Food as Medicine

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November 7, 2019

I had the pleasure of returning to my alma mater in the Bronx – Montefiore Hospital – where I did some of my clerkships in medical school, and the majority of the clinical work during my pulmonary fellowship.  It’s been renovated so much in the 31 years since I’ve been there that the only building I recognized was the concrete garage across the street.

This conference, “The Third Annual Montefiore Preventative Cardiology Conference” could have been titled, “Food as Medicine”.  The focus was on the importance of food in preventing and reversing coronary artery disease.  It was organized by cardiologist Robert Ostfeld, MD, MSc, the founder and director of the Cardiac Wellness Program at Montefiore, which encourages patients to embrace a whole-foods, plant-based diet.  There were many remarkable success stories recounted, in which patients gained energy and were able to discontinue medications due to adoption of plant-based nutrition.

Speakers included world renowned physicians Dr. Caldwell Esselstyn, a cardiac surgeon who has spent decades helping patients to avoid cardiac surgery, and Dr. Walter Willett, Professor of Medicine and Epidemiology and Nutrition at the Harvard Schools of Medicine and Public Health, respectively.  These and many others who shared the podium have a long list of accolades.  There were also several enthusiastic physicians in training who were chosen to present case histories.  Traditionally, there has been very little time devoted to nutrition in medical school, so it’s encouraging to see that some schools will now graduate doctors who will be conpetent and confident in counseling their patients about it.  My alma mater among them!

It’s hard to know where to begin to share the info presented.  It’s too much for one sitting, so this post is just Part One.  

Dr. Esselstyn declared that nutritional literacy, not a pill or procedure, is needed for a seismic revolution.  Changing your diet can decrease your risk for coronary artery disease for life.  Having a stent placed does not help avoid future blockages.  

The Economist has named 2019 The Year of the Vegan, as 25% of 25-34 year olds are vegan or vegetarian.  Vegan refers to a totally plant based (PB) diet, avoiding all fish, chicken and beef, as well as dairy, eggs, honey, etc.  Vegetarian refers to a bit more liberal diet and comes in many varieties among them those who eat eggs and/or dairy (ovo-lacto-vegetarian), fish (pescatarian), or occasional other animal products (flexitarian).  

This is not an all-or-none issue.  The process of moving toward a plant-based diet can be overwhelming if you are an omnivore and aim for perfection.  What follows is information that might encourage you to add more healthy foods to your total nutrition to improve your own long-term health and that of the planet.  I hope to inspire you to give you options for healthy, colorful vegetarian foods, and to move along the continuum of nutrition options headed toward a healthier heart, body and mind in the long run.

Younger people often choose a plant-based diet as much for environmental reasons as health reasons – raising cattle uses a tremendous amount of land and produces greenhouse gases, an important factor in global warming.  Only 5% of arable land is used for produce for our consumption.  The rest is used for feed, ethanol, etc. We were assured that climate change is not a hoax.  And it is not linear – it is accelerating at an increasing rate.  One way to slow down the harm we do to our planet is with a global shift toward PB nutrition.  

While we’re on the subject of beef, the recent study that made headlines was addressed.  The conclusion trumpeted in the popular press was that eating meat was no worse than the comparison diet – which was a Western diet, not a PB diet.  So beef is just as unhealthy as a diet that we know to be unhealthy.  Agreed! The authors have clearly been linked to the ‘swine’ industry.  We all should question headlines that seem to go against everything else we know.   

The question arose about Impossible Burger and Beyond Burger.  In brief, either one is a processed product that is high in saturated fat and sodium.  It’s better than beef for those who are conditioned to have burgers but are trying to avoid them.  Otherwise, there’s no benefit to them.  Personally, I’m not a fan.  I think they leave a strange aftertaste.  

An important point is that an unhealthy vegan diet is no better than any other diet.  Potato chips and soda can be vegan. So the ideal is whole food plant based nutrition.  Natural and minimally- or non- processed.  

A comical photo shown by Dr. Andrew Freeman in reviewing 2019’s ‘year in plant-based diets’ showed supermarket shelves before a hurricane.  There was no milk, cheese or toilet paper to be found, but the tofu shelves were still full!  Other points of interest from him in a whirlwind run through medical journal articles from 2019 (with some editorializing by me):

  • Fish oil pills are of no benefit. 
  • For vegans, supplements can include folate and B12.  Supplements such as niacin or ‘anti-oxidants’ or the many others available are unnecessary for anyone, just leading to expensive urine as they are excreted.  Berries are richer in anti-oxidants than fish is. 
  • Statins aim for a 50% reduction in LDL (bad cholesterol); the same can be accomplished with diet.
  • The American Diabetic Association now recommends a vegan diet for diabetics
  • Increased fiber intake (i.e. plants) are associated with a decrease in depression, weight, cholesterol, long-term sugar (hemoglobin A1c) and death, and an increased quality of life.
  • In as little as 4 weeks, healthier diets can help to decrease blood pressure, cholesterol level and medications – these changes vary person to person of course, and medications should only be adjusted by your physician.
  • Ketogenic diets (extremely low carbs) can increase LDL and reduce maximum muscle power, so the weight loss associated with them isn’t all good.  He said they allow for a ‘skinnier coffin’.
  • In Blue Zone areas with the lowest mortality rates, carb intake is about 50% of total calories.  Under 40% carbs is associated with an increased risk of atrial fibrillation, and over 70% is not good either.
  • Sweetened beverages, whether containing natural or artificial sweeteners, increase the risk of stroke when more than two per day are consumed.
  • Even when there are genetic tendencies toward stroke, a healthy lifestyle including a healthy diet, exercise, sleep and stress reduction can decrease the risk.  (The same has been shown in the past regarding risk for Alzheimers.)
  • Soy and cruciferous veggies (broccoli, Brussels sprouts, cauliflower) decrease the risk of breast cancer.  For years there was concern soy might increase the risk, but that seems not to be the case.  
  • Gluten should be avoided only in those allergic or sensitive to it.  Otherwise, there is no need to shun it.  Increased intake of gluten is associated with a decreased risk of diabetes.  Often gluten-free foods are higher calorie than traditional products. 
  • It’s never too late to start exercising to reduce the risk of heart failure.  150 minutes per week of moderate exercise decreases the risk of heart disease and cancer.
  • Sleeping less than 6 hours per night increases the risk of atherosclerosis by 27%.   

Well, that’s about it for now.  There’s more to come.  Try to eat your colors – a large variety of fruits and vegetables, along with whole grains, nuts and legumes. It can be as simple as having a peanut butter and apple sandwich or a store-bought lentil soup for lunch.

Don’t let perfection be the enemy of good.  There is a huge range of choices to meet your nutritional needs.  If you can ease your way toward a plant-based diet, you will be doing your body good.  It doesn’t need to be all or none, just better than before.  

I’ll suggest more resources in future posts.  Here are some of my favorite recipes from our own blog:

Butternut squash chili

Sweet potato black bean stew with sweet peppers and peanut sauce

Caramelized tofu

Lentil stew – one pot dinner

Asian slaw with peanut dressing