Health Europa Quarterly’s editor Lorna Rothery spoke to Dr Shireen Kassam, consultant haematologist and founder of Plant-based Health Professionals UK about the power of a plant-based diet in mitigating the risk of chronic disease and environmental impact.
The world of nutrition can often feel overwhelming, so much so that many of us overlook the extensive benefits of simple fruits, vegetables, and legumes. Though there has been a gradual uptake in the adoption of planet-friendly and plant-based diets, this too has encouraged an influx of ultra-processed ‘alternative’ food products making the blueprint for healthy eating all the more difficult to navigate. Intending to provide clear and validated information about plant-based nutrition and the many benefits this offers, Plant-based Health Professionals UK is growing its community of healthcare professionals and providing education on whole food plant-based nutrition to empower individuals to make informed choices about their health and ultimately reduce the burden of chronic disease.
To discuss some of the latest research around plant-based nutrition and the importance of discussing diet alongside conventional medical practices, Lorna Rothery spoke to the organisation’s founder Dr Shireen Kassam. As well as being a board-certified lifestyle medicine physician, she is a consultant haematologist, honorary senior lecturer at King’s College Hospital, and author of the recently published book, Eating Plant-Based: Scientific Answers to Your Nutrition Questions (Hammersmith Books, £6.99)
How did you become interested in plant-based nutrition?
Initially, I became vegan for ethical reasons and then through my exploration of how to adopt a healthy vegan diet, I discovered a wealth of information that really supported healthy plant-based nutrition as a way of optimising physical and mental health and wellbeing, and as a tool for use in clinical practice. During that time, most of my learning and education was coming from the US where all of the pioneers of plant-based and lifestyle medicine have been working for the last few decades. After four or five years of education, courses, and exams, I decided to bring that education to the UK, and I do that in a number of ways; it was initially through a community interest company called Plant-based Health Professionals UK that entails education and advocacy on healthy plant-based diets. Through that, I had the opportunity to bring the education to university level at the University of Winchester and I offer a course to health professionals to essentially speed up the acquisition of knowledge that took me quite a while to achieve.
How has the plant-based health professionals’ community grown since you founded the organisation?
It continues to grow and our network increases, we have members from all over the world. It was mainly aimed at bringing together individuals like myself, healthcare professionals who were advocating for healthy plant-based diets for themselves and their patients. We are a membership organisation and have gone from 200 members in 2019 to now almost 1000.
Healthcare professionals who are more acutely concerned about the climate and planetary health are also connecting with us and that has opened up a new network of individuals who want to adopt a more plant-based diet.
Eating healthy whole foods to help curb disease development can sound like a relatively simple concept, why do you think society is only really starting to recognise the importance of preventative measures through diet and the benefits of plant-based nutrition? Why are we not talking about this alongside conventional medicine?
The data has been out there for decades, and the studies are robust and support the plant-based approach alongside conventional therapy when you need it. Nobody is going to intrinsically oppose the fact that fruits, vegetables, whole grains, and beans are really healthy for us and minimising everything else around it is best. When it comes to our healthcare education and our healthcare system, we are very much based on a sick care model where you see the doctor when you are ill and you are in such a state that you need pharmaceutical intervention. For us as healthcare professionals, it is much easier to prescribe rather than spend that longer period that is required to instil behaviour change. We spend 5% of the NHS budget on prevention and the rest is sort of firefighting, most of us are in that firefighting position of supporting patients when they have established disease.
The food environment has a lot to answer for, whether it be in our supermarkets, restaurants, or our public sector catering. We are not going to change that narrative until we have a way – whether it is through legislation – to change the food environment. People’s choices are made by what is available and affordable, and what they consider as their cultural and social norms. 70% of land in the UK is dedicated to raising animals for food yet most of us do not need any of that in our diet. We should be focusing on producing food that promotes our health. That connection between the agricultural sector and the health sector does not seem to be lined up. This is also reflected on costs; it is more expensive to buy healthy whole foods than it is to buy ultra-processed food. It is not the case if you are comparing healthy omnivorous versus healthy plant-based but given that more than 50% of what we eat is ultra-processed food it is cheaper calorie for calorie.
There is a growing movement of healthcare professionals who want to find a way of incorporating this knowledge into their clinical practice, but it is tough because you need more time, you need to follow up, people do not change their habits just because they have the knowledge. We need a systems approach within the community and within society as a whole that is going to help people put these changes or healthy diets into action, and the messaging is currently not aligned with the science.
The information around healthy eating can sometimes seem quite confusing, especially with the rise in processed, alternative foods. What do you think are the key barriers to the wider uptake of plant-based diets?
The messaging is really confusing, but I think the cost aspect is a myth. There was a recent study by Marco Springmann and colleagues looking at the cost of vegan, vegetarian, omnivorous and pescetarian diets and actually, a vegan diet for high-income countries was the most affordable. However, it is a vegan diet centred around whole foods including fruits, vegetables, whole grains, and beans and these are really cheap. Regardless of diet pattern, we are so used to more than 50% of what we put in our shopping baskets being ultra-processed food, people are comparing ultra-processed omnivorous dishes to these newer, ultra-processed vegan products, which are expensive.
I think we have forgotten the skills and knowledge of how to cook from scratch, a lot of us do not have time and there are many socio-economic factors that come into play. People who are holding down two jobs, have kids and trying to get through everyday life are probably not going to have time to cook from scratch. There are a lot of factors, it is not just cost. A vegan diet comes out cheaper if you are sticking to healthy whole foods, but we are so far away from that because even if you look at the UK’s Eat Well Guide, two-thirds of that is healthy whole plant foods and it says to prioritise plant protein and beans in that protein section, but none of us are even doing that.
What might people need to be aware of if they are transitioning to a fully plant-based diet?
The basis of any healthy plant-based diet is centred around four main food groups: fruits, vegetables, whole grains, beans, and a small portion of nuts and seeds. Then, mainly water for hydration. The key is to concentrate on variety because we know it is not just about being plant-based it is about the variety of plants we consume.
There is not much in the way of alternatives you need, the category of what constitutes healthy fats can be a little confusing, but the basics are straightforward. Plant sources of fat are better than animal sources, mainly because plant sources are unsaturated fatty acids. There are a couple of exceptions including tropical oils like coconut and palm oil which are less healthy and should not be prioritised in the diet because they comprise predominantly saturated fat. Healthy fats can include nuts, seeds, and avocado and whether you choose to have whole nuts or nut butter is fine, as long as they are not full of oil and salt, and sometimes even sugar.
If you are eating a fully plant-based or vegan diet, you need to be aware of certain nutrients that are not abundant in a plant-based diet. The number one is vitamin B12 because it is not found in animals or plants, it is made by microorganisms, and this can be taken as a daily tablet. Vitamin D is also important in all diets, and I find that none of my patients are taking it and all of their levels are low; somehow that messaging still has not gotten out there despite the pandemic. Iodine would be my third main recommendation, omnivorous and western-style diets tend to include iodine in dairy products even though it is a by-product and cows do not produce it. In the UK, most people get iodine from dairy, so you need to understand the sources, whether it is from fortified plant-based milk, supplement or you are incorporating some sea vegetables into your diet. Finally, those following a plant-based diet need to ensure they are consuming enough calories, people often forget that they need to eat a bit more in volume because of the low-calorie density.
Regardless of your diet pattern, you need to make sure you get all the nutrients that you need. We have a lot of resources available to download on the Plant-based Health Professionals website including the plant-based eat well guide.
What are the key benefits of a plant-based diet in terms of treating or mitigating chronic disease?
The issues that I face, and that we could really make a big difference on in terms of cancer prevention and age-related conditions, is when patients come and see me and may already have high blood pressure, high cholesterol, heart disease, type two diabetes or are carrying too much weight. This makes my life much more difficult when I need to administer quite intensive treatments that require patients to be of a certain level of fitness. It also requires us to alter the therapies that we can offer, and we might not be able to offer optimal therapies. The treatments can also impact -most commonly – heart health, and therefore, starting out with good heart health is going to be better for you. A lot of the cancers I treat are treatable and potentially curable so that is great, but we know that people who have received lymphoma treatment still do not live as long and as healthily as the general population because they are dying of second cancers and cardiovascular disease. Impacting long-term health is really important and we could really shift the paradigm of healthcare if we address diet and lifestyle.
There are a number of recently published studies showing that just a diagnosis of cancer increases your risk of cardiovascular disease before treatment has even started and people who have survived and completed treatment for any sort of cancer have a doubled risk of developing heart disease and type two diabetes. Cancer care is an area where this holistic approach can be hugely beneficial. Similarly, scientific literature has gone completely wild on the role of the microbiome in predicting outcomes from cancer therapy, and that is a space we really need to watch carefully. That is where we can make a big difference because studies are coming out to show that those with the healthiest gut microbiome respond better and have a longer response to certain anti-cancer treatments. We all know what impacts our microbiome, you can change your microbiome within 24 to 48 hours of changing your diet. Some really important things we can do during cancer treatment is to eat more plant foods including fermented foods and polyphenol-rich foods, all those things that we know are good for the microbiome.
Where plant-based diets come into their own for treatment has been demonstrated in studies on early-stage prostate cancer. So, if you have a ‘watch and wait’ cancer whereby you do not need to do something now but may need treatment in the future, then there is evidence you can make a big difference with plant-based diets and other healthy lifestyle habits. I think when it comes to treatment, the main use of plant-based diets is in managing weight and obesity; it is much easier to be a healthful weight on a plant-based diet than it is on an omnivorous diet as well as treating and putting type two diabetes into remission, halting the progression of heart disease and all the risk factors associated with that. 90% of cardiovascular disease could be wiped out if we addressed those risk factors and a lot of those risk factors could be modified or eliminated with diet and a healthy lifestyle.
Clearly, a healthy lifestyle is not achieved through diet alone, there are many factors that impact our health including exercise, sleep and stress; it is an overall approach. However, if diet is not addressed then you are not going to achieve all those health benefits that are up for grabs.
The narrative around plant-based nutrition certainly seems to be moving in the right direction but how would you like to see policymakers and healthcare systems support this more holistic approach to health and wellbeing?
Things are really going to change on a bigger scale if we role model this in everyday life. The National Food Strategy was a great step forward, even if the recommendations are a little bit diluted. I really want to see that embedded into our UK approach to the food system, increasing our intake of fruits, vegetables and fibre and reducing our reliance on animal and processed foods. We have the blueprint for that, but I am yet to see any real shift. That has to be embedded in our policy and our healthy eating recommendations.
We really need to address the food environment too and hold companies to account and implement rules or regulations. That means that certain foods are prioritised and made easily accessible and other foods are less accessible and have a higher price tag if they are going to result in ill health. Public sector catering has a huge role to play here.
I work at King’s College Hospital and have been trying to change the food environment. In the last two years, myself and a colleague have been able to highlight campaigns like Veganuary and No Meat May and in our staff canteen, we agreed to do meatless Mondays and had a plant-based day on Earth Day. The narrative is changing, but the speed of change is really slow. Public sector catering, including hospitals, need to be virtually, if not fully plant-based. Why not role model what is the ideal and expected way to consume our food? It starts with educating ourselves as a healthcare body and then changing our food environment and being very consistent in that messaging. There is still a lot of resistance; diet is emotional, people do not like to be told what to eat and how to eat, and sometimes taste preferences take priority.
It is important that we move toward a food system that will sustain our personal health and the health of our planet. The shift towards plant-based is even more urgent given that it is the single most impactful action we can all take to reduce carbon emissions. The messaging needs to be clearer, and we really need to support farmers to move over to more crop farming, and ultimately become more self-sufficient in our provision of healthy plant foods.
Dr Shireen Kassam MB BS, FRCPath, PhD, DipIBLM
Consultant haematologist at King’s College Hospital
Lifestyle medicine physician
Founder of Plant-based Health Professionals UK