Guest Blogger: Dr Gemma Newman, www.gemmanewman.com
Dr Gemma Newman has worked in medicine for 17 years and is the Senior Partner at a family medical practice where she has worked for 13 years. Inspired by her husband’s marathon training performance and recovery when following a plant-based diet, she decided to research the science behind a plant-based diet to understand how eating more plants could potentially benefit her patients, beyond athletic performance.
It’s Earth Day 2021 and I’m delighted to have been invited to discuss my work on plant-based eating. It ties so closely with the urgent need to shift our society’s eating habits – for both human and planetary health. After all, there is no human health without planetary health. Read to the end and you’ll also find a couple of delicious plant-based recipes – perfect for an Earth Day meal!
Let’s start with some stark facts – which are actually inter-related:
- There is no doubt that our health is affected by the food we eat. In 2017, 11 million deaths worldwide were attributed to poor diet. High intake of salt, low intake of wholegrains and low intake of fruits were the leading dietary risk factors for deaths globally.
- In environmental science, the ecosystems on which we and all other species depend on are deteriorating more rapidly than ever, which is significantly and directly related to our food system and how we eat.
In 2019, the EAT-Lancet Commission was formed to address concerns surrounding human and planetary health. The group of 37 nutritional scientists from across the globe looked at the reality our current global ecology, agricultural systems and increasing overpopulation, and asked ‘What could we do that would avoid the complete collapse of our planet’s ability to support our species?’ The answer? A predominantly plant-based diet.
What does a ‘Planetary Health Diet’ look like?
According to the EAT-Lancet Commission, in order to avoid potentially catastrophic damage to our health and the planet, global consumption of unhealthy foods such as red meat and added sugar needs to fall by around 50%, along with large reductions in food waste and revolutionary improvements in global agriculture practices and efficiency.
Their analysis resulted in the development of the Planetary Health Diet, which consists of the following recommendations to reduce consumption of animal products:
- Protein primarily sourced from plants where possible, with fish or alternative sources of omega-3 fatty acids consumed several times per week. An optional modest consumption of poultry and eggs alongside very low intakes of red or processed meat. No more than 98g of red meat (pork, beef or lamb), 203g of poultry and 196g of fish per week
- At least five servings of fruits and vegetables should be consumed per day excluding potatoes
- At least 50g of nuts and 75g of legumes per day including dry beans, lentils and peas
- Dietary fats primarily from unsaturated plant sources with low intakes of saturated fats
- Carbohydrates predominantly from whole grains with low intake of refined grains and less than 5% of energy from sugar. Recommended consumption of 232g of wholegrains per day including rice, wheat and corn and 50g of tubers or starchy vegetables per day including potatoes and cassava
- Moderate levels of dairy consumption are an option: 250g of dairy per day
These are global recommendations and EAT-Lancet made it clear that they need to be adapted to each country. What is clear is that changing the types of food we eat and how often we eat them, can help to reduce pressure on the global food system. Dietary survey data in the UK reveals we’re still consuming too much animal foods such as meat and dairy. But how can we ensure that our advice for a planetary health diet is achievable and realistic?
If you want to get more detail on what that looks like for diets in the UK and Ireland, check out the MyNutriWeb Eating Sustainably Without Nutrient Compromise webinar with Elphee Medici and the Sustainable Healthy Eating webinar with Dr Fabrice DeClerck, Science Director at EAT.
Taking the plant-based plunge for health
Here, though, I’ll focus on what a change to plant-based eating means for health – one of the key motivating factors, alongside sustainability. The evidence to support that change is overwhelming. For example:
- In the UK, the Department of Health recommends a predominantly plant-based diet with two portions of fish each week, some meat and no more than 70g red and processed meat a day. The average pork sausage weighs 75g, so it’s likely many of us may need to reassess our intake of meat products for our health.
- The American College of Cardiology recommends plant-based diets as one of the foundational principles for preventing heart disease.
- The World Cancer Research fund talks about fruits, vegetables, legumes and wholegrains as being the cornerstone of a cancer preventing diet.
- Diabetes UK talks about how a healthy diet rich in fruits, vegetables and plant-based fats with limited red and processed meat is one of the key lifestyle factors in preventing Type 2 Diabetes.
These guidelines are all supported by a wealth of research.
Antibiotic resistance and meat
One topic that gets people talking is the very real issue of antibiotic resistance. A new report from the United Nations Interagency Coordination Group (IACG) on Antimicrobial Resistance concluded that drug-resistant diseases already cause at least 700,000 deaths globally a year. A figure that could increase to 10 million deaths globally per year by 2050 if no action is taken. So, what has this got to do with our diets?
One major cause of antibiotic resistance is the misuse and overuse of antibiotics in humans, animals and plants. On many farms across the world, routine antibiotics are given to animals to prevent the spread of disease when they are packed closely together. This overuse of antibiotics leads to the emergence of antibiotic resistant bacteria, which then makes its way into our food chain increasing the risk of humans getting infections that are difficult or impossible to treat. So, whilst frequently getting antibiotics from your doctor will play a role in antibiotic resistance on a personal level, one of the more common risk factors may be in the food we eat.
The World Health Organisation (WHO) recommends an overall reduction in antibiotic use in food-producing animals to help preserve their effectiveness for human medicine.
The UK Government’s One Health Report (2019) found that compared to other European countries, the UK has below average antibiotic use in both animals and humans and further steps are being made to reduce the amount of antibiotics used even more.
With both planetary and human health in mind, should we be recommending that patients steer-clear of meat as standard? Or is that a step too far for most?
Vegan vs Plant-based
Plant-based lifestyles and veganism share many similarities, but there is a difference. Veganism seeks to exclude, as far as is practical, animal products from all aspects of living. Vegan clothing, cleaning products and make-up also avoid the use of animals in testing or for ingredients.
Vegan diets tend to benefit from more fruits and vegetables and removing animal products, but a vegan diet is not always healthier. Vegan and plant-based diets can also include processed food, such as crisps, fizzy drinks and sweets and as the plant-based trend booms in popularity, so does the availability of vegan ice creams and ready prepared foods.
From ‘no-chicken’ nuggets to vegan desserts, there are now many options, which is a good thing for the environment and freedom of choice, but it stands to reason they may not always be better for your health. It’s helpful to think about the health benefits ‘compared to what’: for example, a bean burger will be healthier than a processed beef burger – more plant nutrients, less fat and salt – but when you compare a vegan cheese and meat replacement burger to the bean burger, the benefits are not so clear-cut. Some vegan substitutes are high in salt and/or coconut oil and may contain preservatives and processed oils. They are to be enjoyed, and they can be helpful to avoid meat, but it’s not the same health-wise as fresh and minimally processed plant foods.
Eating ‘plant-based’ means you simply commit to adding more of these plant-based foods to each meal for a ‘plant-forward’ or ‘plant-heavy’ approach. Plants and wholefoods play a starring role and the more and higher proportion of plants and wholefoods consumed, the more benefits we see.
So why don’t we talk about plant-based diets more freely? Why do some of our patients still feel uncomfortable at the thought of eating fewer animal products?
Eat MORE plants, FEWER animal products
There is a certain type of ‘all-or-nothing’ thinking many people are prone to, where if we make a mistake, we are tempted to pack it all in. However, we don’t all need to shift to an exclusively plant-based diet overnight to reap the rewards of a plant-power. Instead it’s about making small, incremental changes that fit into your lifestyle for a positive impact.
- Discover the why: Encouraging a shift in dietary intake can be a challenge with some patients, so it’s important to first discover the ‘why’. Sometimes people don’t have a very strong motivation to make changes, and sometimes they really do! If you can help them focus on what it is they want to achieve, how they want to feel, the things they are looking forward to doing, then that’s a recipe for success because initial motivation only lasts so long. If a patient is finding themselves doing things that align to their values – be that health, being able to move their body more, or environmental concerns – then keeping that in the forefront of their mind really helps.
- Simple swaps: A complete diet overhaul is overwhelming and unlikely to last. The key to success is through simple swaps and healthy additions. For example, try asking a patient “What one more vegetable could you add to this meal?”. Encourage patients to switch beef mince for non-beef mince, add lentils to a Bolognese sauce or swap a chicken curry for a chickpea curry Start with classic favourites, once or twice a week, and gradually build it up as your patient becomes more comfortable with their new meat-free meals.
- Gradual increase of plants: Gradually increase fibre-rich plant foods in the diet to avoid bloating and gastrointestinal issues. Think of it as a gym workout for your gut. It’s good for your gut to gradually get more legumes and wholegrains, but just as you wouldn’t go to the gym and pick up the heaviest weight straight away, you don’t want to suddenly increase the amount of plant food without building up gradually, so your ‘gut workout’ game can be strong!
Motivate patients to make positive changes in a consultation, using BLEND IT:
Believe – Belief is an important step to success. First you need to believe that a patient is capable of making changes. Then you need to help them to believe they are capable of change.
Listen – Listen to your patient first. Only by listening can you really understand what they are looking for, what their needs are, and what they are expecting from you. Then you can tailor your approach accordingly.
Evoke – This is about helping them to see what they could achieve. Ask them the questions that will help them to think about what they can do to make themselves feel better.
No bossing – You can’t tell them what to do. Nobody likes being told what to do and its not effective. By telling a patient what they must do to eat healthier or fix their problems, you may end up getting them more ingrained in what they were doing before. You should be making suggestions for changes that they choose to make.
Desire – Building and maintaining a desire for change is important. A real desire to change lasts longer than the 1-2 weeks of initial motivation when starting something new. Its about building a desire for a shift in identity and lifestyle.
Information – Ask if they are happy to receive information about a topic and then give them the information that they need.
Timed – Give them a specific timeframe so they can focus on what they actually want to do and by when. It doesn’t have to be big. Small simple shifts are fantastic because your patient can feel great about what they’ve managed to achieve and small changes can easily fit into their lifestyle, it’s not something they can’t do day in day out. Once they’ve achieved the small shifts they have built their confidence and can choose to change other things.
Resources for further reading:
- The Plant Power Doctor by Dr Gemma Newman – Dr Gemma has written an accessible and friendly step by step guide to help you live the Plant Power Way. The book is a great resource for healthcare professionals looking to support patients to eat more plants offering practical tips as well as a full reference list to read more.
- Eat Lancet Commission Brief for Healthcare Professionals. 2019. Eat Lancet.
- One Blue Dot: Eating patterns for health and environmental sustainability. 2020. BDA.
- Plant food sources of protein – Vanessa Clarkson
- Sustainable diets – BDA One Blue Dot – Tom Embury, Clare Pettinger, Lynne Garton
- Sustainable healthy eating – What does this really look like? – Dr Fabrice DeClerck, Elphee Medici
- Eating sustainably without nutrient compromise – Elphee Medici
- Nutritional adequacy of plant-based diets for kids– Vanessa Clarkson
- Vegan diets – Person-centred practice – Heather Russell
- How to be vegan savvy – A practical guide – Azmina Govindji, Heather Russell
- Is a sustainable diet more expensive? – Dr Christian Reynolds
- Diet change – The impact on agriculture and ecology – Perrine Laroche, Ursula Arens
Try these plant-based recipes
This hearty and rich dish is the perfect alternative to a meat-based version with mushrooms and aubergines for texture and red wine for extra flavour – it hits the spot every time! Some of these veggies can be substituted with Quorn® or soya mince.
Makes 4 portions
- 1 tbsp olive oil (if using oil)
- 1 onion, finely chopped
- 1 small carrot, finely chopped
- 1 stick celery, finely chopped
- 1 small aubergine, finely diced
- 100g mushrooms, finely diced
- 4 garlic cloves, finely chopped
- 1 tsp dried oregano
- 1 bay leaf
- 100ml red wine (optional, can add more stock instead)
- 400g tin tomatoes
- 200ml mushroom or vegetable stock
- Salt and pepper
- 500g wholemeal spaghetti or other type of pasta
- Vegan parmesan (optional)
If using the oil, heat it in a large casserole or saucepan. Add the onion, carrot, celery, aubergine and mushrooms and sauté, stirring regularly. If not using oil, add a little water to the pan at the same time. Sauté in the same way, stirring regularly. Eventually the vegetables will collapse down to around half their original volume and any liquid they have given out will evaporate off. At this point, increase the heat and allow to brown.
Add the garlic and cook for a further couple of minutes, then stir in the herbs and red wine. Bring to the boil and bubble until most of the wine has evaporated, then add the tomatoes and stock. Season with salt and pepper.
Leave to simmer for around 30 minutes until the sauce has reduced down and smells rich and savoury.
Cook the pasta in plenty of boiling, salted water until al dente. Serve the pasta with the sauce spooned over and a little vegan parmesan, if using.
No tuna sandwich
It can sometimes be hard to know what to put on your sarnie but this option is mouth-watering and packed full of nutrients!
Makes 4 generous sandwiches
For the chickpea mix
- 1 x 400g tin chickpeas
- Zest and juice of 1 lemon
- 1 tbsp Dijon mustard
- 1 tbsp capers, finely chopped
- 1 tbsp gherkins or cornichons, finely chopped
- 1 tbsp olives, finely chopped
- 2 spring onions, finely chopped
- 1 stick celery, finely chopped
- A few tarragon leaves, finely chopped (optional)
- 100g cooked sweetcorn
- Salt and pepper
For the sandwich
- 8 slices wholemeal bread
- ½ cucumber, thinly sliced
- A handful of rocket leaves
- Vegan mayo (optional)
Put the chickpeas, lemon zest and juice and mustard into a food processor and pulse until the chickpeas have broken down and look creamy. You can also use a potato masher for this. Stir in all the remaining ingredients and season with salt and pepper. The mixture should be quite firm.
Spoon the chickpea mixture over 4 slices of bread and top with the cucumber and rocket leaves. Add vegan mayo if you like. Top with the remaining slices of bread and serve.
 The Global Burden of Disease Study. 2019. Lancet.
 Accelerated Modern Human-Induced Species Losses: Entering the Sixth Mass Extinction. 2015. Ceballos G et al.