The Economic Benefits of Plant-Based Diets

Written by Dr. Steve Chaney on . Posted in Benefits of Plant-Based Diets

Could Plant-Based Diets Cut Healthcare Costs?

Author: Dr. Stephen Chaney

 

Could saving the healthcare system be one of the economic benefits of plant-based diets?

economic benefits of plant-based diets healthcare system costsI don’t need to tell you that our healthcare system is in crisis. Costs are out of control. The Centers for Medicare and Medicaid Services (CMS) estimates that healthcare costs will account for 25% of the gross domestic product by 2025. They also predict that 47% of that spending will be financed by federal. State, and local governments. That is unsustainable.

Our politicians have no answer. Neither political party has a viable plan to cut costs. Perhaps it is time to take matters into our own hands. What if there were a way to improve our own health and the viability of our healthcare system? A recent study suggests there may be a way to accomplish both goals.

How Was The Study Done?

In a recent study (L. Annemans and J. Schepers, Nutrition, 48: 24-32, 2018 ) scientist at Ghent university in Belgium set out to investigate the effect on public health and healthcare costs if just 10% of the population of Belgium and England switched to a primarily plant-based diet. They started with two diets for which the health benefits have been well established by multiple studies. These diets are:

economic benefits of plant-based diets soy#1: A Soy-Containing Diet: This is defined as a diet in which soy protein foods were consumed in place of animal protein foods more than 5 times per week. The soy foods included in their study were soybeans, tofu, miso, soy protein drinks, and soy yoghurt.

The soy-containing diet was chosen because previous studies have shown it protects against obesity, heart disease, stroke, diabetes, and breast, colon, stomach, lung, and prostate cancer.  (Yes. In spite of the erroneous information you find on the internet, soy foods decrease cancer risk.)

#2: The Mediterranean Diet: This is defined as a diet rich in fruits, vegetables, whole grains, nuts, seeds and large amounts of olive oil. It includes a moderate to high consumption of fish and other seafood and a low intake of meat and dairy products.

economic benefits of plant-based diets mediterranean dietsThe Mediterranean diet was chosen because previous studies have shown it protects against heart disease, stroke, diabetes, and breast cancer. I have documented these health benefits in more detail in my book Slaying The Food Myths.”

This study did not look at the benefits of other plant-based diets. For example, as discussed in “Slaying The Food Myths,” the Seventh-Day Adventist studies have shown comparable health benefit for a variety of vegetarian diets.

This study looked at the prevalence of each of these diseases in Belgium and England and estimated what the effect would be if the prevalence of these diseases were reduced by the amounts reported in previous studies of soy-based and Mediterranean diets.

The study reported two outcomes: the increase in Quality of Life Years (QALYs) and the decrease in healthcare costs. Increased Quality of Life Years simply means the increase in disease-free years. That is the outcome most important to each of us personally. However, we should be equally interested in the decreased healthcare costs. The dollars our government spends on healthcare don’t grow on trees. They come out of our pockets.

 

Economic Benefits of Plant-Based Diets: Decreasing Healthcare Costs?

 

economic benefits of plant-based dietsWith that buildup, you are probably wondering what the outcome of the study was. The news was good:

If 10% of the population switched to a soy-based diet there would be:

  • An increase of 154 Quality of Life Years/1,000 people and a decrease in healthcare costs of $1.9 billion/20 years in Belgium.
  • An increase of 130 Quality of Life Years/1,000 people and a decrease in healthcare costs of $10.7 billion/20 years in England.

If 10% of the population switched to a Mediterranean diet there would be:

  • An increase of 166 Quality of Life Years/1,000 people and a decrease in healthcare costs of $1.6 billion/20 years in Belgium.
  • An increase of 116 Quality of Life Years/1,000 people and a decrease in healthcare costs of $7.4 billion/20 years in England.

[Note: In case you were wondering, the authors said the reason why plant-based diets had less of an effect on Quality of Life Years in England than in Belgium is because public health interventions have already significantly decreased the incidence of heart attack and stroke in England. Conversely, the reason healthcare savings are higher in England is because healthcare costs are higher there.]

Finally, if one were to extrapolate the British healthcare savings to the costs of the US healthcare system, one would predict:

  • If 10% of the US population were to switch to a soy-based diet, healthcare savings might amount to $17 billion/20 years.
  • If 10% of the US population were to switch to a Mediterranean diet, healthcare savings might amount to $12 billion/20 years.

The authors concluded: “The result of the present analysis suggests that both a soy-containing diet and the Mediterranean diet could contribute to health promotion because they are predicted to lead to substantial health benefits and societal savings.”

How Accurate Are These Estimates?

The benefits of soy-based and Mediterranean diets on which these estimates are based are very solid. The benefits are based on association studies, but the studies are very well done and are remarkably consistent.

The major weakness of these estimates is the benefits of these diets have been demonstrated in other parts of the world and are being extrapolated to a region of the world where neither of those diets are commonly followed. The authors tried very hard to control for all confounding variables, but the possibility remains that lifestyle differences unique to those geographic regions also contributed to the health benefits of soy-based and Mediterranean diets.

The authors acknowledged that some of the foods that are normally part of soy-based and Mediterranean diets were not as readily available in Belgium and England. They raised the possibility that something like the “New Nordic Diet”, which is also primarily plant-based but incorporates more familiar foods, might be equally effective. The equivalent diet in the US might be the DASH diet.

The economic benefits of plant-based diets may not depend so much on the diet, as long as it is plant-based and those foods are readily available.

 

The Bottom Line:

 

A recent study looked at the effect of a plant-based diet on Quality Of Life Years (disease free years) and healthcare costs in Belgium and England. The study estimated:

If 10% of the population switched to a soy-based diet there would be:

  • An increase of 154 Quality of Life Years/1,000 people and a decrease in healthcare costs of $1.9 billion/20 years in Belgium.
  • An increase of 130 Quality of Life Years/1,000 people and a decrease in healthcare costs of $10.7 billion/20 years in England.

If 10% of the population switched to a Mediterranean diet there would be:

  • An increase of 166 Quality of Life Years/1,000 people and a decrease in healthcare costs of $1.6 billion/20 years in Belgium.
  • An increase of 116 Quality of Life Years/1,000 people and a decrease in healthcare costs of $7.4 billion/20 years in England.

If one were to extrapolate the British healthcare savings to the costs of the US healthcare system, one would predict:

  • If 10% of the US population were to switch to a soy-based diet, healthcare savings might amount to $17 billion/20 years.
  • If 10% of the US population were to switch to a Mediterranean diet, healthcare savings might amount to $12 billion/20 years.

The authors concluded: “The result of the present analysis suggests that both a soy-containing diet and the Mediterranean diet could contribute to health promotion because they are predicted to lead to substantial health benefits and societal savings.”

For more details, read the article above:

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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Do Omega-3s Lower Blood Pressure in Young, Healthy Adults?

Posted August 14, 2018 by Dr. Steve Chaney

What Is The Omega-3 Index And Why Is It Important?

Author: Dr. Stephen Chaney

 

Do omega-3s lower blood pressure in healthy adults?

omega-3s lower blood pressure young adultsThe literature on the potential health benefits of omega-3s is very confusing. That’s because a lot of bad studies have been published. Many of them never determined the omega-3 status of their subjects prior to omega-3 supplementation. Others relied on dietary recalls of fish consumption, which can be inaccurate.

Fortunately, a much more accurate measure of omega-3 status has been developed and validated in recent years. It’s called the Omega-3 Index. Simply put, the Omega-3 Index is the percentage of EPA and DHA compared to 26 other fatty acids found in cellular membranes. Using modern technology, it can be determined from a single finger prick blood sample. It is a very accurate reflection of omega-3 intake relative to other fats in the diet over the past few months. More importantly, it is a measure of the omega-3 content of your cell membranes, which is a direct measure of your omega-3 nutritional status.

A recent extension of the Framingham Heart Study reported that participants with an Omega-3 Index >6.8% had a 39% lower risk of cardiovascular disease than those with an Omega-3 Index <4.2% (WS Harris et al, Journal of Clinical Lipidology, 12: 718-724, 2018 ). Although more work needs to be done, an Omega-3 Index of 4% or less is generally considered indicative of high cardiovascular risk, while 8% or better is considered indicative of low cardiovascular risk. For reference, the average American has an Omega-3 Index in the 4-5% range. In Japan, where fish consumption is much higher and cardiovascular risk much lower, the Omega-3 Index is in the 9-11% range.

Previous studies have suggested that omega-3 fatty acids lower blood pressure to a modest extent. Thus, it is not surprising that more recent studies have shown an inverse correlation between Omega-3 Index and blood pressure. However, those studies have been done with older populations, many of whom had already developed high blood pressure.

From a public health point of view, it is much more interesting to investigate whether it might be possible to prevent high blood pressure in older adults by optimizing omega-3 intake in a young, healthy population, most of whom had not yet developed high blood pressure. Unfortunately, there were no studies looking at that population. The current study was designed to fill that gap.

 

How Was The Study Done?

omega-3s lower blood pressure young healthy adultsThe current study (M.G. Filipovic et al, Journal of Hypertension, 36: 1548-1554, 2018 ) was based on data collected from 2036 healthy adults, aged 25-41, from Liechtenstein. They were participants in the GAPP (Genetic and Phenotypic Determinants of Blood Pressure) study. Participants were excluded from the study if they had been diagnosed with high blood pressure and were taking medication to lower their blood pressure. They were also excluded if they had heart disease, chronic kidney disease, other severe illnesses, obesity, sleep apnea, or daily use of non-steroidal anti-inflammatory medications.

Blood samples were collected at the time of their enrollment in the study and frozen for subsequent determination of Omega-3 Index. Blood pressure was also measured at their time of enrollment in two different ways. The first was a standard blood pressure measurement in a doctor’s office.

For the second measurement they were given a wearable blood pressure monitor that recorded their blood pressure over 24 hours every 15 minutes during the day and every 30 minutes while they were sleeping. This is considered more accurate than a resting blood pressure measurement in a doctor’s office because it records the variation in blood pressure, while you are sleeping, while you are exercising, and while you go about your everyday activities.

 

Do Omega-3s Lower Blood Pressure In Young, Healthy Adults?

omega-3s lower blood pressure young adults equipmentNone of the participants in the study had significantly elevated blood pressure. The mean systolic and diastolic office blood pressures were 120±13 and 78±9 respectively. The average Omega-3 Index in this population was 4.6%, which is similar to the average Omega-3 Index in the United States.

When they compared the group with the highest Omega-3 Index (average = 5.8%) with the group with the lowest Omega-3 Index (average = 4.6%):

  • The office measurement of systolic and diastolic blood pressure was decreased by 3.3% and 2.6% respectively
  • While those numbers appear small, the differences were highly significant.
  • The 24-hour blood pressure measurements showed a similar decrease.
  • Blood pressure measurements decreased linearly with increasing Omega-3 Index. [In studies of this kind, a linear dose-response is considered an internal validation of the differences observed between the group with the highest Omega-3 Index and the group with the lowest Omega-3 Index.]

The authors concluded: “A higher Omega-3 Index is associated with statistically significant, clinically relevant, lower systolic and diastolic blood pressure in normotensive, young and healthy individuals. Diets rich omega-3 fatty acids may be a strategy for primary prevention of hypertension.”

 

What Does This Mean For You?

omega-3s lower blood pressure young adults questionPerhaps I should first comment on the significance of the relatively small decrease in blood pressure observed in this study.

  • These were young adults, all of whom had normal or near normal blood pressure.
  • The difference in Omega-3 Index was rather small (5.8% to 4.6%). None of the participants in the study were at the 8% or above that is considered optimal.
  • Liechtenstein is a small country located between Switzerland and Spain. Fish consumption is low and omega-3 supplement consumption is rare.

Under these conditions, even a small, but statistically significant, decrease in blood pressure is remarkable.

We should think of this study as the start of the investigation of the relationship between omega-3 status and blood pressure. Its weakness is that it only shows an association between high Omega-3 Index and low blood pressure. It does not prove cause and effect.

Its strength is that it is consistent with many other studies showing omega-3 fatty acids lower blood pressure. Furthermore, it suggests that the effect of omega-3s on blood pressure may also be seen in young, healthy adults who have not yet developed high blood pressure.

Finally, the authors suggested that a diet rich in omega-3s might reduce the incidence of high blood pressure by slowing the age-related increase in blood pressure that most Americans experience. This idea is logical, but speculative at present.

However, the GAPP study is designed to provide the answer to that question. It is a long-term study with follow-up examinations scheduled every 3-5 years. It will be interesting to see whether the author’s prediction holds true, and a higher Omega-3 Index is associated with a slower increase in blood pressure as the participants age.

 

Why Is The Omega-3 Index Important?

 

The authors of this study said: “The Omega-3 Index is very robust to short-term intake of omega-3 fatty acids and reliably reflects an individual’s long-term omega-3 status and tissue omega-3 content. Therefore, the Omega-3 Index has the potential to become a cardiovascular risk factor as much as the HbA1c is for people with diabetes…” That is a bit of an overstatement. HbA1c is a measure of disease progression for diabetes because it is a direct measure of blood sugar control.

In contrast, Omega-3 Index is merely a risk factor for cardiovascular disease. However, if it is further validated by future studies, it is likely to be as important for predicting cardiovascular risk as are cholesterol levels and markers of inflammation.

However, to me the most important role of Omega-3 Index is in the design of future clinical studies. If anyone really wants to determine whether omega-3 supplementation reduces cardiovascular risk, high blood pressure, diabetes or any other health outcome they should:

  • Start with a population group with an Omega-3 Index in the deficient (4-5%) range.
  • Supplement with omega-3 fatty acids in a double blind, placebo-controlled manner.
  • Show that supplementation brought participants up to an optimal Omega-3 Index of 8% or greater.
  • Look at health outcomes such as heart attacks, cardiovascular deaths, hypertension, stroke, or depression.
  • Continue the study long enough for the beneficial effects of omega-3 supplementation to be measurable. For cardiovascular outcomes the American Heart Association has stated that at least two years are required to obtain meaningful results.

These are the kind of experiments that will be required to give definitive, reproducible results and resolve the confusion about the health effects of omega-3 fatty acids.

 

The Bottom Line

 

An accurate measure of omega-3 status has been developed and validated in recent years. It’s called the Omega-3 Index. Simply put, the Omega-3 Index is the percentage of EPA and DHA compared to 26 other fatty acids found in cellular membranes.

Although more work needs to be done, an Omega-3 Index of 4% or less is generally considered indicative of high cardiovascular risk while 8% or better is considered indicative of low cardiovascular risk.

Previous studies have shown an inverse correlation between Omega-3 Index and blood pressure. However, these studies have been done with older populations, many of whom had already developed high blood pressure.

From a public health point of view, it is much more interesting to investigate whether it might be possible to prevent high blood pressure in older adults by optimizing omega-3 intake in a young, healthy population, most of whom had not yet developed high blood pressure. Until now, there have been no studies looking at that population.

The study described in this article was designed to fill that gap. The participants in this study were ages 25-41, were healthy, and none of them had elevated blood pressure.

When the group with the highest Omega-3 Index (average = 5.8%) was compared with the group with the lowest Omega-3 Index (average = 4.6%):

  • Both systolic and diastolic blood pressure were decreased
  • Blood pressure measurements decreased linearly with increasing Omega-3 Index.

The authors concluded: “A higher Omega-3 Index is associated with statistically significant, clinically relevant, lower systolic and diastolic blood pressure in normotensive, young and healthy individuals. Diets rich omega-3 fatty acids may be a strategy for primary prevention of hypertension.”

Let me translate that last sentence into plain English for you. The authors were saying that optimizing omega-3 intake in young adults may slow the age-related increase in blood pressure and reduce the risk of them developing high blood pressure as they age. This may begin to answer the question “Do omega-3s lower blood pressure in young, healthy adults?”

Or even more simply put: Aging is inevitable. Becoming unhealthy is not.

For more details, read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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