Learning to Eat- A letter to fellow physicians

Patricia L. Raymond MD FACG

Learning to eat was about learning to live – a deciding to live;

and it is one of the most radical things I’ve ever done.

~Anne Lamott, from Traveling Mercies 

If you’re expecting a militant vegan to chastise you that ‘your food has a face’, I’m not her. I regard myself as Whole Food Plant Based (WFPB) in my ‘real’ life, but am also an opportunistic carnivore– that opportunism occurring with frequency at drug rep dinners and friends’ supper parties.  Should you invite me into your home, I won’t angst over your lack of Tofurky– Mom raised me right.

However, I believe that you should also embrace WFPB, and encourage your patients to do so. Here I share my personal voyage to Beanville. 

Like so many in medicine, I began reasonably lean after college, then began packing on the pounds with unwise food choices, stressors, and frequent free food opportunities. I ballooned up, and as I reached menopause, I was a hundred pounds overweight with bad knees. Being a good scientist, I researched my options. After a partially successful several year stint at Weight Watchers, a patient introduced me to a notable no sugar/flour plan called “Bright Line Eating”. 

Some of my BLE Facebook friends were also doing WFPB, and I was intrigued. I played at increasing my bean intake and dropping animal protein and fat. In a burst of cosmic synchronicity, my CNA shared a flyer for the upcoming International Conference on Nutrition in Medicine, hosted by the PCRM up the road in Washington D.C. I was free, it was inexpensive and offered CME; let’s go!

People are fed by the food industry,

which pays no attention to health, 

and are treated by the health industry,

which pays no attention to food. 

~ Wendell Berry

There, my brain exploded. (When was the last time you attended a medical conference and suffered a cranial combustion?) Why did I, as a healthcare provider, not know this information? Was it perhaps because ‘Big Broccoli’ doesn’t sponsor office lunches? I learned many chronic American diseases could be reversed by pursuing a WFPB diet– that is vegan, low fat, no processed food. I heard data on coronary artery disease, type 2 diabetes, obesity, multiple sclerosis, Alzheimer’s, arthritis, migraines, and yes– colorectal cancer. 

And I was appalled that we, the arbitrators of the digestive tract, do not know, and do not teach, the role of diet in disease.  As masters of the alimentary canal, we in Gastroenterology should own both these diseases and our expanding obesity epidemic. Who else?

Let’s look at some of the things I’ve learned:

Processed meat is classified as carcinogenic to humans (Group 1), based on sufficient evidence in humans that the consumption of processed meat causes colorectal cancer. Daily consumption of 50 grams of processed meat increases the risk of colorectal cancer by 18%. Red meat is in Group 2A (probably carcinogenic to humans). https://www.iarc.fr/wp-content/uploads/2018/07/pr240_E.pdf

When your post-polypectomy FHCC patient inquires what they can do to reduce their CRC risk, are you discussing specifics of processed and unprocessed red meat consumption?

Dr Stephen Devries’s 2017 study of cardiologists reveals them to be woefully undertrained in nutrition, despite Dr Ornish demonstrating CAD reversal by diet in the 1970s. (A Deficiency of Nutrition Education and Practice in Cardiology Am J Med(2017) 130, 1298-1305) https://amjmed.org/a-deficiency-of-nutrition-education-and-practice-in-cardiology/

Among cardiologists, 90% reported receiving no or minimal nutrition education during fellowship, 8% self-described as having “expert” nutrition knowledge, 95% believe that their role includes personally providing patients with at least basic nutrition information. Only 20% of cardiologists ate 5 vegetables/fruits servings daily. Do we expect that Gastroenterology results would differ?

Where am I now? I am starting my next phase in my gastroenterology career, advocating for a WFPB diet for all.  My website www.EatWell.MD will burst with tasty vegan recipes, humor, and links to peer-reviewed journal articles supporting diet to eliminate or prevent disease. I will produce targeted cookbooks and videos for spectacular (yes, spectacular) bean recipes, and compose digestive ditties about the vegan life (www.ButtMeddler.com). And I will continue living my healthiest life ever. I’m sad that it took me thirty years of not being at my peak to choose to embrace WFPB.

Americans will eat garbage,

provided you sprinkle it liberally with ketchup.

~ Henry Miller

I challenge you to research of WFPB and disease for yourself and your patients. Consider joining the PCRM (www.PCRM.org), download their comprehensive app (https://nutritionguide.pcrm.org/nutritionguide), take free nutrition CME courses (www.nutritioncme.org), and send your patients who are veg-curious to download a free 21 Day Kickstart Program at www.kickstart.pcrm.org.

We are physicians. We must teach our patients to heal themselves.

Let food be thy medicine and medicine be thy food.

~ Hippocrates

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