How To Defend Your Vegan Diet To Your Skeptical Doctor

How To Defend Your Vegan Diet To Your Skeptical Doctor

In this piece, renowned cardiologist Dr. Joel Kahn shares the benefits of a plant-based diet and explains how to present them to your own health care provider. If you're interested in learning more, check out his mindbodygreen course, Everyday Hacks for Long-Lasting Health: How to Eat, Move & Live for Longevity.

I've followed a plant-based diet since 1977, when the salad bar at my freshman dormitory at the University of Michigan was the only choice that looked edible. Today, I'm now an academic cardiologist as well as the owner of an award-winning plant-based restaurant in Ferndale, Michigan. That means I receive many questions about plant-based nutrition. One of the most common questions I get: "My doctor isn't supportive of a plant-based diet. What information can I share?”

Fortunately, the Kaiser-Permanente Medical Group, one of the nation's largest health plans, produced an excellent document, “Nutritional Update for Physicians: Plant-Based Diets,” that's a great resource to share with your health care provider. It appeared in a peer-reviewed journal and includes many scientific references your provider should respect. The paper presents a balanced view of plant-based nutrition—including five main benefits of the diet and five concerns—and can help your doctor understand your health journey. Here's a summary:

The key benefits of plant-based nutrition

1. It fights obesity.

In a review of studies on the topic of weight management, the report notes a number of main findings:

  • “A vegan diet caused more calories to be burned after meals in contrast to nonvegan diets."
  • “Vegetarian diets are nutrient dense and can be recommended for weight management without compromising diet quality."
  • “A plant-based diet seems to be a sensible approach for the prevention of obesity in children."
  • "Plant-based dietary patterns should be encouraged for optimal health.”

This information, along with the supporting references, can assist you in explaining why you're following a plant-based diet.

2. It can prevent diabetes.

The report also reviewed the fact that plant-based nutrition may offer an advantage for the prevention and management of diabetes. They noted that a "low-fat, plant-based diet with no or little meat may help to prevent and treat diabetes” and that “people on the low-fat vegan diet were able toreduce their medication."

3. It lowers high blood pressure.

When it comes to managing blood pressure, the report also found that “vegetarian diets were associated with lower systolic blood pressure and lower diastolic blood pressure."

4. It can reverse heart disease.

The strongest data for the health benefits of plant-based nutrition are for heart issues. The authors reviewed data from Dean Ornish, M.D., including the startling finding that “regression of even severe coronary atherosclerosis after only one year” was observed. In another study group, “vegetarians had a 24 percent reduction in ischemic heart disease death rates compared with nonvegetarians." Those are pretty convincing statements.

5. It could reduce mortality.

Need one more powerful reason to choose plant-based nutrition for your health goals? The Dietary Guidelines Advisory Committee notes that “plant-based diets were associated with a reduced risk of cardiovascular disease and mortality compared with non-plant-based diets."

The main concerns about plant-based nutrition:

1. Protein

The authors note that “generally, patients on a plant-based diet are not at risk for protein deficiency." They go on to say that “a well-balanced plant-based diet will provide adequate amounts of essential amino acids and prevent protein deficiency." Let’s give a giant supportive cheer—that should help answer the #1 objection you'll likely hear from your doctor.

2. Iron

Iron stores may be lower if you follow a plant-based diet. But the authors also note, "iron-deficiency anemia is rare even in individuals who follow a plant-based diet."

3. Vitamin B12

According to the report, “individuals who follow a plant-based diet that includes no animal products may be vulnerable to B12 deficiency and need to supplement their diet with vitamin B12." That is a fair statement and a good plan of action.

4. Calcium and vitamin D

There are a number of plant-based sources high in calcium, including greens and tofu. And vitamin D is found in soy milk and cereal grains. The report also notes: "Supplements are recommended for those who are at risk for low bone mineral density and for those found to be deficient in vitamin D." I'd advise you to ask for a blood level of your vitamin D-25OH.

5. Fatty acids

Linoleic acid (an omega-6 fatty acid) and alpha-linolenic acid (an omega-3 fatty acid) are the two essential fatty acids. Vegans are most likely to be deficient in omega-3. “Foods that are good sources of n-3 fats should be emphasized," the report says. "They include ground flaxseeds, flax oil, walnuts, and canola oil." Increasingly, blood tests that measure omega-3 levels are available and not expensive. I advise them for all of my patients, vegan or not.

Overall, the Kaiser-Permanente update is a great resource to help you explain your diet to your health team. The authors note that “the major benefits for patients who decide to start a plant-based diet are the possibility of reducing the number of medications they take to treat a variety of chronic conditions, lower body weight, decreased risk of cancer, and a reduction in their risk of death from ischemic heart disease”—that's a powerful endorsement that more in the medical world need to read and incorporate.

I recently handed out many copies of the Kaiser-Permanente paper to guests of my restaurant, which is often populated by medical residents, students, and health care providers. Print out the paper yourself, and share it with your health care team—I hope it makes your journey easier.

Joel Kahn, MD, FAAC

Chronic disease runs in my family. I think my genes are at fault. What can I do?

Is your health determined by the genetic code you inherited from your mother and father? Or do you have the ability to impact your fitness and longevity by practicing a healthy lifestyle? When completion of the Human Genome Project was announced in 2003 many expected that the paradigm that one gene for one malady would leave little control over our wellness.

Joel Kahn, MD

Joel Kahn, MD

That this concept was short lived was the center of conversation last night with my friend Evan. His belief was that there was heart disease in his family and it was inevitable that he would suffer the same fate. Evan was no lightweight. He had completed an advanced education degree years ago and was a successful business and community leader. The idea that his health was predetermined by his nature, or his genetic content, weighed on his mind.

The Human Genome Project determined that the human genetic code was smaller than expected, about 22,000 genes, which is "more than a chicken but less than a grape." Indeed, our genes, though not many in number compared to some species, are under the influence of our environment, and specifically our lifestyle. This scientific discovery is called epigenetics. The influence of diet, or nutrigenomics, plays a particularly potent role. While you may not eat your way into blond hair and blue eyes (genetically determined features that are not influenced by lifestyle) your risk of disease can be shifted dramatically and quickly.

The response that I got explaining this to Evan is one I share with many patients and inspires hope that nurturing our nature with a healthy lifestyle can determine the likelihood of years of health or disease. I explained to him some of the findings made by Dr. Dean Ornish in the last decade. For example, in a group of men with low-grade prostate cancer placed on plant based diets along with stress reduction and walking programs, 453 genes controlling tumor growth were less active and 48 genes related to tumor suppression were more active after only 3 months. In another study using the same program in 63 men with heart disease, 3 months after making lifestyle changes 26 genes were expressing different amount of proteins and after 1 year 143 genes were doing the same, reducing proinflammatory activity that harm arteries. Finally, if it is the fountain of youth you are after there is even more hope. Following the Ornish lifestyle program for five years led to measurements of relative telomere length, a marker of aging, disease, and premature morbidity, to increase favorably while a control group demonstrated the usual shortening or aging. Other factors that may play a role in controlling our genes included sleep, stress, exercise, and environmental exposures.

The power of understanding that we are not doomed to live out a pre-determined path controlled entirely by our genes is empowering and Evan responded with excitement. I could sense that relief and hope resulted from my brief scientific overview. While we have much to learn about the amount of control we have over the genetic input to our health, and the most effective methods of producing desired results, we should not wait. Clean food, air, and water along with sleep, and the avoidance of smoking and unmanaged stress is a powerful plan for nurturing our nature.

Are MD's telling me everything I need to know about heart health?

You said what most people have learned about LDL and HDL cholesterol is too simplistic to accurately assess their heart health. Would you explain?

JK: Let’s start with LDL cholesterol, the so-called "bad cholesterol." The standard blood test most Americans receive just gives you the raw LDL number, as well as your raw HDL number and overall cholesterol number. But that raw LDL number isn’t enough to ascertain your risk for heart disease. Two people can have the same LDL number, but one may have a much higher risk for a heart attack and the other may not have much risk at all.

The difference in risk largely depends on two other factors that the standard blood test doesn’t measure: the number of LDL particles and their size.

A good analogy is a stretch of highway with 100 passengers. If those passengers are driving 10 to a minivan, then the road isn’t congested—there are only 10 large vehicles on it. But if all 100 passengers are riding in individual cars, you have congestion.

The same thing happens with LDL cholesterol. If you have many LDL particles with only a small amount of cholesterol in each one, that’s of concern, because your arterial highway is very congested. But if you have fewer and more packed particles, your arterial highway might not be congested at all.

Two people can have the same LDL number, but one may have a much higher risk for a heart attack and the other may not have much risk at all.
— Joel K. Kahn, MD

This situation typically arises where people have a low LDL number, but it could also occur where someone has a higher LDL number. Let’s say your LDL is 160, and your overall cholesterol number is 240. Without further data, that isn’t looking very good. But if you have a relatively modest number of LDL particles, maybe 1200, the results aren’t so unfavorable. A second person with the same overall cholesterol and same LDL number who has 2500 or 3000 particles has a much higher risk of a heart event.

What LDL particle numbers and sizes are considered desirable, and which are of concern?

JK: So far, only a few large data sets have looked at these more advanced cholesterol panels, but here’s what we know: An LDL particle number close to 1000 is at the lower risk part of the spectrum, and numbers of 2000 — 3000, which routinely arise, point to a much higher risk.

When it comes to particle size, the bigger the better. Small particles are typically sized 19 nm or under. Hard and dense, they’re like small "golf balls" that knock into your arteries to cause plaque. Bigger particles are generally over 21 or 21.5 nm. They tend to be more spongy and much less likely to harden your arteries. And they’re changeable. Lifestyle changes particle size better than anything, though of course medications can do this too.

So, get an advanced cholesterol panel, at least once. These days insurance companies are covering it pretty routinely. Even when they don’t, the cost is way under $100.

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What is Vitamin L and why is it important to heart health?

What is Vitamin L and why is it important to heart health?

You say in The Whole Heart Solution that more than 75% of heart disease diagnoses could be prevented. That’s an outstanding figure. How do we know this is true?

JK: Predominantly from studies that were designed this way: Let’s take 20,000 people that on entry have no detectable heart disease—no chest pain, no bypass, no stents, etc. Then let’s take detailed histories of their lifestyle—do they smoke, what do they eat, do they sleep well, etc. Let’s follow them for 15−20 years, and at the end of that time period, reassess: Who’s had a stroke, a heart attack, a bypass, a stent. And let’s look at the lifestyle that predicts freedom from having a heart event.

Many of these studies have been done and reported on in the last 10 years. They’re from all over the world: from England, Sweden, the U.S. They encompass well over 100,000 people, and they all have remarkably similar findings, which are: With a simple pattern of habits that are not expensive and not exotic, you can achieve more than 75%, an even up to 85% heart-attack free, stroke-free life.

Joel K. Kahn, MD - Holistic Heart Doc

Joel K. Kahn, MD - Holistic Heart Doc

The results are pretty conclusive, and personally I think we’re likely to get even better results, higher than 85%, if we add in medical evaluations, which these studies didn’t require.

I’m very excited that lifestyle, or what I like to call Vitamin L, is the key factor in heart disease prevention.

What’s the protocol for "Vitamin L"— the healthy lifestyle habits that give up to 85% heart disease protection?

JK: Five essential lifestyle habits consistently appeared across all the studies:

Don’t smoke. We don’t know and still debate what about smoking is so dangerous, but all the studies reinforce the now 40-year-old notion that smoking is an extremely bad habit.
Be active. We’re talking moderately active. These studies didn’t ask how many pounds you can clean jerk or how many spinning classes you took last week. They asked, "Do you walk 30−40 minutes a day on average?"

Control weight. The weight parameters aren’t extreme either. The general guideline is to maintain a relatively healthy weight. The most consistent finding is a prediction of freedom from heart attack for men who keep their waists under 40 inches and women who keep theirs under 35. These also predict freedom from diabetes, and, to a lesser extent, freedom from stroke and cancer.

Consume alcohol in moderation. This finding is very controversial, but the data is the data: Almost every study showed that some consistent use of alcohol was favorable in predicting up to 85% freedom from heart attack. And it’s interesting, because different countries have different alcohol cultures, but the results indicate that one ounce of hard liquor, five ounces of wine, and eight ounces of beer are relatively equivalent in protection. Some studies showed positive results with a few drinks a month; others supported as much as daily ingestion of one drink.

Seven hours of sleep on average. This relatively novel finding, assessed in just a few of the studies, is that if you average fewer than seven hours of sleep a night, you’re at significant increased risk of heart attack. The Morgen Study of 1,000 people, for example, found that the people who did all the lifestyle habits we’re talking about but typically slept under seven hours had about a 65% chance of being heart attack-free, compared to up to 85% for those who got seven hours. Good sleep offers a substantial amount of heart attack freedom.

Five or more servings of vegetables and fruits a day. I saved this habit for last because it’s the one people hit the least--only 1−3% of Americans do it—but it’s the most important. Every single one of these studies said that five plus servings of vegetables and fruits a day is that "special sauce" in achieving the up to 85% number. And there’s no reason we can’t do it. It’s simple and very doable. It’s not expensive, no one specified you have to eat organic produce, although we could talk about whether or when going organic might be helpful in some instances.

That’s the program. And we should be teaching it as the "holy grail" of heart disease prevention in this country, where heart disease is the #1 killer of both men and women over 30.

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I sit the majority of the day. Is this unhealthy?

Dr. Joel - Holistic Heart Doc

Dr. Joel - Holistic Heart Doc

I took a plunge into the modern world this weekend by using my Uber app for the first time in Boston to navigate my daughter's university graduation schedule of events. Without the glass barrier normally found in NYC cabbies, I had a chance to talk with the drivers and the conversation turned to the amount of time spent sitting on the job. Fortunately, most of these drivers were doing it part time between other jobs and school schedules but it prompted me to pause and consider the masses of persons who do sit all day in order to make a living. Does their health suffer?

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