The Planetary Health Diet - Today's Dietitian Magazine

June 2019 Issue

The Planetary Health Diet
By KC Wright, MS, RDN, LD
Today’s Dietitian
Vol. 21, No. 6, P. 24

Today’s Dietitian provides an overview of the landmark EAT-Lancet report that’s urging a global shift toward healthful dietary patterns and improvements in food production practices to protect human and environmental health.

Just as the foods we choose to eat can have varying influences on the progression of many diseases—cardiovascular illnesses, diabetes, certain cancers, osteoporosis, and obesity—how we produce those foods can have differing effects on the environment.1

With that in mind, meet the new diet in town: the planetary health diet. This diet is just as it sounds—a diet to benefit both people and the planet. And with good reason, as food and the environment are unequivocally and inextricably linked, according to the independent peer-reviewed report “Food in the Anthropocene: The EAT-Lancet Commission on Healthy Diets From Sustainable Food Systems,” released earlier this year.2 Specifically, the evidence-based EAT-Lancet report calls for a substantial global shift towards healthful dietary patterns, large reductions in food loss and waste, and major improvements in food production practices.

As countries around the world have become more urban and incomes have risen, traditional diets (typically higher in quality plant-based proteins) have been gradually replaced by Western diets, comprising more calories, mainly from refined carbohydrates; highly processed foods dense in added sugars, sodium, and unhealthful fats; and excess consumption of animal products.3,4 Meanwhile, strong evidence has shown that food production is among the largest drivers of global environmental change by contributing to climate change, biodiversity loss, freshwater use, interference with the global nitrogen and phosphorus cycles, land-system change, and chemical pollution.5 The EAT-Lancet Commission confirmed that global food production is the largest pressure caused by humans on earth, threatening local ecosystems and the stability of the earth system—an integrated dynamic system composed of four primary interlocking components: atmosphere, solid earth, biosphere (where living organisms exist), and hydrosphere (all waters on the earth’s surfaces).6 Food production depends on continued functioning of healthy biological systems to regulate and maintain a stable earth; therefore, these systems and processes provide a set of globally systemic indicators of sustainable food production.

Promoting a plant-based diet is nothing new. The EAT-Lancet findings are consistent with many previous reports on diet and health, including the 2015–2020 Dietary Guidelines for Americans as well as research data on the Mediterranean diet.7,8 Yet, the planetary health diet is distinct in recognizing that most current food production methods contribute to poor nutrition worldwide. A detailed nutrient analysis of the planetary health diet shows that the adoption of the dietary targets would greatly improve the nutrition and health status of most people, with better intakes of healthful mono- and polyunsaturated fats while reducing consumption of unhealthful saturated fats. The planetary health diet also would increase essential micronutrient intake, such as iron, zinc, folate, and vitamin A, along with calcium in low-income countries. The commission doesn’t specifically endorse a vegan or vegetarian diet (although potentially healthful diets), rather it describes an omnivorous diet that includes approximately two servings of animal-sourced foods daily.2

Key Messages for a ‘Great Food Transformation’
“Food in the Anthropocene” (anthropo for “man” and cene for “new”) describes the geological time characterizing humans as the dominating driver of change on earth, now presenting an immediate challenge of providing a growing global population with healthful diets from sustainable food systems. Addressing this challenge is the mission of the EAT-Lancet Commission that has outlined key messages to define its work. An understanding that unhealthful and unsustainably produced food poses a global risk to people and the planet is essential.

According to the commission’s report, more than 820 million people have insufficient food, while many more consume unhealthful diets that contribute to morbidity and premature death. Current dietary trends, combined with projected population growth to about 10 billion by the year 2050, will exacerbate risks to people and the planet. The global burden of lifestyle diseases is predicted to worsen, and the effects of food production on greenhouse gas emissions, nitrogen and phosphorus pollution, biodiversity loss, and water and land use all will reduce the stability of the earth system.2

Thus, the EAT-Lancet Commission deems that a great food transformation to healthful diets from sustainable food systems is essential to achieve the United Nations (UN) Sustainable Development Goals (SDGs) and the Paris Agreement. The SDGs are a call to action for all countries (adopted by all UN members in 2015) with global objectives to provide a shared blueprint for dignity, peace, and prosperity for people and the planet.9 Healthful food and sustainable agriculture are imperative to achieving all 17 of the SDGs, and the planetary health diet is intertwined with these goals. The Paris Agreement, also established in 2015, undertakes a common but ambitious cause with all countries to combat climate change and adapt to its effects.10 The agreement establishes a global warming goal of well below 2° C on preindustrial averages. The Paris Agreement achieved commitments from almost 200 countries. (In 2017, the United States withdrew from the agreement.11) The EAT-Lancet Commission has declared that missing these two global initiatives will leave today’s children to inherit a severely degraded planet where much of the population suffers from malnutrition or noncommunicable diseases.

The planetary health diet is a global reference diet for adults that’s symbolically represented by half a plateful of fruits, vegetables, and nuts, while the other half of the plate consists primarily of whole grains, plant proteins (beans, lentils, pulses), unsaturated plant oils, modest amounts of meat and dairy, and some added sugars and starchy vegetables. The diet is quite flexible and allows for adaptation to dietary needs, personal preferences (including vegetarian and vegan diets), and cultural traditions. But transformation to healthful diets by 2050 will require substantial shifts in food intake, including a more than 50% decrease in global consumption of unhealthful foods, such as red meat and sugar, and more than a 100% increase in consumption of healthful foods, including nuts, fruits, vegetables, and legumes. Food choices for dietary changes will differ greatly by region.2

Through its research, the Eat-Lancet Commission estimates that dietary changes from current diets to healthful diets are likely to substantially benefit human health, averting about 11 million deaths annually—a reduction of 19% to 24%.2 The Global Burden of Disease Study more recently confirms this finding that worldwide, 1 in 5 deaths each year likely could be prevented with improved nutrition intake. In 2017, poor dietary patterns led to 10 million deaths from CVD, 913,000 from cancer, and around 339,000 from type 2 diabetes. Countries where populations adhered mostly to a Mediterranean diet had the best outcomes.12

Since most current food production systems cause major global environmental risks, sustainable food production needs to operate within a safe operating space for food systems at all scales on earth. This means using no additional land, safeguarding existing biodiversity, managing water responsibly, substantially reducing nitrogen and phosphorus pollution, producing zero carbon dioxide emissions, and causing no further increase in methane and nitrous oxide emissions. According to the commission, transformation of sustainable food production by 2050 will require at least a 75% reduction of yield gaps, global reduction of fertilizers and water use, reduction of greenhouse gas emissions, adoption of land management practices that shift agriculture to limit carbon output, and a fundamental shift in production priorities. Achieving healthful diets from sustainable food systems requires large reductions in food losses and waste and major improvements in food production practices.2

The Road From Healthy Farm to Healthy Fork
Although the EAT-Lancet Commission focuses mainly on environmental sustainability of food production and health consequences of consumption, it recognizes that the transformation of the global food system ultimately should involve multiple stakeholders from individual consumers to policy makers and all those who play a role in the food supply. Achieving healthful diets from sustainable food systems for everyone requires strong commitment to global partnerships and actions—no simple task.

Thus, it would come as no surprise that business and industry that profit from any aspect of animal food production (or the sugar industry) might criticize the EAT-Lancet Commission’s report. For example, Joel Newman, president and CEO of the American Feed Industry Association, has called the report “another organized attack on animal agriculture that is not reflective of the current and accurate science.”13

For different reasons, the World Health Organization recently withdrew its support of the EAT-Lancet Commission’s report, after Italy’s ambassador, Gian Lorenzo Cornado, questioned its impact on people’s health and the livelihood of developing countries that depend on animal livestock production for economic stability and the prevention of malnutrition. A press release on the launch of the EAT-Lancet Commission report stated that “The total or nearly total elimination of foods of animal origin (in particular meat and dairy products) would mean the end of cattle farming and many other activities related to the production of meat. Besides, all companies involved in the production of foods or beverages that the authors arbitrarily regard as unhealthy will be forced to withdraw such products from the market and diversify their business. This provision would concern all producers of meat, milk, cheese, sweets, wine, and a lot of other foods, with dramatic consequences on the economy of many countries, including the loss of millions of jobs and the end of hundreds of thousands [of] small and medium-size enterprises, especially in the developing world.”

Despite this opposition, over the previous two years, the EAT-Lancet Commission convened 37 world-leading scientists from across the globe to identify and define dietary principles best for both people and the planet and deliver the first full scientific review of what constitutes a healthful diet from a sustainable food system, including actions to support and speed up food system transformation. The commission affirms it has used all of the best scientific evidence on diet and human health, and that the conclusions are based on consistent evidence from many types of studies, including randomized controlled feeding studies, randomized trials assessing weight as well as those that assess risk of specific diseases, and long-term epidemiologic studies involving hundreds of people over many decades.2

“We have a body of evidence that is quite consistent showing that red meat has a high environmental footprint,” says Sharon Palmer, MSFS, RDN, an expert in plant-based food and nutrition and sustainable food systems. “It is quite clear to me that the science shows we need to eat a more plant-based diet.”

Other stakeholders appear to have aligned with the Eat-Lancet Commission. For example, 80 investor groups—representing more than $6.5 trillion in assets—called on six of the largest fast food companies, including McDonald’s and the corporate owners of KFC and Pizza Hut, to set targets for cutting greenhouse gas emissions from their meat and dairy supply chains.14

As with any large report encompassing changes in dietary intake, it’s essential to consider how it’s funded. The EAT-Lancet Commission was funded through The Wellcome Trust,15 a politically and financially independent foundation that supports research and campaigns for better science, and the Children’s Investment Fund Foundation, and neither had a role in writing the report.15 EAT-Lancet commissioners received no financial compensation for their contributions; rather, they’re independent scientists financially supported by their individual institutions.

“The Lancet is an extremely authoritative and credible source of information,” says Edward Cameron, PhD, a climate change expert who has worked at the interface of climate, development, and human rights for more than 20 years, including at The World Bank. “Their publications on health and climate have been extremely influential,” he says. “They are not political in their work and find smart ways to communicate science.”

Due to the targeted changes needed in the global food system on the scale envisioned by the Eat-Lancet Commission, the commission developed the following strategies for effectiveness in achieving this food transformation:

seek international and national commitment to shift towards healthful diets;
reorient agricultural priorities from producing high quantities of food to producing healthful food;
sustainably intensify food production to increase high-quality output;
strong and coordinated governance of land and oceans; and
at least halve food losses and waste, in line with UN SDGs.

RD Food For Thought
Without a doubt, the EAT-Lancet Commission—now considered the reference for critical dietary changes—demonstrates that our food system is threatening both human and environmental health.16 The commission notes that achieving the scientific targets for a planetary health diet will depend on providing high-quality education on healthful diets. Now more than ever, it’s imperative for dietitians to recognize that food, and thus nutrition guidance, is inextricably linked to the environment. In response to the EAT-Lancet Commission report, the Academy of Nutrition and Dietetics released a statement saying that many of the dietary recommendations in the report are achievable if people around the world also receive guidance in nutrition and meal planning.17

Many dietitians and hospitals have been working on sustainable food initiatives for some time. Stacia Clinton, RD, national program director for Health Care Without Harm’s (HCWH) Healthy Food in Health Care Program, works to harness the purchasing power, expertise, and voice of the health care sector to advance the development of a sustainable food system. “This has been an important approach to me because I think it is important to recognize that food choices go well beyond what is nutritionally healthful,” Clinton says. She acknowledges that the findings of the EAT-Lancet Commission are aligned with what HCWH has been promoting with its Balanced Menu program that was launched in 2008 (now called Less Meat Better Meat More Plants), an initiative to reduce a hospital’s meat and poultry purchases and invest their cost savings in sustainable meat options. “HCWH will point to EAT-Lancet as a valuable assessment of available research that reinforces our Less Meat Better Meat More Plants initiative and underscores our environmental approach to looking beyond nutrients when determining the health of food,” Clinton says.

The Eat-Lancet summary report is an excellent resource for RDs, while the EAT forum provides podcasts, blog entries, and practical tips to brief clients on health and sustainability.18,19 The Harvard T.H. Chan School of Public Health’s Nutrition Source has tips that demonstrate how to prepare a planetary health plate, along with a sample seven-day meal plan.20 The commission warns that even small increases in consumption of red meat or dairy foods would make the goal of healthful diets from sustainable food systems difficult or impossible to achieve.2

Farmer and author Wendell Berry may have said it best when he wrote, “Eating is inescapably an agricultural act, and how we eat determines, to a considerable extent, how the world is used.”21

— KC Wright, MS, RDN, LD, is a research dietitian at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, and maintains a nutrition communications practice. She advocates for good food and sustainable food systems at www.wildberrycommunications.com.

References
1. Protein. Harvard T.H. Chan School of Public Health website. https://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/protein/. Accessed March 21, 2019.

2. Willett W, Rockström J, Loken B, et al. Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems. Lancet. 2019;393(10170):447-492.

3. Popkin BM, Adair LS, Ng SW. Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev. 2012;70(1):3-21.

4. Delgado CL. Rising consumption of meat and milk in developing countries has created a new food revolution. J Nutr. 2003;133(11 Suppl 2):3907S-3910S.

5. History of agriculture. Johns Hopkins Center for a Livable Future website. http://www.foodsystemprimer.org/food-production/history-of-agriculture/index.html. Accessed March 21, 2019.

6. The Earth’s dynamic environment: a systems approach to global change. University of Southern California website. https://earth.usc.edu/~slund/systems/topic1.html. Accessed March 28, 2019.

7. US Department of Agriculture; US Department of Health and Human Services. Scientific report of the 2015 Dietary Guidelines Advisory Committee. https://ods.od.nih.gov/pubs/2015_dgac_scientific_report.pdf. Published February 2015. Accessed March 19, 2019.

8. Estruch R, Martínez-González MA, Corella D, et al. Effect of a high-fat Mediterranean diet on bodyweight and waist circumference: a prespecified secondary outcomes analysis of the PREDIMED randomised controlled trial. Lancet Diabetes Endocrinol. 2016;4(8):666-676.

9. Sustainable Development Goals. Food and Agriculture Organization of the United Nations website. http://www.fao.org/sustainable-development-goals/overview/en/. Accessed March 21, 2019.

10. What is the Paris Agreement? United Nations Climate Change website. https://unfccc.int/process-and-meetings/the-paris-agreement/what-is-the-paris-agreement. Accessed March 28, 2019.

11. Roberts T. One year since Trump’s withdrawal from the Paris climate agreement. Brookings website. https://www.brookings.edu/blog/planetpolicy/2018/06/01/one-year-since-trumps-withdrawal-from-the-paris-climate-agreement/. Published June 1, 2018. Accessed March 28, 2019.

12. GBD 2017 Diet Collaborators. Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017 [published online April 3, 2019]. Lancet. doi: 10.1016/S0140-6736(19)30041-8.

13. EAT-Lancet Commission recommendations create a fuss. Farm Progress website. https://www.farmprogress.com/farm-life/eat-lancet-commission-recommendations-create-fuss. Published January 18, 2019. Accessed March 28, 2019.

14. Gustin G. Investors join calls for a food revolution to fight climate changes. Inside Climate News website. https://insideclimatenews.org/news/29012019/global-food-system-shocks-climate-change-mcdonalds-obesity-malnutrition-Investors-lancet-scientists. Published January 29, 2019. Accessed March 22, 2019.

15. Wellcome website. https://wellcome.ac.uk. Accessed March 28, 2019.

16. Nestle M. The Lancet/EAT Forum report on healthy and sustainable diets. Food Politics by Marion Nestle website. https://www.foodpolitics.com/2019/01/weekend-reading-the-lancet-eat-forum-report-on-healthy-and-sustainable-diets/. Published January 25, 2019. Accessed March 22, 2019.

17. EAT-Lancet report’s recommendations are achievable if nutrition education is included, says Academy. Academy of Nutrition and Dietetics website. https://www.eatrightpro.org/media/press-releases/positions-and-issues/eat-lancet-report-response. Published January 18, 2019. Accessed March 21, 2019.

18. EAT. Summary report of the EAT-Lancet Commission. Healthy diets from sustainable food systems: food, planet, health. https://eatforum.org/content/uploads/2019/01/EAT-Lancet_Commission_Summary_Report.pdf. Accessed January 22, 2019.

19. A weekly planetary health menu. EAT website. https://eatforum.org/learn-and-discover/a-weekly-planetary-health-menu/. Accessed January 22, 2019.

20. Plate and the planet. Harvard T.H. Chan School of Public Health website. https://www.hsph.harvard.edu/nutritionsource/sustainability/plate-and-planet/. Accessed March 21, 2019.

21. Berry W. The pleasures of eating. In: What Are People For? New York, NY: North Point Press; 1990.