Joanne Evans, MEd, RN, APRN

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Joanne Evans has been a nurse for over 50 years and was an experienced clinician, administrator, author, researcher and educator before retiring from a leadership position at the American Nurses Credentialing Center. She is certified in plant-based nutrition by both eCornell and the McDougall Foundation. She is also a member of the Physicians Committee for Responsible Medicine Medical Advisory Board. She has presented on plant-based nutrition at many national, state, and local nursing conferences. In addition, she has published on this topic in the Journal of Holistic Nursing, the American Journal of Nursing, and the Journal of American Association of Nurse Practitioners. She is also the author of two books, including Cultivating Seeds of Health with Plant-based Nutrition – Nurses Share Their Educational Approaches to Prevent and Reverse Chronic Disease and Redefining Retirement for Nurses. She also now offers free 21-day Kickstart programs to introduce nurses to plant-based nutrition.

Connections: 
Can you define a plant-based diet?

Evans:  
We are essentially talking about fruits and vegetables, whole grains, plants, nuts, seeds, and legumes, and omitting dairy and animal foods and limiting oil, white flour, sugar, salt or processed foods.

Connections: 
How did you come to focus on plant-based nutrition? 

Evans: 
It all had to do with my own health. About 20 years ago I was training for a Marine Corps marathon with my sister. I had never run before, and as I trained, I became sicker and sicker. Everyone said, ‘you will get runner’s high, and you will be fine.’ I did finish it, but I was clearly not doing well and never got the runner’s high. It turned out that I was suffering from mercury toxicity caused by an old dental filling that had cracked. My blood pressure was up and down. I had dizzy spells. I was losing body hair. I had trouble concentrating. I had memory problems and muscle weakness. 

I was sick for about six months, and I went to many different doctors. I worked in the ER, and all the physicians were trying to help figure out what was wrong. I had blood and urine tests, which found nothing. Finally, I went to a naturopath. He gave me a 24-hour urine test, which found that I had severe mercury toxicity poisoning. It took a year of intravenous chelation once a month to get the mercury out of my system. That’s when I started really looking at nutrition and health.

All the women in my family have had breast cancer – my mom, grandmother, and sister. I knew I could also get it, but if I could do anything to avert it, I would try. I learned there was a correlation between breast cancer and dairy, and that’s when I started cutting out dairy. Then I cut out all animal foods because I also had a history of heart disease in the family. It was gradual. Now, my diet has been plant-based for 20 years. 

Connections: 
Talk about the relationship between a diet that includes meat vs. a plant-based diet in terms of health.

Evans: 
Cancer, diabetes, obesity, heart disease – they are all correlated with meat-based diets. I am not totally opposed to medication to treat these illnesses, but if there is any way I can use food instead of medication, that is what I’ll do. 

Heart disease is a major cause of death in the U.S., and we have extensive research that correlates animal foods and heart disease. The marketing departments of the beef industry have done a phenomenal job of convincing people they need more protein from beef. And the FDA, which is very much associated with the meat and dairy industries, is still promoting animal foods, while the World Health Organization came out and said all processed meats, including hotdogs, and bologna, were carcinogenic. I do not understand why we are still serving these foods in schools or hospitals.
 
In California there are 27,000 NPs and 325,000 nationally. NPs could be giving out information about plant-based nutrition, or they could be suggesting a nutritional treatment for someone who is having a bad side effect from medication. I have learned that nurses don’t do this because they don’t feel they know enough about plant-based nutrition. They are worried that if people ask them questions, they will not know the answers, or they won’t know who to refer patients to if they are interested in plant-based nutrition. They also may assume the patient won’t follow their recommendations if they did tell them, or they think a plant-based diet is too expensive. 

Another problem is that there is big money in health care. Pharmaceutical companies make money when people are sick. It benefits people to stay well, but it does not benefit the health care system financially. If you try to get people healthy with nutrition, there is limited reimbursement for health care providers. They get paid based on tests they order and the meds they prescribe so patients frequently keep coming back.

Connections: 
Why is it important to educate nurses on the importance of nutrition in health care?

Evans: 
In all settings, whether as administrators or as faculty, we are influencing the next generation of nurses. We take nutrition class as undergrads, but at the graduate level we have nothing on plant-based nutrition. We should be connecting every disease with nutrition. If you see a person with heart disease, you can prescribe medicines, but you should also be giving them information on nutrition. Medical schools now are doing internships on plant-based nutrition. There is no reason nurses shouldn’t be doing this. The rest of society is engaged in the plant-based nutrition movement. Many restaurants have plant-based menus, and more and more fast-food restaurants offer plant-based options. 

Connections: 
Is part of the problem that most nurses do not have a plant-based diet themselves?

Evans: 
I think it is very hard to teach someone something that you don’t practice yourself. I don’t fault nurses, but we need to begin to practice what we are teaching our patients. Nurses at least need to give people the information. Patients can decide not to follow their recommendations, but we need to give people all the options rather than making the decision for them. 

Another thing to recognize is that often people will hear the same information five times and then on the sixth time it clicks. What changes? Did they get tired of dealing with their own illnesses, or did they read a compelling article? It is important to just keep giving people information. We need to recognize some patients will say no and it’s OK. Food can be an emotional and complicated issue. 

Connections: 
You were a psychiatric nurse. What is the relationship between nutrition and mental health? 

Evans: 
There’s extensive research on depression, anxiety, and other mental health issues and their relationship to nutrition. One study by Government Employees Insurance Company (GEICO) found that participants who ate a plant-based diet were less depressed, had better concentration, and were more productive. Dr. Michael Greger has excellent free videos focusing on the brain and the microbiome connection. In addition, there is research focusing on dopamine and mental health issues. Food impacts both the microbiome and dopamine. 

Connections: 
If someone wanted to begin to move toward a plant-based diet, what would you suggest they do? 

Evans: 
First, figure out why they want to change. Some change for their health, while for others it is the environment or to reduce animal factories. Next it is important to identify how plant-based they want to be in the beginning. Sometimes people make the change slowly and other times they jump right in.  

I would encourage you to take your regular recipes and see which ones you want to try to convert them to plant-based. Maybe develop a menu plan for the week so you know ahead of time what to eat, and make substitutions for foods that are not plant-based. For example, if the recipe calls for yogurt, you can substitute soy, almond, or coconut yogurt. If you like lasagna, there are plenty of plant-based cheeses. You can use beans instead of meat for chili. I suggest not buying cookbooks in the beginning. There are lots of plant-based recipes on the internet and YouTube. Once you have a better idea of what you like, then get a cookbook that suits what you like. There is a great 21-day kickstart program that has cooking demos, recipes, menus. And it’s free.  

Connections: 
What are some of the challenges nurses face in trying to follow a plant-based diet? Can you do it wrong or in an unhealthy way?

Evans: 
Many hospitals have really unhealthy food. For some nurses, the challenge is not having food readily available. California now requires plant-based options for hospital patients. It should also be available for staff. A lot of nurses also do impulse buying. When people have families, I encourage them to get their children involved in picking out menus and recipes. It’s hard if your family is not helping or they are giving you a hard time about being plant-based. But kids love to help, and it is important to involve them in the process.

One pitfall is using a lot of processed foods, as they are often unhealthy and filled with fats and chemicals. They can be used in small quantities as people transition to plant-based nutrition. More and more companies are selling processed plant-based foods as they have learned there is a market for them, but whole foods are the best. 

Another challenge is just knowing what the diet is and is not. I can go into any restaurant and I never feel, “I can’t have a specific food.” I know I can choose any food I want. I just want fruits, vegetables, legumes and grains. I think it makes a big difference when you know you can choose any food and specifically choose healthy ones. 

Also, we overestimate how much protein we actually need. We only need 10% protein. All your legumes and many vegetables and fruits have protein. When I worked in the ER we never had anyone come in with a protein deficiency.

When working with patients, I have found I have been more successful asking people what they eat, rather than just telling them what to eat. This helps them become more aware of what they are eating so they can begin to eat more consciously. 

Eating a plant-based diet is easier than most think. You can buy anything now pre-cut or even pre-cooked. You can get hummus, avocados, nuts, and fruits – all foods that are simple and healthy. I tell people to keep food in the car all the time, so they are not tempted to buy fast food and they won’t be hungry. It is important that people who are plant-based are eating enough. It should never be a diet of deprivation. 

I feel nurses have an opportunity to change our health care system and help people heal from many chronic diseases. Plant-based nutrition has been well researched, and now it’s time for nurses to use this research to benefit ourselves and our patients. It has been said for many years – let food be thy medicine and medicine be thy food.