Is it all or nothing?

This article was originally published in The Jerusalem Post on 4 May 2023: https://www.jpost.com/opinion/article-742002

“The doctor of the future will give no medication but will interest his patients in the care of the human frame, diet and in the cause and prevention of disease”—Thomas A. Edison

There is always resistance to change.  We are, unfortunately, creatures of habit.  So when the subject of whole-food, plant-based eating comes up, some people dismiss it as out of hand and undoable.  “I could never do that” is a common refrain.  We also see resistance to adding in more activity and exercise into our daily routine.  True, people who have severe cases of chronic disease really need to be 100% plant-based compliant to reverse their disease.

What about people who have early stages of disease or those trying to prevent illness? What about individuals who just want to lose weight?

Just like medication, there is a dose to take of healthy, plant-based eating in order to achieve positive results.

All or nothing attitude

Let’s digress for a moment about the harm that “all or nothing” (perfectionist) thinking can cause. The idea of distorted thoughts is first documented by psychologist Dr. Albert Ellis in his rational emotive behavior therapy. It was subsequently refined by Dr. Aron Beck with his 10 categories of distorted thinking, known today as Cognitive Behavioral Psychology (CBT).

Dr. Beck’s has “all or nothing thinking” as number one on his list of distorted thought.  This is a type of thinking that refers to thinking in extremes. You are either a success or a failure. Your performance was totally good or totally bad. If you are not perfect, it’s a disaster. There is no consideration for anything in between; what some people might refer to as shades of gray.  In the end, you will have a negative outlook toward yourself and others.

How does this apply to nutrition and lifestyle in general?

Severe or mild

I have been helping people with fitness, nutrition, and weight loss for over 25 years.  As I stated, some individuals really need to strive for 100% compliance on a diet to reverse disease.  For instance, people who do Dr. Caldwell Esselstyn’s program for reversing heart disease are usually at an advanced state of coronary artery disease. There is really no wiggle room on the diet if they want to succeed.  There is a lot of variety within their diet, but they have to stay within the program guidelines. And they are successful!

This is not all or nothing thinking.  It is simply what must be done in order to lengthen their lives and bring quality of life.

What about people with mild disease?

Examining the many epidemiological studies on lifestyle and disease, clearly show that we need not be 100% plant-based in order to reverse mild disease and certainly to prevent disease.   Most large population studies show that for the majority of people, if you are 80-90% whole-food, plant-based, you will do well.  This, of course includes not eating vegan junk food.

Look at the Blue Zones—5 places in the world where people live to be 100 years old and maintain very good quality of life throughout their years. We see that they do include very small amounts of meat, fish, and in one of those places, even a little bit of dairy.  However, the size of animal protein portions are very small and are more of a condiment or side dish to the meal. They are not consumed daily, and they are never the main course.

Change has it’s challenges

Back to our all or nothing approach.  I have seen people try to be perfect in their nutrition program and go off.   If they tend to be perfectionists, they can easily go from eating a diet full of fruits, vegetables, whole grains, legumes, and nuts to one of donuts, pizza, hamburgers, and chocolate bars.  They couldn’t go all the way so they went in reverse. This is why I try to be careful with what I require from my clients when they are given their food programs.

Yes, if you want success, then you have to make changes.  And many times those changes are difficult because they are new.  So, for clients without a severe disease, I try to leave them a few things that make the diet plant-predominant and healthy, but not 100% plant-based. Sometimes, it is a trial and error process. Many times we need to adjust and make a few changes as our sessions progress.  For most people, plant-predominance, especially with a lot of variety, will do the trick and is extremely sustainable. Unlike diets that usually fail, this will bring long-term compliance.

A personal approach

Personally, I eat a very small piece of chicken at our Friday night meal and a very small piece of fish at our Shabbat day meal.  The rest of my week is free of meat, poultry, fish, eggs, and dairy. On holidays, there is a small piece of red meat. On this regimen, I greatly improved all markers on my blood tests. I would say over the course of a year, I am 95% whole-food, plant-based. I also eat very low oil, salt, and sugar. Ultra processed foods are probably not even 1% of my diet. Considering they make 63% of the standard American diet, that also makes a huge difference.

As Dr. David Katz points out often, we don’t have a study of 100% whole-food, plant-based eating versus 80%.  He points out that although it makes sense that it would be more effective in both prevention and reversal of disease, we can’t really prove it.  What we do know is that for some people, if we make it impossible, it ends up being counterproductive.  I would say that a typical client at The Wellness Clinic starts his program in 75%-85% plant-based range.  What surprises me is how many of them, on their own, take it further when they start feeling so much better.

Best way to alter a diet

Adjusting diet is very individualized.  Do we do this in stages or just put it out there?  This is a point of debate amongst the plant-based doctors and dieticians.  There seems to be validity in each approach.  The approach must take into consideration the state of one’s health and not just their personality.  As Dr. B.J. Fogg, behavioral researcher at Stanford University has shown, we certainly need to create ability in order to get compliance.  It is more important than motivation. It is important to set up an environment that makes it easy.  In either approach, one can’t go back to the diet mentality.  It’s not okay to say, “it’s just this time” or “it’s just a little bit.”  It’s okay to build in non-plant-based food in specific small amounts at specific times, but not more than the prescribed amount.  I can tell you that based on clinical experience, it is essential to approach it in that manner and not allow the client to slip back into diet mode.

It’s bothersome that all the fantastic research we’ve amassed is not bringing more people in the direction of a healthy, plant-predominate diet.  No, we can’t water it down so much that it is ineffective.  But physicians and patients alike must put that which is the most effective for healing—whole-food, plant-based eating—at least on par with, the less effective method for chronic disease –pharmaceuticals.

“Doctor…”

In the United States and in New Zealand, drug companies are allowed to advertise on television (a bad idea).  This bring patients into the doctor’s office asking for specific drugs.  And a survey showed that the majority of the time, the doctor writes the prescription.

Let’s try something else:  “Doctor—I saw a lot of research about using whole-food, plant-based eating to reverse my illness.”  Maybe, if enough people start doing that, we can see an even bigger change in approach than what we’ve seen so far.

We are making a lot of progress

I just attended a very interesting webinar with Dr. David Katz with the The Health Sciences Academy.  The subject was about the future of public health nutrition.  I want to share an interesting fact that Dr. Katz pointed out toward the end of the interview. In its early days, about 20 years ago, the Amercian College of Lifestyle Medicine had 400 physicians as members.  Here we are 20 years later and there are now 10,000 doctors as members and growing all the time.  There is hope that the opening quote in this article from Thomas Edison will really happen. Instead of having a society where more people are sick than well, which is what we have now, we will have most of society well and thriving.  We will “add hours to our days, days to our years, and years to our lives.”