Food based dietary patterns and chronic disease prevention
BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k2396 (Published 13 June 2018) Cite this as: BMJ 2018;361:k2396
Food for thought
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I am delighted to see this BMJ series on nutrition and health. Nutrition is an area that is overlooked by much of the medical field, yet a healthy diet and lifestyle has the potential to prevent the majority of chronic diseases prevalent in affluent countries.
I am however, disappointed to find that the evidence in support of predominantly plant-based diets or a whole food plant-based diet has not been included. Although the series of articles promote fruits, vegetables and whole grains as healthful components of the diet, it fails to recognise the substantial literature supporting the minimisation/elimination of animal products, including eggs and dairy from the diet. The scientific literature not only supports this dietary pattern for optimal human health and wellbeing but as a sustainable diet for the health of our planet.
There are a number of studies demonstrating the role of plant-based diets in preventing chronic disease. The Adventist Health Studies (https://publichealth.llu.edu/adventist-health-studies/researchers/scient...) demonstrate that those following a vegan diet having a significantly lower body weight and risk of cardiovascular disease, cancer, hypertension and diabetes, when compared to other dietary patterns. There are several human intervention studies, some randomised, demonstrating that a low fat whole-food plant-based diet can arrest and even reverse coronary artery disease (Lancet 1990; 336:129-33), early stage prostate cancer (J Urol. 2005;174:1065-1070) and diabetes (Am J Clin Nutr 2009;89(suppl):1588S–96S). If there was a pharmaceutical drug that could claim to have these effects, it would have made a fortune. Of course more scientific data would be beneficial to strengthen the argument, but whilst we are waiting for this surely we should act upon the knowledge we already have. The longest lived, healthiest populations around the world 'The Blue Zones' consume a predominately unprocessed whole food plant-based diet. Lets capitalise on this simple prescription.
Competing interests: No competing interests
Many thanks for a terrific article.
I agree with the above responder's sentiments re the dangers of dairy, however I recognize that this line of investigation would have demonstrated a departure from the general scope of the review. I don't feel there is compelling data that dairy causes Type 1 Diabetes per se, but when the landmark TRIGR trial finds that hydrolyzing the milk proteins does not mitigate the risk (which is substantial, hence the landmark trial) it does leave serious questions over its use, especially in infant formula. Furthermore, as cows milk allergy is so common in pediatric clinics, ED and in primary care one would wonder why the safe alternative of soy milk is not advised (ignoring the multibillion dollar infant formula industry issue). If dairy was a novel drug I cannot see it passing phase II i.e., safety, and I see no such concerns for soy. The spectacular lack of evidence for milk and bone protection (excellent study by Michaellson et al last year BMJ) and the worrying studies regarding prostate and breast cancer with dairy deserved mention also.
Regarding the review, I feel they missed the narrative behind the DASH diet. On inspection you will see it is a de facto vegan diet, the addition of only two animal protein portions per week was likely a work-around to sell a vegetarian diet to an American public (which is less palatable than a carcinogenic standard American diet, only in America). The original DASH study pitted the DASH diet against a "fruit and vegetable" diet, whereby the DASH has contained more fruit and vegetables than the "fruit and vegetable" diet (which was in fact laden with meat and confectionary). it was akin to your parents having to dress up healthy food with some sort of narrative to get you to eat it when you were a child!
The review also missed a macroscopic view, which is best summarized by Prof Walter Longo 5 pillars of interpreting nutritional literature which includes looking at populations with the most centurions per capita. For me there are 3 things to look at. 1- population studies, Who lives longest and healthiest globally (answer: the 5 "Blue Zones", they all eat a whole food plant based diet). 2 - what do the observational studies tell us (we accept them with their inherent flaws at inception as they are still a rich source of data) and 3- the kicker, the cell-cell studies i.e., is there a cellular mechanism of action that explains what we can see at a population level. In this respect only the WholeFood-PlantBased diet achieves all three points i.e., multiple objective independent and repeated studies from population to petri dish.
The major impasse I see is not in collecting more quality data, we already have more than enough to act on, but in imparting the knowledge we have accrued. In this respect I wholly commend this nutrtion review by the BMJ. I am viewing it in conjunction with the stellar concurrent work that is being carried out by Goldacre, Godlee, Heneghan et al with the BMJ and EBM Oxford i.e., calling for an objective evidence base that is appropriately regulated.
Many thanks for considering my thoughts on this important subject matter.
Competing interests: No competing interests
Food is fuel for life and health. But what is a healthy diet? Is it tasty and satisfying?
A healthy diet is nutritious food without toxins or addictions. Both toxins and addictions make us sick. So we should avoid toxins like pesticides, herbicides, and fungicides; and we should avoid addictions like sugar, honey, chocolate, vanilla, cola, coffee, tea, alcohol, tobacco, and drugs. What should we eat?
We should eat organic food and follow a lacto-ovo-vegetarian diet. Organic food minimizes toxins, and a lacto-ovo-vegetarian diet (no meat, chicken, or fish) minimizes our craving for addictions. The result is an organic, addiction-free Lacto-Ovo-Vegetarian diet, which I call the “LOVE Diet," my acronymic recipe for health.
We shouldn't eat meat, chicken, or fish, because they cause addiction. So the LOVE Diet replaces meat, chicken, and fish with eggs, dairy, fruits, vegetables, grains, beans, nuts, and seeds. Delicious and nutritious, the LOVE Diet is a recipe for peace and health, our most crucial but elusive goals.
The opposite of the LOVE Diet (nutrition) is the “HATE Diet” (addiction). The HATE Diet (Honey, Alcohol, Tobacco, Espresso) is a non-organic diet that includes meat, chicken, fish, and addictions. With cravings and ravings, the HATE Diet is a recipe for conflict and sickness. So delete meat, and pledge veggies. Choose LOVE, not HATE.
Competing interests: No competing interests
The authors are ignoring a major cause of why food has become dangerous. Food protein containing vaccines, program the immune system to recognize food as pathogens.
Injecting cow's milk containing vaccines causes IgE mediated
sensitization to cow's milk proteins (bovine casein, bovine folate
receptor (FR) proteins, bovine insulin etc.)
Subsequently consuming cow's milk (either because allergy is mild or
oral immunotherapy) causes synthesis of IgG4 against all of the above
proteins.
Alum-Containing Vaccines Increase Total and Food Allergen-Specific IgE,
and Cow's Milk Oral Desensitization Increases Bosd4 IgG4 While Peanut
Avoidance Increases Arah2 IgE: The Complexity of Today's Child with Food
Allergy
https://www.jacionline.org/article/S0091-6749(15)02364-7/abstract
Vaccines and the development of food allergies: the latest evidence
https://www.bmj.com/content/355/bmj.i5225/rr-0
Food protein containing vaccines cause the development of food allergies
https://www.health.harvard.edu/blog/giving-antacids-and-antibiotics-to-b...
IgG4 against bovine casein causes eosinophilic esophagitis (EoE).
IgG4 against bovine FR causes autism.
IgG4 against bovine insulin causes type 1 diabetes.
Food-specific IgG4 is associated with eosinophilic esophagitis
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5053831/
A milk-free diet downregulates folate receptor autoimmunity in cerebral
folate deficiency syndrome
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2715943/
Effect of cow's milk exposure and maternal type 1 diabetes on cellular
and humoral immunization to dietary insulin in infants at genetic risk
for type 1 diabetes. Finnish Trial to Reduce IDDM in the Genetically at
Risk Study Group.
https://www.ncbi.nlm.nih.gov/pubmed/11016449
Cow milk feeding induces antibodies to insulin in children--a link
between cow milk and insulin-dependent diabetes mellitus?
https://www.ncbi.nlm.nih.gov/pubmed/9496688
Presence of anti-insulin reaginic auto-antibodies of the IgG4 class in
insulin-dependent (type I) diabetic patients before insulin therapy.
https://www.ncbi.nlm.nih.gov/pubmed/8400892
Competing interests: No competing interests
Dietary patterns, frailty and the Mediterranean diet: when the issue of anorexia is in-between.
Dear Sir,
We read with much interest the article by Schulze et al. (1), which recently appeared in the series “Food for thought” of the BMJ and analyzed the knowledge of the associations between dietary patterns and chronic diseases, including cardiovascular diseases, diabetes and cancer. In particular, the authors focused on food based dietary patterns preventing chronic diseases, considering vegetables, fruits, legumes, whole grains and fish as food to prioritize, and sugar beverages and red/processed meat as food to discourage in consumption (1). The type and quality of diet appear extremely important, in particular when focusing on the role of the Mediterranean diet, which has been shown in several observational and randomized trials to lower chronic disease risk and to confer specific health benefits (1,2). However, the authors highlighted several limitations of randomized controlled trials on dietary intervention and health including high dropout rates and low adherence to the prescription (1).
We believe that food based dietary patterns described in the article (1) are important not only in the prevention of chronic diseases, but also during aging, a condition that can be associated or not with chronic diseases. In this light, it was recently focused on the potential positive effect(s) of the Mediterranean diet to prevent and treat frailty in older subjects (3), for whom it is important to modify food habits to improve nutritional status, quality of life, and possibly outcomes.
Nutritional aspects in frailty are clinically relevant considering that older adults present nutrients deficiencies for many reasons and several metabolic derangements that alter nutrients availability and utilization (4). Therefore, the clinical picture that we observe is often represented by unintentional body weight loss and low physical performance (3,5), that may overlap with the presence of protein-energy malnutrition. In particular, aging is associated with changes in body composition, such as increased total body fat mass and lower lean body mass, being predictive of a great and fast decline in muscle quality with age (5).
However, if we plan to prescribe in older frail subjects a tailored nutritional intervention, including the Mediterranean diet, we believe that is a crucial point to consider, as first step, the possible presence of anorexia.
Anorexia, defined as the loss or reduction of the desire to eat, is highly prevalent in older subjects and negatively impacts on survival (6). The pathophysiology of anorexia is complex and still not completely clear and several factors, including changes in peripheral gastrointestinal hormones, such as ghrelin, glucagon-like peptide, and cholecystokin, play a major role in the development of the loss of appetite during aging (4). Also, inflammation and alterations in the central regulation of appetite may occur, and experimental evidences indicate that a large number of neurotransmitters stimulating appetite are significantly reduced during aging (4). In addition, depression, acting as a powerful inhibitor of appetite, is one of the major cause of anorexia in older persons (7) and it should be early diagnosed and properly treated.
In this light, although the benefits of the Mediterranean diet may be highly valuable to treat also frailty in older subjects, we highlight the issue of anorexia of aging as a potential and important “barrier” to an ideal diet. Health care professionals, including physicians, dietitians, and nurses, should have the instruments to correctly diagnose and, when possible, to treat anorexia before considering a nutritional intervention, including the prescription of the Mediterranean diet, in frail older adults.
In summary, taking into account the considerations by Schulze et al. (1), we believe that dietary interventions are “key factors” to treat chronic conditions, although with some challenging aspects should be considered to improve dietary adherence.
References
1. Schulze MB, Martínez-González MA, Fung TT, Lichtenstein AH, Forouhi NG. Food based dietary patterns and chronic disease prevention. BMJ 2018;361:k2396. doi: 10.1136/bmj.k2396
2. Sofi F, Macchi C, Abbate R, Gensini GF, Casini A. Mediterranean diet and health status: an updated meta-analysis and a proposal for a literature-based adherence score. Public Health Nutr 2014;17:2769-82. doi:10.1017/S1368980013003169
3. Voelker R. The Mediterranean diet's fight against frailty. JAMA 2018;319:1971-2. doi:10.1001/jama.2018.3653
4. Morley JE. Anorexia of ageing: a key component in the pathogenesis of both sarcopenia and cachexia. J Cachexia Sarcopenia Muscle 2017;8:523-6. doi:10.1002/jcsm.12192
5. Fabbri E, Chiles Shaffer N, Gonzalez-Freire M, et al. Early body composition, but not body mass, is associated with future accelerated decline in muscle quality. J Cachexia Sarcopenia Muscle 2017;8:490-9. doi:10.1002/jcsm.12183
6. Molfino A, Laviano A, Rossi Fanelli F. Contribution of anorexia to tissue wasting in cachexia. Curr Opin Support Palliat Care 2010;4:249-53. doi:10.1097/SPC.0b013e32833e4aa5
7. Sanford AM. Anorexia of aging and its role for frailty. Curr Opin Clin Nutr Metab Care 2017;20:54-60. doi: 10.1097/MCO.0000000000000336
Competing interests: No competing interests