Dr. Neal Barnard on beating food cravings, the myth of moderation, and the health-changing power of a plant-based diet.
Photo Credit: Evelyn Hockstein, Polaris
During the mid-1980s, fresh out of his medical residency, Dr. Neal Barnard founded the Physicians Committee for Responsible Medicine, an organization that would become one of the most influential forces behind our national health and nutrition policies. In the past 30 years, the nonprofit has swelled to include thousands of physicians and lay members who are known for promoting healthful school lunches, encouraging the U.S. government to revamp nutritional recommendations, and pressuring research institutions to end inhumane animal testing.
A prolific researcher and the author of 15 books—including Power Foods for the Brain, 21-Day Weight Loss Kickstart, and Breaking the Food Seduction—Barnard spoke with S&H about the power of diet to change our health.
What led you to form the Physicians Committee for Responsible Medicine?
I wanted to find a way to help more people than doctors could just by treating one patient at a time. The medical profession also seemed stuck in the past. One hundred years ago, infectious diseases were our biggest health threats. Now, in the West, tuberculosis and diphtheria are not our biggest issues. Chronic diseases such as diabetes, heart disease, and Alzheimer’s disease are—and what we eat is in large part the cause of those illnesses.
I wanted to get that message out there, and I wanted to see more research on the connection between food and health. In the beginning, I thought PCRM would become 15 or so doctors who worked together to create white papers. Now almost 30 years later, PCRM includes 150,000 health care professionals and concerned citizens. That’s so good to see. And the message is being very well accepted. We have a very active research program, including a major diabetes study funded by the National Institutes of Health, our findings are published in leading journals, and the world is finally starting to change.
What’s the biggest myth about the connection between food and health?
Many people—including physicians—imagine that health problems are primarily genetic or perhaps just come by chance and that the way to handle them is with a prescription. But the fact is, lifestyle changes—and especially dietary changes—are far more powerful than most people, including doctors, realize.
Regrettably, when people come into a clinic and seek treatment, they often don’t expect a cure. Diabetes, hypertension, heart disease—these problems are here to stay, they believe. They merely hope their physician will find a way to manage their problem. Some of these patients are already resigned, thinking that as time progresses, they will be prescribed additional prescriptions, undergo increasingly invasive procedures, and pay steeper medical bills, even as their bodies slowly deteriorate.
They never imagine that they’ll be able to completely turn their poor health around. But they can, and they can usually do it through dietary and lifestyle changes alone.
For example, one of my patients came in with such advanced diabetes that his nerves had been damaged, and he felt miserable. He was in chronic pain. He didn’t think it would ever be possible to be pain-free, and other doctors didn’t think it would be possible for him, either. Yet after six months of a plant-based diet, his pain went away. And his diabetes improved dramatically.
You can’t achieve what you can’t envision. If you think you are going to fight a losing battle with your disease, you won’t get very far. If you realize that you can not only manage but actually reverse your symptoms, you’ll be far more motivated to make the major lifestyle changes that will get you there.
If I want to live to beyond age 100—and I want to be pain-free and be able to remember the names of all my friends—what should I be eating?
Giving up animal products is a great first step for anyone who wants to improve their health. Then once people successfully get animals off their plates, we teach them how to cut back on greasy foods and added oils. Once they do that, we help them choose the healthiest carbohydrate foods, the whole foods that are loaded with fiber and nutrients and are low on the glycemic index. After that, if they are still having health problems, we might look at possible food intolerances, such as reactions to gluten.
Why is a vegan diet the first step?
Back in 1909, the Department of Agriculture tracked what Americans were eating: 123.9 pounds of meat per person, per year. That may sound like a lot, but it’s a fraction of how much meat most Americans now consume. Over the years, the consumption of meat has gone up and up and up. In 2004, we hit a new peak: 201.5 pounds of meat. When you do the math, you can easily see that the average American is eating nearly 78 more pounds of meat than the average person did a century ago.
We’re also eating more cheese. A century ago, cheese was almost nonexistent in the American diet. The average person ate fewer than 4 pounds a year. Today that’s 34 pounds. And consumption of sugar and grease has gone up, too.
This has led to a huge number of health issues, including the obesity epidemic.
The good news is that this has started to change. In 2005 something remarkable happened. Meat intake started to drop, and it’s been dropping 10 percent over the past decade. We are not near where we need to be, but we’re moving in the right direction.
Why is meat consumption falling?
Two decades ago, Dr. Dean Ornish showed that a vegetarian diet combined with a healthy lifestyle could do more than slow the progression of heart disease. It could actually open up blood vessels again. Until he published that research, no one thought that was possible. We’ve since shown that you can do the same for diabetes and also with many forms of chronic pain. The research has proven that a plant-based diet is a powerful step toward better health.
As more and more studies are published, more and more people are starting to understand how powerful a plant-based diet can be for their health. At the same time, it’s getting easier and easier to be a vegan. It used to be, to purchase a veggie burger, you had to go to a dingy place that passed for a health food store and talk to a cashier named Sunshine. Now, health food stores are huge and inviting, and you are presented with an enormous array of choices. You don’t just find one substitute for a hot dog or a burger, you find a whole aisle.
By vegan, you’re talking no animal products at all? What’s wrong with the philosophy “All things in moderation”?
The idea of “moderation in all things” only applies to good things like vegetables, exercise, and yoga. Broccoli is good for you and, if you happen to love it, you might eat it once a day, but you wouldn’t eat only broccoli. That’s an example of eating a good food in moderation.
On the other hand, we don’t apply moderation to things like heroin or cigarettes. And if a food is killing you, you don’t want to include it in your diet at all, and the uncomfortable fact is that meat is slowly killing us. It’s much more effective for your health if you dive into the pool rather than stand at the edge and merely stick your toe in the water. People who consume a semi-vegetarian diet are, on average, heavier and unhealthier than people who eat no animals at all.
We’ve seen so many other approaches that recommend the sticking-the-toe-in-the-water approach. They often recommend changing just one small lifestyle habit at a time, seeing if you can keep that up, and then adding more over time. Why do you recommend doing so much at once?
During the mid-1990s, we reviewed all the studies ever done on helping people reduce their fat consumption in order to help their hearts. We found that the more you asked people to do, the more they did. If I tell a patient, “Just try meatless Mondays,” the patient may do that but is not likely to go any further. If I suggest, “Let’s try a vegan diet all the time,” the patient may or may not get there but will definitely do a lot more than if we just suggest a once-a-week healthy meal. The more we ask, the more patients will do, the more benefit they will get, and the more likely it is that they will stick with it. Don’t get me wrong; I love meatless Mondays as a promotional campaign, but to return to health, we need to go much further.
In your presentations, you mention how, for years, you tried to get your parents off meat, but they resisted. It wasn’t until your mother suffered health problems and wanted to avoid taking prescription medication that she was willing to follow the diet you recommend. Her health and your father’s health dramatically improved, but it raises the question, If death isn’t staring them in the face, are most people willing to make such dramatic changes?
Everyone is different. There are some people who will change their diet only because they are sick and want to be well, but many others do it for other reasons. Some are willing to give up meat to support their family members who are doing the same. Many others do it because of ethical reasons. What happens on a farm is not kind. My grandparents raised and slaughtered cows. I have driven cattle to the stockyards. I know what happens there, and it’s not pretty.
Others give up meat for environmental reasons, and still others because they know it’s the healthiest way to eat. When people change their diet for one reason, the other reasons start making sense, too.
Many people tell me that they can’t give up meat because they either need the protein or the iron. True?
Those are myths, and sometimes rationalizations. We always do careful nutritional analyses on patients as they switch to a vegan diet, and they consistently get more than enough protein. This even includes athletes. Also despite popular belief, green veggies are loaded with iron. When people switch to a plant-based diet, their iron intake typically rises.
You even recommend giving up fish. It seems so many studies have shown that fish is good for us. Why give it up?
While it’s true that certain types of fish contain health-promoting omega-3 fatty acids, most of the fat in fish is not omega-3. It’s a mixture of saturated and other types of fat that pad your waistline. In studies, we’ve found that fish eaters are more likely to be obese and have diabetes than vegans. Fish really is more like beef than it is like broccoli.
In Breaking the Food Seduction you wrote that cheese is one of the foods people miss the most. Why is that?
People often miss cheese even more than they miss ice cream. That’s because during digestion, casein, the protein in cheese, releases casomorphins, which are mild opiates. The good news, though, is that over time you stop missing it. At first, when you see people tucking in to greasy foods, you might crave them. Over time, though, you’ll see them for what they really are: unhealthy. By getting away from cheese and other animal products, you’ll lose weight. Your digestion will improve. Your pain may well go away. Your sex life will rebound, and people will compliment you on the way you look. You’ll think, “Do I want to sacrifice all of this just for a grilled cheese sandwich?” No, you won’t.
You’ll eventually even get to a point that you’re revolted by it, just as a former smoker is often annoyed when someone else lights up.
You’ve also written that sugar and chocolate are addictive. Why give up cheese but still eat sweet treats in moderation?
There’s no question that we crave sugar and chocolate and that those cravings are biochemical. But just because something is addictive doesn’t mean it’s particularly dangerous. It’s hard to make a case that small amounts of sugar do much harm, and some have suggested that dark chocolate in small amounts may even be good for your health.
Let me be clear: Sugar is clearly not a health food. But it has nowhere near the disease-causing potential that meat and cheese do.
If you’re thinking about giving up or cutting back on desserts, the first thing you need to ask yourself is this: Do I need to break this habit? You may or may not. If you are at a healthy weight, don’t have any serious illnesses, and feel satisfied with a small amount of dessert every now and then, who cares? What clogs our arteries and harms our health is not the occasional lollipop.
If, on the other hand, you decide that desserts are a problem for you, then you will probably find it easier to get away from them entirely rather than slowly wean yourself off.
You’ll also find that your cravings will ebb over time. If you had sugar yesterday, you’ll crave it more today. But as more time goes by, you’ll crave it less and less. One or two months from now, you might find that you don’t crave it at all.
What do you hope for the future?
Currently conventional medicine emphasizes medications and surgery over diet and lifestyle changes. That needs to be reversed. When you have a health condition, a dietary change should be the conventional medicine. It should be our first-line treatment. Then, if a healthful diet is not enough, we can look into prescription medicines and other treatments as “alternative medicine.”
My hope is that more and more people will put the power of food to work in their lives and that they will really benefit. Then their doctors will be so impressed that they will decide to change their own diets and recommend a plant-based diet to other patients. In this way, we can change the face of medicine for the better.
Alisa Bowman wrote about grief in the Nov/Dec 2013 issue of Spirituality & Health.