Welcoming Plants Into The Bronx

When my sister and I attended HealthFest in MarshallTexas, for the first time, I saw a presentation by Dr. Robert Ostfeld, founder and director of the Cardiac Wellness Program at Montefiore Medical Center in New York City. His expertise on the use of plant-based nutrition to treat cardiac issues was compelling, and his endearing humor kept everyone engaged. My sister had lost her first husband to a cardiac event. Wanting to learn how to prevent further illness among our family members, we took his message to “heart.” His program educates area residents about the role of plant-based nutrition in the treatment and prevention of cardiac illness. I was truly inspired to interview him in the hopes of helping him spread this vital message.  

~ Amy Johnson, writer and plant-based food blogger 

Q. When was it that you realized you wanted to treat your patients with nutrition versus solely pharmaceuticals? 
Dr. Ostfeld: It was a few years into practicing as a cardiologist here at Montefiore. During 11 years of medical school, residency, and fellowship, I trained with incredible people, wonderful physicians and learned a lot. But, I learned virtually nothing about nutrition. After training, I came to Montefiore to work and did all I was trained to do—prescribed guideline-based medications and performed procedures—which all can be very important. And maybe I recommended a Mediterranean-style diet, although I couldn’t quite define exactly what that was. Patients got a little bit better but not a heck of a lot better, so I started to get disillusioned. I didn’t go into medicine just to get people a teeny bit better.  

I remember  one weekend—a few years after I came to Montefiore —when I was on call. I was sitting on the hospital floors, frankly feeling sorry for myself that I was there on a nice Sunday morning. patient who had come in the night before with a big heart attack, and the interventional cardiologist did a terrific job. They put in a stent, and it worked out really well—which is great. I was sitting there thinking, it seems like the people who are really saving patients—within my cardiology division—are the ones doing those 3 a.m. procedures for giant heart attacks. I was thinking that there HAD to be a different way to prevent this from happening in the first place and to stop the (seemingly) inevitable march to more and more disease that I kept seeing around me. It was that morning that my disillusion intensified. Shortly after that, I was introduced to the book The China Study by a friend, and being a myopic cardiologist, I went straight to the cardiology chapter. I was very taken by it.  

Q. Give us a brief timeline of how the Cardiac Wellness Program at Montefiore got started. Was it always focused on treating patients with plant-based nutrition education? 
Dr. Ostfeld: The timeline began about 6 ½ years ago when I decided that I wanted to start a wellness program that focused on plant-based nutrition. Shortly thereafter, Dr. Esselstyn gave cardiology Grand Rounds here, and invited me to Cleveland to stay with him and visit his wellness program. My Chief of Cardiology, Dr. Mario Garcia, was incredibly supportive of my desire to bring a wellness program to Montefiore, so I flew out to visit Dr. Esselstyn in Cleveland 

About five years ago, we officially launched the Montefiore Cardiac Wellness Program, the goal being the use of a plant-based diet to prevent and reverse disease. And I want to be clear…it’s not to the exclusion of medications and procedures. Those are also used because they can be helpful. But plant-based nutrition has always been and still remains the focus of the program. 
Q. How receptive are your patients to treating their diseases and health conditions by living the plant-based lifestyle? How much convincing do you have to do? 
Dr. Ostfeld: It’s a mixed bag, as you can imagine. Some people come to our program having already heard about it and are 99% plant-based already, but the majority of people coming to the clinic are not. They just happen to need a cardiologist and by random circumstance, get an appointment with me. When I mention a plant-based diet to this group of patients, the overwhelming majority of them look at me like I am from Mars. They’ve NEVER heard about this. We work in The Bronx, and I don’t think a plant-based diet has penetrated much into the common behaviors/eating patterns that we see here. From that starting point, getting to a plant-based diet can be a steep climb. I’ve had some patients give me the "Heisman" for as long as three years—and by Heisman, I mean not doing it. If you’ve ever seen the Heisman trophy, there’s a guy running with a football. He has his arm extended, stiff-armed, so he can push players away, and they won’t be able to tackle him. That’s what I mean by giving me the Heisman—pushing me away. But then, they’ll come back doing it.  

Patients coming to me with prior knowledge of the wellness program (who somehow already have an interest) are starting out on second base. It’s much easier to get them further along the path. But those who haven’t heard about it take more work. Nevertheless, many of them do it. Many do it a lotmany do it part way, many do everything in between, and some don’t do it. But, I keep trying and trying. We’re like friendly pit bulls.  
Q. What is the most common question your patients ask you? 
Dr. Ostfeld: The most common question I get from the general population is, “Where do I get my protein?” And to start, the typical answer I give is, “Well, elephants and gorillas are pretty big right?” And then people will typically say, “Yes.” Then I’ll say, “Well, they eat plants, and they don’t seem to be protein-deficient. I don’t think we need more protein than an elephant or a gorilla.” That’s sort of where we start the conversation. Then, we dive into how vegetables, beans, lentils and whole grains have protein, taking a more scientific tilt as opposed to a goofy anecdote.  

The most common question I get from people who are already on second base is, “Why are more doctors not doing this? Why doesn't my physician recommend this, or why does my physician actively discourage me from doing this?”  
Q. You’ve been working with people on an outpatient basis for some time now, but I hear that the hospital is now spreading the message of the plant-based lifestyle to inpatients. How has that come about, and what does that type of education look like when a person is staying at the hospital?  
Dr. Ostfeld: As part of my job, I would make rounds in the hospital to see patients with cardiovascular issues walking into their rooms, discussing their medical issues and talking to them about plant-based nutrition. Five minutes after leaving,  later dinner was served, and it was chicken totally undercutting me.  I realized some system changes were needed so that the recommendations I made hamore legs, reinforcement, if you will,—especially for the inpatients. Because I may see them only once or twice ever, the opportunity to introduce the wellness program is fleeting. I needed more infrastructures to make it happen. When I recommended they eat that way, I needed  to give the patients meals that enabled them to actually eat that way. It makes sense.  

Also, I needed to outsource some of the education since it takes time to dive into plant-based nutrition with patients. But first, I needed meals. Our food services (and many other people) created an optional menu with a week’s worth of plant-based meals—breakfast, lunch, and dinner—available in our medical order system for inpatients.  Plant-based meals come with a handout, in English and Spanish, which describes what the patient is eating and why it is healthy.  

Then I thought, “Well, that’s not enough.” Reinforcement in an entertaining way was needed. Because they’re a passive audienceI thought it would be great if we had something on TV that inpatients could watch. I had the opportunity to work with great, great partnersthe Forks Over Knives team and Patient Education at MontefioreWe now have Forks Over Knives playing on the inpatient TVs. I can walk into a patient’s room, mention the plant based diet, and I have my plant-based posse with me. We can order the meals, provide the handout, and inpatients can watch the film. It’s a great combination. 
Q. Are there other hospitals offering this type of education that you’re aware of? Would you say that Montefiore is a pioneer of treating diseases and health conditions with food and lifestyle changes? 
Dr. Ostfeld: I’m not aware of any other hospital having the combination of plant-based meals and Forks Over Knives. I believe we’re the first in the worldwe are a pioneer in this space. Plus, there are a number of other firsts that we’ve helped to help make happen. For example, our wellness program (which has been around for about five years) periodically offers free four-hour Saturday morning sessions fopatients. These sessions are funded through donations. There may be another free program like this in the world, but I'm not aware of it. I wanted to democratize this information as much as possible since there’s a very large indigent patient population here. Charging for these Saturday morning sessions would preclude a lot of people from coming. This was our second first.  

Montefiore now owns The Albert Einstein College of Medicine. For the last four years or so, I’ve given the entire second year medical school class a lecture on plant-based nutrition as part of their core curriculum—which is pretty great. That’s about 175 students each year. I have also had the opportunity to work with the medical school regarding the re-vamping of their curriculum. I’m excited to say that they are now going to weave nutrition education into the entire medical school curriculum, effective in 2018. The specifics are yet to be worked out. It won't be just plant-based nutrition; however, it’s going to be nutrition education woven in--which is phenomenal. I’m not aware of any other medical school in the country that does that. That was our third first.   

Our fourth first is recently publisheda special-themed issue in the Journal of Geriatric Cardiology about plant-based nutrition and cardiovascular disease. It contains approximately ten different review-type articles written from a scientific and practical perspective by renowned physicians and educators. To my knowledge, there is no other plant-based-themed issue in the academic medical literature, so I feel as though it fills a void.  

I do think that Montefiore as a system is a pioneer.  

Q. What results have you seen in your patients? 
Dr. Ostfeld: I’ve seen some of the most incredible patient turnarounds I’ve ever dreamt I’d see. We’ve had people avoid bypass surgery and stents, come off more than a dozen medications, lose 80-100 pounds, drop LDL bad cholesterol more than 100 points and diminish chest painInterestingly, I’ve seen things that we didn’t anticipate would get better—things that weren’t on our radar but just happened to get better when patients ate this way. I can’t prove positively that the way they ate caused these things to get better, but diet was the only thing that was changed. I’ve seen improvement in someone with really bad cystitis, which is a painful inflammation of the bladder, and in others with really bad prostate inflammation, a variety of skin issues, aches and pains, and Syndrome X, which is an uncommon type of chest pain. Someone with inflammatory artery disease improved dramatically, as well as others with inflammatory diseases. And then, those things you would expect – like high blood pressure, diabetes, cholesterol. I’ve seen so many incredible turnarounds, completely rejuvenating me as a doc. I circle back to that Sunday morning when I was sitting in the hospital thinking, “What is my purpose?” Now when I think about it, it’s like night and day. I feel so honored to have learned about this and to be able to stand with and on the shoulders of the people who came before me, like Dr. Esselstyn, Dr. Campbell, Dr. Ornish and Dr. Barnard. It’s such a  pleasure to apply their incredible findings and call them friends and colleagues.  

Q. If someone wanted to financially contribute to the awesome work you are doing, how can they do that? 

Your donation is tax-deducible.  

Check out more about the Cardiac Wellness Program at Montefiore: http://www.montefiore.org/cardiacwellnessprogram 

Thank you so much to Robert Ostfeld, MD, MSc, cardiologist, Director of Preventive Cardiology at Montefiore Health System, founder and director of the Montefiore-Einstein Cardiac Wellness Program, and Associate Professor of Clinical Medicine, Albert Einstein College of Medicine for taking the time out of his busy schedule to share the incredible work he and his staff are doing.