So I borrowed his book, "Dr. Neal Barnard's Program for Reversing Diabetes" from our local library.
It's a quick read, full of examples of patients who lost weight and improved their health dramatically by following his vegan approach. I'm not diabetic myself, but I thought it looked interesting nevertheless. He claims his patients are thrilled to embrace a plant-based diet. What I am not sure about is what percentage of people succeed on his diet plan, even though the cover loudly (but vaguely) proclaims that it is "3 times more effective than other diet plans."
I have no quarrel with several of Dr. Barnard's premises. Let's get these out of the way first: Like proponents of ancestral eating, he rejects processed foods, refined starches, hydrogenated fats, and sugar. Vegetables and fruits are in. He is firmly against dairy products, as are many (though by no means not all) supporters of the Paleo diet.
But that's where the similarities end.
Dr. Barnard reveals himself to be severely fat-phobic. He believes dietary fat is very, very bad for you. He claims that sufficient essential fatty acids can be obtained by eating vegetables (though he's not an avid eater of avocadoes, nuts and coconut), and that dietary fat causes inflammation and disease. For example, on page 25 we read that:
You have eaten fatty foods, and, as a result, tiny bits of fat have accumulated in your muscle cells. This fat interferes with the normal workings of the cells, including their ability to respond to insulin. If insulin is unable to work, glucose cannot get into the cells, and it builds up in the bloodstream. Then, those fatty foods actually seem to disable your genes that would produce the mitochondria you need to burn up this accumulating fat. Your ability to eliminate fat inside your cells seems to be slowed down when you eat fatty foods.There is no discussion of the role of carbohydrates in this process. All the blame is placed squarely at the feet of fat containing foods.
Similarly, he is quite adamant that dietary cholesterol is the cause of high cholesterol in the bloodstream. Throughout, he writes about LDL cholesterol, qualifying it as "bad cholesterol" each time. Since dietary cholesterol is only found in food derived from animal sources, he writes on page 59 that:
Your new diet is not low in cholesterol; it has no cholesterol at all. It also has no animal fat, which is important because animal fat (like other sources of saturated fat) encourages your body to make cholesterol.Frankly, I am amazed that a medical doctor with a special interest in diet can make these claims. I would have thought that everyone in this field realized by now that dietary fat doesn't just lodge itself in the arteries, and that the consumption of cholesterol is known to play only a very minor role in the cholesterol in the blood. I was so surprised that I double-checked when the book was published -- maybe it was a very old edition. But no, it was published in 2007. That is sufficiently recent for there to be little excuse for such an oversight.
Another oddity is his claim that animal protein is bad for the kidneys. Here is the paragraph on page 43 where this is discussed:
Now, you will notice that the diet I recommend is not just free of animal fat; it is also free of animal protein. That is important because animal protein can harm the kidneys, and protecting them is a key goal. Protein from plant sources is the way to go.Do you get that? I didn't. I have no idea why animal protein is damaging to the kidneys but plant protein isn't. Surely, protein is protein? If not, why would there be a difference? Why doesn't the quantity of protein consumed play a role? According to Dr. Barnard, even small quantities of animal protein are potentially harmful. I was very disappointed that this wasn't fleshed out (sorry, I had to use that!) a little better.
I am fully aware that diabetics are at higher risk of kidney impairment than people who are not diabetic. So it makes sense to be careful around this subject in a book aimed at diabetics. But I can't help thinking that Dr. Barnard's firm vegetarian convictions played a role in defining what kind of protein is acceptable on his diet plan.
I do agree with him that there are some very serious problems with the way that meat is brought to the market. I also find the treatment of animals in CAFO (concentrated animal feeding operations) very disturbing. It is precisely for this reason that we buy our meat from a small local farmer, and we raise our own chickens for their eggs. In my opinion the abhorrent treatment of animals in these massive CAFO operations is a great justification for being vegetarian, if consumers are unable to find alternative sources that meet their approval. However, to say that animal protein is harmful to the kidneys, while vegetarian protein is not, makes no sense to me.
I think by now that you have an idea of what I think of Dr. Barnard's plan. I should add that is puzzling to me that he claims to be very successful with his approach. Perhaps veganism does work for some people, just as a paleo diet works for others. It certainly seems to work for Dr. Barnard, who looks very healthy on the cover of the book. Could it be that either a low carbohydrate or a low fat/protein approach to losing weight could be successful, but that it is the combination of carbohydrates with fats that leads to problems at the cellular level?
Dr. Barnard's diet is not likely to work for me. "Frying" onions in water, which is what he recommends, is most unappealing. I do cook plenty of vegan dishes, but they are almost exclusively low carbohydrate dishes. I feel far too healthy eating a variety of fats from both animal and vegetable sources. I'm also not about to give up my almost daily omelettes made from eggs from pastured chickens.
But even if the idea of giving up dietary fat and animal protein doesn't hold much appeal, I think what is more disappointing is that Dr. Barnard does not support his dietary approach with convincing scientific research. I am quite willing to believe that it can work for some people, but the problem is that his book doesn't explain very well why it works, and because of this, the book left me feeling quite confused and not at all convinced.