scott e. wagnon pa-c oregon medical group internal medicine … · 2018-10-03 · have patients...
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Scott E. Wagnon PA-COregon Medical Group
Internal MedicineEugene, OR
Dictionary: The state of being free from illness or 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
occasional 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 of 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
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