A doctor presented on the science of plant-based nutrition. He discussed the new paradigm of viewing nutrition as the synergistic effects of whole foods rather than their individual components. A whole food plant-based diet is recommended, as it is associated with reduced risk and potential reversal of various diseases like cancer, heart disease, diabetes and autoimmune conditions. Factors like phytonutrients, gut health, mindfulness and lifestyle habits were reviewed in relation to health outcomes. Billing codes were also presented to allow for nutrition counseling reimbursement.
1. Science of Plant-Based
Nutrition
Ashwani K. Garg, MD
Board certified family medicine, lifestyle medicine
Certificate in plant-based nutrition
Saturday, March 16, 2019
2. Goals
• Discuss nutrition basics of plant-based diet
• Phytonutrients and antioxidants
• Nutrition for specific diseases
• Putting it all together, analyzing diet
• Billing for health professionals
4. The old nutrition paradigm (reductionism)
Food is thought of in terms of its components
Macronutrients (fat, protein, carb)
Micronutrients (vitamin A, B, C, D…)
Fiber
Leads to:
macro confusion
supplements
poor health outcomes (rearranging the deck chairs on a sinking ship)
5.
6.
7. The NEW paradigm (wholism)
• Defines nutrition as the synergistic and wholistic effects of FOODS on health
• Nutrients interact with other nutrients and don’t work in isolation
• Effect of the whole food is greater than any of its components.
• A fruit is not “sugar”
• Brown rice is not a “carb”
• An avocado is not “fat”
9. Nutrition… (according to
Campbell)
• The biologically “wholistic” process by which elements of
food and water are used by the body to optimize health
• The highly integrated reactions and events of countless food
chemicals working together, as in a symphony
10. Whole food plant-based diet
"One of the most fortunate findings from the mountain of nutritional
research I’ve encountered is that good food and good health is simple. The
biology of the relationship of food and health is exceptionally complex, but
the message is still simple. The recommendations coming from the
published literature are so simple that I can state them in one sentence: eat
a whole foods, plant-based diet, while minimizing the
consumption of refined foods, added salt and added fats.”
- T. Colin Campbell, PhD
12. Nutrient Composition
Plant and Animal-Based Foods (Per 500 Calories of Energy)
1. USDA Nutrient Database for
Standard Reference.
http://ndb.nal.usda.gov/ndb/.
2. Holden JM, Eldridge AL, Beecher
GR, et al. “Carotenoid content of
U.S. foods: an update of the
database.” J. Food Comp. Anal.
12 (1999): 169–196.
3. The exact food listings in the
database were: Ground Beef,
80% lean meat/20% fat, raw;
Pork,fresh, ground, raw; Chicken,
broilers or fryers, meat and skin,
raw; Milk, dry, whole;
Spinach,raw; Tomatoes, red,
ripe, raw, year-round average;
Lima Beans, large, mature
seeds, raw; Peas,green, raw;
Potatoes, russet
*B12 is from soil bacteria and is variable; can be obtained
from supplements or supplemented foods
14. Protein requirements
A balanced plant-based diet with adequate calories will always contain enough protein.
For a 150 lb. person, minimum is about 1/3 of the weight or 50 gm.
50 gm = 200 calories worth
Even a “low protein” diet of 10% will give enough if 2000 kCal/day
16. Plant proteins are the best fuel for the body
• Nutrient-dense
• Anti-inflammatory, anti-oxidative stress
• Increased energy
• Optimized athletic performance
• Reduction and treatment of cancer
• Prevention AND reversal of heart disease
17. Phytochemicals
• Phytochemicals are compounds only in plants that promote health
• There is no daily reference intake for phytochemicals
• New research shows they may very well be essential to life, and for
prevention of cardiovascular diseases and cancer
• ONLY about 1/5 of Americans meet the minimum intake
18. Flavonoids
• Pigments in foods found in pigmented foods such as leafy greens, citrus, tea,
berries, and chocolate
• Over 5000 natural occurring flavonoids have been isolated
• Antioxidant, anti-inflammatory, anticancer, antiplatelet, antibacterial
19. Carotenoids
• Alpha/beta carotene, lutein, lycopene, zeaxanthin
• Found in Carrots, fruits, vegetables, tomatoes
• Reduce muscle fatigue, neutralize free radicals, reduce risk of
prostate cancer
• Regulate cell growth, modulate gene expression
• Carotenoids also regulate body fat and modulate obesity
20. Nonstarchy polysaccharides
• fucoidan, beta glucan
• Mushrooms, barley, oats, brown seaweed, wheat bran
• Apoptosis of cancer cells, brain development,
antithrombotic, blood pressure, reduced risk of
breast/colon cancer, improved cholesterol and
reduced CVD
21. Lignans
• Outer coat of seeds, woody parts of plants, provide building blocks
• 100 times higher in flax than other foods
• Lowering of blood pressure
• Hormone regulation (phytoestrogen)
• Protective against heart disease and breast cancer
22. Glucosinolates
• Sulfur containing compounds found in brassica
(cruciferous vegetables)
• Indole-3-carbinol (I3C) formed from metabolism
• Denatured by high heat (boiling) and activated by
chewing
• Antibiotics will inactivate the absorption
• Anti-cancer, anti-CVD, immune regulation
23. Isoflavones (soy)
• Isoflavones (genistein and dadzein) act as agonist/antagonist for estrogen receptor
• Isoflavones were thought to be harmful based on ANIMAL studies
• HUMAN research supports benefit of soy foods
• Lower type 2 diabetes risk
• Lower menopause symptoms
• Lower breast and gynecologic cancers
• Lower prostate cancer
24. Omega-3 fatty acids
• ALA is an essential fatty acid, converted to DHA/EPA
• Omega-6 found in oils will “compete” with the conversion and interfere
• DHA can be obtained in algae form (for example Vegetology)
• Turmeric can increase absorption of DHA
• Role in heart health, brain health, anti-inflammatory
25. Cancer
• 2nd leading cause of death in the US
• We have cancer cells in our bodies every day, there is a balance between cell
death and cell division
• Plant-based diet shifts the balance and modulates inflammation and blood
flow (angiogenesis)
33. Osteoporosis
• Calcium paradox identified by WHO – countries with highest calcium intakes
have the most osteoporosis
• Acidification by high intake of proteins leaches out calcium
• Other factors – lack of sun, sedentary lifestyle, caffeine, salt
• Yoga for osteoporosis – sciatica.org
• Osteoporosis drugs benefit but also harm
34. Heart Disease
• NO OTHER diet has been shown to reverse heart disease, not the
Mediterranean, not a low carb diet, not the standard diet or the AHA or
DASH diet.
• Whole food Plant-Based is the only one that reverses heart disease.
36. • Our gut microbes number 10 times the number of cells in our body
• Protect us from infection, support metabolism, promote healthy digestion and elimination
• 100,000,000,000,000 organisms in gut, ¾ of immune system
• 90% of serotonin in the gut
• “second brain” “gut feeling”
• Metabolic/diabetes
• Digestive diseases
• Autoimmune disease
• Heart Disease/Kidney Disease
• Psychiatric Illnesses/Neurologic
• Allergy/Asthma/Eczema
• Leaky Gut ----------------------
“All Disease Begins in The Gut.”
- Hippocrates
37. Autoimmune Disease
• Leaky Gut syndrome is thought to be a possible cause of autoimmune disease
• Animal proteins can go through intact and form immune reaction to our own
bodily tissues, as animals have those very same proteins as us in our bodies
• A whole food plant-based diet has been shown to reverse many autoimmune
diseases including psoriasis, rheumatoid arthritis, lupus, Crohn’s disease, and
others.
• Asthma/allergy are immune diseases that can also be treated with plant-based
diet
• Dairy is one of the most inflammatory foods and most often consumed
38. Gut-Brain
• Enteric nervous system
• Vagus nerve connects the 2 nervous systems
• 90-95% of serotonin lives in the gut not the brain
• (“happy hormone”)
• Sympathetic and parasympathetic nervous systems
• Are involved in digestive functions (or malfunctions)
• Stress can lead to maladaptive behaviors
• Proper diet can improve both brain/gut health
39. Every day, we make a choice what to eat and on
living beings’ lives.
It’s up to us to choose.
40. Is eating “plants only”
healthy?
Statement by 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. 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… Vegans need reliable sources of vitamin B-12
https://jandonline.org/article/S2212-2672(16)31192-3/abstract
44. Mindful Eating
“Savor, Mindful Eating, Mindful Life” atin
• Lilian Cheung, Editorial Director, HSPH Nutrition Source
(written with Thich Nhat Hanh)
• (1) Honor the food (sometimes we forget where the food comes
from)
• (2) Engage ALL your senses (taste, sight, aroma, texture, beauty of the
food)
• (3) Be mindful of portion sizes (don’t take too much – modest
amount)
• (4) CHEW your food – enzymes digest food, taste is more powerful
45. Savor - continued
• (5) Eat slowly and mindfully – enjoy and taste food thoroughly
• (6) Don’t skip meals – you will overeat in this way
• (7) Eat a PLANT-based diet
(when I say PLANT-based, I really mean plants only)
(eating meat increases risk of cancer and other diseases)
• https://www.youtube.com/watch?v=Emd9q6_o6Z0
46. Other lifestyle factors
adapted from Dr. David Katz
• Feet (150-300 minutes of exercise weekly, with 2 days of resistance)
• Forks (plant-based diet)
• Fingers (avoid alcohol / tobacco)
• Sleep (7 to 8 hours per night of good quality sleep)
• Stress (mindfulness, regular practice of prayer/meditation, fellowship)
• Love (Love for one’s significant other, the Earth, the Animals, cultivation of
universal love)
47. Example analysis (plant-based)
Cronometer.COM
(1) breakfast smoothie, soy milk, spinach, banana, pineapple, kiwi, hemp
(2) lunch chickpeas, broccoli, bulgur
(3) apple/PB snack
(4) dinner bean/veg/kale curry with swt potato, tahini + 4 brazil nuts
(5) 10 almonds for a snack w/soymilk
56. Billing code 99401
• Billing code 99401 can offer a way to be reimbursed by private insurance for
a brief (8-15 minute) nutrition intervention in the medical office setting
• Deliver a brief questionnaire of food intake, starting with plant-based food
• After taking a full nutrition inventory, counsel with motivational interviewing
mindset, shifting the bar forward to plant-based
• Paste the answers to patient’s questions back into visit summary to take
home
58. Albert Einstein:
“Nothing will benefit human
health and increase the chances
for survival of life on Earth as
much as the evolution to a
vegetarian diet.
