Despite recommending patients to follow a plant-based diet, very few cardiologists actually do so themselves, a new study has found.
The gap between heart doctors who prescribe a whole-food plant-based diet to patients and those who follow it themselves is sizeable, according to a new study.
Researchers from four US universities surveyed 166 members of the American College of Cardiology’s CardioSurve panel, with questions revolving around lifestyle medicine, personal dietary patterns, physical activity, sleep, alcohol and smoking, and recommendations for patients.
The findings, published in the Journal of the American College of Cardiology, show that two in five (41%) of heart doctors frequently recommend patients to follow a whole-food plant-based diet to prevent cardiovascular diseases.
Kim Williams, a professor at the University of Louisville and lead author of the study, explained that this is because of the primary prevention guidelines developed by the American College of Cardiology and the American Heart Association in 2019.
“All animal protein sources increase mortality relative to plant-protein consumption,” he told Green Queen. “Vegetarian/vegan diets can reverse or improve hypertension, diabetes, hyperlipidemia, inflammation, chronic kidney disease, and coronary artery disease (CAD), to name just a few. This reversal of CAD was on 32 months of [the] vegan Esselstyn diet.”
However, only 8% of cardiologists comply with their own advice and personally follow a whole-food plant-based diet. “Despite recognising the importance of lifestyle medicine as a foundation for cardiovascular disease prevention, many respondents reported inconsistent personal compliance to key pillars, particularly dietary and physical activity recommendations,” the researchers wrote in the study.
Heart doctors don’t avoid red meat, despite known harms
Cardiovascular disease is the leading cause of death both globally and in the US. In fact, the condition kills one American every 33 seconds. Among the main drivers of heart disease are high blood pressure and cholesterol levels, which themselves are caused by excessive sodium and saturated fat intake.
Red meats like beef and pork contain high amounts of saturated fat, which is linked to increased inflammation in the heart. And processed forms of meat, including bacon, sliced ham and hot dogs, have excessive salt.
These products have been directly linked to increased risks of heart disease (among other conditions). It’s why scientists advising the US government on its upcoming dietary guidelines have recommended a reduction in red and processed meat consumption, while highlighting the benefits of plant proteins.
Still, research shows that 63-74% of Americans consume red and processed meat on any given day. And the damaging health evidence hasn’t deterred cardiologists from their cheeseburgers either, with the study finding that only 8% of respondents actively avoid red meat.
Instead, they’re more focused on abstaining from alcohol (92%), maintaining strong social connections (84%), and incorporating physical activity into patient care (91%).
Late last year, a Harvard University study found that people who eat a higher amount of plants in their diet see drastic reductions in the risk of developing cardiovascular disease and coronary heart disease. And last month, the American Heart Association’s scientific advisory reinforced recommendations to limit ultra-processed foods that are high in salt, saturated fat and sugar, and increase the intake of whole plant-based foods like fruits, vegetables, whole grains, beans, nuts, seeds and lean proteins.
In this latest survey, 68% of respondents said they consumed either an omnivorous or flexitarian diet. Explaining why their actions don’t meet their whole-food plant-based recommendations, doctors cited concerns about patient compliance (63%), social and cultural challenges (40%), and protein adequacy (28%).
“The latter is known to be inaccurate if a variety of inexpensive beans, grains, nuts, seeds, and mushrooms are included in the diet,” the study noted.
Williams said the best way to overcome these barriers is to “read up” and “realise that lifestyle [medicine] comes first by every recent guideline, can save lives and reduce healthcare costs”, while also helping the environment and reducing animal cruelty. “Why wouldn’t we all do this?” he asked.
Formal lifestyle medicine training can close knowledge-behaviour gap
The survey also found that 87% of heart doctors in the US had not received formal training in the “adoption or counselling on the six pillars of lifestyle medicine”, which includes a whole-food plant-based diet. “This is consistent with publications citing the critical gap in physician nutrition training,” the researchers said. “However, 8% adopting a whole-food plant-based diet is significantly higher than the 0.3% rate recently published for academic physicians.”
This is a global problem that spans multiple facets of the medical sector. In New Zealand, while 96% of midwives feel equipped to give their patients advice on general nutrition, this level of preparedness falls to just 72% for plant-based nutrition. Moreover, 14% say they’re wholly unprepared to advise on meat-free pregnancies, and only 7% and 3% think plant-based diets are better for mothers’ and babies’ development.
“The teaching and training of healthcare professionals in general is still based around omnivorous diets when it comes to nutrition,” Dr Shireen Kassam, a consultant haematologist and founding director of medical association Plant-Based Health Professionals UK, told Green Queen in May.
“Gaining relatively specialised knowledge from general public health resources is challenging, and there remains a significant information gap in terms of plant-based diets,” she added.
A recent survey by the Physicians Committee for Responsible Medicine found that half of Americans believe plant-based diets are healthy, and 65% were open to eating this way if they were shown this evidence. But only one in five have had their primary care doctor speak to them about the benefits of a vegan diet.
For the cardiologists in the new study, bridging the gap between knowledge and behaviour “may improve physician wellbeing and model more effective, credible counselling for patients”, the authors stated. “Integrating formal training in lifestyle medicine into cardiology education could play a pivotal role in achieving this dual benefit,” they added.
Will patients lose faith in the plant-based diet if they knew their doctors didn’t follow their own advice? Williams thinks it’s likely, unless they go to a cardiologist who eats a whole-food plant-based diet. “Then they don’t go back,” he said. “They like taking fewer medications and feeling stronger, [and] not ageing as quickly.”
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