"Vegan" is more a sociological term, designating people who don't eat (or use) animal products, and that could be for environmental, ethical, animal welfare or health reasons. But, "no meat"is not nutrition. Potato chips and coke might be vegan, it is not nutritious. The Whole Foods Plant-Based diet, without added Sugar, Oil or Salt (SOS), is the nutritionally sound basis for a healthy vegan lifestyle. The focus is on #WFPB without SOS, based on the work of T. Colin Campbell in The China Study.
The other day, we had our Lifestyle Medicine dinner at Neerob. Varun Ponmudi, the CEO of Aayas Table gave us a presentation about the six person pilot program they offered in October - a month of WFPB instruction in your own home. Some basic biometrics were reported before and after. The mix of dietary habits was interesting, but on the whole the group averaged out on the healthy side of what is unfortunately normal, nevertheless, the results were significant, including a 4.5 lb weight loss during the period.
Results were good, but there were a few lapses.
Varun Ponmudi presenting results of AayasTable pilot program
Total Cholesterol went down for all six participants, with four out of six reporting ending numbers of below 150, Dr. Esselstyn's definition of "heart-attack-proof."
Triglycerides were more mixed. Two were up and four were down.
LDL at 30 days was down across the board.
A few people lapsed with some oil and processed vegan.
Unfortunately, none of the participants could be attend the dinner at this time, but from personal feedback I know that this program made a critical difference for some people. It is an enormous support to have someone help you out in your own home.
The high point of the evening in many ways was when Md. "Khokon" Rahman, the owner of Neerob, shared his own experiences. In August when he had a heart-attack, he was hospitalized with TC above 180, and his last bloodwork on 10/12/2019 showed TC at 92, prompting his physician to ask him how he did it.
The result is that Khokon is now a leader in his community in this area, along with the Bangladeshi nurse at Elmhurst, Md. Shariful Islam, who spoke at one of our dinners previously. Mr. Islam is always a shining example to me, because he came all the way from Elmhurst to become the patient of Dr. Ostfeld in the Bronx, purely because Dr. Ostfeld is a plant-based cardiologist. Here is a spectacular report on one of Dr. Ostfeld's patients, who googled his way out of bypass surgery to go and use lifestyle medicine instead, becoming a patient in Dr. Ostfeld's Cardiac Wellness Program at Montefiore Hospital in the Bronx.
The whole point of the exercise in a way is that at a point when it is critical, an intervention may be unavoidable, e.g. a stent, or whatever, but as long as it is elective, things can be turned around very quickly on a Whole Foods, Plant-Based diet.
The Food at Neerob
As per usual, Neerob did an outstanding job on the food. A great fresh green salad, a vegetable spaghetti salad, bean soup, a nice dal, brown rice, chinese style veggies, steamed broccoli.
Neerob will become a destination for #WFPB food in the Bronx. They achieved a Plant Pure Communities Restaurant certification in February 2019 and it is getting better all the time.
On November 1st, 2018 we had a "Party with a Purpose," from Plant Pure Communities at the HQ of Visiting Nurse Service of New York, in Manhattan.
All the usual suspects were there.
Jody Kass, Nelson Campbell, Eric Adams, T. Colin Campbell, and Jim Courage
All of the team leaders from NY and surroundings were there, the five boroughs, LI, Westchester plus people from all over the country and all over the world even. I met two people from my native Holland, which was kind of fun!
This coming weekend SOMOS Community Care has the kickoff of their first Jumpstart in East Harlem - and it is already over subscribed. They have others in the planning for northern Manhattan, for Brooklyn and the Bronx. They are an organization of 2,000 doctors, servicing 700,000 medicaid patients and they are poised to totally reform medicaid around the city into a system that pays for results, not treatment, meaning that Lifestyle Medicine and the Whole Foods, Plant-Based diet is the name of the game from now on. It is happening right here, right now.
The model for the Jumpstart program was the movie Plant Pure Nation, and the sequel will be the Healing America movie, based on the Healing America Together tour, and here is one success story that will be part of that movie.
It was a memorable event and I won't even attempt to produce a full account here by touching on some of the highlights.
I think this was a historical conference, all the greats from the world of the Whole Foods, Plant-Based nutrition were there, creating a very comprehensive view of the field in a single day, with very up to date information.
Robert Ostfeld, MD, MSc, FACC
Neal D. Barnard, MD
Valentin Fuster, MD, PhD
Kim A. Williams, MD, MACC, FAHA, MASNC, FESC
W. H. Wilson Tang, MD, FACC, FAHA, FHFSA
Caldwell B. Esselstyn, Jr., MD, FACS, FACC, FALM
T. Colin Campbell, PhD.
Michelle McMacken, MD
Joel Kahn, MD, FACC
Lauren Graf, MS, RD, CDE
Plus some new players, young doctors just starting and interns, from whom we are sure to hear more in the future. One of them is in the process of launching a new plant-based clinic at Yale. They presented some explosive reports.
T. Colin Campbell for Nobel Prize
What made this conference unique was the presence of T. Colin Campbell, for one way or another, and ex-post facto in some cases, the nutritional science behind the Whole Foods, Plant-Based (#WFPB) paradigm is the anchor for the only realistic healthcare reform in this country and in the world.
T. Colin Campbell
I can only say this: I feel so very grateful to have completed the Plant-based certificate at the institute for nutrition studies, and this was my first opportunity to meet Dr. Campbell in person. All I could do was thank him from the bottom of my heart, since I know that without the nutritional science to back it up, all of these plant-based doctors would just be fighting their lonely battles. Campbell's work is the connective tissue from that point of view. This is the reason that one doctor created a petition to nominate Dr. Campbell for a Nobel Prize. Please sign the petition.
Brooklyn Borough President Eric Adams: "Food is crack."
Here in the Bronx, we are blessed with a few politicians who have their own personal stories to tell about the significance of #WFPB nutrition, such as senator Luis Sepulveda and Council man Fernando Cabrera. However, even in the Bronx' #not62 campaign, #WFPB has not played much of a role yet. In Brooklyn it is different, for Brooklyn Borough President Eric Adams is truly a man on a mission and being very effective at it.
Eric's own story is remarkable, having been predictably (as he now recognizes), but 'unexpectedly' (denial is NOT a rive in Egypt!) diagnosed with diabetes, and told he would have to be on insulin and several medications, instead, he googled "reversing diabetes," and made an appointment do see Dr. Esselstyn in Cleveland and on the plane he read Dr. Greger's book How not to die. Having been told he might lose his eyesight altogether, he instead completely recovered it in three weeks without medications, and in three months he was no longer a diabetic. Earlier this year, his 80-year old mother decided that she wanted some of what Eric had, and in a few months she was off of insulin and medications.
Eric is in the unique position to really do something about this new found wisdom and he has not skipped a beat. His events at Borough Hall are not to be missed.
In an impassioned speech, Eric Adams called our industrialized food out because of what it does, adulterated as it is to create the cravings that brings customers back again and again, he stated what is exactly the point: "Food is crack." This is even more painfully true in the African American community where "soul food," made a virtue out of necessity, and is the cause why "Southern food," with it's reliance on meat, grease and sugar and other refined carbs is an extremely unhealthy diet.
Finally, he acknowledged Dr. Michelle McMacken, who will be heading up the new plant-based program at Bellevue Hospital.
Dr. Kim Williams: Reducing risk of heart disease by 50% for blacks
Dr. Kim Williams in audience, Dr. Neal Barnard on stage
When Dr. Kim Williams spoke later in the day, he raised the same issue by pointing out that changing from a "Southern diet" (and as Dr. Williams pointed out this is code for a black diet), to a Whole Foods, Plant-Based diet reduces risk of heart disease by 50%. The romance with soul food, which is understandable, because it did make a virtue out of necessity and symbolized the resilience of black culture under atrocious conditions has become the new slavery. Thus the Whole Foods, Plant-Based diet symbolizes a new freedom. The beauty is that this time around, we have a combination of clinical experience from all the doctors in this field, backed by the nutritional science of Dr. T. Colin Campbell. The growing recognition of this new lifestyle is decisively the most hopeful thing that is happening in the healthcare field, in America and world-wide. Here is an interview with Dr. Williams:
At the end, Dr. Williams was also on the panel, and an important question came up from a Bangladeshi man, who is a nurse at Elmhurst Hospital in Queens, but came to the Bronx to become a patient of Dr. Robert Ostfeld, because he could not find a plant-based cardiologist at the time when he had his first heart-attack at age 36. In Dr. Williams' answer we learned that the American College of Cardiology recently visited Bangladesh, where the average age of heart attack patients is 43, apparently in part because genetically blood vessels are narrower in that population than is typically the case with Westerners, so that blockages develop earlier. In short, the Bangladeshi population should be extremely interested in the opportunity to drastically improve their quality of life and life-expectancy by switching to a Whole Foods, Plant-Based diet. It is also well known that diabetes is explosive in the South East Asian population, with white rice, animal protein and cooking oil being a leading causes. In the Western world in particular, food is the leading cause of death, but some populations are just genetically more prone to this form of suffering. Fortunately, it is reversible and the Southeast Asian cuisine offers a very good starting point for brown rice, lentils and chick peas as well as many of the traditional vegetables and spices can create endless variations of healthy food with very little effort.
Dr. Valentin Fuster speaks of starting early
Some of the Bangladeshi doctors I've gotten to know, were familiar with Dr. Valentin Fuster from the cardiology textbook he wrote, which they apparently used in medical school in Bangladesh. Dr. Fuster presented a very information-laden speech on the need to start early, in particular by teaching children. He has been a medical adviser to Sesame Street to do exactly that.
Treating the disease at the end state is expensive, not to mention unaffordable, and more than "prevention," starting with adults with bad habits already formed, he argues for starting with children. It was very compelling.
Dr. Ostfeld, common sense in underserved communities
With his usual, delightful and very gentle sense of humor, Dr. Ostfeld presented some of his experiences and solutions in serving a very under-served community in the Bronx and making affordable solutions work, including his practice of funneling all of his patients with their significant others into a half-day workshop on Whole Foods, Plant-Based cooking.
He mentioned some of the many sources which are available for inspiration to live a plant-based lifestyle on a budget, including some links on Forks over Knives which discuss plant-based living on a budget:
(In general you can find more by searching for "budget" on Forks over Knives.)
Particularly important is his clinical experience of how he gets patients motivated to comply, but the all important first step is to simply demonstrate that the improvements to be had from the plant-based diet out perform any drugs, such as statins.
Dr. Ostfeld's support system
He builds it up from a 30-minute first visit, which is largely fact finding and an initial plan, to a second follow-up visit and an invitation to his plant-based workshop. He is truly a leader in this emerging field. The PBNSG.org website he mentioned is another important resource.
Through the looking glass with Dr. Wilson Tang
In a fascinating presentation, Dr. Wilson Tang took us into the latest finds in the rapidly advancing field of understanding the gut biota with the primary bad boy being TMAO. Specifically, the fact that TMAO is a flagrant demonstration of oxidative stress in the body and comes from animal nutrition is interesting, and should point people quickly to diet as a cause for heart disease. Planteaters simply do not have the problem of this major villain lurking in their gut. See here some info from the Cleveland Clinic.
This type of information has us looking at causation, and at the same time puts us on a track to fixing it, for maybe, just maybe, if we ate something different, the outcome could be different... what would that be? Oh wait... Whole Foods, Plant-Based nutrition of course.
To hell and back with Essy, or... Dr. Esselstyn for you
Actually the discussion with Dr. Wilson Tang showed us the road to hell, and Dr. Esselstyn first showed us what heart disease looks like up close and what healing looks like. He took us through his experiences, including all the supporting evidence for #WFPB in general, and with particular attention to how eating a hand full of green leafy vegetables with balsamic vinegar, paves the way back, because it creates the nitric oxide which heals the endothelium and keeps our arteries limber. The deeper point is, as always, that 'vegans´ only know what you don't eat, and #WFPB is about knowing what you should eat and why. Once you have a firm understanding of that, it should be a lot easier to comply. Dr. Esselstyn's discussion of how a fatty meal prevents the normal expansion of the arteries, which is supposed to occur with strenuous effort, for four to six hours after that meal... by which time we eat again, is priceless and should also be powerful motivation for beginners. Understanding why you should do ABC or D, is the most important thing to get people to do it.
Notes on Keto-diets
The ketogenic diet is sort of an urban myth that refuses to die. There's always a new huckster promoting it. Throughout the day it came up both directly and indirectly. The information on TMAO in the gut of meat eaters alone should make it clear why this type of a diet comes with increased risk and mortality in the long run. Heart disease, diabetes, and cancer have all been associated with meat consumption. In short, there is nothing scientific about it. Dr. Joel Kahn had a recent article on How to Evaluate Nutrition Science (And Why Cranky Old Men on Twitter are Not the Source) which is yet another refutation of this particular craze.
Conclusion
This conference took place at a time when more and more people realize that we cannot continue with a healthcare system that consumes 20% of our Gross National Product and two times what the next most expensive country pays, but produces health outcomes that are somewhere in the range of 25th to 50th in the world, depending on which analysis you follow. Since 37 of the top 40 leading causes of death, mostly the typical, chronic diseases of affluence that are thought to be incurable, respond well to a Whole Foods, Plant-Based diet and many are preventable or even reversible with such a diet, it is becoming increasingly imperative we make the change, even if it takes a generation. We cannot afford not to.
The question period at the end was exhaustive - every last question was answered. Again, I left out a lot of detail here, in order to present sort of a bird's eye view of this whole affair, which we are blessed to have in the Bronx, if we ever hope to get serious about #not62.
For most of my life, I thought I knew something about nutrition. As a child I loved to help out in the kitchen, and learn cooking. In our household cooking was a serious affair: my mother ran the place like a hotel, for my father was a psychiatrist and had his practice at home, and meals were a major social occasion, both lunch and dinner. Whether it was us kids bringing friends over, or my father's friends and professional contacts, including other doctors, psychiatrists, and psychologists from all over Western Europe, authors, economists, ministers of state, and clergy. Lunch and dinner were often social events. Proper meals were being served and conversation was usually in three languages, mostly Dutch and German, but sometimes French or English. Ever since we went vegetarian when I was age two-and-a-half, my mother was always preoccupied with meal planning and nutrition. In those days, there seemed to be a lot of preoccupation with: but how do you get your protein? This being Holland, the answer was of course dairy, although there was some awareness of pulses, peas, beans and certain grains as sources of protein. But we definitely thought cheese was a health food, and eggs weren't bad either. Milk was still nature's perfect food. That was then, this is now.
As an adult, during a 20-year marriage, I was the cook. Cooking was my relaxation when I came home from work. In those years I had become omnivore, but still always had a vegetarian-leaning cooking style. I made pasta sauce completely vegetarian, using mushrooms, and my Italian (now ex-) wife within six months admitted my pasta sauce was better than her mother's. For which my mother-in-law never forgave me. During those years however, I also thought an organic filet mignon was health food, and if it wasn't organic I'd eat it too.
The last 20 years, I was slowly drifting back to a more vegetarian lifestyle, until I decided for health reasons that it was necessary to become a bit more rigorous, and after one false try maybe five years ago, I finally and completely shifted to the Esselstyn diet in May of 2015, and the results were dramatic. These days I am off of all medication and back at my fighting weight of age 22.
Vegan or Whole Foods Plant-Based (WFPB)
Vegan means strictly speaking that you're not eating animal protein: no meat, fish, fowl, dairy or eggs. Strictly speaking the term means little else.
Ever since Dr. Caldwell Esselstyn's work gained popularity (which got a big push when Clinton credited him with overcoming his heart disease), a more strict regimen has become more popular, no-oil vegan. No processed oils, and moderation in oily fruit (avocado, coconut), nuts and oil seeds. The biggie for most people is no more cheese. No, cheese is not a healthfood, as Dr. Neal Barnard of Physicians Committee for Responsible Medicine explains in his tell-all book about cheese, The Cheese Trap. Three months after stopping all dairy, I indulged in cheese at a reception, along with some red wine. The taste still seemed attractive at first, but the after taste was of having eaten window caulking and it felt heavy. Then I read the book and finally it all made sense. No wonder statistically cheese is totally correlated with the American obesity crisis... from 4 lbs per person per year, we are gobbling 33 lbs per person/per year today.
Most people fail to make the transition at first, as did I when I first tried the Esselstyn approach, because the preparation of food became a challenge, but this time around I prepared myself better, got some more vegan cookbooks, and accessed all the information I could find. Meals became fun explorations of new possibilities, and presently, a year and a half later, it feels like I am entering a consolidation phase based on a whole new cooking paradigm and a new ability to improvise with flavors and textures with the excitement of the discovery that everything tastes better and more flavorful if you stop cooking with oil. And your arteries will thank you!
The truth is not in what you don't eat but in what you can and should eat, and that is a very rich and varied plant-based diet, full of veggies, legumes, fruits etc., and it becomes an entirely new journey of discovery, as this blog tries to show. In short, the first time I tried the Esselstyn diet, I made two mistakes. One was to focus on what I could not have and trying to find alternatives, and the other was not to be sufficiently clear on the methods of preparation.
And there are tons of resources, such as Forks over Knives, the Engine2 diet, and the 21-day kickstart program from PCRM, and many other places where you can go for support. Here in the Bronx there is the wonderful resource of the Cardiac Wellness Program at Montefiore Hospital, run by Dr. Robert Ostfeld, who offers a half-day course to learn the Whole Foods Plant-Based diet, in the best of the Caldwell Esselstyn tradition, and on a budget. You can even bring your significant other, so that at least you get support at home. I am now registered to go to his next workshop on July 15th. The bottom line is with the growing support options, people who are looking to make the change have an extensive support system at their finger tips. A lot of it is free, and once in a while perhaps you'll buy a book or do a workshop. And the fear that you can't afford it is not well founded, for meat and dairy are expensive both in dollars, and in the toll you pay with your health.
Books
Always first: Dr. Caldwell Esselstyn, Jr., Prevent and Reverse Heart Disease: The Revolutionary, Scientifically Proven, Nutrition-Based Cure and
T. Colin Caldwell, The
China Study: Revised and Expanded Edition: The Most Comprehensive Study
of Nutrition Ever Conducted and the Startling Implications for Diet,
Weight Loss, and Long-Term Health
Dr. Neal Barnard,The Cheese Trap: How Breaking a Surprising Addiction Will Help You Lose Weight, Gain Energy, and Get Healthy
Not strictly no-oil vegan, but a helpful little guide: Amy Cramer and Lisa McComsey, The Vegan Cheat Sheet: Your Take-Everywhere Guide to Plant-based Eating
A new life-style
Most surprising for some is the experience that you can eat whatever you want whenever you want once you're on this track, as long as you stay within the bounds of no-oil veganism, and use only whole foods. But there is never a sense of dieting. Eat to your heart's content, and your body will adjust, and weight management is no longer an issue.
The potential for no-oil vegan for the restaurant business
This to me is the most exciting realization that has come to me, and I've begun to discuss it with restaurant owners: Not only does no-oil vegan cooking simply taste better, but it is the most universal choice for a restaurant menu. A vegan won't touch a merely vegetarian meal, but a vegetarian will eat no-oil vegan, a vegan will eat no-oil vegan and a no-oil vegan will obviously eat no-oil vegan. So, when a party of 6 enters your restaurant and one is vega-anything, you can always accommodate them with a no-oil vegan dish. You simply cannot go wrong. This new life is getting interesting.
