Scott E. Wagnon PA-C Oregon Medical Group Internal Medicine - - PowerPoint PPT Presentation

Scott E. Wagnon PA-C Oregon Medical Group Internal Medicine Eugene, OR

 Dictionary: The state of being free from illness

• r injury.

 “Good health is a way to get more out of your

life-more energy, more enjoyment, more potential, more purpose, more life.” (Sidney Garfield M.D. founding Physician of Kaiser Permanente)

 What we eat  How we deal with stress (emotional resilience)  Good sleep  Loving relationships  Social connections  Purpose in life  The chemicals we use (medications, tobacco,

alcohol, drugs, etc.)

 Dictionary: The condition of being physically

fit and healthy

 Is it possible to be physically fit and not be

healthy?

 2012: Riding my bicycle 7,000 miles a year and

could easily ride for 7+ hours (100 miles a day) multiple days in a row

 Most would consider that being physically fit

 43 year old male  BMI: 29  BP: 138/92  Total Cholesterol: 210  LDL: 105  A1c: 6.2%  Daily IBS symptoms  On no medications

 What did I do?

 Studied Nutrition  Why did I start there?  Felt like I slept well  Cope fine with stress  Good marriage, family life, career  Not on medication, no tobacco, drugs, only

• ccasional alcohol, and plenty of exercise

 Graduate level nutrition textbooks  Medline search of the peer reviewed nutrition

studies and articles

 Larger nutrition studies

 Harvard Nurses Health Study  EPIC Study  Adventist Health Study 1&2  China Study/Project (Population Study)  Lifestyle Heart Trial (RCT) (Dean Ornish)  Longitudinal Study (20+ years) on reversing heart

disease (Caldwell Esselstyn Jr. M.D.)

 Food is personal

 Food is Mom, Grandma, culture, social, religion,

comfort, memories, feelings, emotions

 Nutrition is a science, and science is not personal…it

is what it is

 “Science is defined by the scientific method; it’s an

unbiased search for truth and a willingness to be proved wrong.” (T. Colin Campbell phD from his book titled, “Whole”)

 First we must discuss two Paradigms

Reductionism Wholism

 Looking at single chemicals  Single nutrients  Single mechanisms  Most often evaluated in Randomized

Controlled trials (RCT’s)

 Good for Pharmaceuticals  Many advances in Science as a result

 Multiple Variables  Thousands of Nutrients  Thousands of Mechanisms  Evaluated in Population studies and dietary

change experiments which are weaker levels of evidence as you get mostly associations

 Association does not prove causation

 But, when these associations are shown over

and over, for example when 19 out of 20 associations point in the same direction, they are highly likely to be true

 Nutrition is a Wholistic science

 We get more data and information on how things

work from Reductionist studies

 We get more knowledge and wisdom from Wholistic

studies

 Most of the large nutrition studies are

Wholistic studies (Population studies, Longitudinal, Observational, and Dietary change experiments)

 Exception: Lifestyle Heart Trial by Dean Ornish

M.D. was an RCT (1990; published in the Lancet)

 It appears the closer you move toward a more

whole foods plant based diet, the lower are the rates of chronic disease

 The closer you are toward the Standard

American Diet (SAD) diet, the more likely you will have a chronic disease

 Whole, unprocessed plant foods

 Vegetables  Fruits  Beans, Peas, Chickpeas, Split Peas, Lentils  Potato’s, Sweet Potato’s  Intact Whole Grains (Rice, Oats, Quinoa, Bulgar, etc.)  Nuts and Seeds  Herbs and Spices

 Meat (Beef, Pork, Chicken, Turkey, Fish, Other

Seafood)

 Processed Meats (Lunch Meat, Hotdogs, Bacon,

Pepperoni)

 Dairy Products (Milk, Cheese, Yogurt, Butter, Sour

Cream, Cottage Cheese)

 Processed Foods (Chips, Cookies, Pretzels,

Crackers, Donuts, French Fries, Ice Cream, Refined Sugar and Flour Products)

 Fast Food  Sugar sweetened beverages

 Yes and No  A Whole Foods Plant Based diet if you are

following it 100% is a Vegan Diet…but a Vegan diet isn’t necessarily a Whole Foods Plant Based Diet

 Many Vegans eat a lot of processed Vegan

Foods (Chips, Donuts, French Fries, Vegan Bacon, Vegan Sausage, Vegan Ice Cream, Lots

• f added oil, etc…)

 Started making changes toward the “Plant

Based,” Plant Strong” end of the Spectrum based on my health goals.

 Tastes change over time  After a year doing this myself, I then started

recommending it to patients

 Whole plant foods are low in calorie density

and high in nutrient density (weight loss)

 No calorie counting, weighing food, counting

carbs, portion control (don’t have to be hungry)

 Get all the protein, including all the Amino

Acids you need

 Loaded with vitamins, minerals,

phytonutrients, fiber and “good” fats

 Sustainable way to eat from an environmental

standpoint

 Made by bacteria in the soil

 Dirt on food, drinking stream water

 Animals are the “middle man”  Is this a problem?

 Even Omnivores are often deficient secondary to

absorption issues (lack of Intrinsic Factor/PPI’s)

 Take a supplement (2,500mcg SL per week)

 Position statement from the Academy of Nutrition

and Dietetics (2016)

 2015 USDA Dietary Guidelines Advisory

Committee

 American Diabetes Association (2018)  American Association of Clinical Endocrinologists

(2018 Guidelines)

 The American Institute for Cancer Research  The dietary guidelines of Sweden, Brazil, Canada,

Germany, Qatar, Netherlands, Denmark, Finland, Iceland, and Norway

 In 2015 classified processed meats such as

bacon, sausage, hot dogs, lunch meats, etc. as Class 1 Carcinogens (Definitely cause Cancer)

 Which is the same classification as Tobacco,

Asbestos and Plutonium

 This was released to the public and medical

profession at the time.

 How many of you were aware of this?

 In the summer of 2017 the AMA unanimously

passed a resolution to eliminate processed meats from all U.S. Hospitals

 Offer Plant Based meals

 Have patients watch the documentary, “Forks

Over Knives”

 There is a new documentary about to come out

called “The Game Changers”

 Plant Based Quick Start Guide from the

Plantrician Project

 Resources list full of websites, cookbooks, other

articles and free resources

 Teach about Calorie Density and Food Label

Reading

 Two 30 minute appointments per day  Bill for time (99214)  Class B Recommendation per the United States

Preventative Services Task Force (USPSTF) published in the Annals of Internal Medicine, Oct 2014

 Covered diagnoses include Diabetes, Pre-Diabetes,

Hyperlipidemia, Hypertension

 Most of our patients , right?

 43y/o male  Meds: None  BP: 140/90  Weight: 218lbs (BMI: 29.6)  TC: 210 LDL: 105  A1c: 6.2%  Started moving toward a Whole Foods Plant

Based Diet

 1 Year Later  Meds: Still None  BP: 110/60  Weight: 172lbs (BMI: 23.3)(-46lbs)  TC: 110 (-100pts) LDL: 50 (-55pts)  A1c: 4.7% (-1.5pts)  Feels Great!!

 55y/o Male  Type 2 Diabetes, HTN, Obesity and

Cardiomyopathy

 Meds: Glipizide, Metformin, Lisinopril, ASA,

Carvedilol, Toujeo 300u/mL at 12u qhs

 BP: 110/70  Weight: 226lbs (BMI: 30.7)  A1c: 13.8%

 6 Months Later  Off Toujeo, Glipizide, and Metformin  Lisinopril reduced from 40mg to 10mg a day  Still on Carvedilol and ASA for

Cardiomyopathy

 BP: 122/82  Weight: 206lbs (BMI: 28.0)(-20lbs)  A1c: 7.4% (-6.4pts)

 64y/o Female  HTN, Prediabetes, and Obesity  Mostly wheelchair bound secondary to her

weight and bad knees

 Meds: Lisinopril, Furosemide, Spironolactone  BP: 160/98  Weight: 367lbs (BMI: 59.4)  A1c: 5.8%

 9 Months Later  No Med changes  BP: 128/84  Weight: 328lbs (BMI: 53.1)(-39lbs)  A1c: 5.6% (-0.2pts)  Feels Great!!  Can now stand up and walk around as her

knees feel much better

 Scott E. Wagnon PA-C  Questions?  Feel free to Email me  sewscott@aol.com