Whole-food Plant-based Diet Research Articles

A whole-food, plant-based dietary intervention and cognitive function in women with metastatic breast cancer.

e24160 Background: Disease-specific quality of life (QOL) is consistently regarded as one of the most important outcomes by women with metastatic breast cancer (mBC), and it predicts survival. Treatment-related symptoms such as cognitive impairment greatly impact QOL in women with mBC. Patients undergoing treatment for breast cancer are highly interested in diet and nutrition, but despite this high level of interest, very few trials have tested dietary interventions in women receiving systemic breast cancer therapy and; the majority of research has been conducted in survivors who have completed primary treatment. Given the limited treatment options for cognitive impairment we evaluated whether our results show a whole food plant based (WFPB) dietary intervention might improve perceived cognitive function (CF) in women undergoing treatment for metastatic breast cancer. Methods: Patients with stage 4 breast cancer receiving treatment were randomized 2:1 into 2 arms: 1) WFPB diet (n = 20) or 2) usual care (n = 10) for 8 weeks with assessments at baseline, and 8 weeks. Our WFPB diet consisted of an ad libitum whole-food, plant-based diet; 3 meals/day were provided, which included fruits, vegetables, whole grains, nuts/seeds and excluded meat, dairy, eggs, added oils, solid fats and most sugars. Patient reported outcomes for perceived CF were collected using FACT- COG and EORTC-QLQ-C30. Paired t-tests were used to assess within group changes from baseline to week 8. The between group difference (WFPB diet vs control) was assessed by ANCOVA model. Results: Patients on the WFPB diet began with a mean baseline score of 140.8 on the FACT-COG which significantly improved to 156.6 (p = 0.005) at 8-weeks post intervention. The reported minimally important difference (MID) between groups is (9.6) and we observed a clinically significant difference of 17.1 (p = 0.03). Similar results in CF were observed for EORTC-QLQ-C30. The baseline mean score of 73.3 was improved to 84.7 (p = 0.004) at 8-weeks post intervention. The reported MID between groups is (4) and we observed a clinically significant difference of 12.6 (p = 0.07), with no significant changes in perceived CF for the control group. Conclusions: Our 8-week WFPB diet resulted in clinically meaningful and statistically significant improvements in perceived cognitive function in women with metastatic breast cancer. A phase 3 clinical trial is needed to confirm the results of this novel intervention. Funding: 3UG1CA189961. Clinical trial information: NCT03045289 .[Table: see text]

Whole-food plant-based diet (WFPBD) to control weight and metabo-inflammation in overweight/obese men with prostate cancer (PC) receiving androgen deprivation therapy (ADT): A multi-center randomized control trial.

TPS5098 Background: Obesity promotes a chronic inflammatory state that is associated with PC progression. ADT can cause significant side effects including weight gain, accumulation of body fat, insulin resistance, and an increased risk of diabetes and cardiovascular disease. A WFPBD has been shown to promote weight loss, decrease chronic inflammation, and shift gut microbial profiles to a microbiome that promotes insulin sensitivity. We hypothesize that a WFPBD and behavior intervention will promote weight loss and a reduction in adiposity in overweight/obese patients with PC on ADT and will decrease biomarkers of metabo-inflammation; and that a WFPBD, which is enriched in fiber, will modulate the fecal microbiota and metabolites, and alter study participants’ serum metabolome. Correlative studies will offer insight into the impact of nutrition on metabolic pathways that are known to be affected by PC, ADT and/or excess body fat, including steroid metabolism, ketogenesis, and fatty acid metabolism. Methods: Key eligibility criteria include pts with PC with a BMI ≥ 27 receiving ADT with an LHRH/GnRH analogue for >24 weeks pre-study (+ androgen receptor pathway inhibitor for >3 mos) with anticipation of >26 more weeks of ADT. 60 patients randomized 1:1 between two cohorts. Cohort 1: pts receive 12 prepared meals (provided by Plantable) per weeks 1-4 and 6 meals weeks 5-8 plus Plantable coaching, nutritional counseling and education to assist in self-prepping plant-based meals (weeks 9-26); Cohort 2 (control): pts receive general nutritional counseling from a Registered Dietician weekly for 8 weeks, then monthly x 4. Collection of baseline and serial measurements (pre-intervention, weeks 4, 8 and 26) including weight, serum carotenoid levels (to monitor dietary compliance), dual energy x-ray absorptiometry (DXA) scans, MnSOD polymorphisms, and biomarkers of inflammation and metabolism. The primary comparison is weight loss at 4 weeks (with an 80% power to detect an effect size 0.74 standard deviations with a 2-sided significance level of 0.05 using a two-sample t-test). Secondary objectives will assess and compare changes in: a) biomarkers of metabolic disorders (Hemoglobin A1c, fasting insulin/glucose) and cardiovascular risk (LDL cholesterol, HDL cholesterol, triglycerides); b) pro-inflammatory markers (IL-6, hsCRP) and adipokines (leptin, adiponectin); c) fecal microbiota; and d) quality of life measurements. Exploratory objectives will assess the effects of a WFPBD on serum and fecal metabolomics and on clonal hematopoiesis. Trial is open at Weill Cornell Medicine (WCM), John Hopkins University and Columbia University. First pt enrolled at WCM September 2022. Funding support from the Prostate Cancer Foundation; PC Clinical Trials Consortium c22-301. Clinical trial information: NCT05471414 .

0590 Effect of a whole-food plant-based diet on daytime sleepiness in patients with obstructive sleep apnea

Abstract Introduction Consumption of diet rich in high saturated fats has been associated with a higher degree of daytime sleepiness. A whole-food, plant-based (WFPB) dietary pattern, which is low in saturated fat, has been shown to be beneficial in weight loss and other health conditions. Patients with obstructive sleep apnea (OSA) frequently experience excessive daytime sleepiness despite treatment. This study aims to assess the effect of a short term (21 days) WFPB diet on daytime sleepiness in patients with obstructive sleep apnea. Methods Patients were recruited from the Mayo Clinic Jacksonville sleep clinic who have a diagnosis of OSA who are on PAP therapy but have daytime sleepiness with Epworth Sleepiness Scale (ESS) score of 5 or above. Participants were asked to follow a strict WFPB diet for 21 days using the Fork Over Knives handbook as a guide. They were also asked to complete ESS before switching to and after completing a WFPB diet for 21 days. Results A total of 10 participants completed the 21-day WFPB diet. Eight out of ten participants had reported a reduction in daytime sleepiness. Overall, we found a mean decrease in ESS score of 3.8 in all participants, with 3 patients had a significant decrease in ESS score of ≥ 7. All participants completed the study with ≥ 90% adherence to a WFPB diet. In addition, participants also reported a mean weight loss of 4.2 kg. Two participants noted headaches during this 21-day period. Conclusion Significant improvement with daytime sleepiness was found in patients who switched to a WFPB diet for 21 days. No significant correlation between improvement in ESS and weight loss was found. Support (if any)

Whole-food plant-based diet reduces daytime sleepiness in patients with OSA

Consumption of a diet high in saturated fat has been associated with daytime sleepiness. A whole-food plant-based (WFPB) dietary pattern, which is low in saturated fat, has been shown to be beneficial in a variety of health conditions. We assessed the effect of a short-term (21 days) WFPB diet intervention on daytime sleepiness in 14 patients with obstructive sleep apnea (OSA). We found a mean decrease of 3.8 points (SD = 3.3, p = 0.003) on the Epworth Sleepiness Scale (ESS) after switching from a standard Western diet to a WFPB diet. Our results suggest that a WFPB diet could be a viable dietary intervention to reduce symptom of daytime sleepiness.

Whole-food plant-based Jumpstart for a Deaf and Hard of Hearing cohort.

Deaf and Hard of Hearing (DHH) patients are at high risk of developing chronic illness, and when they do, are at higher risk of poor outcomes than in a hearing community. Rochester Lifestyle Medicine Institute adapted its online, Zoom-based, medically-facilitated 15 Day Whole-Food Plant-Based (WFPB) Jumpstart program, to give DHH participants knowledge, skills, and support to make dietary changes to improve their health. Adaptations included having a medical provider present who is fluent in American Sign Language (ASL), is board-certified in Lifestyle Medicine, and has a Master of Science in Deaf Education; spotlighting participants when asking a question during the Q&A session; using ASL interpreters; utilizing closed captioning/automatic transcription during all Zoom meetings; and employing a Success Specialist to provide outreach via text and email throughout the program. Participants had significant positive changes in their eating pattern. They reported improvements in biometric measures as well as in how they were feeling. They all reported that they planned to continue to eat a more WFPB diet than they did prior to Jumpstart. All either agreed or strongly agreed that they learned important information, were confident that they knew the best eating pattern for health, and gained the skills they needed to make changes. Although this was a small pilot program, it suggests that this model can be used to provide education and support for behavior change that will lead to improved health in a DHH community.

Health Achieved Through Lifestyle Transformation (HALT): A Kaiser Permanente Diet and Lifestyle Intervention Program for Coronary Artery Disease and Type 2 Diabetes.

A whole-food plant-based (WFPB) diet in combination with healthful lifestyle modifications has been shown to be an effective approach to managing and reversing the progression of coronary artery disease and type 2 diabetes mellitus (T2DM). The Health Achieved Through Lifestyle Transformation Program (HALT) is a 20-week real-world healthful diet and lifestyle intervention program implemented at Kaiser Permanente South Sacramento Medical Center (KPSSC), whose goal is to treat, and where possible, reverse CAD and T2DM. Here, our objective is to describe HALT, including enrollment, the intervention, adherence, and data collection activities during a 2-year period from October 15th, 2016, through October 9th, 2018. There were 204 KPSSC members enrolled, of which, 19 (9.3%) had CAD only, 166 (81.4%) had T2DM only, and 19 (9.3%) had both CAD and T2DM. Among the enrolled, 196 (96.1%) completed self-administered questionnaires, and 88.2 to 97.5% completed blood tests, depending on the test. The enrolled were predominantly female (63.2%), ≥50years old at program entry (83.3%), and white (32.8%) or black (25.5%). HALT has the potential to become a valuable resource for examining the impact of dietary and lifestyle modifications on patients diagnosed with CAD and/or T2DM.

Abstract P4-07-31: A whole food, plant-based (WFPB) dietary intervention to improve cardiometabolic and cancer-related outcomes in women with breast cancer

Abstract Background: With dramatically rising obesity rates in the US, obesity at breast cancer diagnosis is common; further compounding the problem is that breast cancer treatment often results in additional weight gain. Among women undergoing breast cancer treatment, both obesity at diagnosis and post-diagnosis weight gain are associated with increased all-cause mortality and increased breast cancer mortality. We tested a WFPB dietary intervention in metastatic breast cancer patients to improve cardiometabolic and cancer-related outcomes, as it has been shown to reduce weight and improves cardiometabolic health in overweight and obese individuals. Methods: Women with stage 4 breast cancer receiving treatment were randomized 2:1 into 2 arms: 1) a WFPB diet (N=21) or 2) usual diet (N=11) for 8 weeks with assessments at baseline, 4, and 8 weeks. Our WFPB diet consisted of an ad libitum whole food, plant-based diet; 3 meals/day were provided to WFPB subjects, which included fruits, vegetables, whole grains, nuts and seeds, and excluded meat, dairy, eggs, and added oils/solid fats. WFPB subjects received weekly education regarding diet. Subjects in the usual care group were asked to continue their usual diet for the next 8 weeks. Outcomes include cardiometabolic risk factors, related sex hormones, and cancer progression markers. Effects of the WFPB diet on the outcomes were assessed by comparing marginal means by arm estimated at 8 weeks from the analysis of covariance model controlling for the baseline value. Results: Of the 32 subjects randomized, 30 subjects (20 WFPB and 10 usual care) completed all 3 assessments. Reductions in weight, BMI, total cholesterol, and LDL cholesterol were statistically significant as well as clinically meaningful, both within the WFPB group and between the groups. In the WFPB group, subjects lost a mean of 6.2% of their body weight versus 0.7% body weight loss in the control group (p< 0.01). LDL cholesterol was reduced by a mean of 20.0% in the WFPB subjects versus a 10.6% increase in control subjects (p< 0.01). Reductions in insulin and HOMA-IR, a measure of insulin sensitivity, were statistically significant within the WFPB group and trended towards significance between the groups. Sex hormone binding globulin (SHBG) levels increased significantly both within the WFPB group and between groups. There was a significant decrease in both IGF-1 and free testosterone within the WFPB group from baseline to week 8. Conclusions: Our WFPB intervention resulted in improvements in several cardiometabolic and hormonal markers. The intentional weight loss, which was clinically large given the duration of the trial, was accompanied by reduced cholesterol, insulin resistance, free testosterone, and IGF-1. Given the moderate to large effect sizes noted, further study is warranted to evaluate the sustainability of benefits over time and to assess their potential impact on cancer-related outcomes. Table 1: Cardiometabolic and Cancer-Related Outcomes Citation Format: Erin Campbell, Thomas Campbell, Eva Culakova, Nellie Wixom, Joseph Guido, Lisa Blanchard, James Fetten, Michelle Janelsins, Karen Mustian, Luke Peppone. A whole food, plant-based (WFPB) dietary intervention to improve cardiometabolic and cancer-related outcomes in women with breast cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-31.

Abstract P5-07-07: Feasibility of a Whole-Food, Plant-Based Intervention Among Women with Metastatic Breast Cancer and its Effect on Patient-Reported Outcomes

Abstract Background: Women diagnosed with breast cancer commonly gain weight during and after treatment; this obesity/weight change is associated with decreased quality of life (QOL) and other patient-reported outcomes (PROs) such as cognitive dysfunction. Whole-food, plant-based (WFPB) dietary interventions lead to weight loss and cardiometabolic improvements, but their feasibility among metastatic breast cancer patients and their effect on cancer-related PROs have not previously been studied. Methods: Women with stage 4 breast cancer and stable disease were randomized 2:1 into: 1) a WFPB dietary intervention (N=21) or 2) usual care (N=11) for 8 weeks with assessments at baseline, 4 and 8 weeks. Our WFPB diet consisted of weekly educational visits and an ad libitum whole-food, plant-based diet. Three prepared meals a day were provided for the duration of the trial. The diet included fruits, vegetables, whole grains, legumes, nuts and seeds and excluded meat, dairy, eggs, and added oils/solid fats. Effects of the WFPB diet on the outcomes were assessed by comparing marginal means by arm estimated at 8 weeks from the analysis of covariance model controlling for baseline. Results: Of 32 subjects randomized, 20 intervention subjects and 10 control subjects completed all 3 assessments. Baseline and week 8 dietary intake among the intervention subjects is shown in table 1. Cognitive function, as measured by the Functional Assessment of Cancer Therapy – Cognitive Function (FACT-COG) questionnaire and a modified MD Anderson Symptom Inventory (MDASI), showed significant improvement within the intervention group as well as in comparison to the control group (Table 2). Overall quality of life, emotional and physical wellbeing, and breast cancer-specific symptoms, as measured by Functional Assessment of Cancer Therapy – Breast (FACT-B) questionnaire improved significantly within the intervention group. Mean fatigue was lower at 8 weeks within the intervention group as measured by the Brief Fatigue Inventory (BFI), but this did not reach statistical significance (p=0.10). When intervention subjects were asked, “On a scale from 1 to 10 [1 being “would not recommend” and 10 being “highly recommend”], how strongly would you recommend that other cancer patients be given this type of nutrition and support intervention if they were able and willing to participate?” participants’ mean score was 9.5. Conclusion: Our WFPB intervention was feasible and acceptable, with high compliance despite asking subjects to make major changes in dietary intake. Clinically and statistically significant improvements in several PROs, including cognitive function, overall QOL, physical and emotional wellbeing were noted for those in the WFPB group. Given the benefits to QOL and PROs, longer studies are required to demonstrate durability of behavior changes and outcomes. Table 1: Nutrient Intake of the Intervention Group (n=19*) *One participant was missing one three-day food record Table 2. Patient-Reported Outcomes Citation Format: Thomas Campbell, Erin Campbell, Eva Culakova, Nellie Wixom, Joseph Guido, Lisa Blanchard, Michelle Janelsins, Karen Mustian, James Fetten, Luke Peppone. Feasibility of a Whole-Food, Plant-Based Intervention Among Women with Metastatic Breast Cancer and its Effect on Patient-Reported Outcomes [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-07-07.

A Pilot Plant Based Dietary Intervention in MGUS and SMM Patients with Elevated BMI Is Feasible and Associated with Improvements in Metabolic and Microbiome Biomarkers of Progression

Introduction Obesity, low adiponectin, high leptin, high insulin, high IGF-1, and diets lacking plant-based foods or high in insulinemic foods are all risk factors for plasma cell disorders (PCDs). Patients (pts) with monoclonal gammopathy (MGUS) and an elevated body mass index (BMI) are twice as likely to progress from MGUS to multiple myeloma (MM). Additionally, there is gut dysbiosis in pts with PCDs, and whole food plant-based diets (WFPBDs) increase stool butyrate concentrations. Butyrate has anti-cancer (HDAC and NFkB inhibition) and anti-inflammatory (proinflammatory cytokine inhibition) properties. Prior studies show that increased relative abundance of stool butyrate producers are associated with improved outcomes in PCDs. Therefore, there is a rationale to study a dietary intervention in MGUS/smoldering MM (SMM), given the standard of care is observation despite the risk of progression. Methods Therefore, we initiated a pilot dietary intervention study (NUTRIVENTION) of a WFPBD in MGUS/SMM pts with BMI ≥25 (NCT04920084) with the primary objective of determining feasibility, as measured by weight loss (>5%) and adherence (>70%) at 12 weeks (wks). Here, we present interim results on feasibility, metabolic markers (insulin, adiponectin leptin ratio, IGF-1), microbiome (relative abundance of butyrate producers, short chain fatty acids) and secreted inflammatory biomarkers (CRP, Olink proteomics) for pts analyzed to date. The intervention, consisting of fully prepared WFPBD meals and behavioral coaching was provided by Plantable. Patients received self-selected WFPBD meals (lunch/dinner) for 12 wks, along with guidance for snacks and breakfast. Behavioral counseling was provided by health coaches and a research dietitian for 24 wks. Adherence was calculated as the percentage of kcal that were whole unprocessed plant foods out of total kcal consumed. Plasma total adiponectin, leptin, IGF-1 and insulin were measured via ELISA immunoassays. Stool samples were analyzed with 16S sequencing and gas chromatography mass spectrometry for short chain fatty acids and plasma was analyzed with the Olink Target 96 inflammation panel. We calculated the median at baseline and the median change % (median change/median at baseline) at 4 and 12 wks. Results The study has completed enrollment of 22 pts (2 dropped out within 12 wks for pt preference and were replaced), with 14 having completed the 12-wk intervention. The baseline demographics for 22 pts include median age 62 years (range 40-79), 45% male, 45% minorities (black, Hispanic, or other), 50% MGUS, 77% obese, and 27% prediabetic/diabetic. Preliminary results for clinical and correlative endpoints are provided in table 1. The study met both feasibility endpoints with 7% median BMI reduction and 90% median adherence at 12 wks as described in table 1. Metabolic markers indicate an improvement in LDL cholesterol, HgbA1c, insulin and adiponectin leptin (AL) ratio. The AL ratio is a marker of insulin resistance and higher levels imply improved insulin sensitivity, reduced BMI, and inflammation. Increased insulin, leptin, IGF-1 as well as decreased adiponectin are associated with the development of MM. Microbiome shows an improvement in the relative abundance of butyrate producers at 4 wks and stool butyrate concentrations at 12 wks. Additionally, a decrease in the branched chain fatty acids are seen. There is a decrease in the proinflammatory cytokines IL8, IL12B and TNFB, a decrease in DNER, a NOTCH1 activator and an increase in the protein FGF21 that is known to promote insulin sensitivity and downregulate hepatic IGF-1 production. Butyrate is known to inhibit the formation of proinflammatory cytokines and increase FGF21 via HDAC inhibition and inhibit NOTCH signaling. Conclusions This is the first interventional study in PCDs with mechanistic insights into risk reduction through modifiable risk factors with the potential to empower pts. Preliminary results show that a WFPBD is feasible given the BMI reduction and adherence in pts with PCDs. Our data suggests that a WFPBD improves metabolic profile (BMI, insulin resistance, AL ratio and FGF21) as well as increases stool butyrate producers and butyrate levels which in turn leads to a reduction in proinflammatory cytokines. Positive changes in metabolic, microbiome and inflammation markers are potential mechanisms by which diet may alter disease trajectory. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Microbial Changes in Response to a Plant-Based Diet and/or Supplements in SMM Patients: A National Multi-Arm Randomized Prospective Telehealth Study Via Healthtree: The Nutrition Prevention (NUTRIVENTION-2) Study

Background and Scientific Rationale: Multiple myeloma (MM) is often preceded by monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM). However, the current standard of care for MGUS and SMM is observation. Studies have found that patients with plasma cell disorders have gut dysbiosis. Plant-based diets, probiotics, omega 3, and curcumin supplements have previously been shown to alter the gut microbiome and increase stool butyrate. Butyrate is a short-chain fatty acid (SCFA) that inhibits histone deacetylases and NF-κB resulting in reduced formation of pro-inflammatory cytokines. It, therefore, has anti-cancer and anti-inflammatory properties. Therefore, a dietary/supplement intervention will be studied in patients with SMM. This is a two-week randomized study to evaluate the effects of a whole-food plant-based diet (WFPBD), probiotics, omega 3, and curcumin supplements on the gut microbiome and stool butyrate levels compared to baseline in SMM patients. This study builds on our prior NUTRIVENTION pilot study (NCT04920084). To our knowledge, this is the first telehealth national nutrition intervention study design with a microbiome endpoint. Study Design and Methods: This is a randomized, non-blinded, telehealth-based, remote, national pilot study with 100 patients in 4 arms (25 per arm) in partnership with HealthTree Foundation (Figure 1). Randomization will be stratified based on BMI (normal/elevated). Study Population: 100 SMM patients over the age of 18 years will be enrolled and randomized to one of four arms (25 patients per arm). Inclusion Criteria:ECOG performance status 0-3Willingness to comply with studyInterested in learning to cook plant-based recipesAccess to smart mobile phone or deviceBe residing within the United States for the study duration Exclusion Criteria:Supplement intake (other than those needed for a medical indication) must be reviewed by PI before enrollment. If patient is on a supplement (including curcumin, probiotic, omega 3) they must stop these for 2 weeks prior to enrollment on study.Legume allergySevere allergies such as anaphylactic shock to peanutsConcurrent participation in weight loss/dietary trials or defined programs (that require specified diets/supplements) Study Treatment: Patients will be randomized to one of four arms and will receive a whole-foods plant-based diet with nutrition counseling (via Plantable) or probiotics (via Vita Miracle) or omega-3 (via QWell pharmaceuticals) or curcumin (via Sabinsa pharmaceuticals) supplements twice daily for 2 weeks (Figure 1). The supplements will be provided through the WellRabbit platform. Data on dietary intake will be collected for all participants using a dietary monitoring app, Keenoa. Dietary adherence will be assessed by a research dietitian. Patients will participate in study visits remotely. Objectives: PrimaryEvaluate change in stool butyrate levels on a plant-based diet, curcumin, omega 3, and probiotic intervention at 2 weeks when compared to baseline. Secondary and Exploratory objectives include change in stool butyrate at 1 week, compliance at 2 weeks, baseline dietary patterns, other changes in the gut microbiome, and racial differences in the microbiome. Statistical Methods: The primary endpoint is change in stool butyrate levels at 2 weeks when compared to baseline (average of -1- and 0-week samples). Based on previous and internal studies, we expect the study to be adequately powered to detect a difference of ≥20% from baseline to the end of the intervention. We will call the intervention promising if we detect an increase in stool butyrate levels at 2 weeks (i.e., one-sided p-value <0.05) when compared with baseline. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Hypertension, Anxiety and Obstructive Sleep Apnea in Cardiovascular Disease and COVID-19: Mediation by Dietary Salt.

This perspective paper used a grounded theory method to synthesize evidence proposing that sodium toxicity from excessive dietary salt intake is a potential common pathophysiological mechanism that mediates the association of hypertension, obstructive sleep apnea, and anxiety with cardiovascular disease and COVID-19. Increased anxiety in these conditions may be linked to a high-salt diet through stimulation of the sympathetic nervous system, which increases blood pressure while releasing catecholamines, causing a “fight or flight” response. A rostral shift of fluid overload from the lower to the upper body occurs in obstructive sleep apnea associated with COVID-19 and cardiovascular disease, and may be related to sodium and fluid retention triggered by hypertonic dehydration. Chronic activation of the renin-angiotensin-aldosterone system responds to salt-induced dehydration by increasing reabsorption of sodium and fluid, potentially exacerbating fluid overload. Anxiety may also be related to angiotensin II that stimulates the sympathetic nervous system to release catecholamines. More research is needed to investigate these proposed interrelated mechanisms mediated by dietary salt. Furthermore, dietary interventions should use a whole-food plant-based diet that eliminates foods processed with salt to test the effect of very low sodium intake levels on hypertension, anxiety, and obstructive sleep apnea in cardiovascular disease and COVID-19.

Implementation of a Whole Food Plant Based Diet in a Food as Prevention Program in a Resource Constrained Environment.

The efficacy of a Whole Food Plant-based (WFPB) diet has been shown in randomized controlled trials in diabetes, cardiovascular disease and obesity. However, it's effectiveness in routine clinical settings is less well documented. This study describes the implementation and outcomes of a "Food as Prevention" program run by a single clinician. Participants were referred to a "Food as Prevention" program run by a single gastroenterologist at an academic teaching center. The program included 5 physician-led discussion and small group educational sessions. Data collected included demographics, weight and biochemical measurements before and after completion of the program. Statistical analysis included paired t-test and Pearson correlation coefficients were used to assess differences before and after WFPB implementation. A total of 17 participants (age 59 years; 59% female) with an average weight of 90.0 kg attended a median of 3 group sessions. Majority of patients had hyperlipidemia (71%) followed by hypertension (47%) and coronary artery disease (35%), fatty liver disease (35%) and diabetes mellitus (29%). Adoption of a WFPB diet led to significant decreases in weight (4.3 kg; p < 0.01), total cholesterol (0.72 mmol/L; p = 0.046), and triglycerides (0.53 mmol/L; p = 0.005) with an increase in high-density lipoprotein (HDL) (0.10 mmol/L; p = 0.01).Conclusions Implementation of the WFPB diet in this novel pilot program led to weight loss and improvement in biochemical markers of disease. Future studies are needed to implement this model on a larger scale.

Validation and results of a novel survey assessing decisional balance for a whole food plant-based diet among US adults.

ImportanceConsuming a whole food plant-based diet (WFPBD) is a promising, low-risk strategy for reducing risk of prevalent chronic disease and certain cancers, with synergistic benefits for climate and environment. However, few US adults report consuming a WFPBD. Understanding the reasons for this inconsistency is important for developing and implementing interventions for promoting a WFPBD. However, no research to elucidate decisional balance driving current consumption patterns in the US exists.ObjectiveThis research aims to validate an online survey to assess decisional balance for the consumption of a WFPBD, describe attitudes and beliefs toward adopting a WFPBD, and evaluate socio-demographic differences in decisional balance for consuming a WFPBD among a convenience sample of US adults.DesignOnline cross-sectional data collection followed by confirmatory factor analysis (CFA), validation of internal consistency, and examination of invariance across socio-demographic variables. Sensitivity analysis of full vs. truncated survey to predict self-reported dietary patterns and consumption behaviors were evaluated. Results of the survey and significant differences by socio-demographics were assessed.SettingOnline survey based on previous research, created via Qualtrics, and administered through MTurk.ParticipantsA total of 412 US adults, majority female (66%), White (75%), 30–60 years old (54%), ≥ Bachelor’s degree (85%), and earning ≥ $45K (68%).Main outcomes and measuresFactor loadings, covariance of survey items, associations with self-reported dietary pattern and consumption measures, and differences in pros, cons, and decisional balance across socio-demographic variables.ResultsCFA reduced the survey from 49 to 12 items and demonstrated invariance across socio-demographic variables. Pros and cons varied inversely and significantly (cov = –0.59), as expected. Cronbach’s α ’s for subscales in the final, reduced model were high (>0.80). Pros, cons, and decisional balance in both the full and the reduced model were significantly (p < 0.05) associated with self-reported dietary pattern and consumption.Conclusion and relevanceOur analyses indicate the WFPBD Survey is a parsimonious and psychometrically sound instrument for evaluation of decisional balance to consume a WFPBD diet among our sample of US adults. These results may be instrumental for development and deployment of interventions intended to promote consumption of a WFPBD in the US.

Biology in Public Health: Course-Based Experiential Learning Strategies to Promote Active Experimentation Among Undergraduate Public Health Students

Experiential learning is a critical aspect of undergraduate public health education. However, there is limited literature on the implementation of experiential learning in undergraduate public health programs. The course “Biology in Public Health” was developed to better link population-level public health concepts with the biological sciences through multiple experiential learning opportunities. The course provides students opportunities to apply concepts of population health and biological sciences to their own lives and the lives of others. The course includes several experiential learning components and over its tenure has been adapted to increase the emphasis on experiential learning. Three core experiential components that have been the basis for the class since its inception are: (1) weekly mindfulness and meditation practice, (2) guest presentations by individuals living with the week’s health condition, and (3) participation in an optional 10-day whole-food plant-based diet intervention. Data from course evaluations and surveys of diet intervention participants show impacts on students’ health behaviors and attitudes. Thirty-eight percent of students self-reported utilizing meditation outside of class to manage stress at the end of the semester, and all participants in the diet intervention stated that they would decrease their animal protein and dairy intake at the end of the intervention. This article provides an overview of the course structure and details the experiential learning strategies utilized to promote students’ active experimentation with health behaviors, improve student comprehension of the impact of stress and diet on health outcomes, and foster the utilization of this knowledge in their future public health careers.

Low dietary sodium potentially mediates COVID-19 prevention associated with whole-food plant-based diets.

Compared with an omnivorous Western diet, plant-based diets containing mostly fruits, vegetables, grains, legumes, nuts and seeds, with restricted amounts of foods of animal origin, are associated with reduced risk and severity of COVID-19. Additionally, inflammatory immune responses and severe acute respiratory symptoms of COVID-19, including pulmonary oedema, shortness of breath, fever and nasopharyngeal infections, are associated with Na toxicity from excessive dietary Na. High dietary Na is also associated with increased risks of diseases and conditions that are co-morbid with COVID-19, including chronic kidney disease, hypertension, stroke, diabetes and obesity. This article presents evidence that low dietary Na potentially mediates the association of plant-based diets with COVID-19 prevention. Processed meats and poultry injected with sodium chloride contribute considerable amounts of dietary Na in the Western diet, and the avoidance or reduction of these and other processed foods in whole-food plant-based (WFPB) diets could help lower overall dietary Na intake. Moreover, high amounts of K in plant-based diets increase urinary Na excretion, and preagricultural diets high in plant-based foods were estimated to contain much lower ratios of dietary Na to K compared with modern diets. Further research should investigate low Na in WFPB diets for protection against COVID-19 and co-morbid conditions.

Remotely Delivered Behavioral Weight Loss Intervention Using an Ad Libitum Plant-Based Diet: Pilot Acceptability, Feasibility, and Preliminary Results.

BackgroundMany traditional lifestyle interventions use calorie prescriptions, but most individuals have difficulty sustaining calorie tracking and thus weight loss. In contrast, whole food plant-based diets (WFPBDs) have previously shown significant weight loss without this issue. However, most WFPBD interventions are face-to-face and time-intensive, and do not leverage gold standard behavioral strategies for health behavior change.ObjectiveThis open pilot trial was the first to evaluate the feasibility of a fully featured, remotely delivered behavioral weight loss intervention using an ad libitum WFPBD.MethodsOver 12 weeks, participants (N=15) with overweight or obesity received a newly designed program that integrated behavioral weight loss and a WFPBD prescription via weekly web-based modules and brief phone coaching calls. Assessments were performed at baseline, midtreatment (6 weeks), and after treatment (12 weeks).ResultsThe intervention was rated as highly acceptable (mean 4.40 out of 5, SE 0.18), and attrition was low (6.7%). In all, intention-to-treat analyses revealed that 69% (10.4/15) of the participants lost 5% of their weight (mean –5.89, SE 0.68 kg). Predefined benchmarks for quality of life were met.ConclusionsA pilot digital behavioral weight loss intervention with a non–energy-restricted WFPBD was feasible, and the mean acceptability was high. Minimal contact time (80-150 minutes of study interventionist time per participant over 12 weeks) led to clinically relevant weight loss and dietary adherence for most participants (10.4/15, 69% and 11.8/15, 79%, respectively), and quality of life improvements (reliable change indices >1.53). We hope that this work will serve as a springboard for future larger scale randomized controlled studies evaluating the efficacy of such programs for weight loss, dietary change, and quality of life.Trial RegistrationClinicalTrials.gov NCT04892030; https://clinicaltrials.gov/ct2/show/NCT04892030

Reduction in Ferritin Concentrationsamong Patients Consuming a Dark-Green Leafy Vegetable–Rich, Low Inflammatory Foods Everyday (LIFE) Diet

ABSTRACTBackgroundFerritin is an iron-containing protein and acute-phase reactant, which may be elevated due to systemic iron overload or inflammation. Various diseases are associated with excess iron, but therapeutic iron chelation is suboptimal. Prior studies suggest that several plant phytochemicals possess iron-chelating properties, indicating that a plant-based diet may benefit patients with iron overload.ObjectivesThe aim was to investigate whether patients who consume a nutrient-dense, dark-green leafy vegetable–rich diet, called the Low Inflammatory Foods Everyday (LIFE) diet, experience reductions in ferritin concentrations.MethodsThis was a retrospective study in which patients were intensively counseled to follow the LIFE diet. Compliance was assessed by patient interviews and serum B-carotene measurements. Primary outcomes included changes in ferritin, B-carotene, and C-reactive protein (CRP). Patients with elevated CRP concentrations at baseline were excluded in order to separate the impact of inflammation from iron overload on ferritin concentrations. Premenopausal women, who lose iron from menstruation, were also excluded.ResultsThirty-two patients met the inclusion criteria. The median follow-up was 183 d. Following the dietary intervention, ferritin decreased (−81 μg/L, P = 0.006) and B-carotene increased (46 μg/L, P < 0.0001), whereas CRP remained unchanged (−0.02 mg/L, P = 0.86). Adherent patients had greater reductions in ferritin compared with nonadherent patients (−138 μg/L vs. 15 μg/L, P = 0.001). Among all patients, there was an inverse relation between B-carotene and ferritin (−2.02, P = 0.03).ConclusionsThe LIFE diet, or similar dark-green leafy vegetable–rich, whole-food plant-based diets, may benefit patients with disorders of iron overload and iron-induced oxidative stress.

Adherence, Compliance, and Diet Quality Among Popular Diet Followers

Objectives1. To compare diet quality of vegan, vegetarian, paleo, and whole-food plant-based (WFPB) diets; 2. To examine how adherence varies by diet and relates to quality and diet duration; 3. To examine how compliance varies by diet and relates to quality, adherence, and duration. MethodsAnalysis was conducted on a subsample of ADAPT participants (n = 1392) who completed a demographics and food frequency questionnaire (FFQ; DHQ-II). After excluding implausible energy intake (600 ≤ KCAL < 5,000), the final sample was 1291 (vegan [n = 355]; vegetarian [n = 90]; WFPB [n = 710]; paleo [n = 136]). Diet quality was measured with HEI and AHEI. Duration was categorized as short [<2 years (n = 501)]; moderate [2 to <7 y (n = 200)]; and long-term [7–10 + y (n = 592)]. A self-report adherence score was derived from questions targeting commitment to diet, ranging from 0–32. Compliance score for each diet was derived from reported intakes and DHQ-II (i.e., diet-specific restrictions), and data were %-based standardized. Models were adjusted for age and sex; select models were adjusted for diet duration. ResultsMean (SD) HEI score was high in all plant-based diets, highest for WFPB 76.7(5.8), vegan 75.7 (6.5), vegetarian 72.6 (9.2), compared to paleo 62.5 (8.5); and with a similar ranking for AHEI. Vegans had highest mean adherence 23.5 (2.8) and paleos the lowest 20.0 (3.3). Vegetarians had highest mean compliance 71% (9) and WFPB lowest 53% (10). Compliance was positively associated with HEI score for WFPB and vegan with one percentage point of compliance associated with a 6.4-point increase in HEI for WFPB (SE ± 2, p < .004) and 17.1 for vegan (SE ± 4, p < .0001). For every point increase in compliance, adherence improved (5.4 ± 0.8, p < .0001) in the full sample, and by diet group. Diet duration was significantly associated with adherence in all but vegetarian. No relationship was observed between duration and compliance within diet. ConclusionsWFPB and vegan diets had the highest diet quality; all four had higher mean HEI than reported average in US adults (HEI = 59). Findings suggest that even imperfect compliance to plant-based diets is associated with greater diet quality. Diet adherence is a complex component of eating behavior, however reported adherence appears to predict higher compliance and longer maintenance. Funding SourcesUSDA Cooperative Agreements; NIFA National Needs Fellowship.

A whole-food, plant-based (WFPB) dietary intervention to improve cancer-related and cardiometabolic outcomes in metastatic breast cancer patients.

e24116 Background: Obesity rates in the US have increased dramatically in recent years. Breast cancer treatment is associated with additional weight gain, and among patients with breast cancer, obesity and weight gain are associated with negative outcomes such as reduced progression-free and overall survival due to cardiometabolic co-morbidities. New evidence suggests that cardiometabolic comorbidities themselves can further accelerate breast cancer progression. We used a WFPB dietary intervention because it results in significant weight loss and larger improvements in cardiometabolic outcomes than a traditional, calorie-restricted omnivore diet. Methods: Patients with stage 4 breast cancer receiving treatment were randomized 2:1 into: 1) a WFPB dietary intervention (N = 19) or 2) usual care (N = 9) for 8 weeks with assessments at baseline, 4, and 8 weeks. Our WFPB diet consisted of education and an ad libitum whole-food, plant-based diet; 3 prepared meals a day were provided to WFPB subjects for the duration of the trial. The diet included fruits, vegetables, whole grains, legumes, nuts/seeds and excluded meat, dairy, and eggs. Outcomes include compliance, weight, cardiometabolic outcomes, and cancer progression markers. Effects of the WFPB on the outcomes were assessed by comparing marginal means by arm estimated at 8 weeks from the analysis of covariance model controlling for baseline. Results: Dietary compliance was high, with 95% of WFPB subjects consuming ≥80% of their calories from “on plan” foods. The WFPB group (mean baseline BMI = 31.6 kg/m2), on average, lost 6.7% (p &lt; 0.01) of their total body weight. Adjusting for baseline weight, the WFPB group lost 8.9 lbs. more (p &lt; 0.01) and 5.8% more of their total body weight (p &lt; 0.01) than the control group. Conclusions: Our WFPB dietary intervention resulted in clinically meaningful and statistically significant improvements in weight and cardiometabolic outcomes, with a trend towards improving a clinically used cancer progression marker. Larger studies with longer interventions are needed to confirm these findings and investigate the sustainability of the benefits. Clinical trial information: NCT03045289. [Table: see text]

Bringing the "Joy of Healthy Eating" to Advanced Medical Students: Utilizing a Remote Learning Platform to Teach Culinary Medicine: Findings from the First Online Course Based on the ACLM's Whole-Food Plant-Based Culinary Medicine Curriculum.

Over 80% of chronic disease is caused by lifestyle practices, including an unhealthy diet. Despite this, most medical students in the United States graduate having received minimal nutrition education, guidance towards improving their nutrition, or skills needed to coach patients to adopt a healthier diet. This study aimed to educate fourth-year medical students in evidence-based knowledge regarding a delicious, whole-food plant-based diet while introducing practical culinary skills and patient coaching skills. We adapted an open-source culinary medicine curriculum designed for in-person teaching of pre-clinical medical students to provide a novel 1-month online elective to fourth-year medical students. We used a 26-item pre/post questionnaire to assess change in evidence-based knowledge regarding nutrition, culinary skills, patient coaching skills, and attitudes toward a whole-food plant-based diet. In addition, we reviewed narrative comments by the student participants, course directors, and medical-school administrators. Scores in all 4 domains were tested, and for all individual questions, they showed statistically significant improvement following the course. Most narrative responses were positive, and areas for improvement were also identified. We successfully adapted an open-source whole-food plant-based culinary medicine curriculum for advanced medical students into a 1-month elective taught on a virtual platform. This course filled a need for training in nutrition and counseling for these students as they start their professional careers.