Culture ClashHow We Win the Battle for

Better Health

PART I

Dr. Steven AldanaCEO WellSteps

Four Part Agenda

Part I. What’s the ProblemPart II. How Our Culture Has ChangedPart III. Culture is the Cause: A New Culture is the SolutionPart IV. How to Create a New Culture By Creating Islands of

Health

Percent of Americans Who Are Obese

Percent of Americans Who Are Obese

Estimated

Obesity by State 2009

Diabetes Prevalence 1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

Life Expectancy

New Normal

New Normal

• Talking to me?• Talking to yourself?• Talking to someone else?

New Normal

New Normal

Burrito Grande

What is the Problem?

• Our food and activity patterns have changed• Our nation’s health is poor and getting worse• Individuals are dying prematurely and quality of life

is declining• Health care costs continue to increase which creates

a burden to employers

How Do We Fix the Problem?

1. We need to know what is causing these changes.2. We need to address the direct cause.

What is Causing These Changes?

• Genetics?• Environmental toxins or chemicals?• Something in the air or water?• Changes to our culture?• Something else?

It’s Our Culture

Proof It’s Our Culture:

Percent of Adults Overweight

USA

England

Canada

Austria

France

Korea

Percent of Adults Overweight

USA

England

Canada

Austria

France

Korea

Brazil

“It is actually cheaper to eat fast food than cook healthy food at home here. There is now an

overrepresentation of cheap fast food in the region which is driving our diabetes epidemic.”

Dr. DarwicheRashid Center for DiabetesUnited Arab Emirates

Ranking Country Cases of Diabetes(in millions)

1 India 31.72 China 20.83 U.S. 17.04 Indonesia 8.45 Japan 6.86 Pakistan 5.27 Russian Federation 4.68 Brazil 4.69 Italy 4.3

10 Bangladesh 3.2

Ranking Country Cases of Diabetes(in millions)

1 India 31.72 China 20.83 U.S. 17.04 Indonesia 8.45 Japan 6.86 Pakistan 5.27 Russian Federation 4.68 Brazil 4.69 Italy 4.3

10 Bangladesh 3.2

The Dark Side of Capitalism

New Exposure

Greater Exposure Rates

Lifetime Risk of Diabetes for Children Born in 2000

35%

43%

0%5%

10%15%20%25%30%35%40%45%50%

White Black Hispanic

Venkat Narayan, JAMA 2003;290:1884

49%

Diabetes Among the Pima

One-half of adult Pima Indians have diabetes and 95% of those with diabetes are overweight.

Am. J. Epidemiol. (1978) 108 (6):497-505.

Proof Summary:

• Greater exposure to a Western culture is associated with greater obesity and diabetes

• Rapid acculturation is associated with rapid declines in health

• Health worsens faster for those who were healthiest to begin with (Pima)

Quiz

How old is the human race?

a) 6,000 years oldb) 10,000 years oldc) 100,000 years oldd) 1,000,000 years old

Two parts to this problem:

• Unhealthy culture• Our ancient physiology

60,000 BC

100,000 BC

present

100,000 BC

present

100,000 BC

present

100,000 BC

present

100,000 BC

present

100,000 BC

present

Milk

100,000 BC

present

MilkSugar

100,000 BC

present

Milk

HFCS

Sugar

100,000 BC

present

What did they eat and how do we know?

1. Look at people who are still hunters and gatherers2. Study the remains and living environments of

Paleolithic peoples3. Study the bones of our ancestors

• +/- 50% wild game (35-70%)• +/- 50% plants

More hunting than gathering.Meat then was different than today’s meat.

Today’s meat is different:

• Steroids• Growth hormone• Antibiotics• Feed lots fed• Genetically manipulation• More saturated fat

What about today’s plants and food?

• Whole grains, refined grains• Herbicides and insecticides• Dairy• Cheese• Salt, Sugar, and Fat

Lucky Charms:

Oat flour, marshmallow bits (sugar, modified corn starch, corn syrup, dextrose, gelatin, calcium carbonate, yellow 5&6, blue I, red 40, artificial flavor), sugar, corn syrup, corn starch, salt, calcium carbonate, color added, trisodium phosphate, zinc and iron (mineral nutrients), vitamin C (sodium ascorbate), a B vitamin (niacinamide), artificial flavor, vitamin B6 (pyridoxine hydrochloride), vitamin B2 (riboflavin), vitamin B1 (tiamin mononitrate), vitamin A (palmitate), a B vitamin (folic acid), vitamin B12, vitamin D, wheat starch, vitamin E (mixed topopherols) added to preserve freshness

Modern Discord: Culture Clash

• We have ancient bodies• We live in a modern world• Our bodies have not had enough time to adapt• Adaptation is a slow process

– European descent vs native populations

Maladaption

• Hypercholesterolemia• Hypertension• Hyperglycemia• Osteoporosis• Chronic diseases including Alzheimers

Medications

Treatment Protocol

1. TLC (Therapeutic Lifestyle Change)2. Medications

Most physicians don’t believe patients are able to change lifestyles.

Percent of Adults Overweight

USA

England

Canada

Austria

France

Korea

Brazil

Common Questions:

• Are we sure it’s our culture?• Are we confident we know what our ancestors ate?• Who want’s to live like a caveman?• Humans are living longer, how can there be a

problem with our health?• Isn’t this just your opinion?

Summary

• Our health is getting worse• Our culture is the most likely culprit• There is nothing we can do to speed up human

adaptation• Since we cannot change our genetics, the only thing

we can change is our culture and environment

Up next.. Part II How Our Culture Has Changed

• We will discuss the only realistic solution to our poor health

• We will learn how and why our current culture has changed.

• We will understand the different pieces of our unhealthy culture and how to avoid or replace them