When Dietary Dogma Meets Inconvenient Facts

In nutrition, we encounter a fair amount of dietary dogma. But dogma is not confined to nutrition. Obesity prevention, obesity treatment, and health promotion are all teeming with it. Asking questions and paying attention to inconvenient facts can be most unwelcome.

However, if the goal is better health, it’s essential. Both public and individual health improve when we know the difference between facts, suppositions, and myths. Objectivity and scientific curiosity are important tools for progress. They mark the difference between doing research and proving a point.

So we recommend the following thread by Danielle Belardo, describing her own personal journey in pursuit of better health for her patients as a vegan cardiologist.

Why I’m the most disliked vegan doctor, by vegans.

Intellectual honesty doesn’t always make you popular.

A thread.

— Danielle Belardo, MD (@DBelardoMD) September 12, 2020

First of all, I’m vegan. It’s my personal choice. Veganism is a lifestyle, not a diet. I don’t eat animal products, wear leather, and I do everything I can to minimize my harm to sentient beings.

— Danielle Belardo, MD (@DBelardoMD) September 12, 2020

But when it comes to my patients, I’m a cardiologist first. This means, I HAVE to follow the science. I cannot restrict myself to the dietary dogma in the vegan community that low fat plant based diets are the only way to eat.

— Danielle Belardo, MD (@DBelardoMD) September 12, 2020

I happen to love the health benefits of being on a well planned plant-based diet. For the last 6 years as a physician, I have been blessed to see numerous patients improve their health & put chronic disease HTN & HLD into remission using a plant-based or plant-predominant diet.

— Danielle Belardo, MD (@DBelardoMD) September 12, 2020

But I used to follow the low fat plant-based dietary dogma, hard. I used to tell my patients they couldn’t eat olive oil, nuts or avocado, because every Plant-Based doctor was advocating for this exact dietary plan.

— Danielle Belardo, MD (@DBelardoMD) September 12, 2020

Then something happened. I grew up a LOT in cardiology training. I did over 200 caths. I brought the plant-based diet trials to journal club & learned from brilliant interventional cardiologists why this was not actually disease reversal…

— Danielle Belardo, MD (@DBelardoMD) September 12, 2020

Plant-based diets may improve outcomes, which is important, but I started to question the data that claimed “plant-based diets reverse CAD”. (See @AviBittMD threads for more info about our critique)

— Danielle Belardo, MD (@DBelardoMD) September 12, 2020

I began to realize that every single Tuesday in my plant-based clinic, I was spending hours trying to convince my vegan patients that there is NOT robust data that they can reverse their CAD, and they NEED to stay on their statins in secondary prev (& many cases of primary prev)

— Danielle Belardo, MD (@DBelardoMD) September 12, 2020

I started to realize how frightening over promising and under delivering was, in any dietary paradigm.

And just because vegan doctors do it, doesn’t make it right.

— Danielle Belardo, MD (@DBelardoMD) September 12, 2020

I began learning from a lot of world renowned nutrition scientists like @KevinH_PhD @KCKlatt and @Dr__Guess how to better evaluate and dissect nutrition science.

— Danielle Belardo, MD (@DBelardoMD) September 12, 2020

The more I’ve learned and understood the science, the less I was drawn to the dogma. I’ve lost my dogmatic approach completely.

I’m still vegan, that will never change.

— Danielle Belardo, MD (@DBelardoMD) September 12, 2020

But the days of only recommending a highly restrictive low fat plant based diet are long gone. The idea that I ever thought olive oil, nuts or avocado was harmful, now makes me uncomfortable. But sadly, this is still pushed by many vegan physicians.

— Danielle Belardo, MD (@DBelardoMD) September 12, 2020

I still recommend well planned plant-based and plant predominant diets, because there are so many levels of evidence showing that a healthful plant-forward approach is beneficial in preventing chronic disease, improving outcomes, etc.

— Danielle Belardo, MD (@DBelardoMD) September 12, 2020

But I respect all dietary patterns, & understand there are many ways to be healthy. I’ve had patients thrive on plant-based keto, or high protein, or various other macronutrient patterns. I appreciate that you do not have to be 100% plant based to be healthy. Just eat plants.

— Danielle Belardo, MD (@DBelardoMD) September 12, 2020

Questioning science by well known vegan doctors has definitely been painful for me.

Including a stream of sexist memes and attacks because I said “olive oil does not cause heart disease”https://t.co/BN12Upxs7p

— Danielle Belardo, MD (@DBelardoMD) September 12, 2020

And much more…

— Danielle Belardo, MD (@DBelardoMD) September 12, 2020

I don’t expect I’ll ever be invited to speak at a vegan conference ever again. And if that’s the cost of intellectual honesty…
I can live with that.

— Danielle Belardo, MD (@DBelardoMD) September 12, 2020

I care about being an evidence based cardiologist above all else. Even if that means critiquing research in my own preferred dietary pattern.

— Danielle Belardo, MD (@DBelardoMD) September 12, 2020

At the end of the day, I want to help my patients get well any way that works for them: if that’s a low fat plant based diet, high (unsaturated) fat plant based diet, high protein plant based diet, or a diet that includes some animal products.

— Danielle Belardo, MD (@DBelardoMD) September 12, 2020

It’s undeniable that plant based diets are healthful, can help prevent chronic disease. But they are not a cure all. In many diseases, kale can not replace guideline directed medical therapy. But in nutrition, the dangers of overpromising and under delivering are real

— Danielle Belardo, MD (@DBelardoMD) September 12, 2020

Eating a healthful diet + following a healthful lifestyle + while adhering to guideline directed medical and procedural therapy when indicated, needs to be emphasized by every dietary paradigm.

— Danielle Belardo, MD (@DBelardoMD) September 12, 2020

The Unwrit Dogma, painting by N.C. Wyeth / WikiArt

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September 13, 2020