This transcript has been edited for clarity.
Michelle L. O’Donoghue, MD, MPH: Hi. I’m Dr. Michelle O’Donoghue and I report for Medscape. With me today is Dr. Rob Ostfeld, who has been a leader in the field of plant-based nutrition and has implemented changes within his own hospital system with respect to the foods delivered . You also participated in the discussion of one of the latest clinical trials looking at a type of grocery store intervention.
I think that lends itself to a natural topic of conversation, which isn’t necessarily what is the right diet for our patients—because I know there are different points of view—but ultimately it goes back to how we as doctors are often confused on the subject. There are very little training in medical school, as we know, and the headlines contradict each other every day about the best diet to follow. Ultimately, how do we get education not only for ourselves, but also for our patients? Where do you see this going in general?
Beneficial Minimally Processed Diets
Robert J. Ostfeld, MD: Thank you very much for having me. It’s an honor to be here with you.
You’re absolutely right: dietary intervention or dietary change is critically important to our health and that of our patients, but perhaps the attention or time devoted to teaching us this is somewhat limited. . In fact, the number one cause of illness is an unhealthy diet, so making dietary changes is extremely important.
The American College of Cardiology guidelines are very much aligned with eating more plant-based foods, more vegetables, more fruits, more whole grains, beans, and lentils, and of course, incorporating oily fish as well. This is supported by multiple basic science studies, test tube studies, observational studiesand randomized controlled trials.
I know there is a lot of noise and confusion out there, but eating a plant-based, smart or minimally processed diet is very helpful. There is really an interesting analysis by Dr. Bundy published in the Journal of the American Heart Association in 2021. They first tried to estimate food quality in the United States, and unsurprisingly, it was pretty poor.
They looked at five measures of healthy diet. One is the consumption of at least 4.5 servings of fruits and vegetables per day, at least three servings of whole grains per day, low salt intake, low consumption of sugary drinks and fatty fish at least two times per week. If you had four or five, you had an ideal diet; however, 0.7% of the US had an ideal diet and about 75% had a poor diet. They estimated that if everyone ate an ideal diet, after 1 year cardiovascular event rates would drop by just over 40%.
There’s so much we can do when all of this is done to help our patients every day. Sometimes there are useful procedures; there are medicines that are helpful and a way of life too. It’s all of the above to help people, and of course, it’s fully within the guidelines of the American College of Cardiology.
Hospitalization, an opportunity for behavior change
O’Donoghue: The importance of lifestyle should be emphasized. I think many cardiologists conceptually understand that this is something they should recommend to their patients. Honestly, they’re often the ones who say, “Think about your healthy lifestyle.”
How do we really effect change? I started by saying that in your hospital system, Montefiore, you had been a proponent of really change menu the. Is this a teachable moment when we think about how to get our patients to start eating more plant-based foods? If they are hospitalized for their myocardial infarctioncould this be the golden opportunity we are looking for?
Ostfield: I think you’ve touched on the key question: how do you make the healthy choice the easy choice? There are all kinds of ways to achieve this. It’s a steep lift. We’re not good at that, and we’re not good at behavior change.
I think you are right. When the patients arrive, hopefully we can use that as a teachable moment. That’s something we’ve had the opportunity to do at Montefiore, where we now have what’s called the plant-based cardiac diet that you can order through our electronic medical record (EMR) system, and the patient can get herbal diet regimen. We can also give them a document explaining why it might be useful. We also have a documentary film playing on a continuous loop on one of the hospital patients’ televisions, talking about healthier eating, with Spanish subtitles, free for patients to help outsource some of the education, because no one has the time.
It’s a wonderful learning moment, and it can be reinforced by the medical system by the interventional cardiologist who is very busy putting in a stent for myocardial infarction. They might say, “We’ve had wonderful results with the stent. Here are some medications you will need to take. We really need you to eat healthy to help protect your heart. The nurse upstairs can reinforce it, and the PA upstairs, and the cardiologist rounding it up the next day. All the little pieces.
We know that you don’t have to go all the way with dietary changes to see improvements in results. In fact, in a wonderful study by Dr. Song, they showed that if you simply replace 3% of your calories from animal protein with 3% of calories from plant protein, it is associated with a longer life. Every little gesture counts.
I think our intervention at Montefiore was helpful in at least being a teachable moment and planting the seed in the patients. Fortunately, we also serve this food in our cafeterias at several hospitals, and the director of food services tells me that it is profitable. It’s really wonderful and great that we can offer this to our staff and people passing by.
The mayor of New York and plant-based diets
As you mentioned earlier, of course, there’s quite a sea change going on in New York right now. our mayor, Eric Adams, is on a plant-based diet, and he’s had a wonderful health turnaround because of it. He is a strong nutrition advocate and has helped through the NYC Health + Hospitals system, which is Bellevue, Jacobi and other major New York hospitals, to develop a fairly robust health and lifestyle program, with Dr. McMacken at the helm of that. They created herbal or vegan fridays in schools, so it keeps the conversation going. It gets people talking. It’s just another bite of the apple, in the Big Apple, of our ability to bend the curve
O’Donoghue: I think people are overwhelmed when you say “plant based diet”. They say, “Wow, I could never do that.” It’s so important to put the food in front of them. Put this menu choice in front of the kids or offer this option in the hospital and help them see that it’s actually a very easy diet to follow once you have that mindset and you are ready to make the change.
Ostfield: I totally agree. With anything, there’s a bit of a learning curve. You know, if you’re going to work in a new hospital, you have to find out where the restrooms are and where you park. There is also a small learning curve when changing your diet. But society is changing and there are more and more herbal options. There are thousands of recipe books, lots of options in the supermarket, in the produce section, wonderful types of food you can eat. The activation energy becomes lower and lower.
Quite frankly, in our program in the Bronx 12 years ago, I mentioned plant-based nutrition to some patients and they looked at me like I was from Mars. They never heard of it. In a borough south of Manhattan, a lot of people are eating smoothies, green juices and all, but it might as well have been from different planets. Now, 10 or 12 years later, they don’t look at me like I’m from Mars anymore. They heard about it. Society changes.
O’Donoghue: I really think the opportunity we were hoping for is to put in place better supports. You talked about the hospital changes that are being made.
You were the speaker of a trial which was led by Dr. Dylan Steen, where he partnered with a chain of grocery stores. What I liked was that they looked at diet adherence after different forms of instruction.
One of those interventions was actually walking the grocery store aisles with people and helping them make the right choices. I think that’s ultimately what we should be aiming for. All the money we spend on pharmaceuticals, when insurers could really shift some of those dollars into grocery-based interventions that can have a profound effect as well.
Ostfield: It is useful for health reasons and, as you say, it is extremely important for financial reasons. We spend a large part of the GDP on health care – 80% of it on chronic conditions, many of which can be avoided or improved through a healthier diet. Creative initiatives like that of Dr Steen are ways to help us get there.
We are facing headwinds. There are vested interests in place that want us to eat things that may not be so healthy. It is important to continue to build momentum, to continue to accumulate data and to continue to pursue a variety of interventions. Dr. Steen has really been at the forefront of this wonderful and very interesting study, leveraging a link between research and retail.
O’Donoghue: Thank you very much for the work you are doing in this area. I continue to watch eagerly to see what comes next, and I’m also trying to make changes at our own hospital. Thank you.
Ostfield: Thank you.
O’Donoghue: Signing off for Medscape, here’s Dr. Michelle O’Donoghue.
Michelle O’Donoghue is a cardiologist at Brigham and Women’s Hospital and principal investigator of the TIMI Study Group. A strong believer in evidence-based medicine, she loves discussions of published literature. Canadian-born Michelle loves spending time outdoors with her family, but shamefully admits she’s never played hockey.