Impact of Provider-Directed Plant-Strong Nutrition & Counseling on Cardiometabolic Health: A Case Series at the Michael E. DeBakey VA Medical Center

Background: Cardiometabolic syndrome, Type 2 diabetes mellitus (DM), and non-alcoholic fatty liver disease (NAFLD) share common pathogenic mechanisms including inflammation, insulin resistance, lipid accumulation, and increased oxidation. Diet is an important modifiable determinant in cardio-metabolic diseases (CMD) progression. The clinician/specialist provides pharmacotherapeutic guidance, but often defers nutrition guidance to supportive services. We present the impact of specialist-directed nutrition counseling for 3 patients with various manifestations of CMD. Clinical Case Series: A 63-year-old man with Type 1DM, status post coronary artery bypass grafting (CABG), reported high animal fat/protein intake, very low carbohydrate (CHO) intake and soda consumption. The specialist educated the patient on anti-inflammatory benefits of plant-strong nutrition, recommended liberalizing healthy CHO, grains, fruits and vegetable intake, limiting animal products to 1 serving daily and eliminating processed foods and beverages. The patient followed the diet, lost 50 pounds in 7 months with improvement in blood pressure and lipids. Insulin requirements reduced by 50% while maintaining HbA1C 7%. A 71-year-old man with T2DM, NAFLD, obesity, coronary artery disease status post CABG, HbA1C 9.6% reported increased fatigue, depressive symptoms, and maladaptive coping strategies including excessive alcohol consumption. The endocrinologist recommended plant-strong nutrition for weight loss and glycemic benefits, reduced animal fat/protein consumption and complete elimination of alcohol intake. The patient adopted plant-based nutrition and stopped alcohol consumption. After 18 months, he lost 100 pounds, achieved HbA1C 7.6%, without additional medication. A 63-year-old man with Crohn’s disease, NAFLD, obesity, referred for NAFLD, reported consuming six servings of soda, unchecked fried foods with limited vegetable intake. Exam was notable for abdominal adiposity. The endocrinologist recommended to eliminate soda and fried foods. The patient initially declined, but after 4 months of continued reinforcement, he adopted a plant-forward diet. After 2 years, the patient lost 160 pounds and transaminitis resolved. All specialist-directed nutrition counseling was in accordance with American Heart Association and American Diabetes Association recommendations for macronutrient and micronutrient nutrition consumption. Conclusion: These cases signify how provider-directed nutrition counseling can have an impact on CMD. The first step to integrate nutrition counseling into practice is to become well-versed in basic concepts of nutrition science and develop a broader understanding of nutrient composition. We therefore encourage the integration of nutrition science into medical curricula that could translate into improved cardiometabolic health outcomes.