Abstract
The objective of this article is to present to physicians an update on plant-based diets.
Concerns about the rising cost of health care are being voiced nationwide, even as unhealthy lifestyles are contributing to the spread of obesity, diabetes, and cardiovascular
disease. For these reasons, physicians looking for cost-effective interventions to improve
health outcomes are becoming more involved in helping their patients adopt healthier
lifestyles. Healthy eating may be best achieved with a plant-based diet, which we define
as a regimen that encourages whole, plant-based foods and discourages meats, dairy
products, and eggs as well as all refined and processed foods. We present a case study
as an example of the potential health benefits of such a diet. Research shows that plantbased diets are cost-effective, low-risk interventions that may lower body mass index,
blood pressure, HbA1C, and cholesterol levels. They may also reduce the number of
medications needed to treat chronic diseases and lower ischemic heart disease mortality
rates. Physicians should consider recommending a plant-based diet to all their patients,
especially those with high blood pressure, diabetes, cardiovascular disease, or obesity.
Introduction
In the HBO documentary The Weight
of the Nation, it was noted that if you
go with the flow in the US, you will
eventually become obese.1 In 2011, Witters reported that in some areas of the
country, the rate of obesity is 39% and is
increasing at a rate of 5% per year.2 Risks
of obesity, diabetes, hypertension, and
cardiovascular disease, along with their
ensuing complications (eg, behavioral
health and quality-of-life problems) often
go hand-in-hand and are strongly linked
to lifestyle, especially dietary choices.3
Of all the diets recommended over the
last few decades to turn the tide of these
chronic illnesses, the best but perhaps
least common may be those that are
plant based.
Despite the strong body of evidence
favoring plant-based diets, including studies showing a willingness of the general
public to embrace them,4 many physicians
are not stressing the importance of plantbased diets as a first-line treatment for
chronic illnesses. This could be because
of a lack of awareness of these diets or a
Philip J Tuso, MD, is the Regional Co-Lead for the Complete Care Program of the Southern California Permanente
Medical Group and the National Physician Lead for the Care Management Institutes Total Health Program. E-mail:
phillip.j.tuso@kp.org. Mohamed H Ismail, MD, is a Physician at the Riverside Medical Center in CA. E-mail:
mohamed.h.ismail@kp.org. Benjamin P Ha, MD, is the Associate Area Medical Director for Family Medicine at the
Bakersfield Medical Center in CA. E-mail: benjamin.p.ha@kp.org. Carole Bartolotto, MA, RD, is a Senior Consultant for
Regional Health Education for the Southern California Permanente Medical Group. E-mail: carole.a.bartolotto@kp.org.
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an increased risk of cardiovascular mortality.29 Low meat intake has been associated
with longevity.30
In 2012, Huang et al31 performed a
meta-analysis to investigate cardiovascular
disease mortality among vegetarians and
nonvegetarians. They only included studies that reported relative risks and corresponding 95% confidence intervals. Seven
studies with a combined total of 124,706
participants were analyzed. Vegetarians
had 29% lower ischemic heart disease
mortality than nonvegetarians.31
Health Concerns About
Plant-Based Diets
Protein
Generally, patients on a plant-based
diet are not at risk for protein deficiency.
Proteins are made up of amino acids,
some of which, called essential amino
acids, cannot be synthesized by the body
and must be obtained from food. Essential amino acids are found in meat,
dairy products, and eggs, as well as many
plant-based foods, such as quinoa.32 Essential amino acids can also be obtained
by eating certain combinations of plantbased foods. Examples include brown
rice with beans, and hummus with whole
wheat pita. Therefore, a well-balanced,
plant-based diet will provide adequate
amounts of essential amino acids and
prevent protein deficiency.33
Soybeans and foods made from soybeans are good sources of protein and
may help lower levels of low-density
lipoprotein in the blood34
and reduce the risk of hip
Vegetarian
fractures35 and some cancers.
diets were
A study in the Journal
associated
of the American Medical
with lower
Association36 reported that
women with breast cancer
systolic and
who regularly consumed soy
diastolic blood
products had a 32% lower
pressure
risk of breast cancer recurrence and a 29% decreased
risk of death, compared with women who
consumed little or no soy.36 An analysis
of 14 studies, published in the American
Journal of Clinical Nutrition, showed that
increased intake of soy resulted in a 26%
reduction in prostate cancer risk.37
Because of concerns over the estrogenic nature of soy products, women
with a history of breast cancer should
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Medicine
Let food be thy medicine and medicine be thy food.
Hippocrates, c 460-370 BCE, ancient Greek physician in the
Age of Pericles known as the father of modern medicine
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