The opinion of KwaZulu-Natal dieticians regarding the use of a whole foods plant based vegan diet in the managment of non-communicable diseases.

Master of Science in Dietetics and Human Nutrition. University of KwaZulu-Natal, Pietermaritzburg, 2018.Introduction: A whole foods plant based vegan diet (WFPBVD) is one that promotes the intake of fruit, vegetables, wholegrains, nuts and seeds. To date, many international studies have investigated a WFPBVD’s effect on non-communicable diseases (NCDs) mainly obesity, type 2 diabetes, cholesterol and heart disease. The positive outcome of these studies has resulted in some international doctors turning to a WFPBVD as a treatment method. South Africa is transitioning from infectious to NCDs such as heart disease, cancers, chronic respiratory disease and diabetes which are currently presenting a threat to health and development. Most of these NCDs can be reduced by eliminating the risk factors associated with them. Studies have shown that adopting a WFPBVD is beneficial in both the prevention and the treatment of NCDs. Dieticians are experts in the field of nutrition and therefore it was imperative to gather their opinion of this diet to assess whether they consider is a suitable treatment option for the prevention of NCDs. Aim: To determine whether dieticians would use a WFPBVD to address NCDs by assessing their opinion toward the benefits and barriers of this diet. Objectives: To determine the dieticians knowledge and attitude of a WFPBVD including definitions and use of the diet in practice; to determine the opinion toward the perceived benefits and barriers of the diet including health and personal benefits, information availability and personal barriers. Methods: A cross-sectional study was conducted on KZN dieticians registered with the Association for Dieticians in South Africa. The study involved the use of an online survey questionnaire consisting of four parts. Results: The study was completed by 101 dieticians of which 95% were female and 5% were male. Respondents were predominantly White (71.3%, n=72) followed by Black African (18.8%, n=19) with the lowest response rate from the Indian (9.9%, n=10) population. Most of the subjects obtained their qualification from the University of KwaZulu-Natal (66.3%). The sample was represented by 44.6% (n=45) of government employed dieticians and 47.5% (n=48) of private practicing dieticians (PPDs). Government dieticians were significantly more likely to be referred patients with cancer, non-communicable diseases (NCDs), HIV/AIDS and TB, liver disease and renal disease compared to non-government dieticians. All but one dietician was familiar with the term vegan and 52% of the sample was familiar with the term ‘whole foods plant based diet’. There was significant agreement that a vegan diet could be nutritionally adequate (p<0.011), but insignificant agreement that a vegan diet made up whole plant based foods could be nutritionally adequate. Subjects reported that training on a PBD at university level was inadequate however a significant sample (p<0.05) was confident in prescribing a PBD in practice and interested in improving their knowledge on this topic. The strongest perceived benefits of a WFPBVD reported were “It is associated with an improved fibre intake”, “It encourages a lower saturated fat intake due to reduced animal products” and “it is associated with reduced risk of constipation”. There was disagreement with the statements “It is an easy diet to follow” and “It is a suitable option in low-income households”. The strongest barrier reported to prescribing a WFPBVD were, “There is not enough awareness around whole food plant based vegan diets for the public” and “People prefer to consume meat and animal by-products”. Conclusion: While dieticians felt that they did not receive adequate training on a PBD at university level, they did report confidence in prescribing this type of meal plan and interest in learning more about this topic. Using a WFPBVD in the treatment and prevention of NCDs is a topic that has been studied on an international level but not yet on a national level. NCDs were reported as a major reason for referral in both government and non-government dieticians and therefore this diet could be a potential treatment option. Dieticians however did not feel that this lifestyle would be suitable in low income communities which may be an interesting topic for future research. Barriers in this study included lack of public awareness about this lifestyle as well as resistance to changing current dietary habits. However, the health benefits of a WFPBVD were seen as being significantly more important than the personal benefits of this diet. Dieticians are at the forefront of nutritional communication to the public. Developing platforms to provide more training and learning opportunities to health care providers and the public on a WFPBVD may be beneficial

Limiting livestock production to pasture and by-products in a search for sustainable diets

A method was developed for designing ‘fair’ diets (not using more than globally available arable land percapita) and for assessing the sustainability of such diets. The diets were based on the principle of ‘ecological leftovers’ for livestock production, i.e. raising livestock on pasture and by-products not suitable for or wanted by humans. The method was applied to Sweden using three different scenarios for livestock production, all taking the starting point that semi-natural pastures should be grazed by ruminants for reasons of biodiversity conservation. The scenarios also included differing use of by-products (from crop production and food processing) to either boost milk production (I-Milk scenario) or produce eggs and pig meat (E-Milk and Suckler scenarios). In I-Milk, milk and meat were produced in intensive systems in which dairy cows and their offspring only grazed to a limited extent, resulting in the human diet containing recommended levels of dairy products (350 ml milk per day) and meat twice a week. Milk could also be exported. In E-Milk, pasture was used more for dairy cows and their offspring, resulting in fewer animals and less milk (150 ml milk per day) and four servings of meat per week. In the Suckler scenario, pasture was grazed by suckler herds providing no milk but meat four times per week. The environmental impacts of the diets were assessed using the planetary boundaries framework. The results showed substantially lower environmental impacts compared with the average current Swedish diet, but the strict absolute climate boundary and the N and P input boundaries were still exceeded for all diets. The approach adopted, of letting the ecological resource capacity act as the constraining factor for livestock production, is in line with agroecology principles and efficient use of land to improve food security,and could be useful in discussions about sustainable consumption of animal products

Dietary Protein Quality, Muscle Mass, and Strength in Vegetarian Athletes

abstract: Vegetarian diets can provide an abundance of nutrients when planned with care. However, research suggests that vegetarian diets may have lower protein quality than omnivore diets. Current protein recommendations assume that vegetarians obtain a majority of their protein from animal products, like dairy and eggs. Studies have shown that this assumption may not be valid. The recommended dietary allowance (RDA) may not be adequate in vegetarian populations with high protein requirements. The purpose of this study is to analyze dietary protein quality using the DIAAS (Digestible Indispensable Amino Acid Score) method in both vegetarian and omnivore endurance athletes. 38 omnivores and 22 vegetarians submitted 7-day food records which were assessed using nutrition analysis software (Food Processor, ESHA Research, Salem, OR, USA). Dietary intake data was used to calculate DIAAS and determine the amount of available dietary protein in subject diets. Dietary data was compared with the subjects’ lean body mass (obtained using DEXA scan technology), and strength (quantified using peak torque of leg extension and flexion using an isokinetic dynamometer). Statistical analyses revealed significantly higher available protein intake in the omnivore athletes (p<.001). There were significant correlations between available protein intake and strength (p=.016) and available protein intake and lean body mass (p<.001). Omnivore subjects had higher lean body mass than vegetarian subjects (p=.011). These results suggest that vegetarian athletes may benefit from higher overall protein intakes to make up for lower dietary protein quality.Dissertation/ThesisMasters Thesis Nutrition 201

Exploring the concerns, attitudes and experiences of health professionals regarding a vegan diet during pregnancy and early life : a mixed-method study : a thesis presented in the partial fulfilment of the requirements for the degree of Master of Science in Human Nutrition, Massey University, Albany, New Zealand

Appendix 1 is ©2020 American Psychological Association and has been removed.Background: There is an increasing trend in vegan diet consumption globally and in New Zealand. A restrictive and unplanned vegan diet may have negative health implications, especially during pregnancy and early life, when nutrient needs are elevated. Health professionals who interact with individuals following a vegan diet must be knowledgeable about the nutritional risks of poorly-planned vegan diets, and have access to appropriate educational resources. Aim: Explore concerns, attitudes, and experiences with regards to a vegan diet during pregnancy and early life, among health professionals in New Zealand. Methods: Healthcare professionals who work with pregnant, breastfeeding women and young children, as well as specialists who provide dietary advice, were invited to participate in this mixed-method study. An online questionnaire was first used to collect quantitative data on knowledge and attitude. Subsequently, qualitative data from semi-structured interviews provided descriptions of experiences, concerns, and perspectives about the adoption of vegan diets during pregnancy and early life. Results: A total of 14 health professionals completed both the quantitative and qualitative phases of the study. All health professionals showed positive attitudes towards the adoption of vegan diets during pregnancy but some exhibited greater concern about the restrictive nature of vegan diets during early childhood. In particular, health professionals were concerned about iron and vitamin B12. Health professionals discussed the insufficiency of educational resources on vegan diets and the limited availability of dietitians. The lack of evidence-based consensus and updated government guidelines were reasons impacting confidence levels among health professionals in providing nutritional advice on vegan diets. Conclusion: Healthcare providers support individuals and families in nutrition care. Knowledge must thus be aligned with changing diet trends. Continual professional education and updated evidence-based resources may improve knowledge and confidence in providing guidance on vegan diets

More Than Just A Diet: An Inquiry Into Veganism

BACKGROUND: The vegan diet has gained momentum in recent years, with more people transitioning to the diet, whether for health or more ethically based reasons. The vegan diet, often characterized as very restrictive, is associated with health benefits but raises concerns. Controversy regarding the diet exists within the public sphere, with those actively supporting and advocating for it, and others questioning its purpose and proposed benefits, even disparaging its existence, perhaps because of a lack of knowledge about the diet. OBJECTIVE: This study aimed to provide a fuller picture of the vegan diet, encompassing both the nutrition and health of the vegan diet as well as related ethical beliefs by studying scientific and popular literature in tandem. Furthermore, the study aimed to provide an insider’s perspective of the vegan diet as a means of combating stereotypes and making the diet more relatable/understandable to those who are not vegan. By combining all three sources, the project aims to educate the public regarding a diet and lifestyle that is often perceived, at least partially, in a negative manner. METHODS: The research was conducted in two parts – literature review and interview study. A literature review of both the scientific and the popular literature was conducted and reviewed from August to November. Pubmed database was used to research the scientific findings while food blogs, vegan websites, and newspaper articles comprised the popular literature. The interview study involved semi-structured, one-time, in-person private interviews conducted during February and March. Twenty vegans (10 students from the University of Pennsylvania and 10 Philadelphia residents) were interviewed and questions targeted personal history of veganism, related health beliefs, factors influencing the decision to become vegan, and diet composition. Once all data was obtained, it was analyzed in tandem. RESULTS: Findings suggest that a well-rounded vegan diet is healthy and such is evidenced by the variety of whole foods and increased vegetable and fruit intake. Health benefits include a decrease in cholesterol, lipid levels, blood pressure, weight, and a reduced risk for a variety of diseases including obesity, diabetes, cardiovascular disease, and cancer. Despite the benefits, health concerns do exist, especially in regard nutrient deficiencies, without a well-planned and varied diet. Nutrient concerns include calcium, vitamin D, iron, and particularly vitamin B-12 for which supplements should be taken. The nature of the interviews conducted for this paper was such that a comprehensive but diverse collection of information was obtained, precisely because the interviewees have chosen the vegan diet for a multitude of reasons, and approach their diet and lifestyle in varied ways. However, there are some commonalities that were revealed. Results of the interview studies demonstrate that about half of the vegans are potentially at risk for vitamin D deficiency because most are taking neither vitamin D supplements nor a multivitamin. Comparing the scientific literature with the interview results reveal that most of the vegans include working out within their daily routines, such that they place emphasis upon physical fitness, suggesting that the vegan lifestyle has benefits beyond merely nutritional. Finally, comparing popular literature to the information gleaned through the interviews conducted establishes that many of the stereotypes regarding the vegan diet are unfounded. CONCLUSIONS: The vegan diet is one that is chosen by individuals for various reasons, including health and/or ethical reasons. While many health benefits exist, it is essential for those who are vegan or are planning to become vegan to be educated about potential nutrient deficiencies to prevent adverse outcomes. In addition, it is evident that the vegan diet is much more than a diet itself, but has developed into a lifestyle, often associated with animal rights and environmental advocacy as well as a greater concern for physical activity and mindfulness. Further research begs the question of whether the health benefits associated with the diet are solely attributable to the diet or in conjunction with a greater physical activity level and mindful living. With regard to providing an accurate picture of veganism in the popular literature, it is essential to combat negative unsubstantiated stereotypes and myths by providing vegans with unbiased voice with which to share their own stories and beliefs. Lastly, the popularity of the vegan diet and the question of whether it is nutritionally sound, raise issues of anthropologic significance. Specifically, it prompts consideration of whether our ancestral diet was vegetarian in nature, or depended upon meat for evolutionary progress. Moreover, this study demonstrates that the human diet has changed over time, such that our dietary needs, choices and preferences are inherently reflective of cultural and nutritional anthropology

The motives and challenges facing South African vegans and the nutritional quality of their diet.

Masters Degree. University of KwaZulu-Natal, Pietermaritzburg.Introduction: A vegan diet is a voluntarily chosen plant-based diet that excludes all meat and animal products and includes wholegrains and legumes, fruit and vegetables, nuts and seeds and healthy fats. There are many different motives that influence an individual to become vegan including ethical motives, environmental motives and health motives. Internationally, many studies have been conducted to investigate these motives along with the nutritional intake and quality of the vegan diet. This diet is also becoming increasingly popular in South Africa, yet there is a paucity of studies that have been conducted to determine what motivates South Africans to follow this diet, what challenges they face while following the diet and what the nutritional quality of their diet is. Aim: To determine the motives of South African vegans, challenges faced and the nutritional quality of the South African vegan diet. Objectives: To determine the demographic characteristics of South African vegans; the motives that influenced the decision to become a vegan; challenges associated with following a vegan diet and how these challenges are overcome; and to determine the nutritional quality of dietary intake compared to recommendations (EARs) consumed and identify the variety of food groups and types of processed food in the vegan diet. Methods: A cross-sectional study in the form of an online questionnaire was conducted using South African vegans who were part of the South African Vegan Society online group on Facebook. The questionnaire consisted of four sections. Section one obtained information regarding the demographics of South African vegans. Section two obtained information on the main motives for following a vegan diet. Section three obtained information on the challenges experienced while following a vegan diet and how these challenges were overcome. Section four obtained information on the nutritional quality of the vegan diet which included a veganspecific Food Frequency Questionnaire (FFQ) with 291 food items and one 24-hour recall. Results: The first two sections of the online questionnaire were completed by 205 respondents, of which 82.4% (n = 169) were female and 17.6% (n = 36) were male. The respondents were predominately White (82.4%, n = 169), resided in the Gauteng province (43.9%, n = 90), were more likely to be single (53.2%, n = 109) and belonged to the 18-29 (29.3%, n = 60) and 40-49 age category (22.0%, n = 45). Most of the respondents had followed a vegan diet for one to less than three years (38.5%, n = 79). A significant number of respondents did not engage in smoking (83.9%, n = 172) but did consume alcoholic beverages less than once a week (60.0%, n = 123) (p<0.0005). Most of the respondents participated in varying amounts and intensities of physical activity (84.9%, n = 174) and made use of nutritional supplements (72.7%, n = 149). There was a significant agreement that ethical concern for animals (p<0.0005); followed by protecting the environment (p < 0.0005); and the effect of animal product consumption on climate change (p < 0.0005) were the main motivating factors for choosing to become a vegan. Most of the respondents reported that their initial motivation to become a vegan had not changed (71%, n = 146) and there was a significant agreement that experimenting with food assisted the respondents during their transition into the vegan diet (p < 0.0005). Section three of the questionnaire was completed by 197 respondents. Over one third of the respondents reported that it was “easy” to transition into the diet (35.1%, n = 72) and their initial emotions were enthusiasm and excitement (29.3%, n = 60). A significant number of respondents reported that they did not experience any financial challenges following the diet (74.6%, n = 176) and that their main challenge was finding vegan meal options in a restaurant (p < 0.0005). The respondents in this study overcame any challenges by conducting research on the internet and agreed that vegan recipes were easily accessible (p < 0.0005). The respondents significantly agreed that a vegan diet was nutritionally complete and adequate for a healthy lifestyle (p < 0.0005). The FFQ was completed by 113 respondents. Respondents consumed a wide variety of fruit; most often bananas (22.4%, n = 46) at least once a day, leafy-vegetables- most often cooked spinach (24.9%, n = 51) at least once a week, non-leafy vegetables- most often cooked broccoli (36.1%, n = 76) at least once a week. The starches most often consumed were whole-wheat bread (18.0%, n = 37) once a week, grains and cereals- most often white or brown basmati rice (20.0%, n = 41) once a month, peas and beans- most often chickpeas (32.2%, n = 66) at least once a week, fats- most often olive oil (20.5%, n = 42) at least once a day, snacks- most often potato chips (19.0%, n = 39) at least once a month. Desserts most often consumed were eggless cake (17.1%, n = 35) at least once a month, sweeteners- most often brown sugar (17.1%, n = 35) at least once a day and beverages- coffee decaffeinated or regular (29.3%, n = 60) at least once a day. The most commonly consumed plant-based milk alternative and meat alternative was soy milk (21.0%, n = 43) consumed at least once a day and soya products (28.8%, n = 59) at least once a week respectively. The 24-hour recall was completed by 134 respondents. The mean total energy of the respondents was 7471.15 kJ (SD = 3093.39). Males had a mean total energy of 7893.76 kJ (SD = 3415.37) and females had a mean total energy of 7374.22 kJ (SD = 3023.43). All respondents met the estimated average requirement (EAR) for protein (56 g for males and 46 g for females), carbohydrates (130 g) and the percentage of total energy for fat (10 - 35%). The respondents mean intake for protein was 74.73 g (SD = 52.28), carbohydrates 190.40 g (SD = 190.40) and fat 62.34 g (SD = 62.34), which contributed 18.5%, 47.36% and 33.7% respectively, of total energy in the diet. Females consumed significantly greater amounts of added sugar than males (M = 20.51 g) vs (M= 13.18 g). Both gender categories met their EARs for fibre, iron, vitamin C, vitamin B6, vitamin A, thiamine, riboflavin, folate and vitamin K. The respondents had a decreased intake of cholesterol, saturated fat and mono-unsaturated fatty acids and higher intakes of poly-unsaturated fatty acids. Females met their EARs for zinc and niacin, 9.02 mg and 15.32 mg respectively, while males were below their EAR, consuming 9.8 mg and 15.59 mg respectively. Males met their EAR for vitamin E consuming 20.32 mg, while females were below their EAR, consuming 13.56 mg of vitamin E. The respondents were shown to be lacking in calcium, sodium, vitamin D and vitamin B12. Conclusion: This study revealed that although veganism is widespread in South Africa, White females living in Gauteng were more likely to be following this lifestyle and be members of the South African Vegan Society online group on Facebook. Their main motive for following the diet was preventing cruelty towards animals and protecting the environment and its resources. This suggests that South African vegans are concerned about animal rights and the environment and their knowledge about veganism should be further investigated. The main challenge faced by the respondents was finding vegan options in restaurants. Therefore, restaurants that are vegan-specific or have vegan options available are recommended to list their restaurants online and upload their menus to assist vegans, as the internet was commonly used for research among this group. Major retail supermarkets are recommended to increase their stock and variety of options of vegan products especially plant-based milk and meat alternatives as these products are widely consumed. Research has shown that the vegan diet is linked to many potential health benefits, yet there is concern regarding whether the diet leads to nutrient deficiencies over time. As veganism is growing in South Africa, this study highlights the need for fortified food products and nutritional supplements to reduce nutrient deficiencies in the vegan diet. Longitudinal studies will also assist in examining trends and sustainability of a vegan diet in South Africa as well as determine whether nutrient deficiencies develop over time

Comparison of Animal Versus Plant-Based Protein Supplementation to Nitrogen Balance in Female College Students

Plant-based diets have become popular in the past 10 years, with approximately 11% of Americans self-identifying as vegan or vegetarian, and many others trying to reduce meat consumption. Due to this increasing interest, the plant-based food market has exploded with several novel innovative products serving as alternatives to animal-based products. One such example is almond protein powder, a fairly new protein supplement created as an alternative to whey protein. A number of studies have compared animal-based protein supplementation, such as whey to plant-based supplementation, such as soy, on muscle protein synthesis and skeletal muscle preservation. Due to the novelty of almond protein, little is known regarding how well the protein supplement performs in the body. The effects of both almond and whey-based protein beverage on nitrogen balance, body composition, and hydration in the body were investigated in the work presented herein. Twenty female students aged 20-25 were randomly assigned to consume either an almond or whey-based protein drink twice daily for 7 days. A 24-hour urine collection was performed at baseline and endpoint of the 7-day treatment period, and nitrogen balance was assessed. The effects of supplementation on nitrogen balance in almond and whey protein were equally capable of increasing significantly the N balance from 8.58g to 11.66g (p =0.05), indicating that almond protein powder may be a functional plant-based replacement to whey protein powder, and may be of interest in future research regarding muscle mass and body composition changes

Food in Hospitals: National catering and nutrient specification for food and fluid provision in hospitals in Scotland'. Edinburgh: The Scottish Government

EdinburghFood in Hospitals: National Catering and Nutrition Specification for Food and Fluid Provision in Hospitals in Scotland has been developed to support Scottish NHS Boards in implementing (1) the NHS QIS Clinical Standards for Food, Fluid and Nutritional Care in Hospitals specifically standards 3, 4 and 5 which aim to address the risks of malnutrition in hospital patients and (2) the delivery of a healthy balanced diet for patients who are considered to be 'nutritionally well'.sch_diepub810pu

Muscle Growth and Strength Development Following a 12-Week Resistance Training Program: a Comparison Between Consuming Soy and Whey Protein Supplements Matched for Leucine Content

abstract: Sustainability, as it relates to nutrition, affects all aspects of food from systems-level production to consumption. Viability of local food systems in the southwest of the United States has been largely understudied. In order to address this gap in the literature, semi-structured interviews were conducted with 20 farmers in Arizona and New Mexico to determine best practices, challenges and barriers to farming. Interviews were recorded, transcribed, and coded for themes. Many trends were consistent with those reported elsewhere in the US, but the importance of water emerged, a unique need not explicitly noted in other regional studies. Vegetarian diets are typically more sustainable than omnivorous ones due to using less environmental resources in the production of food. An important consideration with plant protein and vegetarian diets, however, is whether this would affect athletic performance. To examine this, 70 male and female endurance athletes were compared for maximal oxygen uptake (VO2 max), peak torque when doing leg extensions, and body composition. Vegetarians had higher VO2 max, but peak torque was not significantly different by diet. Omnivores had higher total body mass, lean body mass, and there was a trend for peak torque to be higher. To investigate whether plant-protein can comparably support development of lean body mass and strength development in conjunction with strength training, 61 healthy young males and females began a 12-week training and protein supplementation study. While previous training studies have shown no differences for lean body mass or strength development when consuming either soy (plant) or whey (animal) protein supplements in very large amounts (>48 grams), when consuming around 15-20 grams, whey has contributed to greater lean body mass accrual, although strength increases remain similar. The present study matched supplements by leucine content instead of by total protein amount since leucine has been shown to be a key stimulator of muscle protein synthesis and is more concentrated in animal protein. There were no significant differences between the whey or soy group for lean body mass or strength development, as assessed using isokinetic dynamometry doing leg extensions and flexions.Dissertation/ThesisDoctoral Dissertation Physical Activity, Nutrition and Wellness 201