“Small steps” to a plant-based diet yield huge benefits

Source: McMacken M. Food as Medicine. Presented at: ACP Internal Medicine Meeting; April 28-30, 2022; Chicago.

Disclosures: McMacken does not report any relevant financial information.


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CHICAGO — Food choices are among the most important choices a person can make for their health, Michelle Mc MackenMD, FACP, DipABLM, said during a presentation at the CPA Internal Medicine Congress.

However, many Americans make food choices that can predispose them to various health problems. In fact, the top source of calories for Americans ages 2 and older are grain-based desserts, according to McMacken, executive director of nutrition and lifestyle medicine at NYC Health and associate professor at NYU Langone. Health and at NYU Grossman. Medicine School.

Various healthy and unhealthy foods
Food choices are among the most important choices a person can make for their health. Source: Adobe Stock.

Patients believe that physicians are the most credible source of information for nutritional advice. Yet many physicians do not receive adequate nutrition training in medical school or residency, McMacken told Healio.

Michelle McMacken

Michelle McMacken

“It’s important for physicians to recognize that dietary habits have a critical impact on the risk of chronic disease and premature mortality,” she said.

Cardiovascular health

Consumption of red and processed meats is linked to increased cardiovascular risk, including diabetes, stroke, coronary heart disease and heart failure.

McMacken referenced the Nurses’ Health Study and the Health Professionals Follow-Up Study during his presentation. The study found that in people with one or more mortality risk factors, replacing just 3% of calories with plant protein instead of animal protein was linked to a 34% reduction in meat mortality. processed red meat and 12% for unprocessed red meat.

In addition to meat, sugar consumption has been linked to cardiovascular health.

The average sugar consumption in the United States is about double the recommended daily value. The American Heart Association advises a maximum of 6 teaspoons of added sugars per day for women and 9 teaspoons for men. However, the average American consumes about 17 teaspoons of sugars per day.

McMacken pointed out that the risk is from consuming added sugars, not naturally occurring sugars. Two and a half servings of fruits and vegetables a day can significantly reduce cardiovascular risk, including an 8% decrease in coronary heart disease, a 16% decrease in stroke, and a 10% decrease in all-cause mortality , according to McMacken.

Insulin resistance

Processed and red meat and added sugars have also been linked to insulin resistance and diabetes, McMacken said during his presentation.

In fact, a daily serving of bacon (or other processed meat) was associated with a greater risk of diabetes (37%) than red meat (17%) and sugary drinks (21%).

Replacing just 5% of calories from animal protein with plant protein can reduce the risk of type 2 diabetes by 23%, according to research. Additionally, replacing approximately 35% of an individual’s total animal protein intake with plant protein significantly reduced HbA1c, fasting blood glucose, and fasting insulin.

Regular consumption of added sugars can keep a person’s blood sugar levels continually elevated, causing certain lipid subtypes to accumulate in the cytoplasm of skeletal muscle, resulting in lipotoxicity. Lipotoxicity can generate excess fat on the liver and increased fat in skeletal muscle, eventually leading to insulin resistance.

Cancer risk

In addition to the risk of cardiovascular disease and diabetes, the consumption of red and processed meats also increases the risk of cancer.

The WHO’s International Agency for Research on Cancer has labeled processed meats, including sausages, hot dogs, bacon and salami, as Group 1 carcinogens, meaning it has been proven that they cause cancer. Other red meats, including beef, pork, and lamb, are labeled as Group 2A carcinogens, meaning they likely cause cancer.

The risk of colorectal cancer increases by 17% for every 100g per day of red meat consumed and 18% for every 50g per day of processed meat consumed, according to McMacken.

However, healthy plant-based foods can have a protective and healing effect on cancer risk.

Increasing whole-grain fiber intake has been linked to a survival benefit, even in people who already have colon cancer, McMacken said. Specifically, each 5g per day increase in whole grain fiber represents a 33% decrease in colorectal cancer mortality in patients with stage I-III colon cancer.

Additionally, every three servings per day of whole grains consumed is associated with a 17% decrease in colorectal cancer risk and total cancer mortality.

Practical nutritional advice

Given the amount of research linking food choice to health risks and benefits, McMacken made the case for a plant-based diet in his presentation.

“A plant-based food pattern is really just a food pattern around which [plant-based foods] are really the base,” she said. “That doesn’t mean you have to be 100% plant-based. It just means you’re focusing a lot of your calories on the healthiest foods.

A healthy plant-based diet low in unhealthy plant-based foods like fruit juices, white flour, desserts, and sugary drinks has been shown to lower blood pressure, promote healthier body weight , improves glycemic control, improves vascular health, decreases inflammation and lowers lipids.

McMacken advised eating mostly vegetables, beans, lentils, peas, fruits and whole grains, and avoiding or working to limit red and processed meats, sugary drinks and highly processed foods. A 20% improvement in diet quality has been linked to an 8% to 17% decrease in mortality, she said.

However, getting patients to adopt and sustain dietary improvements can be difficult.

“Small steps work best for a lot of people,” McMacken said. “At the end of the day, it’s about progress, not perfection!”

When implementing nutritional advice in practice, McMacken recommended:

  • initiate the conversation and gauge the patient’s level of interest;
  • assess current diet with 24-hour recall, general questions, or 3-day food diary;
  • advise and examine the situation as a whole;
  • agree on the intensity of your approach based on the patient’s willingness and ability to make changes;
  • help the patient set a specific, measurable, achievable, realistic, and time-bound goal (recommend specific food exchanges or similar additions to a prescription); and
  • organize follow-ups.

“One strategy I’ve found effective is to focus on healthy foods that the patient already likes, has access to, and finds culturally relevant,” McMacken said. “These foods can be used to gradually ‘crowd out’ less healthy foods from the plate.”

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