Plant-Based Nutrition as the Foundation of Patient Health: Positioning Drugs and Surgery as Complementary Therapies

Most primary care physicians find that patients are often willing to discuss topics such as depression or cancer, but many are reluctant to talk about nutrition, or consider it a difficult subject to broach. In fact, this topic is of critical importance.

For patients with diabetes, dietary issues can lead to amputation. For those with heart disease, such conversations can help them avoid work-related injuries or enable them to work more effectively. For individuals who are steadily gaining weight, prioritizing dietary concerns can help them avoid gastric bypass surgery or manage obesity and weight-related complications through lifelong medication.

Many people attribute weight gain to a lack of willpower. A survey by the University of Chicago found that consumers consider willpower to be the primary obstacle to weight loss. Americans spend $60 billion annually on diets and weight control, yet with limited success. Nearly 70% of adults are overweight or obese, and 60% of adults are currently dieting.

Renowned U.S. internist Agustina Saenz shares her insights on diet and health, compiled by VCBeat (WeChat: vcbeat). As the physician states, each of us should take responsibility for our own health, while our doctors should play a guiding role. In the United States,Improper Diet Is a Leading Cause of Death and Disability. Strengthening our willpower will not resolve our obesity crisis or make us healthier.

In fact, sugar is quite natural. However, whether trade groups should promote it at the National Dietitians Conference, as they did at this month’s event, has become a focal point of controversy. The associated event is the annual Food and Nutrition Conference and Expo, a veritable promotional extravaganza centered on food-related products.

However, the substantial financial support for this event may also come from corporations and trade associations, which in some cases has reinforced the perception that “Big Food” brands are undermining the dietary guidelines provided annually to millions of Americans. For many years, the organization hosting the event—the Academy of Nutrition and Dietetics—has paid increasing attention to these issues.

“There has been so much criticism of the relationship between industry and society,” said Katherine Tucker, a Professor of Nutritional Sciences at the University of Massachusetts Lowell who also taught at Tufts University for many years. “I think everyone is taking a close look and trying to minimize conflicts of interest.”

Tucker is the Editor-in-Chief of Advances in Nutrition, a journal published by academic affiliates of the American Society for Nutrition. She stated that the current reality is thatNutrition research relies on support from food industry conglomerates, and its dependence on private enterprises is greater than that of scientists in other fields.Dairy farmers offer photo opportunities with giant cows. An oversized avocado mascot strolls through the exhibition hall. Nutritionists line up for free Subway sandwiches, candy, yogurt, soda, and smoothies with countless combinations. Representatives of high-fructose corn syrup companies distribute green pencils topped with yellow corn stalks, while strategizing how to promote their products as healthy.

This is a major event.

“We are a very powerful team,” said Lucille Beseler, Chair of the Academy of Nutrition and Dietetics. “We can influence everything.” Beseler stated that she is not concerned about the influence of food companies. “I know our members understand the difference between marketing hype and the scientific evidence base,” she said. “We show them the actual products and then consider whether the science aligns with what the food industry claims.”

This approach is not beneficial for everyone. In 2013, a small group of members, after exposing the financial ties between the Academy and U.S. food companies, formed a rogue faction of nutritionists committed to professional integrity within academia. Prior to this year’s conference, the splinter group warned attendees about corporate influence and urged them to avoid “health washing”—corporate marketing tactics that make foods appear healthier than they actually are.

Announcements on the group’s website and Facebook page noted that some spokespersons were peddling research findings to cover industrial production costs, a practice that warrants careful scrutiny. For instance, the diabetes symposium included reports authored by the chairperson as well as paid consultants for diabetes pharmaceutical manufacturers.

Andy Bellatti, co-founder of Las Vegas-based nutritionists and nutrition experts, said: “Many people, including professionals, may not be aware of the existence of these relationships.”

“We are not saying that everything is wrong or terrible. There will certainly be some improvements. McDonald’s and Coca-Cola, as in previous years, were not present at the conference. However, we believe that certain companies and organizations are not appropriate attendees for a nutrition conference,” said Bellatti. A typical example, he noted, is the Sugar Association and its industry-funded publications.

“Their entire reason for existence is to promote sugar, attempt to defend it, and strive to reverse any negative assessments of sugar,” said Bellatti. “It is well known that Americans have been consuming excessive amounts of sugar; a responsible public health message would be to advise people to reduce their sugar intake.” Courtney Gaine, CEO of the Sugar Association, defended the team’s efforts in an email.

“Most registered dietitians recognize that people need to enjoy the food they eat,” she said, “and sugar can improve the flavor of highly nutritious foods in a healthy diet.”

When questioning the company representative, Tucker was polite. Even when asked about a single-ingredient soda with supplements, she stated that reducing blood glucose by 25% to 30% would take only a few hours. “I want to see long-term studies,” she said.

Jonathan Marks, director of the Bioethics Program at Pennsylvania State University, has examined the impact of corporate funding on academic research, particularly in the field of food studies. He agrees that conflicts of interest can distort scientific findings. “There are meta-analyses showing that industry-funded studies yield more favorable results, and the interpretation of these results tends to be even more favorable within such studies,” Marks said. He pointed out that past research on the influence of pharmaceutical industry gifts on physicians indicates that large gifts are not necessary to exert an effect. “We found that even small gifts can create subtle reciprocity and influence,” he said.

At this year’s conference, the Academy of Nutrition and Dietetics sponsored a workshop on the disclosure of conflicts of interest by dietitians themselves. In addition to the panelists, several rows of chairs remained empty in the audience. Diane K. Polly, an attorney and ethics instructor known to many attendees, told the audience, “There are two schools of thought.”

“One is that we are professionals and cannot be bought. The other is that appearances are reality.”

We attribute it to an educational issue.Only 1/4 of medical schools provide students with formal nutrition training. This training gap reveals that although 94% of physicians consider nutrition important, only 14% are capable of discussing this issue with patients with ease. This is a disgrace, as patients have always valued the nutritional information provided by their physicians.

However,Clinical practitioners’ nutritional information is easily influenced by industries producing American-style foods such as red meat, sugar, ice cream, and soda.The “relief” clause soon emerged. Hospitals, once the sacred sanctuaries where the most critically ill patients sought treatment and recovery, have also begun selling readily accessible fast food.

To effectively manage chronic diseases, physicians, their healthcare teams, and patients should prioritize food-as-medicine prescriptions over fad diets or industry-backed claims. This recommendation is well-founded: a survey involving ten million participants revealed that 50% of adults seek nutritional guidance. It is time for healthcare providers to take the lead.

Weight control, increased physical activity, adoption of healthy dietary habits, and smoking cessation can prevent 90% of type 2 diabetes cases. The “blood glucose stabilizers” we refer to are not medications such as insulin or metformin, but rather a diet rich in leafy green vegetables, legumes, and fruits, combined with an active lifestyle. This recommendation is highly suitable for inclusion in prescription orders, and patients should be encouraged to consult registered dietitians or participate in local cooking classes.

Whenever people discuss weight loss, fiber—a technical term for plant-based foods and whole grains—becomes the most popular topic. In addition to promoting satiety and reducing calorie intake, fiber helps lower cholesterol and blood pressure, as well as alleviate inflammation. In Paleolithic cultures, the average daily fiber intake per person was at least 45 grams, three times higher than today’s levels.

Compare these two options: broccoli, brown rice, and soybeans containing 302 calories and 18 grams of fiber; cheese crackers containing 312 calories and 1 gram of fiber. Fiber is unique to plant-based foods. It contributes to a healthy weight. Adequate nutrition and satiety can bolster willpower to its strongest level.

Kaiser Permanente is encouraging its healthcare providers to promote a whole-food, plant-based diet to all patients, particularly those with obesity and other chronic conditions such as diabetes, chronic kidney disease, and heart disease. Kaiser is not the only healthcare organization taking this approach. My organization, the Physicians Committee for Responsible Medicine, is also encouraging healthcare providers to prescribe whole-food, plant-based dietary regimens for their patients. The current President of the American College of Cardiology has personally adopted this dietary strategy and hopes that his colleagues and their patients will do the same.

This plan not only requires patients to consume more vegetables, but also encourages them to build dietary habits based on plant-based foods such as vegetables, fruits, grains, and legumes. Examples include butternut squash boats, beet burgers, and DIY dinners rich in traditional grains, legumes, and abundant vegetables.

Is such a dietary strategy effective?

Chad Teeters, Director of the Cardiology Department at Highland Hospital, personally tried this approach after hearing about it at last year’s American College of Cardiology conference. Believing that he needed to lead by example in weight loss to encourage patients to make genuine lifestyle changes, he adopted a plant-based diet. To date, he has lost more than 50 pounds.

This has inspired many patients and staff members to change their diets and lifestyles. Hospitals now stock fresh fruits and vegetables, rather than soda and unhealthy snacks, in staff kitchens.

Physicians have played a pivotal role in combating tobacco use, sugary soda consumption, and unsafe driving. They recognize that the greatest threat to public health today stems from “Big Food,” rather than from Zika virus or drug-resistant infections, although these remain significant concerns.

We need to embrace the upcoming food revolution under the guidance of physicians.To promote plant-based dietary patterns, physicians must first understand their mechanisms of action and how to prescribe them.

We should prioritize learning nutrition science, disseminate this knowledge to our healthcare teams and patients, and simultaneously establish a supportive environment for plant-based dietary recommendations, while utilizing medications and surgery as adjunctive therapies.Future health insurance costs will inevitably decrease, job satisfaction is likely to rise, and the prevalence of non-communicable diseases will decline sharply. All this requires is that we cultivate healthy eating habits.