Plant-Based Diets: A Physician's Guide

Are plant-based and omnivorous diets the same for muscle hypertrophy? A narrative review of possible challenges of plant-based diets in resistance-trained athletes

This narrative review examines the potential challenges associated with plant-based diets in supporting muscle hypertrophy among resistance-trained athletes. Contrary to common assumptions, current evidence suggests that plant-based diets, when properly planned, can provide protein comparable to omnivorous diets. However, plant-based proteins are generally considered less anabolic due to lower digestibility, essential amino acid (EAA) content, and particularly lower leucine levels. The review discusses challenges and solutions for athletes aiming to maximize hypertrophy through plant-based diets, while highlighting the need for more robust research on advanced resistance-trained athletes.

Biological properties of vitamin B12

Vitamin B12, cobalamin, is indispensable for humans owing to its participation in two biochemical reactions: the conversion of l-methylmalonyl coenzyme A to succinyl coenzyme A, and the formation of methionine by methylation of homocysteine. Eukaryotes, encompassing plants, fungi, animals and humans, do not synthesise vitamin B12, in contrast to prokaryotes. Humans must consume it in their diet. The most important sources include meat, milk and dairy products, fish, shellfish and eggs. Due to this, vegetarians are at risk to develop a vitamin B12 deficiency and it is recommended that they consume fortified food. Vitamin B12 behaves differently to most vitamins of the B complex in several aspects, e.g. it is more stable, has a very specific mechanism of absorption and is stored in large amounts in the organism. This review summarises all its biological aspects (including its structure and natural sources as well as its stability in food, pharmacokinetics and physiological function) as well as causes, symptoms, diagnosis (with a summary of analytical methods for its measurement), prevention and treatment of its deficiency, and its pharmacological use and potential toxicity.

Mentha haplocalyx Briq. (Mint): a comprehensive review on the botany, traditional uses, nutritional value, phytochemistry, health benefits, and applications

Mentha haplocalyx Briq. (M. haplocalyx), a notable member of the Lamiaceae family, occupies a significant role in the realm of health foods and botanical medicines. Traditionally, it has been employed to address various diseases, including colds, coughs, fever, indigestion, asthma, and influenza. Recent phytochemical investigations have identified the presence of terpenoids, flavonoids, phenolic acids, anthraquinones, alkanes, and polysaccharides in M. haplocalyx, with terpenoids being the primary bioactive constituents. Notably, both in vitro and in vivo studies have demonstrated its diverse health benefits, such as neuroprotective, anti-asthmatic, anti-inflammatory, gut health improvement, hypoglycemic, anti-aging, anti-bacterial, and antioxidant effects. Additionally, M. haplocalyx is a rich source of carbohydrates, dietary fiber, amino acids, minerals, and vitamins, further underscoring its nutritional value. A thorough literature review was conducted using databases like PubMed, Google Scholar, Web of Science, and China National Knowledge Infrastructure (CNKI) to consolidate existing knowledge on M. haplocalyx. This review synthesizes recent advancements in the botany, traditional uses, nutritional value, phytochemistry, health benefits, and research on the edible uses of M. haplocalyx. Furthermore, the commercial potential and future research opportunities for M. haplocalyx are briefly explored, with the goal of fostering continued interest in this multifunctional plant and inspiring future research and commercial endeavors.

Attitudes and Beliefs of Primary Care Physicians and Nurses in Spain Toward Vegan Diets

BACKGROUND

As dietary habits shift in response to environmental concerns and health awareness, understanding healthcare professionals' perceptions of vegan diets is crucial.

OBJECTIVES

This study aimed to identify the beliefs and attitudes of primary care doctors and nurses in Spain towards vegan diets.

METHODS

A questionnaire-based, observational, cross-sectional study was conducted among 208 healthcare professionals.

RESULTS

87% of participants followed an omnivorous diet, while only 3.4% identified as lacto-ovo-vegetarian (LOV) or vegan. Statistically significant differences were observed by sex, with women more likely to agree that livestock farming contributes to global warming (27.3% and 28.0% vs. 17.0% and 12.8%, respectively; p = 0.02). Additionally, women were more inclined to consider vegan diets suitable for vulnerable groups, such as pregnant women and children, when adequately supplemented (24.8% and 17.4% vs. 10.6% and 10.6%, respectively; p = 0.030). Healthcare professionals who followed a LOV or vegan diet were more likely to disagree with the notion that vegan diets do not provide the necessary macronutrients and micronutrients compared to omnivores (strongly disagree 19.9%, 56.3%, 85.7%; p = 0.001 for omnivores, flexitarians, and LOVs/vegans, respectively).

CONCLUSIONS

Current nutrition training may not meet the needs of doctors and nurses. Furthermore, it is implied that some professionals' attitudes towards vegan diets may be more influenced by personal beliefs than by scientific literature. These findings can inform future clinical guidelines and support a more evidence-based approach to dietary counselling for vegan populations.

Domestic dogs maintain clinical, nutritional, and hematological health outcomes when fed a commercial plant-based diet for a year

Domestic dogs can maintain health on complete and well-balanced canine plant-based nutrition (K9PBN). Novel insight on health outcomes in dogs consuming K9PBN is of relevance to veterinary professionals and consumers given a growing interest in non-traditional dog foods with perceived health benefits, while considering potential safety concerns. We aimed to investigate nutritional equivalence by measuring clinical health outcomes in adult dogs fed K9PBN over twelve months compared to a meat-based diet at baseline. We enrolled fifteen clinically healthy adult dogs living in households in Los Angeles County, California in a prospective cohort study and evaluated clinical, hematological, and nutritional parameters in dogs at 0, 6, and 12 months, including complete blood count (CBC), blood chemistry, cardiac biomarkers, plasma amino acids, and serum vitamin concentrations. The study found that clinically healthy, client-owned, adult dogs maintain health, based on physical exams, complete blood count, serum chemistry, plasma amino acids, serum vitamins, and cardiac biomarkers combined with client-reported observations, when fed commercial K9PBN over a twelve-month period. This study is the most comprehensive and longest known K9PBN investigation to date and provides clinically relevant evidence-based nutrition data and new knowledge on outcomes in clinically healthy dogs who thrive without consumption of animal-derived ingredients. These results also provide a valuable foundation for the future study of K9PBN as a potential nutritional intervention for clinically relevant pathologies in canine medicine. Lastly, it is of major relevance to One Health paradigms since ingredients produced independent of industrial food animal production are both more sustainable and help to circumvent ethical dilemmas for maintenance of health in domestic dogs.

Harmony in Motion: Unraveling the Nexus of Sports, Plant-Based Nutrition, and Antioxidants for Peak Performance

The intricate interplay between plant-based nutrition, antioxidants, and their impact on athletic performance forms the cornerstone of this comprehensive review. Emphasizing the pivotal importance of dietary choices in the realm of sports, this paper sets the stage for an in-depth exploration of how stress and physical performance are interconnected through the lens of nutrition. The increasing interest among athletes in plant-based diets presents an opportunity with benefits for health, performance, and recovery. It is essential to investigate the connection between sports, plants, and antioxidants. Highlighting the impact of nutrition on recovery and well-being, this review emphasizes how antioxidants can help mitigate oxidative stress. Furthermore, it discusses the growing popularity of plant-based diets among athletes. It elaborates on the importance of antioxidants in combating radicals addressing stress levels while promoting cellular health. By identifying rich foods, it emphasizes the role of a balanced diet in ensuring sufficient intake of these beneficial compounds. Examining stress within the context of sports activities, this review provides insights into its mechanisms and its impact on athletic performance as well as recovery processes. This study explores the impact of plant-based diets on athletes including their types, potential advantages and challenges. It also addresses the drawbacks of relying on plant-based diets, concerns related to antioxidant supplementation and identifies areas where further research is needed. Furthermore, the review suggests directions for research and potential innovations in sports nutrition. Ultimately it brings together the aspects of sports, plant-based nutrition, and antioxidants to provide a perspective for athletes, researchers and practitioners. By consolidating existing knowledge, it offers insights that can pave the way for advancements in the ever-evolving field of sports nutrition.

The Effects of an Eight-Week Swimming Program on Body Composition and Assessment of Dietary Intake in Post-COVID-19 Patients

COVID-19 infection and its consequences (long-term COVID-19 syndrome) have implications for weight loss, body composition, and diet quality. In the context of the "PostCovSwim" project, which is part of a broader international study, the impact of an eight-week swimming program on post-COVID-19 patients' nutritional status (i.e., body composition and dietary intake) was evaluated. Body composition and dietary intake were assessed by medically approved and calibrated bioelectrical impedance (Tanita 780 S MA) and food frequency questionnaires. At the baseline, most participants were classified as overweight based on their body mass index (BMI). However, their body fat percentage (BF%) classification indicated normal weight, although females were near obesity thresholds. Furthermore, at the baseline, according to the BMI classification, 62% of females and 61% of males were female, whereas according to the BF% for obesity classification, 44% of females and 43% of males were considered overweight or obese. Surprisingly, despite the eight-week program, there were no significant changes in body composition. Additionally, the assessment of dietary intake, which remained consistent throughout the study, revealed dietary imbalances characterized by an unhealthy low-carbohydrate, high-fat dietary pattern. This dietary pattern entailed excessive consumption of ultraprocessed foods; reduced carbohydrate intake (39% E vs. 37% E); increased total fat intake (46% E vs. 47% E); increased saturated fatty acids (14% E vs. 13% E); increased cholesterol (412 mg/d vs. 425 mg/d); increased free sugars (7% E vs. 7% E); and inadequate intake of fibre (24 g/d vs. 20 g/d), polyunsaturated fatty acids (6.6% E vs. 7.7% E), vitamin B12 (in females: 3.1 µg/d), vitamin C (86 mg/d vs. 66 mg/d), vitamin D (2 µg/d vs. 3.2 µg/d), folate (in males: 258 µg/d), calcium (777 mg/d vs. 743 mg/d), and selenium (in males: 66 µg/d). After an eight-week swimming program following COVID-19, no significant changes were observed in the subjects' body composition. Their dietary intake was found to not align with the dietary recommendations. These findings underscore the urgency of implementing comprehensive dietary and lifestyle interventions for post-COVID-19 patients to optimize their recovery and overall well-being. Physical activity, like a swimming program, may positively affect various aspects of human well-being.

Nutritional Assessment of the Symptomatic Patient on a Plant-Based Diet: Seven Key Questions

Plant-based diets, both vegan and vegetarian, which emphasize grains, vegetables, fruits, legumes, nuts, and seeds are increasingly popular for health as well as financial, ethical, and religious reasons. The medical literature clearly demonstrates that whole food plant-based diets can be both nutritionally sufficient and medically beneficial. However, any person on an intentionally restrictive, but poorly-designed diet may predispose themselves to clinically-relevant nutritional deficiencies. For persons on a poorly-designed plant-based diet, deficiencies are possible in both macronutrients (protein, essential fatty acids) and micronutrients (vitamin B12, iron, calcium, zinc, and vitamin D). Practitioner evaluation of symptomatic patients on a plant-based diet requires special consideration of seven key nutrient concerns for plant-based diets. This article translates these concerns into seven practical questions that all practitioners can introduce into their patient assessments and clinical reasoning. Ideally, persons on plant-based diets should be able to answer these seven questions. Each serves as a heuristic prompt for both clinician and patient attentiveness to a complete diet. As such, these seven questions support increased patient nutrition knowledge and practitioner capacity to counsel, refer, and appropriately focus clinical resources.

The Effect of a Vegan Diet on the Cardiovascular System

The vegan diet, often known as a plant-rich diet, consists primarily of plant-based meals. This dietary approach may be beneficial to one’s health and the environment and is valuable to the immune system. Plants provide vitamins, minerals, phytochemicals, and antioxidants, components that promote cell survival and immune function, allowing its defensive mechanisms to work effectively. The term “vegan diet” comprises a range of eating patterns that prioritize nutrient-rich foods such as fruits and vegetables, legumes, whole grains, nuts, and seeds. In comparison to omnivorous diets, which are often lower in such products, the vegan diet has been favorably connected with changes in cardiovascular disease (CVD) risk markers such as reduced body mass index (BMI) values, total serum cholesterol, serum glucose, inflammation, and blood pressure. Reduced intake of low-density lipoprotein (LDL), saturated fat, processed meat, and greater consumption of fiber and phytonutrients may improve cardiovascular health. However, vegans have much smaller amounts of nutrients such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), selenium, zinc, iodine, and vitamin B12, compared to non-vegans, which may lead to detrimental cardiovascular effects. This review aims to present the effect of plant-based diets (PBDs), specifically vegan diets, on the cardiovascular system.

Introduction of Alternative Proteins for Health Professionals' Diet: The Transtheoretical Model and Motivational Interviewing of Nutritional Interventions

The World Health Organization has documented the impact that a balanced diet has on disease prevention. Overconsumption of meat can lead to obesity, arteriosclerosis, thrombosis, type 2 diabetes and many life-threatening diseases. A new group of proteins has currently emerged in the scientific community of alternative nutrition called "alternative proteins". Several interventions have been introduced by a large number of healthcare providers in order to promote and enhance people's dietary habits. Two of the most prevalent models of health-related behaviour modification are the transtheoretical-stages of change-model (TM) and motivational interviewing (MI). The purpose of this study is to research and examine how the ΤΜ and MI could be effectively implemented in the diet of health professionals through alterations of eating habits. The population of the study is to comprise health professionals from «AΤΤΙΚOΝ» University General Hospital, Athens, Greece. The sample of participants is to be selected by the professional environment of the researcher. Participants, through random selection, are to be divided into two groups: the control group, consisting of 50 individuals, and the intervention group, consisting of 50 individuals. The duration of the study is to be from November 2022 to November 2024. The present study is concerned with productive mixed-quantitative and qualitative-evolutionary research along with the application testing of both the ΤΜ and the MI. It is to be conducted specifically on health professionals via self-administered questionnaires and semi-structured interviews.

Are We What We Eat? The Moral Imperative of the Medical Profession to Promote Plant-Based Nutrition

The typical Western diet, high in processed and animal-based foods, is nutritionally and ethically problematic. Beyond the well-documented cruelty to animals that characterizes the practices of the factory-farming industry, current patterns of meat consumption contribute to medical and moral harm in humans on both an individual level and a public health scale. We aim to deconstruct, by highlighting their fallacies, the common positive and normative arguments that are used to defend current nutritional patterns. Animal-based foods promote the mechanisms that underlie chronic cardiometabolic disease, whereas whole-food plant-based nutrition can reverse them. Factory farming of animals also contributes to climate change, antibiotic resistance, and the spread of infectious diseases. Finally, the current allocation of nutritional resources in the United States is unjust. A societal shift toward more whole-food plant-based patterns of eating stands to provide significant health benefits and ethical advantages, and the medical profession has a duty to advocate accordingly. Although it remains important for individuals to make better food choices to promote their own health, personal responsibility is predicated on sound advice and on resource equity, including the availability of healthy options. Nutrition equity is a moral imperative and should be a top priority in the promotion of public health.

Modern Diets and the Health of Our Planet: An Investigation into the Environmental Impacts of Food Choices

Popular modern diets are often seen as a panacea for improving health and promoting weight reduction. While there is a large body of literature reporting the health benefits of popular diets, few studies have described their planetary benefits. Our investigation aims to evaluate the simultaneous impacts of six popular diets within the United States on both human and planetary health. Using carbon footprint databases and representative meal plans, the environmental and health-related impacts of the Standard American, Mediterranean, vegan, paleo, keto, and climatarian diets are compared using the currently available literature. Results indicate that diets that exhibit lower carbon footprints also have positive effects on human health. The diets found to have the lowest environmental impacts were the vegan, climatarian, and Mediterranean diets. These low-carbon-footprint diets can likely be attributed to a reduced reliance on ruminant meat (cattle and sheep) and processed food consumption, while diets with high carbon footprints are more dependent on ruminant meat and saturated fat. Moderate consumption of meats such as chicken, pork, and fish in conjunction with an emphasis on locally grown fruits and vegetables can be maintained without adversely affecting the planetary carbon footprint and with the added benefit of promoting good health. Thus, making simple substitutions within each individual's diet can be advertised as an effective approach to collectively lower the environmental impact in tandem with improving health and longevity.

Mentha: Nutritional and Health Attributes to Treat Various Ailments Including Cardiovascular Diseases

A poor diet, resulting in malnutrition, is a critical challenge that leads to a variety of metabolic disorders, including obesity, diabetes, and cardiovascular diseases. Mentha species are famous as therapeutic herbs and have long served as herbal medicine. Recently, the demand for its products, such as herbal drugs, medicines, and natural herbal formulations, has increased significantly. However, the available literature lacks a thorough overview of Mentha phytochemicals' effects for reducing malnutritional risks against cardiovascular diseases. In this context, we aimed to review the recent advances of Mentha phytochemicals and future challenges for reducing malnutritional risks in cardiovascular patients. Current studies indicated that Mentha species phytochemicals possess unique antimicrobial, antidiabetic, cytotoxic, and antioxidant potential, which can be used as herbal medicine directly or indirectly (such as food ingredients) and are effective in controlling and curing cardiovascular diseases. The presence of aromatic and flavor compounds of Mentha species greatly enhance the nutritional values of the food. Further interdisciplinary investigations are pivotal to explore main volatile compounds, synergistic actions of phytochemicals, organoleptic effects, and stability of Mentha sp. phytochemicals.

Influence of Seaweeds on the Quality of Pasta as a Plant-Based Innovative Food

This study evaluated the effect of the incorporation of seaweed on the physicochemical and technological quality of pasta. For this purpose, enriched wheat pastas from different seaweeds (sea lettuce-Ulva lactuca, nori-Porphyra tenera, and wakame-Undaria pinnatifida) were made and compared with durum wheat pasta as a control treatment. Firstly, optimal cooking times were established by visual and instrumental methods. Then, the technological properties of weight gain (WG), swelling index (SI), cooking losses (CL), and moisture (H%) were determined. Protein and fiber analyses, texture profile analysis (TPA), and color measurements were also performed to evaluate the physicochemical properties. Overall, enriched pasta with seaweed revealed slightly shorter optimal cooking times than control pasta. Texture properties were also modified, with a lower value of hardness, and higher values of adhesiveness and resilience. However, due to the low percentages of seaweed (3%), noticeable effects were not appreciated. Moreover, color variations of enriched pasta were relevant due to the difference among seaweeds. Nonetheless, these additions increased the protein content and soluble fiber in these foods. In conclusion, pasta enriched with marine ingredients improved this nutritional profile, and the changes in technological properties did not have a major impact on the product quality.

Vegetarian and Vegan Diets: Beliefs and Attitudes of General Practitioners and Pediatricians in France

Studies suggest a decreasing trend in the consumption of meat products and a growing interest in vegetarian diets. Medical support may be relevant, especially when switching to a vegan diet. Our objective was to describe the beliefs and attitudes of primary care physicians toward vegetarian diets. A cross-sectional survey was conducted among general practitioners and pediatricians thorough a questionnaire including socio-demographic characteristics, specific care to vegetarians, and the risks and benefits of vegetarian diets according to physicians. Out of the 177 participating physicians, 104 (59%) have seen at least one vegetarian patient in consultation in the last three months. Half of the physicians declared that they would dissuade their patients from switching to a vegan diet (n = 88, 51%) and 14% (n = 24) from switching to an ovo-lacto-vegetarian (OLV) diet. Most physicians (n = 141, 88%) did not feel informed enough about these diets. Physicians thought that the most frequent deficiencies for OLV and vegan diets were iron (76% and 84%, respectively) and protein (45% and 79%, respectively). These results highlight the fact that French primary care physicians feel concerned by this subject and need more information on these diets. Specific recommendations would be useful to support their practice and relationship with vegetarians.

Sustaining Human Nutrition in an Increasingly Urban World

The complex interaction between social, economic, and environmental processes coupled with transformations of the landscape primarily driven by urbanization have impacts on the access, availability, and distribution, of food. This has resulted in a global micronutrient deficiency and hunger. Given rapid urbanization and population growth, a more sustainable food system is necessary to feed more urban populations and provide adequate nutrition, especially in developing countries. Existing frameworks for modelling urban-environment interactions contain components related to food security, however, lack the specificity needed to evaluate the effects of land use decisions and agricultural production strategies on the health of local populations measured through metrics such as nutritional output. The research presented here proposes an urban nutrition (UN) extension to the previously published urban ecological economic system by developing a focused component that simulates scenarios of different degrees of urbanization and agricultural production techniques to improve the nutritional output of agricultural land, while considering the conservation of soil. This simulation approach was subsequently applied to the Toluca Metropolitan Zone, Mexico. Results showed that nutritional output would greatly increase when adding a variety of crops, even in scenarios where agricultural land is limited. The proposed extension can be used by decision makers worldwide to evaluate how landscape configurations and agricultural production systems affect the nutritional needs of the local population while fostering sustainable practices.

Faba Bean: An Untapped Source of Quality Plant Proteins and Bioactives

Faba beans are emerging as sustainable quality plant protein sources, with the potential to help meet the growing global demand for more nutritious and healthy foods. The faba bean, in addition to its high protein content and well-balanced amino acid profile, contains bioactive constituents with health-enhancing properties, including bioactive peptides, phenolic compounds, GABA, and L-DOPA. Faba bean peptides released after gastrointestinal digestion have shown antioxidant, antidiabetic, antihypertensive, cholesterol-lowering, and anti-inflammatory effects, indicating a strong potential for this legume crop to be used as a functional food to help face the increasing incidences of non-communicable diseases. This paper provides a comprehensive review of the current body of knowledge on the nutritional and biofunctional qualities of faba beans, with a particular focus on protein-derived bioactive peptides and how they are affected by food processing. It further covers the adverse health effects of faba beans associated with the presence of anti-nutrients and potential allergens, and it outlines research gaps and needs.

Benefits of a plant-based diet and considerations for the athlete

Individuals may opt to follow a plant-based diet for a variety of reasons, such as religious practices, health benefits or concerns for animal or environmental welfare. Such diets offer a broad spectrum of health benefits including aiding in the prevention and management of chronic diseases. In addition to health benefits, a plant-based diet may provide performance-enhancing effects for various types of exercise due to high carbohydrate levels and the high concentration of antioxidants and phytochemicals found in a plant-based diet. However, some plant-based foods also contain anti-nutrional factors, such as phytate and tannins, which decrease the bioavailability of key nutrients, such as iron, zinc, and protein. Thus, plant-based diets must be carefully planned to ensure adequate intake and absorption of energy and all essential nutrients. The current narrative review summarizes the current state of the research concerning the implications of a plant-based diet for health and exercise performance. It also outlines strategies to enhance the bioavailability of nutrients, sources of hard-to-get nutrients, and sport supplements that could interest plant-based athletes.

Health- or Environment-Focused Text Messages as a Potential Strategy to Increase Plant-Based Eating among Young Adults: An Exploratory Study

Previous plant-based diet (PBD) adoption strategies have primarily focused on health rather than environmental rationale and meat reduction rather than plant-based protein promotion. In this study, we explored the effect of a theory-informed text-message intervention on dietary intentions and behaviors in young adult omnivores and the potential explanatory role of PBD beliefs, subjective norm, self-efficacy, moral norm, and health and environmental values. Participants completed baseline questionnaires and reported dietary intake before being randomly assigned to receive 2–3 health- or environment-focused text messages per week for eight weeks and then repeated baseline assessments. Although we did not see significant changes in meat or plant protein intake, we did observe a marked decrease in intentions to consume animal protein and a marginal increase in fruit and vegetable consumption intention. We identified subjective norms, self-efficacy, and moral satisfaction as the strongest predictors of changes in intention to consume animal or plant protein. Although few group differences were observed, those receiving environment-focused text messages experienced a greater change in values and were more likely to increase vegetable intake. Messages that improve sustainability awareness and provide practical adoption strategies may be part of an effective strategy to influence PBD intake among young adults.

Placing a Well-Designed Vegan Diet for Slovenes

Interest in vegan diets has increased globally as well as in Slovenia. The quantity of new scientific data requires a thorough synthesis of new findings and considerations about the current reserved position of the vegan diet in Slovenia. There is frequently confusion about the benefits of vegetarian diets that are often uncritically passed on to vegan diets and vice versa. This narrative review aims to serve as a framework for a well-designed vegan diet. We present advice on how to maximize the benefits and minimize the risks associated with the vegan diet and lifestyle. We highlight the proper terminology, present the health effects of a vegan diet and emphasize the nutrients of concern. In addition, we provide guidance for implementing a well-designed vegan diet in daily life. We conducted a PubMed search, up to November 2021, for studies on key nutrients (proteins, vitamin B12, vitamin D, omega-3 long chain polyunsaturated fatty acids (eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)), calcium, iron, zinc, iodine and selenium) in vegan diets. Given the limited amount of scientific evidence, we focus primarily on the general adult population. A well-designed vegan diet that includes a wide variety of plant foods and supplementation of vitamin B12, vitamin D in the winter months and potentially EPA/DHA is safe and nutritionally adequate. It has the potential to maintain and/or to improve health. For physically active adult populations, athletes or individuals with fast-paced lifestyles, there is room for further appropriate supplementation of a conventional vegan diet according to individuals' health status, needs and goals without compromising their health. A healthy vegan lifestyle, as included in government guidelines for a healthy lifestyle, includes regular physical activity, avoidance of smoking, restriction of alcohol and appropriate sleep hygiene.

The Association of Plant-Based Diet With Cardiovascular Disease and Mortality: A Meta-Analysis and Systematic Review of Prospect Cohort Studies

Background: The association between plant-based diets and cardiovascular disease (CVD) remains poorly characterized. Given that diet represents an important and a modifiable risk factor, this study aimed to assess (1) the relationships between the impact of adherence to plant-based diets on cardiovascular mortality, incident CVD, and stroke; (2) if associations differed by adherence to healthful and less healthful plant-based diets.

Methods and Findings: MEDLINE and EMBASE databases were searched up to May 2021. Studies assessing CVD outcomes with relation to plant-based dietary patterns or according to plant-based dietary indices (PDI) were included. A meta-analysis of hazard ratios (HR) was conducted using DerSimonian and Laird random effects model. Thirteen studies involving 410,085 participants were included. Greater adherence to an overall plant-based dietary pattern was significantly associated with a lower risk of cardiovascular mortality (pooled HR: 0.92, 95% CI: 0.86–0.99 p = 0.0193, I² = 88.5%, N = 124,501) and a lower risk of CVD incidence (pooled HR: 0.90, 95% CI: 0.82–0.98, p = 0.0173, I² = 87.2%, N = 323,854). Among the studies that used PDI, unhealthful plant-based diets were associated with increased risk of cardiovascular mortality (pooled HR: 1.05, 95% CI: 1.01–1.09, p = 0.0123, I² = 0.00%, N = 18,966), but not CVD incidence. Conversely, healthful plant-based diets were associated with decreased CVD incidence (pooled HR: 0.87, 95% CI: 0.80–0.95, p = 0.0011, I² = 57.5%, N = 71,301), but not mortality. Vegetarians also had significantly lower CVD incidence (HR: 0.81, 95% CI: 0.72–0.91, p = 0.0004, I² = 22.2%, N = 16,254), but similar CVD mortality or stroke risk when compared to the meat-eaters.

Conclusion: To date, this comprehensive study examines the effects of a plant-based diet on major clinical endpoints using more holistic PDIs. These findings highlight the favorable role of healthful plant-based foods in reducing cardiovascular mortality and CVD.

Meta-analysis of effect of vegetarian diet on ischemic heart disease and all-cause mortality

Objective

To summarize the association between vegetarian versus non-vegetarian diet on mortality due to ischemic heart disease, cerebrovascular disease, or all-cause mortality.

Methods

We searched PubMed, Cochrane databases, and ClinicalTrials.Gov from the inception of the databases to October 2019 with no language restriction. Randomized controlled trials or prospective observational studies comparing the association between vegetarian versus non-vegetarian diets among adults and reporting major adverse cardiovascular outcomes were selected. We used Paule-Mandel estimator for tau2 with Hartung-Knapp adjustment for random effects model to estimate risk ratio [RR] with 95% confidence interval [CI].The primary outcome of interest was all-cause mortality. The secondary outcome was ischemic heart disease mortality.

Results

Eight observational studies (n = 131,869) were included in the analysis. Over a weighted mean follow-up of 10.68 years, very low certainty of evidence concluded that a vegetarian diet compared with a non-vegetarian diet was associated with similar risk of all-cause (RR: 0.84, 95% CI: 0.65-1.07, I² : 97%) or cerebrovascular mortality (RR: 0.84, 95% CI: 0.63-1.14, I² : 90%), but was associated with a reduced risk of ischemic heart disease mortality (RR: 0.70, 95% CI: 0.55-0.89, I² : 82%).

Conclusion

A vegetarian diet, compared with a non-vegetarian diet, was associated with a reduced risk of ischemic heart disease mortality, whereas it had no effect on all-cause and cerebrovascular mortality. However, the results are to be considered with caution considering the low certainty of evidence. Despite recent studies supporting no restriction on animal protein intake gaining wide media attention and public traction, consideration for vegetarianism amongst those with risk factors for coronary artery disease should be contemplated.

Managing Psoriatic Arthritis With a Whole Food Plant-Based Diet: A Case Study

A 40-year-old female teacher presented to the rheumatology clinic in 2003 with nonspecific back, knees, and right ankle pain. She was subsequently diagnosed with psoriatic arthritis and was taking methotrexate to control her disease. Over the years, her symptoms were mostly under control. However, in 2018, after adopting a whole food plant-based diet free of added salt, oil, and sugar, she was able to stop taking methotrexate. She was discharged from the rheumatology clinic and has remained symptom-free since. The available literature on managing psoriatic arthritis with diet shows that less than 2% of patients with psoriatic arthritis are able to discontinue medication as a result of disease remission. This case report adds to support and encourages further research in the field of managing inflammatory polyarthropathies with diet and lifestyle.

Post-diagnostic reliance on plant-compared with animal-based foods and all-cause mortality in omnivorous long-term colorectal cancer survivors

BACKGROUND

Plant-rich diets are associated with lower cardiometabolic risks and longer survival in the general population, but their association with mortality in cancer survivors is still unclear.

OBJECTIVES

We aimed to examine the associations of 3 postdiagnostic plant-based diet indices with all-cause mortality in omnivorous long-term colorectal cancer (CRC) survivors.

METHODS

Diet was assessed with FFQs at a median of 6 years after diagnosis in 1404 CRC survivors (56% male; median age, 69 years) in a Northern German prospective cohort study. An overall, a healthful plant-based, and an unhealthful plant-based diet index were derived by scoring intakes of animal foods reversely and intakes of healthy (whole grains, vegetables, fruits, legumes, nuts, oils, tea/coffee) and less healthy plant foods (refined grains, fruit juices, sugar-sweetened beverages, potatoes, sweets/desserts) positively or reversely, depending on the index. Vital status follow-up was conducted via population registries. Cox proportional hazards regression was applied to estimate HRs for all-cause mortality according to plant-based diet adherence.

RESULTS

Within 7 years (median) after diet assessment, 204 deaths occurred. The overall plant-based diet index displayed a significant, inverse association with all-cause mortality (HR per 10-point increase in diet index, 0.72; 95% CI, 0.57-0.91). Although not statistically significant, higher healthful plant-based diet scores showed a strong tendency towards lower mortality (HR, 0.82; 95% CI, 0.67-1.01). The unhealthful plant-based diet index was associated with higher mortality, but lost statistical significance after multivariable adjustment (HR, 1.19; 95% CI, 0.96-1.48). A subgroup analysis revealed that the tendency towards a positive association of the unhealthful plant-based diet with mortality was restricted to less physically active individuals (<95 metabolic equivalent of task hours/week).

CONCLUSIONS

An overall plant-based diet was inversely associated with all-cause mortality in long-term CRC survivors. However, more research is needed to further disentangle the impacts of different qualities of plant-based diets on cancer survivors' health.

Dietary intake is associated with neuropsychological impairment in women with HIV

BACKGROUND

Diet is a modifiable risk factor that may influence cognition in people with HIV.

OBJECTIVES

We examined the association between dietary intake and cognition in women with HIV (WWH) and HIV-seronegative women.

METHODS

An 18-item dietary National Cancer Institute screener was completed by 729 WWH and 346 HIV-seronegative Women's Interagency HIV Study participants. Daily intake frequencies of processed meats, sweet beverages, fish, whole milk, and vegetables were calculated. Participants completed biennial neuropsychological (NP) testing. NP domains included attention/working memory, executive function, processing speed, memory, learning, fluency, and motor function. NP impairment was defined as demographically adjusted T-scores (mean = 50; SD = 10) ≤40 at ≥1 visit after completing the dietary screener. Multivariable logistic regression, stratified by HIV serostatus, examined associations between intake frequency tertile (referent = lowest intake) and NP performance.

RESULTS

Dietary intake frequencies of individual food line items were similar between WWH and HIV-seronegative women, except for sweet beverages, for which HIV-seronegative women reported higher intake frequencies than WWH (P values < 0.05). In WWH, multivariable-adjusted models indicated higher odds of NP impairment with higher intake frequencies of processed meat [P = 0.006; ORupper tertile = 1.91 (95% CI: 1.23-2.95; P = 0.003); ORmiddle tertile = 1.66 (95% CI: 1.14-2.42; P = 0.01)], sweet beverages [P = 0.02; ORupper tertile = 1.75 (95% CI: 1.17-2.64; P = 0.007)], fish [P = 0.01; ORupper tertile = 1.70 (95% CI: 1.10-2.64; P = 0.02)], and whole milk [P = 0.029; ORupper tertile = 1.66 (95% CI: 1.14-2.42; P = 0.008)]. Lower odds of NP impairment [P = 0.005; ORupper tertile = 0.65 (95% CI: 0.45-0.95; P = 0.02); ORmiddle tertile = 0.42 (95% CI: 0.24-0.73; P = 0.002)] were associated with higher vegetable intakes. In HIV-seronegative women, multivariable-adjusted models did not show associations between food line items/diet quality score and NP outcomes.

CONCLUSIONS

Intakes of processed meat, sweet beverages, whole milk, fish, and vegetables may be associated with NP functions among WWH. Associations among WWH are not directly comparable to those among HIV-seronegative women, because models were conducted on each group separately given controls for HIV-specific covariates in WWH. Further studies are needed using more rigorous dietary assessment methods and lengthier longitudinal follow-ups.

Vegan Diet Health Benefits in Metabolic Syndrome

Plant-based diets (PBDs) are increasingly consumed by the Italian population and around the world. In particular, among PBDs, the vegan diet is a food pattern characterized by the exclusion of all animal-origin foods. What drives people to adopt this model are mainly ethical, health and environmental reasons. A vegan diet, if well-balanced and varied, can help in achieving and maintaining an optimal state of health. However, this nutritional approach, if not well-balanced, can cause deficiencies in proteins, ω-3 fatty acids, iron, vitamin D and calcium, zinc, iodine and, above all, vitamin B12. Oral food supplements especially fortified foods are recommended in these cases to restore the nutritional deficiencies. A vegan diet generally reduces the risk of developing chronic non-communicable degenerative diseases, such as metabolic syndrome (MetS) and, in addition, requires fewer natural resources for food production than an omnivorous diet. The aim of this review is to analyze the possible impact of the vegan diet on MetS onset and its treatment.

Foods for Plant-Based Diets: Challenges and Innovations

Plant-based diets have become popular as a means of reducing the environmental footprint of the diet and promoting human health and animal welfare. Although the percentages of vegetarians and vegans are low compared to omnivores, their numbers have increased significantly in the last years. The use of non-animal food products other than meat alternatives is also increasing and this tendency constitutes an opportunity for the food industry. In this review, we present that plant-based meat and milk alternatives are consolidated but that there is a niche for egg, seafood alternatives, and new products which may not resemble any traditional animal food. However, not all animal food substitutes are sustainable and some of them are even ultra-processed. In addition, there are concerns on safety and labeling, and consumers demand clear information and regulation. The challenges in this field are connected with food design and technology, sensory science, nutrition, and dietetics. Moreover, adequate selection and combination of foods is important in order to achieve consumer acceptance while preventing nutritional deficiencies in those who choose this type of diet.

Dietary Strategies for Metabolic Syndrome: A Comprehensive Review

Metabolic syndrome is a cluster of metabolic risk factors, characterized by abdominal obesity, dyslipidemia, low levels of high-density lipoprotein cholesterol (HDL-c), hypertension, and insulin resistance. Lifestyle modifications, especially dietary habits, are the main therapeutic strategy for the treatment and management of metabolic syndrome, but the most effective dietary pattern for its management has not been established. Specific dietary modifications, such as improving the quality of the foods or changing macronutrient distribution, showed beneficial effects on metabolic syndrome conditions and individual parameters. On comparing low-fat and restricted diets, the scientific evidence supports the use of the Mediterranean Dietary Approaches to Stop Hypertension (DASH) diet intervention as the new paradigm for metabolic syndrome prevention and treatment. The nutritional distribution and quality of these healthy diets allows health professionals to provide easy-to-follow dietary advice without the need for restricted diets. Nonetheless, energy-restricted dietary patterns and improvements in physical activity are crucial to improve the metabolic disturbances observed in metabolic syndrome patients.

Metabolomics-Based Study of the Effect of Raw Materials to the End Product of Tempe-An Indonesian Fermented Soybean

Tempe is a fermented soybean food from Indonesia, made by inoculating Rhizopus spp. onto cooked and dehulled soybean. Tempe has been a part of Indonesian culture since the 16th century and is now produced globally as a highly nutritious plant-based food. Despite a longstanding history on the production of tempe, very few studies have been reported to understand the effect of raw material to the end product metabolite composition. In this research, we applied GC/MS-based metabolite profiling to investigate the effect of various possible factors that might affect the final product (environmental factors, raw materials, and starter cultures). Representative samples were tempe produced by Indonesian industries, Japanese industries as well as laboratory made tempe. The results showed that both environmental factors and raw materials (soybean, water, and starter culture) contributed to the tempe metabolite profile. Here we found the possibility that starter cultures might play a greater role to determine the metabolite profiles compared to other tested factors. This research might provide useful insights for the larger scale industries to maintain the quality of tempe for the benefit of the consumers.

Whole-Food Plant-Based Lifestyle Program and Decreased Obesity

Failure of weight-loss programs is high. We evaluated a whole-food plant-based (WFPB) lifestyle program. We investigated the obesity indices of 151 healthy adults who were on our ongoing, community-based program for the short (0.5 to ≤2 years), medium (2 to ≤5 years), or long term (5 to 10 years). Body composition indices were measured by medically approved bioimpedance. Body composition changes were favorable for all 3 groups and both genders. There were no differences in body composition between the males for all 3 groups, while there were lower body mass (BM), body mass index (BMI), and muscle mass in females on long-term versus short-term programs. All participants experienced a decrease in BMI (−2.5 kg/m2), BM (−7.1 kg), and body fat percentage (−6.4%; P < .001 for all). The reductions for those with a baseline BMI of obese, overweight, and normal were −5.6, −2.4, and −0.9 kg/m2 for BMI, −16.1, −7.1, and −2.5 kg for total BM, and −9.5%, −6.6%, and −4.8% for body fat percentage (baseline vs current; P < .001 for all). A total of 86% of parents of underage children introduced the WFPB lifestyle to children. Our WFPB lifestyle program provides a long-term reversal of obesity.

A Comprehensive Review of the Benefits of and the Barriers to the Switch to a Plant-Based Diet

In recent decades, the food industry has been faced with new challenges, and it has had to develop new types of diets and produce new types of foods that can slow down the spread of chronic diseases. The aim of our research was to identify the characteristics of plant-based nutrition, based on international and Hungarian literature. The comprehensive analysis was performed based on the theoretical model called Theory of Planned Behavior, in the course of which the perceived and objective benefits of and barriers to the conversion to a plant-based diet were examined. According to our results, the main benefits of plant-based nutrition are its many factors associated with a reduction in risk of developing numerous chronic diseases. This is followed by benefits of well-being and satisfaction, followed by ethical and environmental benefits. The most commonly reported inhibitory factor of a vegetarian diet is the enjoyment of eating meat and the difficulty in giving up meat consumption. This is followed by health considerations, e.g., lack of various ingredients in foods. Convenience and taste factors are also important disincentives, as well as the irrelevant nature of some plant-based nutrition information sources. Besides, social barriers, negative discrimination, and negative effect on mental health associated with them can also be a hindrance, as can financial barriers. The classification developed during our analysis can serve as a relevant guideline for decision-makers, and also as a basis for further primary qualitative and quantitative research.

Poor dietary consumption and limited sun exposure are risk factors for vitamin D deficiency in premenopausal Kuwaiti women: A cross-sectional study

Background: Low serum vitamin D levels are reported constantly among females living in the Arabian Gulf countries, presumably due to their lifestyle, which limits direct sun exposure. Because Vitamin D deficiency has been implicated in a wide range of ailments, healthy females with the deficiency might be at risk for developing many health problems. Thus, the aim was to assess lifestyle risk factors for vitamin D deficiency in healthy women in Kuwait. Methods: A total of 104, disease-free, premenopausal women were recruited for assessment of their serum 25OHD and intact PTH levels. Physical examination, blood withdrawal and interviewer-administered questionnaires were used to collect the relevant data. Associations were detected statistically using nonparametric tests and logistic regression was used to identify risk factors for vitamin D deficiency. Results: Vitamin D deficiency ( < 25 nmol/L) occurred in 84.6%, and hyperparathyroidism ( ≥ 6.9 pmol/L) occurred in 25% of women, among which all were vitamin D deficient. Significant risk factors of vitamin D deficiency were nondaily milk intake (OR:25, CI%:4.2-147), no fish intake (OR:5, CI%:1-22.8), and no weekend sun exposure (OR:8.2, CI%:1.28-52.6). Having PTH ≥ 6 pmol/L was also associated with a higher likelihood of having vitamin D deficiency. Conclusion: Vitamin D deficiency is very common in disease-free, premenopausal Kuwaiti women and can be avoided by improving food consumption and obtaining more sun exposure.

Seeds

A wide variety of plant species provide edible seeds. Seeds are the dominant source of human calories and protein. The most important and popular seed food sources are cereals, followed by legumes and nuts. Their nutritional content of fiber, protein, and monounsaturated/polyunsaturated fats make them extremely nutritious. They are important additions to our daily food consumption. When consumed as part of a healthy diet, seeds can help reduce blood sugar, cholesterol, and blood pressure.

Characterization, dietary habits and nutritional intake of omnivorous, lacto-ovo vegetarian and vegan runners - a pilot study

BACKGROUND

The number of people preferring plant-based nutrition is growing continuously in the western world. Vegetarianism and veganism are also becoming increasingly popular among individuals participating in sport. However, whether recreationally active vegetarian and vegan populations can meet their nutritional needs is not clear.

METHODS

The purpose of this cross-sectional study was to compare the nutrient intake of omnivorous (OMN, n = 27), lacto-ovo vegetarian (LOV, n = 25) and vegan (VEG, n = 27) recreational runners (two to five training sessions per week) with intake recommendations of the German, Austrian and Swiss Nutrition Societies (Deutsche, Österreichische und Schweizerische Gesellschaften für Ernährung, D-A-CH) for the general population. Lifestyle factors and supplement intake were examined via questionnaires; dietary habits and nutrient intake were determined based on 3-day dietary records.

RESULTS

More than half of each group did not reach the recommended energy intake (OMN: 10.4, 8.70-12.1; LOV: 9.67, 8.55-10.8; VEG: 10.2, 9.12-11.3 MJ). Carbohydrate intake was slightly below the recommendations of > 50 EN% in OMN (46.7, 43.6-49.8 EN%), while LOV (49.4, 45.5-53.3 EN%) and VEG (55.2, 51.4-59.0 EN%) consumed adequate amounts (p = 0.003). The recommended protein intake of 0.8 g/kg body weight (D-A-CH) was exceeded in all three groups (OMN: 1.50, 1.27-1.66; LOV: 1.34, 1.09-1.56; VEG: 1.25; 1.07-1.42 g/kg BW; p = 0.047). Only VEG (26.3, 22.7-29.8 EN%) did not achieve the recommended fat intake of 30 EN%. The supply of micronutrients, such as vitamin D and cobalamin, was dependent on supplement intake. Additionally, female OMN and LOV achieved the recommended daily intake of 15 mg iron only after supplementation, while VEG consumed adequate amounts solely via food.

CONCLUSION

All three groups were sufficiently supplied with most nutrients despite the exceptions mentioned above. The VEG group even showed advantages in nutrient intake (e.g. carbohydrates, fiber and iron) in comparison to the other groups. However, the demand for energy and several macro- and micronutrients might be higher for athletes. Thus, it is also necessary to analyze the endogenous status of nutrients to evaluate the influence of a vegetarian and vegan diet on the nutrient supply of athletes.

TRIAL REGISTRATION

German Clinical Trial Register (DRKS00012377), registered on April 28, 2017.

The Power of Plants: Is a Whole-Foods, Plant-Based Diet the Answer to Health, Health Care, and Physician Wellness?

The exponential rise in the cost of health care since the 1980s in the US is unsustainable. It is estimated that more than 70% of health care dollars are spent addressing the result of unhealthy lifestyles that are increasing the rates of obesity, diabetes, and cardiovascular disease. There is also a severe and worsening epidemic of physician burnout in the US, which threatens the health of physicians and patients alike. In this article, I share why I believe a whole-foods, plant-based diet is a powerful prescription for optimal health and the answer to health, health care, and physician wellness.

Dietetics Program Directors in the United States Support Teaching Vegetarian and Vegan Nutrition and Half Connect Vegetarian and Vegan Diets to Environmental Impact

Registered Dietitian Nutritionists (RDNs) are clinicians trained in the application of food, nutrition, and dietetics. Vegetarians and vegans have a lower risk of many nutrition-related chronic diseases that are epidemic while vegetarian and vegan diets are associated with reduced environmental impact. Despite this strong diet-disease and diet-environment connection, it is not known if dietetics students are taught the principles of vegetarian and vegan nutrition. The overarching goal of our study was to investigate curricular practices in accredited dietetics training programs in the United States (U.S.) including (1) the prevalence and perceived importance of vegetarian and vegan nutrition instruction and (2) if program directors connect vegetarian and vegan diets to climate change mitigation and resource conservation. Primary data were collected by way of a cross-sectional, Internet-based survey. All Accreditation Council for Education in Nutrition and Dietetics (ACEND) program directors in the U.S. (N = 574) were sent a 37-question survey and invited to participate in the study. Outcome measures included the prevalence of vegetarian and vegan nutrition instruction, quantifying if relationships exist among variables, and the frequency of connecting vegetarian and vegan diets to environmental impact. Descriptive and inferential statistics were utilized. Respondents (n = 205) indicated that over 51% of programs teach vegetarian nutrition while 49% teach vegan nutrition. There were significant differences between program type and the prevalence of vegetarian (p = 0.00005) and vegan (p = 0.00005) nutrition instruction. Over 90% of program directors believe that vegetarian and vegan nutrition should be taught. Over 50% of programs identify the connection between vegetarian and vegan diets in climate change mitigation and resource conservation. Most ACEND program directors believe vegetarian and vegan nutrition should be taught and half connect diet to environmental concern. Nevertheless, there is a discrepancy between beliefs and practice behaviors. These results suggest the need for increased collaboration and the use of novel techniques that better incorporate vegan and vegetarian nutrition throughout dietetics education.

No common denominator: Plant-based diets and treatment-induced neuropathy of diabetes

Treatment-induced neuropathy of diabetes is a poorly understood and underestimated iatrogenic complication of aggressive glycemic control in individuals suffering from diabetes. Symptoms, including severe neuropathic pain and autonomic dysfunction, usually follow an abrupt improvement in glycemic control. The latter is usually triggered by pharmacotherapy, however, treatment-induced neuropathy of diabetes (TIND) has also been associated with severe dietary restriction. Dietary modifications are of paramount importance in the treatment of type 2 diabetes. Hereby, calorie restriction and fasting diets as well as plant-based diets enjoy uninterrupted popularity. While cases of TIND have been reported with (very) low calorie diets, a case of TIND in the context of a whole-food plant-based diet has not been published to the best of my knowledge. Is this a simple coincidence or is there potentially a reason behind it? The hypothesis presented in this paper is that whole-food plant-based diets and TIND do not share a common denominator. Both evidence in support and evidence against this, admittedly, speculative hypothesis, is presented in this manuscript. A special focus is put on HbA1c dynamics with plant-based diets and reduced medication needs.

Uric Acid and Plant-Based Nutrition

Plant-based diets (PBDs) are associated with decreased risk of morbidity and mortality associated with important noncommunicable chronic diseases. Similar to animal-based food sources (e.g., meat, fish, and animal visceral organs), some plant-based food sources (e.g., certain soy legume products, sea vegetables, and brassica vegetables) also contain a high purine load. Suboptimally designed PBDs might consequently be associated with increased uric acid levels and gout development. Here, we review the available data on this topic, with a great majority of studies showing reduced risk of hyperuricemia and gout with vegetarian (especially lacto-vegetarian) PBDs. Additionally, type of ingested purines, fiber, vitamin C, and certain lifestyle factors work in concordance to reduce uric acid generation in PBDs. Recent limited data show that even with an exclusive PBD, uric acid concentrations remain in the normal range in short- and long-term dieters. The reasonable consumption of plant foods with a higher purine content as a part of PBDs may therefore be safely tolerated in normouricemic individuals, but additional data is needed in hyperuricemic individuals, especially those with chronic kidney disease.

Is There a Lack of Support for Whole-Food, Plant-Based Diets in the Medical Community?

Since the early 2000s, plant-based nutrition has increased in popularity in the general population. Kaiser Permanente significantly contributes to this development by promoting plant-based diets and by continuously incorporating plant-based nutrition on the front lines with their dietary recommendations. Despite a continuously growing body of evidence and the meticulous work of renowned experts in this field worldwide, the latest findings in this area have not found their way into US national dietetic guidelines.We must ask ourselves why this is the case, given the numerous advantages and health benefits of a whole-food, plant-based diet. What role do physicians play in this context? Is there potentially a lack of support for whole-food, plant-based diets and comprehensive lifestyle change programs in the medical community?

A Practical Guide for Physicians and Health Care Workers to Reduce Their Carbon Footprint in Daily Clinical Work

With Earth Overshoot Day having recently passed, there is no space for complacency regarding taking care of our planet. On August 2, 2017, humanity used nature's resource budget for the entire year. For decades, we have lived far beyond our means by overexploiting natural resources and spewing pollution, such as microplastics and industrial chemicals, into our environment. On the other hand, public awareness of human-induced climate change has also increased since the 1980s. The frequent media coverage about extreme weather conditions and natural disasters, such as Hurricane Irma in 2017, serves as an important reminder that anthropogenic climate change is happening now.Adverse health conditions associated with climate change include an increased prevalence of diseases and disorders. Although we all contribute to this development, as physicians we also have the privileged duty to protect global human health. Therefore, we should make every effort to cut down our own carbon footprint and adapt a more sustainable lifestyle.The aim of this commentary is to provide feasible tips and strategies to effectively reduce one's individual carbon footprint, with a special focus on daily clinical and hospital work. Not only are these strategies easy to implement in daily clinical routine, but most of them are associated with important health benefits.

Lifestyle Medicine: A Brief Review of Its Dramatic Impact on Health and Survival

By ignoring the root causes of disease and neglecting to prioritize lifestyle measures for prevention, the medical community is placing people at harm. Advanced nations, influenced by a Western lifestyle, are in the midst of a health crisis, resulting largely from poor lifestyle choices. Epidemiologic, ecologic, and interventional studies have repeatedly indicated that most chronic illnesses, including cardiovascular disease, cancer, and type 2 diabetes, are the result of lifestyles fueled by poor nutrition and physical inactivity.In this article, we describe the practice of lifestyle medicine and its powerful effect on these modern instigators of premature disability and death. We address the economic benefits of prevention-based lifestyle medicine and its effect on our health care system: A system on the verge of bankruptcy. We recommend vital changes to a disastrous course. Many deaths and many causes of pain, suffering, and disability could be circumvented if the medical community could effectively implement and share the power of healthy lifestyle choices. We believe that lifestyle medicine should become the primary approach to the management of chronic conditions and, more importantly, their prevention. For future generations, for our own health, and for the Hippocratic Oath we swore to uphold ("First do no harm"), the medical community must take action. It is our hope that the information presented will inspire our colleagues to pursue lifestyle medicine research and incorporate such practices into their daily care of patients. The time to make this change is now.