Medical Bites – Complex Topics Bite Sized

Is a traditional Atlantic diet a remedy for reducing emissions contributing to climate change? Can it reduce the incidence of metabolic syndrome while also saving the planet? Let’s dig in and find out!

Population:

Families in rural town of A Estrada in northwestern Spain.

Intervention:

1:1 randomization to intervention or control. The intervention group received educational sessions, cooking classes, written supporting material, and foods characteristic of the Atlantic Diet.

Comparison:

The control group continued their habitual diet. This was based on a previously published study on this cohort, which essentially had the control group continue with a “standard Western diet”. High in calorie-rich UPF, processed grains, fried foods, sweets, and whole-fat dairy products. ²

Outcome:

The trial assessed the effect of diet on the incidence of metabolic syndrome (MetS) as defined per the National Cholesterol Education Program Adult Treatment Panel III guidelines.  

“According to the NCEP ATP III definition, metabolic syndrome is present if three or more of the following five criteria are met: waist circumference over 40 inches (men) or 35 inches (women), blood pressure over 130/85 mmHg, fasting triglyceride (TG) level over 150 mg/dl, fasting high-density lipoprotein (HDL) cholesterol level less than 40 mg/dl (men) or 50 mg/dl (women) and fasting blood sugar over 100 mg/dl” ³

231 families completed the trial, and the 126 families in the intervention group had a significantly reduced risk of incident cases of MetS (RR 0.32; 95% CI 0.13-0.79). In addition, they had fewer MetS components (proportional OR 0.58; 95% CI 0.42-0.82) than the control group.

They also assessed the environmental footprint of the dietary intervention.

The authors performed a Lifecycle Analysis of the foods with a cradle-to-farm gate approach. They then accounted for the transportation of local and international foods to the participants. Of note, they also included food waste, which is important because it is a large portion of the food system’s emissions contributions.

This analysis showed no statistically significant difference compared with the control group.

30,000ft view:

An Atlantic diet is similar to probably the best-studied dietary pattern on Earth: the Mediterranean diet. It is a diet that is rich in fruits, vegetables, whole grains, beans, and olive oil. The Atlantic diet, traditional to folks in northwestern Spain and Portugal, also features high fish and seafood consumption, starch-based products, dried fruits, milk, cheese, and moderate meat and wine intake. Not surprisingly, the switch away from a standard Western dietary pattern to one that focuses on whole foods rich in plants resulted in improved health outcomes, in this case for markers that determine one’s risk for metabolic syndrome.

How should this modify your practice:

My hope would be that most serious practitioners are already encouraging their patient’s to make whole plant foods (fruits, veggies, whole grains, nuts and seeds) the star of their plates with restrained inclusion of animal-sourced foods. His study only reinforces the data in this cohort to eat this way.

My two takeaways from this study include the need to help support our patients. The intervention group received an incredible support package to help them achieve their dietary needs. Cooking classes, food delivery, group support, and education are sorely missed in many interactions with patients in the medical office. The second is that even though the intervention switched to a more traditional dietary pattern, their emission footprint didn’t improve. This is a huge problem because an essential part of any intervention, particularly dietary, is to maintain the traditions and culture of the participants (in my opinion, this improves adherence and satisfaction). But it does highlight some essential pressure points where change can be made. Animal-sourced foods are by far the highest emissions burden in the food system, with beef stratosphere above the rest. Making switches to focus on more plant-sourced options to reduce the reliance on animal-sourced foods would be likely a move in the right direction. Perhaps with comprehensive education as was provided for the dietary intervention, we may have seen a significant reduction in emissions between the two groups.

Author:            Dr Adrian Cois, MD

                        Assistant Professor
                        Emergency Medicine

                        @dr_cois

Extend Yourself:

Everyone should read the EAT-Lancet commission and their Planetary Diet report. ⁴

References:

1.         Cambeses-Franco C, Gude F, Benítez-Estévez AJ, et al. Traditional Atlantic Diet and Its Effect on Health and the Environment. JAMA Netw Open. 2024;7(2):e2354473. doi:10.1001/jamanetworkopen.2023.54473

2.         Calvo-Malvar M, Benítez-Estévez AJ, Leis R, Sánchez-Castro J, Gude F. Changes in Dietary Patterns through a Nutritional Intervention with a Traditional Atlantic Diet: The Galiat Randomized Controlled Trial. Nutrients. 2021;13(12):4233. doi:10.3390/nu13124233

3.         Huang PL. A comprehensive definition for metabolic syndrome. Dis Model Mech. 2009;2(5-6):231-237. doi:10.1242/dmm.001180

4.         Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems – The Lancet. Accessed February 11, 2024. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31788-4/fulltext