Health Tips From The Professor The Economic Benefits of Plant-Based Diets

Could Plant-Based Diets Cut Healthcare Costs?

Author: Dr. Stephen Chaney

 

Could saving the healthcare system be one of the economic benefits of plant-based diets?

economic benefits of plant-based diets healthcare system costsI don’t need to tell you that our healthcare system is in crisis. Costs are out of control. The Centers for Medicare and Medicaid Services (CMS) estimates that healthcare costs will account for 25% of the gross domestic product by 2025. They also predict that 47% of that spending will be financed by federal. State, and local governments. That is unsustainable.

Our politicians have no answer. Neither political party has a viable plan to cut costs. Perhaps it is time to take matters into our own hands. What if there were a way to improve our own health and the viability of our healthcare system? A recent study suggests there may be a way to accomplish both goals.

How Was The Study Done?

In a recent study (L. Annemans and J. Schepers, Nutrition, 48: 24-32, 2018 ) scientist at Ghent university in Belgium set out to investigate the effect on public health and healthcare costs if just 10% of the population of Belgium and England switched to a primarily plant-based diet. They started with two diets for which the health benefits have been well established by multiple studies. These diets are:

economic benefits of plant-based diets soy#1: A Soy-Containing Diet: This is defined as a diet in which soy protein foods were consumed in place of animal protein foods more than 5 times per week. The soy foods included in their study were soybeans, tofu, miso, soy protein drinks, and soy yoghurt.

The soy-containing diet was chosen because previous studies have shown it protects against obesity, heart disease, stroke, diabetes, and breast, colon, stomach, lung, and prostate cancer.  (Yes. In spite of the erroneous information you find on the internet, soy foods decrease cancer risk.)

#2: The Mediterranean Diet: This is defined as a diet rich in fruits, vegetables, whole grains, nuts, seeds and large amounts of olive oil. It includes a moderate to high consumption of fish and other seafood and a low intake of meat and dairy products.

economic benefits of plant-based diets mediterranean dietsThe Mediterranean diet was chosen because previous studies have shown it protects against heart disease, stroke, diabetes, and breast cancer. I have documented these health benefits in more detail in my book “Slaying The Food Myths.”

This study did not look at the benefits of other plant-based diets. For example, as discussed in “Slaying The Food Myths,” the Seventh-Day Adventist studies have shown comparable health benefit for a variety of vegetarian diets.

This study looked at the prevalence of each of these diseases in Belgium and England and estimated what the effect would be if the prevalence of these diseases were reduced by the amounts reported in previous studies of soy-based and Mediterranean diets.

The study reported two outcomes: the increase in Quality of Life Years (QALYs) and the decrease in healthcare costs. Increased Quality of Life Years simply means the increase in disease-free years. That is the outcome most important to each of us personally. However, we should be equally interested in the decreased healthcare costs. The dollars our government spends on healthcare don’t grow on trees. They come out of our pockets.

 

Economic Benefits of Plant-Based Diets: Decreasing Healthcare Costs?

 

economic benefits of plant-based dietsWith that buildup, you are probably wondering what the outcome of the study was. The news was good:

If 10% of the population switched to a soy-based diet there would be:

  • An increase of 154 Quality of Life Years/1,000 people and a decrease in healthcare costs of $1.9 billion/20 years in Belgium.
  • An increase of 130 Quality of Life Years/1,000 people and a decrease in healthcare costs of $10.7 billion/20 years in England.

If 10% of the population switched to a Mediterranean diet there would be:

  • An increase of 166 Quality of Life Years/1,000 people and a decrease in healthcare costs of $1.6 billion/20 years in Belgium.
  • An increase of 116 Quality of Life Years/1,000 people and a decrease in healthcare costs of $7.4 billion/20 years in England.

[Note: In case you were wondering, the authors said the reason why plant-based diets had less of an effect on Quality of Life Years in England than in Belgium is because public health interventions have already significantly decreased the incidence of heart attack and stroke in England. Conversely, the reason healthcare savings are higher in England is because healthcare costs are higher there.]

Finally, if one were to extrapolate the British healthcare savings to the costs of the US healthcare system, one would predict:

  • If 10% of the US population were to switch to a soy-based diet, healthcare savings might amount to $17 billion/20 years.
  • If 10% of the US population were to switch to a Mediterranean diet, healthcare savings might amount to $12 billion/20 years.

The authors concluded: “The result of the present analysis suggests that both a soy-containing diet and the Mediterranean diet could contribute to health promotion because they are predicted to lead to substantial health benefits and societal savings.”

How Accurate Are These Estimates?

The benefits of soy-based and Mediterranean diets on which these estimates are based are very solid. The benefits are based on association studies, but the studies are very well done and are remarkably consistent.

The major weakness of these estimates is the benefits of these diets have been demonstrated in other parts of the world and are being extrapolated to a region of the world where neither of those diets are commonly followed. The authors tried very hard to control for all confounding variables, but the possibility remains that lifestyle differences unique to those geographic regions also contributed to the health benefits of soy-based and Mediterranean diets.

The authors acknowledged that some of the foods that are normally part of soy-based and Mediterranean diets were not as readily available in Belgium and England. They raised the possibility that something like the “New Nordic Diet”, which is also primarily plant-based but incorporates more familiar foods, might be equally effective. The equivalent diet in the US might be the DASH diet.

The economic benefits of plant-based diets may not depend so much on the diet, as long as it is plant-based and those foods are readily available.

 

The Bottom Line:

 

A recent study looked at the effect of a plant-based diet on Quality Of Life Years (disease free years) and healthcare costs in Belgium and England. The study estimated:

If 10% of the population switched to a soy-based diet there would be:

  • An increase of 154 Quality of Life Years/1,000 people and a decrease in healthcare costs of $1.9 billion/20 years in Belgium.
  • An increase of 130 Quality of Life Years/1,000 people and a decrease in healthcare costs of $10.7 billion/20 years in England.

If 10% of the population switched to a Mediterranean diet there would be:

  • An increase of 166 Quality of Life Years/1,000 people and a decrease in healthcare costs of $1.6 billion/20 years in Belgium.
  • An increase of 116 Quality of Life Years/1,000 people and a decrease in healthcare costs of $7.4 billion/20 years in England.

If one were to extrapolate the British healthcare savings to the costs of the US healthcare system, one would predict:

  • If 10% of the US population were to switch to a soy-based diet, healthcare savings might amount to $17 billion/20 years.
  • If 10% of the US population were to switch to a Mediterranean diet, healthcare savings might amount to $12 billion/20 years.

The authors concluded: “The result of the present analysis suggests that both a soy-containing diet and the Mediterranean diet could contribute to health promotion because they are predicted to lead to substantial health benefits and societal savings.”

For more details, read the article above:

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Health Tips From The Professor Protein and Heart Disease: Meat vs Plant-Based

Does Meat Protein Increase Heart Disease Risk?

Author: Dr. Stephen Chaney

 

Is a plant-based diet better than eating meat when it comes to protein and heart disease?

protein and heart disease plant-basedThere are a multitude of studies showing the long-term health benefits of plant-based diets. Among the best of these studies are the Seventh-Day Adventist Studies. That’s because the Adventist church advocates a vegan diet but allows personal choice. This means Seventh-Day Adventists eat a more plant-based diet than most Americans. However, there is also significant variation in the diet of Adventists.

 

Not all Adventists are vegans. Significant numbers of Adventists choose lacto-ovo-vegetarian (dairy, eggs & vegetarian), pesco-vegetarian (fish & vegetarian), and semi-vegetarian (meat & vegetarian).

Because of this variation, Adventists provide a rich database for clinical studies. You can compare health outcomes of a vegetarian diet to the standard American diet by comparing Adventists to the non-Adventist population living in the same area. You can also use the Adventist population to compare the health outcomes of the various types of vegetarian diets.

I have described the Adventist Health Studies in detail in my new book, Slaying The Food Myths. Let me briefly summarize the results with an emphasis on heart disease risk:

  • Compared to the standard American Diet, vegetarian diets decrease cardiovascular deaths by 41% in men and 51% in women.
  • The reduction in cardiovascular death is greater for vegans than for lacto-ovo-vegetarians.
  • If we look at the average of multiple studies, the risk of heart disease, diabetes, and cancer is less for vegans than for lacto-ovo-vegetarians, which is less than the risk for pesco-vegetarians, which is less than the risk for semi-vegetarians, which is much less than the risk for people consuming the standard American diet.

There are multiple reasons why vegetarian diets decrease the risk of heart disease compared to the standard American diet. These will be discussed below. The current study was designed to look at the proteins found in vegetarian and non-vegetarian diets and ask what effect these proteins had on heart disease.  This was a good study of protein and heart disease.

How Was The Study Done?

protein and heart disease heart healthThis study (M. Tharrey et al, International Journal of Epidemiology, 2018, 1-10 doi: 10.1093/ije/dyy030 ) utilized a database of 81,337 men and women over age 25 who were enrolled in the Adventist Health Study-2 between 2002 and 2007.

At the time of enrollment, a very detailed food frequency questionnaire was administered. The participants were divided into groups based on the most prevalent protein source in their diet as follows:

  • Grains: This group averaged 44% of their protein intake from grains.
  • Processed foods: This category included protein from cheese, eggs, and milk. However, it also included processed plant proteins and protein from cold breakfast cereals.
  • Meats: The largest protein contributors to this category were red meat, processed meat, and poultry. Fish made only a minor contribution.
  • LFV (Legumes, fruits & vegetables): Legumes were the biggest protein contributors in this category.
  • Nuts and seeds: This included peanuts, tree nuts and seeds.

The participants in the study were followed for an average of 9.4 years during which there were 2276 cardiovascular deaths. The study then asked what effect protein intake from each of these food groups had on cardiovascular risk.

 

Meat Protein and Heart Disease?

 

protein and heart disease meatsSome of the findings from this study were expected, but some were surprising. When studying protein and heart disease for example:

  • When they compared people getting the most protein from meat with those getting the least (24% versus 1% of their protein intake from meat), the risk of cardiovascular death was increased by 61%. This is consistent with several previous studies suggesting that meat, particularly red meat, increases the risk of heart disease.
  • When they compared people getting the most protein from nuts and seeds with those getting the least (18% versus 2%), the risk of cardiovascular death was decreased by 40%. Again, this is consistent with previous studies suggesting that nuts and seeds reduce the risk of heart disease.
  • They found no significant effect of protein intake from grains on cardiovascular death. This could be considered as surprising because whole grains are an excellent source of fiber, which reduces the risk of heart disease. However, the difference in protein intake between the groups getting the most protein from grains versus the least was relatively small (34% versus 19%). In addition, the study did not differentiate between whole grains and refined grains.
  • There was a slight, but non-significant, increased risk of cardiovascular death for people getting the highest amount of protein from processed foods. This is also a bit surprising. It may be because the survey included both meat-based and vegetarian processed foods in the processed foods classification, and there are many processed foods that are marketed specifically to vegetarians.
  • There was also no significant effect of protein from legumes, fruits and vegetables on cardiovascular death. This is also surprising and will be discussed below.

The authors concluded “Our results suggest that healthy choices can be advocated based on protein sources, specifically preferring diets low in meat intake and with a higher intake of plant proteins from nuts and seeds.”

What Does This Mean For You?

protein and heart disease nuts and seedsThis study does not fundamentally alter what we know about diet and heart disease risk. That is because this study focused solely on the protein and heart disease not on the foods and heart disease. The data were statistically corrected for every other beneficial and detrimental effect of those foods. For example:

  • The people in this study with the highest intake of processed foods were more likely to be overweight and physically inactive. They were also more likely to be smokers. These factors increase the risk of cardiovascular disease. However, the data were statistically adjusted to remove these considerations from the analysis.
  • The people in this study with the highest intake of whole grains, legumes, fruits and vegetables also had the highest intake of fiber, antioxidants, and B vitamins. These factors decrease the risk of heart disease. However, the data were statistically adjusted to remove these considerations from the analysis.

In short, processed foods are still probably bad for the heart, but that is not due to the protein component of processed foods. Similarly, whole grains, legumes, fruits, and vegetables are still good for the heart, but it is not the protein component of these foods that conveys the heart-healthy benefits.

Where the study breaks new ground and leaves some unanswered questions is with the effect of meat, nuts, and seeds on heart disease risk. For example:

  • The American Heart Association has recently released a Presidential Advisory statement warning that the saturated fat in meats increases heart disease risk. However, the data in the present study were statistically adjusted to remove the effect of saturated fat from the analysis. Thus, this study suggests that the protein in red meat also contributes to heart disease risk. If this is confirmed by subsequent studies, it is an important advance. It might mean, for example, that grass-fed beef is no healthier than conventionally raised beef.

However, it is unclear why meat protein increases heart disease risk. One recent study has suggested that meat-based diets favor a population of gut bacteria that metabolize a compound called carnitine, also found in meat, into a metabolite that increases heart disease risk. However, this mechanism has not yet been confirmed.

[Note: The effects of saturated fats and carnitine on heart disease risk are covered in detail in my new book “Slaying the Food Myths.” In my book I carefully analyze the arguments of saturated fat proponents as well as saturated fat opponents.]

  • Conventional wisdom has attributed the heart health benefits of nuts and seeds to their omega-3 fatty acids. However, the data in this study were statistically adjusted to remove the effect of omega-3 fatty acids from the analysis. Thus, this study suggests that the protein in nuts and seeds decreases heart disease risk.

Once again, the mechanism of this effect is unclear. The authors suggest it might be due to higher levels of the amino acids glutamate and arginine in seed and nut protein. However, these two amino acids are abundant in a variety of plant-based proteins. Their presence in nut and seed proteins would not appear to be sufficient to confer a special heart health benefit.

In short, this is the first study of this kind and the mechanisms of the effects described are unclear. Thus, one cannot yet definitively claim that meat protein is bad for the heart and nut and seed proteins are good for the heart.

Whether it is the protein component of these foods that affects heart health is relatively unimportant. It does not change what we know about diet and heart health. As discussed in “Slaying The Food Myths,” multiple studies show that meat-based diets increase heart disease risk and primarily plant-based diets decrease heart disease risk. Multiple studies also show that nuts and seeds decrease heart disease risk.

 

The Bottom Line:

 

A recent study looked at the effect of the protein content of various foods on heart disease risk. The study reported:

  • Meat protein increased the risk of cardiovascular deaths by 61%.
  • Proteins from nuts and seeds decreased the risk of heart disease deaths by 40%.
  • Proteins from processed foods, grains, legumes, fruits, and vegetables had no effect on cardiovascular deaths.

This study does not fundamentally alter what we know about diet and heart disease risk. That is because this study focused solely on the protein component of various foods rather than the foods themselves. The data were statistically corrected for every other beneficial and detrimental effect of those foods. Because of that:

  • Processed foods are still probably bad for the heart
  • Whole grains, legumes, fruits and vegetables are still good for the heart.
  • Meat, especially red meat, is probably bad for the heart, while nuts and seeds are good for the heart.

The major new information provided by this study is that:

  • The increased risk of heart disease associated with meats is not just due to their saturated fat content. Meat protein may also increase heart disease risk. If confirmed by subsequent studies, this is an important finding because it suggests that lean cuts of meat and grass-fed beef may not eliminate heart disease risk.
  • The decreased risk of heart disease associated with nuts and seeds is not just due to their omega-3 content. Nut and seed proteins may also decrease heart disease risk.

For more details, read the article above:

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.