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How to help patients transition to a healthy and sustainable plant-based diet

Shireen Kassam is a consultant haematologist, lifestyle medicine physician, and founder of Plant-Based Health Professionals UK (@plantbasedhpuk).

Leila Dehghan is a doctor-turned-nutritionist and a member of the Advisory Board for Plant-Based Health Professionals UK.

Laura Freeman is a dual licensed GP, lifestyle medicine physician and medical director of Plant-Based Health Online.

Meat and dairy farming are a leading cause of climate change and ecological collapse. The most comprehensive analyses of the global farming system concluded that shifting to a plant-based diet would have the most impact on planetary health than any other single driver of climate change.

International consensus supports a global transition to a plant-based diet as an urgent imperative. The Eat-Lancet Commission evaluated the best available science and developed recommendations for a global healthy reference diet, termed the ‘Planetary Health Diet’.

… the Planetary Health Diet is estimated to prevent 11 million deaths annually from diet-related illnesses.

This diet consists predominantly of whole plant foods, with minimal animal-derived and processed foods. Meat, eggs, and dairy are considered optional and if consumed, provide <13% of calories. Not only would this diet keep the global food system within planetary boundaries, it is estimated to prevent 11 million deaths annually from diet-related illnesses.

Health professionals are a trusted source of evidence-based information. As such, they are key players in helping patients transition to a plant-based diet. In reality, many lack the knowledge to counsel patients, yet implementing such change is well within our capabilities and aligned with current recommendations.

The key components of a healthy plant-based diet are fruits, vegetables, whole grains and beans, in approximately equal proportion, a small portion of nuts and seeds on most days, and water being the main beverage. All animal-derived foods are removed or minimised. Fish is considered the healthiest option for animal-derived food, although its consumption for a global population of 10 billion by 2050 is unsustainable. Some countries rely on aquaculture, but here in the UK, fish is not a dietary necessity.

There remain engrained myths and fears about plant-based diets. Nutrients of concern are protein, calcium, iron, iodine, omega-3 fatty acids, and vitamin B12; however, with some education and planning these can be easily obtained. Furthermore, plant-based diets are abundant in nutrients such as fibre, potassium, magnesium, folate, antioxidants, and anti-inflammatory compounds that are often lacking in the typical British diet.

Some straightforward advice to give your patients could include:

1) Start with a healthy breakfast: porridge oats with a tablespoon of ground flaxseeds or chia seeds, for essential omega-3 fatty acids, and a portion of fruit. Use a fortified plant milk such as soya or oat.
2) For main meals, swap out meat for beans, pulses, lentils, or chickpeas. For example, bean chilli, lentil Bolognese, or tofu curry.
3) Swap out refined grains for whole grains; brown rice, whole wheat bread, pasta and couscous, bulgar and buckwheat.
4) Learn to make a variety of soups using different vegetables. Add beans or lentils to increase the protein and fibre content even further.
5) Learn to love big salads. Add beans, lentils, or tofu and top with seeds.
6) Aim for 10 portions of fruits and vegetables daily, including as snacks.
7) Eat a 30g portion of nuts on most days.
8) Calcium-set tofu is a rich source of calcium, as are leafy greens, beans, fortified plant milks, and yogurts.
9) Good sources of iron include chickpeas, lentil, tofu, cashew nuts, flaxseeds, pumpkin seeds, kale, dried figs and apricots, and raisins. Cooking with iron cast cookware can help increase intake. To increase absorption, eat iron-rich foods with a source of vitamin C. Avoid tea and coffee an hour before and after meals.
10) Know where to get iodine. This is present in sea vegetables and seaweeds, but their content is variable and if not consumed regularly a daily 150 mcg supplement is appropriate.
11) On a 100% plant-based diet, a B12 supplement is required; 25–100 mcg daily or 2000 mcg weekly.
12) In the winter months or if sun exposure is inadequate everyone in the UK requires a vitamin D3 supplement.
13) Reduce your food bill by cooking from scratch, bulk buying dry grains, beans, and pulses, using frozen and tinned fruits and vegetables, and batch cooking.
14) Your patients will come from a variety of backgrounds and cultures. Many traditional cuisines like Indian and African are mostly plant-based already.

There are numerous resources available to help health professionals guide patients and community groups that provide support. There will be circumstances when patients need to be guided by a nutritionist/dietitian. Nonetheless, doctors need to play their part and lead by example.

 

Featured photo by Andy Kelly on Unsplash

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serena strickland
serena strickland
3 years ago

Fantastic, practical and succinct advice. Interestingly Asda now fortifies oat milk with iodine – to my knowledge its the only one that is.

Samantha Rice
Samantha Rice
3 years ago

Brilliant, informative article that gives realistic tips on how to incorporate evidence based lifestyle advice into consultations. Preventing illness through diet should be a priority.

Alex Cinquegrana
Alex Cinquegrana
3 years ago
Reply to  Samantha Rice

Very well written article! Succinct and informative. It can be easily implemented to help any patient. Thank you

Catherine Manson
Catherine Manson
3 years ago

Excellent article, really useful advice

Sian Nasse
Sian Nasse
3 years ago

Great advice and article

Annette Henry
Annette Henry
3 years ago

Very good and easy to follow advice.

Lisa Simon
Lisa Simon
3 years ago

Excellent article, highlighting the important role doctors can play when guiding and supporting their patients to make positive dietary changes. Some really useful tips too – so helpful for those wanting to adopt a plant based diet.

Deb Williams
Deb Williams
3 years ago

This is a great article with easy, doable advice, that GPs and other health professionals can share quickly with their patients.
Thank you so much.

Caroline Collard
Caroline Collard
3 years ago

Excellent article and absolutely necessary that doctors start promoting a whole foods plant-based diet, especially for those diagnosed with one of the many common chronic diseases that are often developed as a result of lifestyle choices.

Dr Robert Ayto
Dr Robert Ayto
3 years ago

Thank you for this excellent and practical article. A topic that needs more air time given it’s importance for human and planetary health.

Dr Kirrili Taylor
Dr Kirrili Taylor
3 years ago
Reply to  Dr Robert Ayto

This is awesome to see!

Betty Burns
Betty Burns
3 years ago

Thank you for this sensible and very useful advice.

Dr Anupma Parihar
Dr Anupma Parihar
3 years ago

Appreciate this.. comprehensive, practical and informative. Thank you!

Ruth Jenkins
Ruth Jenkins
3 years ago

This is so important. Thank you for bringing this together for us.

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A review of the week’s plant-based nutrition news 26th September 2021This week I cover papers on plant-based diets for obesity and cardiometabolic health, the impact of foods, including plant-based meats, on the gut microbiome, health outcomes for people following a healthy vegan diet and the environmental impact of animal agriculture.Full paperOBESITY AND CARDIOMETABOLIC HEALTH: This large systematic review includes 84 papers that investigate the efficacy of vegan, vegetarian and plant-based whole foods (PBWF — exclusively plant-based or minimal animal foods including eggs and dairy) diets in treating obesity, hyperlipidaemia, insulin resistance, glycaemic control, type 2 diabetes, cardiovascular disease and hypertension.The paper reviews the impact of each of the three diet pattern on the various health outcomes listed above. Overall the findings confirm that all three types of diets reduce body weight to a greater extent than healthy omnivorous diets, including those recommended by the American Heart Association (AHA), American Diabetes Association and the National Cholesterol Education programme and in some studies performed better than the comparison calorie-restricted diet. Studies have also shown greater loss of subcutaneous, visceral and intramuscular fat with a plant-based diet. All three diets improve glucose control, insulin sensitivity and result in reductions in HbA1c in people with diabetes, with the ability to reverse diabetes in some. This has also been shown in the community setting amongst free-living people. Plant-based diets are very effective at lowering total and LDL-cholesterol but less effective for reducing triglyceride (TG) levels and may result in lower HDL-cholesterol levels. A Mediterranean diet is better at lower TG levels compared to vegetarian or vegan diets. Plant-based diets are also effective at lowering blood pressure but this may not be superior to other therapeutic healthy diet patterns, such as the DASH diet. A vegan diet has been shown to be more effective at lowering high sensitvity CRP (a marker of inflammation) compared to the AHA recommended diet in people with coronary artery disease. Studies by Dean Ornish have confirmed that a low-fat vegetarian diet has the potential to reverse coronary artery disease.Overall, the differences between the three categories of plant-based diets were less important than the differences between the conventional comparator diet. Based on the results the authors conclude that recommendations in clinical practice should include a plant-based diet comprised mainly of whole plant foods. If animal foods are chosen to be included then this should be limited to fish and low fat dairy. White flour products, sugar-sweetened beverages and ‘poor-quality’ animal foods (factory farmed beef and chicken and processed meat) should be limited/avoided.Accepting that there is a need for more high quality, randomised studies, the authors conclude that ‘All motivated patients with type 2 diabetes and cardiovascular disease should be informed of the potential reversibility or at least halting of progression of these illnesses with comprehensive lifestyle modification that includes plant-predominant eating patterns’.Full paperHEALTHY FOODS AND THE GUT MICROBIOME: We are only now beginning to fully understand the important of the gut microbiome to our overall health. The trillions of micro-organisms that reside in our gastrointestinal tract have many essential functions including maintaining the gut barrier function, maintaining the health of the immune system, making bioactive compounds such as vitamins and hormones that communicate with distant organs such as the brain, lungs, skin and joints, metabolise bile acids and regulation of hunger and glucose control. Production of short chain fatty acids (SCFAs) from the fermentation of fibre is a crucial aspect of healthy gut bacteria. Diet and food choices are probably the most important predictor of gut health and to date we know the important components include fibre, polyphenols and probiotic foods.The current study examined the associations between the gut microbiota and consumption of food items recommended to be part of a healthy diet in a large, Finnish, population-based cross-sectional study, including 4930 participants. The main objective was to assess whether healthy food choices are related to gut microbiota composition within samples (microbial diversity or alpha diversity) and between samples (compositional differences or beta diversity). Dietary information from participants was used to create a healthy food choices (HFC) score based on Nordic Nutrition Recommendations. Food items chosen to be components of the score were fibre-rich breads; vegetables (including beans and lentils); fruits; berries; fresh, non-sweetened berry and fruit juices; fish; poultry; low-fat cheeses; salad dressings and oils; and nuts and seeds. The HFC score effectively acts as an indicator for an omnivorous Nordic diet rich in plants, fibre, and PUFAs (polyunsaturated fatty acids).The results showed that microbial diversity was associated with a high HFC score with positive associations with fibre-rich breads, followed by poultry, fruits, low-fat cheeses, and berries. Microbial composition was also positively associated with a higher HFC score with the most prominent associations observed for vegetables, followed by berries and fruits. Microbiota responsibility for producing SCFA’s were more abundant in participants with a higher HFC score. The foods that adversely affected the gut microbiome were processed and red meat.There is no doubt that a fibre-rich plant-based diet is best for the health of the gut microbiome and this then supports the health of all the different organs of the body. Healthy vegetarian and vegan diets are consistently associated with better gut health and thus a key mechanism by which these diet patterns support good health and prevent chronic illness.Full paperPLANT-BASED MEAT ALTERNATIVES (PBMAs): I certainly flip flop in my views about PBMAs. On the one hand I understand they make a great transition food for those new to a plant-based diet. On the other hand it just seems more of the same corporate control over our food system with investment channelled to products that are really not required given the abundance of healthy whole plant food options. Nonetheless, its good to consider their impact on health and whether they represent a healthier option that meat. We have had one small, short study, albeit well designed and conducted that demonstrated that Beyond meat products did have some health benefits when compared to grass-fed, organic beef. Participants in the SWAP-MEAT study had reductions in body weight, LDL-cholesterol and TMAO levels when on the Beyond meat part of the study compared to the beef part.The current small study investigated the impact of PBMAs on the gut microbiome. Twenty participants were randomised to replace several meat-containing meals per week with meals cooked with PBMAs. Participants were requested to replace a minimum of 4 animal-protein based meals with a plant-based meal per week for four weeks. Stool samples were collected and compared to 20 participants that had not changed their usual animal-based diet. The PBMAs were donated from The Meatless Farm in Leeds, UK. Pea was the main source of protein in most of the products and they also had high levels of phenolic compounds such as lutein, ferulic acid and genistein.Participants ended up swapping an average of 5 meals per week from animal containing ones to including PBMAs instead.The main finding from the stool analysis was a significant increase in the butyrate-production pathways with slightly more abundance of butyrate producing bacteria.Butyrate is one of the SCFAs, along with acetate and propionate, produced by fermentation of fibre by certain gut microbes. Butyrate is particularly important as it is the main energy source of colonocytes. These SCFAs are important for glucose regulation, satiety signalling, immune system health, hormone and vitamin synthesis and more.The authors conclude that although PBMAs are often considered a processed or ultraprocessed food, their impact on health may still be better than consuming meat and swapping some meals for PBMAs may not be detrimental and at the very least may support the health of the gut microbiome. Of course, there are a wide range of PBMAs with some made of more whole food ingredients, and hence better choices, than others. This article by Dr Matthew Nagra provides a details summary on the potential health impacts of PBMAs.Full paperHEALTH STATUS OF ‘HEALTH CONSCIOUS’ VEGANS: We all know that describing a diet as vegan does not tell you what a person is eating but rather what they are not consuming. An unhealthy vegan diet composed of refined grains and ultraprocessed foods is just as unhealthy if not more so than an omnivorous diet. When studying the long-term health of vegans, it can be difficult to tease out the true health impact because of the differences in quality of the diet amongst participants. Therefore it is great to see a study that focuses on surrogate markers of health of vegans consuming a healthy plant-based diet.This cross-sectional study conducted during a COVID-19 lockdown in Slovenia included 80 self-selected subjects (51 vegans, 67% females, and 29 non-vegans, 55% females). The average age of vegans was 46 years and non-vegans 57 years. Participants were invited through health/fitness coaches or sports and recreational groups, thus targeting people with a healthy, active lifestyle. Participants had the same diet pattern for more than 1 year and the vegans were mostly following this diet for health rather than ethical reasons. Dietary and lifestyle information was collected and correlated with data on blood lipids, blood pressure, body mass index (BMI) and body fat.The results showed that vegans had a significantly lower BMI (22.8 vs 26.6) and body fat percentage (19.3 vs 25.8). Interestingly, vegans had a higher calorie intake than non-vegans and as would be expected a higher intake of carbohydrates, starches, fibre and polyunsaturated fatty acids with lower intakes of saturated fat and free sugar and no intake of cholesterol. In this cohort the vegans outperformed the non-vegans in terms of micronutrients intakes, including vitamins B12 and D, calcium, iron and zinc. Both groups had lower than recommended vitamin D intakes. The recommended calcium intake in Slovenia is 1200mg per day and both groups had lower intakes (vegans 979mg and non-vegans 826mg. Iodine intakes were also low in both groups (vegans 112mg non vegans 96mg). Interestingly, 67% of vegans and 47% of non-vegans were supplementing with long-chain omega-3 fatty acids (EPA/DHA). A third of each group were also consuming protein supplements. Non-vegans consumed more alcohol but still lower than average.Regarding blood biomarkers, vegans had significantly lower total and LDL-cholesterol levels and triglycerides level but HDL-cholesterol did not differ between groups. The lower cholesterol levels were explained by higher fibre and lower saturated fat intakes. In addition both systolic and diastolic blood pressure were significantly lower in the vegan group.Of course there a limitations to this small, cross-sectional study in which most of the data collected is self-reported. Nonetheless, it does support the notion that a well planned plant-based or vegan diet composed of minimally processed whole foods (i.e. a whole food plant-based diet) is nutritionally adequate when appropriate supplementation is included and has benefits for cardiometabolic health compared to a relatively healthy non-vegan diet.Full paperGREENHOUSE GAS EMISSIONS (GHG) FROM ANIMAL AGRICULTURE: Yet another study confirming the negative impact of animal agriculture on climate health. This paper provides an extensive analysis of the production and consumption-related GHG emissions around the globe from plant and animal foods, assessing the whole of the supply chain (farm to fork). The researchers built a database that provided GHG emission data of 171 crops and 16 animal products from more than 200 countries.Overall, food-related GHG emissions accounted for around 37% of total global emissions. The contribution of animal agriculture was found to be much greater than once thought and accounts for 57% of food system GHG emissions when all aspects of production and distribution are taken into account. The production of beef alone accounts for 25% of food-related emissions.South America was found to be the region with the largest share of animal-based food emissions, followed by south and south-east Asia and then China. Food-related emissions have grown rapidly in China and India as increasing wealth and cultural changes have led more younger people in these countries to adopt meat-based diets.Overall, GHG emissions from animal foods are twice that from plant foods. The main exception is rice, which is a source of methane when rice is grown in flooded paddies. There are ways of reducing methane production from rice, such as the System of Rice Intensification (SRI), but we can also help by eating a variety of grains rather than relying only on rice.Image sourceWhat was not calculated in the paper was the opportunity costs of lost carbon sequestration capacity of agricultural land that would otherwise revert to forest if allowed to return to its natural state. However, this paper from 2020 did just that. The study found that shifting to a vegan diet globally and releasing the land currently dedicated to producing food from animals back to nature would remove around ten years worth of fossil fuel emissions from the atmosphere, with the biggest gains would be made by high and middle-income countries.I applaud that more than 200 medical journals have simultaneously published an editorial, ‘Call for emergency action to limit global temperature increases, restore biodiversity, and protect health’, calling Government and leaders to act now and also calling healthcare professionals to action ‘As health professionals, we must do all we can to aid the transition to a sustainable, fairer, resilient, and healthier world’. However, diet is only mentioned once, with no acknowledgment of the urgent need to transition to a plant-based food system. Without food system and diet change we can not meet climate targets. Diet change could reduce GHG emissions immediately without the need for new technologies and health professionals can and should play a key part in making this happen.Please follow my organisation ‘plant-based health professionals UK’ on Instagram @plantbasedhealthprofessionals and facebook. You can support our work by joining as a member or making a donation via the website. Back To News

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Review of PBHP UK’s top publications from 2021It’s that time of year when I start to look back at the plant-based highlights of the year. This week I start with publications from the PBHP UK team in both popular and medical press. Full paperSUPPORTING PATIENTS: Healthcare professionals have been called to action. The climate and ecological crisis is also a health crisis. One of the clear solutions is to adopt a plant-based diet and as trusted members of society, healthcare professionals are well placed to support this transition through their interactions with patients and their communities. However, we hear all the time that doctors and allied health professionals learn very little clinical nutrition in their training and even the nutrition and dietetic professions have curricula based about around the typical omnivorous diet, with plant-based diets only being discussed in the context of ‘restrictive diets’ and ‘risk of nutritional deficiencies’.Health professionals don’t need to be experts, but we do need to understand the basics of a healthy, nutritionally adequate, plant-based diet. This article by Dr Laura Freeman, Dr Leila Dehghan and myself summarises some easy recommendations to support patients on their journey and sign posts to reputable resources (i.e. PBHP UK !). Full paperPLANT-BASED DIET AND PSORIATIC ARTHRITIS: It was an honour to be able to publish the case history of PBHP UK’s patient advocate, Kate Dunbar. She has been able to manage psoriatic arthritis, achieving a remission and coming off medication, with a whole food plant-based diet. Not only that, she is now part of the vegan runners club and has run half marathons. Pretty remarkable.Although the data supporting a plant-based diet for managing rheumatoid arthritis are stronger, there is no reason why it is not an optimal choice for psoriatic arthritis and indeed psoriasis alone. These conditions share in common underlying inflammation and disruption of the gut microbiome, both easily addressed with an anti-inflammatory, fibre-rich plant-based diet.The paper is behind a paywall, but you can read Kate’s story here from our website. We hope it inspires others with psoriasis to just give it a go. Absolutely nothing to lose and everything to gain. Full articleTRANSITIONING TO A PLANT-BASED DIET: With some basic knowledge and skills, Rohini Bajekal, Nutritionist, writes about the simplicity yet abundance of a whole food plant-based diet. This type of diet pattern is centred around a variety (that being key) of fruits, vegetables, whole grains, beans, nuts and seeds and plenty of herbs and spices. Mainly water for thirst and tea and coffee if you enjoy it. You do of course need to understand where to obtain certain nutrients such as iron, calcium and vitamin B12, but all diet patterns need an element of thoughtful consideration and planning.Along side Rohini’s article, you can take a look at our Plant-Based Eatwell guide, adapted from the UK dietary guideline, for a more in depth review. Then just take the plunge. You won’t regret it and you will benefit your long-term health no end. Full articleTRANSITIONING FROM A VEGETARIAN TO A VEGAN DIET: I had a long vegetarian phase (too long in retrospect) but found transitioning to a vegan diet quite straight forward. In part, because the South Asian diet pattern is easily adapted to a whole food plant-based diet. In addition, once you have acknowledged the unnecessary cruelty of the egg and dairy industry, there is no going back. For some, removing dairy, particularly cheese, and eggs from the diet may seem a challenge.Lisa Simon, RD gives a practical guide to swapping out eggs and dairy without feeling like you are missing out. There are so many milk, cheese and egg substitutes these day, both shop bought and recipes for home cooking. There really is no reasonable excuse not to make your diet cruelty free. You may even realise some benefits. Commonly reported ones are better skin, healthier weight, lower blood cholesterol and glucose, just to mention a few. Full articleIMPROVING HEALTH OUTCOMES IN SOUTH ASIANS: Rohini Bajekal and I are passionate about supporting South Asians to reduce our high risk of chronic disease. Heart disease and type 2 diabetes are at least twice as common is South Asians and occur a decade earlier than in Caucasian populations. India now has one of the highest and fastest rising rates of type 2 diabetes, with more than 10% of the population affected. A healthy plant-based diet is key to reducing this risk. Being vegetarian is clearly not enough. A whole food plant-based diet, low in added oil, salt and sugar is the optimal approach, whilst focusing on a variety of plant foods. Most South Asian diets have unfortunately become reliant on a handful of common foods and typically high in refined grains, sugar and oil (ghee). Interesting, India is now the largest producer of dairy in the world. This has been driven by industry influence and misleading advertising on the role of dairy in the diet. Given that the majority of the Indian population are lactose intolerant, this trend is rather nonsensical. In contrast, Indians in India are not eating enough fruit, vegetables and legumes.Rohini and I were interviewed by the European Heart Journal about our work at PBHP UK and why it is so relevant to South Asian populations around the world. Full articleREDUCING MEAT CONSUMPTION AND FOOD WASTE ARE IMPORTANT ISSUES: High income countries need to drastically reduce meat consumption to improve both human and planetary health. Food waste also remains a real issue globally, with around 30% of food wasted somewhere along the supply chain, with most wasted in our own homes. This is an area where we can all make a positive impact on the wider food system problems. Of course a plant-based diet is less wasteful in terms of land and water resource and also because you are going to the direct source of nutrients rather than using animals as a ‘go between’. The conversion of animal feed to final nutrients for humans is hugely inefficient.This article by Leila Dehghan, Nutritionist, outlines some easy ways to reduce meat consumption and food waste, including tips on how to shop and store your food. Full articleBENEFITS OF A WHOLE FOOD PLANT-BASED DIET: Although this information is well known to my audience, it’s great to have an evidence based article to share with friends, colleagues and family members. Dr Leila Dehghan, Nutritionist, provides a succinct summary of the numerous benefits of a healthy plant-based diets, also explaining the underlying mechanisms involved. The evidence is now overwhelming and largely undisputed. Supporting individuals and communities to implement this type of diet should be the focus of public health interventions. Full articleIS A VEGAN DIET HEALTHY?: We commonly hear in the media that a vegan diet is unhealthy. One such article was published recently in the New Scientist. Veganism is a social justice movement that centres animals at its core. It is not a diet but an ethical position that avoids the consumption and use of animals. A vegan diet can therefore be healthy or unhealthy depending on its composition. There is no doubt that choosing a healthy vegan diet composed of fruits, vegetables, whole grains, beans, nuts and seeds, whilst minimising added salt, sugar, oil and processed foods is one of the healthiest choices you can make. The overconsumption of processed foods is not a unique problem of a vegan diet, but all diet patterns. In the UK, more than 50% of purchases at the supermarket are classified as ultra-processed foods.In this article, Rosie Martin, plant-based RD, provides an excellent summary on how to ensure a vegan diet is healthy and one that is going to maximise your chances of achieving your best health, whilst reducing the risk of chronic disease. We do not need to compromise personal health when living a life true to our ethical values. Full articleVEGAN DIETS IN CHILDREN: This topic has been poorly covered in the mainstream media this year and now in a high impact medical journal. A BMJ journalist wrote about vegan diets for children referring to just one study of Polish vegans published in June 2021. Of course this study hit the mainstream media and I wrote about it in my weekly review on 13th June. It was disappointing that the author of BMJ article did not delve any deeper to provide a true reflection of the scientific literature. Despite the fact that vegans diets are deemed nutritionally adequate for all stages and ages of life, the article gives the impressive that a vegan diet may result in negative health outcomes for children. My rapid response tries to balance the article with a broader review of the available literature. Luckily its open access where as the original article is behind a paywall, thank goodness! Full articleIF NOT NOW THEN WHEN, IF NOT YOU THEN WHO. We all need to play our part in finding our way out of the most critical crises of our lifetime. Health professionals are not exempt. We have entered the sixth mass extinction event and the process is accelerating as I write. Many have realised that they are going to have to become ‘activists’ in their own right, in order for the message to be heard loud and clear. True respect to organisations such as Doctors for XR who are using the tried and testing method of civil disobedience. We all thank you.Our advocacy at PBHP UK focuses on a transition to a plant-based food system. In this article Dr Laura Freeman and I lay bare the facts and put out a call to action. We are so pleased that this is now in print in the December issue of the British Journal of General Practice.Please follow my organisation ‘plant-based health professionals UK’ on Instagram @plantbasedhealthprofessionals and facebook. You can support our work by joining as a member or making a donation via the website. Back To News

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