Online Health Chat with Mladen Golubic, MD, PhD

Friday, April 4, 2014


A poor diet can lead to numerous chronic diseases including obesity, type 2 diabetes mellitus and cardiovascular disease. Most people know eating healthy is important, but in this “supersized” world it can be difficult to find a nutritious diet that is sustainable.

When a system of group-based, hands-on interventions is used to guide people to transition to plant-based nutrition, it effectively changes a repetitive pattern of unhealthy eating into a healthy lifestyle. This type of diet benefits patients with coronary artery disease, as well as those who suffer from obesity, type 2 diabetes, and several types of cancer, such as prostate, breast, and colon. In addition to nutritional guidance, lifestyle interventions incorporate education in culinary techniques, physical activity, and stress management approaches of therapeutic yoga and behavioral health coaching to improve outcomes for patients at risk and those who already have common chronic diseases.

About the Speaker

Mladen Golubic, MD, PhD is the Medical Director for the Center for Lifestyle Medicine and specializes in lifestyle medicine, cardiovascular disease reversal, integrative medicine approaches to lifestyle-related cancer management. Dr. Golubic graduated from University of Zagreb School of Medicine and went to complete his doctorate at Sveuciliste u Zagrebu. He has also worked as a project scientist at Cleveland Clinic in molecular biology, neurosurgery and integrative medicine and completed his residency in Internal Medicine at Huron Hospital.

Let’s Chat About Benefits of Plant-based Diets

Moderator: Welcome to our chat today with Cleveland Clinic expert Dr. Mladen Golubic. We are thrilled to have him here with us to share his knowledge about the benefits of plant-based diets.

Let's begin with your questions.

Starting a Plant-based Diet

LucyintheSkies: How do I begin to make a change to a plant-based diet? What behaviors do I need to improve in order to stick with it? I am starting from scratch, and enjoy sugars, carbohydrates and meats. It is going to be a major life change for me, but I have arthritis, high blood pressure and high cholesterol (the latter two conditions are controlled with medications). The arthritis in my hands is painful and anti-inflammatory medications are not helping.

Mladen_Golubic,_MD,_PhD: Think evolution rather than revolution. Introduce one new, plant-based recipe per month, and in a year you have great ideas for eating for two weeks. Identify one or two types of breakfast you can eat on most days. Replace all of the simple carbohydrates, breads and pastas with 100 percent whole grain product. Add beans to your salads and eat more vegetables.

Any change requires some effort. If you want a different result, i.e. better health, you have to be willing to introduce changes that may be uncomfortable at first. Our taste buds do not like change. So, essentially you have to educate your taste buds and do this with a mindfulness and sense of purpose when you are changing your diet. If you stay long enough, one month or two off of addictive sugars and fats (and salt as well), you will stop craving those altogether. Just take the first step in your mind that you want to change to a plant-based diet if you have a sense that such changes will benefit you.

Portion Control and Preferred Foods

ccligal: What about portion control? Do you have a suggested shopping list?

Mladen_Golubic,_MD,_PhD: It is hard to take in too many calories by eating nutrient-dense and calorie-poor plant foods (that is why people eating this kind of diet have less problems with weight control than omnivores), but it can be done if you work hard on it. For example, you can overdo with intake of, most often, the 100 percent whole grain products or fruits. Vegetables are the best choice if you feel like chewing longer and not to break you calorie bank.

What should you have on your shopping list? Make sure you have steel cut oats and/or old fashioned rolled oats, one of the alternative milks (soy, almond, oat, hemp, rice, and etc.) without added sugar and low in fat, some frozen berries and vegetables (for morning cereals or a quick meal, respectively), fresh fruits (especially the kind that are in season), fresh green leafy and solid vegetables, 100 percent whole grain bread and pasta, few grains purchased in bulk (at least brown rice and quinoa), tomato sauce for pasta, and beans (both purchased dry and in bulk that you can cook and in cans. Read the label to avoid added sodium). Please, check out the book by Caldwell B. Esselstyn, Jr, MD titled “Prevent and Reverse Heart Disease” for the more comprehensive shopping list.

Plant-based Diet: Protein and Other Nutrients

GeorgeBMac: How much protein is really needed? My nutritionist told me that I should get 64 grams per day (.8 g/kg)—which is about 15 percent of my total calories daily. But T. Colin Campbell, PhD said that 10 percent is adequate and more than that may be undesirable... Others say that 20 percent is best for an active person. Is there any consensus on this? I get much of my protein from soy milk. Yet I keep hearing vague, undefined 'concerns' with soy protein. Do these concerns have any validity?

Mladen_Golubic,_MD,_PhD: Several similar questions about the adequacy of protein intake for people eating fully plant-based diet have been posted by others. If you eat a variety of whole foods of plant origin (vegetables, legumes, 100 percent whole grains and fruits) and not refined food-like products, it is very unlikely that you could be deficient in protein intake, even if your needs are higher (after major surgery, for example). In other words, if you get enough calories from whole plant foods, you get enough protein.

The more protein—especially animal protein—one eats, the higher the risk of different chronic diseases. For example, in a recent study of more than 6,000 people in the best nationally representative dietary survey in the United States, those between 50 and 65 years old who reported high protein intake had a 75 percent increase in dying from any cause, a four-fold increase in cancer death risk during the following 18 years, and a five-fold increase in death from diabetes. Those with moderate intake had increased cancer death risk three-fold when compared with the low protein intake group! It is important to note that these associations were either abolished or attenuated if the proteins were plant derived. The composition of amino acids, building blocks of protein, derived from animals is different than from plant proteins. What we need are amino acids, not the proteins themselves. As for the amount of protein we eat, it is not practical or very accurate to measure that on a daily basis. 0.8 g/kg is generous. According to the World Health Organization, 0.5 g/kg is adequate for good health. Make sure you get enough calories from unprocessed whole foods of plant origin and you will get enough protein.

jcary: What are the best sources of non-animal proteins?

Mladen_Golubic,_MD,_PhD: You should eat a variety of legumes (beans of any type, shape or color, including soybeans, lentils and peas), and 100 percent whole grain products and vegetables. Do not worry about getting enough proteins. If you get enough calories from these whole foods, you are getting enough protein.

laura628: What about other nutrients that you would normally find in meat or fish?

Mladen_Golubic,_MD,_PhD: As for other nutrition, there is not a single nutrient (with possible exception of vitamin B12) that you cannot get from plants. In fact, meat or fish do not have any dietary fiber, and only minuscule amounts of beneficial compounds that are not technically essential nutrients. However, these essential nutrients are richly present in plants and seem quite beneficial for human health.

Omega Fatty Acids

Dyno: The Mayo Clinic diet for heart health recommends one serving of high-fat fish per week. This is presumably a source of omega-3 fatty acids. Is there a plant-based substitute that can deliver the same heart benefits?

Mladen_Golubic,_MD,_PhD: I am glad you asked that question because this is an important consideration for people eating plant-based diet with no intake of foods from animal origin. Humans need to consume only two essential fatty acids, meaning we cannot make those in our bodies. First one is the omega-6 fatty acid called linoleic acid, the second is the omega-3 fatty acid called alpha-linolenic acid. Fish and mammals (us), derive long-chain omega-3 fatty acids from their diet. The essential omega-3 fatty acid, that is alpha-linolenic acid, is converted into long chain omega-3 fatty acids called EPA and DHA .

For fish, phytoplanktons are rich in alpha-linolenic acid and EPA and DHA. For humans, flaxseed and chia seeds are rich sources of alpha-linolenic acid and blue green algae of EPA and DHA. If you want, you can take algae-derived DHA or EPA+DHA commercially available products in the capsule form, which were developed originally to be added to baby formulas (to avoid contaminants that may be present in fish oil preparations containing EPA and DHA).

In large epidemiological studies, vegetarians (those who eat dairy and eggs) and vegans (who do not eat anything from animals) were found to have lower, but not deficient levels of EPA and DHA omega-3 fatty acids. In fact, the levels were much higher than predicted. Women had higher levels than men.

Green leafy veggies have low levels of fats to begin with, but almost half of it can be alpha-linolenic acid. Legumes, such as soy, are also good sources.


kfoodie: Can you explain the different kinds of cholesterol? I am told there is a "fluffy" kind that is good but can make your numbers look too high. Is the “fluffy” kind LDL or HDL? Is there any negative to having an HDL number around 100?

Mladen_Golubic,_MD,_PhD: I am glad you benefitted from a plant-based diet in regard to your cholesterol levels. We know that populations who barely have coronary artery disease and eat plant-based diets have very low levels of total LDL and HDL cholesterol. What determines the health benefit of all types of cholesterol is whether or not it is oxidized—meaning damaged. So therefore, plant-based diets are protective since they provide an abundance of naturally curing heart and broad spectrum antioxidants. The size of cholesterol particles also matters, but eating a plant-based diet you do not need to be concerned about that.

Alkaline Status

stokesl2: Is there any real significance of the body being more alkaline than acidic?

Mladen_Golubic,_MD,_PhD: If you eat a plant-based diet, you are more likely to be alkaline than acidic. I would not worry about being alkaline vs. acidic, but I would make sure that your plant foods are whole and unrefined.

Diet for Cardiovascular Health

rjfp: Can you comment on which would be the optimal diet for the regression and prevention of cardiovascular disease? Which one would you choose from between the low-fat, low-cholesterol and high-fiber diets of Caldwell B. Esselstyn, Jr, MD, Dean Ornish, MD, and Pritikin vs. the Mediterranean diet, which seems to be very much in favor these days—even recommended by Steven E. Nisssen, MD of the Cleveland Clinic?

Mladen_Golubic,_MD,_PhD: Many more studies have been done on the effects of the Mediterranean diet for primary prevention (in healthy adults to prevent development of coronary artery disease) or secondary prevention (in people who had heart attack or required surgery for their coronary artery disease to prevent another heart attack) than have been conducted on the diets of Drs. Ornish or Esselstyn or Pritikin. The studies were also larger and many were done in a randomized fashion with a control group. That is the reason why the Mediterranean diet is currently considered the best diet for heart health.

That does not mean that we cannot do better. The studies by Drs. Esselstyn and Ornish and Pritikin do clearly indicate that better outcomes are possible with the elimination of all food sources that have potential to damage heart health. Their diets achieve LDL cholesterol levels that are seen in populations that basically have no heart disease. Clearly, one needs to further study those diets and directly compare them with a fully plant-based with no added oil diets.

datepim: I am so sorry that no diet can help diastolic dysfunction I/IV, or might I be wrong?

Mladen_Golubic,_MD,_PhD: I am not sure why you are so certain that it cannot. Try eating a whole food, plant-based diet, mindful of the sodium intake, meditate or do yoga or Tai Chi or any other meditative practice on a regular basis, and be physically active. Even if it does not do anything to your diastolic dysfunction, you will feel better, your body will be healthier, and global function of your heart may improve.

Plant-based Diet with Associated Medical Conditions

tlr84b: I have begun researching plant-based diets (like DASH [Dietary Approaches to Stop Hypertension]) to deal with kidney stones, and struggling with what I can and cannot eat. How can you eat healthy when there's so much they're asking you to stay away from? This includes dark fruits and vegetables (berries, spinach, broccoli, Brussels sprouts, beans and nuts). It's very confusing and frustrating.

Mladen_Golubic,_MD,_PhD: In our therapeutic lifestyle medicine programs, the Dean Ornish, MD program for reversing heart disease, and the Caldwell B. Esselstyn, Jr, MD program, we have had patients who had kidney or other problems besides coronary artery disease or other food restrictions, such as food allergies or celiac disease. With close nutritional guidance and monitoring, these patients were able to eat a heart-healthy diet and improve the functions of other organs, such as the kidney or liver. Not all vegetables, grains and legumes are equal. Variety is the key and finding those that you can eat. So, my advice would be that you work with a dietitian and explore types of foods that you may normally not consider. Also, paying attention to fluid intake is a good idea.

FrancesC: What advice would you give healthy eating vegans who exercise regularly yet are underweight, have menstrual pain and scar easily?

Mladen_Golubic,_MD,_PhD: First of all, you can eat a vegan diet and still not eat a healthy diet. For example, you can eat white flour pizza with soy cheese and drink sodas and still call yourself a vegan. The key is that you eat whole foods of plant origin. If you are underweight, you probably are not taking in enough calories. In our experience with patients, who follow a whole food, plant-based diet, is most often they are not eating enough of 100 percent whole grain products and legumes. With regard to the menstrual pain issue, Neal Bernard, MD has shown in a clinical study that eating a whole food, plant-based diet was helpful for women with menstrual pain. Therefore, one needs to find the reason for your menstrual pain, but changing your diet to a fully plant-based diet may be of help. With regard to the scarring, I would need to more about your medical history and any medications that you may be taking.

Diet and Paraplegia

Fabysan: What diet can be helpful for me? I am a 45-year-old male, who has been trying to lose weight since 2008. I am a paraplegic and weigh over 100 kg. I am also a vegetarian.

Mladen_Golubic,_MD,_PhD: In your particular situation, diet is the key because you cannot exercise. However, from research we know that the key to losing weight is in diet and exercise is less important. I would make sure that you eat a fully plant-based diet consisting of unrefined, unprocessed foods that you chew well, eating mindfully and slowly. In other words, eat a diet that is rich in dietary fiber that will help you feel full and not hungry. In this way, you will ingest less calories, and feel full. That may enable you to lose some weight.

Effect of Plant-based Diet on Medications

chickbull: Do plant-based diets have a negative effect on medications such as blood thinners?

Mladen_Golubic,_MD,_PhD: Yes, they can have a negative effect if you take blood thinners that inhibit vitamin K, for example, Coumadin® (warfarin). By increasing intake of foods rich in vitamin K (such as green, leafy vegetables), you may have sub-therapeutic levels of the drug and get a blood clot. So, if you start eating differently to include more plants, please make sure your doctor knows about it. Initially, you will need more frequent blood tests to see if you need higher doses of medication. It is best to have a determined set of vegetable intake per day, and minimize variation from that intake from day to day. (This will produce more reliable blood test results of the effect of your dietary changes on your medication dose.)

Fish in Diet

marie: Can I eat wild salmon safely?

Mladen_Golubic,_MD,_PhD: Salmon is technically not a part of a plant-based diet (meaning only plant foods and no animal-derived foods of any kind). However, if you want to eat it in addition to plants, then go for a wild type, not the farm-produced fish. Wild salmon (and other wild types of fishes) contain less PCBs and other organochlorine compounds and have higher levels of long chain omega-3 fatty acids, EPA and DHA, than the farm-raised variety.

datepim: Is it OK to add fried sardines two or three times per week to a plant-based diet (for the omega-3)?

Mladen_Golubic,_MD,_PhD: Eating fried sardines to get long-chain omega-3 fatty acid is not the wise choice. With fried sardines you will get extra non-omega 3 fat that you probably do not need. The protein and calcium you can easily get from plant sources along with dietary fiber (which sardines have zero) and numerous phytonutrients that plants will provide. You can simply take a capsule of algae-derived omega-3 EPA and DHA instead.

Low Carbohydrate Diet

debing: I recently saw a television show where a physician talked about how a diet with carbohydrates leads to "grain brain." He brought neurological studies as evidence to the argument that a diet that is not "low carbohydrate" leads to neurological impairment and can destroy your brain. I find myself confused by conflicting arguments between what professionals say. Can you please clarify why I should not be concerned about eating a diet with whole grains (contrary to the diet suggested by David Perlmutter, MD)?

Mladen_Golubic,_MD,_PhD: The populations throughout the world that are the healthiest and the happiest based their diet on grains and other plant-based foods. Clearly, there are individuals who may have difficulties with certain types of grains or legumes, and then those can be avoided in the diet. I would not be concerned about eating a 100 percent whole grain and unrefined plant-based foods.

Organic Fruits and Vegetables

Gail Ann: Must a plant-based diet be only organic fruits and vegetables? Are there any countries that supply nonorganic fruits and vegetables which are less toxic?

Mladen_Golubic,_MD,_PhD: A plant-based diet consists of whole foods of plant origin, i.e. 100 percent whole grains, legumes, vegetables and fruits of as many varieties as possible. These plant foods do not need to be organic to have the most health benefits. You can purchase fresh produce at local farmers markets from farmers who do not use pesticides, but are not certified organic. To avoid plant foods that contain the highest level of pesticides, visit the Environmental Working Group website at where the "dirty dozen"—the most pesticide containing fruits and vegetables are listed. You may choose to buy organic produce according to what you see on that list.

Kale and Cabbage

datepitam: I eat a lot of kale, various cabbages and "kristalna" salad. Is there such a thing as too much kale in combination with Tritace® 2.5mg (ramipril) and Vasilip® 20 mg (simvastatin)?

Mladen_Golubic,_MD,_PhD: You can always overeat with any type of food. There was a case report in the medical literature of an older woman who every day ate several pounds of bok choy and she developed a serious condition with her thyroid gland—but those are exceptions. If you eat a wide spectrum of plant foods and use kale and other cruciferous vegetable as your main vegetable source (rather than other types of vegetables), it is more likely that you will only have benefits to your health rather than experiencing any ill effects. It is a good idea to quickly steam or boil those vegetable prior to eating rather than eating them constantly raw.

Nuts, Seeds and Avocado

Metta: What about eating nuts, seeds and avocados?

Mladen_Golubic,_MD,_PhD: If you are healthy and have a good cholesterol level, you can eat nuts—especially walnuts—and avocados. Flax and chia seeds are also good for everyone, including patients with coronary artery disease. These are calorically very dense foods, so portion control is important here.


Leighmini: What are your thoughts on the juicing craze? Is it a healthy alternative or can it be dangerous?

Mladen_Golubic,_MD,_PhD: Above all else, eat—that is chew your foods well. If you have issues with chewing (dental problems, undergoing chemo, etc.), juicing veggies is a good way to obtain a spectrum of high-quality nutrients. You can clearly pack more of these beneficial phytochemicals if you juice because you lose dietary fiber in the process, stuff that is bulky and prevents us from taking too many calories. Dietary fiber is the food for our gut microorganisms and we know that keeping our gut bugs healthy will keep us healthy. Also, if you juice, avoid using fruits, because you could be taking a lot of naturally occurring sugars that get absorbed in the gut quickly when there is no or little dietary fiber around. So, chew first, and only if you cannot, let the blender do the chewing for you.

Dark Chocolate

datepim: Does eating 30 g per day of dark chocolate (cacao 74 percent) spoil the plant diet with its amount of calories?

Mladen_Golubic,_MD,_PhD: Thirty grams is one third of the usual 100 g package. What about eating half of the 30 grams to please your “sweet tooth”? If you eat it mindfully, savoring the great taste of this smooth substance melting in your mouth, you will thus avoid eating extra empty calories that usually come in the form of sugar added to chocolate?

Plant-based Diet and Oils

Highpointer42: The issue of olive oil is a conundrum. Caldwell B. Esselstyn, Jr, MD says oil is oil—there is fat in it. Yet Cleveland Clinic cardiologists present a different view in the book titled "411", saying some fats are alright—especially those included in a Mediterranean diet. What is the definitive answer or does it simply depend on the advocate?

Mladen_Golubic,_MD,_PhD: The currently accepted opinion is that certain oils such as olive oil are better than other kinds of oil. However, from the experience of Drs. Esselstyn and Ornish, we know that excellent heart health can be achieved without any additional oil in the diet. We do not know the final answer of how low that amount needs to be because no comparative studies have been done. I want to be clear that are no deleterious effects of adding oils to a whole food, plant-based diet. There is a possibility that such an approach may be helpful.

chickbull: What can be used instead of oil for cooking?

Mladen_Golubic,_MD,_PhD: You don't have to use anything. You can prepare delicious meals by following recipes and simply omitting the oil in most situations. Our patients in the Caldwell B. Esselstyn, Jr, MD and Dean Ornish, MD programs, who experience the great taste of foods that are prepared this way, after a while no longer have a desire to use oils in their cooking. For most of human history, since the Stone Age, we did not know how to process foods to create oil. Therefore, our Stone Age genes function very well without any additional oil in the diet. Fats that naturally occur in unrefined grains, legumes and vegetables are fully sufficient to support excellent health.

Sugar, Artificial Sweeteners and Stevia

Highpointer42: What about sweeteners on a plant-based diet, including sugar, Stevia, Splenda®, saccharin, etc.?

Mladen_Golubic,_MD,_PhD: Like with any type of diet, to obtain the maximum health benefits, it is a very good idea to avoid all types of sugars, refined carbohydrates, syrups and molasses. You should eat exclusively 100 percent whole grain products. It is also a prudent idea to avoid a artificial sweeteners, such as Splenda® and saccharin, or even natural ones such as Stevia. Constant exposure to such substances causes our taste buds in the feeding centers of the brain to crave constant sweetness. Because of that we are more likely to eat foods that contain simple carbohydrates or even to eat more food.

bauccor: What about honey? Is it OK to use honey as a natural sweetener?

Mladen_Golubic,_MD,_PhD: In the way it elevates blood sugar, there are no differences between regular sugar, honey, maple syrup, molasses, etc. Although honey does have some potentially beneficial compounds compared with the sugar, is the benefit worth the negative aspects? I would say no. But small quantities should be fine in the context of generally good diet for some special occasions.

Vitamins and Supplements

LSparks: What are the best vitamins, supplements and diet to prevent and possibly reverse heart disease?

Mladen_Golubic,_MD,_PhD: The best way is that you avoid eating foods that initiate and stimulate the development of coronary artery disease (i.e. foods derived from animals) and eat foods that are protective, i.e. plant foods. If you eat a whole foods, plant-based diet, it is good idea to take vitamin B12 daily. (In fact, according to the National Academy of Sciences and Institute of Medicine, all adults older than age 50 need to take a vitamin B12 supplement.) Also, if your level of vitamin D is low (you can find that out by a simple blood test), you can take vitamin D2 or vitamin D3 that is derived from plants. Please, make sure to take vitamin D with a meal. It is a fat-soluble vitamin and you need to have some fat in your gut to have vitamin D absorbed. If you take it on an empty stomach, little if any will get absorbed.

datepim: Can you suggest us the quantities per day of vitamins that we should take? In addition to including vitamin B12, omega-3 and vitamin D3, do you suggest any others?

Mladen_Golubic,_MD,_PhD: Vitamin B12 can be taken as 500 or 1,000 micrograms under the tongue three times per week. You can take vegan vitamin D2 or D3 with the meal (very important to take it with food to make sure it is absorbed well) at the dose that would depend on your current blood level. (If your level is low, larger doses may be required.) You can take 200 mg of vegan, algae-derived DHA or one capsule of a preparation called Ovega-3™, which contains 500 mg of EPA + DHA per day.

Marathon Running and Plant-based Diets

Baldedemiel: I am a marathon runner and wonder how I can get the right nutrition with a plant-based diet. Do you have any suggestions, particularly what are good things to take with you before or while running?

Mladen_Golubic,_MD,_PhD: There are professional triathlon athletes, marathon runners and ultra-marathon runners who eat fully whole food, plant-based diets. A good book to read is by Rip Esselstyn called “The Engine 2 Diet”. This book will give you ideas about other resources that can help you address your question.

Plant-based Dieting Abroad

datepitam: Greetings from Zagreb, Croatia! A long time ago, I have purchased the book by Caldwell Esselstyn, Jr, MD with the intent of learning about healthy nutrition, but this book only refers the traditional brands of products in the United States that may not be available in Croatia. How can I find equivalent (substitute) products to use in suggested recipes? Does the vegetarian diet decrease or help with the progression of atherosclerosis?

Mladen_Golubic,_MD,_PhD: I am glad that Dr. Esselstyn has followers in Croatia, as he has throughout the world. Less than a year ago I visited my family in Varazdin, Croatia and realized that it is not difficult to find foods to adhere with Dr. Esselstyn’s dietary suggestions. Beans, 100 percent whole grains, vegetables and fruits are widely available and should be the biggest part of your diet.

For other foods that you may have difficulty finding, I would suggest to visit Makronova macrobiotic center in Zagreb (adresa je Ilica 72) where Zlatko Pejic and/or members of his organization can be of help. (Just make sure you stay away from added oils that may be present in some of the products.) Or you can live without those foods, just like the healthiest populations in the world do, eating a variety unprocessed plant foods. Over there, you have a fantastic selections of vegetables, legumes and fruits. At the macrobiotic store, you can easily find unrefined 100 percent whole grain products.

It is hard to tell whether atherosclerotic changes on aortic valves would be reduced or eliminated by following Dr. Esselstyn’s diet. (I would say yes, but the effects may not be as dramatic as on the atherosclerosis of coronary arteries.) Eating his diet will help you in many other ways, even if it does not help in regard to your valve problems. Please make sure you follow with your cardiologist to be sure that you do not miss on some other therapies (like surgery) if they are indicated for your particular situation.

Social Response to Plant-based Diet

writer53: In the China Study, T. Colin Campbell, PhD emphasizes that a plant-based diet is the best way to prevent cancer, inflammation, and a host of other diseases. Some naturopaths, however, emphasize the Paleo-Mediterranean diet as the best way to build health and prevent disease. My daughter has a rare autoimmune disease and emphasizes plants and vegetables in her diet, but is not a purest. (She is neither vegan nor vegetarian.)

  1. If a plant-based diet is the key to health, why is this not taught in medical school and ingrained into our culture through our medical, educational, social and other institutions?
  2. Why are sugar, refined carbohydrates, excessive fats, etc. culturally condoned if these are actually responsible for escalating the current healthcare crisis?
  3. Do you foresee an eventual wedding of Western medicine and integrative/ complementary/ alternative medicine with its emphasis on substantive dietary change?
  4. How long are we going to keep playing this game of preaching health while living as we please?

Mladen_Golubic,_MD,_PhD: To answer your questions:

  1. The therapeutic potential of diet and other lifestyle factors is not yet recognized as important enough to be prominent in the education of medical students, residents and fellows mostly because the nature of scientific evidence is weaker than for medications (i.e., you cannot do a “blinded” study of patients by not revealing the source of a food, like you can blind a patient to the drug). But, as more data are gathered and more people experience benefits, this will start to change. It is hard to present the case that education of medical professionals should have more hours of study concerning the healing effects of foods and omit education about genomics for instance.
  2. There are strong economic interests behind sugar. Also, sugared foods are so loved by many people so there isn’t a push for the removal of sugar from foods. Sugary foods are nice way to self-medicate chronic psychological stress, for example. This may produce short-term relief, but results in long-term problems.
  3. Yes, I do see a marriage of Western medicine and integrative/ complementary/ alternative medicine with its emphasis on substantive dietary change. The more we learn about the healing power of our everyday food choices, the change will occur when people get more educated. It will be mostly driven by people like you who care about their health and the wellbeing of society at large.
  4. The change needs to start with health professionals. As an example, it is clear to everyone that I will not be very effective at convincing you to stop smoking if I also continued to smoke. Likewise, medical professionals who do not eat well or are not physically active will have hard time convincing their patients to do the same. Better farm policies, taxing sugar (just like cigarettes), and having good options on restaurant menus will need to happen. Some of the positive changes are already under way.

Dietary Changes for the Busy Family

Madler4: How can I move my family to a healthier eating lifestyle. I am a single mother with four children and a parent living with me. We are always on the run.

Mladen_Golubic,_MD,_PhD: That will be a more difficult task considering your situation than for an average person, but you can still eat healthier. Make sure that you always have available 100 percent whole grain products, and easy-to-use snacks such as hummus or guacamole. You can buy pre-washed and cut vegetables, either fresh or frozen. You can cook the grains, such as quinoa or brown rice, ahead of use and have them ready in your refrigerator. It is also helpful to have a variety of canned beans available so that you can quickly fix a healthy salad, soup or main dish. Depending upon the age of your children, you can engage them in the meal preparation making it a fun family activity! Make sure that you have pre-cut fruit in your refrigerator ready for your kids to grab-and-go.

Program Suggestions

ccligal: I would like to find a program in New York City that promotes a plant-based diet for weight loss. Do you have any suggestions? I have been wrestling with considerable weight for 25 years without success.

Mladen_Golubic,_MD,_PhD: I do not know about New York City specifically. However, you can contact the Vegetarian Resource Group at and you will find what you are looking for. You may also email us at and we will help you find further information.


Moderator: I am sorry to say that our time with Dr. Mladen Golubic is now over. Dr. Golubic, I would like to thank you for sharing your time to answer questions today.

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On Plant-Based Nutrition and Nutritional Wellness
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A remote second opinion may also be requested from Cleveland Clinic through the secure Cleveland Clinic MyConsult® website. To request a remote second opinion, visit

Reviewed: 05/14

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