This is a question I get from time to time. A patient has learned about the benefits of a whole food plant-based diet and they are incredulous. Why haven’t I been told? This is due to many factors and I’ll run through a few here.
1. We work in silos
2. Complexity of the medical system (and hierarchy)
3. Lag between research and clinical practice changing
4. Inconsistency between health care workers
5. Time requirements
6. Old school practitioners / those who disagree
7. Sensationalism with each new finding causing us to change viewpoints
I’ll keep this brief
1. We work in silos.
When I work as a General Practitioner I work in isolation. Once medical school is over there is little opportunity in our day-to-day working lives to be able to reflect and learn from our colleagues. When I have taken the time out and asked to sit in with another practitioner, I’ve been really impressed at their different techniques, communication styles, and perspectives. It’s a hugely valuable tool, but this comes at a cost – you have to do it on your own time unless you are completing a specific training programme. As a result, some of the best approaches and ideas that our colleagues have we are not necessarily being exposed to.
2. Medicine has a complex structure and hierarchy
Getting really good ideas to all of the people we need to in a medical system is difficult, especially when it’s hard for people to know which ones are the most important. Hierarchy has led to the downfall of many a good idea throughout many systems. Having the person with the most experience make decisions makes sense, except when they don’t necessarily have the training (as with doctors lacking lifestyle medicine training).
3. Lag times
There is a massive lag between published research (if it gets to that stage) and an idea being accepted, THEN put into practice. Each of these introduces time to the process.
4. Inconsistency between healthcare workers
If I say do X and another person says do Y and they’re completely different, this makes it very difficult to know what to do. It’s important to work together as team members in order to deliver effective care for patients. This is harder when there are strong differences of opinion.
5. Time requirements
Lifestyle changes require time, and they’re not necessarily urgent. When there are five problems and they’re all important to varying degrees but the lifestyle management of a person’s disease is the most long-term problem, it becomes difficult to prioritise this over more urgent problems, when the medical system is not always set up to promote this. Working in General practice in NZ we are very fortunate to have episodic, recurrent interactions with patients, can build rapport, trust, and develop these ideas over time.
6. Old school practitioners
I’ve had more than my share of run ins with people who disagree with a plant based diet, and unfortunately much of the resistance has come from health professionals who are simply not willing to entertain the idea. This is a challenging scenario and over the years I’ve become better at dealing with it, and it’s become a lot less frequent partly because it’s become so much more mainstream. The focus for many professionals is overly reductionist, and (much like the problem with smoking) if a person can’t imagine giving up milk or dairy themselves then their chances of advocating for this are slim. More than old-school I suppose the problem is closed mindedness. Whilst some people will go in guns blazing the best approach here is an understanding approach seeking to see why these differences exist and build better knowledge so we can get better outcomes for our patients.
There is an overwhelming weight of evidence for plant-based diets, and not much for other approaches. Some other diet fads have interesting articles to support them here and there, and ask and potentially answer some very interesting questions, but nothing has the broad base of the population level data (epidemiology), clinical trials, biochemical data, and first principles to back it up like a plant-based approach. The science is extremely solid. I don’t blame the media for delivering the information as neutrally as possible, however sorting through the confusing and seemingly contradictory data can be difficult, and that’s not just for health professionals, but for media and public also.
All of these reasons are why we are seeing some really interesting changes with lifestyle medicine approaches. We are seeing people who are making documentaries which is causing a groundswell of scientifically literate people of all ages to engage with the research and change their diets. The speed at which terms like plant-based have become popular with the media is quite astonishing, and when 5 years ago I’d get weird faces whenever I ordered a meal, nowadays people (especially the younger ones) don’t even blink!