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Becoming More Plant-Centric: A Review of Plant-Based Diets

plant-based diet

Author: Christian Maino Vieytes, Masters Candidate, University of Illinois

Dr. Ellsworth Wareham lives a comfortable and simple life as a retired cardiothoracic surgeon. He left medical practice 40 years ago when he was 74 years of age. That makes him a fruitful and thriving 104-year-old, today! The question on everyone’s mind, I would imagine, is: how does he do it? How did Dr. Wareham achieve centenarian status? Well, prodding Dr. Wareham with the relevant question prompts a simple response: he attributes his longevity to the adoption of a whole-foods plant based diet over 50 years ago, a common practice within his religious community of the Seventh-Day Adventists. But Dr. Wareham is probably just a genetic outlier, right? Well, let’s take a look at what the science has to say about plant-based diets before we cast judgment.

Definition

We’ve heard the term, perhaps, thrown around loosely, but what does it actually mean to follow a plant-based diet? Researchers at Harvard have established that a plant-based diet “emphasizes intake of whole grains, fruits, vegetables, nuts and legumes” and consists
“of a diverse family of dietary patterns, defined in terms of low frequency of consumption of animal foods.” Some describe the diet as completely abstaining from all animal products; an exclusively plant-based diet. The popular Mediterranean Diet, with its focus on these food groups and the minimization of animal products, would certainly fit the definition. Plant-based diets distinguish themselves from vegan diets, which also define themselves by the elimination of all animal products, in that vegans do not necessarily get the majority of their calories from whole plant foods. You can be vegan and eat as many fries (fried in oil) and Oreos as you please but it does not mean it’s healthy!

Cancer

Much of the beneficial effects of consuming a primarily or exclusively plant-based diet arise from the ratio of fruits/vegetables to products of animal origin. With respect to cancer, several studies have demonstrated that this ratio is highly relevant to one’s risk of developing the disease. Studies on the Mediterranean diet have also established that variations of the diet that maximize fruit and vegetable consumption while minimizing meat and other animal products are associated with a reduced risk of various types of cancer. Specifically, various chemicals found in plants have been found to have protective effects while chemicals that arise in meat and also through the cooking process are responsible for mutations in our DNA that can lead to cancer.

Cardiovascular Disease and Diabetes

Much of the benefits of a plant-based diet come from the large amounts of antioxidants, fiber, and whole grains that people on this diet consume relative to the rest of the population. Average fiber intake in the United States for adults is 17 g/day, which is nowhere close to the recommended intake level of ~30 g per day. Those on a plant-based diet may easily consume upwards of 60-80 g per day. Eating primarily high-fiber, whole-plant foods has been shown to effectively promote healthy weight loss by increasing feelings of fullness and lowering the total intake of calories, since fiber has no digestible calories. Fiber is also known for its cholesterol-lowering effects in the blood and its ability to regulate blood-sugar levels. Put all together, these effects provide the basis for why plant-based diets are so effective in treating cardiovascular disease and type 2 diabetes. Patients can work with their physicians or dietitians to develop a plan that promotes this pattern of eating.

A Sustainable Alternative

Aside from the health benefits associated with eating an exclusively plant-based diet, there are also substantial environmental benefits that the planet can profit from by incorporating more fruits and vegetables on our plate. Did you know it requires 2,500 gallons of water to produce one pound of beef? Not only does livestock agriculture guzzle astronomical amounts of this limited resource but the United Nations recognizes it as a leading contributor of greenhouse gas emissions, water contamination, and species extinction.

Who knew we could both benefit our bodies and the planet by filling our plate with more fruits and vegetables?

Bibliography

Barnard, Neal D., et al. “A low-fat vegan diet and a conventional diabetes diet in the treatment of type 2 diabetes: a randomized, controlled, 74-wk clinical trial–.” The American journal of clinical nutrition 89.5 (2009): 1588S-1596S.

Ford, Brian J. “Impact of cultured meat on global agriculture.” World Agriculture 2.2 (2011): 43-46.

Grosso, Giuseppe, et al. “Mediterranean diet and cancer: epidemiological evidence and mechanism of selected aspects.” BMC surgery 13.2 (2013): S14.

Jenkins, David JA, et al. “Type 2 diabetes and the vegetarian diet.” The American journal of clinical nutrition 78.3 (2003): 610S-616S.

Kapiszewska, Maria. “A vegetable to meat consumption ratio as a relevant factor determining cancer preventive diet.” Local Mediterranean food plants and nutraceuticals. Vol. 59. Karger Publishers, 2006. 130-153.

Melina, Vesanto, Winston Craig, and Susan Levin. “Position of the Academy of Nutrition and Dietetics: vegetarian diets.” Journal of the Academy of Nutrition and Dietetics 116.12 (2016): 1970-1980.

Orlich, Michael J., et al. “Vegetarian dietary patterns and mortality in Adventist Health Study 2.” JAMA internal medicine173.13 (2013): 1230-1238.

Pevreall, K. (2018, June 13). 102 Year Old Former Surgeon Shares Secret To Avoiding Heart Disease. Retrieved from https://www.livekindly.co/102-former-surgeon-secret-avoiding-heart-disease/

Satija, Ambika, and Frank B. Hu. “Plant-based diets and cardiovascular health.” Trends in cardiovascular medicine (2018).

Steinfeld, Henning, et al. Livestock’s long shadow: environmental issues and options. UN Food & Agriculture Org., 2006.

Yokoyama, Yoko, Susan M. Levin, and Neal D. Barnard. “Association between plant-based diets and plasma lipids: a systematic review and meta-analysis.” Nutrition reviews 75.9 (2017): 683-698.

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The Road Ahead: Medicaid & Medicare

Written by: Christopher Plein, Ph.D.  West Virginia University and MFLN Military Caregiving Team

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Recently, I made a community presentation to social workers, education specialists, healthcare prevention workers and other helping professionals in my home state of West Virginia.  Among those in attendance were professionals working with veterans, some of whom are long retired and others more recently separated from military service.

The meeting helped my thoughts turn again to how closely military families are tied to the “civilian world.”  I introduced the group to the work that we do in the Military Families Learning Network emphasizing the common bonds that we all share in helping families. We talked about recent trends in Medicare and Medicaid and possible future developments for these two keystones of the American health system.

Active duty military families may find that family and loved ones are eligible for these programs due to health conditions, age or economic need.  Those facing retirement and separation from the military also need to consider the road ahead and how Medicaid and Medicare may figure into their plans.

Most know that Medicare is a federal health insurance program primarily for those over 65 years of age.  It also serves those with specific diseases and disabilities.  Medicaid operates as a state-federal partnership providing health insurance for lower income populations as well as those with special health conditions and disabilities.   As we have noted in previous blogs and webinars, these programs are a complex yet vital part of our healthcare infrastructure.

For well over a decade, both programs have changed due to various federal legislative and regulatory reforms.  The best known of these is the Affordable Care Act of 2010 which made some revisions to Medicare but most importantly allowed for Medicaid expansion to newly eligible populations of low income adults.

Along with demographic changes in our population (many of us are getting older), policy changes are resulting in more and more Americans being covered by either Medicaid or Medicare. Currently, 33 percent of the U.S. population is covered by one or the other helping to bring our overall uninsured rate down to 9 percent.

Utilizing helpful data from the Kaiser Family Foundation and comparing these to data on active duty military populations in the states, we offer a quick glimpse of trends in the tables and charts below.

As noted in a previous blog, almost half (49 percent) of all active duty military are based in just five states:  California, Virginia, Texas, North Carolina, and Georgia.  The table below is from that blog that and relies on data from Defense Manpower Data Center (MDDC).  We’ll call these states the “Big Five.”

Source: Understanding Military Assignment Dynamics in the U.S.: A Look at the Data & Some Questions to Ponder (Plein, 2018).
Source: Understanding Military Assignment Dynamics in the U.S.: A Look at the Data & Some Questions to Ponder (Plein, 2018).

Medicaid & Medicare Enrollment

Now let’s take a look at Medicaid and Medicare enrollment trends in these states.  What we find is an interesting and varied portrait of what is happening.  In California, for example, 36 percent of the population is covered by either Medicaid or Medicare.  To date, California is the only state among the “Big Five” to implement an expanded Medicaid program.  By expanding Medicaid coverage to previously ineligible groups, enrollment numbers have increased.  As the data suggest, this helps to reduce overall uninsured rates.

  Medicaid Medicare Uninsured
United States 19% 14% 9%
California 25% 11% 8%
Virginia  12% 14% 10%
Texas 16% 11% 15%
North Carolina 18% 15% 11%
Georgia 17% 12% 12%

Source: Health Insurance Coverage of the Total Population, Henry J. Kaiser Family Foundation, 2016

Both Virginia and Texas lag behind the national average for Medicaid and Medicare coverage.  However, the picture in Virginia may change soon as it has recently passed legislation to expand Medicaid.

Because Medicaid and Medicare can figure so prominently in providing assistance to family members, it is worth considering the status of these programs when making location and caregiving decisions.  While Medicare coverage provisions are uniform across the United States, Medicaid varies widely from state to state.

One trend that we can anticipate is that more states, even in traditionally “red” regions, will decide to expand Medicaid in order to help lower income adults.  In the 2018 mid-term elections, three states, Idaho, Nebraska, and Utah all approved ballot measures to expand Medicaid eligibility to new low income groups.

More broadly, there is growing interest in expanding Medicare coverage to new populations. This would be a real game changer — especially for those who have difficulty accessing care due to health conditions or age. There are active discussions and legislative proposals now being considered to allow those nearing retirement age (say between the ages of 55 and 64) and those with serious health conditions to “buy-in” to Medicare at a reduced premium or to be entitled to the program.  Excellent and accessible analysis and reporting on these developments can be found online through the Kaiser Family Foundation.

In the months to come, we should anticipate further conversations about Medicaid and Medicare as platforms for healthcare coverage and access.  New Medicaid expansion efforts in states will no doubt inspire others, but will also have their own share of growing pains and difficulties.  As for Medicare, we can anticipate that both sides of the aisle will give active consideration to ideas on how this program can help those in need.

Note: The research assistance of Lonnie Long, MPA student and MFLN Military Caregiving special needs graduate assistant in preparing this blog is appreciated.