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The Public Health Paradox

It’s encouraging to see that Public Health England have initiated steps to improve the health of that nation following results of research that showed a 40% increase in adults putting on weight during lockdown. It’s particularly encouraging to see that the emphasis, certainly as reported in this Guardian article, is on health and fitness rather than simply losing weight. The big question must surely be why so late? Why, when a pandemic is likely the easiest of disasters to plan for, was the nation’s health in a period of unprecedented lockdown not taken into account in the planning? The clue is in the question; lockdown was both unprecedented and not part of any planning, not in the UK, nor in the disaster planning of the World Health Organisation. So how could it be known how a population would respond to this thoroughly unrehearsed and unplanned strategy? How do individuals process and respond to fear, anxiety, loneliness, restrictions to their practical day-to-day routines? We couldn’t know, so before we become incredulous that anyone would knowingly eat unhealthily and put on weight at a time when the news reports were relentlessly spewing forth horror stories of those with overweight and the associated comorbidities, we really need to consider what it is we’ve just experienced, and how we can turn around our health at least on an individual basis.


Managing and maintaining a healthy weight can be challenging at any time, and one of us (Graham) has had direct experience of this for a considerable portion of his life. It took him many years to find a solution that worked for him and his personal weight loss story was featured on the Plant Based Health Professionals UK website back in 2020. So what might we expect, when we find ourselves caught up in a situation the likes of which none of us has ever experienced before and can never have imagined? A situation that affects how we conduct our lives and how we interact with others, both those that we love and the general public, every day? It’s inevitable that it will have an influence on our habits and emotions and what and how we eat and drink is inextricably linked to how we feel.


It’s fair to say that each of us will have run the gauntlet of emotions over the course of the pandemic, experiencing a mixture of fear, anxiety, sadness, grief, despair, relief, hope, and more despair...it’s been a veritable roller-coaster. When we perceive an imminent, potentially life-threatening danger, our body responds accordingly; our autonomic nervous system (the part of us that controls all of the functions that we don’t have to think about and that happen involuntarily) goes into ‘sympathetic’ mode and prepares us for “fight or flight”. When the threat is temporary and the danger is removed, this is a good thing, as this is what can save our lives; but when the perceived threat is longer-term, and this stress response plays out every day, it can be damaging to our health. How does this happen?


In response to stress, our body releases the hormones adrenaline and cortisol. Both of these raise our blood sugar, and our body uses this sugar, or glucose, to provide energy for our cells so that we can run or fight. So far so good. But when this happens, in order to transport sugar into the cells from our blood, our body creates insulin. Fine...except that insulin also tells our body to make and store fat. When this occurs over an extended period, as in when we are in a state of chronic stress and our body is stuck in the “fight or flight” mode, this can lead to weight gain, and the chance of this is higher if we fail to engage in regular exercise to burn off the excess glucose that our body is producing. Unfortunately, the “Stay at Home” directive issued during the first lockdown in particular and the enforced closure of gyms and recreation centres prevented many from exercising as regularly as they otherwise might. To further compound this, stress can also lead to sleep problems (insomnia) and there is plenty of scientific evidence of an association between sleep deprivation and obesity, as highlighted in this BMJ review. When we feel stressed, we also tend to offset this by seeking distraction and comfort and inevitably we are thus drawn to foods that provide pleasure. Unfortunately, those foods are often the foods that are full of sugar, fat and salt, and nowhere are these combinations more readily available than in the highly calorific processed foods that we can access virtually everywhere and anytime of day. See what’s happening here? Bearing all this in mind, is there any wonder then that we are seeing an epidemic of weight gain and obesity on the back of this pandemic?


So what can we do? What does eating healthily really mean? It’s unsurprising that we’re in an almost constant state of confusion about food choices, what’s good and what isn’t and how sometimes a food gets both positive and negative headlines within the space of just a few weeks. This type of approach, however, will always be at least somewhat unsatisfactory if we persist in looking at it through the wrong end of the telescope: eating and good health are (w)holistic endeavours, not processes that respond to individual foods, or individual nutrients. Food is medicine, but applying it in the way we apply pharmaceutical approaches will lead us astray and have us believing that food is an inadequate response to good health.


But there is good news, and it’s also emerged during the pandemic. There are two recent studies that give cause for real optimism. The first of them, published in the BMJ, tracked almost 3000 healthcare workers from 6 different countries. They were all in close contact with Covid 19 patients and their own Covid outcomes were measured and aspects of their lifestyles observed and recorded. The results were compelling: Those who followed a plant-based diet had 73% lower odds of experiencing moderate-to-severe COVID-19, compared with participants who did not. This even exceeded the good results for pescatarians (ie those eating mostly plants and fish, commonly thought of as a Mediterannean diet) who had 59% lower odds of moderate-to-severe COVID-19. And there’s more, the diets were simply acknowledged as ‘plant-based’ or ‘vegetarian’ with no reference to the quality of their diets. Could it be that simply swapping out animal foods for plant foods and plant-based alternatives made the difference? What might the results be like for those specifically following a nutrient dense, high quality wholefood plant-based diet? These results would be of great interest! It’s worth noting too that those who followed low carbohydrate high protein diets e.g. keto diets had a 48% greater risk of moderate-to-severe Covid-19 compared with other participants. This study has not yet been peer-reviewed which means that it won’t be used yet to guide clinical practice, but does this need to mean that we should ignore its findings when considering how to feed ourselves?


The second, and even more recent revelation comes from contributions to the ZOE Covid Study in Autumn 2020. More than 600,000 took part by detailing the food they were eating before and after the pandemic. It revealed that those eating a high quality plant-rich diet were less likely to be hospitalised with Covid-19 and even infection with the virus was lower amongst this group! This has been the first recorded indication that eating predominantly plants can actually reduce the likelihood of even catching the virus in the first place. And if you want the figures: people who ate the highest quality diet were around 10% less likely to develop COVID-19 compared to those with the lowest quality diet, and 40% less likely to become severely ill if they developed COVID-19.


These results don’t surprise the two of us; our wholefood plant-based way of eating has left us in no doubt about the potency of such a diet for dealing with the range of health challenges that we each faced in previous times. Added to this, the already well-established (but widely under emphasised) study results of such diets on heart disease, diabetes and some cancers must make us collectively stop and take notice. And do notice too, that the pluralisation above of the word ‘diet’ is quite deliberate; there are several different ways ...styles, you might say of whole food plant-based diets, all we need to do is to choose, or construct, our own style and make it work for us!


We realise we’re making this sound very easy and it can be, but often it isn’t for a whole range of different reasons. It’s why we, Annette and Graham, do what we do. We want to help people to help themselves either by being part of a community of people doing the same, or by accessing more direct help and support. If you’ve not yet joined us as a member, you’d be very welcome whatever your current food and health-related circumstances. The website address is here.


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