Top 5 Misconceptions About Food: A Doctor’s Daily Experience by Michelle McMacken, M.D.

As a primary care doctor, I spend my days taking care of patients with diabetes, high blood pressure, high cholesterol, heart disease, and obesity. I also see “healthy” patients whose eating habits are starting them on the road to a future filled with doctor’s appointments and hospital visits.

I enjoy reminding my patients that their fork can be more powerful than my prescription pad when it comes to preventing and reversing chronic diseases. This conversation usually uncovers some common misconceptions about food and nutrition. Here are five myths that I hear almost every day, among patients and colleagues alike:

1. “I need to eat more protein.”

Many people don’t realize that the average American consumes more than twice the Recommended Dietary Allowance (RDA) of protein, most of it from animal products. 1,2Unfortunately, animal-based proteins have been shown to promote faster growth, not only of normal cells but of cancer cells, and have been linked to a variety of cancers as well as heart disease, diabetes, Alzheimer’s disease, and kidney stones.3,4

Plant foods contain plenty of protein, and a whole-foods, plant-based diet actually provides exactly what’s recommended in terms of protein requirements – about 8-10% of total daily calories from protein.  This happens naturally when people eat a diet of diverse, whole plant foods – there is no need to count grams of protein!  And unlike animal proteins, plant proteins from whole foods are not associated with cancer or other chronic diseases.  In fact, these foods actually prevent many of the diseases we see today!

2. “I need to drink milk to have strong bones.”

Many people equate dairy with calcium, strong bones, and the prevention of osteoporosis (low bone density). Generations of advertising slogans have perpetuated this idea. However, dairy isn’t the answer here. Studies show that dairy products may actually increase the risk of fractures related to osteoporosis!5-7

The biological purpose of cow’s milk is to support the rapid growth of a calf. Humans have no nutritional or medical need to consume the milk of cows or any other nonhuman species. Cow’s milk has significant levels of female hormones, and usually contains antibiotics, pesticides, saturated fat, and cholesterol — substances that definitely do NOT do a body good! Dairy has been specifically linked with prostate, ovarian, and uterine cancer, as well as heart disease and early death.7-13

The best sources of calcium come from the earth, in foods such as kale, broccoli, bok choy, and Brussels sprouts. As a bonus, these vegetables are high in vitamin K, which is also important for strong bones. Beans may be an especially good source of calcium, because they are also high in phytates, antioxidant compounds that may enhance mineral absorption14 (despite common perception to the contrary) and thus protect bone density.15 Many brands of soy milk, almond milk, orange juice, and tofu are fortified with calcium and vitamin D, just as cow’s milk is artificially fortified with these nutrients. However, there is no need to specifically target calcium sources in the diet; a diverse, whole-foods, plant-based diet will provide all of the calcium you need.

3. “Chicken, turkey, fish, and eggs are healthy sources of protein.”

Chicken, turkey, fish, and eggs contain significant amounts of cholesterol and saturated fat, in many cases as much as beef,16 so they are not “heart healthy” foods. Plant-based sources of protein contain zero cholesterol and far less saturated fat. Chicken and turkey usually contain antibiotics, pesticides, and fecal contaminants, and have been associated with salmonella, staph, and other infectious disease outbreaks. Chicken, fish, and eggs have been associated with an increased risk of diabetes.17-25 Almost all fish contain mercury, which can cause neurologic and cognitive problems; many also contain polychlorinated biphenyls (PCBs), a toxin associated with cancer.16 And a recent study showed that eggs cause intestinal bacteria to make a substance called TMAO, which can trigger heart attacks and other cardiovascular events.26

Whole plant foods supply plenty of protein, and they don’t come packaged with cholesterol or high levels of saturated fat. Instead, their protein is bundled with fiber and many necessary nutrients! Great plant-based sources of protein include lentils, chickpeas, black beans, kidney beans, soybeans, and quinoa. Green vegetables such as spinach, collards, broccoli, and peas are also quite high in protein per calorie. But remember, it’s not necessary to seek out plant foods high in protein, since a varied whole-food, plant-based diet will naturally provide enough protein, without special effort.27

4. “I can’t eat carbs.”

Many people are mistakenly led to believe they should avoid carbohydrates, particularly for weight management and diabetes control. Instead, they focus on proteins — especially animal proteins — and fats. Sadly, this approach actually increases the risk of chronic disease and death,28-32 and it deprives people of the numerous nutrients found in carbohydrate-containing foods.

It is true, however, that not all carbohydrates are created equal. Refined, highly processed carbohydrates can raise triglycerides, promote weight gain, and drive up blood sugar. On the other hand, starches that come from whole grains bring fiber, essential fatty acids, B vitamins, zinc, and protein into our diets and provide an excellent source of energy. Beans, legumes, starchy vegetables, and fruits are other healthy carbohydrate sources. Balancing these foods with nonstarchy vegetables is an optimal way to eat for weight loss, diabetes control, and reversal of heart disease.

5. “Healthy food is too expensive.”

You don’t need to shop at a gourmet health food store to find nutritious foods. Actually, some of the healthiest foods are the least expensive, and they are readily available at most grocery stores and many local farmers’ markets. Beans, lentils, brown rice, and frozen vegetables are usually inexpensive, especially when bought dried and in bulk. (Organic fruits and vegetables can cost more, but eating nonorganic plant-based foods is still more nutritious than eating meat, chicken, fish, eggs, and dairy, organic or otherwise.)

Even when processed foods and animal products are sold cheaply, they are expensive in terms of the cost to your health. What you may save now, you could end up spending later in pharmacy co-payments and medical bills!

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Michelle McMacken, M.D., is a board-certified internal medicine physician and an assistant professor of medicine at NYU School of Medicine.  She practices primary care at Bellevue Hospital Center in New York City, where she also directs a medical weight-loss program.  An enthusiastic supporter of plant-based nutrition, she is committed to educating patients, medical students, and doctors about the power of healthy eating and lifestyle modification. Be sure to connect and follow Dr. McMacken on Twitter.

This article was previously published on Forks Over Knives.

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References:

1 Institute of Medicine. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington, DC: National Academies Press; 2002.

2 Rizzo NS, Jaceldo-Siegl K, Sabate J et al. Nutrient profiles of vegetarian and nonvegetarian dietary patterns. J Acad Nutr Diet 2013; 113(12):1610-9.

3Campbell TC, Campbell TM. The China Study: Startling Implications for Diet, Weight Loss, and Long-Term Health. Dallas: BenBella Books; 2006.

4 Barnard NB, Weissinger R, Jaster BJ, et al. Nutrition Guide for Clinicians, First Edition. Washington, DC: Physicians Committee for Responsible Medicine; 2007.

5 U.S. Department of Health and Human Services. Bone Health and Osteoporosis: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Office of the Surgeon General; 2004.

6 Feskanich D, Willett WC, Colditz GA. Calcium, vitamin D, milk consumption, and hip fractures: a prospective study among postmenopausal women. Am J Clin Nutr 2003; 77:504-11.

7 Michaëlsson K, Wolk A, Langenskiöld S, et al. Milk intake and risk of mortality and fractures in women and men: cohort studies. British Medical Journal2014;349:g6015.

8 Qin LQ, Xu JY, Wang PY, et al. Milk consumption is a risk factor for prostate cancer: Meta-analysis of case-control studies. Nutr Cancer 2004; 48(1):22-7.

9 Qin LQ, Xu JY, Wang, PY, et al. Milk consumption is a risk factor for prostate cancer in Western countries: Evidence from cohort studies. Asia Pac J Clin Nutr 2007; 16(3):467-76.

10 Chan JM, Stampfer MJ, Ma J, et al. Dairy products, calcium, and prostate cancer risk in the Physicians’ Health Study. Presentation, American Association for Cancer Research, San Francisco, April 2000.

11 Chan JM, Stampfer MJ, Giovannucci E, et al. Plasma insulin-like growth factor-I and prostate cancer risk: a prospective study. Science 1998; 279:563-565.

12 Genkinger JM, Hunter DJ, Spiegelman D, et al. Dairy products and ovarian cancer: a pooled analysis of 12 cohort studies. Cancer Epidemiol Biomarkers Prev 2006; 15:364–72.

13 . Ganmaa D, Sato A. The possible role of female sex hormones in milk from pregnant cows in the development of breast, ovarian, and corpus uteri cancers. Med Hypotheses 2005; 65:1028–37.

14 http://nutritionfacts.org/video/phytates-for-the-prevention-of-osteoporosis/

15 López-González AA, Grases F, Monroy N, et al. Protective effect of myo-inositol hexaphosphate (phytate) on bone mass loss in postmenopausal women. Eur J Nutr 2013; 52(2):717-26.

16 Simon, D. Meatonomics. San Francisco, Conari Press, 2013.

17Li Y, Zhou C, Zhou X, et al. Egg consumption and risk of cardiovascular diseases and diabetes: a meta-analysis. Atherosclerosis 2013; 229(2):524-30.

18 Djoussé L, Gaziano JM, Buring JE, et al. Egg consumption and risk of type 2 diabetes in men and women. Diabetes Care 2009; 32(2):295-300.

19 Radzevičienė L1, Ostrauskas R. Egg consumption and the risk of type 2 diabetes mellitus: a case-control study. Public Health Nutr 2012; 15(8):1437-41.

20 Tonstad S, Butler T, Yan R, et al. Type of vegetarian diet, body weight, and prevalence of type 2 diabetes. Diabetes Care 2009; 32(5):791–6.

21 Chiu TH, Huang H, Chiu Y. Taiwanese vegetarians and omnivores: dietary composition, prevalence of diabetes and impaired fasting glucose. PLoS One 2014; 9(2):e88547.

22 van Nielen M, Feskens EJ, Mensink M. Dietary protein intake and incidence of type 2 diabetes in Europe: the EPIC-InterAct Case-Cohort Study. Diabetes Care 2014; 37(7):1854-62.

23 van Woudenbergh GJ, van Ballegooijen AJ, Kuijsten A, et al. Eating fish and risk of type 2 diabetes: a population-based, prospective follow-up study. Diabetes Care 2009; 32:2021–6.

24 Kaushik M, Mozaffarian D, Spiegelman D, et al. Long-chain omega-3 fatty acids, fish intake, and the risk of type 2 diabetes mellitus. Am J Clin Nutr 2009; 90:613–20.

25 Djoussé L, Gaziano JM, Buring JE, et al. Dietary omega-3 fatty acids and fish consumption and risk of type 2 diabetes. Am J Clin Nutr 2011; 93:143–50.

26 Tang WH, Wang Z, Levison BS. Intestinal microbial metabolism of phosphatidylcholine and cardiovascular risk. N Engl J Med 2013; 368(17):1575-84.

27 Young VR, Pellett PL. Plant proteins in relation to human protein and amino acid nutrition. Am J Clin Nutr 1994; 59 (suppl):1203S-1212S.

28 Larsson SC, Orsini N. Red meat and processed meat consumption and all-cause mortality: a meta-analysis. Am J Epidemiol 2014; 179(3):282-9.

29 Lagiou P, Sandin S, Lof M, et al. Low carbohydrate-high protein diet and incidence of cardiovascular diseases in Swedish women: prospective cohort study. British Medical Journal 2012; 344:e4026.

30 Fung TT, van Dam RM, Hankinson SE, et al. Low-carbohydrate diets and all-cause and cause-specific mortality: two cohort studies. Ann Intern Med 2010; 153(5):289-98.

31 Noto H, Goto A, Tsujimoto T, et al. Low-carbohydrate diets and all-cause mortality: a systematic review and meta-analysis of observational studies. PloS One 2013; 8(1):e55030.

32 de Koning L, Fung TT, Liao X, et al. Low-carbohydrate diet scores and risk of type 2 diabetes in men. Am J Clin Nutr 2011; 93(4):844-50.

As always the information presented in this blog is for educational purposes only. It should not be considered as specific medical, nutritional, lifestyle, or other health-related advice.

Patient Googles His Way Out of Bypass Surgery*

By Robert Ostfeld, MD, MSc

One of the most common operations performed in the world today is coronary artery bypass graft surgery (CABG). I would like to share with you the remarkable story of a recent Cardiac Wellness Program patient here at Montefiore Medical Center (I’ll call him Mr. J), who changed his diet and averted the CABG knife.

Mr. J is a middle-aged man with high cholesterol and a family history of heart disease. Understandably, he desperately wanted to avoid the problems that many in his family had faced, so he ate a “healthy” diet of chicken, fish, and low-fat dairy, with a few fruits and vegetables mixed in. And he exercised. A lot. In fact, he loved exercising so much that he would do it for two to three hours a day — brisk walking, playing sports, etc.

Mr. J. first visited a cardiologist at age 55, after having experienced several weeks of tightness in his neck during physical activity. The condition had worsened to the point that only 30 to 45 seconds of exercise brought on significant discomfort. The doctor ordered a stress test, to see if heart disease could be contributing to this symptom. The test results were so wildly abnormal that he was sent immediately to the hospital for a cardiac catheterization, to look for cholesterol blockages in the vessels that supply his heart with blood. Such severe blockages were found that he was admitted directly to the hospital for coronary artery bypass graft surgery. In less than one day, his life had changed dramatically.

While lying nervously in his hospital bed, he began to think that maybe there was another way to approach this disease, so he went online. There, he read about the impact of a whole-food, plant-based diet on heart disease, and he decided that was the path for him. He called the nurse, gave back his hospital gown, and despite the pleas of his medical team, signed himself out of the hospital against medical advice. Mr. J’s nurse was so concerned that before he was able to leave, she called his wife to have her convince him to stay. He did not. Later, the nurse even called Mr. J at home to plead for his return. He politely declined.

Soon thereafter he found our Cardiac Wellness Program at Montefiore. He was already taking all the appropriate medications, and he chose to completely change his lifestyle as well. He fully embraced a whole-food, plant-based diet without oil and had perhaps the most remarkable turnaround I have ever seen. Within one week, he went from being able to walk only a block before feeling tightness in his neck to walking 25 blocks without incident! Fast-forward three months and he was back to exercising two to three hours each day without symptoms. That is what I call remarkable!

A few weeks later, Mr. J got another call from his nurse. She had just been diagnosed with cholesterol blockages in her heart, and her doctors were recommending cardiac procedures. With Mr. J in mind, she told her doctors no way and called him to learn how to do exactly what he did: embrace a whole-food, plant-based diet!

Mr. J never did get that bypass surgery, nor did he get a coronary stent. In fact, he did not need to have any procedures at all. He got healthier with appropriate medications and by wholeheartedly embracing a whole-food, plant-based diet.

The key to health, it seems, lies at the end of your fork.

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*Postscript: While many heart patients may reverse their disease with lifestyle change alone, Mr. J also continued his prescribed medications, given the severity of his condition, and their doses were lowered as his health improved. Please note that I am not recommending lifestyle change over medical intervention for any particular person, as every case is of course different. Some cases are fraught with more risk than others, so please consult with both your physician and a physician trained in lifestyle medicine before making significant lifestyle changes.

This post was originally published on the Forks Over Knives blog, here.

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Cardiologist Robert Ostfeld, MD, MSc is the founder and director of the Cardiac Wellness Program at Montefiore Medical Center in New York City, where he encourages patients to embrace a whole-foods, plant-based diet. He earned his MD at Yale and his MSc in epidemiology at Harvard, and he is an associate professor of clinical medicine at the Albert Einstein College of Medicine.

As always the information presented in this blog is for educational purposes only. It should not be considered as specific medical, nutritional, lifestyle, or other health-related advice.

The Holistic Heart Book Review and Giveaway

Last month Dr. Joel Kahn offered a great guest post about where people can find reliable information about health and nutrition (I swear his very kind comment about my site was completely unsolicited!) However today I’m reviewing his new work and Dr. Kahn also agreed to send a copy of his book to a lucky winner so be sure to enter below!

Joel K. Kahn, M.D. The Holistic Heart Book: A Preventive Cardiologist’s Guide to Halt Heart Disease Now. A Reader’s Digest Book, 2013.

Since the early 90s when Dean Ornish, M.D. and Caldwell Esselstyn, M.D. first published their respective works proving that heart disease is not only caused by, but can also be reversed through lifestyle changes and diet, there has been a fury of research on the topic. Despite this, heart disease continues to be America’s number one killer, taking nearly 600,000 lives every single year. Dr. Joel Kahn, a preventative cardiologist and Clinical Professor of Medicine at Wayne State University School of Medicine has recently published his own heart health manifesto, which neatly ties the best research on heart disease into one easy to read and very informative book. It is no exaggeration to say, this book can literally change your life.

In clear and precise language Dr. Kahn explains how complex the heart really is, comparing it to the brain, as the heart has its own neurons, hormones, and electrical field. Dr. Kahn’s work is broken down into two sections. The first section reviews the most current research on heart disease.

Unlike Dr. Esselstyn’s Prevent and Reverse Heart Disease which focuses exclusively on diet and heart health, Dr. Kahn’s book takes a different approach and demonstrates that it takes a healthy body to have a healthy heart. For instance, the thyroid gland, which sits about a foot above the heart, can have a profound impact on heart health. Roughly 2% of Americans have an overactive thyroid, and another 5% have an underactive thyroid (hyperthyroidism and hypothyroidism). The disturbance caused by these hormonal imbalances can both greatly affect the heart in negative ways. In this section, Dr. Kahn also demonstrates the importance of healthy arteries and further complicates our understanding of HDL – basically it’s not as simply as calling it “good cholesterol.”

In the second part of the book, Dr. Kahn offers over 70 “prescriptions” that he often writes for his patients. However, these prescriptions are a far cry from the one your doctor would typically write you. Instead, this is where the book truly becomes “holistic,” although I mean that in best possible light. Backing everything up with citations to peer-reviewed articles, (and admitting when the evidence on certain topics is still weak - such as grounding). These prescriptions range all over the place, from eating your greens, to changing your cleaning supplies and deodorant, to practicing yoga (vitamin Y, as Dr. Kahn puts it).  

Surprisingly, (and perhaps slightly controversial) Dr. Kahn highly recommends several different vitamins and supplements. While he is very careful about which ones he actually recommends, he suggests discussing these with your primary doctor before adding any supplements to your regimen. Besides claiming that the research on the benefits of supplements is strong, he has also seen many of his patients thrive when they start including some supplements and vitamins. One in particular is CoQ10 – Coenzyme Q 10, which is a powerful antioxidant made by the body, helps assist cells to produce energy. Around the age of 40, our body’s production of this antioxidant begins to slow, and Dr. Kahn recommends it to many of his patients. (note: there was not a citation on this supplement)

While all of this could be overwhelming, Dr. Kahn recommends that people start slow, picking just a few of his prescriptions out to try for a few weeks before adding more to the routine. He writes that the goal is to incorporate as many as possible without adding additional stress to our lives. In fact, reducing stress is one of his main goals!

It needs to be added that Dr. Kahn considers himself an ethical vegan. That said, while he promotes and encourages a complete plant-based lifestyle, he is far less dogmatic than some of the other authors on this topic. In fact, in his book, he includes some pointers for those simply looking to make wiser choices when it comes to animal products.

This book stands out when compared to the other works on this topic, both for its easy-to-follow writing style as well as for its holistic approach. If you are looking for practical and easy-to-incorporate advice to help protect your heart look no further. The added benefit is all of the advice will help improve your overall health, not just your heart. As Dr. Kahn says, it takes a healthy body to have a healthy heart. 

I got to meet Dr. Kahn and his wife Karen at the NYC Veg Fest!

GIVEAWAY

Here are the rules. First, the winner needs to live in the United States (sorry international readers, no disrespect). The contest will end on March 15th at midnight. To enter, you must be a subscribed reader to BYOL. To increase your chances of winning leave a comment on this post. You will also gain a point if you "like" Bring Your Own Lentils facebook page. 

Also be sure to find Dr. Kahn on facebook. He is always post interesting articles on health and fitness

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As always the information presented in this blog is for educational purposes only. It should not be considered as specific medical, nutritional, lifestyle, or other health-related advice.