Plant-based diet for treating heart disease

Coronary artery before and after plant-based diet (C. Esselstyn 2001)

Coronary artery before (left) and after (right) plant-based diet (Esselstyn CB Jr: Preventive Cardiology 2001;4: 171-177)

Few people realise that a plant-based diet not only prevents heart disease but can also reverse it. Choosing whole grains, fruits and vegetables and avoiding simple sugars, and saturated and trans fats, as in meat and dairy products, has been shown to result in regression of coronary atherosclerosis after 1 and 5 years in some studies (1) (2) and to continue for over 12 years in other studies (3).

In contrast, standard medical interventions for cardiac patients, such as coronary artery bypass, bypass grafts, atherectomy, angioplasty or stenting, treat only the symptoms, not the disease.  It is therefore not surprising that patients who receive these interventions alone often experience progressive disease, graft shutdown, restenosis, more procedures, progressive disability, and ultimately death from disease (4).

Caldwell Esselstyn MD persuaded 18 cardiac patients to continue with a plant-based diet for over 12 years. Adherent patients experienced no extension of clinical disease, no coronary events, and no interventions. This finding is all the more compelling when we consider that the original compliant 18 participants experienced 49 coronary events in the 8 years before the study (4).

Some patients believe that there is no need to change their diet if they have had heart surgery, stents inserted and/or are taking drugs like statins and aspirin.

A recently published international study (5) indicated that individuals (more than 31,000 men and women of an average age of 66 in this study) who chose whole grains, fruits, vegetables, nuts, and fish over meat, eggs and refined carbohydrates had a 35% reduction in cardiac death rates over 5 years. That’s a 35% reduction in addition to the decrease from surgery and optimal medical management. And these men and women were older, where you’d expect diet to be able to reverse less.

So it is never too late to make simple changes to your diet and lifestyle to improve your long-term health, whether you have medically-managed heart disease or not.

If you have heart disease, you can eat a wonderful variety of delicious, nutrient-dense foods:

  • All vegetables except avocado. Leafy green vegetables, root vegetables, vegetables that are red, green, purple, orange, and yellow – every colour of the rainbow
  • All legumes—beans, peas, and lentils of all varieties.
  • All whole grains and products, bread and pasta, that are made from them—as long as they do not contain added fats.
  • All fruits

You need to avoid:

  • Red meat, poultry and fish
  • Dairy products
  • Oils of all kinds (even olive oil)

 

For recipe ideas, tips and information about following a plant-based diet please sign up for my free newsletter and check out my website.

You can also find me on Facebook, Twitter and LinkedIn.

 

References

(1) Ornish, D. et al (1998). Intensive lifestyle changes for reversal of coronary heart disease. JAMA, Vol 280, No. 23, 2001-2007

(2) Ornish, D. et al (1990). Can lifestyle changes reverse coronary heart disease?  The Lancet, 21 July 1990, Vol 336, No. 8708, 129-133

(3) Esselstyn, C. (2001).  Resolving the coronary artery disease epidemic through plant-based nutrition.  Preventive Cardiology, 4, 171-177

(4) Esselstyn, C.  Updating a 12-Year Experience With Arrest and Reversal Therapy for Coronary Heart Disease (An Overdue Requiem for Palliative Cardiology).  Article on Caldwell Esselstyn’s website.

(5) Dehghan, M. et al. Relationship Between Healthy Diet and Risk of Cardiovascular Disease Among Patients on Drug Therapies for Secondary Prevention: A Prospective Cohort Study of 31 546 High-Risk Individuals From 40 Countries. Circulation, 4 December 2012, 126: 2705-2712

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Healthy Food Healthy Business

Eating out is no longer an occasional luxury.  Consumers in the UK spent a staggering £81 billion on catering services in 2008 (1) and sales on food eaten out have increased by 23 percent since 2003 (2).  Market surveys estimate that between 7.5 and 8.5 billion meals were eaten out in the UK in 2009 (3).  DEFRA statistics suggest that one in every six meals in the UK is eaten out and the catering industry provides at least three meals per week for the average person in Britain (1).  Approximately 20 to 30 percent of each household’s food budget is spent on food and drink consumed outside the home (1). 

So what are the most important factors driving consumer food choices in the eating out market?

Recent surveys by the Food Standards Agency (4) and leading market research organizations (3), as well as sales data from supermarkets (5), indicate that health consciousness has moved right to the top of the consumer agenda. There is growing evidence that consumers are beginning to give health similar priority to price and value for money when deciding what to eat. 

Worldwide, more than 60 percent of deaths are caused by chronic diseases (6), thus almost everyone knows someone who has suffered from cancer, heart disease, stroke and diabetes.  Public awareness of the key role played by diet in the development of many of these diseases is increasing.  People are therefore concerned about the amount of calories, salt, saturated fat and sugar they are consuming.  As eating out becomes more common, the nutritional quality of the eating out diet is starting to receive scrutiny.

Latest figures show that 11 percent of total energy intake comes from eating out (1).  This number would be substantially higher if alcohol consumption were included.  The eating out diet has more fat and less carbohydrate than the household diet. 

Several consumer surveys conducted in the UK and the USA between 2006 and 2009 point to a growing demand for healthier menu items and a frustration at this need not being met (3) (7) (8) (9).  In one UK survey conducted by Consumer Focus (10), 94 percent of respondents indicated a desire for increased availability of healthier food when eating out.  At the same time, Datamonitor reported that 35 percent of European consumers cannot find healthier menu items when dining out (8).  On top of this, consumers are beginning to request more information about the provenance of their food and its nutritional content (11). 

Supermarkets have already reacted to this trend and implemented front of pack ‘traffic light labelling’ to provide consumers with information on the content of major nutrients and on whether the item is relatively healthy (green) or unhealthy (amber or red).  In 2009, Sainsbury’s reported a dramatic shift in purchasing patterns as a consequence of introducing such labels.  Sales of healthier items increased by 40 to 97 percent, whilst those of less healthy items decreased by 30 to 40 percent (5).

The National Restaurant Association reported that 60 percent of US consumers are aware of calorie information when making menu choices and 25 percent use this information to influence their choices (12).  A study published by Stanford University in January 2010 looked at the impact of mandatory calorie labelling in Starbucks in New York, Boston and Philadelphia.  They found that calorie posting led to a 6 percent reduction in calories per transaction.  This was entirely related to food choices and did not affect beverage consumption.  Interestingly, in Starbucks outlets within 50m of a competitor, the calorie posting led to an increase in Starbucks’ revenue (13).

In the UK, the FSA started working with 18 large catering businesses in 2009 to provide voluntary labelling of calorie content of menu items; the outcome of this is still being evaluated.

So the evidence suggests that today’s eating out consumers are cost-conscious, health-conscious and ethically-conscious.  The successful catering business will capitalise on these trends and create value by delivering what the consumer wants.

The good news is that making small and simple changes to menus to reduce content of calories, saturated fat, salt and sugar can enhance both health and profit margins.  Training courses are available to provide information and practical suggestions about how this can be achieved (14).

For example, there is plenty of scope to reduce portion size and reduce costs and food wastage.  The latest National Diet and Nutrition Survey published in February 2010 shows that average intake of protein is almost double that of the guideline intake (15).  Protein content of dishes can thus be reduced, thereby reducing cost.  Likewise, a number of businesses have reported increased margins as a result of reducing fat content of their menu items.

As life expectancy of the burgeoning world population continues to rise along with the incidence of overweight and obesity, the number of people with chronic diseases will increase.  There is also an increase in the number of the “worried well”.  Health consciousness is likely to intensify and caterers who provide healthier menu choices will position themselves to generate healthier businesses.

For further information and practical suggestions for providing healthier menu items, please come to a Healthier Catering Training Course in the UK.  Suitable for caterers and for professionals involved in encouraging healthy eating in the population.

Works Cited

1. DEFRA. Food Statistics Pocketbook. 2009.

2. Mintel. Eating Out Review. 2009.

3. Allegra Strategies. Review. 2009.

4. Food Standards Agency. Quarterly Public Attitudes Tracker. December 2009.

5. Sainsbury’s. Effect of food labelling on food purchasing choices. 2009.

6. World Health Organisation. World Health Report. 2002.

7. Nestle Professional. 2010.

8. Datamonitor. Workplace consumption: targeting a captive audience. 2005.

9. Aramark (NYSE, RMK) Dining Styles. Research presented to clinical researchers and health professionals at the 2006 NAASO Obesity Summit in Boston October 22-24. 2006.

10. Consumer Focus. s.l. : http://www.consumerfocus.org, 2006.

11. Food Standards Agency. June 2008.

12. National Restaurant Association. 2008.

13. Bollinger, B., Leslie, P. and Sorenson, A. Calorie posting in chain restaurants. s.l. : Stanford University, http://www.gsb.stanford.edu/news/StarbucksCaloriePostingStudy.pdf, January 2010.

14. Philpott, J.K. Healthier Catering Training Courses. s.l. : http://www.cookingforhealth-uk.com/healthier-catering.php.

15. Food Standards Agency and Department of Health. National Diet and Nutrition Survey. Headline results from Year 1 of the Rolling Programme 2008-2009. s.l. : FSA and DoH, February 2010.

McDonald’s Map – fast food forward?

macdonalds_us_high_9_25This week photographer Stephen Von Worley set the blogosphere buzzing with his astonishing image of the distribution of the 13,000 McDonald’s fast food outlets across the United States.

Close to highways and population centres, there is apparently no escape from the Big Macs, fries, 710-calorie salads and super-sized vats of coke.

Is anywhere sacred, wondered Von Worley?

“For maximum McSparseness, we look westward, towards the deepest, darkest holes in our map: the barren deserts of central Nevada, the arid hills of southeastern Oregon, the rugged wilderness of Idaho’s Salmon River Mountains, and the conspicuous well of blackness on the high plains of northwestern South Dakota.  There, in a patch of rolling grassland, loosely hemmed in by Bismarck, Dickinson, Pierre, and the greater Rapid City-Spearfish-Sturgis metropolitan area, we find our answer.  Between the tiny Dakotan hamlets of Meadow and Glad Valley lies the McFarthest Spot: 107 miles distant from the nearest McDonald’s, as the crow flies, and 145 miles by car!”

Yesterday, Britain’s Telegraph Newspaper reported that America’s Fast Food Temple is celebrating its 30th anniversary in France by opening its 1,142nd Gallic outlet a few yards from the Louvre Museum.

“This is the last straw,” said one art historian working at the Louvre, who declined to be named. “This is the pinnacle of exhausting consumerism, deficient gastronomy and very unpleasant odours in the context of a museum.”

This echoes the sentiment of many in France who view “McDo” as the Trojan horse of globalisation and the scourge of local produce and long lunches.

Despite this, statistics suggest the battle of Le Big Macs has already been lost. France has become McDonald’s biggest market in the world outside of the US, according to the chain. While business in traditional brasseries and bistros is in freefall, the fast food group opened 30 new outlets last year in France and welcomed 450 million customers – up 11 per cent on the previous year.

British people will either be horrified or reassured to know that despite the comparatively tiny size of our islands, we still find room for an artery-busting 1,250 McDonald’s outlets.

Is it any wonder we have an obesity crisis?

 

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Over-eating when eating out

Recently, I gave the menu of a well-known chain restaurant to a group of students and asked them to select what they would eat if they were dining there. 

 

They selected a starter (garlic bread with cheese), a main course (traditional lasagne with a salad), a dessert (ice cream) and a drink (a can of coke). 

 

Using the restaurant’s own nutritional information, they calculated the nutrient content of what they had chosen (Table 1).  The results left the students open-mouthed.

 

Their menu selection had provided:

 

n 106% of the guideline daily amount of calories (assuming 2000 kcal per day);

n 141-171% of the guideline daily amount of protein (depending on whether they were male or female);

n 61% of the guideline daily carbohydrate;

n 109% of the guideline daily amount of total fat;

n 192% of the guideline daily amount of saturated fat

n 52% of the guideline daily amount of salt. 

 

It is worth noting that the dietary reference value for salt in the UK is 6 g per day, compared with 2.3 g per day in the USA.

 

Thus, one meal out would have provided more than the entire day’s requirement for calories; enough protein to last for one and a half days; and enough saturated fat to last for two days.

 

Most people have no idea of the nutrient content of the food they are eating, nor of the potentially damaging effects on their health of a dietary excess of sugar, saturated fat and salt. 

 

Given that at least one–third of household expenditure on food and drink is spent on food eaten outside the home in the UK, food manufacturers and caterers have a real opportunity to contribute to an improvement in public health whilst also making a profit themselves. 

 

There is now convincing research evidence to suggest that increasing the amount of fruit, vegetables and whole grains in the diet, whilst decreasing the amount of sugar, saturated fat and salt, helps to protect the body from chronic conditions such as obesity, type 2 diabetes, heart disease and various cancers.

 

A two-day professional training course is offered, tailored to equip caterers, and those involved in encouraging healthier catering practices, with information and practical tools to achieve healthier eating in the population.

 

By the end of the course, participants will:

  • Understand the basic principles of nutrition
  • Be aware of the importance of food in the maintenance of health and well-being
  • Appreciate the role of lifestyles and culture in influencing diet
  • Recognise the potential benefits for both caterers and customers of providing a choice of healthier options
  • Know more about ingredient selection and methods of food production and processing that can be used to create healthier options, whilst being attractive and convenient to modern tastes and lifestyles
  • Be able to apply appropriate and relevant skills and knowledge when advising catering businesses or when planning, preparing, promoting and serving healthier foods

For further information on the course content and the course tutor, Dr Jane Philpott, please click http://cookingforhealth-uk.com/healthier-catering.php.

 

 

Table 1

Menu item

Calories per portion

Protein g per portion

Carbohydrate g per portion

Total fat g per portion

Saturated fat g per portion

Salt g per portion

 

Starter

 

568

 

29.8

 

35.6

 

34

 

16.5

 

1.15

 

Main course

 

934

 

 

42.2

 

74.4

 

33.1

 

14.6

 

1.84

 

Dessert

 

 

475

 

5.5

 

18.8

 

18.1

 

11.1

 

0.15

 

Drink

 

 

139

 

0

 

35

 

0

 

0

 

0

 

 

 

 

 

 

 

 

Total

 

 

2116

 

77.5

 

163.8

 

85.2

 

42.2

 

3.14

 

Gov guideline

 

 

2000 kcal

 

45 g/day (women)

55 g/day (men)

 

267 g per day

 

78 g per day

 

22 g per day

 

6 g per day

 

% of guidelines

 

 

106%

 

171% (women)

141% (men)

 

 

61%

 

109%

 

192%

 

52%

 

 

 

Obesity in children

Overweight and obesity among children is widely regarded as being even more serious than it is among adults, with a very rapid rise in prevalence in the last two decades. Child obesity is likely to continue into adulthood, and many of the problems linked to obesity are more severe if the obesity has been present for a long period. Adults with the highest risk of diabetes, cardiovascular disorders, liver malfunction and orthopaedic dysfunction, are likely to have the most extreme levels of obesity and to have been obese since childhood[i].

fat_kid

Projections of child obesity based on trends from the 1980s and 1990s indicate that the annual increase in child obesity prevalence is itself increasing[ii]. By the year 2010, some 26 million school children in the EU are expected to be overweight, of which 6 million will be obese. The numbers of overweight children will rise by some 1.3 million per year, of which the numbers of obese children will rise by over 0.3 million per year.

At a conservative estimate, over a million obese children in the EU are likely to show a range of indicators for cardiovascular disease, including high blood pressure and raised blood cholesterol levels, and to have three or more indicators of the metabolic syndrome[iii]. Over 1.4 million children could have early stages of liver disorder.

The costs of childhood obesity have not been estimated but should include lost educational opportunity. A study of children’s quality of life found the psychological effects of severe obesity to be equivalent to a diagnosis of cancer[iv].

Behaviour, learning and mental health problems in children are rising as fast as rates of obesity and diabetes. Food affects brains as well as bodies, and early malnourishment can have devastating effects on both. Conversely, improving nutrition can help reduce antisocial behaviour as well as symptoms of ADHD, dyslexia, depression and related conditions[v].

The only pan-European estimates of children’s food consumption patterns are from self-reported surveys of health behaviours of children aged 11-15 years[vi]. The most recent (for 2001-2002) found:

  • In virtually all countries fewer than 50 per cent of children ate vegetables every day. On average, 30 per cent of children said they ate vegetables daily, but the children in countries once famous for their Mediterranean diets reported lower than average levels, especially Spain, where vegetables were typically eaten daily by only 12 per cent of children.
  • In virtually all countries fewer than 50 per cent of children ate fruit every day. On average, 30 per cent of boys and 37 per cent of girls reported eating fruit daily, but in sixteen countries only 25 per cent of children were eating fruit more than once a week. Lowest levels of consumption were reported among children in Northern European countries.
  • Soft drinks and confectionery were consumed daily by about 30 per cent of children (over 40 per cent in some countries).

According to the last National Diet and Nutrition Survey in the UK[vii]:

  • 92 per cent of children consume more saturated fat than is recommended
  • 86 per cent consume too much sugar
  • 72 per cent consume too much salt
  • 96 per cent do not consume enough fruit and vegetables

Governments are trying to improve children’s diets, but young people’s exposure to marketing pressures in our time-poor, anxiety-ridden, media-driven society is at an all-time high.

Widespread action is needed to reverse current trends – and we all need to take responsibility for what we are feeding young bodies and minds.

In a Cooking for Health class focused on Healthy Cooking for Your Children, we look at:

  • The best and the worst food for children
  • Easy steps to free your child from food traps
  • Simple, child-friendly recipes
  • Practical tips to help your child make the best food choices

The class involves 100% hands-on practical cooking in a small, supervised group, combined with teaching of up-to-date information and research findings on the effects of diet on health. Clear, easy-to-follow presentations and handouts are provided with plenty of opportunity for questions and discussion.

References

[i] Policy options for responding to obesity. Summary report of the EC-funded project to map the view of stakeholders involved in tackling obesity – the PorGrow project. Dr Tim Lobstein and Professor Erik Millstone. http://www.sussex.ac.uk/spru/porgrow

[ii] Jackson-Leach R, Lobstein T. Estimated burden of paediatric obesity and co-morbidities in Europe. Part 1. The increase in the prevalence of child obesity in Europe is itself increasing. Int J Pediatric Obesit 2006;1:26-32.

[iii] Lobstein T, Jackson-Leach R. Estimated burden of paediatric obesity and co-morbidities in Europe. Part 2. Numbers of children with indicators of obesity-related disease. Int J Pediatric Obesity 2006;1:33-41.

[iv] Schwimmer JB, Burwinkle TM, Varni JW. Health-related quality of life of severely obese children and adolescents. J Am Med Ass 2003;289:1813-9.

[v] Richardson, A. They Are What You Feed Them. Harper Thorsons (5 Jun 2006)

[vi] HBSC. Young people’s health in context: Health Behaviour in School-aged Children 2001/2002. Health Policy for Children and Adolescents 4. C Currie et al (eds) Copenhagen: WHO Regional Office for Europe, 2004.

[vii] Gregory, J. et al. National Diet and Nutrition Survey: Young People Aged 4-18 years (The Stationery Office, 2000)

 

 

 

Mediterranean diet may help prevent prostate cancer

Recently reviewed evidence relating diet and prostate cancer suggests that a traditional Cretan Mediterranean style diet based on a variety of plant foods (fruits, vegetables, wholegrain cereals, nuts and legumes), olive oil as the main source of fat, moderate to low intake of dairy foods, moderate to high intake of fish and moderate intake of wine, mostly with meals, may be helpful in reducing prostate cancer risk.

mediterranean_food

A recent meta-analysis of prospective cohort studies using a score to assess adherence to a Mediterranean diet found that stronger adherence was associated with reduced all cause, cardiovascular and cancer mortality, as well as decreased incidence of Parkinson’s and Alzheimer’s diseases [i].

Two intervention studies have supported the benefits of a Mediterranean style diet on metabolic risk factors [ii] [iii].  In a Spanish study, men and women with elevated levels of cardiovascular risk factors were randomised to either of two ‘Mediterranean’ diets and provided with either olive oil and nuts, or to a control low fat diet.  After 3 months the Mediterranean diet groups had lower mean plasma glucose, systolic blood pressure and total/HDL cholesterol ratio than the control group [ii].  Italian adults with the Metabolic Syndrome were randomised to a ‘Mediterranean’ diet or a ‘prudent’ diet, both with similar macronutrient (carbohydrate, protein, fat) composition.  The ‘Mediterranean’ diet was associated with greater improvements in markers of vascular risk and endothelial function than the control group [iii].  In both studies the ‘Mediterranean’ diet groups received more nutrition education than the control groups.

The Lyon Heart Study demonstrated that a modified Cretan diet low in butter and meats, and high in fish, fruits and enriched with alpha-linolenic acid from canola oil was more effective than a ‘prudent’ diet in the secondary prevention of coronary events and overall mortality [iv]. 

Simopoulos [v] notes that the traditional Greek diet resembles the Paleolithic diet in terms of fibre, antioxidants, saturated and monounsaturated fat, thus is consistent with human evolution.  While traditional diets must reflect regionally available foods, the dietary principles of the traditional Greek diet may be applied in many countries.  The evidence suggests that a traditional Greek or Cretan style diet is consistent with what humans have evolved to consume and may protect against common chronic diseases, including prostate cancer.

For information and practical tuition in how to incorporate the dietary principles of the Mediterranean diet into your own cooking, why not come along to a Cooking for Health course, run throughout the year in Somerset, UK.

Jane Philpott

References

[i] Sofi, F., Cesari, F., Abbate, R., Gensini, G F., Casini, A. Adherence to Mediterranean diet and health status: meta-analysis.  BMJ 2008: 337: a1344.

[ii] Estruch, R., Martinez-Gonzalez, M A., Corella, D. et al.  Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomised trial.  Ann Intern. Med. 2006: 145: 1-11.

[iii] Esposito, K., Marfella, R., Ciotola, M. et al.  Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomised trial.  J Am Med Assoc 2004; 292: 1440-6.

[iv] de Lorgeril, M., Salen, P. Modified Cretan Mediterranean diet in the prevention of coronary heart disease and cancer.  In Simopoulos A,P., Visioli, F. eds.  Mediterranean Diets.  World Review Nutr. Diet. Basel: Karger, 2000: 1-23.

[v] Simopoulos, A P. The traditional diet of Greece and cancer.  Eur J Cancer Prev 2004; 13:219-30.