Food: Life’s Tastiest Medicine

Debbie Movsesian, PA-C

Intro

• Debbie Movsesian: wife and mother of 2 children (11 & 14 year old daughters)

• PA for 20 years

• Cardiology and electrophysiology

• Disease prevention and reversal

How'd I get here?

What if we had a magic pill?

Proven to lower blood pressure, lower cholesterol, reverse insulin resistance, reverse CAD, reduce risk of cancer,

promote weight loss, and prevent Alzheimer’s…

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Whole food, plant based nutrition is that magic pill

Fruits, veggies, whole grains, legumes, nuts and seeds

Chronic Diseases are Rapidly Increasing! 1

Most chronic diseases are preventable!

• 80% of Heart Disease, Stroke and T2DM

• 40% of cancers

• Heart disease is still #1 cause of death

• >20 million Americans have T2DM (3x 1990)

• 1 out of 3 in 2050 will have T2DM

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As practitioners

• Do we know what “whole foods plant based diet” means?

• Do we believe it?

• Do we practice what we preach?

• Do we know what the healthiest foods are?

3 Main Factors we need consider when it comes to changing our

chronic disease epidemic

• The focus of our healthcare system

• What the real data shows

• What we as PAs can do

The focus of our healthcare system

• Acute care, management

• “Prevention” efforts = Screening -> meds/procedures

• Nutrition isn’t taught in medical schools

• Manage symptoms and numbers, not treating disease (ex. type 2 diabetes)

• Confusion (studies and recommendations funded by food industry)

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The data• Dr. Ornish and Dr. Esselstyn -> reversal of CAD

• Dr. Barnard -> reversal of type 2 diabetes

• Dr. Campbell -> relationship between animal protein (dairy) and cancer

• Blue Zones (Ikaria, Greece; Okinawa, Japan; Ogliastra Region, Sardinia; Loma Linda, Calif.; and Nicoya Peninsula, Costa Rica)

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• Blue Zones - areas in the world where people live the longest

Mostly plant based, exercise regularly, get enough sleep, community, no smoking

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BMI, DM, HTN lower 10

Nutrition Myths

• Protein must come from meat or dairy

• T2DM is due to too much sugar and carbs

• Need dairy for calcium

• Genes cannot be overcome by lifestyle

• Soy is bad

FACTS• FIBER >>>> Protein

• Plants give you ALL the protein you need (and we need way less than the RDA)

• Increases insulin resistance

• Heme iron is pro-oxidant

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Fiber• Most Americans get less than 1/2, only found in plants

• Cholesterol

• Blood glucose levels

• May decrease BP

• Constipation

• Microbiome - anti inflammatory, feed “good bacteria”

• Lowers CV Dz mortality

• Lowers death from cancer

T2DM• Caused by (saturated) fat affecting insulin

sensitivity and secretion

• Fat -> accumulation in muscle and liver cells -> lipotoxicity -> increased cytokines -> cells become more insulin resistant

• Improved by limiting fat and protein

• Cells become more sensitive -> DM is reversed

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Calcium• Can get enough from plants (dairy calcium comes from

the plants they eat)

• Only absorb 30% of calcium from dairy

• Animal protein and sodium -> calcium loss

• Increased dairy associated with cancer and higher risk of hip fractures, cancer and premature death (in milk drinkers)

• Calcium supplements are not recommended (increase risk of heart attacks)

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Epigenetics• External factors changing gene expression (ex

DNA methylation)

• Diet and lifestyle changes have been shown to turn genes on and off (ex soy in breast cancer)

• Our microbiome cells overwhelm our human cells 10:1 and microbiome is influenced by our diet -affects our immune system, digestion, absorption of nutrients, production of vitamins, etc

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Soy

• Soy associated with decrease risk of breast cancer and improved breast cancer survival

• GMO - concern my actually be the pesticide they were created to withstand (stimulating growth of estrogen-receptor-positive human breast cancer cells)

• SAD >>> concern than soy of any form

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Root causes of disease• Free radicals >> antioxidants -> Oxidative stress

• Telomere (DNA structures at end of chromosomes) shortening

• Chronic low grade inflammation

• Carcinogens causing DNA damage

• Epithelial wall damage

Antioxidants • Up to hundreds more than animal products

• Decrease damage to small vessels in brain

• Decrease artery stiffness

• Lower inflammation

• Lower BP

• Associated with longer telomere length (aging)

Polyphenols• Type of antioxidants

• Role in epigenetics (reactivate silenced tumor suppression genes or inactivate oncogenes)

• Locked to fiber of plants

• Specific foods (turmeric, grapes, green tea, broccoli, soy)

• Receptors specially for these

Phytates

• Found in seeds of plants (whole grains, beans, nuts and seeds)

• Detoxify excess iron (excess iron -> free radicals

• Target cancer cells (antioxidant, anti-inflammatory, and immune- enhancing activities)

• Protect bones

Power of Plants• Fruit: Berries have most antioxidants, fiber, other phytonutrients

(protection against cancer, boost immune system, protect liver and brain, decrease risk of CV disease death )

• Legumes; beans, peas and lentils: Protein, iron, zinc, fiber, folate and potassium (cancer prevention (phytates) plus associated with slimmer waist and lower BP, regulation of glucose, insulin levels, cholesterol)

• Vegetables: Dark leafy greens are most healthy foods on planet, have most antioxidants of the veggies, cruciferous (potentially prevent DNA damage with specific polyphenols) There are specific receptors for the phytonutrients to bind. The more the diverse the better!

• Flaxseeds: omega 3 fatty acids - lower blood pressure, protect against breast and prostate cancer

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Power of Plants• Mushrooms: amino acid with potent antioxidant effect on mitochondria

(protects against DNA damage and cell death)

• Nuts and seeds: may extend your life (walnuts are the healthiest with most omega 3 and antioxidants) decreases stroke risk

• Herbs and spices: packed with antioxidants, turmeric (many beneficial effects in treatment and prevention of cancer, anti-inflammatory effects)

• Whole grains: decrease inflammation, associated with living significantly longer, reduce risk of heart disease, T2DM, obesity and stroke

• Supplements have not been proven to be effective like the whole foods

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Power of Processed (and animal) foods

• Salt, sugar and fats are addictive - act on neurochemical reward centers in our brain, release dopamine

• Dull our tastebuds so healthy foods don’t taste as good

• Three quarters of our sodium intake

• High caloric, low nutrient density - don’t cause satiety effectively so overeat

• Dairy: hormones naturally, lactose, proteins, added hormones, contaminants, antibiotics

Power of Processed (and animal) foods

• Trans fats, saturated fats and cholesterol -> arterial plaque and dysfunction and are found in meat and dairy and hydrogenated oils (processed foods)

• Animal products contain chemicals and pollutants from their environment, contain hormones and antibiotics, fish contains mercury, toxins

• AGE (advanced glycation end products) highest in cigarette smoke and meats when heated -> oxidative stress, inflammation, accelerate aging

• Animal proteins -> liver -> IGF-1-> cancer promoting

• They replace the healthy, nutrient dense whole foods and disease is the result

How do we get people to change their diets?

• Align mindset with health goals - what do you really want how do you want to live in 5, 10, 20, 50 years? take an honest look at daily choices and habits (food journal)

• Increase plants into everyday meal choices, make veggies and legumes the main course, start with small realistic changes initially

• Decrease processed foods, dairy, eggs and meats and substitute staple processed foods with whole foods (oatmeal, smoothies, veggie pasta, hummus, veggie sticks or fruit for snacks, legumes instead of meat)

What can we as PAs do to affect the health care crisis?

• Acknowledge we have the answer

• Educate ourselves, learn about nutrition and lifestyle change

• Change focus to treat the root cause of disease

• Expect more from patients, be sure they understand how critical their choices are

• Take a stand for ourselves and our patients; Empower them to take responsibility and stop saying “they won’t do it anyway”

• Don’t accept the status quo

• Meds alone can’t save our patients or our healthcare system

• Create relationships with cardiac rehab centers, dietitians and health coaches

Summary

• Increase whole foods, plants

• Strive to make half your plate full of veggies

• Decrease or eliminate processed foods and dairy, eggs and meat

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10. Am J Clin Nutr. 2009 May; 89(5): 1607S–1612S.Vegetarian diets: what do we know of their effects on common chronic diseases?11. Ivonne Sluijs, MSC, Joline W.J. Beulens, PHD, Daphne L. van der A, PHD, Annemieke M.W. Spijkerman, PHD, Diederick E. Grobbee, MD, PHD and Yvonne T. van der Schouw, PHD Diabetes Care 2010 Jan; 33(1): 43-48. Intake of Total, Animal, and Vegetable Protein and Risk of Type 2 Diabetes in the European Prospective Investigation into Cancer and Nutrition (EPIC)-NL Study12. Débora Estadella, Claudia M. da Penha Oller do Nascimento, Lila M. Oyama, Eliane B. Ribeiro, Ana R. Dâmaso, and Aline de Piano, Mediators Inflamm. 2013: 137579: Effects of Dietary Saturated and Transfatty Acids13. BMJ 2014; 349 Karl Michaëlsson, professor, Alicja Wolk, professor, Sophie Langenskiöld, senior lecturer, Samar Basu, professor, Eva Warensjö Lemming, researcher1, Håkan Melhus, professor, Liisa Byberg, associate professor Milk intake and risk of mortality and fractures in women and men: cohort studies14. J Intern Med. 2015 Oct;278(4):354-68 Reid IR1,2, Bristow SM1, Bolland MJ Calcium supplements: benefits and risks.15. Epigenomics. 2011 Aug 1; 3(4): 503–518. Tabitha M Hardy1 and Trygve O Tollefsbol Epigenetic diet: impact on the epigenome and cancer16. Nutrition Today: March/April 2013 - Volume 48 - Issue 2 - p 68–75; Messina, Mark PhD, MS; Messina, Virginia L. MPH, RD Exploring the Soyfood Controversy17. JAMA. 2009 Dec 9;302(22):2437-43. Soy food intake and breast cancer survival.Shu XO1, Zheng Y, Cai H, Gu K, Chen Z, Zheng W, Lu W.18. Environ Health Perspect. 2005 Jun;113(6):716-20 Differential effects of glyphosate and roundup on human placental cells and aromatase. Richard S1, Moslemi S, Sipahutar H, Benachour N, Seralini GE.

19. McCullough ML, Peterson JJ, Patel R, Jazques PF, ShahR, Dwyer JT. Flavonoid intake and cardiovascular disease mortality in a prospective cohort of US adults Am J Clin Nutr. 2012; 95 (2): 454-6420. BMC Med. 2013 Jul 16;11:164. Frequency of nut consumption and mortality risk in the PREDIMED nutrition intervention trial. Guasch-Ferré M, Bulló M, Martínez-González MÁ, Ros E, Corella D, Estruch R, Fitó M, Arós F, Wärnberg J, Fiol M, Lapetra J, Vinyoles E, Lamuela-Raventós RM, Serra-Majem L, Pintó X, Ruiz-Gutiérrez V, Basora J, Salas-Salvadó J; PREDIMED study group.21. Crit Rev Food Sci Nutr. 2014;54(3):352-72. Antioxidant potential of spices and their active constituents. Srinivasan K1.22. JAMA Intern Med. 2015 Mar;175(3):373-84. Association between dietary whole grain intake and risk of mortality: two large prospective studies in US men and women. Wu H, Flint AJ, Qi Q, van Dam RM, Sampson LA, Rimm EB, Holmes MD, Willett WC, Hu FB, Sun Q.

Thank you!For resources for you or your patients, email me at

debmo99@gmail.com