Is a plantbased. complete? Dr. Conor Kerley PhD, BSc, H. Dip, MINDI

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1 Is a plantbased diet complete? Dr. Conor Kerley PhD, BSc, H. Dip, MINDI

2 For the socialites Twitter Facebook

3 Conor Kerley PhD Graduated from Trinity College, Dublin in Human Nutrition and Dietetics in 2010 PhD with the UCD School of Medicine and Medical Sciences An active member of several professional societies, including the INDI, Nutrition Society, Irish BP Council Lecturer in DIT Content manager at T. Colin Campbell Center for Nutrition Studies

4 July 2016 ICNM Washington DC PCRM

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10 Insufficient micronutrient intake has short term and long term implications for disease risk E.g. immune function is adversely affected by poor intakes of nearly every essential vitamin and mineral (Corman 1985)

11 Inadequate micronutrient intake: Short term Long term Increased risk of infection Increased risk of heart disease Increased risk of cancer

12 Nutrients and plant based nutrition

13 Talk outline 1. Components not found in plant foods 2. Nutrients of concern on plant based diets 3. Nutrients of abundance on plant based diets

14 Components not found in plant foods

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16 Cholesterol Vitamin A Vitamin D 3 Vitamin B12

17 Cholesterol

18 Essential to humans Cholesterol Human cell walls and some hormones made of cholesterol! e.g. testosterone estrogens vitamin D

19 Cholesterol Found in every single animal based food Not found in any plant based food

20 Cholesterol Made by our liver à no dietary need!!! Dietary cholesterol may be unhealthy!

21 Vitamin A

22 Vitamin A Important for: Bone growth, Cell division & differentiation, Immunity

23 Vitamin A Deficiency Total or night blindness à Very rare in the developed world! May: increase infection risk; decrease growth rate; slow bone development; àvery rare in the developed world!

24 Vitamin A

25 β-carotene

26 Too much vitamin A Impairs the effect of vitamin D (Johansson & Melihus 2001) Consumption of moderate amounts of retinol may cause bone toxicity (Penniston & Tanumihardo 2006) Excess vitamin A increases death rate by 16% (Bjelakovic et al 2008) In developed countries, vitamin A toxicity is much more common than vitamin A deficiency (Hathcock et al 1990)

27 Vitamin A toxicity Reduced bone mineral density; Birth defects, Liver abnormalities, Central nervous system disorders à pregnant women shouldn t eat liver!

28 Can t get too much β-carotene!

29 Vitamin D

30 Vitamin D Maintenance of normal blood levels of calcium and phosphorus; Promotes bone mineralization; Regulates cell growth & differentiation, Immune function

31 D 2 vs. D 3 Vitamin D 2 (Ergocalciferol) n Made commercially by irradiating & purifying ergosterol extracted from yeast n UV irradiated mushrooms Less effective than D 3 (Trang et al 1998; Armas et al 2004; Houghton & Vieth 2006; Zarowitz 2008). Vitamin D 3 (cholecalciferol) n Produced in the skin on exposure to UVB radiation from sunlight n Animal foods/certain supplements Substantially more potent than D 2 (Romagnoli et al 2008; Heaney 2010) Less bioavailabiltiy, poorer stability & shorter duration of action (Armas 2004; Zarowitz 2008)

32 2500 Vitamin D Sources Swiss cheese (28g) Beef liver Whole egg Fortified cereal Fortified margarine Fortified milk Tinned sardines Cooked mackerel Cooked salmon RDA Supplement

33 Vitamin D Sources

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35 In Winter No sun in Ireland = no vitamin D production Can be a good idea to supplement e.g. 1,000iu vitamin D per day

36 Vitamin B12

37 Vitamin B12 blood formation neurologic function

38 Vitamin B12 Not made by humans or plants or animals! Made by micro-organisms found in soil or intestines including human intestines!

39 Vegans & vegetarians USA UK 60% Elmadfa & Singer % Gilsing et al 2010 Had B12 deficiency

40 Vitamin B12 No reliable natural plant source of vitamin B12! Need to ensure a steady supply Regularly eat foods fortified with B12 e.g. soy, cereal etc. Supplement on a daily or weekly basis

41 Other nutrients of concern on plant based diets

42 Other nutrients of concern in plant based diets Calcium Iodine Iron Zinc N-3 fatty acids Protein

43 Calcium

44 Component of teeth and bones; Blood vessel, Muscle function, Nerve function

45 Calcium Green veg: broccoli, bok choy, kale, collard greens Beans soybeans, chickpeas, pinto beans Sesame seeds Tofu Oranges, berries, apricots, figs, dates Fortified plant milks, cereals etc.

46 Calcium Compared to those eating an omnivorous diet there is Some evidence: that those eating plant based diets need less calcium those eating plant based diets have healthy bones

47 Bone health

48 Iodine

49 Iodine Component of the thyroid hormones thyroxine (T4) and triiodothyronine (T3) Helps regulates metabolism

50 Iodine deficiency Mental retardation, goiter, cretinism, Too much & too little iodine affect thyroid function and metabolism

51 Iodine Found in the sea! à Grown in or near the sea contains iodine: Seaweed Iodine salt Kelp supplements * Iodine supplements (esp pregnancy)

52 Iron

53 Iron Heme proteins Component of enzymes necessary for metabolism

54 Iron deficiency à iron deficiency anaemia à physical and mental fatigue

55 Heme iron Non heme iron

56 Heme iron Non heme iron

57 Iron No route for excretion once absorbed

58 Some meat eating populations may have iron stores far in excess of those needed for health (Lauffer 1992) Among elderly participants in the Framingham Heart Study, 13% had high iron stores, while approximately 3% were iron deficieny (Fleming et al 2002)! à higher risk of heart disease, cancer, and diabetes (Fleming et al 2002)

59 Iron High heme intake is associated with increased risk of several cancers, including colorectal cancer, pancreatic cancer and lung cancer. Likewise, the evidence for increased risks of type-2 diabetes and coronary heart disease associated with high heme intake is compelling" Nutrients Mar 13;6(3):

60 Iron Decreased absorption of iron from plant based foods may be one reason why those on a plant based diets have so many health advantages!

61 Zinc Component of enzymes Anti oxidant Deficiency: Growth retardation, Hair loss, diarrhea, impotence, eye and skin lesions, loss of appetite, delayed wound healing

62 Zinc Beans, Grains, Nuts, Seeds

63 Those with or at risk of iron or zinc deficiency Phytates are present in some plant foods & can inhibit absorption of these minerals by the body Vitamin C increases absorption Avoidance of tea, coffee with foods Garlic & onion can increase the rate of iron absorption from plant foods

64 Essential fatty acids

65 Humans can make fat from any calorie source! 2 essential fatty acids cannot be made in the body and must be eaten These 2 fatty acids: linolenic and linoleic acids are used to build specialized fats called omega 3 & omega 6

66 Omega 3 and omega 6 fatty acids are important! à normal functioning of all tissues of the body Deficiencies cause: Liver & kidney abnormalities Blood changes decreased immune function, Depression, skin changes Adequate intake of the essential fatty acids results in numerous health benefits: Less: heart disease, cancer, autoimmune disease

67 Short vs. long chain essential fatty acids

68 Omega 6 Leafy vegetables, Seeds, Nuts, Grains, Vegetable oils Flaxseed, Chia seeds, Omega 3 Hemp seeds, Walnut, Wheat germ, Soybean

69 Long chain fatty acid Only short chain fatty acids are present in plant foods, Humans can make long chain fatty acids! But... The rate varies and is unpredictable à vegans commonly have lower circulating levels of long chain fatty acids than non-vegans

70 Omega 3 Ensure a daily supply of essential fatty acids Consider supplementing: Algae based DHA & EPA Some seaweeds

71 Protein!

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73 Protein Important for: Growth and repair of tissue including muscle & bone Immune system

74 Protein

75 There are 20 amino acids 11 non-essential amino acids 9 essential amino acids

76 Protein In general: Vegetable In general: Animal Incomplete or low quality protein Complete or high quality protein 1 or more amino acid is lower than others Contains contain all essential amino acids in equal amounts

77 Protein combining? Example: Grains lack 1 amino acid (lysine) Beans lack 1 amino acid (methionine) à Combine grains & brans at meals to provide complete protein!?

78 Plant protein can meet requirements when a variety of plant foods is consumed and energy needs are met. Research indicates that an assortment of plant foods eaten over the course of a day can provide all essential amino acids and ensure adequate nitrogen retention and use in healthy adults thus complementary proteins do not need to be consumed at the same meal

79 Complete plant protein Soy Quinoa Most legumes are pretty close

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83 Nutrients of abundance on plant based diets

84 Phytochemicals Antioxidants (e.g. Vitamin C, Vitamin E) Fiber Potassium Magnesium Folate (natural form of folic acid) Nitrate

85 Phytochemicals Nonvitamin, nonmineral antioxidants responsible for the majority of antioxidant effects (Cao et al 1998) Populations eating greater amounts of phytochemical containing foods (eg, fruits, vegetables, whole grains) have a significantly lower: heart disease cancer, diabetes High blood pressure arthritis Early death Michels et al 2002; Kris-Etherton et al 2002; Fraser et al 1999

86 Antioxidants

87 Oxidation

88 The antioxidant content of foods varies several thousand-fold Diets comprised mainly of animal based foods are low in antioxidants Diets based mainly on a variety of plant-based foods are antioxidant rich, due to the thousands of bioactive antioxidant phytochemicals found in plants

89 Fiber

90 Roughage provides bulk in the intestines Keeps you fuller for longer Maintain steady blood sugar levels Decreases cholesterol levels Feeds intestinal bacteria

91 If you pass small stools, you have to have large hospitals

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93 Found in all plant

94 Fiber Found in no animal foods Food in all plant foods!

95 Phytochemicals Antioxidants (e.g. Vitamin C, Vitamin E) Fiber Potassium Magnesium Folate (natural form of folic acid) Nitrate

96 Potassium crucial to heart function plays a key role muscle contraction important for normal digestive and muscular function

97 Sources of potassium Beans, Leafy green veg, Potatoes, Squash, Avocados, Mushrooms, Bananas.

98 Potassium 2% of US adults consumed 4700mg/d (ie, met recommendations for potassium)

99 Sources of potassium Beans, Leafy green veg, Potatoes, Squash, Avocados, Mushrooms, Bananas.

100 Magnesium Helps to maintain normal nerve function, Helps to maintain normal muscle function, Supports the immune system Aids bone strength

101 Sources of magnesium Whole grain Leafy green veg Legumes Nuts

102 Folate (folic acid) Heart heart Blood health Nervous system health

103 Folate in foods Folate per 100g Folic acid supplement Pepper Leaks Spinach Asparagus Avocado Chick peas Peanuts Sunflower seeds

104 Dietary nitrate Only found in some vegetables Inside the body converts to a gas Decreases blood pressure Increase blood flow e.g. to brain Increases exercise tolerance

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106 Should I take supplements?

107 As much as possible nutrients should be eaten as food not swallowed as supplements!

108 The China Study P. 227

109 Exceptions Vitamin B12 Vitamin D 3 Long chain fatty acids e.g. DHA

110 Plant based with care Pregnant Breast-feeding Babies Adolescents Elderly

111 It is the position of the ADA that appropriately planned vegetarian diets, including total vegetarian or vegan diets, are healthful, nutritionally adequate, and may provide health benefits in the prevention and treatment of certain diseases. Well-planned vegetarian diets are appropriate for individuals during all stages of the life cycle, including pregnancy, lactation, infancy, childhood, and adolescence, and for athletes.

112 The results of an evidence-based review showed that a vegetarian diet is associated with a lower risk of death from ischemic heart disease. Vegetarians also appear to have lower lowdensity lipoprotein cholesterol levels, lower blood pressure, and lower rates of hypertension and type 2 diabetes than nonvegetarians. Furthermore, vegetarians tend to have a lower body mass index and lower overall cancer rates.

113 Summary Enjoy a wide variety of whole plant foods Focus on: Veg Fruit Legumes Whole grains Add some nuts & seeds Always ensure a steady & reliable course of vitamin B12 Consider omega 3, vitamin D & iodine

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116 Before you make any major lifestyle changes speak to a healthcare professional!

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119 Conor Kerley, PhD, BSc, H. Dip * conorkerleynutrition@gmail.com