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Eating to Thrive

Neal Barnard, M.D., is one of America's leading advocates for health, nutrition, and higher standards in research. He is the president of the Physicians Committee for Responsible Medicine, and an Adjunct Associate Professor of Medicine at the George Washington University School of Medicine in Washington, D.C. The author of dozens of scientific publications, Dr. Barnard has also written fifteen books, including the New York Times bestseller, 21-Day Weight Loss Kickstart: Boost Metabolism, Lower Cholesterol, and Dramatically Improve Your Health.

Find out what Dr. Barnard has to say about the latest findings in diabetes treatment, some of which come from studies he has personally directed. Hint: The most powerful tool isn't a drug, it's the food on your plate. Then, get his take on cancer, soy, weight loss, and many other crucial topics of our day.

JOHN ROBBINS: You grew up in a North Dakota family of cattle ranchers and doctors. When you look back now, do you feel that those early experiences helped shape your current view of the world and your work?

DR. NEAL BARNARD: My grandpa was a cattle rancher, and his father was a cattle rancher, and his father was a cattle rancher. And my own father was too, except that he really did not care for the cattle business and soon got out of it. He ended up going to medical school and then spent the later part of his life treating diabetes in Fargo. But we still ate like we were in the cattle business. I have vivid memories of bringing cattle to slaughter and that kind of thing. Now, all of those people were good, decent folks, and I am sympathetic to how people have gotten into these walks of life. At the same time, we can clearly do better. Science has moved on and shown us that there is a better path.

JOHN ROBBINS: Speaking of science moving on, you were awarded a $350,000 research grant from The National Institutes of Health a few years ago to study the effect of a low-fat, vegan diet on diabetes. The study results, which you published in Diabetes Care, the peer reviewed journal, found that a low-fat, vegan diet did improve glycemic and lipid control and actually did so with greater results than those achieved on a diet that was based on the American Diabetes Association guidelines. Has the Diabetes Association made any changes in their guidelines as a result of your findings?

DR. NEAL BARNARD: When you look around the world, people who tend to not get diabetes don't follow the sort of typical diabetes diet that American doctors hand to patients. A typical clinically recommended diet says that patients should avoid carbohydrates: “Don't eat bread, don't eat pasta, don't eat sweet potatoes, don't eat rice, etc.” But if you look in Japan and China in decades past, rice was a staple, and they were the thinnest, healthiest, longest-lived people on the planet—that is, until burgers and cheese came in. Then as rice consumption fell and fat intake rose, diabetes rates skyrocketed.

What the NIH funded us to do was to test an entirely plant-based diet, loaded with vegetables, fruits, whole grains, and beans. It was very low in fat, and the animal products were eliminated. Several things happened. People lost weight very well, and their cholesterol levels improved. But what the diabetes researchers especially noticed was that their blood sugars improved so much that many of them ended up reducing their medications and in some cases, diabetes was no longer even detectable.

In 2009, the American Diabetes Association began citing our research studies in its clinical practice recommendations, and we are grateful for that. We hear every day from people whose diabetes is improving dramatically. More importantly, when people make dietary changes, they may be able to prevent this disease from starting in the first place.

JOHN ROBBINS: My father, who as you know was the founder and for many years the owner of the Baskin-Robbins (31 Flavors) ice cream company, developed a very serious form of diabetes in his 70s, and the prognosis was very poor. But as a result of reading my books and similar ones, he made some major changes in his diet and his diabetes went into remission. He no longer needed injections of insulin or even diabetic pills. The amputation of a foot or a leg that had been envisioned wasn't necessary, and he lived many more good years. He didn't go as far with his dietary changes as you or I might have ideally wanted, but he made major ones. I thought, if a person at that age with such an investment in the lifestyle that he maintained could make those changes and experience dramatic health results in a positive way, then perhaps there is hope for just about anybody.

DR. NEAL BARNARD: Your father was very lucky to have you looking out for him. And we have seen the same sort of success many times. I vividly recall a man who came into our research study and told me about his family history. He had diabetes all up and down his mother's side and his father's side, and his own father was dead at age 30. This young man was 31 when he got his diabetes diagnosis. He came in to see us five or six years later. We put him on a plant-based diet. He was thrilled to do it, and he told us it was much easier than the diets he had been prescribed before. Because he could eat as much as he wanted, and he felt good and energetic. He lost about sixty pounds over the course of a year, at which point the diabetes was no longer detectable.

Another man in the study had had diabetes for nearly twenty years and was on injections several times a day. He suffered from a complication called diabetic neuropathy, which is pain in the feet and ankles that comes from the nerves being attacked by the disease. I remember him telling me how miserable this had been, and that life was hardly worth living. After about five or six months on a healthy, vegan diet, he came in to say, “You won't believe this. My neuropathy is completely gone!”

I followed with him for years because I had never heard of this happening before. In medical school we were taught that diabetes is a one-way street. But for this man, the neuropathy never came back. And we have seen this for many people since that time. What we discovered is that diet changes really are powerful. They vary from person to person, of course, but it is wonderful to see what can happen when a person puts a healthy diet to work.

JOHN ROBBINS: You founded Physicians Committee for Responsible Medicine (PCRM) in 1985. What does your organization do?

DR. NEAL BARNARD: We promote preventive medicine, especially good nutrition. We also do clinical research studies. We have done quite a lot on the role of nutrition in diabetes, weight loss, and cholesterol management, as well as a number of studies looking at migraines, arthritis, and menstrual pain. We have done studies on the applications of dietary changes, such as on how people can make nutritional changes at the workplace or in doctors' offices. We also want research to be done better, meaning more ethically. So we promote alternatives to the use of animals in research.

JOHN ROBBINS: When you publish your research in medical journals, have you ever been challenged for your advocacy of a vegan diet on the grounds that you may be concerned for the animals, regardless of the actual health data?

DR. NEAL BARNARD: No, and there are a couple of reasons for that. First of all, let me say that concern for animals is a really good thing. I wish everyone were motivated by compassion, because that would make for a better world. And for myself, I wish that I had a keener, ethical sense earlier in life, because I have often reflected about the times when I drove cattle to slaughter or went hunting as a kid. We did a lot of things that, now that I am a little older and maybe wiser, I really wouldn't do again.

Having said that, when we do a clinical trial, it goes through a rigorous process of independent peer review. Our statistics are all done by people who are unbiased and are masked to the specifics of the research. When they are evaluating blood tests and other results, they don't know who is in which diet group. So when the NIH or other funders or reviewers look at our data, they can see that they are without bias. As a result, our diabetes trial yielded six or seven separate research publications. The American Diabetes Association published our first results in its journal, followed by The American Journal of Clinical Nutrition, The Journal of the American Dietetic Association, and several others.

With that said, sometimes a broader social perspective can be helpful. People come in to see us because they want their diabetes to get better or they want to lose weight or to get their cholesterol down. But after they have been on a plant-based diet a little while, many end up saying, “You know, I read an article by somebody named John Robbins.” Or they read other enlightened authors, and they say, “The diet that is good for the environment is not much different from the diet that is good for my coronary arteries.” Or they read something about animals. They have these “ah-ha!” moments that I am glad to see, because it means they have that much more motivation for staying on a healthy regimen.

JOHN ROBBINS: I actually find it a source of gratitude that the same food choices that are healthiest for us; that give us the strongest immune systems and the healthiest, longest lives; and that lead to the least susceptibility to diabetes, heart disease, and cancer, are also the kindest to other animals and the best for the environment. The fact that there is that coherence doesn't jeopardize or cast any kind of aspersion on the diet, it actually strengthens it and it shows that we are connected to the world in which we live in ways that we sometimes aren't even aware of.

DR. NEAL BARNARD: Yes. And think back a few years. In the late 1950s and early 1960s it was becoming quite clear that tobacco caused lung cancer. The researchers doing that work found themselves absolutely convinced. And yet they still studied smoking in order to try to tease out what is it in the cigarette smoke that causes cancer, what happens to people over time as they develop lung problems, or other aspects of the tobacco-health puzzle. In the process, most cancer researchers stopped smoking. The same is happening now, a generation later, with diet.

Now researchers are saying, “Wait a minute. Vegetables really are good for you, and so are fruits. And so is getting away from cholesterol, and, for that matter, from animal products in general.” There comes a time when research findings are so overwhelming. We have seen that, for example, with hot dogs and other processed meats and colorectal cancer. It is beyond dispute that these foods contribute to colorectal cancer. You simply can't be open-minded about it anymore because now the evidence is just open and shut. Even so, there are still open questions, and we still have to do our research in as unbiased a way as possible, and we have ways to eliminate bias among those who analyze the results.

JOHN ROBBINS: Well speaking of research and public confusion, you and I have both been highly critical of The Atkins Diet. When Dr. Robert Atkins died, PCRM obtained and released a medical report on his death and there was an ensuing controversy. What actually happened there and most important, how does this reflect on the health consequences of the diet that Dr. Atkins followed and advocated?

DR. NEAL BARNARD: Well it was quite a time. The Atkins books were at the top of the bestseller lists, and Dr. Atkins encouraged people to believe that they could safely eat high-cholesterol foods and high-fat foods without risk. All the while, he was hiding from the public that he had cardiovascular disease himself. When he died, his autopsy report laid out the facts. A cardiologist who lived in the Midwest asked for a copy from the coroner, because he felt it was important for people to know the truth. So he sent it to us and we released it to the press. People did, with some justification, ask why we were talking about a dead man's medical condition. I made the judgment that it was critical for those tens of millions of people who imagined they could safely eat gravy and bacon to know that they really were putting themselves at risk. Unfortunately much of the residue of that diet has continued. People still, in many cases, think there is something wrong with bread or rice and that there is something safe about pork rinds. That is a terribly dangerous lesson for people to have memorized.

JOHN ROBBINS: There are many people who are afraid that soy products are unhealthy. Can you share some of your insights?

DR. NEAL BARNARD: The Internet is a wonderful thing. It shares information very quickly, but it shares misinformation just as quickly. Many decades ago, researchers became aware that soy products and many other foods in the legume (or bean) category contain substances called isoflavones. If you were to draw the chemical structure of a typical isoflavone on a blackboard, it would look somewhat similar to estrogen—female sex hormones. Isoflavones are not estrogens, but they look somewhat similar. So some people then worried that, if isoflavones really did act like female sex hormones, then men consuming soy products might become effeminate or have a lower sperm count, or women consuming soy might be at risk for cancer. Researchers have studied these things, and it is very clear that in parts of the world where men consume large amounts of soy—for example in China or Japan, where tofu and soy milk have long been consumed—there has been no problem with fertility.

Studies following girls who consume soy products during adolescence, when the breast tissue is forming, have shown that their risk of developing breast cancer is actually about 30 percent less than that for women who did not consume soy. So, if anything, soy products are helpful.

We now have three research studies looking at what happens when women consume soy after they have had breast cancer—two in the United States, and one from China. They show that women who consume tofu, soy milk, or other soy products have about a 30 percent reduction in their risk of the cancer coming back. So in other words, soy seems to be protective. Having said that, soy products are totally optional. A healthful plant-based diet could follow a Mediterranean pattern based on vegetables and fruit and pasta. It could follow a Latin American pattern with beans and tortillas. Or it might follow an Asian pattern, which is where soy products come in. Soy does not increase cancer risk. It does quite the reverse, but you don't have to have it if it is not your thing.

JOHN ROBBINS: Cancer is a terrifying prospect in a lot of people's lives, and rates have been increasing. You founded The Cancer Project. What is the organization doing, and why is its work so important?

DR. NEAL BARNARD: This is near and dear to my heart. My father was diagnosed with prostate cancer when he was in midlife and he had a miserable time with it. So many people know nothing at all about what leads to cancer or what might help prevent it. But we have abundant evidence that foods play a big role. The Cancer Project offers nutrition and cooking classes in cities across the United States. If you live in Pittsburgh or Los Angeles or Seattle or in one of a hundred other cities, you can come on in and there will be others just like you who want to know about how foods can protect you against cancer or help after diagnosis. You will learn about nutrition and cancer, and will have a chance to stir the spaghetti sauce, and can even bring your reluctant spouse in too, so that we are all learning together. We have instructors, we have books, we have videos, and we have a website, which is www.cancerproject.org.

My aspiration is that instead of only hoping for research to find a cure, or just hoping that a mammogram or a PSA test will find your cancer early enough, we can go another step. I hope we can use foods to prevent cancer so that it never has to happen in the first place.

JOHN ROBBINS: You have been at this for many decades now. When you look back on these years and on your work, what has surprised you?

DR. NEAL BARNARD: Everything surprises me. It surprises me that Bill Clinton, a President who was known for jogging to the nearest fast-food chain and eating junk food, and who was gaining weight and looking less and less healthy, finally decided to change. He not only adopted a plant-based diet, but he decided to tell the whole world. He went on television saying that the change was not so hard, and encouraging others to give it a try.

It surprises me that in almost every school in America, students are asking for vegetarian or vegan choices.

But it also surprises me that the people working for the meat, dairy, and junk-food industries persist not only in producing unhealthful products, but also in fighting efforts to change what is in school lunches, and what is in the food stamp (SNAP) program. Even though their own families are at risk and they themselves are paying a price for unhealthy eating habits, they fight to keep the worst foods front and center on the American plate.

So frankly, everything surprises me. But what can you do? Life is short. You have to just work as hard as you can to get the word out. And over time people really do take this knowledge in hand, and they share it with other people they know. The most important thing is that they share it with their kids, because that will change the fundamental direction in which we're headed.

JOHN ROBBINS: Many things that I had once thought were controversial have over time become mainstream. Things that had been bitterly fought are now being taken as self-evident. At this point in history, at this point in the arc of change, what steps would you like to see people take?

DR. NEAL BARNARD: We need to think societal change. The Internet enables us to reach many, many people with the click of a button. That is great, and we need to use it. We also need to leverage the power of business. We have been working with a number of businesses now, including the GEICO insurance company that is known for its cute, green lizard icon. GEICO instituted plant-based diets at ten of its thirteen facilities around the United States, so that their employees could try it, taste it, and adapt to healthier meals. And we have tracked the results. In our first GEICO study over the course of 22 weeks, employees lost an average of 11 pounds, and saw their blood-pressure levels drop. They also missed less days from work. We published those findings in the American Journal of Health Promotion.

We need to work for societal change, because the price of bad food habits is simply too high. Americans now eat more than a million animals every hour. And many more are consumed elsewhere around the world. The environment is degrading faster than many of us had ever thought, and human health is paying a terrible price for our current shortsightedness.

JOHN ROBBINS: What is the food revolution that you would like to see take place?

DR. NEAL BARNARD: My hope is that what is on the plate will be different and that what is growing in the fields will be different, as well. In turn, animals will have an entirely different experience—that is, they will no longer be considered dinner. When I went downtown yesterday to a meeting, I went into a large office building. There was a man outside finishing up his cigarette before he could go into his nonsmoking building. And I hope that, ten or twenty years from now, that same guy will be standing outside finishing up his chicken wing before he is allowed to go into his vegan office building.

JOHN ROBBINS: There are so many people today waking up to the reality that the industrial food machine is spewing out and advertising to our kids some of the most unhealthy foodlike substances imaginable. The price we are paying for it as individuals, as families, and as a society, is exorbitant. Yet so many of the policies of our government have reinforced and supported the industrial food machine: feedlot agriculture, Monsanto, McDonald's, factory farms, and even now, genetically engineered foods. In the face of the momentum of that and all the lobbyists down in Washington, what are the steps that a group of people can take to make a difference politically?

DR. NEAL BARNARD: Every five years, Congress decides what the agricultural subsidy programs are going to look like as it formulates the Farm Bill. Up until this point, the U.S. Government gives almost nothing to vegetables and fruits, and it gives huge subsidies to animal agriculture. The biggest part of the Farm Bill is the SNAP Program—the Supplemental Nutrition Assistance Program, which used to be called Food Stamps. The program is well intentioned—it is supposed to provide food for needy people. However, the program has become largely a service for the junk-food industry. Other food-assistance programs provide reasonably healthy food. The WIC program, which serves women, infants, and children, is limited to a finite list of foods that are more or less healthful. School lunches have at least some limitations now as well. For example, you can't serve sugary sodas in most school lunches. The SNAP program is different and is not remotely health conscious. It does cover vegetables and fruits and grains and beans, but it also covers sausage, cheese, Red Bull, candy, potato chips, and sugary sodas. The fact is, convenience-store operators who operate in neighborhoods in “food deserts” are reimbursed just as well for junk food as they are for fresh fruits and vegetables. As a result, they have no incentive for stocking anything other than candy and packaged snacks. They are not going to put an orange or some fresh spinach on the shelf because fresh things have a shorter shelf life. If the food stamps pay for potato chips and other things that have a longer shelf life, economic pressures favor the worst foods. Small wonder that economically disadvantaged people are at higher risk for obesity and diabetes, compared with their wealthier counterparts.

We would like to limit the SNAP program to those foods that are healthy: grains, beans, vegetables, and fruits, whether they are fresh, frozen, or perhaps in a can. If the retailers were only compensated with government money for healthful foods, it would spell the end of food deserts. The result would be that needy folks who are now paying a terrible price for the junk food avalanche that is all around them could instead become the healthiest people in America.