People choose to ‘go vegan’ for a myriad of reasons, from animal welfare to environmentalism. But is veganism automatically healthier just because it’s plant-based? What do people need to know before they make the whole food switch?
On this episode of On Nutrition, we talk with Dr. Dawn Mussallem, a longtime vegan and doctor of osteopathic medicine, about how a plant-based diet has helped both herself and her patients—and how it could help you.
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Read the transcript:
Tara Schmidt:
This is “On Nutrition,” a podcast from Mayo Clinic where we dig into the latest nutrition trends and research to help you understand what’s health, and what’s hype. I’m Tara Schmidt, a registered dietician with Mayo Clinic in Rochester, Minnesota. This episode, [we’re discussing] veganism.
In the last decade or so, we’ve seen the diet go from being considered a radical diet to a serious, long-term lifestyle. There are now vegan options at restaurants and grocery stores. In a recent market research survey of over a thousand Americans, more than a third expressed interest in going vegan. Plant-based diets are here to stay, with plenty of benefits for the planet and your health.
Here to talk to me about those benefits is Dr. Dawn Mussallem, a doctor of osteopathic medicine who specializes in holistic care for cancer patients at Mayo Clinic in Jacksonville, Florida. Dr. Mussallem is a longtime vegan with an incredible passion for this topic, fueled by her remarkable life story.
Thank you for being here with me, Dr. Mussallem. I really appreciate your time today.
Dr. Dawn Mussallem:
Tara, thanks for having me. I think you and I love food. Food is medicine. Food is love. Food is a lot of things. It’s culture. I’m so excited to talk about our topic.
Tara Schmidt:
I would love to start, if you’re comfortable, with you sharing your story. I think your story is beautiful. So cool, and it’s amazing, and you’re a physician on top of it, so do you mind telling us your background and what brought you to veganism? Your journey, I’ll call it.
Dr. Dawn Mussallem:
When I was a kid, I would tell people I wanted to be a doctor and so from a very young age, I set forth to be very healthy. It was just a passion of mine as a kid. It was so cool. Fortunately enough, my family was very healthy as well. I went on to undergraduate studies, studied exercise, physiology, and nutrition, went on to medical school, and followed my dream. A few months into medical school, I wasn’t feeling good. Multiple doctors told me “it’s in your head.”
Then I eventually collapsed one day, ended up in the hospital. Next day, I was diagnosed with stage four cancer. I was given three months to live without treatment, 20 months to live with treatment. It was a diffuse large B cell lymphoma. They had told me I needed to drop out of medical school. I wouldn’t be able to have kids one day. And so –
Tara Schmidt:
Were you in your 20s at this point in time?
Dr. Dawn Mussallem:
I was 26. This is in the year 2000. A long time ago. Went through chemo, radiation, a bone marrow transplant, stayed in school the whole time. A few years later I was fortunate enough to be able to have a daughter. Then, after delivering my daughter, I developed advanced heart failure.
This is when I became a patient at Mayo Clinic. I was finishing up my training. Mayo Clinic filled me and my family’s hearts with hope and love and knowing that, gosh, we would start with medicines when medicines aren’t enough.
We may need to move on to procedures, and one day you may need a heart transplant.
Well, Come 2015, 2016, this was a good 10 years with heart failure, kind of waxing and waning complications along the way, but still able to work. 2015 started to really take a nosedive. Then, in 2016, I had a near death experience with a ventricular fibrillation arrest while presenting at Mayo Clinic.
From that point forward, it just continued to go downhill. I was listed for a heart transplant in 2019. I was admitted to the hospital because I continued to decline. No match was found for me for over a year. I was eventually admitted to the hospital in 2020, where I waited for my heart and they found a matching one.
February 5th, 2021. That’s when I had my heart transplant. I wanted to really show people like, wow, amid chronic disease, major disease, how do you attain your vitality? I never left that healthy eating.
I continued to eat healthy the entire time, continued to exercise, and continued to really uphold spiritual elements of my positive experience with all of this. That was how I remained well. I did the same thing with a heart transplant. After the transplant, I had said, “gosh, I want to try to run a marathon.” My one year heart transplant.
Tara Schmidt:
My gosh, you’re insane.
Dr. Dawn Mussallem:
It is. It was crazy, right? My doctor said, “You’re on a lot of medicines post transplant. You’re pretty sick.” But I did it and I attribute the ability to do the transplant 100 percent to the diet because it allowed me to have the anti inflammation, the quick recovery.
I mean, I ran seven marathons since my transplant, and it’s like the next day I can go run after I run a marathon. It’s crazy. It’s like, I’m on all these medicines, you know, it’s the diet, guys.
Tara Schmidt:
Oh my gosh.
Dr. Dawn Mussallem:
It is so healthy and it’s so energizing. Food is medicine: food is love, food is energizing. That’s why I love it, and I’m excited to hopefully inspire and empower and help you make your plate plant-powered food.
Tara Schmidt:
Oh my gosh, I love it. This is exactly why I asked you to share your story. Did you become a vegan as an adolescent, or did you do that as an adult?
Dr. Dawn Mussallem:
We were whole food, plant-predominant. We would have small amounts of animal protein, but in the seventh grade, I became vegan entirely. There’s this hilarious story. I was a competitive gymnast in high school all the way through, but in high school, once I was able to drive and stuff, I remember in between practice it being so hard to get vegan food, so I’d go to Wendy’s and I’d go through the drive through. I’d say, “Okay, I want a Kaiser roll with a lot of lettuce and tomato,” and they would charge me 20 cents, so that’s what I would eat.
I’m not really encouraging that now. I don’t even use that word vegan and we’ll get into why. I like the word whole food, plant-based. I love that because vegan, what does that mean? Veganism or whole food plant predominance has been a part of my diet, from the get go.
Tara Schmidt:
I like to use that phrase too because I think the word “vegan” scares people. They’re like, you are about to take away a thousand foods. Let’s start with plant-forward. Let’s start with plant-based. We can still keep some animal proteins in, should you wish, and if you want to get rid of them over time, that’s great – If not, I can handle that too. The definition of vegan or veganism is scary because there are absolutely no animal products of any kind. Even some vegans do not eat honey because it is derived from bees.
Dr. Dawn Mussallem:
I agree, Tara. My biggest concern with the word vegan is it doesn’t tell us about the quality of the diet. The reason I love [the term] whole food, plant-based is the first part of that – the whole food part. Whole foods to me would mean getting rid of those foods that are coming from a factory and aren’t from nature.
I prefer for patients to get a diet that’s as close to nature as possible – ones that are going to include vegetables, fruits, whole grains, and legumes: that would be beans, split peas, lentils, and then nuts and seeds. That’s going to be the diet that has been shown in high quality research studies to not only prevent disease, which is our number one responsibility, but to also treat many of the chronic diseases we see and even reverse some of those chronic diseases. We know that over 60 percent of the American adult diet is ultra-processed foods. This is a huge problem.
We know that that ultra-processed food increases premature deaths from every single cause. There was a great study. I am a breast cancer specialist and my specialty is lifestyle medicine for women with breast cancer. About 99 percent of what I do is help them [get]on board with whole food, plant-predominant nutrition at the time of diagnosis throughout the remainder of their life. That’s my goal. When they start eating healthier and beyond, we’re reducing the risk of all diseases.
We’re not just improving breast cancer outcomes. The number one reason women who are breast cancer survivors die is the number one reason both men and women die, period: It’s heart disease. Getting rid of these ultra-processed foods is so important and leaning in on the plant-based component – I can’t drive that home enough.
Tara Schmidt:
There’s all of these words: We have vegan, we have vegetarian, we have lacto-vegetarian, we have lacto-ovo-vegetarian, we have flexitarian. Lots and lots and lots of words. I’m not even sure we need to go into the definition of those because the purpose of our conversation is to demystify the scariness around a whole food, plant-based diet and promote all of the wonderful, wonderful things that come with these foods. We’re not going to be scared of carbohydrates and we’re not going to call bananas too high in sugar. My blood pressure is going up as we speak.
It’s one of my pet peeves – and I always use [this] example – a lot of teenagers experiment, myself included, with veganism or vegetarianism, and a very, very popular, very ultra processed cookie is vegan, so you could be a teenager eating cookies and pasta, or cookies and fries, and you are vegan. Like you said, I want to hear what you are eating, not what you are not eating.
Dr. Dawn Mussallem:
Being whole food, plant-based is a pattern of eating that’s quite free. It’s really not exclusionary. It’s just sticking as close to nature as possible.
The one thing that I think is fascinating too, is when you look at these fake foods, that food hijacks the palate. We are making our food hyper-palatable. We no longer, as Americans who are used to that standard American diet, can taste how delicious a strawberry is because it’s not heightened enough.
It takes a while to retrain the palate to appreciate food that’s close to nature. That’s so cool to be able to watch people have that transformation, to actually enjoy food again. Natural food [is] so colorful, naturally, it’s just beautiful.What’s really kind of like a smorgasbord for the senses is people being on board with this whole food plant-based way of eating. It’s just a thrill to see it.
Tara Schmidt:
When you talk to your patients, do you commit to a veganism discussion, or do you let the patient’s preferences drive it?
Dr. Dawn Mussallem:
It’s so important to meet the patient where they’re at. That’s the first question I ask her, what are your goals for today? What can I help you with? I say, I have a lot of things I want to talk to you about, but I want to make sure that I’m respecting where you want to be with this conversation today. I always warn them, I say, “listen, I have a lot of enthusiasm about this.”
Tara Schmidt:
You smile a lot.
Dr. Dawn Mussallem:
I feel great. A lot of them know my story. Most patients coming in to see me, they come ready, like they want to make the change. I have them do a 24 hour food log and we go from there.
Tara Schmidt:
That is so helpful to say, all right, let’s look at what’s the first thing you have when you wake up. I have coffee. I heard coffee is bad.
Dr. Dawn Mussallem:
Actually, coffee’s always been linked to improving survival from every cause. Coffee’s not bad. What you put in your coffee may be bad. Light, medium roast is where you get the most benefit. The dark roast you lose a little bit. But what’s really fascinating is that food science suggests that if you put dairy in coffee, you have reduced absorption of the chlorogenic acid, which is the constituent that gives you that health benefit. Maybe try a plant milk in your coffee.
Tara Schmidt:
For me, I love Soy milk and coffee because it has fat. You want to create when you’re doing those swaps, you want to switch the animal based product out for something that’s going to be very similar in texture and taste and consistency. Soy milk is a beautiful swap for cow milk.
Lunch is usually where I start to see the animal products. That’s where we start to do the conversation. I always try to help people get breakfast and lunch. As plant based as possible. Those are pretty easy. Then at dinner we say, all right, if you want to do a little bit of animal protein, fine, what does that look like?
Maybe three to four ounces, the size of the palm of your hand. We don’t need to supersize me. Let’s make sure that at that same point in time, whenever you’re preparing a meal at dinner, that at least 50 percent of that plate is from vegetables or fruit, a quarter from whole grains. Holy cow. I have so many folks coming in and saying, Oh, I’m carb free. I don’t do grains, blah, blah, blah. You need carbohydrates.
It’s a very important source of fuel. Whole grains give you fiber. We have a fiber deficiency that is huge in America, and we are never, ever, ever meeting the guidelines for fruit and vegetable intake.
Tara Schmidt:
Yes. I know you’re right.
Dr. Dawn Mussallem:
91 percent of women are fiber deficient, 95 percent of men are fiber deficient, and everyone’s worried about protein. No one is protein deficient. Now, I’m not saying you don’t need protein, but I’m saying you need to equally focus on fiber. It’s critical. You get that fiber from plant foods. You don’t get it from animal products.
Very important. Like you just said, Tara, vegetables and fruits. 90 percent of Americans don’t get vegetables and fruits. They don’t get the recommended five a day. When you get five servings of vegetables and fruits a day versus two, five or more is where we see the reduction in mortality.
There was also a really cool study, and what it showed is when you hit that five versus two servings of vegetables and fruits a day, you reduce the mortality. Dying from respiratory disease. What comes to mind is COVID.
There was a really cool study among healthcare workers, and what it showed is those that were more on a plant-based diet or a pescetarian diet, there was 73% lower risk of moderate to severe COVID among those who are plant-based and a 59 percent lower risk among those who were pescetarian. Those people on the keto diet that had low carbohydrates, again, thumbs down in my opinion to low carbohydrate diets.
There was a three and a half fold greater risk of moderate severe COVID. We know that eating this plant based diet with more vegetables and fruits is good, but a serving is equal to the size of the fist. That’s easy. That’s not even that much.
Our problem is 90 percent of Americans don’t get enough. People automatically think, well, that’s probably because of food insecurity. I did a study at Mayo Clinic last year in our cancer center, looking at our breast cancer patients. Only 5 percent of 700 women that the charts reviewed got more than five servings of vegetables and fruits a day.
Only 15 of those 700 express that they had food insecurity. Yes, food insecurity is a major concern that we need to work on. But additionally, this problem is for everyone. It traverses all socioeconomic classes. More vegetables and fruits, very important, more fiber, very important. We want women to get 30 grams of fiber, men, you need 35.
Tara Schmidt:
Yes, ma’am. You’re an honorary dietitian. People told you that. Like, you can just add the letters behind your name.
Dr. Dawn Mussallem:
I want to be. I love it.
Tara Schmidt:
I’m going to have a huge pay cut, but yes, that’s fine.
Dr. Dawn Mussallem:
That’s okay. I love it. I love the food. It’s important.
Tara Schmidt:
An argument that I hear, which you are absolutely dispelling right now, is that eating healthy or eating plants is expensive, and I know that berries are expensive. I have toddlers and they’re going to put my family into debt. I get it. You know what else is expensive? Meat. You know what’s not expensive?
Bananas. Beans. Brown rice. You guys go look at your grocery bill. I mean I don’t know what the meat section says or whatever it says for all of your animal proteins, but I promise you it’s more than you think and it is a lot of money. Yes, blueberries are expensive if you’re in Minnesota in November.
Okay, then let’s talk about either frozen, or let’s talk about what is local to you in the season that you’re in.
Dr. Dawn Mussallem:
That is so important. There was actually a study. This is so cool. It was published in 2023 in JAMA, looking at the cost of a vegan versus a standard American diet, and you are absolutely right, Tara. The vegan diet was 16 percent less expensive than the standard American diet, which was a savings of 500 a year.
So cool.
Tara Schmidt:
Dr. Mussallem is living proof that a whole food plant-based diet can save lives. But let’s talk about that phrase, whole food plant-based. That entails avoiding ultra-processed foods, which increases your chances of developing chronic disease. Going vegan or whole food plant-based doesn’t have to be restrictive. Get curious about the foods you are eating.
If you’re interested in transitioning into a plant-based diet, consider going meat-free for breakfast and lunch. Then for dinner only have a small portion of meat around the size of your palm. The goal is to eat about five fistfuls of fruits and veggies a day. The result is more fiber and protein… and a deeper appreciation for the taste of naturally occurring foods without preservatives or added sugars.
Maybe that means grabbing food from the farmer’s market or frozen food aisle. A whole food plant-based diet is not only better for your health, it might be better for your wallet too. Now let’s talk about some of the most common misconceptions about going meatless.
Tara Schmidt:
Do you mind playing a little vegan true or false with me? True or false, a vegan diet is always healthier. I think we would say false because we just talked about cookies and fries and candy. Right? There’s no vegan candy out there, quote unquote. That one would be false in my mind. Do you agree?
Dr. Dawn Mussallem:
I would a hundred percent agree. Vegan doesn’t classify the quality of that diet. We need to know exactly what they’re eating. We want it to be a predominant whole food, plant predominant.
Tara Schmidt:
Vegans heal faster. Do you have any data on healing?
Dr. Dawn Mussallem:
The problem with some of this research is that a vegan diet doesn’t clarify exactly the quality of that diet. Now we’re doing much smarter research to investigate whole food plant-based. That’s not universally true that there’s going to be faster healing or a healthier profile.
There was this breast cancer study that was great. It was 65, 000 French women. Big study. What they showed is that those on the healthy plant-based diet, that was whole food, had a 14 percent reduced risk of breast cancer, but here it comes. Those on ultra processed, unhealthy, fake food. That’s plant-based. Like the fake cheese, the fake meat, blah, blah, blah. 20 percent increased risk of breast cancer.
When someone comes in and says, “Hey Dawn, I’m vegan. Keep telling me more. What did you have for breakfast today?” Diet Coke and french fries that’s vegan. What does that mean? The quality is so, so important.
Tara Schmidt:
This is a common one. True or false, most vegans do not get enough protein.
Dr. Dawn Mussallem:
Definitely false. Right.
Tara Schmidt:
You can absolutely meet your protein needs without animal products. I promise I’ll help you. You will likely have a nutrition deficiency if you do not eat a wide variety of foods, including animal products.
Dr. Dawn Mussallem:
Definitely not. You do need to plan your food properly. People not doing any animal products are going to need B12 supplementation unless you’re doing fortified foods, which is possible.
Tara Schmidt:
Milk has B12 in it. Like my soy milk, a glass, a cup of it has almost all the B12 I think that’s needed. I’m like, “Oh, that’s pretty good. I’ll keep drinking this.”
Dr. Dawn Mussallem:
Nutritional yeast is another one. That’s a fun add on to foods to make it taste cheesy. There’s a lot of B12 usually, fortified in that as well, but I agree. Nutrient deficiencies, we see a lot in the standard American diet because people are eating meat, they think all of a sudden that there’s a lot of nutrients and it’s actually the opposite.
You’re getting a lot of unhealthy saturated fat, and then you’re eating all those ultra processed foods that don’t have the nutrients you need. Vitamin deficiency of B12 is something though. For whole food plant-based folks we need to be mindful of vitamin D. That’s really more of a hormone than a vitamin anyways, with sun exposure you can get some from milk, from even mushrooms you can get some vitamin D.
Tara Schmidt:
I tell people about four things to be mindful of and I’ll help them. A lot of times it’s teenagers and their parents. My teenager is turning vegan and I’m guaranteed to not get enough of whatever. We talk about the risks, which would be B12. Vitamin D, sometimes calcium.
Again, if you’re eating broccoli you’re great, but keep going. It can be a concern, especially for younger people. Then possibly iron. But again, we have options, but you have to be intentional about it. You absolutely are at risk of these deficiencies, but it’s not inevitable if you plan well.
Dr. Dawn Mussallem:
That’s right. I think another huge one, one I really want to emphasize is omega 3 fatty acids. If you’re doing that vegan diet and you’re not getting chia seeds, flax seeds, walnuts, big problem. You need those omega 3 fatty acids.
Tara Schmidt:
That’s a good reminder that this is not in any way a fat free diet. I know that there are people on the internet right now doing something called “fruitinism,” or they’re just eating fruit, and I have lots of good things to say about fruit, but alarming. We didn’t say fat free. You can get healthy fats from plants.
Dr. Dawn Mussallem:
True or false, vegans lose the ability to digest meat. If you’re not doing animal protein, especially if you’re not doing dairy you’re going to lose some of those enzymes within the gut microbiota that are going to allow you to process it as easily. You may not feel as good. That would be if it’s a longer duration of time that you’re avoiding this meat.
So I would say that it is possible that you may feel uncomfortable, but you don’t totally lose the opportunity if you want to have meat in the future. Again, this is a shout out to say, I don’t tell patients they need to be perfect with this plant-only diet. If they want to have a little bit of animal protein, go ahead. If it’s 80 to 90 percent perfect. If you just add one whole food plant-based meal a week, that’s awesome. You know, little steps are all it takes.
Tara Schmidt:
I hate this myth. I’m just going to call it a myth right now. I think you’re going to bring the research because you’ve got lots of numbers in your head. Consuming soy increases your risk of cancer. Look, you can see like I’m already mad about it. Consuming soy increases your risk of cancer. Just shout it, please.
Dr. Dawn Mussallem:
This is the biggest myth out there. Anytime I talk to doctors I say I need everyone to listen to me right now.
Tara Schmidt:
Shut up and listen.
Dr. Dawn Mussallem:
Listen guys, soy does not increase the risk of breast cancer. Soy may prevent the risk of not just breast cancer, prostate cancer, even lung cancer.
We know it enhances the gut microbiome. When we enhance the gut microbiome, you have better immune function, which is better surveillance for cancer. If you’re a breast cancer survivor, the American Cancer Society just published a beautiful review. In fact, this 2022 publication of the importance of nutrition and exercise
after a cancer diagnosis, there were three whole paragraphs dedicated to soy and breast cancer.
There was a beautiful review that showed those breast cancer survivors that had more soy versus those that didn’t. Those with more soy had a 25 percent reduced risk of breast cancer coming back. This is most predominant in women with the estrogen negative tumor, but we see the benefit among all types of breast cancer in soy, including ER positive. Very, very important.
There’s even an overall survival benefit among these breast cancer survivors. Shout out that soy is very safe and it suggests that it prevents cancer and survivors that can keep it away. So enjoy it.
Tara Schmidt:
It’s also a great source of a lot of things that we talked about that you may be deficient in or be at risk of. If you’re looking for protein, everyone who’s freaked out about not eating protein, soy milk is the most equivalent in terms of protein content to cow’s milk. I think tofu, I know that you got to get used to it.
I think tofu is great. Just get a better recipe. I’ll share my tofu recipes, you guys. It’s not just eating tofu. Like a sponge, can you think of any other myths that, again, like me, drive you absolutely crazy?
Dr. Dawn Mussallem:
No, those are the biggest ones. Building muscle. A lot of people feel that you can’t build muscle, or athletes need more protein, those sorts of things. Absolutely not. We know that if you eat the proper diet, you can absolutely build muscle, and we know that for recovery, some of the world’s top athletes are whole food-plant based because they have very quick recovery. I think you nailed all the major myths that I hear day in and day out.
Tara Schmidt:
Love it. Despite what you might’ve heard, a “vegan” diet isn’t necessarily healthier than one that includes meat and animal products, though a whole food, plant-based diet definitely is.
Going plant-based won’t make you nutrient deficient, either. A whole food diet can actually fulfill someone’s nutritional needs. Protein can be found in beans, lentils, and tofu. Just like you can find how you can get omega 3 from nuts and seeds, or how you can get B12 from fortified nutritional yeast, or soy milk.
Speaking of soy, there’s also no evidence that soy products increase the chance of breast cancer. In fact, it reduces the risk of breast, prostate and lung cancer and is a great source of protein too. Sure, you could still get protein from eating meat but it might not be comfortable for your digestive system.
But what about the practical and social implications of going vegan? What should people know before diving into a whole food diet?
Let’s talk about a topic that is a little bit stuck in the middle. We’re not talking about cookies and fries. We’re also not talking about fruits and vegetables. What about the imitation meats, the imitation cheese, like fake foods? They’re trying to make an animal based food out of a plant, but it’s clearly highly processed because you can’t make a burger out of beans unless you know that you’re eating a bean burger, or they add a lot of extra ingredients to make it taste not like a bean burger.
Dr. Dawn Mussallem:
I agree. This is where you have to show up for yourself. When you’re doing a whole food plant-based diet, you have to spend time doing it. That is the one thing it does require more of is time. You don’t show up for your wellcare, you’re going to show up for your sick care. That’s for sure. I personally do not like these fake food products. There’s not really enough research on them.
What is really interesting when we see some of these studies with fake meat is that there was an interesting study that came out of Stanford. It was a swap meat study. We saw some improved markers, like the gut microbiome, whose constituent is called TMAO. It’s basically what happens when you consume animal protein, when you consume meat, the carnitine in the gut microbiome goes to TMAO, which then causes atherogenic plaque.
If an animal eater gets their TMAO measured, it’s high. If someone’s making fake hamburgers, and those ingredients are ultra processed, we see that TMAO isn’t necessarily as high as it is in a meat eater. But we don’t see the health benefits that we would have expected because there’s going to be other health issues because that’s fake food.
You need to spend time on making a delicious bean burger. They’re wonderful. That is where I really like to give that shout out with the fake cheeses or the fake egg products. You look at those ingredients and the number one ingredient is heavily processed oils, you’ve got to really then compare and say what are you trying to accomplish?
Why are you not going to just do the cheese? The cheese is more whole food.
In those situations, if I have a patient with a tendency to use cheese, I say let’s just use maybe a little less. You get less saturated fat. Cheese is the number one source of saturated fat in our country. We know that fake food is going to be more ethical. It’s going to be more compassionate from that standpoint because you’re not killing animals.
I understand people’s stance on that, but there are many ways to even make cheesy products with cashews. You can make different cheese sauces, so you can have fun in the kitchen to recreate what it is you desire and there’s nothing more pleasurable than taking your favorite cultural food and transforming it to what you want by using whole foods. It’s fun in the kitchen, so involve your kids. This can be a family affair. It’s really lovely.
Tara Schmidt:
I think it’s important when people eat a vegetarian meal that you know what you’re eating. MayoClinic.org has a really, really fabulous black bean beet burger. It’s so good. But I’m not gonna give it to my husband and say this is a burger. I’m giving it to my husband saying I made these black bean beet burgers, put some hummus on it. We’re not pretending that we’re giving you an equivalent in terms of taste.
They are not the same food. But you have to be aware of that and you have to experiment. Something that’s in our plant-based whole foods book at Mayo that we give to patients is if you want to use these kinds of fake foods as you call them, you can use them as transitional food.
Dr. Dawn Mussallem:
I agree, Tara. I use that with my daughter actually, because it was a good stepping stone for her. She did like some animal meat. She was just a little bit towards a carnivore at times when she was younger. I’m like, how is this happening? But you can’t force it. You just make sure there’s healthy things at the same time. But for her, some of those alternative meats were a way to kind of transition her over. Now that she’s in college, she loves the whole food plant-based approach.
Tara Schmidt:
On that same topic, let’s talk about some of the barriers. Family is a barrier. When you have that patient who says, my husband’s never going to do this for my family or I have little kids at home, it sounds like your approach was, okay, we’re not asking, we’re changing those family members’ diets. A 180 degree turn, but we are asking you to do more plants. We’re just trying to add more of the good stuff. Would you agree?
Dr. Dawn Mussallem:
I entirely agree. That’s exactly it. Even if someone’s not interested in removing meat at all, I just say, okay, let’s just try to get you to get your five servings of vegetables and fruits a day and get some whole grains. You can get your fiber and get fuller. It weeds out their opportunity to even need and desire as much meat. I always say 50 percent of whatever you eat, whenever you eat, just look at your bowl or look at your plate and kind of estimate, “Hey, is that 50 percent vegetables or 50 percent fruit,” depending on what your meal is.
That’s like, you’re getting your little three ounces of some chicken or beef, whatever you want. Now with that being said, I always like to say I don’t because I live in harmony with this and that’s very important. I have a lot of patients coming in and they’re whole food plant-based and they’re very turbulent.
They’re kind of stressed about it. They’re doing it because they got stuck with this cancer diagnosis and they feel trapped and I really try to transform that. I want this to be something that’s fun. It fills that heart with joy and love that you’re giving back to yourself and your family. I really want that message.
I love “food is medicine,” but I like “food is love” more. That’s what I want people to really prioritize and look at the beautiful colors of the food. When you put it in your mouth and taste the food. It’s really exciting to have this kind of pivot food. Into this really sensory smorgasbord.
Tara Schmidt:
Another difficulty can be restaurants. I don’t want to be the one who lists 10 substitutions. I don’t want to instruct my server exactly what the chef is going to bring me. How do you navigate eating out?
Dr. Dawn Mussallem:
It can be a little bit tricky. It can, but you are the consumer. This is a service. You’re paying for this.
Tara Schmidt:
They want you to come back as well.
Dr. Dawn Mussallem:
I’m just here to say that if you’re going in and you feel a little timid and shy, I can guarantee I’ve been at a restaurant and I’ve already asked for all those substitutions, so don’t worry about it. But I do it in a way that I’m just so grateful and thankful. I have a friend who’s whole food plant only also, and I went out to dinner with her and I’m like, “do you mind doing this? Do you mind?” Then she orders and she goes, “I would like to make a little special request. I have multiple allergies.”
I’m like, “you do know there’s an easier approach.” She’s like, “I have an allergy to dairy and I have an allergy to animal protein.” They were a little bit more open to helping her than helping me. Because I did this long list of things. You learn over time what restaurants can fill the sort of foods that are going to give you enjoyment.
If you really want to be strict and more towards that perfection of your whole food plant-based or plant predominant diet, but I usually really work with patients and say, “Hey, when we’re at home, let’s try to be perfect at home, so when you eat out, you can kind of let go a little bit.” That’s where I enjoy it.
Still maybe ask them to keep the sauces on the side. Again, 50 percent vegetables or fruits and what you’re getting. Don’t throw the whole meal away, sort of a thing.
Tara Schmidt:
I also tell people that sometimes, or oftentimes, I should say, when you’re making a request, it’s less work for the kitchen, right? Like me asking you to please not put cheese on my salad is not another task for them to do. They’re just going to not put cheese on my salad, right? It’s just not always as complicated as it seems in restaurants.
Dr. Dawn Mussallem:
This is so common in every state across our country now. This movement is more towards food as medicine because we know that poor nutrition is the leading cause of death in our country. The government is really having a lot of initiatives to make us healthier via the food as medicine movement.
Restaurants are helping to support this initiative. Many chefs are really excited in this space themselves. I think it’s become so easy. Oh my gosh, compared to where it was 10, 20, 30 years ago growing up, it is so easy now to do this that I don’t even feel the resistance or the challenges when I go to any restaurant because there’s so many options on the menus.
Ask when you go to the restaurant, do you have a vegan menu? Most of them do. They’re just not bringing it to you or they’ll say, oh, we have these items that would suit you. Then a lot of times I’ll say, “and you know, the chef usually does this too.” That all of a sudden you get your meal out and you’re with this group.
Tara Schmidt:
It’s more of a standard.
Dr. Dawn Mussallem:
Exactly. It’s amazing. You get more volume too. They give you more food.
Tara Schmidt:
Yes, they do.
Dr. Dawn Mussallem:
You need more of like, “Oh, thanks. This is great.” Then I usually thank them and let the chef know this is wonderful for other people coming. I let him know my doctorate Mayo and that this is what I do, and that I’m so grateful that they made this amazing food.
Tara Schmidt:
You have nailed this from a young age, but how do you help people navigate social pressure, cultural pressure, pressure to like, “oh, come on, like just have a burger. It’s not that bad, whatever it is it’s not that bad.” That’s the statement of the week. How do you help people navigate said pressure?
Dr. Dawn Mussallem:
You need to be confident with your choice. You’re doing this for a reason. There’s a purpose and meaning behind it, and you should trust that. You owe it to yourself to be authentic to your own belief, that’s usually what I let patients know. Again, I do work with women with cancer, and so they become very empowered.
The nutrition for them gives them autonomy over their diagnosis and they become advocates towards us. It’s super cool to see this evolution and transformation of that mindset. If you may, they become very proud. A lot of them engage their friends. Not just being competent, but being a change agent.
Tara Schmidt:
No one’s going to argue your cancer diagnosis, improving your health.
Dr. Dawn Mussallem:
Let’s talk about primary prevention. For those of you, probably the majority who don’t have cancer, I never want you to have it. Processed meat is a carcinogen. It’s in the same category as cigarettes.
We know that red and processed meat is linked to cases of colorectal cancer, and we see the rise of colorectal cancer among young people. This is a real thing. We want people to be healthy. We want to prevent disease. The only diet on earth that’s ever been shown to do three things, both prevent treat and reverse diseases like diabetes, coronary heart disease, and even early stage prostate cancer, is that of a whole food plant based diet.
We need to pay attention to this because we can’t continue to be sick and suffer like we have in our country and eating healthier again, not perfect, but eating healthier will help us to accomplish this. Cultural and social pressures may be a thing, but be true to yourself, be authentic to the reason that you want to be the healthiest version of you.
Tara Schmidt:
Social events. Do you show up to every social event with a veggie platter. You can obviously always control what you bring, but sometimes it’s not a potluck.
Sometimes you’re at a happy hour. Sometimes you’re at someone else’s house. How do you navigate those social situations?
Dr. Dawn Mussallem:
If you are going to someone’s house, bring something that’s plant based that’s delicious. Bring your favorite recipe to really inspire those other folks that are there. I recently had an event with a group of Mayo clinic staff members that was at the baseball field and things were busy.
I didn’t call ahead. Usually I call ahead and make sure there’s something plant-based, but they must’ve known I was coming because sure enough, they had this huge bowl of salad with the dressing on the side.
It was a gorgeous salad at the baseball field. They had some nuts, which are fine, so there’s always, in my experience, going to be something that you can find that’s doable. I’ve not been to anything where there wasn’t something I can enjoy. I always keep a piece of fruit in my handbag and a bag of nuts and things that if there isn’t in the case, something there, I could just reach in and nibble on whatever I brought with me and there you go.
Tara Schmidt:
I will say it out loud, you and I have privilege. We live in cities that have grocery stores with entire vegan plant-based aisles. We have access to fresh fruits and vegetables. What about people who do not have as much access?
Dr. Dawn Mussallem:
I really enjoy this question and this is something that I really am working to be an active change agent as well. We have the blue zones project in Jacksonville and Mayo clinic. We’re part of this, and so we’re working with the supermarkets in these areas of food deserts.
We’re working with community farmers. We’re working with insurers to try to also understand this food is medicine. Do produce prescriptions. Look at wic and snap and federally-funded food programs where there’s a discount on healthy food.
Helping these folks understand and learn how to cook their cultural cuisine in a way that’s healthier.
Beans can come in a can. They’re dry, they have shelf life. Very easy in a situation for a healthy base protein. Growing a garden. Time and nature, but really leaning on the community, looking at these initiatives with different farms and gardens, farmers markets in these local areas.
Tara Schmidt:
Local farmer’s markets recently added snap benefits. Because those can be expensive. Farmer’s market foods can be more expensive than the grocery store.
Dr. Dawn Mussallem:
You bring up something important and frozen vegetables in frozen fruit are great, Just perfect. I really encourage that. Canned vegetables are usually going to be a little higher in sodium. Canned fruit usually has sugar in it. I would rather people do the frozen. Fresh is great, but frozen is just as good.
I have the majority of frozen vegetables and fruits in my refrigerator because of the busy schedule. It allows me to have things that don’t perish and I rely on that.
Tara Schmidt:
Thank you so, so much, Dr. Lisalem, for being here today. I think we could probably go on for a long, long time, so maybe we’ll just have to schedule more time together because this was so informative and so fun for me.
Dr. Dawn Mussallem:
Tara, thank you. I just springboarded right off of your enthusiasm and they can’t see us, but our smiles are ear to ear.
Tara Schmidt:
We have a lot of teeth.
Dr. Dawn Mussallem:
We just wish you good luck in your journey with being the healthiest version of you and make sure you try to eat as plant forward as possible.
Tara Schmidt:
While imitation foods like cheese or premade bean burgers might be an ethical and tasty way to transition over to veganism, the processed ingredients may be less healthy than intended. A whole food diet presents a great opportunity to become more mindful of and involved in the preparation of your food.
Even if your household isn’t on board for a total whole food switch, they can still benefit from a gradual or partial introduction. Where it might get awkward is restaurants with limiting menus. There, the choice is yours. You could claim to have a meat or dairy allergy. You could ask for vegan substitutions. Or you could take what’s available and jump back into the whole food diet at home.
The true middle ground is social gatherings. You can bring your own snacks or dishes to share, or there may be something that suits your diet already available.
Regardless of the environment, a whole food plant-based diet has too many benefits to be ashamed of. Be loud and proud! Your body will thank you.
That’s all for this episode. But if you’ve got a question or topic suggestion you can leave us a voicemail at 507-538-6272 – we might even feature your voice on the show!
For more On Nutrition episodes and resources, check us out online at mayoclinic.org/onnutrition. Thanks for listening, and until next time, eat well, and be well.
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