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We sit down with Roxanne Becker, a lifestyle medicine physician, to discuss the urgent implications of the first human case of H5N1 avian influenza contracted from a dairy cow. We explore how zoonotic diseases like H5N1 and COVID-19 can rapidly mutate and lead to pandemics, the role of intensive farming practices in the spread of these diseases, and the importance of shifting to a whole-food, plant-based diet. Roxanne sheds light on the public health recommendations to prevent zoonotic diseases, the impact of antibiotic use in animal agriculture, and how our dietary choices can reduce the risk of future pandemics.

Roxanne Becker is a lifestyle medicine physician.

She discusses the KevinMD article, “Eating our way to the next pandemic.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Roxanne Becker. She’s a lifestyle medicine physician. Today’s KevinMD article is “Eating our way to the next pandemic.” Roxanne, welcome to the show.

Roxanne Becker: Thanks so much for having me.

Kevin Pho: So let’s start by briefly sharing your story and journey.

Roxanne Becker: All right. So I’m a medical doctor, born, raised, and trained in South Africa. And during my second year of medical school I started following a plant-based diet for personal reasons, and noticed that my health dramatically improved. My concentration, my energy levels, my PMS symptoms, all of those dramatically improved.

But then I went to the hospitals as a medical student, and I was learning from my own research that nutrition is so powerful at preventing so many of these chronic diseases of lifestyle. But then I went to the hospitals and people were suffering from the consequences of obesity and diabetes and heart disease and hypertension. And so I realized that there really was a deficiency in nutrition education, and I know it’s the same here in the United States. And so that’s where my passion for nutrition and educating medical students really came about.

Fast forward to the COVID-19 pandemic. I was working in COVID wards, I ran a COVID ward for a while, and it was really disheartening and difficult to see so much suffering, so much death. And really what I noticed was most of the patients that I lost were very overweight, obese, had a lot of comorbidities. You know, we’ve seen in research that all of these diseases like diabetes and hypertension increase the risk of death and severe disease from COVID-19.

And so I really realized that nutrition was so important, and I wanted to divert the rest of my career to educating more people about it. And so at the moment I work for the Physicians Committee for Responsible Medicine here in Washington, D.C., where I’m based locally now. And my work really focuses around educating medical students, educating the general population about the importance of nutrition. And also I do clinical research, specifically looking at the role of plant-based nutrition in treating type 2 diabetes.

So that’s where I’ve ended up. And my main concern with this whole H5N1 outbreak is that it could throw us back into the situation that we had with COVID-19, where we’re aggressively playing defense when there are steps that we could be taking now to prevent another possible pandemic. Which is how I got to writing this article and why I’m speaking out about this.

Kevin Pho: All right. So let’s talk about that article, “Eating our way to the next pandemic.” For a little bit of context, tell us what the situation is now with the H5N1 avian influenza.

Roxanne Becker: Absolutely. So H5N1 influenza has been around for many, many years, and it has been transmitted from poultry. There’ve been around 900 cases over the last 20 years. And what’s really concerning is that this H5N1 that has been transmitted from birds has a mortality rate of around 50 percent, which is really scary compared to around 0.1 percent with COVID.

So now what we’re seeing for the first time is that this H5N1 bird flu has been transmitted to dairy cows and then to farm workers. So at the moment we’ve had three cases that we know about that have been reported, one in Texas, two in Michigan. At the moment the symptoms seem pretty mild, mainly mild respiratory symptoms. But there is the potential for a new pandemic with us that could be a lot more fatal than COVID-19.

And already with the third case, upon genomic testing, we’ve seen that there are already mutations present that weren’t present in the first case. So especially with COVID we’ve seen how rapidly these viruses can mutate to gain increased transmissibility, increased disease severity. And so with this it’s really important that we act now, as urgently as possible, to prevent another COVID situation.

Kevin Pho: So we hear some isolated stories in the news, like you said, there’s been fewer than five cases of transmission so far. So tell us, how worried should we be about this? You know, we just are emerging from COVID, and now we have this H5N1 virus that is in the news. How worried are you, how worried should we be?

Roxanne Becker: You know, Kevin, I think that’s a really difficult answer, because it could go either way, right? We could have three cases and never hear of it again, or this could potentially be a lot worse than COVID. So it is important that we keep on top of it.

I think what is concerning about the progress of this H5N1 potential pandemic is that we’ve now seen that it can infect meat. So cows that have been infected by H5N1, their meat has tested positive for the infectious virus, so that’s a possible route of infection.

We’ve also seen that raw and pasteurized milk contains the infectious virus, so people could potentially be infected through consuming this raw milk, which is scary because it’s such a massively popular trend on social media at the moment to drink raw milk.

And aside from that, one in five commercial samples of pasteurized milk in the United States have tested positive for viral fragments. And while those aren’t infectious, it is concerning, because this is across states. It means that either infected milk or infected dairy cows are being transported across state borders.

And so, you know, whether this does develop into a pandemic or not, we need to act urgently now to reduce this risk as much as possible.

Kevin Pho: So you said before that we’ve been playing defense. So what are some of the suggestions that you have to get ahead of this?

Roxanne Becker: Absolutely. So I do think that the current public health strategy is important, washing hands, preventing contact with dead birds, all of that. But really my article focuses on why a plant-based diet should form part of our public health strategy, both against H5N1 and against zoonotic diseases in general. And there are three main reasons why I have suggested this.

The first is we could potentially avoid disease transmission through avoiding the consumption of infected foods. We’ve already spoken about the meat and the dairy. But also during the COVID-19 pandemic there was research done in health care professionals who were working on the front lines across six different countries, and those who followed a plant-based diet were less likely to be infected by COVID-19. So it could potentially reduce the transmission. That’s the first reason.

The second reason is that a plant-based diet can also reduce disease severity. Again during the pandemic we saw that those who followed a plant-based diet had, in this study across six countries, a 73 percent lower odds of having moderate to severe disease.

Part of the reason for that seems to be the antioxidants that are found especially in fruits and vegetables. They help to fight the excess of inflammation that we see with these infectious diseases. But at the same time it also addresses some of the underlying risk factors that I’ve mentioned, heart disease, obesity, type 2 diabetes.

We have consistently seen in cohort studies, when we follow people for several years and look at their dietary patterns, that those who follow plant-based diets have a lower risk of these diseases of lifestyle. And more recently, over the last 10, 20 years, we’ve also seen clinical trials that have shown that a plant-based diet can be used to treat some of these diseases and potentially even put some of them into remission.

At the Physicians Committee we focused a lot of our research on type 2 diabetes, and we’ve seen that when people start to follow a high carbohydrate, high fiber, low fat diet, their glycemic control improves, the medication requirements are reduced, and they also have other cardiometabolic benefits like a lower total and LDL cholesterol, they experience weight loss. And so if we’re able to address these underlying risk factors that I saw were so important in the risk of dying and having severe disease, we could potentially reduce the impact that this has on people.

And the third reason is that following a plant-based diet could potentially reduce the demand for concentrated animal feeding operations, or CAFOs for short. People more commonly know this as factory farming or intensive agricultural practices. And this is where animals are confined into very small spaces, they are very stressful conditions, which obviously weakens their immunity. There is genetic homogeneity, right, animals are bred to produce more milk, to produce more eggs, to grow faster. And we know that when there’s genetic variety that strengthens the population in the wild, because they’re more likely to be able to fend off diseases.

And so these CAFOs or factory farms are no longer just an ethical issue, it’s also a public health issue. A recent United Nations report implicated these factory farms in around 50 percent of zoonotic diseases that we see today.

And aside from that, there is this widespread overuse and misuse of antibiotics by farmers to try and prevent these diseases from arising, and that’s contributing to antibiotic resistance in humans, which is a rising cause of death as well. Not to mention foodborne illnesses.

And all of this comes back to a very simple supply and demand. These factory farms exist because there is a demand for meat and eggs and dairy. And so by switching to more plant-based foods we could potentially reduce this demand as well. So those are the three main reasons why a plant-based diet should be included in a public health strategy against this.

Kevin Pho: So from a practical standpoint, how do you implement more of a plant-based approach? Is it more education, should it be a public health strategy involvement as you suggest, should it be some policy changes? So from a practical standpoint, how do you convince more of our society to adopt some of the benefits of that diet?

Roxanne Becker: That is a very, very good question, and it’s a multipronged approach, right? So policy is a very important part of it. And so part of the work that we’re doing is having campaigns in Ohio and Michigan to try and get the state to offer transition grants for people who want to move away from animal farms to crop farms. We also are working on the dietary guidelines to try and get more plant-based foods into the dietary guidelines. So there’s definitely an important policy approach from that.

But then also, what I’m involved in is educating medical students. And I think the role of dietitians is so important in the multidisciplinary approach. But at the same time, if people are hearing the same message about the importance of nutrition and exercise and other lifestyle habits at every point of contact in the health care system, they’ll be more likely to change. And so it’s also really important that health care professionals get on board and are promoting good nutrition and lifestyle practices to their patients.

And then of course it’s also educating the general public. I think a large reason why people are so unhealthy these days is that they just don’t have access to the right information and the right tools. And so educating the public, empowering people to take their health into their own hands, is also very important, and part of the work that we do.

Kevin Pho: Now when you talk to medical students and you go to medical schools in general, do these students get a lot of nutrition education in the curriculum?

Roxanne Becker: Unfortunately not. It’s a common theme that I’ve seen, and it doesn’t seem like we’re moving in the right direction in terms of medical schools offering this, which is why we’re going in as an outside party to provide this to them. But we also have been working to get more nutrition points into CME education and credits for physicians, and so we’re also working in that. But by and large it’s still definitely not a part of the curriculum here in the United States.

Kevin Pho: Now, historically, are you aware of any societies that have made that shift from an animal-based diet to a plant-based diet successfully? Has there been any precedent?

Roxanne Becker: So if we look at the Blue Zones, we see that these are areas where people live the longest, healthiest lives. These are where the most centenarians live, people that reach 100 years old, which is a pretty foreign concept these days but is pretty incredible.

And what’s really important to note about these people is that they’re not living to 100 but bed bound for the last 30 years of their lives. They are active members in society, they’re playing a role in their community. And they obviously have a lot of factors at play, but what we see is that these people get the majority of their calories from plant-based whole foods. And if they do include meat, eggs, or dairy, it’s more of a garnishing on a dish rather than the focus of the whole meal.

And so we’ve seen this in Loma Linda, California, Okinawa, Japan. Interestingly, during the COVID pandemic, Okinawa, Japan also had much lower rates of COVID than other areas of Japan. And so we’ve seen that these societies that live the longest tend to follow a whole food plant-based diet as well.

Kevin Pho: We’re talking to Roxanne Becker. She’s a lifestyle medicine physician. Today’s KevinMD article is “Eating our way to the next pandemic.” Roxanne, we’ll end with some of your take-home messages that you want to leave with the KevinMD audience.

Roxanne Becker: All right, thank you so much. I think the two main take-home messages that I want to leave your audience with is that a plant-based diet is one of the most underutilized tools that we have as health care professionals to recommend to our patients, and the evidence really supports that it can be used for a variety of medical conditions. And even if you don’t personally follow it 100 percent, I think that because the evidence is there to support it, our patients deserve to know about it.

And I think also the impact of switching to a plant-based diet extends far beyond personal health. Many organizations such as the American Medical Association are calling on the shift for environmental sustainability as well, and we could potentially also influence public health by shifting towards a plant-based diet.

And I think finally, just one more thing, is that people shouldn’t be cautious of recommending a healthful plant-based diet out of fear that people cannot afford it. I was recently a speaker at a dietary sustainability conference, and one of the questions that came up was, a plant-based diet sounds great but it’s really for the rich and the privileged and people that can afford it. And there have been two major studies that were done this year that found that a whole food plant-based diet actually results in around a 16 percent average food cost savings. And so I think it’s really important that we don’t let the fear of the cost of a healthy diet deter us from recommending it to our patients.

Kevin Pho: Perfect. And you know what, I’m going to ask actually one more question. I’m a primary care physician, so in the exam room, if I wanted to introduce more plant-based concepts to one of my patients and make it a more incremental change for them, what are some suggestions that you have for physicians to introduce plant-based concepts in the room?

Roxanne Becker: Absolutely. I think that one of the most practical ways to do this is to suggest that people take some of their favorite meals, start with one meal a day, and try to make it more plant-based. Try to crowd out the processed foods and the animal based foods with more whole foods.

So for example, if you’re doing egg and bacon on toast, you could do a tofu scramble instead. If you usually have a quesadilla with meat and cheese, you can make a bean quesadilla or bean burrito instead. So start by making individual meals, shifting them towards a more plant-based diet, and try to crowd out the more unhealthful foods with healthful alternatives.

Kevin Pho: Roxanne, thank you so much for sharing your perspective and insight, and thanks again for coming on the show.

Roxanne Becker: Thank you so much.