Randomised Controlled Trials (RCTs), particularly those utilising a Double-Blind (DBRCT) design, are the gold standard in medical research. However, applying this model to dietary interventions-especially Plant-Based Diets (PBDs)-poses considerable methodological and ethical challenges. The inability to blind participants, adherence variability, and the prolonged time horizon required to observe dietary effects render DBRCTs impractical for PBD research. Despite a growing body of evidence from observational studies, case series, and non-blinded interventional trials demonstrating the efficacy of PBDs in managing Coronary Heart Disease (CHD), widespread scepticism persists within the medical community. Criticisms often cite small sample sizes, observational designs, and perceived researcher bias, compounded by peer reviewers' resistance, industry influence, and systemic biases in scientific publishing.
Against this backdrop, the Cardiology Centre at Bethsaida Hospital, Tangerang, Indonesia, has pioneered the integration of PBDs into standard cardiovascular care since 2018, under the leadership of Prof. Dasaad Mulijono (DM). This initiative represents the first formal adoption of PBD in Indonesia's hospital setting. Over nearly six years, our clinical data show significant outcomes including hypertension reversal, Type 2 Diabetes (T2D) remission, LDL-C reduction without advanced lipid-lowering agents, sustainable weight loss, renal function improvement, enhanced heart failure parameters, regression of atherosclerosis, and a markedly low restenosis rate following Drug-Coated Balloon (DCB) angioplasty. These real-world results support the feasibility, scalability, and transformative potential of PBDs in reversing or stabilising chronic diseases, particularly in low- and middle-income country contexts where cost-effective, preventive strategies are urgently needed.
We argue for a more inclusive and context-sensitive approach to evaluating nutritional interventions-one that recognises the limitations of traditional RCT models and values the cumulative weight of diverse forms of clinical evidence. Bridging the gap between empirical success and academic acceptance is critical to expanding the role of plant-based nutrition in modern medicine.