Food, Health & the Issue of a Generation:
A MM Interview with Dr. Neal Barnard

February 17th, 2014


Neal Barnard, MD

Dr. Neal D. Barnard, M.D., is optimistic that America is turning a corner. After decades of poor diets and resulting health problems, Dr. Barnard is buoyed by trends like our reduced consumption of meat and a leveling off of some diseases. One of America’s leading advocates for plant-based diets, Dr. Barnard is the founder and president of the nonprofit Physicians Committee for Responsible Medicine, an adjunct associate professor of medicine at the George Washington University School of Medicine and Health Sciences, and a clinical researcher focused on the effects of diet on health. He is the author of 15 books, a frequent guest of radio and television programs, and the host of several PBS specials.

MEATLESS MONDAY: Let’s start by taking a look at ourselves. What is the state of America’s health?

Dr. Barnard: I think that after a long difficult journey, we have started to turn a good corner. By that I mean our diet, for a generation or two, got progressively worse until about a decade ago. And now it’s starting to get better. The trend we’ve seen towards increasing obesity is starting to level off. Although diabetes is still increasing, I expect that eventually will level off, too. That said, we still are not in very good shape. Obesity is prevalent. Diabetes is a serious problem. Cancer and heart disease take a big toll. But I think we have turned the corner in that more and more people are improving their diets. So I’m optimistic.

I’m surprised to hear that. ‘Optimism’ is a word we don’t usually hear with regard to America’s health.

We see this in the USDA’s figures regarding meat consumption. Meat consumption peaked around 2004, and has been dropping ever since. So that’s the good news. But we’ve paid a price for that. Take the issue of obesity. People are asking, “could this be caused by a lack of activity?” The answer is decisively “no.” Obesity is not due to a lack of exercise. It’s not that people shouldn’t get plenty of exercise, but the change in exercise in recent decades has not been sufficient to explain the obesity epidemic. It is all on the input side of the equation. It’s the foods that we’re eating.

So our waistlines can’t be blamed on video games.

The USDA has tracked America’s eating habits beginning in 1909. The average American in 1909 ate just under 124 pounds of meat, per year. That slowly–but steadily–went up and hit a peak in 2004, when it hit 201 pounds per person. That is an increase of 75 pounds of meat per person, per year. In the same interval, cheese intake, which was less than 4 pounds per person back in 1909, shot up to about 34 pounds per person, per year. And sugar intake went up, as well. You put all this together, and what do you do with a person who, year after year, is eating 75 more pounds of meat, 30 more pounds of cheese, 40 to 50 more pounds of sugar? The problem is, they will become overweight and have many health problems.

The obvious question is: what happened? Why are we eating so much more meat and cheese than our grandparents did?

One change is that the price of food has gone way down as a proportion of our income. When our grandparents went out to eat, it was a special occasion. A $10 dinner was expensive, and you really thought about it. Today, the price of food, whether at the grocery store or in restaurants, as a percentage of our income, has gone down dramatically. So people can afford to eat, essentially, whatever they want without looking at the price. Another reason is that we do have a subsidy issue. Meat products are subsidized largely through feed grain subsidies; cattle, chicken and other animals are very cheap to produce because the government is paying the cost of feeding them. Today, Americans are eating more than a million chickens per hour. We wouldn’t be doing this if food were more expensive.

So we’re spending billions on farm subsidies and billions on healthcare. Can you imagine if we spent billions promoting fruits and vegetables?

That would be just a wonderful change.

If we could subtract the subsidies for unhealthy foods and either have a neutral market or, ideally, encourage people to choose healthy foods like vegetables, fruits, whole foods and beans, you would revolutionize the health of this country overnight. And it could happen. But it’s strictly a political decision.

But politics becomes personal. Members of my own family, eating a standard American diet, have experienced the same diseases I’m sure every family has: cancer, diabetes, heart disease, Alzheimer’s. Why do Americans just accept these health problems as normal? 

I put that question to Dr. William Costelli 20 years ago. He was the head of the Framingham Heart Study. He said, ‘People just accept that a heart attack is a part of life.’ When I was young, growing up in Fargo, North Dakota, I thought that age 60 was old age, that heart attacks were just part of what happened when you got old. But, of course, poor health is not something caused by age. It’s caused by long exposures to things that cause these disease processes.

So let’s talk about how we can get healthier. You are the president and founder of The Physician’s Committee for Responsible Medicine. PCRM believes that the major killers of Americans—heart disease, cancer, stroke—have a dramatically lower incidence among people with plant-based diets.

If you think about the things that kill Americans, number one is heart disease. It was before, and it still is. And 20 years ago, Dr. Dean Ornish showed that even if you don’t take cholesterol lowering drugs, if you don’t have angioplasty, and if you don’t have any kind of surgery, if you take the meat off your plate, if you follow a healthy diet, if you exercise in a moderate, simple way, if you reduce stress, when you put those things together, the arteries not only stop getting worse, they start opening up again. It rejuvenates the body. Cancer risk starts to fall. There are different estimates but one credible estimate says that people following a plant-based diet have anywhere between 12-40% less cancer risk compared to meat eaters. The risk of diabetes plummets dramatically. We’ve seen many people who had diabetes and it just goes away. I don’t mean to say that that will happen to everybody. Everyone is a little different. But it’s not at all unusual.

These results provide the overarching theme of your new book, Power Foods For the Brain. You write, “the more people steer clear of animal-based foods—meat, dairy, fish, eggs—the healthier they are.”

Yes, that’s exactly it. When people base their menus on healthy plant-based foods, the health payoff is enormous.

So if America is turning a corner and thinking more about healthier food, where do you see movements like Meatless Monday? Obviously, we preach moderation: one day a week, cut out meat.

Meatless Monday has an enormous influence. First of all, in order to make a long-term change, you have to discover what is possible. And if a person has just realized, “here it is Monday, and I just skipped the meat for one day,” that means you’ll discover that your local restaurant may serve a bang-up Angel Hair Pasta with Wild Mushrooms. You learn that you can do it, and you learn what you can have. Or maybe if you’re in a sandwich shop or a taco restaurant, you now know what the possibilities are. And if you can do it one day a week, then you are in charge. You know that you can do it as frequently as you want.

What are the power foods that should be on everyone’s shopping list?


The Power Plate, via PCRM

The foods you want to get, of course, are the vegetables, fruits, whole grains and beans. Why those foods? First of all, they don’t have bad fat. They don’t have saturated fat, to any substantial degree. They don’t have trans-fats. And that’s really important because research has shown that people who reduce the “bad fats” have dramatically reduced their chances of getting Alzheimer’s disease. But these foods at the same time give you the protein and the calcium and so forth that you need. I might also say a word about Vitamin E-containing food. Foods like walnuts, almonds, sunflower seeds and sesame seeds bring you Vitamin E. You don’t need a lot; just as a topping on your salad or pancakes, an ounce or so. Also, blueberries and grapes have both been shown to be memory boosters in studies at the University of Cincinnati. And in Okinawa, where there are more centenarians than anywhere in the world, the dietary staple there is not fish. And it’s not rice. It’s actually sweet potatoes. So sweet potatoes are front and center on my own shopping list. So those are a few foods I like to recommend.

And in your research, when someone starts eating these foods, what happens? How do they feel?

Several things are going to happen. First of all, on day one, you’re likely to feel a little more energetic. A little bit lighter. If you have any kind of digestive problems, they sort themselves out within a day or so. I’m talking about people who have constipation for years. It often gets dramatically better very quickly. Weight loss usually begins the first week. If you are a normal weight, you’re not going to lose any weight. But if you are overweight, whether it’s 15 pounds or 215 pounds, you’re going to start losing weight. And this occurs slowly and steadily as the months roll out. If you have a high cholesterol level, that starts to diminish. If you have high blood pressure, that comes down. If you have diabetes or high blood sugar, that starts improving. And that causes me, by the way, to encourage people to let their doctors know they are doing it. Not that it’s in any way unsafe, but if you are on medicines, your doctor will want to work with you to ratchet you down on your medicines as you don’t need them any more, and it’s good to do that in a careful way.

What I found interesting about Power Foods, although the focus is on preventing Alzheimer’s, was that your plan helps everything: weight loss, better heart health, more energy, diabetes prevention.

That’s the beauty of it, in my view. Everything works together, unlike what happens with medication. We see a lot of patients now with diabetes. And they’re taking one thing for their cholesterol. But the cholesterol pill doesn’t do anything for their blood pressure. So they’re on something for their blood pressure, too. And they’re on something else for their diabetes, and they’re taking these 3, 4, 5 pills. So if I’m able to encourage them to change their diet, a plant-based diet helps all of those things simultaneously.

I want to share your tip about PLU stickers with our readers. I didn’t know those little stickers on fruits and veggies can help identify what you’re buying?

Isn’t that handy? You’re looking around for a sign, you’re asking the guy in the store, but the PLU sticker will tell you. If the number begins with a 9, it’s organic. If it begins with an 8, it’s GMO. Any other number, it’s conventional.

Is the biggest issue still perception? If someone goes on medication for the rest of his or her life, it’s considered normal. When someone commits to eating a plant-based diet, it’s “alternative.” 

Dr. Dean Ornish has made that point very eloquently.

People pay a phenomenal amount of money to have a life saving operation and that’s considered conventional, but eating beans and rice is “alternative.” I think those two should be twisted around. To me, getting away from meat is not the end of a dietary journey. It’s the beginning of one.

Because once you don’t have animal products at the center of your plate, you can think, ‘Alright, what can I do today? Do I want to favor grains? Do I want Asian flavors? Do I want more fruits and vegetables, maybe something with Mediterranean flavors?’ And suddenly the world of culinary exploration is thrown open to you. Growing up in Fargo, we never had Italian food. We didn’t have Chinese food. We didn’t have Mexican or Thai. We didn’t have veggie sushi. And now, I love all of these cuisines. And if you told me you had to go back and eat what I had in Fargo, I would say forget it. My diet that I follow now is much richer than that.

The recipe section on the Meatless Monday web site can attest to that. We have over 1000 recipes. For anyone who wants to get more plants and veggies onto the plate, how to you recommend they get started?   

I would suggest to anyone who is new to this: explore your options. Look at all the things you can use to replace meat. Some are literal translations like veggie sausage instead of pork sausage, or veggie bacon instead of animal-dried bacon. But some changes are not literal replacements. Hummus, for example, is a familiar product for most people. It’s actually a breakfast food in the Middle East, and it’s become a popular lunch item in North America. If you have never made bean chili instead of meat chili, I would try that. Try different recipe books. Try different restaurants. Try different products you see at the store. And every five seconds there’s a new, cool plant-based website. And then go a step further and look at the dairy replacements if you’d like. Why not try Almond Milk if you’ve never had it. Try Soy Milk, Rice Milk, Oat Milk, Hemp Milk. There are a million options. Give them a try and see the exciting world of culinary advancement that’s waiting for you.

No conversation about plant-based diets can be complete without discussing protein. In your opinion, how much protein does a person need, and how much are they actually getting?

It’s a funny thing. At least 30 years ago, the American Dietetic Association said loudly and clearly that you do not need meat or animal products, in general, for protein. And we have looked at that in great detail. When people go on plant-based diets, they always get more than enough protein. This, for some reason, has been one of these perennial preoccupations. An average person, if they would add it up, they would need maybe 50 grams of protein a day. A little more if they are a bigger person, a little less if they are smaller. But that’s a pretty good average. How much are they getting? Quite often, twice that–or more–and that’s not good. You don’t need extra protein and you probably shouldn’t have it, yet this just lives on in people’s minds. I don’t think anyone actually knows what a protein deficiency would look like. But they say, ‘gee, if I was a vegetarian, would I get enough protein?’ Whenever anyone is persistently concerned about protein, I say: get in your car, drive to a rural area, and look over the fence into a field. Look at the biggest bull you can find, or the largest stallion you can see. Those are vegans. And those rippling muscles you see are built entirely on plant-based foods.


Last question: when you look at the rate of obesity, and diabetes, and all the other related diseases, is your passion for helping people get smarter about food choices the issue of our generation?

A generation ago, we were at a fork in the road. It became clear by the early 1960s that tobacco was the culprit in lung cancer. And the question was, should we go along with the government promoting tobacco, subsidizing tobacco, it being tolerated in the workplace, sold in every store, allowed in restaurants, allowed on aircraft? Or, should we change that? Should we take what we actually knew about the health risks and work to change behavior? It was a hard fought battle, but the bottom line is we took a serious health risk and decided to do something about it. And the risk of lung cancer has plummeted. That was a generation ago. Our generation’s issue is food. We know there’s a problem. There is no doubt whatsoever that unhealthy food choices contribute to heart disease, cancer, not to mention backbreaking costs of healthcare and all kinds of personal tragedy. We are at this fork in the road. And the question is: shall we change course or not? And as a doctor, there’s only one way for me to vote. The issue is getting the information in people’s hands, along with tools they can use to put it to work.


Cover photo courtesy of Steve Shapiro with Commercial Image Photography