A way forward for chronic disease

Vegan Australia recently made a submission to the Australian Department of Health as part of its public consultation on how to prevent and manage chronic conditions. The submission, written by vegan nutritionist Robyn Chuter, is summarised below.

How big is the problem?

Chronic diseases are the leading cause of illness, disability and death in Australia, accounting for 90% of deaths in 2011. Over the past 40 years, the burden of disease in Australia has shifted from infectious diseases and injury to chronic conditions. These diseases include heart disease, stroke, diabetes, obesity, arthritis, osteoporosis, depression and cancer.

The situation is dire, with around half of people aged 65-74 suffering five or more chronic diseases, increasing to 70% of those aged 85 and over.

Up to 80% of these diseases are caused by lifestyle behaviours, with diet and nutrition being a primary factor.

Plant-based diet lowers risk of chronic disease

The health system should recognise the pivotal role of nutrition in prevention of chronic disease. It should take into account scientific research that shows that consumption of animal products in anything other than small amounts on an occasional basis is linked to a higher risk of overweight and obesity, coronary heart disease, type 2 diabetes, hypertension, metabolic syndrome and cancer, especially of the colon, gastrointestinal tract and prostate.

Vegans, who consume no animal products, enjoy the highest level of protection against all these diseases. See Beyond Meatless, the Health Effects of Vegan Diets: Findings from the Adventist Cohorts.

Currently, government health bodies do not make clear the link between risk factors, such as high blood pressure, high blood cholesterol, obesity and impaired glucose tolerance, with the consumption of animal products. Failing to make this link explicit inclines both health professionals and lay people to the false conclusion that these risk factors are beyond their control, and require medical or surgical intervention.

Plant-based diet can reverse chronic disease

The health system currently focuses on delivery of medical care for management of chronic conditions, neglecting the substantial literature demonstrating that many of these conditions can be managed more effectively through adoption of a wholefood plant-based diet. These conditions include advanced coronary artery disease, high blood pressure, type 2 diabetes and various autoimmune diseases. Managing these conditions with a wholefood plant-based diet can result in substantially reduced economic costs for both individuals and society as a whole, not to mention substantial improvement in the quality of life of patients.

Rather than showing that medical management of chronic conditions is the only possibility, extensive evidence also exists that a wholefood plant-based diet can reverse some chronic conditions rather than just manage them.

A wealth of scientific literature exists indicating that switching to a wholefood plant-based diet is more effective for weight loss and for reduction of elevated blood pressure, cholesterol, triglycerides and glucose than more modest dietary changes, and in many cases, is more effective than medical management. See the following references.

A wholefood plant-based diet has even been found to reduce painful diabetic neuropathy, a condition for which no effective medical treatment exists. See A dietary intervention for chronic diabetic neuropathy pain: a randomized controlled pilot study and Regression of Diabetic Neuropathy with Total Vegetarian (Vegan) Diet.

Even mental health appears to be improved on a wholefood plant-based diet, with a recent study showing reduced depression and anxiety and improved workplace productivity. See A multicenter randomized controlled trial of a nutrition intervention program in a multiethnic adult population in the corporate setting reduces depression and anxiety and improves quality of life: the GEICO study.

Take a whole-of-government approach to chronic disease prevention

The WHO and European Union have both urged that chronic disease prevention and control considerations should be integrated into policies across all government departments, and that fiscal policies should be employed to promote healthy eating, such as Denmark's saturated fat tax, Hungary's "junk food tax," and France's tax on sweetened drinks. See the following references.

Australian governments should follow these leads and should take a whole-of-government approach. The formation and review of policies in each sector that has an impact on health, such as agriculture, education, planning and environment, should explicitly take into account the impact of these policies on prevention and mitigation of chronic disease.

The WHO emphasises this: "National food and agricultural policies should be consistent with the protection and promotion of public health". In Australia this is suggestion is often ignored by government.

The North Karelia Project in Finland provides an excellent example of the effectiveness of a well-planned whole-of-government approach in reducing chronic disease. Coronary heart disease mortality was reduced by 73% among 30-64 year old males, cancer and all-cause mortality were reduced, and general population health was improved through a portfolio of interventions that encouraged movement toward a more plant-based diet with reduced salt and sugar consumption; smoking cessation; and increased physical activity. Individual measures included subsidising dairy farmers to switch to crop cultivation; working with food manufacturers to reduce the amount of fat, salt and sugar in processed foods; and developing innovative school- and community-based nutrition education programs.

Many factors contributing to chronic disease lie outside the health care system and we need to address the factors to effectively deal with chronic conditions. For example, agricultural and fiscal policies should support production and consumption of health-promoting foods while discouraging production and consumption of foods known to contribute to chronic conditions, such as animal products and refined carbohydrates.

Industry partnerships should be urgently developed to produce beneficial health outcomes. A successful model can be found in the UK's Food Standards Agency's collaboration with the food industry to devise a program of voluntary salt reduction which achieved a 15% drop in 24-h urinary sodium over 7 years. See Salt reduction in the United Kingdom: a successful experiment in public health.

Improve vegan education of health professionals

Health and education bodies should ensure adequate nutritional literacy for health and medical professionals, particularly awareness of the proven benefits of a plant-based diet in preventing and reversing many chronic diseases. See Nutritional update for physicians: plant-based diets.

Health professionals should also be trained in skills to counsel clients to adopt a well-planned plant-based diet for both primary and secondary prevention purposes. This is is especially need for those at heightened risk of or already diagnosed with chronic conditions.

Ensure the health of all Australians, including at-risk populations

A whole-of-government approach and strategic partnerships with industry are required to ensure that at-risk populations throughout Australia have access to affordable fresh fruits and vegetables, whole grains and legumes. There should also be available culturally-appropriate support to adopt healthy, plant-based eating patterns that will reduce their risk of chronic conditions and improve their management.

Change how we measure the health of Australians

To ensure health policies are effective, we need to ensure that how we measure progress is relevant. There should be an emphasis on programs that support the prevention of chronic diseases through diet. Progress towards this can be checked through measures such as an increase in the number of medical schools which have compulsory training in therapeutic nutrition; improved knowledge of the application of therapeutic nutrition among health care practitioners; and more facilities in hospitals, outpatient clinics and schools which focus on patient/community education in both the theoretical and practical dimensions of wholefood plant-based eating. The references provide examples of such initiatives that are already operating in hospitals, and in schools. See the following references.

Other measures include reduced mean population intake of animal products, refined carbohydrates and vegetable oils; increased mean population intake of protective plant foods especially whole fruits, vegetables, whole grains and legumes; and increase number of children receiving a nutritious plant-based diet.

Other measures should include access to nutritious food and competency in healthy meal planning, such as the number of at-risk communities with a grocery store within walking distance; number of schools that have a kitchen garden and healthy food preparation program; number of communities that have community gardens and low-cost, culturally sensitive cooking classes that teach wholefood plant-based nutrition.

Conclusion

The current narrow focus on addressing the prevention and treatment of chronic conditions through the health system is out of step with World Health Organization and European Union policies which urge a whole-of-government approach.

A whole-of-government approach is required to achieve prevention of chronic conditions, with the health, agricultural, education and planning and environment departments playing primary roles. Co-ordination between these sectors is essential to ensure the generation of policies that positively impact on individuals' and communities' risks of developing chronic disease.

Encouraging the adoption of a wholefood plant-based diet by all Australians would dramatically reduce risk factors for many chronic conditions, including obesity, type 2 diabetes, ischaemic heart disease, many types of cancer and some mental health conditions.

For those already suffering from chronic conditions, incorporation of a wholefood plant-based diet into their treatment plan is a powerful secondary prevention strategy, and may result in reduced medication usage and in some cases, reversal of the condition.

Thanks

Vegan Australia thanks Robyn Chuter for writing this submission to the proposed National Strategic Framework for Chronic Conditions.

Find the full submission here.

Robyn Chuter is a naturopath, counsellor and EFT therapist who specialises in helping people reverse serious and chronic illnesses such as autoimmune conditions, type 2 diabetes, heart disease and chronic fatigue syndrome, using a plant-based diet and emotional healing.

Her other speciality is helping people who suffer from emotional eating, food addiction and poor body image. She developed The LEAN Program, a 6-week online mind-body intensive, to empower people struggling with these issues to have a healthy relationship with food and with themselves.

Robyn's dual background as a physical and mental health professional uniquely equips her to help her clients bridge the gap between knowing what to do to be healthy and happy, and actually doing it. She goes way beyond simply educating her clients about the changes they need to make in order to overcome disease and achieve optimal health. She works intensively with her clients to get them past their own psychological, behavioural and social barriers to change, so they can implement what she teaches them and reap the many benefits.

Visit www.empowertotalhealth.com.au to receive Robyn's free action guide 'The 5 Steps to Breaking Bad Habits' and subscribe to her free weekly e-newsletter, Empowered!




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