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Life & Times

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

Shireen Kassam, Leila Dehghan and Laura Freeman
British Journal of General Practice 2021; 71 (704): 127. DOI: https://doi.org/10.3399/bjgp21X715121
Shireen Kassam
Consultant Haematologist, lifestyle medicine physician, and founder of Plant-Based Health Professionals UK. Email: @plantbasedhpuk
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  • For correspondence: shireen.kassam@nhs.net
Leila Dehghan
Doctor-turned-Nutritionist and a member of the Advisory Board for Plant-Based Health Professionals UK.
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Laura Freeman
Dual licensed GP, Lifestyle Medicine Physician, and Medical Director of Plant-Based Health Online:
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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 compared to any other single driver of climate change.1

International consensus supports a global transition to a plant-based diet as an urgent imperative. The Eat-Lancet Commission on Food, Planet, Health2 evaluated the best available science and developed recommendations for a global healthy reference diet, termed the ‘Planetary Health Diet’ (https://eatforum.org/learn-and-discover/the-planetary-health-diet).

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 that it could prevent 11 million deaths annually from diet-related illnesses.2 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.3

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.4 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 ingrained 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.5 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.

PATIENT ADVICE

Some straightforward advice to give your patients could include:

  • 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.

  • For main meals, swap out meat for beans, pulses, lentils, or chickpeas. For example, bean chilli, lentil bolognese, or tofu curry.

  • Swap out refined grains for whole grains; brown rice, whole wheat bread, pasta and couscous, bulgur and buckwheat.

  • Learn to make a variety of soups using different vegetables. Add beans or lentils to increase the protein and fibre content even further.

  • Learn to love big salads. Add beans, lentils, or tofu, and top with seeds.

  • Aim for 10 portions of fruits and vegetables daily, including as snacks.

  • Eat a 30 g portion of nuts on most days.

  • Calcium-set tofu is a rich source of calcium, as are leafy greens, beans, fortified plant milks, and yogurts.

  • 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.

  • Don’t forget iodine. It is present in sea vegetables and seaweeds, but their content is variable and if not consumed regularly a daily 150 mcg supplement is appropriate.

  • On a 100% plant-based diet, a B12 supplement is required; 25–100 mcg daily or 2000 mcg weekly.

  • In the winter months, or if sun exposure is inadequate, everyone in the UK should consider taking a vitamin D3 supplement.

  • 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.

  • 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 (for example, https://plantbasedhealthprofessionals.com) to help health professionals guide patients and community groups providing support (for example, https://madeinhackney.org). 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.

Footnotes

  • This article was first posted on BJGP Life on 30 December 2020; https://bjgplife.com/plant-based

  • © British Journal of General Practice 2021

REFERENCES

  1. 1.↵
    1. Poore J,
    2. Nemecek T
    (2018) Reducing food’s environmental impacts through producers and consumers. Science 360, 6392, 987–992.
    OpenUrlAbstract/FREE Full Text
  2. 2.↵
    1. Willett W,
    2. Rockström J,
    3. Loken B,
    4. et al.
    (2019) Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems. Lancet 393, 10170, 447–492.
    OpenUrlCrossRefPubMed
  3. 3.↵
    1. Wonca
    (2019) Declaration Calling for Family Doctors of the World to Act on Planetary Health (Wonca).
  4. 4.↵
    1. Hever J
    (2016) Plant-based diets: a physician’s guide. Perm J 20, 3, 15–082.
    OpenUrlCrossRefPubMed
  5. 5.↵
    (2017) British Dietetic Association confirms well-planned vegan diets can support healthy living in people of all ages (British Dietetic Association).
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British Journal of General Practice: 71 (704)
British Journal of General Practice
Vol. 71, Issue 704
March 2021
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How to help patients transition to a healthy and sustainable plant-based diet
Shireen Kassam, Leila Dehghan, Laura Freeman
British Journal of General Practice 2021; 71 (704): 127. DOI: 10.3399/bjgp21X715121

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How to help patients transition to a healthy and sustainable plant-based diet
Shireen Kassam, Leila Dehghan, Laura Freeman
British Journal of General Practice 2021; 71 (704): 127. DOI: 10.3399/bjgp21X715121
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