32: How nurses bring plant based nutrition to life, with Joanne Evans, RN, PMHCNS-BC, MEd

Adapted from the Indiana Nurse Association Bulletin

Almost 2500 years ago, Hippocrates said, “Let food be thy medicine and medicine be

thy food” (Smith, 2004). These words are still relevant today.

The leading causes of death in the United States from disease are heart disease,

followed by cancer, chronic lung disease, stroke, Alzheimer’s, diabetes, and chronic kidney

disease. (National Center of Health Statistics, 2021). Diabetes is increasing at a rapid rate in the U.S. (Diabetes Research Institute, 2020). According to the Food and Drug Administration (FDA), over 20,000 prescription drug products are approved for marketing (U.S. Food and Drug Administration, 2018). The National Health and Nutrition Examination Survey in 2015–2016 shows 45.8% of the U.S. population uses prescription drugs (Martin, et al., 2019). Nearly 40% of older adults take five or more prescription drugs. All medications, whether over-the-counter or prescription medications, may have side effects, including nausea, fever, chills, headaches, itching, wheezing, tightness in the chest, vomiting, red and irritated eyes, and the list goes on. Pharmaceutical companies are the ones that benefit the most from people being sick.

Is it possible that some chronic diseases could be prevented or reversed through nutrition? There has been extensive research for well over 40 years showing how food can be used to treat and sometimes reverse many chronic diseases. Campbell and Campbell (2006), Esselstyn (2008), McDougall (2013), Greger (2015), and Barnard (2020) have all discussed this in their publications. Their research shows that plant-based nutrition prevents and reverses heart disease, diabetes, and some cancers, decrease cholesterol, and reduces blood sugar levels. Plant-based nutrition also decreases obesity and complications from being overweight and improves mood, sleep, energy, depression, and anxiety; reverses many chronic diseases and increases work productivity.

In a research study conducted at ten corporate locations in the U.S., those participants practicing plant-based nutrition (PBN) showed improvement in body weight, blood sugar levels, and emotional state, including depression and anxiety (Agarwal et al., 2015). In another study, diets that were higher in plant foods and lower in animal foods were associated with a lower risk of cardiovascular morbidity and mortality in a general population, and the longer the participants adhered to a healthy plant-based diet, the lower their risk of cardiovascular disease (Esselstyn et al., 2014). Research shows that obese patients who followed a plant-based diet had more weight loss compared to those who followed a vegetarian and non-vegetarian diet that included dairy, eggs, fish, or meat at two-month and six-month intervals (Turner-McGrievy et al., 2015).

What specifically is plant-based nutrition (PBN)? What does it include?

— Vegetables – dark greens, dark yellows and orange, sweet potato, etc.

— Whole Grains– pasta, rice, corn, whole grain bread, tortilla, etc.

— Fruit – whole fruit which is better than juice due to fiber

— Legumes – beans, peas, lentils, tofu, soymilk, chickpeas, etc.

— Nuts and seeds

— Limited processed foods

— Avoiding oil, flour, and sugar

According to the American Association of Colleges of Nursing (2021), there are over 3

million nurses, therefore it seems we could make a dramatic change in health care for people in the U.S. if we shared information about plant-based nutrition. Nurses work in a wide variety ofsettings including hospitals (state, local and private), ambulatory clinics, outpatient offices,home healthcare, regulatory agencies, organizations, schools, residential care, and more.

I have conducted several 21-day plant-based programs utilizing the free, online Kickstart Program published by the Physicians Committee for Responsible Medicine (2021). The results were published in the American Journal of Nursing (Evans et al., 2017) and the Holistic Nursing Association Journal (2015). Laboratory data was collected and analyzed, and it found that several participants lowered their cholesterol by as much as 59 points within a 21-day period, while others lost weight and reported an improvement in energy and sleep. (Evans, 2015).

In talking with nurses around the country, there seem to be many reasons nurses do not

share information about PBN. Some of the primary reasons reported include nurses feel they did not know enough and were worried they could not answer the patient’s questions; they thought it was too difficult; did not know whom to refer patients to; thought it may be too expensive to adhere to a PBN diet; and thought patients may not be interested (Evans, 2020).

When I spoke with nurses around the U.S., they shared that this form of nutritional

information was not presented to them in nursing schools. All the nurses who interviewed for my book, Cultivating Seeds of Health with Plant-Based Nutrition, Nurses Share Educational Approaches to Prevent and Reverse Chronic Disease (Evans, 2020), learned about PBN aftergraduation from their nursing programs. Some learned about it after their own illness and others when a family member became ill. Several nurses saw their patients taking the recommended medications, and they were still not getting well. Others recognized that “everything in moderation” was not working. Another group of nurses read the China Study (2006) or saw the movie Forks Over Knives, both of which convinced them that PBN was the way to treat many chronic diseases (Evans, 2020).

Once nurses become knowledgeable about PBN, they have many opportunities to share this information, including:

-Talking with colleagues about plant-based nutrition

-Having plant-based food at all meetings and conferences

-Hosting monthly potlucks or lunches with colleagues and community groups

-Showing movies on PBN and discuss the information provided

-Asking more detailed questions about nutrition on intakes with patients, including:

— How many fruits did you eat in the past 24-48 hours?

— How many vegetables did you eat in the past 24-48 hours?

— How many portions of dairy food did you eat in the past 24-48 hours?

— How many portions of meat did you eat in the past 24-48 hours?

— Have them complete a nutritional assessment -http://4leafsurvey.com

-Having discharge and care plans include plant-based nutrition

-Requesting PBN guest speakers in educational settings for undergraduate and graduate

level nursing programs

-Incorporating PBN into all discussions about chronic diseases

-Collaborating with other health care providers interested in plant-based nutrition

-Encouraging hospitals to have plant-based foods at all meals

-Hosting a free online 10-day plant-based program

https://www.drmcdougall.com/health/education/free-mcdougall-program/

or hosting a free 21-day (PCRM) online plant-based program – including menus, recipes,

cooking classes, and additional Information -https://kickstart.pcrm.org/en

There are several groups available for nurses interested in learning more

about plant-based nutrition. PCRM hosts the Nurses Nutrition Network, which provides

educational programs for nurses

(https://www.pcrm.org/good-nutrition/nutrition-for-clinicians/nurses-nutrition-network).

The American College of Lifestyle Medicine has a nurse support group and provides educational presentations open to all nurses. https://lifestylemedicine.org/What-is-Lifestyle-Medicine.

Our patients need to have a choice on how they will resolve their chronic health issues,

and nurses are well-positioned to educate patients on nutritional options to help prevent and possibly reverse many chronic diseases. Patients should be given all the options to make an educated decision about their health. Sometimes it starts with medications while they are making nutrition and lifestyle changes. Eventually, it may be the nutritional changes that reverse the chronic disease process. Let 2021 be the year of change!

Resources

Some examples of breakfast might be the following:

— Cold cereal – with soymilk or rice milk with peaches, berries or another fruit

— Whole grain toast with jam and fruit

— Oatmeal with non-dairy milk with cinnamon and raisins

— Blueberry buckwheat pancakes and meat-free bacon

For lunch, you might consider:

— Veggie burger with whole grain bun and salad

— Bean burrito, fruit

— Soy yogurt, fruit, vegetable soup, whole wheat bread

— Hummus wrap with whole wheat pita, shredded carrots, cucumber, tomato

Some options for dinner might include:

— Black bean chili with cornbread, salad, greens

— Whole grain pasta marinara with mixed vegetables, salad

— Fajitas with peppers, onions, tomatoes, beans, broccoli

— Beans and rice with salsa, corn, salad

Resources for learning about plant-based nutrition are the following:

— Davis, B., & Vesanto, M. (2013). Becoming vegan, express edition: The everyday

guide to plant-based nutrition. Book Pub Co.

— Campbell, T. C., & Campbell,T.(2004).The China Study. Startling implications for diet,

weight loss and long-term health. BenBella Books.

— Greger, M., & Stone, G. (2015). How not to diet: Discover the foods scientifically

to prevent and reverse disease. Flatiron Books.

— Greger, M. (2019). How not to diet. Flatiron Books.

— McDougall, J. (2013). The starch solution. Rodale Books.

— Barnard, N. (2018). The vegan starter kit: Everything you need to know about plant-

based eating. Grand Central Publishing.

— Esselstyn, C. (2007). Prevent and reverse heart disease. Avery Publishing.

Cookbooks include:

— Barnard, N, Burton, D. (2018). Dr. Neal Barnard's cookbook for reversing diabetes:

150 recipes scientifically proven to reverse diabetes without drugs. Rodale Books.

— Campbell, L.(2018). The China study cookbook. Benbella Books.

— Esselstyn, R., & Esselstyn, J. (2017). Engine 2 cookbook. Grand Central Publishing.

— Sroufe, D., Moskowitz, I., Hever, J., Thacker, D., & Micklewright, J.(2012). Forks over

knives―The Cookbook: Over 300 recipes for plant-based eating all through the year.

The Experiment.

— Barnard, N.(2010). The get healthy, go vegan cookbook: 125 easy and delicious

recipes to jump-start weight loss and help you feel great. Da Capo Lifelong Books.

— Greger, M. (2017). How not to diet cookbook. Flatiron Books.

— McDougall, J., & McDougall, M. (1999). The McDougall quick and easy cookbook:

Over 300 delicious low-fat recipes you can prepare in fifteen minutes or less. Plume

Publishing.

— Esselstyn, A., & Esselstyn, J.(2014). Prevent and reverse heart disease cookbook.

Avery Publishers.

Websites:

· Dr. Greger - https://nutritionfacts.org - updated research on nutrition and disease – many

short videos

· American College of Lifestyle - https://www.lifestylemedicine.org

· Dr. McDougall -www.drmcdougall.com – free newsletters, testimonials, current

research, Starch Based Solution Certificate Program, 10-day residential programs

· Physicians Committee for Responsible Medicine - www.pcrm.org – free monthly

Kickstart programs, newsletters, current research, multiple languages, and handouts for

offices

· Forks Over Knives - https://www.forksoverknives.com/ - recipes, plant-based news, meal

plans, success stories, and cooking courses

· Plantrician Project - https://plantricianproject.org/vision- list ofplant-based doctors, peer review journal, conferences, cooking class, research, and more

Apps:

— 21-Day Vegan Kickstart – PCRM

— Dr. McDougall Mobile Cookbook

— Forks Over Knives

— Michael Greger - Dr. Gregers’ Daily Dozen

Plant-based movies include:

· Forks Over Knives– especially for diabetes, heart disease, and chronic health issues

· Code Blue – focusing on medical training and health care system

· Game Changers- focus on vegan athletes

· Cowspiracy – focus on the environment

· Food Inc – food supply and industry

· Eating You Alive - food connected to chronic disease

· Meat the Truth - livestock farming and the environment

References

Agarwal, U., Mishra, S., Xu., J., Levin, S., Gonzales, J., & Barnard, N. D. (2015). A multicenter randomized controlled trial of a nutrition intervention program in a multiethnic adult population in the corporate setting reduces depression and anxiety and improves quality of life: The GEICO Study. American Journal of Health Promotion,29(4), 245-5.

doi: 10.4278/ajhp.130218-QUAN-72

American Association of Colleges of Nursing. (2021). Nursing fact sheet. https://www.aacnnursing.org/news-Information/fact-sheets/nursing-fact-sheet

Barnard, N. (2020). Your body in balance: The new science, of food, hormones, and health. Grand Central Publishing.

Campbell, T. C., & Campbell, T. (2006). The China study. Benbella books.

Diabetes Research Institute. (2020). Diabetes statistics. https://www.diabetesresearch.org/diabetes-statistics

Esselstyn, C. B. Gendy, G., Doyle, J., Golubic, M., & Roizen, M. F. (2014). A way to reverse CAD? Journal of Family Practice; 63(7):356-64.

Esselstyn, C. (2008). Prevent and reverse heart disease. Avery Publishing.

Evans, J. (2015). Plant-based nutrition: Will the next prescription be from the farmers market or the pharmacy. American Journal of Holistic Nursing, 35(2):28-9.

Evans, J. (2020). Cultivating seeds of health with plant-based nutrition: Nurses share educational approaches to prevent and reverse chronic disease. https://www.amazon.com/Cultivating-Seeds-Health-Plant-based-Nutrition/dp/B08GFSYGJJ

Evans, J., Magee, A., Dickman, K., Sutter, R., & Sutter, C. (2017, March). A plant-based program – nurses experience the benefits and challenges of following a plant-based diet. American Journal of Nursing, 117(3), 56-61.

Greger, M. (2015). How not to diet. Flatiron Books

Martin, C. B., Hales, C. M., Gu, Q., & Ogden, C. L. (2019). Prescription drug use in the United States, 2015–2016. (Issue Brief No. 334). NCHS Data Brief. Hyattsville, MD: National Center for Health Statistics. https://www.cdc.gov/nchs/products/databriefs/db334.htm

McDougall, J. (2013). The Starch solution. Rodale Books.

National Center of Health Statistics. (2021, March 1). Leading causes of death. https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm

Physicians Committee for Responsible Medicine (PCRM). (2021). Start your journey to health. https://kickstart.pcrm.org.

Smith, R. (2004). Let food be thy medicine. BMJ, 328(7433). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC318470/

Turner-McGrievy, G. M., Davidson, C. R., Wingard, E. E., Wilcox, S., & Frongillo, E. A. (2015). Comparative effectiveness of plant-based diets for weight loss: A randomized controlled trial of five different diets. Nutrition, 31(2), 350-8. https://doi.org/10.1016/j.nut.2014.09.002

U.S. Food and Drug Administration. (2018). Fact Sheet – FDA at a glance.https://www.fda.gov/about-fda/fda-basics/fact-sheet-fda-glance