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Why the way we eat is making us sick

 

When I joined Doctors for the Environment Australia (DEA) some years ago, I couldn’t understand why they were silent on the topic of food. After all, even by conservative estimates, the production of the world’s food is responsible for the majority of land degradation, biodiversity loss and fresh water use, and for around one third of global greenhouse gas emissions. Modern epidemics of obesity, diabetes and heart disease all relate to our changing diet, and diet is the number one risk factor in the global burden of disease.

After volunteering to write a DEA Position Statement on diet and agriculture, the problems quickly became clear. Food and agriculture is a huge, complex, and contradictory field, and it’s also something on which everyone, absolutely everyone, has an opinion.

Researching food and food systems led me to some of the most riveting non-fiction reading imaginable.

The story of food is one of culture, identity, inequality and social justice, power and wealth. The scope is huge. It takes us from the estimated one billion microbes in a teaspoon of healthy soil, to the sweeping changes made by agriculture to the planetary landscape.

Food has layers of meaning. Providing food to friends and family is one way in which humans demonstrate love, and yet paradoxically the provision of food has evolved into a global system which fails to respect the most basic rights of humans and animals and planetary health.

Out of the complexity of this far-reaching topic, a few very clear and simple truths have emerged for me:

  • Change is urgent and we need to do everything we can.

Put bluntly, the way we eat is making us sick, and the way that we produce and distribute food is making our planet sick.

Too much energy is wasted on arguing about what is the “main problem” or the “best solution”. Big, complex problems need lots of solutions.

For instance, meat production and consumption is one of the major issues, in terms of health and environmental impact, the power of vested interests, and the variety of conflicting opinions.

One person may be passionately devoted to promoting a vegan lifestyle, another will quote evidence that the most effective action is to reduce the meat consumption of the heaviest meat eaters, while another will want to support the livestock farmers who are trying to improve the sustainability of their operations.

Please let’s not argue amongst ourselves. We need all of these approaches; they are complementary.

  • Doctors are a vital part of the solution.

Doctors are trusted messengers, and people want their doctor to help them cut through the confusion surrounding nutrition. People are more likely to make changes to their diet for health reasons than for environmental reasons. Merely changing diets to meet standard dietary guidelines can carry significant environmental benefits.

In a world where the marketing budget of Coca Cola is double the annual budget of the entire World Health Organisation, doctors need to educate themselves, and speak up at every opportunity.

  • Action is required on a number of levels, simultaneously.

This shouldn’t be seen as daunting or overwhelming, but as an opportunity for anyone who cares about food and health to make a contribution in a way that is meaningful for them, and in a sphere where they have influence.

You can make a difference in your own back garden, or your own shopping habits. You can make a difference in the way you talk to your patients about health and diet. You can work with your community to establish a school or community garden. You can lobby government or industry. All of these things are interlinked, and progress in any one area will pave the way for easier wins in other areas.

  • Eat food. Not too much. Mostly plants.

If you want to keep it simple, this introductory line from In Defense of Food by journalist Michael Pollan summarises all you need to know:

To benefit both the environment and human health, reducing consumption of meat and processed food (“edible food-like substances” according to Pollan), and reducing food waste, are the changes most likely to have a significant impact.

  • We need to look after our farmers.

Industrial agriculture, with high inputs of fossil fuels, chemicals and pesticides, contributes disproportionately to the environmental impact of food, and is vulnerable to the effects of a changing climate. We need to look after the farmers who are exploring ways of making food production more sustainable, nourishing and resilient.

The beginnings of agriculture allowed for the development of human civilization. Agricultural practices have evolved over the course of human history, and will need to change again if we are to provide a sustainable and nourishing diet for the growing human population which is expected to reach 9.1 billion by 2050, just 32 years away.

We need nothing less than a paradigm shift in the way we produce and consume.  All of us can help make this shift possible by making changes in the home, in the workplace and anywhere we can.

Dr Kristine Barnden is a Hobart obstetrician, and a member of Doctors for the Environment Australia. She will be co-presenting “Agriculture and Food Security” at DEA’s annual conference in Newcastle, NSW, on Sunday 15 April.

The diet that reduces cardiovascular risk

 

The 5:2 diet championed by TV journalist Dr Michael Mosley appears to be better at reducing certain cardiovascular risks, compared with a more conventional calorie reduction diet, a new study has found.

The research published in the British Journal of Nutrition randomised 27 obese people, with an average BMI of 30 , to either a fasting diet – in which intake is limited to just 600 calories on two days a week – to a more standard weight-loss diet in which participants were advised to reduce their daily intake by 600 calories.

Previous research has focused on blood risk markers taken during fasting periods, whereas this study, undertaken by researchers from the University of Surrey, looked at lipid and glucose metabolism in the postprandial period.

Participants on the 5:2 diet achieved a 5% weight loss more quickly than those on a conventional diet (59 versus 73 days), and they also cleared triglycerides from their bloodstream more efficiently. Although there appeared to be no difference in the way the two diets handled glucose, there were significant variations between the diets in postprandial c-peptide, which is a marker for insulin secretion. This surprising finding needs further investigation, the researchers said.

The researchers also found a significant reduction in systolic blood pressure in those on the 5:2 diet. It was down by 9% in that cohort, and up by 2% in those on the daily calorie reduction diet.

“These preliminary findings highlight underlying differences between intermittent energy restriction and continuous energy restriction, including a superiority of intermittent energy restriction in reducing postprandial lipaemia,” the authors concluded.

But co-author Dr Rona Antoni of the University of Surrey said that although their research found benefits in the 5:2 diet compared with the more conventional alternative, the problem was compliance.

“Some of our participants struggled to tolerate the 5:2 diet, which suggests this approach is not suited to everybody; ultimately the key to dieting success is finding an approach you can sustain long term. But for those who do well and are able to stick to the 5:2 diet, i could potentially have a beneficial impact on some important risk markers for cardiovascular disease, in some cases more than daily dieting.”

You can access the study here.

Diet and dementia: what the research tells us

 

Dying and dementia are the two things people in their middle years tend to say they are most apprehensive about. The former is inevitable, but can the latter be avoided? A number of studies have shown an association between exercise, in particular resistance or muscle-building exercise, and a decreased risk of Alzheimer’s disease and other forms of dementia. The jury appears to be still out on the possible protective effects of brain training. But what about the food we eat?

Diet and dementia has been an intensive area of research, and the best way to learn anything from the myriad studies carried out with varying methods, objects and endpoints is to look at the meta-analyses and systematic reviews. The most recent review, published late last year, looked at all observational studies published between 2014 and 2016 on the relationship between diet and late-life cognitive disorders. This found evidence that combinations of foods and nutrients can act synergistically to provide stronger effects than found with any one particular ingredient. In particular, adherence to a Mediterranean-type diet – with its emphasis on plant-based foods, fish, poultry and olive oil – was associated with decreased rates of cognitive decline.

The review also finds another diet associated with a reduction or delay of Alzheimer’s disease: the emerging DASH – or Dietary Approach to Stop Hypertension – diet, which emphasises fruit, vegetables, whole grains and low-fat dairy foods. It includes meat, fish, poultry, nuts, and beans, but limits sugar-sweetened foods and beverages, red meat, and added fats. As its name suggests, it was originally designed to help in hypertension, which has in itself been linked to higher rates of dementia.

Combining the Mediterranean and DASH diets produces the MIND diet, or the Mediterranean-Dash diet Intervention for Neurodegenerative Delay, which has also been associated with lower rates of dementia in several studies. Put together by a team from the Rush University Medical Center in the US, the MIND diet, like the other two diets, emphasizes the importance of fresh fruit, vegetables, and legumes. But it also includes recommendations for specific foods, such as leafy greens and berries, which have been shown in studies to slow cognitive decline.

The MIND diet appears to be more effective at reducing cognitive decline than either the Mediterranean or DASH diets on their own. One prospective study of over 900 middle-aged and older people, followed for an average of nearly five years, found those with either moderate or high compliance to the MIND diet had significantly lower rates of Alzheimer’s disease diagnoses, with a reduction in risk of a third and a half, respectively, compared with the lowest levels of compliance. But for the DASH and Mediterranean diets, only study participants with high adherence saw an effect.

Another study of around 1000 people found that adherence to the MIND diet significantly slowed cognitive decline, and that those with the highest compliance managed to delay decline by an average of 7.5 years.

Systematic reviews of these dietary interventions do caution that it is very difficult to tease out possible confounders; that more long-term results are needed; and that observational studies can never show causality, only association. Of course, it’s notoriously difficult, and indeed probably impossible, to run a randomised trial of a dietary intervention over many years. That’s not to say we will never get evidence that most in the medical community consider definitive. After all, no randomised trials were ever carried out to prove the link between tobacco use and lung cancer, and yet today there is no doubt at all about the causality.

In the meantime, here are the fundamentals of the MIND diet:

What to eat:

  • Green leafy vegetables – kale, spinach, broccoli, collards and other greens, at least two servings a week;.
  • Other vegetables – a salad and at least one other vegetable every day;
  • Nuts – at least five times a week;
  • Berries – such as blueberries or strawberries, at least twice a week;
  • Beans – three times a week;
  • Whole grains – at least three servings a day;
  • Fish – at least once a week;
  • Poultry – two or more servings a week;
  • Olive oil.

What to avoid:

  • Butter and margarine – not more than one tablespoon daily;
  • Cheese – less than once per week;
  • Red meat – no more than three servings each week;
  • Fried food – less than once per week;
  • Pastries and sweets – no more than four times a week.

 

We all have to die of something, so why bother being healthy?

It’s 6:45 on a cold and rainy Tuesday morning. The alarm blares. As you begin to wake and wonder how it could possibly be morning already, your good intentions dawn on you. It’s run morning – and it’s the last thing you want to do. As you roll over to hit the snooze button, your mind scrambles for a valid excuse.

Why bother trying to be healthy? We all have to die of something, right?

In part this is true. Regardless of our discomfort with death, we all have to die sometime, and we all have to die from something. However, this is where the truth ends.

Today in Australia, the leading causes of death are mostly preventable – or at least can be significantly delayed. Factors like poor diet and tobacco drive ailments including heart disease, stroke, diabetes (type 2), lung disease and cancers. And when you look more deeply at what ill-health brings, it’s not just death that makes the strongest case for getting out of bed.

 

You’ll die later

Sure you have to die of something, but you may not have to die so soon. Science suggests having a healthier lifestyle even at age 50 is associated with a four to seven year longer life expectancy.

Even at older age, improving lifestyle factors can benefit longevity. Avoiding an unhealthy weight, not smoking, maintaining a social network and engaging in leisure activities around age 75 sees a whopping five years added to a woman’s and six years added to a man’s life span.

You’ll be healthier, longer

Trying to be as healthy as you can is not just about adding more years to your life, but adding healthy years, or even decades. Populations who follow healthy forms of behaviour show a 60% decline in dementia, in addition to a 70% reduction in type 2 diabetes, heart disease and stroke when compared with unhealthier peers. Studies also find healthier 50 year-olds live longer without disability than those who are overweight or smoke.

Yes, we all have to die eventually, but we want to be happy, well, independent and pain-free leading up to our deaths.
from www.shutterstock.com

A significant proportion of octogenarians are also living healthier, more active lives. This is seen in measures of mobility, self-care, levels of pain and discomfort, and absence of anxiety and depression. But rather than being related just to age, variations in health-related quality of life are also linked to factors such as exercise, nutrition and social engagement.

So being active and eating well could mean a healthier, more independent life for longer.

You’ll feel better in the meantime

Eating healthier and exercising have also been shown to have benefits on your day-to-day wellbeing. Exercise can improve and protect mental health. As a strategy to manage mild to moderate depression, exercise can provide comparable benefits to some antidepressants, and can complement medications to improve symptoms further. Similarly, exercise can play a role in treating anxiety, obsessive-compulsive disorder, and post-traumatic stress disorder. It can also improve your sleep quality and even benefit self-esteem and confidence.

It’s thought exercise does this by reducing your sensitivity to the symptoms of anxiety, building resilience to stressful mood states, positively altering the neurotransmitters in the brain, and disrupting or distracting you from social isolation.

Getting active can also allay general body aches and pains. An Australian study recently suggested jogging improves the composition of the cushion-like discs in your spine, reducing wear and tear. Exercise not only fortifies the discs but is also generally effective in preventing and treating pain. This is particularly important given 67% of Australians experience pain at least monthly, with inactivity being a major risk factor.

Exercise has benefits for most aspects of our physical and mental well-being.
from www.shutterstock.com

A healthy diet combined with exercise can also strengthen your bones, reducing the risk of fractures if you do have a serious injury.

You’ll save more and spend less

There’s good evidence, including from Australia, that eating healthy food is actually more affordable than an unhealthy diet. And smoking one pack of cigarettes per day, when combined with the health costs that result, is estimated to cost a staggering US$638,750 (A$812,556) to you and society over 50 years.

Type 2 diabetes, often associated with obesity, is estimated to result in A$4,025 per year per person in total costs without medical complications, or in excess of A$9,645 once complications develop. These costs are incurred not only through the need for treatment, but also in job discrimination, higher health insurance costs, lost productivity with sick days and poor physical function.

While no similar analysis exists for Australia, evidence from the US estimates lifetime social and public health costs of obesity at US$92,235 (A$117,332) per person, when combining medical expenditure and reduced productivity.

The direct medical costs to individuals in Australia may be lower due to our universal health system, but the costs from obesity still add up to A$873 million each year. A A$719 million per annum slice of the Australian budget is spent on the complications of physical inactivity alone, through heart disease, stroke, type 2 diabetes, breast cancer, colon cancer, depression and falls.

This isn’t noted to shame anyone or to recommend reducing care, it’s about realising policy and health inaction comes at a huge economic and social cost.

Your kids will be healthier, and maybe even their kids

Poor diet, smoking, alcohol use and a lack of physical activity can also affect your kids’ health – and maybe even the health of their kids.

Firstly, through role modelling. The kids of parents who smoke are significantly more likely to smoke themselves, and likewise with unhealthy drinking and eating. These kids are also more likely to be obese. Some of these effects could also be from socioeconomic factors.

Second, through a mechanism called epigenetics, our own health can influence the health of subsequent generations. This results from alterations in the expression of genes and not through changes in the genes themselves.

Altered epigenetics from physical inactivity, diet and environmental factors are now thought to be passed down through generations. They influence the subsequent risk of metabolic diseases such as obesity and diabetes.

Finally, being overweight, a lack of exercise and even consuming sugary drinks could actually reduce your chances of having kids in the first place. In women, being overweight increases the risk of polycystic ovarian syndrome, which causes irregular ovulation and can occasionally render women infertile.

While in men, excess weight contributes to infertility by reducing the quality of semen, as well as increasing the risks of sexual dysfunction.

The bigger picture

Living a healthier lifestyle is about making small, possible, simple and sustainable changes like taking the stairs instead of the lift – not totally rethinking the way you live.

Being healthy is about small, incremental, sustainable changes over many years.
Flickr / TYFVMP

But while there are many compelling reasons to be healthy, personal discipline alone will never solve our chronic disease and obesity epidemics. If neighbourhoods lack safe spaces for kids to run, or fresh food is inaccessible and unaffordable, good intentions will not get you very far. Government policies need to make health easier, even preferred.

The ConversationIn the meantime, look to friends for motivation; your family to share and support a healthy diet; apps that map and commend the exercise you do; and your GP and important services like Quitline for assistance with alcohol reduction and smoking cessation.

Alessandro R Demaio, Australian Medical Doctor; Fellow in Global Health & NCDs, University of Copenhagen

This article was originally published on The Conversation. Read the original article.