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(Photo by Earl Dotter)
Top four reasons why Latino patients are good candidates to go plant-based
In 2012, Dr. Leon and Dr. Carral, who originally hail from Mexico, launched Vegetariano en 21 Días (at www.vegetarianoen21dias.org [3]) in conjunction with Physicians Committee for Responsible Medicine [4], to provide free Spanish-language 21-day diet challenge along with online support like information on the health benefits of a plant-based diet, webcasts, and recipes. The program was initially designed for US Spanish-speaking audiences, but the challenge went viral, with participants from throughout the Spanish-speaking world. Leaning on its success, PCRM has launched similar challenges for people in India, China, and elsewhere.
But how do you convince patients to try out the diet? Dr. Leon and Dr. Carral postulate that Latinos in the US are ideal candidates to transition to plant-based: their cultural and culinary backgrounds make the switch relatively easier, and the population, with significant diet-based health risks, can greatly benefit from the diet. Here are some reasons Latinos should go whole-foods, plant-based:
Diabetes is sky-high among Latinos. Over 12 percent of Hispanic Americans have diabetes [5], compared to 9.4 percent of the population overall. Among Mexican Americans, the number is 13.8 percent. Additionally, for immigrants, studies show that the longer a person lived in the United States, the more likely they are to develop diabetes [6].
Second-generation Latino immigrants are sicker and die earlier than their parents. “A growing body of mortality research on immigrants has shown that the longer they live in this country, the worse their rates of heart disease, high blood pressure and diabetes. And while their American-born children may have more money, they tend to live shorter lives than the parents,” summarizes a New York Times article [7]. Much can be attributed to the adoption of a standard US lifestyle, including the diet. Returning to the diet of one’s immigrant parents may assist in reducing those increased rates of disease.
Traditional foods were vegan before colonialism. And, until recently, few had the resources to eat meat daily. In pre-Columbian times, that Al Pastor didn’t have any pork [8] and beef, chicken, lamb, and goat were also off the table. This message to “decolonize your diet [9]” is resonating with Latinos, particularly younger ones, who are rediscovering what “traditional” foods really are, and giving beans, vegetables, and whole grains the foci of the dinner plate. Additionally, many of our patients are just one or two generations away from primarily plant-based foods. Dr. Carral encourages giving a pep talk: “You’re in charge. It’s not that hard; your grandparents were doing it, and you can do it, too.”
Latinos still generally know their way around the kitchen. Dr. Carral points out that one of the best ways to improve one’s diet is to start cooking. “Millenials are the first generation that didn’t see their parents cook. We have that advantage: we still know what it is to be in the kitchen and eat homemade food,” he said, noting that many Latino families, because of possibly both culture and economic restrictions, still cook. Those who cook at home consume fewer calories [10] and have a lower risk of diabetes [11], regardless of diet. Familiarity with cooking gives Latinos a significant leg-up in the road to plant-based. Any food made in the home will likely be healthier than what’s available at fast-food restaurants. With recipes, support, and substitutions, Latinos can make quickly prepared and healthy choices in the kitchen that will benefit the entire family.
Earlier this year, dozens of promotores de salud from around the US and Puerto Rico logged in to participate in the final sessions of MCN’s hypertension and diabetes ECHO project, presented in Spanish. The group had come together every two weeks for five months, to talk with experts, hear case studies, and learn from each other on diverse issues like diabetes and mental health, patient management during emergencies, social determinants of health, and telemedicine. The final session focused not just on management, but on prevention and even the reversal of diabetes, hypertension, and other chronic diseases. For most of the attendees, the notion of reversal of diabetes was a shock, but they presented a very viable alternative about which participants were eager to learn: a plant-based diet with lifestyle changes.
Joaquin Carral, MD, co-presenter, wasn’t surprised that the message was new to participants: “In med school, they tell us that diabetes is not reversible. That’s what the drug companies tell us as well. But if we do lifestyle changes, it changes drastically for people… Even people with insulin -- if they make the changes, they can cut medications,” said Dr. Carral.
During the ECHO session, Dr. Carral and Aurora Leon, MD, shared the successes they have had both personally and professionally with a plant-based diet: unprocessed whole foods like whole grains, beans and lentils, vegetables, and fruit -- with no meat (including fish and chicken), dairy, or eggs.
“I have had patients who don’t believe me,” Dr. Leon admitted. One incredulous patient started on the plant-based diet for 30 days as Dr. Leon recommended, and decided to make the change to plant-based eating permanent. “After a month, she noticed she didn’t have pain in her joints, and just because of that, she said she’d never go back.” But patients don’t just notice less joint pain, more energy, less bloating, less acid reflux; the changes are measurable. “You can measure your A1C, your lipids -- you can see your numbers changing. [12] That’s why people continue. They feel good and they can see the results,” she noted.
Recent literature backs their assertions up, demonstrating that such a diet addresses not just diabetes and hypertension but many of the top killers in the US. A diet of whole grains, vegetables, fruits, and legumes and absent of meat, eggs, and dairy has been shown to reduce the risk of heart failure [13] and even reverse heart disease [14]. Studies further show it can reduce prostate cancer cell growth [15], and, paired with exercise, it results in “major reductions” of breast cancer risk factors [16] like the production of insulin-like growth factor-I (IGF-I).
The session was wildly popular, with more questions and conversation after the presentation than any other session in the ECHO series. Alma Galván, MCH, Senior Program Manager and the coordinator and facilitator of the ECHO series, notes that “Dr. Carral and Dr. Leo were very enthusiastic and engaging presenters, providing a professional, clear, and simple way to explain the backbone issues and misconceptions behind unhealthy habits.”
Further interest after the session prompted an post-ECHO project encore presentation during the summer, for the duo to dive deeper into the research. During a follow-up interview, the two physicians went over numerous recommendations on how clinicians can approach the lifestyle change, including the following five tips:
1. “Do the research.”
Clinicians first need to understand the science, they say. The top killers in the United States can be reduced or eliminated by cutting out meat, dairy, and eggs and replacing it with vegetables, whole grains, and legumes. Despite plenty of internet challenges to the contrary, the scientific literature is abundant and easily accessible. Dr. Leon and Dr. Carral recommend several resources for the clinician to better understand what has been studied and what the results indicate.
Forks over Knives articles [17]: The wellness articles section of the popular vegan documentary Forks over Knives includes this hour-long panel discussion on plant-based diets for health from the Unite to Cure Fourth International Vatican Conference in Rome earlier this year. In the video, leading physician advocates discussed a new Harvard study that shows that plant-based diets can reduce mortality by a third [18]. Other new articles catalog the various hospitals going plant-based, new studies on diabetes and nutrition, and more. The website also features healthy recipes and more resources.
Nutritionfacts.org [19]: This comprehensive nutrition site, run by Michael Gregor, MD, runs daily videos examining new nutrition research, on everything from flax and blueberries to coffee and artificial sweeteners. Watch his 1.5-hour long video presentation, “How Not to Die: The Role of Diet in Preventing, Arresting, and Reversing Our Top 15 Killers. [20]” Nutritionfacts.org can be a good resource for patients, as well. Check out the page en Español [21], with text in Spanish and videos with Spanish subtitles.
Proteinaholic [22]: If you prefer a book over a video, Dr. Leon recommends this read from Dr. Garth Davis, a well-known weight loss surgeon from Austin.
2. “Every step in the right direction is a step toward health.”
That’s why each patient’s path is different. One of Dr. Carral’s patients had rising prostate-specific antigen test numbers. He was on four diabetes medications and yet still had an A1C of 12. Dr. Carral could see that he was motivated for health and well-organized -- a good candidate for the complete and “cold-turkey” switch to plant-based. He had never heard of going plant-based for his health concerns, but with Dr. Carral’s encouragement, he adopted the diet. Within a few months, his A1C dropped to 6.5 and he was on just one medication. His PSA dropped and then stabilized. He asked Dr. Carral, “I’ve been coming here for three years and no one ever talked to me about diet.” For other patients, a slower transition would be more effective. Dr. Carral recommends to encourage people to cook food -- any food -- at home. Home-cooked will be healthier, and can set the patient up for increasing vegetable consumption and decreasing meat consumption as he or she gets more comfortable in the kitchen. For other patients, Dr. Carral notes, making diet changes has to wait until drug or alcohol addictions are addressed. “We’re not looking for everyone to become vegan or plant-based. It’s about moving in that direction, seeing it as option,” Dr. Carral clarified. “Everyone can change, little by little.” And each change toward a plant-based diet can benefit the health of the patient.
3. “Change your life first.”
Perhaps the most controversial point in a relatively controversial topic is Dr. Leon’s top recommendation for clinicians. “If the doctor smokes, [she] won’t tell you to quit smoking,” she quips. She recommends doctors to take the 21-day challenge themselves, to see how they feel, to uncover obstacles or unexpected benefits. Many clinicians, she notes, have already cut out meat, dairy, and eggs. “Providers are changing because their patients are trying it and they have had big results. A typical response is ‘just keep doing what you’re doing because it works’… but then they start to become curious.” Many clinics have plant-based diet programs and hospitals’ in-patient meal programs are going plant-based as well.
4. “We’re just starting with trust and empowering the patients.”
Clinicians serving mobile patients like agricultural workers know the frustration of diagnosing a patient with diabetes, prescribing medications, and then discovering a year later, when the patient returns, that the patient was unable to access prescription refills on his migration route -- and his diabetes remains out of control. Empowering patients to embrace a lifestyle option that often saves money compared to the standard diet, is available wherever they go, and -- for Latino patients -- fits their cultural background, can be an effective and efficient treatment option.
5. “We want health from head-to-toe, not just in the waistline.”
Dr. Carral noted that many of the popular diets -- Atkins, Paleo, and Keto, and variations of those -- are effective in losing weight in the short term but are hard to keep up and unhealthy in the long term. A shift to a plant-based diet can be a decision for long-term health and well-being. But any patient who is actively dieting is a great candidate for plant-based, Dr. Carral adds, as the patient is showing the motivation and putting in the effort to switch to a healthier lifestyle. Encouraging patients to transition to plant-based will give them the benefits of other diets -- a loss in weight, an increase in energy -- along with the many long-term health benefits that those diets lack.
[Editor’s Note: Is your curiosity piqued? Have more questions? Read this great Guide to Eating a Plant-Based Diet [23], complete with sections on how to change and what to eat, the added (and significant) environmental consequences of a plant-based diet, and an informative FAQ.]
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