Plant-based Prevention of Disease: A Conversation With Kim A. Williams Sr.
Interview by Ivan Duran
HHPR Editor Ivan Duran interviewed Kim Allan Williams Sr, MD, MACC, FAHA, FASNC. He serves as the Chief of the Division of Cardiology and is the James B. Herrick Professor of Medicine and Cardiology at Rush University Medical Center. He served as President of the American College of Cardiology (ACC, 2015-2016), Chairman of the Board of the Association of Black Cardiologists (ABC, 2008-2010), President of the American Society of Nuclear Cardiology (ASNC, 2004-2005), and is an ACC delegate to the American Medical Association (AMA).
Ivan Duran (ID): What inspired you to become a physician and afterwards a cardiologist?
Kim A. Williams (KW): I went into medicine because of the poor health care that I personally received on the South Side of Chicago. I had a single-parent mother who smoked cigarettes, and I would frequently get upper respiratory illnesses. I met my father when I was 10 years old. He was not wealthy but his family was middle class. He told me that he would buy me a winter coat for my birthday in November of 1965. But he didn't. After walking the mile to school and back in the cold for several weeks, in early December of 1965, I was admitted to South Chicago Hospital with pneumococcal pneumonia. As an 11-year-old with a prior pneumonia history, I had some sense of the importance of getting the antibiotics on time. The nursing staff on the pediatric floor struggled so I started proactively going to the nurses’ station to collect my medication. Soon I started to do the same for my roommate. I vowed at that time to become a physician and fix the healthcare on the South Side of Chicago.
I attended college and medical school at the University of Chicago. There I discovered that my passion was cardiology—not general pediatrics. I always quote that every student should choose a career in a discipline that they enjoy and for which they have a high degree of aptitude. For me, that was cardiology. I learned electrocardiogram (ECG) reading and figured out what aortic stenosis murmurs were as if I had done it before.
ID: One of your most famous quotes is: “There are two kinds of cardiologists: vegans and those who haven’t read the data.” Although it was originally a joke, it shows that you trust the evidence supporting the benefits of a vegan diet. What do you envision for the potential of vegan diets to significantly prevent the leading causes of death in the United States—such as heart disease, cancer, and diabetes?
KW: The medical literature is replete with data indicating the dangers of eating animal products. Plant-based diets are associated with lower rates of obesity and diabetes, high quality of life and longer life-expectancy, as well as less hypertension, dyslipidemia, peripheral artery disease, coronary disease, myocardial infarction, erectile dysfunction, heart failure, stroke and death. One series of articles I like to quote has been published in JAMA (2016, 2019, and 2020), indicating the increased mortality with consumption of animal protein instead of vegetable protein. Same title (“Association of Animal and Plant Protein Intake With All-Cause and Cause-Specific Mortality”), different long-term cohorts, two from the US, one from Japan, but same results. Replacing even 3% of the animal protein with vegetable protein reduces cardiovascular, cancer, and all-cause mortality 1-3 .
ID: The 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease, of which you were one of the authors, recommends for the most part plant-based foods. How do you consider that these dietary guidelines translate into effective public health policy? What policies or trends have you noticed aimed at increasing the prevalence of plant-based diets?
KW: Our guidelines recommend reduction of cholesterol, saturated fat, sodium, refined grains, and sweetened beverages for cardiac risk reduction. However, these guidelines are largely not adopted by physicians and the public. Public policy can’t police people, but a) education of the public on cardiac healthy eating–devoid of marketing influences and b) abolishing congressional subsidies for unhealthy foods and products that detract from our collective health and paradoxically increase health care costs. We have the most expensive health care system and the shortest life expectancy in the developed world. This has to change. However, the trends are improving. Health concerns, social ethics, animal rights or environmental sustainability have affected American diets. Still, only 6% of Americans are vegetarian and 3% are vegan, but many more folks–almost 40% in a recent Nielsen Report—indicated that they are shifting toward eating more plant-based foods. Good news for our health care costs.
ID: A clinical research study, that you and others published in the American Journal of Medicine, reported "a deficiency of nutrition education and practice in cardiology” starting from premedical studies, as well as a positive correlation between health-conscious physicians and the guidance on lifestyle habits they provide to patients. As professor and chief of cardiology, how are you addressing this opportunity? Furthermore, what policies have you noticed aimed at expanding nutrition education for aspiring and current physicians?
KW: At Rush University we focus on education for prevention and large numbers of our staff, faculty and trainees, as well as our patients. But this is far more than just Rush. We have an ACC prevention committee with a nutrition workgroup. We have AMA policy to improve adoption of evidence-based nutrition in schools and hospitals. We need to change our medical school curricula. Without such changes we will continue to have the zero to one percent of cardiologists who stated in our survey that they know enough about nutrition to counsel patients.
ID: One of the most common arguments against vegan diets is that they may cause nutritional deficiencies and diseases. Is that an accurate phenomenon unique to and inherent in vegan diets? How could one prevent these risks?
KW: Vitamin B12 deficiency is avoidable by eating dirt, eating animals who ate dirt, or taking a supplement. I choose to take a B12 supplement. There are no other nutritional deficiencies of a plant-based diet provided that a wide range of plants are used in the nutritional plan. Folks worry about low protein consumption without realizing that the largest land mammals on the planet are vegetarians and that they have never seen a protein deficient horse or cow eating hay and grass.
ID: What advice would you give to our readers interested in transitioning to a plant-based diet? How would substituting animal-based food, such as meat and dairy, for plant-based meat and dairy alternatives improve our health?
KW: We called these plant-based meats and dairy alternatives a “transition diet”. They may or may not be as healthy as a whole food plant-based diet, but they certainly are devoid of the saturated fat, cholesterol, an inflammatory microbiome, and compounds such as creatine, betaine, choline, and phosphatidylcholine (PC) which generate trimethylamine-N-oxide (TMAO). These compounds lead to heart disease, stroke, heart failure, renal failure, and death.
ID: Would you like to comment on anything else? We highly appreciate your insights.
KW: Yes, I would expand on two issues. First, we have to recognize that the risk factors for heart disease and for COVID-19 mortality are very similar, including obesity, hypertension, diabetes mellitus, and hyperlipidemia. This represents an opportunity for nutrition science and plant-based adoption to positively impact our simultaneous dual pandemics of heart disease and the virus. Second, our Medicare system was scheduled to go bankrupt in 2026. The expenses in Medicare have been stretched even thinner by the viral pandemic. Now the estimates are that Medicare will be insolvent in 2024. A 30% reduction in physician fees is anticipated, which will close many practices. This will restrict access to care for many of our elderly people. Now is the time for us to take this seriously and change our collective lifestyles. Everyone should be a normal weight, exercise vegan/vegetarian, and minimize both our illness rate and our health care expenses. At this point, with a crisis looming for our nation, I would say that changing our nutritional habit is essentially our patriotic duty.
References
Song M, Fung TT, Hu FB, Willett WC, Longo VD, Chan AT, Giovannucci EL. Association of Animal and Plant Protein Intake With All-Cause and Cause-Specific Mortality. JAMA Intern Med. 2016 Oct 1;176(10):1453-1463. doi:10.1001/jamainternmed.2016.4182. Erratum in: JAMA Intern Med. 2016 Nov 1;176(11):1728. PMID: 27479196; PMCID: PMC5048552.
Budhathoki S, Sawada N, Iwasaki M, et al. Association of Animal and Plant Protein Intake With All-Cause and Cause-Specific Mortality in a Japanese Cohort. JAMA Intern Med. 2019;179(11):1509–1518. doi:10.1001/jamainternmed.2019.2806
Huang J, Liao LM, Weinstein SJ, Sinha R, Graubard BI, Albanes D. Association Between Plant and Animal Protein Intake and Overall and Cause-Specific Mortality. JAMA Intern Med. 2020;180(9):1173–1184. doi:10.1001/jamainternmed.2020.2790
Ryan was a remarkable member of our HUHPR community, known for his kindness, advocacy, and passion for important policy issues like environmentalism and human rights.