By Dr David Glass, MBChB, FCOG(SA), DipIBLM.
Those of us who have been around for a while remember the bad old days when cigarette vending machines were found in hospital corridors, and the windows and walls of nurses and doctors tearooms were covered in a thin layer of tobacco smoke pollutants. I recall 30 years ago cleaning half the windows and walls in one tearoom at Mowbray Maternity Hospital, to visually demonstrate the amount of pollution that had accumulated. I doubt it made any difference to the smoking practices of the staff there.
But thankfully, Dr Nkosazana Zuma’s lasting legacy was to challenge the might of tobacco companies and enact legislation that banned smoking in public places, and cigarette vending machines. It is now hard to believe that doctors once advertised the benefits of smoking, or would tell their patients to stop, yet their own fingers were stained with nicotine. The prevalence of smoking has diminished worldwide, though there is still much work to be done to eliminate the scourge.
But an even greater threat to global health exists in the form of ultra- and highly processed foods. The pandemic of non-communicable diseases (NCDs) requires as much enthusiasm and energy to counteract (if not more) than the fight against smoking. People can exist comfortably without smoking, but we all need food. Big food industry stands ready and willing to market highly palatable and addictive processed foods without any thought for our health. There was sufficient public support for the anti-smoking efforts. Will there be the same level of support for a healthier diet, when there is so little attention given by clinicians to addressing the dietary and lifestyle causes of NCDs?
But change is on the horizon. There is now abundant evidence for the benefits of the Mediterranean diet1, the DASH diet2, and whole food plant-based diets3 to both prevent and help to manage NCDs. Various large long-term population studies have shown the multiple benefits of a plant-rich diet4,5,6. Increasing numbers of studies are now demonstrating the power of a plant-rich diet to not only prevent but even reverse NCDs7,8,9. How long will it take for the evidence to translate into changes in dietary offerings in hospitals and schools? Will the status quo, lethargy to change, and the power of profits, continue to inhibit positive change?
It has taken the birth place of Lifestyle Medicine, Loma Linda University Health, twenty years to ensure that a whole food plant-based diet (WFPB) is not only offered to patients, but is also the default diet. Following publication of abundant evidence over the years, in 2017 the American Medical Association passed a resolution, subsequently embraced by the American College of Cardiology, advising hospitals across the US to improve inpatient hospital menus. This was to be accomplished by providing plant-based food options and eliminating processed meats.
The best-known example of positive legislation has been in New York City under the leadership of Mayor Eric Adams10, who was himself a beneficiary of a WFPB in reversing diabetes. City-run hospitals and schools now offer a plant-based inpatient menu as the default.
The inspiration for this article was the recent publication by R Florian, et al11, of their experience at Loma Linda University Health with introducing a WFPB diet as the default diet. It makes for interesting and instructive reading. The process was time-consuming because it sought to be inclusive of medical and nursing students and staff, food managers and chefs, hospital administrators, and especially patients. All the recipes were assessed for presentation, appearance, taste, texture, aroma and overall satisfaction. Only those that obtained a score of more than 4,5/5 were subjected to scientific analysis for nutritional completeness. Not only was there buy in by the majority of staff and patients following a process of education, but the intervention incorporated sharing of recipes with patients on discharge, to ensure that the adoption of a healthy diet followed patients home. These same thoroughly researched recipes were also made available to other health care facilities.
Is it time for SALMA and PAN-SA to address healthy nutrition in both private and state health care institutions in South Africa? It will take a great deal of energy and enthusiasm, but we have to start somewhere.
References:
- Tang C, Wang X, Qin LQ, Dong JY. Mediterranean diet and mortality in people with cardiovascular disease: A meta-analysis of prospective cohort studies. Nutrients. 2021;13(8):2623. Doi:10.3390/nu13082623
- Onwuzo C, et al.. DASH Diet: A Review of Its Scientifically Proven Hypertension Reduction and Health Benefits. Cureus. 2023 Sep 4;15(9):e44692. doi: 10.7759/cureus.44692. PMID: 37809159; PMCID: PMC10551663.
- Key TJ, Papier K, Tong TYN. Plant-based diets and long-term health: findings from the EPIC-Oxford study. Proc Nutr Soc. 2022 May;81(2):190-198. doi: 10.1017/S0029665121003748. Epub 2021 Oct 27. PMID: 35934687; PMCID: PMC7613518.
- Orlich MJ, et al. Vegetarian dietary patterns and mortality in Adventist Health Study 2. JAMA Intern Med. 2013 Jul 8;173(13):1230-8. doi: 10.1001/jamainternmed.2013.6473. PMID: 23836264; PMCID: PMC4191896.
- Wang T, Masedunskas A, Willett WC, Fontana L. Vegetarian and vegan diets: benefits and drawbacks. Eur Heart J. 2023 Sep 21;44(36):3423-3439. doi: 10.1093/eurheartj/ehad436. PMID: 37450568; PMCID: PMC10516628.
- Key TJ, Papier K, Tong TYN. Plant-based diets and long-term health: findings from the EPIC-Oxford study. Proc Nutr Soc. 2022 May;81(2):190-198. doi: 10.1017/S0029665121003748. Epub 2021 Oct 27. PMID: 35934687; PMCID: PMC7613518.
- Esselstyn Jr CB, Gendy G, Doyle J, Golubic M, Roizen MF. A way to reverse CAD? J Fam Pract. 2014;63(7):356-364 https://cdn.mdedge.com/files/s3fs-public/Document/September-2017/JFP_06307_Article1.pdf
- Ornish D, et al. . Effects of intensive lifestyle changes on the progression of mild cognitive impairment or early dementia due to Alzheimer’s disease: a randomized, controlled clinical trial. Alzheimers Res Ther. 2024 Jun 7;16(1):122. doi: 10.1186/s13195-024-01482-z. PMID: 38849944; PMCID: PMC11157928.
- Barnard ND, et al. A low-fat vegan diet and a conventional diabetes diet in the treatment of type 2 diabetes: a randomized, controlled, 74-wk clinical trial. Am J Clin Nutr. 2009 May;89(5):1588S-1596S. doi: 10.3945/ajcn.2009.26736H. Epub 2009 Apr 1. PMID: 19339401; PMCID: PMC2677007.
- Mayor Eric Adams unveils $44M investment to get New Yorkers healthier. ABC7 New 22.York. Published December 5, 2022. Accessed December 22, 2022. https://abc7ny.com/lifestyle-medicine-mayor-eric-adams-new-york-city-health/12529494/
- Florian R, Johnson S, Phaeton B, Wilson A, Caswell S, Cramer S. Research to Radicchio: Process Implementation of a Therapeutic Whole Food Plant-Based (WFPB) Inpatient Menu Within a Large Academic Healthcare System. ijdrp. 2024;6(2):11 pp. doi:10.22230/ijdrp.2024v6n2a449