Will the plant-based movement redefine physicians' understanding of chronic disease?

The Ethics of Veganism

In this article, we discuss the ethics of veganism by looking at the moral implications of having a vegan diet or plant-based diet. Veganism is a way of diet that forbids or avoids consuming any animal products. It has drawn a lot of interest recently due to awareness or trends of vegan diet, human health, and ethical behavior benefits. The aim of the research is to look into the moral values that talk about veganism, such as animal welfare, environmental sustainability, and human welfare. In this study, we conduct a thorough assessment of ethical theories and actual evidence in an effort to know about the ethical reasons for veganism and its larger societal impacts. Through an analysis of existing literature and clinical studies, we discuss the various challenges, advantages, lifestyle modification, and nutritional concerns related to a vegan diet.

Are Physicians Obligated to Recommend a Plant-Based Diet? A Response to Maximilian Storz

Maximilian Storz argues that physicians have an ethical obligation to recommend a plant-based diet to patients because such a diet: relieves certain chronic conditions, outperforms the Western diet (e.g. a diet containing animal products, among other things), and is ecologically sustainable. Contrary to these claims, I argue that a plant-based diet alone may not relieve chronic conditions, but potentially does so in combination with other lifestyle factors. With respect to the environment, I illuminate the landscape by discussing agricultural factors consistent across animal and plant farming such as energy and water. I conclude that physicians ought to recommend a diet that follows the science; such a diet as I have claimed is exclusionary: it excludes processed foods, especially added sugars. Lifestylfe factors also deserve to be discussed in the medical encounter as their incorporation may lead to even better health outcomes.

Soy Milk Consumption in the United States of America: An NHANES Data Report

With the increasing adoption of plant-based diets in the United States, more and more individuals replace cow milk with plant-based milk alternatives. Soy milk is a commonly used cow milk substitute, which is characterized by a higher content of polyunsaturated fatty acids and fibers. Despite these favorable characteristics, little is known about the current prevalence of soy milk consumption the United States. We used data from the National Health and Nutrition Examination Surveys (NHANES) to assess soy milk usage in the United States and identified potential predictors for its consumption in the US general population. The proportion of individuals reporting soy milk consumption in the NHANES 2015-2016 cycle was 2%, and 1.54% in the NHANES 2017-2020 cycle. Non-Hispanic Asian and Black ethnicities (as well as other Hispanic and Mexican American ethnicities in the 2017-2020 cycle) significantly increased the odds for soy milk consumption. While a college degree and weekly moderate physical activity were associated with significantly higher odds for consuming soy milk (OR: 2.21 and 2.36, respectively), sex was not an important predictor. In light of the putative health benefits of soy milk and its more favorable environmental impact as compared to cow milk, future investigations should attempt to identify strategies that may help promote its consumption in selected populations.

Nutrition Coverage in Medical Licensing Examinations in Germany: An Analysis of Six Nationwide Exams

The state of nutrition education in medicine is inadequate, with nutrition-related topics being poorly integrated into lectures. Most medical students receive only a few contact hours of nutrition instruction during their entire time at medical school. Identifying potential barriers that may explain the paucity of nutritional knowledge in medical students is thus of paramount importance. The extent of nutrition coverage in the second part of Germany's nationwide medical licensing exam is currently unknown. We addressed this issue and assessed nutrition content, as well as students' scores, in this pivotal test prior to their graduation. We performed a post hoc analysis of six nationwide medical licensing examinations (2018-2020) undertaken by 29,849 medical students and screened 1920 multiple-choice questions for nutrition-related content. Nutrition-related questions accounted for a minority of the questions (2.1%, n = 40/1920). A considerable number of the questions (n = 19) included only a single nutrition-related answer option that was frequently incorrect and served as a distractor. About 0.5% of questions were entirely nutrition related. Despite undeniable barriers, the inclusion of additional nutrition-related examination questions could serve as an incentive to engage students and medical schools in enhancing medical nutrition education. The recently published competence-oriented learning objective catalog in Germany could play a pivotal role in this context, leading to better recognition of nutrition-related topics in medical education.

Knowledge, Attitudes and Application of Critical Nutrient Supplementation in Vegan Diets among Healthcare Professionals-Survey Results from a Medical Congress on Plant-Based Nutrition

Plant-based diets are associated with numerous health benefits but also bear risks of micronutrient deficiencies if inadequately planned. The risk of nutrient deficiencies can be reliably reduced by supplementation but requires risk-awareness. We distributed a paper-and-pencil questionnaire to n = 902 healthcare professionals attending a congress on plant-based nutrition (VegMed 2018, Berlin). On the day of the survey (21 April 2018), n = 475 questionnaires were returned and analyzed descriptively. Of the n = 213 strict vegan participants, 2% (n = 5) took no supplements at all. All supplementing vegans reported taking vitamin B12. Almost three-quarters of vegans (73%, n = 152) took vitamin D, and 22% (n = 45) reported taking omega-3 fatty acids. Iron was supplemented by 13% (n = 28), iodine by 12% (n = 25), calcium by 11% (n = 22), zinc by 7% (n = 14), magnesium by 5% (n = 11), and selenium by 4% (n = 9). For 11%, a supplement other than vitamin B12 was subjectively most important. Nearly 50% had their vitamin B12 levels laboratory tested at least once a year; nearly one-quarter reported testing every two years, and another one-quarter rarely or never. Participants following a vegan diet were better informed about institutional recommendations of the German Nutrition Society and the Academy of Nutrition and Dietetics for vegan diets than participants following vegetarian or omnivorous diets. Vegan nutrition in pregnancy/lactation period and childhood was considered most appropriate by vegans. Despite a high awareness of potential health risks associated with vitamin B12 deficiency on a strict vegan diet and a comprehensive understanding of the official dietary recommendations of nutrition societies, use of supplements and performance of regular laboratory tests were only moderate among vegan healthcare professionals. Considering the paramount importance of adequate supplementation of critical nutrients to avoid nutrient deficiencies, scientific and public discourse should be further facilitated. Further investigation of the supplementation behavior of vegan health professionals could be of particular interest, as a possible correlation with the quality of their own nutrition counseling is not inconceivable.

Reduced dietary acid load in U.S. vegetarian adults: Results from the National Health and Nutrition Examination Survey

Dietary acid load (DAL) is an important determinant of systemic pH and acid–base homeostasis. Diets abundant in acidogenic foods, such as meat and meat products, induce a low‐grade metabolic acidosis state that has been associated with cardiovascular disease, type‐2‐diabetes, and an increased cancer risk. Fruits and vegetables have alkalizing properties and beneficially affect DAL. It has thus been suggested that a plant‐based diet (restricting or excluding animal products) may be a powerful tool in reducing DAL; yet studies in that particular field are scarce. To explore these associations in greater detail, we examined DAL in self‐identified vegetarians from the United States National Health and Nutrition Examination Survey (2007–2010). We compared dietary intake and two widely used markers of DAL (PRAL (potential renal acid load) and NEAP (net endogenous acid production; NEAP_F and NEAP_R)) among 8,398 nonvegetarians and 191 lacto‐ovo‐vegetarians with reliable dietary intake aged 18 years or older. Vegetarians had a more favorable body mass index and consumed fewer calories (1862.31 kcal/d) than nonvegetarians (2041.12 kcal/d). Vegetarians consumed fewer protein (34.17 g/1000 kcal) and phosphorus compared to nonvegetarians (39.50 g of protein/1000 kcal) but had a higher intake of magnesium and potassium. Nonvegetarians exhibited higher median DAL scores (PRAL: 11.90 mEq/d, NEAP_F: 53.59 mEq/d, NEAP_R: 55.67 mEq/d) than vegetarians (PRAL: −0.44 mEq/d, NEAP_F: 39.60 mEq/d, NEAP_R: 41.30 mEq/d). Vegetarians had more favorable DAL scores compared to nonvegetarians in this descriptive epidemiologic study. Future (interventional) trials are warranted to examine the varying acid load in different plant‐based dietary patterns.

Bowel Health in U.S. Vegetarians: A 4-Year Data Report from the National Health and Nutrition Examination Survey (NHANES)

Dietary fiber is of paramount importance in the prevention of large-bowel diseases, yet fiber intake in many high income countries is well below daily recommendations. Vegetarian diets high in fiber-rich plant-foods have been associated with a higher frequency of bowel movements and softer stools. Thus, vegetarians appear to suffer less frequently from constipation and other bowel disorders. The number of studies investigating these associations, however, is limited. The present study sought to investigate bowel health and constipation prevalence in a self-identified vegetarian population from the U.S. National Health and Nutrition Examination Survey (2007−2010). Bowel health assessment included Bristol Stool Scale (BSS), Bowel Movement (BM) frequency and Fecal Incontinence Severity Index (FISI). The present study included 9531 non-vegetarians and 212 vegetarians. We found no associations between vegetarian status and all examined bowel health items (BM frequency, BSS and FISI). Vegetarians consumed significantly more fiber than omnivores (21.33 vs. 16.43 g/d, p < 0.001) but had a lower moisture intake (2811.15 vs. 3042.78 g/d, p = 0.045). The lack of an association of vegetarian status and bowel health is surprising, and may be a result of the relatively low fiber intake in this particular vegetarian cohort, which did not meet the daily fiber recommendations.

Diet and Consumer Behavior in U.S. Vegetarians: A National Health and Nutrition Examination Survey (NHANES) Data Report

An increasing number of individuals adopt plant-based diets for their potential health benefits. Understanding vegetarians' dietary behavior in the context of their socioeconomic background is essential for pro-vegetarian messaging and to influence public beliefs about plant food consumption. Thus, this study sought to investigate diet and consumer behaviors in U.S. vegetarians. This is a cross-sectional, population-based study with data from the Nutrition and Health Examination Surveys (2007-2010). Selected items from three modules (diet and nutrition behavior, consumer behavior, and food security) were compared between vegetarians (n = 352) and the general population (n = 14,328). U.S. vegetarians consumed significantly fewer calories and less cholesterol but more fiber than their omnivorous counterparts. Moreover, vegetarians had significantly fewer soft drinks and salty snacks available at home. We also observed significant intergroup differences with regard to the availability of fruit and dark green vegetables. Vegetarians spent less money on eating out and indicated a lower number of not-home-prepared meals and ready-to-eat foods. We found no differences regarding money spent at supermarkets or grocery stores. Our study contributes to a better understanding of dietary and consumer behaviors in vegetarians. We shed a new light on the economic feasibility of vegetarian diets, highlighting that these diets are not necessarily more expensive than an omnivorous diet.

What makes a plant-based diet? a review of current concepts and proposal for a standardized plant-based dietary intervention checklist

Within the last decades, plant-based diets have received increasing interest for their potential benefits to human and environmental health. The concept of plant-based diet, however, varies widely in its definition. Current definitions range from the exclusion of all animal products to diets that include meat, fish, and dairy in varying quantities. Therefore, the main objectives of this review were twofold: (a) to investigate how researchers use the term plant-based diet in nutrition intervention studies and (b) what types of food a plant-based diet may include. Searching two databases, we found that the term “plant-based diet” evokes varying ideas to researchers and clinicians. Fifty percent of the retrieved studies that included a plant-based dietary intervention completely proscribed animal products and used the term plant-based diet interchangeably with a vegan diet. In contrast, an ~33% of trials included dairy products and 20% of dietary interventions emphasized a semi-vegetarian dietary pattern. Based on specific examples, we point out how the usage of the umbrella term “plant-based diet” may cause significant ambiguity. We often encountered incomplete descriptions of plant-based dietary interventions, which makes comparison and reproducibility of studies difficult. As a consequence, we urge others to use the term “plant-based diet” only in conjunction with a detailed dietary description. To facilitate this process, we provide a template of a standardized plant-based intervention reporting checklist. Finally, the present review also highlights the urgent need for a consensus definition of the term plant-based diet and its content.

Lifestyle Adjustments in Long-COVID Management: Potential Benefits of Plant-Based Diets

Purpose of Review

The SARS-CoV-2-pandemic has caused mortality and morbidity at an unprecedented global scale. Many patients infected with SARS-CoV-2 continue to experience symptoms after the acute phase of infection and report fatigue, sleep difficulties, anxiety, and depression as well as arthralgia and muscle weakness. Summarized under the umbrella term “long-COVID,” these symptoms may last weeks to months and impose a substantial burden on affected individuals. Dietary approaches to tackle these complications have received comparably little attention. Although plant-based diets in particular were shown to exert benefits on underlying conditions linked to poor COVID-19 outcomes, their role with regard to COVID-19 sequelae is yet largely unknown. Thus, this review sought to investigate whether a plant-based diet could reduce the burden of long-COVID.

Recent Findings

The number of clinical trials investigating the role of plant-based nutrition in COVID-19 prevention and management is currently limited. Yet, there is evidence from pre-pandemic observational and clinical studies that a plant-based diet may be of general benefit with regard to several clinical conditions that can also be found in individuals with COVID-19. These include anxiety, depression, sleep disorders, and musculoskeletal pain. Adoption of a plant-based diet leads to a reduced intake in pro-inflammatory mediators and could be one accessible strategy to tackle long-COVID associated prolonged systemic inflammation.

Summary

Plant-based diets may be of general benefit with regard to some of the most commonly found COVID-19 sequelae. Additional trials investigating which plant-based eating patterns confer the greatest benefit in the battle against long-COVID are urgently warranted.

When the Desire for Lifestyle Medicine Counseling Remains Unfulfilled: A Case Report

More and more patients are suffering from multiple concomitant chronic conditions, which are often associated with an unhealthy lifestyle, including inadequate physical activity and poor nutrition. Patients increasingly seek thorough advice on lifestyle counseling, however, many physicians encounter this development with a pharmacotherapy-centered strategy—thereby paying insufficient attention to lifestyle modifications. This case report attempts to capture the concerning experience of a particular patient, who was hospitalized for uncontrolled type-2-diabetes in an American hospital. Despite curiosity and a great interest in lifestyle modifications, his desire for lifestyle medicine counseling was not addressed during a long inpatient stay. This case illustrates that patients wish to make sustainable lifestyle changes but apparently receive insufficient support from their physicians. This applies for both, dietary and exercise counseling. To address the patients’ needs and the increasing burden from chronic diseases, physicians must practice lifestyle medicine now. Appropriate educational resources for physicians are provided.

Can United States Healthcare Become Environmentally Sustainable? Towards Green Healthcare Reform

In 2014, the United States health care industry produced an estimated 480 million metric tons of carbon dioxide (CO2); nearly 8% of the country's total emissions. The importance of sustainability in health care - as a business reliant on fossil fuels for transportation, energy, and operational functioning - is slowly being recognized. These efforts to green health care are incomplete, since they only focus on health care structures. The therapeutic relationship is the essence of health care - not the buildings that contain the practice. As such, this article will first postulate reasons for a lack of environmental sustainability in US health care. Second, the article will focus on current green health care initiatives in the United States in which patients and physicians participate. Third, the rationale for participation in green initiatives will be explained. Fourth, the article will propose that, based on the environmental values of patients and physicians, health care insurance plans and health care insurance companies can be targeted for green health care reform, thereby closing the loop of sustainable health care delivery.