What Diet Should Physicians Recommend?

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Making Plant-Based Diets the New Normal

A Nutritional Update for Physicians was published in the official journal of Kaiser Permanente, the largest managed care organization in the United States. It told physicians that healthy eating may best be achieved with a plant-based diet, defined as a regimen that “encourages whole, plant-based foods and discourages meats, dairy and eggs as well as all refined and processed junk.”

The Update notes:

“too often, physicians ignore the potential benefits of good nutrition and quickly prescribe medications instead of giving patients a chance to correct their disease through healthy eating and active living. Physicians should therefore consider recommending a plant-based diet to all their patients, especially those with high blood pressure, diabetes, cardiovascular disease, or obesity.”

The major downside described is that it may work a little too well. If people are on medications, their blood pressure or blood sugar could actually drop too low, so physicians may need to adjust medications or eliminate them altogether.

The report continues that “despite the strong body of evidence favoring plant-based diets, many physicians are not stressing the importance of plant-based diets as a first-line treatment for chronic illnesses. This could be because of a lack of physician awareness or a lack of patient education resources.” So Kaiser sought to change that. “Want to lose weight, feel better, improve, stabilize, or even reverse chronic disease, and get off some of your medications?” a Kaiser Permanente leaflet (which you can see in my video, What Diet Should Physicians Recommend?) asks. “If you answered ‘yes’ to any of these questions, then a plant-based eating plan may be for you.” Side-effects include: lower cholesterol, blood pressure, and blood sugar; reversal or prevention of heart disease, our number one killer; a longer life; a healthier weight; lower risk of diabetes; improvement of inflammatory conditions like rheumatoid arthritis; and a slowed progression of certain types of cancer.

Kaiser offers tips to get started, such as meal plan ideas, and a list of online resources (including NutritionFacts.org!). The paper ends with a familiar refrain: “further research is needed.” In this case, though, further research is necessary, they explained,  to “find ways to make plant-based diets the new normal for our patients and employees.”

So exciting to see lifestyle medicine suppported. For more on this new medical specialty:

Unfortunately much of medical training is substandard when it comes to nutrition:

-Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of DeathMore Than an Apple a DayFrom Table to Able, and Food as Medicine.


Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.

33 responses to “Making Plant-Based Diets the New Normal

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  1. By coincidence this came over the transom this morning: http://www.sciencedaily.com/releases/2015/12/151214130727.htm
    which suggests that there are substantial environmental benefits to NOT eating a plant-based diet. That got my antennae twitching at once and suggests all sort of questions about the study assumptions, the funding sources, etc. Anomaly? Intentional obfuscation? Bold new discovery by bacon eaters? Any idea what is going on with this? On the face, it seems to defy common sense.

    1. The study looks at ecological footprint per calorie and features lettuce vs pork. Since lettuce has very few calories, it will tend to have a large ecological footprint per calorie. If they did ecological footprint per kg, they would get very different results.

      1. Fencepost: And if we take your very valid insight further given that humans and their health are part of our auditable ecological landscape we see gram for gram:
        Lettuce (Romaine) 100 gms (DV) delivers: +s 174% Vit A, fibre 8%, Vit C 40%, Iron 5%, Vit K 128% Good omega 3/6 ratio & No negatives unless one considers 18 cals bad!!!
        Pork (bacon raw) (DV) +s? : Vit A 1%, Vit C 0%, K 0% Some niacin etc Negatives: poor omega3/6 ratio, Cholesterol 23%, Saturated Fat 75%, Fat 89% zero fibre, high sodium, 458 calories. Fat chance of winning a nutrition vote…
        The case for plant based foods rests your honor….

    2. They could have compared a lettuce to corn. Looks like there is information omitted. Eating a lettuce is bad for the environment. But eating a pig that ate 1000 lettuces is good?

      1. Exactly! “Eating a lettuce is bad for the environment. But eating a pig that ate 1000 lettuces is good?” Responding more to this now…

    3. I think there are some serious holes in this paper. First off, let’s recall the video by Dr. Greger on climate change. The sources cited (18 to be exact in prominent journals) trumps this one study published in Environment Systems and Decisions. Also, note that the author from this paper is lumping dairy and seafood into the the mix. Dr. Greger points out in the video that research shows animal-based foods are worse for the environment than plants. Furthermore, in a related article on Science Daily (that I found from this article you linked) – Greenhouse Gas Emission Estimates of U.S. Dietary Choices and Food Loss – it states:

      “While a drop in meat consumption would help cut diet-related greenhouse gas emissions, increased use of dairy products — and to a lesser extent seafood, fruits and vegetables — would have the opposite effect, increasing diet-related emissions, according to the U-M researchers. In the United States in 2010, food production was responsible for about 8 percent of the nation’s greenhouse gas emissions. In general, animal-based foods are responsible for more greenhouse gas emissions per pound than plant-based foods. The production of both beef cattle and dairy cows is tied to especially high levels of greenhouse gas emissions. For starters, cows don’t efficiently convert plant-based feed into muscle or milk, so they must eat lots of feed. Growing that feed often involves the use of fertilizers and other substances manufactured through energy-intensive processes. And then there’s the fuel used by farm equipment. In addition, cows burp lots of methane, and their manure also releases this potent greenhouse gas. Greenhouse gas emissions associated with producing the U.S. diet are dominated by the meats category, according to Heller and Keoleian. While beef accounts for only 4 percent by weight of the food available, it contributes 36 percent of the associated greenhouse gases, they conclude. The U-M researchers found that a switch to diets that don’t contain animal products would lead to the biggest reductions in this country’s diet-related greenhouse emissions.”

      So my thoughts are that this one study titled “Energy use, blue water footprint, and greenhouse gas emissions for current food consumption patterns and dietary recommendations in the US” is very misleading. It almost seems like an attack on a previous announcement by the former California Governor urging citizens to eat less meat to help battle climate change. Regardless, it’s safe to say the totality of the evidence points to a plant-based as one of the best solutions to fight climate change.

      1. Joseph, the first sentence of your quote from Science Daily lumps fruit and vegetables in with seafood, and then lumps them together with dairy, saying that eating these would lead to greater greenhouse emmisions. It may presume that most people arn’t going from meat-eating to WFPB, but to being vegetarians or “pescatarian.” That may be the rational to justify saying that vegetarian diets are worse for the environment?

        1. The whole thing is slightly irrational because they compare the calories of lettuce to that of bacon. Well of course it would take hundreds of cups of lettuce to equal the amount of kcals from a strip of bacon. Ginny Messina has more on this if interested. She wrote an article.

          1. But people NEED those greens, anyway, if if that person is a bacon-eater, it’s not like they can be healthy not eating greens day after day. Lettuce is undoubtably the most popular green leafy for vegetarians and meat-aholics alike. Almost no one is eating lettuce all day. If they want to compare bacon to a vegans food production, maybe they should compare it to vegan protein.

            1. Exactly! Bacon is not a health-promoting food so the argument that more bacon is better for the environment vs. lettuce is quite null considering no one (and I mean no one), based on AICR’s stance on avoiding processed meat, ought to be eating bacon.

  2. Thank you so much for educating us, Dr. Greger. I’ve purchased the hard copy of your new book as well as the audio version. I learn something new and beneficial every time I pick it up or listen.

  3. Whenever I go to a Kaiser hospital, I visit the cafeteria, watch the docs eat, talk to the nurses and cafeteria staff. ( A huge percentage of all staff are obese, or nearly.)

    The food served and consumed is SAD, but for a few unappetizing exceptions, the nurses entirely ill-informed, the docs as well. Very discouraging. I write our Northern CA Kaiser bureaucracy about WFPB and get formulaic non-responses. Very discouraging! Today, waiting for a friend in heart surgery, I finally, after 3 yrs. of looking, read in a Kaiser classes booklet that a 2-day class and one cooking lesson were offered in San Francisco on WFPB, but they charge $35! That will surely discourage signups. But perhaps now if you go to the KP.org site you might get SOME response if you search WFPB!

    1. I find it odd that folks will pay a trainer $60 at the gym for an hour, but balk at a $35 fee for a cooking class that could change their life! I really hope folks in the N. California area can sign up for this! Thanks for sharing and goodness I hope your friend recovers swiftly.

      1. Indeed! I think what Kaiser National needs is to combine in-person classes with an online program with online support of all sorts like the one Dr Neal Barnard offers at http://www.pcrm.org/health/diets/kickstart/kickstart-programs, or like the very interactive one Joel Fuhrman has that includes fabulous videos and well-commented recipes. Of course, if your team had the time…you have the research and compelling…humor!
        Kaiser is clearly dragging their feet fearing loss of client base of groups working in restaurant, dairy, and meat industries. Difficult problems. Thank you, Joseph, my college buddy is doing well with a taped aortic aneurism and a new heart valve.

        1. Good to hear! Thanks for mentioning PCRM they have nationwide cooking classes – Food for Life Team – and I have helped train many instructors when I worked with Dr. Barnard. These instructors are fabulous and it’s worth every penny supporting their life saving work.

    2. Thanks for bringing that up. That underlines what I think is the crucial step required before any progress is made, i.e. getting the medical staff on board. Clearly if the docs themselves are reluctant to adopt a plant based diet, regardless of what Kaiser as an institution pushes, it’s hard to imagine them recommending it for their patients. And given how much big food and big pharma does to “support” medical practitioners this seems like no small roadblock.

      All that said however, I recently switched health plans to Kaiser, and I have to say that this is the first time I didn’t have to actually fight against my doctor’s recommendations re. being a vegan. My current Kaiser doc, reasonably, just wanted to check my B levels (which were fine), but aside from that she fully supports my being a vegan.

      1. That is great to hear, Karl. What Kaiser do you frequent? We have read (in Consumer Reports?) that Kaiser Northern CA ( Santa Rosa, San Rafael, and San Francisco but not South San Francisco) gets the highest marks. My second Kaiser internist seems to admire our WFPB, but knows little. Or first seemed clueless, but not at all negative. From a group that claims to foster our thriving, I expect more. Every nurse I have questioned was way overweight and said things like, ” Yes, they tried to take away our french fries!” She, at least, had heard rumblings of changes in the cafeterias. I have wondered if there were an effective movement we WFPB Kaiser members could start to help Kaiser do what they know they should and what would save them $ on the not- very- long run.

        1. The Kaiser I frequent is San Francisco and they do seem to at least be pushing WFPB institutionally, e.g. the health tips they send out via the phone apps. And I hold out some hope for Kaiser in general on this score as they seem to be one of the only HMO’s that made any attempt at what was supposed to be the economically sound model for HMO’s, i.e. promoting preventative care (this despite the no doubt enormous pressure from the food and drug companies to promote sickness as the economically sound model – i.e. the best way to extract the most cash out of the people widgets). But as you point out, one of the major roadblocks is converting the foot soldiers, i.e. medical staff. And maybe you’ve identified the right approach, i.e. pressure from the “shareholders”.

  4. Funny. I was just seen by a Kaiser doctor who thought that my 139/79 blood pressure was just fine. I didn’t think so. I thought it was way too high and committed myself to a whole food plant based, low salt diet. Thank you for your book. It gave me very valuable help, that Kaiser didn’t give me.

    1. Bummer about the experience. Awesome that you’re making these changes to improve your health! I am so glad you are utilizing the book. I have heard many success stories already and it’s only been out a week! Gosh you guys are quick readers. I know Dr. Greger is thrilled when he learns folks are feeling better. Don’t give him too much credit though ;-) you were the one who made the changes! Dr. Greger is one of the most selfless men I know and only wants the best for all. Happy Tuesday, Niels.

    2. My guess, I’m not an MD, is you are borderline hypertensive. Medication is not yet warranted, so the doc was just following protocol. I’m not defending him mind you, he was just acting within the protocols of his training. I’m surprised he didn’t at least bring it to your attention and inquire further, e.g., are you anxious, stressed, what did you have for lunch, any caffeine today, etc. There’s also a very real condition called “white coat hypertension.” Anyway, good for you for being proactive. Don’t discount exercise; its as important as diet IMHO. The good doc recommends up to 90 minutes/ day of walking. Unless you’re otherwise restricted by a health condition, to me, its not exercise unless your respiration and BP are elevated, within your own personal limits of course. Sure, eat all the plants you want, but 90 walks are great for granny. You’ll accomplish more in less time with a little more demanding activity. Good luck, and good health to you. Lastly, don’t forget to increase your electrolytes; there’s videos here on that I’m sure.

  5. WOW! Powerful image of the heart! That’s what people are doing to themselves every day. And then complain about getting heart attacks and strokes. We have to take responsibility for what we put into our mouths.

  6. They left out a very important benefit. I don’t mean to offend anyone, either. If you can get over being “shy” you can really get people to listen and consider this advantage. “A benefit to eating a plant based diet is having a rock hard erection that will last until the sun comes up.” My husband and I changed our diets five years ago and this was one surprising benefit. I lost 100 pounds and he lost 75 pounds. Our bodies and health have improved in so many ways it’s simply amazing!

    1. Love it! They mentioned this lovely side benefit in Forks Over Knives. I remember a talk I hear from Dr. Barnard (I think it was Dr. Barnard) where he described talking to a bunch of ranchers somewhere in the midwest. He was going over all the stats about heart disease, weight, etc. He could see that no one was interested. Then he mentioned the effect on erections and all of a sudden, he had the whole room’s interest. Afterward, when people came up to ask questions, that’s all they wanted to talk about. I tend to think that this matters to people far more than death and we should probably list it as the number one benefit. :-)

      For anyone interested: Dr. Greger has a few videos on this topic:

      1. If you’re taking Viagra, Joe! Lol. I think she was employing a figure of speech about it lasting All Night Long, there were probably breaks! But seriously, we vegan elders are some lucky lovebirds. I wouldn’t trade my vegan he-man for a rock star.

    1. A plant base diet, when properly done, helps everything but may take time for the results to show. A person in chronic pain usually has a set of problems (not only the pain) that are related and that are not mechanically specific like for example a bad wire in a car. It depends on the mind (how much you know) seeing the problem.

    2. bahminj: For osteoporosis, I like to refer people to the book, “Building Bone Vitality-A Revolutionary Diet Plan to Prevent Bone Loss and Reverse Osteoporosis”. It is based on a review of over 1,200 studies. It is a pretty fast/easy read, but by the end, you will have a good understanding of what it takes to build healthy bones. In my opinion, the information/advice in the book is very consistent with the advice here on NutritionFacts.

      I don’t think anyone can say over the internet whether you should take meds or do a plant based diet. Maybe both will be called for? Either way, I think you would have to work that out with your doctors. But if you read the book, you will have some good science to bring to the discussion. And the book includes a chapter on medications. That should help too.

      I hope this helps.

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