Why Lifestyle Medicine Advocates Whole-Food Plant-Based Diet

Overview

One of the areas of focus on Lifestyle Medicine is nutrition. When you hear the word “nutrition”, isn't it that the first thing that enters your mind is food because it nourishes you?

Food is a vital part of our culture and traditions. We celebrate birthdays, anniversaries, weddings, and other festivities with food. Daily, we socially connect over food like having a cup of tea with a friend or telling a story to your family while having dinner. Thus, for us, food represents so many things. Yet, how ironic that the food that is supposed to nourish us is becoming one of the factors that could kill us.

This article will explain why it is so and why Lifestyle Medicine advocates a whole-food plant-based diet.

Food

As mentioned earlier, food is something that nourishes and sustains us. If we read the Bible, God has given instructions on what and what not to eat. Over the course of history, man learned to use heat (it could mean fire and/or spices), salt, sugar, and fat in food. Also, man learned how to preserve foods to make it last a little longer.

However, as the world becomes industrialized and modern, so do our methods of food preparation and preservation. Mechanical processes of food packaging became fast and food manufacturing became a booming business. What used to take hours to prepare and to cook could be served in an instant. What used to be served hot on a plate could now be bought frozen to be microwaved for a few seconds just before serving.

The government, on the other hand, promoted food groups (from the Go, Grow, and Glow foods, to the Food Pyramid, up to the My Plate food groups) to encourage every household to be conscious of food and nutrition.

Then enter advertising and promotions, the most powerful influencer of all time. Through advertising people could make choices on what food to buy or eat and where to buy it from. Yet, almost 70% of Americans are either overweight or obese and majority of the causes of death are lifestyle-related.

A lot of people are gaining weight because of the meals they are choosing to eat. The gourmet recipes that are often demonstrated by chefs on television contain high amounts of fat, sugar, and salt. We don’t really get a lot of representation on media of foods that are much healthier to us. As a result, what we’re seeing on media has been influenced by the companies wanting to make profits and sell their products rather than what foods that we need to eat.

This is rather a challenging issue.

Forks Over Knives

For those who haven’t read about my story, I used to be overweight, had diabetes, gastric bloating, and sinus allergy. My husband, who is also a physician, had gouty arthritis, asthma, high cholesterol, diabetes, hypertension, sleep apnea, and obesity.

One evening in August 2017, we just had dinner. I finished tidying up the kitchen and proceeded to our home office to watch this Filipino TV series that I've been following for some time. After a few minutes, I stood up to go and get something from the kitchen and passed by my husband who was sitting at our formal dining table and watching what I thought was a movie. I stopped and asked him what he was watching.

"Forks over Knives," he said. "I think you'll like this one because it talks about food and healthy eating which reverse chronic disease.”

It intrigued me, especially when I saw Dr. Michael Greger in that documentary. I attended Dr. Greger's two-hour presentation, bought his book "How Not to Die," but I didn't actually read it. I sat beside my husband and together watched the documentary.

Forks Over Knives became a light bulb that switched us on into a different attitude towards food. At first, we had many doubts. We never heard about this in medical school or in our medical training. But after so many years of making serious changes to our diet and practicing everything we know in medicine, we felt nothing helped. So what is there to lose if we try switching to the whole-food plant-based diet?

Whole-Food Plant-Based Diet

The definition of what constitutes a whole-food, plant-based diet is vague. It is not necessarily a set diet like what most popular diets are but it is more of a lifestyle.

In September 2018, the American College of Lifestyle Medicine (ACLM) issued an official position statement on the role of diet in Lifestyle Medicine. They recommend on eating a predominantly plant-based food such as vegetables, fruits, whole grains, legumes, nuts and seeds for the treatment, reversal and prevention of lifestyle-related chronic disease. For chronic lifestyle-related diseases the best treatment is intensive lifestyle change which could restore health and wholeness.

Based on the ACLM’s recommendation, the whole-food, plant-based (WFPB) diet follows these basic principles:

• WFPB diet focuses on vegetables, fruits, whole grains, legumes, seeds, and nuts. These should make up the majority of what you eat rather than having them as secondary ingredients or garnishes.

• WFPB diet emphasizes whole, minimally-processed foods. For example, choose a food item made from whole potatoes rather than made from potato flour. Or prefer freshly-squeezed orange juice rather than the one you bought from the store.

• WFPB diet limits or avoids animal products like dairy, eggs, and honey. Your head may be shaking but you'll see later why.

• WFPB diet excludes refined foods like added sugars, white flour, and processed oils.

• WFPB diet pays attention to food quality. As much as possible, food should be locally sourced and organic whenever possible.

Because plant-based diets vary depending on the amount of animal products are present in their diet, the WFPB diet is often confused with vegan or vegetarian diets. Although similar in some ways, these diets are not the same.

Vegetarian diets exclude all meat and poultry from their diets, but some vegetarians may eat eggs, seafood or dairy. Vegan diets abstain not just from meat and poultry but also from any animal products, including dairy, seafood, eggs and honey. The WFPB diet, on the other hand, avoids all meat, poultry, animal products, eggs, milk and dairy products, and seafoods. Unlike the vegan diet, the WFPBD pays special attention to a high fiber diet and avoids (if not limit) intake of of any processed foods, oil, sugar, artificial sweeteners, and salt.

The Science Behind It

Before I proceed to discuss more about the WFPB diet, let me go back to the Forks Over Knives documentary.

One of the doctors featured in the documentary was Dr. Colin Campbell of Cornell University’s nutritional science department. In the mid-1960s Dr. Campbell was giving more protein to millions of malnourished children in the Philippines. To keep costs down he and his colleagues decided not to use animal-based protein. The program was beginning to show success but then Dr. Campbell stumbled upon two studies.

The first study centered on affluent families in the Philippines who were relatively eating high amounts of animal-based foods and at the same time their children were found to be susceptible to getting liver cancer.

The second study (and this blew my mind) came from a scientific paper published in a little-known Indian medical journal. It detailed work that had been done on a population of experimental rats that were first exposed to a carcinogen called aflatoxin. Then, these rats were fed a diet of casein, the main protein found in milk. They tested the effect of protein on the development of cancer. They used different levels of protein: one group were fed 20% protein out of the total calories and the other group were fed a much lower level of 5%. The result showed that those rats fed with 20% protein developed cancer, while the other rats that were fed with 5% protein did not.

This Indian study together with what Dr. Campbell had learned about increased liver cancers in children eating animal-based foods combined to create a decisive moment in his work. If you have time to watch Forks Over Knives, you’ll see how a whole-food plant-based diet could reverse chronic diseases and why you should limit or avoid animal meat and by-products.

Your Food Choices in the WFPB Diet

For simplicity, let us group the foods in the WFPB diet into six:

Vitamins & Minerals:

• Vegetables: kale, spinach, tomatoes, broccoli, cauliflower, carrots, asparagus, peppers, etc.

Proteins:

• Legumes: green peas, chickpeas, lentils, peanuts, black beans, etc.

• Seeds, nuts and nut butters: almonds, cashews, macadamia nuts, pumpkin seeds, sunflower seeds, etc.

• Unsweetened plant-based milks: soy milk, almond milk, cashew milk, etc.

• Plant-based protein: tofu, tempeh, tahini, mushrooms, etc.

Carbohydrates:

• Starchy vegetables: potatoes, sweet potatoes, taro, yam, etc.

• Whole grains: brown rice, oats, quinoa, wheat, barley, etc.

Fats:

• Healthy fats: avocados, nuts, seeds

Sugars:

• Fruits: berries, citrus fruits, pears, peaches, pineapple, bananas, etc.

Others:

• Spices, herbs and seasonings: basil, rosemary, turmeric, curry, black pepper, salt, etc.

• Condiments: salsa, mustard, nutritional yeast, soy sauce, vinegar, lemon juice, etc.

• Beverages: coffee, tea, water, natural fruit juices

You will see that everything our body needs is found on plants. All you have to do is to mix and match these items to suit your needs and taste. Also, you can start substituting these items for animal-based products that you were used to. For example, choose soya or almond milk over cow’s milk.

How To Transition

Transitioning to a whole-foods, plant-based diet doesn’t have to be difficult. You don’t have to go 100% immediately. Even just by taking one step at a time, such as replacing one meat-based meal a week with a vegetarian meal, would do. Here are some tips to help you get started.

• Start building a meal around a salad. Fill a bowl with salad greens such as Romaine lettuce, iceberg lettuce, spinach, or any other leafy greens. Add an assortment of other vegetables like carrots, cucumber, bell peppers, onions, beans, peas, or tofu. Season with fresh or dried herbs and make your own salad dressing.

• If you’re already used to eating salads, eat lots of other vegetables, too. Fill half of your plate with vegetables during lunch and dinner. Make sure to include as much as the colors of the rainbow in choosing vegetables. Each food color is rich in certain vitamins and minerals which other colors don’t have as much.

• Another way for you to transition to the WFPB diet is to cook a vegetarian meal at least once a week. Remember #MeatlessMonday? You can start having your own meals around beans, whole grains, and vegetables. Try substituting tofu and mushrooms for meat.

• Vegetables like cucumber, carrots, and jicama can be eaten as a healthy snack. You can also start with plant-based dips like hummus, salsa, or guacamole.

• Change the way you perceive meat as the source of protein. As I've mentioned earlier, plants do have proteins, too. Start by having a smaller portion of meat and use it as a garnish or flavor instead of making the meat as the dish’s main ingredient.

• Choose good fats. Start using olive oil, and nut butters. Soon, you'll discover that plant-based fats and oils are not as "heavy" as animal fat or lard.

• Breakfast should include whole grains. Start with oatmeal or quinoa. Add some nuts or seeds, fresh or dried fruits, and plant-based milk.

• Try other cooking methods. Learn how to cook using different methods like steaming, blanching, grilling, braising, or stir-frying to preserve their flavor and nutrients. As much as possible, avoid deep-frying.

• For dessert, eat a fruit. Let fruits be your source of natural sugars. Eat whatever fruits in season.

The Benefits

Eating a whole-food plant-based diet has its benefits.

• Weight Loss - The high fiber content of the WFPB diet plus the avoidance of processed foods is already a winning combination in weight loss. Cutting out soda, candies, fast food, and refined grains is already a powerful weight loss plan in itself.

• Lower Risk and Reduced Symptoms of Chronic Diseases - Plant-based diets have a higher number of antioxidants and compounds that have been shown to reduce the risk of developing diabetes or to slow the progression of Alzheimer’s disease. Same is true with heart diseases and cancers.

• Protection of the Environment - Adopting sustainable eating habits can help reduce the greenhouse effect, water consumption and land used for factory farming, which are all factors in global warming and degradation of the environment.

• Assistance to our Local Farmers - Reducing the number of animal products in your diet and purchasing local, sustainable produce helps drive the local economy. This reduces the reliance on factory farming which is an unsustainable method of food production.

Conclusion

The food industry has spent lots of money experimenting what particular food combinations and marketing strategies are going to make us most likely to buy their products. It is easy to become quite attached to these foods, not only because we are already used to it but also because to go without them gives us withdrawal effects. Thus, when transitioning to a whole-food plant-based diet, many would ask, “How should I do it?” or “Do I go slowly or do I simply go cold turkey?” It depends very much on who you are and what you are trying to achieve.

The whole-food part is just telling us that nature has provided us with food. Let us try and respect the food in the way nature provides us rather than processing it by adding preservatives, flavorings, colorings, etc. For example, with grains, the more we refine them and make them into flour, the more they bypass our natural digestive system so that we get rapid rises of blood sugar by eating white flour products as opposed to a whole grain bread.

The plant-based part is telling us to choose foods from plants and avoiding animal products. As I've said earlier, you don’t have to go 100% in an instant. Replace one meat-based meal a week with vegetables and test the waters. Try it out and see how it feels.

And most importantly, you have to love yourself. There is no point beating yourself up, then feeling you're a failure, and eventually giving up. Lifestyle change is recognizing that life is challenging but hopeful as long as there is time. Let time work with you rather than against you. Gently nurture yourself and decide how you want to go forward.

Also, get support. It’s great when you can do it with other people. Finding someone else who is interested in joining you along the journey would help you achieve the lifestyle change you’re desiring for.

If you are not yet ready to go 100% on a whole-food plant-based diet, feel free to schedule a consultation. I will help and work with you to make changes at whatever pace you are comfortable with. There is a health program that might suit your needs. Or if you want to hear from me discuss more about Lifestyle Medicine, feel free to listen to my podcast. If you want to be updated with news and features from this website, subscribe to my newsletter or reach out using the contact forms below.

Sources:

American College of Lifestyle Medicine. 2018. “Position Statement for Treatment and Potential Reversal of Disease.” PR Web, September 25, 2018.

Flower, Meridee. 2020. “Why Adopt the Whole Food Plant Based Diet?” Atticus Health. October 27, 2020.

Fulkerson, Lee. 2011. “Forks over Knives.” Documentary film. https://www.forksoverknives.com/. https://www.forksoverknives.com/the-film/.

Kubala, Jillian. 2018. “Whole-Foods, Plant-Based Diet: A Detailed Beginner’s Guide.” Healthline. June 12, 2018.

McManus, Katherine. 2018. “What Is a Plant-Based Diet and Why Should You Try It? - Harvard Health Blog.” Harvard Health Publishing, Harvard Medical School. September 27, 2018.

Lifestyle Medicine: The Foundation of Conventional Medicine

This website mentioned in one of the pages that Lifestyle Medicine is the foundation of conventional medicine. When you think about it, it is true. Lifestyle Medicine is a new subspecialty although it has been practiced for thousands of years.

The current COVID-19 pandemic --- together with its consequential imposed safety protocols, quarantines, and community lockdowns --- has forced us to return to the basics and evaluate our current lifestyles. It has changed our approach to everything and that includes a heightened understanding of the importance of exercise, nutrition, stress management, sleep, social relationships, and avoiding toxic substances. Suddenly, the six main focus of Lifestyle Medicine became the center of public consciousness. This article will explain why and how it is so and will describe the basic structure of Lifestyle Medicine as a medical discipline.

Historical Perspective

To understand better the origins of Lifestyle Medicine, let us compare the causes of death between 1900 and 2019. The figure below shows a big difference.

During the 1900’s, acute and infectious diseases ranked high among the causes of death. You will see that all forms of pneumonia ranked first followed by all forms of tuberculosis.

At that time, the technology in medicine focused on the discoveries of cures. The identification of bacteria, the creation of antibiotics and vaccines, and the improvements in sanitation and hygiene that started in the late 19th century trickled down to the early 1900s in the race for eradicating these infectious diseases.

Yet, in 1918, the Spanish flu pandemic came and caused 20 million deaths worldwide in less than one year. This clearly illustrates how unpredictable the emergence of diseases could be. The appearance of AIDS, the re-emergence of multidrug-resistant TB strains during the 1980s and early 1990s provide additional evidence that as long as microbes can evolve, new diseases will appear. Who would have thought that COVID-19 could be this dangerous?

These infectious diseases underscore the importance of disease prevention through continual monitoring of underlying factors.

However, as time went on, the modern post-industrial era resulted in changes of living conditions and lifestyle behaviors. Scientific and technological advances played a major role and became the foundation for today's disease surveillance and control systems.

But despite the technological advances, by 2019, the leading causes of death became chronic in nature. You will see that heart diseases ranked first followed by all forms of cancer. It is even disturbing that suicide ranked tenth. Studies indicated that most chronic diseases are the result of lifestyles fueled by poor nutrition and physical inactivity. It just shows that there is a correlation between modernity and technologies that developed over time during the 20th and early 21st centuries and the changes in human lifestyles.

Chronic diseases are also responsible for most of our health care expenditures. Since 2010, nearly 18% of the US gross national product has been spent on health care, which exceeded $3.0 trillion in 2015. And with the current COVID-19 pandemic, our healthcare system might be on the verge of bankruptcy. If 1 in 10 individuals in the United States would adopt a healthy lifestyle, the amount of money saved could result in billions of dollars saved.

And that is what medical experts have been talking about the past decades until now. Lifestyle medicine first became a movement then later on it developed into a medical discipline.

Lifestyle Medicine vs. Conventional Medicine

Medical experts defined Lifestyle Medicine as the application of the principles on environment, behavior, and motivation, including self-care and self-management, in the management of chronic diseases which were lifestyle-related in a clinical setting. As mentioned in this website, Lifestyle Medicine is also an evidence-based approach. Below is a comparison between conventional medicine as we know it and Lifestyle Medicine as a discipline.

As you can see, the focus has shifted to the patient himself as it emphasizes self-care and self-management. The doctor acts only as the coordinator and motivator.

In order to prevent further complications of chronic diseases and chronic diseases itself, lifestyle medicine should become the primary approach to its management and prevention. It is time to change the destiny of our health by shifting our attitude toward a healthy lifestyle. That shift should also provide a positive impact which should be carried forward to our children as they mature. It is also our aim that the younger population should be exposed to this healthy lifestyle approach and should begin at a very young age.

The idea that many chronic diseases are simply the result of aging must be corrected. Hypertension, heart disease, diabetes, and osteoarthritis are not inevitable outcomes of aging, but are an end product of poor lifestyles.

There are four areas in conventional medicine where lifestyle medicine could be added: 1) the science (the epidemiology), 2) the art (the skills), 3) the materials (the tools) and 4) the procedures (the actions).

The Science

The dictionary defines “epidemiology” as a branch of medical science that deals with the incidence, distribution, and control of disease in a population. Simply put, it understands the causes of the disease and where the disease is, plus it includes its control and prevention. It was rather easy for infectious diseases to study its epidemiology because medical experts can pinpoint to a single biological cause and can also pinpoint the corresponding cure.

However, when it comes to chronic diseases, it is rather complex. Medical experts cannot pinpoint a single cause, but rather defines its epidemiology in collective terms like “determinants”, “markers”, or “risk factors”. Also, in a recent medical study, the term “anthropogens” surfaced. It is defined as “man-made environments, their by-products and/or lifestyles encouraged by those environments, some of which have biological effects which may be detrimental to human health”. The figure below shows how determinants or risk factors could become chronic diseases over time.

Therefore, a Lifestyle Medicine physician would study the interactions between these determinants of chronic diseases and conditions because all influences, and not just the obvious, need to be managed for optimal health. However, through the decades, leading proponents of lifestyle medicine have faced resistance or marginalization. Yet, studies show that more than 80% of chronic diseases could be avoided by recommending changes to a healthy lifestyle. Also, 80% of the population wants to live in a better state of health but do not know how to pursue it.

The Art

It was only during the last few decades that medicine was considered not just a science but also an art. The practice of Lifestyle Medicine requires huge amounts of motivation which includes both academic and professional skills in behavioral science and change. These skills are used in persuasion, motivation, education, and coaching.

Also, Lifestyle Medicine focuses on the risk factors rather than the disease itself although medical prescriptions are still an adjunct to therapy and medical intervention.

It also zeroes into the problem of poor lifestyle choices based on misinformation. Most patients typically gather their food and nutrition information from popular media rather than from clinicians, many of whom may have limited knowledge of lifestyle interventions. Another factor is the limited time provided in the traditional one-on-one medical consultation.

The Tools

Digital technologies has resulted in an array of lifestyle tools that help monitor and provide feedback to individuals. These self-operated digital gadgets are available to the public and most health-conscious individuals use these to monitor their blood pressure, blood sugar, heart rate, etc. This behavior has shifted the patients’ role from a minimally-informed recipient to an active collaborator. Thus, Lifestyle Medicine tools center on the concept of the “quantified self”. Patients now have the responsibility and control to measure what needs to be measured and monitored.

The Procedures

There are still several existing procedures in conventional medicine such as referrals, medication, and surgery (if needed) that are used in the practice of Lifestyle Medicine. I incorporate Lifestyle Medicine in my practice of Internal Medicine although there are new procedures that are unique to Lifestyle Medicine like shared medical appointments for the Group Starter Program and telephone triaging during the free medical consultation.

Integrating Lifestyle Medicine into clinical practice in the areas of food, nutrition, exercise, and stress reduction is now common. Creating change takes courage and a willingness to think creatively as we shift our medical system.

There are professional associations in Lifestyle Medicine in 18 countries around the world and still counting. The structure and pedagogy of Lifestyle Medicine as a medical discipline is still in its infancy. That is why sharing best practice models among peers will result in the most effective care of our patients.

Conclusion

Chronic diseases predominate the leading causes of death in the recent decade. But since there is no single cause for chronic diseases, medical experts describe its epidemiology collectively as risk factors. Studying these risk factors points out to lifestyle as the bottom line and over time, what first became a movement became a medical discipline called Lifestyle Medicine. Also, Lifestyle Medicine adds to the science, the art, the tools and the procedures of conventional medicine. Although Lifestyle Medicine is now recognized worldwide, it is still a medical discipline in progress.

Should you be interested in Lifestyle Medicine, feel free to schedule a consultation. Who knows? There is a health program that might suit your need. If you want to hear from me discuss more about Lifestyle Medicine, feel free to listen to my podcast. If you want to be updated with news and features from this website, subscribe to my newsletter or reach out using the contact form below.

Sources:

Birrell, Fraser. 2020. “Inaugural Lifestyle Medicine Editorial.” Wiley Lifestyle Medicine. May 15, 2020.

Bodai, Balazs, Therese Nakata, William Wong, Dawn Clark, and Steven Lawenda. 2017. “Lifestyle Medicine: A Brief Review of Its Dramatic Impact on Health and Survival.” The Permanente Journal. September 17, 2017.

Centers for Disease Control and Prevention. n.d. “Leading Causes of Death, 1900-1998.” Centers for Disease Control and Prevention. Accessed March 17, 2021.

---. “Leading Causes of Death.” National Center for Health Statistics, Centers for Disease Control and Prevention.

Egger, Garry. 2019. “Lifestyle Medicine: The ‘Why’, ‘What’ and ‘How’ of a Developing Discipline.” Australian Journal of General Practice. October 2019.

Merriam-Webster, Inc. n.d. “Epidemiology.” Merriam-Webster Dictionary. Accessed March 19, 2021.