Here is our story.

As a plant-based cardiologist at Montefiore Health System, I have had the privilege of seeing patients transform before my eyes; I’ve witnessed them evolve from illness toward health, from despair toward hope, mostly by changing what is at the end of their fork. The initial seed of change, however, may not immediately take root. Plant-based diets are uncommon in the community where I work, namely, the Bronx, New York. In fact, the Bronx is one of the least healthy inner cities in America, in part due to its limited access to healthier foods; however, Montefiore is working to change that.

When I mention a plant-based diet to some of my patients, they quite literally look at me like I am from Mars. They have never heard of such a thing, and the climb sometimes can be very steep. I have had patients chose not to pursue a plant-based diet for years, then something clicks and they suddenly decide to adopt it and come to their next visit twenty pounds lighter. That is always a great feeling, and these patients become some of the strongest advocates for plant-based nutrition.

These transformations take place in our outpatient clinic. However, sometimes we meet patients for the first time when they are admitted to the hospital. Many times this encounter occurs following a heart attack, an episode of heart failure, or some other urgent cardiac issue. These hospitalizations are great opportunities to teach people about ways by which they can become healthier. So, breaking from the usual mold, we decided to bring plant-based nutrition and education into the hospital.

We wanted to reinforce physician discussions with in-patients about plant-based vegan meals and offer in-patients the opportunity to watch Forks Over Knives in real-time, in the hospital. This combination is a win, win, win: the medical team highlights the importance of plant-based nutrition, the patient then tastes it, and the film powerfully reinforces the message.

So we did just that. After a successful collaboration with Montefiore’s Department of Food and Nutrition Services, we created plant-based vegan meals for in-patients that can now be ordered in five of our hospital locations. Simultaneously, Montefiore’s Department of Patient Education worked closely with the incredible team at Forks Over Knives, and now the Forks Over Knives film is available to play in those same five hospitals, in front of roughly 2,300 patient beds!

To my knowledge, Montefiore is the only hospital in the world to offer this combination of resources for patients. I hope many more will join in soon.

Now, when I visit my in-patients, I know that I have my plant-based posse with me. I discuss the diet with the patient (and perhaps their family), we order the patient plant-based meals (we call them “Heart Healthy Vegan” in our system), and I ask them all to watch the film (I even offer to turn it on before leaving the room!).

A strong seed has been planted, and the feedback has been great. In fact, we’ve even had patients watch the film before being seen by a physician, and then call the nurses’ station to ask if they could eat the “Forks Over Knives” way.

This great collaboration has made Mars seem a little less far away. Thank you, Forks Over Knives!

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I often hear some version of the above from friends and acquaintances: during a hospital stay, they or their loved ones are served the types of foods that may have caused their problem in the first place.

The disconnect between cause and effect just kills me.

A Missed Teaching Opportunity

A hospital stay can be scary. People are confronted with their mortality and they may feel a loss of control and a loss of independence. Yet even in this confusing time, a hospital stay has the potential to be a great teachable moment. I often wonder how much more powerful our interventions would be if they were coupled with education about how lifestyle changes can actually get to the root of the problem. Many surgeries just sweep the problem under the rug for a time, not getting to the underlying cause at all – which is frequently lifestyle.

Here is the scenario that Western medicine often offers its patients:

“Yes, Ms. Jones. We will need to do coronary bypass surgery tomorrow, where we will saw your chest in half, stop your heart, and sew a vein from your leg on to your heart. You will be in intensive care for a couple of days afterward, and in about three months you will be fully back on your feet.”

It’s great that we can perform these procedures if we have to… But it is better to prevent them.

The time for change is yesterday.

How It Could Be…

Now imagine a scenario in which Ms. Jones’s care includes the following:

“During your recovery we will be feeding you foods that will nourish your body and set you on a course to drastically reduce your likelihood of recurrence. We will send you home with videos and other material that will teach you how eating plants can reduce or eliminate your diabetes, high blood pressure, high cholesterol, and coronary artery disease. We will offer you suggestions for eating out and instructions for buying and preparing simple nutritious meals at home so that you can maintain a healthier lifestyle.”

Picture Ms. Jones’s entire medical team, including her surgeon, taking the time to emphasize (both to her and her family) the importance of plant-based eating for her future well-being. And instead of a steak or burger and fries, picture a satisfying plant-based meal filled with leafy greens and other vegetables, whole grains, beans, and fruit.

With this kind of care and education, her hospital stay could serve as a springboard to a healthier life.

The Future of Hospital Food

Increasingly, the news is not all bad. Adventist hospitals have long offered many vegan options. And in recent years, numerous US hospitals are making strides to improve the quality of the food they serve, including planting gardens, offering up more plant-based meals, and removing fast food restaurants from their lobbies. The hospital where I work, Montefiore Medical Center in New York City, now offers plant-based meals for inpatients and makes “Forks Over Knives” available in their rooms. Its cafeteria, in addition to having a terrific salad bar, serves vegan sushi, smoothies, and other delicious plant-based options. And the American Medical Association recently passed a resolution calling on hospitals to improve the health of patients, staff and visitors by offering plant-based meals and meals that are low in fat, sodium and added sugars, eliminating processed meats, and providing and promoting healthful beverages.

Times are changing, and you can help: if you are hospitalized, ask your medical team about plant-based options. Bring it up with your local physician and local politicians. Your voice will go a long way.

I look forward to the time when serving steak, burgers, fries, and chicken nuggets is no longer customary in hospitals.

Because right now, it just kills me.

(Editor’s note: This post was updated with new information on Montefiore Medical Center and the American Medical Association in July, 2017.)

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Eighteen months and 75 pounds ago, Ms. R. was unhappy. In her late 40s, she was getting admitted to the hospital every six to eight weeks with flares of her asthma. She was morbidly obese, could barely walk a couple of blocks without feeling out of breath, and she was on nineteen different medications for high blood pressure, high cholesterol, chronic pain, and other conditions. She felt terrible.

Also troubling was the fact that she could never find clothes she liked to wear. She felt as if she was just “draping a curtain” around herself. She didn’t like any of it. She had tried all kinds of diets, and nothing worked.

She was highly skeptical about the plant-based diet when we met. It was completely different than what she had been told about nutrition and from how she was raised. “Protein comes from meat, no?” But she also knew that the path she was on was killing her, so she guardedly embraced the lifestyle.

As she got the hang of it, she flourished. She lost 75 pounds, and her husband, who joined her on the program, lost 50.

Soon she would venture out on long walks without difficulty — something she could not previously do. And she found dresses to wear. She felt great!

In 18 months, she reduced her nineteen meds down to three and she has not required a single hospital admission!

With tears of joy in her eyes, she told me how happy she was. That never happens after I write someone a prescription for cholesterol-lowering medication.

So energized by her turnaround, she began to look to her community, which she noted could be healthier. She has now inspired dozens of her neighbors, friends, and family members to embrace plant-based eating — a mission that fills her life with meaning … and also feeds her soul.

For Ms. R., health was simply a choice.

The post How My Patient Lost 75 Pounds, Reduced 19 Meds to 3, and Found Joy in Inspiring Others appeared first on Forks Over Knives.

When we eat red meat, its carnitine interacts with our gut bacteria, forming trimethylamine, which is then metabolized by the liver into TMAO. And it appears that TMAO is not our friend.^1,2

TMAO promotes the formation of cholesterol plaques in our blood vessels, which make them less healthy and may lead to heart attack, stroke, and death. TMAO reduces our body’s ability to excrete cholesterol.^1,2 And, if that is not bad enough, TMAO may be linked to death from prostate cancer.³

The good news is that people who eat an exclusively plant-based diet appear to form little TMAO. In fact, when researchers fed steak to a vegan, virtually no TMAO was made.²  Why is that? Vegans, it seems, do not select for the specific gut bacteria that lead to the formation of TMAO, whereas meat eaters do. Hence, it’s as if plants create a coat of armor in our stomachs, protecting us when they are not even there.

So if we’re protected by plants, is it okay for us to eat steak for just a few days? Are we protected from TMAO? It appears that we may not be. The trillions of bacteria in our gut change very quickly. In fact, they may meaningfully shift even within one to two days!⁴ So aside from the many other deleterious effects of meat, even one day of steak could cut a chink in the natural armor afforded us by eating plants.

Notably, red meat is not the only source of TMAO. Choline, which is found in chicken, fish, dairy ― and even plants ― is another. Choline is structurally similar to the carnitine in red meat, and with the help of the same gut bacteria, also forms TMAO. Accordingly, when investigators fed omnivores an egg, they made TMAO.¹

Although we have no dietary need for carnitine, we do require dietary choline. So how can we get the choline we require without the unwanted company of toxic TMAO? The answer appears to be in the armor. Eating a plant-based diet selects for gut bacteria that do not lead to the formation of TMAO.² So even though we are eating choline in plants, our stomach’s plant-derived protection is in place, practically freeing us from concern about TMAO.

Science’s understanding of the interaction of our diet and gut bacteria and their influence on our health is at an early stage. However, evidence is mounting that a plant-based diet may be beneficial for this interaction in many ways. Yet another reason to go (or stay) plant based!

The post TMAO: A Toxic Substance Formed When You Eat Meat Can Make You … Dead Meat appeared first on Forks Over Knives.

However, ten years ago I would not have been writing this post or otherwise extolling the benefits of a plant-based diet. During my training at Yale and Harvard with many outstanding physicians and scientists, I learned little about this approach. For years after my training, I applied evidence-based medicine, recommended a “healthier” lifestyle, which typically included a Mediterranean-style diet, and watched as my patients’ diseases often progressed. I became frustrated. There had to be something more.

Fortunately, I was introduced to the work of Drs. Campbell and Esselstyn. Based on their research, I started a Cardiac Wellness Program at Montefiore Medical Center in New York City, where we encourage patients to embrace a whole-foods, plant-based diet. The results have been amazing. My patients’ chest pain and shortness of breath have dramatically improved. Their cholesterol has plummeted, they have lost weight, and they are able to eliminate or reduce the need for multiple medications for problems such as hypertension, diabetes, high cholesterol, and chronic pain.

I’d like to share a real-life example: A patient in his late 50s began to develop chest discomfort. It progressed to the point where he would feel it even as he sat still. Cholesterol blockages in his heart were the cause. He did not want any cardiac procedures, and he was started on all of the appropriate medications. However, he continued to have discomfort even walking a block or two. He then changed his lifestyle, embracing a whole-foods, plant-based diet. His cholesterol fell dramatically, he lost weight, and after just a few months he could walk over a mile. Now, two years and no procedures later, he is jogging over two miles and says he feels 30 years younger!*

Patients also describe benefits they may not have originally expected, such as more energy, improved complexion, clearer thinking, better sleep, fewer colds, improved erectile function, increased stamina, and more! In fact, patients have cried tears of joy from the results they have achieved. Frankly, I have fallen in love with being a physician all over again.

I am grateful that you are reading this, as the need for this type of lifestyle change is only growing. Heart and blood vessel disease is the number one killer of adult men and women in the United States,^{1, 2} and approximately two out of every three twelve-year- olds in the US has early signs of cholesterol disease in the blood vessels that feed their hearts with blood.³ We are literally killing ourselves from diet-driven disease.

Each of you influences many people in your family and community. Please join the Forks Over Knives team in helping to spread awareness about the benefits of the whole foods, plant-based lifestyle.

In my years of practice I have learned that it is never too early to make this change, and it is never too late. When we are born, our bodies are like turbo engines. A few decades of animal products and processed foods later, we turn those bodies into clunkers. Let’s turn back the clock … because we can!

*Patient identifiers have been changed.

¹ American Heart Association. Heart disease and stroke statistics–2004 update. Dallas, Texas: American Heart Association, 2003.
² Heart disease and stroke statistics–2010 update: a report from the American Heart Association. Circulation. 2010;121:e46-e215.
³ Stary HC. Evolution and progression of atherosclerotic lesions in coronary arteries of children and young adults. Arteriosclerosis. 1989 Jan-Feb;9(1 Suppl):I19-32.
– S Castle and A Goodman. Rethink Food: 100+ Doctors Can’t Be Wrong. Two Skirts Productions, Houston, TX, 2014.

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