I have 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. Fast-forward to the present and in my dual roles as owner of an award winning plant based restaurant in Ferndale, Michigan and an active practice as a preventive academic cardiologist, I receive many questions about plant based nutrition (PBN). One of the most common is “my doctor is not supportive and I do not know what to information to share”. Fortunately, the Kaiser-Permanente Medical Group, the nation’s largest HMO, produced an excellent document “Nutritional Update for Physicians: Plant Based Diets” that is a resource for sharing this information with your health care provider. While it is now a few years old, it appeared in a peer-reviewed journal and has many scientific references your provider should respect. The paper provides a balanced view of PBN with 10 key points that can help your doctor understand your health journey.
5 Benefits of PBN
1) Obesity. Statements that “a vegan diet caused more calories to be burned after meals in contrast to non-vegan 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”, and “plant-based dietary patterns should be encouraged for optimal health” with supporting references can assist you in explaining your diet to your doctor.
2) Diabetes. The fact that PBN may offer an advantage for the prevention and management of diabetes was reviewed. Statements made include “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 to reduce their medication”. The references are from respected researchers.
3) High Blood Pressure. In a review on the topic, the opinion that “vegetarian diets were associated with lower systolic blood pressure and lower diastolic blood pressure” was expressed and the data to support it.
4) Heart Disease. The strongest data for the health benefits of PBN are for heart issues. The researchers reviewed data from Dean Ornish, MD including the startling finding that “regression of even severe coronary atherosclerosis after only 1 year” was observed. In another study group, “vegetarians had a 24% reduction in ischemic heart disease death rates compared with non-vegetarians”. Pretty convincing statements.
5) Mortality. A quote from the Dietary Guidelines Advisory Committee that “plant-based diets were associated with a reduced risk of cardiovascular disease and mortality compared with non-plant based diets” is a powerful reason to choose PBN for health goals.
5 Concerns about PBN
1) Protein. Let’s give a giant supportive cheer of ‘hooray”. The writing group indicated “generally, patients on a plant based diet are not at risk for protein deficiency”. They went on to say “a well-balanced plant-based diet will provide adequate amounts of essential amino acids and prevent protein deficiency”. That should help answer the #1 biggest question.
2) Iron. Iron stores may be lower by following PBN. The authors point out that “the American Dietetic Association states that iron-deficiency anemia is rare even in individuals who follow a plant-based diet”.
3) Vitamin B12. Vitamin B12 is produced by bacteria, not plants or animals “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. Plant based sources high in calcium include greens and tofu. Vitamin D is found in soy milk and cereal grains. “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 would advise you 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. They include ground flax seeds, 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 or not.
Overall, the Kaiser-Permanente update is a great resource for the medical world and to help your explain your diet to your health team.. The statement 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” is a powerful endorsement more in the medical world need to read and incorporate.