Should we care what our patients eat?

The ‘Global Burden of Disease’ study published in The Lancet revealed that 71.3% of deaths in 2015 were caused by dietary and lifestyle choices, an increase from 57.6% in 1990.

In 2017, an estimated 11 million deaths globally were attributable to poor diet (22% of all deaths among adults), especially cardiovascular disease, cancer and type two diabetes mellitus. Key features of poor diets include: high sodium intake, insufficient intake of whole grains, and low fruit consumption.

For comparison, tobacco use was associated with 8.0 million deaths in 2017. In Australia, cigarette smoking rates are relatively low (<14%), and less than half the global average (32%). Over 55% of our population (and >75% of young adults) have never smoked.

Approximately 67% of Australian adults are overweight or obese, and 47% have one or more chronic conditions.

How are Australians eating?

Only 7.5% of adults meet the recommended nutritional guidelines for vegetable intake. Just over 50% of Australians regularly consume the recommended fruit intake. Less than 6% meet the criteria for both.

Approximately one-third of the average Australian’s diet comes from ‘discretionary foods’ (foods high in energy and low in nutrients, such as biscuits, cakes, ice-cream, and fried potato products). The average Australian diet also contains excessive amounts of sugar, saturated fat and sodium.

What can food do?

While the benefits of good nutrition are vast, let’s start by addressing heart disease, our biggest killer.

Intensive lifestyle changes, and specifically a low fat (<10%) diet consisting of whole plant foods, has been shown to reduce cardiac vessel stenosis after one year, and halve the number of cardiac events, compared to a control group. This intervention also lowered cholesterol levels by 37.2% without statin therapy, compared to 6% reduction in the control group who were taking pharmaceuticals.

Large prospective studies have also found that every serving (28 g/day) of whole grains is associated with 9% lower cardiovascular mortality, independent of other dietary and lifestyle factors.

Cutting back on the great Australian BBQ may also help our hearts; with rates of hypertension decreasing from 15%, to 5.8% in men who avoid eating animal products, and down from 12.1% to 7.7% in women. Those cutting out animal products also reduce their risk for cerebrovascular disease by approximately 12%.

The saying ‘an apple a day keeps the doctor away’ may also ring true; an additional 7 g/ day of total dietary fibre, equivalent to a large apple or one cup of broccoli, can reduce stroke risk by 7%.

I would argue that almost all Australian doctors are well aware of the harms of cigarette smoking, and wouldn’t hesitate to advise cessation with their patients, and provide tools and resources to help them do so. With poor diets now overtaking cigarette smoking as the leading risk factor for morbidity and mortality for Australians… isn’t it time we take a similarly aggressive approach? We should be screening, counselling, educating, and providing tools to help Australians make dietary changes that could help prevent (and even reverse) significant disease morbidity, reduce mortality rates, and minimise the public health burden.

The time to care about what your patients are eating is now!

To learn more about the relationship between diet and disease, join Thomas and other international and local experts for the Doctors for Nutrition Australasian Nutrition in Healthcare Conference in Melbourne from 17–19 February 2023. The conference will feature evidence-based research and content exploring the relationship between diet and disease. Alongside two full days of academic sessions, the conference will also include a whole food plant-based menu, a social program, networking opportunities and an exhibition space.

*Dr Renae Thomas, MD, MPH, is an Australian living in the USA, a triple boardcertified Physician in Family Medicine, Lifestyle Medicine, General Preventive Medicine and Public Health and is an ACLM Lifestyle Medicine Intensivist. She is the Medical Director of Fasting Escape, where she provides lifestyle-medicine-based consultations and is also an International Advisor for Doctors For Nutrition.

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