The Plant-based Plan Lynne Garton BSc (Hons) RD Consultant Nutritionist and Registered Dietitian www.alimenta.co.uk

@dietlg Overview…

 What is plant-based eating?  Reviewing the latest science  What’s new?  Current nutritional status of Europe  Nutritional rationale for more plant-based eating  Heart health benefits of plant-based eating  Plant-based eating in practice Types of Plant-based Eating Patterns Reviewing the latest science...

 Search conducted in Medline  Search terms: “plant-based” all references  “Vegetarian” + health issue, e.g. cholesterol, heart, BP, bone, weight etc  “Mediterranean Diet” + health issue  Hand search of references, reviews, meta analyses  Total number of references: 1008 references

 Primary source of data were human studies  Population studies  Randomised controlled trials What’s new…

• Nutritional Benefits  • Health Benefits  • Environmental Benefits  Key European Nutritional and Dietary Recommendations

Nutrient WHO/ FAO* EFSA Dietary Fat (%e) 15-30 (15-35*) 20-35 Saturated Fat (%e) < 10 Not set, but advised to be as low as possible within a nutritionally adequate diet PUFA’s 6-11%e 4%e linoleic acid (AI) *n-6 PUFAs 2.5-9.0 %e + 0.5%e (AI) linolenic acid *n-3 PUFAs 0.5-2.0 %e + 250mg LC n-3 PUFA Protein (%e) 10-15 0.83g/kg body weight/d (PRI) • Men (74.6kg) = 62g/ day • Women (62kg) = 52g/ day Fibre (g/ day) > 25 25 Fruit and Vegetables (g/ ≥ 400 day) Nutritional Achievements

Nutrient WHO Western Western Recommendation Recommendations European European Achieved? Men Women

Dietary Fat 15-30 34.8 – 36.5 35.1 – 36.9 x (%e)

Saturated < 10 13.7 – 14.6 13.7 – 14.7 x Fat (%e)

PUFA’s 6-11%e 6.7 – 7.0 6.7 

Protein (%e) 10-15 14.7 – 16.3 15.6 – 17.0 

Fibre (g/d) > 25 12.8 – 24.4 10.4 – 20.1 x

Elmadfa et al, (2009) Forum Nutr.62;1-405 Selected Nutrient Intakes for Adults as a Percentage of the Recommended Amounts WOMEN MEN 180 180

160 160

140 140

120 120

100 100

80 Fat (%e) 80 Saturated fat (%e) 60 60 PUFA's (%e) 40 40 Protein (%e) 20 20 Fibre (g/ day)

0 0 Percentage of the Recommended of Amount theRecommended Percentage

Elmadfa et al, (2009) Forum Nutr.62;1-405 Major European Nutritional Challenges…

 Reducing Saturated Fat  Improving the Fat Quality  Increasing Fibre (Wholegrains, Fruit and Vegetables) Sources of Saturated Fat in the Diet

Average contribution of major food groups to Average contribution of major food groups to saturated fat intake in men from selected countries saturated fat intake in women from selected countries participating in the EPIC Study participating in the EPIC Study

UK (2008/9 – 2011/12) • 20% of SFA from meat products • 22% of SFA from dairy • 5% of SFA from butter Dutch population (2011) • 19% of SFA from meat products • 30% of SFA from dairy

Linseisen et al (2009) Eur J Clin Nutr 63(4);S61-80. Individual European Countries Meat Consumption

Typically Europeans eat double the recommended amount of red meat

Westhoek H, et al (2011) PBL Netherlands Environmental Agency Meat Consumption in Selected European Countries

EFSA Concise European Food Consumption Database Fruit & Vegetable Consumption in EU Countries

* Mean intake

% of popn. consuming <400g/d

Tennant DR, et al (2014) Br J Nutr. 112(7);1214-25 Wholegrain Intake

Scandinavian countries - USA – 3+ minimum 75 g whole grain per servings a day 10 MJ (2,388 kcal) per day

• Average adult intake 20g/day • 18% of adults ate no wholegrains • 17% of adults met the US recommendations

Mann, KD, et al (2015) Br J Nutr;1-9 Nutritional Rational for Eating More Plant-based Foods

 Population studies have found plant-based eating is associated with a better nutritional intake in line with recommendations  Nutritional benefits not just due to the absence of animal foods but also the inclusion of a wide variety of important plant-foods

No need to completely exclude animal foods, but plant foods should be at the core Average daily intake of selected nutrients in the AHS-2 study

Rizzo NS, et al (2013) J Acad Nutr & Diets 113(12); 1610 Food & Nutrient Intakes According to Pro- Vegetarian Eating Patterns +ve weighting given to • Fruit • Vegetables • Nuts • Cereals • Legumes • Olive oil • Potatoes

-ve weighting given to • Added animal fats • Eggs • Fish • Dairy products • Meats or meat products

TOTAL SCORE 12 -60

Martinez-Gonzales, et al (2014) Am J Clin Nutr, 100(S1);320S Daily Intake of Selected Food Groups of Low Meat and Regular Male Meat Consumers

Gilsing AM, et al (2013) Nutr J 12;156 Plant-based Eating and Cardiovascular Health…

Type of Study Measurement Outcome Observational CVD risk  15 – 20% Clinical studies LDL-C -7% to -15% compared to baseline BP  Portfolio studies LDL-C -20% to -35% (long term study -13%)

SBP -4.2mmHg DBP -2.3mmHg (long term study) The Sum of the Whole Is Greater than it’s Parts…

Lower Low energy Saturated High density Fat Fibre Low Fat

Rich in Rich in potassium Plant Protein phytonutrients Low Good source of GI unsaturated fats The Sum of the Whole is Greater than it’s Parts…

Rich in High Lower energy potassium Fibre density Good source of Rich in unsaturated fats phytonutrients PLANT-BASED

Plant BENEFITS Low Plant Low Stanols/ Low GI Saturated Protein Fat Sterols Fat International Dietary Support 

  Consumer’s Readiness to Eat a Plant- Based Diet… Higher Benefit Scores - Well-being benefits - Weight and health benefits Higher Barrier Scores - Convenience and financial benefits - Information barriers - Family & personal Barriers - Convenience Barriers 28% - Health barriers 28% MORE • F & V • Nuts & seeds 14%14% • Wholemeal bread 58% 58% • Cooked cereals

LESS • Meat (white & red) • Dairy

Lea EJ, et al (2006) Eur J Clin Nutr: 60(3):342-51 • White bread STEP 1: Define Plant-based Eating…

More than just Fruits and Vegetables…

• WHOLEGRAINS

• NUTS AND SEEDS

• PULSES – INCLUDING SOYA

• FRUITS AND VEGETABLES STEP 1: Principles of Plant-based Eating

LiveWell for Life…

 Eat more plants foods, e.g. fruits, vegetables, wholegrains, legumes, nuts and seeds  Eat a variety of foods – have a colourful plate  Waste less food  Moderate your animal food consumption – enjoy other sources of proteins such as peas, beans and nuts  Buy foods that meet a credible standard  Eat fewer highly processed foods and foods high in fat, salt and sugar Well-being Ethical

Step 2: Discuss Benefits

Convenience & Weight & Health Financial

Lea E.J, et al. (2006) Eur J Clin Nutr 6(3):342-51 Cost Information

Step 2: Overcome Barriers…

Nutritional Practical skills Adequacy/ Health

Lea E.J, et al. (2006) Eur J Clin Nutr 6(3):342-51 STEP 2: Nutrition & Health Barriers…

Appropriately planned plant-based diets are healthy, nutritionally adequate and provide environmental benefits

Macdiarmid JI, et al (2012) Am J Clin Nutr;96:632–9 : Scarborough P (2012) EJCN66,710–715 : Livewell Report (2011) http://assets.wwf.org.uk/downloads/livewell_report_corrected.pdf : Livewell for LIFE http://livewellforlife.eu/wp- content/uploads/2013/02/A-balance-of-healthy-and-sustainable-food-choices.pdf :Friel, et al (2009) Lancet;374:2016–25 : Aston LM, et al (2012); BMJ Open;2:e001072 : J Acad Nutr Diet. (2015);115 (5):801-10 STEP 2: Cost Barriers…

 Healthy plant-based diets are not necessarily more expensive

 Meat/ animal protein tends to be the most expensive part of the meal

Plant Sources (cost/ 100g) Animal Sources (cost/ 100g) £0.38 Chicken breast fillet £0.60 Soya mince £0.33 Lean mince £0.60 Unsalted mixed nuts £0.85 Beef steak £1.50 Lentils (canned) £0.14 Eggs £0.30 (2 eggs) Baked beans £0.10 Mature cheddar £1.00

Source: www.mysupermarket.co.uk – Tesco. Accessed Nov. 2015 STEP 2: Cost Barriers…

UK Livewell Plate £28.40/wk (£32.12/wk)

FRANCE SWEDEN Livewell Plate Livewell Plate €4.36/d 44.07 SEK/d (€4.90/d) (44.64 SEK/d)

SPAIN Livewell Plate €3.479/d (€3.479/d)

www.livewellforlife.eu STEP 3: Provide Practical Information…

• Re-shaping the plate

• Simple swaps

• Meal make-overs

• Meat free days Re-shaping the Plate…

 Emphasis is on plant- based foods

 Visualise the plate

 Serve plant foods first

 Plan meals around plant foods and consider meat as an accompaniment Simple Swaps…

FOOD GROUPS PLANT-BASED ALTERNATIVES Dairy products e.g. , yoghurts, Fortified plant-based alternatives to dairy e.g. soya alternative to milk; soya milkshakes, etc. alternatives to yoghurts. Fortified milk, drink, hazelnut drink Snacks such as crisps, sweets, Fresh or dried fruit; fruit smoothie; soya shakes; soya nuts; other unsalted chocolates and biscuits nuts; seeds; whole-grain cereal bars; rice cakes; pitta/ vegetable sticks/ oatcakes with hummus or salsa; plain popcorn; wholegrain crackers with nut butter; wholemeal scones and currant buns; malt loaf; soya desserts White bread, pasta and rice Wholemeal bread, wholegrain pasta and brown rice Refined breakfast cereals Wholegrain cereals Butter made from vegetable oils Lard Vegetable oils such as olive oil, rapeseed oil, sunflower oil Creamy meat based pasta sauce Tomato and vegetable based pasta sauce Mince, burgers, sausages, etc Meat analogs such as soya mince, Quorn, veggie burgers and sausages Meat/ chicken-based curries or Vegetable curries, dhal, / tofu stir fries and noodle dishes Chinese dishes Desserts/ Puddings Soya alternatives to yoghurts; soya desserts; fruit crumble (topping made with wholemeal flour and ) served with soya custard; stewed fruit topped with soya cream alternative; meringues with berries and soya alternative to cream; fresh fruit; fruit sorbet Meal Make Overs… BREAKFASTS

 Instead of granola and Greek yoghurt try sugar free muesli with soya alternative to yoghurt and mixed berries

 Wholegrain cereal, topped with fruit (fresh or dried) and served with a plant based alternative to milk or yoghurt MAIN MEALS

 Use more beans, lentils and vegetables, and cut down on meat in dishes

 Try vegetable and bean salads that include pasta, rice, noodles, couscous or potatoes

 Add extra grains to stews or soups e.g. Bulghur/ cracked wheat or pearl barley

 Pile a shop bought cheese and tomato pizza with extra vegetables and serve with a side salad LIGHT MEALS

 Chunky bean and vegetable soup served with a wholegrain roll

 Wholemeal toast topped with scrambled eggs, baked beans or sardines in tomato sauce

 Wholegrain starchy foods, such as bread, rolls, bagels, pittas, wraps and chapattis filled with a protein food based on plants e.g. hummus, falafel, beans, bean pate or nut butter 2. Meat Free Days… In Summary…

 International dietary recommendations emphasise plant foods to promote good health

 Diets in many Western European countries are higher in total fat and saturated fat and lower in fibre than is recommended

 Plant-based eating places the emphasis on plant foods (whole-grains, legumes – including soya, fruit, vegetables, nuts and seeds)

 Plant-based eating patterns tend to be low in total fat and saturated fat, include a good level of unsaturated fats, and are high in fibre

 Plant foods also provide a wide range of nutrients that are thought to contribute to positive health and well-being

 Plant-based eating has been associated with healthy hearts, body weights and blood sugar levels

 The wide variety of plant foods available provides a number of options for designing a delicious healthy plant-based eating plan

 Appropriately planned plant-based eating patterns are both healthy and can meet the nutritional requirements throughout the lifecycle Thank you for your attention

Acknowledgements The endeavour, help and support of my co-author Janice Harland is gratefully acknowledged as is the support of the Foundation