The content of this presentation is copyrighted. It is intended for the EXCLUSIVE use of the attendees of the 2nd. European Health Conference and specifically authorized entities of the Seventh-day Adventist Church. It is strictly and expressly forbidden to copy, republish, translate, transmit, distribute or post any part, parts or the entirety of this presentation on Internet, Social Media or any other form of electronic or printed media or to use it for any commercial purpose.

UniquePerspectivesonDietaryChoices

FredHardinge,DrPH,RDAssociateDirector

GeneralConferenceHealthMinistriesDepartment

1

The“Original”DietIsthatdietstillavailable,andisitgoodforme?

2

OriginalDiet

• Genesis1:29:“ThenGodsaid,Igiveyoueveryseed-bearingplantonthefaceofthewholeearthandeverytreethathasfruitwithseedinit.Theywillbeyoursforfood.”• Genesis3:18:adds“...andyouwilleattheplantsofthefield.”

3

WhatKindsofFood?

• Fruit

•Vegetables

•Wholegrains

• Legumes

•Nuts&seeds

4

TheseFoodsAreBest…whenconsumedastheycomefromnature:notrefined,notpulledapart,orfractionated.✓Lowinfat✓Lowinsaturatedfat✓Nocholesterol✓Highindietaryfiber✓Lowinrefinedsugar✓Containsrichsourcesofvitaminsandminerals

✓Highamountsofprotectivesubstances:phytochemicals,antioxidants

5

NutritionAuthoritiesAgree

Useplantfoodsasthefoundationofyourmeals.Eatingavarietyofgrains(especiallywhole-grains),fruitsandvegetablesisthebasisofhealthyeating.

6Perspectives of Dietary Choices.key - April 19, 2018

Howdowedefineplant-baseddiets?

7

–American Dietetic Association and Dieticians of Canada, February 16, 2014

" ... plant-based diets, defined as diets that include generous amounts of plant foods and

limited amounts of animal foods"

8

–The Permanente Journal. Kaiser Permanente. 17 (2): 61–66

“... a plant-based diet, which we define as a regimen that encourages whole, plant-based foods and discourages meats, dairy products, and eggs as well as all refined and processed

foods.”

“A key distinction is that although most of these diets are defined by what they exclude,

the plant-based diet is defined by what it includes.

9

–Nutrition, Exercise, and Behavior: An Integrated Approach to Weight Management, 2012

“A plant-based diet is not necessarily a vegetarian diet. Many people on plant-

based diets continue to use meat products and/or fish but in smaller quantities.”

10

Plant-based Diets

Ovo-lactovegetarian

FlexitariansTotalvegetarian(vegan)

Semi-vegetarians

Pesco-vegetarian

11

–Huffington Post, 05/24/2017

Vegans abstain from eating any animal products… But it doesn’t necessarily mean they’re eating lots of whole

foods plant-based meals. Vegans could get through life eating processed foods and snubbing their veggies just

like anyone else. Think potato chips, (vegan-friendly) gummy candy, and even cookies.

“A whole foods plant-based diet, on the other hand, emphasizes eating whole fruits and vegetables,

consuming lots of whole grains, and staying away from (or at least minimizing) the intake of animal products and

processed foods for health reasons. That means that even vegan desserts made with refined sugar or

bleached flour are out.”

12Perspectives of Dietary Choices.key - April 19, 2018

UnhealthfulTotalVegetarianDietsNotallplantfoodsarenecessarilybeneficialforhealth.

• Ladenwithrefinedgrainslikewhitebreadandwhiterice

• Useofsugar-sweetenedbeveragesandjuices

• Mealsfilledwithcookiesandcrackers

• Chips

• Dairy-freeicecream,puddings,etc.

13

NutrientsofConcern• VitaminB12

• Calcium• VitaminD• n-3FattyAcids• Iron• Zinc• Iodine

J Am Diet Assoc. 2009;109: 1266-1282.

14

SuggestionsforaHealthyAnimal-freeDiet

• Ensureamplegrains,vegetables,legumes,fruits,nuts,seedsandberries.• Avoidreplacinganimalfoodsbyrefined,sweet,fattycommercialproducts,eveniffromplantsources.

• TakeasupplementofvitaminB12daily.

• Obtainadequatesunlightandemphasizehighcalciumvegetables,orsupplementwithcalcium.• Considersupplementshighinomega-3fattyacids.

15

WhynottakeVitaminD?

• Virtuallynoprovablehealthbenefits• Reviewofmorethan100systematicreviewsfoundonlyafew“probable”relationshipsbetweenserumvitaminDlevelsandclinicaloutcomes,andthatsupplementationdoesnotincreaseBMDorreducefactorriskorfalls.• USPSTFfoundinsufficientevidencetosupporttestingorsupplementationincommunitylivingadults.

LeFevreML,LeFevreNM.VitaminDscreeningandsupplementationincommunity-dwellingadults:commonquestionsandanswers.AmFamPhysician.2018;97(4):254–260.

16

IsaTotalVegetarianDietforEveryone?

17

MustAlwaysTakeaGlobalPerspective

• Availabilityoffortifiedfoods• Affordabilityofthosefortifiedfoods• Abilitytoimplementhealthydietarychanges• Availabilityofqualitysupplements• Affordabilityofsupplements• Leveloffoodandnutritionknowledge

18Perspectives of Dietary Choices.key - April 19, 2018

WilltheAdventistHealthStudyResultsAnswerAlltheQuestions?Therearenosimpleanswers.Onedietisunlikelytobebestforalldiseaseoutcomes.

19

DietaryPatternandTotalMortality*Risk Factor RR 95% Confidence Intervals

Non-vegetarian 1.00

Total 0.85 0.71-- 0.93

Lacto-ovo- 0.91 0.82 – 0.96

Pesco- 0.81 0.69 – 0.88

Semi- 0.92 0.80—1.06*Adjustedforage,gender,andethnicity.

20

RedMeatandTotalMortality*Risk Factor RR 95% Confidence Intervals

No red meat 1.00

1 oz/day (28 g) 1.27 1.19– 1.35

2 oz/day (56 g) 1.61 1.42 – 1.83

3 oz/day (84 g) 2.05 1.70 – 2.47*Adjustedforage,gender,andethnicity.

21

TotalMortalityDifferences(ComparativeDifferencesinRR)

Total Veg vs L-O Veg

No Red Meat vs 28 g

No Red Meat vs 56 g

No Red Meat vs 84 g

0 0.275 0.55 0.825 1.1

1.05

0.61

0.27

0.06

22

DietaryPatternandCHDMortality*Risk Factor RR 95% Confidence Intervals

Non-vegetarian 1.00

Total 0.91 0.67– 1.10

Lacto-ovo- 0.90 0.80 – 1.12

Pesco- 0.80 0.64 – 1.05

Semi- 0.85 0.58—1.07*Adjustedforage,gender,andethnicity.

23

DietaryPatternandTotalCancer*Risk Factor RR 95% Confidence Intervals

Non-vegetarian 1.00

Total 0.92 0.65 - 0.93

Lacto-ovo- 0.90 0.83 – 1.02

Pesco- 0.94 0.82 – 1.11

Semi- 0.94 0.66 - 0.97*Adjustedforage,gender,andethnicity.

24Perspectives of Dietary Choices.key - April 19, 2018

RedMeatandColonCancer*Risk Factor RR 95% Confidence Intervals

No red meat 1.00

1 oz/day (28 g) 1.35 1.07– 1.71

2 oz/day (56 g) 1.83 1.14 – 2.93

3 oz/day (84 g) 2.48 1.22 – 5.03*Adjustedforage,gender,andethnicity.

25

CancerMortalityDifferences(ComparativeDifferencesinRR)

Total Veg vs L-O Veg

Total Veg vs Pesco

No Red Meat vs 28 g

No Red Meat vs 56 g

No Red Meat vs 84 g

0 0.4 0.8 1.2 1.6

1.48

0.83

0.35

0.08

0.02

26

Thevegetarianadvantageisveryclearalmosteverywhere!

27

OverallConclusions

• Vegetariandietshaveclearandimportanteffectsonriskofchronicdisease

• Dietsareverycomplexanddissectingouttheactivecomponentsisdifficult,butanon-goingtaskinAHS-2

• Whichtypeofvegetariandietisbestwillprobablyhavenosimpleanswer,asonedietisunlikelytobebestforalldiseaseoutcomes

• Strongconclusionsrequirestrongevidence—AHS-2ishelpingtoprovidethiskindofevidence.

28

WhatistheOptimumVegetarianDiet?

• Sofartotalvegetarianslookverygood,butnotyetconvincinglysuperiortolacto-ovovegetarians.• Weneedtokeeplookingasthedatagrowsmorerobust.

29

PracticalConclusion

• Theevidencerightnowissufficienttosupportawholeplant-baseddietthat:• maystillincludesomelacto-ovofoods(usedprimarilyascondiments);

• isotherwiseplant-based,ortrendsstronglyinthatdirection.

• avoidsallredmeats(includingpoultry)!

30Perspectives of Dietary Choices.key - April 19, 2018

Let’sMovetheConversationto…1. Torecognizehealthismuchmorethanwhatweeat!

• FaithinGodandservicetoothers• Exercise

• Sleep• Avoidingalcohol,tobacco,andcaffeine• Adequatehydration

• Awholesome,balancedplant-baseddiet

2. How’sofeatinghealthfully…notjustthedo’sanddon’ts.3. Theimportanceofavoidingredmeat.

31

Ifyouwaittomodifyyourlifestyleuntilallthedetailsareknownforsure—youwillbedead!

32

Perspectives of Dietary Choices.key - April 19, 2018