Food as Medicine:
Interview with Don Forrester, MD

Bart Brodsky: Dr. Forrester, please tell us about your experiences with patients who followed your dietary prescriptions.

Don Forrester, MD: I practiced medicine with Kaiser Permanente for over 30 years until I "retired" in 2008. In the last several years of my practice I prescribed a low-fat, plant based diet with vitamin B12 supplementation for my patients. The patients who followed my recommendations were often amazed at the results. They not only saw improvement in their targeted conditions, such as diabetes, heart disease, hypertension or obesity, but they often saw improvement in many symptoms and conditions they had been suffering with for years (e.g. heartburn, constipation, fatigue, abdominal and muscle skeletal pains).

It was rewarding to me as a physician to observe patients getting healthier while decreasing and often eliminating their medications. For instance, I had many patients with non insulin-dependent diabetes who were able to eliminate all diabetic medications and achieve normal laboratory results--effectively curing their diabetes. These patients were often able to decrease or avoid medications for blood pressure or cholesterol problems, as well.

BB: I'm still on the quest for the perfect diet. Setting aside ethical and environmental considerations, is there any scientific or clinical evidence of a health advantage to consuming a 100% whole foods plant based diet versus a 100% whole foods, 95% plant based diet, adding 5% meat or eggs as a condiment or occasional feast food? Might there even be some advantages to very limited consumption of animal products, such as reducing the need for supplements or the addition of specific micronutrients to one's diet?

DF: You ask excellent questions in this complex and important area. The answers aren't entirely clear and probably never will be, but based on the best current peer reviewed science I think several things are supported at this point:

There is no advantage to consuming animal products except for the fact that you will be less likely to be Vitamin B-12 deficient. So a varied whole foods plant based diet with Vitamin B-12 supplementation is the best way to go for individuals who are otherwise healthy. There are some other considerations such as zinc, selenium and iodine, but they are more minor at this point and are easy to meet without supplementation.

Patients who have chronic illnesses benefit as well, although depending on the disease certain things need to be stressed.

The disadvantages of animal protein (higher in sulfur based amino acids) are many, but for me the major points are:

1. Animal studies combined with epidemiological studies show that animal protein seems to be associated with initiation and growth of cancer cells. This effect seems to increase given the amount of animal protein consumed. Dr. Campbell believes there is no threshold. Caldwell Esselstyn's work with patients with coronary artery disease showed that patients who continued to consume small amounts of animal products had recurrent events, much less than folks who continued regular standard American diets or AHA diet with statins. Those who followed plant based diets with no processed oils (all of which contain saturated fats) did not have subsequent events. His initial study was not large but he is working on publishing follow-up results with over 200 patients. He says his results have continued to confirm his earlier work.

Animal products have more fat then whole plant foods with the exception of nuts.

2. Alzeheimers' Disease may turn out to be a vascular problem. This would then be best avoided through the same approach Dr. Esselstyn advocates.

3. Plant foods come with antioxidants and fiber which aren't in animal products and contribute to improved health and less disease.

4. The Nurses Study showed that consumption of animal protein and not plant protein contributes to decline in kidney function once they begin to show signs on decline. The study wasn't designed well enough to answer the question in normal kidneys.

5. Animal products put a higher acid load on the blood requiring use of calcium salts from the bone to neutralize increasing loss of calcium from the bone.

6. We need essential amino acids to build our proteins. It is not necessary to consume animal products for this, as the essential amino acid profile of eggs is almost identical to asparagus and broccoli.

7. Clinical studies on groups of patients show that when patients eat a whole foods plant based diet they consume fewer calories and are less obese. Lower calorie consumption has been associated with living longer in animal studies.

8. Animal products contain chemicals such as dioxin, arsenic, lead, pthalates (chemicals found in soft plastic), antibiotics, pesticides and mercury in much higher concentrations than plants.

So it is a continuum: A 0% meat and egg diet is better than a 5% meat and eggs diet is better than a diet of 10% meat and eggs. I see nothing in our [biological] design or the science to support the consumption of dairy products at any age, unless to avoid starvation. So, the weight of evidence supports a varied whole food plant based diet with B12 supplementation.

Of course the science is constantly changing as we discover more micronutrients and realize how complicated the human metabolic system is. With 6000 to 7000 studies on human nutrition every year it is important to keep current. The current studies support the concept that isolated nutrients cause more harm unless there are clear signs of deficiency.

The search for optimal nutrition, which varies from person to person, will continue as will your quest for the perfect diet. In my opinion, we would be better off if we devoted more resources to the study of primary prevention (preventing diseases) and secondary prevention (the reversal and cure of conditions). As it is today we focus more research on tertiary prevention (the control of diseases) with drugs and procedures. This research is usually relatively short-term so we don't know long-term consequences and benefits of therapy. We also focus on studies which are reductionistic. We need to temper our search for "magic bullets." Much of our current research is of limited value in studying complex systems.

BB: We all want the benefits of modern medicine but we want to eat "natural," too. It's curious that vegans must take B12 in supplement form, suggesting that the optimal diet for modern man may not be the most "natural" after all. Eating meat and eggs may provide B12 naturally, but it's likely to be a poor health trade-off.

DF: I agree. Remember that Vitamin B12 is made by bacteria. We evolved in a surrounding where we were exposed to bacteria in the water we drank as well as incidental consumption of dirt on tubers and such. Today when our water and food supplies are sanitized we are not exposed to bacteria as we were. It is a poor trade-off, but if I wasn't able to supplement, some meat would be one option to meeting our needs. There are some studies suggesting that even omnivores need to take supplemental B12.

BB: Great insights, Dr. Forrester. I read recently that B-12 deficiency may be as common among omnivores, especially seniors, as it is for vegans, so eating animal protein may not confer any special benefits after all. Meanwhile, pass the veggies!

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