrition

    In 2023 we:

    • Up-skilled 379 doctors and medical students via a blended learning course.
    • Helped 100% of our participants feel more confident talking with patients about plant-based diets.

    Feedback shows that the course fills an important knowledge gap; rather than turning to medication, they now have another tool in their bag…whole food plant-based nutrition.

    Learn more about our free online course for GPs, medical students & health professionals.

    Prescribing nutrition feedback

    Doctors Health Challenge

    In 2023 we launched the Doctors Health Challenge. We set out to show GP’s first hand the benefits of whole food plant-based nutrition. Ultimately, we wanted to increase the number of GP’s championing whole food plant-based nutrition in patient care and also teach them how to make a dietary shift, providing the necessary tools to assist their own patients.

    The month long challenge included bite-sized lessons on topics such as simple meals and convenience foods for busy professionals through to medication modification that may be required. The challenge also offered an online live cooking demo, online Q&A sessions and a final challenge celebration.

    Doctors Health Challenge
    Dr Heleen Haitjema

    Food Vitals Webinars

    Food vitals stats

    In 2023 we hosted 5 Food Vitals Webinars. The topics covered were:

      1. The role of nutrition in women’s hormonal health and polycystic ovarian syndrome (PCOS)
      2. Chronic kidney disease: the role of nutrition
      3. The role of nutrition in acne
      4. Breast cancer: the role of nutrition
      5. Remission of rheumatoid arthritis with nutrition
    Food vitals webinar

    Face-to-face events

    WONCA, Sydney
    WONCA, Sydney
    ASLM, Melbourne
    ASLM, Melbourne
    GPCE, Melbourne
    GPCE, Melbourne
    AMSA, Gold Coast
    AMSA, Gold Coast

    Besides hosting our own event we were out and about in the community. In 2023 we reached more than 2,700 health professionals and medical students by collaborating, presenting and exhibiting at 4 health conferences and events:

    1. Australian Medical Students Association (AMSA) National Convention on the Gold Coast
    2. Australian Society of Lifestyle Medicine (ASLM) Conference in Melbourne
    3. WONCA Sydney
    4. General Practice Conference and Exhibition (GPCE) Melbourne

    More than 2,600 Doctors For Nutrition resources were distributed to health professionals and medical students, including ‘Plant-based nutrition: A guide for health professionals’, patient handouts and meal plans.

    Our team had 820 face-to-face interactions with health professionals and medical students, many of whom were excited to hear about a charity promoting the important role of plant-based nutrition in healthcare.

    Fundraising

    Doctors For Nutrition is a fully independent charity that relies solely on donations. We are able to deliver all that we do thanks to the generosity of our donors.

    A generous donor offered us the opportunity to raise funds by matching up to $50,000 of donations received up until 31 December 2023. We were so grateful to our supporters to helped us raise $47,116. This equated to an impressive $94,231 in matched donations!

    In recognition of the importance of future healthcare professionals, Doctors For Nutrition were fortunate to be able to offer five scholarship places to our Nutrition in Healthcare Conference, also made possible by the generosity of our donors.

    Medical students who received NIHC Scholarships
    Medical students who received NIHC Scholarships

    The year ahead

    Next year we will run the Doctors Health Challenge again, continue with our much-enjoyed Food Vitals Webinars and up-skill more health professionals via our Prescribing Nutrition course.

    For the broader community, we also look forward to delivering a series of online cooking demonstrations and are in the midst of developing a new course to help transition to whole food plant-based nutrition for life.

    Alongside these projects, we’ll be continuing to strengthen and grow alliances with other organisations and seek impactful opportunities to gain traction for our messages about whole food plant-based nutrition for health — human health and planetary health.

    From all of us at Doctors For Nutrition, thank you for accompanying us on our mission. We’re excited about what the future holds, and we’re looking forward to your support.

    If you’d like to get involved in supporting our work you can find out more now.

  • Nutrition in Healthcare Conference 2023

    Nutrition in Healthcare Conference 2023

    Doctors For Nutrition was delighted to once again host Australasia’s only whole food plant-based nutrition conference in February 2023.

    NIHC wrap-up

    Over 250 delegates, the majority of whom were healthcare professionals, gathered in-person or virtually. Those joining face-to-face gathered in Australia’s cultural capital, Melbourne. The conference ran over two full days and we were joined by 24 local and international experts who showcased both the long-established and the latest research on the leading lifestyle factor to influence health outcomes: our diet. Delegates learnt about the role of a whole food plant-based approach to eating in the prevention, management and reversal of numerous chronic disease conditions.

    Centrepiece outside
    Entering NIHC venue
    Welcome to NIHC
    Name passes NIHC
    Inside NIHC venue
    NIHC Wrap-up 2

    A key focus of the event was providing practical tools and techniques to support delegates in transitioning to a whole food plant-based diet themselves or helping their patients to do so. Interactive sessions facilitated real-time responses to the most popular questions from the crowd.

    Outside of the main academic program there were many other opportunities in which to partake: chances to get moving including a mindfulness session, a run and a guided walk. During the conference dinner we were honoured to be joined by Professor Boyd Swinburn to discuss The Global Syndemic. We enjoyed plenty of belly laughs thanks to our entertaining MC Clint Paddison. Our Board-Chair Dr Heleen Haitjema and Dr Ayesha Sherzai also guided us through a cooking class.

    Another highlight of the jam-packed weekend was the entirely whole food plant-based menu, keeping our delegates fuelled and supporting the evidence-based philosophy of the conference.

    Food 4

    We were pleased to be able to offer health professionals Continuing Professional Development (CPD) credit for NIHC. The conference was approved for CPD hours by the Royal Australian College of General Practitioners (RACGP) and with the Australian College of Rural and Remote Medicine (ACRRM).

    In recognition of the importance of future healthcare professionals, Doctors For Nutrition were fortunate to be able to offer five scholarship places, made possible by the generosity of our donors.

            Another fantastic outcome from the conference was that I got to meet like-minded medical students from other universities.

    Five university scholarship students joining us at the NIHC

    Following is a very brief recap on the academic sessions throughout the two days. If you are interested in accessing the full recordings on-demand head to our ‘on-demand access’ page. CPD hours are available with RACGP and ACRRM, they may also be available for other professional bodies based on self-reporting requirements.

    DAY ONE

    What is whole food plant-based nutrition and how can I prescribe it?
    Dr Renae Thomas

    This session kicked-off the conference with an introduction to whole food plant-based (WFPB) nutrition from a clinical perspective. Dr Thomas discussed the nuances (such as salt, oil, and sugar), specifics (inclusions and exclusions), nutrition as a spectrum, and frequently asked questions (such as around protein, calcium, and iron). She provided a foundational overview of the benefits of WFPB nutrition for patients (and health professionals alike)! Following this, Dr Thomas delved into what is often the most challenging component – the practical aspect of how to prescribe nutrition in a clinical setting and specific methods to make this easily accessible, understandable, implementable, and results driven.

    Dr Renae Thomas

    Preventing Cognitive Decline
    Drs Dean and Ayesha Sherzai

    Drs Dean and Ayesha Sherzai started off our academic sessions by looking at what we know about our amazing brain, the diseases that affect it, their consequences, and what we can do as a society to reduce their risk and prevalence.

    With dementia being the #1 disease in most countries of the world (74.7m people impacted globally) this in-depth session provided hope that we all have the ability to improve our brain health.

    They discussed the myths and misunderstandings that relate to Alzheimer’s Disease. As opposed to being purely a genetic disorder, for instance, adherence to a healthy lifestyle can in fact offset the genetic component: genetic risk combined with an unhealthy lifestyle sees risk skyrocket by 360% but, genetic disease combined with a healthy lifestyle reduces risk to less than 30%.

    The doctors presented evidence showing that a healthy lifestyle can prevent or reduce the advancement of dementia. Central to this is food which is considered to be most important for the brain’s internal environment protecting from oxidative stress and reducing inflammation.

            Eat a cup of greens and you’ll have an 11 yr younger brain.

    Evidence-based weight loss
    Dr Michael Greger

    Physician, New York Times bestselling author and internationally recognised speaker on nutrition, Dr Michael Greger joined us via treadmill from the US to present on evidence-based weight loss. Dr Greger reiterated that the single most effective long-term weight loss strategy is a whole food plant based diet. He focused on the significance of calorie density and a shift from restriction to concentrating on quality whole foods.

    General Practitioner Panel: Turning the tide on type 2 diabetes
    Dr Anis Ta’eed, Hollie Waters APD and Dr Gemma Newman

    Hollie Waters APD, Dr Gemma Newman, Dr Anis Ta’eed and Clint Paddison
    Hollie Waters APD, Dr Gemma Newman, Dr Anis Ta’eed and Clint Paddison

    Our experts shared research and experience regarding nutrition and type 2 diabetes mellitus (T2DM), shedding light on the pathophysiology of T2DM, why ketogenic/low-carb diets aren’t appropriate in T2DM, preventing and reversing T2DM and meal planning.

    Dr Anis Ta’eed reminded us how critical it is that the underlying cause of T2DM is addressed; it does not need to be inevitable that decline in health, or death, will happen as a consequence of diabetes. Dr Gemma Newman shared information on how to control diabetes, including thoughts on calorie restriction and the use of lower carb diets. Hollie Waters APD provided practical advice on what a well-planned WFPB diet may look like, and shared simple substitutions and tips on meal planning.

    NIHC Blog 1200x200

    Nutrition and Skin Conditions
    Dr Niyati Sharma

    Dermatologist Dr Niyati Sharma delved into the nutrition link with common skin conditions such as acne, rosacea, psoriasis and others, including urticaria and hidradenitis suppurativa. She provided recommendations for these conditions and explanations of the potential causes. Dr Sharma shared details about the complex interplay between the immune system, the skin microbiome and the environment resulting in a breakdown of the skin barrier. She highlighted that It is just as important for dermatologists to talk about nutrition as it is for a cardiologists.

    Dr Niyati Sharma
    Dr Niyati Sharma

    Nutrition and Indigenous Health
    Tracy Hardy APD

    Tracy delved into the importance of culturally responsive, trauma integrated care, practice and healing approaches. With so many critical lessons to be learnt from First Nations Peoples of Australia her presentation was invaluable. It was an area of care in which many delegates were seeking more education. Tracy highlighted the Aboriginal holistic wellbeing model and the impact of colonisation. She raised the need to find ways to tackle the systemic disconnect we have with where our food comes from, making it more disposable and adding to our significant food waste problem.

    Tracy Hardy APD
    Tracy Hardy APD

    Hormone Harmony
    Dr Gemma Newman

    We were fortunate to have Dr Newman join us on the stage for a second time to speak about the key role that nutrition can play in keeping our hormones in check. She delved into common conditions linked to women’s health including PCOS, fibroids and endometriosis and how lifestyle can improve these problems. Dr Newman explored how various lifestyle measures can impact hormone-related conditions

            All of the pillars of lifestyle medicine apply to PCOS.

    Dr Gemma Newman warming-up the crowd with the 'Gemma wiggle'
    Dr Gemma Newman warming-up the crowd with the ‘Gemma wiggle’

    DAY TWO

    Meat and Gut Health
    Dr Alan Desmond

    Consultant Gastroenterologist Dr Alan Desmond explained the effect that meat consumption has on the human gut microbiome and reviewed the evidence on the links between meat consumption and many common digestive disorders.

    NIHC wrap-up 3

    He presented some staggering statistics around the increase in bowel cancer rates locally and reviewed the most up-to-date scientific publications on meat and gut health, explaining the therapeutic potential of a whole-food plant-based diet in helping patients to restore their gastrointestinal health.

    Food and the Environment
    Dr Peter Johnston APD

    Dr Johnston recapped the dire situation we’re currently in from a planetary perspective. He investigated the impact of our food system on the environment and the way forward to optimise human health and environmental sustainability on Earth. Sadly he pointed out that we pay for low-cost animal foods three times: at the checkout, in subsidies (taxes) and in the enormous clean-up cost to our health and environment.

            To deal with the problem of protecting the environment, we first need to know what the problem is.

    Dr Peter Johnston
    Dr Peter Johnston

    Nutrition and Heart Health
    Dr Caldwell Esselstyn

    Eminent MD, Dr Caldwell B. Esselstyn, one of the most well-known and respected luminaries in the plant-based healthcare movement, joined us from the US for his greatly anticipated presentation on Nutrition and Heart Health.

    Dr Esselstyn discussed how we should treat the cause of coronary artery disease. Rather than drugs and procedures which do not treat the causation of this disease, people who transition totally to plant-based foods may halt and selectively reverse their disease.

            Food and food alone can halt and reverse the effects of coronary artery disease.

    A nutritional approach to cardiac rehabilitation
    Dr Ahmad Farshid

    Delegates enjoyed the inaugural presentation of dietary and outcome data, from cardiologist Dr Ahmad Farshid, for a group of high risk patients using a plant-based diet for treatment and prevention of ischaemic heart disease. Importantly Dr Farshid confirmed that individuals with heart disease will take responsibility for their own health and that they will make sufficient changes to affect their risk factors such as blood pressure, weight and cholesterol.

    NIHC Blog 1200x200(1)

    GP Panel Discussion
    Dr Luke Wilson, Dr Alyce Churchill, Dr Sam Gartland, Dr Martyn Williamson, Dr Juliette Roex

    A panel of GPs with specialities in different areas discussed a broad range of common questions that arise in the areas of mental health, challenges in primary care with whole food plant-based lifestyle interventions, nutrition and autoimmune conditions and effective patient change communication.

    Dr Alyce Churchill (speaking)
    Dr Alyce Churchill (speaking)
    Dr Martyn Williamson
    Dr Martyn Williamson
    Dr Juliette Roex
    Dr Juliette Roex
    Dr Luke Wilson
    Dr Luke Wilson
    Dr Sam Gartland
    Dr Sam Gartland

    WFPB Immersions and Workplace Programs
    Dr Malcolm Mackay, Dr Peter Johnston APD, Jenny Cameron

    Dr Mackay, Dr Johnston and Jenny shared exactly how they obtain such impressive results with their retreat and group program clients. They explained how they walk with them through the barriers to making change, the strategies for overcoming these and took a dive into the dose-response nature of dietary intervention.

    Dr Malcolm Mackay, Jenny Cameron, Dr Peter Johnston
    Dr Malcolm Mackay, Jenny Cameron, Dr Peter Johnston

    Nutrition and Cancer Panel
    Dr Despina Handolias, Dr Alan Desmond, Dr Renae Thomas

    Oncologist Dr Handolias presented the cellular pathways of cancer, genetic alterations, nutritional/dietary interventions in oncology, and the main dietary interventions that have been studied. She examined risk reduction in the context of the complexity of cancer. Dr Thomas explored hormonal cancers and known potential risk factors in terms of prevention and relapse prevention, as well as dietary pattern. Dr Desmond returned to the stage for a second time to dive deeper into bowel cancer and the role played by the gut microbiome and diet in bowel cancer risk.

    Dr Alan Desmond, Dr Despina Handolias, Dr Renae Thomas
    Dr Alan Desmond, Dr Despina Handolias, Dr Renae Thomas

    Behaviour Change in a Community Setting
    Dr Dean Sherzai

    After a robust 2 days exploring the evidence base behind WFPB nutrition, Dr Sherzai detailed a neuroscientific approach to behaviour change in a community setting. He explored: why behaviour change often fails; the roles of different parts of our brain in the change process; and The Habit Loop. He generously shared what has worked for him in their community projects and looked into effective behaviour change approaches.

    Dr Dean Sherzai
    Dr Dean Sherzai

    I never thought it was possible … until we did it
    Dr Renae Thomas

    It was a perfect high energy wrap-up to the NIHC with an inspiring look at how the landscape has changed in regards to nutrition in the healthcare field through the lens of an Australian Preventive and Lifestyle Medicine Physician who has lived and practised it in the USA since becoming a doctor.

    Dr Alan Desmond
    Dr Alan Desmond
    Dr Ahmad Farshid
    Dr Ahmad Farshid
    MC Clint Paddison
    MC Clint Paddison
    Prof Boyd Swinburn
    Prof Boyd Swinburn
    Dr Sherzai, Dr Haitjema
    Dr Sherzai, Dr Haitjema

    Doctors For Nutrition were elated at the positive response to the NIHC. The energy at the venue was electric and everyone of our phenomenal speakers were so generous with their time outside of their sessions. They each gave us so much insight and knowledge into their specialist areas, and, most importantly, provided actionable and practical advice. Our brilliant MC, Clint Paddison, kept the weekend flowing smoothly.

    Thanks also goes out to our facilitators who got our minds and bodies moving each morning, our conference organising partner, Think Business Events, our sponsors and exhibitors and the CENTREPIECE team (particularly for the bespoke menu).

    Finally an important thanks to our delegates who will take away their knowledge and share it with others!

    NIHC Blog 1200x200(2)
  • Doctors For Nutrition 2022: Year In Review

    Doctors For Nutrition 2022: Year In Review

    As another successful year draws to a close, we review the highlights and look ahead to growing our impact in 2023.

    2022 continued to be a challenging year for many; we saw the ongoing repercussions of the global pandemic and frequent devastating weather events. The positive side of these hard times was that making conscious choices, for both ourselves and the planet, remained high on many people’s agenda.

    On a climate action front we saw Australia pass the country’s first climate change legislation in more than a decade. May 2022 saw the release of Aotearoa New Zealand’s first Emissions Reduction Plan (ERP), including a Māori ‘climate action platform’. COP27 negotiations in Egypt highlighted it was now crunch time for countries like Australia and New Zealand to step up and take urgent action at home. 8 in 10 Australians are concerned about climate change, seeking ways they can make a meaningful impact.

    Fortunately, one way becoming universally acknowledged is turning to a plant-based diet. A recent study conducted by La Trobe University, Griffith University and Queensland University of Technology surveyed more than 3000 Australians about their views on diet and eating habits. 32% of participants said they had reduced their meat consumption in the past 12 months.

    Another area that needs focus, and can be addressed through a healthful plant-based diet, is the ever present obesity epidemic. 2 in every 3 adults, and 1 in 4 children are overweight or obese in Australia, these numbers are mirrored in New Zealand. Without a significant improvement in these statistics we will see more chronic diseases and early death, greater vulnerability to infectious diseases and significant increase in health care costs. COVID-19 has shown that people with obesity or chronic diseases get sicker and are more likely to die from infectious diseases.

    The urgent need for whole food plant-based nutrition has never been clearer, Doctors For Nutrition continues to strive to make this the norm.

    2022 Year in Review

    Once again it has been a busy and rewarding year at Doctors For Nutrition. We are humbled by all the supporters and allies who have joined us to champion the power of nutrition to transform healthcare.

    We successfully launched an online nutrition training course, well received by the participants who were all general practitioners or medical students. The ‘Prescribing Nutrition’ course was approved as a CPD Activity with the Royal Australian College of General Practitioners and the Australian College of Rural and Remote Medicine.

    General Practice Conference and Exhibition Sydney
    General Practice Conference and Exhibition Sydney
    Australian Society of Lifestyle Medicine Conference
    Australian Society of Lifestyle Medicine Conference
    Adelaide Medical Students’ Society O'week Lunch
    Adelaide Medical Students’ Society O’week Lunch

    The team enjoyed being able to attend more face-to-face events again this year and ran a range of events over the course of the year, presenting and exhibiting at 7 health conferences and events across the country.

    In August we launched a new website: it includes a distinct portal for health professionals and the general public, a new search functionality and expanded content. After 3 months, the time spent by visitors on the new site was up 56% versus the same period last year.

    We also launched the ‘Find a clinician’ tool, a directory connecting the public with plant friendly health professionals. We look forward to the number of health professionals growing exponentially in 2023.

    The team has been hard at work preparing for our upcoming conference: Nutrition in Healthcare 2023. This event, being held in Melbourne on 17-19 February 2023, will welcome global leaders in nutrition.

    We continued to inform many thousands of people across the healthcare sector and wider community through educational webinars, resources, mainstream and social media.

    See further details of the year’s achievements in the snapshots below, and read on to discover what’s in store for 2023.

    NIHC logo

    Growing our reach

    In 2022 we:

    • Built our e-list to over 7,000 subscribers; gaining an average of 85 new subscribers every month.
    • Had 83,000 unique website page views; over 70% of which occurred following the launch of our new website, with our recipe collection and our NIHC23 conference pages proving highly popular.
    • Increased our social following to 16,425 across our social channels.
    • Continued providing our expert-opinion across a range of magazines, newspapers, radio, podcasts and websites.
    • Continued our regular contributions to Nourish Magazine, Aotearoa Vegan and Plant-Based Living, and NZ Vegetarian Magazine.
    Growing our reach

    Educational events

    Online course: Teaching doctors and students how to prescribe nutrition

    In 2022 we:

    • Piloted our new course Prescribing Nutrition in March 2022, then launched as an on-demand offering in November 2022.
    • 491 doctors, medical students and other healthcare professionals have received important knowledge and and practical tools on how to best introduce nutrition to their patients
    • 100% of those who participated said they felt more confident talking with patients about plant-based diets.
    • 70% of survey respondents did not identify as WFPB or vegan before the course commenced, meaning that the majority were not already familiar with plant-based diets and their benefits, including the positive impact on many common chronic diseases. 64% of respondents were inspired by the course to eat either slightly or significantly more whole plant foods, while another 30% were inspired to keep going with the changes they have already made.
    Prescribing nutrition quote

    Food Vitals Webinars

    In 2022 we:

    • Became an approved CPD Education Provider with the Royal Australian College of General Practitioners and the Australian College of Rural and Remote Medicine.
    • Ran 4 CPD approved Food Vital Webinars, viewed more than 1280 times.
    • Topics included: ‘Sustainable and healthy eating patterns’, ‘Type 2 Diabetes: Reversal and Weight Loss’, ‘The role of nutrition in optimising men’s health’, and ‘Recovery from autoimmune conditions’.
    • More than 50% of webinar registrants had not attended a previous event or webinar hosted by Doctors For Nutrition—demonstrating we are reaching new audiences.
    • The majority of survey respondents indicated that the webinars had increased their confidence for discussing plant-based nutrition with patients, assessing diet, and making nutrition recommendations.

    All the webinar recordings can be accessed freely via our Food Vitals web page.

    Food Vitals Speakers for 2022 blog

    Face-to-face events

    In 2022 we:

    • More than 3000 Doctors For Nutrition resources were distributed to health professionals and medical students, including ‘Plant-based nutrition: A guide for health professionals’, patient handouts and meal plans.
    • Our team had 550+ face-to-face interactions with health professionals and medical students, many of whom were excited to hear about a charity promoting the important role of plant-based nutrition in healthcare.
    • Highlights included Dr Heleen Haitjema and Dr Peter Johnston presenting to an audience of medical students at the AMSA Global Health Conference, and supporting the AMSS to ditch their traditional sausage sizzle during O’week and replacing this with a sustainable plant-based lunch.

    Fundraising

    In 2022:

    • Ten plant-powered enthusiasts trekked through part of the Larapinta Trail to help raise awareness of whole food plant‑based nutrition:
      • The walk was led by the World Expeditions team, who prepared delicious whole food plant-based meals and snacks. The group raised $17,187 for Doctors For Nutrition to help continue our nutrition education programs for healthcare professionals.
    Larapinta team
    Marion Meloni and Dr Heleen Haitjema
    Marion Meloni and Dr Heleen Haitjema
    • EthicalJobs.com.au offered us the opportunity to raise funds by matching up to $7,000 of donations received over the course of a week. Thanks to our generous donors, we exceeded our goal and raised $7,454 — turning that into a total of $14,454!

    Agenda 2023

    2023 will be a milestone year for us, holding our second Nutrition In Healthcare Conference (NIHC). Welcoming both international and local experts, the conference offers a program rich with evidence-based research and content exploring the relationship between diet and disease. Alongside two full days of academic sessions, the conference will also include a whole food plant-based menu, a social program, networking opportunities and an exhibition space.

    Thanks in part to the generous support of the Center For Nutrition Studies, we have been able to offer our Prescribing Nutrition course on-demand. In 2023 we expect to reach 600 more healthcare professionals and medical students.

    Other projects in the pipeline include: more educational events, both online and in person; new free web resources for health professionals; a forthcoming collection of whole food plant-based recipes with accompanying meal plan; a health professionals plant-based challenge and, more tools and support for those transitioning to a whole food plant-based diet.

    We will also continue to engage with decision-makers across the spectrum of healthcare institutions to highlight the evidence for whole food plant based nutrition, with a key focus on the review of the Australian Dietary Guidelines.

    Alongside these projects we’ll be continuing to strengthen and grow alliances with other organisations, and seek impactful opportunities to gain traction for our messages about the science and practice of whole food plant-based nutrition for health.

    From all of us at DFN, thank you for accompanying us on our mission. Here’s to a year ahead filled with action towards health and wellbeing through, both now and into the future.

    Click here if you’d like to get involved in supporting our work or make a donation. Or if you’d like to meet face-to-face it is not too late to register for NIHC!

    Team
    Louisa C
    Karyn O
    Sarah W
    Team 2
    Alicia T
    Marion M
    Hannah O
  • Is plant-based for you?

    Is plant-based for you?

    Making the transition can seem a little overwhelming, but we’re here to say: plant-based is for everyone! Article first published in Nourish Magazine.

    Thinking about making the plant-based transition, but worried it’s not for you? Or maybe you’ve already made the switch, but have questions about sticking with it. Common concerns include meeting nutritional requirements, feeling full enough, and experiencing digestive distress, among other things. These most often come up in the adjustment period and you can rest assured that when choosing to eat wholefood plant-based, you have quite likely chosen the healthiest diet out there.

    No need for nutrient FOMO

    While some people worry about how they’ll meet their nutritional needs when going plant-based, a varied wholefood plant-based diet provides all the necessary ingredients for optimal health. In fact, plants are some of the most nutrient-dense foods available. Dark leafy greens and legumes are rich in iron, zinc, and calcium. Wholegrains, fruits, and vegetables provide a range of essential vitamins, minerals, and phytochemicals. While beans, lentils, nuts, and seeds are high in protein and dietary fibre. As with any way of eating, it’s important to ensure your diet is well-balanced. Changes in the way we farm and process foods, and a shift in the way we live and spend our time, means some vitamins and minerals may require a little extra attention. Here’s a few to be aware of.

    Vitamin B12 – This is an essential vitamin that is important for the maintenance of the nervous system and formation of healthy red blood cells. Plants, fungi, and animals are unable to make this vitamin. Luckily, B12 is made by bacteria so you don’t need animal products to obtain it; it’s easy to meet your needs through supplements and fortified foods.

    Vitamin D – This fat-soluble vitamin is produced by our bodies in response to sun exposure. With greater efforts to avoid the damaging effects of UV rays, and more time spent on indoor activities, many people are at risk of vitamin D deficiency. Although some vitamin D can be obtained through your diet, without adequate sun exposure or supplementation, you may be at risk of low levels. Speak to your GP about a blood test to check your levels..

    Iron – There is a common misconception that eating a plant-based diet places you at greater risk of low iron levels. This simply isn’t the case – even for non-vegetarians, most iron in the Australian diet comes from plant foods while less than 20 percent of iron intake comes from meat and meat products. Including plenty of wholegrains, legumes, and green leafy vegetables ensures adequate iron intake. Eating these foods with those high in vitamin C enhances absorption, a process that is carefully regulated by our gut. Another benefit of choosing a whole food plant-based diet is that it contains no heme iron – the type of iron found in animal foods – which has been linked to multiple sclerosis and heart disease.

    Calcium – By eating a varied plant-based diet, you’ll get all the calcium you need without the added health risks that come with consuming dairy products. Leafy green vegetables, like kale, bok choy, broccoli, and Brussels sprouts, are particularly good sources. Beans, lentils, tofu, tempeh, fortified plant milks, almonds, blackberries, and oranges are also rich in this mineral.

    Healthy jar
    People cooking

    Keeping your fuel tank full

    Some people think they may not feel full enough when following a plant-based diet. Rest assured, carbohydrates are the main source of fuel for our body and are preferred by our brain. Including plenty of fruits, vegetables, wholegrains, and beans – naturally rich sources of complex carbohydrates – will ensure you easily meet your daily energy needs. The higher levels of fibre also slow down the digestive process, providing sustained energy throughout the day and keeping you feeling fuller for longer.

    Focus on whole plant foods because these retain more of the vitamins and minerals that may be lost with processing. An adequate intake of iron-rich foods will also ensure your energy levels remain high. Remember, good sources include beans, lentils, chickpeas, dark green leafy vegetables, tofu, tempeh, wholegrains, nuts, and seeds.

    If your daily routine is demanding, eat regularly throughout the day to stay fuelled up, including carbohydrate-rich foods like oats, potatoes, brown rice, wholemeal pasta, legumes, and fruit. If you are particularly active, it may also be helpful to add an energy-dense snack or two, such as hummus, dried fruit, nuts, or seeds.

    Too much, too soon

    When starting to eat more plant-based, some people can experience digestive upsets. This doesn’t mean plant-based isn’t for you! The time it takes to adjust to a new way of eating is very individual. It may be helpful to start out slowly, introducing a wider variety and larger quantities of certain foods, over time.

    In fact, a wholefood plant-based diet has been shown to improve the health and diversity of our gut microbiota, increasing the number of beneficial bacteria that feed on the abundance of dietary fibres that are naturally present in plant foods. A healthy microbiota, in turn, plays an important role in preventing and treating conditions like heart disease, diabetes, and inflammation associated with autoimmune diseases.

    To limit digestive discomfort, enjoy your meals in a relaxed environment, chew food well, and drink plenty of water. Limit caffeinated and carbonated beverages as they may exacerbate bloating and stomach pain. Soak, cook, and rinse legumes well before eating and, finally, consider a gentle exercise regime. Increased blood flow can promote gut motility, and body movement may help you naturally release gas to alleviate bloating.

    A healthy microbiota plays an important role in preventing and treating conditions like heart disease, diabetes, and inflammation associated with autoimmune diseases.

    What about a healthy social life?

    Transitioning to a plant-based diet doesn’t have to mean giving up shared meals or eating out. As more and more people become conscious of the health benefits associated with this way of eating, and the environmental impact of our food choices, plant-based diets have become one of the biggest culinary trends of this decade. Your friends and family may be open to trying new foods with you! And if not, respect their choice and instead let them observe the delicious meals you eat and the positive effects your diet has on your health. You may find they become more interested to try plant-based foods over time.

    When it comes to eating out, you’ll be spoilt for choice these days! Most restaurants will offer vegan-friendly options. To keep up your healthy approach, look for plant-based dishes that are likely to be low in fat and full of vegetables, legumes, and wholegrains – or those that could be easily modified to suit. If the meal can only be served with white rice or pasta, don’t be beat yourself up over having to compromise. Just select the best available plant-based option. You can also choose restaurants cuisines that traditionally rely on plant-based wholefoods, such as Indian, Mexican, Ethiopian, Thai, Vietnamese, and Italian.

    All-in or slow and steady?

    When making changes, some people like to go all-in from the start, while others find a gradual approach more sustainable. Think about other lifestyle changes you have made and what worked best for you then.

    If slow and steady is your style, start by adding more legumes, vegetables, and wholegrains to your meals. These foods keep you full and feeling satisfied for longer, so you’ll naturally eat less animal products and processed foods. When items in your fridge or pantry run out, replace them with wholefood plant-based  alternatives, like wholemeal pasta in place of white. You can also leave some items off your shopping list entirely, such as refined oils and processed foods with added salt or sugar in their many forms.

    When exploring plant-based alternatives, choose carefully if health is your priority. Use the nutrition information panel and ingredient list to identify the best choice. As a general guideline, select those with recognisable wholefood ingredients that contain at least 3 grams of fibre per serve. Keep salt to a minimum – multiply the milligrams of sodium by four and aim to keep this lower than the kilojoules per serving. Also try to stick to products that are low in fat, aiming for those with less than 3 grams per hundred and avoid foods with added sugars. Check the ingredient list for sugar and its many aliases, such as agave, fructose, and dextrose.

    Be mindful that a successful dietary change is often a matter of trial and error. Test a variety of products to find the ones you like best and for which application. For example, one plant milk may be great in coffee, but another is better for cooking. Investing in a few key appliances can also make clean eating easier. A pressure cooker, or multi-cooker, significantly cuts cooking time for beans and wholegrains, while a high-speed blender or food processor can be used for making oil-free dressings, sauces, and hummus, as well as raw desserts.

    There are many great reasons to adopt a wholefood plant-based diet; but it’s important to identify your ‘why’. Being clear on what spurred your decision will help you navigate any challenges as you make the change. Any big life change can seem overwhelming at first, but allowing time for learning and adjustment each step of the way will help you stick to your goals. Finally, don’t be afraid to ask for help. Consider consulting an accredited dietitian to ensure your new diet meets your individual needs.

    This article is republished with permission from nourishmagazine.com.au.

  • A snack for every season

    A snack for every season

    Seasonal eating is something we should all pay attention to. Your health and your back pocket will thank you! First published in Aotearoa Vegan Magazine.

    As a self-proclaimed health nut, I have been on a quest for many years to optimise my nutrition, searching for the most nutrient dense foods of superior quality. Therefore, I naturally found myself ‘down the rabbit hole’ of seasonal eating and its relevance to human health. Seasonal eating is consuming the foods within your geographic area that are in peak harvest for that time of year. Here’s an insight into my discoveries.

    How seasonality influences our health

    Studies show fresh seasonal foods have a higher nutrient profile when compared to foods that have been imported from overseas or outside local perimeters and where ripening agents have been used. For example, studies show broccoli holding higher concentrations of vitamin C during peak season, turnips higher in antioxidants and other phytonutrients, and rosemary higher in antioxidants, alongside enhanced antimicrobial properties.

    Commonly used ripening agents forcefully ‘speed up’ or ‘slow down’ the fruit and vegetable ripening process, going against their natural growing tempo. This artificial method may be used in the hope of prolonging stability of the food during transportation, as well as a way to meet the demands of consumers. Some of the agents often used are calcium carbide, ethylene, acetlyne and ethanol. Research suggests that calcium carbide, for example, should not be used due to its potential link to ailments such as poor mental health, neurological pathologies, headaches and sleep disorders.

    Imported produce, often travelling from the other side of the globe, may arrive with less bioactive compounds and micronutrients due to variables such as travel conditions, storage and impact of temperature. Foods, including cruciferous vegetables (broccoli, cabbage, brussels sprouts) and cherries, have shown to decrease in antioxidants when stored at cooler temperatures. Although evidence around snap frozen vegetables suggests they retain their nutrient value if stored in the freezer directly after harvesting. The nutrients are then preserved delivering comparable nutritional quality as when freshly picked.

    Eat the rainbow

    Eating seasonally increases your chances of eating a wider variety of fruits and vegetables, encouraging you to ‘change up’ your produce choices and maybe reach for something you have never tried before! This creates a diverse gut-microbiome, which simply means creating an assortment of the types of ‘good bacteria’ that live in our gastrointestinal tract, optimising our digestive and overall health.

    Research conducted on a remote North American demographic by the University of Chicago found our gut bacteria changes from season to season to ‘align’ with the foods we’re meant to be eating at that time of year. Furthermore, a comparative study concluded digestive microbes have drastically declined in variety and abundance within modernised populations when compared to traditional cultures such as the Hadza Hunter-Gatherers of Tanzania.

    Learnings from our ancestors

    Ancient practices such as ayurvedic medicine in India have named the practice of seasonal eating as ritucharya. The philosophy emphasises that to obtain optimum health and as a

    Child eating fruit in Autumn
    Child eating fruit in Summer

    prophylactic measure towards illness, one must eat in accordance with the season. In Australia, First Nations people recognise a connection between indigenous astronomy and seasonal foods. Carefully analysing the astronomical position of the stars provides insight into seasonal changes, notifying them of animal and plant behaviours which indicates what foods to utilise as medicines.

    Sourcing your seasonal produce

    Every Sunday morning, without fail, you will find me at my local farmers market bright eyed and bushy tailed, reusable mesh vegetable bags in-hand, with ‘seasonal’ snatching at the forefront of my mind. Not only do I know I will be supporting my local farmers, likely drastically reducing my exposure to pesticides, herbicides, and the ripening agents we touched on above, I’ll also be putting myself in a position where seasonal foods are in abundance comparative to mainstream supermarkets.

    Another option is growing your own produce at home. It is not only fun and exposes you to nature, but also a fantastic way to encourage a seasonal predominant eating pattern. The foods you grow in your backyard garden or balcony pots are most likely not going to flourish unless you plant produce right for its environment in accordance to the time of year.

    Inform yourself of what’s in season. As a general guide I have provided a list below, although where you’re located may influence this guide.

    Seasonal gains beyond your personal health

    Commercial greenhouses are typically trying to meet consumer demands, providing access to specific types of fruits and vegetables all year round. Unfortunately, they also require a lot of energy to maintain and then transport to their final location. On the other hand, eating seasonal food grown close to home under natural sunlight aligns with sustainable purchasing, reducing detrimental effects consumption has on our planet. We must be mindful that where we purchase our food from can either positively or negatively influence our carbon footprint.

    Finally, seasonal eating is favourable to your wallet! Due to the produce being more readily available to suppliers, you will potentially be finding yourself paying less in the months where that food is in season.

    Perhaps, there truly is ‘a snack for every season’.

    Connect with Celeste at www.thelifestylemedicco.com.au

  • Food and your mood

    Food and your mood

    Can what we eat and drink affect our mental health? You bet it can. Here’s how you can harness the protective power of plants to feel your best. Article first published in Nourish Magazine.

    Most of us know that when we are physically unwell or exhausted it can negatively impact our mental health – in the ways we think, cope, and act. And how we feel mentally also influences our physical self-care, such as eating well, moving, and resting. The connectedness of our physical and psychological state is undeniably intertwined and is particularly significant for several mental health conditions, including depression and anxiety disorders. Because our physical health is greatly impacted by our diet, there are some protective actions we can take when it comes to what we eat and drink, which can also be beneficial for mental health.

    The gut-brain connection

    Our body can influence our psychological state through the gastrointestinal tract, or the gut. Our gut has the wonderful ability to communicate with our brain through the enteric nervous system and with chemical messengers (hormones) such as serotonin. Serotonin is produced by specialised cells within our intestines. Foods rich in tryptophan can help increase your production of serotonin, well-known for its calming effect as it works to reduce anxiety and improve depression. Choosing plant-based sources can simultaneously help you build a healthy gut microbiome and reduce your risk of many chronic diseases.

    Our gut bacteria, or microbiome, is also capable of producing gamma-aminobutyric acid, or GABA, another important chemical made in the brain and found in some foods. GABA works to reduce anxiety and improve mood and sleep. We know eating a wide variety of plants helps to promote a healthy gut microbiome, but are there foods of increased benefit? The science says yes! Fermented foods like kimchi, sauerkraut, and soy yoghurt contain GABA and probiotics to nurture your microbiome. Consuming foods rich in glutamate and vitamin B6, the building blocks of GABA, is also beneficial for boosting GABA levels.

    Foods that improve serotonin
    Pineapple
    Foods that improve mood

    The simple act of eating is enough to release dopamine, another feel-good hormone. Unfortunately, high-fat and high-sugar foods are particularly good at causing a dopamine boost. Biologically, this is why a doughnut or ice-cream can feel so much more pleasurable than a less indulgent option. The reasons for this are rooted in human species survival and not longevity or good mental health. High-fat and high-sugar foods are addictive, and breaking the cycle of craving and consumption, termed ‘The Pleasure Trap’ by renowned psychologist and researcher Dr Doug Lisle, is important to gain control over your physical and mental health. Breaking up with these foods might be difficult at first but your taste buds will adapt quickly, your microbiome will improve, and you can continue to enjoy a normal dopamine boost from healthy plant-based foods.

    Eating for optimal mental health

    Studies have shown that diets rich in neuro-protective vitamins and minerals such as B vitamins, Omega 3 DHA, iron, magnesium, and zinc are beneficial to our brain and mental health. Deficiencies in these various nutrients can affect your brain’s development, learning and memory, as well as increase the risk of feeling irritable, stressed, and fatigued. Fortunately, your nutritional needs can be easily met by eating a wide variety of plants. Here’s where to find these neuro-protective nutrients.

    Dark leafy greens

    Vitamin B6 – bananas, watermelon, peanut butter, almonds, sweet potatoes, peas, avocados, hemp seeds, chia seeds, beans, chickpeas, prunes, wheat germ, sunflower seeds, pineapple, pumpkin, green beans, pistachios, figs, nutritional yeast, baker’s yeast, garlic, kale.
    Vitamin B9 – spinach, beans, lentils, asparagus, lettuce, tomatoes, broccoli, avocados, mangoes, oranges, most whole grains, nutritional yeast, baker’s yeast, basil, peanuts, artichokes, rock melon, walnuts, flaxseeds, sesame seeds, cauliflower, tahini, sunflower seeds, peas, okra, celery.
    Vitamin B12 – supplementation is recommended and can easily be found in pharmacies. Also found in some fortified cereals, fortified plant-based milks, and nutritional yeast.
    Omega 3 DHA – flaxseeds, chia seeds, hemp seeds, dark leafy greens, seaweed.
    Iron – legumes, dark leafy greens, broccoli, nuts, dried fruit, iron-fortified bread and cereals, oats, tofu.
    Magnesium – kelp, oats, almonds, cashews, seeds, cacao, dark leafy greens, bananas, sweet potato, whole grains, beans, wild and brown rice.
    Zinc – legumes, nuts, seeds, oats, tofu.

    Think about what you drink

    Hydration also has a significant impact on mental functioning. How much you hydrate, and with what fluids, can impact on your concentration, mood, and anxiety symptoms. It can even affect your sleep. Regularly and adequately hydrating with water and other healthful options, such as herbal tea, can improve your focus, increase your performance, reduce fatigue, and best support your psychological wellbeing.

    However, there are some beverages that can negatively affect our mental health. Alcohol and caffeinated drinks are the main culprits. Caffeine acts as a stimulant to our nervous system with enticing effects such as a reduction in fatigue, increased alertness, and improved mental performance. These effects are temporary and have to be weighed up against other well-known side effects, including increased heart rate and blood pressure, increased feelings of anxiety, restlessness, difficulties with sleep, and diuretic effect (the need to urinate more frequently). Good hydration can be an uphill battle if you’ve already had a few coffees by mid-morning.

    Then there’s alcohol, which is quite a messy substance for the brain. The anticipation and consumption of alcohol can produce a satisfying but temporary increase in dopamine. However, regular consumption, and in particular alcohol-dependency and withdrawal states, leads to suppression of serotonin and GABA production (our happy hormones and mood improvers mentioned earlier). This can reduce your ability to manage stress, increase anxiety and panic, and result in lower mood. Alcohol is also no friend to your gut microbiome.

    The evidence we have to date says that reducing your exposure to alcohol has benefits for your mental and physical health. Adhering to the Australian National Health and Medical Research Guidelines is strongly recommended. They advise quite clearly that no amount of alcohol consumption is risk free and that all healthy and non-pregnant adults should limit their consumption of alcohol to a low-risk quantity of no more than 10 standard drinks per week or 4 on any one day.

    The science is clear

    Drinking more water, eating a lot more whole plant foods, and consuming less refined products (and yes, I’m afraid this includes caffeine and alcohol too) can give many people a much-desired boost in both their mental and physical health. This is one nutrition prescription that is widely accessible, relatively easy to implement, economical, and comes with a long list of additional health benefits.

    If you are struggling with your mental health, it’s also important to talk to your GP, psychiatrist, or psychologist, so that the most appropriate treatment options for you can be considered. Conventional approaches including psychology and medication will be part of the journey to better mental health for many people, and dietary change should be seen as a complementary treatment, not a substitute. With a holistic approach encompassing evidence-based nutritional and lifestyle improvements, there is potential to enhance the effects of other treatments, reduce relapse risk, and build better general health.

    Of course, even if you aren’t currently experiencing a mental health issue, it’s beneficial to consume foods that contain neuro-protective nutrients and that promote good gut health, which can affect hormone production and mental health. And this can be as simple as focusing on eating a wide variety of whole plant foods and keeping well hydrated.

    This article is republished with permission from nourishmagazine.com.au.

  • Unbreakable bones

    Unbreakable bones

    Strong bones are important for all ages. While bone health is critical for healthy ageing, it’s the bones you bank today that can protect you from osteoporosis later. Article first published in Nourish Magazine.

    Bones play an essential role in the human body – they support movement, protect our vital organs, and store essential nutrients.

    Bone is living tissue and undergoes continuous change throughout our lives via a process called remodelling, which is a biological process where older bone tissue is removed and new bone tissue is formed. This process protects our bones from stress failure and is essential in maintaining normal blood calcium levels, important for many critical functions in our body including healthy heart and nerve function. Remodelling is regulated by many factors: our diet, physical activity, hormones, and medications.

    Lady exercising

    Your bone bank account

    When it comes to bone health, we often associate it with ageing, although we should be paying attention to our bones much earlier than this. The more bone mass we ‘bank’ in our younger years, the better protected we are from osteoporosis and fractures later in life.

    Puberty is often correlated with growing taller, but what isn’t as obvious is the rapid increase in bone mass, reaching its maximum when we are around 25 to 30 years of age. By the time we are in our forties and fifties, we slowly begin to lose bone mass as a normal part of aging. We can, however, take steps to optimise bone health at any age to avoid osteopaenia or osteoporosis later in life.

    Osteoporosis is a condition that results in loss of bone strength, making bones more fragile and prone to fractures. Osteopaenia, often referred to as ‘pre-osteoporosis’, is where bone mass is abnormally low, but not to the same extent as osteoporosis.

    As a general rule of thumb, bone formation tends to slightly exceed bone breakdown in the first half of our life, contributing to an increase in bone mass during our younger years. In the second half of our life, bone breakdown exceeds bone formation, tipping the balance towards a gradual decrease in bone mass over time. Osteopaenia and osteoporosis occur when bone mass decreases more than what would typically be expected as part of ageing.

    Osteoporosis is a common condition in both men and women, although it is more common in women. For women, the drop in oestrogen levels that occurs around menopause upsets the balance of bone remodelling, resulting in increased bone loss. An initial rapid decrease is often experienced, which tends to slow over time. For men, the rapid bone loss phase tends to be delayed, typically commencing in their mid to late sixties. For most of us, bone loss can be significantly slowed through proper nutrition and regular exercise.

             For most of us, bone loss can be significantly slowed through proper nutrition and regular exercise.

    The best nutrition for strong bones

    Let’s get one thing out of the way first. ‘Milk builds strong bones’ is a reductionist way of approaching this important part of human health. Bone health is much more complex than consuming adequate calcium. First, achieving and maintaining excellent bone health is multifactorial: it is a combination of excellent nutrition, regular physical activity, sunlight exposure, and avoiding factors that can be detrimental to bone health where possible. Second, more than adequate dietary calcium levels can be achieved by adopting a diverse wholefood, plant-based diet that excludes dairy. And third, from a purely nutritional perspective, while calcium forms a critical dietary contribution to bone health, there are many other dietary factors that work to either optimise or hinder bone health.

    If you already eat a diverse diet rich in whole plant foods while minimising processed foods, you are well-on the way to achieving and maintaining bone health. Let’s explore some important nutritional requirements required for healthy bones.

    Calcium

    It is well known that calcium is an important nutrient for healthy bones, and over 98 percent of our body’s calcium is held within our bones. Here’s the catch with that pervasive milk marketing: while dairy products contain calcium, they also regularly contain growth factors, lactose sugar, occasional contaminants, and often a significant amount of fat and cholesterol, making them an unfavourable choice for obtaining this nutrient.

    As a general rule, the most healthful calcium sources are green leafy vegetables and legumes. Broccoli, Brussels sprouts, kale, and other greens are loaded with highly absorbable calcium and a host of other healthful properties. Exceptions are spinach and chard, which contain a large amount of calcium but hold on to it tenaciously, making it difficult to absorb. You will also find plenty of calcium in legumes including chickpeas, beans, and lentils. Soy products like tofu and soy milk are available fortified with calcium (look out for at least 100mg of added calcium per 100mL). These also contain phytoestrogens, or plant compounds, that have a similar structure to oestrogen and help to reduce excessive bone breakdown.

    Magnesium

    Approximately 60 percent of this essential mineral is found in bone. Low magnesium intake is associated with a lower bone mass. Beans and greens are magnesium rich, while other great sources are whole grains, nuts and seeds, bananas, and even dark chocolate (80 percent cocoa or more). Stick to a high-quality vegan variety and remember, don’t go crazy, it comes with other additives we are best to minimise.

    Vitamin D

    The importance of vitamin D for bone health is evident through the range of bone conditions that can be experienced when intake is inadequate, in particular Rickett’s disease and osteomalacia. While vitamin D is often considered a dietary requirement, it is primarily obtained from sunlight, and only small quantities actually come from our food. Vitamin D is crucial in promoting calcium absorption into the bloodstream from the gastrointestinal tract. The best and most efficient way for us to obtain vitamin D is through sunlight exposure. If you can’t obtain adequate sun exposure, then a supplement is recommended.

    Vitamin K

    Several studies have found low vitamin K intake to be associated with low bone mass and increased risk of fractures. Good sources of vitamin K include dark green leafy vegetables such as spinach and kale. Just one cup of raw spinach will provide more than the recommended daily intake. Other sources include Brussels sprouts, broccoli, cauliflower, and blueberries.

    Zinc, Copper, Manganese and Phosphorus

    Zinc, copper, and manganese have been shown to play an important role in bone health while phosphorous is necessary to support increases in bone mass, and is predominantly stored with calcium in bones. All of these can be found in abundance in a variety of plant foods: wholegrains, legumes, nuts, seeds, fruits, and vegetables.

    Calcium plant foods

    The bone thieves

    So, we now know eating a variety of whole plant foods is important for supporting strong bones. But there are also factors that can diminishdimmish bone health These are often referred to as the ‘bone thieves’. Here’s what you might want to avoid or limit where possible.

    Alcohol

    Excessive alcohol consumption is a well-recognised risk factor for decreased bone mass and osteoporosis. Simply put, it has a toxic effect on our bone forming cells.

    Medications

    Corticosteriods Corticosteroids such as prednisone suppress bone formation, contributing to a decline in bone mass and an increased risk of osteoporosis. Certain anti-seizure medications are associated with Vitamin D deficiency, also negatively affecting bone health. It’s important to remember that medication is frequently necessary. In situations where chronic usage is unavoidable, a proper assessment of bone health should be conducted and bisphosphonate treatment may be considered.

    Smoking

    There are many reasons to take heed of this message, although you may be interested to know that achieving and maintaining healthy bones is one of them. Smoking creates an imbalance in bone turnover, contributing to lower bone mass and an increased risk of osteoporosis.

    Sugar-sweetened drinks and caffeine

    Soft drinks are high in phosphates that tend to inhibit calcium absorption. Both soft drinks and sugar-sweetened beverages (especially cola drinks) are associated with increased risk of fractures. Be aware that caffeinated beverages such as coffee are associated with accelerated bone loss. It’s best to keep coffee to a minimum and, ideally, eliminate sugar-sweetened drinks.

    Weights

    Move it or lose it

    Physical activity is vital to bone health for all age groups. Weight bearing activities, such as jogging or jumping, in combination with resistance training is recommended. These activities place our bones under mechanical strain, resulting in an increase in bone formation while suppressing bone breakdown. As we age, we are likely to sustain good bone health or experience a slower decline in bone mass if we maintain an exercise regime.

    Bone health is a complex, lifelong process. A diverse wholefood, plant-based diet puts you on the right track for maintaining healthy bones. Combine optimal nutrition with regular physical activity and sunlight exposure to maximise your bone mass and minimise your risk of developing osteoporosis. Remember, it is never too late, no matter what life-stage you are in – you can always improve your bone health with these strategies.

    This article is republished with permission from nourishmagazine.com.au.

  • Hormone harmony

    Hormone harmony

    Healthy hormones are a bit of a balancing act, and many common health complaints are caused by imbalances. It may surprise you to learn that what you eat can help or hinder here. Article first published in Nourish Magazine.

    Excess oestrogen exposure

    In Western countries, girls are starting their periods younger, and women are tending to go through menopause later. This means lifetime exposure to the female sex hormone oestrogen is extended, putting females at increased risk of hormone-dependent cancers.

    Oestrogen is vital, however, not in excess. So what can we do about it? Doing what we can to ensure regular bowel movements is a great start. Constipation can make us overexposed to oestrogen. Our body discards excess hormones and products of metabolism through our faeces. When we get blocked up, those waste products seep back into our bodies through the intestinal wall and are re-metabolised, increasing our hormonal exposure.

    Fibre rich foods

    A high fibre diet is useful for hormonal regulation because it increases the size of your stools and makes them softer, helping to keep you regular. Fibre will also lower cholesterol, keep you feeling full longer, and is important for gut health, which has other knock-on benefits for overall wellbeing. Put simply, fibre is the part of plant foods that your body does not digest. There are many different types of fibre in nature, so to benefit most, you need to include a variety of plant foods: wholegrains, legumes, nuts, seeds, fruits, and vegetables (skin on where possible).

    Painful periods

    There is a connection between the food you eat and your body’s oestrogen levels. Animal products, processed foods, and added oils increase your levels of oestrogen, in part because they are inflammatory. The more of these foods you consume, the more likely your uterine lining will become abnormally thick. As a result, when it begins to break down during the menstrual cycle, this process creates more prostaglandins. Painful periods are often caused by these hormone-like lipids that make your uterus contract to help get rid of its lining. The higher the levels of prostaglandins, the more severe the cramping.

    In addition, eating foods that decrease inflammation in the body can help to tame period pain. Research has shown that a meat-free eating pattern works to decrease inflammation in the body. One study demonstrated that a healthy, plant-based diet significantly reduced the intensity and duration of period pain. The effect of the diet was so powerful that some of the women participating refused to switch back to their regular diet, even though the way the study was designed required this.

    Interestingly, there are vitamin D receptors in the womb, and it is thought vitamin D could be helpful to reduce prostaglandins and therefore period pain. Ginger, best known as a calming remedy for an upset stomach, has also proven effective for period pain. In one study, it was shown to be equally effective as two different types of anti-inflammatory painkillers. Curcumin, an active compound in turmeric, also has benefits due to polyphenols, and is recommended this is taken just before your period starts.

    To alleviate period pain, try eating lots of fibre-rich foods plus good amounts of turmeric and ginger just before your period starts and throughout, as well as adding a vitamin D supplement if your levels are low. This may provide some big improvements within just a few cycles.

            Eating foods that decrease inflammation in the body can help to tame period pain. Research has shown that a meat-free eating pattern works to decrease inflammation in the body.

    Polycystic ovarian syndrome

    In Australia, polycystic ovarian syndrome (PCOS) affects around one in 10 women of reproductive age and around one in 5 of First Nations women. It is a common cause of fertility difficulties and can also be a risk factor for pre-diabetes, gestational diabetes, and type 2 diabetes. Symptoms include irregular ovulation, erratic periods, weight gain, and acne.

    PCOS is a condition fuelled primarily by insulin resistance, and many of the same strategies that apply to diabetes management can also minimise the effects of PCOS. Once again, fibre is king. Foods high in fibre will combat insulin resistance by slowing down the rate of digestion, in turn regulating blood sugar. Processed foods void of nutrients, such as white flour, sugar-sweetened drinks, cakes, and other treats should be minimised. If you are craving something sweet, try reaching for a piece of fibre-packed fruit instead.

    Organic, non-GMO soy foods, like tofu and edamame, can improve many aspects of PCOS, including reduced triglycerides, blood sugars, body weight, and insulin levels. Soy also has a high polyphenol content. Polyphenols are a family of plant-based compounds with a wide range of anti-inflammatory and antioxidant capacities. Because chronic, low-grade inflammation is common for PCOS sufferers, this is desirable.

    Menopausal matters

    Hot flushes, insomnia, sexual dysfunction, vaginal dryness, mood changes, and weight gain are all associated with ‘the change’. But do we have to accept this as a part of life? No. There are many ways to deal with these symptoms, including medical treatments, lifestyle changes, and food choices.

    A series of interviews with women in the US, Canada, and Japan, conducted by anthropologist Margaret McGill, brought interesting insights into menopause. One of the most common complaints, hot flushes, was not experienced by women in Japan to the same extent as those in the other countries. In fact, it is so infrequent that they did not even have a word for the phenomenon. The only symptom mentioned, other than the cessation of periods, was shoulder stiffness – and men reported this symptom about as often as women did!

    Healthy lady

    Thinking about the traditional Japanese diet, it is based on rice with relatively little meat and no dairy. The hormonal impact of avoiding dairy hormones could play a part here. Also, the Japanese women were slimmer on average, meaning that the oestrogenic effect of fat cells was also minimised. These women tended to eat a lot of soy, in the form of miso soup, tofu, tempeh, and edamame beans. Soy is a source of complete amino acids, but also phytoestrogens. The isoflavones contained in soy – specifically genistein – have been shown in studies to improve menopausal symptoms and bone mineral density, while reducing the risk of breast, prostate, and colon cancers. Another study that followed Japanese women over time found that those who ate more soy were 68 percent less likely to experience hot flushes than those who did not. However, various studies have had mixed results, and it is likely that overall this may benefit most women, but will not necessarily result in complete elimination of symptoms.

    Low sperm count

    If you or your partner have been diagnosed with a low sperm count, there are simple steps that can improve quality and quantity. Smoking and drinking are two habits to toss. Also, take the time to consider exposure to hormone-disrupting chemicals. Dioxins and heavy metals, which are especially concentrated in plastic-heated foods, farmed fish, and processed meats, have been associated with reduced sperm quality.

    Studies have shown an association between reduced sperm count and saturated fat. If you have already said goodbye to animal products, there are only a few plant foods to be aware of that contain saturated fat, such as coconut, coconut oil, palm oil, and palm kernel oil. While reducing or eliminating these foods, also think about optimising vitamin E, selenium, and Co-enzyme Q10, which may also be helpful for healthy sperm. You can get these from nuts and seeds.

    These are only a few of the major conditions that can be mediated by our hormones. It quickly becomes clear there is a common thread to maintaining balance: an eating pattern that avoids animal products, minimises refined or processed foods, and includes an abundance of fibre, antioxidants, phytonutrients, and numerous other health-promoting substances found in whole, plant foods. It’s clear, healthy hormones are connected to a healthy diet.

    Hormonal health hacks

    This article is republished with permission from nourishmagazine.com.au.

  • NZ’s updated Eating and Activity Guidelines allow for “totally plant-based”

    NZ’s updated Eating and Activity Guidelines allow for “totally plant-based”

    The Ministry of Health of Aotearoa New Zealand has recently announced an update to its national Eating and Activity Guidelines, including a number of meaningful changes that Doctors For Nutrition is encouraged to see.

    The Ministry of Health of Aotearoa New Zealand has recently announced an update to its national Eating and Activity Guidelines.[1] While the central ‘Eating and Activity Guidelines Statements’ for adults remain the same and were not reviewed, several meaningful changes have been made that are welcomed by health-promotion charity, Doctors For Nutrition.

    1. Kiwis have a new ‘plate model’ with a focus on whole plant foods

    The tools used to describe what a healthy eating pattern looks like have changed and the Ministry of Health has created a plant-centric image [2] that looks somewhat similar to Canada’s Food Guide.

    This updated image makes it clear that if an adult chooses to eat red meat, chicken or fish, these components should be a small segment of overall food intake.

    As the nutritional guidance developed in 2015 was not reviewed, the ‘milk and milk products’ segment remains. However in 2019 the NZ Ministry of Health recommended ‘reducing dairy’ within its ‘Sustainability in the Health Sector’ report [3], so chances are high that the ‘milk and milk products’ segment will be reconsidered in future.

    When Canada’s Food Guide was updated in 2019, a strong emphasis was placed on plant-based eating patterns for health and environmental sustainability. Dairy no longer has a stand alone segment, instead becoming a minor part of the ‘protein foods’ segment, alongside a statement to ‘choose protein foods that come from plants more often’.

    2. The guidance is “largely plant-based” and explicitly allows for “totally plant-based” eating patterns

    NZ ‘Choose a Balance of Healthy Food Every Day’
    Figure 1. Eating and Activity Guidelines image: ‘Choose a Balance of Healthy Food Every Day’

    While the flexible guidelines do allow for moderate amounts of animal-based foods (eggs, dairy, poultry, seafood) and small amounts of red meat, it’s now clear that fully plant-based eating patterns are covered by these guidelines too.

    Official recommendations are made for plant-forward changes to the eating practices of New Zealand adults, including limiting processed and red meat and increasing consumption of vegetables, fruit, legumes, nuts and seeds.

    Will Kiwis get on board with putting this advice into action? Research by Colmar Brunton shows over 1.5 million New Zealanders are already eating less meat and that interest in ‘flexitarianism’ is growing fast. [4]

    Despite this progress, there is much work to do to implement equitable policies that ensure all individuals and households have reliable access to healthy, affordable and sustainable food.

    Health professionals are making their voice heard on these key issues, including OraTaiao: New Zealand’s Health and Climate Council, an organisation representing over 700 health professionals, who have called for Government Ministers to establish a Tiriti-based food system that is equitable, improves health, and reduces climate pollution. At a regional level, health advocates in Nelson are urging their City Council to adopt C40 Good Food City policies to make it easier for everyone to access healthy, sustainable food.

    Table 1. Recommended dietary changes for New Zealand adults, from the 2020 Eating and Activity Guidelines for New Zealand Adults
    Table 1. Recommended dietary changes for New Zealand adults, from the 2020 Eating and Activity Guidelines for New Zealand Adults

    3. For those that choose to include meat in their diets, the recommended standard serving size for cooked lean meat has decreased to 65g

    The new serving size for lean meat applies to cuts including beef, lamb, pork and veal. Further guidance suggests adding legumes to meat dishes to help increase intake of plant foods.

    Serving sizes for cooked or canned beans, lentils, chickpeas, or split peas are generous at 1 cup (150g) and the serving size for tofu is 170g.

    4. The Guidelines include commentary on the “urgent need to promote diets that are healthy and have low environmental impacts”

    For the first time, the eating guidance acknowledges that the current food system is having a negative impact on the environment and the importance of promoting eating patterns that factor in environmental sustainability. This includes considering greenhouse gas emissions, fresh water quality and scarcity, land use, soil health and food waste when recommending eating patterns.

           “Globally, people are increasingly focusing on the way that food is produced and consumed, and the negative impacts the food system is having on the environment. There is an urgent need to promote diets that are healthy and have low environmental impacts.” 

    – 2020 Eating and Activity Guidelines for New Zealand Adults

    Doctors For Nutrition is hopeful that the New Zealand Ministry of Health will follow up this acknowledgement by swiftly reviewing their ‘Eating and Activity Statements’ to more clearly recommend plant-based sustainable eating patterns with reduced meat and dairy.

    The Ministry of Health acknowledges the government sector has more work to do to define what constitutes sustainable healthy diets in the New Zealand context. A recent study by researchers at Otago University found that a population shift towards healthy, low-waste plant-based diets could reduce diet-related climate emissions by up to 42%. [5]

    The study authors call for immediate action on policies to support this transition, stating “our findings reinforce the message from the recent EAT-Lancet Commission that the global evidence base is sufficiently strong to justify urgent action among policymakers, and that further postponement poses a great risk to society”. [6]

    5. Advice has been added for pregnant and breastfeeding women, including statement to “Encourage, support and promote breastfeeding”

    It is clear that nutrition is critical during the phases of pregnancy, breastfeeding and infancy and Doctors For Nutrition are pleased to see updates provide guidance for mothers, including advice for vegetarians and vegans. Pregnant and breastfeeding women who follow vegetarian or vegan diets are encouraged to discuss nutrition with their team of health professionals.

    The guidelines recommend exclusive breastfeeding until 6 months and continued breastfeeding until two years and beyond, listing a wide range of health benefits for both infant and mother.

           “Breast milk is the ideal food for babies because it provides important nutrition plus antibodies, enzymes, hormones and growth factors that cannot be replicated in commercially produced infant formula. [7] Improving breastfeeding rates in Aotearoa/New Zealand will directly contribute to achieving equity for Māori”

    – 2020 Eating and Activity Guidelines for New Zealand Adults

    Alongside the health benefits, the guidelines describe breastfeeding is also the most environmentally sustainable option for feeding a baby. [8]

    Importantly, it’s also acknowledged that the responsibility for breastfeeding does not lie solely on the mother and that everyone has a role to play in supporting breastfeeding, from partners, family, whānau, friends and health professionals to workplaces, early learning services, health facilities and the wider community. More information on breastfeeding and supporting breastfeeding can be found here.

    If you are seeking more information on plant-based pregnancies, retired paediatrican Dr Heleen Haitjema has some reassuring advice.

    6. The updated Guidelines acknowledge the wider determinants that influence people’s food and physical activity choices, and ultimately their health.

    Age, ethnicity and socioeconomic status shouldn’t be a barrier to healthy nutrition, which is a basic human right. Yet these factors unjustly have a significant influence on both diet and health outcomes. Data from the New Zealand Health Survey shows that while most children live in food secure households, almost one in five children (19%) in New Zealand lived in severely to moderately food-insecure households in 2015/16. [9]

    The Eating and Activity Guidelines acknowledge that there are a range of factors that influence dietary choices and many of these are not under individual control.

          “Many different factors contribute to people’s food and physical activity choices, and ultimately their health. These include social, cultural, economic, accessibility, practical and personal factors and it is important to acknowledge that many of them are not under people’s direct control. Differences in these underlying factors contribute significantly to the inequity in relation to diet, physical activity and health in New Zealand.”

    – 2020 Eating and Activity Guidelines for New Zealand Adults

    The Guidelines also refer to pae ora, the Government’s vision for Māori health. Pae ora is a holistic view of health that sees the elements of mauri ora (healthy individuals), whānau ora (healthy families) and wai ora (healthy environments) as interconnected and mutually reinforcing.

    To achieve food security for all whilst improving human health, health equity and environmental wellbeing, leaders must follow the lead of scientists in acknowledging food as an urgent priority. Doctors For Nutrition look forward to Government progress on policies and initiatives that foster pae ora and ensure that all whānau have reliable access to healthy, affordable sustainable kai.

    Summary

    While the main dietary recommendations were not reviewed and hence remain unchanged, Aotearoa New Zealand’s updated 2020 Eating and Activity Guidelines contain useful additions and may signal further positive changes to come.

    • There is more clarity that the guidelines describe an eating pattern that is ‘largely plant-based and the new ‘plate model’ helps to communicate this in visual form.
    • It’s pleasing to see that “totally plant-based” eating patterns are noted to fit within the flexible guidelines.
    • Serving size recommendations have been updated. For those that choose to eat meat, a standard serve of lean meat is just 65g.
    • Acknowledgement of the wider determinants of food choices gives hope that national policy action will follow to support everyone to have reliable, equitable access to a nutritious diet.
    • Endorsement of breastfeeding and its benefits, as well as the need for everyone to play a role in supporting breastfeeding, is a key new update.
    • Arguably the most significant addition is the inclusion of commentary on environmental sustainability and the “urgent need to promote diets that are healthy and have low environmental impacts”.

    This progress and increased clarity is pleasing to see. But in the face of health, equity and environmental crises, revision of the more substantial Eating and Activity Guidelines Statements is urgently needed.

    The Australian Government has recently announced that they will provide $2.5 million to the National Health and Medical Research Council to review the 2013 Australian Dietary Guidelines. During this review process, Doctors For Nutrition will call for health equity and environmental sustainability to be key factors in the updated guidance, and a strong emphasis on promoting whole food plant-based eating pattern.

    1. Ministry of Health. 2020. Eating and Activity Guidelines for New Zealand Adults: Updated 2020. Wellington: Ministry of Health. https://www.health.govt.nz/system/files/documents/publications/eating-activity-guidelines-new-zealand-adults-updated-2020-jul21.pdf
    2. Ministry of Health. 2020. Choose a Balance of Healthy Food Every Day PDF. Wellington: Ministry of Health. https://www.health.govt.nz/system/files/documents/publications/choose-balance-healthy-food-every-day-dec20.pdf
    3. Ministry of Health. 2019. Sustainability and the Health Sector: A guide to getting started. Wellington: Ministry of Health. https://www.health.govt.nz/system/files/documents/publications/sustainability-and-the-health-sector-30jul2019_1.pdf
    4. Food Frontier and Life Health Foods, 2019. Hungry for plant-based: New Zealand consumer insights. Colmar Brunton. https://www.foodfrontier.org/wp-content/uploads/2019/10/Hungry-For-Plant-Based-New-Zealand-Consumer-Insights-Oct-2019.pdf.
    5. Drew J, Cleghorn C, Macmillan A, Mizdrak A. Healthy and Climate-Friendly Eating Patterns in the New Zealand Context. Environ Health Perspect. 2020;128(1):17007. doi:10.1289/EHP5996
    6. Willett W, Rockström J, Loken B, et al. Food in the Anthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems. Lancet. 2019;393(10170):447-492. doi:10.1016/S0140-6736(18)31788-4
    7. Davidove M, Dorsey J. 2019. Breastfeeding: A Cornerstone of Healthy Sustainable Diets. Sustainability, 11(18), 4958. doi:10.3390/su11184958
    8. Victora, Cesar G et al. 2016. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. The Lancet, Volume 387, Issue 10017, 475 – 490. https://doi.org/10.1016/S0140-6736(15)01024-7
    9. Ministry of Health. 2019. Household Food Insecurity Among Children: New Zealand Health Survey: Summary of findings. Wellington: Ministry of Health. https://www.health.govt.nz/publication/household-food-insecurity-among-children-new-zealand-health-survey
  • Protein needs are easily met among plant-based eaters

    Protein needs are easily met among plant-based eaters

    New research led by Doctors For Nutrition’s lead dietitian for NSW, Joel Craddock (APD) of the University of Sydney, highlights protein quality of plant-based dietary patterns, and points to limitations in the commonly-used Digestible Indispensable Amino Acid Score, or ‘DIAAS’.

    In recent years, plant-based dietary patterns have been increasing in popularity, with a growing body of literature demonstrating significant associated health benefits, and for athletes, significant improvements in recovery and performance.

    Protein intake is often raised as a macronutrient of concern for people following plant-based dietary patterns, particularly athletes; however there is no evidence that, with a wide variety of food intake required, intakes are not achieved easily.

    Now, a new review has revealed limitations with the current Food and Agriculture Organisation-endorsed method for determining protein digestibility, the Digestible Indispensable Amino Acid Score (DIAAS).

    weights

    The DIAAS was principally designed for use in developing nations where protein intake and availability is scarce, however is now often used in Western nations. Emphasising protein quality in the West is typically unproductive, detracting from other truly prevalent nutritional shortcomings (such as fibre). Many of the limitations of the DIAAS are emphasised when used in groups following plant-based dietary patterns.

           Protein digestibility among plant-based eaters is underestimated by the current DIAAS methodology.

    The DIAAS limits the contribution to overall dietary protein intake made by fruits, vegetables, meat analogs, nuts and seeds. This can be quite significant given those following plant-based dietary patterns consume a much greater quantity when compared to omnivores. This difference can mean true protein digestibility is underestimated.

    In addition, assessment of protein digestibility is often made using single, uncooked protein isolates, whereas actual food is consumed cooked and with a variety of components, likely considerably increasing amino acid absorption.

    Another more generalised point the research team flags is that the DIAAS has been modelled in animals such as pigs and rats. There are similarities in digestion between these animals and humans, but there are also substantial differences. Protein in these fast-growing animals is generally required for tissue growth, whereas in humans it’s largely required for maintenance.

    These factors should be taken into account when assessing protein quality of overall plant-based dietary patterns, especially in individuals where a higher protein intake is recommended, such as in the case of athletes.

    The review, published in Current Nutrition Reports in January 2021, is available online at SpringerLink.

    Craddock, J.C., Genoni, A., Strutt, E.F. et al. Limitations with the Digestible Indispensable Amino Acid Score (DIAAS) with Special Attention to Plant-Based Diets: a Review. Curr Nutr Rep (2021). https://doi.org/10.1007/s13668-020-00348-8

  • DFN wins Change Maker of the Year Award!

    DFN wins Change Maker of the Year Award!

    Doctors For Nutrition are honoured to have won Change Maker of the year in the inaugural Nourish Vegan Awards, which celebrate the best in plant-based living, as voted by readers of Nourish Magazine.

    Back in May we were excited to learn that Doctors For Nutrition had been nominated for the 2020 Change Maker Award. We are now delighted to announce that we have won!

    Nourish is Australia’s leading plant-based magazine, and the awards are the first of their kind in Australia. Nominees across a range of categories were shortlisted by experts from the Nourish team, followed by voting by more than 17,000 members of the Nourish community.

    Speaking about the win, Doctors For Nutrition’s director and co-founder Dr Heleen Haitjema said:

    “It is a thrill for Doctors For Nutrition to have won this award. The articles we contribute to each issue are a fantastic opportunity for our medical and nutrition experts to share actionable evidence-based information on how to thrive on a plant-based diet.

    Noursih Change Maker of the Year
    Nourish Award

    “We are humbled to have received the most votes in the Change Maker category, and thank everyone who voted for us. It is a heartening testament to the growing interest in whole food plant-based nutrition within the community.

    “We take our hats off to the other nominees and finalists in our category, all of whom do inspiring work that helps show people both why and how to embrace plant-based living.”

    Doctors For Nutrition experts have contributed to every issue of Nourish Magazine since December 2018, reaching a wide audience throughout Australia, New Zealand and internationally. After each issue, DFN’s articles are republished with permission on our blog, where they continue to receive thousands of hits every month.

    Past articles by DFN expert contributors can be browsed in our articles section, and many are also published on the Nourish website.

  • DFN’s 2020 year in review and 2021 plans

    DFN’s 2020 year in review and 2021 plans

    2020 was an important year where, despite the challenges and disruptions that have touched every corner of the globe, we made some significant strides forward on our shared mission. Below we outline the key achievements of 2020 and preview the year ahead.

    Year in review 2020

    Despite the enormous collective challenges of 2020, we were privileged to be able to continue our work with focus and determination throughout the year, with our passionate community by our side at every step.

    Never before has the need for healthy plant-based diets been clearer, both to address many of the diet-related chronic diseases that make people the most vulnerable to severe COVID-19 outcomes and to reduce the risk of future emerging pathogens by scaling back animal agriculture.

    Alongside releasing our new nutrition and health toolkit for clinicians in 2020, we informed many thousands of people across the healthcare sector and wider community through educational events, website resources, policy submissions, mainstream and social media.

    We welcomed new team members, nurtured fruitful strategic partnerships, grew our reach, particularly among our target cohorts of health professionals, and saw encouraging growth in our movement and growing awareness of the multiple benefits of plant-based dietary shift, both locally and abroad.

    It was a particularly heartening moment when we learnt that DFN had won Nourish magazine’s Changemaker of the Year Award: an honour for our young charity and a testament to the growing appetite for an evidence-based ‘nutrition first’ approach to health.

    See further details of the year’s achievements in the snapshots below, and read on to discover what’s in store for 2021.

    Growing our reach

    In 2020 we:

    • Built our e-list to over 3,000 subscribers, and 12,500 followers across our social channels, representing significant growth since last year (40% and 25% respectively).
    • More than tripled our website’s reach in 2020, to 70,000 unique page views.
    • Published 26 articles on our blog, with a cumulative total of >15,000 views (>14,000 unique).
    • Launched our Australasian plant-based health professionals Facebook group, which now stands at over 100 active health-professional members.
    • Reached over 1,300 video viewers this year, who together have watched 207 hours of our educational content, primarily through our Food Vitals series: read more below.
    • Achieved media coverage across a range of outlets including our first TV news story announcing our new Plant-based nutrition and health resources for health professionals.
    • Continued to contribute articles on plant-based nutrition to every issue of Nourish magazine, whose readership is continuing to expand in our region and beyond.

    Educational events

    During 2020 we hosted, co-hosted and presented at a range of events, both online and in-person where possible, aimed at a variety of professional and lay audiences. Highlights:

    • The Heart of the Matter nutrition in healthcare symposium (Adelaide)
    • The Pleasure Trap: an evening with Dr Doug Lisle (Canberra)
    • South Pacific Society of Lifestyle Medicine Conference: Turning the Tide on NCDs (Fiji)
    • Our Food Vitals webinar series (online)
    • Adelaide Vegan Festival (Adelaide)
    • Lifestyle Medicine 2020 (online)

    Together, these events enabled us to reach a large number of delegates. Our Adelaide Symposium in February and Food Vitals webinar series together attracted almost 2000 registrants, of whom approximately 60% were healthcare professionals. We were also delighted to have the proceedings from the Adelaide symposium published in the International Journal of Disease Reversal and Prevention.

    Plant-based nutrition resources for health professionals

    The release of our guide for health professionals and accompanying resources was our milestone project of 2020. Developed with the expertise of our Advisory Council members, the toolkit of resources aims to educate practitioners on the fundamentals of a whole food plant-based eating pattern and its health benefits, and to assist them in promoting this dietary pattern to their patients.

    Impact since the toolkit launched in September 2020:

    Reach

    • >400 hard copy guides and toolkits distributed across AU and NZ.

    • >1800 digital downloads.

    • Web page aimed at health professionals viewed >3,400 times (>2,500 unique views).

    • The data we have from orders, downloads and evaluations indicate that around 70% of those who have accessed the resources are from the health sector.

    Demographics

    • The health professionals most frequently accessing the resources are doctors (around 30%) of whom a majority are GPs; dietitians, nutritionists and nurses are next (10% each), with the remainder being from other health professions.

    • Of the respondents working in the health sector, 93% are in roles where they provide patients with health advice.

    Feedback

    • 38% of all respondents to our evaluation questionnaire (n=84 as at 1/1/21) said the proportion of their diet coming from whole plant foods increased as a result of the resources, either significantly or slightly. This rises to 81% when those who already follow a WFPB diet are excluded.

    Among health professionals in patient-facing roles:

    • 92% said they will be using one or more DFN resources in their practice on an ongoing basis.
    • 95% strongly agree or agree that ‘the DFN resources have improved my confidence in discussing plant-based nutrition with patients’.
    • 74% agree that ‘the DFN resources improved my confidence in responding to patient queries about plant-based diets’.

    Food Vitals webinar series

    This webinar series was launched alongside our Plant-based nutrition and health materials as a further free educational offering to explore the role of diet in preventing and treating specific disease processes or optimising health in different population groups.

    Self-rated prior knowledge was an average of 6 on a scale of 1-10, therefore meeting a clear need to build on this knowledge.

    Impact

    • Around 90% of all respondents report being inspired to eat more whole plant foods, or to keep going with changes they have already made (around 30% and 60% respectively), with only 10% saying they would not be making changes.
    • 89% of health professionals in patients-facing roles report being more willing and confident to recommend WFPB nutrition within their practice (70% of these significantly; 30% slightly).

    All the webinar recordings can be accessed freely via our Food Vitals web page.

    Agenda 2021

    2021 holds ambitious plans for us as we seek to amplify our message about the benefits of healthy plant-based dietary patterns, with a focus on providing practical tools for health professionals and patients alike to help with their implementation.

    Projects in the pipeline include: more educational events, both online and in person; new free web resources for health professionals; a forthcoming collection of whole food plant-based recipes with accompanying meal plan; preparation for our 2022 Nutrition in Healthcare Conference and, excitingly, a new transition guide to support individuals in going plant-based for their health.

    We will also continue to engage with decision-makers across the spectrum of healthcare institutions to highlight the evidence for whole food plant based nutrition, with a key focus on the review of Australia’s national dietary guidelines.

    Alongside these projects we’ll be continuing to build our foundations, strengthen and grow alliances with other organisations, and seek impactful opportunities to gain traction for our messages about the science and practice of WFPB nutrition for health.

    From all of us at DFN, thank you for accompanying us on our mission. Here’s to a year ahead filled with action towards health and wellbeing through, both now and into the future.

    Click here if you’d like to get involved in supporting our work.

  • Planning your plant-based holiday feast

    Planning your plant-based holiday feast

    Whether you’re an old hand at plant-based eating, cooking for a plant-based family member or wanting to include more whole foods these holidays, we have the menu for you. This holiday feast will impress everyone!

    Christmas friends

    There is no doubt an important part of the Christmas season is enjoying good food with loved ones. This time of year is the perfect opportunity to show them how delicious plant-based eating can be.

    Doctors For Nutrition plant-based menu

    We have gathered some festive favourites from our expert Advisory Council. Each recipe is easy to prepare and the ingredients are readily available in local shops.

    The time for sharing

    A completely plant-based menu may raise some common questions from friends and family, such as ‘how do you get enough protein’? Take the time to be prepared, have a read over our mythbusters and information on health conditions so you are equipped with the facts to help you feel more confident when sharing your knowledge.

    Remember, this is the season for joy and laughter. When discussing a whole food plant-based diet focus on the many evidence-based positives such as lowering blood-pressure, maintaining a healthy weight, and preventing or even reversing chronic disease, rather than the negatives associated with eating animal-based products.

    Give the gift of health

    Are you looking for some healthful gift ideas to inspire your loved ones? You could consider:

    • Gifting them a whole food plant-based home-cooked meal on a day of their choice.
    • Compiling some of your whole food plant-based ‘go-to’ recipes in a scrapbook, complete with some of your own personal notes and pictures.
    • Offering them a whole food plant-based shopping experience. Take them to your local farmers markets, introduce them to your favourite seasonal fruit and veg and suggest how it could be used.
    • Dedicating a donation on behalf of your loved-one to Doctors For Nutrition, including a special message. We are a registered Australian charity with Deductible Gift Recipient status, so donations over $2 are tax deductible.
    Plant-based holiday feast menu and recipes

    Encouraging your friends and family to include even a few more high-quality, nutrient-dense plant-based foods in their weekly repertoire is a step in the right direction. You’ll definitely be on the ‘nice list’ this year!

    Make sure you tag us on Facebook and Instagram and hashtag #DoctorsForNutrition if you create any of our recipes; we’d love to see your photos!

    Download the recipes now.

  • DFN joins health organisations’ call for a healthy, regenerative and just future

    DFN joins health organisations’ call for a healthy, regenerative and just future

    Doctors For Nutrition is among 29 health organisations calling on the Australian government to take urgent policy action to address the climate emergency and protect health.

    DFN is part of a coalition of health groups led by the Climate and Health Alliance (CAHA) calling for a national climate change response to secure a healthy, regenerative and just future.

    Between August and October 2020, we took part in a roundtable series convened by the alliance. Our General Manager, Marion Meloni, joined thought leaders from multiple sectors to engage in a process of futures thinking for a health-centred post-COVID recovery.

    This work fed into CAHA’s updated policy roadmap entitled Healthy, Regenerative and Just: Our vision for a better future. Published on 16th November, the document sets out recommendations under eight areas of policy action to tackle the climate and biodiversity crisis, and deliver significant public health, economic and environmental benefits.

    These include measures to transform energy, transport, infrastructure and land use systems, including a new sustainable approach to food and agriculture to improve nutrition while safeguarding the environment, achieving cost-savings and reducing the risk of new communicable disease outbreaks.

    As CAHA’s Executive Director Fiona Armstrong said, “Right now, in this moment of disruption, we have the opportunity to re-shape our society for a better future.”

    Building on CAHA’s 2017 Climate, Health and Wellbeing Framework, the new vision now specifically advocates diets based on plants among its health-promoting and emission reducing initiatives. It also calls for research funding to establish the cost-savings of a plant-based dietary shift.

    The new policy roadmap was released along with an open letter to Prime Minister Scott Morrison, calling on him to implement the recommendations as a matter of urgency.

    CAHA 2020 Healthy Regenerative and Just cover
    CAHA signatories
    DFN is one of 29 signatories to the CAHA-led open letter to Prime Minister Scott Morrison

    Colleagues and friends who support this message are also warmly encouraged to email their local MP calling for action on climate and health using CAHA’s template letter, which can be adapted to maximise impact.

    Below, we set out some key facts and references about the health and climate benefits of whole food plant-based diets that our fellow plant-based health advocates may like to refer to when writing to their own MPs

    Whole food plant-based dietary shift for healthy people and planet

    • The pathway to a healthy future requires transitioning to a sustainable food system, starting now. Key to this is a shift to plant-based dietary patterns.
    • The world’s appetite for animal products, especially in high-income countries like Australia, has exceeded safe limits for greenhouse gas emissions, nutrient flows and biodiversity loss, and urgently needs to be scaled back.
    • Australia is also facing worsening rates of diet-related disease. The latest findings from the Global Burden of Disease study shows that we are living longer in poor health. Four of the five risk factors associated with the highest number of deaths and reduced healthy life years in Australia are conditions that a whole food plant-based diet has been proven to prevent and alleviate, including high blood pressure, high body-mass index, and high fasting plasma glucose.
    • Multiple studies confirm the benefits of replacing animal with plant protein: for example, overall mortality risk has been found to decrease by 10% for every 3% energy increment replacement of plant for animal protein.
    • As noted in the policy roadmap, “land-clearing, has been linked to the rise of zoonotic diseases, such as COVID-19.” Transforming our food system towards plant-based diets has a significant role to play in mitigating this, since the main driver of land-clearing both globally and in Australia is livestock production.

    Read more about DFN’s membership of the Climate and Health Alliance and our other advocacy work.

    Ask your MP to support a healthy, regenerative and just future via the template letter, and forward us a copy of your email!

    1. Clark M et al. Global food system emissions could preclude achieving the 1.5° and 2°C climate change targets. Science. 2020;370(6517):705-708. doi:10.1126/science.aba7357
    2. Willett W et al. Food in the Anthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems. Lancet. 2019;393(10170):447-492. doi:10.1016/S0140-6736(18)31788-4
    3. Henry et al 2019. The role of global dietary transitions for safeguarding biodiversity
    4. Song M et al. Association of animal and plant protein intake with all-cause and cause-specific mortality. JAMA Intern Med. October 1, 2016;176(10): 1453–1463. doi:10.1001/jamainternmed.2016.4182
    5. The Global Burden of Disease 2019. http://www.healthdata.org/gbd/2019
    6. United Nations Global Land Outlook, 2017. https://knowledge.unccd.int/glo/GLO_first_edition
  • Clear up carbohydrate confusion to improve diabetes outcomes

    Clear up carbohydrate confusion to improve diabetes outcomes

    Contrary to popular belief, it isn’t carbohydrates or sugar that cause insulin resistance. Dr Chau Tran explains.

    Diabetes is the fastest growing chronic condition in Australia. More than 1.2 million Australians are living with known diabetes, while many more remain undiagnosed. Prevalence of diabetes in Australia has tripled over the past 25 years and there is no sign of this slowing.

    World Diabetes Day (14 November) is an important awareness raising initiative, which this year focuses on ensuring all health professionals are equipped with the correct knowledge and understanding to support those living with diabetes.

    Dr Chau Tran, Endocrinologist and Doctors For Nutrition NSW Ambassadoc, said it isn’t all bad news. Type 2 diabetes, which accounts for 85 per cent of all cases, is largely preventable by maintaining a healthy lifestyle.

    “Evidence shows that type 2 diabetes can be prevented or delayed in up to 58 per cent of people by following a healthy eating plan, maintaining a healthy weight and being active. “Sounds simple right? Well, the confusion is rife, particularly when it comes to diet, especially carbohydrates,” Dr Tran said.

    “The underlying mechanism of type 2 diabetes is insulin resistance. Contrary to popular belief, it isn’t carbohydrates or sugar that cause insulin resistance. Insulin resistance is caused by a build-up of fat inside muscle and liver cells.

    “Studies have shown that high intake of saturated fat, as opposed to monounsaturated and polyunsaturated fats, causes insulin resistance, impairs insulin secretion and is toxic to the cells that produce insulin in the pancreas. Eating greater amounts of saturated fat is also linked to high blood cholesterol levels and an increased risk of heart disease,” he said.

    World Diabetes Day 2020

             Contrary to popular belief, it isn’t carbohydrates or sugar that cause insulin resistance. Insulin resistance is caused by a build-up of fat inside muscle and liver cells.

    – Endocrinologist and DFN Ambassadoc, Dr Chau Tran

    These fats are found in animal-based products such as meat, processed meats and dairy foods, many manufactured or packaged foods and a few plant-derived products like palm oil, coconut (flesh, oil, milk and cream) and some margarines.

    Dr Tran said: “The foods which should make up the bulk of a healthy diet are whole plant foods such as wholegrains, legumes, fruits and vegetables, which have been shown in studies to be beneficial in both preventing and managing diabetes.

    “People, with or without diabetes, should include an abundant diversity of these healthful foods in their diet. The major emphasis should be on reducing intake of foods high in saturated fat and avoiding processed sugars and highly refined carbohydrates.

    “A low carbohydrate diet may provide short-term improvements in body weight and blood glucose levels, but there is no strong evidence that a low carbohydrate diet will benefit your health, or even be safe, in the long-term. Healthy weight, excellent glucose control and better overall long-term health outcomes can be sustainably achieved on a diversified whole food plant-based diet,” he said.

    “Diabetes is one of the biggest challenges confronting Australia’s healthcare system. We must use events like World Diabetes Day to shine the spotlight on diabetes education, including nutrition education, to empower both patients and health professionals,” he said.

    Phone interviews with Endocrinologist Dr Chau Tran available on request.

    More information on whole food plant-based nutrition for type 2 diabetes can be found at doctorsfornutrition.org/type-2-diabetes.

  • COVID-19: a tipping point for a change in dietary behaviour

    COVID-19: a tipping point for a change in dietary behaviour

    COVID-19 has increased the focus on new opportunities to efficiently manage health outcomes in Australia and Aotearoa New Zealand. We must harness this unique moment in time to fight the pandemic and, more broadly, manage the rising tide of chronic disease.

    The pandemic has highlighted the importance of maintaining overall health; in Australia more than 70% of COVID deaths had pre-existing conditions. The value of a healthy, balanced diet, rich in whole foods is more crucial now than ever.

    Doctors For Nutrition, a registered health-promotion charity led by medical and dietetic professionals, has launched a toolkit to assist medical professionals in leveraging this opportunity.

    Dr Adrian Griscti, a rural GP for over 33 years and Doctors For Nutrition Advisory Council member, welcomes the launch of Doctors For Nutrition ‘Plant-based nutrition and health: A guide for health professionals’.

    “We’d all agree that diet is the number one decision you make for your health each day. Health practitioners play an important role in inspiring and supporting people to improve their diet and longer-term quality of life,” he said.

    12-page guide

    “Although our training often does not include nutrition education, patients still turn to us for advice about healthy eating.

    “Unfortunately many GPs simply don’t have enough time during appointments to provide their patients with nutrition advice. Also patients may not realise how vital simple dietary steps can be in improving their ailments. This guide helps to bridge that gap.

             Diet is the number one decision you make for your health each day.

    “In just 10 minutes, you’ll be informed about the benefits of shifting to a more whole food plant-based eating pattern, how it is linked to reduced rates of chronic disease and the range of positive outcomes for those who adopt these changes. It provides evidence-based guidance on healthy, sustainable eating patterns,” Dr Griscti said.

    The guide includes practical tools such as a quick diet survey to find easy areas for improvement. There are also useful support tools for patients such as a 2 page patient handout and dietitian-designed shopping list.

    Emma Strutt, Australian Practising Dietitian and Doctors For Nutrition Queensland Lead Dietitian, said the guide has been designed to be very user friendly.

    “Even health professionals with limited nutritional knowledge will feel comfortable using and sharing the tools with clients. For instance the shopping-list requires minimal explanation, making it an effective handout that won’t take up too much precious consultation time.

    “I believe plant-based nutrition has been one of the most powerful and underutilised interventions in healthcare. This way of eating centres on unprocessed fruits and vegetables, wholegrains and legumes.

             Plant-based nutrition has been one of the most powerful and underutilised interventions in healthcare.

    “Unfortunately this isn’t the last, or the most severe, pandemic we are likely to experience. By using this global crisis as an accelerator towards healthy, nutritious and sustainable diets, we will improve resilience to future pandemics, reduce rates of chronic disease and help address environmental crises.

    “Doctors For Nutrition is providing health professionals an extremely relevant and simple tool to do this,” Emma said.

    Free access is available to health professionals and the general public at here.

    Interview opportunities with Dr Adrian Griscti and APD Emma Strutt are available on request via phone or on location in Adelaide for Dr Griscti. An Advisory Council member in your area may also be available.

    Media contact via email

  • The Cancer Consensus

    The Cancer Consensus

    Is cancer part of a genetic lottery or can prevention really begin on our plate? Dr Renae Thomas explores the role of healthy whole food plant-based nutrition as part of the cancer prevention toolkit. Article first published in Nourish Magazine.

    When I was four years old, my father was diagnosed with metastatic cancer. This type of cancer is one that spreads from where it started in the body to other areas. Despite the fear, pain and suffering, thankfully, he has been cancer-free and healthy for 25 years since. I can now reflect on the positives that came out of this challenging time for our family, which ended up being my introduction to nutritional medicine.

    I will never forget many of the awful experiences my father went through: the seemingly endless vomiting, the weight loss, losing his hair, and the pallor of his skin. He became a shell of himself from total exhaustion. But equally, I remember more amusing events, such as his lips and hands stained orange from juicing (oh, the noise of that juicer day in, day out!), the playful arguments we had over dinners of pureed vegetables (again!), and – much to the horror of almost everyone at that time – our transition to a plant-based diet. We now cringe at some of the experimental foods we ate back then before veganism became mainstream (homemade, frozen, congealed tofu dessert anyone?).

    I will never know for sure whether my father’s lifestyle changes contributed to his cancer recovery, subsequent remission, and relapse prevention. However, he was always very conscious of basing his choices on the best scientific evidence available. The emerging research that continues to be published remains founded on the same principles – that preventing many of the chronic diseases that still plague us today has a strong relationship with nutrition.

    What are the chances?

    Cancer has become a deep-rooted fear for much of the world’s population. This is not without reason, given cancer is the second leading cause of death globally. Every year, approximately 17.5 million people receive a new diagnosis of cancer, a figure predicted to increase by about 70 percent by the year 2030.

    And, it’s not simply a lottery of genetics. The American Institute for Cancer Research estimates that, at most, 10 percent of cancers are secondary to genetic causes and that around 40 percent of cancer cases are preventable. This means about seven million cases of cancer could be prevented every year by optimising controllable cancer risk factors – including nutrition.

    Cauliflower

    It is estimated that one in every three cancers may be directly associated with sub-optimal dietary intake. What we eat represents a multiple-times-per-day environmental exposure that varies greatly between individuals. This is why dietary differences and their relationship to cancer have been extensively studied. Nutrition research has been broadly divided into two categories: dietary exposures related to increased cancer risk and dietary exposures that may have a protective effect against the development of cancer.

             One in every three cancers may be directly associated with sub-optimal dietary intake

    The bad news first

    Nutritional patterns and foods that appear to be related to an increased cancer risk have been identified by observing dietary patterns in populations, conducting experimental human and laboratory studies, and developing theories based on known biological processes. The International Agency for Research on Cancer, a division of the World Health Organization, identifies carcinogenic (cancer-causing) substances, including foods. Those with the strongest evidence are known as class-1, or ‘known’ carcinogens, and class-2, or ‘probable’ carcinogens.

    Combined with high-quality, peer- reviewed and published scientific research, much of the evidence we currently have suggests that diets high in animal products and low in plant-based foods increase the risk for cancer development, recurrence, and risk of dying from cancer. This evidence is consistent with results generated by numerous meta-analyses and systematic reviews as well as with large research studies of various populations worldwide. Here is what the research tells us about cancer and animal products.

      • High intakes of animal protein have been associated with increased risk of cancer mortality. Many of the known class-1 and class-2 carcinogens can become concentrated in animal products, especially those higher in fat. Consumption of these increases exposure to many environmental toxins and pollutants, including pesticides, herbicides, insecticides and heavy metals.
      • The World Cancer Research Fund states that both unprocessed and processed red meats can increase inflammation and cellular stress, and increase exposure to compounds such as nitrites. For example, every 50 grams of processed meat consumed per day (such as one hotdog or two slices of ham) is associated with an eight percent increase in the risk of dying from cancer.
      • ‘Meat-cooking-related mutagens’ (Heterocyclic Amines and Polycyclic Aromatic Hydrocarbons) are classed as known carcinogens. These are found in well-cooked meat, poultry and fish products, in pan drippings, and in any meat surface that is browned or chargrilled.
      • Eating seafood and white meats is also associated with increased exposure to many known carcinogens, including heavy metals, added hormones, antibiotics, and plastics.
      • High intakes of dietary fat and cholesterol are associated with increased risk for cancer. Animal products contribute to much of this in the standard Western diet. Just half an egg, one and a half serves of dairy, and 125 grams of meat, poultry or seafood per day exceeds the maximum recommended intake of dietary cholesterol.

    It’s also important to understand that some typically plant-based foods can also increase cancer risk. These include ultra-processed foods, alcohol, carbonated beverages, and excess refined carbohydrates.

             Much of the evidence suggests that diets high in animal products and low in plant-based foods increase the risk for cancer development, recurrence, and death

    Bag of produce

    So, what’s the good news?

    There are specific foods associated with decreased cancer risk, and the ones with the most consistent evidence are plant- derived. These include wholegrains, legumes, starchy vegetables and tubers, non-starchy vegetables, fruits, nuts, seeds, herbs, spices, and the foods subsequently made from all of these. There is extensive research that supports these foods for not just cancer prevention, but overall human health and diminished risks for both chronic and many acute disease processes.

    Let’s look at the benefits of plant foods according to the research.

    • Plant foods are high in substances known as phytochemicals, which have antioxidant properties that reduce stress on DNA and can protect cells from turning into cancer.
    • Plant foods are the only source of fibre in human diets, with numerous large studies providing evidence that higher fibre intake is associated with reduced risks for many types of cancer.
    • Wholegrains contain a vast variety of substances that can be protective against cancer formation, including fibre, vitamins and minerals, healthy plant chemicals, nutritious plant fats, and antioxidants. These can support cell, gene and hormonal functions, while reducing inflammation, cholesterol and cellular stress.
    • Fruits and vegetables similarly contain many health-promoting compounds, such as fibre and antioxidants, which help protect and detox DNA, cells and enzymes from stress and damage. Cruciferous vegetables (such as broccoli, cauliflower, cabbage and kale) are particularly powerful for cancer prevention.
    • The anti-cancer properties of nuts and seeds include many compounds that have been found to support healthy cell function and growth, and also suppress many cell functions that may lead to cancer. Nuts and seeds are also high in fibre, vitamins and minerals, anti- inflammatory substances, and healthy fats – many of which have been associated with a decreased cancer risk.
    • Numerous studies have documented the antioxidant, anti-inflammatory, and immune-boosting effects of herbs and spices. Research suggests they may enhance prevention and treatment of several cancers by supporting healthy cells and DNA, preventing the growth and spread of cancer cells, optimising hormones, and making cancers more responsive to treatments including radiotherapy and chemotherapy.

    What we eat matters

    The general consensus of all scientific research is that the processes of cancer and its treatment, remission and recurrence are highly complex, with significant interaction between human genes and environmental exposures. Excitingly, there is a growing body of high-quality evidence that suggests cancer risk reduction strategies can lie in the foods we eat each day. While there are no guarantees or absolutes, it does appear that for many (like my dad), a shift towards eating more plants and less animal products can have a protective effect against cancer development.

    What we eat can even enhance treatment response, raise the chances of full remission, and help avert the likelihood of cancer recurrence. This information is incredibly empowering for the global fight against cancer. But it gets even better as the science also shows eating more whole plant foods is protective against many other chronic diseases such as type 2 diabetes and cardiovascular disease. Much of this evidence exists on a spectrum, meaning it doesn’t have to be all or nothing. Every step in the right direction can be celebrated, because each healthy choice contributes towards improvements.

             What we eat can enhance treatment response, raise the chances of full remission, and help avert the likelihood of cancer recurrence

    As a traditionally educated medical doctor, I continue to advocate for appropriate medical evaluation of all cancer patients. Radiology and chemotherapy can be the best option for many people with a cancer diagnosis. However, it’s important to understand that the prevention, treatment, and risk-reduction for recurrence of cancer is multifactorial. There is no harm in at least reviewing the current evidence surrounding cancer and nutrition, and subsequently discussing with your doctor what may be beneficial for you to incorporate into your life. In no way do I suggest a plant-based diet is a substitute for medical care; there are no ‘miracle cures’. However, I am confident that the peer-reviewed scientific research that has fascinated me since childhood shows us nutrition plays a powerful role in health and disease prevention.

    It brings me great satisfaction to have a nutrition prescription in my tool kit to help support my patients. This information can be applied in an attainable and sustainable way for those with a diagnosis as much as it can by those who wish to minimise risk. In short, my research and experiences have taught me to eat more plants… and that Dad is always right!

    This article is republished with permission from nourishmagazine.com.au.

  • Recovering from Multiple Sclerosis with dietary and lifestyle changes

    Recovering from Multiple Sclerosis with dietary and lifestyle changes

    Dr Sam Gartland is a GP based in Ballina NSW. In 2008 he was diagnosed with relapsing-remitting MS. Through evidence-based lifestyle changes, including a whole food plant-based diet, Sam has achieved a full recovery, and is now an active advocate for these approaches to be at the centre of MS patient care.

    PinkGreen-Plain-Hashtag_ENG

    What is Multiple Sclerosis?

    MS is considered to be an autoimmune, degenerative and progressive disease of the central nervous system (brain and spinal cord). The resulting symptoms can manifest throughout the body, including motor impairments from weakness and spasms to paraplegia, optic neuritis, bladder and bowel dysfunction, as well as intense fatigue and cognitive decline over time.

    MS is the commonest disabling disease of young adults affecting 25,607 people in Australia – an increase of around 20% between 2010-2017.[1]

    It is a devastating disease with a large number (up to 58%) unable to retain employment following diagnosis [2] and 75% ceasing work within 10 years of diagnosis.[3]

    Nurture before nature

    Studies of identical twins have demonstrated that genes contribute 25% to the risk of developing MS. [4] The stronger the genetic background risk the earlier the onset of MS. [5] Of importance to PwMS (People with MS) and their treating doctors is the finding that genetics has little role to play in disease progression and outcomes in MS.

    • The largest genetic study of PwMS, The International MS Genetics Consortium study, looked at the genome of 9772 PwMS and found, “no evidence for genetic associations with clinical course, severity of disease or month of birth, and no evidence of interaction with gender…”[6]
    • The largest meta-analysis of established MS genetic risk variants and disease severity found no effect of genes on clinical outcomes over the longer term (10 + years).[7]
    • A smaller (n=127) study did show an up to 30% effect of genes on disease progression in the first 5 years of the disease.[8]
    Multiple Sclerosis nerve - healthy v damaged myelin
    Healthy versus damaged nerve myelin

    It is clear that environmental and lifestyle factors are the main drivers of MS. Fortunately there is a lot known about these risk factors. The known environmental and lifestyle factors include:

    • A Western diet high in saturated fats and low in Omega 3s [9, 10]
    • Cow’s milk exposure [11, 12]
    • Viral infections (EBV, HHV) [13]
    • Low Vitamin D and sunlight exposure [14, 15]
    • Smoking [16, 17, 18]
    • Stress [19, 20, 21, 22]
    • Shift work [23, 24, 25]

    Therefore, just as with other modern chronic conditions, any comprehensive treatment program has to address these modifiable risk factors.

             It is clear that environmental and lifestyle factors are the main drivers of MS.

    The lifestyle prescription

    In 1948 the Neurologist Prof Roy Swank recognised the association between animal fat consumption and the incidence of MS. This prompted him to set up a remarkable 34 year study that investigated the effect of a low saturated fat diet in MS. Publishing his work in The Lancet in 1990 he demonstrated that those that adhered to this diet (regardless of disability at the beginning of this study) stabilised the disease with little or no progression of disability and survived for the duration of the study. Those that didn’t keep to the dietary changes significantly deteriorated with the majority being dead at the end of the study.[26, 27]

    Little was made of this study until the work of Professor George Jelinek, a Professor in Emergency Medicine. He developed MS himself and went back through the literature to develop a comprehensive lifestyle intervention program to manage MS. In 1999 he developed the “Overcoming MS Program” (OMS).[28]

    This approach advocates:

    • Adopting a plant-based diet that avoids dairy and altered fats (allowing seafood if desired)
    • Supplementing with flaxseed
    • Maintaining a Vitamin D level at 150-225nmol/L
    • Meditation
    • Regular exercise
    • Smoking cessation

    Those following this program demonstrate significant improvements within 1 year: improved mental health 12%, physical health 19%, and overall quality of life 11%. [29] These changes are sustained and increase over a 5-year period with improvements in: mental health 23%, physical health 18%, and quality of life 20%.[30]

    Lifetsyle changes

    Since this time there has been an abundance of data supporting the steps that Professor Jelinek has advocated. For example, the HOLISM study surveyed over 2500 PwMS in 57 countries and found that those following the steps of the OMS program had better health outcomes: Less disability, fewer relapses[31], better quality of life[32], and less incidence of depression[33] and fatigue.[34]

    Exercise has also been well documented to improve quality of life and function[35] and immunological markers in PwMS.[36] A new RCT showed that resistance training can have a neuro-regenerative effect with increases in cortical thickness.[37]

    The nutrition connection

    While more dietary studies are needed, the existing evidence has shown a consistent link between saturated animal fat intake and MS.[38-43] Observational studies have additionally found that PwMS had lower antioxidant blood levels than people without MS, indicating that eating a plant-based diet high in antioxidants may also be protective against MS.[44]

    So far, there has been one pilot RCT of a plant-based diet in PwMS that ran for 1 year. This did not demonstrate significant improvements on disease activity or MRI, which aligns with Swank’s findings that it takes up to 5 years to achieve disease stability. However, patients in the pilot did experience improvements in fatigue, BMI and metabolic biomarkers, which represents a significant improvement in quality of life.[45]

    Further long-term RCTs are needed to develop our understanding of the diet/MS connection, but what we know so far strongly indicates that whole food plant-based diets are effective for both prevention and mitigation of MS.

    Having experienced my own recovery journey, I am committed to advocating for healthy diet and lifestyle: this includes updating medical training and putting lifestyle and diet research at the forefront of MS research.

             Healthy diet and lifestyle must be at the forefront of our approach to preventing and treating MS, with whole food plant-based nutrition as a central pillar.

    The take-home message

    The understanding of the causes and (non-drug) treatment interventions for MS has increased greatly. PwMS and their treating health professionals now have a large and congruent evidence base on which to plan their treatment. The tertiary prevention of MS must include comprehensive lifestyle changes to optimise outcomes. This has finally been recognised by Neurologists. The January 2018 editorial of the Journal Neurology declared:

    “encouraging a healthy lifestyle (healthy eating, a normal weight, routine physical activity or exercise, and avoiding smoking) should be a fundamental message we give to all newly diagnosed patients with MS.”[46]

    1. MS Research Australia (2017). Health Economic Impact of Multiple Sclerosis in Australia in 2017.
    2. van der Hiele K, van Gorp D, Ruimschotel R, Kamminga N, Visser L, Middelkoop H. Work Participation and Executive Abilities in Patients with Relapsing-Remitting Multiple Sclerosis. PloS one 2015; 10(6): e0129228-e.
    3. Coyne KS, Boscoe AN, Currie BM, Landrian AS, Wandstrat TL. Understanding Drivers of Employment Changes in a Multiple Sclerosis Population. Int J MS Care 2015; 17(5): 245-52.
    4. Parnell GP, Booth DR. The Multiple Sclerosis (MS) Genetic Risk Factors Indicate both Acquired and Innate Immune Cell Subsets Contribute to MS Pathogenesis and Identify Novel Therapeutic Opportunities. Front Immunol 2017; 8: 425-.
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    Dr Sam Gartland

    About the author

    Dr Sam Gartland is a GP based at The Clinic, East Ballina. He was diagnosed with relapsing-remitting MS in 2008. In January 2009 he attended an Overcoming MS program run by Professor George Jelinek at the Gawler foundation. By following this program he managed to return to work full time and has remained relapse free. The lesions on his MRI scan resolved and he now feels in the best shape of his life. His recovery is in line with the published results of the OMS program. His story and others can be found in the book, Recovering from MS – real life stories of hope and inspiration. Sam has been involved with Doctors For Nutrition since attending the inaugural Nutrition in Healthcare Conference in 2019. Connect with Sam via his website drsamgartland.com.

  • Red and processed meat: fact and fiction

    Red and processed meat: fact and fiction

    There was a collective sigh of relief from the bulk of the population when a re-examination of scientific studies recently concluded people could continue to eat red and processed meat.

    Evidence

    The fact that the review did not find eating red or processed meat was safe did not seem to matter. The widely-reported message was that, although the science showed eating meat was harmful, it was only a little bit harmful, and not enough for people to worry about.

    The article which captured the world’s attention contradicts well-established advice to cut down on red and processed meat, which for a long time has been associated with cardiovascular disease, several cancers, and other chronic lifestyle diseases such as type 2 diabetes.

    A 14-member team from the Annals of Internal Science – a journal run by the American College of Physicians – reviewed past studies that fit their criteria. One of the reviews looked at people’s attitudes about eating meat. Predictably, it found that omnivores are reluctant to give it up, even if they know their health is at risk. These results were factored into the guidelines, essentially saying that since people don’t want to give up meat, they don’t need to.

    Interestingly, three of the panel members dissented from the conclusions and advice from this latest review.

    Industry ties

    Everyone involved with the research signed a disclosure form that they did not have any conflicts of interest to report during the past three years, a standard set by the International Committee of Medical Journal Editors.

    The New York Times has since reported that Bradley Johnston, an epidemiologist at Dalhousie University in Canada, who co-led the endeavour behind the new recommendations, has previously received funding from the International Life Sciences Institute (ISLI) in 2016 for a study which argued that warnings to cut sugar were based on weak evidence. As the ILSI study fell just outside the 3 year timeline, Johnston did not make this disclosure.

    ISLI is a corporate-funded nonprofit organisation claiming to conduct “science for the public good.” However, investigations by academics, journalists and public interest researchers show that it is a lobby group that protects the interests of the food industry, not public health.

    A report from the World Health Organisation in 2000 found that ILSI was used by certain tobacco companies to thwart tobacco control policies.

    Getting clear on the facts

    Many organisations have been critical of the latest recommendations from the Annals of Internal Medicine and have expressed grave concerns about the potential for damage to public understanding, and public health.

    The Physicians Committee for Responsible Medicine called the results misrepresentations and said that there’s abundant evidence linking red and processed meat to heart disease and increased risk of premature death. It found the findings a major disservice to public health, and called on the journal to issue a public retraction.

    The American Heart Association called the conclusions of the study questionable.

    Dr. Frank Hu, the chair of the nutrition department at the Harvard T.H. Chan School of Public Health, said he was stunned when he realised that Dr Johnston was both the leader of the meat study and the same researcher who led the industry-funded review that attacked guidelines advising people to eat less sugar. He notes that the tool he employed in his meat and sugar studies could be misused to discredit all sorts of well-established public health warnings, like the link between secondhand smoke and heart disease, air pollution and health problems, physical inactivity and chronic disease, and trans fats and heart disease.

    Summary

    Annals cliff notes

    In detail

    Excellent rebuttals have been provided by several members of our Advisory Council:

    We also commend the commentary from the following other experts and organisations:

    There is understandable confusion among the public and healthcare professionals alike, given the daily deluge of confusing and contradictory reports about diet. To help address this, DFN continues to develop evidence based information for healthcare professionals and the general public.

  • Type 2 diabetes and nutrition

    Type 2 diabetes and nutrition

    The relationship between diabetes and nutrition is often oversimplified and equated with an excess of ‘sugar’ or glucose in the diet, by clinicians and laypeople alike. Unfortunately, this widely held belief and the resulting dietary choices are contributing to the current epidemic of type 2 diabetes and poor outcomes for patients with diabetes.

    Certainly, both types of diabetes are defined by an excess of glucose in the blood. However, the amount of glucose in our blood depends mostly on our body’s ability to use the glucose we consume, with availability and sensitivity to insulin being the critical factor. Excitingly, by revising our own and our patients’ nutritional approach to diabetes, we can ‘reverse’ most cases of type 2 diabetes, and help those with type 1 diabetes dramatically reduce their insulin use and risk of complications and chronic disease.

    It is clear that the Western diet plays a key role in our current epidemic of type 2 diabetes.

    This diet is characterised by high fat consumption, high protein consumption (both largely from animal sources), and a moderate intake of carbohydrate (largely from refined sources, especially sugar and flour). For example, the average diet in Australia and New Zealand is approximately 32% energy from fat, 17% protein, and 46% carbohydrate. As we see populations that have traditionally consumed a diet considerably higher in carbohydrate, but lower in fat and protein move towards the Western dietary pattern, a dramatic corresponding increase in type 2 diabetes occurs.

    In China in 1980 less than 1% of the population had type 2 diabetes. At this stage, the Chinese diet had just begun to shift towards Westernisation. In 1970 for example, the Chinese diet was approximately 8% energy from fat, 10% protein, and 83% carbohydrate. By 2011, this had ‘Westernised’ to 32% fat, 13% protein, and 54% carbohydrate. It has been estimated that 11.6% of the Chinese population now have diabetes and 50.1% have prediabetes.

    Across the Pacific in the United States, the Native American Pima people of Arizona are thought to have perhaps the highest prevalence of type 2 diabetes in the world: about 50% of all Pima over the age of 35 are affected. Their diet is similar in both total energy and macronutrient composition to that of the general population in the US, with approximately 35% energy from fat, 15% protein, and 47% carbohydrate. Intriguingly, the Pima of Mexico, who are very closely related genetically, have a substantially lower prevalence of type 2 diabetes at 13.4%. Their diet is more traditional and ‘…remarkable for the low percentage of calories derived from fat…’ at approximately 26% fat, 11% protein, and 62% carbohydrate.

             While Westernisation of diet is also accompanied by increased food availability and substantially reduced physical activity, increases in rates of type 2 diabetes trend with increased fat intake, not an increased carbohydrate intake.

    While Westernisation of diet is also accompanied by increased food availability and substantially reduced physical activity, increases in rates of type 2 diabetes trend with increased fat intake, not an increased carbohydrate intake. Even refined sugar, often blamed for the diabetes epidemic, seems to have little role in its aetiology besides as a source of additional energy. Furthermore, the idea that refined sugar is hazardous for glycemic control in people with type 2 diabetes is not supported by research. In one study, glucose control actually improved on a higher sugar diet, where participants were supplemented with 60g of fructose per day in place of complex carbohydrates, despite no changes in body weight10! Of course, there are plenty of other reasons why we should all minimise or avoid refined sugar, but at the very least from the above examples we can conclude it is possible to eat a diet that is very high in carbohydrate, perhaps even refined carbohydrate, compared to current diets in Australia and New Zealand without developing type 2 diabetes. If the high fat intake of the Western diet is instead implicated, why might this be the case?

    It is now well known that body mass index and type 2 diabetes are closely related.

    The risk essentially increases linearly as BMI increases, and weight gain after age 18 is a major determinant of risk. While it is often assumed that refined sugar and carbohydrate are the major contributors to excess energy intake in Western society, again this idea is not supported by research. A recent UK study found that compared to those with normal BMI, obese participants had a 14.6%, 13.8%, 9.5% and 4.7% higher intake from fat, protein, starch and sugar, respectively. In fact, it was concluded that because the proportion of fat in the diet, rather than sugar, was higher among overweight and obese individuals, focusing public health messages on sugar may mislead on the need to reduce fat and overall energy consumption.

    Unsurprisingly then, type 2 diabetes can be effectively treated by weight loss.

    A recent and exciting finding was that intensive weight management in a primary care setting resulted in remission of diabetes in 46% of participants. Remission varied with the weight loss achieved, increasing from 7% of participants who maintained 0-5kg of weight loss to 86% of those who lost 15kg or more. Unfortunately, the intervention was indeed ‘intensive’, replacing all food with a mere 825-853kcal a day of a high carbohydrate, low fat formula for between 3-5 months…