A Plant-Based Diet for the Big Apple? That's the Plan

Miriam E. Tucker

September 24, 2021

In 2016, Brooklyn Borough President Eric Adams fought his type 2 diabetes diagnosis by adopting a plant-based diet. Now, as the presumptive next mayor of New York City, he plans to bring his constituents along on his "healthy at last" journey.

"It's important to change our healthcare system from being sick care to health care, and there's no greater impact in doing that than to look at how we are feeding the crisis on a governmental level. Built into my response is to introduce a whole-food plant-based diet to everyday New Yorkers…We're going to start transitioning to a healthier lifestyle," Adams told Medscape Medical News in an interview.

Adams, who was a police captain and then a state senator prior to becoming Brooklyn Borough president in 2013, won the NYC mayoral Democratic primary in June 2021 and is widely expected to win the general election on November 2.

In October 2020, he published a book, Healthy at Last, chronicling his journey from unhealthful eating habits when he was a cop, which followed him into elected office, to his life-changing decision to adopt a completely plant-based diet after receiving a diagnosis of type 2 diabetes in March 2016, at the age of 56. He also explains the many drawbacks of the typical Western diet and the cultural African American "soul food," reviews some of the science supporting plant-based diets in preventing and mitigating chronic health conditions, and offers tips for making the switch. In the last chapter, he provides 51 plant-based recipes.

Adams cut all animal products from his diet, including meat, poultry, dairy, and fish, and advocates doing so in his book.

But he doesn't expect all New Yorkers to do the same (at least not yet) and his messaging won't use the word "vegan." Rather, the plan involves making plant-based diets the top menu option in places where the city government feeds people, starting with hospitals and perhaps later expanding to prisons and city office buildings. (School meals are under the jurisdiction of the US Department of Agriculture.)

"We're going to be extremely creative...So instead of automatically giving people bad food, highly processed food, we're going to make plant-based as the default. If someone wants something other than plant-based, they can reach out and we'll make that available, but we're going to start with having people default to plant-based," he said.

Eric Adams fought his type 2 diabetes diagnosis by adopting a plant-based diet.

Can One Be "Healthy at Last" and Still Eat Animal Products?  

Adams writes in the book that one morning in March 2016 he woke up and couldn't see. A blood test showed his A1c was 17% (extremely high, almost three times the "normal" level of 6%). His doctor prescribed insulin along with several other medications and told him that the diabetes and eye damage were likely permanent. But, already harboring the desire to become mayor of New York City, he began googling for other answers. He found the website of Caldwell Esselstyn, MD, of the Cleveland Clinic Center of Wellness and Preventive Medicine in Ohio and prominent long-time advocate of plant-based diets for cardiovascular health.

Soon after, Adams attended one of Esselstyn's 6-hour seminars in Cleveland along with his girlfriend, Tracey, a public-school administrator who had been diagnosed with prediabetes. Once back in New York City, the pair threw away all their animal-based foods and dove into the plant-based regimen.

Adams writes that the changes happened very quickly. Within 2 months his vision cleared up, he had shed 35 pounds, and his A1c had dropped to below 6%. He was able to come off insulin and all the other medications he'd been prescribed.

That response is not unusual, Esselstyn told Medscape Medical News in an interview. "His experience is so common. What makes this so gratifying in lifestyle medicine is to see how profoundly and promptly these results can ensue. It really is life changing."

In 2014, Esselstyn published results from nearly 200 individuals with established cardiovascular disease who had participated in his program, finding dramatic reductions in recurrent cardiovascular events over nearly 4 years among the 89% who adhered to the plant-based program.   

One problem with the current medical system, Esselstyn said, is that "nutrition isn't taught in medical schools, even to cardiologists. So, they have no grasp of the causation of the illness they have been designated to treat."

According to Esselstyn, exclusion of all animal-based products is key to cardiovascular health, rather than diets such as the Mediterranean that focus on plants but also include fish and low-fat dairy. "To my knowledge, if you look at a group of patients seriously ill with heart disease, there has never been a study with a Mediterranean diet that has halted and reversed their disease. I grant you, Mediterranean is better than a typical Western diet, but it's just a question of whether you want to develop your disease more slowly — I don't think that's how it ought to be. I think it ought to be a diet that halts and reverses disease."

"It's Unrealistic for Everyone to Be Vegetarian or Vegan"

But Frank B. Hu, MD, professor and chair of the Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, told Medscape Medical News that the scientific literature tends to define "plant-based products" broadly, and not all are completely free of animal products. And, he argued in a recent article, "plant-based" doesn't necessarily mean healthy if it contains items such as refined grains, French fries, and sugary drinks. (Adams also makes that point in his book.)

"In terms of different eating patterns, vegetarian and vegan diets can be very healthy if the plants are mostly whole foods or minimally processed foods. And of course, they also need to make sure that they have adequate micronutrients, especially B12, iron, and omega-3 fatty acids if they don't contain fish at all," Hu said.

But other eating patterns can be healthful, too, Hu said, including the traditional Mediterranean diet, which even includes a small amount of red meat along with large amounts of plant-based foods. And the Dietary Approaches to Stop Hypertension (DASH)  diet, which includes large amounts of low-fat dairy in addition to vegetables, whole grains, and nuts, has also been shown to reduce blood pressure and has beneficial effects on cardiovascular disease.

Even a low-carbohydrate or ketogenic diet, often promoted for diabetes management, can be healthful depending on what types of foods are eaten instead of the carbs. It's possible to eat a lot of fat and protein from plant sources, such as nuts and olive oil, and a relatively small amount of animal products, Hu noted.

"It's unrealistic for everyone to adopt a vegetarian or vegan diet. It's also not necessary...There are healthy dietary patterns that include moderate amounts of animal products and have been demonstrated to be as effective as healthy plant-based diets in terms of diabetes management, weight loss, and chronic disease prevention. I think it's better to give people options and flexibility while adhering to some basic nutrition principles which are shared across different eating patterns," Hu emphasized.

Eric Adams cut all animal products from his diet, including meat, poultry, dairy, and fish.

Weight Loss the Key to Adams' Success

Regarding Adams' story, Hu said, "It's remarkable, especially given the severity of his diabetes in the beginning. I think the weight loss is probably the key...Type 2 diabetes is strongly related to body weight, and diabetes complications are correlated to obesity...I think the diet has direct and indirect effects, with the direct being the weight loss. Nutrients like polyphenols and healthy fats and fiber and minerals can directly impact blood lipids and have anti-inflammatory effects, but those effects aren't likely as strong as those of the weight loss."

Hu praised Adams' plan for New York City. "I think it's a good direction in terms of pushing whole-food, plant-based diets and increasing the availability and accessibility of plant-based foods in government buildings. The key is what foods should be removed when you have healthy foods coming in. If highly processed carbs like white bread, donuts, cookies, and sugary beverages can be replaced by healthy plant-based foods and meals, I think that would be a good thing."

"Food Should Be Our Medicine"

Adams has already been promoting plant-based diets in Brooklyn. In 2018 he piloted a "Meatless Mondays" program in 15 borough schools. That program was subsequently expanded to all New York City public school breakfasts and lunches in the 2019-2020 school year, covering approximately 1.1 million children.

In 2019, Adams worked with the New York City deputy mayor for Health and Human Services to open the Plant-Based Lifestyle Medicine Program at the NYC Health + Hospitals/Bellevue location. The clinic treats patients with heart disease, hypertension, type 2 diabetes, and related conditions using lifestyle along with traditional medical approaches.

To counter the "food desert" problem in lower-income areas, Adams allocated extensive funding to support "urban agriculture" initiatives around Brooklyn and aims to expand such programs around the five NYC boroughs if elected mayor. He also aims to expand "healthier bodega" and pharmacy "vegetable prescription" programs already in place around the city.

Adams exercises every morning and works from a stand-up desk. When invited to events that involve food, he told Medscape Medical News: "I like to eat beforehand a good healthy meal so I'm walking into the event not being hungry and tempted. You can always find some form of salad or vegetable at the event, so you can be sociable and not offend your host, but at least I had the foundation of my meal before walking in."

And he still monitors his blood glucose to see the effects of different plant-based foods. For example, he learned that bananas tend to raise it. "So now, instead of eating a whole banana, I might eat half a banana and just slice it into my steel-cut oatmeal." On the other hand, "blueberries don't spike my blood sugar at all and I'm able to consume them. So it's really about understanding your body."

Asked about his message for healthcare professionals, Adams replied: "I believe physicians have responded to a calling, and that calling is at the foundation of what modern medicine has been built on, and that's do no harm."

"We can't continue to treat symptoms when we can go after the underlying reasons that people are experiencing chronic diseases...We need to go back to the roots and understand that food should be our medicine and medicine be our food."

Adams, Esselstyn, and Hu have reported no relevant financial relationships.

Miriam E. Tucker is a freelance journalist based in the Washington, DC, area. She is a regular contributor to Medscape, with other work appearing in The Washington Post, NPR's Shots blog, and Diabetes Forecast magazine. She is on Twitter: @MiriamETucker.

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