Diet Blamed for 1 out of 5 Deaths

According to a 2019 study led by Dr. Ashkan Afshin, an assistant professor at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in Seattle:

               One of every five deaths globally is attributable to suboptimal diet, more   than any other risk factor, including tobacco.

In 2017, poor diets were responsible for 11 million deaths.

That number breaks down to 22% of all adult deaths, with cardiovascular disease (CVD) as the leading cause, followed by cancers and diabetes.

Additionally, a suboptimal diet resulted in 255 million disability-adjusted life years (DALYs), which equals the sum of years lost and years lived with disability. Poor diet represents 16% of all DALYs among adults globally.

Why is that?

One of the reasons is food and nutritional insecurity.

Food and Nutritional Insecurity

You can’t scroll through social media these days without coming across something about how whole food plant-based diets are reversing atherosclerosis.

Seeing all those vibrant foods in beautifully staged videos or photos makes my mouth water.

Who wouldn’t want to come home after a long day at work to a whole food, organic, sustainably sourced meal? But, unfortunately, that’s only realistic for some people.

Unless you’re Beyonce and can afford to hire a personal chef, a personal shopper, or have your own private farmer tending your own personal organic garden, it’s nearly impossible to sustain such a diet.

But, my focus isn’t on expensive, organic foods. I’m talking about simple, real, old fashioned fruits and vegetables.

Food and nutritional insecurity is a critical element of chronic illness and obesity.

The Healthy People 2030 initiative, in its fifth iteration, defines food insecurity as:

“A household-level economic and social condition of limited or uncertain access to adequate food. In 2020, 13.8 million households were food insecure at some time during the year. Food insecurity does not necessarily cause hunger, but hunger is a possible outcome of food insecurity.”

It’s more about having access to nutritional food and being able to store and prepare it properly than it is about having food.

Do you think America’s food banks regularly stock cauliflower sandwich thins and Beyond Burgers? Instead, they’re jam-packed with Kraft Macaroni and Cheese and canned soups.

I have volunteered at some food banks and seen hardly nutritious choices loaded with sodium, sugar, and fat. All the culprits of chronic disease. It’s a recipe for disaster.

Let’s be honest. There’s a significant amount of people who need more access to nutritious food. Relative to their:

• Location
• Economic status.

 They may have barriers to obtaining nutritious food and:

• Need transportation.
• Need money. 
• Have low health literacy.
• Living in homeless shelters.
• Home-bound.
• Victims of domestic violence.

Many people have time constraints because of their work-school-childcare or eldercare obligations.

Many need more adequate kitchen appliances for refrigeration or cooking.

Many don’t know how to cook.

Many need higher health literacy as it relates to nutrition.

And that is just the butt ugly truth.

We know that:

• Food insecurity is a social determinant of health.

• Whole food plant-based diets are associated with reducing the risk of chronic diseases.

• A diet containing large amounts of sugar, salt, cholesterol, and fat can increase the risk of diabetes mellitus, high blood pressure, hyperlipidemia, obesity, and coronary artery disease.

Recent research suggests that lifestyle management that includes a diet of primarily plants may help prevent and reverse CAD, among other chronic diseases.

But are we bringing nutritious food to people in need?

I am well-traveled. I have seen a lot. But you don’t have to be a genius to notice where the healthy food is. … or isn’t. It’s not in the inner cities or the small rural towns.

McDonald’s calls it the “Dollar Menu” for a reason.

Have you ever visited a Wendy’s or Burger King during the day? Fast food companies target older citizens with special pricing making this an irresistible and inexpensive meal, leading them to ignore dietary restrictions.

Just because Nana loves Burger King doesn’t mean she should be eating it four times a week. So, is it a surprise when Nana has elephant legs and gets out of breath just dressing herself? 

That’s a hospital RE-admission and Class IV heart failure diagnosis!

Food Deserts and Food Swamps

Food deserts are areas that lack affordable, nutritious foods:

• Locations in urban or suburban neighborhoods, often lower-income neighborhoods, need more grocery stores offering healthy food choices.
• Rural areas are isolated from shopping centers that offer healthy food choices.

Food swamps are urban, suburban, and rural areas overwhelmed with access to unhealthy, calorie-dense, and inexpensive junk foods, fast foods, and other high-fat, salt, and sugar foods. Food swamps:

• Are a predictor of obesity, especially in communities with limited access to public transportation.

So, how are we bringing the food to the people?

Approaches to Food Insecurity

In September 2022, the Biden Administration revealed a plan to address food and nutrition insecurity. The project expands Medicare and Medicaid roles in providing nutrition and weight loss counseling and supports legislation to pilot Food-as-Medicine programs.

Private insurers can also expect to play a role in solving food insecurity and food-related illness. Additional strategies include:

• Federal healthcare systems will screen for food insecurity
• Incentivize payers and providers to screen for food insecurity, including new procedure codes.

• Increase food affordability, physical activity, and research aimed at reducing sodium, fat, and sugar consumption.
• Invest in parks and outdoor spaces for physical activity.
• Increase funding for food insecurity and nutrition research.
• CMS will implement quality measures, likely tied to reimbursement.

Many complex approaches are necessary for reducing food and nutrition insecurity in the U.S.

• Engaging communities in local health programs; for example, addressing gaps between food access and intake.
• Redesign and utilize the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutritional Program for Women, Infants, and Children (WIC) programs.
• Coordinated efforts between retailers to enable tactical healthy food placement, promotion, and prices to influence healthier choices.
• Consider taxing sweetened beverages and junk food to discourage consumers and removing taxes on fruit, vegetables, and water to entice them.

Follow The Science

In a 2015 study, researchers found that plant-based nutrition can prevent diabetes, high blood pressure, and cardiovascular events.

In the same study, people who frequently consume red meat, compared with people who eat less red meat and consume more fruit and vegetables; the latter showed to have lower body mass index, lower systolic blood pressure, lower serum levels of LDL, and thinner vessel walls, indicating less plaque.

If a plant-based diet reduces atherogenesis and atherothrombotic CAD, I’d say it’s safe to refer to food as medicine. 

Thank God we have an arsenal of great medications to lower cholesterol. But wouldn’t it be favorable to offer a safe, effective alternative without the side effects?

Now, about 90% of Americans love their juicy steaks and aren’t going to give them up. However, even reducing meat intake proved beneficial in reducing risk factors.

Gut Microbiota

There’s a lot of data floating around about gut microbiota. I am not getting in those weeds; I’ll tell you this: Humans have trillions of microbes, especially bacteria, that reside in the gut.

Most microbes in the body are helpful, but they may become harmful when out of balance. For example, overeating red meat throws off the gut microbiota.

When we eat red meat, our gut bacteria convert a certain phospholipid to a metabolite, TMAO (or trimethylamine N-oxide). In humans, elevated levels of TMAO are associated with an increased risk for major adverse cardiovascular events (MACE) such as heart attack and death.

If we develop a plant-based diet microbiota, our bacteria will not convert phosphatidylcholine to TMAO, even with occasional meat consumption. Additionally, the study data suggest that polyphenols from fresh fruits and vegetables increased survival.

Reducing red meat intake can keep TMAO in check. Therefore a diet high in fruit and vegetables and low consumption of red meat is optimal. 

A plant-based diet may be a lower-cost intervention to prevent and reverse atherosclerotic CAD compared to life-long medical therapy, repeat hospitalizations, angioplasty with stent placement, and open heart surgery. Therefore, prevention and lifestyle management are always preferred and essential for disease prevention.

What Are Healthcare Organizations Doing to Address Food Insecurity?

The  Food Policy Review and Intervention Cost-Effectiveness (Food-PRICE) research initiative collaborates to identify cost-effective nutrition strategies to improve health in the United States. 

The research team modeled healthy food prescriptions’ health and economic effects, experimenting with Medicare and Medicaid patients. The team used two separate models, both with 30% coverage:

• Fruit and vegetable
• Fruits, vegetables, whole grains, nuts, seeds, seafood, and plant-based oils.  

Study data from this research found that using health insurance coverage to offset the cost of healthy food for Medicare and Medicaid patients would reduce healthcare utilization, improve outcomes and be vastly cost-effective after five years.

The 2018 Farm Bill includes a $25 million Produce Prescription Program, while private insurance companies are also now considering food prescription plans.

The idea is to have a healthcare provider determine eligibility, typically low-income, food insecure with diet-related health conditions such as diabetes, obesity, and hypertension. The provider’s innate credibility legitimizes and reinforces the importance of a mainly plant-based diet for preventing and treating chronic diseases.

Home-bound patients can have fresh produce dispensed directly from the healthcare center or delivered to their homes. In addition, fruit and vegetable vouchers or produce prescriptions for redemption at specific produce retailers or farmers’ markets will guide people to healthier eating.

Both study models estimated that a healthy food program would improve health and reduce healthcare utilization over a lifetime.

The fruit and vegetable-only model could prevent 1.93 million cardiovascular diseases (CVD)  cases.

The more comprehensive healthy food model that included whole grains, nuts, seeds, seafood, and plant-based oils, would prevent 3.28 million CVD cases and 120,000 diabetes cases.

Both models are estimated to save $39.7 billion and $100.2 billion, respectively, in healthcare costs. 

That’s some very compelling data.

What about the genetic factor? No matter how much fruit and vegetables you eat or how many marathons you run, you’re still making plaque and will be at risk for a heart attack because your father died of one at age 41. And he never smoked.

I’ll be addressing genetics in a future post.

Prevention and lifestyle management are always primary in reducing risk regardless of genetic factors.

And yeah, thank God for statins and stents!

Fortunately, it turns out; you don’t need expensive cauliflower sandwich thins and beyond burgers to sustain a healthy diet. Instead, reduce red meat and eat fruit and vegetables. Eat real food. 

So to wrap this up, happening now in five states and Washington, D.C.:

Wholesome Wave’s Fruit and Vegetable Rx Program (FVRx)

Wholesome Wave is a non-profit that links healthcare providers and local food producers to families with diet-related illnesses.

During an intake visit, patients are screened and receive a FVRx prescription—prescriptions for redemption at participating retailers. Participants then attend monthly clinic visits to refill their prescriptions, review health indicators and set new goals.

Contact Wholesome Wave to find out how your organization can become a partner! Brent@wholesomewave.org

To all healthcare providers and stakeholders who love to talk about plant-based diets, and show pretty pictures of them, I challenge you to do your part to combat food insecurity.

Make a move and do something real for your communities.

Sources

The Lancet. Health effects of dietary risks in 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Published, April 3, 2019. Accessed, May 8, 2023.

Tufts Now. Food as Medicine Prescriptions Could Be Good For Health and Budgets. Published, March 19, 2019. Accessed, May 9, 2023.

National Library of Medicine.Trimethylamine N-Oxide: The Good, the Bad, and the Unknown. Published November 8, 2016. Accessed, May 9, 2023.

 National Institute of Minority Health and Health Disparities. Food Accessibility, Insecurity, and Health Outcomes. Revised, April 26, 2023. Accessed, May 9, 2023.

Oxford Academic. A “Food as Medicine” Program and Its Effects on Healthy Eating and Cooking Confidence. Published, June 1, 2019. Accessed, May 9, 2023.

National Library of Medicine. A Plant-Based Diet, Atherogenesis and Cardiovascular Disease Prevention. Published 2015. Accessed, May 9, 2023.

WhiteHouse.gov. White House National Strategy for Food Insecurity. Published, September 27, 2022. Accessed, May 9, 2023.

British Medical Journal. Food is medicine: actions to integrate food and nutrition into healthcare.Published, June 29, 2020. Accessed, May 8, 2023.

U.S. Department of Health and Human Services. Healthy People 2030: Food Insecurity. Accessed, May 8, 2023.