Eating For Life

Prevention and Treatment of Chronic Disease with a

Whole-Food, Plant-Based Diet

Shipra Bansal, MD

July 29, 2017

Outline

What is the standard American diet?

What is a whole-foods plant-based eating pattern?

Eating for nutrient density

Inflammation

What does the literature tell us?

Medication versus food therapy

What to tell patients

How much would you pay for a pill that

could…

Reverse heart disease and lower your risk of heart attack or stroke

Reverse (cure) most diabetes type II, high cholesterol and hypertension

Reduce your risk for multiple cancers

Decrease risk of age-related macular degeneration

Diminish or eliminate symptoms of numerous auto-immune conditions

Improve energy and mood

Decrease risk of dementia, particularly Alzheimer's

Decrease the incidence of kidney stones, and more….

Leading Causes of Mortality in the US

Heart disease: 611,105

Cancer: 584,881

Chronic lower respiratory diseases: 149,205

Accidents (unintentional injuries): 130,557

Stroke (cerebrovascular diseases): 128,978

Alzheimer's disease: 84,767

Diabetes: 75,578

Influenza and Pneumonia: 56,979

Nephritis, nephrotic syndrome, and nephrosis: 47,112

Intentional self-harm (suicide): 41,149

Source: CDC.gov, accessed 4/16/2015

Standard American Diet

What are We Missing?

Whole Plant Foods

High in antioxidants

High in phytonutrients

High in complex carbohydrates

Low in fat

High in vitamins/minerals

Optimal protein levels

High in fiber

Minimizes processed foods

Standard Western Diet

Inadequate antioxidants

Inadequate phytonutrients

Low in complex carbohydrates

Usually high in fat

Contains essential vitamins/minerals

Excessive protein levels

Low in fiber

Heavy in processed foods

Processed Foods Poorest quality foods overall. Highly inflammatory with heavy

omega-6 levels, low in vitamins and minerals, high in

processed carbohydrates.

Current Focus Limited

Macronutrients versus Micronutrients

Protein, fats, carbohydrates - Important start but not complete

Micronutrients – richest sources are plant foods

Phytonutrients – over 25,000

Anti-oxidants

Co-factors/vitamins

Other nutrients

Fiber

Phytosterols/stanols

Absolute nutrients versus Nutrient density

Overall impact of food: inflammation, acidity, carcinogenic potential

What is a Whole-Foods Plant-based diet?

Foods eaten as close to their natural state as possible

Excludes processed foods

Plant-based

Excludes animal flesh, organs, dairy, seafood and eggs

Research has shown most benefits at >90% adherence

How are phytonutrients beneficial?

Serve as antioxidants

Enhance immune response

Enhance cell-to-cell communication

Alter estrogen metabolism

Precursors to Vitamin A

Cause apoptosis

Repair DNA damage caused by smoking and

other toxic exposures

Detoxify carcinogens through the activation of

the cytochrome P450 and Phase II enzyme

systems

Dr. Michael Greger’s Daily Dozen

Daily Dozen App

Nutrient Density

Standard diets are high in all macronutrients –

protein, carbohydrates, fat – the basis of our

calorie intake

American’s average intake is believed to be

between 2,200 to 3,300 calories/day

Despite this abundance in calories, we are

undernourished in many micronutrients

In general, plant foods are more nutrient dense

than animal foods

How are plant foods nutrient dense?

Broccoli, frozen,

chopped boiled

Romaine

Lettuce

Kale,

cooked

Beef Short Loin,

Porterhouse Steak,

separable lean &

fat,

1/8 “ fat, broiled

Beef short Loin,

Porterhouse Steak,

separable lean &

fat,

1/4” fat, broiled

Calories 100 100 100 100 100

Weight (g) 357 (12.6oz) 588 (20.7oz) 358 (12.6oz) 34 (1.2oz) 30 (1.0oz)

Protein (g) 11.1 7.2 6.8 8.0 6.5 Fat (g) 0.4 1.8 1.4 7.4 7.7

Carbohydrate (g) 19.2 19.4 20.2 0 0

Fiber 10.8 12.4 7.2 0 0

Cholesterol 0 0 0 24.1 21.6

Calcium (mg) 118 194 258 2.7 2.4

Iron (mg) 2.2 5.7 3.2 0.9 0.8

Magnesium (mg) 46 82 64.4 7.8 6.0

Potassium (mg) 507 1453 816.2 109 76.5

Vitamin C (mg) 143 23.5 146.8 0 0

Thiamin (mg) 0.2 0.4 0.2 0 0

Riboflavin (mg) 0.3 0.4 0.3 0 0

Niacin (mg) 1.6 1.8 1.8 1.4 1.2

Vitamin B6 (mg) 0.5 0.4 0.5 0.1 0.1

Folate (mcg) 200 800 46.5 2.4 2.1

Vitamin A (IU) 3609 51253 48763 0 0

Vitamin K (mcg) 315 603 2924 0 0

Source: http://www.drfuhrman.com/faq/question.aspx?sid=16&qindex=9 Data was obtained from Nutritionist Pro Nutritional Analysis Software, Version 4.7, Axxya Systems , Stafford TX, 2012.

Nutrient Dense - Calorie Sparse

Is this the same as a vegan or

vegetarian diet?

Protein and Calcium

Isn’t animal protein better quality than plant protein?

Spikes IGF-1

Breast, prostate, colorectal and pancreatic cancers

Acidic

Impacts microbiome negatively

Heme iron

Calcium

Calcium intake above 500mg daily not associated with reduced hip-fractures

BMJ 2014 Swedish study

Best sources low oxalate leafy greens

Vitamin K intake associated with decreased hip-fractures

What About Nutritional Deficiencies?

Standard Diet Whole Foods Plant Based

Antioxidants Inadequate Adequate

Calcium Adequate Adequate with dark leafy greens and dietary variety

Fiber Inadequate Adequate

Folate Can be inadequate during

pregnancy

Adequate

Magnesium Commonly deficient Adequate

Phytonutrients Inadequate Adequate

Vitamin B12 Adequate Must supplement

Zinc Usually adequate Eat a variety or supplement

Iodine Adequate with iodized salt otherwise supplement

Omega-3 Recommend supplement

Vitamin D Supplement if lab values low

Inflammation

Atherosclerosis

Esselstyn, Caldwell. Prevent and Reverse Heart Disease: The Revolutionary, Scientifically Proven, Nutrition-Based Cure. February 2007.

Cardiac Research – Dr. Esselstyn Starting in 1985, took 24 patients aged 43-67 years old who all had advanced coronary artery

disease.

Intervention

Cut out animal and processed foods, including oil

Very low fat - 10% of calories

Moderate alcohol and caffeine allowed

Six dropped out – went back to regular cardiologist

13 cardiac events through 1998

Of the remaining 18

One died of a cardiac arrhythmia within first month

At 5 years, 11 had angiograms. All showed disease arrest with 8 of these showing regression

At 12 years, all but one compliant with the diet

No cardiac events and no interventions in 17. This group had 49 cardiac events in the 8 years prior to starting the dietary intervention.

All 17 survived 20+ years

Source: Esselstyn CB Jr. The Am J of Cardiology 1999 August 1; 84:339-34

CT Angiogram

Esselstyn, Caldwell. Prevent and Reverse Heart Disease: The Revolutionary, Scientifically Proven, Nutrition-Based Cure. February 2007. Figure 1

Blood Flow 3 Weeks After Nutritional Intervention

Esselstyn, Caldwell. Prevent and Reverse Heart Disease: The Revolutionary, Scientifically Proven, Nutrition-Based Cure. February 2007. Figure 7. Please also see Figures 8-11.

Healthy Endothelium

Normal functions of the endothelial cells include regulation of coagulation,

platelet adhesion, immune function, and control of volume and electrolyte

content of the intravascular and extravascular spaces

Nitric oxide and

Prostacyclins are key

Factors such as smoking,

elevated blood pressure

and elevated sugars

damage the protective

single layer lining

• Increased permeability

• Reduced NO

production

Endothelial Dysfunction Impact

A Larger Follow Up Study

198 consecutive patients with established heart disease

All with vascular disease documented by arteriography, stress testing or enzyme documented MI. 44 (23%) had a history of heart attack

5 hour introductory seminar on diet. No meat, fish, dairy or added oil to foods. No avocados or nuts. Exercise encouraged but not necessary

Followed for an average of 3.7 years

Source: Esselstyn Jr. CB, et al., “A Way to Reverse CAD?” Journal of Family Practice. 2014; 63(7): 356-364.

198 Total Cardiac events due to progression of disease

Events experiencing event (%)

177 Compliant 1 Stroke, by-pass surgery 1.2

21 non-compliant 13 Sudden cardiac death, stroke, MI, by-pass surgery, stent placement

62

Cardiac Research – Dr. Ornish

Lifestyle Heart Trial, 1986-1992

48 participants with moderate to severe cardiac disease

Randomized to intervention or standard care

Intervention included a 10% fat, whole-food vegetarian diet (no cholesterol lowering agents)

Also included aerobic exercise, stress management, smoking cessation and psychological support as needed

35 of 48 completed a 5-year trial

Twice as many cardiac events in control group compared to experimental over the 5 year period

All underwent cardiac arteriography to evaluate change in artery narrowing from study onset

1-year 5-year

Experimental ↓4.5% ↓7.9%

Control ↑5.4% ↑27.7%

Source: Ornish, D, et al, Intensive Lifestyle Changes for Reversal of Coronary Heart Disease, JAMA. 1998;280(23):2001-2007. doi:10.1001/jama.280.23.2001

Why Not Take Medications to Control

My Chronic Disease?

Supplements and medications work on limited pathways and

have not shown to have the impact of whole foods

Side effects

Statins

Calcium Channel Blockers

Insulin

NSAIDs…...

Why not take Meds to control my

chronic disease?

Disease progresses in most cases even on meds

We often treat markers rather than the actual disease process

Physiological Impact of Insulin

Increases glucose uptake

Increases protein synthesis

Increases IGF-1

Decreases fat breakdown

The Impact of Statins

Source: Ganz, P; Hsue, P. Endothelial Dysfunction in Coronary Heart Disease is more than a Systemic Process. Published online June 11, 2013. http://dx.doi.org/10.1093/eurheartj/eht199 2025-2027 Accessed 11/7/15.

Why not take meds to control my

chronic disease?

Many interventions minimally decrease overall mortality

Statins in patients with known heart disease

Mortality benefit: 1.2%

Aspirin in those with a prior cardiovascular event

Mortality benefit: 0.3%

Clopidrogel (Plavix) in those with a prior cardiovascular event

Mortality benefit: 0.3%

Anti-hypertensives (all combined)

Mortality benefit: 0.8%

Source: thennt.com. Accessed 11/7/15

TheNNT.com

A nutrient-dense plant-based eating

pattern is the most effective

PREVENTION and THERAPY for many of

our most common chronic diseases.

I’m Convinced but…

My Patients Won’t Eat this Way

My patients won’t eat this way

Providers as well as patients are usually unaware of the power of diet to reverse disease

When providers don’t know the impact of diet on disease, we are unlikely to adequately present it to our patients

Research indicates there are significant numbers of patients open to WFPB diets

Multiple studies show the “general acceptability” of diet a patient starts is not correlated with their likelihood to continue the diet

We can do better

We must explore innovative approaches to discuss diet and help our patients with the challenges they face

Clearing up misconceptions

Navigating social pressures

Learning to cook differently

Working through addictions

Our patients deserve to know their options with associated risks and benefits and it is our job to offer this vital information

What do I tell patients?

2/3 of your plate should be filled with vegetables and fruit. Focus on vegetables, particularly green leafy ones. Use apps and visuals to keep you on track

Focus on the need to take in enough nutrients rather than eliminate certain foods.

Stop shopping in the middle of the store – filled with processed foods that have oil, salt, sugar to make it taste good.

Do not worry about portions or WFPB calories – eat until you are full and anytime you are hungry

Do not count carbs – you will be eating more carbs but healthy ones. Diabetics will see their sugars go down

You don’t have to be perfect

- work to be effective -

Up to 10% “other” calories allowed. This means approximately

150-200 calories of meat/dairy/eggs/seafood/processed food per day maximum

1.5 slices of cheese OR

1-2 omelets OR

Approx 7 tablespoons non-dairy creamer

Keep in mind, any oil or butter used to cook is not considered here and is part of the 10%

Meat and dairy are best used as condiments for flavor rather than as a main dish

If you are trying to reverse disease, stay closer to 95% of daily calories from nutrient dense plant foods

Empower patients

Do what is sustainable

Every healthy food you eat helps

The more you do, the more change you will see

Keep clear on why you are making this change (motivational interviewing)

Values

Advantages list

Your genes are your pre-disposition but not your fate

Questions or Comments

“The doctor of the future will no

longer treat the human frame with

drugs, but rather will cure and

prevent disease with nutrition.”

Thomas Edison