Dietary Strategies to Support Planetary Health

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DIETARY STRATEGIES TO SUPPORT PLANETARY HEALTH PRESENTER: MARY PURDY, MS, RDN Describe the positive impact of consuming more plant based foods and wasting less food on planetary health

LEARNING Strategize with and counsel patients on how to make realistic behavior changes to improve OBJECTIVES human and environmental health

Provide easy and palatable ideas for how to incorporate healthy and mostly plant based foods as well as low impact nutritional choices

 Global emissions are reaching record levels  The last four years: hottest on record  Sea levels rising  Coral reefs dying  Air pollution, heatwaves, floods and risks to food security  Human Influence established

i. https://www.un.org/en/climatechange/un-climate-summit-2019.shtml

“Human wellbeing depends on reducing social inequity and protecting the environment. “ United Nations Development Program. Sustainable Development Goals. 2015 QUICK REALITY CHECK

The Goal: Impact is disproportionate  IPCC: Limiting global warming to  Affecting lower income communities, 1.5ºC would have clear benefits to elders, children, communities of color, people and natural ecosystems developing countries (2, 3) ensuring a more sustainable and  Culture – Indigenous communities equitable society.  National Climate Assessment  Poverty reduces resilience and increases vulnerability (4)

1. IPCC Special Report 2. Brown 2018 3. National Climate Assessment 4. Columbia University, 2016 CDC. Center for Disease Control. Climate Effects on Health. 2019 MENTAL HEALTH EFFECTS & “ECO-ANXIETY”

 Climate change-related natural disasters have had a profound negative impact on the mental health of survivors (1)

 Suicides have increased, as have depression, anxiety, stress, grief, anger and PTSD. (2)

 Patients may be concerned and anxious (3)

 Think of how empowering it may be for them to know there is something they can do.

1. Hayes, 2018 2. American Public Health Association 3. Schlanger, 2017 FOOD SYSTEM = ¼ OF GREENHOUSE GASES (1)

 Food Consumption  Food Production (2)  What we eat or don’t eat  Biodiversity loss  Where we purchase  Freshwater use  The food itself  Interference with the global nitrogen and phosphorus cycles,  Packaging  Land-system change  Transportation  Chemical pollution.  It accounts for over 50% of US land use  What we waste  80% of consumptive water use  Our “FoodPrint”  16% energy use  http://css.umich.edu/factsheets/us-food-system-factsheet

 Impact on the health of our food system – affects health of our patients  Flooding,  Drought,  Heat, fire,  Lost farmland because of development,  Soil degradation,  Pesticides

COPYRIGHT © BY MARY PURDY. ALL RIGHTS RESERVED. Food and Agriculture Organization of the United Nations. “The State of Food Security and Nutrition in the World2019 OUR SOIL HAS CHANGED BECAUSE OF CLIMATE CHANGE AND FOOD SYSTEM

 Less healthy  Degraded and nutrient depleted  ½ topsoil of the earth has been lost  Carbon sequestering power diminished (1)  60 years of farming left if soil degradation continues. (2)

 Supporting Regenerative Agricultural Practices is key

1. World Wildlife Fund. 2017 2. Arsenault, 2014

 Can be achieved only by reducing greenhouse gas emissions from all sectors including land and food.  70 % of Amazon Rainforest has been converted for use in commercial agriculture  Carbon Sequestering potential diminished

Animal foods are more resource intensive than plant based foods. (1)

Emissions per gram of protein for beef and lamb are about 250 times those of legumes; (2)

Twenty servings of vegetables have fewer greenhouse gas emissions than one serving of beef. (2)

1. World Resources Institute 2. Tilman, 2014

OUR FUTURE

Livestock = 15 % of GHG = same amount generated by our transportation system. (1) Cattle: milk and meat = 65% Green Fact: 70% of the deforestation of the Amazon is to provide land for cattle ranches. http://www.fao.org/3/a-i3437e.pdf

 If continues as is:  80 percent increase in global greenhouse gas emissions from food production  Habitat destruction due to land clearing for agriculture around the world. (1)

 What’s good for the planet is also good for human health! THE SPECIAL REPORT ON CLIMATE AND LAND BY THE INTERGOVERNMENTAL PANEL ON CLIMATE CHANGE (IPCC)

 100 experts  Many from developing countries  Deforestation:  Releasing over 50 billion tonnes of carbon into the atmosphere in 30 to 50 years  “Plant-based diets as a major opportunity for mitigating and adapting to climate change”  Policy recommendation to reduce meat consumption.

 37 world-leading scientists from 16 countries from various scientific disciplines.  Goal:  Healthful dietary patterns,  Large reductions in food loss and waste,  Major improvements in sustainable food production practices.

The EAT-Lancet Commission on Food, Planet, Health, 2017.

 “Red meat and sugar will need to  ESTIMATE: decrease by 50% while consumption of  Changes in food production nuts, fruits, vegetables and legumes must practices could reduce agricultural double. GHG emissions in 2050 by about 10%  Currently 216 lbs of meat per  Increased consumption of plant- person/year based diets could reduce emissions  ½ lb of meat/day by up to 80%.

BEANS LENTILS PEAS GRAINS NUTS/SEEDS

https://www.wri.org/resources/data- visualizations/protein-scorecard World Resources Institute. Shifting Diets for a Sustainable Food Future, https://www.barillacfn.com/en/dissemination/double_pyramid/ NO ONE HAS TO GO VEGAN. RECOMMENDATIONS AND SOLUTIONS …OR BE A DIFFERENT PERSON POSITION OF THE SOCIETY FOR NUTRITION EDUCATION AND BEHAVIOR: THE IMPORTANCE OF INCLUDING ENVIRONMENTAL SUSTAINABILITY IN DIETARY GUIDANCE

 “Dietary choices are a personal matter, but many American consumers are motivated by a concern for the environment and would welcome sound advice from credentialed nutrition professionals. ”

INCORPORATE What connections do you see between what is going on CLIMATE for you medically and climate change?” CHANGE ISSUES Let me know if you are interested at all in hearing about IN YOUR INTAKE how some of the recommendations we talk about around FORM your health can also be beneficial for the environment.

Normalize https://eatforum.org/content/uploads/2019/01/EAT- Lancet_Commission_Summary_Report.pdf https://eatforum.org/eat-lancet-commission/eat-lancet-commission- summary-report/ EAT LANCET COMMISION

 Proteins should primarily be sourced from plants  Carbohydrates: where possible  Grains - mostly whole grains  Fish or other Omega 3 sources 3X/week  1 cup of grains/day  6oz/week  <5 % added sugar  Note: fish – sustainable? (More later)  Tubers or starchy vegetables  Modest eggs and chicken  1/2-c up to 1 cup  6 oz chicken/week

 Very little red meat: 3 oz/week  > 5 servings of fruits and vegetables/day

 Nuts: 1/3 -1/2 cup/day  Dairy: moderate and optional  Beans: At least ½ cup day  0 – 16oz

 Bkfst: 1 cup oatmeal with 1/3 cup nuts/seeds = 12 grams protein  ½ cup beans/lentils = 7-9 grams of protein  Lunch: 1 cup lentil soup = 18 grams of protein  ½ cup nuts/seeds = 10 grams of protein  Snack: ½ cup hummus and veggies = 5 grams  1 oz meat/fish = 7 grams of protein protein  3 oz tofu = 10 grams of protein  Dinner: 3 oz fish = 21 grams of protein  Other foods throughout the day = 5-10 grams  TOTAL = 55-65 grams of protein

Food is emotional

Food is personal

Food can be comfort

Food choices may be dictated by: Stress, busy lifestyle, convenience, food access, finances, environment, lack of education, culture EXPLORE RELATIONSHIP TO FOOD

 POSSIBLE SOLUTIONS:  Food is very personal.  Talk with/explore with patient his/her relationship with  Hear their story food.  ASK:  Explore negative self talk and encourage neutral talk  “What is your relationship to food?”  Encourage awareness of patterns and behavior  “What does food mean to you?” History? Childhood?  Nothing can change if we aren’t aware  “What do you crave?” “When?”  Ensure that they aren’t skipping meals or lacking balance in meals that can increase cravings.  “How do you feel about your intake of ______”  Reminder: Balanced plate

ASK! ACKNOWLEDGE!

 “What is your relationship to food?”  Point out and acknowledge the efforts they have already made  “What does food mean to you?” History? Childhood?  Validate successes  Find out what matters to them  Even just showing up!  What do they care about?  Celebrate their awareness  Children/Grandchildren/Future generations?  Do they spend time in nature?  “When a person feels accepted for who they are and what they  Hear their story do, it allows them the freedom to consider change rather than  Reflect back to them to defend against it. “  Bill Miller  Bottom Line: Many recommendations that you might give to support health are going to support the planet HELPFUL QUESTIONING ABOUT FOOD PREFERENCES

EXPLORE WITH THEM INCLUDE THEM  How would you feel about ______?  What flavors do you love?  What might you be ready to shift?  Which vegetables do you enjoy?  What’s the biggest barrier?  What’s your favorite bean?  What do you think you could do?  Favorite fruit?  What would make it easy for you to make that happen?  What do you love about______?  What do you think the benefit might be?  How could you see yourself getting in more/less  “Tell me and I forget. Teach me and I remember. Involve  Beans me and I learn.”  Veggies  Sugar - Benjamin Franklin  Soda MANY STUDIES SHOWING BENEFITS OF PULSES

 Improved glycemic profile  Reduction in HTN  Improvement in body weight  Associated with decreased CHD  Antioxidant Benefits  Reduced Inflammation

43 1. Ha, V, 2014, 2. Sievenpiper, J, 2009,3. Singh B, 1., 2017 CREATIVE WAYS TO INCORPORATE BEANS

 Chili  Bean burgers  Lentil soup  Black bean  Hummus & Bean dips  Add to salads  Combine with meaty flavors HAVE RECIPES, CANNED OPTIONS AND COOKBOOK EXAMPLES

Recipes for Beans/Legumes https://pulses.org/recipes/ CREATIVE WAYS TO INCORPORATE NUTS AND SEEDS (GET OUT OF THE ALMOND RUT)

 Throw atop cereals and yogurt

 Add to grains  Health Benefits: ¼-1/2 cup/day (1)  Sprinkle on salads  Improved lipid profiles  Bake into muffins  Support health weight  Tahini Salad Dressing  Hemp Seeds: (2)  Make nut milks: Blend ¼ nuts + 8-10 oz water  High-yielding  Add to smoothies  Low inputs  Smear nut butter on banana or apple  Positive impact on the environment

COMBINE FOODS & COMBINE START WITH ADDING! FLAVORS THEY ENJOY

 Bacon WITH Greens  Soups/Stews with meat AND beans  Meatloaf/Burgers WITH more vegetables or ½  Tacos/burritos with chicken and beans mushroom  Curry using tofu in place of meat/chicken  Sandwiches WITH more vegetables  Scrambled Eggs/Omelette WITH vegetables  ADD beans to soups OFFER ALTERNATIVES

SUGAR & SWEETS REFINED FLOUR CHIPS

 Naturally sweet fruits/dried fruit  Nuts and seeds  Dates, Figs, Raisins, Prunes  Baked veggies  Frozen berries, banana  Whole grain crackers  Banana or apple with nut butter  Crunchy veggies:  Sweet veggies  Snap peas  Squash, sweet potatoes, beets, carrots, onions,  Carrots  Baking with honey, maple syrup  Celery YES, YOU CAN HAVE LENTILS/BEANSFOR BREAKFAST AND DESSERT!

BREAKFAST DESSERTS

 Lentil muffins  Black bean brownies  Lentil and egg quiche  White bean blondies  Beans in smoothie  Garbanzo bean “Cookie Dough”  Lentil nut balls  https://www.lentils.org/10-prep-ahead-breakfasts-to-  https://www.popsugar.com/fitness/Chickpea-Cookie- make-this-month/ Dough-Recipe-28371473  https://ohsheglows.com/ HAVE SAMPLES AND FOOD EXAMPLES ON SHELVES IN YOUR OFFICE FOR EDUCATION AND INCREASED FAMILIARITY/EDUCATION HAVE RESOURCES AND VISUAL AIDS FOR PATIENTS ON YOUR WALL, IN YOUR WAITING ROOM

https://www.usapulses.org/consumers/resources PROMOTE POSITIVE ASSOCIATIONS WITH IMAGES ON WALL OR WAITING ROOM FARMER’S MARKETS, RECYLCLING

https://www.freepik.com/free-photos-vectors/reduce-reuse-recycle REDUCE FOOD WASTE WITH EDUCATION: “ BEST BEFORE” THE DATE BY WHICH A FOOD COMPANY ESTIMATES THAT A FOOD WILL TASTE ITS BEST. NOT ABOUT SAFETY SUPPORT AND ENCOURAGE ORGANIC AND REGENERATIVE AGRICULTURAL FARMING WHEN POSSIBLE

 Healthier for humans  Improves soil microbial population  Fewer pesticides  Fewer energy needs  Less pollution  Less water usage  Stores more carbon  Improves bio-diversity  More resilient to climate change

 1. Food and Agriculture Organization of the United Nations. “Organic Agriculture and Climate Change”. ENCOURAGE COOKING/MEAL PREP: THE GREAT CONNECTOR

 Better for Health & Environment  Relationship with and Connection to food  Purchase an herb plant if possible.  Connection to community  Connection to culture and tradition  Way to slow down and be mindful  Saves money  Reduces waste  How can they ENJOY it?

COPYRIGHT © BY MARY PURDY. ALL RIGHTS RESERVED. “HEALTHCARE WITHOUT HARM” IS PAVING THE WAY. ( 2.) HEALTHCARE CONTRIBUTES TO 1. FOOD SERVED 9% OF OVERALL GHG (1) 2. SUPPORTING LOCAL/SUSTAINABLE AGRICULTURE

1. Francis, D et a; How healthcare can help heal communities and the planet 2. https://noharm.org/ FOR HEALTHCARE WORKERS: https://eatforum.org/lancet.../healthcare- professionals/

RESOURCES FOR FOR CULINARY PROFESSIONALS: HEALTHCARE https://eatforum.org/lancet.../food-service- professionals/ " WORKIERS

HANDOUTS FOR PATIENTS ON CLIMATE CHANGE: https://noharm- uscanada.org/content/us-canada/patient-education https://www.epa.gov/sustainable-management- food/food-recovery-hierarchy WHAT YOU CAN DO PROFESSIONALLY: SPEAK UP!

 University Connections:  Promote these concepts both in the classroom but at the institutional level  Recycling? Compost? Plant based foods in cafeteria?  Social Media Platforms  Promote plant food, organic, sustainable practices  GOAL:  Keep the messages positive  Conferences where you serve food: These practices become the norm!  Vegetarian options  Modify menus –ask what customers may want to reduce waste  Less styrofoam, plastic water bottles  Let participants know this is an initiave so they make different choices

 Buy local/organic  Add in more plant based foods  Bring containers to coffee shops/restaurants  Ask restaurants and chefs to serve more plant based options.  Have these conversations with friends and colleagues  Contact your local and state representatives  Keep an eye on the “Farm Bill”. What are you already doing?

What have you thought about doing that you aren’t doing but could do? QUESTIONS TO ASK YOURSELF How could you see yourself as an agent for change both in personal and professional life?

What is one thing you commit to doing this week? RESOURCES TO SHARE WITH PATIENTS

SERVICES PlANT BASED RECIPE SITES

 https://pulses.org/recipes/  American Community Garden Association  https://ohsheglows.com/ https://www.communitygarden.org/  https://www.whitneyerd.com/category/recipes  https://www.imperfectfoods.com/  https://sharonpalmer.com/recipes/  https://thewallyshop.co/  http://www.nourishingmeals.com/  http://www.greeneatz.com/foods-carbon-footprint.html  https://minimalistbaker.com/

 Documentaries:  The Need to Grow: lost ¼ of its farmable soil in the last 40 years RESOURCES FOR FURTHER EDUCATION

 Planetary Health Alliance:  Marion Nestle: https://www.foodpolitics.com https://planetaryhealthalliance.org/  World Resources Institute: https://www.wri.org  Clinicians for Planetary Health: https://www.planetaryhealthalliance.org/clinicians-for-  World Wildlife Fund: planetary-health https://www.wri.org/blog/2016/04/sustainable-diets-what- you-need-know-12-charts  Food Tank: https://foodtank.com/  Natural Resources Defense Council  Barilla Center for Food and Nutrition Foundation: https://www.nrdc.org/ https://www.barillacfn.com/en/  International Panel on Climate Change:  The Food Sustainability Index: https://www.ipcc.ch/about/ http://foodsustainability.eiu.com/  Environmental Health: An Integrative Approach  Center for Biological Diversity (2018-2020) https://www.biologicaldiversity.org/about https://integrativemedicine.arizona.edu/education/online_co  World Wildlife Fund: https://www.worldwildlife.org/ urses/enviro-med.html

 Article From Food Print:  https://foodprint.org/issues/how-our-food-system-affects-climatechange/

 Meatless Mondays Campaign Group Via Center for a  Rodale Institute Blog: Livable Future:  https://rodaleinstitute.org/blog/  https://meatless-monday.hivebrite.com/topics

 Catering to the Climate: How Earth Friendly Menus at  Planetary Health Alliance FB Group: Events Can Help Save the Planet:  https://www.facebook.com/groups/planetaryhealthcollective/  https://www.takeextinctionoffyourplate.com/pdfs/environmental_c atering_report_catering_to_the_climate_final_report_2019.pdf

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 Aleksandrowicz L, Green R, Joy EJM, Smith P, Haines A (2016) The Impacts of Dietary Change on Greenhouse Gas Emissions, Land Use, Water Use, and Health: A Systematic Review. PLoS ONE 11(11): e0165797. https://doi.org/10.1371/journal.pone.0165797  American Public Health Association. Making the connection: climate changes mental health. Website: https://www.apha.org/~/media/files/pdf/topics/climate/climate_changes_mental_health.ashx Accessed October 2019  Arsenault, C. Only 60 Years of Farming Left If Soil Degradation Continues. Scientific American. Website. https://www.scientificamerican.com/article/only-60-years-of-farming-left-if-soil-degradation-continues/ Published December 5, 2014. (Accessed Oct 2019)  Brown, S. The Impact of Climate Change on Communities of Color. The Greenlining Institute. Website: http://greenlining.org/press/2018/the-impact-of-climate-change-on-communities-of-color/ Published October 2018. Accessed October 2019  CDC. Center for Disease Control. Climate Effects on Health. Website: https://www.cdc.gov/climateandhealth/effects/default.htm Updated September, 2019. Accessed October 2019.  The EAT-Lancet Commission on Food, Planet, Health. EAT-Lancet Commission Summary Report. https://eatforum.org/eat-lancet-commission/eat-lancet-commission-summary-report/ 2017. Accessed October, 2019  Columbia University. National Center for Disaster Preparedness. Earth Institute. The disproportionate consequences of climate change. Website: https://ncdp.columbia.edu/ncdp-perspectives/the-disproportionate- consequences-of-climate-change/ Published February, 2016. Accessed October 2019  Food and Agriculture Organization of the United Nations. “The State of Food Security and Nutrition in the World: Building Climate Resilience for Food Security and Nutrition.” IFAD, UNICEF, WFP and WHO, 2018. http://www.fao.org/3/I9553EN/i9553en.pdf Accessed OCtober, 2019  Food and Agriculture Organization of the United Nations. “Organic Agriculture and Climate Change”. Website: http://www.fao.org/organicag/oa-specialfeatures/oa-climatechange/en/ Accessed October 2019.  Fourth National Climate Assessment. Chapter 15: tribes and indigenous peoples. Website: https://nca2018.globalchange.gov/chapter/15/ Accessed October 2018  Francis, D et al. How healthcare can help heal communities and the planet. BMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l2398  Ha V, Sievenpiper JL, de Souza RJ, et al. Effect of dietary pulse intake on established therapeutic lipid targets for cardiovascular risk reduction: a systematic review and meta-analysis of randomized controlled trials. CMAJ. 2014;186(8):E252–E262. doi:10.1503/cmaj.131727  Hayes K, Blashki G, Wiseman J, Burke S, Reifels L. Climate change and mental health: risks, impacts and priority actions. Int J Ment Health Syst. 2018;12:28. Published 2018 Jun 1. doi:10.1186/s13033-018-0210-6 REFERENCES

 History of Agriculture. Johns Hopkins Center for a Livable Future Website. http://www.foodsystemprimer.org/food-production/history-of-agriculture/index.html Accessed October 2019  Intergovernmental Report on Climate Change. SPECIAL REPORT: Global Warming of 1.5, . Website: https://www.ipcc.ch/sr15/ Accessed October 2019  Intergovernmental Report on Climate Change. IPCC | Climate Change and Land (2019) IPCC Special Report on Climate Change, Desertification, Land Degradation, Sustainable Land Management, Food Security, and Greenhouse gas fluxes in Terrestrial Ecosystems, August, 2019 https://www.ipcc.ch/site/assets/uploads/2019/08/4.- SPM_Approved_Microsite_FINAL.pdf  Nelson, M. Hamm, M, H, F. et al. Alignment of Healthy Dietary Patterns and Environmental Sustainability: A Systematic Review. Advances in Nutrition, Volume 7, Issue 6, November 2016, Pages 1005–1025, https://doi.org/10.3945/an.116.012567  Poore, RJ, Nemecek, T. Reducing food’s environmental impacts through producers and consumers. Science 01 Jun 2018: Vol. 360, Issue 6392, pp. 987-992 DOI: 10.1126/science.aaq0216  Reganold, J, Wachter, J. Organic agriculture in the twenty-first century. Nature Plants volume 2, Article number: 15221 (2016)  Ranganathan, J, Vennard, D, Waite, R, et al. Shifting Diets for a Sustainable Food Future. Creating a Sustainable Food Future, Installment Eleven. World Resources Institute. Website. https://www.wri.org/publication/shifting-diets  Rose, D, et al. Position of the Society for Nutrition Education and Behavior: The Importance of Including Environmental Sustainability in Dietary Guidance. Journal of Nutrition Education and Behavior, Volume 51, Issue 1, 3 - 15.e1, January 2019.  Sabate, J, Oda, K, Ros, E. Nut Consumption and Blood Lipid Levels. A Pooled Analysis of 25 Intervention Trials Arch Intern Med. 2010;170(9):821-827. doi:10.1001/archinternmed.2010.79  Schlanger, Z. We need to talk about “ecoanxiety”: Climate change is causing PTSD, anxiety, and depression on a mass scale. Website: https://qz.com/948909/ecoanxiety-the-american- psychological-association-says-climate-change-is-causing-ptsd-anxiety-and-depression-on-a-mass-scale/ Published April 2017. Accessed, Oct 2019. REFERENCES

 Schiermeier, Q. Eat less meat: UN climate-change report calls for change to human diet. Nature. Website: https://www.nature.com/articles/d41586-019-02409- 7?fbclid=IwAR23nlSfnF-soU93JEiVnC7ii69vResJUegRO8Y6IPy-eCfcF5BMAIFNFo4 Published August, 2019. Accessed October 2019  Sievenpiper, J.L., Kendall, C.W.C., Esfahani, A. et al. Effect of non-oil-seed pulses on glycaemic control: a systematic review and meta-analysis of randomised controlled experimental trials in people with and without diabetes Diabetologia (2009) 52: 1479. https://doi.org/10.1007/s00125-009-1395-7  Tang K, Fracasso A, Struik PC, Yin X, Amaducci S. Water- and Nitrogen-Use Efficiencies of Hemp (Cannabis sativa L.) Based on Whole-Canopy Measurements and Modeling. Front Plant Sci. 2018;9:951. Published 2018 Jul 16. doi:10.3389/fpls.2018.00951  United Nations, Climate Action Summit, 2019. Website: https://www.un.org/en/climatechange/un-climate-summit-2019.shtml Accessed, October 2019  United Nations. Climate Reports. Website: https://www.un.org/en/climatechange/reports.shtml Accessed October 2019  United Nations Development Program. Sustainable Development Goals. Website: https://www.undp.org/content/undp/en/home/sustainable-development- goals.html, Published 2015. Accessed October 2019  United Nations Food and Agriculture Organization - http://www.fao.org/food-loss-and-food-waste/en/ Food Loss and Food Waste, 2019. Accessed October 2019.  United Nations Food and Agriculture Organization, Key Facts and Findings. http://www.fao.org/news/story/en/item/197623/icode/  World Wildlife Fund. Threats: Soil Erosion and Degradation. Website: https://www.worldwildlife.org/threats/soil-erosion-and-degradation Published 2018. Accessed October 2019