This lecture discusses how personal choices and lifestyle factors are powerful influences on health. It begins by exploring current health statistics in America, which show high rates of obesity, diabetes, heart disease and other chronic diseases. These poor health outcomes are linked to most Americans eating more calories, sugar, salt and meat compared to the past, while being less physically active. The lecture then reviews several scientific studies that demonstrate how lifestyle modifications like improved nutrition, increased exercise, weight management and avoiding tobacco can significantly reduce risks for chronic diseases and mortality. It emphasizes that lifestyle is a major determinant of health outcomes. The lecture concludes by encouraging participants to prioritize healthy living through personal goal setting and lifestyle changes.

1. Healthy Living Lecture Series
Stephan Esser MD, USPTA

2. The Power of Personal Choices

3. Esser’s Health
Ranch
Dr William Esser ND, DC 1911-2003

5. • Your Personal Choices may just be the most
powerful influences of your health, today,
tomorrow and for years to come

6. Goals
• Explore the Health of America Today
• Learn why what you do matters
• Develop a plan of health for your life

7. A Paradigm Shift

8. “A global response to a
global problem: the epidemic
of overnutrition.” WHO
It is estimated that by 2020 2/3rds
of the global
burden of disease will be attributable to chronic
non-communicable diseases, most of them
strongly associated with diet. The nutrition
transition towards refined foods, foods of animal
origin, and increased fats plays a major role in
the current global epidemics of obesity, diabetes
and cardiovascular diseases, among other non-
communicable conditions. Sedentary lifestyles and the
use of tobacco are also significant risk factors. …….. A
concerted multi-sectoral approach, involving the use of
policy, education and trade mechanisms, is necessary
to address these matters.

9. Mortality Statistics

10. Leading Causes of Death in US

11. Top Ten Causes of Death for Men in the United States

12. “A global response to a
global problem: the epidemic
of overnutrition.” WHO
It is estimated that by 2020 2/3rds
of the global
burden of disease will be attributable to chronic
non-communicable diseases, most of them
strongly associated with diet. The nutrition
transition towards refined foods, foods of animal
origin, and increased fats plays a major role in
the current global epidemics of obesity, diabetes
and cardiovascular diseases, among other non-
communicable conditions. Sedentary lifestyles and the
use of tobacco are also significant risk factors. …….. A
concerted multi-sectoral approach, involving the use of
policy, education and trade mechanisms, is necessary
to address these matters.
DiabetesDiabetes
High Blood PressureHigh Blood Pressure
High CholesterolHigh Cholesterol
Heart DiseaseHeart Disease
ObesityObesity

13. 2 of 32 of 3

14. Associated Pathology
• CVD:
– Hypertension
– Congestive Heart Failure
– PVD
– Impotence
– Claudication
• Endocrine:
– Diabetes
– PCOS
– Hypothyroidism
– Infertility
• Orthopedics:
– Osteoarthritis
– AVN
• Hepatic:
– #1 cause of liver dz in US
• Obstetrics:
– Gestational DM
– Macrosomia
– Inc. C Section rate
– Inc. Perinatal Morbidity
– Inc. Pre/Eclampsia
• Cancer:
– Prostate
– Colon
– Breast
– Endometrial
– Renal Cell
– Gallbladder
– Esophageal Adeno.
• Other:
• Hyperuricemia, Pancreatitis,
Gallstones, Sleep Apnea, Alzheimer’s,
Dyslipidemia, Metabolic Syndrome
DIABETES

16. Overweight ↑ risk of DM2 by 3 fold
Obesity ↑ risk by 9 fold

20. The Problem
1:9 adults1:9 adults

21. The Problem
• High Blood Pressure:
– 1 in 3 adults
1:3 adults1:3 adults

22. 1:6 adults1:6 adults

24. How did this Happen?

26. ↑39%
Av. of 52 tsp added sugar/person/day

27. •IOM:
(UL) for salt is 5.8 g/day
> 95 percent US Males 31 - 50
> 75 percent of US females 31- 50
regularly in excess of the UL.
< 2 g/day< 2 g/day

28. 83.9 lbs/person/year83.9 lbs/person/year
↑88%↑88%
20122012

29. US Meat Consumption
↑57 lb/capita

30. Year Bee
f
Pork Total
Red
Meat
Total
Chicken
Turkey Total
Poultry
Total
Red
meat
and
Poultry
Commerci
al Fish and
Shellfish
1965 74.7 51.5 133.9 36.9 7.6 44.4 178.4 10.9
2000 67.5 50.8 120.2 77.4 17.3 94.7 214.8 15.2
2016
Prj.
55.0 49.2 105.3 91.4 16.2 107.6
213
NA
As of 9/6/15

31. ↑300%
33.533.5
20122012

32. 8% from Fruits
and Vegetables
8% from Fruits
and Vegetables
≈ 50% from Added
fat/oil and
processed flour
≈ 50% from Added
fat/oil and
processed flour

33. Perspective
• We eat more
– Sugar, Salt, Fat, Meat, Dairy
– 1970-2017:
• ↑ 24.5 % C/day ≈
504K/day
• We get less then ideal Physical Activity
– 18.8% of adults achieved CDC reccs on
Exercise
– 10% of adults >65 y/o

34. Michelangelo’s David:
12 month 20 city tour of the US

35. What we Know
• Americans
– Eat More
– Exercise Less
• 2017:
– Obesity
– Diabetes
– Metabolic Syndrome
– CV Disease

36. HealthCare Spending = $2.7 trillion = 17.7% GDPHealthCare Spending = $2.7 trillion = 17.7% GDP

38. Associated Pathology
• CVD:
– Hypertension
– Congestive Heart Failure
– PVD
– Impotence
– Claudication
• Endocrine:
– Diabetes
– PCOS
– Hypothyroidism
– Infertility
• Orthopedics:
– Osteoarthritis
– AVN
• Hepatic:
– #1 cause of liver dz in US
• Obstetrics:
– Gestational DM
– Macrosomia
– Inc. C Section rate
– Inc. Perinatal Morbidity
– Inc. Pre/Eclampsia
• Cancer:
– Prostate
– Colon
– Breast
– Endometrial
– Renal Cell
– Gallbladder
– Esophageal Adeno.
• Other:
• Hyperuricemia, Pancreatitis,
Gallstones, Sleep Apnea, Alzheimer’s,
Dyslipidemia, Metabolic Syndrome

40. 1: Essential Hypertension
7: Diabetes Mellitus
15/17: Heart Disease
1: Essential Hypertension
7: Diabetes Mellitus
15/17: Heart Disease
Top 35 leading diagnosis groups at ambulatory care clinicsTop 35 leading diagnosis groups at ambulatory care clinics

41. Number and rate of discharges from short stay hospitals 2009Number and rate of discharges from short stay hospitals 2009
2: Heart Disease
8: Strokes
11: Diabetes Mellitus
17: Essential Hypertension
2: Heart Disease
8: Strokes
11: Diabetes Mellitus
17: Essential Hypertension

42. Admission Diagnosis to Nursing Homes 2009Admission Diagnosis to Nursing Homes 2009
1: Disease of Circulatory System1: Disease of Circulatory System

43. Can WEChange this?

44. Can we Change Health through Lifestyle
Or are Genetics the end of the story?

45. They did not display their parent’s susceptibility to cancer and diabetes….
……..the effects of the agouti gene had been virtually erased.

46. Pima Indians

48. “A global response to a global
problem: the epidemic of
overnutrition.” WHO
It is estimated that by 2020 2/3rds
of the global burden
of disease will be attributable to chronic
noncommunicable diseases, most of them strongly
associated with diet. The nutrition transition towards
refined foods, foods of animal origin, and increased fats
plays a major role in the current global epidemics of
obesity, diabetes and cardiovascular diseases, among
other noncommunicable conditions. Sedentary
lifestyles and the use of tobacco are also significant
risk factors. …….. A concerted multi-sectoral approach,
involving the use of policy, education and trade
mechanisms, is necessary to address these matters.
……if…….Lifestyle is the
Problem
……if…….Lifestyle is the
Problem
What is the answer……..?What is the answer……..?

49. Lifestyle Medicine
Physical Modalities
Pharmaceuticals
Surgery

50. What HAS worked?

51. • What if……..
– You ate MOREfruits, vegetables,
unprocessed whole grains, nuts, seeds and beans?
– You ate LESS foods of animal origin (meat, dairy,
fish) and processed foods
– You reduced Toxic exposures
– You exercised daily

53. 12 year Cohort Study
1507 men 832 Women
Ages 70-90 years
Outcomes: 10 yr all cause mortality
4 Factors: More plants, Moderate EtOH, physical exercise
and non-smoking were ass. w ↓ in ACM
50% ↓ in all-cause
and cause specific
mortality

54. “Not only do persons with better health habits
survive longer, but in such persons, disability is
postponed and compressed into fewer years
at the end of life.”
Vita, AJ et al. NEJM 1998; 338:1035-1041

55. Finnish Diabetes Prevention Trial
Total 522: 172M 350W
Av. age 55
Av. BMI 31
Randomized to standard of care or
individualized lifestyle counseling
Av. f/u 3.2 yrs
Risk of
Diabetes ↓ 58 %
(P<0.001)
N Engl J Med 2001;344:1343-50
“The reduction in the incidence of diabetes was
directly associated with changes in lifestyle”

56. Healthy living is the best revenge: findings from
the European Prospective Investigation Into
Cancer and Nutrition-Potsdam study 2009
• 23,153 participants (35 to 65yr) for about 8 years
• Rates of type 2 diabetes mellitus, myocardial
infarction, stroke, and cancer
• 4 Variables:
– Never smoking
– BMI<30
– 3.5 h/wk or more of physical activity
– healthy dietary principles (high intake of fruits,
vegetables, and whole-grain bread and low meat
consumption).
If you had all 4 factors at baseline you had
• 78% lower risk of developing a chronic disease
•
• 93% lower risk of diabetes
•81% lower risk of myocardial infarction
•50% lower risk of stroke, and
•36% lower risk of cancer
If you had all 4 factors at baseline you had
• 78% lower risk of developing a chronic disease
•
• 93% lower risk of diabetes
•81% lower risk of myocardial infarction
•50% lower risk of stroke, and
•36% lower risk of cancer
Sign Me Up!Sign Me Up!

57. What we Know
Health Comes from
Healthy Living
Health Comes from
Healthy Living

58. We know
• Health Comes from Healthy Living
–MORE Color
–MORE Movement
– Reduce/Eliminate Toxins
– Spiritual/Emotional Well-Being

59. Stages of Change
(Prochaska and DiClemente)
1: Pre-contemplation
2: Contemplation
3: Preparation/planning
4: Action
5: Maintenance
6: Permanent Maintenance (Termination)

60. GROW
• Goals
• Reality today
• Options
• Will

61. Conclusion
• YOU are powerful
• Health Comes from Healthy Living
• Learn More
• Be Dynamic

62. Profound Simplicity

63. Thank You!
Stephan Esser MD, USPTA

64. 2017-2018 Goals
• Increase Awareness
– Personal Health Goals
– What You do and how it affects these
• “Celebrate with Color”
• Move

65. Conclusion
You are the most powerful influence
in your health today, tomorrow and
for years to come!

66. Thank You!
Stephan Esser MD
www.esserhealth.com

67. What can I do
to
stay healthy?

68. Fingers
Feet
Forks
the
Master Levers of Health Destiny

69. Feet

70. Exercise and Physical Health
• Reduces risk of
– Heart Disease ≈ 40%
– Obesity: ≈ 30-100%
– Stroke ≈ 50%
– Type 2 Diabetes ≈ 50%
– Hypertension ≈ 50%
– Disability delayed ≈15 years
– Colon Cancer ≈ 25-40%
– Breast Cancer ≈ 20%-44%
– Osteoporosis ≈ 20+%
• As many as 250,000 deaths per year in the United States
areattributable to a lack of regular physical activity

71. Exercise and Mental Health
• Regular Exercise:
– Reduces risk/severity of:
• Depression
• Anxiety
• ADD/ADHD
• Alzheimers Dementia
– Improves:
• Mental Clarity, test scores, focus

72. Exercise and Emotional Health
• Regular Exercise:
– Increases Self Confidence
– Teaches skills to manage adversity
– Enhances Self Esteem
– Develops Discipline
– Encourages Goal setting and self awareness

73. Exercise means pink spandex, going to a
gym, sweating with a bunch of people I
don’t even know or like!

75. Categories
• Leisure time Exercise: organized sports,
running, gym activities, rehabilitation etc.
• Lifestyle Exercise: activity incorporated into our
daily pattern of life
– eg: parking in the distant portion of the parking lot rather then the first
bumper, taking the stairs instead of the elevator etc.

76. Present Recommendations
• Cardiovascular:
– 150 minutes of moderate-intensity exercise per
week.
– 30-60 minutes of moderate-intensity exercise (five
days per week) or 20-60 minutes of vigorous-
intensity exercise (three days per week).

77. Present Recommendations
• Resistance Training:
– 2-3 days per week
– All major muscle groups
– 2-4 sets of each exercise
– 48 hours in between sessions
http://www.acsm.org/about-acsm/media-room/news-releases/2011/08/01/acsm-issues-new-
recommendations-on-quantity-and-quality-of-exercise

78. Present Recommendations
• Flexibility:
– 2-3 days/week to improve range of motion
• Balance:
– 2-3 days/week
– Eg: Tai Chi, Yoga

79. All Kinds
• People
• Programs
• Locations
• Products: Pedometers, Accelerometers etc

80. Intensity of Exercise
Maximal Heart Rate:
220-Age or 206.9-(0.67x age)
Heart Rate Reserve (HRR):
Max. HR- Resting HR = HRR
Target HR=HRR x % intensity + HR @ rest
Maximal Heart Rate:
220-Age or 206.9-(0.67x age)
Heart Rate Reserve (HRR):
Max. HR- Resting HR = HRR
Target HR=HRR x % intensity + HR @ rest
Talk Test:
-Easy: Can Talk and Sing
-Moderate: Can Talk but not sing
-Intense: Can’t talk or sing
Talk Test:
-Easy: Can Talk and Sing
-Moderate: Can Talk but not sing
-Intense: Can’t talk or sing

81. Nutrition
• Up to 50% of Americans are on a Diet
DIEtDIEt
LifestyleLifestyle

82. Nutrition
• Health Promoting Nutrition:
• Majority of Calories derived from Plant-Based
Sources
• Limited Calories from Refined Foods and
Foods of Animal Origins

83. Nutrition
Think more about Health and
less about Weight Loss

84. GoodGood
BadBad
Health
Promoting
Health
Promoting
Health CompromisingHealth Compromising

85. Nutrition
Think about Calorie Density
and less about individual
Calories

86. Toxins
• Get em’ out
• Get help if you need it
• You can do it
• You deserve it

87. Basics
• Physical Activity:
– Achieve 150 min of aerobic exercise and 2
sessions of strength training per week
• Nutrition:
– Eat a high nutrient density program
– Limit/moderate lean meats, limit refined foods,
fat, sodium and cholesterol
• Eliminate Smoking and Limit Alcohol
Consumption

88. Now What?

89. Stages of Change
(Prochaska and DiClemente)
1: Pre-contemplation
2: Contemplation
3: Preparation/planning
4: Action
5: Maintenance
6: Permanent Maintenance (Termination)

90. GROW
• Goals
• Reality today
• Options
• Will

91. Setting Goals
•Specific
•Measureable
•Achievable
•Realistic
•Timely

92. Break Out: 4 minutes
• Set YOURSELF a SMART Goal for 1 Lifestyle
Measure and share it with your neighbor!
• Specific
• Measureable
• Achievable
• Realistic
• Timely
Exercise
Nutrition
Toxins
Sleep
Emotional
Poise(Stress)
Exercise
Nutrition
Toxins
Sleep
Emotional
Poise(Stress)

93. Conclusion
• Personal Choices are powerful Medicine
• Assess YOUR Health Today
• Identify your health goals
• Develop a support team
• Take charge of your health today!