Healing with Food or Managing with Injection? A New Era in Chronic Disease Care

The global burden of chronic diseases, particularly obesity, diabetes, and cardiovascular diseases, continues to rise. While pharmacological interventions, such as Semaglutide, provide short-term benefits in weight management and glycaemic control, they present limitations, including high costs, side effects, and limited long-term efficacy. In contrast, a Plant-Based Diet (PBD) offers a sustainable and cost-effective approach that directly addresses the underlying metabolic dysfunctions driving chronic diseases.

At Bethsaida Hospital in Indonesia, our cardiology centre, led by Prof. Dasaad Mulijono, has successfully implemented a PBD therapeutic strategy, yielding substantial clinical improvements. Patients with Coronary Artery Disease (CAD), Type 2 Diabetes (T2D), and hypertension have demonstrated sustained weight loss, reduced medication dependence, and reversal of key disease markers. Many hypertensive patients have discontinued antihypertensive therapy following sustained blood pressure normalisation, while diabetic patients have achieved exceptional glycaemic control (Hba1c < 6%), often eliminating insulin dependence. Overweight patients have attained a healthy BMI (21 - 22), and those with hyperlipidaemia have reached LDL-C levels below 30 mg/dL through a combined plant-based and pharmacological approach. Moreover, patients with moderate renal impairment have experienced normalised serum creatinine levels. Most notably, our cardiology patients exhibit an exceptionally low restenosis rate (~2%) and strong evidence of atherosclerotic stabilisation and plaque regression.

These findings underscore the transformative potential of PBDs in preventing and reversing chronic diseases. Unlike pharmacological interventions, which primarily mitigate symptoms, dietary interventions offer a comprehensive and sustainable solution to improving metabolic health and cardiovascular function. Integrating Artificial Intelligence (AI) can further personalise and facilitate adherence to plant-based dietary interventions. A paradigm shift from pharmacological dependence to lifestyle medicine is imperative to reducing healthcare costs and enhancing long-term patient outcomes.

Semaglutide, a Glucagon-Like Peptide-1 Receptor Agonist (GLP-1 RA), has gained popularity due to its efficacy in weight reduction and diabetes management. However, its use has several drawbacks, including high costs, gastrointestinal side effects, and the need for lifelong dependency to maintain results [1-3]. In contrast, a PBD provides a sustainable, cost-effective, and natural solution to these health concerns [4-6]. This article highlights the superior long-term benefits of PBD compared to Semaglutide, particularly in Indonesia, where local food resources support an optimal dietary shift.

The long-term benefits and drawbacks of Semaglutide

Semaglutide has demonstrated notable efficacy in weight loss and glycaemic control, making it a valuable pharmaceutical intervention for patients struggling with obesity and T2D. However, its long-term use presents several challenges;

• High cost: Semaglutide is expensive, making it inaccessible for many patients, particularly in low- to middle-income countries.
• Side effects: Common adverse effects include nausea, vomiting, diarrhoea, and an increased risk of pancreatitis [7].
• Dependency: The weight loss achieved with Semaglutide is often reversed once the medication is discontinued, necessitating continued use for sustained benefits [8].
• Limited scope: Semaglutide effectively reduces weight and improves glycaemic control, but it does not address the root cause of chronic diseases, such as poor dietary habits and lifestyle choices.

PBD as a sustainable alternative

A PBD, which emphasises vegetables, fruits, whole grains, legumes, nuts, and seeds, has been extensively studied for its role in preventing and reversing chronic diseases [9-11]. The advantages of PBD over pharmacological intervention include:

• Sustainability and affordability: Unlike Semaglutide, plant-based foods are naturally available and cost-effective. With abundant fresh vegetables, legumes, and tropical fruits, Indonesia offers an ideal setting for adopting this approach [12].
• Reversal of chronic diseases: Numerous studies, as well as our cardiology centre’s experience, have demonstrated that a PBD not only prevents but also reverses conditions such as cardiovascular diseases, diabetes, and hypertension [13-15].
• Improved overall health: Unlike medications targeting specific symptoms, a PBD enhances metabolic health, reduces inflammation, and improves overall well-being.
• Permanent lifestyle change: Unlike Semaglutide, which requires continuous administration, a PBD approach leads to long-term behavioural changes, resulting in lifelong health benefits without dependency [16].

Cardiology care at Bethsaida Hospital: Transforming heart health with PBD

Over the past few years, we have effectively leveraged AI to disseminate educational content, provide evidence-based information on PBD, and curate meal plans tailored for our cardiology patients. The outcomes have been remarkable, with a notable increase in patient adherence to plant-based dietary patterns and significant improvements in overall health outcomes.

At Bethsaida Hospital, Indonesia, our cardiology centre has successfully implemented a PBD approach as a therapeutic strategy for managing chronic diseases. Patients with CAD, T2D, and hypertension have demonstrated substantial health improvements, including sustained weight loss, reduced dependence on medications, and reversal of key disease markers, unlike Semaglutide, which primarily functions as a weight-loss aid, a PBD directly addresses the underlying metabolic dysfunctions responsible for chronic illnesses, offering a comprehensive and sustainable solution to disease management.

The clinical benefits we have observed are profound. Many hypertensive patients have successfully discontinued antihypertensive medications following sustained blood pressure normalisation. Overweight patients have achieved a healthy Body Mass Index (BMI) of 21-22. At the same time, those with hyperlipidaemia have reached target LDL-C levels below 30 mg/dL through an integrative approach combining a PBD with high-intensity statin and ezetimibe therapy. Patients with moderate renal impairment have experienced normalisation of serum creatinine levels. At the same time, individuals with diabetes have shown exceptional glycaemic control, with Hba1c levels consistently below 6%, often eliminating the need for insulin therapy.

Most notably, our cardiology patients exhibit the lowest restenosis rate—approximately 2%—with strong evidence of atherosclerotic stabilisation and, in many cases, regression of coronary plaque burden. These findings highlight the transformative potential of PBD in preventing and reversing chronic disease. This paradigm extends beyond weight loss to fundamentally improving metabolic health, cardiovascular function, and overall patient well-being.

A PBD offers a natural and sustainable approach to health, free from adverse side effects, making it a powerful strategy for disease prevention and overall well-being. In contrast, Semaglutide is highly effective but not intended for long-term use. It comes with a high cost, potential side effects, and a risk of weight regain upon discontinuation.

The role of AI in lifestyle medicine

With the advancement of AI, implementing a PBD has become more accessible than ever. AI-driven applications can provide personalised meal plans, track dietary adherence, and offer real-time health analytics, empowering individuals to make informed nutritional choices. By integrating AI into lifestyle medicine, healthcare providers can facilitate a more effective and scalable approach to managing chronic diseases [17,18].

Transforming medical mindset: From pharmaceuticals to lifestyle medicine

One of the significant obstacles in promoting PBD is the prevailing reliance on pharmaceutical interventions by both patients and physicians. Many healthcare providers prioritise medications and medical procedures over lifestyle changes, reinforcing a reactive rather than preventive healthcare model. By publishing this article, we aim to challenge this outdated paradigm and advocate for a more holistic approach to health that prioritises nutrition and lifestyle modifications over pharmacological dependence.

Economic and societal benefits of plant-based healthcare approaches

Implementing PBD as a primary healthcare strategy can significantly reduce healthcare expenditures. Governments worldwide, including Indonesia, can reduce the costs of treating chronic diseases by promoting dietary interventions [19,20]. Additionally, a healthier population results in improved productivity, reduced absenteeism, and a better quality of life, making it a valuable public health investment [21].

While Semaglutide presents a viable short-term solution for weight loss and diabetes management, it falls short as a long-term strategy due to its cost, side effects, and lack of disease reversal capability. A PBD, on the other hand, offers a sustainable, affordable, and life-lasting solution to chronic disease prevention and treatment. Given Indonesia’s rich availability of plant-based foods, adopting this dietary approach is practical and beneficial. AI-driven solutions can further facilitate this transition, making personalised nutrition accessible to a broader population. Finally, shifting the medical community’s focus from pharmacology to lifestyle medicine will reduce healthcare costs and enhance overall societal health and well-being.

D.M.; Conceptualization, writing, review, and editing.

Funding

This research received no external funding.

Institutional review board statement

Not applicable.

Informed consent statement

Not applicable.

Data availability statement

Data are contained within the article.

Conflict of interest

The authors declare no conflict of interest.

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