SOUTH AFRICAN LIFESTYLE MEDICINE ASSOCIATION

Plant-Based Diets Could Cut Costs in South Africa

Written by Dr Roxie Becker

“Healthy” lifestyle choices are often equated with buying food from Woolworths, only eating organic food, and drinking bottled water, and essentially only for the rich and privileged. Why should we even speak about eating healthy food with our patients when they may be struggling to make ends meet? Growing research is showing that shifting to a plant-based diet may actually help to cut food and healthcare costs.

Following tuberculosis, diabetes is the second leading cause of death among South Africans. Stroke, hypertension, and heart disease are also in the top 10 causes of death in our country, as we shift from being primarily faced with a burden of infectious disease, to fighting chronic diseases of lifestyle as well.1 The Global Burden of Disease Study, published in 2019, estimated that 22% of premature deaths in adults globally are due to poor nutrition.2 Simply put, we eat too many animal products and ultra-processed foods, and too few plants, like whole grains, beans, fruits, and vegetables.

A plant-based diet has been shown to prevent, treat, and even sometimes reverse chronic diseases of lifestyle, like heart disease and type 2 diabetes, which are diseases that place a huge burden on our healthcare system in South Africa.3-6 These chronic diseases often require daily medication, frequent follow up consultations, and occasional hospitalizations, all of which contribute to significant healthcare expenditures.

Research conducted in Loma Linda, California demonstrated that adults over 60 years of age who followed a vegan diet required 58% fewer medications compared to their nonvegetarian counterparts.7 Similarly, a clinical trial by the Physicians Committee revealed that 35% of individuals with type 2 diabetes who transitioned to a plant-based diet were able to reduce their medication usage over a 74-week period.8 While medical aid may pay for certain chronic medications, many South Africans are on hospital plans that will not cover such medications, or cannot afford medical aid by choose to utilize private healthcare and pay out of pocket for these expenses. Reducing the medication burden resulting from chronic disease could reduce direct healthcare costs.

Healthier individuals also benefit from lower medical aid premiums, and lower payment increases when they are not claiming for chronic ill health. There are also the indirect savings on absenteeism, low productivity, and childcare costs as health improves.

Research done in the United States in 2023 found that shifting to a plant-based diet can result in food cost savings as well. A randomized clinical trial placed people on a low-fat vegan diet or on a control diet. Using standardized prices, those in the vegan group reduced their grocery costs by 16%.9 Another 4-week randomized crossover trial compared various diets, and one week on a low-fat vegan diet had nearly 40% lower daily food costs compared to one week of the participants’ conventional diets at the start of the study.10

Aside from chronic disease, research done during the Covid-19 pandemic found that plant-based diets may protect against infectious disease as well, mainly through the anti-inflammatory effects of antioxidants found in plant-based foods. People who followed a plant-based diet during the pandemic were found to have lower rates of Covid-19 infection, lower disease severity, and less frequent hospitalizations.11,12

Plant-based diets may be able to help individuals save money through lower grocery and healthcare costs. Economically, improving public health through improved nutrition could reduce the burden on our public and private healthcare systems. We should meet our patients where they are in their readiness to change, and take into account their financial resources when making recommendations.

References:

  1. Department of Statistics South Africa. TB tops leading causes of death in SA in 2018. Updated June 15, 2021. Accessed September 29, 2024. https://www.statssa.gov.za/?p=14435
  2. GBD 2017 Diet Collaborators. Health effects of dietary risks in 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2019 May 11;393(10184):1958-1972. doi: 10.1016/S0140-6736(19)30041-8
  3. Esselstyn CB Jr, Gendy G, Doyle J, Golubic M, Roizen MF. A way to reverse CAD? J Fam Pract. 2014 Jul;63(7):356-364b.
  4. Ornish D, Scherwitz LW, Billings JH, et al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. 1998;280(23):2001-7. doi:10.1001/jama.280.23.2001
  5. Panigrahi G, Goodwin SM, Staffier KL, Karlsen M. Remission of Type 2 Diabetes After Treatment With a High-Fiber, Low-Fat, Plant-Predominant Diet Intervention: A Case Series. Am J Lifestyle Med. 2023 Jun 15;17(6):839-846. doi: 10.1177/15598276231181574
  6. Barnard ND, Cohen J, Jenkins DJ, 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;89(5):1588S-1596S. doi:10.3945/ajcn.2009.26736H
  7. Dos Santos H, Gaio J, Durisic A, Beeson WL, Alabadi A. The Polypharma Study: association between diet and amount of prescription drugs among seniors. Am J Lifestyle Med. 2021;0(0). doi:10.1177/15598276211048812
  8. Barnard ND, Cohen J, Jenkins DJ, 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;89(5):1588S-1596S. doi:10.3945/ajcn.2009.26736H
  9. Kahleova H, Sutton M, Maracine C, et al. Vegan diet and food costs among adults with overweight: a secondary analysis of a randomized clinical trial. JAMA Netw Open. 2023;6(9):e2332106. doi:10.1001/jamanetworkopen.2023.32106
  10. Campbell EK, Taillie L, Blanchard LM, et al. Post hoc analysis of food costs associated with Dietary Approaches to Stop Hypertension diet, whole food, plant-based diet, and typical baseline diet of individuals with insulin-treated type 2 diabetes mellitus in a nonrandomized crossover trial with meals provided. Am J Clin Nutr. 2024;119(3):769-778. doi:10.1016/j.ajcnut.2023.12.023
  11. Kendrick KN, Kim H, Rebholz CM, Selvin E, Steffen LM, Juraschek SP. Plant-based diets and risk of hospitalization with respiratory infection: results from the Atherosclerosis Risk in Communities (ARIC) Study. Nutrients. 2023;15(19):4265. doi:10.3390/nu15194265
  12. Soltanieh S, Salavatizadeh M, Ghazanfari T, et al. Plant-based diet and COVID-19 severity: results from a cross-sectional study. BMJ Nutr Prev Health. 2023;e000688. doi:10.1136/bmjnph-2023-000688
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