The Plant Power Doctor
References

Introduction

He started to read about what ultra-runners do – how did they manage to run for hundreds of miles at a time successfully?

Roll, R. Finding Ultra (Potter/Ten Speed/Harmony/Rodale, 2013)

Jurek, S. Born to Run (Mariner Books 2013)

Brazier, B. Thrive (Penguin 2008)

The evidence for increasing the proportion of whole plant foods was compelling and persuasive.

Barnard ND, Goldman DM, Loomis JF, et al. Plant-Based Diets for Cardiovascular Safety and Performance in Endurance Sports. Nutrients. 2019;11(1):130. Published 2019 Jan 10. doi:10.3390/nu11010130

Trapp D., Knez W., Sinclair W. Could a vegetarian diet reduce exercise-induced oxidative stress? A review of the literature. J. Sports Sci. 2010;28:1261–1268. doi: 10.1080/02640414.2010.507676.

Sutliffe JT, Wilson LD, de Heer HD, Foster RL, Carnot MJ. C-reactive protein response to a vegan lifestyle intervention. Complement Ther Med. 2015;23(1):32-37. doi:10.1016/j.ctim.2014.11.001

I wondered if there was a way to reverse my fate and take control of my own heart disease risk.

Kim H, Caulfield LE, Garcia-Larsen V, Steffen LM, Coresh J, Rebholz CM. Plant-Based Diets Are Associated With a Lower Risk of Incident Cardiovascular Disease, Cardiovascular Disease Mortality, and All-Cause Mortality in a General Population of Middle-Aged Adults. J Am Heart Assoc. 2019;8(16):e012865. doi:10.1161/JAHA.119.012865

Kim H, Caulfield LE, Rebholz CM. Healthy Plant-Based Diets Are Associated with Lower Risk of All-Cause Mortality in US Adults. J Nutr. 2018;148(4):624-631. doi:10.1093/jn/nxy019

When I turned to the literature, I found that others had achieved similar results time and again when they adopted a wholefoods plant-based diet.

Turner-Mcgrievy GM, Wirth MD, Shivappa N, Wingard EE, Fayad R, Wilcox S, et al. Randomization to plant-based dietary approaches leads to larger short-term improvements in dietary inflammatory index scores and macronutrient intake compared with diets that contain meat. Nutr Res. (2015) 35:97–106. doi: 10.1016/j.nutres.2014.11.007

Najjar RS, Moore CE, Montgomery BD. Consumption of a defined, plant-based diet reduces lipoprotein(a), inflammation, and other atherogenic lipoproteins and particles within 4 weeks. Clin Cardiol. (2018) 41:1062–8. doi: 10.1002/clc.23027

Kim MK, Cho SW, Park YK. Long-term vegetarians have low oxidative stress, body fat, and cholesterol levels. Nutr Res Pract. (2012) 6:155–61. doi: 10.4162/nrp.2012.6.2.155

[flaxseeds] could be as effective in some people at reducing blood pressure as medication.

Alexander S, Ostfeld RJ, Allen K, Williams KA. A plant-based diet and hypertension. J Geriatr Cardiol. 2017;14(5):327-330. doi:10.11909/j.issn.1671-5411.2017.05.014

Whelton SP, Hyre AD, Pedersen B, Yi Y, Whelton PK, He J. Effect of dietary fiber intake on blood pressure: a meta-analysis of randomized, controlled clinical trials. J Hypertens 2005;23:475–81.

Rodriguez-Leyva D, Weighell W, Edel AL, LaVallee R, Dibrov E, Pinneker R, Maddaford TG, Ramjiawan B, Aliani M, Guzman R, et al. Potent antihypertensive action of dietary flaxseed in hypertensive patients. Hypertension 2013;62:1081–9.

Dodin S, Lemay A, Jacques H, Legare F, Forest J-C, Masse B. The effects of flaxseed dietary supplement on lipid profile, bone mineral density, and symptoms in menopausal women: a randomized, double-blind, wheat germ placebo-controlled clinical trial. J Clin Endocrinol Metab 2005;90:1390–7.

Chapter 1: What is a Wholefoods Plant-Based Diet?

High intake of salt, low intake of wholegrains, and low intake of fruits were the leading dietary risk factors for deaths globally.

GBD 2017 Diet Collaborators. Health effects of dietary risks in 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2019;393(10184):1958-1972. doi:10.1016/S0140-6736(19)30041-8

In environmental science the elephant in the room is that the ecosystems on which we and all other species depend is deteriorating more rapidly than ever.

Ceballos G, Ehrlich PR, Barnosky AD, García A, Pringle RM, Palmer TM. Accelerated modern human-induced species losses: Entering the sixth mass extinction. Sci Adv. 2015;1(5):e1400253. Published 2015 Jun 19. doi:10.1126/sciadv.1400253

The good news is that in finding solutions that can improve our health and our resilience to disease, we can also improve the biodiversity of the planet.

Poore J, Nemecek T. Reducing food’s environmental impacts through producers and consumers [published correction appears in Science. 2019 Feb 22;363(6429):]. Science. 2018;360(6392):987-992. doi:10.1126/science.aaq0216

To reach their recommendations, the UK and Ireland would have to reduce meat and dairy consumption by at least 90 per cent.

EAT Lancet Commission: https://eatforum.org/eat-lancet-commission/eat-lancet-commission-summary-report/

I like to look at the findings of large, independent bodies of research to help with this. 

https://www.hsph.harvard.edu/nutritionsource/

The ‘True Health Initiative’ brought together over 100 experts from over 30 countries from around the world to create a consensus they could agree on.

True Health Initiative: Truehealthintiative.org

A WFPB diet emphasises fresh, nutritious and minimally processed foods.

Chapter 2: Why is a Wholefoods Plant-Based Diet Healthy?

https://nutritionstudies.org/whole-food-plant-based-diet-guide/

Most plant foods contain many – carrots, for example, have over 100 – and they all do different things and complement each other.

Rui Hai Liu, Health benefits of fruit and vegetables are from additive and synergistic combinations of phytochemicals, The American Journal of Clinical Nutrition, Volume 78, Issue 3, September 2003, Pages 517S–520S, https://doi.org/10.1093/ajcn/78.3.517S

Evidence shows that taking phytochemicals in supplement form may not provide the same benefits.

Pro-oxidant activity of low doses of resveratrol inhibits hydrogen peroxide-induced apoptosis. Ahmad KA, Clement MV, Pervaiz S, Ann N Y Acad Sci. 2003 Dec; 1010():365-73.

For example, a raw unpeeled apple contains up to 332 per cent more vitamin K, 142 per cent more vitamin A, 115 per cent more vitamin C, 20 per cent more calcium and up to 19 per cent more potassium compared with a peeled apple.

https://www.ars.usda.gov/ARSUserFiles/80400535/DATA/sr21/sr21_doc.pdf

This can lead to chronic low-level inflammation throughout your body.

Gouin, J.-P., Glaser, R., Malarkey, W. B., Beversdorf, D., & Kiecolt-Glaser, J. (2012). Chronic stress, daily stressors, and circulating inflammatory markers. Health Psychology, 31(2), 264–268.

Mullington JM, Simpson NS, Meier-Ewert HK, Haack M. Sleep loss and inflammation. Best Pract Res Clin Endocrinol Metab. 2010;24(5):775-784. doi:10.1016/j.beem.2010.08.014

Shivappa, Nitin. “Diet and Chronic Diseases: Is There a Mediating Effect of Inflammation?.” Nutrients vol. 11,7 1639. 18 Jul. 2019, doi:10.3390/nu11071639

Thompson, Patricia A et al. “Environmental immune disruptors, inflammation and cancer risk.” Carcinogenesis vol. 36 Suppl 1,Suppl 1 (2015): S232-53. doi:10.1093/carcin/bgv038

In contrast, excess calories, protein, iron, trans fats and saturated fats had the opposite effect.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3925198/ Dietary inflammation index

It is a sad reality that less than 10 per cent of us eat as much fibre as we need, which can lead to all sorts of problems.

Quagliani D, Felt-Gunderson P. Closing America’s Fiber Intake Gap: Communication Strategies From a Food and Fiber Summit. Am J Lifestyle Med. 2016;11(1):80-85. Published 2016 Jul 7. doi:10.1177/1559827615588079

After looking at many factors, he concluded that a high amount of fibre is necessary for maintaining good health.

https://www.cambridge.org/core/journals/nutrition-research-reviews/article/denis-burkitt-and-the-origins-of-the-dietary-fibre-hypothesis/1DA569CF06DB93A4FF2DA54629A5D566/core-reader

Chapter 3: Longevity: Who Lives To 100?

a handful of magical places where the number of people living to 100 is up to ten times higher than the rest of the world.

Buettner D, Skemp S. Blue Zones: Lessons From the World’s Longest Lived. Am J Lifestyle Med. 2016;10(5):318-321. Published 2016 Jul 7. doi:10.1177/1559827616637066

Studies have shown that people with long telomeres live longer and healthier lives than people with short telomeres.

Dellara F. Terry, Vikki G. Nolan, Stacy L. Andersen, Thomas T. Perls, Richard Cawthon, Association of Longer Telomeres With Better Health in Centenarians, The Journals of Gerontology: Series A, Volume 63, Issue 8, August 2008, Pages 809–812, https://doi.org/10.1093/gerona/63.8.809

just three months of eating a plant-based diet significantly boosted telomerase activity.

Ornish D, Lin J, Daubenmier J, et al. Increased telomerase activity and comprehensive lifestyle changes: a pilot study [published correction appears in Lancet Oncol. 2008 Dec;9(12):1124]. Lancet Oncol. 2008;9(11):1048-1057. doi:10.1016/S1470-2045(08)70234-1

In a follow-up study, telomere length was noted to have actually increased in the plant-based diet group.

Ornish D, Lin J, Chan JM, et al. Effect of comprehensive lifestyle changes on telomerase activity and telomere length in men with biopsy-proven low-risk prostate cancer: 5-year follow-up of a descriptive pilot study. Lancet Oncol. 2013;14(11):1112-1120. doi:10.1016/S1470-2045(13)70366-8

other studies have shown that even more vigorous exercise and similar amounts of weight loss have not affected telomere length in this way.

Chilton W, O’Brien B, Charchar F. Telomeres, Aging and Exercise: Guilty by Association?. Int J Mol Sci. 2017;18(12):2573. Published 2017 Nov 29. doi:10.3390/ijms18122573

This reduces your risk of high blood pressure, which then lessens your risk of heart disease long-term.

Ahmad A, Dempsey SK, Daneva Z, et al. Role of Nitric Oxide in the Cardiovascular and Renal Systems. Int J Mol Sci. 2018;19(9):2605. Published 2018 Sep 3. doi:10.3390/ijms19092605

Nitric oxide also has a role in making insulin more effective by grabbing glucose from the bloodstream and putting it into the cell more easily.

Sansbury BE, Hill BG. Regulation of obesity and insulin resistance by nitric oxide. Free Radic Biol Med. 2014;73:383-399. doi:10.1016/j.freeradbiomed.2014.05.016

The polyphenols in plants can also increase nitric oxide production in the body.

Kobayashi J, Ohtake K, Uchida H. NO-Rich Diet for Lifestyle-Related Diseases. Nutrients. 2015;7(6):4911-4937. Published 2015 Jun 17. doi:10.3390/nu7064911

TOR is absolutely necessary when we are young, but is implicated in cancer, heart disease, diabetes, Alzheimer’s, and other diseases as we get older.

Cornu M, Albert V, Hall MN. mTOR in aging, metabolism, and cancer. Curr Opin Genet Dev. 2013;23(1):53-62. doi:10.1016/j.gde.2012.12.005

Eating less animal protein has been shown to dampen down TOR activity, mimicking the effects of energy restriction, but without the side effects.

Kitada M, Ogura Y, Monno I, Koya D. The impact of dietary protein intake on longevity and metabolic health. EBioMedicine. 2019;43:632-640. doi:10.1016/j.ebiom.2019.04.005

Amazingly, fruits and vegetables have phytochemicals that function as natural TOR inhibitors too.

Huang S. Inhibition of PI3K/Akt/mTOR signaling by natural products. Anticancer Agents Med Chem. 2013;13(7):967-970. doi:10.2174/1871520611313070001

Chapter 4: Eat More and Weigh Less

We live in a world where more people die from complications relating to obesity than malnutrition.

Wang H, Dwyer-Lindgren L, Lofgren KT, et al. 1970-2010: a systematic analysis foer the Global Burden of Disease Study 2010. Lancet. Vol. 380, No. 9859. Published 2012 Dec 15.

In a 2017 survey, it was found that 28.7 per cent of adults in the UK are obese and a further 35.6 per cent are overweight.

https://digital.nhs.uk/data-and-information/publications/statistical/health-survey-for-england/2017

the worldwide prevalence of obesity nearly tripled between 1975 and 2016.

https://www.worldobesity.org/about/about-obesity/prevalence-of-obesity

poor diet and inactivity are drivers of weight gain but there are many other factors at play.

Mann, T. “Secrets from the Eating Lab: The Science of Weight Loss, the Myth of Willpower and Why You Should Never Diet Again” (Harper Wave 2017).

Research tells us that on average, we make around 15 conscious food choices each day, but well over 200 unconscious ones.

Newell BR, Shanks DR. Unconscious influences on decision making: a critical review. Behav Brain Sci. 2014;37(1):1-19. doi:10.1017/S0140525X12003214 as discussed in a lecture by Professor Paul Chadwick, UCL.

By eating these types of foods, it also helps us get back to a more instinctive way of eating, so we remain full.

Koithan M, Devika J. New Approaches to Nutritional Therapy. J Nurse Pract. 2010;6(10):805-806. doi:10.1016/j.nurpra.2010.07.001

A WFPB diet is one of the most nutrient dense patterns of eating, and will likely contain more folate, Vitamin C, beta-carotene (for making Vitamin A), riboflavin, thiamine, magnesium and potassium and less saturated fat and cholesterol than a meat and dairy heavy diet.

Fuhrman J, Sarter B, Glaser D, Acocella S. Changing perceptions of hunger on a high nutrient density diet. Nutr J. 2010;9:51. Published 2010 Nov 7. doi:10.1186/1475-2891-9-51

Vegan and vegetarian diets have been shown to help curb hunger by improving levels of three key hunger hormones that we make, boosting our satiety.

Karlsen MC, Rogers G, Miki A, et al. Theoretical Food and Nutrient Composition of Whole-Food Plant-Based and Vegan Diets Compared to Current Dietary Recommendations. Nutrients. 2019;11(3):625. Published 2019 Mar 14. doi:10.3390/nu11030625

Much data now also exists that people who eat a plant-based diet or those who do not eat meat tend to have lower BMIs than those who do eat animal products.

Tonstad S, Butler T, Yan R, Fraser GE. Type of vegetarian diet, body weight, and prevalence of type 2 diabetes. Diabetes Care. 2009;32(5):791-796. doi:10.2337/dc08-1886

Turner-McGrievy G, Mandes T, Crimarco A. A plant-based diet for overweight and obesity prevention and treatment. J Geriatr Cardiol. 2017;14(5):369-374. doi:10.11909/j.issn.1671-5411.2017.05.002

Le LT, Sabaté J. Beyond meatless, the health effects of vegan diets: findings from the Adventist cohorts. Nutrients. 2014;6(6):2131-2147. Published 2014 May 27. doi:10.3390/nu6062131

Many people who go on diets end up gaining weight.

Siahpush M, Tibbits M, Shaikh RA, Singh GK, Sikora Kessler A, Huang TT. Dieting Increases the Likelihood of Subsequent Obesity and BMI Gain: Results from a Prospective Study of an Australian National Sample. Int J Behav Med. 2015;22(5):662-671. doi:10.1007/s12529-015-9463-5

Their attention is biased toward food and research shows that they may even find food tastier.

Masterson TD, Brand J, Lowe MR, et al. Relationships Among Dietary Cognitive Restraint, Food Preferences, and Reaction Times. Front Psychol. 2019;10:2256. Published 2019 Oct 9. doi:10.3389/fpsyg.2019.02256

Two out of the four patients with diabetes reduced their dosage or reliance on diabetes medications, including one who no longer required insulin

Wright N, Wilson L, Smith M, Duncan B, McHugh P. The BROAD study: A randomised controlled trial using a whole food plant-based diet in the community for obesity, ischaemic heart disease or diabetes. Nutr Diabetes. 2017;7(3):e256. Published 2017 Mar 20. doi:10.1038/nutd.2017.3

Studies show that having four healthy habits […] reduces weight-based differences in early mortality.

Matheson EM, King DE, Everett CJ. Healthy lifestyle habits and mortality in overweight and obese individuals. J Am Board Fam Med. 2012;25(1):9-15. doi:10.3122/jabfm.2012.01.110164

They really add to the satisfaction of a meal.

Klementova M, Thieme L, Haluzik M, et al. A Plant-Based Meal Increases Gastrointestinal Hormones and Satiety More Than an Energy- and Macronutrient-Matched Processed-Meat Meal in T2D, Obese, and Healthy Men: A Three-Group Randomized Crossover Study. Nutrients. 2019;11(1):157. Published 2019 Jan 12. doi:10.3390/nu11010157

The healthiest populations on the planet eat beans and pulses.

Li H, Li J, Shen Y, Wang J, Zhou D. Legume Consumption and All-Cause and Cardiovascular Disease Mortality. Biomed Res Int. 2017;2017:8450618. doi:10.1155/2017/8450618

They are a protein and fibre powerhouse and can even help reduce the sugar spike of other meals, and so are really helpful for people with diabetes too.

Higgins JA. Whole grains, legumes, and the subsequent meal effect: implications for blood glucose control and the role of fermentation. J Nutr Metab. 2012;2012:829238. doi:10.1155/2012/829238

You might have been told to cut the carbs, but intact wholegrains are consistently valuable for health.

McRae MP. Health Benefits of Dietary Whole Grains: An Umbrella Review of Meta-analyses. J Chiropr Med. 2017;16(1):10-18. doi:10.1016/j.jcm.2016.08.008

alcohol use is a leading risk factor for increased risk of death from any cause, especially cancer, and the level that minimises loss of health is . . . zero.

GBD 2016 Alcohol Collaborators. Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016 [published correction appears in Lancet. 2018 Sep 29;392(10153):1116] [published correction appears in Lancet. 2019 Jun 22;393(10190):e44]. Lancet. 2018;392(10152):1015-1035. doi:10.1016/S0140-6736(18)31310-2

Chapter 5: Heart Health

leading to more oxidised low-density lipoproteins (LDL).

Benson TW, Weintraub NL, Kim HW, et al. A single high-fat meal provokes pathological erythrocyte remodeling and increases myeloperoxidase levels: implications for acute coronary syndrome. Lab Invest. 2018;98(10):1300-1310. doi:10.1038/s41374-018-0038-3

Diets high in saturated fats raise cholesterol levels

Hooper L, Martin N, Jimoh OF, Kirk C, Foster E, Abdelhamid AS. Reduction in saturated fat intake for cardiovascular disease. Cochrane Database Syst Rev. 2020;5:CD011737. Published 2020 May 19. doi:10.1002/14651858.CD011737.pub2

Foods high in saturated fat can also trigger the body into producing more cholesterol.

Ginsberg HN, Karmally W, Siddiqui M, et al. A dose-response study of the effects of dietary cholesterol on fasting and postprandial lipid and lipoprotein metabolism in healthy young men. Arterioscler Thromb. 1994;14(4):576-586. doi:10.1161/01.atv.14.4.576

The plant ‘cholesterol’ that they do contain (phytosterols) can block cholesterol from being absorbed by the human body.

Fred H. Mattson, R. A. Volpenhein, B. A. Erickson, Effect of Plant Sterol Esters on the Absorption of Dietary Cholesterol, The Journal of Nutrition, Volume 107, Issue 7, July 1977, Pages 1139–1146, https://doi.org/10.1093/jn/107.7.1139

They are also rich in fibre, which helps to lower cholesterol.

Gunness P, Gidley MJ. Mechanisms underlying the cholesterol-lowering properties of soluble dietary fibre polysaccharides. Food Funct. 2010;1(2):149-155. doi:10.1039/c0fo00080a

Soluble fibre slows the absorption of cholesterol and reduces the amount of cholesterol the liver produces.

Hiroshi Hara, Satoko Haga, Yoritaka Aoyama, Shuhachi Kiriyama, Short-Chain Fatty Acids Suppress Cholesterol Synthesis in Rat Liver and Intestine, The Journal of Nutrition, Volume 129, Issue 5, May 1999, Pages 942–948, https://doi.org/10.1093/jn/129.5.942

Potassium […] is known to decrease blood pressure.

Houston MC. The importance of potassium in managing hypertension. Curr Hypertens Rep. 2011;13(4):309-317. doi:10.1007/s11906-011-0197-8

Magnesium is also another important mineral that helps blood vessels relax to regulate blood pressure.

Zhang X, Li Y, Del Gobbo LC, et al. Effects of Magnesium Supplementation on Blood Pressure: A Meta-Analysis of Randomized Double-Blind Placebo-Controlled Trials. Hypertension. 2016;68(2):324-333. doi:10.1161/HYPERTENSIONAHA.116.07664

Lab studies on human and animal cells show that SCFAs […] have a crucial role in lowering cholesterol, reducing fatty liver and minimising the risk of stroke.

Alferink, L.J.M., Erler, N.S., de Knegt, R.J. et al. Adherence to a plant-based, high-fibre dietary pattern is related to regression of non-alcoholic fatty liver disease in an elderly population. Eur J Epidemiol (2020). https://doi.org/10.1007/s10654-020-00627-2

40 per cent lower risk of coronary heart disease compared with men who ate the least fibre.

Threapleton DE, Greenwood DC, Evans CE, et al. Dietary fibre intake and risk of cardiovascular disease: systematic review and meta-analysis. BMJ. 2013;347:f6879. Published 2013 Dec 19. doi:10.1136/bmj.f6879 and the Health Professionals Follow Up Study

We know that lifestyle interventions can cut our risk of heart disease.

Kerley CP. A Review of Plant-based Diets to Prevent and Treat Heart Failure. Card Fail Rev. 2018;4(1):54-61. doi:10.15420/cfr.2018:1:1

They were able to demonstrate a 50 to 70 per cent reduced risk of a cardiovascular event.

de Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation. 1999;99(6):779-785. doi:10.1161/01.cir.99.6.779

Not only that, but the patients lost weight and crucially experienced less angina pains than the control group.

Ornish D, Brown SE, Scherwitz LW, et al. Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet. 1990;336(8708):129-133. doi:10.1016/0140-6736(90)91656-u

This compared to a 27 per cent worsening in the blockages for those in the original control group.

Ornish D, Scherwitz LW, Billings JH, et al. Intensive lifestyle changes for reversal of coronary heart disease [published correction appears in JAMA 1999 Apr 21;281(15):1380]. JAMA. 1998;280(23):2001-2007. doi:10.1001/jama.280.23.2001

Of the 22 patients, 17 stuck with the diet and their disease progression halted.

Esselstyn CB. A plant-based diet and coronary artery disease: a mandate for effective therapy. J Geriatr Cardiol. 2017;14(5):317-320. doi:10.11909/j.issn.1671-5411.2017.05.004

Of the 21 people who didn’t stick with the plan, thirteen (62 per cent) had a cardiac event (a heart attack, stroke or bypass operation).

Esselstyn CB Jr, Gendy G, Doyle J, Golubic M, Roizen MF. A way to reverse CAD?. J Fam Pract. 2014;63(7):356-364b.

whereas replacing meat with nuts and seeds was associated with 40 per cent reduction in mortality rate.

Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published correction appears in Circulation. 2019 Sep 10;140(11):e649-e650] [published correction appears in Circulation. 2020 Jan 28;141(4):e60] [published correction appears in Circulation. 2020 Apr 21;141(16):e774]. Circulation. 2019;140(11):e596-e646. doi:10.1161/CIR.0000000000000678

and even bypass surgery was found to prolong life in less than 3 per cent of those who underwent surgery.

Boden WE, O’Rourke RA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356(15):1503-1516. doi:10.1056/NEJMoa070829

Whereas according to the INTERHEART study […] changing lifestyle could prevent the vast majority of all heart disease.

Ounpuu S, Negassa A, Yusuf S. INTER-HEART: A global study of risk factors for acute myocardial infarction. Am Heart J. 2001;141(5):711-721. doi:10.1067/mhj.2001.114974

Chapter 6: How Fat Influences Our Health

The NHS recommends that men have no more than 30g saturated fat a day, women should have no more than 20g of saturated fat a day, and children should have less.

https://www.nhs.uk/live-well/eat-well/different-fats-nutrition/

However, having too much cholesterol in the diet can stop these receptors from working well.

Mustad VA, Etherton TD, Cooper AD, et al. Reducing saturated fat intake is associated with increased levels of LDL receptors on mononuclear cells in healthy men and women. J Lipid Res. 1997;38(3):459-468.

Trans fats are known to raise cholesterol and to increase the risk of developing heart disease and a number of other chronic illnesses, including Type 2 diabetes and Alzheimer’s.

Ginter E, Simko V. New data on harmful effects of trans-fatty acids. Bratisl Lek Listy. 2016;117(5):251-253. doi:10.4149/bll_2016_048

we can improve our health and lower our cholesterol and heart disease risk.

Hayes J, Benson G. What the Latest Evidence Tells Us About Fat and Cardiovascular Health. Diabetes Spectr. 2016;29(3):171-175. doi:10.2337/diaspect.29.3.171

These particles can compromise the immune function and reproductive health of fish.

Hoole D. The effects of pollutants on the immune response of fish: implications for helminth parasites. Parassitologia. 1997;39(3):219‐225.

Akhter A, Rahaman M, Suzuki RT, Murono Y, Tokumoto T. Next-generation and further transgenerational effects of bisphenol A on zebrafish reproductive tissues. Heliyon. 2018;4(9):e00788. Published 2018 Sep 15. doi:10.1016/j.heliyon.2018.e00788

Crucially, both micro-plastics and chemicals can accumulate up the food chain, affecting us too.

Dórea JG. Persistent, bioaccumulative and toxic substances in fish: human health considerations. Sci Total Environ. 2008;400(1-3):93-114. doi:10.1016/j.scitotenv.2008.06.017

According to many scientists, world fish stocks will collapse by 2050 at current use and levels of sea warming.

Laffoley, D.Baxter, J. M. IUCN Report. Explaining ocean warming : causes, scale, effects and consequences, 2016 p456

For some people, oils can trigger inflammatory arthritis pains.

Zhang J, Chen X, Yang R, et al. Thermally Processed Oil Exaggerates Colonic Inflammation and Colitis-Associated Colon Tumorigenesis in Mice. Cancer Prev Res (Phila). 2019;12(11):741-750. doi:10.1158/1940-6207.CAPR-19-0226. Not enough research has been done on cooking oils at high temperature and its effects on intestinal barrier function. This is an animal study from 2019 which is relevant for inflammatory conditions as it looked in particular at the effects of cooking oil consumption on worsening inflammatory bowel disease and increasing colon cancer potential. More research on this is needed.

Low-oil and oil-free diets have been used to improve heart disease too.

Tuso P, Stoll SR, Li WW. A plant-based diet, atherogenesis, and coronary artery disease prevention. Perm J. 2015;19(1):62-67. doi:10.7812/TPP/14-036

Chapter 7: Rethinking Cancer

Cancer is one of the leading causes of premature death in the UK and by that, I mean death before the age of 75.

https://www.who.int/news-room/fact-sheets/detail/cancer

One in two people born after 1960 will develop cancer.

Ahmad AS, Ormiston-Smith N, Sasieni PD. Trends in the lifetime risk of developing cancer in Great Britain: comparison of risk for those born from 1930 to 1960. Br J Cancer. 2015;112(5):943-947. doi:10.1038/bjc.2014.606

Our genetics directly contribute to about 10 per cent of cancers and this is something we cannot control.

Anand P, Kunnumakkara AB, Sundaram C, et al. Cancer is a preventable disease that requires major lifestyle changes [published correction appears in Pharm Res. 2008 Sep;25(9):2200. Kunnumakara, Ajaikumar B [corrected to Kunnumakkara, Ajaikumar B]]. Pharm Res. 2008;25(9):2097-2116. doi:10.1007/s11095-008-9661-9

food is the main building block we use to create our body, cancer cells and all.

Donaldson MS. Nutrition and cancer: a review of the evidence for an anti-cancer diet. Nutr J. 2004;3:19. Published 2004 Oct 20. doi:10.1186/1475-2891-3-19 https://www.ncbi.nlm.nih.gov/pubmed/15496224

animal products and processed foods with increased sugar and fat may account for much of the increase in the disease.

Contaldo F, Santarpia L, Cioffi I, Pasanisi F. Nutrition Transition and Cancer. Nutrients. 2020;12(3):795. Published 2020 Mar 18. doi:10.3390/nu12030795

Exposure to benzenes has been linked to blood cancers like leukaemia and has also been found to affect fertility.

Heck JE, He D, Contreras ZA, Ritz B, Olsen J, Hansen J. Parental occupational exposure to benzene and the risk of childhood and adolescent acute lymphoblastic leukaemia: a population-based study. Occup Environ Med. 2019;76(8):527-529. doi:10.1136/oemed-2019-105738

Bonde JP. Occupational causes of male infertility. Curr Opin Endocrinol Diabetes Obes. 2013;20(3):234-239. doi:10.1097/MED.0b013e32835f3d4b

This is the first and most toxic metabolite from alcohol and reacts with our DNA to form cancer-promoting compounds.

Seitz HK, Becker P. Alcohol metabolism and cancer risk. Alcohol Res Health. 2007;30(1):38-47.

Lab studies on animals, as well as population data shows this to be the case.

Seitz HK, Stickel F, Homann N. Pathogenetic mechanisms of upper aerodigestive tract cancer in alcoholics. Int J Cancer. 2004;108(4):483-487. doi:10.1002/ijc.11600

Heterocyclic amines (HCAs) are formed in animal proteins that are cooked at high temperature, such as over an open flame.

Zheng W, Lee SA. Well-done meat intake, heterocyclic amine exposure, and cancer risk. Nutr Cancer. 2009;61(4):437-446. doi:10.1080/01635580802710741

HCAs are highest in pan-fried and barbecued meats and can be in lower concentration when meat is poached or stewed.

Skog KI, Johansson MA, Jägerstad MI. Carcinogenic heterocyclic amines in model systems and cooked foods: a review on formation, occurrence and intake. Food Chem Toxicol. 1998;36(9-10):879-896. doi:10.1016/s0278-6915(98)00061-1

There are no HCAs produced when you barbecue vegetables.

Platt KL, Edenharder R, Aderhold S, Muckel E, Glatt H. Fruits and vegetables protect against the genotoxicity of heterocyclic aromatic amines activated by human xenobiotic-metabolizing enzymes expressed in immortal mammalian cells. Mutat Res. 2010;703(2):90-98. doi:10.1016/j.mrgentox.2010.08.007

A study of over 29,000 men from 2005 identified PhIP from cooked meat as a likely factor in the increased rates of prostate cancer in the men participating in the study.

Cross AJ, Peters U, Kirsh VA, et al. A prospective study of meat and meat mutagens and prostate cancer risk. Cancer Res. 2005;65(24):11779-11784. doi:10.1158/0008-5472.CAN-05-2191

They found that fried meat, beef and processed meats in the diet were all associated with pre-cancerous changes in the breast tissue that was removed from these women.

Sabine Rohrmann, Sea-Uck Lukas Jung, Jakob Linseisen, Wolfgang Pfau, Dietary intake of meat and meat-derived heterocyclic aromatic amines and their correlation with DNA adducts in female breast tissue, Mutagenesis, Volume 24, Issue 2, March 2009, Pages 127–132,

including polycyclic aromatic hydrocarbons (PAHs) and advanced glycation end products (AGEs).

Genkinger JM, Koushik A. Meat consumption and cancer risk. PLoS Med. 2007;4(12):e345. doi:10.1371/journal.pmed.0040345

Acrylamide is a carcinogen that occurs when oils with low smoke points are heated.

Lim PK, Jinap S, Sanny M, Tan CP, Khatib A. The influence of deep frying using various vegetable oils on acrylamide formation in sweet potato (Ipomoea batatas L. Lam) chips. J Food Sci. 2014;79(1):T115-T121. doi:10.1111/1750-3841.12250

Acrylamide is a carcinogen that occurs when oils with low smoke points are heated.

Block G, Patterson B, Subar A. Fruit, vegetables, and cancer prevention: a review of the epidemiological evidence. Nutr Cancer. 1992;18(1):1-29. doi:10.1080/01635589209514201

Wang H, Khor TO, Shu L, et al. Plants vs. cancer: a review on natural phytochemicals in preventing and treating cancers and their druggability. Anticancer Agents Med Chem. 2012;12(10):1281-1305. doi:10.2174/18715201280383302 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017674/

with one study highlighting the moderate ability of black, green and rooibos tea as well as cherry, spinach and onion juices to block these compounds.

Edenharder R, Sager JW, Glatt H, Muckel E, Platt KL. Protection by beverages, fruits, vegetables, herbs, and flavonoids against genotoxicity of 2-acetylaminofluorene and 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP) in metabolically competent V79 cells. Mutat Res. 2002;521(1-2):57-72. doi:10.1016/s1383-5718(02)00212-7

High levels of the hormones insulin and IGF-1 (insulin like growth factor 1).

Karlstad O, Starup-Linde J, Vestergaard P, et al. Use of insulin and insulin analogs and risk of cancer – systematic review and meta-analysis of observational studies. Curr Drug Saf. 2013;8(5):333-348. doi:10.2174/15680266113136660067

Weroha SJ, Haluska P. The insulin-like growth factor system in cancer. Endocrinol Metab Clin North Am. 2012;41(2):335-vi. doi:10.1016/j.ecl.2012.04.014

This is a problem especially for people who are overweight or living with insulin resistance and Type 2 diabetes.

Jee SH, Kim HJ, Lee J. Obesity, insulin resistance and cancer risk. Yonsei Med J. 2005;46(4):449-455. doi:10.3349/ymj.2005.46.4.449

growth of the cancerous cells, vascularisation of cancerous tissue (blood vessel growth) and metastasis (spread).

Grimberg A. Mechanisms by which IGF-I may promote cancer [published correction appears in Cancer Biol Ther. 2004 Feb;3(2):139]. Cancer Biol Ther. 2003;2(6):630-635.

Eating animal products causes our bodies to produce more IGF-1 than we need.

Pasanisi P, Bruno E, Venturelli E, et al. A Dietary Intervention to Lower Serum Levels of IGF-I in BRCA Mutation Carriers. Cancers (Basel). 2018;10(9):309. Published 2018 Sep 4. doi:10.3390/cancers10090309

IGF-1 is known to be a risk factor for bowel cancer, where the foods we eat interact directly with the gut lining.

Giovannucci E. Insulin, insulin-like growth factors and colon cancer: a review of the evidence. J Nutr. 2001;131(11 Suppl):3109S-20S. doi:10.1093/jn/131.11.3109S

Population studies show us that increased IGF-1 is linked to increased prostate cancer.

Wolk A, Mantzoros CS, Andersson S-O, Bergstrom R, Signorello LB, Lagiou P, Adami H-O, Trichopoulos D: Insulin-like growth factor 1 and prostate cancer risk: a population-based, case-control study. JNCI 90: 911–915, 1998

In fact, the strength of the IGF-1 and prostate cancer link is considerable.

Chan JM, Stampfer MK, Giovannucci E, Gann PH, Ma J, Wilkinson P, Hennekens CH, Pollak M: Plasma insulin-like growth factor-I and prostate cancer risk: a prospective study. Science 279: 563–566, 1998

Mantzoros CS, Tzonou A, Signorello LB, Stampfer M, Trichopoulos D, Adami HO: Insulin-like growth factor 1 in relation to prostate cancer and benign prostatic hyperplasia. Br J Cancer 76: 1115–1118, 1997

Pollak, M., Beamerand W., Zhang J.C., Insulin-like growth factors and prostate cancer Cancer and Metastasis Reviews 17: 383–390, 1999.

Restricting energy (fasting) and restricting animal protein causes IGF-1 levels to fall to normal in animal studies.

Rahmani J, Kord Varkaneh H, Clark C, et al. The influence of fasting and energy restricting diets on IGF-1 levels in humans: A systematic review and meta-analysis. Ageing Res Rev. 2019;53:100910. doi:10.1016/j.arr.2019.100910

The good news is that in humans, restricting animal protein alone seems to be better at reducing IGF-1 than severe calorie restriction.

Fontana, L., Weiss, E.P., Villareal, D.T., Klein, S. and Holloszy, J.O. (2008), Long‐term effects of calorie or protein restriction on serum IGF‐1 and IGFBP‐3 concentration in humans. Aging Cell, 7: 681-687. doi:10.1111/j.1474-9726.2008.00417.x

Oestrogen is another key player in the development of hormone-linked cancers such as breast, ovarian and prostate.

Williams GP. The role of oestrogen in the pathogenesis of obesity, type 2 diabetes, breast cancer and prostate disease. Eur J Cancer Prev. 2010;19(4):256-271. doi:10.1097/cej.0b013e328338f7d2

Cleary MP, Grossmann ME. Minireview: Obesity and breast cancer: the estrogen connection. Endocrinology. 2009;150(6):2537-2542. doi:10.1210/en.2009-0070

Our bodies produce more oestrogen in certain types of fat cell, which may be why obesity is linked with a higher risk of certain cancers.

Simpson ER, Ackerman GE, Smith ME, Mendelson CR. Estrogen formation in stromal cells of adipose tissue of women: induction by glucocorticosteroids. Proc Natl Acad Sci U S A. 1981;78(9):5690-5694. doi:10.1073/pnas.78.9.5690

What we can say for sure is that cow’s milk contains more oestrogen than it used to, given that cows are pregnant at the same time as lactating nowadays, and pregnancy increases oestrogen levels in all mammals.

Malekinejad H, Rezabakhsh A. Hormones in Dairy Foods and Their Impact on Public Health – A Narrative Review Article. Iran J Public Health. 2015;44(6):742-758.

Certain types of plastics are also known to be hormone disruptors which can mimic oestrogen in our bodies.

Yang CZ, Yaniger SI, Jordan VC, Klein DJ, Bittner GD. Most plastic products release estrogenic chemicals: a potential health pr oblem that can be solved. Environ Health Perspect. 2011;119(7):989-996. doi:10.1289/ehp.1003220

But the body has no way of regulating its absorption of haem iron and haem iron also oxidises easily

Romeu M, Aranda N, Giralt M, Ribot B, Nogues MR, Arija V. Diet, iron biomarkers and oxidative stress in a representative sample of Mediterranean population. Nutr J. 2013;12:102. Published 2013 Jul 16. doi:10.1186/1475-2891-12-102

Haem iron has also been found to cause the formation of N-nitroso compounds (NOC) in the body – which damage the cells that line the bowel and contribute to bowel cancer.

Ward MH, Cross AJ, Abnet CC, Sinha R, Markin RS, Weisenburger DD. Heme iron from meat and risk of adenocarcinoma of the esophagus and stomach. Eur J Cancer Prev. 2012;21(2):134-138. doi:10.1097/CEJ.0b013e32834c9b6c

It also showed that eating meat increased NOC in stools, whereas veggie iron sources did not.

Cross A, J., Pollock, JRA., Haem, not Protein or Inorganic Iron, Is Responsible for Endogenous Intestinal N-Nitrosation Arising from Red Meat, Amanda Jane Cross, Jim R. A. Pollock and Sheila Anne Bingham, Cancer Res May 15 2003 (63) (10) 2358-2360;

Having said that, plant foods do not let go of their iron as easily, as it is bound to substances called phytates and oxalates.

Sotelo A, González-Osnaya L, Sánchez-Chinchillas A, Trejo A. Role of oxate, phytate, tannins and cooking on iron bioavailability from foods commonly consumed in Mexico. Int J Food Sci Nutr. 2010;61(1):29-39. doi:10.3109/09637480903213649.  It is widely thought in nutrition circles that oxalates inhibit iron absorption, but this study suggests that in fact oxalates do not inhibit iron from plants after all.

genannt Bonsmann SS, Walczyk T, Renggli S, Hurrell RF. Oxalic acid does not influence nonhaem iron absorption in humans: a comparison of kale and spinach meals. Eur J Clin Nutr. 2008;62(3):336-341. doi:10.1038/sj.ejcn.1602721

You can maximise your absorption of iron by pairing vitamin C-rich foods with your beans and wholegrains (like squeezing lemon juice on your curry) and avoiding tea and coffee with your meals (which contain tannins that have been found to reduce the amount of iron the body can absorb).

Hallberg L, Brune M, Rossander L. The role of vitamin C in iron absorption. Int J Vitam Nutr Res Suppl. 1989;30:103-108.

Red meats, such as beef, lamb and pork have been classified as Group 2A carcinogens, which means that they probably cause cancer.

IARC Working Group on the Evaluation of Carcinogenic Risks to Humans International Agency for Research on Cancer/World Health Organization, Red Meat and Processed Meat. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, WHO Press, On-line pub, March 2018 No. 114.

Based on the average man eating about 88g of red meat a day, the suggestion was made to lower this amount to 70g.

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/339309/SACN_Iron_and_Health_Report.pdf

Alongside understanding the impact meat has on our health, we are becoming much more aware as a society of the environmental impact of intensive breeding of livestock too.

William J. Ripple, Christopher Wolf, Thomas M. Newsome, Mauro Galetti, Mohammed Alamgir, Eileen Crist, Mahmoud I. Mahmoud, William F. Laurance, 15,364 scientist signatories from 184 countries, World Scientists’ Warning to Humanity: A Second Notice, BioScience, Volume 67, Issue 12, December 2017, Pages 1026–1028, https://doi.org/10.1093/biosci/bix125

The damage that their waste products does to our water systems, the inefficient use of land (for growing food that goes to the animals and not to humans), and the long-term risks when antibiotics are used to treat animals who become unwell when living in cramped conditions.

William J Ripple, Christopher Wolf, Thomas M Newsome, Phoebe Barnard, William R Moomaw, World Scientists’ Warning of a Climate Emergency, BioScience, Volume 70, Issue 1, January 2020, Pages 8–12, https://doi.org/10.1093/biosci/biz088

When we eat animals that have been treated with antibiotics, we also increase our own risk of antibiotic resistance.

National Research Council (US) Committee to Study the Human Health Effects of Subtherapeutic Antibiotic Use in Animal Feeds. The Effects on Human Health of Subtherapeutic Use of Antimicrobials in Animal Feeds. Washington (DC): National Academies Press (US); 1980. Appendix K, Antibiotics In Animal Feeds.Available from: https://www.ncbi.nlm.nih.gov/books/NBK216502/

In addition, there are studies that show that antibiotics deplete our gut bacteria which in turn increases our risk of getting certain forms of cancer.

Zhang YJ, Li S, Gan RY, Zhou T, Xu DP, Li HB. Impacts of gut bacteria on human health and diseases. Int J Mol Sci. 2015;16(4):7493-7519. Published 2015 Apr 2. doi:10.3390/ijms16047493

In the Adventist Health Study 2, vegans have a 16 per cent reduced risk of cancer and the vegetarians have an 8 per cent reduced risk of cancer.

Orlich MJ, Singh PN, Sabaté J, et al. Vegetarian dietary patterns and mortality in Adventist Health Study 2. JAMA Intern Med. 2013;173(13):1230-1238. doi:10.1001/jamainternmed.2013.6473

In the EPIC-Oxford study, vegans have a 19 per cent reduced risk of cancer and the vegetarians have an 11 per cent reduced risk of cancer.

Tong Tammy Y N, Appleby Paul N, Bradbury Kathryn E, Perez-Cornago Aurora, Travis Ruth C, Clarke Robert et al. Risks of ischaemic heart disease and stroke in meat eaters, fish eaters, and vegetarians over 18 years of follow-up: results from the prospective EPIC-Oxford study BMJ 2019; 366:l4897

The people who had high scores on the Plant-Based Diet Index had a 15 per cent reduced cancer risk and there was a particular benefit seen for reducing the risk of colorectal cancer and lung cancer.

Madigan M, Karhu E. The role of plant-based nutrition in cancer prevention. J Unexplored Med Data 2018;3:9. http://dx.doi.org/10.20517/2572-8180.2018.05

They also contain a group of compounds called glucosinolates, which are responsible for the bitter taste and flavour of these vegetables, and are associated with decreased inflammation and improved liver health.

Nho CW, Jeffery E. The synergistic upregulation of phase II detoxification enzymes by glucosinolate breakdown products in cruciferous vegetables. Toxicol Appl Pharmacol. 2001;174(2):146-152. doi:10.1006/taap.2001.9207

Sturm C, Wagner AE. Brassica-Derived Plant Bioactives as Modulators of Chemopreventive and Inflammatory Signaling Pathways. Int J Mol Sci. 2017;18(9):1890. Published 2017 Sep 1. doi:10.3390/ijms18091890

Studies have found strong links between greater consumption of cruciferous vegetables and lowered risk of lung, breast, prostate, colorectal, and other cancers.

Verhoeven DT, Goldbohm RA, van Poppel G, Verhagen H, van den Brandt PA. Epidemiological studies on brassica vegetables and cancer risk. Cancer Epidemiol Biomarkers Prev. 1996;5(9):733-748.

More recent studies have concluded that the compounds found in cruciferous vegetables ‘turn on’ genes that slow tumour growth, and stimulate self-destruction of cancer cells, a process called apoptosis.

Su X, Jiang X, Meng L, Dong X, Shen Y, Xin Y. Anticancer Activity of Sulforaphane: The Epigenetic Mechanisms and the Nrf2 Signaling Pathway. Oxid Med Cell Longev. 2018;2018:5438179. Published 2018 Jun 6. doi:10.1155/2018/5438179

In fact, vitamin supplements in excess have in some cases been found to be actively harmful.

Penniston KL, Tanumihardjo SA. The acute and chronic toxic effects of vitamin A. Am J Clin Nutr. 2006;83(2):191-201. doi:10.1093/ajcn/83.2.191

Lab studies show that butyrate helps keep colon cells healthy, prevents the growth of tumour cells and encourages cancer cell destruction in the colon.

Tang, Y., Chen, Y., Jiang, H., Robbins, G.T. and Nie, D. (2011), G‐protein‐coupled receptor for short‐chain fatty acids suppresses colon cancer. Int. J. Cancer, 128: 847-856.

Toscani A, Soprano DR, Soprano KJ. Molecular analysis of sodium butyrate-induced growth arrest. Oncogene Research. 1988 ;3(3):223-238.

Scharlau D, Borowicki A, Habermann N et al. Mechanisms of primary cancer prevention by butyrate and other products formed during gut flora-mediated fermentation of dietary fibre. Mutation Research 2009 Jul-Aug;682(1):39-53.

Wong, Julia M. W. RD; de Souza, Russell RD; Kendall, Cyril W. C. PhD; Emam, Azadeh MSc; Jenkins, David J. A. MD Colonic Health: Fermentation and Short Chain Fatty Acids, Journal of Clinical Gastroenterology: March 2006 – Volume 40 – Issue 3 – p 235-243

Many studies in populations of people have also linked high-fibre diets to reduced risk of colon cancer.

Farvid MS, Eliassen AH, Cho E, Liao X, Chen WY, Willett WC. Dietary Fiber Intake in Young Adults and Breast Cancer Risk. Pediatrics. 2016;137(3):e20151226. doi:10.1542/peds.2015-1226

Chan CW, Lee PH. Association between dietary fibre intake with cancer and all-cause mortality among 15 740 adults: the National Health and Nutrition Examination Survey III. J Hum Nutr Diet. 2016;29(5):633-642. doi:10.1111/jhn.12389

Masrul M, Nindrea RD. Dietary Fibre Protective against Colorectal Cancer Patients in Asia: A Meta-Analysis. Open Access Maced J Med Sci. 2019;7(10):1723-1727. Published 2019 May 30. doi:10.3889/oamjms.2019.265

One study found that women who consumed a higher amount of fibre reduce their lifetime risk of developing breast cancer by 16 per cent.

Chen S, Chen Y, Ma S, et al. Dietary fibre intake and risk of breast cancer: A systematic review and meta-analysis of epidemiological studies. Oncotarget. 2016;7(49):80980-80989. doi:10.18632/oncotarget.13140 .

The Women’s Intervention Nutrition Study (WINS) showed that women who had been diagnosed with breast cancer tended to live longer without relapse when they reduced their fat intake, which is generally linked with reduced consumption of animal foods.

Blackburn GL, Wang KA. Dietary fat reduction and breast cancer outcome: results from the Women’s Intervention Nutrition Study (WINS). Am J Clin Nutr. 2007;86(3):s878-s881. doi:10.1093/ajcn/86.3.878S

However, good nutrition can help people to maintain weight and energy, help with tolerating treatment-related side effects, and promote healing and faster recovery from sometimes gruelling courses of chemotherapy.

Barrera S, Demark-Wahnefried W. Nutrition during and after cancer therapy. Oncology (Williston Park). 2009;23(2 Suppl Nurse Ed):15-21.

Researchers have demonstrated that apigenin, which is found in fruit (including apples, cherries, grapes), vegetables (including parsley, artichoke, basil, celery), nuts and in some teas and has been shown to have potential anti-tumour effects in several kinds of cancer.

Xin Cai, Xuan Liu et al Inhibition of Thr-55 phosphorylation restores p53 nuclear localization and sensitizes cancer cells to DNA damage. Proceedings of the National Academy of Sciences Nov 2008, 105 (44) 16958-1696

Ling-Zhi Liu, Jing Fang, Qiong Zhou, Xiaowen Hu, Xianglin Shi, and Bing-Hua Jiang Apigenin Inhibits Expression of Vascular Endothelial Growth Factor and Angiogenesis in Human Lung Cancer Cells: Implication of Chemoprevention of Lung Cancer The American Society for Pharmacology and Experimental Therapeutics Mol Pharmacol 68:635–643, 2005

Ujiki, M.B., Ding, X., Salabat, M.R. et al. Apigenin inhibits pancreatic cancer cell proliferation through G2/M cell cycle arrest. Mol Cancer 5, 76 (2006). https://doi.org/10.1186/1476-4598-5-76

Sung B, Chung HY, Kim ND. Role of Apigenin in Cancer Prevention via the Induction of Apoptosis and Autophagy. J Cancer Prev. 2016;21(4):216-226. doi:10.15430/JCP.2016.21.4.216

If there is no VEGF, the blood vessels tumours need to support their growth will not be able to form.

Sagar SM, Yance D, Wong RK. Natural health products that inhibit angiogenesis: a potential source for investigational new agents to treat cancer-Part 1. Curr Oncol. 2006;13(1):14–26.

Khanna S, Roy S, Bagchi D, Bagchi M, Sen CK. Upregulation of oxidant-induced vegf expression in cultured keratinocytes by a grape seed proanthocyanidin extract. Free Radic Biol Med. 2001;31:38–42.

One study looking at the medical records and eating habits of over 100,000 adults, showed that every 10 per cent increase in ultra-processed foods that they ate was linked to a 10 per cent increase in risk for certain cancers.

Fiolet T, Srour B, Sellem L, et al. Consumption of ultra-processed foods and cancer risk: results from NutriNet-Santé prospective cohort. BMJ. 2018;360:k322. Published 2018 Feb 14. doi:10.1136/bmj.k322

But those who had all five lifestyle factors under control had a 65 per cent reduced risk of death from cancer.

Li Y, Schoufour J, Wang DD, et al. Healthy lifestyle and life expectancy free of cancer, cardiovascular disease, and type 2 diabetes: prospective cohort study. BMJ. 2020;368:l6669. Published 2020 Jan 8. doi:10.1136/bmj.l6669

Interestingly, they found that there was nearly a 40 per cent reduction in excess risks of cancer and cancer deaths for people who exercised regularly.

Anne-Claire Vergnaud, Dora Romaguera, Petra H Peeters, et al Adherence to the World Cancer Research Fund/American Institute for Cancer Research guidelines and risk of death in Europe: results from the European Prospective Investigation into Nutrition and Cancer cohort study, The American Journal of Clinical Nutrition, Volume 97, Issue 5, May 2013, Pages 1107–1120

Light during the ‘biological night’ disturbs the circadian system, alters sleep-activity patterns (including when we eat and the efficiency of our digestion), suppresses melatonin production, and wreaks havoc on the circadian genes for cancer-related pathways in the body.

Erren TC, Falaturi P, Morfeld P, Knauth P, Reiter RJ, Piekarski C. Shift work and cancer: the evidence and the challenge. Dtsch Arztebl Int. 2010;107(38):657–662. doi:10.3238/arztebl.2010.0657

Some animal studies show increased DNA oxidation when the animals are exposed to typical amounts of electromagnetic radiation as would be emitted from a mobile phone.

National Research Council (US) Committee on Assessment of the Possible Health Effects of Ground Wave Emergency Network (GWEN). Assessment of the Possible Health Effects of Ground Wave Emergency Network. Washington (DC): National Academies Press (US); 1993. 6, Effects of Electromagnetic Fields on Organs and Tissues. Available from: https://www.ncbi.nlm.nih.gov/books/NBK208983/

Case control studies show an association between long-term mobile phone use and malignant brain tumours.

Hardell L, Carlberg M, Söderqvist F, Mild KH. Case-control study of the association between malignant brain tumours diagnosed between 2007 and 2009 and mobile and cordless phone use. Int J Oncol. 2013;43(6):1833–1845. doi:10.3892/ijo.2013.2111

Levis AG, Minicuci N, Ricci P, Gennaro V, Garbisa S. Mobile phones and head tumours. The discrepancies in cause-effect relationships in the epidemiological studies – how do they arise?. Environ Health. 2011;10:59. Published 2011 Jun 17. doi:10.1186/1476-069X-10-59

Zhao L, Liu X, Wang C, et al. Magnetic fields exposure and childhood leukemia risk: a meta-analysis based on 11,699 cases and 13,194 controls. Leuk Res. 2014;38(3):269-274. doi:10.1016/j.leukres.2013.12.008

Zhao G, Lin X, Zhou M, Zhao J. Relationship between exposure to extremely low-frequency electromagnetic fields and breast cancer risk: a meta-analysis. Eur J Gynaecol Oncol. 2014;35(3):264-269.

More studies are needed, as animal studies and case control studies are simply not evidence enough to say with certainty whether there is an effect on humans in being surrounded by wireless technology, or not.

Hardell L. World Health Organization, radiofrequency radiation and health – a hard nut to crack (Review). Int J Oncol. 2017;51(2):405-413. doi:10.3892/ijo.2017.4046

A European Parliament report (from the EPRS) published in March 2020 concluded more research was needed and called for coordinated efforts by physicists, engineers and medics to understand if there is a potential risk to human health worth understanding.

European Parliamentary Research Service Briefing Document: Effects of 5G wireless communication on human health Published March 2020.

Until more is known, I feel a precautionary principle is worth taking.

Simkó M, Mattsson MO. 5G Wireless Communication and Health Effects-A Pragmatic Review Based on Available Studies Regarding 6 to 100 GHz. Int J Environ Res Public Health. 2019;16(18):3406. Published 2019 Sep 13. doi:10.3390/ijerph16183406

Clinical studies over the past 30 years have provided strong evidence for links between chronic stress, depression and social isolation and the progression of cancer.

Moreno-Smith M, Lutgendorf SK, Sood AK. Impact of stress on cancer metastasis. Future Oncol. 2010;6(12):1863–1881. doi:10.2217/fon.10.142

In breast cancer patients, social support has been related to longer survival in several large-scale studies.

Funch DP, Marshall J. The role of stress, social support and age in survival from breast cancer. J. Psychosom. Res. 1983;27:77–83.

Maunsell E, Brisson J, Deschenes L. Social support and survival among women with breast cancer. Cancer. 1995;76(4):631–637.

Chapter 8: Diabetes Discoveries

More people than ever before have diabetes, and if nothing changes, more than 5 million people will have diabetes in the UK by 2025 (at the time of writing it is thoughtthat 4.7 million people in the UK have diabetes and someone is diagnosed every three minutes).

https://www.diabetes.org.uk/professionals/position-statements-reports/statistics

Around 90 per cent of people with diabetes have Type 2 diabetes – and although the tendency to Type 2 diabetes runs in families, it can usually be prevented through our lifestyles.

Qian F, Liu G, Hu FB, Bhupathiraju SN, Sun Q. Association Between Plant-Based Dietary Patterns and Risk of Type 2 DiabetesA Systematic Review and Meta-analysisJAMA Intern Med. 2019;179(10):1335–1344. doi:10.1001/jamainternmed.2019.2195

The dramatic increase in obesity is the main reason there are so many more people living with Type 2 diabetes today than there were just 20 years ago.

Al-Goblan AS, Al-Alfi MA, Khan MZ. Mechanism linking diabetes mellitus and obesity. Diabetes Metab Syndr Obes. 2014;7:587-591. Published 2014 Dec 4. doi:10.2147/DMSO.S67400

Sometimes this could be a virus, or a trauma, and some studies even point to cow’s milk protein exposures in susceptible people.

Chia JSJ, McRae JL, Kukuljan S, et al. A1 beta-casein milk protein and other environmental pre-disposing factors for type 1 diabetes. Nutr Diabetes. 2017;7(5):e274. Published 2017 May 15. doi:10.1038/nutd.2017.16

Adler K, Mueller DB, Achenbach P, et al. Insulin autoantibodies with high affinity to the bovine milk protein alpha casein, Clinical and Experimental Immunology. Apr 2011; 164(1): 42–49. doi: 10.1111/j.1365-2249.2011.04324.

Vaarala O, Ilonen J, Ruohtula T, et al. Removal of Bovine Insulin From Cow’s Milk Formula and Early Initiation of Beta-Cell Autoimmunity in the FINDIA Pilot Study. Arch Pediatr Adolesc Med. 2012;166(7):608-614. doi:10.1001/archpediatrics.2011.1559

Chia, J.S.J.; McRae, J.L.; Enjapoori, A.K.; Lefèvre, C.M.; Kukuljan, S.; Dwyer, K.M. Dietary Cows’ Milk Protein A1 Beta-Casein Increases the Incidence of T1D in NOD Mice. Nutrients 201810, 1291.

However, with WFPB diet changes, people living with Type 1 diabetes can reduce their insulin needs and their risk of complications while increasing their potential life span.

J W Anderson, K Ward. High-carbohydrate, high-fiber diets for insulin-treated men with diabetes mellitus. Am J Clin Nutr. 1979 Nov;32(11):2312-21

Many Type 1 diabetics are told to simply adjust their insulin levels to what they eat, without being told that what they eat and when they eat are really important for improving the quality and length of their life.

Mameli C, Mazzantini S, Ben Nasr M, Fiorina P, Scaramuzza AE, Zuccotti GV. Explaining the increased mortality in type 1 diabetes. World J Diabetes. 2015;6(7):889-895. doi:10.4239/wjd.v6.i7.889

The good news is that your lifestyle choices can have the biggest impact on whether you will develop Type 2 diabetes or not

Ley SH, Hamdy O, Mohan V, et al. Prevention and management of type 2 diabetes: dietary components and nutritional strategies. Lancet. 2014;383:1999–2007

Research shows that the more plant-based foods you eat, the lower your risk of Type 2 diabetes

Ye EQ, Chacko SA, Chou EL, et al. Greater whole-grain intake is associated with lower risk of type 2 diabetes, cardiovascular disease, and weight gain. J Nutr. 2012;142:1304–13.

Cooper AJ, Forouhi NG, Ye Z, et al. Fruit and vegetable intake and type 2 diabetes: EPIC-InterAct prospective study and meta-analysis. Eur J Clin Nutr. 2012;66:1082–1092.

Rizkalla SW, Bellisle F, Slama G. Health benefits of low glycaemic index foods, such as pulses, in diabetic patients and healthy individuals. Br J Nutr. 2002;88(Suppl 3):S255–S262.

They noted that these diets improve both insulin sensitivity and blood pressure, which both play a role in the development of diabetes.

Qian F, Liu G, Hu FB, Bhupathiraju SN, Sun Q. Association Between Plant-Based Dietary Patterns and Risk of Type 2 DiabetesA Systematic Review and Meta-analysisJAMA Intern Med. 2019;179(10):1335–1344. doi:10.1001/jamainternmed.2019.2195

McMacken M, Shah S. A plant-based diet for the prevention and treatment of type 2 diabetes. J Geriatr Cardiol. 2017;14(5):342-354. doi:10.11909/j.issn.1671-5411.2017.05.009

This way of eating also reduces weight gain and chronic low-grade inflammation, other factors that may lead to the development of diabetes.

Kahleova H, Fleeman R, Hlozkova A, Holubkov R, Barnard ND. A plant-based diet in overweight individuals in a 16-week randomized clinical trial: metabolic benefits of plant protein. Nutr Diabetes. 2018;8(1):58. Published 2018 Nov 2. doi:10.1038/s41387-018-0067-4

Campmans-Kuijpers MJ, Sluijs I, Nothlings U, et al. Isocaloric substitution of carbohydrates with protein: the association with weight change and mortality among patients with type 2 diabetes. Cardiovasc Diabetol. 2015;14:39.

Kahleova H, Matoulek M, Malinska H, et al. Vegetarian diet improves insulin resistance and oxidative stress markers more than conventional diet in subjects with type 2 diabetes. Diabet Med. 2011;28:549–559.

Sargrad KR, Homko C, Mozzoli M, et al. Effect of high protein vs high carbohydrate intake on insulin sensitivity, body weight, hemoglobin A1c, and blood pressure in patients with type 2 diabetes mellitus. J Am Diet Assoc. 2005;105:573–580.

Trapp CB, Barnard ND. Usefulness of vegetarian and vegan diets for treating type 2 diabetes. Curr Diab Rep. 2010;10:152–158.

This causes fatty liver and fatty muscles.

L M Goff, J D Bell, P W So, A Dornhorst, G S Frost. Veganism and its relationship with insulin resistance and intramyocellular lipid. Eur J Clin Nutr. 2005 Feb;59(2):291-8

Alferink, L.J.M., Erler, N.S., de Knegt, R.J. et al. Adherence to a plant-based, high-fibre dietary pattern is related to regression of non-alcoholic fatty liver disease in an elderly population. Eur J Epidemiol (2020)

This process reduces the number and activity of the insulin receptors on the surface of your cells.

Ward GM, Simpson RW, Simpson HC, Naylor BA, Mann JI, Turner RC. Insulin receptor binding increased by high carbohydrate low fat diet in non-insulin-dependent diabetics. Eur J Clin Invest. 1982;12(2):93-96. doi:10.1111/j.1365-2362.1982.tb00944.x

They can enter your fat tissue (adipose tissue) too.

Allan D Sniderman, Raj Bhopal, Dorairaj Prabhakaran, Nizal Sarrafzadegan, Andre Tchernof, Why might South Asians be so susceptible to central obesity and its atherogenic consequences? The adipose tissue overflow hypothesis, International Journal of Epidemiology, Volume 36, Issue 1, February 2007, Pages 220–225, https://doi.org/10.1093/ije/dyl245

After a while these cells can burst open and spill fatty acids into the fluid surrounding the tissue.

Boden G. Fatty acid-induced inflammation and insulin resistance in skeletal muscle and liver. Curr Diab Rep. 2006;6(3):177-181. doi:10.1007/s11892-006-0031-x

But this process triggers long-term inflammation and increased risk of other diseases such as cancer.

Zhang L, Han L, He J, Lv J, Pan R, Lv T. A high serum-free fatty acid level is associated with cancer. J Cancer Res Clin Oncol. 2020;146(3):705-710. doi:10.1007/s00432-019-03095-8

Sadly, fatty acids cause ‘beta cell lipotoxicity’ and can result in programmed cell death, or ‘apoptosis’.

Yoshikawa H, Tajiri Y, Sako Y, Hashimoto T, Umeda F, Nawata H. Effects of free fatty acids on beta-cell functions: a possible involvement of peroxisome proliferator-activated receptors alpha or pancreatic/duodenal homeobox. Metabolism. 2001;50(5):613-618. doi:10.1053/meta.2001.22565

D A Cunha, M Igoillo-Esteve, E N Gurzov, C M Germano, N Naamane, I Marhfour, M Fukaya, J M Vanderwinden, C Gysemans, C Mathieu, L Marselli, P Marchetti, H P Harding, D Ron, D L Eizirik, M Cnop. Death protein 5 and p53-upregulated modulator of apoptosis mediate the endoplasmic reticulum stress-mitochondrial dialog triggering lipotoxic rodent and human β-cell apoptosis. Diabetes. 2012 Nov;61(11):2763-75. doi: 10.2337/db12-0123

Even when many of these cells have died, a change in diet towards more whole plant foods can mean the remaining cells can boost their efficiency and begin to work normally.

J W Anderson, K Ward. High-carbohydrate, high-fiber diets for insulin-treated men with diabetes mellitus. Am J Clin Nutr. 1979 Nov;32(11):2312-21

Fibre has the ability to regulate blood sugar and even small increases in soluble fibre have been proven to help lower blood glucose levels

Anderson JW, Ward K. High-carbohydrate, high-fiber diets for insulin-treated men with diabetes mellitus. Am J Clin Nutr. 1979;32:2312–2321.

Amazingly, fibre from legumes also causes something called ‘the second meal effect’ which means not only does it reduce the sugar response of the meal we are eating right now, but that the next meal we eat, and even the one after that, will also be absorbed more slowly too.

Rizkalla SW, Bellisle F, Slama G. Health benefits of low glycaemic index foods, such as pulses, in diabetic patients and healthy individuals. Br J Nutr. 2002;88(Suppl 3):S255–S262.

Proprionate (one of the SCFAs) produced by good gut bugs when we eat beans, slows the rate at which food leaves our stomachs so we get less of a sugar rush.

Tarini J, Wolever TM. The fermentable fibre inulin increases postprandial serum short-chain fatty acids and reduces free-fatty acids and ghrelin in healthy subjects. Appl Physiol Nutr Metab. 2010;35(1):9-16. doi:10.1139/H09-119

Pingitore A, Chambers ES, Hill T, et al. The diet-derived short chain fatty acid propionate improves beta-cell function in humans and stimulates insulin secretion from human islets in vitro. Diabetes Obes Metab. 2017;19(2):257-265. doi:10.1111/dom.12811

The participants who ate black beans and pinto beans saw the best results.

Thompson SV, Winham DM, Hutchins AM. Bean and rice meals reduce postprandial glycemic response in adults with type 2 diabetes: a cross-over study. Nutr J. 2012;11:23. Published 2012 Apr 11. doi:10.1186/1475-2891-11-23

But be warned, this is not a long-term strategy for health.

Noto H, Goto A, Tsujimoto T, Noda M. Low-carbohydrate diets and all-cause mortality: a systematic review and meta-analysis of observational studies [published correction appears in PLoS One. 2019 Feb 7;14(2):e0212203]. PLoS One. 2013;8(1):e55030. doi:10.1371/journal.pone.0055030

Studies show that the only low-carb eaters who lose weight are the ones who reduce their overall intake of calories.

Foster GD, Wyatt HR, Hill JO, et al. A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med. 2003;348(21):2082-2090. doi:10.1056/NEJMoa022207

Hall KD, Chen KY, Guo J, et al. Energy expenditure and body composition changes after an isocaloric ketogenic diet in overweight and obese men. Am J Clin Nutr. 2016;104(2):324-333. doi:10.3945/ajcn.116.133561

But this doesn’t always happen when on a low carb diet, where a significant minority of people eating this way can actually have a rise in their lipid profiles despite weight loss.

Schwingshackl L, Hoffmann G. Low-carbohydrate diets and cardiovascular risk factors. Obes Rev. 2013;14(2):183-184. doi:10.1111/j.1467-789X.2012.01060.x

This increases the risk of high blood pressure, heart attacks and stroke.

Merino J et al Negative effects of a low carbohydrate high protein high fat diet on small peripheral artery reactivity in patients with increased cardiovascular risk. BJCN 2012

Similarly, a study directly comparing the coronary arteries of patients on a healthy low carb diet vs a healthy high carb diet showed significantly reduced blood flow to the heart (the coronary arteries) with the low carb diet.

Fleming RM. The effect of high-protein diets on coronary blood flow. Angiology. 2000;51(10):817-826. doi:10.1177/000331970005101003

So, my advice is that although low-carb diets can be beneficial for controlling blood sugars or weight loss, they are not an optimally healthy long-term solution.

Bolla AM, Caretto A, Laurenzi A, Scavini M, Piemonti L. Low-Carb and Ketogenic Diets in Type 1 and Type 2 Diabetes. Nutrients. 2019;11(5):962. Published 2019 Apr 26. doi:10.3390/nu11050962

Petrisko M, Kloss R, Bradley P, et al. Biochemical, Anthropometric, and Physiological Responses to Carbohydrate-Restricted Diets Versus a Low-Fat Diet in Obese Adults: A Randomized Crossover Trial. J Med Food. 2020;23(3):206-214. doi:10.1089/jmf.2019.0266

Lu M, Wan Y, Yang B, Huggins CE, Li D. Effects of low-fat compared with high-fat diet on cardiometabolic indicators in people with overweight and obesity without overt metabolic disturbance: a systematic review and meta-analysis of randomised controlled trials. Br J Nutr. 2018;119(1):96-108. doi:10.1017/S0007114517002902

Schwingshackl L, Hoffmann G. Low-carbohydrate diets and cardiovascular risk factors. Obes Rev. 2013;14(2):183-184. doi:10.1111/j.1467-789X.2012.01060.x

His diabetes improved dramatically.

Thompson SV, Winham DM, Hutchins AM. Bean and rice meals reduce postprandial glycemic response in adults with type 2 diabetes: a cross-over study. Nutr J. 2012;11:23. Published 2012 Apr 11. doi:10.1186/1475-2891-11-23

What became clear with my patient, and of course when I understood the mechanisms of insulin resistance, was that the optimal eating pattern to lessen the effects of diabetes – or even reverse the diagnosis – is a WFPB-lifestyle approach.

Dinu M, Abbate R, Gensini GF, Casini A, Sofi F. Vegetarian, vegan diets and multiple health outcomes: A systematic review with meta-analysis of observational studies. Crit Rev Food Sci Nutr. 2017;57(17):3640-3649. doi:10.1080/10408398.2016.1138447

Kempner W, Peschel RL, Schlayer C. Effect of rice diet on diabetes mellitus associated with vascular disease. Postgrad Med. 1958;24:359–371.

D M Dunaief, J Fuhrman, J L Dunaief, G Ying. Glycemic and cardiovascular parameters improved in type 2 diabetes with the high nutrient density (HND) diet. Journal: Open Journal of Preventive Medicine; ISSN 2162-2477; Vol. 02; Issue: 03; Start page: 364; Date: 2012

Tonstad S, Butler T, Yan R, Fraser GE. Type of vegetarian diet, body weight, and prevalence of type 2 diabetes. Diabetes Care. 2009;32(5):791-796. doi:10.2337/dc08-1886

Scientists in the 1930s observed that mice who were forced to restrict their food intake lived longer than those who could eat whenever they wanted, and this observation triggered an explosion of research trying to understand the biological mechanisms that result in boosted longevity, memory and weight loss and reduced risk of chronic diseases such as diabetes, cancer and dementia.

Balasubramanian P, Howell PR, Anderson RM. Aging and Caloric Restriction Research: A Biological Perspective With Translational Potential. EBioMedicine. 2017;21:37-44. doi:10.1016/j.ebiom.2017.06.015

We have yet to fully understand how fasting affects the resilience of our gut bug populations, for better or for worse.

Paoli A, Tinsley G, Bianco A, Moro T. The Influence of Meal Frequency and Timing on Health in Humans: The Role of Fasting. Nutrients. 2019;11(4):719. Published 2019 Mar 28. doi:10.3390/nu11040719

Karakan T. Intermittent fasting and gut microbiota. Turk J Gastroenterol. 2019;30(12):1008. doi:10.5152/tjg.2019.101219

Over the last few years, studies have shown that people with Type 2 diabetes tend to have less mitochondria in their muscle cells, and those they do have can be less efficient.

Sivitz WI, Yorek MA. Mitochondrial dysfunction in diabetes: from molecular mechanisms to functional significance and therapeutic opportunities. Antioxid Redox Signal. 2010;12(4):537-577. doi:10.1089/ars.2009.2531

Chapter 9: Reset Your Skin

Yet, some cultures do not have issues with acne at all.

Cordain L, Lindeberg S, Hurtado M, Hill K, Eaton SB, Brand-Miller J. Acne vulgaris: a disease of Western civilization. Arch Dermatol. 2002;138(12):1584-1590. doi:10.1001/archderm.138.12.1584

More research is now establishing specific enzyme pathways that can lead to acne in susceptible people – and that diet can indeed improve this for some of us.

Smith RN, Mann NJ, Braue A, Mäkeläinen H, Varigos GA. A low-glycemic-load diet improves symptoms in acne vulgaris patients: a randomized controlled trial. Am J Clin Nutr. 2007;86(1):107-15.

B C Melnik. Diet in acne: Further evidence for the role of nutrient signalling in acne pathogenesis. Acta Derm. Venereol. 2012 92(3):228 – 231.

B C Melnik, S M John, G Plewig. Acne: Risk indicator for increased body mass index and insulin resistance. Acta Derm Venereol. 2013 93(6):644 – 649.

Overstimulation of this TOR enzyme pathway can contribute to premature puberty as well as acne.

B C Melnik. Excessive Leucine-mTORC1-Signalling of Cow Milk-Based Infant Formula: The Missing Link to Understand Early Childhood Obesity. J Obes 2012 2012:197653.

B C Melnik. Dietary intervention in acne: Attenuation of increased mTORC1 signaling promoted by Western diet. Dermatoendocrinol 2012 4(1):20 – 32.

Cow’s milk has three times more leucine (an amino acid) than human milk, which is one of the primary activators of TOR.

F W Danby. Turning acne on/off via mTORC1. Exp Dermatol 2013 22(7):505 – 506.

B C Melnik, C C Zouboulis. Potential role of FoxO1 and mTORC1 in the pathogenesis of Western diet-induced acne. Exp Dermatol 2013 22(5):311 – 315.

B C Melnik, S M John, P Carrera-Bastos, L Cordain. The impact of cow’s milk-mediated mTORC1-signaling in the initiation and progression of prostate cancer. Nutr Metab (Lond) 2012 9(1):74.

Leucine also increases cellular ageing, according to the Nobel-prize-nominated research of Professor Valter Longo along with many other longevity researchers.

Longo VD, Antebi A, Bartke A, et al. Interventions to Slow Aging in Humans: Are We Ready?. Aging Cell. 2015;14(4):497-510. doi:10.1111/acel.12338

Mirzaei H, Suarez JA, Longo VD. Protein and amino acid restriction, aging and disease: from yeast to humans. Trends Endocrinol Metab. 2014;25(11):558-566. doi:10.1016/j.tem.2014.07.002

Refined sugar can cause inflammation in the body, and chocolate is the worst culprit when it comes to spots, it seems.

Block SG, Valins WE, Caperton CV, Viera MH, Amini S, Berman B. Exacerbation of facial acne vulgaris after consuming pure chocolate. J Am Acad Dermatol. 2011;65(4):e114-5.

Vongraviopap S, Asawanonda P. Dark chocolate exacerbates acne. Int J Dermatol. 2016;55(5):587-91.

Especially white chocolate, which is high in sugar and fat, but even dark chocolate and cocoa powder can be problematic.

Pierre Dougan and Naser Rafikhah, 2014. Dark and White Chocolate Consumption and Acne Vulgaris: A Case-Control Study. Asian Journal of Clinical Nutrition, 6: 35-40.

Cocoa seems to be linked to acne outbreaks – even in a blind placebo-controlled trial where people were given cocoa powder in capsule form.

Caperton C, Block S, Viera M, Keri J, Berman B. Double-blind, Placebo-controlled Study Assessing the Effect of Chocolate Consumption in Subjects with a History of Acne Vulgaris. J Clin Aesthet Dermatol. 2014;7(5):19-23.

Greasy foods have been shown to increase sebum production, which can contribute to breakouts.

Kucharska A, Szmurło A, Sińska B. Significance of diet in treated and untreated acne vulgaris. Postepy Dermatol Alergol. 2016;33(2):81-86. doi:10.5114/ada.2016.59146

Wholegrains on the other hand have been shown in many studies to be associated with good health and longevity, so it is worth including them unless you have a specific reason not to.

Zhang B, Zhao Q, Guo W, Bao W, Wang X. Association of whole grain intake with all-cause, cardiovascular, and cancer mortality: a systematic review and dose-response meta-analysis from prospective cohort studies. Eur J Clin Nutr. 2018;72(1):57-65. doi:10.1038/ejcn.2017.149

You can potentially switch some of these hereditary triggers off through improving gut health and eating a more plant-focused diet.

Carey OJ et al: The effect of lifestyle on wheeze, atopy, and bronchial hyperreactivity in Asian and white children. Am J Respir Crit Care Med 154:537, 1996 [PMID:8756835]

Zhang A, Silverberg JI: Association of atopic dermatitis with being overweight and obese: a systematic review and metaanalysis. JAAD 72:606, 2015 [PMID:25773409]

Gdalevich M et al: Breast-feeding and the onset of atopic dermatitis in childhood: a systematic review and meta-analysis of prospective studies. J Am Acad Dermatol 45:520, 2001 [PMID:11568741]

In adults, diet, hormones, environmental triggers and stress can all play a part.

Renz-Polster H, David MR, Buist AS, et al. Caesarean section delivery and the risk of allergic disorders in childhood. Clin Exp Allergy. 2005;35(11):1466-1472. doi:10.1111/j.1365-2222.2005.02356.x

Bager P, Wohlfahrt J, Westergaard T. Caesarean delivery and risk of atopy and allergic disease: meta-analyses. Clin Exp Allergy. 2008;38(4):634-642. doi:10.1111/j.1365-2222.2008.02939.x

Kim DH, Han K, Kim SW. Effects of Antibiotics on the Development of Asthma and Other Allergic Diseases in Children and Adolescents. Allergy Asthma Immunol Res. 2018;10(5):457-465. doi:10.4168/aair.2018.10.5.457

Jones SM, Sampson HA: The role of allergens in atopic dermatitis. Clin Rev Allergy 11:471, 1993 [PMID:8143262]

Langan SM, Williams HC: What causes worsening of eczema? A systematic review. Br J Dermatol 155:504, 2006 [PMID:16911274]

It’s also worth being aware that if a child has eczema and a nut allergy, they are 80 per cent more likely to develop asthma later in childhood.

Foong RX, du Toit G, Fox AT. Asthma, Food Allergy, and How They Relate to Each Other. Front Pediatr. 2017;5:89. Published 2017 May 9. doi:10.3389/fped.2017.00089

The third trigger for flare-ups is stress.

Wright RJ, Cohen RT, Cohen S. The impact of stress on the development and expression of atopy. Curr Opin Allergy Clin Immunol. 2005;5(1):23-29. doi:10.1097/00130832-200502000-00006

Liezmann C, Klapp B, Peters EM. Stress, atopy and allergy: A re-evaluation from a psychoneuroimmunologic persepective. Dermatoendocrinol. 2011;3(1):37-40. doi:10.4161/derm.3.1.14618

There is not enough data on this for me to advise whether probiotics are useful, but they are used a lot in the skin industry, so perhaps time will tell.

Ogden NS, Bielory L: Probiotics: a complementary approach in the treatment and prevention of pediatric atopic disease. Curr Opin Allergy Clin Immunol 5:179, 2005 [PMID:15764910]

Viljanen M et al: Probiotic effects on faecal inflammatory markers and on faecal IgA in food allergic atopic eczema/dermatitis syndrome infants. Pediatr Allergy Immunol 16:65, 2005 [PMID:15693914]

Panduru M et al: Probiotics and primary prevention of atopic dermatitis: a meta-analysis of randomized controlled studies. J Eur Acad Dermatol Venereol Apr 4 [PMID:24698503]

For example, research from Holland has shown that people who ate the most fruit and vegetables had the healthiest lung function.

Ochs-Balcom HM, Grant BJ, Muti P, et al. Antioxidants, oxidative stress, and pulmonary function in individuals diagnosed with asthma or COPD. Eur J Clin Nutr. 2006;60(8):991-999. doi:10.1038/sj.ejcn.1602410

Studies there have shown that if a breastfeeding mum’s diet is high in animal fats and low in omega-3, the risk of her baby developing eczema increases.

Baïz N, Just J, Chastang J, et al. Maternal diet before and during pregnancy and risk of asthma and allergic rhinitis in children. Allergy Asthma Clin Immunol. 2019;15:40. Published 2019 Jun 22. doi:10.1186/s13223-019-0353-2

those whose diets contained the highest amounts of meats and processed foods had a 57 per cent greater risk for atopic dermatitis (eczema) when compared with individuals whose diets contained the least.

Park S, Choi HS, Bae JH: Instant noodles, processed food intake, and dietary pattern are associated with atopic dermatitis in an adult population (KNHANES 2009-2011). Asia Pac J Clin Nutr 25:602, 2016 [PMID:27440696]

Additionally, the International Study on Asthma and Allergy in Children (ISAAC) performed in Colombia found that children whose diets contained the highest amounts of traditionally eaten foods, such as fresh fruit and legumes, had an almost 40 per cent lower risk for having eczema, compared to those eating the lowest amounts of these foods.

Cepeda AM et al: A Traditional Diet Is Associated with a Reduced Risk of Eczema and Wheeze in Colombian Children. Nutrients 7:5098, 2015 [PMID:26121530]

Eat a healthy diet rich in fruit, vegetables, nuts, seeds, wholegrains and omega-3s.

Tanaka T et al: Vegetarian diet ameliorates symptoms of atopic dermatitis through reduction of the number of peripheral eosinophils and of PGE2 synthesis by monocytes. J Physiol Anthropol Appl Human Sci 20:353, 2001 [PMID:11840688]

Kaczmarski M, Cudowska B, Sawicka-Żukowska M, Bobrus-Chociej A. Supplementation with long chain polyunsaturated fatty acids in treatment of atopic dermatitis in children. Postep Derm Alergol. 2013;30:103-107.

Chapter 10: Hormones and Health

Premature puberty is a serious problem because it is linked to greater risk for breast cancer, heart disease, diabetes and even adult-onset asthma.

Day FR, Elks CE, Murray A, Ong KK, Perry JR. Puberty timing associated with diabetes, cardiovascular disease and also diverse health outcomes in men and women: the UK Biobank study. Sci Rep. 2015;5:11208. Published 2015 Jun 18. doi:10.1038/srep11208

The high-fat, low-fibre Western diet, as well as reduced exercise, advances the onset of puberty for our young women, who may not be ready psychologically for the onset of womanhood, let alone the physical aspects of it.

Lazzeri G, Tosti C, Pammolli A, et al. Overweight and lower age at menarche: evidence from the Italian HBSC cross-sectional survey. BMC Womens Health. 2018;18(1):168. Published 2018 Oct 19. doi:10.1186/s12905-018-0659-0

Women in the Western world also tend to go through menopause later, which means our lifetime exposure to oestrogen is higher, and puts us at increased risk of hormone-dependent cancers.

Trichopoulos D, MacMahon B, Cole P. Menopause and breast cancer risk. J Natl Cancer Inst. 1972;48(3):605-613.

Maintaining a normal weight, moving our bodies and making sure we visit the toilet regularly are a great start because being overweight can in itself mean we have a higher hormone exposure.

Hershcopf RJ, Bradlow HL. Obesity, diet, endogenous estrogens, and the risk of hormone-sensitive cancer. Am J Clin Nutr. 1987;45(1 Suppl):283-289. doi:10.1093/ajcn/45.1.283

When we get bunged up, those waste products seep back into our bodies through the intestinal wall and get re-metabolised.

Meier R, Beglinger C, Dederding JP, et al. Influence of age, gender, hormonal status and smoking habits on colonic transit time. Neurogastroenterol Motil. 1995;7(4):235-238. doi:10.1111/j.1365-2982.1995.tb00231.x

Plastics and insecticides can have hormone-mimicking effects and have been linked to breast and prostate cancer.

Wang Z, Liu H, Liu S. Low-Dose Bisphenol A Exposure: A Seemingly Instigating Carcinogenic Effect on Breast Cancer. Adv Sci (Weinh). 2016;4(2):1600248. Published 2016 Nov 21. doi:10.1002/advs.201600248

Gao H, Yang BJ, Li N, et al. Bisphenol A and hormone-associated cancers: current progress and perspectives. Medicine (Baltimore). 2015;94(1):e211. doi:10.1097/MD.0000000000000211

Mnif W, Hassine AI, Bouaziz A, Bartegi A, Thomas O, Roig B. Effect of endocrine disruptor pesticides: a review. Int J Environ Res Public Health. 2011;8(6):2265-2303. doi:10.3390/ijerph8062265

In fact, as an example, many studies on phthalates (chemicals used to help the durability and flexibility of plastics) shows they disrupt our hormones and have been linked to developmental issues, fertility problems and obesity.

Braun JM, Sathyanarayana S, Hauser R. Phthalate exposure and children’s health. Curr Opin Pediatr. 2013;25(2):247-254. doi:10.1097/MOP.0b013e32835e1eb6

Kay VR, Chambers C, Foster WG. Reproductive and developmental effects of phthalate diesters in females. Crit Rev Toxicol. 2013;43(3):200-219. doi:10.3109/10408444.2013.766149

Vafeiadi M, Myridakis A, Roumeliotaki T, et al. Association of Early Life Exposure to Phthalates With Obesity and Cardiometabolic Traits in Childhood: Sex Specific Associations. Front Public Health. 2018;6:327. Published 2018 Nov 27. doi:10.3389/fpubh.2018.00327

One study shows us a mechanism by which phthalates induce proliferation and invasiveness of breast cancers.

Hsieh TH, Tsai CF, Hsu CY, et al. Phthalates induce proliferation and invasiveness of estrogen receptor-negative breast cancer through the AhR/HDAC6/c-Myc signaling pathway. FASEB J. 2012;26(2):778-787. doi:10.1096/fj.11-191742

The researchers also found increased sex hormone binding globulin (SHBG) in the bloodstream.

Barnard ND1, Scialli AR, Hurlock D, Bertron P. Diet and sex-hormone binding globulin, dysmenorrhea, and premenstrual symptoms. Randomized controlled trial. Obstet Gynecol. 2000 Feb;95(2):245-50.

There are vitamin D receptors in -the womb and one trial showed us that with a single high-dose vitamin D treatment period pains could potentially be reduced.

Lasco A, Catalano A, Benvenga S. Improvement of Primary Dysmenorrhea Caused by a Single Oral Dose of Vitamin D: Results of a Randomized, Double-blind, Placebo-Controlled Study. Arch Intern Med.2012;172(4):366–367.

Ginger has been shown in another study to be equally as effective as two different types of anti-inflammatory painkiller.

Rahnama P, Montazeri A, Huseini HF, Kianbakht S, Naseri M. Effect of Zingiber officinale R. rhizomes (ginger) on pain relief in primary dysmenorrhea: a placebo randomized trial. BMC Complement Altern Med. 2012;12:92. Published 2012 Jul 10. doi:10.1186/1472-6882-12-92

The women did this for three cycles and found improved mood, reduced pain and increased BDNF levels.

Ozgoli G, Goli M, Moatar F. Comparison of effects of ginger, mefenamic acid, and ibuprofen on pain in women with primary dysmenorrhea. J. Alter. Compl. Med. 2009;15:129–132.

Interestingly, people with PCOS tend to have more receptors for AGEs (advanced glycation end products).

Garg D, Merhi Z. Relationship between Advanced Glycation End Products and Steroidogenesis in PCOS. Reprod Biol Endocrinol. 2016;14(1):71. Published 2016 Oct 21. doi:10.1186/s12958-016-0205-6

The soy group had significantly reduced body weight, waist circumference, insulin hormone, insulin resistance, blood sugars and triglyceride fats in the blood.

Karamali M, Kashanian M, Alaeinasab S, Asemi Z. The effect of dietary soy intake on weight loss, glycaemic control, lipid profiles and biomarkers of inflammation and oxidative stress in women with polycystic ovary syndrome: a randomised clinical trial. J Hum Nutr Diet. 2018;31(4):533-543. doi:10.1111/jhn.12545

Khani B, Mehrabian F, Khalesi E, Eshraghi A. Effect of soy phytoestrogen on metabolic and hormonal disturbance of women with polycystic ovary syndrome. J Res Med Sci. 2011;16(3):297-302.

This is primarily a diagnosis linked to excess oestrogen and, as discussed for period pain in general, a healthy plant-based diet may help.

Trabert B, Peters U, De Roos AJ, Scholes D, Holt VL. Diet and risk of endometriosis in a population-based case-control study. Br J Nutr. 2011;105(3):459-467. doi:10.1017/S0007114510003661

One study found a link between the consumption of red meat and chicken and the development of endometriosis – the women were followed up for 20 years and had had their endometriosis confirmed by laparoscopy.

Yamamoto A, Harris HR, Vitonis AF, et al. A prospective cohort study of meat and fish consumption and endometriosis risk. Am J Obstet Gynecol 2018;219:178.e1-10. 10.1016/j.ajog.2018.05.034

Exposure to phthalates from plastics may be linked to endometriosis too, and interestingly foods containing the most phthalates include fish (from UK data) and chicken (from US data).

Bradley EL, Burden RA, Bentayeb K, et al. Exposure to phthalic acid, phthalate diesters and phthalate monoesters from foodstuffs: UK total diet study results. Food Addit Contam Part A Chem Anal Control Expo Risk Assess. 2013;30(4):735-742. doi:10.1080/19440049.2013.781684

Schecter A, Lorber M, Guo Y, et al. Phthalate concentrations and dietary exposure from food purchased in New York State. Environ Health Perspect. 2013;121(4):473-494. doi:10.1289/ehp.1206367

There is a correlation between exposure to endocrine disruptors within our fat cells and increased fibroid risk.

Diamanti-Kandarakis E, Bourguignon JP, Giudice LC, et al. Endocrine-disrupting chemicals: an Endocrine Society scientific statement. Endocr Rev. 2009;30(4):293-342. doi:10.1210/er.2009-0002

Katz TA, Yang Q, Treviño LS, Walker CL, Al-Hendy A. Endocrine-disrupting chemicals and uterine fibroids. Fertil Steril. 2016;106(4):967-977. doi:10.1016/j.fertnstert.2016.08.023

Perhaps unsurprisingly, fibroid lumps are associated with eating beef and ham, and one study showed green vegetables and citrus fruits are thought to be protective.

Sparic R, Mirkovic L, Malvasi A, Tinelli A. Epidemiology of Uterine Myomas: A Review. Int J Fertil Steril. 2016;9(4):424–435. doi:10.22074/ijfs.2015.4599

Fabio Parazzini, Mirella Di Martino, Massimo Candiani & Paola Viganò (2015) Dietary Components and Uterine Leiomyomas: A Review of Published Data, Nutrition and Cancer, 67:4, 569-579, DOI: 10.1080/01635581.2015.1015746

Drinking alcohol has also been linked to the development of fibroids, as well as stress and reduced physical activity.

Takala H, Yang Q, El Razek AMA, Ali M, Al-Hendy A. Alcohol Consumption and Risk of Uterine Fibroids. Curr Mol Med. 2020;20(4):247-258. doi:10.2174/1566524019666191014170912

Qin H, Lin Z, Vásquez E, Xu L. The association between chronic psychological stress and uterine fibroids risk: A meta-analysis of observational studies. Stress Health. 2019;35(5):585-594. doi:10.1002/smi.2895

Wise LA, Laughlin-Tommaso SK. Epidemiology of Uterine Fibroids: From Menarche to Menopause. Clin Obstet Gynecol. 2016;59(1):2-24. doi:10.1097/GRF.0000000000000164

Men reported this symptom about as often as the women did.

Lock M. Menopause: lessons from anthropology. Psychosom Med. 1998;60(4):410-419. doi:10.1097/00006842-199807000-00005

The isoflavones contained in soy – specifically genistein – have been shown in studies to improve menopausal symptoms, bone mineral density and reduce risk of breast, prostate and colon cancers.

Nagata C, Takatsuka N, Kowakami N, Shimuzu H. Soy product intake and hot flashes in Japanese women: results from a community based prospective study. Am J Epidemiol. 2001;153:790-793.

One study followed Japanese women over time, and those who ate more soy were 68 per cent less likely to experience hot flushes than those who did not.

Nagata C, Shimizu H, Takami R, Hayashi M, Takeda N, Yasuda K. Hot flashes and other menopausal symptoms in relation to soy product intake in Japanese Women. Climacteric. 1999;2:6-12

These figures double after 10 years of use.

Munsell MF, Sprague BL, Berry DA, Chisholm G, Trentham-Dietz A. Body mass index and breast cancer risk according to postmenopausal estrogen-progestin use and hormone receptor status. Epidemiologic Reviews 2014; 36:114-136.

And three alcoholic drinks a week can increase relative risk by 15 per cent compared to women who are teetotal.

Chen WY, Rosner B, Hankinson SE, Colditz GA, Willett WC. Moderate alcohol consumption during adult life, drinking patterns, and breast cancer risk. JAMA. 2011;306(17):1884–1890.

Studies have shown that reduced sperm counts, missing testes at birth (crypto-orchidism) testicular tumours and hypospadias (opening of the urethra on the underside of the penis) have all been associated with phthalate exposure.

Bonde JP Male reproductive organs are at risk from environmental hazards. Asian J Androl. 2010 Mar;12(2):152-6. doi: 10.1038/aja.2009.83. Epub 2009 Dec 7.

Hu GX, Lian QQ, Ge RS, Hardy DO, Li XK. Phthalate-induced testicular dysgenesis syndrome: Leydig cell influence. Trends Endocrinol Metab. 2009;20(3):139-145. doi:10.1016/j.tem.2008.12.001

Studies show both binge drinking and having more than fourteen drinks a week can affect sperm count and quality.

Ricci E, Al Beitawi S, Cipriani S, et al. Semen quality and alcohol intake: a systematic review and meta-analysis. Reprod Biomed Online. 2017;34(1):38‐47.

Dioxins and heavy metals, especially concentrated in plastic heated foods, farmed fish and processed meats, have been associated with reduced sperm quality and increased length of time to conceive.

Mendiola, Jaime et al. Food intake and its relationship with semen quality: a case-control study Fertility and Sterility, Volume 91, Issue 3, 812 – 818

so cutting back on meat and dairy if you are a big lover of steak and cheese may help your sperm swim to their best.

Jill A. Attaman, Thomas L. Toth, Jeremy Furtado, Hannia Campos, Russ Hauser, Jorge. E. Chavarro, Dietary fat and semen quality among men attending a fertility clinic, Human Reproduction, Volume 27, Issue 5, May 2012, Pages 1466–1474,

Cito G, Cocci A, Micelli E, et al. Vitamin D and Male Fertility: An Updated Review. World J Mens Health. 2020;38(2):164-177. doi:10.5534/wjmh.190057

Boosting low vitamin D is important – several studies link higher levels with improved sperm.

Cito G, Cocci A, Micelli E, et al. Vitamin D and Male Fertility: An Updated Review. World J Mens Health. 2020;38(2):164-177. doi:10.5534/wjmh.190057

A study from Italy conducted in 2004 found that overweight men who had erectile dysfunction improved after cutting down on foods high in cholesterol (which is found only in animal products) and triglycerides (found also in oily foods).

Esposito K, Giugliano F, Di Palo C, et al. Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. JAMA. 2004;291(24):2978‐2984. doi:10.1001/jama.291.24.2978

The name ‘phyto-oestrogens’ understandably leads people to think soy products could have feminising effects, but the literature actually suggests it is a SERM (selective oestrogen receptor modulator).

Paterni I, Granchi C, Katzenellenbogen JA, Minutolo F. Estrogen receptors alpha (ERα) and beta (ERβ): subtype-selective ligands and clinical potential. Steroids. 2014;90:13-29. doi:10.1016/j.steroids.2014.06.012

Mahmoud AM, Al-Alem U, Ali MM, Bosland MC. Genistein increases estrogen receptor beta expression in prostate cancer via reducing its promoter methylation. J Steroid Biochem Mol Biol. 2015;152:62-75. doi:10.1016/j.jsbmb.2015.04.018

For menopausal women this is particularly useful, one study showed soy milk daily could actually increase bone mineral density compared to progesterone hormone cream and no intervention.

D. L. Alekel, A. S. Germain, C. T. Peterson, K. B. Hanson, J. W. Stewart, and T. Toda, “isoflavone-rich soy protein isolate attenuates bone loss in the lumbar spine of perimenopausal women,” American Journal of Clinical Nutrition, vol. 72, no. 3, pp. 844–852, 2000.

Iodine is found in cow’s milk because it is used in sanitising agents for milk storage units and is also given in the feed of cows who provide milk.

Castro SI, Berthiaume R, Robichaud A, Lacasse P. Effects of iodine intake and teat-dipping practices on milk iodine concentrations in dairy cows. J Dairy Sci. 2012;95(1):213-220. doi:10.3168/jds.2011-4679

Some epidemiological data suggests that plant-based diets are associated with lower rates of hypothyroidism.

Tonstad S, Nathan E, Oda K, Fraser G. Vegan diets and hypothyroidism. Nutrients. 2013;5(11):4642–4652. Published 2013 Nov 20. doi:10.3390/nu5114642

Other research shows us how beneficial plant-based diets can be for reducing risk and improving various autoimmune diseases.

Manzel A, Muller DN, Hafler DA, Erdman SE, Linker RA, Kleinewietfeld M. Role of “Western diet” in inflammatory autoimmune diseases. Curr Allergy Asthma Rep. 2014;14(1):404. doi:10.1007/s11882-013-0404-6

Chapter 11: A Healthy Gut

We know that the gut microbiome affects the body from before birth and determines not only the digestion of the food that we consume but a host of systems, including our immune system, our central nervous system and our risk of obesity, cancer and chronic disease.

Hills RD Jr, Pontefract BA, Mishcon HR, Black CA, Sutton SC, Theberge CR. Gut Microbiome: Profound Implications for Diet and Disease. Nutrients. 2019;11(7):1613. Published 2019 Jul 16. doi:10.3390/nu11071613

However, we also know diet plays a significant role and even though our gut microbiota is relatively stable, what we eat in just 24 hours can change our microbiome, for better or worse.

Singh RK, Chang HW, Yan D, et al. Influence of diet on the gut microbiome and implications for human health. J Transl Med. 2017;15(1):73. Published 2017 Apr 8. doi:10.1186/s12967-017-1175-y

Our food choices can significantly impact our gut microbiota and modern lifestyles, including a Western diet, have led to substantial depletion of gut microbial diversity.

Zinöcker MK, Lindseth IA. The Western Diet-Microbiome-Host Interaction and Its Role in Metabolic Disease. Nutrients. 2018;10(3):365. Published 2018 Mar 17. doi:10.3390/nu10030365

Some worry that a WFPB approach will restrict them, when in fact it introduces a much broader range of different foods for our microbiome than the same staples from a standard Western diet.

Tomova A, Bukovsky I, Rembert E, et al. The Effects of Vegetarian and Vegan Diets on Gut Microbiota. Front Nutr. 2019;6:47. Published 2019 Apr 17. doi:10.3389/fnut.2019.00047

A lack of diversity of gut bugs has been shown too in people with chronic diseases including diabetes, irritable bowel syndrome (IBS), coeliac disease, Alzheimer’s, and psoriatic arthritis.

Mosca A, Leclerc M, Hugot JP. Gut Microbiota Diversity and Human Diseases: Should We Reintroduce Key Predators in Our Ecosystem?. Front Microbiol. 2016;7:455. Published 2016 Mar 31. doi:10.3389/fmicb.2016.00455

Changes to their gut microbiome were swift too, which is what surprised the researchers the most.

Najjar RS, Feresin RG. Plant-Based Diets in the Reduction of Body Fat: Physiological Effects and Biochemical Insights. Nutrients. 2019;11(11):2712. Published 2019 Nov 8. doi:10.3390/nu11112712

These are endotoxins which cause inflammation within our bodies.

Murphy EA, Velazquez KT, Herbert KM. Influence of high-fat diet on gut microbiota: a driving force for chronic disease risk. Curr Opin Clin Nutr Metab Care. 2015;18(5):515-520. doi:10.1097/MCO.0000000000000209

Trimethylamine N-oxide increases risk of heart disease, heart failure and chronic kidney disease.

Kanitsoraphan C, Rattanawong P, Charoensri S, Senthong V. Trimethylamine N-Oxide and Risk of Cardiovascular Disease and Mortality. Curr Nutr Rep. 2018;7(4):207-213. doi:10.1007/s13668-018-0252-z

Suzuki T, Heaney LM, Bhandari SS, Jones DJ, Ng LL. Trimethylamine N-oxide and prognosis in acute heart failure. Heart. 2016;102(11):841-848. doi:10.1136/heartjnl-2015-308826

Tang WH, Wang Z, Kennedy DJ, et al. Gut microbiota-dependent trimethylamine N-oxide (TMAO) pathway contributes to both development of renal insufficiency and mortality risk in chronic kidney disease. Circ Res. 2015;116(3):448-455. doi:10.1161/CIRCRESAHA.116.305360

if you feed a vegan a beef steak their TMAO blood levels remain low.

Koeth RA, Wang Z, Levison BS, et al. Intestinal microbiota metabolism of L-carnitine, a nutrient in red meat, promotes atherosclerosis. Nat Med. 2013;19(5):576-585. doi:10.1038/nm.3145

Janeiro MH, Ramírez MJ, Milagro FI, Martínez JA, Solas M. Implication of Trimethylamine N-Oxide (TMAO) in Disease: Potential Biomarker or New Therapeutic Target. Nutrients. 2018;10(10):1398. Published 2018 Oct 1. doi:10.3390/nu10101398

SCFAs protect against inflammation (see also page 000) and play a key role in immunity.

Vinolo MA, Rodrigues HG, Nachbar RT, Curi R. Regulation of inflammation by short chain fatty acids. Nutrients. 2011;3(10):858-876. doi:10.3390/nu3100858

Corrêa-Oliveira R, Fachi JL, Vieira A, Sato FT, Vinolo MA. Regulation of immune cell function by short-chain fatty acids. Clin Transl Immunology. 2016;5(4):e73. Published 2016 Apr 22. doi:10.1038/cti.2016.17

Fibre also adds bulk and softens stools to relieve constipation and can prevent and relieve problems such as haemorrhoids or piles, diverticulitis and irritable bowel syndrome (IBS).

Aldoori WH, Giovannucci EL, Rockett HR, Sampson L, Rimm EB, Willett WC. A prospective study of dietary fiber types and symptomatic diverticular disease in men. J Nutr. 1998;128(4):714-719. doi:10.1093/jn/128.4.714

El-Salhy M, Ystad SO, Mazzawi T, Gundersen D. Dietary fiber in irritable bowel syndrome (Review). Int J Mol Med. 2017;40(3):607-613. doi:10.3892/ijmm.2017.3072

There is also evidence that eating a diet high in fibre lowers risk of developing serious conditions such as diabetes, heart disease and some kinds of cancers – especially bowel cancer.

Brighenti F, Benini L, Del Rio D, Casiraghi C, Pellegrini N, Scazzina F, Jenkins DJ, Vantini I. Colonic fermentation of indigestible carbohydrates contributes to the second-meal effect. Am J Clin Nutr. 2006 Apr;83(4):817-22.

Mollard RC, Wong CL, Luhovyy BL, Anderson GH. First and second meal effects of pulses on blood glucose, appetite, and food intake at a later meal. Appl Physiol Nutr Metab. 2011 Oct;36(5):634-42.

Erkkilä AT, Lichtenstein AH. Fiber and cardiovascular disease risk: how strong is the evidence? J Cardiovasc Nurs. 2006 Jan-Feb;21(1):3-8. Review.

Lairon D, Arnault N, Bertrais S, Planells R, Clero E, Hercberg S, Boutron-Ruault MC. Dietary fiber intake and risk factors for cardiovascular disease in French adults. Am J Clin Nutr. 2005 Dec;82(6):1185-94.

Pereira MA, O’Reilly E, Augustsson K, Fraser GE, Goldbourt U, Heitmann BL, Hallmans G, Knekt P, Liu S, Pietinen P, Spiegelman D, Stevens J, Virtamo J, Willett WC, Ascherio A. Dietary fiber and risk of coronary heart disease: a pooled analysis of cohort studies. Arch Intern Med. 2004 Feb 23;164(4):370-6.

Kunzmann AT, Coleman HG, Huang WY, Kitahara CM, Cantwell MM, Berndt SI. Dietary fiber intake and risk of colorectal cancer and incident and recurrent adenoma in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Am J Clin Nutr. 2015;102(4):881-890. doi:10.3945/ajcn.115.113282

One meta-analysis suggests that every 10g of fibre we eat per day cuts our premature mortality risk by an amazing 10 per cent.

Yang Y, Zhao LG, Wu QJ, Ma X, Xiang YB. Association between dietary fiber and lower risk of all-cause mortality: a meta-analysis of cohort studies. Am J Epidemiol. 2015;181(2):83-91. doi:10.1093/aje/kwu257

The logic is that antibiotics wipe out your gut bacteria long with the harmful bacteria, so by taking probiotics, you can replenish your microbiome.

Yoon MY, Yoon SS. Disruption of the Gut Ecosystem by Antibiotics. Yonsei Med J. 2018;59(1):4-12. doi:10.3349/ymj.2018.59.1.4

Saccharomyces boulardii is a bacteria often given for preventing and treating diarrhoea in the form of probiotic tablets.

Kelesidis T, Pothoulakis C. Efficacy and safety of the probiotic Saccharomyces boulardii for the prevention and therapy of gastrointestinal disorders. Therap Adv Gastroenterol. 2012;5(2):111-125. doi:10.1177/1756283X11428502

The evidence is mixed, and we still do not know the long-term effects of taking probiotics. Some research has even shown that they can delay gut-health recovery.

Suez J, Zmora N, Zilberman-Schapira G, et al. Post-Antibiotic Gut Mucosal Microbiome Reconstitution Is Impaired by Probiotics and Improved by Autologous FMT. Cell. 2018;174(6):1406-1423.e16. doi:10.1016/j.cell.2018.08.047

Antibiotics are given extensively to animals bred for farming around the globe.

Martin MJ, Thottathil SE, Newman TB. Antibiotics Overuse in Animal Agriculture: A Call to Action for Health Care Providers. Am J Public Health. 2015;105(12):2409-2410. doi:10.2105/AJPH.2015.302870

Most people suffering from diverticulitis are normally recommended a low-fibre diet but there is little evidence for its effectiveness

Barroso AO, Quigley EM. Diverticula and Diverticulitis: Time for a Reappraisal. Gastroenterol Hepatol (N Y). 2015;11(10):680-688.

Many studies have shown that eating fibre-rich foods can control diverticular symptoms.

Aldoori WH, Giovannucci EL, Rockett HR, Sampson L, Rimm EB, Willett WC. A prospective study of dietary fiber types and symptomatic diverticular disease in men. J Nutr. 1998;128(4):714-719. doi:10.1093/jn/128.4.714

Cummings JH, Engineer A. Denis Burkitt and the origins of the dietary fibre hypothesis. Nutr Res Rev. 2018;31(1):1-15. doi:10.1017/S0954422417000117

Painter NS. The high fibre diet in the treatment of diverticular disease of the colon. Postgrad Med J. 1974;50(588):629-635. doi:10.1136/pgmj.50.588.629

National Institute for Health and Care Excellence, Diverticular disease: diagnosis and management. NICE guideline NG147, pub. November 2019.

Half of all patients require surgery within ten years of being diagnosed.

Frolkis AD, Dykeman J, Negrón ME, et al. Risk of surgery for inflammatory bowel diseases has decreased over time: a systematic review and meta-analysis of population-based studies. Gastroenterology. 2013;145(5):996-1006. doi:10.1053/j.gastro.2013.07.041

We know that high-fat, low-fibre and animal-heavy diets can worsen these problems.

Rizzello F, Spisni E, Giovanardi E, et al. Implications of the Westernized Diet in the Onset and Progression of IBD. Nutrients. 2019;11(5):1033. Published 2019 May 8. doi:10.3390/nu11051033

More research is being done in this area but we know that cutting out processed foods, emulsifiers, meat and dairy, and increased intake of dietary fibre is beneficial.

Hou JK, Abraham B, El-Serag H. Dietary intake and risk of developing inflammatory bowel disease: a systematic review of the literature. Am J Gastroenterol. 2011;106(4):563-573. doi:10.1038/ajg.2011.44

Shivappa N, Hébert JR, Rashvand S, Rashidkhani B, Hekmatdoost A. Inflammatory Potential of Diet and Risk of Ulcerative Colitis in a Case-Control Study from Iran. Nutr Cancer. 2016;68(3):404-409. doi:10.1080/01635581.2016.1152385

Haskey N, Gibson DL. An Examination of Diet for the Maintenance of Remission in Inflammatory Bowel Disease. Nutrients. 2017;9(3):259. Published 2017 Mar 10. doi:10.3390/nu9030259

A recent case study has also shown a man with Crohn’s disease achieved complete remission within six months of following a WFPB diet.

Sandefur K, Kahleova H, Desmond AN, Elfrink E, Barnard ND. Crohn’s Disease Remission with a Plant-Based Diet: A Case Report. Nutrients. 2019;11(6):1385. Published 2019 Jun 20. doi:10.3390/nu11061385

The Harvard Nurse’s Study, involving over 120,000 women, showed that women with a higher intake of fibre had a 40 per cent reduced risk of developing Crohn’s.

Ananthakrishnan AN, Khalili H, Konijeti GG, et al. A prospective study of long-term intake of dietary fiber and risk of Crohn’s disease and ulcerative colitis. Gastroenterology. 2013;145(5):970-977. doi:10.1053/j.gastro.2013.07.050

This fascinating link may explain why mouthwash use has in a handful of studies been linked to increased risk of diabetes and high blood pressure.

Preshaw PM. Mouthwash use and risk of diabetes. Br Dent J. 2018;225(10):923-926. doi:10.1038/sj.bdj.2018.1020

Bondonno C P, Liu A H, Croft K D et al. Antibacterial mouthwash blunts oral nitrate reduction and increases blood pressure in treated hypertensive men and women. Am J Hypertens 2015; 28: 572-575.

Late-night eating disrupts the circadian rhythm of your gut bugs as well as spiking your blood sugar.

Kaczmarek JL, Thompson SV, Holscher HD. Complex interactions of circadian rhythms, eating behaviors, and the gastrointestinal microbiota and their potential impact on health. Nutr Rev. 2017;75(9):673-682. doi:10.1093/nutrit/nux036

New research shows that social stress, such as loneliness, alters both the composition and behaviour of gut bacteria.

Karl JP, Hatch AM, Arcidiacono SM, et al. Effects of Psychological, Environmental and Physical Stressors on the Gut Microbiota. Front Microbiol. 2018;9:2013. Published 2018 Sep 11. doi:10.3389/fmicb.2018.02013

If you suffer from insomnia, your microbiome shifts towards bacterial populations that promote obesity.

Smith RP, Easson C, Lyle SM, et al. Gut microbiome diversity is associated with sleep physiology in humans. PLoS One. 2019;14(10):e0222394. Published 2019 Oct 7. doi:10.1371/journal.pone.0222394

Believe it or not, exercise can diversify your gut flora and increase your butyrate levels (one of the short chain fatty acids that your gut bugs love).

Sohail MU, Yassine HM, Sohail A, Al Thani AA. Impact of Physical Exercise on Gut Microbiome, Inflammation, and the Pathobiology of Metabolic Disorders. Rev Diabet Stud. 2019;15:35-48. doi:10.1900/RDS.2019.15.35

Monda V, Villano I, Messina A, et al. Exercise Modifies the Gut Microbiota with Positive Health Effects. Oxid Med Cell Longev. 2017;2017:3831972. doi:10.1155/2017/3831972

Tasnim N, Abulizi N, Pither J, Hart MM, Gibson DL. Linking the Gut Microbial Ecosystem with the Environment: Does Gut Health Depend on Where We Live?. Front Microbiol. 2017;8:1935. Published 2017 Oct 6. doi:10.3389/fmicb.2017.01935

Washing your hands with soap and drying them is just as effective – without the exposure to chemicals that disrupt your skin biome.

Lunjani N, Hlela C, O’Mahony L. Microbiome and skin biology. Curr Opin Allergy Clin Immunol. 2019;19(4):328-333. doi:10.1097/ACI.0000000000000542

antibiotics, NSAIDs (anti-inflammatories such as ibuprofen and naproxen), and oral contraceptives can be particularly problematic for our gut microbes and the integrity of our gut lining.

Rogers MAM, Aronoff DM. The influence of non-steroidal anti-inflammatory drugs on the gut microbiome. Clin Microbiol Infect. 2016;22(2):178.e1-178.e9. doi:10.1016/j.cmi.2015.10.003

Cornish JA, Tan E, Simillis C, Clark SK, Teare J, Tekkis PP. The risk of oral contraceptives in the etiology of inflammatory bowel disease: a meta-analysis. Am J Gastroenterol. 2008;103(9):2394-2400. doi:10.1111/j.1572-0241.2008.02064.x

Steer clear of emulsifiers

Chassaing B, Van de Wiele T, De Bodt J, Marzorati M, Gewirtz AT. Dietary emulsifiers directly alter human microbiota composition and gene expression ex vivo potentiating intestinal inflammation. Gut. 2017;66(8):1414-1427. doi:10.1136/gutjnl-2016-313099

Although more research is needed, artificial sweeteners like aspartame, sucralose, xylitol and trehalose can all adversely affect our gut microbiome and trehalose may increase populations of harmful bug C. difficile which is a cause of severe colitis.

Ruiz-Ojeda FJ, Plaza-Díaz J, Sáez-Lara MJ, Gil A. Effects of Sweeteners on the Gut Microbiota: A Review of Experimental Studies and Clinical Trials [published correction appears in Adv Nutr. 2020 Mar 1;11(2):468]. Adv Nutr. 2019;10(suppl_1):S31-S48. doi:10.1093/advances/nmy037

Collins J, Robinson C, Danhof H, et al. Dietary trehalose enhances virulence of epidemic Clostridium difficile. Nature. 2018;553(7688):291-294. doi:10.1038/nature25178

Chapter 12: Immunity

Reducing inflammation is critical to good health.

Sutliffe JT, Wilson LD, de Heer HD, Foster RL, Carnot MJ. C-reactive protein response to a vegan lifestyle intervention. Complement Ther Med. 2015;23(1):32-37. doi:10.1016/j.ctim.2014.11.001

Jaceldo-Siegl K, Haddad E, Knutsen S, et al. Lower C-reactive protein and IL-6 associated with vegetarian diets are mediated by BMI. Nutr Metab Cardiovasc Dis. 2018;28(8):787-794. doi:10.1016/j.numecd.2018.03.003

Haghighatdoost F, Bellissimo N, Totosy de Zepetnek JO, Rouhani MH. Association of vegetarian diet with inflammatory biomarkers: a systematic review and meta-analysis of observational studies. Public Health Nutr. 2017;20(15):2713-2721. doi:10.1017/S1368980017001768

One 2018 analysis found that RA patients who lost more than 5kg of body weight were three times more likely to experience improvements than those who lost less than 5kg.

Alwarith J, Kahleova H, Rembert E, et al. Nutrition Interventions in Rheumatoid Arthritis: The Potential Use of Plant-Based Diets. A Review. Front Nutr. 2019;6:141. Published 2019 Sep 10. doi:10.3389/fnut.2019.00141

WFPB diets promote healthy gut bacteria and diversity of the microbiome, which is often lacking in patients with arthritis.

David LA, Maurice CF, Carmody RN, et al. Diet rapidly and reproducibly alters the human gut microbiome. Nature. 2014;505(7484):559-563. doi:10.1038/nature12820

Horta-Baas G, Romero-Figueroa MDS, Montiel-Jarquín AJ, Pizano-Zárate ML, García-Mena J, Ramírez-Durán N. Intestinal Dysbiosis and Rheumatoid Arthritis: A Link between Gut Microbiota and the Pathogenesis of Rheumatoid Arthritis. J Immunol Res. 2017;2017:4835189. doi:10.1155/2017/4835189

In fact, SCFAs have been shown to inhibit three of the most powerful inflammatory signallers in the body.

Vinolo MA, Rodrigues HG, Nachbar RT, Curi R. Regulation of inflammation by short chain fatty acids. Nutrients. 2011;3(10):858-876. doi:10.3390/nu3100858

Ratajczak W, Rył A, Mizerski A, Walczakiewicz K, Sipak O, Laszczyńska M. Immunomodulatory potential of gut microbiome-derived short-chain fatty acids (SCFAs). Acta Biochim Pol. 2019;66(1):1-12. doi:10.18388/abp.2018_2648

There is evidence that a WFPB diet can alleviate the symptoms of rheumatoid arthritis.

Kjeldsen-Kragh J, Haugen M, Borchgrevink CF, et al. Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis. Lancet. 1991;338(8772):899-902. doi:10.1016/0140-6736(91)91770-u

participants experienced significant improvements in morning stiffness, pain, joint tenderness, and joint swelling.

McDougall J, Bruce B, Spiller G, Westerdahl J, McDougall M. Effects of a very low-fat, vegan diet in subjects with rheumatoid arthritis. J Alternat Complement Med. (2002) 8:71–5. doi: 10.1089/107555302753507195

Although this is a small study, it guides future research.

Elkan AC, Sjöberg B, Kolsrud B, Ringertz B, Hafström I, Frostegård J. Gluten-free vegan diet induces decreased LDL and oxidized LDL levels and raised atheroprotective natural antibodies against phosphorylcholine in patients with rheumatoid arthritis: a randomized study. Arthritis Res Ther. 2008;10(2):R34. doi:10.1186/ar2388

It has also been noted that a WFPB diet is packed with nutrients that can support and help to balance immunity, including potassium, fibre, vitamin A, vitamin C, vitamin K, magnesium, and beta-carotene.

Alwarith J, Kahleova H, Rembert E, et al. Nutrition Interventions in Rheumatoid Arthritis: The Potential Use of Plant-Based Diets. A Review. Front Nutr. 2019;6:141. Published 2019 Sep 10. doi:10.3389/fnut.2019.00141

As with arthritis, a WFPB diet can help to alleviate symptoms.

Constantin MM, Nita IE, Olteanu R, et al. Significance and impact of dietary factors on systemic lupus erythematosus pathogenesis. Exp Ther Med. 2019;17(2):1085‐1090. doi:10.3892/etm.2018.6986

One of his studies found that MS strongly correlated with the amount of saturated animal fat eaten.

SWANK RL, LERSTAD O, STRØM A, BACKER J. Multiple sclerosis in rural Norway its geographic and occupational incidence in relation to nutrition. N Engl J Med. 1952;246(19):722‐728.

So dietary change helped, but only for as long as they kept the same habits day to day.

Swank RL, Dugan BB. Effect of low saturated fat diet in early and late cases of multiple sclerosis. Lancet. 1990;336(8706):37‐39.

Participants were also able to lose weight and reduce cholesterol levels and they also had higher scores in quality of life and overall mood.

Yadav V, Marracci G, Kim E, et al. Low-fat, plant-based diet in multiple sclerosis: A randomized controlled trial. Mult Scler Relat Disord. 2016;9:80-90. doi:10.1016/j.msard.2016.07.001

even one day of poor shut eye can have a big impact.

Besedovsky L, Lange T, Born J. Sleep and immune function. Pflugers Arch. 2012;463(1):121-137. doi:10.1007/s00424-011-1044-0

It makes sense that nasal hairs and nitric oxide production in the paranasal sinuses are a small but relevant defence to airborne pollution and viruses.

Christoph T, Müller-Röver S, Audring H, et al. The human hair follicle immune system: cellular composition and immune privilege. Br J Dermatol. 2000;142(5):862-873. doi:10.1046/j.1365-2133.2000.03464.x

Vitamin C may shorten the duration of a cold, and it can be found in abundance in oranges, kiwis, peppers and cauliflower to name a few.

Ran L, Zhao W, Wang J, et al. Extra Dose of Vitamin C Based on a Daily Supplementation Shortens the Common Cold: A Meta-Analysis of 9 Randomized Controlled Trials. Biomed Res Int. 2018;2018:1837634. Published 2018 Jul 5. doi:10.1155/2018/1837634

One study showed that vitamin D deficiency can contribute to poor respiratory functioning and health in middle-aged adults.

Hughes DA, Norton R. Vitamin D and respiratory health. Clin Exp Immunol. 2009;158(1):20-25. doi:10.1111/j.1365-2249.2009.04001.x

Chapter 13: Mastering the Building Blocks of WFPB Eating

Looking at population studies, most evidence points to the benefits of having poly-unsaturated fats (PUFAs) and mono-unsaturated fats (MUFAs) from plants contributing 20–30 per cent of our diet.

DiNicolantonio JJ, O’Keefe JH. Good Fats versus Bad Fats: A Comparison of Fatty Acids in the Promotion of Insulin Resistance, Inflammation, and Obesity. Mo Med. 2017;114(4):303-307.

Jakobsen MU, O’Reilly EJ, Heitmann BL, et al. Major types of dietary fat and risk of coronary heart disease: a pooled analysis of 11 cohort studies. Am J Clin Nutr. 2009;89(5):1425-1432. doi:10.3945/ajcn.2008.27124

Farvid MS, Ding M, Pan A, et al. Dietary linoleic acid and risk of coronary heart disease: a systematic review and meta-analysis of prospective cohort studies. Circulation. 2014;130(18):1568-1578. doi:10.1161/CIRCULATIONAHA.114.010236

Mozaffarian D, Micha R, Wallace S. Effects on coronary heart disease of increasing polyunsaturated fat in place of saturated fat: a systematic review and meta-analysis of randomized controlled trials. PLoS Med. 2010;7(3):e1000252. Published 2010 Mar 23. doi:10.1371/journal.pmed.1000252

Zong G, Li Y, Sampson L, et al. Monounsaturated fats from plant and animal sources in relation to risk of coronary heart disease among US men and women. Am J Clin Nutr. 2018;107(3):445-453. doi:10.1093/ajcn/nqx004

Hayes J, Benson G. What the Latest Evidence Tells Us About Fat and Cardiovascular Health. Diabetes Spectr. 2016;29(3):171-175. doi:10.2337/diaspect.29.3.171

Extra-virgin olive oil (EVOO) has been shown to be heart healthy for its MUFAs and the polyphenols it contains.

Rigacci S, Stefani M. Nutraceutical Properties of Olive Oil Polyphenols. An Itinerary from Cultured Cells through Animal Models to Humans. Int J Mol Sci. 2016;17(6):843. Published 2016 May 31. doi:10.3390/ijms17060843

Marcelino G, Hiane PA, Freitas KC, et al. Effects of Olive Oil and Its Minor Components on Cardiovascular Diseases, Inflammation, and Gut Microbiota. Nutrients. 2019;11(8):1826. Published 2019 Aug 7. doi:10.3390/nu11081826

To see an example of the ideal ‘plate’, the UK government produced a well-researched ‘Eat Well Guide’ in 2016 which has been adapted for a plant-based diet by dieticians and researchers from the Plant-based Health Professionals UK in 2019.

https://plantbasedhealthprofessionals.com/wp-content/uploads/Plant-Basted-Eatwell-Guide-A4.pdf

Cruciferous vegetables are notoriously bitter, however, research has shown that repeated exposure to bitter foods can change the proteins in saliva, making these bitter foods more palatable

Laura E Martin, Kristen E Kay, Ann-Marie Torregrossa. Bitter-Induced Salivary Proteins Increase Detection Threshold of Quinine, But Not SucroseChemical Senses, 2019; 44 (6): 379 DOI: 10.1093/chemse/bjz021

While 5 a day is good for you, one large-scale study showed that eating 10 a day could prevent up to 7.8 million premature deaths worldwide every year.

Aune D, Giovannucci E, Boffetta P, et al. Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality-a systematic review and dose-response meta-analysis of prospective studies. Int J Epidemiol. 2017;46(3):1029-1056. doi:10.1093/ije/dyw319

After all, peer-reviewed science lacks strong evidence that organic produce is more nutritious than conventionally farmed foods.

Crystal Smith-Spangler, Margaret L. Brandeau, Grace E. Hunter, J. Clay Bavinger et al. Are Organic Foods Safer or Healthier Than Conventional Alternatives? Annals of Internal Medicine 2012 157:5, 348-366

It is hard to assess the effect of these insecticides across a human lifespan.

Hayes TB, Case P, Chui S, et al. Pesticide mixtures, endocrine disruption, and amphibian declines: are we underestimating the impact?. Environ Health Perspect. 2006;114 Suppl 1(Suppl 1):40-50. doi:10.1289/ehp.8051

Rahimi T, Rafati F, Sharifi H, Seyedi F. General and reproductive health outcomes among female greenhouse workers: a comparative study. BMC Womens Health. 2020;20(1):103. Published 2020 May 13. doi:10.1186/s12905-020-00966-y

Nicolopoulou-Stamati P, Maipas S, Kotampasi C, Stamatis P, Hens L. Chemical Pesticides and Human Health: The Urgent Need for a New Concept in Agriculture. Front Public Health. 2016;4:148. Published 2016 Jul 18. doi:10.3389/fpubh.2016.00148

Some research has linked pesticide exposure to allergies in children and Alzheimer’s in the elderly.

Hoppin JA, Umbach DM, Long S, et al. Pesticides are Associated with Allergic and Non-Allergic Wheeze among Male Farmers. Environ Health Perspect. 2017;125(4):535‐543. doi:10.1289/EHP315

Buralli RJ, Dultra AF, Ribeiro H. Respiratory and Allergic Effects in Children Exposed to Pesticides-A Systematic Review. Int J Environ Res Public Health. 2020;17(8):2740. Published 2020 Apr 16. doi:10.3390/ijerph17082740

Hyland, C.; Laribi, O. Review of take-home pesticide exposure pathway in children living in agricultural areas. Environ. Res. 2017, 156, 559–570. Int. J. Environ. Res. Public Health 2020, 17, 2740 14 of 15

Bradman, A.; Castorina, R.; Barr, D.B.; Chevrier, J.; Harnly, M.E.; Eisen, E.A.; McKone, T.E.; Harley, K.; Holland, N.; Eskenazi, B. Determinants of organophosphorus pesticide urinary metabolite levels in young children living in an agricultural community. Int. J. Environ. Res. Public Health 2011, 8, 1061–1083. [CrossRef

Lu, C.; Toepel, K.; Irish, R.; Fenske, R.A.; Barr, D.B.; Bravo, R. Organic diets significantly lower children’s dietary exposure to organophosphorus pesticides. Environ. Health Perspect. 2006, 114, 260–263.

Marks, A.R.; Harley, K.; Bradman, A.; Kogut, K.; Barr, D.B.; Johnson, C.; Calderon, N.; Eskenazi, B. Organophosphate pesticide exposure and attention in young Mexican-American children: The CHAMACOS study. Environ. Health Perspect. 2010, 118, 1768–1774.

Roberts, J.R.; Karr, C.J. Pesticide exposure in children. Pediatrics 2012, 130, 11.

Salameh, P.R.; Baldi, I.; Brochard, P.; Raherison, C.; Saleh, B.A.; Salamon, R. Respiratory symptoms in children and exposure to pesticides. Eur. Respir. J. 2003, 22, 507–512.

Salam, M.T.; Li, Y.F.; Langholz, B.; Gilliland, F.D. Early-life environmental risk factors for asthma: Findings from the children’s health study. Environ. Health Perspect. 2004, 112, 760–765.

Xu, X.; Nembhard, W.N.; Kan, H.; Becker, A.; Talbott, E.O. Residential pesticide use is associated with children’s respiratory symptoms. J. Occup. Environ. Med. 2012, 54, 1281–1287.

Bukalasa, J.S.; Brunekreef, B.; Brouwer, M.; Koppelman, G.H.; Wijga, A.H.; Huss, A.; Gehring, U. Associations of residential exposure to agricultural pesticides with asthma prevalence in adolescence: The PIAMA birth cohort. Environ. Int. 2018, 121, 435–442.

Raanan, R.; Harley, K.G.; Balmes, J.R.; Bradman, A.; Lipsett, M.; Eskenazi, B. Early-life exposure to organophosphate pesticides and pediatric respiratory symptoms in the CHAMACOS cohort. Environ. Health Perspect. 2015, 123, 179–185.

Raanan, R.; Balmes, J.R.; Harley, K.G.; Gunier, R.B.; Magzamen, S.; Bradman, A.; Eskenazi, B. Decreased lung function in 7-year-old children with early-life organophosphate exposure. Thorax 2016, 71, 148–153.

Richardson JR, Roy A, Shalat SL, et al. Elevated Serum Pesticide Levels and Risk for Alzheimer Disease. JAMA Neurol. 2014;71(3):284–290. doi:10.1001/jamaneurol.2013.6030

There is little doubt that glyphosate-based herbicides are linked to the development of Non-Hodgkin’s Lymphoma as well.

Luoping Zhang, Iemaan Rana, Rachel M. Shaffer, Emanuela Taioli, Lianne Sheppard. Exposure to glyphosate-based herbicides and risk for non-Hodgkin lymphoma: A meta-analysis and supporting evidence, Mutation Research/Reviews in Mutation Research, Volume 781, 2019, Pages 186-206, ISSN 1383-5742, https://doi.org/10.1016/j.mrrev.2019.02.001.

Zahm SH, Blair A. Pesticides and non-Hodgkin’s lymphoma. Cancer Res. 1992;52(19 Suppl):5485s‐5488s.

Pearce N, McLean D. Agricultural exposures and non-Hodgkin’s lymphoma. Scand J Work Environ Health. 2005;31 Suppl 1:18‐7.

In a large study from 2018 of more than 68,000 French volunteers, people who ate organic food were found to have a lower overall risk of cancer.

Baudry  J, Assmann  KE, Touvier  M,  et al.  Association of frequency of organic food consumption with cancer risk: findings from the NutriNet-Santé Prospective Cohort Study  [published online October 22, 2018].  JAMA Intern Med. doi:10.1001/jamainternmed.2018.4357

Bees play a significant role in the pollination of the foods that we eat.

Goulson D, Thompson J, Croombs A. Rapid rise in toxic load for bees revealed by analysis of pesticide use in Great Britain. PeerJ. 2018;6:e5255. Published 2018 Jul 19. doi:10.7717/peerj.5255

Pettis JS, Lichtenberg EM, Andree M, Stitzinger J, Rose R, Vanengelsdorp D. Crop pollination exposes honey bees to pesticides which alters their susceptibility to the gut pathogen Nosema ceranae. PLoS One. 2013;8(7):e70182. Published 2013 Jul 24. doi:10.1371/journal.pone.0070182

Aizen MA, Garibaldi LA, Cunningham SA, Klein AM. How much does agriculture depend on pollinators? Lessons from long-term trends in crop production. Ann Bot. 2009;103(9):1579-1588. doi:10.1093/aob/mcp076

But it is not just the bees – the effects on soil of chemical heavy farming and tillage of the soil is just as much of a problem.

Davis DR, Epp MD, Riordan HD. Changes in USDA food composition data for 43 garden crops, 1950 to 1999. J Am Coll Nutr. 2004;23(6):669–682.

Irakli Loladze. Hidden shift of the ionome of plants exposed to elevated CO2 depletes minerals at the base of human nutrition. Ecology, Epidemiology and Global Health, May 7, 2014.

Soil erosion means topsoil is washed away into the ocean with heavy rainfall, rather than absorbing the rain water into the soil.

Halweil, B. Still No Free Lunch: Nutrient Levels in U.S. food supply eroded by pursuit of high yields. The Organic Centre Critical Issue Report September 2007.

What is the solution? Conservation agricultural methods.

Springmann M, Clark M, Mason-D’Croz D, et al. Options for keeping the food system within environmental limits. Nature. 2018;562(7728):519-525. doi:10.1038/s41586-018-0594-0

51. Kassam, T. Friedrich, R. Derpsch. (2019) Global spread of Conservation Agriculture. International Journal of Environmental Studies 76:1, pages 29-51.

Buying more plant-based options will be absolutely vital.

N. Stamp, “Out of the quagmire of plant defence hypotheses,” The Quarterly Review of Biology, 2003, 78: 23-55; Kirsten Brandt and Jens Peter Molgaard, “Food quality,” in Paul Kristiansen, Acram Taji and John Reganold (eds.), Advances in Organic Agriculture (CSIRO Publishing, Australia: 2006), pp. 305- 327.

Turmeric and black pepper, for example, are a particularly powerful combination because they increase the amount of curcumin, known to reduce inflammation that can be absorbed into the body (known as bioavailability) by up to 2000 per cent.

Prasad S, Tyagi AK, Aggarwal BB. Recent developments in delivery, bioavailability, absorption and metabolism of curcumin: the golden pigment from golden spice. Cancer Res Treat. 2014;46(1):2-18. doi:10.4143/crt.2014.46.1.2

Used for the treatment and soothing of burns for many years, this plant has also been found to have antimicrobial properties and potential benefits in the management of diabetes and ulcerative colitis.

Visuthikosol V, Chowchuen B, Sukwanarat Y, Sriurairatana S, Boonpucknavig V. Effect of aloe vera gel to healing of burn wound a clinical and histologic study. J Med Assoc Thai. 1995;78(8):403‐409.

Maenthaisong R, Chaiyakunapruk N, Niruntraporn S, Kongkaew C. The efficacy of aloe vera used for burn wound healing: a systematic review. Burns. 2007;33(6):713‐718. doi:10.1016/j.burns.2006.10.384

Rahmani AH, Aldebasi YH, Srikar S, Khan AA, Aly SM. Aloe vera: Potential candidate in health management via modulation of biological activities. Pharmacogn Rev. 2015;9(18):120‐126. doi:10.4103/0973-7847.162118

Langmead L, Feakins RM, Goldthorpe S, et al. Randomized, double-blind, placebo-controlled trial of oral aloe vera gel for active ulcerative colitis. Aliment Pharmacol Ther. 2004;19(7):739‐747. doi:10.1111/j.1365-2036.2004.01902.x

a double blind randomised controlled trial showed a twice daily dosage of 500mg could also reduce cholesterol and triglycerides in patients with high blood lipids.

Upadya H, Prabhu S, Prasad A, Subramanian D, Gupta S, Goel A. A randomized, double blind, placebo controlled, multicenter clinical trial to assess the efficacy and safety of Emblica officinalis extract in patients with dyslipidemia. BMC Complement Altern Med. 2019;19(1):27. Published 2019 Jan 22. doi:10.1186/s12906-019-2430-y

It has been found to have a variety of benefits in pre-clinical trials including liver protective and anti-diabetic effects.

Thilakchand KR, Mathai RT, Simon P, Ravi RT, Baliga-Rao MP, Baliga MS. Hepatoprotective properties of the Indian gooseberry (Emblica officinalis Gaertn): a review. Food Funct. 2013;4(10):1431‐1441. doi:10.1039/c3fo60237k

Fatima N, Hafizur RM, Hameed A, Ahmed S, Nisar M, Kabir N. Ellagic acid in Emblica officinalis exerts anti-diabetic activity through the action on β-cells of pancreas. Eur J Nutr. 2017;56(2):591‐601. doi:10.1007/s00394-015-1103-y

several studies show benefits for reducing anxiety, and one interesting trial showed improved hormone levels in men (DHEA and testosterone) which may explain the reported benefits of ashwaghanda for treating fatigue as well.

Auddy B., Hazra J., Mitra A., Abedon B., Ghosal S. (2008). A standardized Withania somnifera extract significantly reduces stress-related parameters in chronically stressed humans: A double-blind, randomized, placebo-controlled study. Journal of the American Nutraceutical Association, 11, 50–56.

Choudhary D., Bhattacharyya S., Joshi K. (2017). Body weight management in adults under chronic stress through treatment with ashwagandha root extract: A double-blind, randomized, placebo-controlled trial. Evidence-Based Complementary and Alternative Medicine, 22(1), 96–106. doi:10.1177/2156587216641830

Andrade C., Aswath A., Chaturvedi S. K., Srinivasa M., Raguram R. (2000). A double-blind, placebo-controlled evaluation of the anxiolytic efficacy of an ethanolic extract of Withania somnifera. Indian Journal of Psychiatry, 42(3), 295–301.

Lopresti AL, Drummond PD, Smith SJ. A Randomized, Double-Blind, Placebo-Controlled, Crossover Study Examining the Hormonal and Vitality Effects of Ashwagandha (Withania somnifera) in Aging, Overweight Males. Am J Mens Health. 2019;13(2):1557988319835985. doi:10.1177/1557988319835985

It has a variety of ways of reducing inflammatory pathways in the body and animal trials have shown benefits for reducing severity of heart attacks and heart failure.

Cao C, Su M. Effects of berberine on glucose-lipid metabolism, inflammatory factors and insulin resistance in patients with metabolic syndrome. Exp Ther Med. 2019;17(4):3009‐3014. doi:10.3892/etm.2019.7295

Feng X, Sureda A, Jafari S, et al. Berberine in Cardiovascular and Metabolic Diseases: From Mechanisms to Therapeutics. Theranostics. 2019;9(7):1923‐1951. Published 2019 Mar 16. doi:10.7150/thno.30787

This is a herb with anti-bacterial, anti-parasitic and anti-fungal properties and has also been found to be useful for people with dry, itchy, red skin conditions.

Subapriya R, Nagini S. Medicinal properties of neem leaves: a review. Curr Med Chem Anticancer Agents. 2005;5(2):. doi:10.2174/1568011053174828

Tabassum N, Hamdani M. Plants used to treat skin diseases. Pharmacogn Rev. 2014;8(15):52‐60. doi:10.4103/0973-7847.125531

Much like oats, these soluble fibres help improve cholesterol, heart health and blood sugars.

Kupcova K, Stefanova I, Plavcova Z, Hosek J, Hrouzek P, Kubec R. Antimicrobial, Cytotoxic, Anti-Inflammatory, and Antioxidant Activity of Culinary Processed Shiitake Medicinal Mushroom (Lentinus edodes, Agaricomycetes) and Its Major Sulfur Sensory-Active Compound-Lenthionine. Int J Med Mushrooms. 2018;20(2):165‐175. doi:10.1615/IntJMedMushrooms.2018025455

Notable among them is Reishi, which has been nicknamed ‘the mushroom of immortality’ due to its immune system protecting polysaccharides and has been shown more generally to reduce inflammation and calm the mind.

Wang J, Cao B, Zhao H, Feng J. Emerging Roles of Ganoderma Lucidum in Anti-Aging. Aging Dis. 2017;8(6):691‐707. Published 2017 Dec 1. doi:10.14336/AD.2017.0410

Lion’s mane is said to be beneficial for brain health, cordyceps for exercise performance, and turkey tail and chaga for immune-system regulation, among other things.

Lai PL, Naidu M, Sabaratnam V, et al. Neurotrophic properties of the Lion’s mane medicinal mushroom, Hericium erinaceus (Higher Basidiomycetes) from Malaysia. Int J Med Mushrooms. 2013;15(6):539‐554. doi:10.1615/intjmedmushr.v15.i6.30

Tuli HS, Sandhu SS, Sharma AK. Pharmacological and therapeutic potential of Cordyceps with special reference to Cordycepin. 3 Biotech. 2014;4(1):1‐12. doi:10.1007/s13205-013-0121-9

Pre-clinical trials show reduced inflammation to the cartilage within joints with similar modes of action to anti-inflammatory painkillers (without reported gastrointestinal side effects).

Park et al, 2008. Anti-inflammatory activities of ent-16αH, 17-hydroxy-kauran-19-oic acid isolated from the roots of Siegesbeckia pubescens are due to the inhibition of iNOS and COX-2 expression in RAW 264.7 macrophages via NF-κB inactivation.  European Journal of Pharmacology, 558: 185-193.

Hong et al, 2014. Anti-inflammatory effects of Siegesbeckia orientalis ethanol extract in in vitro and in vivo models. Biomed Research International, 2014 (2): 329712

It has been shown to benefit metabolic syndrome, provide pain relief, and is also helpful in the management of inflammatory and degenerative conditions.

Gupta SC, Patchva S, Aggarwal BB. Therapeutic roles of curcumin: lessons learned from clinical trials. AAPS J. 2013 Jan; 15(1):195-218.

Aggarwal BB, Harikumar KB. Potential therapeutic effects of curcumin, the anti-inflammatory agent, against neurodegenerative, cardiovascular, pulmonary, metabolic, autoimmune and neoplastic diseases. Int J Biochem Cell Biol. 2009 Jan; 41(1):40-59.

Panahi Y, Hosseini MS, Khalili N, Naimi E, Simental-Mendía LE, Majeed M, Sahebkar A. Effects of curcumin on serum cytokine concentrations in subjects with metabolic syndrome: A post-hoc analysis of a randomized controlled trial. Biomed Pharmacother. 2016 Aug; 82():578-82.

A large study published in 2017 shows that the global prevalence of lactose intolerance due to lack of lactase activity is 68 per cent of people, and in those affected, having dairy products leads to diarrhoea, bloating, cramps, nausea or headaches.

Misselwitz B, Butter M, Verbeke K, et al, Update on lactose malabsorption and intolerance: pathogenesis, diagnosis and clinical management, Gut 2019;68:2080-2091.

However, dairy’s place in a balanced diet is increasingly being questioned, partly because of intensive farming practices and the environmental cost of the dairy industry but the health benefits are also now being re-evaluated.

Springmann M, Wiebe K, Mason-D’Croz D, Sulser TB, Rayner M, Scarborough P. Health and nutritional aspects of sustainable diet strategies and their association with environmental impacts: a global modelling analysis with country-level detail. Lancet Planet Health. 2018;2(10):e451-e461. doi:10.1016/S2542-5196(18)30206-7

Lampe JW. Dairy products and cancer. J Am Coll Nutr. 2011;30(5 Suppl 1):464S-70S. doi:10.1080/07315724.2011.10719991

A compilation of studies found no correlation between drinking more milk and lowering risk of bone fracture.

Michaëlsson K, Wolk A, Langenskiöld S, et al. Milk intake and risk of mortality and fractures in women and men: cohort studies. BMJ. 2014;349:g6015. Published 2014 Oct 28. doi:10.1136/bmj.g6015

In fact, some studies show that fracture rates and premature mortality are highest in populations with the greatest milk consumption.

Feskanich D, Bischoff-Ferrari HA, Frazier AL, Willett WC. Milk consumption during teenage years and risk of hip fractures in older adults. JAMA Pediatr. 2014;168(1):54-60. doi:10.1001/jamapediatrics.2013.3821

While milk can be drunk in moderation, it is noted that galactose, a sugar found in milk, has been shown to induce oxidative stress and chronic inflammation.

Bo-Htay C, Palee S, Apaijai N, Chattipakorn SC, Chattipakorn N. Effects of d-galactose-induced ageing on the heart and its potential interventions. J Cell Mol Med. 2018;22(3):1392-1410. doi:10.1111/jcmm.13472

These chronic inflammatory states are associated with heart disease, cancer, bone loss and muscle loss.

Cramer DW, Greenberg ER, Titus-Ernstoff L, et al. A case-control study of galactose consumption and metabolism in relation to ovarian cancer. Cancer Epidemiol Biomarkers Prev. 2000;9(1):95-101.

Cui X, Zuo P, Zhang Q, et al. Chronic systemic D-galactose exposure induces memory loss, neurodegeneration, and oxidative damage in mice: protective effects of R-alpha-lipoic acid. J Neurosci Res. 2006;83(8):1584-1590. doi:10.1002/jnr.20845

Segall JJ. Hypothesis: is lactose a dietary risk factor for ischaemic heart disease?. Int J Epidemiol. 2008;37(6):1204-1208. doi:10.1093/ije/dyn169

Dairy has been associated with increased rates of prostate, breast and ovarian cancer in population studies.

Fraser G, Miles F, Orlich M, Jaceldo-Siegl K, Mashchak A. Dairy Milk Is Associated with Increased Risk of Breast Cancer in the Adventist Health Study-2 (AHS-2) Cohort (P05-026-19). Curr Dev Nutr. 2019;3(Suppl 1):nzz030.P05-026-19. Published 2019 Jun 13. doi:10.1093/cdn/nzz030.P05-026-19

Song Y, Chavarro JE, Cao Y, et al. Whole milk intake is associated with prostate cancer-specific mortality among U.S. male physicians. J Nutr. 2013;143(2):189-196. doi:10.3945/jn.112.168484

Larsson SC, Orsini N, Wolk A. Milk, milk products and lactose intake and ovarian cancer risk: a meta-analysis of epidemiological studies. Int J Cancer. 2006;118(2):431-441. doi:10.1002/ijc.21305

Fairfield KM, Hunter DJ, Colditz GA, et al. A prospective study of dietary lactose and ovarian cancer. Int J Cancer. 2004;110(2):271-277. doi:10.1002/ijc.20086

Ji J, Sundquist J, Sundquist K. Lactose intolerance and risk of lung, breast and ovarian cancers: aetiological clues from a population-based study in Sweden. Br J Cancer. 2015;112(1):149-152. doi:10.1038/bjc.2014.544

For example, scientists have found a bacterium contained in milk, Mycobacterium avium paratuberculosis (MAP), which releases a molecule that prevents our blood cells from killing E Coli, a bacterium known to be in high numbers in Crohn’s disease bowel tissue

Naser SA, Ghobrial G, Romero C, Valentine JF. Culture of Mycobacterium avium subspecies paratuberculosis from the blood of patients with Crohn’s disease. Lancet. 2004;364(9439):1039-1044. doi:10.1016/S0140-6736(04)17058-X

This same bacterium has also been implicated in the development of Type 1 diabetes.

Rani PS, Sechi LA, Ahmed N. Mycobacterium avium subsp. paratuberculosis as a trigger of type-1 diabetes: destination Sardinia, or beyond?. Gut Pathog. 2010;2(1):1. Published 2010 Mar 29. doi:10.1186/1757-4749-2-1

Dow CT. Paratuberculosis and Type I diabetes: is this the trigger?. Med Hypotheses. 2006;67(4):782-785. doi:10.1016/j.mehy.2006.04.029

There is also evidence emerging that links rheumatoid arthritis to MAP exposure in those who are genetically susceptible.

Bo M, Erre GL, Bach H, et al. PtpA and PknG Proteins Secreted by Mycobacterium avium subsp. paratuberculosis are Recognized by Sera from Patients with Rheumatoid Arthritis: A Case-Control Study. J Inflamm Res. 2019;12:301-308. Published 2019 Dec 3. doi:10.2147/JIR.S220960

The recent Canadian Dietary Guidelines have removed dairy products completely from their recommendations, and many people are turning away from dairy for environmental reasons too.

https://food-guide.canada.ca/en/guidelines/

Groot MJ, Van’t Hooft KE. The Hidden Effects of Dairy Farming on Public and Environmental Health in the Netherlands, India, Ethiopia, and Uganda, Considering the Use of Antibiotics and Other Agro-chemicals. Front Public Health. 2016;4:12. Published 2016 Feb 24. doi:10.3389/fpubh.2016.00012

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/618167/government_dietary_recommendations.pdf

Boiling these veg reduces oxalate levels by 30 to 80 per cent (and is more effective than steaming or baking) although it also diminishes nutrients like vitamin C.

Chai W, Liebman M. Effect of different cooking methods on vegetable oxalate content. J Agric Food Chem. 2005;53(8):3027-3030. doi:10.1021/jf048128d

genannt Bonsmann SS, Walczyk T, Renggli S, Hurrell RF. Oxalic acid does not influence nonhaem iron absorption in humans: a comparison of kale and spinach meals. Eur J Clin Nutr. 2008;62(3):336-341. doi:10.1038/sj.ejcn.1602721

It is most nutritionally similar to cow’s milk and is a good source of protein and calcium and often fortified with additional vitamins and minerals.

Vanga SK, Raghavan V. How well do plant based alternatives fare nutritionally compared to cow’s milk?. J Food Sci Technol. 2018;55(1):10-20. doi:10.1007/s13197-017-2915-y

All these plant milks produce a third of the greenhouse gases made in the production of cow’s milk and ten times less land is required to produce the equivalent quantity of plant milk to cow’s milk.

Poore J, Nemecek T. Reducing food’s environmental impacts through producers and consumers [published correction appears in Science. 2019 Feb 22;363(6429):]. Science. 2018;360(6392):987-992. doi:10.1126/science.aaq0216

On a chemical level, by the time you have eaten and absorbed the amino acids, it makes no difference whether they have come from animal or plant sources.

Katz DL, Doughty KN, Geagan K, Jenkins DA, Gardner CD. Perspective: The Public Health Case for Modernizing the Definition of Protein Quality. Adv Nutr. 2019 Sep 1;10(5):755-764.

Bariatric surgeon Dr Garth Davis eloquently wrote in his book Proteinaholic that if we in the Western world spent half as much time worrying about whether we had had enough fibre as we do about whether we have enough protein, we’d be far healthier as a society.

Davis, G. Proteinaholic Harper One. 2015

For the average woman, this is 45g and for the average man is 55g.

https://www.bhf.org.uk/informationsupport/heart-matters-magazine/nutrition/protein

There is much published data on protein being associated with cellular ageing

Mirzaei, Hamed et al. “Protein and amino acid restriction, aging and disease: from yeast to humans.” Trends in endocrinology and metabolism: TEM vol. 25,11 (2014): 558-66.

and animal proteins specifically being associated with higher mortality rates.

Song, Mingyang et al. “Association of Animal and Plant Protein Intake With All-Cause and Cause-Specific Mortality.” JAMA internal medicine vol. 176,10 (2016): 1453-1463.

A 2018 review of 17 studies reported that a very low protein intake seems to slow the progression of kidney failure.

Hahn D, Hodson EM, Fouque D. Low protein diets for non-diabetic adults with chronic kidney disease. Cochrane Database of Systematic Reviews 2018, Issue 10. Art. No.: CD001892.

eat some tuna and within three hours your kidney filtration rate can shoot up by 36 per cent.

Nakamura H, Takasawa M, Kashara S, Tsuda A, Momotsu T, Ito S, Shibata A. Effects of acute protein loads of different sources on renal function of patients with diabetic nephropathy. Tohoku J Exp Med. 1989 Oct;159(2):153-62.

Meat-based diets are largely acid-producing and can produce metabolic problems for those with impaired kidney function.

Adeva M.M., Souto G. Diet-induced metabolic acidosis. Clin. Nutr. 2011;30:416–421.

Frassetto L.A., Todd K.M., Morris R.C., Sebastian A. Estimation of net endogenous noncarbonic acid production in humans from diet potassium and protein contents. Am. J. Clin. Nutr. 1998;68:576–583.

All these factors are linked to a lower risk of chronic diseases and early death.

Chen, Z., Glisic, M., Song, M. et al. Dietary protein intake and all-cause and cause-specific mortality: results from the Rotterdam Study and a meta-analysis of prospective cohort studies. Eur J Epidemiol (2020).

My hope is that patients with kidney disease will soon be offered the chance to understand the benefits of a WFPB diet when the guidelines catch up with the research on this important issue.

Cases, Aleix et al. “Vegetable-Based Diets for Chronic Kidney Disease? It Is Time to Reconsider.” Nutrients vol. 11,6 1263. 4 Jun. 2019, doi:10.3390/nu11061263

Chapter 14: WFPB For Families

A WFPB diet has been deemed suitable for all stages of life by the American Dietetic Association and the British Dietetic Association.

Craig WJ, Mangels AR; American Dietetic Association. Position of the American Dietetic Association: vegetarian diets. J Am Diet Assoc. 2009;109(7):1266-1282. doi:10.1016/j.jada.2009.05.027

https://www.bda.uk.com/resource/british-dietetic-association-confirms-well-planned-vegan-diets-can-support-healthy-living-in-people-of-all-ages.html it is recommended by the NHS that pregnant women should only eat an extra 200 calories in the last three months of their pregnancy.

https://www.nhs.uk/news/pregnancy-and-child/new-weight-advice-for-pregnancy/#:~:text=Further%20advice%20reported%20in%20the,three%20months%20of%20their%20pregnancy.

Existing research indicates that a plant-based diet rich in fibre, low in fat and micronutrient rich is likely to be protective against medical conditions in pregnancy such as pre-eclampsia, gestational diabetes, and preterm delivery.

Carter JP, Furman T, Hutcheson HR. Preeclampsia and reproductive performance in a community of vegans. South Med J. 1987;80(6):692-697. doi:10.1097/00007611-198706000-00007

Zhang C, Liu S, Solomon CG, Hu FB. Dietary fiber intake, dietary glycemic load, and the risk for gestational diabetes mellitus. Diabetes Care. 2006;29(10):2223-2230. doi:10.2337/dc06-0266

Pistollato F, Sumalla Cano S, Elio I, Masias Vergara M, Giampieri F, Battino M. Plant-Based and Plant-Rich Diet Patterns during Gestation: Beneficial Effects and Possible Shortcomings. Adv Nutr. 2015;6(5):581-591. Published 2015 Sep 15. doi:10.3945/an.115.009126

It is vital to take a prenatal vitamin supplement to ensure a baseline level of vitamins for your growing baby, ideally from the time you begin trying for a baby

Sebastiani, G.; Herranz Barbero, A.; Borrás-Novell, C. et al The Effects of Vegetarian and Vegan Diet during Pregnancy on the Health of Mothers and Offspring. Nutrients 2019, 11, 557.

Folic acid (600 mcg/day) from foods and supplements is needed to avoid neural tube defects like spina bifida. In addition, adequate levels of vitamin D (600 UI/day), choline (450 mg/day), iodine (220 mcg/day) and calcium (1200mg/day) are needed for normal growth and brain development of your baby.

https://www.nhs.uk/conditions/pregnancy-and-baby/vitamins-minerals-supplements-pregnant/#Vitamin

Korsmo HW, Jiang X, Caudill MA. Choline: Exploring the Growing Science on Its Benefits for Moms and Babies. Nutrients. 2019;11(8):1823. Published 2019 Aug 7. doi:10.3390/nu11081823

Yarrington C, Pearce EN. Iodine and pregnancy. J Thyroid Res. 2011;2011:934104. doi:10.4061/2011/934104

Cormick G, Belizán JM. Calcium Intake and Health. Nutrients. 2019;11(7):1606. Published 2019 Jul 15. doi:10.3390/nu11071606

But iron needs are still double what they would normally be (27mg from 15mg).

Brannon PM, Taylor CL. Iron Supplementation during Pregnancy and Infancy: Uncertainties and Implications for Research and Policy. Nutrients. 2017;9(12):1327. Published 2017 Dec 6. doi:10.3390/nu9121327

Food and Nutrition Board Institute of Medicine, Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Managense, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. National Academy Press. Published 2001. http://books.nap.edu/openbook.php?record_id=10026&page=R1

Current recommendations for daily iodine doses are 250mcg for pregnant and breastfeeding women.

World Health Organization, Fortification of Food-Grade Salt with Iodine for the Prevention and Control of Iodine Deficiency Disorders, Geneva: 2014.

Luckily, we can convert plant-sourced ALA into EPA and DHA.

Skeaff & Mann (2012) Essentials of Human Nutrition, 4th Edition. Chapter 4: Lipids p50-69

Breastfeeding your baby until they are around six months old will mean they are less likely to get diarrhoea, vomiting and respiratory infections.

Li R, Dee D, Li CM, Hoffman HJ, Grummer-Strawn LM. Breastfeeding and risk of infections at 6 years. Pediatrics. 2014;134 Suppl 1(Suppl 1):S13-S20. doi:10.1542/peds.2014-0646D

Chantry CJ, Howard CR, Auinger P. Full breastfeeding duration and associated decrease in respiratory tract infection in US children. Pediatrics. 2006;117(2):425-432. doi:10.1542/peds.2004-2283

But the benefits of breastfeeding last for far longer than six months, and the WHO suggests to breastfeed for as long as you can, to the age of two and beyond.

Hoddinott P, Tappin D, Wright C. Breast feeding. BMJ. 2008;336(7649):881-887. doi:10.1136/bmj.39521.566296.BE

Milk contains HMOs (human milk oligosaccharides) that provide nutrition not to the baby, but instead feed their microbes

Musilova S, Rada V, Vlkova E, Bunesova V. Beneficial effects of human milk oligosaccharides on gut microbiota. Benef Microbes. 2014;5(3):273-283. doi:10.3920/BM2013.0080

For mothers, breastfeeding decreases the risk of breast cancer and it may also offer some protection against ovarian cancer.

Unar-Munguía M, Torres-Mejía G, Colchero MA, González de Cosío T. Breastfeeding Mode and Risk of Breast Cancer: A Dose-Response Meta-Analysis. J Hum Lact. 2017;33(2):422-434. doi:10.1177/0890334416683676

Li DP, Du C, Zhang ZM, et al. Breastfeeding and ovarian cancer risk: a systematic review and meta-analysis of 40 epidemiological studies. Asian Pac J Cancer Prev. 2014;15(12):4829-4837. doi:10.7314/apjcp.2014.15.12.4829

Babies from birth to one year of age who are being breastfed are advised to be given daily vitamin drops containing 8.5 to 10 micrograms (mcg) of vitamin D.

https://www.nhs.uk/conditions/pregnancy-and-baby/vitamins-for-children/

A systematic review and meta-analysis from 2014 of the safety of soy-milk formulas found that ‘the patterns of growth, bone health, and metabolic, reproductive endocrine, immune and neurological functions are similar to those fed human milk or cow’s milk formula’.

Yvan Vandenplas, Pedro Gutierrez Castrellon, Rodolfo Rivas et al Systematic Review with Meta-Analysis Safety of soya-based infant formulas in children British Journal of Nutrition (2014), 111, 1340–1360

Almost one in five children are overweight or obese when they begin school, and one in three by the time they leave primary school.

Childhood obesity stats: https://www.rcpch.ac.uk/key-topics/nutrition-obesity/about-childhood-obesity

A well-planned WFPB approach can reduce the risk of developing heart disease, diabetes and cancer.

Kim H, Caulfield LE, Rebholz CM. Healthy Plant-Based Diets Are Associated with Lower Risk of All-Cause Mortality in US Adults. J Nutr. 2018;148(4):624-631. doi:10.1093/jn/nxy019

But the most immediate advantage for kids is that WFPB diets are also associated with reduced risk of asthma, allergies and recurrent infections in childhood

Jihad Alwarith, Hana Kahleova, Lee Crosby, Alexa Brooks, Lizoralia Brandon, Susan M Levin, Neal D Barnard, The role of nutrition in asthma prevention and treatment, Nutrition Reviews, , nuaa005, https://doi.org/10.1093/nutrit/nuaa005

Moorman JE, Akinbami LJ, Bailey CM et al. National surveillance of asthma: United States, 2001-2010 Vital Health Stat 3 2012;35:1–58

Haas F, Bishop MC, Salazar-Schicchi J, et al. . Effect of milk ingestion on pulmonary function in healthy and asthmatic subjects. J Asthma. 1991;28:349–355.

Yusoff NA, Hampton SM, Dickerson JW, et al. . The effects of exclusion of dietary egg and milk in the management of asthmatic children: a pilot study. J R Soc Promot Health. 2004;124:74–80.

Nylund L, Nermes M, Isolauri E, Salminen S, de Vos WM, Satokari R. Severity of atopic disease inversely correlates with intestinal microbiota diversity and butyrate-producing bacteria. Allergy. 2015;70(2):241-244. doi:10.1111/all.12549

Turner-McGrievy G, Mandes T, Crimarco A. A plant-based diet for overweight and obesity prevention and treatment. J Geriatr Cardiol. 2017;14(5):369-374. doi:10.11909/j.issn.1671-5411.2017.05.002

Cvejoska-Cholakovska V, Kocova M, Velikj-Stefanovska V, Vlashki E. The Association between Asthma and Obesity in Children – Inflammatory and Mechanical Factors. Open Access Maced J Med Sci. 2019;7(8):1314-1319. Published 2019 Apr 29. doi:10.3889/oamjms.2019.310

In 2010, this had jumped to 25.7 million people.

Tarlo SM, Balmes J, Balkissoon R, Beach J, Beckett W, Bernstein D, et al. Diagnosis and management of work-related asthma: American College Of Chest Physicians Consensus Statement. Chest. 2008 Sep. 134(3 Suppl):1S-41S.

This may in part be fuelled by increasing obesity, as well as increases in air pollution.

Romieu I, Barraza-Villarreal A, Escamilla-Núñez C, et al. . Dietary intake, lung function and airway inflammation in Mexico City school children exposed to air pollutants. Respir Res. 2009;10:122.

And plants may help to provide a solution.

Lindahl O, Lindwall L, Spångberg A, et al. . Vegan regimen with reduced medication in the treatment of bronchial asthma. J Asthma. 1985;22:45–55.

In another study of 158 children with asthma, the more the kids stuck to a Mediterranean diet pattern, the better their lung function turned out to be.

Rice JLGASP Study InvestigatorsRomero KM, Galvez Davila RM, et al. Association between adherence to the Mediterranean diet and asthma in Peruvian children. Lung. 2015;193:893–899.

All the benefits of a WFPB diet are particularly useful as we age, because this is the time at which health issues that we could ignore in our youth become more insistent and start to encroach upon our quality of life.

Clinton  CM,  O’Brien  S,  Law  J,  Renier  CM,  Wendt  MR.  Whole-foods,  plant-based    diet    alleviates    the    symptoms    of    osteoarthritis.    Arthritis. 2015;2015:708152-708161.11.

Eating a WFPB diet can also slow down ageing on a cellular level by increasing telomerase, which is an enzyme that repairs the telomeres at the end of human DNA strands.

Min, K., Min, J. Association between leukocyte telomere length and serum carotenoid in US adults. Eur J Nutr 56, 1045–1052 (2017).

As we age, our nutritional requirements change.

Leslie W, Hankey C. Aging, Nutritional Status and Health. Healthcare (Basel). 2015;3(3):648-658. Published 2015 Jul 30. doi:10.3390/healthcare3030648

Our need for macronutrients increases but we need fewer calories and our metabolism naturally slows.

Benelam B. Satiety and the anorexia of ageing. Br J Community Nurs. 2009;14(8):332-335. doi:10.12968/bjcn.2009.14.8.43512

As we will eat less, it is important to ensure all food is nutrient dense, so every bite counts.

Drewnowski A, Shultz JM. Impact of aging on eating behaviors, food choices, nutrition, and health status. J Nutr Health Aging. 2001;5(2):75-79.

Protein-rich foods will be more important over the age of 65, to help reduce the muscle wasting that tends to occur in these years.

Lonnie M, Hooker E, Brunstrom JM, et al. Protein for Life: Review of Optimal Protein Intake, Sustainable Dietary Sources and the Effect on Appetite in Ageing Adults. Nutrients. 2018;10(3):360. Published 2018 Mar 16. doi:10.3390/nu10030360

But it’s not just about bone health – muscle cells have special receptors for vitamin D in their nucleus, which promote muscle growth and can also improve balance.

Rejnmark L. Effects of vitamin d on muscle function and performance: a review of evidence from randomized controlled trials. Ther Adv Chronic Dis. 2011;2(1):25-37. doi:10.1177/2040622310381934

Dhesi JK, Bearne LM, Moniz C, et al. Neuromuscular and psychomotor function in elderly subjects who fall and the relationship with vitamin D status. J Bone Miner Res. 2002;17(5):891-897. doi:10.1359/jbmr.2002.17.5.891

on average, we lose 1 per cent of our muscle mass every year after the age of 40, and 30 per cent every decade after the age of 50.

Faulkner JA, Larkin LM, Claflin DR, Brooks SV. Age-related changes in the structure and function of skeletal muscles. Clin Exp Pharmacol Physiol. 2007;34(11):1091-1096. doi:10.1111/j.1440-1681.2007.04752.x

What will good bone and muscle strength mean? A reduced risk of falls.

Halfon M, Phan O, Teta D. Vitamin D: a review on its effects on muscle strength, the risk of fall, and frailty. Biomed Res Int. 2015;2015:953241. doi:10.1155/2015/953241

Falls are a leading cause of death in older people, as fractures lead to frailty, immobility and increased risk of blood clots and infections.

Padrón-Monedero A, Damián J, Pilar Martin M, Fernández-Cuenca R. Mortality trends for accidental falls in older people in Spain, 2000-2015. BMC Geriatr. 2017;17(1):276. Published 2017 Nov 28. doi:10.1186/s12877-017-0670-6

Vitamin B12 deficiency is common over the age of 50, whatever your diet habits.

Wong CW. Vitamin B12 deficiency in the elderly: is it worth screening?. Hong Kong Med J. 2015;21(2):155-164. doi:10.12809/hkmj144383

A common condition called atrophic gastritis can occur, which can reduce the amount of vitamin B12 you absorb.

Cavalcoli F, Zilli A, Conte D, Massironi S. Micronutrient deficiencies in patients with chronic atrophic autoimmune gastritis: A review. World J Gastroenterol. 2017;23(4):563-572. doi:10.3748/wjg.v23.i4.563

Medications that are commonly taken as we get older, including certain diabetes medications such as metformin, and stomach-acid-suppressing drugs, can also reduce how much B12 we absorb.

Liu KW, Dai LK, Jean W. Metformin-related vitamin B12 deficiency. Age Ageing. 2006;35(2):200-201. doi:10.1093/ageing/afj042

Lam JR, Schneider JL, Zhao W, Corley DA. Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency. JAMA. 2013;310(22):2435-2442. doi:10.1001/jama.2013.280490

Chapter 15: Supplements

Vitamin B12 doesn’t originate in meat, but it is found cow, pig and chicken meat because they have eaten soil or drank water containing these micro-organisms, or eaten corn feed with B12 supplements added to it.

Girard CL, Matte JJ. Effects of intramuscular injections of vitamin B12 on lactation performance of dairy cows fed dietary supplements of folic acid and rumen-protected methionine. J Dairy Sci. 2005;88(2):671-676. doi:10.3168/jds.S0022-0302(05)72731-4

Sapkota AR, Lefferts LY, McKenzie S, Walker P. What do we feed to food-production animals? A review of animal feed ingredients and their potential impacts on human health. Environ Health Perspect. 2007;115(5):663-670. doi:10.1289/ehp.9760

These recommendations are safe and will ensure you have enough not only to prevent deficiency, but to also reliably break down an amino acid called homocysteine, which in excess causes oxidative stress and is implicated in having higher risk of heart attacks and strokes.

Lehotský J, Tothová B, Kovalská M, et al. Role of Homocysteine in the Ischemic Stroke and Development of Ischemic Tolerance. Front Neurosci. 2016;10:538. Published 2016 Nov 23. doi:10.3389/fnins.2016.00538

Your body absorbs vitamin B12 more efficiently in frequent small amounts, so the less often you have it, the more you need.

Paul C, Brady DM. Comparative Bioavailability and Utilization of Particular Forms of B12 Supplements With Potential to Mitigate B12-related Genetic Polymorphisms. Integr Med (Encinitas). 2017;16(1):42-49.

For childred from age four onwards and for adults, it is recommended that everyone should consider a daily supplements containting 10 micrograms during autumn and winter.

https://www.gov.uk/government/publications/sacn-vitamin-d-and-health-report

UK advice is for 10mcg for everyone in the winter and all year round for at risk groups, without need to check levels.

https://www.nhs.uk/news/food-and-diet/the-new-guidelines-on-vitamin-d-what-you-need-to-know/

One to two tablespoons of milled flax every day will help keep your blood vessels supple and could also drop your blood pressure and boost heart health.

Rodriguez-Leyva D, Weighell W, Edel AL, et al. Potent antihypertensive action of dietary flaxseed in hypertensive patients. Hypertension. 2013;62(6):1081-1089. doi:10.1161/HYPERTENSIONAHA.113.02094

Caligiuri SP, Aukema HM, Ravandi A, Guzman R, Dibrov E, Pierce GN. Flaxseed consumption reduces blood pressure in patients with hypertension by altering circulating oxylipins via an α-linolenic acid-induced inhibition of soluble epoxide hydrolase. Hypertension. 2014;64(1):53-59. 

Caligiuri SP, Rodriguez-Leyva D, Aukema HM, et al. Dietary Flaxseed Reduces Central Aortic Blood Pressure Without Cardiac Involvement but Through Changes in Plasma Oxylipins. Hypertension. 2016;68(4):1031-1038. doi:10.1161/HYPERTENSIONAHA.116.07834

Chapter 16: Let’s Get Started

You are not weak-willed

Wansink, Brian & Sobal, Jeffery. (2007). Mindless Eating: The 200 Daily Food Decisions We Overlook. ENVIRONMENT AND BEHAVIOR. 39. 106-123.

The bit about food and willpower: “Secrets from the Eating Lab: The Science of Weight Loss, the Myth of Willpower and Why You Should Never Diet Again” by Traci Mann (2015).

Professor BJ Fogg at Stanford discusses behaviour change science in terms of a garden analogy, which of course I love!

Fogg, B.J. Tiny Habits: The Small Changes That Change Everything (Virgin 2019)

Conclusion

Spanish flu came from poultry, swine flu came from pigs, and avian flu came from birds.

Carroll D, Watson B, Togami E, et al. Building a global atlas of zoonotic viruses. Bull World Health Organ. 2018;96(4):292-294. doi:10.2471/BLT.17.205005

Taubenberger JK. The origin and virulence of the 1918 “Spanish” influenza virus. Proc Am Philos Soc. 2006;150(1):86-112.

Sims LD, Peiris M. One health: the Hong Kong experience with avian influenza. Curr Top Microbiol Immunol. 2013;365:281-298. doi:10.1007/82_2012_254

Jilani TN, Jamil RT, Siddiqui AH. H1N1 Influenza (Swine Flu). In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2020.

We’ve also seen SARS-CoV (from civets), MERS-CoV (from camels), HKU1 (from mice) and of course now SARS-CoV-2, which was likely to have come about from destruction of bat habitats and human use of animals in wet markets.

Kandeil A, Gomaa M, Nageh A, et al. Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in Dromedary Camels in Africa and Middle East. Viruses. 2019;11(8):717. Published 2019 Aug 5. doi:10.3390/v11080717

Wang LF, Eaton BT. Bats, civets and the emergence of SARS. Curr Top Microbiol Immunol. 2007;315:325-344. doi:10.1007/978-3-540-70962-6_13

Zhang T, Wu Q, Zhang Z. Probable Pangolin Origin of SARS-CoV-2 Associated with the COVID-19 Outbreak [published correction appears in Curr Biol. 2020 Apr 20;30(8):1578]. Curr Biol. 2020;30(7):1346-1351.e2. doi:10.1016/j.cub.2020.03.022

Whatever the origins of this virus, we know that diseases that spread from the use of animals (‘Zoonotic’ disease) infect 2.5 billion people each year.

Gebreyes WA, Dupouy-Camet J, Newport MJ, et al. The global one health paradigm: challenges and opportunities for tackling infectious diseases at the human, animal, and environment interface in low-resource settings. PLoS Negl Trop Dis. 2014;8(11):e3257. Published 2014 Nov 13. doi:10.1371/journal.pntd.0003257

We have already touched on the impact that antibiotics in the food chain have on our health.

Founou LL, Founou RC, Essack SY. Antibiotic Resistance in the Food Chain: A Developing Country-Perspective. Front Microbiol. 2016;7:1881. Published 2016 Nov 23. doi:10.3389/fmicb.2016.01881

Intensive animal farming is also the cause of salmonella (a serious outbreak in the UK happened in 1988 and infections are again rising) and E-coli infections.

Heredia N, García S. Animals as sources of food-borne pathogens: A review. Anim Nutr. 2018;4(3):250-255. doi:10.1016/j.aninu.2018.04.006

Do you need to eat meat, fish and dairy every day, if at all?

Dinu, Monica & Abbate, Rosanna & Gensini, Gianfranco & Casini, Alessandro & Sofi, Francesco. (2017). Vegetarian, vegan diets and multiple health outcomes: A systematic review with meta-analysis of observational studies. Critical Reviews in Food Science and Nutrition. 57. 3640-3649. 10.1080/10408398.2016.1138447.

Ornish D, Weidner G, Fair WR, et al. Intensive lifestyle changes may affect the progression of prostate cancer. J Urol. 2005;174(3):1065-1070. doi:10.1097/01.ju.0000169487.49018.73

McDougall J, Litzau K, Haver E, Saunders V, Spiller GA. Rapid reduction of serum cholesterol and blood pressure by a twelve-day, very low fat, strictly vegetarian diet. J Am Coll Nutr. 1995;14(5):491-496. doi:10.1080/07315724.1995.10718541

2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2019;March 17 Plant based diets as part of primary prevention of heart disease

Kelly, J., Karlsen, M., & Steinke, G. (2020). Type 2 Diabetes Remission and Lifestyle Medicine: A Position Statement From the American College of Lifestyle Medicine. American Journal of Lifestyle Medicine.

What can you do to change your lifestyle to make you and your family better equipped to deal with whatever disease life might throw at you?

Ute Nöthlings, Lynne R. Wilkens, Suzanne P. Murphy, Jean H. Hankin, Brian E. Henderson, Laurence N. Kolonel, Meat and Fat Intake as Risk Factors for Pancreatic Cancer: The Multiethnic Cohort Study, JNCI: Journal of the National Cancer Institute, Volume 97, Issue 19, 5 October 2005, Pages 1458–1465

Cross AJ, Leitzmann MF, Gail MH, Hollenbeck AR, Schatzkin A, Sinha R (2007) A Prospective Study of Red and Processed Meat Intake in Relation to Cancer Risk. PLoS Med 4(12): e325.

Cross AJ, Leitzmann MF, Gail MH, Hollenbeck AR, Schatzkin A, Sinha R (2007) A Prospective Study of Red and Processed Meat Intake in Relation to Cancer Risk. PLoS Med 4(12): e325.

DellaValle, C., Daniel, C., Aschebrook-Kilfoy, B. et al. Dietary intake of nitrate and nitrite and risk of renal cell carcinoma in the NIH-AARP Diet and Health Study. Br J Cancer 108, 205–212 (2013). https://doi.org/10.1038/bjc.2012.522

Faramawi, M.F., Johnson, E., Fry, M.W. et al. Consumption of different types of meat and the risk of renal cancer: meta-analysis of case–control studies. Cancer Causes Control 18, 581 (2007). https://doi.org/10.1007/s10552-007-0120-4

Richman EL, Kenfield SA, Stampfer MJ, Giovannucci EL, Chan JM. Egg, red meat, and poultry intake and risk of lethal prostate cancer in the prostate-specific antigen-era: incidence and survival. Cancer prevention research (Philadelphia, Pa) 2011;4:2110-21

Richman EL, Kenfield SA, Stampfer MJ, et al. Choline intake and risk of lethal prostate cancer: incidence and survival. Am J Clin Nutr 2012;96:855-63.

My hope is that you will embrace the suggestions in this book as a way to live that will give you the tools you need for a happier, healthier life, as well as a more sustainable world.

Steffen W, Persson A, Deutsch L, et al. The anthropocene: from global change to planetary stewardship. Ambio. 2011;40(7):739-761. doi:10.1007/s13280-011-0185-x

The science on climate change is now clear – unless we take action there will be catastrophic consequences.

Razis DV. The risk of a sixth mass extinction of life and the role of medicine. J R Soc Med. 2010;103(12):473-474. doi:10.1258/jrsm.2010.010090

Ceballos G, Ehrlich PR, Barnosky AD, García A, Pringle RM, Palmer TM. Accelerated modern human-induced species losses: Entering the sixth mass extinction. Sci Adv. 2015;1(5):e1400253. Published 2015 Jun 19. doi:10.1126/sciadv.1400253

Air pollution, increased temperatures, reduced water supplies and disrupted food supplies can and will affect everyone in the future – unless we do something today.

Bowles DC, Butler CD, Morisetti N. Climate change, conflict and health. J R Soc Med. 2015;108(10):390-395. doi:10.1177/0141076815603234

Schleussner CF, Donges JF, Donner RV, Schellnhuber HJ. Armed-conflict risks enhanced by climate-related disasters in ethnically fractionalized countries. Proc Natl Acad Sci U S A. 2016;113(33):9216-9221. doi:10.1073/pnas.1601611113

Lake IR, Hooper L, Abdelhamid A, et al. Climate change and food security: health impacts in developed countries. Environ Health Perspect. 2012;120(11):1520-1526. doi:10.1289/ehp.1104424