I work with at-home care patients as my second job and part of that work as their visiting nurse is to discuss lifestyle changes and health promoting activities, especially for patients who have chronic conditions, such as type 2 diabetes and heart disease. Living in an economically depressed area with a very high diabetic population, coupled with high poverty levels (all of my home care patients are funded through Medicaid), I wondered if the use of switching to a vegetarian or vegan diet as an intervention would provide any impact on risk reduction regarding heart attacks in adult obese patients who have type 2 diabetes.
Plant-based foods are cheaper than buying meat, milk, cheese, butter, etc. Also, as a therapeutic activity, many of my patients do some sort of container gardening on their porch, patio, or in their back yards. It would be easy for them to supplement their grocery income with vegetables grown in their containers from early spring through the fall.
I reviewed several studies which did conclude that there is strong inverse association between vegetarian and vegan lifestyles and heart attack risk in patients who have diabetes. The benefits of a wholly plant-based diet include reduction of BMI, Waist-hip ratio, lipid levels, as well as better control of blood sugar levels. I found this to be a very interesting study. I have always followed what is called an “omnivorous diet” and was somewhat skeptical of the vegan diet due to concerns regarding insufficient protein intake. The research indicates that there is low risk of protein deficiency, and that vegans are no more likely to require supplementation of minerals and vitamins than people following a standard diet.
Your research topic is fitting with current trends in society seeking healthier diets and lifestyles. Adjusting diet as a form of health promotion correlates with primary prevention techniques we as health care providers often provide education on. The findings of your research indicate a plant based diet reduces risk for heart attack. How would you propose implementing this type of intervention on a larger scale with the patients you have on a day-to-day basis?
Jennie,
I’d start with communication with their primary care provider to make certain that they are on board with this intervention. Then I’d focus on family and patient education regarding basic nutrition and showing how easy and inexpensive to prepare nutritious, healthy, vegetarian or vegan dishes can be. Many of my patients grew up eating beans, potatoes, and vegetables out of their garden, but their home care workers did not and have a harder time cooking “from scratch” than my patients did when they were able to cook. Educating the people who will be doing the food preparation is key. Also reassurance that the patient is at very low risk for protein deficiency is important.
Eating a whole-food, plant-based diet also falls in line with the recommendations from the American Diabetes Association regarding eliminating saturated fats, processed and sugary foods, as well as increasing fiber in the diet, (American Diabetes Association, 2016).
Discussion with the patient’s physician and following the results from lab work, as well as checking how the patients are feeling as they make dietary changes would be part of the ongoing process. I’d also ask them to prepare a food diary for review to take to their doctor or dietitian appointments to ensure that they are eating a large enough variety of foods.
When making major changes in lifestyle, encouragment and support from others is a key component.
American Diabetes Association. (2016). What can I eat? Arlington, VA. http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/
This poster is a reminder of the past. Dean Ornish, M.D. told of the benefits of limiting meat in the diet. Dr. Ornish states “even severe heart disease often can be reversed by changing diet and lifestyle, without drugs or surgery” He wrote a book call Eat More, Weigh Less. His book gave tips on how to make lifestyle changes without feeling hungry. This is not a vegan or vegetarian diet, but meat is limited. It does give tips on how to decrease fats such as rinsing hamburger meat after browned. It was noted that most people will not give up meat. The diet created by Dr Ornish is “based on the type of food rather than the amount of food.” Dr Ornish also provides gourmet recipes that contain 10% or less or fat(Ornish, 1993 pp. xv, 6).
This is a pertinent issue for healthcare and a 2020 goal to decrease obesity. Having dietitians available it is easy to not mention diet in many nursing areas. This is a great reminder of the importance of diet for all people.
Reference:
Ornish, D. (1993). Eat more, weigh less. New York, N.Y. HaperCollins Publishers.
Catherine,
I agree that because we have dietitians available in many healthcare settings, it is very easy to forget to talk about diet with patients. Also, it can be difficult to discuss during a primary care visit as there is only so much time during an appointment and care is typically focused on the chief complaint, but I think that is where our healthcare system is flawed. We really do need to take time to discuss diet, nutrition, and determine if there is ready availability of nutritious food for our patients.
Focusing more on preventive care is one of the Healthy People 2020 goals, including “Increas[ing] the proportion of physician office visits that include counseling or education related to nutrition or weight,” (Healthy People 2020, 2014). Other objectives include increasing the amount and variety of vegetables while decreasing fats and sugars in the diets of Americans.
Healthy People 2020. (2014). 2020 Topics & Objectives: Nutrition and Weight Status. Washington, DC. Retrieved from: https://www.healthypeople.gov/2020/topics-objectives/topic/nutrition-and-weight-status/objectives#4939
There are so many benefits noted in your poster and I personally believe that a limited meat diet is a healthier alternative. Bone health is however important as well and people who follow a vegan diet “may be at increased risk for developing low bone mass due to lack of adequate consumption of specific bone-benefiting nutrients found largely in animal products, such as calcium, vitamin D, protein, vitamin B12, zinc, and n-3 fatty acid” (Mangano, K.M., Tucker, K.L., 2017). Just like with protein, there are nutrient enriching foods within the vegan diet that promote bone health; it would all need planning and research.
Reference:
Mangano, K.M., Tucker, K.L. (2017). Bone health and vegan diets. Disease Prevention; Pages 315-331. Retrieved from: doi.org/10.1016/B978-0-12-803968-7.00017-4
I agree that a vegan diet would need to be well-managed and include as many diverse nutritionally dense foods as possible, especially since people can be what’s called a “junk food vegan” and eat mainly processed, starchy, low-nutrient density foods. They would have just as many health issues a would an omnivore with a nutrition-poor diet.
According to Sharon Palmer in an article in Today’s Dietitian, (Palmer, S., 2016) “calcium intake is much lower in Asia and Africa, due to the very low intake of dairy products, yet the prevalence of osteoporosis is much lower in these countries than in the United States and Europe. About 75% of the world’s population loses their lactose enzymes after weaning, raising the question about whether dairy products are essential to bone health.”
There are many plant-based foods with easy bio-availability of calcium, including turnip greens, collards, and kale, as well as calcium-set tofu. These greens are cheap to buy or can easily be grown in a small area of land. I agree that osteoporosis is a potential issue, especially for elderly people who are also not as physically active and able to perform weight-bearing exercises as easily as younger adults can.
As in any other diet which has been prescribed for health, the patient’s physician and dietitian or nutritionist should be highly involved to monitor and ensure that all needs are met.
Very good point!
Palmer, S., (2016). Protecting Bone Health Among Vegans. Today’s Dietitian, 7(2) p. 24. Spring City, PA. Retrieved from: http://www.todaysdietitian.com/newarchives/0216p24.shtml
Great job on the poster. The green was oddly visually appealing, especially in light of the topic. Your graphics drew me right in and made me want to read your information.
As someone who struggles with insulin resistance, I eat sugar-free and try to eat lean. I also have a family history of CAD, HTN & MI. Recently, several of my friends are going keto and I just can’t understand how they’re not increasing their cholesterol and CAD risk. One article I found looked specifically at elevated plasma branched-chain amino acids associated with diabetes risk. Changing to a plant and fish based diet has shown to decrease the presence of these amino acid chains (BCAAs) making this risk potentially modifiable. Interesting…
Elshorbagy, A., Jernerén, F., Basta, M. et al.(2017) Amino acid changes during transition to a vegan diet supplemented with fish in healthy humans. European Journal of Nutrition. 56: 1953. https://doi.org/10.1007/s00394-016-1237-6
Brandi,
I’ve struggled with my weight most of my life. My best friend has really good success with keto, but I do not. Her labs always come back in normal ranges, and her doctor encourages her to keep up with the keto diet. My cholesterol levels were moving up, where they’d always been low before trying it, so I decided that it was not in my best interest to continue.
I have first cousins who are about my age and weight and they’ve had heart attacks, diabetes, and one died from pulmonary embolism related to bariatric surgery. So far, I haven’t developed these issues yet, but my last health screening indicated my A1C was creeping up toward the pre-diabetes range.
In the last month or so, since we’ve also had a new cancer diagnosis in the immediate family, I’ve been exploring changes to my lifestyle to help reduce what cancer risks I am able, as well as working on weight reduction to help decrease the risk for developing diabetes.
That’s what got me looking into vegetarian / vegan diets and what I’ve been reading has me switching things up drastically, as a vegan diet also shows to be protective against a wide variety of cancers with a “10 to 12% reduction in overall cancer risk”, (Lanou & Svenson, 2011).
I’ve cut meat to two meals weekly, usually it is fish or chicken of some kind, prepared without oil or fats. I have severely limited my dairy intake by switching out dairy for nut-milks. I’ve never cared for eggs, so that was easy. As a long-time meat eater, it’s been relatively painless to cut back on it, plus my grocery bill is much smaller than it used to be using meat as a sort of “treat” instead of a dietary staple.
The interesting thing is that I actually feel better physically, so I’m giving this a trial with my doctor’s blessing. We’ll keep an eye on the labs to make sure I’m getting everything I need nutrition-wise, plus make sure that I’m improving in the areas that were getting out of hand.
Lanou, A. J., & Svenson, B. (2011). Reduced cancer risk in vegetarians: an analysis of recent reports. Cancer Management and Research, 3, 1–8. http://doi.org/10.2147/CMR.S6910