What is the best diet for health?

26/7/21: Food Vitals Webinar • The best diet for health: evidence and practice • 26 July 2021. Featuring a wonderful talk from Dr Shireen Kassam as the main presenter. I have a role in the Q&A from 54:40.

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Transcript of the Interview

everybody and welcome to this food vitals webinar hosted by doctors for nutrition

i can see everybody’s just joining us now and the numbers are climbing up towards 100 people i’ll just

wait a few more seconds while everyone gets access

so i’m joining you from fockatoo nelson and we have got some pretty wild weather happening outside so my

apologies in advance if you hear any thunder um or if the internet drops out briefly but hopefully

i will be able to stay with you for most of this time um so firstly i would like to

respectfully acknowledge the traditional owners of the whakatuu land from which i meet with you this evening

ngati i pay my respect to their elders past

and present and to all indigenous people here today my name is hannah o’malley and i will be

your host tonight and as i said i’m joining you from nelson altera

i’m the events in education lead at doctors for nutrition as well as being a practicing pharmacist

and certified lifestyle medicine practitioner doctors for nutrition is an australian

health promotion charity working for a future where whole food plant-based nutrition is widely used in disease prevention

management and even reversal our food vitals webinars are one way that we provide

free educational resources to health professionals across australia and new zealand so the

topic of today’s webinar is the best diet for health and we’re delighted to

have the impressive dr shireen kasam joining us from the uk but before i introduce shireen in more

detail i’ve got a few tips to help you get the most out of this experience

and so firstly we welcome you to open the chat box via the zoom toolbar and introduce

yourself and we’d love to know where you’re joining us from maybe even what the weather’s like where

you are we can share stories about what sorts of restrictions or otherwise we’re under

one of the speakers who’s joining us today is sadly in lockdown in melbourne and also

we’d like to learn what you’re hoping to learn this evening and so when you send your messages um

please select the option of when you click to if you select all panelists and

attendees because we often get people just sending messages to all panelists and then not everybody can

see it so i can see a whole lot of messages now um coming through and about half of those are just coming

to the panelists so if you could just select now to change that from all

panelists to include the attendees then we can all see who’s here which would be wonderful

um great so for the best view you can click click on speaker view

in the top right hand of the zoom window and that will allow you to see our presenters

clearly and tonight dr kasam will be answering your questions live

so to submit a question you can click the q a option at the bottom of your screen

and type in your question and we’ll aim to get through as many of these as possible

i now have the pleasure of introducing our speaker dr shireen kasam dr shireen

kasam is a consultant hematologist and honorary senior lecturer at king’s

college hospital in london she is also passionate about promoting plant-based nutrition

for the prevention and reversal of chronic diseases and for optimizing health after treatment of cancer she

qualified as a medical doctor in 2000 initially training in general medicine

and gaining membership of the royal college of physicians she then specialised in hematology and

achieved fellowship of the royal college of pathologists during training she took time out to

undertake a phd sharing discovered the power of nutrition for the prevention and

treatment of disease in 2013 and has since been following a whole food plant-based diet

she has immersed herself in the science of nutrition and health and completed the e-cornell certification and plant-based nutrition

in 2019 she became certified as a lifestyle medicine physician by the international board of lifestyle

medicine shireen founded plant-based health professionals uk

in 2017 in order to bring the evidence-based education on plant-based nutrition to

the uk since then she has been appointed as a visiting professor of plant-based

nutrition at winchester university where she has developed and facilitates the uk’s only

university-based cpd accredited course on plant-based nutrition for healthcare professionals

and that’s a great course to check out if you’re looking at further study in this area in january

2021 shireen co-founded and launched the uk’s first cqc registered online multi-disciplinary

plant-based lifestyle medicine healthcare service called plant-based health online

well that’s quite an impressive intro isn’t it um so on behalf of doctors for nutrition

and our viewers i think we’re up to about we’re up to 175 people here joining us live and if

you haven’t said where you’re joining us from it would be great to hear from you

in the box looks like we’ve had about 65 people um share with us so far um so welcome

shireen i invite you to join us now thank you so much for taking the time to

Dr Shireen Kassam’s Presentation

join us this morning is it about 9 30 am where you are that’s right yeah thanks hannah it’s lovely to be

here and i’m a great admirer of the offense work and really we are a sister organization we’ve been

in touch ever since the inception of both organizations so it’s really uh an honor to be here today

um so i will just share my slides yeah absolutely and we really enjoy

watching everything that you’re doing with plant-based health professionals in the uk thank you

so um i came up with a title with hannah about the best diet for health so let’s hope

i can persuade you as to how we should be eating for our health which is a bit broader than just

um our medical and physical and mental well-being um you’ve seen my introduction already i

guess it’s always good to declare up front um your diet pattern and i have been vegan for nearly eight years now

um so what i hope to cover today um is the current state of our health and i

will delve a bit more into the health of australians and new zealand um residents um what a healthy diet

is for prevention and treatment of chronic disease the international consensus and then thinking a bit more about a one

health approach so i’m going to start and end with some family stories um that took place during

lockdown just to hopefully highlight what’s achievable this is my father he was 77 in september

2020 during our second lockdown i think it was he was um overweight had high triglycerides

and at a routine check was told he was pre-diabetic and given some instructions

to remove carbohydrates from his diet of note he has the unfortunately the

conventional south asian risk factors he’d had his first heart attack at the age of 52

he was hypertensive high cholesterol he’d also had a whipple’s procedure back in 2004

due to presumed pancreatic cancer so it’s quite remarkable that it took 16 years for him to become

pre-diabetic um and of course i wasn’t ready to let him take on that

diagnosis without attempting to reverse the condition i have to say i was fairly pessimistic

with him given the fact that he only has um two-thirds of his pancreas um but

um he was referred to a colleague of mine rahini bajekal who may be on this call a lifestyle medicine practitioner

and a nutritionist and she helped him adopt a healthy plant-based diet that was culturally appropriate

institute daily walks and resistance exercise she did try her best for sleep and stress

management but my dad is a workaholic um but thankfully seven months later he’s

now um a healthier bmi although for south asians we should be aiming for less than

23 and his triglycerides have returned to normal and most most importantly he

no longer meets criteria for being um pre-diabetic and that’s despite only having a portion of his pancreas

left so i think we need to make the connection um with our food system

because our food system as a whole is currently at the center of a number of health crises

and it’s not just human health it’s climate health biodiversity loss loss of soil health

and of course our human health and i like to talk about a fifth crisis which is one of

ethics because our food system really is harming humans and animals and it’s keeping almost a billion people

hungry and the health problem in australia and new zealand you can see here these

are who data they’re really really matching as with

other high income countries the majority of our deaths and chronic illnesses are due to non-communicable diseases

and for both countries cardiovascular disease and cancer account for nearly 60 of all deaths

and as with the uk and the us about 10 of deaths are premature each year less

than the age of 70 years and we’re living with chronic illness more and more one in two australians

have at least one chronic illness with three out of five over the age of 65 having more than one

chronic illness we’re losing millions of years in premature death or living with illness

and billions are being spent on medication and almost 500 dollars per person per year

this top spend in australia is on cardiovascular conditions as you might imagine hypertension and high cholesterol

new zealand i was surprised to find out is actually um one of the most overweight and obese and

countries in the world actually um and one in four people have more than one chronic condition

and the prevalence of type two diabetes is rapidly rising

and it’s not just good enough to talk about life expectancy we have to talk about healthy life expectancy

and although in australia new zealand people live a long life approximately 10 to 12 years of life at

the end of life is spent in ill health so the health span is getting shorter um and i at this

point i do want to acknowledge that there are socioeconomic determinants of health

that i’m not really going to cover here but we can’t overlook but both healthy diet and lifestyle go

hand in hand with socioeconomic status and we need to address both together so when we delve in

more deeply at the risk factors that are leading to death and disability i’d like to put to you that the majority are related to our

unhealthy diet essentially even though it doesn’t directly say this but overweight and obesity high blood

pressure high glucose alcohol use high cholesterol these are fundamentally

related to our unhealthy diet but also some other lifestyle habits

um and these are neck and neck with um australian new zealand with the top risk factors

when we delve a bit more deeply into diets globally this publication from

2019 analyzed dietary risk factors from 195 countries around the world and what the

data showed that one in five deaths globally are caused by an unhealthy diet

so that’s 11 million deaths a year um and there are shared dietary risks the

reason why our diets are unhealthier because they’re too high in animal foods and too low in whole plant foods

and often it’s reliant on ultra processed foods which is a reflection here of the high

sodium being the top dietary risk factors so diets high and sodium are generally those

that rely on prepared and processed foods and below this the next four risk factors are because

we’re not eating enough whole plant foods and globally these unhealthy diets are

leading to deaths from cardiovascular disease cancer and type 2 diabetes

so what are australians eating this is your current food guide that i know is under review but essentially 35 of energy is coming

from these foods here which are called discretionary foods the pastries the cakes sugar sweetened

beverages added sugar is contributing 99 of all energy intake

and your intakes of saturated fat trans fat and salt um a reflection of animal foods and

processed foods is too high people are not eating enough vegetables and fruits and it’s interesting that um

vegetables and legumes are lumped together actually in your food guide to some extent

and the median intake of fruit is just 1.5 servings per day and red and processed meat consumption

is much higher than recommended i’m afraid not doing that much better in

new zealand really there was a study quite recently that i’ve i’ve highlighted

um here showing that ultra processed foods make up 50 of calories in the diet of children by

the age of 12 months which is fairly shocking actually and the majority of children are not

consuming enough fruits and vegetables salt consumption is too high fiber consumption is half of that that’s

recommended and again red and processed meat consumption is is too high

and the vulnerability of um the populations around the world have

been highlighted by the covert 19 pandemic and i know your experience is very different from ours in the uk and

in the u.s but when we’ve looked at those who are suffering the worst with the pandemic virus it’s those with underlying health

conditions very early on in the pandemic a paper was published in the uk showing that more than 90 percent of

people who died in their first wave had at least one underlying health condition and this publication from the u.s

looked at nearly a million admissions to hospital and they found that um with admissions

to co for covert 19 that 60 percent of the admissions were ultimately attributable to hypertension

heart failure obesity and type 2 diabetes and that’s what was leading to the adverse outcomes

from covert 19 and i would like to put to you that these are all preventable conditions so what’s the real solution i know that

you all know this um we’ve got a new um specialty now which is sad really to

some extent because it is all common sense but lifestyle medicine really does address the root cause of a number of

our chronic illnesses and there’s six pillars of lifestyle medicine for me nutrition is the most important

and i’ll concentrate on that today but physical activity avoiding toxins adequate stress

management restorative sleep and healthy relationships all make up the practice of lifestyle medicine

that is thought to eliminate about 80 percent of the chronic illnesses we’re suffering with

and when you delve in deeply to the position statement of the american college of lifestyle medicine the founding organization

the dietary advice is an eating plan that’s predominantly based on a variety of minimally

processed fruits vegetables whole grains legumes nuts and seeds are what we otherwise call a whole food

plant-based diet so i think before we delve into some of the data on a plant-based diet

we do need to consider the key elements of a healthy diet as i say it’s not just about our individual health

of course we expect um our food system to produce healthy and nutritious food

but our food system needs to be sustainable for the producer society and the planet needs to be affordable and accessible to

all such that you know healthy food should be considered a human right it needs to be culturally culturally

adaptable and appropriate and relevant and it needs to be kind and compassionate and i’d like to put to you

that currently our food system does not meet any of these five important considerations but perhaps my

work is done um as you know and the us news and world report every january brings out a list of the

best diets and some of our favorite people like michael clapper and david katz are on the panel of

judges and they put together a list of the best diet and for the last four years the mediterranean diet has come

out on top but i’d like to put to you that if you told the half a billion overweight people in china

or the 77 million diabetics in india that we know what’s best for you eat the

mediterranean diet i don’t think you would get a very good response so it’s a very sort of eurocentric approach

to diet advice but let’s have a look at the diet and from the mediterranean it’s a huge

region of course um and at the base of the pyramid here it’s interesting to see

that um it’s enjoying meals with others and also being physically active that is considered

really hugely important um but the bulk of the pyramid comes from whole plant foods fruits vegetables

whole grains olive oil beans nuts seeds herbs and spices and then the rest of the food from

animal sources is eaten less frequency so frequently so fish poultry eggs and

dairy and then meet um right at the top

but when you look at the data from a country like greece for example so these are data from the greek epic prospective

cohort study a large region in the mediterranean and you analyze which foods

are contributing to health in the mediterranean diet this particular study

looked at mortality and the individual components of the mediterranean diet and what you

can see is to the left of this vertical line are all the foods that contribute

to improved mortality whereas the bars to the right of the midline are

those that don’t impact mortality or adversely impact mortality and all the foods to

the left are the whole plant foods vegetables legumes fruits cereals and mono and

polyunsaturated fats whereas everything else in the mediterranean diet doesn’t seem to have an impact and things like fish and dairy

are probably neutral but obviously red meat and high levels of alcohol have an

adverse impact but the study that really put the mediterranean diet on the map

was the predimed study and i know you will have all heard of this it was one of the largest randomized

nutrition studies nearly 8 000 participants multi-center and it had three arms um supposed

low-fat arm but you have to understand that that control arm never reached a low-fat diet and then two versions of a mediterranean

diet one with extra virgin olive oil 50 mls a day and one with a portion of nuts 30 grams a day

and the study was stopped early after 4.8 years because they had reached their primary end point

which was combined cardiovascular events and they showed a significant reduction

with the mediterranean diet in a number of cardiovascular disease events but when you look at the data

it’s mainly because in the nut group stroke events had been reduced by about 40

percent but what you have to realize that was there was no improvement in mortality people continued to die and have cardiovascular

disease causing death so i’m just going to take a little interlude here and just talk to you

about another way of looking at dietary data so researchers back in 2014 developed

what we now know as the plant-based dietary index because um populations

don’t consistently follow a healthy plant-based diet we can look at the

food frequency data collected from prospective cohort studies by looking at the individual foods and

putting them together into a plant-based dietary score and in this scoring system

healthy plant-based foods are given a positive mark whereas unhealthy plant-based foods

are given a negative mark and all animal foods even fish and dairy and eggs are given a negative mark as

well and the first time this this type of analysis was used was to re-analyze data

from the pretty med um study and you can see here that those individuals within the

predimed study that were most adherent so four or five um in the fourth or fifth quintiles

most adherent to a healthy plant-based diet had actually a reduced risk of death

which was not shown in the overall study and the researchers say in their conclusions we provide evidence

to support that the simple advice to increase the consumption of plant derived foods with compensatory reductions

in the consumption of foods from animals confers a survival advantage in older subjects at high risk of

cardiovascular disease so again summarizing that the main advantages of the mediterranean diet of

the healthy plant foods and so researchers from israel have tried to improve upon the mediterranean

diet and they’ve produced this diet called the green mediterranean diet and you can guess from its name um what

they did they increased the amount of plant foods and they reduced the amount of animal foods and then they

also added in some other healthful components so green tea um more green leafy vegetables walnuts

but also mangkai which is um i hope i’m pronouncing that right probably not but it’s a duckweed so aquatic plant

that has um is a complete source of protein um it contains vitamin b12 as well

um and it’s really high in polyphenols um i have to say i’m not sure that mankind is ever going to be accessible

to everybody and so it really is a sort of clinical research tool but what they’ve shown in a number

of um papers is this enhanced green mediterranean diet actually works better than the

traditional mediterranean diet on cardiovascular risk factors um and also reduces

um intra hepatic fat so fatty liver disease and this was actually conducted in sort of

overweight sedentary individuals who work at a nuclear research plant in israel

so we’ve been waiting for this study and it’s finally here thanks to the researchers at the physicians

committee so we’ve always wanted a head-to-head comparison between the mediterranean diet and a low-fat

healthy whole food plant-based diet which here is called a vegan diet because it excludes all

animal products 62 overweight patients or people rather participants were

randomized in a crossover trial to 16 weeks of a mediterranean diet or 16 weeks of a healthy plant-based

diet and then they swapped over so it lasted the study lasted almost a year um and and there was obviously

group support and people were helped to adhere to the diet and what the result showed that the vegan diet actually came

out um top in terms of weight loss lower cholesterol levels improved insulin sensitivity

now both diets people reduce their blood pressure but this actually was um a greater reduction in the

mediterranean group and we can perhaps um discuss why that might be later and it’s

just um useful to consider why weight loss was better on the vegan diet

it’s because people naturally ate around 700 less calories a day even though both

diets were at libertum they could eat as much as they wanted to they weren’t told to portion control

and the mediterranean diet replicated exactly the diet of the predimed study and therefore included 50 mls of olive

oil a day which no doubt will have hampered any potential weight loss so just coming

back to the data we have um using the plant-based diet index

a number of studies now from large prospective cohorts have analyzed their food frequency data

and using this healthy plant-based diet index so you’ve got here the plant-based diet index in

in in its entirety and then divided into healthy plant-based and unhealthy

plant-based diet and you can see in the healthy section you can reduce the risk significantly of

coronary heart disease type 2 diabetes cancer reduction 15 even stroke

and 10 reduction renal failure fatty liver and there’s a mortality advantage but

unhealthy diets regardless of whether they’re animal based or plant-based

increase the risk of a number of these chronic illnesses another way researchers have looked at

the healthiness of the diet is looking at the inflammatory potential of the diet and we’ll come back to why

that’s important because we know that at the core of a number of chronic diseases is

inflammation which drives a number of disease mechanisms and

our diet can be inflammatory or anti-inflammatory and an abbreviated version of this score

was developed by harvard researchers known as the empirical dietary inflammatory pattern and here you can

see the foods that are inflammatory and of course those are that are anti-inflammatory

of course the whole plant foods the whole grains fruits tea coffee and we’ll come we can talk about alcohol

a bit later i’m not a big fan but um wine certainly has some polyphenols that are anti-inflammatory

and various studies have shown that if you have a diet that’s inflammatory

and because of the animal products and the processed foods you increase the risk of cardiovascular disease coronary

heart disease and stroke and certain cancers particularly colorectal cancer and in older people

you and accelerate the rate of sarcopenia so lean muscle mass loss

now i do want to come back to make it a point that we do really need to have culturally appropriate dietary

advice it’s no point telling me to adopt a mediterranean diet it wouldn’t fit with my palate at all um and so it’s really

interesting to see that a lot of indigenous and cultural diet patterns have traditionally been very healthy so there’s quite a lot of

research in this bolivian tribe um tismani i don’t know if that’s how you pronounce it actually but

um looking at why they have some of the lowest rates of atherosclerosis and of

course it’s because they follow a traditional healthy diet pattern and in the same way you can make um an

indian diet healthy by taking on the principles of the mediterranean diet but making it

appropriate for an indian population and overall when you look at these

traditional eating patterns they’re healthy because they’re high in whole plant foods they’re low in saturated fat

they minimize processed foods they’re free of trans fats low in refined carbohydrates and of course

high in fiber so we come back to talking about um the blue zones

and um i don’t apologize for always mentioning the blue zones and their populations around the world that live

the healthiest and longest lives um and they’re five regions but i suspect they’re more because as i’ve

said the bolivian tribe in south america lives a healthy life also

but we’ve learned a lot about the diet of these blue zones and this is directly from their website

um 95 to 100 of their diet is based around whole plant foods

minimally processed beans are at the center of a healthy diet drinking mostly water for thirst but tea

and coffee is healthful too snacking on nuts and going easy on fish eliminating eggs

slashing the sugar reducing dairy and retreating from meat so predominantly whole food plant-based

when we look at prospective cohort studies and the impact of diet and healthy lifestyle factors

and these data are from the nurses health study and the health professionals follow-up study five healthy lifestyle factors that are

shown here and the healthy diet is based around the alternate healthy eating index which gives high marks to whole plant

foods and high marks to low intakes of red and processed meat and

processed foods in general and after 34 years of follow-up in these study cohorts

what the researchers showed was that best quality diet reduced your chance of dying from cancer by 30

risk of dying from cardiovascular disease by 33 and all healthy lifestyle factors or

five of them further amplified this benefit for cancer mortality dropping by 65

and cardiovascular death dropping by 82 and it’s pretty remarkable and people

lived longer and this is not living longer with ill health it’s living longer with a healthy lifespan without chronic

disease men lived 12 years longer and women lived 14 years longer if they had all five healthy lifestyle factors

so what do we know about vegan health so um studies on people that avoid all

animal products all together and most of our robust data comes from the adventist health study too from north america

and the epic oxford study here in the uk um about a third of the participants are

lacto-ovo vegetarian or vegan um and we’ve learned a lot over the years so we know that people who

avoid all animal foods and have the healthiest body weight and there’s a stepwise reduction in the

risk of overweight and obesity as you eliminate animal foods from the diet exactly the

same pattern for type 2 diabetes vegetarians and vegans have the lowest risk of developing type 2 diabetes um

hypertension pretty much wiped out in in vegans who have a 30 uh

33 reduced risk um and again here from the epic oxford study you’re more likely

to have a healthy cholesterol level if you don’t consume any animal products

and in the latest systematic review looking at multiple health outcomes and those following a vegan and vegetarian

diet vegetarians have a 25 reduced risk of developing coronary heart disease

and vegans have a reduced risk of cancer about 15

now it’s just worth um looking at what we’ve learned about diet and covid like we all intuitively knew that those who had a

healthy diet and lifestyle were less likely to have a severe outcome with covert 19 and now we’ve got

two um papers um the one on the left has been published in the bmj

journal and on the one on the right is um pre-print only and this is a better

quality diet actually so i’ll just home in on this and do look it up and it will be published because it’s

got some really well respected researchers on there and it’s um from data from the now quite famous zoe

covert symptom app study run from king’s college in london um and what they have done is look at

over half a million participants in this um zoe kovadap who gave dietary information at the

start of the pandemic um and what they were able to show is that people following a healthy

plant-based diet as defined by that plant-based dietary index that i showed you a few slides back

and those following the healthiest plant-based diet had a 10 reduced risk of actually getting covered

19 infection but if they did they had a 40 reduced risk of getting a

severe infection and what was even more interesting was that the impact of a healthy diet

was greater in those communities from lower socioeconomic means so it’s really

important for all um individuals to adopt a healthy plant-based

diet so just coming back to what we know about food diet chronic illness the foods that

consistently cause chronic illness are refined carbohydrates and sugars

fried foods sugar sweetened beverages red and processed meat saturated fat mainly found in animal foods

and unfortunately alcohol too um yet the foods that promote health are

the ones that are part of a healthy whole food plant-based diet all the colors of the rainbow the fruits and vegetables beans as the main source of

dietary protein all the micronutrients you find in the healthy plant foods the increased fiber

consumption and herbs and spices essential to get all your antioxidants and anti-inflammatory compounds

essentially water tea and coffee are the healthiest drinks and of course um the pandemic has also

highlighted the role of vitamin d which we often need to supplement with if we’re not getting enough

sunlight um and plant-based diets really do address the root cause of chronic illness which

stem from chronic um ongoing inflammation um and inflammation is

caused by oxidative stress and which can be dietary and lifestyle related insulin resistance

and unhealthy gut microbiome our diet can alter gene expression and adversely

affect this unhealthy diet can shorten the telomeres where we know that plant-based diets can

extend the length of telomeres and more recently and i’ve put the reference here in case you wanted

um a study showed that red and processed meat could directly damage dna in the colon and by causing an

alkylating signature so it’s well worth looking at that publication and of course unhealthy diets can

dysregulate hormones by elevating estrogen levels and insulin like growth factor levels and

things that are addressed by a healthy plant-based diet and i just thought it was worth

commenting on um the source of protein in the diet because animal protein still seems to be

revered by health professionals as a sort of good quality optimal type of protein but the

science tells us quite the opposite um and this is just highlighting the most recent systematic review and

meta-analysis and that followed participants for up to 32 years and basically showed that the more

plant protein you consume the lower your risk of all-cause mortality and cardiovascular

mortality and there was a dose response so the more consumed the lower the risk of mortality

and just swapping out three percent um of protein and swapping it for plant

protein and reduce the risk of death from all causes by five percent so

any step towards more dietary protein from plants is is a positive step and another way

of looking at this is is called substitution analysis which has been done in a number of studies

if you look at people who are substituting animal protein for plant protein you can see here data

from the nurses health study and the health professional studies that in all of these studies and the

data favors plant protein so um you can see here to the left of the line

a plant protein is favorable in terms of all cause mortality and i just like to point out that

here you’ve got fish and if you swap out fish for plant protein you’ve got an advantage

if you swap out eggs and swap it for plant proteins you’ve got a massive advantage and these advantages are shown for

cardiovascular disease cancer and other causes of death and a more recent analysis from the women’s health

initiative study showed that plant protein was able to reduce the risk of mortality from cardiovascular disease and dementia

or causes in general so most dietetical organizations and

this is a statement from the australian dietary guidelines state that an appropriately planned vegetarian diet including total

vegetarian or vegan diets are healthy and nutritionally adequate well-planned vegetarian diets are

appropriate for individuals during all life stages and so this is what we’re talking about

you know the data i’ve presented hopefully convince you that these are the only foods and that are associated with good health

reducing mortality and increasing our healthy lifespan

of course there’s always media hype and we’ve had media hype about vegan diets causing stroke that vegan children are shorter and we

have um more fractures now i do want to say that we do need to pay attention to bone

health because both the adventist health study and the epic oxford study did show a signal to increase risk of fractures

in vegans but the data are more nuanced and it was particularly in people who had a

very low body weight um and it’s people who are not necessarily obtaining enough calcium and

vitamin d in the adventist health study those who obtaining enough calcium and vitamin d that risk was wiped out so we do need to

concentrate on a healthy plant-based diet and avoid what we like to call calcium thieves like

high salt intake alcohol excessive caffeine

all encourage excretion of calcium from the body and we can’t underestimate the

importance of weight-bearing and resistance exercise i just wanted to

just say a little bit about the low-carb trend i mean we’ve got a number of prospective studies showing long-term

data that um tell us that lowering carbohydrate in the diet especially when it eliminates whole plant foods is not

good for us so this is just one example more than a hundred thousand adults followed for 25 years those on a

low carb diet less than 50 carbohydrates increase their mortality

um whereas the lowest mortality was in those who are eating a carbohydrate-rich diet

and where carbohydrates made up 50 to 50 55 of the energy intake and just want to

point out here that high carbohydrate diets also increased mortality but when they delved in deeply

to this data it was purely associated with eating a diet that was too high in refined carbohydrates and

actually substituting animal protein from to plant protein actually reduce the risk

of death so if you’re eating a high carbohydrate diet full of healthy plant foods this is going to be an advantage and

kevin hall who’s pioneered these metabolic um ward experiments where patients or

participants are admitted to a ward they’re kept there on a daily basis with

all the food provided for them and metabolic experiments conducted he’s actually compared a

low-fat plant-based diet to a keto diet and a crossover study and

two weeks on each diet and food was unrestricted and what he showed was that yeah a keto diet could

lower the blood glucose and insulin triglyceride levels but it actually impaired glucose tolerance and you

actually lost muscle mass because your protein is being utilized to generate glucose

whereas on a plant-based diet people naturally ate around 700 calories less a day um

despite having enough food um or food at liberty and they increased their fat loss

compared to the low-carb diet whilst lowering blood pressure and

cholesterol and not causing a deterioration at all in their insulin sensitivity

so we know that healthy diets can prevent chronic disease but we also know

that healthy diets can treat chronic illness and no talk on diet is um complete

without mentioning the work of dr dean ornish he’s the chap that bill clinton consulted after his quadruple bypass and his

healthy lifestyle low-fat plant-based diet approach is um reimbursed by medicare since

the last 10 years really so you can join his reversal of heart disease program and that would

be reimbursed by the national insurance in the united states and we all know

that his diet is a healthy low fat plant-based diet with physical activity stopping smoking and stress management

and he showed back in 1919 as an original publication that when sticking to this sort of diet

you could actually cause regression of atherosclerosis that um was even

better at five years and compared to the control group um the intervention group had um

50 fewer cardiac events and further studies have looked at the

impact of a vegan diet on inflammation because inflammation is also key to generating atherosclerosis

you know in the medical world we’re looking at antibody treatments and such as kanekinemab but we could use

a dietary approach to enhance the impact of these medications and this randomized

study showed that a vegan diet could reduce the level of high sensitivity crp such that the authors concluded that

a vegan diet may use bee sorry a vegan diet may be used to lower inflammation as measured by high sensitivity crp a

key player in the development of major adverse cardiovascular events and that’s why for 10 years in a row in

this same u.s news report that the ornish diet has been

voted the best heart-healthy diet um and so you know if cardiovascular

disease is still one of the top killers around the world i think adopting an ornish-style diet

has to be the default for most of us and of course um you guys in new zealand and pioneered

a low-fat whole food plant-based diet in the community setting for people at high risk of cardiovascular disease

um in the broad study and this study the authors conclude um to the best of

our knowledge this research has achieved greater weight loss at 6 and 12 months than any other trial

that does not limit energy intake and mandate regular exercise so you know you’ve shown in a

community setting that this really is doable without restricting calorie intake dr dean ornish was able to show in

patients who would otherwise have had no intervention and but were suffering with early stages

of prostate cancer that his lifestyle approach was able to reverse early stages of prostate

cancer progression by reducing the prostate cancer marker psa prostate specific antigen and

at two years um 27 of the control group versus only five percent of the

lifestyle group had to undergo um conventional cancer treatments which was surgery and radiotherapy

and he was able to show the mechanisms at play once i’ve talked about already he was able to show

that in peripheral blood mononuclease cells there was an increase in the activity of telomerase

which is a marker um showing you that the telomeres will be being lengthened in the chromosomes and in

prostate prostate biopsies before and after the intervention he was able to show a change in gene expression such that

the intervention was able to switch on cancer suppression genes and switch off cancer promoting genes

so we actually have this in the international guidelines the american college of um cardiologists state that for primary

prevention of cardiovascular disease you can choose either a plant-based diet or a mediterranean diet but they clearly

state the benefits of a vegetarian and vegan diet the american association of clinical

endocrinologists write for people with type 2 diabetes they should obtain an optimal weight through a primarily

plant-based meal plan and of course the world cancer research fund states that a healthy diet for

cancer prevention and after a diagnosis of cancer is a diet that’s rich in whole grains fruits vegetables and

beans limiting other sources of dietary energy um such as red and

processed meat and processed foods so that really is a predominantly whole food plant-based diet

now i don’t think any diet and talk can really um be complete without thinking about

the bigger picture you know our house is on fire we have a climate crisis and emergency

as we speak we have also entered the sixth mass extinction event where more species are

going extinct now than ever before and the authors of this paper really give us a stark warning they say

there is time but the window of opportunity is almost closed we must save what we can or lose the

opportunity to do so forever there is no doubt for example that there will be more pandemics if we continue

destroying habitats and trading wildlife for human consumption as food and traditional medicines it is

something that humanity cannot permit as it may be a tipping point for the collapse of civilization

what is at stake is the fate of humanity in most living species future generations deserve better from

us and the key message here is that animal agriculture is the leading cause of

climate crisis biodiversity loss species extinction greenhouse gas emissions

um and really by eliminating animal agriculture and eliminating the consumption amount of animal foods

we can go some long way to addressing these global crises

and health professionals have been called to action this was in the bmj last year without decisive and urgent action the

climate crisis will increasingly undermine human health and disrupt healthcare delivery there are both moral and practical reasons for

health professionals to be at the forefront of climate action and there are many many aspects of this but

i think we also need to be um advocating for a shift to a plant-based

food system so how what are the best foods for the health and

the environment it’s a win-win situation when we look at whole plant foods because the foods here highlighted that have

um the best impact on our human health and the lowest environmental health are all the foods

that i’ve been talking about today but unfortunately i’m afraid

australians are not doing well at the moment um your current dietary

choices are way above the planetary boundaries for food like way above um and even if you were

sticking to your national dietary guidelines you’d still be breaching these planetary boundaries

for the food system so really something needs to change and if all countries high-income countries

was to continue to eat like this and we transferred our eating habits to the rest of the globe we would need seven planets to be

able to feed the world in the same way as australians are eating and so the solution is um as we’ve been

told repeatedly is this planetary health plate designed by the eat lancet commission who brought

together 36 scientists from 16 different countries and here you can see that it’s a diet that’s predominantly based around whole

plant foods and if you choose to eat food and it does come down to choice because the report clearly states that these foods are not

necessary and are purely optional you should not be having more than 13 percent of your calories from dairy

foods and animal source protein so that really means sort of you know red meat once a week

week poultry twice a week no more than that and um health canada guidelines have taken

this on board and at a similar time they publish their new dietary guidelines which you’ll see completely eliminates

dairy as a food group and it talks about eating protein-rich foods and choosing plant foods

over animal sources of protein and making water your drinker thirst

and really plant-based diets can be affordable although i do need to recognize that people of lower socioeconomic means do

have to spend more of their um a weekly income on food compared to those

of higher incomes but this particular study did show that you know moving to a planetary health

diet would be would be a similar price to the typical australian diet currently

and when it comes to new zealand a large analysis from 2020 showed that um the greenhouse gas

emissions were so much less

we’re down the food chain to the whole plant foods and eliminated these foods here at the bottom from

animal derived sources that were having the greatest impact on greenhouse gas emissions

the authors conclude here for you in new zealand that eating patterns emphasizing the consumption of whole plant

foods offer an opportunity to achieve substantial emissions reductions whilst simula simultaneously

realizing considerable health gains and health system cost savings and so i think we need to speak out we try and

write lots here in the uk in our medical journals if we can we need to really be supporting our

citizens to move to a plant-based diet and now this is not easy and i think we’ll talk about this in the q a

um but really we have to change our style of consultation we shouldn’t be really having a sort of

doctor patient or health professional relationship where we’re considered the expert we need to approach this with a coaching style

whereby we take into account um the individual circumstances of the

person in front of us we need to be honest with them we need to appreciate their own circumstances and then set them

realistic goals in a sort of coaching style of um behavior change and i would urge you

to read this really great paper by beth freitas in in the us called the key to therapeutic

lifestyle change because it’s a completely different way of addressing healthcare with our

patients and in the same ways that most of our patients don’t take the medications we prescribe if we just tell people they need to eat

more fruits and vegetables um and it doesn’t align with their motivations and their ability to access this we are

not going to win um and so you know i know you were distributed a little summary that i’d

written recently you know we we need to start with really small easy steps that people can take

and really in the form of a lifestyle medicine or a dietary prescription where we give some specific

um advice for people who can um make some realistic changes to their

their diet like you know just making a few of the meals a week swapping out the meat for beans

for example going half and half or just removing refined grains and swapping in them in for whole grain

options for example and of course it’s not just the individual level we need to

work upon we need to have community support as well and this is what we’re trying to do at plant-based health professionals so

leila daikin i our educational lead has um uh developed this 21 day plant-based health

challenge that’s available to all of you guys if you want to sign up and see what it’s all about um daily emails for 21 days and we’re

really grateful now to have funding to be able to offer people ongoing weekly support in the

food in the form of live zoom sessions with um layla so that’s a great resource that you can all

use and we can offer our patients as well so just ending my talk by a back to health

during lockdown it just goes to show how you know despite this knowledge being in my family for the best part of a decade

it’s it’s taken a pandemic to get members of my family healthy this is my

husband he’s also a hematologist he was vegan for the last four years but it really took

um the pandemic and and the recognition of the fact that underlying health conditions including obesity

and were worsening outcomes from clovid19 for him to actually change to a healthy whole food plant-based diet so

he was obese at the start of the lockdown his waist circumference was far too high he was hypertensive and as an omnivore

he had a cholesterol of 6.5 um but he finally um allowed me to take

control of the kitchen provide the food and and um uh adopted a whole food plant-based

diet um and increased his exercise um with our dog pansy

and a year later he has a healthy weight he needs to still work on this but he’s no longer hypertensive his cholesterol

is 4.2 and he’s feeling good and i think my family story is really just highlight some of the key

aspects of behavior change you really need to have an internal motivation to make these changes and nobody can tell you to do it um you

have to find that internal motivation and remind yourself of that on a daily basis and also social support is so important

you know my mum has wholeheartedly helped my um dad with adopting a healthy

um a diet and of course i’m here for my husband to cheer him along on his back to health um

journey so i hope what i’ve done today is provide you with a large body of

evidence to support the role of plant-based diets for the prevention and treatment of chronic disease and how this is now embedded in national and

international guidelines and we really have to consider human health and diet patterns in the context

of global planetary health and so if anyone’s interested in our work here in the uk

feel free to join our online course it’s accessible globally and myself and layla co facilitate that

and so there’s bookings now from october for the next academic year um and this comes with um a whole dose

of bias but my father and sister have co-edited this book about um the rethinking food and agriculture and

the food system as a whole so do check out their website which has lots of free um uh extracts from the book

um and you know the usual recommendations um and um yeah that’s the end of my talk

actually i just had a couple of extra slides so thanks very much

Introducing Q+A Convener Dr Peter Johnston

kiara shireen thank you so much for what was a brilliant summary of a lot of the evidence supporting a

healthy and environmentally sustainable eating pattern and i really liked that slide that you

showed on the foods that were win-win for both the health of humans and the health of our environment

and i’d now like to welcome a special guest to join us so dr peter johnston is an accredited

practicing dietitian who is going to kindly join us for the q a discussion

and peter’s also going to share a few thoughts of his own particularly from a

dietitian’s perspective so peter thank you so much for joining us tonight from

melbourne and i’m curious in your view what does this evidence mean for

australians and have you had much success in your own practice with your patients that you see

firstly thank you shireen for a wonderful presentation and thank you doctors for nutrition for this

opportunity to tag along it’s hard to follow in such big footsteps

australians are changing quite fast as the evidence becomes clearer um

i think it’s really exploded in the last five years so more and more people are realizing this

makes sense for all the reasons that shireen outlined for the environment for the ethics for

our health for global equity and justice for reducing pandemic risk for reducing

squandering or ever antibiotic resources um there are just so many reasons so

it’s becoming much much more prevalent

yes very important um points and each one of those could have a lecture on its own couldn’t it

um and peter i’m also aware that you were a participant in the recent united

nations independent food systems dialogue that doctors for nutrition hosted with

um about 30 or 40 amazing thought leaders in the space so i was

wondering if you could give us a little overview of what that dialogue was all about and some of the key insights

the the thank you the food summit was um to feed into the united nations food

summit which is coming up in september 20 this year and to identify bold new

actions to align the global food system with the sustainable development goals

so doctors for nutrition undertook to hold host one of these

independent food systems dialogues a couple of weeks ago and did a fabulous job all credit to

alicia and hannah for their work in getting some real heavy hitters and thought

leaders from around australia and new zealand and abroad on board um it was super

impressive to see such a powerful group of professors and

leaders such as professor boyd swinburne dr sandro demayo

and dr shireen kassan who you just heard this will also help with the lead into

the australian national dietary guidelines which are under review so even though the the participants were

not all plant-based there was broad agreement that we have a lot more in common than

we differ on and the importance of working together and not be wedded to labels

so there was a real desire to see people have much more plant strong plant-dominated

diets which was fabulous to see so [Music]

yeah anything else you’d like me to add hannah oh no i think that was a great overview

and in the email that we’re going to be sending out to everybody who registered for today we’ll be

sending some video clips of our keynote speakers who spoke at that dialogue and shireen was one of those speakers

alongside two others um and we’ll also be writing up a summary which will be published on the

doctors for new nutrition website over the coming weeks great so um we have a lot of questions

coming through based on the discussions that we’ve been having so i think we will just start dipping into

those we also had a great session with the australian medical students association

on saturday and one of our doctors for nutrition co-founders led a cooking class and we had so many

questions from that as well that we couldn’t get through them all so i’m also bringing some of the

students questions here tonight and i know that we have quite a few medical students with us

in the audience as well right so we’ll kick off with these questions and um either peter or shereen

either of you are welcome to answer these as we go through so there’s been a few questions about iron come up and um

Q+A

yeah a couple of people are saying um you know how do we get enough iron on a plant-based

diet um and a couple of people asking if if their iron stores are low but their

hemoglobin is normal is there anything to worry about yeah so

um great question um and we know that iron deficiency is a problem for all diet patterns it’s a global problem

which one of the most common um nutrient deficiencies globally so not a vegan whole food plant-based issue

per se but we do need to pay attention to healthy iron sources in the diet i say i think

if you already got if you’ve got a low ferritin level um lower than the kind of normal

established range you usually find that you do need a period of supplementation just to restore your iron stores and i don’t

think there’s anything wrong with with that you know a ferrous sulfate tablet once a day get your stores um back up because i

think when you’re starting from that level although peter might have a different view it’s quite difficult to just correct it

on with a dietary approach um and then you know the usual tips um on a whole food plant-based um diet are

you know centering your diet around the rich um on rich foods you know the the greens

and the beans and um and also using iron cast cookware can really help you know adding your vitamin

c and avoiding um tannins and from tea and coffee during that but i think if you’ve actually got a lower than normal

ferritin i would i would advise to have a period of supplementation and i think that’s fine you know as young women

menstruating women we often have periods of iron deficiency and and i don’t think you should beat

yourself up about it if you need some supplementation thank you shereen peter

do you have anything to add to that it is healthier to be at the lower end of the range

the range is based on the normal population who are omnivores and the heming and animal food floods in

in a way that we can’t control and we can get too much iron which causes oxidative damage and increases our risk

for heart disease amongst other problems so it is better to be in the lower end of the scale

i would concur with the things shireen has said including to really power in the dark

leafy greens and the legumes and avoiding tea coffee one hour either side of a meal

including vitamin c rich foods with the meal and alliums onion family foods help

light absorption additionally so could you give us an example of

the allium family leeks garlic onions beautiful i know some cultures

don’t have those so not a big deal but vitamin c foods should be should be

very prevalent in a plant-based diet anyway and that’s not just fruits they’re in the capsicums etc so

but most people don’t eat nearly enough dark leafy greens i try to put them into everything and i

have a bowl of steamed kabul for my porridge in the morning just to get more greens nice sounds good

um great so there’s been a question um saying how should a gp attract

address this evidence when talking with conventionally trained dietitians so maybe peter

that might be one that you could give us some tips on that’s a good question and it’s a tricky

one and this stuff wasn’t taught when i trained

back in the mid-90s um there were two people who were vegan in

my course um they weren’t aware of things like the china study

so there’s a lot of catching up to do amongst all health professionals and we just i

think have to be patient and perhaps try to share things like the practitioner’s guide that doctors for

nutrition has produced and is available on requests you know to try and gently

open people’s eyes you can look up doctors who nutrition to find a

plant-based dietitian in in australia or new zealand there aren’t enough yet but i know there are a

lot more coming through who are graduating in the next year or two

or there are other international directories such as plant-based docs pcrm have a directory

um but yeah if there’s no alternative it is a bit tricky because mainstream digestions will generally be omnivores

and will recommend the same kind of thing that they like to eat

yeah and we do we did invite dietitians australia to our food systems dialogue so we are building relationships with

their organization and we’re also both organizations are members of kaha which is the climate and health

alliance so um kaha is producing a position statement around healthy sustainable

diets so we are trying to work together you know with the dietitians and i think you know at that level of

working on policies together hopefully that will help to filter down through to them you know sharing some

more up-to-date evidence and um environmental considerations with their members

um so we have deborah asking peter can you please reiterate why tea and coffee should not be drink

within one hour of eating a meal well as shireen said the tannins bind

the iron and prevent it from being absorbed so

that’s not going to help you get more iron in your system so it’s just better to to give an hour’s

break either side great thank you very clear we have

meredith asking um is there a publication that could be supplied to gps rather than

ones that often end up on their desks that are funded by industry

that would help gps to learn about lifestyle medicine is there anything that you

either of you would suggest to supply to the gps i mean i think as peter said

the the information is now out there it’s like with everything um you know you just have to be

exposed to it and you know bother to read it and that’s the kind of main

issue with sort of changing mindsets isn’t it i mean it’s not difficult you just have to open the

world cancer research fund um guidelines on preventing cancer it’s like you know i presented it

it’s there so i think um it’s just i i personally think you just have to

um demonstrate by example share your success stories of your patients um and the evidence will then just be

you know plain and simple and you know for us now as you know hannah the um international diploma in

lifestyle medicine it’s available anyone can do it it’s global and the nutrition piece is very much

predominantly plant-based and you learn all of this so the education is there it’s just you

know making an individual decide that it’s relevant to them now and and also we know it comes down to

personal habits and and behaviors you know people have to role model so um you’re never going to be

convincing or be able to convince a patient on a particular lifestyle habit unless you’re

embodying it yourself and if you don’t truly believe it yourself then obviously you can’t help your patient so

it really does start from you know changing your own behaviors and until we do that um then it’s it’s difficult isn’t it to

have every single doctor on board with this

messaging and if anyone does want to get started on their own kind of journey in the

kitchen we do have some recipes on the doctors for nutrition website that were contributed by a lot

of different health professionals so that’s a great place to either try and find some new inspiration

for yourself or to sign post patients too um shireen we’ve had a request for

you to share the slide which had the courses on it are you able to pop that up again for another minute or so

just the winchester course was it uh where’s the question i think yeah that was the one

about the courses available yeah well that’s just i mean obviously a a big

dose of bias there because this is the the course that i run on plant-based um nutrition

i think some of your colleagues have have taken it already so um do get the feedback but it’s just on

the winchester university website so if you just put in winchester university plant-based nutrition it’ll come up and we’ve got

lots of places for next academic um year wonderful doctors for nutrition we also

have a web page which has got some information about um various courses and and

sharings is one of them um so maybe alicia you could pop in the chat box

i can also i can also highly recommend dr clapper’s master class series that he

did with plant fewer communities so if you look on the plant for your community’s website you’ll find that

and that’s a 12-week program with two hours per session it was a little bit over 200 us which was really good value

it’s very high quality and really well done so it’s expressly produced for health

professionals to show them the breadth and the power of plant-based nutrition

and he does a fabulous job he’s just such a wonderful teacher fantastic and alicia if you can

pop the link to that one in the chat box that’s dr clapper’s moving medicine forward

um we have a question from sandra about any comments on whether

plant-based diets are appropriate in people with chronic kidney disease and or dialysis

and traditionally these patients might be advised to go on more of a high protein animal product diet

and i guess this could extend to are there any other any groups that you would not recommend a whole food

plant-based diet for yeah i know i mean i say absolutely not it’s relevant for

everybody but anyone who’s on dialysis or got advanced stages of kidney disease need to do this in conjunction

with a specialist dietitian that goes without saying really their diet needs to be planned regardless of what the diet pattern is

however i would like to say that there’s been a complete kind of 360 turnaround in the dietary approaches for

renal failure and if you haven’t already looked up the work of dr shivam joshi who’s based out of the us and he works

very much in conjunction with their main patient advocacy group called the national

kidney foundation there’s a number of papers that have come out just in the last year basically um showing how

a plant-based diet is actually preferable and the recommendations for total protein

intake have actually come down quite a lot in in the kidney setting and obviously

there is increased catabolism and loss of protein when people are on dialysis but it’s quite clear

that you can meet those needs on a well-planned you know um dietitian um supported

uh diet um which is plant-based and they’ve actually come up with a phrase called play-doh which is a um

which is a low which is a plant-based um uh diet for people with renal failure and so if

you look up plato plado and renal failure and shivam joshi you’ll come up with lots of papers that

he’s written recently so i think like with everything it’s taken time to catch up and people have been nervous

but actually the old kind of way of thinking that there’s too much potassium and phosphate

and and things in the diet and for renal patients is just misguided that they were sort of

overstated concerns and actually there’s a really interesting study where they looked at people with advanced stages of

renal failure and either used um sodium bicarbonate tablets um to

address their metabolic acidosis or compared them with a group where the whole family were given fruits and

vegetables and had exactly the same effect without any deterioration in potassium levels and actually brought

down blood pressure and reduced medication costs in the fruit and vegetable group so the studies are there i think it just

with everything in medical practice it takes a decade before it’s adopted and i’ve i’ve had patients who

have had their kidney function come back to normal the gfr has come back to over 90

with shifting to a plant-based diet and dr michael greger in his great book how not

to die talks about the research showing that animal proteins cause a lot more stress

to the kidneys and plant proteins do not cause that they have quite a different impact distinctly different so it’s really much

safer to run your body on a plant-based diet and plant-based proteins for kidney health kidneys are very

highly vascularized too so the vascular damage that leads to our biggest killer heart disease

also is damaging all of the vascular system including the kidneys and so they’re not going to run as well

with damaged blood vessels same as the brain and the and the famous canary in the common for men

erectile dysfunction another highly vascularized organ

thank you great comments if anyone’s interested in learning more we do have a article on the the blog by dr anisse

tyed who is a nephrologist and he goes into a bit more

detail and i also noticed that fuchsia goldsmith who is a dietitian on our advisory council is

here with us this evening and fuchsia works on a renal ward at north shore hospital in auckland

and i understand she’ll be presenting at a nephrology conference soon about plant-based nutrition in this

exact setting so maybe we can get fischer to share some more insights after that

wonderful so we’ve had some questions around supplementation and in particular b12

would either of you like to comment on the role of supplements in a healthy diet and b12

yeah i mean i think you know we all know now um if we’ve been following a plant-based diet for a while that we do need to find a

reliable source of b12 because it’s not found in plant foods or animal foods naturally so yeah absolutely supplementing with

b12 for me is the easiest way to do it some people choose to do it through fortified foods but whatever suits you

but it’s just easier to set an alarm you know once a week or whatever to remind yourself to say take your weekly dose or

daily dose if that is what you choose to do i think you know the other things that you do need to be mindful of

um is where you’re getting your iodine i’m not sure whether you guys iodize your salt but we don’t in the uk

and so um you know we would be looking um to make sure we’re getting a reliable source of iodine most people in the uk

get their iodine from dairy products as a byproduct of the processing procedures and so yeah so that and then of course

vitamin d for for us in the uk um nobody is sufficient um so those are the main ones but um

yeah you know most of the nutrients um we should be getting from from our diet

there is a bit of an open question about long-chain omega-3 fatty acids and i flip-flop between the

date the data but i do make sure i get good sources of plant-based omega-3 fatty acids from my nuts and

seeds right thanks sharon peter would you like to add anything to that

um i can curb with those thoughts i i recommend a hundred micrograms of b12 per day

and i just keep it somewhere where i see it every day like where i make a cup of tea in the morning or buy my toothbrush

and then you can’t miss it um and vitamin d even in melbourne nearly every patient i

see is borderline or low vitamin d so it really is epidemic people are just

not getting enough sun and so it’s important especially in winter for immune function and bone

health to have adequate b12 and so adequate vitamin d levels

and i agree around iodine that can be a a risk um it’s not especially prevalent in our

soils in australia and new zealand so i encourage people to include some sea vegetables once a week or so

makami flakes or dulse dolls things like that noir issues

great thank you um next one we have a question about the benefits

and the cons of intermittent fasting and or longer fasts so would you like to

share any thoughts on that sherry yeah i mean not particularly a plant-based issue i mean i think people

have sort of let me start again so there’s a lot of interest in intermittent fasting um i

would um point you to some of the research done by pcrm and hannah cleo kelly over who’s their main

researcher about metabolic health i think it’s clear that a period of fasting um at least sort of 12 to 13 hours

overnight is good for metabolic health and i think the other thing we know is that eating in line with your circadian

rhythm like eating more in the morning less at lunch time you know not very much in the evening it is desirable but kind of what you do

around that i think at the moment for me it’s the data is that you

you do what suits you best around those sort of um principles really about following

your circadian rhythm and having a period of overnight um fast and not grazing until the moment

you go to to bed but i mean i think overall i don’t think it’s a be all and end all you can

incorporate it or don’t whatever suits um you but overall you need to center your diet on a whole food plant-based

diet there’s obviously no study of fasting and in a whole food plant-based diet etc so you know when these happen

maybe we can answer it in a more sensible way great thank you um the epic oxford study

was on one of your slides sharing and one of the findings did show a high

fracture rate amongst those who are on a fully plant-based diet and it has been debated since um the

study was published about why that might be do you have any thoughts either you or peter about

about that finding yeah no and i think you know like with all things we have to pay attention we can’t just um you know

ignore these things because it’s a well-conducted well-respected study without any sort of

usual bias or anything so i think the key findings were that it was only an issue in women so men did not

have an increased risk of fracture and it was only in women who had a body weight of less than 20

sorry a body mass index of less than 22.5 so really and they had people in that

study who had bmis of sort of below 19. so i think you know that those were the two

main take homes i think the other thing to know is that the epic oxford cohort in general it’s been previously

shown that they’ve had low intakes of vitamin d that’s not been appropriately supplemented

and much lower intakes of vitamin b12 and neither of those factors were adjusted for so we haven’t got a fuller

the fullest picture there i don’t really haven’t found a good answer to why they didn’t correlate it with vitamin d and and b12

levels so i think it still comes back to paying attention to the overall

quality of the diet um and not being complacent about all the other things

that are important in bone health which is you know probably not being underweight you know and um also

your exercise and strength building activities and you know bone health is not just

about one aspect of the diet it’s not just calcium it’s about everything you know your folate your potassium your

um protein etc so it all comes back to that kind of healthy diet index that i

showed you that we really should be centering our diet around the healthy healthy foods like that so that that’s

my interpretation but i think we need to pay pay attention to that and make and and address our

the quality of our diet as vegans and as plant-based um eaters

thank you very much um we have a question from kylie about the controversy about saturated

fatty acid chain length and the issue of whether or not coconut milk for example

is problematic peter would you like to share any thoughts on saturated fats and

the importance or not of those saturated fats are high in coconuts and coconut milk and coconut

cream and obviously coconut oil and demonstrated to increase our risk of

cardiac disease cardiovascular disease so it’s there is there’s no research showing

that coconut is healthy in that sense other than as a condiment and it’s best heaven as a whole food like

desiccated coconut or shredded fresh coconut not the refined oils and and milks and

creams with the fiber taken out the biggest deficiency in the western diet is fiber

so coconuts like any nuts should be a in moderation and a condiment but they

won’t help cardiovascular health if we have too much lovely thank you we’ve got a lot of

questions coming through so we’ll try and get on to a few more as we are getting close to

um wrapping up um we have a question that is asking do you think that there

is a role for a stronger focus in the school curriculum regarding nutrition

i’m only four years out of year 12 and i can hardly recall any nutrition teaching even within the medical

curriculum as a medical student i feel the power of nutrition as medicine is highly under-represented

and do you have any recommended resources [Music] yeah i mean i think peter and i will

completely agree that this all needs to be embedded from the moment well preconception isn’t it you know it starts with

you know when you first um you know planning your family from preconception through pregnancy etc all the way through our

lives i think continuing education on this really crucial topic is essential it’s just how we prioritize

um the education we think is necessary for for children isn’t it you know we often

don’t teach the practical skills and it’s all the sort of academic achievements that are that are um you know uh are focused

on but yeah absolutely and i think it needs to be embedded within within all aspects we’re trying to work on this here in the

uk and actually it’s been led by medical students are demanding it and actually we we’ve managed to get some

sessions starting next academic year in in a handful of medical students mainly actually when we’ve sort of

approached people who are developing their planetary health modules they seem to be much more receptive to

sort of talking about sustainable plant-based diets and and we have an organization in the

uk called nutri tank which is student-led that is asking for and demanding nutrition led

education so i think you know it will be covered but you know i think we also need to accept that you know i’m a hematologist

i didn’t learn any hematology at medical school it was all post-graduate learning and i think it’s

upon ourselves to keep up to date with the science as well in areas that impact our patients health

so um and so so well we can’t learn everything so um i i think it’s a case of lifelong

learning and accessing that accredited information absolutely and that resource that peter

mentioned before the moving medicine forward is a great one to start with we also have our plant-based nutrition

and health toolkit which you can order free from our website at doctors for nutrition

which has got some great um starting tips in it last question

we have someone asking about foods that enhance mental health would

either of you like to comment on the evidence around what sort of you

know eating pattern or specific foods can help support good mental health

peter do you wanna i mean it’s the same dietary pattern i’m sorry i’m gone did you finish cherry

i was only gonna say it’s the same dietary pattern that promotes or all good physical health essentially

because we know that inflammation is contributing to worse

mental health and we also know that some of our key hormones that affect our mood

are made in the gut um and so you know paying attention to our gut health with

a fiber-rich plant-based diet and keeping inflammation low through our colorful fruits and vegetables is

essentially what’s been shown up in their literature so there’s good data for lots of fruits and vegetables and there’s good data for

limiting saturated fat from animal sources and you know many healthy diet patterns

like the mediterranean diet the dash diet and pcrm conducted a really great study with the insurance company geico

that showed improved um mental health and well-being and employees that adopted a

short-term whole food plant-based diet same

lovely peta did you have anything to add no you covered what i was going to say um and we apparently produce about 90 of

our serotonin in the gut if we have a healthy microbiome which requires us to eat a lot of fiber

and a lot of plants and there’s no fiber in animal foods very little in processed foods refined grains oils and

sugars don’t have any so having a healthy microbiome is critical for good mood

for good mental health um the the research is still emerging but but it looks very clear that um

mental health is enhanced by eating well but also good sleep good exercise getting some sun

having good social connections we need all of those things that lifestyle medicine is for to be well mentally and

physically wonderful thank you so much peter and shireen for all your amazing um

insights and knowledge that you’ve shared with us apologies to anyone um who we didn’t get

to address your question we’ll try and cover these through our social media channels over the coming weeks

and we’re also really thankful to everybody who has joined us here this evening and we really hope that the information

shared has been useful and practical enough to be able to use it in your day-to-day

practice and a great next step if you would like to learn more as i

mentioned we do have a toolkit which you can order for free

so if you head to doctors4nutrition.org then we will post that out to you

anywhere in australia or new zealand it contains a guide which has a lot of key references it has

a patient dietary assessment tool a patient handout a shopping ideas list and also a poster

that you can put up in in your clinic or in your waiting room or in the pharmacy where you work or in

your medical school and we um also have an evaluation survey

that we would really appreciate if you could take a few minutes to fill that out and alicia is going to drop the link to that

into the chat box now and this will help us to design future

webinars and other educational tools that we provide and all of our work here at doctors for

nutrition is made possible thanks to the kind support of donors and while tonight was the final

installment in the second season of food vitals all of our recordings are

available free on our website and so you’re very welcome to go and

view any that you have missed if you would like to support doctors for nutrition to

continue to deliver these free educational resources then please consider supporting the

charity through a one-off or a monthly donation and i think alicia is going to put the

link to our donations page in the chat box as well

now we’re really excited to announce that our next events that we’re going to be

taking part in are coming up over the next six weeks um

and whilst covett has disrupted a few of our plans we’re hoping that some of these will um

go ahead so this weekend we’re going to be participating in the australians

australasian society of lifestyle medicines diabetes revolution summit one of our

directors dr luke wilson will be presenting at that and we’ll also be having an online

exhibit and sharing our resources there we’re going to the australian

medical students association global health conference in perth the following weekend

and we’ll be sponsoring the session on planetary health having a short address to that group

and also having an exhibit and giving out lots of resources we’re aiming to be at the royal

australian college of gp conference in melbourne again distributing lots of resources and

then the next one after that the general pathology conference in adelaide where helene will be giving

a 30-minute presentation and one of our dietitians deeney is also helping to design

a lunch menu which is great so we’re looking forward to having a healthy plant-based lunch at that conference

so finally if you do want to access any other resources or previous webinars

then you can head over to our website at doctorsfornutrition.org

and once again shireen thank you for joining us and being in from the other side of the world

it’s always a pleasure to learn from you and the evidence just keeps evolving so it’s

really great to have some of that latest you know up-to-date information particularly around nutrition and

coverage and also how nutrition interacts with other aspects of health including

our environment thank you very much it’s been a real pleasure to be here this morning lovely

great well i wish everybody um a lovely evening wherever you are and um thoughts are with all those who

are in lockdown or other restrictions and hopefully you know we’ll be making

our way through these tough times and be able to connect more in person

over you know the coming months and year ahead so ngamahi thank you

everybody for joining us tonight and i hope to see you soon good night