Designing an Optimal Diet for Life

Designing an Optimal Diet for Long-Term Health and Wellness with Brenda Davis, R.D.

Thank you so much Michael. I’m really excited to be here and so happy to be part of this wonderful event. As we mentioned, the topic is designing an optimal diet for life and we will be covering a fair bit on protein in this talk.

First a quick overview. We’re going to talk a little bit about what is an optimal diet for long-term health and wellness. Then I would be honored to share a little bit about my own experience in putting lifestyle medicine into practice. And then we’ll spend the rest of the time, which is a good chunk of time, looking at five dietary goals that will help us to achieve an optimal diet or to design an appropriate optimal diet. They are: number one, to ensure healthful sources of macronutrients; number two, to ensure sufficient micronutrients; thirdly, to maximize intake of protective dietary components; fourth, to minimize intake of pathogenic dietary components; and last but not least, to make ecologically sustainable food choices. And then we will conclude with a very brief summary about what to eat.

So let’s move on to the first part of the presentation. What is an optimal diet? Well, an optimal diet is one that meets needs for all essential nutrients and it of course also minimizes the risk of chronic disease and finally it supports health and well-being at every single stage of the life cycle.

So what diet best accomplishes these tasks? And I think the answer was brilliantly written in this piece by Dr. David Katz. Can we say what diet is best for health? And I quote: “A diet of minimally processed foods close to nature, predominantly plants, is decisively associated with health promotion and disease prevention.” And national and international health authorities agree.

In 2001 the World Health Organization Europe in this document Plant-based Diets and Their Impact on Health, Sustainability and the Environment said the following: “Taken together the beneficial effects of plant-based diets including the protection they offer against premature mortality provides strong evidence for public health guidelines recommending healthful plant-based diets as a means to prevent and control NCDs or non-communicable diseases or chronic diseases if you will.”

The World Health Organization Europe in their 12 steps to healthy eating, step number one is to eat a nutritious diet based on a variety of foods originating mainly from plants rather than animals. And in the UN’s Intergovernmental Panel on Climate Change 2022 they wrote: “In addition to climate mitigation gains a transition towards more plant-based consumption and reduced consumption of animal-based foods could lower the risk of cardiovascular disease and type two diabetes and reduce mortality from diet related non-communicable diseases.”

And if we look at guidelines from national governments more and more of them are also getting on board. In Brazil: eat foods mainly of plant origin. Canada: healthy eating patterns include mostly plant-based foods. China: cut meat consumption by 50%. Denmark: eat plant rich, varied and not too much. Estonia: eat plant-based, biologically diverse, local and seasonal. Germany: choose mostly plant-based foods. The Netherlands: eat less meat and more plant-based foods. Qatar: emphasize a plant-based diet. Taiwan: plant-based diets are needed to reach 2050 Net Zero Target. The UK: eat more plant-based foods.

Chronic disease authorities also agree. Cancer organizations: the American Cancer Society says eat a healthy diet with an emphasis on plant foods. The World Cancer Research Fund: eat mostly foods of plant origin. The American Institute for Cancer Research: choose mostly plant foods such as vegetables, fruits and whole grains and cut sugary drinks. A heart organization like the American Heart Association: the benefits of plant-based diets are clear — less risk of disease and improved health and well-being. The Canadian Heart and Stroke Foundation: a plant-based diet can lower blood pressure, improve cholesterol and help achieve a healthier weight and lower your risk of heart disease, stroke and type 2 diabetes. Diabetes organizations like the American Diabetes Association says a plant-forward way of eating is associated with improved health outcomes and a decreased risk for a variety of chronic diseases. Diabetes Canada says a plant-based diet is one way people with type two diabetes can maintain good blood glucose levels.

And the evidence is really strong. We have a number of long-term population studies and probably the three most important cohorts are those that compare people living similar healthy lifestyles but consuming different dietary patterns and watching these individuals over time to see who develops what type of disease. And the three cohorts are: the first in North America, the Adventist Health Study 2, over 96,000 participants and this study began in 2002 and it’s ongoing; the UK EPIC-Oxford, over 65,000 participants, began in 1993; and then finally at Taiwan the Tzu Chi studies. They include the vegetarian study with over 12,000 participants began in 2005 and the Tzu Chi health study with over 6,000 participants began in 2007.

And what’s interesting about these cohorts is generally if we compare the people in these health-conscious cohorts, regardless of their dietary group, to the general population they die at about one-third to one-half the rates of the general population in their regions. And what’s really important is that when we’re comparing for example vegans to non-vegetarians we’re comparing them to non-vegetarians who exercise the same amount, who drink the same amount of alcohol, who get about the same amount of sleep — we’re controlling for many confounding variables. So we’re comparing vegans to very similar non-vegetarians.

So what are the results of these studies? Well from EPIC-Oxford if we look at rates of ischemic heart disease they were 32% lower among the vegetarians and vegans combined. Hypertension in the Adventist Health Study 2 was 75% lower among vegans and 55% lower among lacto-ovo vegetarians. Diabetes in the Adventist Health Study 2 was 38% lower among lacto-ovo vegetarians, 62% lower among vegans. Cancer in EPIC-Oxford was 11% lower among vegetarians, 19% lower among vegans. Diverticular disease in EPIC-Oxford was 27% lower among lacto-ovo vegetarians, 72% lower among vegans. Kidney disease in Adventist Health Study 2 was 52% lower among the vegetarians and vegans combined. And cataracts in EPIC-Oxford were 30% lower among lacto-ovo and 40% lower among vegans.

And there were some negative findings which we need to acknowledge and they were particular for hip and other bone fractures. So in EPIC-Oxford the risk of hip fracture was actually 25% higher among vegetarians and 231 percent higher or 2.3 times higher among vegans. Vegans had a 43% higher risk of total fractures as well. And the higher risk was actually only observed in vegans who had a low BMI under 22.5 and the risk was not increased in men, only in women and particularly postmenopausal women. In the Adventist Health Study 2 female vegans had a 55% higher risk of hip fracture than non-vegetarians and with calcium and vitamin D supplementation that risk was not increased at all. There were no associations between diet and hip fractures in men in Adventist Health Study 2.

And the authors when questioned about why they felt there was an increased risk, the main factors that were noted were that vegans do have a lower body mass index and therefore would be at higher risk, they have lower calcium intakes, lower vitamin D intakes, lower protein intakes and they use hormone replacement therapy less often — all of which could increase risk.

Now another group of studies which are super interesting have used something called the plant-based diet index to assess the quality of the diet and the relationship between plant-based diets and disease. Of course we recognize that not all plant-based diets are created equal. So this diet quality scoring system was really developed so that we could ascertain the impact of different types of plant-based diets on disease risk. And the PDI is basically the plant-based diet index and it is an indicator of a high intake of plant foods and a low intake of animal foods. Now they went on to develop this thing called the hPDI or the healthy plant-based diet index in which whole plant foods predominate and unhealthy plant foods are not used as often. And then there’s the uPDI or the unhealthy plant-based diet index and this is where more highly processed plant foods predominate.

And if we look at the studies, we’ve got a lot of studies that have compared the PDI and hPDI and uPDI and we’ve looked at all-cause mortality and a number of researchers have looked at other diseases as well. And if we look at what happens with the PDI, the greater the PDI it seems the greater the response in terms of disease risk reduction. All-cause mortality was reduced 24% for the highest PDIs and we can see a reduction of 8% for heart disease, 20% for diabetes, 44% for obesity, 6% for stroke, 21% for cancer and 46% for cognitive dysfunction which is pretty significant.

Now if we look at the hPDI and we don’t have numbers for all of these indicators but you can see that the impact is even greater when people are eating a healthy plant-based diet. And so you can see heart disease risk being reduced 25%, type two diabetes 34% compared to 20% for just the PDI, a 62% lower risk of obesity, 10% for stroke, 55% for colorectal cancer and 18% for risk reduction for erectile dysfunction.

Now if we look at the uPDI this is where things get a little scary because you actually see an increased risk with an unhealthy plant-based diet index and an increased risk of all-cause mortality of about 30%, 32% for heart disease, 16% for diabetes, 94% for obesity, 5% for stroke, 45% for colorectal cancer, 27% increased risk of erectile dysfunction as well.

And what this means is that we mentioned all plant-based diets are not created equal but if you’re eating a plant-based diet that is mainly highly processed foods, foods made of a lot of white flour and sugar and added fats especially solid fats, you’re not going to be at any advantage over people eating non-vegetarian or non plant-based diets and in fact your risk could be increased.

So why are healthy plant-based diets so protective? Well plant-based dietary patterns actually maximize protective dietary components such as fiber and phytochemicals and antioxidants and plant sterols and pre and probiotics while minimizing potentially pathogenic dietary components like saturated fat and trans fatty acids, refined carbohydrates, Neu5Gc, TMAO and its precursors, chemical contaminants, prooxidants and endotoxins which are found mainly in animal products and or highly processed foods.

How Plant-Based Diets Transform Health – Real-Life Success Stories with Brenda Davis, R.D.

So not only do plant-based diets protect against many chronic diseases but they actually also provide a very safe and powerful treatment option in some cases driving these diseases into remission. And here’s where I’d like to share just a couple of my own personal experiences in putting lifestyle medicine into practice to show you what is possible. And I’ll just share a little bit about my work in the Marshall Islands and the work that I did in Lithuania. And I want to tell you that I’m actually returning to the Marshall Islands in a few days to do an in-service for the staff there and a talk on lifestyle medicine for the president and staff. And so we’ll be really excited. My son is coming with me to be back in the Marshall Islands. The last time I was there was 2017 so this will be an exciting trip.

So for those of you that aren’t familiar with the Marshall Islands they are somewhere between Hawaii and Australia, very very remote in the middle of the Pacific Ocean just above the equator, directly north of New Zealand by about 3500 miles. And the Marshall Islands has declared a state of emergency where type two diabetes is concerned. They have among the highest prevalence of type two diabetes and the highest death rates from diabetes globally. In 2021 the prevalence was 25.1% in people ages 20 to 79 and that was actually down from over 30% previously. About half of all the surgeries on the islands are amputations due to diabetes.

So you might wonder if diabetes was a problem in the past and in fact a century ago diabetes was pretty much unheard of in the Marshall Islands. People were slim, they were physically active and they lived off the land. So what did they eat? Well traditionally they ate whatever they could gather on the islands which was coconut and a few green leaves, breadfruit, bananas, pandanus, whatever plants they could grow and or naturally grew there and of course whatever they could collect from the ocean. So fish and seafood were a big part of their traditional diet and of course they had to work very hard to get these foods so they were getting a lot of physical activity.

So what do people eat today? Well today there are more people on the main island so Majuro for example. You know the island might sustain 500 to a thousand people. Well 30,000 people live there. They’re quite poor, there’s not a lot of employment and so foods must be transported into them. So a lot of these foods are non-perishable foods and highly processed foods.

So just to run through some of these pictures. On the left upper left this little girl has a can of Pepsi and a popsicle in her hand. This is 6:30 in the morning so essentially she’s eating breakfast. The school girl in the middle picture is eating rice and chicken and this is a very typical school meal. The favorite snack of children is dry ramen noodles. They crack open the package, eat them. Sometimes I’ve seen kids sprinkling Kool-Aid powder on top before eating them for flavoring and sometimes even sprinkling Ajinomoto on top which is pure MSG. The meal on the right is a meal that was handed out at a funeral. You can see white rice and meat, a white bread ham sandwich, some white soda biscuits and a donut. The picture in the bottom left is of a first birthday party. You can just see the big bins of meat, mostly processed meat. There’s chicken, there’s some sort of lunch meat and wieners and of course a lot of white rice. The main beverage that people drink is called loak and it’s a concentrate that’s mixed with water but its essentially number one ingredient is high fructose corn syrup and then colors and flavors and so on. Spam is a fairly major staple in the diet as well.

So several years ago, this was back in 2007 actually, I was part of a team that did a randomized control trial in the Marshall Islands. We had five overlapping cohorts with intervention versus control groups and we did three months of very intense lifestyle medicine and we used all six pillars of lifestyle medicine: a healthy whole food plant-based diet and exercise, daily exercise, walking after meals and an exercise class every day. And we did a lot of education about sleep and stress management and support and addiction control and so forth. And the diet was very high in fiber, about 40 plus grams a day. It was a whole food plant-based diet. It was high in phytochemicals and antioxidants. It had minimal highly processed foods if any and it was low in fat, about 20% of calories, most of the fat coming from nuts and seeds.

And so our results paper actually is slated to be out this year which you may find funny but it was a long process. We had some challenges. But essentially in the first two weeks we saw a drop of fasting blood sugar of about 71 milligrams per deciliter and by 12 weeks it was about 48 milligrams per deciliter. It wasn’t quite as good the first two weeks just because at the 12 week mark people were preparing their own food whereas in the first two weeks all the food that they consumed came from us. And before I continue I want to tell you that the investigator in this project, you can see the red circle is myself and Dr. John Kelly and Dr. John Kelly was actually the founding president of the American College of Lifestyle Medicine. And then you can see a drop of close to two points in A1C at 12 weeks and hsCRP which is our measure of inflammation dropped by 1.2 points. So pretty stellar results. And remission was achieved probably in about 30% of participants. And the participants told us over and over again they had less pain, less disability, they could think more clearly, they had better sleep and as you can imagine they had much less constipation. They probably went from about seven or eight grams of fiber a day to 40 grams of fiber a day. So it was really quite a change.

And in Lithuania I went to Lithuania again with Dr. John Kelly and we did basically a demonstration project for the government, for the medical school and we had 10 patients. We did 10 days of intensive lifestyle medicine and the changes we noted were on average about a 25% drop in cholesterol, this is in 10 days, up to 50% drop in triglycerides. We saw improved fasting glucose, reduced measures of inflammation and reduced pain in joints of our participants.

And the bottom line is we know enough. We know enough to make lifestyle medicine the first line therapy for individuals with lifestyle induced chronic diseases. We have clear consistent evidence that whole plant foods are protective to health, that heavily processed foods with added fat, salt, sugar, fast foods and fried foods are damaging to health and meat especially processed meat and red meat increase the risk of disease. The sad reality of course is that most of what consumers eat is a threat to health. Probably in the neighborhood of 60 to 65% of all calories in the US diet are from highly processed foods and probably another quarter or so, 25 or 30%, are coming from animal products. So it’s really a sad state of affairs.

So the rest of this presentation I am going to spend on the finer points of designing an optimal diet. And so as I mentioned we have five dietary goals: number one to ensure the most healthful sources of macronutrients — protein, carbohydrates and fat; to ensure sufficient micronutrients — vitamins and minerals; to maximize the intake of our protective dietary components; to minimize intake of pathogenic dietary components; and to make food choices that are ecologically sustainable.

So let’s move on to goal number one: to ensure the most healthful sources of macronutrients. So let’s just review macronutrients very quickly. They’re nutrients that are needed in large amounts to provide us with energy and to support growth, development, metabolism and all the functioning of all our body systems. And there are three: protein at about four calories per gram, carbohydrate at about four calories per gram and fat at about nine calories per gram. And in North America our needs are determined by the Institute of Medicine. We have an acceptable macronutrient distribution range or an AMDR for each macronutrient and an RDA or a recommended dietary allowance for protein and an AI or acceptable intake for essential fatty acids.

Now macronutrients drive many of today’s most pressing nutrition controversies. Our three biggest dietary trends — plant-based, paleo and keto — are defined by macronutrients. Plant-based is a carbohydrate rich protocol, paleo is protein dominant and keto is fueled by fat. So if we look at macronutrients and compare intakes in these three different protocols with recommended intakes here’s what we see. For carbohydrates you can see the Institute of Medicine recommends 45 to 65% of calories come from carbohydrates, the World Health Organization 55 to 75%. Plant-based generally ranges from 55 to 80, paleo ranges from 20 to 30 and keto from 5 to 10. For protein the Institute of Medicine suggests 10 to 35% of calories from protein, World Health Organization recommends 10 to 15. Plant-based is 10 to 15, paleo is about 30 and keto is 20 to 30. And then in terms of fat the IOM recommends 20 to 35, World Health Organization 15 to 30. Plant-based is usually 10 to 30, paleo 40 to 50 and keto 70 to 85% of calories from fat. And when you look at this you can see that plant-based diets definitely come closest to recommended macronutrient intakes.

And I think it’s important that we recognize that macronutrient quality matters a lot. So while macronutrient ranges are important they matter less than quality. When macronutrients come from unprocessed or minimally processed plant foods they are rich in protective dietary components like fiber and antioxidants and they are consistently protective to health. When macronutrients come from highly processed foods or animal products they’re more commonly associated with adverse health outcomes. And we definitely see this in the Blue Zones. We see a wide range of macronutrients in different populations and yet they’re all healthy and it’s because their macronutrients are coming mainly from unprocessed or minimally processed plant foods.

So let’s move on to looking at protein. This cartoon says “No meat at all? Are you sure you’re getting enough protein?” This little guy is asking this big muscular gorilla and the point being that we have a strong cultural bias towards meat being the only real source of protein. Few of us realize that plant foods provide ample protein for people. While legumes are the most concentrated plant protein sources, grains actually provide about half the world’s protein.

So what are the healthiest sources of protein? Well animal protein sources have an abundance of digestible protein and a generous supply of all essential amino acids. These sources are associated with higher rates of mortality and chronic disease compared to plant protein sources which are associated very consistently with more favorable health outcomes.

If we look at and compare plant protein versus animal protein, compare legumes versus meat, what we see is the food components that we’re wanting to have more of that are protective like fiber and phytochemicals and the enzymes that convert phytochemicals to their active forms and antibiotics and pre and probiotics — they are either high or very high in legumes and they are essentially zero or very low in meat. And we see the exact opposite for the food components that are associated with increased risk like saturated fat and trans fatty acids and Neu5Gc and TMAO and prooxidants and products of high temperature cooking and endotoxins. Generally they are low to very low in legumes and they are moderate to high in meat.

And of course not surprisingly this is reflected in the research on legumes and mortality versus meat and mortality. So for legumes and mortality we have a 2023 meta-analysis of 32 cohorts and over a million participants that reported a 6% drop in mortality for every quarter cup serving of legumes consumed. There was another study of people 70 plus that reported a 7 to 8% reduction in mortality for every 20 grams, about two tablespoons, consumed. Based on this study eating one cup of beans daily would reduce mortality 60 to 68%.

For red meat and processed meat we see the exact opposite. There was a 2023 umbrella review of 40 meta-analyses and high consumption of red and processed meat were associated with higher all-cause mortality and chronic disease risk. For every three and a half ounce serving of red meat they saw 17% increased risk of type 2 diabetes, 15% increased risk of heart disease, 14% increased risk of hypertension, 12% increased risk of stroke. And for every additional 1.75 or 1 and 3/4 ounce serving of processed meat there was a 37% increase risk of type 2 diabetes, 27% increase risk of coronary heart disease, 17% increase risk of stroke and 15% increase risk of all-cause mortality.

And there are a number of studies that have also been quite fascinating. The first in 2016 which followed over 130,000 participants for about three decades and they looked at what would happen in terms of risk of death when 3% of calories from animal protein were replaced with plant protein. Now just to put this into perspective 3% of calories from animal protein is about 60 calories in a 2,000 calorie diet. That’s less than one large egg. So this is about an ounce of fatty meat or an ounce and a half of meat that’s lean for example. So this is a very small amount of animal protein being replaced with plant protein. And what they found in this study was when what we replaced was processed red meat with plant protein we reduced risk of death by 34%. When it was eggs it was 19% risk reduction. With unprocessed red meat 12% risk reduction. For dairy 8%. For poultry or fish 6%.

There was a study from Japan similar, over 70,000 individuals followed for about 20 years. They replace 3% of calories from meat with plant protein and what they found was total mortality with red meat was reduced 34%, processed meat 46%. Remember 3% of calories, 60 calories being replaced. For cancer mortality risk reduction of 42% with red meat and 50% with processed meat.

And then finally the third study this is over 400,000 individuals followed for about 16 years and what they found again they use the same metric replacing 3% of calories from animal protein with plant protein and what they found was replacing 3%, 60 calories of animal protein with plant protein reduced overall mortality 10%. Now if what we were replacing was eggs it was reduced by over 20%. If it was red meat it was 13% for men, 15% for women. Dairy again was 8% and white meat was 2% for men, 5% for women.

And finally another study of over 6,000 participants this was an 18-year follow-up, this is people age 50 plus. They found that protein intakes of over 20% of calories for people 50 to 65 years of age increased mortality 75%. There was a fourfold increased risk of cancer and diabetes mortality but the associations were abolished or greatly attenuated when the protein came from plant. So these huge increases in risk of death and disease were only significantly present when most of that protein came from animal products.

And then of course people say but can we get enough protein and essential amino acids from plants? And the answer is absolutely. All plant protein sources provide all 20 amino acids including all nine essential amino acids. So it makes no sense to think that we can’t get our essential amino acids from plants. It’s essentially where they come from. Even the largest mammals on the planet manage to get enough protein and essential amino acids from plants to build pretty huge muscles so people can too and we do.

So how much protein do we need? Well the RDA in terms of grams per kilogram per day ranges from 1.2 to 1.52 in the first year of life and then it drops to about one gram per kilogram body weight for children from 1 to 13, down to 0.85 for teens, 0.8 for adults. It increases to 1.1 during pregnancy, 1.3 during lactation. And in terms of number of grams of protein a day, of course this refers only to a specific reference person, but you can see it’s about 10 grams for infants, it’s about 13 to 34 for children, it’s about 46 to 56 for adults, less for women more for men. 46 for women, 52 to 56 for boys and men or for adolescent boys and men and then 63 to 75 grams during pregnancy and lactation.

Now you might wonder if people eating whole food plant-based diets might need more. And while there isn’t any separate RDA for plant-based eaters the fiber in plant cell walls does reduce protein digestibility so some experts recommend that for those eating very high fiber whole food plant-based diets adding 10% to the RDA which would take us from about 0.8 g per kilogram to 0.9 g per kilogram would actually help to compensate for losses of protein in the stool because of the fiber that’s there and other things that impair digestibility. So we probably wouldn’t need any increase for those who regularly eat lower fiber foods like tofu, soy milk, plant-based meat alternatives, nut and seed butters for example or plant-based eaters who do include some animal products such as dairy and eggs on a regular basis.

Protein digestibility can actually be increased by breaking down fiber by grinding, blending or other food processing techniques that reduce particle size so hummus or bread for example. Removing or reducing fiber through refining so white flour products for example will have more digestible protein. Reducing or eliminating trypsin inhibitors and lectins just by cooking beans. Reducing phytates by soaking, sprouting, fermenting and leavening. And so what you can see here is that plant products like white bread or white flour products, soy protein isolate, peanut butter, tofu, a whole wheat flour bread because again the particle size has been reduced by grinding we’re looking at about 92 to 96% digestibility of the protein. This is very similar to what we see in animal products. And then for whole plant foods like whole grains and whole beans we’re seeing about a 10% lower digestibility rate than what we see for these more processed products or for animal products.

And of course we need more for athletes. So there’s no separate RDA for athletes but health and sports authorities typically recommend 1.2 to 2 grams per kilogram per day. And some people think it’s difficult for athletes to get sufficient protein but it’s not as difficult as people think. An athlete who needs one and a half grams of protein per kilogram and weighs 60 kilograms or 132 pounds would need about 90 grams of protein per day and for an athlete who consumes 2500 calories that would be about 14% of their calories which is really typical of plant-based eaters. It’s really quite easy to achieve that on a varied plant-based diet.

And the other question that often comes up is is plant protein just as good as animal based protein for building and maintaining muscle mass? And though the research varies a bit on this question we do have a number of studies that suggest that people can build muscle just as well. So there was a study from 2023, this is pretty small study 22 people, reported comparable protein synthesis rates in skeletal muscle hypertrophy in those consuming high protein omnivorous or non-animal sources of protein. There was a study from 2018, this was a big meta-analysis of nine studies comparing soy to animal protein and it reported that soy protein produced similar muscle gains and strength as animal protein sources. And then in 2017 a study of almost 3,000 people consuming different dietary patterns found that muscle mass and quadricep strength were positively associated with total protein intake but plant and animal protein sources were equally effective in promoting muscle mass and strength.

And plant protein sources offer some pretty impressive advantages for athletes. They can improve circulation, reduce inflammation, lower oxidative stress, promote a healthy gut microbiome, enhance glycogen stores and support leaner body weights.

So what about more for older adults? And this is quite a controversial area at this point in time but we don’t have any separate RDA for seniors in North America but they do in many countries including many of the Nordic countries, Australia. There are many countries that have higher RDA for seniors. But consensus is building that higher intakes may be needed. Achieving greater intakes can be challenging for seniors, much more challenging than for athletes who tend to need a lot of calories because caloric needs are typically reduced in this population.

Protein targets for plant-based seniors may actually be increased by about 20 to 25% in those 65 plus. This would mean an intake of 1 to 1.2 gram of protein per kilogram healthy body weight which means about 60 to 90 grams of protein per day or 20 to 30 grams per meal depending of course on body weight and health status.

And so why might older individuals need more protein? Well aging bodies metabolize and absorb protein less efficiently. Muscle protein synthesis tends to be reduced in older adults. An adequate protein intake has been associated with reduced sarcopenia and frailty. It preserves mobility and function and it helps to improve recovery from illness and delay bone loss as well.

And I just want to share my own clinical experience here because I’ve had a number of older whole food plant-based women come to me who have been having some issues with their diet and they tend to pretty consistently be consuming 35 to 40 grams of protein per day. Many of these individuals the last thing on their mind was protein because in the plant-based community there’s a mantra that if you eat enough calories from a variety of foods you get enough protein. Many of these women were complaining of symptoms related to inadequate protein intake like skin fragility, hair loss, brittle nails, muscle weakness, fatigue, inability to fight infection, poor wound healing, longer recovery times, mood changes.

And I wanted to share a testimony from a client. So she said and I of course use this with permission: “I was frustrated by many symptoms after following a whole food plant-based diet for some time. I wondered if I was getting enough protein but the plant-based doctors I was following told me protein was not the issue. Brenda Davis assessed my diet and suggested increasing my protein intake from about 35 to 40 gram a day to about 60 to 70 gram a day. I feel better and look better. My skin is vastly improved on increased protein. No Band-Aids, no bleeding, more opacity and much less bruising. My abdomen is receding. These are issues I’ve dealt with since my mid 70s and now at 83 years of age they’re clearing up.” I think it’s really important that older adults know that even on healthy whole food plant-based diets protein can fall short and increasing protein intake can be very helpful.

Now I want to show you how easy it is to get from 41 to 72 grams of protein which is what we basically did with Tish. So here you can see the breakfast we used. So she was having a cup of oatmeal with almond milk, a banana and flax seeds. So all we did, you can see what we added are in purple, what we changed are in red. So we changed up the almond milk for soy milk that added about seven grams of protein and we added a tablespoon of hemp seeds which just added three grams of protein. At lunch we went from a non-fat dressing to a tahini hemp seed dressing and added tofu as well to the salad. The tofu adds 15 gram of protein. And then at dinner the chia pudding for dessert we just made it with soy milk instead of almond milk and that was all we needed to do to get from 41 to 72 grams of protein. It’s very very simple.

Average adult requirements are about 46 grams a day for women, 56 for men. So with the extra 25% for seniors it would be 58 for women, 70 for men. How much are people actually eating? Well meat eaters are averaging about 92 grams of protein a day, vegetarians about 76 and vegans about 72.

If we look at the amount of protein in various foods we can see that if we eat a cup of legumes or three ounces of veggie meats or half a cup of tofu we’re getting about 15 to 30 grams of protein which is pretty much the same as what you’d get from 3 ounces of meat, poultry or fish. If you eat a quarter cup of seeds or a cup of grains you will get about six to 13 grams of protein which is very similar to what you would get from two eggs, a cup of milk or an ounce of cheese.

So getting enough protein is about including at least one protein rich choice at each meal — beans, lentils, split peas, tofu, tempeh, edamame, seitan, nuts and seeds — including some lower fiber choices in the mix and selecting a plant milk with a little more protein than some of the very low protein milks.

Moving on to carbohydrates. So what are the healthiest sources of carbohydrates? No question, whole plant foods.

The Truth About Carbohydrates and Health with Brenda Davis, R.D.

Popular opinions suggests that carbohydrates are bad news and people should minimize intake. This is in my opinion a huge mistake. The healthiest foods on the planet get most of their calories from carbohydrates. The healthfulness of carbohydrates is determined by the quality of those carbohydrates. And carbohydrate quality: high carbohydrate quality is essentially carbohydrates that are intrinsic to whole plant foods. They’re loaded with protective components such as fiber, prebiotics, phytochemicals and antioxidants. Good examples are fruits, vegetables, legumes, whole grains, nuts and seeds. Low quality carbohydrates are carbohydrates that have been essentially stripped of their protective components by food processing techniques or refining. Good examples are sugar sweetened beverages, white flour products, white rice, processed starchy vegetables such as potato chips.

Refined carbohydrates increase our risk of overeating and obesity, metabolic associated fatty liver disease or what we used to call nonalcoholic fatty liver disease, and insulin resistance and diabetes and high triglycerides and heart disease.

So I want to talk a little bit about the dirt on refined sugar. There was a very interesting umbrella review and this umbrella review looked at over 8600 articles, 73 meta-analyses and added sugars had significant harmful associations with 18 endocrine or metabolic outcomes, 10 cardiovascular outcomes, seven cancer outcomes and 10 other outcomes. The authors ended up recommending that we reduce free sugars or added sugars to less than 25 grams a day or about six teaspoons a day and that we limit consumption of sugar sweetened beverages to less than one serving per week or approximately 7 to 12 ounces in a week.

And then World Health Organization also recommends less than 10% of calories from sugar or less than 12 teaspoons a day but they add that less than 5% of calories or six teaspoons a day is better for additional health benefits. American Heart Association suggests no more than 6% of calories or nine teaspoons a day for men, six teaspoons a day for women. They also add no added sugars for those under two and less than six teaspoons a day for children and teens.

So how much do we actually consume? Well we consume about 17 teaspoons a day in the United States. And a teaspoon of sugar has about four grams of sugar equals about a teaspoon. And you can see in this chart that we get more, 12 or so teaspoons from one serving of sweet foods like a serving of a can of soda or flavored coffee or a cup of fruit yogurt or a big cinnamon bun. We get close to the six teaspoons from a typical energy bar or a quarter cup of barbecue sauce. We get about three and a half teaspoons from one flavored instant oatmeal. And almost half of the sugar we consume comes in the form of liquid sugar in sweet beverages. Another almost one-third comes from sweets and snacks. So just eliminating those two things would do a lot to getting us closer to where we need to be.

And it’s a similar story for refined starches. So refined starches if you take a kernel of wheat and you turn it into white flour you’re essentially removing two of the three parts of the wheat: the bran which is the fiber rich and mineral rich outer layer and the germ which is where we store most of the phytochemicals and nutrients in the kernel of wheat. And what we’re left with is of course just the endosperm which is the middle layer. And in this process we’re taking away about 80 to 90% of the fiber, 70 to 80% of the vitamins and minerals and 95% of the protective phytochemicals. And then of course nobody eats a bowl of white flour. Before they eat the white flour we tend to add fat, sugar, salt, food additives and then we eat the white flour. And therein lies the problem. Not only have we stripped the valuable components from the flour but we’ve added a bunch of components that we know are strongly associated with increased risk of disease. So it’s a double whammy here.

On the other hand we know that whole grains are healthy foods. Whole grains we have a 2016 meta-analysis of 45 studies that reported a reduced risk of mortality per three ounces or three servings of whole grains: all-cause mortality 17% risk reduction, cardiovascular mortality 22% risk reduction, diabetes mortality 51% risk reduction, total cancer 15% and respiratory disease 22%. So really quite significant.

But it’s also important that people recognize that all whole grains are not created equal. A granola bar doesn’t equal a bowl of oatmeal and a box of kamut flakes does not equal a bowl of kamut berry cereal or sprouted kamut berry cereal. There is really a hierarchy of whole grains which I developed to help people understand that all whole grains are not created equal. At the top of the hierarchy are intact whole grains. These are grains that have had nothing harmful added, nothing healthful taken away. They’re just either sprouted or cooked and consumed whole. Then we have cut whole grains like steel cut oats. Then we have rolled whole grains like rolled oats. Then we have shredded whole grains like Shredded Wheat. Then ground whole grains like whole wheat flour products. Then flaked whole grains like corn flakes cereals and finally puffed whole grains like puffed wheat, rice or millet. And as you go down the hierarchy you’re increasing the surface area of the food, increasing the rate at which it will be absorbed into the bloodstream and you’re reducing nutritional value by exposing the food to heat, light, pressure, oxygen. And so the higher you can stay on the hierarchy generally the better off in terms of prevention and treatment of disease.

Carbohydrate common sense: get carbohydrates from high fiber whole plant foods. Avoid added sugars especially beverages. Drink water instead. Minimize all refined carbohydrates both starches and sugars.

Moving on to fat. What are the best and worst fat sources?

The Best and Worst Sources of Fats for Optimal Health with Brenda Davis, R.D.

Well plant foods are the primary sources of healthful fats such as mono and polyunsaturated fats including our essential fatty acids. Highly processed foods, deep fried foods, fast foods and animal products are our primary sources of harmful fats such as saturated fat, trans fatty acids and oxidized fats.

And there’s a difference between fat from whole foods versus concentrated fats and oils. High fat whole plant foods are preferred because they contain a myriad of protective dietary components like fiber for example. By contrast fats and oils are more concentrated in calories, they have fewer nutrients, they have no fiber and we should be limiting our intake of these added fats especially solid added fats.

We want to cut back on saturated fat. The American Heart Association suggests under five to six% of calories for heart disease risk reduction which would be less than 16 grams in a 2,000 calorie diet. And so if we look at that 16 grams is our absolute upper limit. You get at least that much or more from two slices of meat lovers pizza, a double cheeseburger or soft taco with beef and cheese and you’ve eaten nothing else all day you’re already at or above your upper limit. Even milk and cheese if you ate 2 ounces of cheese and a cup of milk you would be at 17 grams. So it’s very easy eating animal products for the saturated fat to add up. And by contrast if you look at plant foods even high fat plant foods are pretty low in saturated fat. So if we look at avocados, a half an avocado, nuts and seeds, tofu, olives we’re looking at about a half a gram to about two grams of saturated fat per serving. The only exception really are the tropical oils and coconut at about seven grams of saturated fat per ounce.

We also want to minimize our exposure to damaged fats. And we do this by avoiding fried and highly processed foods, minimizing oils in cooking and if we do use a little bit of oil do not allow oils to smoke. Store high fat foods including shelled nuts and seeds in the refrigerator or freezer to preserve their important fats that they contain.

We want to optimize omega-3s. We can do this by ensuring sufficient alpha-linolenic acid about 1.1 grams for females, 1.6 for males and we can double that amount if we don’t consume any direct sources of EPA and DHA. The main direct source of EPA and DHA in the population is fish and so if you’re not consuming fish you can consider getting a direct source of EPA and DHA from an external supplement and if you take the supplement then you wouldn’t have to double the ALA intake.

So plant sources of ALA you get about 2.6 grams in an ounce of walnuts. You get about close to two grams in a tablespoon of flax or chia seeds and about a gram in a tablespoon of hemp seeds. So that’s fairly easy if you’re using these foods to meet your ALA AIs. And plant sources of EPA and DHA certainly EPA and DHA rich microalgae which is available in supplement form and I would say taking microalgae is well advised for pregnant and lactating women, for those who don’t convert ALA to EPA and DHA very efficiently like older adults, people with certain chronic diseases like diabetes and possibly for everyone. This is still controversial. I think it’s a reasonable choice and generally 200 to 300 milligrams per day is recommended. Some people may need more. For children it’s usually about 100 milligrams per day.

The Importance of Micronutrients, Calcium, Vitamin D, Vitamin B12, Iron, and Zinc from Plant-based Sources

Goal number two is to ensure sufficient micronutrients so vitamins and minerals. So micronutrient basics: micronutrients are needed in tiny amounts, milligrams or micrograms per day. They are necessary for body function and there are 13 vitamins and at least 15 minerals that are essential to human health. In North America needs are determined by the Institute of Medicine and they set an RDA for most of these micronutrients and an AI or an acceptable intake when we have insufficient data to set an RDA. So an AI is sort of like a best guess really.

If we look at most common micronutrient shortfalls we can see the nutrients that more commonly fall short in plant-based diets in green and those that more commonly fall short in Western diets in red. And so you can see for vitamins Western diets would tend to more commonly lack folate and vitamins C and E and K whereas plant-based diets would more commonly lack B12 and vitamin D. And for minerals plant-based diets may more commonly be low in calcium, iodine, iron and zinc and in Western diets more commonly in magnesium and potassium.

So we’re going to take a look at the micronutrients that more commonly fall short in plant-based diets: calcium, vitamin D, iron, zinc, B12 and iodine.

First calcium. A lot of people the big question they ask is but don’t we need dairy for calcium? And the answer is absolutely not. Every mammal species produces milk for its offspring and to me it just defies rationality to assume that any species would require the milk of another species for its survival. It wouldn’t make any sense. In pre-agricultural populations when people had no access to the milk of other species they averaged about 1,500 milligrams of calcium per day.

So how much calcium do we need? Well recommended calcium intakes vary widely around the world. Our recommended intakes in North America are actually quite high relative to what they are in some other countries like the UK for example. But in North America we recommend about 700 for toddlers, 1,000 for 4 to 8 year olds, 1,300 for 9 to 18 year olds, 1,000 for adults women to age 50, men to age 70 and 1,200 for women over 50 and men over 70.

So how can we get enough calcium without dairy? Well number one is to get familiar with calcium in plant foods and to start to really incorporate them into your diet regularly. So low oxalate greens like kale and broccoli and bok choy and turnip greens and so forth are good choices. Certainly some nuts and seeds like almonds and chia seeds and tahini. Some legumes like black beans and Great Northern beans and other white beans and tofu are great sources. And blackstrap molasses is a remarkably good source of calcium. Figs are a reasonably good source as well.

And then the other thing we can do is to select calcium fortified non-dairy milks and other foods with added calcium. They tend to have about, the milks about 300 milligrams of calcium per cup. Tofu tends to provide about 100 to 300 milligrams per half cup. And so one to two servings of non-dairy milk along with other calcium rich choices will typically meet the RDA for both adults and children. So that’s a really reasonable way to boost intake.

We want to be aware of factors that impact calcium absorption. So things that have a negative impact: excessive oxalates or phytate, excessive sodium, high acid load, alcohol and caffeine. And things that have a positive impact: vitamin D, younger age, pregnancy increases our absorption and distributing the intake throughout the day can be very helpful instead of having it all at one meal.

Vitamin D. Most people don’t make enough vitamin D from sun exposure. Our ability to produce sufficient vitamin D depends of course on the latitude in which we live, the time of year, the time of day, the cloud cover, our age, our body weight, our skin color and our skin exposure. So how much vitamin D do we need? Well infants need about 400 IUs, people from 1 to 70 about 600 IUs and those over 70 about 800 IUs.

And so meeting needs the main dietary sources are fish, eggs, liver and mushrooms that are growing in UV light and of course fortified foods like non-dairy and dairy milks and cereals. Those eating only plants especially whole plant foods only may be at increased risk just because there are fewer dietary sources.

Now I found this quite fascinating. I did a little research to see what I could find about the amount of vitamin D in mushrooms and how we can increase vitamin D in the mushrooms we’re eating. And of course mushrooms create vitamin D when they’re exposed to sunlight or UVB light. Mushrooms grown in sunlight have much greater vitamin D levels than those grown indoors and we can actually increase the vitamin D in our mushrooms that we purchase by exposing them to sunlight before we eat them. And essentially what we need to do is just place the mushrooms gills up or sliced if we want for about 10 to 15 minutes or even longer if we so desire. A three and a half ounce serving of mushrooms that have been exposed to light in this way will have over 100% of the RDA for vitamin D or the amount found in about eight eggs. So that’s pretty impressive. The vitamin D that the mushrooms get from being exposed will last about eight days in the refrigerator so that’s really encouraging.

What about supplements? Well vitamin D of 400 IUs is recommended for all infants to age 2. 600 is often suggested for children. 1,000 to 2,000 IUs are commonly recommended for adults. Higher intakes may be needed especially for seniors and for some individuals. Vitamin D3 seems to raise serum levels to a greater extent than D2 and maintains higher levels longer than D2 and plant-based D3 is pretty widely available so it’s just not an issue.

Vitamin B12. Plant foods do come up short on B12. They’re not reliable sources unless they’re fortified. Even foods commonly thought to be reliable sources like organic vegetables, seaweed, fermented foods and mushrooms cannot be relied on as sole sources of B12. So how much do we need? Well it’s about one to two micrograms for children and then about two and a half to three for adults. It gets a little higher during pregnancy and lactation.

Vitamin B12 stores may last 2 to 3 years or more in adults but breastfed babies born to B12 deficient mothers can develop B12 deficiency within months or even weeks of birth in some cases resulting in irreversible brain damage. And seniors are at higher risk. 10 to 30% of people over 50 have a diminished ability to cleave the B12 off the protein it’s bound to in animal products and therefore the Institute of Medicine recommends supplements and or fortified foods for everyone over 50 which would be the exact same sources that vegans would rely on. B12 deficiency increases the risk of dementia and Alzheimer’s disease so it’s just really important that we don’t mess with B12. Plant-based eaters and everyone over 50 needs to ensure reliable daily sources of B12 and it’s a reasonable idea to monitor your B12 status.

So what are reliable sources? Well supplements. What is recommended is a 1000 micrograms twice a week for adults, 500 to 1,000 micrograms daily for seniors. Vitamin B12 fortified foods are reliable sources and animal products for those under 50 who are not vegan.

Moving on to iron. Plant-based eaters consume at least as much or more iron than omnivores but the absorption of iron from plant foods is lower because it’s non-heme iron. The risk for iron deficiency isn’t usually higher except in menstruating women although we do have lower serum ferritin stores and this is lower iron stores generally within the normal range don’t appear to affect how a person feels and doesn’t appear to be a disadvantage when diet replaces iron losses. In fact it may actually turn out to be an advantage because higher serum ferritin is associated with an increased risk of some chronic diseases.

So how much do we actually need? Well women need the RDA is about 18 milligrams for women and during pregnancy it goes up to 27 milligrams. During lactation it goes down to nine because typically we wouldn’t be menstruating if we’re lactating. For men it’s only eight milligrams. Now the one thing I think it’s important to note is that it’s even higher for infants and children than it is for full grown men. So we need to be especially careful of iron sources for children. It’s 11 milligrams for infants. It’s an unbelievable amount. It’s a lot of iron for children 7 to 10 and then for teens 11 for males, 15 for menstruating teenage girls.

So how can we ensure sufficient iron? Well we can select iron-rich foods from each food group. So legumes are all rich in iron but the richest would be lentils and then beans, chickpeas and tofu. Nuts and seeds: all seeds are good sources of iron. Almonds, Brazil nuts, cashews and pine nuts are pretty decent sources. And the grains generally the pseudograins tend to be a little higher. Amaranth is fairly high, quinoa, wheat and fortified grains of course. Other sources veggies and fruits: peas, string beans, leafy greens, dried fruit and prune juice are the best choices in those categories.

We can boost iron absorption enhancers as well. So when we eat iron rich foods with vitamin C rich foods we will absorb more iron probably two to six times more. And so some strawberries on our cereal, some lemon juice on our salad with beans that will help with absorption. Spices like pepper, turmeric and ginger can help with absorption. Allium vegetables like onions and garlic can help. Beta-carotene rich foods such as carrots can also help. And thirdly we want to replace meat with legumes rather than dairy. Why? Because dairy’s low in iron, meat and legumes are high in iron. Dairy also inhibits the absorption of iron.

Moving on to zinc. Sufficient zinc is necessary for many bodily functions: immune function, wound healing, growth and reproduction, the activity of hundreds of enzymes, cell signaling and cell division, building proteins and DNA. Just a very very important nutrient. The recommended intakes are low about 3 to 5 milligrams during early childhood. During adolescence and for females about 8 to 9 milligrams and then for men and adolescent males it’s about 11 and then during pregnancy and lactation it is 11 for pregnancy, 12 for lactation.

And it’s important to note that needs can be up to 50% higher in those eating very high fiber high phytate plant-based diets because phytates really reduce the absorption of zinc. And homeostatic mechanisms do appear to help people adjust to lower intakes over time so that can be helpful. We need to pay attention to zinc especially during the growing years because it’s very important to growth and development.

So factors increasing our risk are just inadequate intakes, insufficient calories, poor quality diets, poor zinc absorption. So poor quality diets a lot of refined foods. When we refine grains we don’t add zinc back. We add iron back sometimes but we don’t add zinc back. And then poor zinc absorption like very high phytates like adding wheat bran to our food for example. Digestive diseases and malabsorption syndromes can be an issue too.

So where do we get zinc? Well the most concentrated sources you’ll see in red certainly beans and tofu especially azuki beans. Nuts and seeds like pumpkin seeds and chia seeds in purple are foods that provide at least one and a half milligrams per serving and in red it’s foods that provide at least two milligrams per serving. And then oatmeal is a remarkably good source of zinc so that’s kind of good to know about 2.4 milligrams per cup and then wheat sprouts and kamut berries are also decent sources.

So how to boost intake? Well include more zinc rich foods at meals. Limit the use of very high phytate foods like wheat bran. Use food preparation techniques that reduce phytate like soaking, sprouting, fermenting, yeast leavening and cooking. Ensure sufficient calories. Use a high quality vitamin mineral supplement with zinc and this can be a reasonable choice for a child as well.

And finally iodine. Iodine is a nutrient that is super super important especially during infancy and childhood but throughout life. Severe iodine deficiency results in cognitive impairment and is the number one cause of preventable brain damage in the world. A mild deficiency in pregnant women and infants can lower IQ by 10 to 15 points adversely of course impacting learning ability.

So how much do we need? Well for anyone 14 years of age or over it’s 150 micrograms a day and during pregnancy it’s a little higher 220 during pregnancy, 290 during lactation. It’s quite high during infancy 110 for the first six months, 130 for the second and during childhood we start out from 1 to 8 years of age at 90 and 120 for 9 to 13 years of age.

Now this is super super important. The upper limit for a toddler is 200 micrograms that’s just over double the RDA. For four to eight year olds it’s 300 micrograms and it gets higher. It’s 1100 for 14 plus. But I think it’s just really important to recognize we can go above the upper limit quite easily. People eating 100% plant-based diets are at increased risk unless they’re regular seaweed consumers because there are just fewer plant sources.

And the main iodine sources to get the 150 micrograms: a half a teaspoon of iodized salt, a 16th of a teaspoon of kelp powder, two nori sheets, a half a teaspoon of dulse granules, a cup and a half of milk, six large eggs, six ounces of fish and six slices of bread would provide the 150 micrograms. So you can see that if you’re just eating a whole food plant-based diet and not including any seaweed it can be challenging especially if you don’t use iodized salt or you’re a very low salt consumer which we generally recommend not to be eating a lot of salt.

So what can we do to boost intake? We can include appropriate amounts of seaweed. Be very very cautious there because an eighth of a teaspoon of kelp powder can exceed the upper limit for a toddler so we need to be very careful. Use a supplement, iodine drops or multivitamin. If using salt select an iodized salt or an iodized sea salt.

We are moving on to goal number three. Goal number three is to maximize protective dietary factors: fiber, phytochemicals, plant enzymes, antioxidants and pre and probiotics.

And fiber provides so many benefits beyond just promoting regularity. Fiber builds and maintains a healthy gut microbiome. It increases satiety, reduces cravings, reduces risk of colorectal cancer, reduces cholesterol level, stabilizes blood sugar, reduces risk of GI disorders, enhances immune function and lessens hormonal imbalances. And the recommended intakes are 14 grams per thousand calories or about 38 grams a day in men, 25 for women. Optimal intakes I would say are in the range of at least 40 to 60 plus grams a day especially for treatment of diseases like type two diabetes. Actual intakes are about 15 to 17 grams a day in the standard American diet, about 40 to 80 in a whole food plant-based diet. And just so you know Paleolithic intakes range from 70 to 150 gram a day so high intakes were a part of our history so certainly high intakes are a very very reasonable thing to do.

So where do we get fiber in foods? Well we get fiber in legumes about 10 to 20 grams per cup. From avocados, whole grains and berries somewhere three to about 13.5. Well I would say three to 10 for a cup of grains or berries and 13.5 in one 200 gram avocado and then about two to five in other plant foods. And of course only plant foods contain fiber. Low or no fiber foods include first the low fiber foods: refined carbohydrates, fast foods, highly processed foods and no fiber foods would be meat, poultry, fish, eggs, all the animal products and fat and oil of course.

The Power of Phytochemicals and Antioxidants for Disease Prevention with Brenda Davis, R.D.

Phytochemicals and antioxidants are another thing that we want to maximize and the most phytochemical and antioxidant rich foods are whole plant foods and sprouts which are even higher, fermented foods and teas like green teas and herbal teas.

We get a lot of protection from phytochemicals and antioxidants and they can protect us against disease and enhance dietary treatment and they do this by reducing oxidative stress and inflammation, enhancing gut microbiota, improving fasting glucose and insulin sensitivity, supporting immune function and protecting against DNA damage.

And to maximize intake we want to go for variety. The wider the range of plant foods in the diet the greater the variety and content of phytochemicals and antioxidants. We want to go for color. The richest sources are often the most colorful. To maximize protective phytochemicals and antioxidants we might want to choose purple instead of white onions or black instead of or red instead of brown rice, dark instead of light greens. We want to choose foods from the entire rainbow. So I would say in terms of fruits and vegetables go for at least three green, two orange yellow, two pink red, one purple blue, one white beige every single day. One of the things I love to do with salads is to try to put something that gets every color on the rainbow in the salad. Pile on the herbs and spices. Gram for gram they are very potent, maybe the most potent sources of antioxidants in the diet and phytochemicals.

Eat more raw foods. Raw foods contain enzymes. Some raw foods contain enzymes that convert phytochemicals into their active form. For example we have myrosinase in cruciferous vegetables that helps to convert glucosinolates into isothiocyanates like sulforaphane which is a potent detoxifier in the body. It kicks Phase 2 enzymes into gear to help get rid of potentially damaging chemicals. Alliinase in allium vegetables helps to convert alliin to allicin. And we can start sprouting. The phytochemical army poised to protect the delicate new plant multiplies when we sprout by five to 50 times. And we can drink antioxidant rich teas like turmeric tea or hibiscus tea or ginger tea or matcha tea. And of course eat whole plant foods. Minimize highly processed foods.

Goal number four is to minimize pathogenic dietary components like Neu5Gc, TMAO, endotoxins, environmental contaminants and the products of high temperature cooking.

Neu5Gc is a sialic acid sugar molecule not produced by humans but it’s very common in red meat. Human tissues contain Neu5Gc only if animal products are ingested and Neu5Gc is a very pro-inflammatory molecule that’s associated with an increased risk of chronic disease.

Next is TMAO and its precursors. TMAO is trimethylamine N-oxide which is a compound present in some fish or it’s formed from carnitine or choline by gut bacteria and the main sources are animal products such as meat and dairy products. TMAO concentrations are positively associated with inflammation, endothelial dysfunction, type 2 diabetes, central adiposity, hypertension and cardiovascular disease.

Endotoxins are the components of the outer cell membranes of gram negative bacteria that are released in circulation when the bacteria die and endotoxins are associated with inflammation and chronic disease risk. Endotoxins come from unfriendly bacteria in the gut or directly from foods. Diets that are high in saturated fat, animal products or refined carbohydrates induce endotoxemia more markedly than fiber rich plant-based diets and fiber actually helps to reduce the uptake of endotoxins as well.

Environmental contaminants. Here we’re talking about things that increase oxidative stress, fuel inflammation, disrupt hormones, damage vital organs including beta cells and damage DNA and the central nervous system. Environmental contaminants include pesticides from conventional produce, heavy metals like mercury from fish and seafood or from rice, chicken, fish and seaweed and persistent organic pollutants or POPs like PCBs, DDT and dioxins mainly from animal products. These are contaminants that move up the food chain so they’re found mostly in fish, meat and dairy products.

Solutions here very simple: choose organic foods more often as often as possible. Eat lower on the food chain. And vary your grains. A lot of people use rice as a staple. The more you can vary your grains the lower your intake of arsenic will be. And inorganic arsenic may actually increase the risk of both type two diabetes and cardiovascular disease. Now if you’re not sure about your rice one thing that you can do to reduce the arsenic in rice is to boil your rice for five minutes, get rid of the water and then cook it as usual. And the reason for cooking it in water for 5 minutes and then cooking it as usual is that if you cook it in the large amount of water for the entire 45 minutes or however long you’re cooking it you get rid of quite a lot of nutrients. So by cooking it in the large amount of water for just five minutes you preserve more nutrients and then you just cook it in the two parts water to one part rice.

High temperature products of high temperature cooking. We’re talking about things like heterocyclic amines, polycyclic aromatic hydrocarbons, acrylamide and advanced glycation end products. And there was a 2023 study that reported that high temperature cooking can damage the DNA of food and when this damaged DNA is absorbed it may negatively impact the DNA of the consumer and the damage appears most pronounced in meat as it has a high DNA content compared to plants. I thought that was kind of an interesting study.

But the most concentrated sources of these potentially carcinogenic and potentially damaging compounds are first of all for heterocyclic amines. Heterocyclic amines are formed only in animal products, meat and eggs primarily and usually when they’re cooked at high temperature, grilled or fried. The food needs to contain creatine or carnitine to produce heterocyclic amines. Poly aromatic hydrocarbons are formed in anything that’s blackened so whether it’s a plant or an animal product. So we want to try to reduce the blackening of foods. Acrylamide is formed in a number of foods but mainly starchy foods and the probably most concentrated sources are potato products because they’re high in the amino acid asparagine and asparagine is needed for the formation of acrylamide. So fried potato products are really problematic. Advanced glycation end products or AGEs are formed most concentrated in processed meat especially if it’s cooked at high temperatures. And so these are things we want to avoid.

Solutions here: avoid charred blackened foods especially meat, poultry or fish. Avoid fried foods especially deep fried foods and use more moist cooking methods like steaming, stewing, boiling, water sautéing. They produce fewer products of oxidation.

Sustainable Diets to Save Your Health and the Planet with Brenda Davis, R.D.

And finally to goal five we want to make food choices that are ecologically sustainable. Human health is dependent on the health of planet Earth. Greenhouse gas emissions could be reduced by up to 70% if people switch to plant exclusive diets. And I like this study. A study from 2023 actually compared the carbon footprint of a variety of diets including keto, paleo, omnivore, pescatarian, vegetarian and vegan and compared to vegan diets. And they looked at the kilograms of carbon dioxide equivalence per thousand calories and compared to vegan diets the carbon footprint was 4.2 times greater in keto diets, 3.8 times greater for paleo diets and 3.2 times greater for omnivorous diets.

And why would the carbon footprint be so much lower with a vegan diet than with an animal based diet or a diet containing some animal products even? Well it’s really very simple. The greenhouse gas emissions in terms of kilograms of carbon dioxide equivalents per kilogram of food are far greater from animal products than from plant foods. You can see beef being by far the highest and grass-fed beef is even higher than feedlot beef. Then lamb, cheese, coffee comes in here as well, shrimp, pork, chicken and eggs. And then you see the plant foods. Rice has a higher carbon footprint than most of the other plant foods but you can see nuts at 0.2 kilogram of carbon dioxide equivalent per kilogram of food compared to 60 plus for beef.

And finally we will just very quickly go through what to eat. So we want to eat of course a diet of predominantly whole plant foods and this is not a diet of deprivation. This is a diet of beautiful delicious colorful foods. I would aim for at least nine or more servings of vegetables and fruits a day and we’re talking a serving being a half a cup cooked or a cup raw of leafy vegetables or a half a cup raw or cooked. And then at least three servings of legumes and it doesn’t mean three bowls of beans. It can be tofu, it can be fresh peas, it can be split peas, it can be peanut butter, it can be soy milk for example. They can all count here. You want to vary your grain intake with your energy needs so your intake could range from about two to 12 or 14 servings a day depending on your caloric needs. You want your grains to be mostly intact. You want to include at least a serving of nuts and seeds per day and you want that to include an omega-3 source. And then you want to sprinkle it all with generous amounts of herbs and spices. And you can add in high quality supplements when they’re needed and you need to ensure reliable sources of B12, vitamin D, iodine and omega-3 fatty acids. A multivitamin mineral supplement is recommended during pregnancy and lactation and may be well advised for those who are at risk for shortfalls.

I wanted to share with you Canada’s food guide. Food guides can be very useful tools. Canada’s food guide is now completely usable by plant exclusive eaters. Half the plate is fruits and vegetables, a quarter of the plate is whole grains and a quarter of the plate is protein-rich foods. And in Canada’s food guide the recommendation is that we choose plant sources of protein every day and that they provide advantages over animal protein. The drink of choice is water. Dairy products no longer have an exclusive group. They are part of the protein group but they don’t have their own exclusive group. You can also use plant-based food guides like the one in Nourish or the one in Plant-Powered Protein.

So the take-home message of this presentation is every time you eat or drink you either feed disease or fight disease. Well-designed whole food plant-based diets are the highest quality diets. They are consistently associated with health promotion and disease risk reduction.

And these are a few of my books at the top the more recent ones: Plant-Powered Protein, The Kick Diabetes Essentials, Kick Diabetes Cookbook and Nourish and of course our classics down below. Thank you so much for your attention and I will stop my share and take any questions you might have.

Bone Health in Vegans, Essential Supplements for Vegans, EPA and DHA, Diabetes Lifestyle Medicine Trial, and Recent Dementia Studies with Brenda Davis, R.D.

Great thank you so much for that extremely informative and thorough presentation Brenda that was great. Oh you’re most welcome. So before we begin our Q&A session can you let people know how to get in touch with you where they can follow you where to get your books. Obviously we have your books available through our bookstore at the real truth about health.com but just where can they get in touch with you?

Yeah so they can get in touch with me via Facebook or via my email which is Brenda@Davisrd.com and my website is BrendaDavisRD.com. We have websites for most of our books as well. Plant-Powered Protein I think it’s plantpoweredprotein.com. So those are probably the best ways of getting a hold of me.

All right great. So now we’re going to begin our Q&A session. We just have about 15 or maybe a little bit more minutes left. If anybody would like to ask a question you can go ahead and raise your hand in the zoom. We don’t take questions from the chat. And I’ll go ahead and ask the first questions.

So what studies and research have been pivotal to you coming to these conclusions and forming this design for the whole food plant-based diet as the optimal diet?

Well you know the studies that have really impacted me are the studies that I mentioned at the beginning: the EPIC-Oxford, the Adventist Health Study, the Tzu Chi studies that compare people eating, living similar healthy lifestyles and eating different dietary patterns and looking at the differences in their disease risk and their longevity and so on and so forth. I think those studies are really really important studies. But a lot of the studies that have looked at the healthy plant-based diet index and their impact on disease I think those are very important studies as well. And certainly we have a number of studies that have looked at nutrient intakes and of course a lot of those studies come from EPIC-Oxford and Adventist Health Study as well that have helped us to understand what nutrients we need to be more or less concerned about. So these are studies that I think are really critical to plant-based eaters.

And you mentioned early on in the presentation about bone health and yes with regard to vegans actually having an increased likelihood of breakage specifically women I think in their postmenopausal years. How or what are the best ways to avoid having that issue for that population?

Yeah to me there are really two key things. Number one is to be physically active. Being physically active, doing weight-bearing exercise every day gives your bones a message to stay strong. And so physical activity is number one and I would recommend an hour of good physical activity every single day. Walking whenever you can but doing some of the weights and some of the HIIT classes or whatever kind of exercise you prefer but it does need to be some weight-bearing exercise. And then secondly is to make sure your diet provides the nutrients that are so important to bone health. So we need enough protein. Protein is used for building and maintaining bones. We need enough calcium. We need enough vitamin D. We need enough vitamin K. We need enough potassium and zinc and the list goes on but we need to have a good varied diet. We do tend to fall short quite commonly on calcium and vitamin D and so those are nutrients we need to pay special attention to. And if it needs to be a supplement then you know most people need to take a B12 supplement. There’s just no question. Vitamin D I mean we just got a whole pile of snow today in Calgary. I’m in a winter wonderland so here we are in April and it’s like winter so we are going literally from October to April with no vitamin D production whatsoever so we need to rely on food or supplements and as I said we don’t get enough from food so for most of us the supplement becomes pretty important.

Okay and thank you for that. So now you had a slide that featured getting high quality supplements and you had B12, D, iodine, omega-3. Previously you’d also mentioned other important nutrients just zinc etc. Are those four supplements the ones that you recommend that people on a whole food plant-based diet take and perhaps everybody and are there other supplements that we should consider taking?

Yes so certainly we all need to be taking B12. Most of us need to be taking vitamin D unless you’re exposed to a lot of sunshine and you’ve had your levels measured and you know you’re good to go. I think most people need vitamin D. And then of course iodine it depends on do you use iodized salt or are you using a lot of seaweed or even a small amount of seaweed you may be getting enough but if you’re not doing either of those then you need to have a reliable source and a supplement is a good reliable source. And then EPA and DHA is still very controversial but in my opinion I think it’s a very very reasonable thing to do. I take it myself and I think most people should be taking some direct source of long-chain omega-3s which means a supplement. Now for some people especially people that their diet is sort of all over the place they may want to take a good quality whole food multivitamin mineral supplement so they get the trace amounts of selenium and choline and you know there’s some other nutrients zinc and maybe a little extra iron and so that’s a very reasonable option in my view as well. And if you’re doing that you may get enough of some of those other nutrients like iodine is often, you can check to make sure there’s iodine in your multi and then you wouldn’t have to do a single nutrient supplement for that. You may check for B12 as well. And so if you’re doing a multi with B12 and having some fortified foods you’re probably doing just fine. You may want to top it up with 1,000 microgram single nutrient B12 just to make sure but in my experience people who are doing some fortified foods and a little bit of B12 supplement their B12 tends to be very very good.

All right great. Now with regard to EPA and DHA you mentioned that it’s a bit controversial. I know Dr. Joel Fuhrman is a big advocate for it. I know I think last year Dr. Michael Klaper said he wasn’t really into taking it but then Joel Fuhrman kind of persuaded him that it actually was worth taking. What can you describe the controversy?

Yeah so the controversy has been really that EPA and DHA are formed from alpha-linolenic acid from plants in the body and so some people are thinking that well if you take it directly you may compromise your ability to convert. I’m going to back up a little bit. So ALA is converted but not very efficiently so most experts will say maybe two to 5% is converted. We’ve seen better conversion in women up to 36% to EPA, DHA and DPA. We’ve seen reasonable conversion to EPA in men and even to DPA but not to DHA in some studies. So there is a group within the plant-based world that believes that supplying EPA and DHA is not a good idea that it might increase risk of prostate cancer these kinds of things and so we shouldn’t be taking it. There’s another group that believes that because our conversion is so inefficient and because vegans and vegetarians and especially vegans have much lower blood levels of EPA and DHA probably about a third to a half of what omnivores have that it makes sense to take EPA and DHA directly and especially because it’s so important to brain development in infants and children into brain health long term that why risk it we may as well just take it. People who eat fish twice a week we look at how much they get and then we say well we’ll divide that by seven and we’ll consume two or 300 milligrams a day to equal what people eating fish twice a week would get. And so to me that’s a very very reasonable choice. I as I said I do it myself and I think not doing it could put us at some risk so I’m definitely in favor of it.

Okay and you mentioned earlier in your presentation about the Marshall Islands. Can you provide an overview of the diabetes lifestyle medicine trial that took place in the Marshall Islands?

Yeah sure. So we basically went in and we interviewed many people and found people that were able to be part of our study that had A1Cs that were above eight that essentially had type two diabetes and then the people that qualified for the study we randomized them to either a control group or an intervention group. And the control group continued to receive the usual care so they would continue on their medications they would continue with the diet they were recommended for their diabetes and so forth. Whereas the intervention group received a very intensive lifestyle intervention. So they were literally with us for four days a week for probably five six seven hours a day. It was quite intensive. So we would feed them breakfast lunch and dinner. We would do nutrition education sessions. Teach them to read labels. Bring them to the grocery store. Do exercise classes every day. Go for walks with them after the meals. So it was very very intense intervention. And we saw just remarkable results in very short order. I was to be honest I was shocked at how fast the blood glucose levels normalized and people started to feel so much better. So our results were good. The biggest problem with our intervention was that our blood work we lost a lot of the blood work because basically we would get the blood work done and then the blood work would get sent on to Hawaii or whatever for assessment and it didn’t always get sent appropriately or safely or efficiently time-wise and so some of the results then were not valid because the blood work wasn’t good. So that was the biggest challenge there was to keep our lab results usable.

But essentially the study was a really quite a wonderful experience. When we got to the Marshall Islands people didn’t walk. They basically took a taxi even two blocks because taxis were 25 cents and if you walked it was because you were too poor to take a taxi. By the time we left there were walking paths for the whole population that everybody was walking. We brought in free running shoes. We just got some good changes. The restaurants started having diabetes wellness menu items and the grocery stores started carrying healthier foods and so it really did have an impact. And the church groups and the government groups and the teachers they all wanted us to go in and provide educational sessions. And in 2017 I went in with a colleague and we created new curriculum for all the public schools for nutrition. So they continue to ask us to do things to help reduce the diabetes epidemic. That’s really amazing impact.

So can you provide an overview of the recent studies that compare the rates of dementia among those following long-term vegan diets versus the general population?

Yeah so there haven’t been a lot of studies on vegans to be honest but the Adventist Health Study 2 found that healthy plant-based diets showed better memory and language ability people that were consuming those diets compared to the omnivores. That was I think in 2021. And then there was a 2022 study from Adventist Health Study 2 that reported slower decline in global cognition and memory in African-Americans. And in 2022 there was a Taiwanese study that showed vegetarians had a 33% reduced risk of developing dementia compared to non-vegetarians. And these participants weren’t vegan but they’re very close to vegan because as you know Asian vegetarians aren’t big dairy consumers. They tend to have a little bit of egg in the diet but very very little dairy so it’s a very near vegan diet.

And then the other thing we have is we have a number of studies that have actually looked at the plant-based diet index and plant-based diets generally and cognitive function. There was one out of China I think it was 2022 that looked at the highest quartiles of the plant-based diet index and they were associated with an over 50% decreased risk of cognitive impairment. But every 10 point increase in the hPDI was associated with a 30% risk reduction. And another study a 2023 study out of China showed that those that had the largest increase in hPDI had a 28% lower risk. And then another study out of the Czech Republic did a review of vegan diet on Alzheimer’s disease risk and plant-based diets like Mediterranean, DASH, MIND diet which are all largely plant-based diets showed reduction in cognitive decline but they just had very limited evidence for vegan diet so weren’t able to make any huge pronouncements. And so we’re still at the stage where we know that plant predominant diets are protective but in terms of vegan diets we still have lots of work to do.

All right great Brenda thank you so much for all of that information. That about wraps up our time so if we can unmute the audience everyone can say thank you. Thank you.