Will Your Next Prescription be for the Pharmacy or the Farmacy?

by Joanne Evans, MEd, RN, PMHCNS-BC, ISNA Member

Almost 2500 years ago Hippocrates said, “Let food be your medicine and medicine be your food.” These words are still relevant today. Some diseases are acute while others are chronic. Those that are chronic may include heart disease, hypertension, diabetes, asthma, arthritis, COPD, kidney disease, and some cancers.

The leading causes of death in the US from disease are heart disease, followed by cancer, chronic lung disease, stroke, Alzheimer’s, diabetes, and chronic kidney disease. Diabetes is actually the fastest-growing chronic disease in the US. In 2017, Indiana was ranked 6th in the country with diabetes being the leading cause of death and 13th in the country with heart disease as the leading cause of death.

In 2014, they counted over 6600 medication prescriptions plus over-the-counter medications. We can only imagine what the number is today. According
to the data from the National Health and Nutrition Examination Survey in 2015–2016, 45.8% of the U.S. population used prescription drugs. Nearly 40% of older adults take five or more prescription drugs. All these medications have side effects including nausea, fever, chills, headaches, itching, wheezing, tightness in chest, vomiting, red and irritated eyes, and the list goes on and on. Pharmaceuticals are actually the ones that benefit the most from people being sick.

Is it possible that some of these chronic diseases could be prevented or reversed by nutrition? There has been extensive research for well over 40 years showing how food can be used to treat and sometimes reverse many chronic diseases. There is continual research showing that plant-based nutrition:

  • Prevents and reverses heart disease, diabetes, and some cancers
  • Decreases cholesterol and reduce blood sugar levels
  • Decreases obesity and complications from being overweight
  • Improves mood, sleep, energy, depression, anxiety
  • Reverses many chronic diseases
  • Increases work productivity

Plant-Based Benefits

In a research study in five corporate locations in the US, those practicing plant-based nutrition (PBN) showed improvement in body weight, blood sugar levels, and emotional state including depression and anxiety. In another study, diets that were higher in plant foods and lower in animal foods were associated with a lower risk of cardiovascular morbidity and mortality in a general population. The more people adhered to a healthy plant-based diet, the lower their risk of cardiovascular disease. In regards to obesity, research shows that those who followed a plant-based diet had more weight loss compared to those who followed a vegetarian and nonvegetarian diet that included dairy, eggs, fish, or meat at two-month and six-month intervals.

What specifically is plant-based nutrition (PBN)? What does it include?

  • Vegetables – dark greens, dark yellows and orange, sweet potato, etc.
  • Whole Grains – pasta, rice, corn, whole grain bread, tortilla etc
  • Fruit – whole fruit which is better than juice due to fiber
  • Legumes – beans, peas, lentils, tofu, soymilk, chickpeas, etc.
  • Nuts and seeds
  • Limited processed foods
  • Avoiding oil, flour, and sugar

With over three million nurses, it seems we could make a dramatic change in health care for people in the US, including Indiana if we shared information about plant-based nutrition. We all work in a wide variety of settings including hospitals, (state, local and private), ambulatory clinics, outpatient offices, home healthcare, regulatory agencies, organizations, schools, residential care and etc.

I have volunteered to conduct several 21-day plant-based programs utilizing the Physicians Committee for Responsible Medicine (PCRM) which is a free online Kickstart program. The results were published in the American Journal of Nursing and the Holistic Nursing Association Journal. I collected lab work on two occasions which supported the research already published. Some people dropped up to 59 points in cholesterol in 21 days while others also lost weight, improved their energy, and were sleeping better.

In talking with nurses around the country, there seem to be many reasons nurses do not share information about plant-based nutrition. They reported the
following:

  • Feel they do not know enough and were worried they could not answer patient’s questions
  • Think it was too difficult
  • Did not know who to refer patients to
  • Thought it may be too expensive
  • Thought patients may not be interested

Spreading The Word To Our Nurses

When I spoke with nurses around the US, they shared that this form of nutritional information was not given to them in nursing schools. All the nurses interviewed for my book, Cultivating Seeds of Health With Plant-Based Nutrition, Nurses Share Educational Approaches to Prevent and Reverse Chronic Disease (available on Amazon) learned about PBN after graduation from their nursing programs. Some learned about it after their own illness and others when a family member became ill. Several nurses saw their patients taking the recommended medications and they were still not getting well. Others recognized that “everything in moderation” was not working. Another group of nurses read the China Study by Dr. Colin Campbell or saw the movie Forks Over Knives, both of which convinced them that PBN was the way to treat many chronic diseases.

Once nurses become knowledgeable about plant-based nutrition, they have many options to share this information including:

  • Talking with colleagues about plant-based nutrition (PBN)
  • Having plant-based food at all meetings and conferences
  • Hosting monthly pot lucks with colleagues and community groups (post-COVID)
  • Show movies on PBN and discuss the information provided
  • Ask more detailed questions about nutrition on intakes with patients including
    • How many fruits did you eat in the past 24-48
      hours
    • How many vegetables did you eat in the past 24-48
      hours
    • How many portions of dairy food did you eat I
      past 24-48 hours
    • How many portions of meat did you eat in past
      24-48 hours
    • Have them complete a nutritional assessment -
      http://4leafsurvey.com
  • Have care plans include PBN
  • Have discharge summaries include PBN
  • Request PBN guest speakers in educational settings for undergraduate and graduate-level nursing programs
  • Incorporate PBN into all discussions about chronic diseases
  • Join a community PBN group or start one
  • Collaborate with other health care providers interested in PBN
  • Encourage hospitals to have plant-based foods at all meals
  • Monthly lunches with discussions on various PBN topics (post-COVID)
  • Host a free online 10-day (McDougall) plant-based program https://www.drmcdougall.com/health/education/free-mcdougall-program/ or host a free 21-day (PCRM) online plant-based program – including menus, recipes, cooking classes, and additional Information - https://kickstart.pcrm.org/en

There are several groups available specifically for nurses interested in learning more about plant-based nutrition. PCRM hosts the Nurses Nutrition Network which provides educational programs for nurses. https://www.pcrm.org/good-nutrition/nutrition-forclinicians/nurses-nutrition-network. The American College of Lifestyle Medicine has a nurses’ support group and has presentations open to all nurses. https://lifestylemedicine.org/What-is-Lifestyle-Medicine.

There is also a new health care professionals group forming in Indiana focusing on PBN and lifestyle to prevent and reverse chronic diseases. There are about 110,00 nurses in Indiana. Our patients need to have a choice on how they will resolve their chronic health issues and nurses can educate patients so they hear for the first time that there is a nutritional option to prevent and reverse many chronic diseases. Patients should be given all the options to make educated decisions about their health. Sometimes it starts with
medication while they are making nutrition and lifestyle changes. Eventually, it may be the nutritional changes alone that reverse the chronic disease process. Nurses have an opportunity to educate people to be healthier in Indiana. Let 2021 be the time that it happens!

Plant-Based Resources

Resources for meal ideas:

Some examples of breakfast might be the following:
• Cold cereal – with soymilk or rice milk with peaches, berries, or another fruit
• Whole grain toast with jam and fruit
• Oatmeal with non-dairy milk with cinnamon and raisins
• Blueberry buckwheat pancakes and meat-free bacon

For lunch, you might consider:

• Veggie burger with whole-grain bun and salad
• Bean burrito, fruit
• Soy yogurt, fruit, vegetable soup, whole wheat bread
• Hummus wrap with whole wheat pita, shredded carrots, cucumber, tomato

Some options for dinner might include:

• Black bean chili with cornbread, salad, greens
• Whole grain pasta marinara with mixed vegetables, salad
• Fajitas with peppers, onions, tomatoes, beans, broccoli
• Beans and rice with salsa, corn, salad

Resources for learning about plant-based nutrition are the following:

  • Becoming Vegan, Express Edition: The Everyday
  • Guide to Plant-based Nutrition, Brenda Davis, RD and Melina Vesanto, MS, RD
  • The China Study. Startling Implications For Diet, Weight Loss and Long-Term Health. T. Colin Campbell, PhD and with Thomas M. Campbell II, MD
  • How Not to Die: Discover the Foods Scientifically
  • Proven to Prevent and Reverse Disease, Michael Greger MD. FACLM and Gene Stone
  • How Not To Diet, Michael Greger MD
  • The Starch Solution, John McDougall MD
  • The Vegan Starter Kit: Everything You Need to Know About Plant-Based Eating, Neal Barnard MD
  • Prevent and Reverse Heart Disease, Dr. Caldwell Esselstyn

Some good cookbooks are:

  • Dr. Neal Barnard’s Cookbook for Reversing
  • Diabetes: 150 Recipes Scientifically Proven to Reverse Diabetes Without Drugs, by Neal Barnard MD and Dreena Burton
  • The China Study Cookbook by Leanne Campbell, PhD
  • Engine 2 Cookbook by Rip Esselstyn and Jane Esselstyn
  • Forks Over Knives–The Cookbook: Over 300
  • Recipes for Plant-Based Eating All Through the Year, by Del Sroufe, Isa Chandra Moskowitz, Julieane Hever MS, RD, CPT, Darshana Thacker, Judy Micklewright
  • The Get Healthy, Go Vegan Cookbook: 125 Easy and Delicious Recipes to Jump-Start Weight Loss and Help You Feel Great, Neal Barnard, MD
  • How Not to Die Cookbook, Michael Greger, MD
  • The McDougall Quick and Easy Cookbook: Over 300 Delicious Low-Fat Recipes You Can Prepare in Fifteen Minutes or Less, John McDougall, MD and Mary McDougall
  • Prevent and Reverse Heart Disease Cookbook, Ann Crile Esselstyn and Jane Esselstyn

Nurses interested in websites might consider:

  • Dr. Greger – https://nutritionfacts.org – updated research on nutrition and disease – many short videos
  • American College of Lifestyle – https://www.lifestylemedicine.org
  • Dr. McDougall – www.drmcdougall.com – free newsletters, testimonials, current research, Starch Based Solution Certificate Program, 10-day residential programs
  • Physicians Committee for Responsible Medicin
  • www.pcrm.org – free monthly Kickstart programs, newsletters, current research, multiple languages, handouts for offices
  • Forks Over Knives – https://www.forksoverknives.com/ – recipes, plant-based news, meal plans,
    success stories, cooking course
  • Plantrician Project – https://plantricianproject.org/vision – list of plant-based doctors, peer review journal, conferences, cooking class, research and more

Some good plant-based movies are:

  • Forks Over Knives – especially for diabetes, heart disease, and chronic health issues
  • Code Blue – focusing on medical training and health care system
  • Game Changers- focus on vegan athletes
  • Cowspiracy – focus on the environment
  • Food Inc – food supply and industry
  • Eating You Alive − food connected to chronic disease
  • Meat the Truth − livestock farming and the environment

Nurses looking for apps may be interested in:

  • 21-DayVegan Kickstart – PCRM
  • Dr. McDougall Mobile Cookbook
  • Forks Over Knives
  • Michael Greger – Dr. Gregers’ Daily Dozen

About The Author

Joanne Evans MEd, RN, PMHCNS is an advanced practice nurse and has been practicing for almost 50 years. She is certified in plant-based nutrition
by two national organizations and has been a speaker at many national, state, and local nursing conferences. She has published on this topic in several journals in nursing organizations. She recently published Cultivating Seeds of Health With Plant-Based Nutrition, Nurses Share Educational Approaches to Prevent and Reverse Chronic Disease which is available on Amazon. She can be reached at healthynursesandcommunities@gmail.com.

References:
American Association of Nurse Practitioners Journal. A whole-food plant-based experiential education program for health care providers results in personal and professional changes. Oct 2019. A. Lessem, S. Gould, J. Evans et al.
American Journal of Nursing, March 2017 – A Plant-based program – Nurses experience the benefits and challenges of following a plant-based diet
American Journal of Holistic Nursing, April 2015 - Plantbased nutrition: Will your next prescription be for the farmers market OR the pharmacy
Martin CB, Hales CM, Gu Q, Ogden CL. Prescription drug use in the United States, 2015–2016. NCHS Data Brief, no 334. Hyattsville, MD: National Center for Health Statistics. 2019. https://www.cdc.gov/nchs/products/ databriefs/db334.htm
Katcher, H.I., Ferdowsian, H.R., Hoover, V.J., et al. (2010) A worksite vegan nutrition program is well accepted and improves health-related quality of life and work productivity. Ann Nutr Metab, 56(4), 245-52
Agarwal, S., Mishra, S., Xu, J., Levin, S., Barnard, N.D., (2015) A multicenter randomized controlled trial of a nutrition intervention program in a multiethnic adult population in the corporate setting reduces depression and anxiety and improves quality of life: The GEICO Study. Am J Health Promot 29(4), 245-54.
Trapp, C., Barnard, N., Katcher, H. A Plant-based diet for type 2 diabetes. (2010, February, 25). Diabetes Educator. https://journals.sagepub.com/ doi/10.1177/0145721709357797
Roberts, W.C., (2010) It’s the cholesterol, stupid! Am J Cardiology. 106(9),1364-6.
Esselstyn CB, Jr., et al. A way to reverse CAD? J Fam Pract
2014;63(7):356-64.
Turner-McGrievy, G.M., et al. (2015). Comparative effectiveness of plant-based diets for weight loss: a randomized controlled trial of five different diets.
Nutrition 31(2), 350-8.