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Food As Medicine

Lyndi Schwartz

Description

Lyndi Schwartz, MD OBJECTIVES 1. Describe consensus views on nutrition. 2. Discuss what science suggests we should eat. 3. Discuss the relationship of nutrition to CV disease, Insulin resistance, cancer and obesity. 4. Based on the evidence presented, explain how food choices impact the Holy Spirit’s transforming power

Presenter

Lyndi Schwartz

Physician practicing in Kettering, Ohio

Conference

Recorded

  • November 1, 2019
    4:00 PM
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I'm a physician and. Those of us that went to medical school I realized that the others who have not didn't go to medical school but those of us that went to medical school spent a lot of time in medical school learning things that we no longer remember Dr smallest Yeah he's a surgeon but if you ask me anatomical question I think I'd be hard pressed to give an answer but we have to study all those things but certainly be to study you know things like. Barry Barry. Biochemistry and so forth and remember anything like that I have never seen a case of beriberi is anybody ever seen a case of Bear Bear you have most of in the mission field some place here in the states Alep Ok well that would be possible that's sort of a mission field I agree. But you know we do treat things like hypertension and diabetes and and coronary disease and stroke and gout and those kinds of things and that's what we really need to look at the reason that's significant is that if you look at this data. In the United States if the 10 most common causes of death and this was actually reported from up to 2016 but beyond it's the same if you look at that the top 10 causes 5 of them at least are related to or dietary and food choices and then if you look for risk factors. For chronic disease and deaths it is dietary risk factors. The magnitude of our food choices is really hardly realised it's not tobacco use high blood pressure or anything like that and this other slide brings it home even further this was published in the Jama in 2018 and what you see here actually is that it's not genetics or anything like that people say it's my genes that I have all these diseases but we realize that overall it is related to sub optimal dietary choices so I think that's why this is really important and the majority of practitioners. We spend a lot of our time. Mopping up the floor in service shutting off the faucet and I get really frustrated when I see physicians who don't agree or believe that somehow turning off the faucet is really important what we're going to talk about this afternoon is how to shut off the faucet so let's just look at this paper this paper was published in May of this year. In May of this year in the Lancet this is actually done every year the global burden of health of this global disease study this was published in May but the data was from 1900 to 2017 the collaborators on this particular project are from all over the world. And included places in the United States like the Mayo Clinic and Harvard School of Public Health are some of the collaborators on this they put in their paper that they published and Jemma did in the last in 2019 what we aren't eating is killing us dietary risks are responsible for 11000000 deaths 2C5X5WW disability adjusted life years cardiovascular disease deaths were followed by cancers and type 2 diabetes mellitus these are diseases related to dietary choices and then what are we eating that's killing us whole grains fruits and nuts in moderation I list those 3 things 1st 12 and 3 because those to not be the most significant dietary absences that are the cause of or associate with these diseases Additionally vegetables and seeds and too much salt Now look at this though so far as looking at a diet related deaths by by country. In terms of the lowest death rates the netted Kingdom ranked 23rd above arland which was 24th and Sweden which was 25 the United States ranked 43rd behind Rwanda and Nigeria. That's really significant. Now how many of you are worth the study that was published in the Annals of Internal Medicine in October just this month right and I write this I said this is a contrary view the Annals of Internal Medicine for those who don't know is really the the signature Journal in internal medicine and it's are actually also the publication from the American College of Physicians home if you go on to the American College of Physicians this e.p. or I do that is the premier organization for Internet and so I belong to that organization. So this is what that this study said unprocessed understate the title goes really quickly and processed red meat and processed meat consumption dietary God I reckon missions from Nutri Rex consortium what is recommended is that the panel suggests that adults continue current and processed red meat consumption it got a week recommendation with low certainty evidence it also recommended that they continue current processed meat consumption again a week recommendation lost in the evidence what is significant about that is that the major thing that they looked at was the preferences of people in terms of diet that was a major factor in these recommendations Additionally they said that people don't change anyway so let them go and eat their stuff that's really interesting read. So this is the challenges in nutrition science that we face the challenge an invitation signs are several I just want to read these quickly because we have so much interesting material to go over today the totality of the evidence includes randomized control trials epidemiologic studies who are studies case control studies and case series of reports as well as systematic with the use of better analyses so this is the type of data involved in decision science and when we go over the stuff today all the studies we go over will be under one of these categories Additionally the prospect of cold hard studies are the strongest observational evidence because the intervention which is the doctor exposure precedes the development of disease so that's me in that perspective there is a best every year patients are bombarded with the latest new miracle diet book that claims to promote health affect weight loss and reduce disease risks some of you have to hear your patients say I got this thing what do you think Doc So I do this or not right and they get really confused and so clinicians must have an understanding of the specific comment actually buttes of healthy dietary patterns to appropriately access the literature in this area if we don't really appreciate the common dietary recommendations and then we're going to kind of not do a very good job the last thing the significant when you look at challenges in nutrition science is the funding source oftentimes is the private sector and that is significant Ok Who can tell me what city this is besides my twin sister. She just bought her t.v. they've been over this is. Now Singapore it's not. Anybody else. The year. Would you say how come no you know the lottery guys are on the right continent but this is Bangkok and I show this picture just because this is actually in the middle here is a real I was out of like everything too but this is a ridge the river the ghost of the city of Bangkok for both our 29th wedding anniversary my husband I went to went to Thailand last year had the most amazing time on the planet you can have a better time any time anywhere it was amazing Now I show you this and my husband planned the whole ship he plans everything and he planned a 1st class trip that cannot be reproduced by anybody is awesome but I show you that city because I want to show you this whenever you look at nutrition studies what you're looking at is what does the overall skyline show you notice that some of the buildings are short some of them are medium height some of them are skyscrapers right this is you look at the nutrition literature what you look at is the overall skyline What is the strength and weight of the evidence that's pushed me you're really looking at when each individual study comes out and you grab hold of it you may want to look at other studies and say how does do these studies fit in with what is the body of the whole literature All right so what I'm going to cover is this and this will only be in in in certain points here consensus views are nutrition What do Americans I was there take the pills are I give this talk in. The Philippines a couple years ago. And so I really miss my just a level just points to it as literature's increase but we're going talk about cardiovascular disease and insulin resistance and briefly hit on cancer in the interest of time this material really takes probably a couple hours or so hour and a half to go over so when we can get we're done in an hour we're going to cover that can be very fast paced and so it will be on p.d.f. the people can get that and key points about macronutrients and so forth so what we're going to do is this works really nicely for a far more wide variety of audiences and so the framework we're going to look at this as at this nutrition science is the framework is going to be where we will call the red box foods the yellow box foods and the green box foods so what does that mean. If you look at these studies the red box foods the weight of the evidence and the broad consensus is that these foods promote harm it is very difficult to find a paper that will say contrary to the fact that they produce harm the green box foods foods where there is broad consensus in the literature that these foods are health promoting it's very difficult to find a study that would say that these foods are not health promoting the yellow box foods are where the controversy is the yellow box foods in fact are they look good compared to the red box foods and we point you are to something here very significant border which I had appointed anyway I met might have come unprepared but anyway. No there's nothing like this I guess there we go our uses So so when you look at these You're about to do just a little bit of an aside you see this right here eggs. The dietary guidelines advisory committee in 2015 said that you know if this is the initial pass this said that eggs are fine because dietary cholesterol ingestion affects the serum cholesterol very little it's usually saturated fat and trans fat so go ahead and eat eggs this was the initial statement with that the the media picked it up and said butter is back well when they finally published their 20152020 guidelines they said actually we should limit that mission is it that much right and then when you look at some studies in cancer on whole milk and we won't be able to get to cancer I'm pretty sure but looking at home look in January of 2018. In the journal prostate there was a study that was published that whole milk probably contributed to the recurrence of cancers and also in if the man is obese so there's lots of stuff so these these yellow box foods really are debatable what we know in America is that the majority of people derive the majority of their calories from red and yellow box foods that's where the majority of Americans spend their time eating so we're going to be looking at that. First of all we're going to look at processed meat any processed meat is any meat it is done something to cure all smoke from mentored whatever it includes all those things hotdogs Bologna's sausage all that stuff this is processed food Ok We're going to red meat Reg meat is any mammalian muscle meat so pork is not the other white meat any mammalian Muslimeen is is red meat Ok We're going to skip added sugar because it's fairly. Easy to go over but refined grains. Has anybody heard the carbs are bad for you. Ok there anybody did Tony carbs carbs are bad this is one of my soap box items so 1st of all have a good look at is the anatomy of a grain the number when the grain has 3 parts the bran the germ and the sperm This is the whole grain on the left of my left we see the whole grains you see the wonderful clean water under similar grains. Is but taluk seed but functionally it's a green So these are very excellent things in there to totality you can see that if they have all these parts that's a grain Now the problem is if you deplete the the grain of the bran and the germ you end up with a very nutritionally depleted product but just the end of it has 80 percent less fiber and 80 percent less nutrients Ok so how if you think this looks like a wonderful slice of loaf of bread looks good doesn't it right Ok so what's the issue go with this loaf of bread busybody washer out what's the issue with this loaf of bread. And bleached Ok so this is when you see wheat bread multi-grain 7 grain bread this is a marketing trick to get you to think that this is healthy bread now the question is how do I know what is this product if you see an bleached enriched That means that this they have taken out the good stuff by refining processes now they've added back 7 grains to what they already depleted. So you recognize that the only difference between that and white bread is that it's not bleached that's the only difference so what you're looking for is when the the 1st point I want everyone to take away from here is when you go to buy bread in the store you get the 1st word you want to have after ingredient is the word whole then you know you can buy a whole Ok this is whole buy it if it says and bleach don't buy research and wished don't buy it all right that's the 1st thing and I have a couple story so why why is it that carbohydrates have such a bum rap if you look at the my left hand side and your left hand side and your right hand side on the left hand side is green box foods on the right hand side is red box foods and so why would you want to lump lentils with candy as they do recover hydrate or why would you want to lump foods with Fruit Loops it doesn't rude and so couple hydrates what I tried to do is to get people to stop saying carbohydrates and instead talk about whole grain or refined grain it's much more clarifying for people when they begin to appreciate that now. Also processed foods these ultra processed foods are industrially prepared they are scientifically engineer to keep people coming back for more Additionally they are highly palatable highly palatable How do I know. I'm a human being that's no no no. At this point I'm going to give everybody us poilus allude. There was a very nice article it was actually a viewpoint that came out actually this is great this came out in Jama October 22 who could tell me what October 22 is is the great disappointment on October 22 publishing Jemma of this is just Mother week ago they published an article on p b m a who could tell me what p.b. m a is Richard healthy to my p.b.m. ears. To hear somebody plant based meat alternatives. Guess which 2 products they picked specifically in this article. Who said that my colleague might have eaten Moonstruck grapes before these are delicious and guess what you get the bag of Moon drops Krige I. Don't like. So guess what if the impossible burger and Beyond Meat those are highly processed it is true they are using plant protein one is using soit as the using p.b. on meat is using p. the impossible because using So a protein but these are highly processed food the upshot of it is do not think that just because it's plant based does not mean it's a process and carries the same problems that the others do is interesting as anybody even a possible. Does anybody like a possible book I can't stand it I get I thought something is wrong with this they added him to it. Now we don't we don't know if the hearing that is dangerous to talk about as we go along is this is the you know the human meat is dangerous we don't know if the plant he was better not but we do know that he causes cancer and so that impossible burger is impossible don't eat it Ok so these foods are highly palatable and my recommendation is impossible to eat them now this is what I was talking about the dietary guidelines advisory committee the dietary guidelines advisory committee is a team of nutrition scientists those nutrition sighters come together every 5 years to determine what should Americans eat but I told you but the egg situation that happened already when they published the guidelines right here for example they sell a diet higher in plant based foods such as vegetables fruits whole grains grooms nuts and seeds and lower in calories and animal based foods the media and missed this fact and said but it was back eat eggs no problem but it is more of health promoting and is a source with less environmental impact than is the current us diet every 5 years these guidelines are published and this was published and we're due for a new set of guidelines in 2020 well like this nutrition writer eat food not too much mostly plants and that's what we're supposed to do and this is a secular guy that wrote this so what is a plant based diet I try to get away from words like vegan and vegetarian because it is very very very what they actually mean. So plant based diet means that one to Rives their calories for the most part from health promoting foods they eat in a green box and it's anywhere from 80 percent to 100 percent and the plate is prioritized in a in a green box food area and look at all those nice wonderful things that we get to eat now the Mediterranean diet let me just say something about the measuring people think about this kind of thing we think about the the the Mediterranean diet the Mediterranean diet actually comes from 3 areas. Greece Crete and southern Italy and that particular geographic area people recognize that the that that population of of people had less access to health care yet they lived longer and they had less chronic disease so people said let's study these people and see what is it about them they have no health care they have no common diseases they're living longer and they discovered several things this diet is not homogeneous it changes by region so it's really an issue of geography and time that determines the Mediterranean diet so if you look at this year for example and you see if I can get this find the point of. Can't find the point you know. They were Ok so so based on. Traditional doctor patterns and these people the food they got points for eating grains beans fruits vegetables all of the fish and a small amount of wine and they lost points if they ate meat including poultry and dairy products there were 2 major trials one of them was the premier trial which is the primary. Prevention trial pretty familiar with the premier trial and the issues surrounding that that study it was published in The Journal of Medicine like in 2016 or so and then it was republic again in 2018 because there was issues with randomization families was thinking I'll just talk myself wanted this and this group it up in randomised to that particular group but the problem and study there were several arms one of them was nuts the other was olive oil the Leone heart study was this secondary prevention trial and so that's really important so this is what was found there some of the 3 papers I'm just going to bring up here. And especially when you look at this paper right here when they deconstructed the results of the Mediterranean diet what they found was that more plants better outcomes. More meat worse outcomes and fish all of all alcohol were not the primary benefit in other words the benefit was related to plant based food particularly this was when the digger tried that here and study it in particular. So that is really significant is the plant based products that that which we the benefit is derived from so that's really significant. Here's a quiz now I'm going to have a show of hands Ok. So which of the following is the number one source of calories among Americans aged 2 and up Ok so sugar sweetened beverages Ok are some dessert. We have to hand my twin sister who's with my luncheon for inside and Ok and breads bagels and rolls Ok couple for best bacon rolls and cheese and cheese products Ok Great Well the answer do you like dates. The answer is deserved. It's dessert Ok so. You get some I love dates you're welcome Ok and. So the 1st thing then is grain base desserts cakes cookies pies cobbler sweet rolls pastries donuts I don't like donuts by like pie. And I love cookies almost any kind of cookie will do. Ok now what is number 2 what is post number 2 is all right number 2 is breads Now having said bread i hate of says bread it Mr c. we find bread right this is white bread rolls mixed going but that's the that's that nice brown thing that unbeaten reached on it and then flavored bread I don't know there is a pumpkin bread I don't know and big goals now what is number 3 what is posed number 3 is. So who said somebody said. Cheesy but you chicken it's chicken it's chicken. How many chickens 1000 how many chickens are eaten every hour by Americans. Over a 1000000 chickens or even every hour almost 25000 chickens or even every single day by Americans how many of you have ever seen a chicken truck with a big thing going on the road and those who are like doesn't unleash all the kids and let the chickens out you really do and you see the feathers flying it was a sight for those poor chickens Sturgill chicken a magazine a large chicken Ok what's the most number number for. Research. Sugar sweetened beverages Now what is number 5. Is not. Actually before in the room someone said it. It's pizza and pizza is in his own category. So this is interesting if you look at this list here on the board what we noticed is that the majority of Americans are deriving their calories primarily they are prioritizing their plates on what box foods and yellow box foods what we aren't eating is killing us that's what does govern the global goodness disease study Additionally I'll show you this this interesting graphic and what you'll see here is what they say is 70 percent of our calories come from processed and actual processed food now let me show you this so this year is obvious this is the industrial produced stuff 58 percent you see all the stuff there including pizza soft drinks and stores so forth like that. 30 percent is supposed to be the healthier one because this is that also because the un process or mini processed food when you look at this do you notice that 40 percent is meat milk and eggs that's still bad and then 40 percent then is the root vegetables but the fruit includes fruit juice and then that the top that 12 percent is added see the sweetness of animal fats and so forth essentially if you really break this down probably maybe 10 percent of what we eat has any good for us whatsoever so that's really important so what we're going to look at them now we're going to change gears to make a look at. These entities will cover cardiovascular disease and insulin resistance. For sure and I would just make a brief word on cancer because we won't be able to get to obesity in the macronutrients in the time that we have the 1st to me look at this cardiovascular disease and this study here from 953 Jama was around all that long this is what really got us on to things so if you look at the current arteries of a lot of us in the room I love most of coronary disease and this was taken from this soldiers that saw action in Korea u.s. soldiers the action in Korea these u.s. soldiers the average is about 22 point one years old and 77 percent of them had Korea resists and when they did the autopsy saw a very significant and then of course we're very proud about of the blue zones because here we see Loma Linda many of us trained at Loma Linda Medical School and dental school and others and so forth. But these are the Blue Zones and as you look at the blue zone areas you recognize that these people enjoy extraordinary longevity and what is it that binds these blue zones together it is really what they eat in particular is the lagoons and all these kinds of things that really bind them together if they have like poaching meat and eggs of it's under the. Proof of the plate and it's on special occasions like holidays and so forth so that's just what really points these a blue zones together again what we're going to look at is. How these red box yellow box and green box foods affect cardiovascular health that's how we're going to look at this and this particular study right here so red and processed meat in the 2 thousands red meat. Began to be recognized by the World Health Organization as a public health crisis if you were to put in Pub Med red meat in 1970 you get 8 hits on red meat and put in Pub Med I put into Pub Med this month this by the 10 days or so I put it I just had me try red meat almost $7000.00 articles came up with me and red meat there are several different things that you see here remember the global study of the Go burden of disease red meat really favors significantly and causing harm so on the contrary if you eat a meat list. The benefits are significant. Dr Keith this German I hear is from Oxford University he's an epidemiologist He is also was also involved Oxford study as well but what you see is that those who who eat a plant based diet and joy significant benefit of reduction in mortality incidence of a kind of vascular disease as well as mortality from from Carry vascular disease this study right here was a systematic review unmet analysis and this one was it was a prospective study as is this but this study you're also looked at cancers in patients who had meatless diets and the risk of cancers was significantly decreased a monster those who plant based diet as opposed to a guy that was in animal products. This is awesome stuff so the question is what is it about these red box foods this meat that causes problems. And it turns out that the gut microbes is extremely important with with what we eat it has inordinate effect on our cardiovascular health there were at least 4 people that I used as I looked at this this data one of them was it was published in Nature in 2011 that was a very elegant study and that one in miniature. Gave people some stuff this material about to tell you about and what was happening to people was they were measuring this substance that we're going to discuss now plus cholesterol triglycerides and glucose so what happens then when somebody eats and you see here cheese and eggs so cheese and eggs and some sort of meat. Cheese and eggs and also fish there's something called Foster title coli and meat there's also carnitine the 1st Mattel call it can also occur in meat as well what happens when you eat that where you eat that the gut flora the world then. Digest there change that into trimester meaning it goes to the liver and in the liver it is oxidized to try Muslimeen and oxide. Trimester mean and oxide is the substance that is very pro inflammatory in fact it increases played a Geisha and several other things and results in cardiovascular disease so if you if you look. At this particular substance try methyl the mean and oxide you can actually predict 30 day mortality or incidence and recurrence of cardiovascular disease so what they didn't in the journal Nature as well as in the journal jagged joy American College of Cardiology published in 2017 did a very similar research and would give people one little tablet they tried to get the track to convince Vigen vegetarians to eat a steak. What would you do. They didn't either Lou said they give me a tablet one tablet and and check this t.m.a.o. to see if it was if it went up or not and the fact of the matter but just this one dose nothing happened they didn't increase at all but in nature and the paper inject they give the people also in the union the men's They give them significant over like 2 months or so more of the substance orally and some they give eggs to. And those pinched those people actually developed as a squad of vessel disease so it's a very significant thing and when they measured cholesterol total cholesterol l.d.l. cholesterol triglycerides blood sugar those did not change what did change was t.m.a.o. there is something about the interaction of this meat with the gut microbiome that produces this toxic substance that causes the vascular disease fascinating the Cleveland Clinic actually is the only place you can measure this you can send somebody blood to the the Cleveland Clinic so much that American fashion Emergency Department sends a sample up to the Cleveland Clinic they run it and tell you what the chance of them developing an event in 30 days is very elegant wood. I'm not going to let you go off the table and I want to be very answered tell you my weakness does anybody know my wishes for my twin sister my weakness is sugar you know I think I blame my parents for that. When we were immigrants when we came to the states but my parents are plant based but it's going to crazy plant based it was like nothing that tastes good is good for you. So we never had sugar My mother still can't make this and she keeps worse to me I can make it as a mom you cannot make it but didn't give us a dessert when we tasted Sugar Sugar is highly palatable and I think the majority of the 5 of us siblings. Enjoyed sugar except I have one brother that was in the buyer of this now what is the most. Dangerous aisle in the supermarket the cereal aisle look at this beautiful ray of colors of all these cereal boxes amazing Other tell you a funny story. I was in the grocery store. I need to go does she tell another interesting about this nutty this one 1st year I was in the grocery store and this little I don't know she thought I was this nice little old lady. Looking very puzzled here to me with a can of of beans and she said can you help me and I said well sure many of you needed are you shopping but I don't know I said What do you mean she said well I was just diagnosed with with diabetes and the doctor to me I can't eat salt what Bush be should I get I said Well do you have hypertension she says No I just have diabetes I use Are you sure you don't have snow she was our diabetes I said Ok ma'am listen to a bit of a listen with her about canned food and salt in general but not in I don't know what to tell her and so she said to keep hopping and she got some other kind of beans and she looked been so good for you. No you come to the cereal aisle. And she's in the cereal aisle. And she's walking up and on the cereal aisle she says to me ma'am can you help me get what she wished i get i said none. Of them. And the fact of the matter is what she said was I guess a meal as opposed to I don't like oatmeal but by oatmeal is good for you what these 2 studies are really important because what they tell us is that both of these tell us that and let me just add some numbers on here. If you look at the hazard ratio for various percentages of sugar intake the average American eats at least 10 percent of calories and sugar simple sugar and it can go up as high as I don't know what but if you eat 10 percent of your calories in sugar versus 25 percent of the calories and sugar the hazard ratio changes anywhere from 1.3 to 2.75 that means 30 percent more chance of getting kind of Us disease to you know the 3 times that I'm out of it in sugar if you eat 10 percent you know we talk about number need to treat look at number need to have 10 percent of your calories and sure that number needed to harm is 265 another words one person and 265 to 65 people eating 10 percent of the calories and shouldn't well end up with kind of vascular disease where is the number to you to harbor 25 percent is 22 people that's significant right and so so sugar has this has a significant effect on calorie vascular disease so again if it is good don't eat it so here we see this was published in circulation and the recommendation from the American Heart Association for sugar you need to account for women it's 6 teaspoons of added sugar a day that's not a whole lot. Less like I'm up for something and then it's 90 spoons a day. And saw the pop record $21.00 saw the pop 50 years in the in the so the pub the average American is $23.00 teaspoons of sugar a day now for us of the Adventists we love to say I don't you shouldn't I use most of the stuff you're called a garbage. Now but we see you should always the government mom used to have us she had us fooled she said she was Are you sure this uses honey while honey is on the list and she used to can imagine sweeping Limaye with honey you know it. It was you can take it anywhere. And some issues brown sugar you say maybe we can't take that anywhere but here with all this stuff is the same it's still sure added sugar so that's an important. This really relates here to. Trying to look at the dose response. Ratio for fruit if someone's going to eat fruit and vegetable intake and in impact cardiovascular disease what dose of fruit do you need and some patients need to speak in terms of dos because that's all they can think about to eat all this stuff this was a very elegant study actually and what they found out in this particular study that was published in the international journal epidemiology Does anybody here know 60 tons that anybody know 60 times that his wife was one of the she's an incredible research in this area but she looked at $95.00 studies worldwide and it turns out that 2 and a half servings per day is what you need the greatest part of the curve is between that going from 0 to 2 and a half if we can get patients to go from 0 food a day to 2 to half a day there's a clinical benefit in doing that and so today half a day is this I tell people to do half a day is a small banana an apple and some broccoli small banana Apple and broccoli that's what you have to eat to. Minimum when you look at cancer research then they say 7 fruits a days what you need but the benefit is significant so 8 percent to have servings decreases the risk of course not resist by 8 percent strokes 16 percent and all cause mortality 10 percent so very significant It turns out that this right here the whole grains whole grains actually seem to have the maximum benefit on cardiovascular health and anything in that people in the global burden of disease but I didn't tell you was that. In terms of worldwide whole grains are responsible for the greatest number of deaths the lack of them the grave wisdom of deaths in women worldwide the lack of whole grains in men it turns out it's fruit and high salt and then 2nd after that is whole grains so whole grains are important and that seems to have the greatest benefit of health although all these items fruits vegetables everything this is going to be disappointing sly for some of us because plant based diets can be healthy and unhealthy and so this is the group from the Harvard School of Public Health they've done a tremendous work and they look at 3 groups of studies all the time Nurses Health Study one and 2 and then the health professionals follow up study 4800000 person years that's a lot because over 20 years over 200000 people were involved in this study so over 4800000 person years of follow up plant based diet so the whole thing is part based diets are good what they decide to do is they did they were getting didn't look great so the question is was unhealthy was healthy plant based diet so we don't know what's all that healthy is the only healthy though is those mashed potatoes for Thanksgiving that's about to come up next month and French fries. Angelou's and potato chips these are not good so all these all these things these are these are unhealthy plant based type look at the data on that when you separate these things you see these lines here this red line here this is the healthy plant based diet if you loved them all together overall you look as if there's no little benefit to eating a plant based diet but when you look instead at the healthy plant based diet you actually have a 25 percent reduction in kind of vascular disease incidence worst with the unhealthy plant based diet give a 32 percent increase in carry vascular disease these cannot be lumped together we're talking about healthy plant based versus unhealthy plant based diet now this is one of my most favorite things on the planet why what is it about plant based food that confers health what's the mechanism so. First of all it replaces disease promoting foods which is very good but in their own right these foods function as accidents there which in fact are chemicals and polythene also which are will be really good in. Reversing disease now I'm going to talk to you about improved and with your function in a minute but they also reduce inflammation the alter the got the microbes I talked about before the way the food interacts with the got the gut micro biome it lowers the blood pressure via hyper Tasm low potassium it decreases leopards let me tell you a story about this and the theory function issue. And a resident I have to read to reserves one of them was a vegan wonderful guy very persuasive and there was another resident brilliant guy he was from the University of Kentucky we're in a higher being knows where in Ohio. Well one California. They lost the people in Southern California. And the last people in Washington State it were I come from. Both of all high Oh and this resident was from the University of Kentucky so this resident this my other resident who was an Adventist certainly know something I think you stop eating meat I think you should go on a plant based diet try for We've got none in America do that I'm going to diet I'm from the south you know it been potatoes there was no need to try this it is a plant Mr I just for one week so finally this resident from Kentucky said Ok I'll try it are going to plant based diet for a week now this happened about 4 or 5 years ago. So after the week was up this resident give to me so you know something oh by there told you the guy was he was brilliant he came to me said You won't believe this my mind is clear and I was like I wonder why I don't understand I really don't understand never always been plant based why I don't as a robot can I do to make my mind really really clear so it is that I'm my mother's I had no clue why is my was so cleared up until I started this thing here. So all we all know that endothelium is really highly tuned piece of ore body and endothelium produces nitric oxide. If you do something to damaged in the field it does not produce that. It turns out that every fatty mil you eat is pro-inflammatory and what happens is normally in an open ocean the endothermy produced actual oxide that will dilate a lot more blood flow and so you feel good right. And but when you eat a pro-inflammatory that a duck that's high in meat and cheese and all this kind of stuff and beef and I don't know terrible things. It actually causes visual constriction of your blood vessels for at least 5 hours so you go to lunch let's see it breakfast and the 80 big can cheese and something else on a roll. And there by this point some to response the blood vessels constrict what happens in 5 hours. It's lunchtime and then they eat all the same stuff all over again I see most of the doctors large makes my head spin I'm not even going to eat that much that one day. I was so concerned I saw this doctor reaching for something to eat I said that is going to kill you in an hour and he looked at me like I was crazy. But I mean it's this is like. Losing with things and I was like this is really bad so in 5 hours eat the same thing again and you get more shut down right and then another 5 hours eat. None of us think about what the blood vessels are doing on an hourly basis we always think of course I resist in terms of the life time thing we look at over years or months where we don't think about the hour by hour regulation of our blood vessels to allow us to the store for the function so this pro-inflammatory thing is very significant and when I figured out there was nitric oxide that was causing the problems there's some other proteins also called new 5 g. c. that's also the pro-inflammatory thing plus the Chimayo when you add the lack of nitric oxide t.m.a.o. and new g 5 g c All these things your brain is not functioning there's some guy. In London or London knows something's got talent what's the program Something's Got Talent that guy that runs that program who. Ok yes he went plant beast you know what he said the 1st thing he said was My mind has cleared up there's something about that if we have one reason as 7th Day Adventists to be plant based is that the Holy Spirit needs to talk to us and if it is possible that this stuff is making our minds clogged up so we can't even think we need to abandon it and go to a plant based diet this mechanism to me was just opened my eyes it was just astounding that there was actually a physiological reason why the. Rosen said My mind has cleared up so I think that's really significant look at multiple randomized controlled trials have demonstrated the benefit of a vegan diet a plant based diet and soy nuts and fiber and so forth and if you look at all that the benefit in decrease of total cholesterol as well as the l.d.l. cholesterol is significant I want to make a comeback with nuts I love nuts my sisters were talking today my family has not somewhere in a genetic pool my family loves nuts I can eat nuts by the gallon just reached my whole fist in then grab not eat all day long but I got to be got to monitor that because they're very calorie dense and so that's the issue there all right let me skip a lot of my what's the problem let me just just this this was published in a wonderful Journal in Jack also recently and I just want to point to this juicing thing because the bee is a question about juicing. Juicing the data on juicing is mixed but especially if you remove the pope then it is not recommended if you lift the poppy hind again the date is still mixed there is no strong data on juicing In other words the studies have been done and juicing have not been compared to a raw plant based diet or other things like that so it's very difficult to tell if there's really significant benefit there are not Ok and we talk about nuts on so forth and that side I'm going to talk about one of my favorite topics now which is insulin resistance if there is a disease that we have to deal with every day is into this it's diabetes and instrument systems and I believe that the diet that is best for diabetics is not understood by the majority of physicians So again we can look at the same framework the red box foods yellow box foods green box foods and we see how those foods really apply in this particular disease. So half of a dozen us have diabetes or pre-diabetes and I'm just going to use this this this banana to symbolize fruit. What happens when you eat a banana. Piece of fruit So 1st of all the glucose goes up and then. Insulin is singled and it binds to the scepter and through a series of into cellular intermediaries good for goes to the surface and takes in glucose. Let's say now that somebody develops diabetes and that person that has diabetes eats a banana. The blood sugar goes up. It's signals insulin but insulin is not acting and so the blood sugar stays up and now we blame the banana. Is it the bananas fault. The banana is an innocent bystander Now the reason I get my well tip when I talk about this is this right here one of my colleagues who have worked with now for a very long time. Almost almost 3 decades told my residents all the residents that food is bad for everybody why it's fuck those offered to us is bad I said but that's not true you see an issue is that's not true I said this to me a fiver and I missed it when you left I said I made a presentation about food as medicine to my residents so they begin to get the point but this is this is really important. So what is it that causes insulin resistance is it the is it the fruit or what is it exactly so this is what's happening when you eat the banana it still is production of insulin insulin Baxter's with terrorist in kinase which then 1st for all it's the interest cellular insulin receptor substrate that then bang stew and activates a significant protein fast to tell him not all 3 which then so more intimately Aries sense glued 4 to the surface and insolence taken up but there is a problem inside the liver cell or the skull to a muscle cell and that is the accumulation of fat. Lippert subtypes you know what these are these are these are diets or glycerol are skipped is slightly in the middle of the time just to show this this position it was at Yale and this was published in The New England Journal of Medicine in. 2014 and this was in Nice research Additionally there's a diaper tulle just at the University of Texas and Antonio Dr out of funds Oh and he's done a lot of work he's an international diver totally done a lot of work in this same area that he had the same thing what happens now is fact accumulation. In the skull to muscle and the liver cells and basically what you end up having is in some assistance in the skull to muscle this decreased glucose uptake and in the liver you now have gluconeogenesis and very little glycogen to Belo glycogen Genesis so so this is the issue that causes this problem and so at a positive excess calories excess dietary fat inflammation oxidative stress Marikana dysfunction all these things are what is causing the problem is the fact inside the skull so muscle and the liver so that is causing the problem it is not the fruit so it is really not evidence based medicine to tell a patients not to eat fruit I had. An experience recently it was like. This happened in August I was on the was I was attending on the word and my resident just came out the room shaking his head because I had a 29 year old young man that was. Was he had a very very bad bad diabetic foot infection was he had died b.c. was very obese and he was pregnant loses foot so the resin came other mustard whoa this guy is not compliant he keeps asking for fruit. I said Give the man his fruit couldn't sleep for it. And I thought I give him a whole lecture I don't know that they really are appreciate my lecture but I give a lecture and nonetheless Ok so the question then is what is it that really causes insulin resistance if you look at the data processed meat is the greatest cause of insulin resistance because of the excess fat that you find in this in these meat and if you combine these 2 together these 2 camps together do far outweigh the sugar sweetened beverages in causing diabetes and into assistance this really is the problem now let's look at this here again if you look at this live this shows you all the various mechanisms that cause. The cause of type 2 diabetes in some resistance the branch to the middle acids increase saturated fats. At vast like Asian end products there is the he I and I talked about the impossible burger that's got him and it also cost I mean is a direct carcinogen and that's what's fun and meat. Media was brought by. A website dedicated to spreading God's word and audio and much more if you would like to know about.

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