Interview conducted and edited by Chris Clouzet
As chief of cardiology at Kaiser Riverside and Moreno Valley, chair of the Regional Cardiac Services Quality Committee, and assistant clinical professor for University of California, Riverside, School of Medicine, Columbus D. Batiste ’98 is an experienced interventional cardiologist. For him though, it’s as much about the extent that he can intervene in someone’s lifestyle as it is about the stents that prevent a heart attack. He relishes opportunties to share with his patients knowledge he has acquired over more than a decade learning and practicing a lifestyle of whole food plant-based diets combined with physical activity. Dr. Batiste is married to Danette, and they have two children, Brooke and Columbus. Recently, I was able to speak with him about his journey into this role as the “Healthy Heart Doc,” important concepts he shares with patients, and how other physicians can practice “lifestyle medicine.” I have edited the following highlights for clarity and length. (Italicized sections are paraphrases or summaries of Dr. Batiste’s responses.)
WHAT WOULD YOU CALL YOUR MESSAGE? DO YOU CONSIDER IT A “GO VEGAN” MESSAGE, OR IS IT MORE THAN THAT?
It’s definitely not “go vegan.” To be honest, I tend to say there are too many labels. We oftentimes simply have standard American diets “vegan” style or “vegetarian” style. We eat highly refined products, and we focus on what we’re not eating as opposed to what we are eating for our health. Essentially, my message is about building resiliency. In life we either add to our resiliency, or we add to our stress. As our stress increases on that denominator, our health decreases. Nutrition plays a role in that. Added stressors impact us by leading to oxidative stress, which leads to nutritional stressors that potentiate the inflammatory process, cancer, heart disease, etc. Instead, if we’re able to build on our resiliency with our mindset, activity, and nutrition, then we have the opportunity to bolster our health tremendously. It’s not about living forever; it’s about improving the health span.
HOW DID THIS JOURNEY BEGIN FOR YOU?
When I entered into practice, patients would ask, “What do I do now, Doc? What do I eat? How much do I exercise?” I felt there was a gap in my knowledge — despite phenomenal training in internal medicine and cardiovascular disease — as it pertains to lifestyle. As a Seventh-day Adventist, I understood that there is a health message, but I was unlearned in the application of that in a scientific manner. So I went into Barnes & Noble and found physician-written books. They covered everything from the paleo and keto diets to the South Beach diet. Around that time, my dad ended up succumbing to ill effects of diabetes, and that impacted me substantially. I started to look more aggressively into things.
He discovered Dr. Caldwell Esselstyn’s “Prevent and Reverse Heart Disease” and began reading other well-known authors on nutrition, such as Dr. Dean Ornish and Nathan Pritikin. He also began studying literature, such as the EPIC-Oxford trials, about the impact whole food plant-based diets have on modifying disease.
I realized that the evidence is irrefutable in terms of the benefit and power for impacting lives in general. That said, none of my colleagues were talking about nutrition, so I was a little sheepish about venturing into it. I’ll never forget the patient I first decided to discuss nutrition with. They had been referred to me almost as a second opinion from my colleague to do a complex coronary intervention to put in stents and had been turned down before. When they came back, their symptoms had gone away, just as the research had shown. So I told other patients and all had transformative effects from making lifestyle changes. This is without me lecturing; I simply referred them to books, and I, as a physician, validated the importance of healthy lifestyle changes.
That was around 2009. From there, things began to snowball for Dr. Batiste. He met some of the authors whose books he had read, and around 2011 he started a monthly lecture series for his patients called “Missing Link.” Dr. Batiste hired a dietitian so that patients had immediate access to valuable resources for lifestyle changes. A cooking class evolved called “The CATH Lab,” which stands for Cooking Alternative to Health and offers patients a different way to transform their arteries. The lectures and classes are going strong, and Dr. Batiste continues to present widely, also appearing in the 2018 film about plant-based athletes called “The Game Changers.” More recently, Dr. Batiste has directed the inception of a regional home-based cardiac rehab program that has supported nearly 5,000 patients practicing exercise, nutrition, and medication adherence.
HOW DO YOU LIVE OUT THESE CONCEPTS DAY TO DAY, PARTICULARLY AS A BUSY PHYSICIAN?
I use technology and competition. I use my Apple watch and compete with my nurse lead for the department, which keeps me on track getting in my steps. I have a standing desk in my office. I constantly take the stairs. I challenge the staff in between procedures to walk the stairs with me from the basement to the eighth floor. When I first started off, I was very vocal and transparent. This allowed others to hold me accountable.
I find that everyone is busy, and busyness is an excuse. I tell folks it’s about planning. This is a marathon, and everyone isn’t going to be able to hit 26.2 miles the first day. I give them an example. Before work, I may make a green smoothie with coconut water or almond milk. I’ll put in my frozen berries — not fresh, so it doesn’t go bad, and it’s affordable. I put in my frozen kale or spinach, maybe some mango. I put my hot cereal inside a glass bowl with pumpkin spices and a nut-based milk. I pop open a frozen bag of rice, a can of black beans, and frozen vegetables. I put those in a glass bowl, put a lid on top of it, and I’m out the door. Now I have my breakfast and lunch, and I may get some fruit while I’m out. I’m satisfied. It’s healthy, it’s inexpensive, and it took no time to prepare. It’s not necessarily an issue of being too busy; it’s an issue of being mindful and understanding the cue-reward system that’s getting me to create a habit to say that this is a priority.
When people feel guilty for “failing” somehow, Dr. Batiste tells them to avoid what’s called the “what the heck” moment. Instead of starting over next Monday, focus on the next moment, the next meal. He also says to think of the reasons you’ll fail in the coming week and “solve for those problems.” Can you find something healthy to eat near work or meal prep in advance? Would grocery delivery or a food-prep delivery system work for you? He once had this conversation with a couple of physicians and took them grocery shopping. Simply choosing things like rice and vegetables helped them realize how easy it could be.
It’s just a shift in the mindset. I’ll be honest; what excites me now is that passion of the lightbulb turning on for someone. All I’m doing is showing it or demonstrating it or describing it to them as opposed to me putting in a stent.
When it comes to balance and moderation or having “cheats,” Dr. Batiste likens it to investing in one’s retirement. Skipping six months of investing during your 20s may not be so bad, but doing the same during your 50s could be much more impactful.
It depends on where you’re at in terms of the burden of disease that you’re aware of, which may determine the degree of therapy from nutrition you have to be consistent with. When it comes to the concept of “cheat day,” if we’re really honest with ourselves, who are we cheating? And for many of us, that cheat day snowballs into other days, and then we start eating a little on both ends of the cheat day. It’s about asking, “What is my goal? Is this action pushing me toward my health or not?” It’s not about perfection; it’s about being intentional and recognizing what your goals are.
WE WANT TO HEAR SOMEONE LIKE YOU SAY THAT IT’S OKAY TO EAT THAT BURGER ONCE IN A WHILE.
We are always looking for someone to tell us what we want to hear. Here’s the thing with moderation. We say, “Let’s just be moderate in our approach,” which sounds good. But do we ever say, “Be moderate in the amount of water you drink”? No! How about broccoli? No! Salad? Beans? Brown rice? No.
We only use moderation in terms of things that we probably should not be having: alcohol, sweets. I’m not saying I never have anything, but I think we have to be intentional. And it’s about growth. I used to be a sugar-holic. I love desserts and sweets. I don’t have them anymore. But this has been 10 or 15 years in the making. The key is to feed the good guys more than the bad guys in your body through your actions and nutrition.
When it comes to the greatest catalyst toward effective change in people’s lives, Dr. Batiste says success has little to do with data. After all, different arguments can make sense. The goal is to help people embrace the idea that they want to feel better and to discover the reason that motivates them. Incremental improvements are valuable too.
What I find is that if we can create a keystone habit, then we can begin a process of progressive improvement as opposed to me hitting someone with: “I want you to go whole food plant based. No salt, no oil, no sugar. Eat all meals at home. Bring your Instapot when you travel.” That’s too much for most people. But we can choose how to start. With breakfast? With lunch? With a salad before each meal? What specific fruit or leafy green vegetable will you commit to this week? Give them an “actionable” that provides a sense of accomplishment and a feeling of, “You know what? I’m starting to feel a little bit better. I’m feeling this.”
CAN PATIENTS GO TOO FAR IN HAVING FALSE EXPECTATIONS OF A WHOLE FOOD PLANT-BASED DIET? IN OTHER WORDS, “I DON’T NEED MEDICATIONS ANYMORE,” OR “WHY DID I GET CANCER?”
Absolutely. I’ve seen it both ways. It’s like a seesaw effect. As you increase your lifestyle, you may be able to go completely away from medications, or you may still require some. It’s not that medications are evil; it’s a matter of finding the balance that is best for your genetic makeup. We have to incrementally increase our reach in terms of nutrition.
On the other hand, there is going to be an ending to all of us. Yes, you may get cancer or heart disease despite doing everything perceivably right. No one should ever espouse that by eating 100 percent whole food plant-based, running marathons, and being the most giving person in the world that you will never have any disease burden. That’s not true. But I say, “How do you know you wouldn’t have had this 20 years ago if it weren’t for what you’ve committed to in your lifestyle and health?”
HOW CAN ALUMNI START PROVIDING PATIENTS WITH WHAT YOU CALL “TRUE INFORMED CONSENT” — THAT IS, DISCUSSING THE VALUE OF AGGRESSIVE LIFESTYLE CHANGES WHEN SPEAKING WITH PATIENTS ABOUT TREATMENT OPTIONS?
You have to validate the importance of lifestyle to patients. That’s number one. A lot of the time as physicians, we are guarded in areas that we are ill-informed. And a lot of physicians are uninformed as it pertains to the research because it’s not taught inside of medical school — at least when I graduated — and weren’t taught readily or robustly in training either. That means your vantage point pertains to medications, procedures, and surgeries. When you introduce a new area, there is a degree of fear because it hasn’t been validated in your mind.
I tell this to physicians I work with: “You understand that there’s some data on vegetables and their benefit for anti-cancer and heart disease. Espouse that. You know there is some benefit from beans and legumes and fiber rich foods, so espouse that.” You start with what you know as opposed to what you don’t know. And have good support in terms of a health educator or a dietitian that you feel comfortable referring folks to.
WHAT COULD LOMA LINDA IMPROVE IN TERMS OF PREPARING PHYSICIANS TO PROVIDE SUPPORT FOR AGGRESSIVE LIFESTYLE MODIFICATIONS?
The problem on a national level is that resources go where value is placed. Physicians are tested from USMLE for medical school. Are there any questions or content as it pertains to lifestyle within USMLE? If not, why would an institution focus on educating on that? Moving to each area of specialty, if the testing to become board certified does not entertain lifestyle, then the focus — the resources — will not follow because it’s not valued. Then you go into practice. If reimbursement toward lifestyle education is not valued by the health care system, then resources won’t go there. That’s really the heart of the problem. I can’t blame an institution like Loma Linda in isolation — or USC or UCLA or anywhere else — because they are following the money trail and where value is being assigned.
The question is how can we have a grassroots movement to change the value structure inside of the medical profession to highlight lifestyle on an equal plane — not as alternative medicine, but as a primary, intentional therapy. Such that when we speak of informed consent — “Listen. We can treat you with medications; we can do angioplasty stents; we can do open heart surgery” — we should add, “We can do aggressive lifestyle intervention.” Not every situation is the same. If you have a tire that’s blown out, I can’t talk to you about prevention of driving over nails. I need to replace the tire. But if someone keeps coming in with nails: okay, avoid the nails. Let’s change our approach so we can avoid this in the future. That’s really the key message.
There has to be a shift in terms of value. How do we show value? It’s through continued research, and we have to have a unified enemy. The unified enemy is the standard American diet: highly processed, refined substances that have a shelf life that can stand a millennium. Whether it’s paleo style, gluten-free, vegan, vegetarian, whatever you call it, that’s the problem.
That hits us at the heart in Loma Linda because what’s in the stores? These substances that we call fake meat with ingredients you can’t pronounce. And we fry it, we batter it, and we sit around with our chests puffed out and say we are vegetarian and we’re vegan; we’re better than you are. From an environmental standpoint and an animal rights standpoint, absolutely. From a health standpoint? No. Not at all. It’s comparable to wearing a nicotine patch: it’s better than smoking cigarettes, perhaps, with all the additional toxins, but it’s not a healthy option.
SOME RECENT NUTRITION FILMS DESCRIBE HOW IN THE PAST BIG MONEY PROMOTED CIGARETTES FOR HEALTH UNTIL RESEARCH AND PUBLIC AWARENESS CAUGHT ON. BIG MONEY HAS BEEN BEHIND MILK. FOR YEARS IT HAS BACKED THE BEEF INDUSTRY. WHERE IS THE MONEY NOW?
The money trail is convoluted. I think the standard American diet is problematic. I think fast foods are problematic, and in food swamps — areas of overabundance of fast food conglomerates — many businesses are subsidized by the government with small business association loans. On top of that, a lot of the foods they serve are made of substances that are also subsidized by the government: meat and dairy, corn, soy, and so forth that are used to make these highly refined items with high fructose corn syrup and other substances. And then advertising dollars from the government go into it. You start to get a little suspicious about the vicious cycle there. The food is also completely contrary to the food pyramid or the food plate, so in terms of what the government subsidizes and what it espouses for health, they are contradictory.
Many individuals and segments of the population are surrounded by food substances that are deleterious for the body. There is a study that was done out of the Journal of American Medical Association that showed that people who consume the vast majority of government subsidized products had increased obesity and cholesterol and markers for inflammation leading to heart disease and so forth. If you just live close enough for easy access, your risk of heart disease goes up astronomically, and if you ingest fast foods more than three times a week, your risk of heart disease is up by 80 percent. There’s a huge problem. And whether or not I call that fast food “plant-based” or “animal-based,” it’s still fast food. Cheap. Refined.
WILL BIG MONEY EVER GET BEHIND PLANT-BASED DIETS, OR WILL IT ALWAYS FACE A LOSING BATTLE TO FAST FOOD, MEAT, AND DAIRY?
Unfortunately, I do think big money is going to get behind plant-based diets because plant-based diets has taken on a different connotation. There are plant-based ice creams, plant-based chips, plant-based cookies, plant-based burgers. It’s standard American diet, plant-based style. You can have plant-based vegan, but vegan does not equal whole food plant-based. “Plant-based” and “vegan” are now synonymous, and it’s important to delineate “whole food plant-based.” It’s about making whole foods the predominance of your diet.
WHERE ARE WE HEADED?
Right now, we are heading to our peril, but I’m inspired by the hope of the level of accessibility of information now. Speaking to physicians primarily, we have an obligation to speak up and to espouse what has a degree of literature base to it in terms of what’s been shown to be helpful to individuals. If we keep our voices silent, we lose all credibility in this fashion because there is a growing desire to learn more about this thing called nutrition and this interplay with the environment and with animals and with our own health.
And we’re seeing that folks can’t afford it. I just got a text message about someone who developed cancer who is trying to raise money so they can start chemotherapy because insurance won’t pay for it. This issue of health care is so germaine to all of us at some point in our lives. Unless we take strides right now to lay the groundwork for health so we can have improved health spans, this nation is going to crumble with the burden of finance.
Physicians have to step up in terms of research. We have to step up in terms of our awareness. We have to step up in terms of conveying information to direct patients toward a healthier lifestyle, not with judgment but encouragement. Listen, if you’re eating five burgers a day, my issue is trying to get you down to four. Or three. I’m trying to convince you to eat a salad with that. Yes, I want to tell you the big goal, but I want to bring it back in and say, “Wow, that’s incredible. You’re down to two burgers a day? You’re doing a great job.”
The problem once again is the time the doctors have. We only have 10 or 15 minutes per patient, and there are a host of other issues. So we have to ask, “How can we inform patients from a brochure or marketing standpoint? How can I direct people to a YouTube channel to see what my medical practice will tell them about lifestyle? How can we associate with virtual health coaches or dietitians who can guide folks and give them resources because now we’ve validated lifestyle as their physician?” It becomes a prescription, not an afterthought, and that is key.
IT SOUNDS LIKE THAT’S A CHALLENGE TO YOUR COLLEAGUES TO USE THEIR AUTHORITY APPROPRIATELY.
Absolutely. The challenge is that we have to — to use Loma Linda’s terminology — really treat the whole person. We can’t just practice in isolation; we have to look at the whole person. I’ve had individuals who lived in roach-infested apartments with nowhere to cook. They have no avenues. So I’m not looking at them from a standpoint of judgment; I realize they are going to eat fast food. Now I’m trying to think, “What’s the best fast food spot for them to go and eat? What can they get at 99 Ranch Market? What can they microwave quickly to make convenience work for them?” We have to have empathy with our patients and meet them where they’re at to bring them along to a higher place.
Many resources exist for learning about whole food plant-based diets. See below for a list of resources that Dr. Batiste recommends to help get you started.
- “Forks Over Knives”
(A benchmark nutrition film)
- “The Game Changers” (Engaging)
- “The Last Heart Attack”
(By Dr. Sanjay Gupta and CNN)
- “The 22-Day Revolution” by Marco Borges (Author is an exercise physiologist)
- “Prevent and Reverse Heart Disease” by Caldwell Esselstyn, MD (More scientific)
- “The China Study” by T. Colin Campbell, PhD, and Thomas M. Campbell II, MD (Well-known comprehensive study of nutrition)
- Nutritionfacts.org (Useful short videos)
- Kickstart.pcrm.org (A 21-day vegan kickstart program)
- Feastingonfruit.com (Desserts)
TIP FROM DR. BATISTE
- Get Audible (or check your library) for nutrition audiobooks. Listen during your commute or your exercise.