Notes from PBNHC 9-17

Over 3½ days the 2017 Plant-Based Nutrition Healthcare Conference featured 19 talks, a cooking demo and a discussion panel.  In its five years it has grown attendance from 220 to about 1000 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 nonetheless compelling.

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 Plantrician Luminary Award went to Dr. Michael Klaper

    The psychology of behavior change for health: Stoll and Ross

    Research leading to change in position on plant-based nutrition: B. Davis

    Foods to inhibit cancer growth: Li

    How casein, the protein in milk causes cancer: Campbell

    Diet to minimize Alzheimer's disease: Sherzai and Sherzai

    The dangers of fructose in diabetes: Lustig

    The effects of sugar in heart disease: Williams

    A plant-based diet can't fix everything: Klaper, Marbas, Weiss

    Challenges and successes in a career of disease reversal: Ornish

    The effect of diet on breast cancer: Garcia

    Research on heart disease and nutrition: Esselstyn

    Protein and diet from a bariatric surgeon: G. Davis

    How public agriculture policy is making us sick: Weiss

    Microbiome: fascinating but no cures yet: Chutkan

    Evidence linking saturated fat to heart disease: Kahn

    The good and the bad of the Mediterranean diet: Hever

    Cooking demo for penne carbonara and BBQ tempeh tacos: Sarno

    Poor results from out diabetes drugs: Rudolph

    Minimizing cancer through foods that reduce inflammation: Aggarwal

    Reaching your athletic potential by eating plants: Roll

    Questions and answers with a panel: Stoll, Bellatti, B. Davis, Diehl, Klaper

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Luminary Award

This year the Plantrician Luminary Award went to Dr. Michael Klaper (pronounced Clapper) for his exceptional career as a physician, author, speaker, and educator. He currently practices in Santa Rosa, CA.

Keynote: The Science and Psychology of Fat to Fit by Scott Stoll, MD, cofounder of the conference and Milan Ross, transformed patient

Dr. Scott Stoll met Milan Ross who was a patient at a plant-based nutrition immersion program. At that time Milan weighed over 500 lbs and was sick in many ways.

A change results in people losing a part of them, even if it is a negative thing. Studies show that a person typically needs a perceived gain of more than twice the perceived loss in order to act.

Gain-framed messaging leads to more engagement than loss-framed messaging.

People with depression can benefit from an all-in switch to a plant-based diet. Often within a couple weeks, depression can resolve if the patient transitions completely to a plant-based diet because the serotonin, epinephrine, and dopamine all normalize when inflammatory diet elements are removed. This factor is a reason to encourage people to go all-in for a period of time instead of tapering into a healthier diet. The rapid release of depression can help long term behavioral change.

Obese people have their dopamine receptors down regulated, so their pleasure receptors are suppressed. It takes three months of avoiding fat and sugar consumption to get the pleasure system up regulated, so the tendency to relapse during this time is strong.

Writing a journal can be powerful tool for behavior change.

One of Milan’s catalysts for change was when he promised to ride the Harry Potter ride at Disney World with his son for his son’s birthday. He was refused the ride because he was too large. After switching to a plant-based diet, in one year Milan lost 200 pounds. Then he was able to ride the Harry Potter ride with his son.

Plant-Based Nutrition Scientific Foundations by Brenda Davis, RD

Over 40 years, the official position on vegetarian and vegan diets has changed dramatically. It used to be that doctors and nutritionists actively discouraged plant-only diets. Fortunately, the new thinking is captured in the Position of the Academy of Nutrition and Dietetics:

“It is the position of the Academy of Nutrition and Dietetics that appropriately planned vegetarian, including vegan, diets are healthful, nutritionally adequate, and may provide health benefits for the prevention and treatment of certain diseases. These diets are appropriate for all stages of the life cycle, including pregnancy, lactation, infancy, childhood, adolescence, older adulthood, and for athletes.”

One study found that vegan children grew a little slower during years 1 through 3. This study found no difference in size after age 5.

In adults, the EPIC study of about 30,000 health conscious eaters both of meat eaters and vegans  found that vegans die at about half the rates of the general population. Vegan diets are most protective against cardio vascular disease.

The Adventist Health Study found that vegetarians and vegans are at reduced risk of heart disease and diabetes and hypertension.

It had been thought that consuming animal protein was necessary for the growth of muscle mass. However, large mammals and human body builders show growth of large muscle mass without eating animal products. Many plant foods have protein that is as digestible as animal products. Digestibility of plant protein is enhanced by cooking, sprouting, and blending. Most plant foods have a sufficient percentage of protein. We do NOT need to construct a complementary protein diet.

One study found that by replacing 3% of animal protein calories, reduced risk of death from heart disease by 30%.

To get our required omega 3 fatty acids, we do not need animal products. We can get ALA from chia, flax, hemp seeds. We can get EPA/DHA from microalgae. We definitely don't need fish.

Too much omega 6 (inflammatory) in the diet, usually from eating animal products, can suppress the creation of omega 3 (anti-inflammatory).

We need a small amount of vitamin B12 in our diet. B12 is made by certain bacteria. Fermented foods can provide vitamin B12, but the concentrations are highly variable, depending on cleanliness, and so we should not depend on fermented foods for our B12. Mushrooms also can provide vitamin B12, but vary quite a bit. Vegan breast feeding mothers should supplement with B12 supplements. Plant eaters should take 1000 mcg 2-3 times per week from supplements. Vitamin B12 may be degraded by vitamin C and copper in multivitamin/mineral supplements and fortified foods, so we should avoid these supplements and foods.

Dairy is not needed to provide our needed calcium, which comes from plant foods. Only 11% of calcium is determined by intake. The rest is determined by absorption and excretion. Exercise is also important for bone strength. Bone robbers: excess alcohol, excess protein, acidic (animal) diet, preformed vitamin A. You absorb a greater percentage of calcium from kale and broccoli than you would from dairy.

The National Academy of Sciences recommends a global shift to a plant-based diet. A report from the United Nations System Standing Committee on Nutrition says that one steak and shrimp meal produces as much greenhouse gases as driving from New York to LA.

Can You Starve Cancer? by William Li, MD Founder of the Angiogenesis Foundation

Cancer is second only to cardiovascular disease as the cause of death from 2010 projected through at least 2030. Deaths from cancer are expect to go from 13 million to 21million cases with costs going from $290 Billion to $458 Billion.

We all have cancers. But they can't grow more than the size of a pin head without growing blood vessels. We can battle cancer by preventing cancers from building their blood supply.

5-10% of cancers are caused by genes, 30-35% by diet, and the remainder from other environmental causes. However, a dietary intervention can help fight cancers from any cause by inhibiting tumor angiogenesis (creating it blood supply), promoting DNA repair, and synergizing with microbiota.

Many chemicals in plant foods evolved to protect plants or enhance their reproduction. Humans coevolved with plants and so need and can make use of compounds in plants. Many plant foods have anti-angiogenesis properties. One of them is soy. Consumption of soy beans helps fight breast cancer.

Studies found that 2-3 servings of cooked tomatoes per week reduced prostate cancer by 30-40% and oregano reduces breast cancer tumor size by 44%. Consumption of 1 or more apples per day results in 20% reduction in colorectal cancer. Broccoli and mushroom stems have more of the beneficial nutrients than the florets or caps.

Dangers of Dairy by T. Colin Campbell, PhD author of The China Study

Early in his career, Dr. Campbell was working to increase animal protein consumption in children. But then he encountered at first anecdotal and then a study from India that showed that greater consumption of dairy led to dramatically more occurrence of deaths from cancer in lab rats.

Experiments led to the understanding that we have mutated carcinogenic cells, but they remain dormant until we eat casein. The same result with mutations caused by aflatoxin or hepatitis B virus, but promoted by casein. Soy and wheat proteins did not have the same promotional effect on the cancer.

We believe that chemicals in our food cause cancer. But testing is done at very high levels of exposure, and so this does not prove what happens at realistic exposure levels. There is virtually no evidence that environmental carcinogens cause human cancer.

Casein, an animal-based protein, is the most relevant carcinogen ever identified.

Separate research has found not just one but multiple mechanisms by which animal protein promotes cancer at multiple stages of the cancer's progression. The animal protein increases the movement of the mutation chemical into the cell. The animal protein interferes with our body's mechanism for DNA repair. Animal protein interferes with our immune system's killer cells for killing the cancer.

Studies show that milk consumption correlates with multiple sclerosis, breast cancer, uterine cancer, hip fracture. A study published in 1926 shows that elevated cholesterol is due to excess protein in the diet.

A Whole Food Plant Based (WFPB) diet prevents, suspends, and/or cures many diseases as shown in the published research journals.

Smokers consuming food with beta carotene decreased lung cancer 18%. The same experiment with beta carotene in a pill increased lung cancer by 19%.

We each have 10 to 100 trillion cells. Each cell is extremely complex. So a single drug with a single reaction will have many unknown side effects. Nutrients have multiple reactions with no side effects.

Study showed 22 cytotoxin drugs (developed at $2 Billion each) have resulted in 2.1% increase in 5-year survival rate.

Medical schools don't teach nutrition. Medicare does not recognize nutrition as a specialty so doctors cannot be reimbursed for giving nutrition advice.

An online class on nutrition developed by Dr. Campbell is available through eCornell.

Alzheimer's and Diet: New Research Frontiers by Ayesha Sherzai, MD, Dean Sherzai, MD

Our aging population is poised to overwhelm our healthcare system, especially because of degenerative diseases that can be affected by diet.

Alzheimer's is the 6th leading cause of death. And it is underreported and increasing. 1 in 10 people over 65 has Alzheimer's. Alzheimer’s care costs $259 Billion compared to $100 Billion for heart disease. Alzheimer's costs are expected to go to $3 Trillion by 2050.

There is no scientifically proven method for reversing Alzheimer's, but the progression of it can be slowed and prevented, especially by diet. Medications have a 99.6 to 100% failure rate. Lifestyle can prevent 80 to 90% of Alzheimer's.

Studies showed consumers of animal products increased Alzheimer's occurrences.

Diet to minimize Alzheimer's includes whole plant foods, minimizes animal products and sugar, and emphasizes plants with high anti-oxidants.

It is important to adopt the healthy diet early in life to prevent cognitive problems later in life. By the time the mild cognitive impairment is diagnosed, much damage has been done.

Studies show that sugar consumption causes brain damage, but a ketogenic diet (low carb) is dangerous and has multiple negative brain affects over the long term. Insulin resistance, the key attribute of type 2 diabetes, has a strong connection to later Alzheimer's.

Fructose has a number of negative consequences. Fruit calories are for your microbiome. When you juice or smoothie it, the calories are absorbed early in your digestive tract which causes problems. They have estimated that 25% of the diabetes worldwide is explained by sugar.

An experiment reducing sugar consumption in kids, replacing the sugar with an equivalent amount of calories of starch found that in 10 days, cholesterol was down, liver fat was down, and  insulin resistance was down.

The Bitter Truth of Sugar Addiction by Robert H. Lustig, MD, MSL

(Editor’s note: I was looking forward to hearing Lustig’s talk. I believed and still do believe that he has a nugget of information to share about the dangers of fructose in our diet. However, he departed from the topic agreed upon in advance with conference co-founder Scott Stoll and Lustig embarked on a personal attack on Dr. Neal Bernard followed by the remainder of his talk making arguments as to why sugar in our diet is the cause of diabetes and not fat as is claimed by Neal Bernard and many others. Many of Lustig’s arguments were very effectively refuted the next day in talks by Garth Davis, Joel Kahn and others, so I will not include Lustig’s questionable arguments here. After the lively point and counter point, my conclusions are 1. Lustig’s decision to be adversarial obscured what good points he may have had and harmed his professional reputation and 2. the role of dietary fat in causing much of type 2 diabetes is undeniable, yet fructose may contribute to some extent to type 2 diabetes and other diseases. John Tanner)

Sugar and Heart Disease: What Does the Research Say? by Kim Allan Williams, MD, FACC, FASNC, FAHA and Past President of the American College of Cardiology

After a number of years of slowly decreasing heart disease mortality rates, these rates have stopped dropping and last year increased.

Sugar consumption makes lipid profile in the blood worse, causing inflammation and a cascade of blood vessel damage.

Consuming sugar or foods with cholesterol increases the death rate. Drinks with either sugar or artificial sweeteners increase diabetes.

There is now a life insurance company that has lower premiums for vegan eaters.

Government subsidizes food products that end up in unhealthy foods. In Chicago they now have a tax on sugar sweetened beverages. Washington, DC passed a resolution for healthy hospital food. Berkeley passed a tax on sugary foods.

Of all his patients who have gone plant based, none has had a heart event. So this cure is having a huge decrease in revenue for Dr. William’s cardiology practice.

Challenging Case Studies by Michael Klaper, MD, Laurie Marbas, MD, MBA, Ron Weiss, MD

This session was created to show that despite many near-miraculous turn arounds by patients who adopt a plant-based diet, that such a diet cannot cure all ills. Sometimes another more traditional intervention is required or it is simply too late for any successful treatment.

Dr. Ron Weiss treated his patient Joyce, a 49 year old with a Body Mass Index of 50 (30 and above is obese). Despite her obesity, she had no major health problems until an attack of severe ulcerative colitis ruined her life. She quickly developed 30 significant diseases, and was taking 27 medications. The challenges for this case include heartsink on the part of the doctor who doesn't think the patient will survive. But he got her to adopt a plant-based diet and many of the problems began to subside. However, another problem, chronic urticaria (skin rash) developed. Fasting for two weeks caused it to get worse. Under Dr. Weiss’s guidance, Joyce stopped showering and added nitrosomonas spray to reestablish healthy biome on her skin. Her urticaria went away. She came in on the maximum of insulin with sugars of 300. Here HgA1c went from 11 to 5. In 6 weeks she was off all insulin with sugar of 100. Her chronic pain included migraines, peripheral neuropathy, and gut pain. After 30 days, no pain. Her ulcerative colitis and severe diarrhea were gone in 30 days. She dropped 30 pounds in 30 days, 100 pounds in a year. Of her 27 drugs: in a year, no drugs. When she came to Dr. Weiss, she had to rest after walking up 3 steps. A year later, she can walk 7 miles without stopping with no gym training. One problem remains. Even though she lost almost 100 lbs, and her BMI is down to 33, she needs to continue losing weight, but her weight loss has leveled off. She tried a 700 calorie per day diet with little carbs. She tried fasting and slept with cold temperatures - none of these worked. Dr. Weiss will be working to examine her microbiome with the hope of filling gaps and allowing her to lose the remaining weight.

Laurie Marbas

Dr. Marbas treated her patient Dale who had chest pain which was getting worse over a period of years. He was 63 years old and taking no medications. His blood pressure was 194/105 (very high) and his BMI was 35 (obese). He couldn't walk far (20 feet) without stopping. After switching to a plant-based diet, in 28 days, his chest pain was gone and his weight was down from 230 to 217 lbs. His blood numbers improved. After 6 months he lost more weight. Unfortunately, he over exerted and had an episode of chest pain so surgeons convinced him to get a triple bypass surgery.

Michael Klaper

Dr. Klaper treated patient Yvonne, a 42 year old mother who ate lots of chicken and had fatigue. Upon examination, he found stage III follicular lymphoma. She underwent a 21 day water fast followed by a plant-based whole-food diet. In 6 months, she had a complete regression of lymphoma.

In a severely calorie restrictive environment, sirtuin molecules silences certain cancer genes. A study shows that 5 days per month with water-only or water/greens fast increases sirtuins and decreases cancer.

Studies show that chicken workers get a lot of lymphomas due to lymphoma viruses.

Dr. Klaper treated another patient, Sam, 68 years old with blood pressure of 208/106 (very high). They tried a 5 day water fast followed by a high fiber, high water content diet. But his blood pressure didn't go down. They found a little blood in his urine which led them to discover that he had a massive urinary tumor. He died a few weeks later.

An Evening with Dean Ornish by Dean Ornish, MD author of Dr. Dean Ornish’s Program for Reversing Heart Disease

Dr. Ornish shared some of his personal and professional struggles early in his career as he came to study the effects of life style on heart disease and other diseases. His treatment program consisted of promoting four life style changes: eat well, move more, stress less, love more.

After decades of proving lifestyle changes can reverse heart disease, still Medicare wouldn't reimburse for a lifestyle program. It took Ornish 16 years to get Medicare to approve reimbursement for his disease prevention program.

Ornish's has a newer study that showed reversal of prostate cancer through lifestyle changes. In a few months, the expression of over 500 genes was modified. The lifestyle changes increased telomere length (related to life span) and down regulated angiogenesis (blood supply formation needed for tumors to continue to grow).

Breast Cancer Prevention and Plant-Based Nutrition by Delia Garcia, MD

About 1 in 8 women in the U.S. will have breast cancer. The median age is 61, but one patient was 17 years old and died six months later. The biggest risk factor is being overweight. Alcohol consumption increases risk of breast cancer.

Many breast cancers are being over treated. But for the most aggressive breast cancers, surgery is warranted.

Only 5% if cancers are attributable to the BRCA gene.

Epigenetics is the study of turning genes on and off. So it’s not what our genes do to us, it is what we do to our genes that matters. Smoking, radiation, chemicals, and an unhealthy diet can turn on harmful genes.

BPA from plastic bottles is a hormone disruptor. Heterocyclic amines from grilled meat initiate and promote breast cancer. If sleep is disrupted, melatonin is reduced which increase breast cancer. Exercising 3-5 hours per week had the lowest risk of breast cancer death.

Alcohol is a definitive breast cancer promoter. Even one drink a day increases breast cancer. Eating a low-fat diet decreases the recurrence of breast cancer.

Eating a plant-based diet decreases many cancers including breast cancer. Taking statin drugs increases cancer rates. Breast cancer rates increase with obesity and diabetes.

What does not increase breast cancer: abortion, infertility drugs, hair coloring, soy consumption. Soy has phytoestrogen (isoflavones), but does not have the same effect as estrogen. In studies, women consuming soy have better outcomes, regardless of age or receptor status. Limiting alcohol, eating mostly plants, and maintaining normal weight results in 62% less breast cancer.

Prevent and Reverse Heart Disease by Caldwell Esselstyn, Jr., MD author of Prevent and Reverse Heart Disease

Studies show that early atherosclerosis is present in virtually all Americans. Even at high school graduation, we almost all have significant heart disease - not enough to cause heart events yet, but the foundation for later events.

In WWII, when the Germans took over the lowlands of Holland and Belgium, they confiscated the cattle. In the populace that was no longer eating meat, their incidence of heart disease went down. When the war was over and meat came back into the diet, the incidence of heart disease rose back up. We should have at that time understood the benefits of removing meat from the diet, but we didn't.

Eating a plant-based diet interrupts the cascade of failure of the arteries thus making you heart attack proof. Eating animal products harm the endothelial cells that line the arteries preventing them from producing as much nitric oxide, which has multiple critical functions in the vascular system. After decades of abusing our endothelial cells, we have heart attacks, strokes, and death.

Dr. Esselstyn performed a study from 1985 to 1988 that included 24 people ages 44 - 68. The study tracked people for 12 years. Patients were asked to eat a plant based diet and to avoid eating oil due to studies showing harm to endothelial cell function after consumption of oil. Carnitine is transformed by gut bacteria into TMAO, which is very damaging to the endothelial cells. So to avoid damage, don't eat meat.

Tarahumara Indians who eat almost entirely plants, have HDL less than 25. Normally, higher HDL numbers are preferred, but in plant based dieters, total cholesterol and LDL are low, and so HDL can be low too.

Patients with soft plaques can reverse them by switching to a plant-based, no oil diet. Hard plaques can't be necessarily fully reversed, but their effects can be. The endothelium heals inside the plaque-ridden arteries.

The plant-based diet reduces the rate of recurrent heart events from 62% in the control group to 0.6% in the dietary compliant group. The study had no mortality, no morbidity, and the benefits improve over time.

American meat-based diet contributes to brain atrophy and dementia. Also circulation problems in other parts of the body including legs can be reversed by a plant-based diet.

Protein: Animal vs. Plant by Garth Davis, MD author of Proteinaholic

Dr. Davis trained to be a bariatric surgeon. Even his specialty involved no training or discussion of diet.

In this country, we eat the most protein per capita than any other country yet we have one of the worst life expectancies, highest obesity rates, and highest rates of diabetes.

Dan Buetner's Blue Zones finds groups of people throughout the world that live long. They eat mostly plants.

Processed meat is a class 1 carcinogen. Meat is a class 2A carcinogen.

The EPIC/PANACEA study shows people adding 14 years to their lives through lifestyle improvements.

Calorie dense foods like meat and oil provide many calories, but you are still hungry because they don't fill up your stomach. Fruits and vegetable are less calorie dense, so they fill you up.

Eating fat is the root cause of type 2 diabetes. The results prove this: many people have reversed their diabetes by adopting a low-fat plant based diet.

A plant-based diet has plenty of protein.

The benefits of weight loss surgery are short term if at all. Dr. Davis recommends that patients NOT get weight loss surgery and instead adopt a plant-based diet. When they do, he sees spectacular results from his patients.

Farm to Hospital: How the Way We Farm Makes Us Sick by Ron Weiss, MD

Our current health care system is financially unsustainable. Costs began taking off in the 1970s. The government predicts that by 2025 our healthcare costs will become 20.1% of our GDP.

Federal Agriculture Policy is the root cause of our current health crisis. CDC says that chronic disease causes 7 of 10 deaths in this country. Chronic disease causes 86% of our nation's health care costs.

Our food all comes from corn and soy beans and wheat. The majority of the corn we grow is not sweet corn which we eat but instead field corn, which go to livestock as their food.

CAFO (Contained Animal Feedlot Operation - otherwise known as factory farms) feed livestock the following ingredients in order: grains, oil meals and cakes, rendered animal products, 4D (dead, dying, diseased, disabled) animals, animal waste, antibiotics, drugs, plastics.

Only 2% of the grown soy beans goes to feed humans. Most of the rest goes to soy bean oil and meal which goes to feed animals.

Our soy bean oil consumption has increased by a factor of 1000 in the last 100 years. Also, the ratio of omega 6 to omega 3 has changed dramatically. Studies have found a 136% increase in linoleic acid (LA) in adipose tissue in the last 50 years. LA is highly inflammatory and leads to numerous diseases.

The Gulf of Mexico dead zone is due to farm fertilizers washing down the Mississippi River causing an algal bloom which kills all other life.

Biocides (insecticides, herbicides, fungicide) are used so much that one of them (Roundup) is now found in the rain.

During the depression, the government started farm subsidies. In 1972 Earl Butz said, "Plant fence row to fence row", and "Get big or get out."

$245 Billion was spent from the late 90s to 2009 on subsidies for crops that were not eaten by humans.

Conflict of interest between the financial wellbeing of farmers vs the health of the citizens: USDA Policy vs. Healthy Food

Solutions: USDA should STOP subsidizing the production and consumption of UNHEALTHY food. The USDA should start subsidizing the production and consumption of HEALTHY food.

What can you do: 1) Voice opinion on the 2018 Farm Bill and 2) Support PCRM.

Microbiome Solutions: The Future of Medicine by Robynne K. Chutkan, MD, FASGE

Rapid identification of microbes has changed gastroenterology dramatically. Gut microbiome is highly personalized, as is vaginal organisms. Mouth and skin microbes are less personalized.

Babies as they are born naturally at the moment of exiting the birth canal are exposed to microbes from the mother's anus. These babies are much healthier than those who are born by C-section and their gut microbiome is initially colonized by other microbes in the hospital.

With a 5 day course of antibiotic the microbiome loses 1/3 of its colonies. Taking probiotics does NOT replace the lost species.

Proton pump inhibitors (PPI e.g. Nexium) affect the gut microbiome, making the patient more susceptible to C. difficile infection. The PPI effect is even more prominent than that of antibiotics.

When exposed to a pathogen, its effect is determined by the landscape of the existing microbiome.

There is more hay fever and eczema among the wealthier people where the hygiene is better and so kids are exposed to fewer germs.

Inflammatory Bowel Disease could be a dysregulation of mucosal immune system or an inappropriate response to commensal bacteria.

The risk of Crohn's Disease increases with antibiotic application in children and adolescents.

Irritable Bowel Syndrome is thought to be caused by gut microbial differences.

The gene for celiac disease exists in 1 of 4 people of European ancestry, but the gene is necessary but not sufficient. Not all people with the gene ever get celiac disease. There appears to be an immune system trigger. New onset of celiac disease is strongly associated with antibiotic use.

A study was done comparing kids in Italy and Burkina Faso, a small country in west Africa. Initially, vaginally delivered babies had similar microbiomes, but as time went on, the ones consuming a processed animal-products western diet shifted compared to the ones eating an African largely unprocessed plant food.

An experiment was performed that swapped Atkins and plant-based diet among experimental subjects. The results found that their microbiome changed within a matter of days.

Recommendations: let the kids play in the dirt, minimize bathing, avoid the medicine cabinet. Sadly, we don't yet know enough about the microbiome to develop treatments to benefit patients. Fecal transplants and probiotics are not yet proven effective. Actionable recommendation: eat a plant-based diet.

The Scientific Skinny on Saturated Fat by Joel Kahn, MD author of Dead Execs Don’t Get Bonuses

We have over 100 years of evidence that eating saturated fat leads to coronary artery disease. In 1953 Ansel Keys studied the relationship between diet and heart disease. He followed with a 7 country study from 1958 to 1970. The result showed a very clear correlation between serum cholesterol and mortality. Coronary Heart Disease is better correlated with dietary saturated fat.

Gary Taubes has distorted Ansel Keys results. Nina Teicholz, Aseem Malhotra, and Salim Yusuf have contributed to rapid dissemination of inaccurate information by social media. Fortunately, Joel Kahn and others has been able to rebut these posts and get them removed from Youtube.

The experts weigh in with a paper summarizes the latest research: transfat is slightly worse than saturated fat, unsaturated is significantly better than saturated fat in causing heart disease. This paper did not address removing all fatty foods and oils.

Myths that need to be stopped:
    Sugar is the problem so fat is not
    Butter is back
    Full-fat dairy is better
    Low-fat diets fail
    Saturated fat is not the cause of heart disease

Finland had high incidents of deaths from cardiac disease. Through public education efforts, they reduced the consumption of saturated fat and experienced a drop of about 80% in deaths from cardiac disease.

Mediterranean Diet vs. Plant-Based Diet by Julieanna Hever, MS, RD, CPT

There is no perfect diet. Diet evolves as humans evolve. What should we eat?

70% of the people in the US are overweight or obese. We are simultaneously both over nourished and malnourished.

Ansel Keys first investigated the Mediterranean diet. The diet is often thought to include olive oils, wine, and fish and therefore these things are healthy. Not so.

The first study of the relationship between cholesterol and heart disease was done in 1913. Keys found that wealthy Naples residents had a diet and cholesterol rate similar to those of his study group of executives in Minneapolis. Poorer Naples residents had less dietary fat and less cholesterol blood tests.

In summary, over a period of 100 years of research, the link between dietary fat, cholesterol in the blood, and death due to heart disease has been repeatedly confirmed.

Protein is not a food group. An egg contains protein, but so does a potato. The distinction between plant vs animal is a much more valuable distinction than fat vs. protein vs. carbohydrates.

Where do proteins come from: the ribosomes inside our cells construct proteins from amino acids according to our DNA instructions.

Plants provide us vitamins, minerals and phytonutrients. Only 3% of our population gets enough dietary fiber. Animal products have no fiber. Many processed plant foods have much or all of the fiber removed (e.g. white flour, white rice).

Avoid supplements with folic acid. It is not as beneficial as folate sources in whole foods.

Eliminate oils. Limit high fat foods such as avocados and nuts. Supplement with B12 of about 2500 mcg per week.

We can easily get enough iron from plants. Heme iron, available only from animal products, is more easily absorbed, but is harder for the body to resist if it already has enough iron. So eating meat can lead to having too much iron.

The bad parts of Mediterranean diet: some oils, alcohol, and fish.
The good parts of Mediterranean diet: 1) It is primarily a plant-based diet. 2) Synergistic phytonutrition. 3) Overall lifestyle beyond diet. 4) Less is more. 5) Tastes good.

Culinary Wellness, Foundational Cooking Techniques for Taking Control of Health by Chad Sarno, Chef

Chef Sarno demonstrated that healthy food can taste good by preparing penne carbonara (ingredients: cauliflower cream sauce, fresh peas, slow baked tofu, gluten-free pasta, parsley and lemon) and BBQ tempeh tacos (ingredients: BBQ sauce, tempeh, red cabbage, corn tortillas, and cilantro).

Plant-Based Pharmacy by Dustin Rudolph, PharmD, BCPS author of The Empty Medicine Cabinet

Diabetes costs our country more than roads or schools.

Drugs only manage diabetes but do not cure it because drugs don't address the root cause.

Relative risk reduction is very different from absolute risk reduction. Metformin has a 6 to 10% reduction in death or heart attack. Up to 12% of patients taking Metformin will have side effects.

Sulfonylurea or insulin has 2.4% reduction in risk, but 3 to 9 pound weight gain and significant glycemic attacks.

Victoza injections 1.4% reduction in patient death, 3% will get gall stones.

Jardiance 1.5 to 2.5% benefit 18% urinary infections.

Most patients take multiple drugs and drugs can interact. Eg. metformin and tikosyn, metformin and renaxa, victoza with metformin or insulin

Diabetes is caused from 1) insulin resistance, 2) intramyocellular lipids 3) PGC-1a

PGC-1a controls the creation of mitochondria.

To reverse diabetes, avoid animal products, processed foods and high-fat foods including oils.

Moderate exercise decreases insulin resistance and increases PGC-1a.

Inflammation, Diet and Disease: Food Solutions by Bharat B. Aggarwal, PhD author of Healing Spices

Chronic inflammation is the root of cancer. America has more cancer and diabetes than any other country despite spending the most.

Inflammation is important, but if uncontrolled causes disease.

Tumor necrosis factor can facilitate our immune system to kill cancer cells without having healthy cells, but if TNF is uncontrolled it can promote cancer.

90 to 95% of cancers are caused by lifestyle factors.

There are 300 diseases have names ending with "-itis" which means inflammation of. For example "colitis" which means inflammation of the colon.

NF-kappaB mediates many aspects of cancer. The cancer process takes 20 to 30 years to grow from 1 cell to a life threatening tumor. So you need to address the issue now, before the cancer grows large.

In the US we spend more than $300 Billion per year on cancer drugs, yet these drugs are highly ineffective in preventing cancer deaths.

An effective solution to cancer is eating certain of the 900 plants, including fruits, vegetables, grains, and spices. E.g. Long pepper, neem, pomegranate juice, turmeric, ginger, fenugreek, black pepper, black cardamom.

Plant-Powered Athlete by Rich Roll author of Finding Ultra

After a successful collegiate swimming career, he fell into alcoholism, which ruined his life. Through rehab, he was able to recover his life, became a successful lawyer, married. At age 40, he had to pause going up a single flight of stairs.

He felt the need to reboot his relationship with food, so he began a juice cleanse. By day 3, he felt horrible, but by day 7, he felt wonderful. Afterward, he fell back into poor eating habits.

After trying other diets that failed, he tried a plant-based diet. Before long, he felt as good as after the juice cleanse. He went out for a short run, felt good, and kept going. When he stopped he had run 24 miles.

He began wanting to explore his own limits and become interested in extreme triathlon competitions. In his first ultraman trialthlon, he did well on the first day, but had a bad bike accident on the second day. Despite his injuries, he was able to continue and finish the second day. He tried running the third day and worked his way back up from nearly last place to finish 6th place.

When faced with adversity, the decisions you make determine your character.

His friend proposed five iron man competitions in five days. After personal challenges, especially on the 4th day, they finished the 5th race, becoming the first people to do five in five.

Eating a plant-based diet is the most powerful thing you can do for yourself, your community, and your world.

Panel Discussion: Everyday Ideas for Your Practice by Scott Stoll, MD, Andy Bellatti, MS, RD, Brenda Davis, RD, Hans Diehl, DrHSc, MPH, FACN, Michael Klaper, MD

This five-person panel fielded questions from the audience.

Q: How can you make a career from a plant-based practice?
MK: CPT addendums for nutritional counseling (Google search for billing for nutritional counseling).
BD: Try to stick with charging fees for service.
HD: CPT 99404, 99401 pay for group sessions at $60/hr per patient. Get people to pay something. Experience with the CHiP program found that people who get service for free based on pleading poverty generally drop out. They need to have skin in the game.
Dr. Agrawal was asked to come up and comment: A doctor can do plant-based group sessions and charge for it. There is a charge code for a doctor one-on-one visit with others viewing it. This can work into essentially a group session.

Q: What is important when working with teams?
MK: A single sour face or cold attitude can ruin the whole team. Have attainable goals. Acknowledge all team members: front office, nurse, physical trainer, cooking instructors.
BD: Recognize each person's unique abilities, even the janitors.
HD: The traditional system of 15 minute appointments is dehumanizing to both patient and doctor. It is critical for the primary physician to make an initial diagnosis and then confer the authority to the dietician or other team member to implement the behavior change.
AB: Doctor needs to have cultural sensitivity when treating people with diet. Doctor needs to have empathy and be careful not to accidentally do body shaming.

Q: How often do you follow up?
MK: New patients with significant problems, once a week. Always talks with the patient’s primary doctor before starting with them to prepare them to reduce medications.
BD: Just a few sessions as dietician coach.
HD: CHiP program runs 3 months, 19 visits, twice a week at first, then once a week. Insist on staying in touch with primary physicians.
AB: First 30 days is key. At least every other day, touch base - inspirational quote, volunteer to answer questions by text.

Q: How do you communicate with colleagues and partners?
AB: Find common ground, even with separate food camps.
HD: How to overcome skepticism by colleagues: say nothing. As you practice and have success with patients, wait for others to come to you. When they do, help them through the paradigm shift a little at a time. Same with the family - introduce it slowly.
BD: Your personal example is the most powerful force to move others. When you share, make sure of the soundness of the data and then introduce the information with respect for others.
MK: With family, don't give edicts. Let the food do the talking.

Q: What are the predictors of success?
AB: A positive attitude (self-defeating, depressed patients don't do as well).
HD: Support of spouse, educational attainment, curiosity.

Q: How to balance science and passion for plant-based with the standard of care that calls for statin drugs?
MK: Keep them on the statins while you make them healthy, and then taper off or drop the damaging drugs.

Q: What is the role of dental care in overall health?
MK: Poor oral health is a strong indicator of heart disease.
HD: Dentists are in a unique position to encourage people to eat a plant-based diet.
AB: People need to brush teeth, get regular cleanings in addition to eating a plant-based diet.

Q: A ketogenic diet makes people lose weight and feel better. What do you say to them to get them to consider a plant-based diet?
MK: Has a video on this topic on drklaper.com

Q: What is precision medicine?
MK: A cruel fiction. Our biological system is imprecise.
HD: Evidence based medicine has us focusing too much on relative risk which makes it seem like medications with low absolute risk seem good.

Q: What about people that think bean contains harmful chemicals like lectins and phytates?
BD: The lectins in legumes are completely disabled by 30 minutes of cooking.