UKC

The leading causes of disease are either prevented, cured or significantly improved by a wholefood plant-based diet. This is the case for heart disease, strokes, hypertension, respiratory disease, cancers, diabetes, infections from meat, dementia and kidney disease. Yet in my experience working in acute medical/surgical areas, not once, not a single time, have I ever seen a doctor or a nurse discuss even the possibility that 'instead of taking drugs for the rest of your life, would you like to try and actually solve the underlying problem that brought you here in the first place?'.

I can't say I have any of these diseases thankfully, so can't say what is going on in primary care, but my gut feeling is that GP's who are time-pressed and very ill informed about plant-based diet treatments, tend not to have these discussions with patients. I've certainly never met a patient with a dietary care plan for their heart disease... If I sound cynical, it's because I am!

I'd just like to know this: when doctors are asked why they don't talk about diet with patients, it's because the doctor doesn't think the patient will be interested, but is that true? Do you think people would be interested in an alternative? Would you be interested? Is it really that people would rather just take drugs the rest of their lives instead of changing their diets? Is that really it? Or is the NHS failing by not being more upfront/blunt/honest with patients?

I'm not looking to start a debate on diet itself, just interested in how people would respond to healthcare professionals broaching the subject.

Do you have peer-reviewed, medical-standard evidence to support those claims?  You have made a very strong statement in your first sentence without backing it up with appropriate evidence.

But on a wider basis rather than specifically pushing veganism, I do find doctors are very quick to suggest pills rather than lifestyle changes, most notably for blood pressure.  I've never heard of them prescribing a course of running training, for example, or assistance in the purchase of a bicycle, despite these things probably being cheaper than some types of pills for life.  Indeed I find they are quite bad at dealing with e.g. running injuries - "just stop running then" - and not prescribing physio to sort the problem or recommendations on new sports to try.

My dad’s been working with doctors for a decade or so now for an ongoing problem he has.  Various diets (and exercise regimes) have been suggested and followed...

Look harder for examples?

That's like saying, do you have peer-reviewed evidence that smoking causes cancer? The only reason it's not a widely accepted fact is because the food and pharmaceutical industries are employing the exact same misinformation campaigns that the tobacco industry did years ago. There is a wealth of information available, there has been for decades, that the leading causes of disease are modified or prevented or cured by a wholefood plant based diet. I'm not going to start posting dozens of articles as my life is too short, so I'll just ask people to do the research themselves if this is in any way surprising.

But thanks for your reply! Interesting how you mentioned veganism.



 

Well, I have thousands of examples. All of which are in acute medicine and surgery, so by no means all encompassing.

Fair enough - what my dad has is a heart problem.  He had a quad bypass a few years ago.  So sounds like exactly the right area!  Strange...

Iiiiiiiiits a coverup, run for your veggies!

The leading causes of death and disease are either prevented, cured or significantly improved by a wholefood plant-based diet. This is the case for heart disease, strokes, hypertension, respiratory disease, cancers, diabetes, infections from meat, dementia and kidney disease. Yet in my experience working in acute medical/surgical areas, not once, not a single time, have I ever seen a doctor or a nurse discuss even the possibility that 'instead of taking drugs for the rest of your life, would you like to try and actually solve the underlying problem that brought you here in the first place?'.

I don't think death can ever be prevented, maybe delayed but prevented!!

While I agree some conditions can be alleviated or cured even, by a change of diet, diabetes springs to mind, this doesn't mean all diseases can be, not even all leading diseases.

There's still a debate going on about fat vs oils in our diets, and dairy  products seem to change sides on a weekly basis.

If you don't mind me asking, what kind of diets has your father been prescribed? I'm just curious.

Then post it and its sources.

Otherwise, accept that I will treat your post as attempted "proof by assertion", which carries no credibility whatsoever, just like people making similar statements against the COVID vaccination programme.

I certainly think a healthier diet is pretty well established as helping many medical conditions, and everyone knows that even if they don't practice it.  But simply excluding meat is more than that.  I had a vegan lunch - chips (fried in veg oil) and beans - but if I had that 3 times a day I can't imagine I'd last long before a heart attack.  Mediterranean diets for example seem to do well for health and they contain plenty of meat.

So "should doctors advise people to eat a better diet before they advise pills?"  Absolutely, and that's well known.  Should it be vegan?  Much more controversial, hence my call for quality evidence to support your post.

Call a spade a spade.  "Plant-based diet" is just a trendy term for "vegan diet", or I suppose "slightly lazy vegan diet with the odd bit of meat".

I'd not previously heard of a link between a poor diet and dementia. Have a I been the victim of a sophisticated disinformation campaign by Greggs? 

Thanks, but you knew what I meant! I certainly don't think all disease can be modified by diet, but the majority of the leading causes are modifiable to some degree with diet, like those I mentioned. The fat thing seems to be a prime example of misinformation. Remember 'butter is back'? Hilarious!

I appreciate your point of view as I often take that same tack myself in discussion, but in this case I'm not going to spend hours, days even, collating the vast quantities of evidence that eating plants is great for your health, because my life is far too short to indulge you. I'm sorry. You are more than welcome to disbelieve anything I say and indeed I expect 95% of people who read this to, because why would something you've been eating your whole life be bad for you? It defies belief. I understand that because I've thought it myself.

Putting that to the side, hypothetically, if your doctor broached the subject of diet with you, how would you respond?

I think veganism is a lifestyle to varying degrees, whereas wholefoods plant-based is purely a diet. Also, try selling veganism to patients. WFPB has a lot less stigma.

Various, but anti meat cheese bread (wheat) sugar (No mochas).  At one point he lived off veggie curry and nothing else.  Also exercise, has a physio at the moment I think.

Correlation doesn't always equal causation. The 'meat is bad for you' argument has been done to death and still not proven.

When a study includes obese people who's diets include Maccies on a regular basis, then it is easy to say that it is meat that is the issue. You could just as easily change them to grass fed steaks and get them same results as a plant based diet.

Meat is not the issue. Saturated fat, sugars and lack of exercise are the issue.

Doctors should certainly be promoting/prescribing a good diet, exercise and strong immune system, especially given the past 18 months.

Well, I eat a gluten free diet because otherwise I get quite unwell?  Though that is self-prescribed, coeliac wasn't well known when I worked it out myself.

But I would expect the doctor to provide me information on why, and references etc.  The NHS is fairly good at little leaflets about stuff like that.

It's still "not eating meat and dairy", things that have been part of the human diet for thousands of years, so I'd be expecting some pretty big and reputable evidence.  And it still damages your credibility to me that you're not even attempting to provide that evidence.

If ever a man needed to bang his head against a wall in despair...

Provide your reputable, peer-reviewed evidence that a vegan diet (sorry, I'm not using bull**** terminology) is better than say a lean meat and salad based Mediterranean style diet, and people might respect your point better.

You are refusing to do this so you're no better than an anti-vaxxer doing the same.  I'd venture it's because you don't have any or it wouldn't be credible.

Of course it's well known what a healthier diet is and how that might help, but it doesn't have to be to the exclusion of meat and dairy.

"Proof by assertion" is worthless.  If anything it often provides counterevidence to the point attempting to be made, because it only tends to be used by people who don't have actual evidence for their point.

You can construct a healthy vegan diet or an unhealthy one, same as with meat and dairy.  A bag of sugar is vegan.  Chips and beans and a can of fat Coke is vegan.

Yes, you show all the hallmarks of making me want to do just that

I await your in depth response and supporting evidence proving me wrong.

Every time I see a patient with a family history of macular degeneration (AMD), or the early signs of it on their retina, I talk to them about diet (I'm an optometrist). But, I have no expectation that when I tell them to eat kale and spinach (as well as a bunch of other stuff but those two are the best sources of the relevant nutrients) they're actually going to do this (unless they do already, in which case they can feel pleased with themselves).

Any lifestyle interventions in healthcare would need to be "enforced" by some kind of structured "nagging regime", or other short-term incentive system, or there'll be zero compliance. I imagine GPs will look people up and down and make a judgement on whether or not it's even worth bothering making lifestyle recommendations, given the amount of experience they will have providing life-saving information to patients and watching it come straight out the other ear. [Apologies to any GPs etc. who are brilliant at actually getting people to make lifestyle changes!]

But yes of course, healthcare professionals are trained to make lifestyle recommendations. 

I think you have to accept that there's going to be misinformation on the plant based side too (Netflix documentaries are the obvious example). There's a lot of money to be made shifting people's diet and YouTube/Netflix seem like unregulated advertising spaces at times.

Personally I eat more saturated fats and avoid the seed oils. But I don't have a particular foot in either camp ideologically, just based on my own reading/viewing, and finding something that works for me. But depending on what you read/watch you could obviously end up thinking the opposite.

There are other good reasons for veganism, such as making good use of land and carbon emissions.  I just take exception to someone starting a discussion with an unproven premise, without which the rest of it is worthless, on the basis of getting people to start from that premise.

Vegans seem to have a habit of doing that, and it's just zealotry.

Of course we could have had a better discussion on the actual subject line had the OP not bothered with that zealotry and started it on the basis of a *healthier* diet, e.g. a Mediterranean one.

(Note: a load of Youtube videos or vegan websites aren't evidence, I'm thinking of something in the Lancet, perhaps, as a start).

Does veganism make good use of land?

Much more land and water is used to grow food for a cow than would be used to grow appropriate vegetables to feed the same people as the cow fed with its milk and beef.

https://www.smithsonianmag.com/travel/is-the-livestock-industry-destroying-...

(Just chucked that in to prove I'm not fundamentally anti-veganism, to be fair )

If you're not prepared to back it up, don't assert it. Otherwise nobody worth talking to will indulge you.
We all know eating less shite is good for you. That's not the same as saying veganism cures all ills.
The answer to our epidemic of these problems in the western world is first and foremost to put down the fork. Once we've mastered that we can consider arguing about what was on the fork.

No it doesn't. More if anything. It's just a wanky way of saying turbo-vegan. Not sure who you think you're fooling. Might as well throw in a 'locally-sourced' too.

I would certainly question your claims about a wholey plant based diet. While accepting that in general less meat is preferable and a vegetarian diet has significant health benefits (as well as environmental ones) I am dubious of all the "meat will kill you claims" as meat contines protiens and vitamins that are hard to get from a plant only diet unless to take great care to add suppliments. everytime I look into it I find poor research trying to push an aggenda. My aunt died at 107 and my father is currently 89, both ate meat all their life so I was just wondering when all the bad stuff is supposed to kick in.

In contrast smoking was known to be bad from quite early on and there was robust evidence that the tobacco companies chose to ignore. In contrast dietry science is a lot harder to pin down.

I suppose he's sort of got a point in that a vegan won't buy a car with leather seats, whereas someone who just doesn't eat meat might.  But it's a bit niche, and the term has just become more than a little bit hipster.

Just to flip it on it's head...

I've been a veggie for decades and occasional vegan. I partake in lots of regular, hard physical activity etc.

If my dr said you need to eat a steak or two and get some omega 3 from fish. I'd tell them to fork right off. I'd consider it to be ignorant and patronizing.

Your hypothetical sick carnivore might consider it to be the same sort of nonsense. They wouldn't accept it if you said, eat brown bread and do a Park Run, or even just swap chicken for quorn.

We give people the choice to do dumb things. You could easily rephrase your argument "should doctors treat smokers or drinkers?". After all, they are unhealthy lifestyle choices, which exacerbate other conditions.

As a medical practitioner, I don't suppose there is any harm in saying 'go veggie for a month and we'll measure X again to see if it makes any difference'. Some will be receptive, others less so.

I think that's simplistic, all land isn't the same, all animals aren't cows. It certainly isn't proof that totally removing meat and dairy from your diet is a good use of land.

And you've also got the point that what health issues are caused are relevant.  Personally, I'd like to live fully "with it" to a reasonable age then just drop dead one day.  What I don't want is a slow, painful death, which is what tends to be caused by smoking-related cancers and other stuff it causes.  I'm not interested in another 20 years if they'll be sat in a home wearing a nappy and not knowing what day it is.

I guess what you're driving at here is that the blunt change of "everyone going vegan" isn't the most effective way to tackle the issue of land use (and carbon emissions).

FWIW, my vague idea of an optimal food culture wouldn't be vegan, it would include high quality, expensive, high welfare, tasty AF meat. We'd eat it as a treat once a week (that's those on average incomes and below), or if you're loaded, good for you, you can eat the stuff every day. But cheap-as-chips chicken nuggets would not exist. Find a way to grow something in a lab for that job, don't grow it in a miserable little animal.

Yes.

Maybe not here, but I suspect large swathes of the population, if they were sat in the GPs office and presented the choice between pills and a significant change in diet, would choose the pills.

Changing diet is hard. Taking pills is easy. People are lazy.

There is an industry built around pedalling diet pills - so there are evidently plenty of people who would rather take pills than follow an effective diet and exercise regime.

Perhaps a serious diagnosis would provide enough motivation for some. I used to work with a morbidly obese person who had some health scares and an embarrassing security barrier related incident at work*. He started a fairly serious diet plan, his subsequent weight loss was really impressive. I do wonder whether the embarrassment with the barrier was significant here - would the health issues alone have been enough? I could see social stigma being a more powerful driver, e.g. is the increasingly negative view of smoking within society a bigger cause of the reduction in the number of people smoking than the constant health warnings etc? Might have to do a bit of research here...

Yes I am cynical.

Often when someone gives humanity in general the benefit of the doubt, part of me thinks they just haven't met enough people.

* There was an automated system with two doors kinda like an airlock. You swiped your pass and went through the first door, which closed behind you. There were some sort of scales built into the floor and if the weight exceeded a certain threshold, the system decided it was two people and you were trapped between the doors till the security people came to see if you were trying to sneak someone in. The chap in question was large enough to trigger this.

I think so. There's a lot of competing misinformation, a bit like diet. And I'm not sure where the balance lies really.

Just one link to one peer reviewed article would be a big step forward from the silence from Mr SharpEnd that we've had so far. That can't be asking too much surely? 

Martin

This is hyperbole and not even accurate. By far the biggest influence on health (outside of family history and environment) is life-style and that includes a whole range of different things from exercise, stress, smoking, drinking and yes eating. In almost every case the rule is balance. Vegan diets can be healthy, vegetarian diets can be healthy, even meat and fish diets can be healthy. what isn't healthy is living off beefburgers, chowing down on margaretta pizza, turkey swizzlers, and washing it down with 10 pints of ale or a bottle of plonk. Avoiding processed food, high sugar, too much fat is good for you but also avoiding malnutrition by making sure your body gets all it needs.

Avoid meat for ethical or health reasons by all means but don't try to sell it as a cure all because that just won't wash

for the record. If my doctor told me to take crystal meth mixed with lard as a dietry regime I'd probably ignore it.

First question is what balance are we trying to achieve. I think there's huge cultural value in eating animals that I don't want to end. So I think some of our "carbon budget" should be set aside for producing meat so we can continue to enjoy the good bits of our food culture. Making and/or eating a delicious meat-based meal can be an art form, and a source of enormous satisfaction for millions of people.

I might be proven totally wrong, and our ethical values may change such that the whole idea of eating animals becomes regarded as repugnant by mainstream society in future. But then, would we feel moral disgust at every omnivorous species as well? I'm not convinced I can see that happening - eating meat is just too delicious and satisfying at a visceral level. 

I’ve heard a fair number of healthcare professionals suggest lifestyle changes to people in various contexts, but often not very effectively IMO. I think the way it is delivered is pretty critical. If people are just told “you need to/should stop X” then they’ll probably walk off feeling defensive and told off and be even less likely to make a change. Unfortunately that often seems to be the case. There’s a lot of skill in providing this sort of information effectively and sensitively exploring any barriers to change. It’s a skill I think is too often neglected.

If my doctor told me to change my diet to vegan I'd treat her suggestion with the gravity it deserves then ignore it, she's my wife and in the doctor/patient relationship like all doctors my employee.

If your doctor told you to take homeopathic medicine and pray rather than antibiotics would you follow their advice?

A friend was asked what he was eating by his doctor, and made some changes to his diet. IIRC he had issues with energy and mood. 

If it was a terminal illness I'd try anything

Why? The body needs a certain amount of fat to work properly particularly for brain function. The trick is to not overdo it.

Social prescribing, exercise on prescription etc, has been going on in Wigan for ages. 10 to 15 years?

Not long enough to undo the damage done by Wigan's eponymous gift to the world

A vegan diet is better than a really poor diet, but is it better than a balanced diet, eating a modest amount of meats, fish and diary? 

Is an ill thought out, poor vegan diet worse than a balanced diet? 

A balanced diet in Wigan is a pie in each hand

I was thinking about land use from an environmental and health perspective. How do we feed a population, keep them healthy, and look after the environment? I would have thought some meat and/or dairy would be useful. At least in some areas of the world.

FTFY

I share your hunch. But god forbid we have to only think about the environment and health at the complete expense of enjoyment, such that everything we eat is beige and tastes of cardboard. I'd rather choke to death on pollution and have my liver explode like foie gras than suffer that fate (and I'm not even much of a foodie, I just like my dinner to have a meaningful impact on my gustatory system).

This is very much my take. I used to practice calorie restriction (ie maximum food value for minimum calorie intake). Lots of veg, no red meat, no chocolate (or very little), little alcohol, etc. and counted the calories of everything I consumed. I eventually decided that I would rather skip the extra 15 years of life not to live the next 60 odd in misery. I still eat lots of veg and don't go mad on the cakes and alcohol but I stopped being precious about it. Life is too short to waste it trying to live longer

Just call it mental health.

From an evolutionary perspective, wouldn't you expect tasty food to be healthy? Obviously the modern industrialised world has thrown a spanner in the works. But eating for pleasure needn't preclude eating healthy. Not sure how you balance that against the environment.

Yes but we evolved on the plains of Africa without Deliveroo and Uber Eats.

Overeating to get a bit fat when food was occasionally abundant was the healthy option compared to starving later when food was scarce.

I guess our diet then was wholefood and plant-based because hunting produced less than gathering. For us omnivore teeth make sense rather than carnivore or herbivore teeth.

Herbivore animals graze (regularly) and carnivore animals gorge (intermittently) probably sums of the plant vs meat balance of the early human diet.

I think you might have missed the part of my post where I said pretty much the same!

Ooops!

Ha yes. As well as going climbing, I need to have a steak pie and a pint after, or I'm having a doctors sick note for the next 3 months.

[Apologies to those who will inevitably find this comment offensive, but from someone with a history of depression, you need to lighten up if you're going to survive the internet.]

Yes, exactly. And to a large extent I do find healthy foods (among) the most satisfying cause I never "developed a tolerance to" or "normalised" the amount of fat, salt and sugar in a MacDonalds Happy Meal.

My worry is when you add in the environmental angle, the best thing is probably mung bean protein grown in a hydroponic tank or something, and most likely tastes like a cardboard crap. I was thinking of the amount of land and carbon needed just to grow spices with no nutritional value. Or the amount of energy etc it probably takes to make a bottle of Lea and Perrins with its amazing affinity for umami receptors. Not losing those just because my non-existent grandchildren would prefer we turned the planetary thermostat down a notch.

Of course I'm not saying "eff the planet, where's me steak". But I am saying that out of the sacrifices I'm prepared to make, I'll drive a slower car or take fewer trips abroad rather than eat mung bean protein for the rest of my days.

If I can't have my steak pie and pint, I'm out.

I don't agree with all of your assumptions in the question about plant based diets, yes I agree people eat way too much meat products especially highly processed ones, but sweeping that aside to focus on the bigger question about doctors and advice on diet and health.

The biggest issue as I understand it is obesity

Despite stats on Covid outcomes showing that obesity is the biggest factor people have that they can control and also other stats showing that people who are obese develop 40% less antibodies in response to vaccination (compared to people of a healthy BMI) this is an area that is neglected.

This time last year there was a fairly low key poster campaign about weight and diet but that didn't run for long at all. I absolutely don't support bullying and discrimination of any kind including people's weight but an admirable drive to prevent bullying has been conflated with the HAEW (healthy at every weight) campaign and discussing people's weight is a minefield. In this perverse situation doctors can be accused of discrimination if they seek to push their agenda of specific BMI ranges being healthy. So understandably docs and others back off and keep quiet.

I do think that this whole idea that environmentally friendly food is likely to be bland is a bit wide of the mark. In my experience of growing food, herbs and other flavourings such as chilli and garlic take up very little land compared to the plants that give you the bulk of your calories, squashes, potatoes etc. It really is meat, and to a lesser extent dairy that uses up a lot of land.

If my GP asked me to change my diet then yes, I would.

If my body suggests I change my diet, as it recently has by reacting to gluten, then yes, I have.

If a random internet stranger suggests it then no, I wouldn't.

T.

That's encouraging. Obviously meat is horrifically wasteful whatever way you cut it (thick slices, rare in the middle please. Or carpaccio, actually. Both - put the carpaccio on the roast, then put Lea and Perrins on it, yeah).

Sorry I got distracted. I agree, and I think that because food is important to people, we won't really end up injecting mung beans intravenously, etc. My concerns about the mung bean takeover and the death of flavour are hopefully misplaced, and I'll still get my steak pie as a treat every now and then.

Pasta.

Can't say I like the taste. Looking at the ingredients, I'd prefer to just eat the eggs.

That would be my experience. I went to the doctor earlier this year and surprise surprise I have high blood pressure, not that high at 130/90 but enough that she wants me on pills. I refused saying if I can't sort it via diet and exercise in 6 months I will take the pills but not until then. This lead to a heated discussion that ended with me saying prescribe them if you want but I won't be collecting the prescription. 

I don't know my current pressure but in the last 3 months I have cut all the crap and salt (I used to put salt on bacon) from my diet, doing a bit more exercise and I have taken in 3 notches on my belt. In 3 months time we will see what happens. 

It is tough for them.

I had borderline high cholesterol so changed my diet after a test and talk to my Doctor but specific weight issues are hard to address.

But there's now a tough balance between body positivity and health. There was a shift towards acceptance of different body types but there's a massive correlation between weight and heart disease/strokes/diabetes. 

There's now a huge movement in the US called Girl Trek to get black women more active because deaths from obesity and heart disease in black women is much more prevalent than covid. But I'm not sure the Dr is necessarily the best person to push the message.

https://www.girltrek.org/

Covid, in the US and elsewhere was made so much worse by the pandemic hitting an obesity epidemic. Yet sadly we don't seem to have tackled this issue. It should have been the shot across the bows to change our ways and I'm not sure it was at all.

I've always been pretty curious about different ways of eating so would I try a recommended change, yeah probably. In my experience I've found I can tell if it will 'work' or not fairly soon simply by how I feel, and can find what is sustainable.

I certainly don't feel confronted or threatened by dietary ideas, cultish or not, but then I've never had health problems that required a doctor to tell me what to eat. Personally I don't even see plant based whole food as a special thing really, it's just a nice way for saying 'don't eat shit' and doesn't need a professional to say it when entire populations who eat like that set the example (with other lifestyle aspects in the mix).

I do find the voodoo and confrontationalism that comes with anything dietary fascinating though, seemingly normal people can become very agitated the moment it arises.

It’s only anecdotal evidence but when I was trying to reduce my blood pressure the only thing which ultimately made a big difference was cutting sugar. There’s a BMJ paper called The Wrong White Crystals which might support that observation, but maybe there’s a BMJ paper to suggest any observation.

At one point I had an appointment with the nurse and she said my weight was a bit high. The only "suggestion" she made was to eat more vegetables. She didn't ask what I did eat (lots of vegetables! But also lots of sugar!), and she didn't suggest any deeper look into my diet. Pretty useless really!

I still eat lots of vegetables, but far less sugar. Much better weight now.

It certainly seems that if diet changes are going to be suggested, it needs to be done properly and actually listen to the patient rather than make assumptions!

Leaving aside your particular diet choice, and the poor quality of studies of  restrictive diets in general, due to the amount of confounding factors, there is good well publicised evidence that dietary intervention is very poor in leading to health outcomes, largely because people don’t stick to the prescribed diets. As such I wouldn’t be surprised if a lot of doctors don’t bother, as they know that in the majority of cases they are wasting their time. 

I’m not sure in the UK but in the US they don’t get that much training on diets as and especially athletes. Just BMIs which are useless for athletes. Even as a pretty good runner my muscle mass has always been an issue when it came to BMI tables. I was never obese but on the upper range of normal.

my heart rate always causes massive concerns now but any Dr who has dealt with people who have done lots of endurance sports isn’t concerned at all. 

"heart disease, strokes, hypertension, respiratory disease, cancers" are CURED through diet?? You lost me right there, with your first sentence. Cancers are CURED by diet, really?? Please supply references for that

(To your second paragraph above - IMO doctors (e.g. during a 10-minute appointment in a local surgery) don't talk about diet because they don't have enough time)

I don't think that is even considered high by UK standards?

Edit: systolic is not (140), diastolic is right on the line.  The US and WHO recognise prehypertension as 120 or more systolic/80 or more diastolic, but the NHS doesn't.

Personally I will refuse tablets for blood pressure until the underlying cause is found and established to be irreversible.  I think the NHS is very bad at doing that sort of root cause analysis and needs to get better at it.

FWIW I'd make a formal complaint about your GP.  Medical treatment is not without risks and side effects, and thus no doctor should be forcing it on anyone.  It is meant to be a partnership in which they advise and you decide.  I have had much more amicable discussions about mine (which is slightly borderline but higher than yours).

Body shaming is a balance.  We shouldn't be accepting people being overweight, but equally *shaming* them puts them into a spiral of depression and overeating.  It needs to be a positive approach, but very much not one of simple acceptance unless a medical condition is the cause.

I've noticed more interest in diet from dentists than GP's.

You are embarrassing 

That's a totally idiotic assertion, but entirely consistent of the sneering attitude you tend to get when it gets out that you're vegetarian.  It reminds me strongly of the attitude of smokers in the 80s. 

I remember, with other non-smoking colleagues, attempting to get management to segregate the work offices between the two camps - we had to share at the time. Both them and the smoking camp employed exactly the dismissive attitude, non-sequiturs, whataboutery and general poor and bad faith thinking you've illustrated so well above.  To me it seemed indicative of a group of people fully aware that they'd made poor lifestyle choices, but were unable to change and couldn't give a f*ck about anyone else.  They were wrong then (and knew it) and you're wrong now (and know it).

https://www.nia.nih.gov/health/what-do-we-know-about-diet-and-prevention-al...

By qualified people who actually look like they practice what they preach. I still think lack of activity is a bigger problem than diet for most. 

I think it was Michael Jordan in his prime who had a BMI that made him obese.

Presume you're talking low resting HR - I've learnt not to surreptitiously try out hospital pulse oxymeters when I'm not the patient 😁

You can't out run a bad diet!

For me, it is entirely diet. I run 4 or 5 days a week, bike commute large distances*, spend my working day on my feet and yet at the moment my weight has crept up a little because I have been less strict of late on the amount of sugar I eat. My main meals are home made, mainly veg and whole grain carbs with a little, good quality meat and fish a couple of times a week. But if I allow myself chocolate bars or similar my weight goes up very quickly. 

* Yesterday's bike commute was 30km each way, with a day of work at an outdoor center. My shorter bike commutes are around 15km each way with a day of care work. Today I am driving because I am taking the dog, but am about to run 10km before breakfast.

That was my thought too. There is a little more to the story though. I went in having had chronic pain in both arms a few days previous (it stopped after a few hours but the Mrs nagged me until I went in).

As well as the BP tablets the doc did an ECG, the results of that lead to a cardiac ultrasound and a couple of weeks ago a consultant rang me and I got the "we don't think there is anything to worry about but we would like to book you in for an MRI" speech. Family history played a big part, both my dad and grandad had sudden fatal heart attacks at 60 years old (I'm 49).

On the plus side the cardiac consultant agrees with my 6 month to sort myself out before medication plan. 

This is very true. Or you'd need to run an awful lot and even then it's only the calorie content of a bad diet that you'd escape. There was a study done a wee while back which showed that people over estimated the amount of calories an exercise session burned and often tended to reward themselves following exercise with treats that undid any calories burned.

I'd agree, the repeat customer scam of weight watchers, the I've been good all week mentality, so I'll just treat myself to a 2000calorie takeaway. 

But exercise sets people off on the right, obvious health benefits both physical and mental. Given the clear links between severe covid and obesity or diabetes you'd think the government would be helping things like park run get started again, rather than worrying about pubs. 

I think you're right Jon. The 'land use' argument for veganism ignores the simple fact that healthy soil requires big herbivores. We can't remove animals from the equation and expect soil productivity to remain stable. So if you want sustainable farming that doesn't involve pouring chemicals over everything and killing a huge percentage of our wildlife, you need mixed farming with livestock.

The problem is that most of the meat we consume currently - especially if we shop at a supermarket - is intensively reared and also part of the problem. Bring back shopping at a butcher or a local farm shop, and buying quality meat. Pay more for it but eat less of it.

Had a quick skim through that link, it's not exactly definitive... e.g. "Overall, the evidence suggests, but does not prove, that following a Mediterranean or similar diet might help reduce the risk for Alzheimer’s dementia or slow cognitive decline."

(My emphasis)

I find the current growth in study of gut bacteria interesting. I think it's one to watch. There does seem to be a link between gut bacteria and Alzheimer's. I presume our gut bacteria is a mix of genetics and diet? Interesting area to watch I think

https://www.sciencedaily.com/releases/2020/11/201113124042.htm

The bad faith is from the OP who has made an unproven and controversial assertion without evidence as if it were proven fact.  I am therefore quite rightly sneering at him.

If his posting had started with an evidenced assertion, and he hadn't repeatedly refused to provide said evidence when challenged, then I might have spoken to him differently.  But as it is he is no better than an anti vaxxer.

Well at least your hyperbole has led to some useful discussion eventually. However as a doctor, and a vegetarian for about the last 35 years, I’d just like to say that posting tripe like that and refusing to justify it is just going to put peoples back up. I have sympathy with your point but not the way you are making it. 

Part of my job routinely involves trying to help the super-obese breathe at night. Most of these people will be well over 200kg. There is absolutely no value in me talking to them about diet at this point. They can’t breathe. Dietary intervention was really important when they were going from 70kg to 120kg; now they need assistance from a ventilator overnight, bariatric surgery and some psychological support. 

Across the population if we want to make a difference then it’s legislation regarding foods (particularly around marketing of foods to children), supermarkets, bike lanes, not selling off the school playing fields, diminishing people’s embarrassment over exercise and body shaming, and the whole multimodality all of government approach to make getting off your backside and walking, cooking and generally making good decisions because the environment they live in makes it easy to do so. Instead we are in a indolent, obesogenic, highly carnivorous society where a lot of people still believe vegetables are the enemy and a meal isn’t a meal without a whole load of meat. And you can imagine how that would play on social media, with some astroturfing from assorted food lobbyists to stoke the flames of indignation about BEING TOLD WHAT TO EAT! 

Your doctor might be able to help with some pointers but the main reason we don’t do so is time and having learnt that it is generally futile for the vast majority. Dietary change must be societal rather than driven by individual GPs. 

And for whoever suggested a formal complaint about the GP, Dax H please don’t do this. Formal complaints take weeks or months to sort out and you have already done exactly what you wanted to do, and good on you for doing so. When you go back to see your GP you will either be completely right, and they will be amazed and happy, or you weren’t - and in that case they were right anyway. Formal complaints make their life a misery, damage the working relationship (such as it was) between patient and doctor, and don’t usually result in much change of practice. When your BP is back to normal through lifestyle modifications (which is possible but often very difficult without dramatic changes in salt intake) then you can be absolutely delighted and proud, and your GP will probably be happy for you too!

(Dr) B

Bravo! 

Well, homeopathy would be excellent if you had terminal dehydration.

This reminds me I must keep working on my latest project which will make me rich: dehydrated water. Just imagine, whenever you're out on a long walk all that weight saved and what a boon for desert travel. Put some in a mug and just add .... Must give it some more thought.

I've certainly heard it linked to obesity which kind of goes hand in hand

Excellent post! Well done

Lots of people who have a normal BMI and reasonable diet etc go on to develop dementia (I can think of 2 such cases close to me). My point was that the OP - "The leading causes of disease are either prevented, cured or significantly improved by a wholefood plant-based diet. This is the case for heart disease, strokes, hypertension, respiratory disease, cancers, diabetes, infections from meat, dementia and kidney disease." was hyperbole. A wholefood plant based diet has not been shown to cure dementia - I'm not saying there's no benefit to eating healthy - I'm saying don't exaggerate!

BMI is a useful tool, but certainly there are limitations of that tool (some people are outliers) and that is all too often missed. Also a pitfall exists with the term obese. I got told off by a doc once in a social/private conversation for saying "obese" when in fact I meant to say someone was fat, and she was right obese and fat are different.

A good example is the actor Dwayne Johnson depending on bulking for roles his BMI is in the high 29s and can stray into 30 territory. When it hits 30 that makes him "obese" because that word is defined by BMI not bodyfat levels. So he's a well known person who is obese at a bodyfat of around 10 to 11%

Even in my own previous post I was scared to discuss people being "fat" and incorrectly used the term "obese". Being obese is an indicator that a person is very likely to be fat but isn't analogous.

While you bring BMI into the picture as being a very useful tool for its  purpose that has limitations, please can recognise "obese" is a technical term derived from BMI and is not the same as the general term "fat". These words should be used correctly, obviously with great care not to use them as abusive labels!

Walk to the pie shop?

I'm not disagreeing with you.

Don't worry, the last thing I would do is put in a complaint about my GP unless there was a justified reason. Looking out for my health is far from a justified reason. (GP has enough to do without dealing with a bullshit complaint) My GP doesn't know me, she sees a 49 year old 120kg highly stressed business owner who eats at least 6 packets of crisps a day and puts salt on bacon sandwiches. (we won't even go in to the volume of pork scratchings I eat). What she doesn't know is my will power. I wasn't going to change until I had to change, I now have to change so I have. Crisps gone, scratchings gone, salt only on fish and chips once a week as a treat.  I have also dramatically changed the meat to veg ratio on my dinner plate. 

As posted above, salt intake is probably the biggest thing I have done. I am or was a salt monster. I know I can do it. 5 years ago the dentist gave me the hard word and I went from 2 lts of full fat coke a day to 1 can a week and went from 3 sugars in a tea to 1/2 a sugar. 

May be the case for vascular dementia but no evidence as far as I recall relating to Alzheimers dementia...

Skim read the thread.....

To answer the question in the title, - would you listen to your doctor if he told you to change your diet? - I think for most people it depends on how fat the doctor is.

Chapeau! Sounds like it is going well. Good luck. 

B

Oh so that's ok then?

youtube.com/watch?v=wxaDaSARCPU&

For those of you who are interested in a cardiologist taking about diet.

One of my favourite YouTubers

I think that for many people changing from a libertarian, carnivorous diet to a vegan, or even vegetarian diet for the sake of their health, is too big a price to ask.

Meanwhile, back at the covidface:

https://www.sciencefocus.com/news/plant-diet-covid-19/

The idea of 'my' Dr seems quite quaint, in my surgery it's an endless stream of temp locums

Do they look at a normal diet?

The choices seem to be high protein/low carb or vegetarian or pescatarian?

And it looks like they found no relationship between BMI and severity of covid-19 which goes against most findings.

The healthiest people are generally those of a moderate BMI, with those with very low BMI's and very high BMI's being obviously at risk.

Thing is with diets, it's like the association between flossing and IQ or longevity, those who think about their diet are likely to think about many aspects of their life and generally be healthier. 

I'd forgotten how much of a roasting I usually get when I start talking about diet. Thanks to everyone for their impassioned responses!

So where did the animal you are eating, get these important proteins (amino acids)? From the plants they are eating, which is where you can also get them from... Unless you an obligate carnivore like a cat, which you are not. 

Don't ruminants and omnivores have a different digestive system? A cow can get by on grass, and we can't, because it can extract what we cannot.

In non-ruminants, the main and unique source of amino acids is from the true protein portion of the diet.

In ruminants, the main sources of amino acids is generally the ruminally-produced bacterial protein. The second important source of amino acids include dietary protein that escaped ruminal degradation but are digested in the abomasum and the intestine.

Some of the digestive adaptations include: a) cud chewing (i.e., rumination); b) pre-gastric fermentation of the feed in the rumen (in addition to gastric digestion; c) large amount of saliva high in bicarbonate and phosphate buffers that neutralized acids produced in the rumen in order to provide a hospitable envionment for microbial growth in the rumen; and d) A liver that has adapted to converting VFAs into nutrient that can be used by the body tissue of the host. For example, propionic acid is converted to glucose in the liver by neoglucogenesis, which can be taken up by the mammary gland to synthesize lactose (milk sugar) while acetic and butyric acids serve as building block of fatty acids that can be stored in body fat).

https://kb.wisc.edu/dairynutrient/414RN/page.php?id=55808

In other words we are built differently.

interesting article on it here:

https://amino4u.com/en/essential-amino-acids-vegan

Also I am not saying it is impossible to get enough amino acids from plant based foods, just that you have to think about it more and you will still need B12 suppliments. Which is a different thing from the "meat will kill you argument"

see here:

https://aminoacidsreview.com/amino-acids-from-a-vegan-diet/

There are now plant-based foods that also contain a rich amount of essential amino acids. What’s exciting about it is that these foods also contain a decent quantity of protein. A vegan who knows how to do a well-rounded diet who includes plant-based sources of protein could still have the essential amino acid he/she needs.