Who’s Right, Anyway?

Next week, I’m joining a group of women for an informal pot-luck/cooking club.  The idea is pretty straightforward.  Pick a theme each month and bring a dish to share.  The reality isn’t so straightforward.

Julia is gluten free.  Marly is on an anti-inflammatory diet.  I’m whole-foods-plant-based, a.k.a. vegan.  Sarah is low-carb, but does eat some gluten.  Pauline is Paleo.  Melissa is starting Whole30 next week.

What the what?  When did food get so complicated?  Humans have been eating as long as there have been humans.  It’s a luxury to have the option to be so selective about what we eat.  In the past two months that I’ve been WFPB, I can say absolutely that I have noticed positive changes in my health, my energy level and my weight.  But I’m equally sure that within shouting distance of our home I can find a dozen fierce advocates for a smorgasbord of different diet plans.  Each of these individuals has their own success story, and each of them have made choices based on what seems logical and feels right to them.

So what to do?  Is there one right answer?  I’m a neophyte to the nutrition literature, but I was impressed this week by an article that my hubby passed along to me.

“Association of Changes in Diet Quality with Total and Cause-Specific Mortality” by Mercedes Soto-Prieto Ph.D. at al, published in the New England Journal of Medicine this past week.  The crux of the article was to look at the effect of “diet quality” on a very large pool of research subjects — more than 73,000 — on their overall risk of death.  There are a few things I like about this study.

First, they looked at overall risk of death, not intermediate endpoints like serum cholesterol or bone density.  Many studies use these intermediate endpoints — like cholesterol — because they’ve been associated with a higher risk of, for example, a heart attack.  Things can get muddy with secondary endpoints, because they don’t have a 100% correlation with the things we truly care about.  But dying, well that’s an endpoint that pretty much everyone can agree is important.

Second, they focus on dietary patterns, rather than single nutrients.  The foods we put in our mouths each day are incredibly complex.  How our bodies process these foods, and how these foods interact with each other as we digest them adds infinite layers of complexity.  Add in the variation between different people’s food choices, and the complexity becomes immeasurable.  It’s not realistic to, say, have study group A eat nothing but oatmeal three times daily for fifteen years, and study group B eat nothing but eggs.  To find relationships between our health and what we eat, we’re going to have to look at patterns that arise from complex systems.  But I appreciate that rather than trying to focus on single nutrients or food classes, the authors of the study tackled the whole messy complexity of dietary choices.  In fact, they used three different measures of dietary quality:  the Alternate Healthy Eating Index, the Alternate Mediterranean Diet Index and DASH (Dietary Approaches to Stop Hypertension) diet score.  I would have loved to see a measure that included subjects who followed a WFPB diet, but I can appreciate their rationale of using measures that could be applied to a large number of subjects.

So shall we cut to the chase?  Participants who had the greatest improvement in diet quality in the 12-year period of the study had an 8-17% decrease in risk of death.  “Common food groups in each score that contributed most to improvements were whole grains, vegetables, fruits and fish or n-3 fatty acids.”  From the data, the authors extrapolate that “an increase in consumption of nuts and legumes from no servings per day to 1 serving per day and a reduction in consumption of red and processed meats from 1.5 servings per day to little consumption will result in an improvement of 20% in the [alternate healthy eating index] score,” which could reduce your risk of death by nearly 20% in the subsequent 12 years.

The take-home points from this study:

  • Eat more vegetables and fruits.
  • Choose whole grains rather than processed grains
  • Increase your consumption of nuts and legumes and decrease your consumption of red and processed meats.

It’s just one study, and it’s not enough to answer which of my friends at the potluck really has the best diet plan.  But it’s enough for me to continue to enjoy my WFBP diet with gusto, and happily bring a dish with vegetables, whole grains and legumes to share, wishing each of these women great health.


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