Speaking at the recent conference Nutrition in Medicine, A Focus on Plant-based Nutrition, Dublin-based Dr John Allman - an expert in plant-based nutrition - described his experience as a General Practitioner in identifying these obstacles as well as suggesting strategies to overcome them and help people move to a whole food plant-based diet (WFPBD).
Lack of knowledge both on the patient and on the healthcare practitioner side was a key roadblock, suggested Allman.
“The first barrier is ignorance. If a patient doesn’t know [about nutrition], they can’t change. If a doctor doesn’t know, they can’t change.”
According to Allman, it is important that doctors have knowledge about nutrition and are willing to practise that knowledge and therefore share the information with patients.
Sharing of positive experiences or evidence about plant-based nutrition would also be a good approach for patients wishing to take the initiative with their GPs, he added.
However, the expert noted that ten minute patient appointments - which are standard length appointments - are 'very restrictive' for a doctor to educate patients about plant-based diets.
Time constraints faced by GPs, both to learn about, and to disseminate nutrition knowledge therefore present another barrier, and one that has no easy answer, he said.
Despite these time pressures, Allman suggested that in some cases, doctors might be failing to do their duty by not offering a dietary solution.
“I would argue that I would feel it's negligent the doctors have a patient with advanced heart disease who is at the end of the road for medical treatment and is not offered the option of changing diet,” he said.
Changing to a plant-based diet from a typical high-fat Western diet is a challenge in terms of people who are accustomed to specific tastes. The food industry has been large responsible for this by their creation of hedonistic foods which combine fat, sugar and salt into products with addictive taste and texture, Allman explained.
“We have a biological mechanism whereby we release the dopamine neurotransmitter which is the pleasure hormone and it creates a behavioural condition that makes us keep coming back for more,” he elaborated.
Food choices therefore often become an unconscious habit. Allman suggests that keeping a food diary is a good way of making people aware of their choices in terms of fat, sugar, salt and calories. He also emphasised that people need to realise that it takes time to ‘wean’ themselves off these foods. This may take up to three months, he advised.
“Once you decrease your salt, decrease your fat, you actually appreciate less of it."
Referring to his former passion for a particular chocolate-biscuit bar, Allman added:
“I can remember having a sweet tooth, but after going plant-based, it was shocking for me personally to see that my physical taste for something that I had an intense emotional attachment with had gone.”
Skills and Time
Another barrier facing people wanting to adopt a WFPBD is the combination of cooking skills and time available to prepare meals.
“You are going have to learn how to cook, you are going to have to learn new recipes, learn what are beans and pulses, what are wholegrains? How do you cook them?” said Allman.
“With new recipes, there's an issue with convenience. We are all living in a society that's really speedy; and often when you go speedy and you are plant-based you go unhealthy vegan,” he added.
Cooking skills are essential to achieve the healthy vegan option, namely a whole food diet, argued Allman.
“To go whole food I would argue you need to learn how to cook and that is a barrier for a lot of people.”
Even with cooking skills, the social environment may affect people’s ability to follow a WFPBD. If family and friends eat in a different way, it is difficult to cook more than one set of meals. Additionally, the social isolation of following a different dietary pattern may have negative health consequences, Allman cautioned.
Despite the barriers, Allman suggested a number of positive measures to raise awareness of the health benefits of a WFPBD. Healthcare practitioners should lead by personal example and practise their knowledge passionately, while keeping the message simple.
“It’s all about fruits and vegetables and beans and grains,” said Allman.
This simple message should be shared with patients and clients, while respecting that some people may not be ready to change their eating habits. Nevertheless, it was important to support people who did wish to adopt a WFPBD and help them maintain their new regime through encouraging a receptive environment.
This environment should include continuing to widen the choice of wholefood plant-based items in restaurants and shop, concluded Allman.