April 2018 - NON-MEDICATED LIFE
Role of a Whole Food, Plant-Based Diet in Preventing Disease - Part TWO
By Paul E. Lemanski, MD, MS, FACP
Medicines are a mainstay of American life and the healthcare system not only because they are perceived to work by the individuals taking them, but also because their benefit may be shown by the objective assessment of scientific study. Clinical research trials have shown that some of the medicines of Western science may reduce the risk of heart attacks, strokes and cardiovascular death while others may reduce certain types of cancer.
In the first 81 installments of the Non-Medicated Life, informed diet and lifestyle have been shown to accomplish naturally for the majority of individuals most of the benefits of medications in the prevention and treatment of chronic medical conditions such as hypertension, high cholesterol, diabetes, and heart disease. With respect to diet, increasingly, nutritional research supports a predominately whole food, plant-based diet as optimal. What constitutes such a diet and what is the evidence for its use was addressed in Part One (February 2018 issue). How one most easily may incorporate this approach into one’s daily way of eating is addressed here, in Part Two.
Embracing a predominantly whole food, plant-based diet starts with Part One by reviewing the benefits, specifically as it relates to your own health and your own health risks. Such a review may increase the motivation to change and provide a focus. In part, the benefit will be realized by avoidance of foods and means of preparation that increase your own health risks. In part, the benefit will be realized by foods that specifically lower the risk of diseases you either currently have or at risk for developing because of predictive tests or family history.
For example, if you have had a heart attack or have a close family member who has had a heart attack at a young age, your concern would be to find ways to avoid a recurrence, in the case of the former, or a similar outcome, in the case of the latter. The consumption of large amounts of animal protein is associated with increased cardiovascular mortality, in part, because increases in saturated fat contribute to the elevation of serum LDL or the “bad” cholesterol. In turn, this can lead to the accelerated development of cholesterol plaques within artery walls increasing the rates of coronary artery disease and stroke.
Decreasing the amount and frequency of animal protein consumption and choosing those types which contains less saturated fat will help reduce LDL cholesterol and risk. Emphasizing fish or chicken breast over red meat or choosing the leaner cuts of red meat (filet, eye of the round, flank steak, London broil) will help; avoiding fried food will also decrease saturated fat intake.
Vegetables and legumes are naturally very low in saturated fat. Increasing vegetables and legumes in the diet helps with the limitation of animal protein because vegetables have low caloric density, that is, markedly increased volume for calories consumed. Vegetables distend the stomach and activate stretch receptors located in the stomach wall increasing satiety, thereby limiting the drive to eat more meat.
The Mediterranean way of eating is an example of a predominately whole food, plant-based diet that limits animal protein. In those with heart disease, emphasizing whole food, plant-based only meals the majority of the week, if not completely, will both significantly reduce LDL cholesterol and dramatically increase antioxidants that can help to reduce the inflammation in arteries that causes cholesterol plaques to rupture, leading to heart attacks and strokes.
Increasing vegetables, legumes and fruit in your diet, however, need not start with the acceptance of a totally new way of eating all at once. If you simply begin to eat lunch consisting of a large leafy green salad (mixed greens, arugula, baby spinach or kale) and add raw veggies including tomatoes, cucumbers, carrots, onions, and legumes, then vegetable intake can increase with minimum fuss. Using balsamic vinegar based dressing without oil or with small amounts of olive oil will also reduce saturated fat intake. Adding a large salad of similar composition before dinner will also help to limit the portion size of the entrée consumed, reducing saturated fat and total calories.
Salad ingredients may be purchased on the weekend, cut up, and stored in individual plastic bags, and refrigerated, keeping everything fresh and speeding evening weekday meal preparation considerably. Stocking a plant-based pantry with low sodium canned beans, whole wheat and lentil flour pasta, walnuts, almonds, low sodium canned tomatoes, salsa, and balsamic vinegar will speed meal preparation. Hummus and salsa are excellent accompaniments to cut up raw vegetables. Low sugar containing fresh fruits such as apples, pears and berries are satisfying for dessert, contain anti-inflammatory antioxidants, and help avoid more highly caloric and saturated fat laden alternatives.
It is also reasonable to follow a three-step approach used at Kaiser Permanente, one of the largest, most successful HMOs in the country. First, identify whole food, plant-based meals that you already enjoy to incorporate into your weekly meal planning. Black bean burritos, whole-wheat pasta dishes with marinara, or minestrone or lentil soups are good places to start. Second, identify a favorite recipe that may be adapted to a whole food, plant-based approach that could serve as another meatless evening meal. For example, vegetarian chili may be an acceptable substitute for its meat filled counterpart. Finally, once whole food, plant-based meals become a part of your repertoire, new recipes can be tried to extend the repertoire. Web sites such as plantricianproject.org may help ease the transition.
In summary, a predominantly whole food, plant-based diet is easy to incorporate into your daily eating style and may be eased into slowly. Increasing vegetables and legumes may be as easy as consuming a large salad for lunch and eating a large salad before dinner. Beginning with plant-based meals already enjoyed, and then adapting some easy to convert meat based meals to a plant-based alternative and finally exploring new plant-based options has proved to be a useful three-step approach. As presented in Part One and Part Two, a predominately whole food, plant-based diet may be eased into and may help to effectively prevent and treat both cardiovascular disease and cancer and provide a firm foundation upon which to live a Non-Medicated Life.
Paul E. Lemanski, MD, MS, FACP (firstname.lastname@example.org) is a board certified internist at the Center for Preventive Medicine, CapitalCare Medical Group in Albany. He is medical director of the Department of Community Medicine and Population Health at CapitalCare Medical Group. Paul has a master’s degree in human nutrition. He is an assistant clinical professor of medicine at Albany Medical College, and a fellow of the American College of Physicians.