Plant Based Nutrition

Candice Baxendale, DNP, APRN, FNP-C

Objectives Recognize the leading causes of death and the states of

health in the United States and Oklahoma

Discuss the impact of nutrition on chronic disease

Compare plant based nutrition v. pharmacology for treatment of chronic diseases

Assess nutritional adequacy of plant based diets through the life cycle and strategies for meeting dietary recommendations

Identify resources for assisting patients in adopting a plant based lifestyle

Who am I?

Why am I here?

Hippocrates460BC-370BC The Father of

Medicine

“Let food by thy medicine

and medicine by thy food”

Nutrition Education…for providers???

Nutrition is not emphasized in medical training

Only about ¼ of medical schools offer a single nutrition class

Studies show that medical students receive less than 5 hours per year of nutrition training!

Bottom line, the public trusts medical providers to be credible sources of nutrition

Oklahoma’s State of Health

Source: http://www.healthylunches.org/nutrition101.htm

U.S. 10 Leading Causes of Death

#1 Heart Disease 647,457

#2 Cancer

599, 108#3 Accident

169,936

#4 Chronic lung disease

160,201

#5 Stroke 146,383

#6 Alzheimer's disease 121,404

#7 Diabetes 83,564

#8 Influenza and pneumonia

55,672

#10 Suicide 47,173

#9 Kidney Disease 50,633

https://www.cdc.gov/nchs/fastats/deaths.htm

#1 Heart Disease Genetics???

Ugandan autopsy study 1940s

Immigration studies from rural Japan

Korean War autopsies 1953

Accidental death autopsies

To reduce the amount of fat in our arteries we have to reduce the amount of fat in our diets.

Stents and bypasses only bypass the problem

The only diet that has been proven to REVERSE heart disease is a whole food, plant-based diet

Dr. Caldwell Esselstyn, MD

• 46 y/o male MI

• Distal LAD blockage

• Angiogram at time of MI

then 32 months later

Dr. Dean Ornish, MDLifestyle Heart Trial

(1998)

At 1 year:

• Plant based: 37.2% LDL and 91% anginal episodes.Average % diameter stenosis from 40.0% to 37.8%

• Expert care by cardiologist: LDL levels by 6% and 165% anginal episodes. Average % diameter stenosis from 42.7% to 46.1%.

#2 Cancer 5 million Americans die every year from cancer.

Estimated that up to 35% of cancer is attributed to diet

Nurses Health study

NIH-AARP study

The China Study

US v. India

Why is there so much cancer in the US?

Colon Cancer Claims 50,000 American lives annually

America is suffering from fiber deficiency

Fiber is only found in plants!

How much do we need?

Benefits of fiber

Slow release of macro and micronutrients

Stool size/transit time

Feeds healthy gut microbiome

World Health Organization:

Processed red meat – bologna, pepperoni, salami, hot dogs, bacon, ham- Class I Carcinogen: known to be carcinogenic in humans

Red meat– Class 2A Carcinogen: evidence and associations that it may cause colon cancer

“America is a constipated nation…if you pass small

stools, you have to have large hospitals”

–Dr. Dennis Burkitt

Esophageal Cancer Claims 18,000 American lives annually

Incidence has increased six-fold the past 30 years

Risk factors include: smoking, heavy alcohol consumption, and GERD

1 in 4 Americans suffer from GERD

Long term acid reducer use is associated with multiple safety concerns

Dietary changes – eat less fat???

Breast Cancer 230,000/year diagnosed, 40,000/year die

MD Anderson recommends a plant based diet to lower cancer risk

American Institute for Cancer Research Study

Limiting alcohol, eating mostly plant foods, and maintaining a normal body decreased risk of developing breast cancer by 62%

Barnard et al – blood study – 30% greater cancer fighting power

Prostate Cancer Harvard study - factors increasing risk of progression of

prostate cancer

Daily egg intake doubled risk of progression

Regular poultry intake quadrupled risk of progression

Physicians Health Study

Men who eat SAD have 250x the risk of dying of prostate cancer and 67% increased risk of all cause mortality

Compared to plant based men who had a 36% lower chance of death from all causes

More petri dish studies

Drip cow’s milk on prostate cancer = growth rate >30%

Drip almond milk on prostate cancer = growth rate >30%

#4 Lung Disease Lung Cancer

Broccoli study-broccoli eating smokers had 41% fewer DNA mutations in their blood over 10 days

Tumeric study-1 tsp/day dropped smokers DNA mutation rate by 38%

COPD

Study on supplementation with beta-carotene and alpha-tocopherol (vitamin E)

“In conclusion, supplementation with vitamin E or beta-carotene for 5–8 years did not prevent the development of symptoms related to chronic obstructive pulmonary disease, BUT a diet rich in these substances offered some protection even among elderly, long-term smokers.”

#5 Stroke 5 or more servings of fruits and vegetables a day are

associated with 26% decrease in risk for stroke

Increased intake of fiber considerably decreases risk of stroke

Seventh Day Adventists II study

Flexitarians 23% lower rates of HTN

Pescatarians (fish) 38% lower rates of HTN

Vegetarians 55% lower rates of HTN

Vegans 75% lower rates of HTN

#6 Alzheimer's Is it in your genes?

1 in 4 people have a copy of the Apolipoprotein E4 (ApoE4) gene linked to Alzheimer’s

Inherit 1 gene-risk of getting Alzheimer’s triples

Inherit gene from both parents-9x the risk

What does ApoE4 do?

Nigerian paradox

Highest frequency of ApoE4 gene occurs in Nigerians

Nigerians have some of the lowest rates of Alzheimer’s

Nigerian diet consists of mostly grains and vegetables with very little meat

#7 Diabetes Type II Diabetes is reversible

What Causes Insulin Resistance

Blood sugar is a symptom of diabetes, not the cause

5 year study compared 96,469 Seventh Day Adventists to the general population:

Flexitarians 28% lower rates of Type II DM

Pescatarians (fish) 51% lower rates of Type II DM

Vegetarians 61% lower rates of Type II DM

Vegans 78% lower rates of Type II DM

American Diabetes Association Guidelines

ADA Diet

15–20% protein, <7% saturated fat, 60–70% carbohydrate and monounsaturated fats, and cholesterol ≤200 mg/day

HgA1C 0.38 percentage points

Weight loss 6.8lbs

LDL 10.7%

Plant Based Diet

10% of energy from fat, 15% protein, and 75% carbohydrate

HgA1C 1.23 percentage points

Weight loss 14.6lbs

LDL 21.2%

#9 Kidney Disease Kidneys are highly vascularized organs

High fat and cholesterol diets are nephrotoxic

animal protein load increases acid load on kidneys

ammonia production hyperfiltration

2010 Harvard Study: Associations with diet and albuminuria and kidney function decline

Kidneys handle plant proteins differently

Fruits and vegetables create alkaline environment

#10 Suicide 40,000 Americans take their life each year

Major depression is one of the most commonly diagnosed mental illnesses

16 million Americans are suffering from depression

Higher consumption of vegetables cuts the odds of developing depression by 62%

Apples, berries, grapes, onions, green tea, cloves, oregano, cinnamon and nutmeg contain phytonutrients that naturally inhibit MAO

Need 7-8 servings of fruits and vegetables daily to have a meaningful impact on mental health

Part 2

Pharmacology v. Plant Based Nutrition

The “Cost” of Pharmacology Price – prescription drugs account for about 10% of

overall healthcare costs $328 billion annually

Death – Estimated that medications given in hospitals kill around 106,000 Americans annually and that around 7,000 people die each year from receiving the wrong medication

Side Effects – we’ve all heard the commercials

Lipid Lowering DrugsPlant Based Diet

20-40% reduced LDL

No harmful side effects

No increased risk of diabetes

Statin reduction of LDL

Atorvastatin 38-54%

Fluvastatin 17-33%

Lovastatin 29-48%

Pitavastatin 31-41%

Pravastatin 19-40%

Rosuvastatin 52-63%

Simvastatin 28-41%Source: UpToDate

Source: https://www.pcrm.org/good-nutrition/nutrition-information/lowering-cholesterol-with-a-plant-based-diet

Antihypertensive DrugsPlant Based Diet

DASH low sodium diet dropped 20.8/7.9 points

Flaxseed daily 15/7 points

Hibiscus tea SBP 6 points

Beets SBP 8 points

Vegetarian Diet decrease BP by 5/2 points

Decrease in SBP/DBP by drug

Thiazide Diuretics decreased BP by 9/4

Calcium Channel Blocker decrease BP by 8/3 points

ACE inhibitors decrease BP by 5/2 points

ARBs decrease BP by 8/5 points

Acid ReducersPPI and Standard

Dietary Precautions

Reflux Symptom Index percentage of reduction in symptoms after 6 weeks of tx : 54.1%

Plant Based Diet

Reflux Symptom Index percentage of reduction in symptoms after 6 weeks of tx : 62.6%

Diabetes DrugsInsulin on diabetic diet

Patients on average using 26 units/day

Plant Based

Cut insulin requirements by more than ½ down to 11 units/day

½ got off insulin completely

After 16 days!!!

Diabetic Neuropathy Regression of Diabetic Neuropathy with Total

Vegetarian (Vegan) Diet in 2009

Complete relief of the Systemic Distal Polyneuropathy pain occurred in 17 of the 21 patients in 4 to 16 days

Follow-up 1-4 years

71% compliance and in all except 1 of the 17 patients

the relief from neuropathy continued, or there was further improvement

Cancer Treatments Unethical to design a study to randomize cancer pts

Dr. Dean Ornish studied 93 men who chose not to undergo treatment for low grade prostate cancer

After 1 year

Control group: PSA up 6%

Plant based group down 4%

No surgery, no chemo, no radiation, no impotence

Anti-depressant DrugsSaffron

The world’s most expensive spice

30mg/day had the same effectiveness as 20mg Prozac

No side effects!

Prozac

Possible side effects:

Sexual dysfunction

Insomnia

Headache

Anxiety

Dizziness

Abnormal dreams

Vomiting

COPD DrugsMedication

Systematic Review of literature:

Inhaled Anticholinergics

Inhaled Long Acting Beta 2 Agonists

Inhaled Corticosteroids

Plant Based

Alzheimer’s DrugsMedication

Aricept-modest improvement, stabilization, or a slowed rate of clinical decline. Some patients show no clinical improvement at all.

Memantine-similar clinical effects as Aricept

Average cost: $5/day or $1800/year

Plant Based Prevention

Total cholesterol levels ≥240 mg/dL in midlife had a 57% risk of Alzheimer’s 3 decades later, compared to those with cholesterol <200 mg/dL

Dietary and Lifestyle Guidelines for the Prevention of Alzheimer's Disease 2014

“Vegetables, legumes (beans, peas, and lentils), fruits, and whole grains should replace meats and dairy products as primary staples of the diet.”

Part 3

What is a Whole-Food, Plant-Based Diet?

Definition A whole food, plant-based diet is abundant in intake

of fruits, vegetables, whole grains, beans, lentils, chickpeas, mushrooms, nuts, seeds, herbs and spices

Whole plant foods contain powerful ingredients:

Fiber

Phytonutrients

Antioxidants

Water

Meat, dairy products, eggs, highly refined foods like bleached flour, refined sugar, and oil are minimized in a plant based diet.

“We don’t consume nutrients independently; the relationship between food and health is much more complex”

-Dr. T. Colin Campbell

Benefits of a WFPB Diet Prevents, arrests, and even reverses

chronic conditions like heart disease and type II diabetes

Decreases cancer risk/slows progression of some cancers

Helps prevent and halt the progression of a number of autoimmune diseases

Prevents erectile dysfunction

Lowers cholesterol

Lowers blood pressure

Improves sleep, mood and mental clarity

Prevents/reverses constipation

Enables healthy weight loss/maintenance

Improves immune function

Can prevent and treat asthma, allergies, acne, and acid reflux

Longevity enhancing

Increases energy

Decreases stress

Environmentally friendly

Where do you get your…Protein? Protein is an essential

macronutrient necessary to build cells, organs and muscles

9 essential amino acids that our bodies cannot make which means they must be consumed. Contrary to popular belief, plants contain all of these amino acids.

The recommended daily intake (RDI) of protein is 0.8 gram per kg per day. So a 160lb adult needs about 58 grams of protein a day.

Plant-Based Sources of Protein

Food Protein

1 cup tofu 20 grams

1 cup cooked lentils 18 grams

1 cup cooked black beans 15 grams

1 black veggie burger 11 grams

1 large potato 8 grams

1 cup cooked quinoa 8 grams

2 Tbsps peanut butter 8 grams

1 cup cooked oatmeal 6 grams

1 cup brown rice 6 grams

Source: The Vegetarian Resource Group http://www.vrg.org/nutrition/calcium.php

Plant Based Protein in a Day Breakfast: Cinnamon Blueberry Overnight Oats -- 1 cup

oatmeal, blueberries walnuts, and 1 cup soymilk = 17 grams protein

Lunch: Lentil Soup with hummus spread over whole grain toast and a garden salad = 21 grams protein

Snack: Apple and almond butter = 4 grams protein

Dinner: Black bean tacos with avocado and salsa in corn tortillas with side of cilantro brown rice = 19 grams protein

Total Protein = 60 grams

https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/

Where do you get your…Calcium?

The dairy debacle. Cow’s milk contains calcium because cow’s eat plants that contain calcium

Beans and greens are packed with calcium. Look for calcium fortified plant milks.

Spend 20 minutes in the sun every day to increase Vitamin D levels with helps to increase Calcium absorption

Plant Based Sources of CalciumFood Amount Calcium (mg)

Plant based milks, Calcium fortified 8 ounces 300-500

Collard greens, cooked 1 cup 357

Tofu 4 ounces 200-420

Orange juice, calcium fortified 8 ounces 350

Soy yogurt 6 ounces 300

Turnip greens , cooked 1 cup 249

Kale, cooked 1 cup 179

Edamame 1 cup 175

Mustard greens, cooked 1 cup 152

Okra, cooked 1 cup 135

Navy beans 1 cup 126

Almond butter 2 Tbsp 111

Broccoli, cooked 1 cup 62

Source: The Vegetarian Resource Group http://www.vrg.org/nutrition/calcium.php

Where do you get your…iron? Iron

Recommended Dietary Allowance

8mg/day for adult men and post-menopausal women

18 mg/day for pre-menopausal women

Heme (blood based iron) found in meat and non-heme(plant based)

Heme is more easily absorbed, is this a good thing?

Studies show that although non-heme iron is not as well absorbed, iron deficiency anemia is no more common in vegans than in the general population

Plant Based Sources of IronFood Amount Iron (mg)

Lentils, cooked 1 cup 6.6mg

Tofu ½ cup 6.6mg

Spinach, cooked 1 cup 6.4mg

Kidney beans, cooked 1 cup 5.2mg

Chickpeas, cooked 1 cup 4.7mg

Black Eyed peas 1 cup 4.3mg

Quinoa 1 cup 2.8mg

Brussel sprouts, cooked 1 cup 1.9mg

Potato with skin 1 large 1.9mg

Raisins ½ cup 1.5mg

Veggie burger 1 patty 1.4mg

Almonds ¼ cup 1.3mgSource: The Vegetarian Resource Group http://www.vrg.org/nutrition/calcium.php

Where do you get your…Omega-3 Fatty Acids?

World Health Organization recommends getting ½ - 2 percent of your calories from short-chain omega-3 ALA daily

Where do fish get their Omega 3s?

Essential fatty acids....why do we need them?

Ideal ratio of omega-6:omega-3 fatty acids is : 2:1 - 3:1

The Standard American Diet ratio: 20:1- 40:1

Plant Based Sources of Omega-3sFood Amount Alpha Linolenic Acid

Walnuts ¼ cup 2,270mg

Flaxseed, ground 1 tsp 570mg

Soybeans, cooked ½ cup 320-510mg

Tofu ½ cup 400mg

Pecans ¼ cup 240mg

Soymilk 1 cup 210mg

Broccoli, cooked 1 cup 190mg

Cabbage, cooked 1 cup 165mg

Kale, cooked 1 cup 130mg

Avocado halve 125mg

Tempeh 3oz 120mg

Source: The Vegetarian Resource Group http://www.vrg.org/nutrition/calcium.php

Where do you get your…Vitamin B12?

Vitamin B12 essential to good health

Plant-based adults <65 need cyanocobalamin 2,500mcg weekly or 250mcg daily (sublingual for best absorption)

or B12 fortified foods

Nutritional Yeast 2tsps 3x/day

Fortified plant milks

Where do animals get their B12?

Plant Based for KidsAges: 0-3 y/o Ages: 4-18 y/0

Fat: 25%

Protein

Toddlers: 6%

Kids: 7%

Puberty: 10%

Teen athlete: 14%

Adults: 10%

Carbohydrates: remaining 61-69%

Carbohydrates: 60%

Fat: 35%

Rapid brain growth and high energy needs

Protein: 5%

Resources-Books How Not To Die by Dr. Michael Greger, MD

Prevent and Reverse Heart Disease by Dr. Caldwell Esselstyn, MD

The China Study by T. Colin Campbell PhD

UnDo It! by Dr. Dean Ornish, MD

Disease Proof Your Child: Feeding Kids Right Dr. Joel Fuhrman, MD

Power Foods for the Brain Dr. Neal Barnard, MD

Blue Zones by Dan Buettner

Resources - Books Plant Based diets on sports performance

Finding Ultra by Rich Roll

Born to Run by Christopher McDougall

Eat and Run by Scott Jurek

Running with the Kenyans Adharanand Finn

Resources - Websites Nutrition facts https://www.Nutritionfacts.org

Mastering Diabetes https://www.masteringdiabetes.org

Physicians Committee for Responsible Medicine www.pcrm.org

Free 21-day Vegan Kickstart - https://kickstart.pcrm.org/en

Forks Over Knives https://ForksOverKnives.com

Ornish Lifestyle Medicine (THIS PROGRAM IS COVERED BY MEDICARE) https://www.ornish.com

Plant Based Oklahoma https://plantbasedoklahoma.com

Resources - Apps Apps

Daily Dozen by Dr. Greger - FREE

Forks Over Knives – Recipes – FREE

21 Day Vegan Kickstart PCRM – FREE

Happy Cow – Plant based restaurant app - $

Resources – Documentaries Forks Over Knives

What the Health

Eating You Alive

Food Inc

Cowspiracy

Game Changers

Resources - Podcasts The Exam Room – Physicians Committee for

Responsible Medicine

Nutrition Rounds – with Dr. Danielle Belardo

The Plant Proof Podcast

Rich Roll podcast – not medical but lots of good info

Follow on Social Media Dr. Danielle Belardo, MD, Cardiologist

@theveggiemd

Dr. Angie Sadeghi, MD, Gastroenterologist @angie.sadeghi

Dr. Jackie Busse, MD, Pediatrician @plantbasedpediatrician

Dr. Gemma Newman, MD, Family Practice @plantpowerdoctor

Dr. Michelle McMacken, MD, Internal Medicine @veg_md

Dr. Ayesha Sherzai, MD, Neurologist @teamsherzai

Dr. Candice Baxendale, DNP, FNP-C, Pediatrics @plantpoweredfnp

Mastering Diabetes

PlantBasedJuniors

ForksOverKnives

VegFestOKC

NutritionStudies

FoodFixation

GoodOldVegan

Plant Based Healthcare Providers of Oklahoma

ADA Position Statement“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. Plant-based diets are more environmentally sustainable than diets rich in animal products because they use fewer natural resources and are associated with much less environmental damage. Vegetarians and vegans are at reduced risk of certain health conditions, including ischemic heart disease, type 2 diabetes, hypertension, certain types of cancer, and obesity. Low intake of saturated fat and high intakes of vegetables, fruits, whole grains, legumes, soy products, nuts, and seeds (all rich in fiber and phytochemicals) are characteristics of vegetarian and vegan diets that produce lower total and low-density lipoprotein cholesterol levels and better serum glucose control. These factors contribute to reduction of chronic disease. Vegans need reliable sources of vitamin B-12, such as fortified foods or supplements.”

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