Notes from PBNHC 9-16

Over 3½ days the Plant-Based Nutrition Healthcare Conference featured 16 speakers, a cooking demo and a discussion panel. In its four years it has grown attendance from 220, 450, 600, to 780 this year. Most attendees were doctors or other medical professionals. The conference was organized to provide doctors with the latest information on treating patients with a plant-based diet. My notes below capture a small fraction of the scientific information presented. In summary, more is known each year about the causes of disease, and the more we learn, the more we find that the consumption of animal products is linked to disease creation and that the consumption of whole plants is linked to health.

Woven through the discussion of the latest nutrition research results, were triumphant case studies of people sick and on the edge of death, learning about a plant-based diet and curing themselves through dietary change. While these cases are too numerous to still be surprising, they are still inspiring.

To your long life and health,

John Tanner, PhD

Director, NuSci, The Nutrition Science Foundation

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Links into the notes below:

    The effects of a plant-based diet range in scale from molecular to planetary: Stoll

    Research on heart disease and nutrition: Esselstyn

    Combining compassion with a plant-based diet: Ornish

    The plant-based diet's role in saving the planet: Hicks

    Getting a plant-based diet into a doctor's practice: Graff

    Results of a plant-based diet in a cardiology practice: Ostfeld

    A history of plant-based diet research: Roberts

    The benefits of a plant-based diet to children: Pridemore

    Diet and Alzheimer's disease: Sherzai

    Inhibiting cancer with spices: Prasad

    Answering criticisms of a plant-based diet: Campbell

    Organic farming - health, sustainability, business: Moyer

    What science says about the Paleo diet: Davis

    Our diet affects our gut bacteria which affect us: Chutkan

    Behavior change techniques for healthier diet: Lianov

    Plant-based nutrition for athletes: Brazier

    Nutrition research summary: Greger

    Questions and answers with a panel: Stoll, Bartolotto, Bellatti, Greger, Klaper, McMacken

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This year the Plantrician Luminary Award went to Dr. Dean Ornish for his exceptional career starting with groundbreaking experiments 40 years ago demonstrating heart disease reversal through a plant-based diet. (See notes from Dr. Ornish’s talk below.)

Atoms to Earth: A Plant Based Solution by Scott Stoll, MD, cofounder of the conference

Dr. Stoll began his journey because his medical school training could not help patients with chronic illnesses. As he began prescribing plant-based diet, to his surprise, his patients’ diseases were cured.

Originally, food was gathered and eaten directly. With the industrial revolution, our food growing became industrialized. During World War II, the U.S. government promoted the idea of avoiding eating meat domestically to save it for the soldiers on the front. This attitude, that meat was so valuable, led to demand for more meat after the war. After the war, industrial plants designed to make the explosive TNT were transitioned to produce nitrogen fertilizer to grow plants quicker. Animals were packed into larger feed lots. Corn silage was required to feed these animals. The sewage drew flies which required DDT spraying to control. Sick animals from the close confinement required antibiotics. Attempts in 1977 to reduce meat and dairy were countered by the meat and dairy industry. Food discussions moved to talking about individual nutrients instead of whole foods. The fast food industry flourished. We moved to buying our food in grocery stores instead of farmers markets. We are now eating the vast majority of calories from foods that didn't exist 100 years ago.

Our DNA chains, at the end of each of our chromosomes, are terminated with a telomere, a cap that protects the end of the chromosome from deterioration or from fusion with neighboring chromosomes. Each time the cell duplicates, the telomere gets shorter, because the duplication machinery cannot run all the way to the end. Thus telomere length is correlated with aging, and a plant-based diet increases telomere length.

Epigenetics studies how genes are turned on and off. New research shows that epigenetic effects can be long lived and passed on to offspring as well. So eating a good diet or a poor one can affect the lives of mothers, their kids, and their grandkids. So epigenetic effects can be long lived, but they can also be quick. Within hours, the food we eat affect how our genes are expressed.

Plant-based nutrition inhibits formation of cross-linking agents within our tissues, thus reducing wrinkles and hardening arteries. Plants enhance DNA repair, detoxify, and aid in cell signaling.

A plant diet is crucial to many of your systems. Your body needs to create new blood vessels in the right amount. If not enough, our wounds don't heal; we get chronic heart disease and strokes. But too much blood vessel creation results in cancer. A plant-based diet optimizes the balance of blood vessel growth. A plant diet enhances the health of the good germs in our body - our microbiome. Eating beans lowers blood sugar in diabetics. Plants heal leaky guts, enhance our immune system and hormonal system, and nourish our artery lining (endothelium). Plants down-regulate inflammation throughout our bodies.
A plant-based diet helps our cardiovascular system, gastrointestinal system, brain, bones, muscles, liver, and kidneys. Multiple Sclerosis (MS) is generally thought to be incurable. Dr. Stoll told a case study of a patient who adopted a plant-based diet and reversed their MS completely. In another case study, a patient reversed long time diabetes in 12 weeks.

At the level of the individual, a plant-based diet improves health, results in less sick days, less pain, improves relationships, saves money, improves psychology, and resolves food addictions.

Growing and cooking plants can bring a community together.

At the international level, health and food is becoming critical. Worldwide we are seeing a 55% increase in diabetes and a substantial increase in cancer. The Center for Disease Control says that 75% of our country’s healthcare costs are avoidable. If everyone on earth ate the standard American diet, it would take two earths worth of farmland. On the other hand, if everyone ate plant-based, 5 billion football fields could be removed from tillage. Plant-based food requires much less water and energy. 100% of CO₂ emissions can be sequestered with a switch to organic farming.

There are many barriers to switching to a plant-based diet including barriers due to our healthcare system, our government, and individuals. The good news is we are making progress. There are a growing number of Google search results on a whole foods plant-based (WFPB) diet, more papers are published, and more books written.

Plant-based Nutrition and Coronary Heart Disease by Caldwell Esselstyn, Jr., MD author of Prevent and Reverse Heart Disease

Historically, it has been thought that HDL was the good cholesterol, able to draw the bad cholesterol out of the artery walls. However, recent research shows that a meat-based diet turns anti-inflammatory HDL into damaging inflammatory HDL, so a high level of HDL can no longer be considered protective in a patient eating animal products.

Lecithin and carnitine in our diet feed our gut bacteria that produce TMA which is a compound oxidized by the liver to produce TMAO which is harmful to arteries. People who don’t eat meat don’t have these bacteria that produce TMA and so don’t have the TMAO that degrades their arteries. Plants are good anti-oxidants to reduce artery inflammation. Green leafy vegetables, especially when chewed, result in nitric oxide which is key to artery health. We should not eat oils. No oils!

Dr. Esselstyn led a team of researchers who tracked 200 patients, all very sick with heart disease. They were all counseled to eat a plant-based no-oil diet. 89% of the patients adhered to the diet. Among adherents, 0.6% had further heart events. This event rate amounted to a reduction of more than 99% of the heart disease event rate compared to those patients who chose not to eat the recommended diet.

Plant-based diet results in essentially no heart disease death or illness and for the patient, a feeling of power over their health.

Dementia is often a result of small strokes that result from the western diet rich in animal products. Damage can't be reversed, so prevention by eating a plant-based diet is recommended. Artery damage can also show up elsewhere in the body. Published research shows the measured blood pulse volume in a patient’s leg increased after a switch to a plant-based diet, resulting in the elimination of leg pain.

Damaged endothelial cells produce chemicals that constrict arteries. As you switch to a plant based diet, this chemical production reduces within a few days. So benefits to a dietary improvement show up in patients much sooner than the time is takes to reduce the plaques in the arteries.

The Compassionate Power of Whole Foods Plant-Based Diets and Lifestyle Medicine by Dean Ornish, MD author of Dr. Dean Ornish’s Program for Reversing Heart Disease

The plant-based diet is good for individuals, families, and the planet.

There are four components to a healthy life: eat well, stress less, move more, and love more. These components are incorporated into Dr. Ornish’s program for heart disease reversal.

In his Lifestyle Heart Trial, people on the lifestyle program did better than people taking medications. They saw a 400% increase in heart artery blood flow in one year and 99% of the patients stopped or reversed their heart disease.

Research shows that for patients with prostate cancer, a lifestyle program not only lowered PSA measurement, but tissue cultures also showed dramatically improvement compared to a control group.

Gene expression is affected by lifestyle forces.

The length of telomeres correlates with the length of life. In an experiment, the perception of stress had a significant effect on the length of telomeres as compared to a control group. Note that this isn’t the amount of physical stress, but the perception of it. That is, it pays to be happy. Experiments also show a correlation between degree of adherence to the lifestyle program and length of telomeres.

Plant-based eaters down-regulate blood vessel growth factors, thus starving cancer better than toxic medications.

Decreasing blood sugar with drugs increases the death rate. Dropping blood sugar with a plant-based diet decreases the death rate.

Fear of death is not a sustainable motivator—it works for 4 to 6 weeks after a traumatic event. Love of life is a much better and longer lasting motivator.

Walking for three hours a day increases the size of brains. Sexual experience increases neural growth. Nine of ten patients showed improvement in dementia in 3 to 6 months of walking. Smoking reduces blood flow and thus causes erectile dysfunction.

You don't want to eat a low-carb diet, but sugar should be limited.

Newspaper and internet articles claiming “butter is back” or “saturated fat is OK to eat” are a result of misinterpretation of underlying research studies.

We are told that we are eating less fat and not getting healthy. But data shows that we have increased fat consumption over time.

Animal protein consumption increases all-risk mortality. Plant protein consumption decreases all-risk mortality.

Paleo or Atkins diets often result in decreases in some of the risk metrics, but increases in the death rate. A study showed 67% greater weight loss by restricting fat instead of carbs.

86% of healthcare costs went to chronic diseases.

8 studies show stents don't work. Heart surgery has a 10 year survival rate about the same as no treatment. Most prostate cancer treatments result in no benefit.

The Ornish lifestyle program has better results in reducing depression than the medication Zoloft.

In one study, people were intentionally infected with a virus through nose drops. While all were infected, those with loving relationships showed 4 times fewer symptoms from the resulting infection. In another study, people with a close friend or confidant were more likely to survive than those without.

In one study, after 35 years, 100% of people who had a poor relationship with their parents had a major disease, compared to 47% of those who had a good relationship with their parents.

Loving has health and longevity benefits.

Healthy Diet, Healthy People, Healthy Planet by Kerry Graff, MD, J. Morris (Jim) Hicks authors of 4Leaf Guide to Vibrant Health

Jim Hicks, also author of Healthy Eating, Healthy World

Based on available farmland on earth, our planet can support only 3 billion people if we all eat a standard western diet. Eating plant-based can support 14 times as many people. Eating an animal-based diet produces more global climate change than all of transportation. Cattle excrement amounts to about 12 pickup loads per person who consumes cattle. Total carrying capacity of the planet if we lived like Europeans would be 2 billion. If we all lived like the US, it would be only 1 billion people. We currently have about 7 billion people, so obviously a high-level of animal consumption for everyone is not possible.

We currently have four unsustainable situations, over population, over consumption, fossil fuel dependence, and animal-based food. Of these, only the last can we change soon enough to buy us time to fix the other three and save our planet.

For every American moving toward a plant-based diet, there are 100 people elsewhere in the world moving toward an animal-based diet. We must get the word out to those people as well. The medical community must get on board and be supportive.

Kerry Graff - "Planting" Your Practice

Kerry suffered from many diseases that went away when she learned about and adopted a plant-based diet. The 4LEAF survey, from the book authored with Jim Hicks, helps patients decide their own health goals. Dr. Graff’s recommendations for doctors includes write a prescription for WFPB diet and loan the DVD for the documentary movie Forks Over Knives.

Confessions of a Reformed Cardiologist: Plant-Based Nutrition in Practice by Robert Ostfeld, MD, MSc, FACC

Other than trauma care, nothing comes close to transformative curing as a plant-based diet. Dr. Ostfeld started using a plant-based diet to cure heart disease, but found that it cures dozens and dozens of diseases.

Dr. Ostfeld had a cardiac patient that had dramatic recovery from heart disease in a few weeks on a plant-based diet but then reverted back to her former diet and within a few weeks required heart surgery.

65% of children ages 12 to 14 show significant artery disease. Heart disease is the leading killer in this country and costs the U.S. $316B/year.

Data from a China population study showed that people that ate more fruit had lower blood sugar. This study is more evidence that diabetes is not caused by the sugar in fruit.

Within health-loving Adventist population, people who avoided animal products had much less diabetes and Body Mass Index (BMI) than animal-eaters.

In 1-2 weeks after switching to a plant-based diet, patients show improvements in their heart disease symptoms. In addition, they almost always get unexpected benefits to some other illnesses.

What Does the Research Say - A Historical Perspective by William C. Roberts, MD

Plutarch (~100AD) “Man has no curved beak, no sharp talons, or claws, no pointed teeth, no intense power of stomach or heat of blood which might help him to masticate and digest the gross and tough flesh-substance. On the contrary, by the smoothness of his teeth, the small capacity of his mouth, the softness of his tongue, and the sluggishness of his digestive apparatus, sternly forbids him to feed on flesh.”

Weston Price, DDS found that societies that ate plants had good teeth, while those that ate animals, had bad teeth (1939).

Diabetes, Coronary Thrombosis, and the Saccharine Disease (1966) by T.L. Cleave and G.D. Campbell showed that those who ate refined carbs had diseases that those who ate unrefined carbs did not.

Western Diseases; Their Dietary Prevention and Reversibility (1994) by Norman Temple and Denis Burkitt documented that a whole set of western diseases (e.g. heart disease, cancer, diabetes) were not found in other countries.

Early books showed that eating fiber eliminated many diseases. Some societies had virtually no arteriosclerosis and had cholesterol less than 150 mg/dL.

Long lived cultures around the world have a higher percentage of their calories from carbohydrates than current Americans. Okinawans eat 3% of their calories from meat, poultry, and eggs vs 29% for Americans. China consumes 15% of their calories as fat vs 36% for US. The death rate due to coronary disease is 17 times less. The Mediterranean diet has about 1/8th as many grams of meat per day than the U.S.

The combined weight of cows on this planet exceeds the combined weight of humans. 25% of our planet’s land mass is used for growing cows and other livestock.

In Texas, 52% of hearts in autopsy are so fatty that they float.

BMI is correlated with death. The fatter you are, the sooner you will die.

Fat consumption correlates with cancer deaths. Eating cheese correlates with cancer. During WWII heart disease dropped in Scandinavian countries when meat became scarce.

The Benefits of PBN for Children by Laura Taylor Pridemore, JD, MD, FAAP

Start Early, Eat from the Garden, Drink from the Well

Dr. Pridemore is a pediatrician and mother of girls ages 12 and 9.

Nowadays, 59% of the calories we consume are from ultraprocessed foods. The AHA recommends no added sugar for children under 2 years old.

Obese or overweight children don’t necessarily need to lose weight. Just stabilizing of weight leads to lower BMI as the child grows taller. 10% of children worldwide are obese. Children average 7-1/2 hours of screen time per day. Dr. Pridemore has seen amputations and blindness from type 2 diabetes in people in their 20s. The age of puberty has dropped from 16 to 12 years of age, probably due to eating meat and dairy. Earlier puberty leads to greater cardio vascular disease and other diseases.

Constipation is a common childhood problem. Eliminating dairy products and eating lots of plants with fiber usually resolves constipation. One study showed 100% of elimination of constipation by completely eliminating dairy products from the diet.

Ear infections are often caused by inflammation of the Eustachian tube due to dairy consumption. A study shows that stopping dairy consumption clears it up. Reintroducing dairy causes the ear infections to return.

Asthma is more common in countries with higher levels of dairy consumption.

Eczema and acne are often caused by diet. A study found increased acne with dairy consumption.

When feeding kids, the parents job is when, where, and what. The kids job is whether to eat and how much. This separation of duties keeps parents from harming kids by forcing them to eat.

Excessive restriction of unhealthy foods causes kids to want these foods more. Dr. Pridemore recommends teaching kids three habits 1) variety, 2) proportion, and 3) moderation. Eat when you are hungry and stop when you are full. Don't bribe your kids with dessert to eat healthy foods. Get kids involved with gardening, planning and preparing food.

Alzheimer's Disease by Dr. Dean Sherzai MD, PhD and Ayesha Sherzai MD

Alzheimer's Disease is the 4th leading cause of mortality in the U.S. and is getting worse. We spend $226B per year and this amount is growing.

1 in 6 women will suffer Alzheimer's Disease.

There are NO medications that stop the decline of Alzheimer's patients but lifestyle changes can help stop the disease.

Genetics have very little to do with this disease.

Plant eaters have lower incidence of Alzheimer's, dementia, and depression.

Having a complex job leads to less cognitive decline with age. So don't retire!

Anti-Inflammatory Lifestyle for Prevention & Treatment of Cancer: Facts & Fiction by Sahdeo Prasad , PhD

Despite Nixon's declaration of war on cancer in 1971, cancer rates continue to grow.

Inflammation is a major contributor to cancer (as well as other diseases).

43% of people with ulcerative colitis get colon cancer within 25-35 years.

The NF-kB molecule is a major regulator of inflammation by in turn regulating hundreds of genes. To avoid cancer we need to safely control NF-kB. The major cancer drugs have a small benefit if that. Plants have a strong property of reducing inflammation.

Long pepper (Piper longam) selectively kills cancer cells via its molecule Piperlongumine. Tocotrienol, which can be found in many plants, suppresses a number of cancers. Ursolic acid, present in many plants, also suppresses cancer. Ginger (zerumbone) eliminates NK-kB and thus inhibits cancer. Boswellia Serrata (boswellic acid) inhibits cancer growth. Neem (Azadirachta indica) has a molecule Nimbolide which down-regulates NF-kB in cancers. Black cumin, fenugreek, fennel (anethole), red chilli (capsaicin), and capsazepine, a synthetic analog, up-regulates death receptors for increased suicide of cancer cells. Cardomom (cardamonin) down-regulates survival proteins. Garcinia indica (garcinol) fights cancer.

Curcumin molecule from turmeric (usually found in curry powder) down-regulates cell propagation by interacting with a number of molecules in our bodies and so also fights HIV and AIDS. Some chemists are inserting curcumin into nanoparticles for better delivery to and uptake by targeted cells. Many trials have been completed for curcumin and many more are underway. In some treatments, curcumin is more effective if combined with quercetin.

Soy isoflavones combined with curcumin reduces prostate specific antigen (PSA) levels, but only in combination.

Curcumin down-regulates NF-kB in patients with multiple myelomas.

Curcumin can benefit arthritis sufferers. In a study, in 3 months, the C-Reactive Protine (CRP) marker for inflammation is nearly eliminated in osteoarthritis patients.

A study showed topical curcumin applied to psoriasis dramatic decreased the disease in 4 weeks.

In a 7 day trial, curcumin reduced cholesterol by 12% for patients with heart disease.

Curcumin lowers blood sugar in diabetes patients as effectively as the medication atorvastatin.

In summary, curcumin, a molecule found in turmeric which is in most curry powders, has many beneficial properties. Fresh is better than dried.

Answering the Criticisms of The China Study by T. Colin Campbell, PhD

Madhavan and Gopalan (1968) found that increased animal protein consumption led to 100% cancer death in animals. This finding was later confirmed by Campbell’s research.

In 1982 the National Academy of Science advocated vegetables, fruits and whole grains and reported the data that protein increased cancer.

Dr. Campbell did laboratory and population studies. Then he met John McDougall, Caldwell Esselstyn, and Dean Ornish who were getting results from people. In 2005 he published The China Study.

In 1975, Ken Carroll published results showing a correlation between animal food consumption and breast cancer. But correlation is not causation. So epidemiological studies don't prove the relationship between nutrition and disease, but they do add to the weight of the evidence. In China and in the U.S., disease rates rise with the consumption of animal products.

Our government pays little attention to nutrition. Of the 28 National Institutes of Health (NIH) institutes, not one is focused on nutrition.

Laboratory experiments show switching dairy protein diet on and off turned the cancer growth on and off. This effect is seen at all stages of cancer from initiation, through promotion, to progression (metastasis). During initiation, not only does the protein promote the cancer, but also interferes with our bodies natural defenses that try to stop the cancer.

During promotion, proteins have multiple mechanisms that aid in promotion. There is not a single mechanism for animal proteins causing cancer, but many contributing mechanisms.

Soy and wheat proteins do not have the same cancer-causing properties. "Casein (milk protein) is the most relevant chemical carcinogen ever identified."

Cancer is not caused by contaminant chemicals within the milk, but by the natural casein in milk.

A plant-based diet can prevent diseases, but it can also be used to treat and reverse diseases. Consuming vitamin E, D, and calcium supplements has been shown to increase diseases.

The amount of each nutrient that actually gets used in our bodies is determined by the body's decisions during digestion, absorption, transport, organ distribution, biochemical action, storage, and excretion. The idea that we can know how much of each nutrient we should eat is thus fraught with peril. We need to consume collections of nutrients that work together—a whole food, plant-based diet. This diet works better than pills to treat disease.

Cornell has dropped Campbell's class due to the influence of the dairy industry which provides major funding to Cornell. The influence is so great that they put a large milk bottle statue in front of the new agriculture building on Cornell's campus.

Academic freedom is a very serious problem.

Dr. Campbell is trying to raise funds for a major study on the relationship between nutrition and cancer. If you know any million dollar level donors, please direct them to Colin Campbell.

It's Not Just What You Eat BUT! How What You Eat Was Producedby Jeff Moyer

J.I. Rodale (~1930) linked organic farming: healthy soil = healthy food = healthy people

"Half of the topsoil on the planet has been lost in the last 150 years" says the World Wide Fund for Nature.

Our food production system is broken because success is judged only by yields.

With conventional farming, nutrients are lost from the soil every year. We are losing 1% of our vitamins and minerals in our foods every year.

A study found that 100% of our children had pesticides in their bodies as determined by urine tests. After 24 hours of eating only organic foods, all pesticides were gone.

Parkinson’s Disease has been linked to pesticides.

Elizabeth Guillette studied young kids from a valley in Mexico. She showed that their ability to draw and perform other cognitive tests was greatly degraded in the kids exposed to chemicals.

It is possible to farm in such a way that the soil gets richer every year.

Organic farming is a $43B industry in US, and has increased 250% since 2002. Organic foods are gaining nutrients each year.

Non-organic farms have such variability from year to year, that the government was required to pay for insurance. Organic farming doesn’t have such variability and so could self-insure.

It takes about half as much energy to produce organic crops than conventional. Organic foods aren't more expensive although they may seem that way because some key costs of conventional farming are externalized (e.g. crop insurance, dredging of lost top soil).

30% of the carbon footprint of growing conventional oranges is in the nitrogen fertilizer.

A private Rodale Institute study and then two university studies showed similar yield between organic and conventional farming, but organic farming uses less energy.

Crops can be grown with no tillage and no herbicides, but still be free of weeds.

The average age of farmers in this country is 58 or 59 years old. The median is 65 years old. We need 1 million new farmers in the next 10 years.

Rodale Institute partnered with St. Luke's Hospital in Easton, PA to put in an organic farm next to the hospital and the food is fed to the patients.

Deconstructing the Paleo Diet: What the Science Says by Brenda Davis, RD

The buzz about the Paleo diet is scary. This unhealthy diet promotes increased meat consumption and sadly has been embraced by some in conventional medicine.

The basic premise is that we should eat what our ancestors ate in the wild as hunters and gatherers.

There was no ONE Paleolithic diet. It varied widely. During the first 80% of the time, our ancestors were vegetarian and during the last 20% they were hunter-gatherers.

What they certainly didn't eat were diary and processed foods.

Does the new Paleo diet equal what they actually ate? Studies conclude that early on, the diet was overwhelmingly plant-based. Loren Cordain, one of the primary promoters of the Paleo diet, puts focus on small populations including artic ancestors. But based on assessment of fiber, fat, and calcium, a mostly plant-based diet is the only possibility. Comparing the vegan diet, the actual Paleo diet and the new Paleo diet, the vegan diet is closer numerically to the actual Paleo diet than the new Paleo diet is.

Meat and vegetables consumed today were not available to our ancestors. Paleo meat was lower in fat. Wild plants have higher fiber than plants we eat today.

The large number of studies showing the modern benefit of a whole-foods plant-based diet agree with Paleo advocates on a number of points: no processed food, dairy; vegetables and fruits are included. However, there is a major disagreement when it comes to legumes, grains, and fish.

Paleo rationale says that legumes were not a part of ancestral diet (not true) and that grains and legumes are high in anti-nutrients (lectins and phytates) (true, but only for timing of nutrient release or for plant defense). Some lectins are harmful, but others are helpful. Lectins break down in cooking, so cooked legumes aren't harmful. Research showing problems with lectins are done with raw legumes.

What is the acid test for what we should eat now? What currently the longest-lived people eat. The National Geographic study of the longest-lived people on earth today labeled the regions where they are found the Blue Zones. Residents in every single Blue Zone eat primarily a plant-based diet with legumes specifically called out by the study. Other studies shows increase in longevity associated with greater legume consumption.

Phytates are the storage from of phosphorus in plant foods. Phytates can impair mineral absorption; however they are reduced by soaking, sprouting, fermenting etc. On the positive side, phytates are an antioxidant that aid in DNA repair and inhibition of tumor growth. So it’s good to have some phytates.

Also, Paleo foods include phytates and lectins.

Do grains cause inflammation? Yes, but only if you have celiac disease. Otherwise, they reduce inflammation.

Paleo supporters claim that meat has good stuff in it necessary to human health. However, when we look at each nutrient they claim is beneficial, we can either get it from plants, our bodies can make it, or we can get it through supplementation.

When it comes to overall disease reversal, the Paleo diet doesn’t work. Paleo can lead to weight loss because of the elimination of processed grains and oils, which can be fine for the short term, but long term it is not good. Studies show that a low-carb diet increases all-cause and cardiac disease mortality.

The problems with meat consumption are numerous including the harmful effects of animal protein, agrochemicals, carnitine, TMAO, heme iron, and nitrosamines to name a few.

A scientific committee observed "remarkable consistency" in evidence against meat: heart disease, cancer, and more. The World Health Organization (WHO) report said that processed red meat is a group 1 carcinogen and unprocessed red meat is a group 2A carcinogen.

Paleo proponents claim wide spread and spectacular benefits of consuming bone broth. However, when Davis searched for studies on this topic, she found no published papers on the health benefits of bone broth.

The EPIC study in the UK and the Adventists study in the US document lower disease and death rates for plant eaters vs. meat eaters.

If we all ate Paleo we would need 15 earths to support it.

The National Academy of Science (NAS) in a 2016 report concluded that by 2050 greenhouse gas would be 29% lower if we observed WHO eating guidelines, but 72% lower if we all ate a vegan diet.

The Microbiome - A Gut Feeling by Robynne K. Chutkan, MD, FASGE

Our microbiome has a vested interest in our survival. They do many things to help us survive and thrive including producing vitamins and digesting our food.

Babies born through vaginal birth swallow microbes from their mother’s rectum providing an essential transfer of microbiome to the baby. Babies born by C-section don't get that and have diseases much later in life due to that lack of healthy microbiome. Now C-Section babies can be swabbed from the mother to provide a start to a healthy microbiome.

The makeup of the child’s microbiome changes dramatically at first and by the third year approaches that of an adult.

A 5 day course of antibiotics eliminates 1/3 of your microbiome, which may take years to come back.

Children from families with more kids have less eczema and asthma. Higher hygiene families have higher asthma.

Inflammatory bowel disease has some genetic correlations, but is really caused by environmental triggers.

Crohn's Disease is associated with antibiotic use, especially the ones used for treating bowel inflammations.

1/4 of people have genes for Celiac disease, but other factors are needed to trigger it. Again antibiotics are implicated.

Cross-species transfer of microbes from an obese human can result in an obese mouse.

Study showed that kids from Burkina Faso and kids from Italy started out with similar bacteria, but when they started eating local foods, the makeup of the bacteria changed dramatically.

A study published in Nature, Jan 2014 found that diet rapidly and reproducibly alters the human gut within about 30 hours of changing their diet.

A study showed patients improved Inflammatory Bowel Disease (IBD) by changing diet. The mean time was 38 days from the diet change to when the patient was feeling the improvement. A plant diet has the best results.

Antibiotics use has increased 35% over the last decade. We average 18 courses of antibiotics by the time our kids are 18 years old.

Proton pump inhibitors affect the gut microbiome in many negative ways. Some people are on these dangerous drugs for years or decades and are ruining their microbiome.

Inflammation of the colon can be caused by a harmful bacteria clostridium difficile (c. diff). A new treatment involves transferring the healthy bacteria from another person’s gut to the sick person using the healthy person’s fecal matter. As gross as this sounds, a study showed that for patients suffering from c. diff colitis that Fecal Microbiota Transplant (FMT) had a 93% cure rate.

While probiotics can have benefits, they replace only a tiny bit of the microbiome that is killed by a course of antibiotics.

Dr. Chutkan prefers the VSL probiotic, but she cautions a probiotic should only be used when there is a need.

Changing Behavior Towards a Plant-based Diet by Liana Lianov, MD, MPH, FACPM, FACLM

Once you know a plant-based diet is best for a patient, you must try to get them to change their behavior to adopt the diet. You can think of the parts of the human brain like an elephant and its rider.

The Rider = the conscious, verbal, thinking brain
The Elephant = the automatic, emotion, visceral brain

To overcome resistance to change, you must
1. Direct the Rider
2. Motivate the Elephant
3. Shape the path

In Changing behavior, knowledge is necessary but insufficient.

A person is influenced at many different levels: intrapersonal, interpersonal, institutional, community/environmental factors, public policy

Studies show that if the friends of your friends are obese, you are more likely to be obese.

There are stages of behavior change: pre-contemplation, contemplation, preparation, action, maintenance. As a facilitator of change, you need to recognize at what stage the patient is and try to move them to the next stage.

The diffusion rate of a new idea depends on its relative advantage, compatibility, complexity, trialability, observability, impact on social relations, reversibility, communicability, time required, risk and uncertainty level, commitment required, modifiability.

For a new idea, people will embrace it on a range of scales: innovators, early adopters, early majority, late majority, late adopters.

Some people may have additional challenges when adopting a plant-based diet: substance abuse (8.5% of adults in the past year), alcohol use (52.7% of 12 years old and older), mental health disorder diagnosis (17.6%), depression, chronic pain, cognitive clutter, and lack of social support.

For effective interventions, studies show that collaboration is more effective than education alone. Providers with empathy result in greater success of patient behavior change. Steps to facilitating change: assess readiness, stage-matched brief intervention, empower the patient to make changes.

Studies show that eating fruits and vegetables increases happiness and sense of purpose. But then being happier leads to choosing to eat more fruit. This is a virtuous cycle.

Principles of motivational interviewing are: express empathy, support self-efficacy, roll with resistance, develop discrepancy between where the patient is and what the patient wants, switch chairs (position your chair to openly express potential barriers, then the patient can take your chair to envision solutions).

Shift the focus away from what they don't want to what they do want.

In clinical practice, a team approach is best: The doctor provides the prescription, other team members do coaching, doctor follow up, use digital tools, facilitate group visits, and all use telemedicine.

Darwin: "It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is the most adaptable." The human brain is wired for change, so it is possible for people to modify their behavior.

PBN for Performance: From Weekend Warriors to Elite Athletes by Brendan Brazier

For top athletes, one of the important aspects of performance is the ability to recover from training sessions. Quicker recovery allows for more training which leads to greater rate of improvement, and eventually more winning. So how do you recover quicker? Brendan experimented with different diets. At first, he tried a plant-based diet and it wasn't working very well because he was eating a lot of processed foods deficient in fundamental nutrients. As he added these nutrients, the plant-based diet worked for rapid recovery. Heavy exercise results in your body generating cortisol which results in problems including difficulty in sleep.

Stress can be good or bad depending on what type it is. Complementary stress includes exercise (the payoff is fitness) and eating nutritious food (the cost is worth it). Uncomplementary stress includes psychological stress (has no payoff) and eating food that doesn't have nutrients (an expenditure without a benefit).

Sprouting grains (e.g. buckwheat, amaranth, etc.) makes them easier to digest and thus a bigger digestive net benefit.

Caffeine provides a short term burst of energy, but in the long term isn't helpful for energy.

Eating leafy greens reduces inflammation which makes moving more efficient so you can run longer and lift heavier weights.

What to eat before an intense 1/2 to 1 hour workout: quick digestible carbs e.g. dates, bananas. For longer workouts (e.g. marathon): hemp seeds, pea protein, not a lot of fiber. You need to be able to burn fat and teach your body to burn fat. After workout: 4:1 carbs to protein. You could have just carbs to replenish, but you need some protein to rebuild damaged muscles. Do not eat too much protein or it slows down the recovery process: banana, date, nuts, hemp protein. Endurance athletes need easier available carbs from fruit and more protein than strength athletes.

Strength athletes: eat alkaline, eat starchy carbs (eg. sweet potatoes, oatmeal, brown rice, sprouted bread)

Get your body to produce human growth hormone by shorter intense workouts (e.g running stairs for 20 minutes, or squats, sprints). Walnuts and pine nuts that you eat before going to bed will stimulate HGH.

Having a darker environment before bedtime will allow your body to release melatonin and so you will sleep better.

Healthy snacks for kids: make an energy bar for them from dates, nuts, seeds. Blend these and then roll them in frozen blueberries.

Making Sense of the Latest Research by Michael Greger, MD author of How Not to Die

Michael Greger’s grandma was confined to a wheelchair with heart disease and sent home to die. Instead she switched to a plant-based diet and within three weeks was walking 10 miles a day. She lived an extra 30 years.

In Uganda where they eat almost no animal products they have almost no heart disease. Heart disease is a choice.

Nearly all kids by 10 years old have fatty streaks in their arteries.

From an article in the Preventive Medicine Journal “The best kept secret in medicine is that, given the right milieu, the body heals itself.” Many of us damage our arteries three times a day through eating animal products.

The best anti-angina medicine extends exercise time to 33 seconds. Plant-based diet adoption leads to former angina sufferers climbing mountains.

An experiment showed major blood toxicity to cancer cells in just two weeks of eating a plant-based diet. Effects improve even more over a longer period.

COPD can be helped with a plant-based diet.

Bananas are thought to be high in potassium, but are far below greens and beans.

Diabetes has been shown to be reversible since studies in the 1930s. In a slightly later study, one patient on insulin for 20 years switched to a plant-based diet. She was off insulin in 13 days.

Kidney disease is a top killer. The top three dietary risks for kidney disease are animal protein, animal fat, and cholesterol. Kidney loading measurements show that consuming animal products increases the kidney load for several hours after. Consuming plant protein instead shows no increase in kidney loading.

Adding fruits and vegetables boosts immune response.

Mood scores improve within two weeks of eliminating eggs, chicken and other meat.

Experiments show e. coli jumping from raw chicken into the gut of the cook even before the chicken went into the oven. More fecal bacteria are found in the kitchen sink than in the toilet due to rinsing the chicken in the sink.

65% of people in the US over 60 years old have high blood pressure. Other countries that eat mostly plants have blood pressure that decreases with age.

An Adventist study showed lowering BMI, diabetes, and blood pressure measurements when going from the meat eater group to semi-vegetarians, pesco-vegetarians, lacto-vegetarians, and to vegans.

Dairy contains neurotoxins that are used in experiments to cause Parkinson's disease in primate tests.

Studies show diary consumption increases bone breaking rates and death.

Number one cause of death and disease is diet.

It took 7000 studies showing the link between cigarette smoking and cancer before the causal relationship was generally recognized. It will take time and effort to get the benefits of a plant-based diet generally recognized.

Panel Discussion: Everyday Ideas for Your Practice by Scott Stoll, MD, Carol Bartolotto, MA, RD, Andy Bellatti, MS, RD, Michael Greger, MD, Michael Klaper, MD, Michelle McMacken, MD

Is it OK to chop food long in advance of eating it? Mostly, yes.

Should we get rid of all milk to children, or just reduce it? GET RID OF IT! Milk today comes from cows that are kept pregnant and so the hormone content is through the roof, leading to premature puberty in girls.

Should we graze throughout the day or eat specific meals? Eat meals to allow insulin to drop between meals.

What do you do about muscle loss when switching to a plant-based diet? Except in extreme cases, or insufficient calories, muscle loss doesn't happen. There are many vegan body builders.

What about the people that have good cholesterol numbers while eating a low carb diet? We don't have any long term Paleo data, but other studies show increased death rate with animal product consumption. They are still setting themselves up for heart disease, colon cancer, and autoimmune disease. Also, cholesterol numbers don't reflect damage to other organs.

How do you manage acid reflux? Lose weight. Don't eat after 6:00pm, elevate the head of the bed, stop drinking alcohol and coffee which negatively affects the esophageal sphincter.

How can one move a hospital toward plant-based practice? Ally with existing organizations (e.g. PCRM), have small group meetings, develop an email list, bring in speakers, show success stories.

When do you introduce dietary ideas to newly diagnosed cancer patients? Oncologists often tell patients what they eat doesn't matter. You need to counter that. Changing to a plant-based diet can often, but not always, slow or reverse cancer.

Is patient satisfaction tied to hospital funding in conflict with dietary change? Yes, if patients are expressing their like of unhealthy hospital food. But try organizing plant-based cooking demos which people like. Also, patients love time with the doctor, so if the doctor spends time with patients talking about nutrition it drives up patient satisfaction.

Patients say they feel better after backsliding to eat animal products. What to do? Encourage transitional foods that aren't perfectly healthy, but more healthy than animal products. For example Follow Your Heart has a vegan egg replacer that isn’t perfect, but is healthier than eggs. Eating meat for a long time adapts the body to become dependent on meat products. For most people, they can easily switch to a completely plant based diet, but a few people will need to maintain a small amount of meat in their diet for a while and slowly taper it off?

What should be the protocol for introducing a plant-based diet to people with IBS? Start with quinoa and boiled greens. Introduce plant foods in a specific protocol, but IMMEDIATELY stop the meat and oil.

Do we need to look for nutritional deficiencies in non-healthy vegans? Supplement with B12. Test for Vitamin D, check omega 3 (could take algae derived DHA), tea and coffee inhibit absorption of iron. Seaweed has B12 analogs that block absorption, so don't count on them for B12 and eat your B12 on days you are not eating seaweed or spirulina so it can be absorbed. Don't supplement with calcium, as problems result.

What happens when people overdose on protein? Kidney disease!

Juicing or whole foods? Juicing is a way to sneak in healthy foods, but otherwise it is not so good. You get hungry faster. A smoothie is better than juice, but it is much better to chew your food.

What about people who suffer chronic fatigue but are already on a plant-based diet? Anti-biotics can damage the gut bacteria and thus cause chronic fatigue syndrome even for plant-only eaters. Processed carbs can be harmful in this case, so get your carbs from beans.

How can we get a plant-based curriculum into medical schools? PCRM has materials that can be used, Dr. Klaper gives lectures at medical schools, the Plantrician web site is a good resource.

What about caffeine? Studies show it is associated with many diseases. Also, coffee has oils that are harmful to the stomach lining.

The next Plant-Based Nutrition Healthcare Conference will be September 17, 2017 in Anaheim, CA.