By Betsy Todd, MPH, RN, CIC, AJN clinical editor
A nutrition conference at which physicians and medical students outnumber either nurses or dietitians is a rare event. This was the case at last month’s International Conference on Nutrition in Medicine: Cardiovascular Disease in Washington, DC, cosponsored by the Physicians Committee for Responsible Medicine (PCRM) and George Washington University.
The speakers, shared a wealth of data on the influence of different types of diets on weight, blood pressure, lipids, serum inflammatory markers, hemoglobin A1c levels, and diseased coronary arteries. More than one pointed out that we too often overestimate the benefits of drugs and medical procedures and discount the effectiveness of diet and lifestyle changes. Some highlights:
Does heart disease begin in utero? Children who are large for gestational age (> 95th percentile) and those born to overweight mothers are at increased risk for cardiovascular disease (CVD). Vascular physiologist Michael Skilton, PhD, associate professor at the University of Sydney in Australia, has also identified microscopic lesions in aortic endothelium of babies born small for gestational age (< 10th percentile). He suggests that their diets include the American Heart Association’s recommendations for omega-3 fatty acid intake beginning in childhood (breast milk, flax seeds, walnuts, or child-friendly omega 3 supplements can be used in lieu of fish-derived omega 3s when mercury is a concern).
Children and heart disease. Gerald Berenson, MD, director of the Tulane University Center for Cardiovascular Health, led Tulane’s Bogalusa Health Study in Bogalusa, Louisiana, beginning in the 1970s, and he and his team published dozens of pioneering articles on childhood risk factors for CVD. Berenson refers to childhood obesity, glucose intolerance, hypertriglyceridemia, and hypertension as a “deadly quartet” leading to the development of CVD early in life. He and his team instituted ongoing, comprehensive health education for elementary school students focusing on nutrition, exercise, cognitive behaviors, and self-esteem.
CVD risk reduction in children through diet. Michael Macknin, MD, professor of pediatrics at the Cleveland Clinic Lerner College of Medicine/Case Western Reserve, recently studied the impact of both the standard American Heart Association (AHA) diet and a plant-based, no-added-fat diet on CVD risk reduction in obese, hypercholesterolemic children and their parents. In just four weeks, the AHA diet led to statistically significant decreases in weight, mid-arm and waist circumference, and myeloperoxidase (MPO, an inflammatory marker for heart disease). The plant-based results were even more striking: statistically significant reductions in weight, cholesterol, and many other measures.
Adults and CVD. Adult research findings have been published for decades, including extensive documentation of the reversal of coronary artery occlusion as demonstrated by coronary angiography. (More than 20 years ago, angiographic evidence from the studies of Dr. Dean Ornish led to the first nonsurgical, nonpharmaceutical therapy for heart disease to qualify for insurance reimbursement.) Caldwell Esselstyn, MD, director of the Cardiovascular Prevention and Reversal Program of the Cleveland Clinic Wellness Institute, who reiterated the observation sometimes made that millions of people around the world who don’t eat as we do in the U.S. never develop CVD, emphasized as well that a no-added-oil, plant-based diet elicits a remarkably rapid response.
The diabetes, heart disease connection. Caroline Trapp DNP, ANP-BC, CDE, FAANP, director of diabetes education and care at PCRM, who noted that a plant-based, whole foods diets for diabetes control can reduce the need for counting or measuring, directed conference participants to some of the practical nutrition education and food preparation guidance available on PCRM’s Web sites. (See, for example, a page focused on diet and lifestyle factors in heart health and the 21 Day Vegan Kickstart Program page.)
Food boot camp. Cardiologist Baxter Montgomery is founder and president of the Montgomery Heart and Wellness Center in Houston. His workup on all new patients includes a detailed nutrition history; the foundation of his treatment regimens is a “nutritional prescription.” Patients attend a food “boot camp” weekend to learn about nutrition and food preparation, followed by regular appointments for education, monitoring, and support.
Robert Ostfeld, associate professor of clinical medicine at the Albert Einstein College of Medicine and director of the Montefiore Einstein Cardiac Wellness Program in the Bronx, New York City, reports seeing “incredible turnarounds” in many patients from the effects of his lifestyle program. He weaves a discussion of nutrition into every patient visit and works closely with a registered dietitian in educating and supporting patients to change the way they eat.
Can people really change their diets? As might be expected, many speakers and attendees at the conference answered this question with a resounding “yes.” Many mentioned long waiting lists at their nutrition programs or educational events and a surge or interest in recent years in the topic from both patients and clinicians. Having witnessed long-term adherence to dietary and other lifestyle changes, they argued that we do a disservice to our patients when we assume that “patients won’t do that” (quit smoking, lose weight, change their diets). Michael Greger, MD, added: “That attitude