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.