Thursday, July 25, 2013

Kaiser Permanente Endorses Whole Food Plant-Based Diets

It's no longer fringe.

Kaiser Permanente, with 9 million members and $48 billion in operating revenues, is the nation's largest managed care organization. It recently came out in support of plant-based diets:

Nutritional Update for Physicians: Plant-Based Diets (pdf), The Permanente Journal, Spring 2013

Permanente's Special Report seeks to train physicians and elevate the topic of plant-based nutrition to mainstream. It does so with a case study and a literature review. They conclude that whole food plant-based diets should be "a first-line treatment for chronic illnesses."

They defined a whole food plant-based diet:
"A healthy, plant-based diet aims to maximize consumption of nutrient-dense plant foods, in their whole form, while minimizing processed foods, oils, and animal foods (including dairy products and eggs). It encourages lots of vegetables (cooked or raw), fruits, beans, peas, lentils, soybeans, seeds, and nuts (in smaller amounts) and is generally low fat."

"It should be noted that the term plant-based is sometimes used interchangeably with vegetarian or vegan. Vegetarian or vegan diets adopted for ethical or religious reasons may or may not be healthy."

Case Study

"A 63-year-old man with a history of hypertension presented to his primary care physician with complaints of fatigue, nausea, and muscle cramps."

His labs:
  • Blood glucose (Random, not fasting): 524 mg/dl (Wow!)
  • HbA1c (Glycosylated hemoglobin, a measure of plasma glucose over several months): 11.1%
  • Total cholesterol: 283 mg/dl
  • Blood pressure: 132/66 mmHg (He was on BP meds)
  • BMI: 25 (High end of normal)

After 16 weeks of a whole food plant-based diet and "exercising 15 minutes twice a day" his meds were substantially reduced (he was taken off insulin entirely).

His labs:
  • HbA1c: 6.3% (This was quite a drop.)
  • Total cholesterol: 138 mg/dl (Holy cow.)
  • Blood pressure: Remained below 125/60 mmHg
  • BMI: Unchanged, so his improvements were likely related to diet, not weight loss.

Review of Literature

Benefit of plant-based diets was seen in the following areas:
Obesity - "A vegan or vegetarian diet is highly effective for weight loss." ... "There was a positive association between meat consumption and obesity."

Diabetes - "A low-fat, plant-based diet with no or little meat may help prevent and treat diabetes, possibly by improving insulin sensitivity and decreasing insulin resistance."

Heart Disease - "In the Lifestyle Heart Trial, Ornish found that 82% of patients with diagnosed heart disease who followed his program had some level of regression of atherosclerosis." ... "Interestingly, 53% of the control group had progression of atherosclerosis."

High Blood Pressure - "Vegetarian diets were associated with lower systolic blood pressure and lower diastolic blood pressure."

Mortality - "Low meat intake has been associated with longevity."

They addressed health concerns:
Protein - "Patients on a plant-based diet are not at risk for protein deficiency." And this about soy:
"Soybeans and foods made from soybeans are good sources of protein and may help lower levels of low-density lipoprotein in the blood and reduce the risk of hip fractures and some cancers."

"Women with breast cancer who regularly consumed soy products had a 32% lower risk of breast cancer recurrence and a 29% decreased risk of death, compared with women who consumed little or no soy. An analysis of 14 studies showed that increased intake of soy resulted in a 26% reduction in prostate cancer risk."
Iron - "The American Dietetic Association states that iron-deficiency anemia is rare even in individuals who follow a plant-based diet."

Vitamin B12 - "Individuals who follow a plant-based diet that includes no animal products may be vulnerable to B12 deficiency and need to supplement their diet with vitamin B12."

Calcium - "Calcium intake ... appears to be irrespective of dietary preferences." They cite tofu and greens such as kale as good sources.

Fatty Acids - "The fatty acids that vegans are most likely to be deficient in are the omega-3 fats (n-3 fats)." They cite ground flax seeds and walnuts as good sources.


Some choice quotes:
"The benefits realized will be relative to the level of adherence and the amount of animal products consumed.

Physicians should advocate that it is time to get away from terms like vegan and vegetarian and start talking about eating healthy, whole, plant-based foods (primarily fruits and vegetables) and minimizing consumption of meat, eggs, and dairy products.

Further research is needed to find ways to make plant-based diets the new normal. ... Patterns of families and other colleagues who may be reluctant to support the efforts of individuals who are trying to change are a challenge to be overcome.

Too often, physicians ignore the potential benefits of good nutrition and quickly prescribe medications instead of giving patients a chance to correct their disease through healthy eating and active living. If we are to slow down the obesity epidemic and reduce the complications of chronic disease, we must consider changing our culture’s mind-set from “live to eat” to “eat to live.” The future of health care will involve an evolution toward a paradigm where the prevention and treatment of disease is centered, not on a pill or surgical procedure, but on another serving of fruits and vegetables."

I can't believe they said all this. Forgive my cynicism but I also can't believe it will come to pass, not anytime soon. The reluctance to treat chronic disease with diet - first and foremost - actually starts in the medical community. Drugs are King in this country; cheap processed foods are Queen. The power and influence of those industries will just be too strong to allow disease to be treated with "another serving of fruits and vegetables." If it will ever come to pass, it will be from the bottom up, not the top down. Although this Special Report by a large healthcare organization offers hope.


caulfieldkid said...

Things don't change over night, but statistics, like these, get hard to ignore over time.


RB said...

Plant based diets as a general rule may not come to pass anytime soon, but when a large healthcare organization like Kaiser Permanente begins to back them it does brighten their radar echo a bit. It is not just a few doctors like Dr. Ornish, Dr. Esselstyn and Dr. Campbell singing their praises. If it gets some doctors to suggest plant based diets to their patients that would be a good thing. Mark Bittman started his "Vegan Before Six" diet after his doctor suggested he needed to go on a Vegan diet. We will know it works if restaurants begin featuring plant based options on their menus the way they did Atkins meals during the height of the Atkins Diet craze.

ArthurV said...

Saw the doc a few weeks ago. Said I was eating less meat and read good things about a veg diet. What does he do? Gives me a big frown and tells me I should be careful about what I read. How's that! From the looks of him, my diet is working out better than his.

Bix said...

ArthurV, That's a really good point. Docs are people too. They arrive at their own best way of eating, which may not mesh with what their patient thinks. How does the conversation go where a doc is pro-plant-based and a patient is pro-low-carb or Paleo? Or the other way around?

RB said...

Just cam across this article: New York Hospitals Prescribing Fruits, Veggies
Perhaps some in the health care business are beginning to see the benefits of healthy diets. It would be great if it were the start of a snowball rolling downhill.