Disease Reversal

and Prevention DIGEST A publication of The Plantrician Project

ISSUE 1 • SPRING 2019

A Community
Approach
To Health In
Midland, Texas

America’s Protein
Obsession

Weight Loss On A
Plant-Based Diet

PLUS
How to go plant-based,
improve your sleep
and be more mindful

Reverse
Heart Disease
With A Plant-Based Diet
Page 68
. Ross Willard Nielsen (rossnielsen@gmail.com)

Welcome to the first edition of

the Disease Reversal and Prevention
Digest, a companion publication to
the International Journal of Disease
Reversal and Prevention (IJDRP).
The Digest’s mission is to promote the advancement
of knowledge to the general public about plant-based
research, education, and use of nutrition and lifestyle medicine
in the treatment, prevention and reversal of chronic disease.
In each edition, we will interview the authors who have published in
the IJDRP about their articles so there is no middle man to interpret
the science. There will be no blogger or journalist putting a slant on
the research outcomes, just the truth and facts about the research in
terms anyone can comprehend. We believe everyone has a right to
understand the science that could impact their health.
Also, in our pages you will find additional articles and interviews about
exercise, wellbeing, stress management, mindfulness, financial health,
delicious and nutritious recipes, overcoming poor health habits,
regeneration of the ecosystem of food and much more. We will also
highlight a success story in each edition of someone who has overcome
serious health issues with lifestyle interventions.
Our hope is that this knowledge will empower and encourage you, the
individual, with the tools to lead a healthy life and share that awareness
with your friends, family and healthcare providers, further promoting
lifestyle interventions as the primary prescription for chronic disease.
Finally, I want to personally invite you to share with us what is important
to you. Share with comments on the articles, suggestions for further
interviews or articles and should you care to write for us please submit
an article. I will respond as soon as possible to each inquiry.
Sincerely,
Laurie L. Marbas, MD, MBA
Editor, Disease Reversal and Prevention Digest
Managing Editor, IJDRP

Laurie Marbas, MD, MBA is a board certified family and lifestyle medicine physician and has been
using food as medicine since early 2012. She is the Senior Managing Editor for the International
Journal of Disease Reversal and Prevention. She received her dual degrees (MD and MBA) from
Texas Tech University Health Sciences Center School of Medicine and TTU School of Business.
She was awarded the Texas Tech University School of Medicine Gold Headed Cane Award. The Gold
Headed Cane is a symbol for excellence in the art of medicine and in the care of patients. She is also
USAF veteran, wife, mother of 3 grown children, podcast host, author, speaker and avid runner.
 DIGEST CONTENTS Click title to jump to each article

Healthy Living Research from

4 Eat Well, Move More, Stress Less,
Love More – A Conversation with
Dr. Dean Ornish
8 The History of America’s Protein
62
Obsession – A Conversation with
Dr. Garth Davis
12 Mindfulness and Habit Formation –
68
A Conversation with Dr. Judson Brewer
18 Health Literacy and Cultural
Competency – A Conversation with
74
Dr. Richard Carmona
24 Tips for Going Plant-Based –
A Conversation with Julieanna Hever
78
30 Grit, Resilence and Flourishing Through
Traumatic Growth – A Conversation
with Caroline Adams Miller
The International Journal
of Disease Reversal and
Prevention
The Use of Plant-Based Diets for
Obesity Treatment – A Conversation
with Dr. Neal Barnard and Susan Levine
Reverse Heart Disease With A Plant-
Based Diet – A Conversation with
Dr. Themis Yiaslas and Dr. Saul Schaefer
Does Diet Impact the Risk of
Non-Hodgkin Lymphoma –
A Conversation with Dr. Shireen Kassam
Efficacy of a Plant-Based
Anti-Inflammatory Diet –
A Conversation with Dr. Joel Fuhrman

36 How to Improve Your Sleep –

by Sheila Hautbois
38 My Health Transformation –
by Mia Taylor

40 Creating a Safe, Efficient and Effective

Aerobic Exercise Program –
by Jeff Young Recipes
46 Lifestyle Medicine at Midland Health – 84 Curry Kale Chips
A Conversation with Dr. Padmaja Patel Spuds, Veggies and Greens
and Marcy Madrid Southwestern Black Bean Salad
Dr. Scott Stoll
87 Minestrone Soup with Vegan Pesto
Disease Reversal Spring Salad
Success Story Dan Purjes
52 Healing Autoimmune Disease 89 Quinoa & Chickpea
with Plant-Based Nutrition – A Tabbouleh Salad
Conversation with Dr. Brooke Goldner Julieanna Hever

The Disease Reversal and Prevention Digest

is sponsored by The Plantrician Project in
association with the International Journal
for Disease Reversal and Prevention.
 Healthy Living Interview • 1
A CONVERSATION WITH DR. DEAN ORNISH

Eat Well, Move

More, Stress Less,
Love More
The power of lifestyle change to prevent and reverse disease

DR. LAURIE MARBAS: We wanted to speak to you not only about

your work, but you have an amazing new book called Undo It and I
think it’s a very important topic to bring out. You have four tenets of
living a very vibrant and thriving life that I think our audience would
be wise to listen to. If you could just speak to what it is that you’re
seeing, how these lifestyle changes can reverse and even prevent
chronic disease, what are those?

DR. DEAN ORNISH: I’ve been doing work for 40 years

and I think our unique contribution has been to use
these very high tech, expensive, state of the art
scientific measures to prove how powerful these very
simple and low tech and low cost interventions can
be. People often think it has to be a new drug or a
new laser to be powerful, but what we’ve been able
to show is that simple lifestyle changes — eat well,
move more, stress less, love more — boom, that’s it.

LISTEN TO AUDIO WATCH VIDEO

OF INTERVIEW OF INTERVIEW

4 DISEASE REVERSAL AND PREVENTION DIGEST

The more diseases we study and the more
mechanisms we look at, the more reasons
we have to explain why these changes can
not only help prevent disease, but often can
even reverse it, sometimes in combination
with drugs and surgery, and sometimes
it’s a direct alternative to them. The more
diseases we study and the more mechanisms
we look at, the more scientific evidence we
have to prove that.
Wonderful. What do you mean by eat well?
What does that incorporate?
It’s mostly to the degree you can move
toward a whole foods, plant-based diet —
fruits, vegetables, whole grains, legumes,
soy products, as close as possible to how
they come in nature, which is pretty low in
fat, low in sugar. It’s not only low on the
things that cause us to get sick, but it’s
high in literally hundreds of thousands of
substances that have anti-cancer, anti-heart
disease, and even anti-aging properties.
Wonderful. That, again, is what we’re always
pushing our patients to do. We see some
amazing results, but also move more. We’re
not well versed on actually prescribing
exercise, as physicians. What, exactly, does
does the research show and what do you
recommend?
Before I forget, the Undo It book has over
70 recipes, but also lists two weeks of
commercially available foods that we
don’t have any financial relationship with
to really help you get started when it
seems overwhelming. Just eat these foods.
Because these biological mechanisms are so
dynamic, you’re likely to feel so much better
so quickly that you’re going to want to learn
how to cook and do these things on your
own. So, that’s eat well.
Move more is basically exercise. If you like it, because I’m doing telemedicine now, but
you’ll do it, so find a kind of exercise that you it works great.
like. To the degree that you can incorporate What about stress less? What do you
that into your daily life, you’re more likely to mean by that? It’s so easy to say it,
do it every day. I find that I run up the stairs a but how do you do it?
couple of flights. Just short little bursts of
exercise can sometimes be as important as
longer, more moderate exercise.
ISSUE 1 • SPRING 2019
Get a portable phone and
walk around your office
when you’re talking on
the phone, or your house.
Try to incorporate some
kind of strength training
and resistance training and
stretching, as well as the
aerobic exercise each day.
A little goes a long way.
Pretty much everything
that we can measure gets
better when you exercise.
Our bodies were built
to move.
And there are also exercises
in the book with resistance
bands, which are amazing, that you can
do at your office, wherever you are. It’s
a great book. You and your wife have
done a great job. Aerobic, resistance,
and flexibility, which we tend to ignore.
It’s a very important part of us.
“ By practicing some simple
stretching and breathing and
meditation techniques, just
even a few minutes a day, you
can be in the same job, the same
environment, the same family,
but you react very differently.”
Yeah, it’s really simple and resistance
bands cost like a dollar. They’re just
stretchy plastic. It’s easy to do.
Yeah. It’s easy, it’s portable. I use it a lot
5
“Love is probably the most powerful
force in our happiness, and in our
healing as well. Anything that brings
you to connect with other people is
really healing.”
People think you have to choose between an more. If you could share with us, what does
interesting life that’s filled with stress and you that entail, exactly?
die early, or you sit under a tree and you’re a
Well, love is probably the most powerful force in
lump and you’re bored and watch your life go
our happiness and in our healing as well. Study
by. That’s not the choice at all because the
after study have shown that people who are
stress comes not simply from what we do, but
lonely and depressed are 3-10 times more likely
more important is how we react to what we do.
to get sick and die prematurely than those who
By practicing some simple stretching and
have a sense of love and connection and
breathing and meditation techniques, just even
community. I don’t know anything in medicine
a few minutes a day, you can be in the same
that has that big an impact on our life, so we
job, the same environment, the same family,
tend to think of the time that we spend with
but you react very differently. It buffers
our friends and our family and our loved ones
the stress.
as a luxury that you do after you’ve done all the
People often say things like, “I used to have a important stuff. What these studies teach us is
short fuse and I’d explode easily, but now my that this is the important stuff.
fuse is longer, so I can accomplish even more
So, it can give permission for you to spend the
without getting stressed and without getting
time. It doesn’t have to be romantic love, which
sick in the process.”
is great, of course, but it can be with your kids
That is so powerful, our perception of stress. or your parents or your dog. It can be with a
I would encourage everyone to look into the sense of community service. Anything that
book. You have some really unique techniques brings you to connect with other people is really
and you go through a wide variety of things healing. Even the word “healing” comes from
about stressing less, but also these things are the root “to make whole.” “Yoga” comes from
synergistic, as you also speak in the book, and the Sanskrit meaning “to unite,” yokes, union.
how each part, as you plug it in, even just a These are really old ideas that we’re
little bit, will build upon itself. rediscovering.
That’s right. We’re also learning that if we don’t work at that
level, it’s very hard for people to make
My favorite, which we had talked about
sustainable changes. When you’re feeling lonely
previously, in a different interview, was love

6 DISEASE REVERSAL AND PREVENTION DIGEST

and depressed, you’re not sure you want to live
longer. You’re just trying to get through the day.
The opioid epidemic we’re seeing is just people
trying to numb their pain. I’ve had patients say,
“I’ve got 20 friends in this pack of cigarettes.
They’re always there for me and nobody else is.
Are you going to take away my 20 friends?
What are you going to give me?” Or food fills
that void, or “fat coats my nerves and numbs
the pain,” I hear people say, or video games
numb the pain, or alcohol, or working all the
time numbs the pain.
We’ve learned that it’s not enough to give
people information or even to focus on the
behavior, but if we can focus on the deeper
issues of how people open their hearts and
be vulnerable and connect at a deeper level, to
the degree they can use meditation and other
techniques, whether religious or secular, to
quiet down their mind and body, to experience
more of an inner sense of peace and joy and
well-being, then they can often go out and
enjoy life even more without getting sick and
without getting stressed in the process.
If it feels good, if you have a sense of meaning
and purpose, if you have a sense of joy and
pleasure when you’re doing this, and love and
support, then it makes all these changes much
more sustainable. Medicare is now covering my
program and most insurance companies are, in
hospitals and clinics around the country. We’re
getting bigger changes in lifestyle, better clinical
outcomes, bigger cost savings, and better
adherence than anyone has ever shown
because we’re not just focusing on the behavior,
but we’re focusing on a much wider aspect.
When we work at that level, then we find that
people are much more likely to make these
changes in ways that are sustainable.
ISSUE 1 • SPRING 2019
I think that’s so powerful. You don’t necessarily
even need to see a lifestyle medicine physician,
but just incorporate them, although I think I’m
going to make a new prescription pad. It’ll say,
“Move more. Eat well. Stress less. Love more.”
I think it’s wrapped around what you had
mentioned earlier, what is their purpose? If I
can find their purpose, all that will feed into
that and that will continue to motivate them.
I think that’s extremely powerful.
Thank you, sir, so much for your time. We
appreciate you and all the work that you
have done. I will put a link for everyone here
to Dr. Ornish’s website, www.Ornish.com,
where all that information, including the
new Alzheimer’s research that they’re
recruiting for.
Thank you again.
Thank you for being a bright light in the
darkness. We’re really grateful to you, so keep
up your great work.
I will, absolutely. Thank you.
Dean Ornish, MD, is the founder and president of the
non-profit Preventive Medicine Research Institute,
and a Clinical Professor of Medicine at the University
of California, San Francisco. He received his MD from
the Baylor College of Medicine, was a clinical fellow
in medicine at Harvard Medical School, and
completed an internship and residency in internal
medicine at the Massachusetts General Hospital.
He is the author of six books, all national bestsellers,
including: Dr. Dean Ornish’s Program for Reversing
Heart Disease; Eat More, Weigh Less; Love & Survival;
The Spectrum; and his most recent book, Undo It.
7
 Healthy Living Interview • 2
A CONVERSATION WITH DR. GARTH DAVIS

The History
of America’s
Protein
Obsession
How we become fascinated with one macronutrient

DR. LAURIE MARBAS: Today, we want to focus on the protein

fascination in America. You’re definitely an expert in that field,
having written Proteinaholic in 2016. Could you give us a little
insight on, first of all, how this all started? How did we become
fascinated with one macronutrient?

DR. GARTH DAVIS: It’s kind of crazy,

right? There are a lot of theories as to why
that happened, but for sure, it happened,
because when I talk to my patients about
eating healthy, the one thing that seems
to catch them all the time is protein.

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OF INTERVIEW OF INTERVIEW

8 DISEASE REVERSAL AND PREVENTION DIGEST

I could tell them I want you to eat more
fruits and vegetables, and then I look at
their diet log when they come back and
there’s no fruits and vegetables at all. I’ll
look at their snack and I usually tell them to
eat an apple for a snack, and there’s a piece
of beef jerky. I’m like, “Why did you eat the
beef jerky?” They’re like, “Well, because of
protein.” That was what prompted me to
write the book.
When I went back and looked at all the
literature and tried to track exactly what
was going on, I saw some interesting
phenomena. I tried to look back at when
did we start eating more protein, when
did we start focusing on it?
If you think about it, at the turn of the
19th to 20th century, we were more
concerned with just being alive than what
macronutrients we were eating. Certainly,
if you were fatter, it was actually a sign of
being wealthy and it was actually looked up
to. If you could get meat, that was great
because that was high calorie density.
A lot of things happened around
hearings and they concluded
that we needed to eat
less meat, but of course,
the industry hated that.
The dairy industry and
the egg industry and
the meat industry fought
this really hard. In so
doing, they changed
the recommendations.
For instance, one of the
recommendations was to eat
less meat. That got changed
to eat more lean meat. All
of a sudden, what happened
was we started – that’s really
where I look back and see that we really
started talking about the macronutrients.
That’s when it was no longer about food.
I mean, there had been talk about —
Ancel Keys and stuff had done studies
on fat intake and things like that, so
that was being done beforehand, but
the national discussion about food really

the 1950s, with the Industrial

Revolution and changes in farming “ We didn’t eat low fat. We never
and the ability to grow more meat
and have more easily available
went low fat. We actually ate
meat, then certainly our nation’s more fat, but of course, we were
worry about under-nutrition
became a movement toward
just eating more of everything.”
subsidizing meat production
because it was high calorie.
changed around that point, where we
What really interested me, though, was
started talking about low fat, lean meat,
the 1960s-70s because at that point, there
and where industry really jumped on and
was the formation of the Senate Select
started providing low fat foods that were
Committee on Nutrition. They were
complete junk foods, like low fat
actually formed to study under-nutrition,
Snackwells and low fat Oreos.
but when they looked around the country,
they were like, “You know what? There is Then, of course, people are eating these
under-nutrition, but there’s more over- low fat meals and they’re not getting any
nutrition. We’ve got more people obese leaner because the meals are high in sugar
and we certainly have more people getting and high in junk food. Of course, we
heart disease,” because at this point there didn’t eat low fat. We never went low fat.
were a lot of people eating meat. They did We actually ate more fat, but of course,
a pretty intensive investigation of the we were just eating more of everything.
literature. They had multiple different

ISSUE 1 • SPRING 2019 9

“ There are so many
different factors that
can lead to a problem
with consumption of
animal meat.”
That really started things because we had It’s so hard, once that’s out there, to retract
this recommendation to go low fat and no that, the misinformation, because people,
one got any healthier. People then started if you hear it enough, believe it’s true.
saying the low fat movement didn’t work,
Right. They believe all kinds of crazy stuff,
so let’s go low carb. Of course, there had
like eat your blood type. I mean, we’ve
been low carb for many years before, but it
show that the blood type diet doesn’t
really got big with Dr. Atkins in the 1970s. In
work and it’s a complete hoax, but I hear it
parallel with everybody recommending low
all the time.
fat, he was doing low carb, so this low fat
versus low carb fight broke out. There were Oh my goodness, yes, absolutely. I could
many studies of low fat versus low carbs go into that forever. That was a really
through the 70s and into the 80s and even fascinating book.
into the 90s and, of course, into the 2000s.
All while low fat is fighting low carb, right Anyway, can you tell us a little bit more
behind it, protein rises to this pedestal about the physiologic harmful effects of this
because it’s either low faat or low carb. added animal protein that Americans are
That means protein must be the one good taking in? What’s going on biochemically,
thing we can eat. in our organs? What is that and why should
people be wary of that?
That’s actually a really interesting thought
There are so many things. I’ll go through a
process, just thinking about what did the
list, but I could go into any of these in detail.
country actually think we did, but we didn’t
We know that certain animal proteins
actually do? We were still eating really high
stimulate IGF-1. IGF-1 is a growth hormone
fat, even though they presumed low fat,
strongly related with cancer. It’s also related
just because of the marketing.
with aging, we now see.
Yeah. We increased our fat intake over the
low fat diet craze. The fact that we ever We also know that certain branch chain
went low fat is complete nonsense. We amino acids, like leucine, activate mTOR,
never went low fat. which is an aging pathway, so that’s another
problem that we see.

10 DISEASE REVERSAL AND PREVENTION DIGEST

We also know that animal protein tends
to be higher in amino acids that have sulfa
moieties in it, that therefore create
acidosis.
We also know that animal meat has
endotoxins in it, so when you consume
them, they tend to stimulate an
inflammatory response.
We know that animal meat has advanced
glycosylated end products, which we know
are harmful.
We know that animal meat is high in
saturated fat, which we know raises
cholesterol and is also harmful.
We know that animal meat, whether it’s the
animal meat or the lack of fiber or both,
hanges our bowel bacteria to a bowel
bacteria that is more harmful for several
reasons. First of all, it turns carnitine and
choline into TMAO and also might have
inflammatory effects because we know
that animal meat is high in heme iron,
which we know oxidizes fat.
We know that animal consumption has
antigens on it, like Neu5Gc, which we know
might create autoimmune response and
possibly influence cancer.
We know that when you cook animal meat,
when you cook the proteins, you create
heterocyclic amines and that may be
carcinogenic.
And, of course, we know animal meat has a
hormone component to it. It’s also got the
antibiotics it’s been fed while being raised
and the chemicals used in the raising of it.
There are so many different factors that
can lead to a problem with consumption
of animal meat.
Absolutely. What are your
recommendations, now, to your patients,
because you’re a bariatric surgeon, or what
would be your general recommendations
for patients or anyone in the United States
or around the world, since our diet is
pervasive around the world now?
ISSUE 1 • SPRING 2019
My general recommendation is that we’ve
got to turn the plate around. Instead of the
entrée being this large piece of meat, we
need large portions of fruits and vegetables
and beans. I mean, if you look at the USDA
recommendation, MyPlate, the plate is 1/4
fruit, 1/4 vegetables, 1/4 grains, and 1/4
protein, and that protein can’t come from
vegetable sources. That’s a pretty good
plate. If people ate like that, we’d be a lot
healthier. I’m quite happy with MyPlate.
The little added glass of milk is completely
ridiculous, but we know where that comes
from — funding.
Now, the interesting thing is, when you
look at that plate and what the USDA
recommends, when you then look at what
our government spends, it doesn’t spend
any money, virtually, on fruits, vegetables,
and grains. Any money it does spend on
grains goes toward feeding the animals we
eat. All the money is spent on the animal
protein, basically, so that’s a real big
problem that we have.
That’s funny, too, because there’s such
a pushback on soy, which again is
unwarranted, but what’s funny is that when
they eat animal products, they’re actually
eating soy. I mean, that’s what is used to
feed these animals.
Exactly.
Dr. Davis, thank you so much for your time
for the Digest today. We so appreciate
your time.
Sure. No problem.
Garth Davis, MD, is the medical director of the Davis
Clinic at the Methodist Hospital in Houston, Texas,
and starred on the hit TLC show Big Medicine. He is
certified by the American Board of Surgery and is a
Fellow of the American College of Surgeons and a
Fellow of the American Society for Metabolic and
Bariatric Surgery. Dr. Davis also competes in
marathons and Ironman triathlons and is the author
of Proteinaholic: How Our Obsession With Meat Is
Killing Us and What We Can Do About It.
11
 Healthy Living Interview • 3
A CONVERSATION WITH DR. JUDSON BREWER

Mindfulness
and Habit
Formation
Becoming more aware and hacking the reward-based
learning system that drives habits

DR. LAURIE MARBAS: Today I’m honored to interview

Dr. Judson Brewer.
The reason we wanted to interview you, and I’m excited
to have you on board, is to discuss mindfulness. This is a
word batted around, but I don’t think people understand
the potential mindfulness has. Can you tell us about
yourself, your research, and what is mindfulness?

DR. JUDSON BREWER: I’d be happy to. I had

no idea what mindfulness was when I first got
into this gig. I started meditating my first day
of medical school. I was stressed out. I was
devoting my life to medicine and it seemed
like a good time to start something else fresh.

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OF INTERVIEW OF INTERVIEW

12 DISEASE REVERSAL AND PREVENTION DIGEST

Fast forward eight years after I finished my
MD/PhD program, I saw the power of this for
myself and was training to be a psychiatrist.
In addiction psychiatry, I saw patients with
all sorts of addictions. There’s a simple
definition — continued use despite adverse
consequences — that caught me. I had a
light bulb moment. I thought, oh my gosh,
we’re all addicted to something. I was
addicted to exercise, trying to eat healthy,
and to thinking. Then I saw it at a deeper
level, seeing triggers for everyday addictions.
Anger, disconnection, and anxiety were all
triggering habit loops of overconsumption,
like eating junk food or going on social media,
which, ironically, just distances us more. But
when people feel disconnected, they go on
social media.
I saw a lot of suffering, so I dedicated my
research to understanding how habits are
formed and if we can work with everyday
addictions. My personal mindfulness practice
had been going on 10 years, so I started doing
research on that. Fast forward a couple of
decades, we actually know alot about this
and it turns out this started 2,500 years ago.
Ancient Buddhist psychology described habit
loop formations and this process that Kandel
got the Nobel Prize for in 2000.
We started making these connections —
ancient psychology, modern science,
psychiatry. I trained to be a neuroscientist
so we could study this stuff neurobiologically,
and we started clinical trials. We’re finding
amazing results, like five times the quit rate
of gold standard treatment for smoking,
and 40% reduction in craving-related eating.
We’re seeing 50% reduction in anxiety in
people who were moderately to severely
anxious.
Can you tell me what mindfulness is and why
is it so powerful?
There are some common definitions of
mindfulness. Probably the most popular one
was coined by Jon Kabat-Zinn. He developed
a mindfulness-based stress reduction
program at UMass Medical School about 40
years ago that has been a foundation for a lot
ISSUE 1 • SPRING 2019
“ Mindfulness helps us pay
attention in the present
moment, nonjudgmentally,
and be with those cravings
and urges. Instead of
habitually reacting, we can
bring awareness in and train
ourselves to be with those
urges and not get sucked
into them.”
of scientific studies in the West. He talks
about paying attention in the present
moment, on purpose and nonjudgmentally.
If we unpack this, from a mechanistic
perspective, and this is what the ancient
Buddhist psychologists were talking about,
it basically talks about how we form habits.
Habit formation probably evolved so we
would remember where our food is. We see
food and eat it, and then this dopamine signal
goes to our brain that says remember what
you ate and where you found it. In modern
day, that gets co-opted by emotions, so
we’re sad and we eat and feel better. That
system gets hijacked, especially with highly
processed food and processed drugs.
If we think of mindfulness, it helps us become
aware of those habit loops and not get sucked
into the push or pull. If we see a cupcake, we
automatically reach for it and eat it. If our
brain is wired to say, “Sugar. Eat the sugar,”
mindfulness helps us pay attention in the
present moment, nonjudgmentally, and be
with those cravings and urges. Instead of
habitually reacting, we can bring awareness in
and train ourselves to be with those urges and
not get sucked into them.
This is different than willpower, right?
Yes. I’m glad you bring up willpower, because
there’s been a lot of emphasis placed on
willpower in the last 40-50 years.
13
“I think of mindfulness as helping
us become aware of what we’re
doing and then hacking the
reward-based learning systems
driving these habits to help us.”
Basically, the youngest part of our brain, For example, if you think of reward-based
from an evolutionary perspective, is the learning, you need a trigger of behavior
prefrontal cortex. That’s been shown to and a reward. That reward drives future
go offline when we get stressed. That’s the behavior; it’s not the behavior itself. If
brain region involved in willpower. There something is rewarding, we’re going to
are tons of movies about this. My favorite do it again. If it’s not, we’re going to stop.
is Chocolat. A substory of that movie We’re going to become disenchanted.
is about a town mayor who gives up
In our smoking studies, we had people pay
chocolate for Lent. He grits his teeth and
attention to their smoking and they realized
is able to make it until the day before
cigarettes don’t actually taste good. They
Easter. He gets stressed out, gets a taste
become disenchanted simply through
of chocolate in his mouth, binges and
paying attention, becoming aware of what
passes out in a chocolate store, only to
they’re doing. Same thing is true when we
be found by the priest on Easter morning.
overeat. Nobody is like, “A bloated belly
That’s a great example of how willpower feels great.” They usually talk about it in
fails. There’s good work showing that it gets terms of feeling terrible.
depleted throughout the day. We don’t go
Mindfulness is about helping us see the
rooting around in the kitchen in the morning
results of our behaviors and tapping into
looking for ice cream. We do it at night or
that reward-based learning system to help
when we’re stressed. [Mindfulness is] very
our brains help us so we’re less excited to
different than willpower on many levels.
do those things in the future. There’s a part
One is that it acts in a different part of the
of the brain called the orbitofrontal cortex
brain. Another is that willpower is about
that stores relative reward value. If smoking
gritting our teeth and forcing ourselves not
was rewarding in the past and we see it’s
to do things, which is not part of the
not rewarding now, the reward value drops.
definition of mindfulness. It’s quite the
That opens up space for something else.
opposite. I think of mindfulness as helping
I think of it as the bigger, better offer. That
us become aware of what we’re doing and
something else can be curiosity itself, so
then hacking the reward-based learning
mindful awareness actually feels good.
systems driving these habits to help us. If
these are the strongest learning processes, Let’s use a concrete example. What feels
we might as well use them. better, craving or curiosity?

14 DISEASE REVERSAL AND PREVENTION DIGEST

Curiosity.
Yeah. Hands down, right? I’d rather be
curious than craving something. We can
bring curiosity itself right in the moment.
We can hack that system. Instead of
reaching for the chocolate, cupcake or ice
cream, we can reach inside for our own
curiosity and go, “What does this craving
feel like?” and turn toward it, instead of
running away from it, trying to feed it, or
stuffing it as quickly as possible. We have
inner resources we can tap into that actually
create a new habit that’s not depleting, that
doesn’t take willpower, because curiosity
itself feels good.
When someone has a craving and you tell
them to turn toward it, they’re not using
willpower, so they’re bringing it to the
foremind and having a conversation about
what’s going on. How does that translate
into stopping the craving? Is it the
disenchantment of the whole process, or is
it that they start asking questions and have
a change in their belief system about what’s
going on? What is the trigger or point of
change of the trajectory of their behavior?
That’s a great question. It’s not necessarily
a change in their belief system. This is where
cognitive strategies can run amok. We can
have these belief systems, like chocolate
is bad or I shouldn’t eat ice cream. These
“shoulds” come out, like we “should” all over
ourselves. I don’t know if you’ve heard that
before, but what mindfulness helps us do
is move from our thinking mind down into
our feeling body. That’s critical, because
emotions are generally what drive behavior.
We can think something, but it gets
overpowered by emotion, so we want to
tap into the power of the feeling body.
If there’s a craving, we’re not going to
necessarily change it, but we can pay
attention to the reward or non-reward
of what happens when we indulge.
When we start seeing, “Oh, I ate four
cupcakes. I don’t feel very good,” that
disenchantment happens from a bottom-up
level. It comes from our body and we can
ISSUE 1 • SPRING 2019
remember that the next time we have a
craving, not in a thinking way, but recalling
what it was like the last time. Our body
keeps score and says, start with one
cupcake and go from there. It's not
necessarily creating restriction, but it’s
helping us see what we get from ingestion.
For me, the same is true when I eat healthy
versus unhealthy food. My indulgence used
to be gummy worms. I couldn’t have a bag
in my house because I would eat them all.
I would think to myself, “Well, the night’s
not going to be very good, but at least there
won’t be any gummy worms left.” I didn’t
even enjoy them much at that point, but
I knew I didn’t have any control.
As I started paying attention to what I got
from eating gummy worms, I could compare
that to eating blueberries. Blueberries, for
me, have this perfect balance of sweetness.
Gummy worms, when I really pay attention,
kind of taste like petroleum. That’s just my
experience. Perfectly ripe blueberries —
bam! — there’s nothing better. When I pay
attention, it’s not like I eat a quart of
blueberries at once, but I can notice when
I’m feeling full and satisfied. I naturally stop
because it feels better to stop when I’m full,
but all of that comes through awareness.
People who are dealing with smoking
cravings or food addiction issues or cravings
for junk food, hyper-processed foods, and
highly palatable foods — how long does it
normally take for them to change a habit
into a healthier path?
We’re still analyzing data. One of our
first studies with app-based mindfulness
training, Eat Right Now, was led by Ashley
Mason at UCSF. She brought in women who
were obese or overweight and found that,
after about two months, they had a 40%
reduction in craving-related eating. It didn’t
necessarily change cravings, but they
reduced that behavior.
It’s a bell curve for any population. On
average, after a couple of months in a
program like Eat Right Now, we’re seeing
significant change, but it depends on a lot
15
 of things. If someone is paying attention every
time they eat something and really diving into
that, that change process can happen quickly.
If someone is not paying as much attention, it
can take longer.
I happened to be on a month-long meditation
retreat, and they’d give us freshly squeezed
orange juice every morning. I remember
drinking that orange juice and seeing so clearly
that my brain said, “Dude, this is sugar water.”
I became completely disenchanted and have
never had orange juice since then. In science,
we think of that as single trial learning. If you
really see a clear result, your brain says I don’t
need any more data, but that’s more of an
anomaly. I think it suggests that, when we’re
really paying attention, our brain is going to
learn quickly.
I think coupling that with a healthy diet
and teaching the value of nutrition would
be powerful.
Can you also couple mindfulness with
something you want to do? Let’s say someone
who’s not exercising, but there are always
excuses. How would they use mindfulness
to help propel themselves forward with
good habits?
I would start with simple things, like a healthy
diet. We can start there and help people learn
the differential reward process.
It also helps train their minds to be able to see
habit loops more clearly and map those out so
they can start applying that to things like
exercise. This could even apply to forcing
ourselves, “I should go for a run,” but instead
taking a step back and, when we’ve been
physically active, reflecting on that moment.
My wife every single time after a run says,
“That’s right. It feels really good to run.” Forcing
ourselves to exercise or change habits doesn’t
last. Instead, I think it’s about bringing in these
micro-moments and bringing awareness to
when we have done something so we can
really see the results of that and also when
we haven’t.
16
What’s it feel like to sit in a chair all day? For me,
it doesn’t feel very good. What’s it like to walk
around for a bit? That feels better than sitting.
I like using a standing desk. Finding something
within somebody’s reach that already is within
their everyday pathway and helping their brain
see the rewards and non-rewards, depending on
what the behaviors are, I think is a good way to
start and then that starts setting up cornerstone
habits for sustainable habit change.
I like the phrase “cornerstone habits”. Starting
small with something they’ve already had
success and pain as well, so you’re using
pleasure to push and pain to avoid and
moving them in that direction.
Our minds are so complex. We’re daydreaming,
thinking of the future, worrying about things,
anxious. When someone learns this, does it
become automated how they come into the
present or is there a phrase you teach them?
How do I go from that craving, when I know I
should be trying to focus on something healthy,
how do you even begin? How do I get my mind
to do the mindfulness? “Okay, brain, we’re
going to stop that and go to mindfulness?”
We’ve learned over the past decade and more
of doing these research studies what people
lean toward. I’ve disproved a lot of my own
hypotheses along the way, which is great. I’m
not going to be a true scientist if I go in with
some idea and then don’t believe my own data.
We’ve found that helping people understand
how their own mind works is a good start, so
just helping them understand reward-based
learning from a simple level.
I think of this as a three-step process. The first
step is mapping out how our minds work. The
second step relates to the reward-based
learning we talked about, where we rub our
noses in the unhealthy behaviors, but also pay
attention to the healthy behaviors, so our
brains start to see what the rewards are that
are worth going for. The third step is the bigger,
better offer, bringing in explicit mindfulness
practices.
DISEASE REVERSAL AND PREVENTION DIGEST
That three-step process is why we’ve developed
specific month-long trainings and packaged
these into apps, because it takes awhile for
someone to really understand this whole
process, yet the process itself is simple. Map
out your mind, really be able to see the rewards
versus non-rewards, and then bring in the more
rewarding options that our brains will then start
naturally inclining themselves toward.
The mindfulness is not work, really. It’s a matter
of changing thinking and letting the natural
process occur, so that does help people then
it becomes a self-fulfilling prophecy. You
encourage finding success and then it
encourages again — positive reinforcement.
Yeah, why do the work if our brains will do the
work for us, especially if we really can’t compete
with our brains? Our thinking mind cannot hold a
candle to these older parts of our brain, from an
evolutionary standpoint.
That is really amazing. You’ve been talking
about your apps, which are phenomenal. I’ve
used them with patients. Anyone who’s listening
should definitely consider using them. Can
you tell us about your apps and what you
have available?
Sure. Folks can find all of these on my website,
DrJud.com. We have one for smoking, called
Craving to Quit; one for eating, called Eat Right
Now; and one for anxiety, called Unwinding
Anxiety. We’ve studied thousands of patients,
most of this through NIH-funded work, where
we can really unpack the mechanisms of how
mindfulness works, figure out the best way to
deliver these trainings, and then give them to
people in bite-sized pieces.
People don’t learn to eat cupcakes in my office,
so why not bring my office to them? This is where
we said, let’s bring this into context so we can
give people these trainings, 10-minute videos, in
the moment exercises, things like that, that they
can learn in the morning and practice throughout
the day. We even give them a mindfulness
training to help them get off to sleep because
a lot of people have trouble sleeping.
ISSUE 1 • SPRING 2019
We say don’t worry about meditating in the
morning. Use these practices throughout the
day, short moments many times in context,
and then meditate as you’re going off to sleep.
That builds the process. These are progressive,
sequential trainings where they get 28 or 30
days of core training and then, whether it’s
geared toward smoking, eating, or anxiety, the
program builds from there depending on their
individual needs.
I had a patient interested in starting
medications. I recommended starting the
Unwinding Anxiety app as well. He was eager
to do both, but upon follow-up a month later,
he chose not to do the medication. He did
your Unwinding Anxiety app, and said he was
so much better that he didn’t need to see me
anymore. I wanted to share that it’s such
valuable work.
The reason I met Dr. Brewer is because of the
Craving to Quit app, which I started using with
patients and had such success that I had to
meet him. It’s pretty phenomenal.
Thank you so much, Dr. Brewer, for your time.
We really appreciate your expertise and your
energy and dedication to helping people be
better.
Thank you. Anybody can join me in conversation
about this stuff on Twitter. I’m @JudBrewer if
anybody wants to join me there.
He does great Tweetorials on different things
that he shares. They’re entertaining!
Judson Brewer, MD, PhD is a thought leader in the
“science of self mastery,” having combined nearly
20 years of experience with mindfulness and
scientific research therein. An expert in mindfulness
training for addictions, Judson has developed novel
treatments to help individuals with substance abuse
and eating disorders. He has also studied the neural
mechanisms of mindfulness using standard and
real¬time fMRI, and is translating these findings
into clinical use. He is currently an Associate
Professor of Psychiatry and Medicine at University
of Massachusetts School of Medicine, where he is
Director of Research at the Center for Mindfulness.
17
 Healthy Living Interview • 4
A CONVERSATION WITH DR. RICHARD CARMONA

Health Literacy
and Cultural
Competency
Improving health outcomes through education and empowerment

DR. LAURIE MARBAS: Welcome, Dr. Carmona. Thank you so much

for taking time out of your day to talk to us about health literacy.

DR. RICHARD CARMONA: Happy to do so.

It’s an important topic. When most of the
literature demonstrates that half or more
of the population in the United States is
health-illiterate, meaning that they don’t
understand the connection between their
everyday behaviors and their ultimate
health outcomes — obesity, sedentary
lifestyle, smoking, all of whom have
deleterious health effects — or understand
the positive things and how they affect
gene expression to keep somebody healthy.

LISTEN TO AUDIO WATCH VIDEO

OF INTERVIEW OF INTERVIEW

18 DISEASE REVERSAL AND PREVENTION DIGEST

Health literacy merely is taking complex
“ Health literacy merely is taking
science that we know, as providers, and
being able to translate it in a culturally
competent health-literate manner and
deliver it to the end user, our fellow citizen
that we call a patient, so they are armed
with the information that they can take
action on that results in sustainable
behavioral change and improved health
outcomes.
Breaking that down, it’s taking the science,
translating it, as we’re the conduit, and
sharing it with our patients, individuals,
family members, friends, or neighbors,
so they can do actionable items. Perfect.
Why is it important for us to break down
information? What is your experience? As
the previous U.S. Surgeon General, you
incorporated something like this with your
reports, correct?
Yes, and we recognized early on that as we
wrote Surgeon General communications,
including Surgeon General reports, these
were very weighty scientific documents
contributed to by all of these federal
acronym agencies, CDC, HRSA, SAMHSA,
NIH. You maybe end up with 800-1,000
pages of science, but then who reads it? Is it
for our peers or is it for the patient? I would
argue our peers probably know a lot of this,
but it’s the patient, so we embarked on a
program that we received a lot of accolades
for, but it was just common sense, that let’s
translate this complex stuff into usable
information.
A 900-page report on second hand smoke,
for instance, gets reduced to a comic book
that’s 25-30 pages that a mom or dad can sit
at the table with the kids and say, “Here’s
why smoking is bad. Look at what it does to
your lungs. Look at what it does to babies
that are forming.” Things like that. It makes
it real, but it’s understood by an average
person, not as a doctor or nurse or health
professional.
Those were really well received, these
people’s pieces, because therein lies that
definition I mentioned, health literacy,
translating complex stuff we know so that
they can understand it and then they can act
ISSUE 1 • SPRING 2019
complex science that we know,
as providers, and being able to
translate it in a culturally
competent health-literate
manner and deliver it to the
end user…”
on it because how they understand
that if they don’t do these things, it’ll have
deleterious health outcomes or, if they
want to improve their health, on the
positive side, it helps them to be
empowered to take action.
We can lead the horse to water, but we
can’t make the horse drink. What I’m trying
to do is get the horse to drink when they’re
at the water hole and health literacy allows
us to do that.
We want people to be inspired. We want
them to take action on their own behalf
and their families, not just wait until
somebody directs them, late in the course
of a disease, when they have chronic
problems that are very costly.
Absolutely. As a patient, how do they
even know that there is something to
understand? How should they approach
their physician?
Great question. A lot of times when,
in the literature, as you know, we talk
about patient noncompliance. I’ll give you
an example. “The patient didn’t take their
medicine.” “The patient didn’t show up for
their appointment.” “I told the patient to
do this and they did that instead.” When
you actually look at some of the literature,
much of noncompliance is often our failure
to communicate effectively to the patient,
whether it’s a medication, a dose, a
complication, or an action that they need
to do, because often the busy provider is
on their iPhone; on their computer,
putting in data; answering a phone call;
and then giving somebody a prescription.
We’re in this very fast-paced world where
we’ve lost the therapeutic value of the
19
“ We want people to be inspired. We want
them to take action on their own behalf
and their families, not just wait until
somebody directs them.”
we’ve lost the therapeutic value of the
patient-doctor relationship, where you
sit with eye contact. Sometimes, the
patient just needs a hug or a hand-hold
or reassurance. Sometimes they need
medication, sometimes they need more
direction, but if this is just rapid throughput
and you’re passing things out or you write a
bunch of orders and then another person
gives those orders to the patient and
they’re busy because they have to get the
next patient in the room, all of those things
show where we can fall through the cracks
on so many things.
It starts with the physician or provider,
nurse practitioner, physician’s assistant,
psychologist, psychiatrist, taking the time
to make sure the patient understands,
translating stuff. Don’t just give the person
some long name of a diagnosis. That doesn’t
help them. What does it mean? What can
you do about this? How can I prevent it from
happening in the future? And so on, so that
health literacy is really translation in action
to get the patient engaged, understand, and
they can help to take action on their own.
Often, that action is important because, as
you know, 75-80% of what we spend our $3
trillion in so-called healthcare on is spent on
things that we cause by our poor behavioral
choices. That’s a very important reason
that we all become health literate, as
professionals, and learn translation so that
patients become involved in their care.
Wow. I think that is brilliant because it
almost feeds upon itself when we have
patients that are noncompliant. It feeds
itself, then we believe this false truth that
I’m not even going to bother now because
20
the patients don’t do anything anyway,
when it was actually our fault, as
physicians. Like you said, we’re not
translating that science appropriately.
That’s the brilliant mindset of health
literacy, if we can use it to actually see
some changes.
I will attest that that is absolutely true.
If you’ll take the time, patients want to
learn. As a physician, don’t you feel like we
actually can make some impact on patients?
They respect what we have to say and they
will take it to heart.
We are teachers and we teach through
stories, through anecdotes, just like the
ancients. Sometimes, that’s a lot more
powerful than just giving a definition of a
complex word. Say, “Let me give you an
example.”
I remember a patient that came in one day
into the emergency room and she looked
like she had an MI, a heart attack. She was in
extremis. She had no blood pressure. What’s
going on here? Her daughter came in. She
only spoke Spanish. The daughter spoke
Spanish and English. We said, “What’s the
matter?” She said, “Oh, Mom has been sick
for a few days. She was home and she forgot
to take her blood pressure medicine. She
had a doctor’s appointment coming up
today or tomorrow and she felt embarrassed
to tell the doctor she didn’t take the
medicine, so she took all the pills today,
before she went to the doctor, so she
wouldn’t have to say, ‘I didn’t take my
medicine.’” Of course, her blood pressure
bottomed out when she’s on an
antihypertensive medication. Therein
DISEASE REVERSAL AND PREVENTION DIGEST
lies a problem of lack of health literacy and that still fry stuff because it’s a cultural thing.
understanding and so on. “That’s what my Mom and Grandma taught
me.” If I give you a bunch of pills for your
There’s so many examples of patients that
hypertension and more pills for your diabetes,
don’t come back for follow-up, who don’t
but I don’t address the issue of the cultural
understand wound care instructions. I mean,
norm that actually is contributing to your
the list is almost endless and a lot of it is
obesity and your diabetes, then I’m giving
because, not all the time, but a lot of the
you incomplete information.
times, we are so busy, we don’t take the time
to engage. Being able to quickly understand the culture
and say, “You know, you can use a different
Another thing that I think is part of health
oil, if you want to fry” or you might try to
literacy and cultural competence, because
approach this with maybe not frying, but try
you have to know that person’s habits, where
baking. There’s a whole host of things, but
they come from, how they see death and
culture is so important, especially because we
dying and how they see living and how they
are the most heterogeneous country in the
see a whole host of things. They may have
world. Hundreds of dialects and languages,
grown up in a third world country that doesn’t
and all these people come from around the
understand Western medicine, but they were
world and make our nation better and
treated by shamans their whole life. Maybe
stronger, but they bring those cultural norms
they had acupuncture. Maybe they had
with them. Some of them don’t know what
energy healing. Who knows? Rather than
medications are. Some of them don’t know
dismiss that, find out where the patient is
about Western medicine because they’ve
coming to their illness from, what they
come from a completely different place, so
understand, and then help them along on
it’s up to us to understand where they came
their journey. Otherwise, it’s really like
from. It’s up to us to communicate what we
you’re talking to somebody in a foreign
might be able to help them with, without
language. You can’t expect them to have the
offending them, because, again, you don’t
instructions that you’re giving because you’re
want to be the ugly American and say, “That
speaking something entirely foreign to them.
stuff’s no good. You have to do it my way.”
Wow. So, how would a physician, or even a
Part of the healing process is establishing a
patient, go about sharing the important
patient-doctor relationship where they trust
things? Let’s say you have a physician and
you. The likelihood of them trusting you
they’re busy and administration’s burden is
where you dismiss 20-30 years of experience
heavy. How would they step out of that? Do
of providers in another country, who did
you have any suggestions of something that
things differently, whether right or wrong,
you’ve used in your past?
doesn’t help you to engage the patient.
First of all, you can do it quickly. The old- Then there’s mistrust.
fashioned Dr. Marcus Welby at the bedside,
When I used to work on the Indian
with an hour visit, is unlikely. On the other
reservations, as Surgeon General, I had
hand, know a little about your patient. Where
responsibility with the Indian Health Service
are they from? Do they speak the language?
and I’d sit down with the village chiefs there
What are their cultural norms? A lot of times,
and the tribal leaders and there would be
if we’re dealing with a patient that is obese,
healers there, faith healers. There would be
wouldn’t it be helpful to know how they buy
people who would pray. Often, I would listen
their food and how they make their food?
to what you might call the shaman or the
Are they frying things? Even in the southeast,
health healer and ask them, “How is it that
along the stroke belt, you see a lot of people
.

ISSUE 1 • SPRING 2019 21

 dismiss that healer. You understand it may
be different, it may be something you
disagree with, but your goal is to build a
relationship of trust so that you can help
move the patient around. Your goal is to
provide additional information to that
healer, who may benefit from what you say,
but you know what? Sometimes they know
something we don’t know as well or might
not use it. Really, it’s kind of what we call
health diplomacy.
I like it. It really is building relationships and
building bridges to a different way of seeing
things.
That was from the practitioner’s standpoint.
As a patient, she’s coming in to a new
situation, recently diagnosed with diabetes
or hypertension or whatever. How should
they approach these doctor visits and these
foreign language words, this medical? How
would you go?
The other side is, okay, the patient is
confused. You’ve probably heard the stories
where the patient sees their primary doctor,
who says, “We’ve got the diagnosis. You have
cancer.” They don’t hear anything after that.
You may give them 10 instructions. They
don’t remember it. All they remember is,
“Oh my god, the big C word.”
The key for the patient is, no matter what the a hug, when you hold their hand. If your
issue is, we should be educating our patients. encounter is impersonal and merely is a
I used to tell my patients, “When you’re
home, you’ll have other questions. Write
them down, so when you come back to me
next time, I want to see what you’ve been
thinking and I want to know what concerns
you, what you didn’t understand, what I
may not have told you, by mistake.”
Empower the patient because a lot of
patients actually are intimidated by a
physician. In many cultures, it would be
wrong for you to question somebody at that
level. I think of my own grandmother, who
had about a third grade education. She didn’t
speak English; she spoke Spanish. She would
take me to the doctor with her to translate
22
when I was 10 years old. How effective is
that? How likely is it that she’s going to tell
me that she has a breast mass or vaginal
discharge or something that’s very personal?
Right there, you have a communication gap,
so those are problems in language, but then
there’s the culture.
In the old days, when I was a resident and
student, when you talked about the
understanding, you’d call an interpreter and
you’d tell the interpreter, who is not a medical
professional, to tell that person that they
have a wound infection and I’m going to treat
them. We’ve gone beyond that now. Of
course, you have to get across the language
barrier, but equally important is the cultural
barrier in such a heterogeneous country. If
you don’t understand the culture, what their
norms are, how they perceive death and
dying and health and wellness, then you’re
going to miss the boat.
Again, it’s this health literacy and part of it is
health diplomacy, building a relationship. As
you know, whether it’s health literacy or just
the patient-physician relationship, everybody
who has practiced medicine, surgery, any
practitioner for years knows there’s a
therapeutic value with the relationship you
have with your patient when they trust you,
when they calm down, when you give them
prescription for medication, you lose
something. We haven’t been able to measure
it. It’s not like it’s quantifiable, but I have not
met a person who has practiced for a while
who doesn’t understand how important that
relationship is, therapeutically.
Right. It’s therapeutic to the physician too.
I think so, for sure.
To your point, it’s two-sided. The doctor has
to understand their role. The patient should
be coming in armed with questions. “Explain
this to me, doctor. I don’t understand what
this disease is. What have I done to cause
this? Is there something I can do to make
myself better?” All of those types of things.
DISEASE REVERSAL AND PREVENTION DIGEST
“ Any practitioner knows there’s a therapeutic value with the
relationship you have with your patient when they trust you, when
they calm down, when you give them a hug, when you hold their
hand. If your encounter is impersonal and merely is a prescription
for medication, you lose something.”
But again, in some of the cultural barriers,
especially if you work in an inner city, say
where there’s a lot of immigrants, they’re
taught not to question authority if you come
from certain countries. You take what the
doctor says.
I can remember, even some of my relatives,
they’re in the office with a doctor, they’re
looking down like this. They don’t have eye
contact. Then, when it’s over, they go, “Okay.
Thank you,” and they back out of the room.
That’s a cultural norm for them.
Maybe – think about it – you may be the most
important person that that person has ever
spoken to in their whole life, if you’re working
with underserved populations and immigrant
populations, for instance. They’re no less
important than a well-educated American
because, for us, it doesn’t make any difference
what party you belong to, what your language
is, what the color of your skin is. We are here
to care for the patient, period, and we have to
use the right tools to do that. Health literacy is
a very important tool to be a more effective
practitioner.
Wonderful. I think that summarizes
everything that’s so important. Is there any
last bit of information you’d like to advise
anyone who might be reading or listening to
this, to improve their overall health or health
literacy?
I would hope that both patients and health
providers, if nothing else, go Google health
literacy and look it up, on both sides. For the
physician, there’s so much you can look up, so
many vetted websites that you can look to
that have good scientific information. There
have been numerous papers and books that I
have contributed to, my colleagues have
ISSUE 1 • SPRING 2019
contributed to, on this subject of health
literacy and cultural competence, so more
than enough information to make you a more
effective practitioner.
On the patient’s side, be empowered.
Understand what your responsibility is in
engaging with your professional. Come ready
with questions. Yes, the time may be short,
but use it effectively. Have your questions
ready. Write them down so you don’t become
intimidated or forget after the first question.
We’ll both be better off if both sides
participate.
Absolutely, and almost take those questions
and narrow down to the top three because
there will be a time crunch, so the doctor
doesn’t feel rushed to answer them, either.
I think that’s fabulous.
Thank you, Dr. Carmona, for your time.
Everyone thanks you for your service as well,
by the way.
My pleasure. Thank you so much and good
luck with this endeavor. It’s very important.
I’m always happy to help you.
Richard Carmona, MD, MPH, FACS is a physician,
police officer, and public health administrator.
He was a vice admiral in the Public Health Service
Commissioned Corps and served as the seventeenth
Surgeon General of the United States. As US Surgeon
General, Dr. Carmona focused on prevention,
preparedness, health disparities, health literacy, and
global health. He also issued many landmark Surgeon
General communications during his tenure, including
the definitive Surgeon General’s Report about the
dangers of second-hand smoke.
23
 Healthy Living Interview • 5
A CONVERSATION WITH JULIEANNA HEVER

Tips for
Going
Plant-Based
Stock your kitchen, save money and what to eat
when traveling and dining out

DR. LAURIE MARBAS: Welcome Ms. Julieanna Hever,

The Plant-Based Dietitian. Could you give us an idea of
what it means to be eating a whole food, plant-based
diet and how you approach this with people who are
thinking about transitioning to this way of eating?

JULIEANNA HEVER: Yes. I think of it as the

most delicious, nutritious, fun, and exciting
adventure. I like people to think of it very
simply, so really, I just want you to eat
vegetables, fruits, whole grains, legumes,
mushrooms, nuts, seeds, herbs, and spices.
There is an infinite delicious opportunity of
options out there. I mean, there’s just a
plethora of ways to enjoy plants and it’s
very exciting.

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24 DISEASE REVERSAL AND PREVENTION DIGEST

People think it’s, “Oh, what am I cutting
out?,” but I like people to focus on what
they’re adding in and just discovering this
entire new world when you start looking
beyond the meat in the middle of the plate,
which most of us grew up with.
Absolutely. What do you suggest they do
focus on, instead of focusing on the meat in
the middle of the plate? How should they go
about even thinking of transitioning their
first meal? How should they start?
Well, think about it in two ways. First of all,
you’re eating side dishes, right? You’re
ordering off the sides of the menu. That’s
one part of it, but the other part of it is that
we’ve all grown up with certain meals that
were plant-based, but you just didn’t think
about, like oatmeal for breakfast, or a
vegetable and tofu stir-fry, or vegetable sushi,
or pasta primavera. You know, there are a lot
of dishes that are inherently plant-based,
but we weren’t thinking of them in that way.
It was just something we liked to eat. I like
people to think about what are those dishes
that they’ve been accustomed to that they
already like, stuff that’s really familiar and
easy, and starting to integrate that into
more of a rotation because most of us only
fluctuate between 1-2 breakfasts, 3-4 lunches,
maybe 5-6 dinners over the week, and we
repeat and repeat and repeat, so we only
really need about 10 recipes that we rely on as
staples. Finding those is everything. Once you
have that repertoire, you just pick and choose
what you love. There really are no more rules
than that, just keeping it simple.
I think some people think that they’re
actually going to have to learn how to cook
all over, but you’re exactly right. They
already know how to do the same thing in “ We’ve all grown up with certain
the kitchen. It’s just replacing a few things,
adding in a few things, and there you go,
you’re ready to start.
Yeah, and I’ll build on that because it is re- oatmeal for breakfast, or a vegetable
learning how to cook, to some extent,
because there’s only so many of those. You’re and tofu stir-fry, or vegetable sushi,
going to want to explore. I taught myself how
ISSUE 1 • SPRING 2019
to cook when I went plant-based, but I did
it in the easiest way possible; I just started
reading recipes. There weren’t that many
back then, 13 years ago, when I started
this. Now, they’re everywhere. There are
thousands and thousands of recipes at
your fingertips, on your computer, at the
bookstore. You just find stuff you like. I still
have piles of recipes that I love. I put a heart
on them and I would keep them. The ones
I would adjust, I would make notes on them
and I would keep them. The ones I didn’t like,
I either X’d out or threw away. It was just
building this repertoire and building a
repertoire of basic cooking skills.
My mom never cooked. I hate throwing her
under the bus, but she would do a recipe and
it would take her all day and she was really
panicked about it, and it gave me this fear of
the kitchen. When I started learning, it can
be fun. Learning how to make rice or baking
a potato or just simple things that you don’t
really practice when you’re growing up. I
didn’t. Some people do, but I didn’t. If I can
learn how to do it, I think anyone can because
it can be very simple and empowering when
you learn each of those different skills.
Absolutely. I guess it depends on how you
grew up, because we grew up in a financially
challenged home, so we grew our own
vegetables and we did a lot of plant-based
meals. We always had some meat and dairy,
but we ate in that way and I was cooking at a
young age, and I forced my children to cook
because I was in medical school when they
were little, so I was like, “Listen, you’ll eat
whatever’s here,” but you’re absolutely right;
it’s just boiling water and as simple as pouring
in the rice or learning how to cook tofu. Oh
my goodness, I never even tried tofu until I
went to a plant-based diet.
meals that were plant-based, but
you just didn’t think about, like
or pasta primavera.”
25
 Do you have any suggestions on some good
staples that people don’t even think about as
staples? Like, you mentioned legumes. Maybe
explain what a legume is because some people
may not understand the terminology, and
maybe what would be good to make sure they
have each week as staples to build recipes on?
“Stick to your list because it’s
very easy to go off the list, then
all of a sudden you’re buying
more than you want to. Also,
don’t shop hungry. That’s a
danger. I always buy twice
as much when I’m hungry.”
Legumes, just to get that out of way, are
any beans, lentils, peas, peanuts (although
nutritionally they’re a little bit different; we
categorize them more in nuts), and soy foods.
Soy foods are included in the legume category.
I recommend people have about three servings
a day, so about 1 ½ cups – ½ cup is a serving – of
legumes every day. That leads into the category
of stocking up at home to have on hand anything
you’re going to want. I like to have my kitchen
really well stocked so that if I come across a
recipe or if my kids are coming over or stuff
happens, I can just pop out a healthy recipe
at any time. I travel a lot, so I’m really big on
having stuff stocked in my pantry and my freezer
because when I’m home, I have an abundance
of fresh produce in my fridge, but the way to
make that easy and consistent for everyone,
regardless of your busy schedule or travel
schedule or anything, is to stock these foods
always and you’ll always have something to
pull from.
26
That includes, in the legume category, dried
beans, dried lentils, dried peas, but also canned.
I have every type of canned bean and lentil in
there. I get the low sodium or sodium-free, or
Eden brand. I like them too. So, I always have
lots of canned beans, lots of dried beans.
In the freezer, I always have frozen cooked rice,
frozen vegetables, so fruits and vegetables
where it’s already chopped. You have a really
good yield, 100% yield, so it’s actually a good,
cost-effective way to have frozen produce and
it’s always really good because it’s flash-frozen,
so the nutrition is saved. It’s actually sometimes
more nutritious than fresh because by the time it
gets from the farm to the market to your plate,
there’s some degradation of the nutrients. So,
having fresh fruits and vegetables in the freezer
is really helpful. You can literally make anything.
Then, there’s stuff in the pantry in jars, like salsas
and marinara sauce. Those are things that you
could pull and they stay for a long time in the
pantry.
Also, dried grains, whole grains, which are really
quick and easy to cook, some quinoa or different
colored wild rice or brown rice or forbidden rice.
Those are things that are staples in the diet. You
could whip up a healthy meal really quickly and
easily when you have those things always in the
kitchen.
Absolutely. Those are some very good tips.
Oftentimes, you can get the organic Eden
beans, if they’re on sale. I noticed that wherever
we shopped, we had those savings cards and
they would send you coupons, but if all you’re
buying are these healthy foods, before you
know it, they start sending you coupons for
them too, so it adds to it. It can be very cost-
efficient. I know that when we transitioned, we
had three teenagers and my husband. Our bill
went down $400 a month, so it was really big
deal. It was like getting a pay raise. Sweet!
You said you travel a lot, so you must have
some great tips for those who travel. What do
you do when you’re traveling? How do you stay
on a healthy diet?
DISEASE REVERSAL AND PREVENTION DIGEST
Well, I always say to put on your green goggles
because wherever you go, you’re going to find
something. It’s a matter of where you’re staying
and scouting out where you’re going to be and
using apps like Yelp and Happy Cow, where you
can look for stores, markets, farmers’ markets,
restaurants that are veg-friendly. On there, it’ll
say veg-friendly.
Whenever you go, like if you’re going to go out to things that might not be mentioned on the side
eat, which happens a lot more when you travel,
most of the time, nowadays it’s exceptionally
easy, but I have a chapter in our book, Plant-
Based Nutrition Idiot’s Guide, where you can find
something even at a steakhouse, even easier
sometimes, because you eat the side dishes.
There’s vegetables everywhere; you just have to
look for them.
I travel extensively in the south. You mentioned
you’re from the south. That has been really
interesting because I’ve been speaking there and veggies. It was delicious. I was like, wow.
I’ve been going there over the years and it’s
gotten progressively way more friendly to find
healthy and delicious plants, and more options.
The worst case scenario is you’re stuck with
steamed veggies or a salad, but that will get you
to your next meal. You won’t always have lots of Do you have a certain way that you go? I know
decadent options, but that’s okay. You can
always find brown rice. You can always find a
baked potato. You can always find some kind of
vegetable. That’s what I recommend focusing on you’re looking at stuff from the grocery store?
because if you can get your vegetables, it’s a
good day. If you can just get that in as your
staple, that’s the most important thing to
prioritize.
Then, if you’re going to a hotel, you can ask for a best. I spend the most amount of time there
refrigerator. You can bring stuff. I always pack
some food with me to have throughout the
week, depending on where I’m going and what
I’m doing. It’s all about preparation and knowing
where you’re going to be and how to navigate
that situation by making it a priority. There’s no That’s a danger. I always buy twice as much
way I’ll end up sacrificing a week’s worth of my
life by eating something bad.
You don’t have to eat every single day. You can
skip a meal. That is liberating, too. You will be
ISSUE 1 • SPRING 2019
okay if you skip a meal. If you fly across the
country without eating, you’re going to be okay.
Then, getting to that next delicious, healthy
meal, you’ll always get there.
I think you’re right. I love how you said the
green goggles. I always tell people, when you’re
looking at menu options, look at all the side
dishes, not only on the side menu, but other
menu that are in another meal. Sometimes that
happens as well.
I found, like you said, at the steakhouse, I
remember I was in Chicago and I went to a
steakhouse and they had literally steak knives
stuck in these forms above where people were
sitting, like this steak was eaten by this
customer. I was like, “Well, this is interesting.
Hey, I’m vegan. What do you have?” They made
the most delicious sweet potato and steamed
Yeah, I’ve had some of my best meals too at
steakhouses, which is interesting.
It is interesting. As far as any tips when you look
at the grocery store, how would you organize?
I tend to do the same thing every time I go to
a grocery store. Now, I’ve kind of come into a
little ritual. Do you have any tips there, when
Yeah, I have a lot of tips. If you want to think
about doing it on a budget and healthy, which
I like to think about, this is what I always
prioritize: First of all, the produce section is the
and that’s where I really fill up my cart, but from
a budgetary perspective, going in there, have a
list. Stick to your list because it’s very easy to go
off the list, then all of a sudden you’re buying
more than you want to. Also, don’t shop hungry.
when I’m hungry because everything looks good
and sounds good and I’m thinking about all the
stuff I want to make. Those are the big tips for
saving money.
27
 Also, use the bulk section and go to the big box
stores. You can find some amazing stores. Here
in LA, I go to Costco or Sam’s Club. You can get
some great prepared food for a lot less, great
organic produce for a lot less, and big things of
things that will last longer, like canned
tomatoes or tomato paste. That’s a really great
way to save money too, but the regular grocery
store, I always spend the most amount of time,
get as much produce as possible. Know what
you’re going to make ahead of time so that you
have it ready to go and you can just – boom,
boom, boom – get everything you need.
Then, make sure you’re stocked up, so that also
is a list. As soon as I run out of something, I put
it on a list. Whether it’s for my Costco list or
wherever I’m going to go, Ralph’s or Whole
Foods or whatever I’m going to go to, I know
what I’m going to get where and then, like you
said, I know the markets so well, so I have my
lists in order of where I’m going to pop through
everything. That helps too.
Staying on track, knowing what you’re going to
make, and having a list is, I think, the easiest
thing to do, just to make sure that you know
what you’re getting yourself into. If you just go
to the market like, “Oh, what should I make?,”
then it can be completely overwhelming.
I love it. I have done that way too many times.
You’re hungry and, ooh, that does look good.
Even that spinach leaf looks good.
Everything sounds good and it’s dangerous.
It is. You’re exactly right there. I actually think
there’s a study that, even if you eat an apple
before you go shopping, you tend to make
healthier choices than if you eat something
that’s unhealthy. It’s really interesting, even
what you’re consuming. They do all sorts of
interesting things at grocery stores. They play
music to make you stay longer.
Yeah, and they put the more expensive things
at eye level.
I also like the recommendation to stay away
from all the processed stuff. I like to look at
labels. The only recommendation I have about
labels is to ignore everything except the
ingredients because everything else is
28
marketing, completely. You want to have the
fewest ingredients possible, everything that a
six-year-old could pronounce. Just real simple. I
want people to eat as simple as possible. There’s
nothing wrong with having boxed foods, like you
can get lentils in a box, but you want to have it
very simple because the simpler your diet, the
more peasant food, as we like to say, the
healthier it is. The staple diet is what is going
to keep you healthiest in the long run and it’s
easier. It’s just easier.
Absolutely. Some of the individuals will have
families that are like, “I ain’t doing this.”
Do you have any suggestions to help families
transition? Let’s say Mom is the one that’s
transitioning her diet and Dad doesn’t want
to, or Dad wants to and Mom doesn’t want to.
What are your suggestions there?
Yeah. I mean, I’ve lived that. I’m living that
situation. It’s very difficult, but I work with a lot
of families. I’ve been a dietitian and a trainer for
20-something years now, so I’ve worked with a
lot of families. Unfortunately, when you’re not
on the same page as your partner, it is much
more challenging because the kids are getting
mixed signals and then Dad, in my case, was
giving them all this stuff that they shouldn’t be
having and then the hyperpalatable foods are
very tempting. It’s a really hard situation.
That said, I’ve also seen a lot of success. That
happens when, ideally, everyone’s on the same
page. That’s when you get the best results
because there’s no question. This is what we eat
and this is what’s for dinner and this is what’s for
breakfast and we all eat the same thing. That’s
the easiest.
Okay, so when it’s not like that, the most
important thing is role modeling. The research
hows that. It’s what you’re eating. If you’re
telling your kid to eat broccoli, but you’re eating
chips on the side, it’s just not going to work.
The other thing is getting children involved,
having them pick out the recipes or helping you
make food or gardening or taking them to the
market and farmers’ market. The more involved
they are, the more invested they’re going to be
in the ultimate outcome. Having them involved
is great. Then, trying to inspire them with
DISEASE REVERSAL AND PREVENTION DIGEST
delicious meals and inspire the other partner,
that’s not interested, with facts and information “ Get children involved, having
and inspiration. Ultimately, I think even the
people that are the most off board, like when
them pick out the recipes or
they have someone that’s really of board, when helping you make food or
they see the results of what it does and the
incredible health benefits and the incredible
gardening or taking them to
energy boost and all of that stuff that we see
every time, it does start to inspire people and
the market and farmers’ market.
it does trickle down and sometimes it just The more involved they are, the
takes time.
more invested they’re going to
It does. When I came home, I literally, overnight,
cleaned out everything. My husband was like,
be in the ultimate outcome.”
“You’re still cooking, right? Alright. Whatever.”
Luckily, my husband will eat anything that The second thing is to mind your supplements.
doesn’t eat him, so I was fortunate. That’s really important, too. There are a lot of
people in the vegan community that are not
The children were a little more like, “What’s going
taking their B12 and it’s a big issue, so B12, just
on?” because they were 13, 15, and 18. That’s very
do your homework on supplementation. It is
true. Over the first year, I said, “At home, we’re
necessary for any diet. No diet is perfect.
eating plant-based.” I eat plant-based wherever
I would just say to be mindful of those two
we go, but if we go out, you order what you
things. Other than that, if you just keep it
want. Over the first year or two, you start seeing
simple and eat vegetables, fruits, whole grains,
them order tofu instead of meat, so there are
legumes, mushrooms, nuts, seeds, herbs, and
some changes that occur. You’re exactly right;
spices, it really can be that easy.
the modeling, getting them involved – I always
made them help cook anyway. I’d tell them Absolutely. I think the B12 alone deserves an
stories of patients reversing diabetes and article, in and of itself, and vitamin D. Those
hypertension, and any research. I made them are the two supplements that I would make
watch Forks Over Knives. I’ve made them watch sure everybody is on, for the most part.
probably every documentary. Earthlings. It Absolutely, the B12.
affected them because they were younger. I was
Thank you, Julieanna, for your time today.
pushing the environmental stuff. That gentle —
well, they might say it wasn’t as gentle — I tend
to be a little more evangelistic, but that really is
true. Modeling is – you’re exactly right. It’s just Julieanna Hever, MS, RD, CPT, is a Registered
like, if you want someone not to smoke, then Dietitian who has been in private practice in Los
don’t smoke. That’s the key. You’re exactly right. Angeles since 2005, specializing in weight
management, disease prevention and management,
As far as any final advice that we would give to and sports nutrition. Julieanna is the author of the
our readers and those listening? The Vegiterranean Diet and the best-selling book,
The Complete Idiot’s Guide to Plant-Based Nutrition,
I would say I’m very concerned about the plant-
and the nutrition columnist for VegNews Magazine.
based community, a lot of people that are eating She is the co-author of the cookbook, The Complete
a lot of processed foods, now that there are a lot Idiot's Guide to Gluten-Free Vegan Cooking, and a
of plant-based processed foods, so that’s a big recipe contributor to Forks Over Knives books.
concern. Don’t fall into that. It’s not going to help Julieanna counsels a variety of clients throughout
you transition to a healthy, whole food, plant- the world from her practice including elite athletes,
based diet, so try to avoid that pitfall. Keep it as a adults, and children with various nutritional and/or
treat mentality, really as a treat, like once in a medical concerns.
while, rare.

ISSUE 1 • SPRING 2019 29

 Healthy Living Interview • 6
A CONVERSATION WITH CAROLINE ADAMS MILLER

Grit, Resiliance and

Flourishing Through
Traumatic Growth
DR. LAURIE MARBAS: Caroline is an expert in positive psychology
and I felt it was important that we share that information with our
audience and how you can share the advantages of looking at
psychology differently in the realm or the paradigm of positive
psychology. Could you give us a little background about yourself
and a little bit about positive psychology?

CAROLINE ADAMS MILLER: Sure. I’ve been in the

field of positive psychology for almost 20 years. 13
years ago, I returned to school and I was in the first
class of the Master’s of Applied Positive Psychology
at the University of Pennsylvania. For people who
track positive psychology, you probably know that
it’s Ground Zero, it’s the epicenter of positive
psychology, so I was one of the first 34 men and
women in the world to really be tutored by experts
in the field of flourishing, for a year, and I got this
really, really cool degree.

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30 DISEASE REVERSAL AND PREVENTION DIGEST

Some people shorten it and call it the science
of happiness, but really, what Marty Seligman
did – he’s at Penn and people credit him with
being the father of positive psychology, but
there are a lot of contributors to the field –
they really wanted to look at and unpack
when individuals/couples/organizations/cities
are flourishing, what are the ingredients?
What can you unpack and then what can
you replicate so that other cities, other “ You’re looking to be optimistic,
people, other organizations, other couples
can flourish?
Until that moment, about 20 years ago,
when Marty was the President of the
American Psychological Association and he
called upon the field to stop focusing on what
was wrong with people and to instead focus
on what was right, so that’s what I do as a
writer, a consultant, a coach, and I just try
to share the applied positive psychology,
the research, how people can do two things.
My expertise is really in how do they set and
pursue scientifically organized goals, so goal-
setting theory and all the related theories,
and then how do you cultivate grit so that you
have what it takes to accomplish the hardest
goals in life, because we know that flourishing
people pursue hard goals, not easy goals
Maybe you can help explain what flourishing
is. Some people may think that just means
getting back to a baseline, but it means so
much more.
Well, you want to be north of zero to flourish.
You want to be about a 7 or 8, is what I’ve
heard over and over from people who really
are at the atop of the field, who have come up
with the self-report measures and the other
measures to measure flourishing and well-
being and life satisfaction. You’re not looking
to be a 9 or a 10. You’re not looking to be
ebullient on a regular basis. You’re looking to
be optimistic, hopeful, zestful, able to be
curious about other people and the world
around you, but generally to be more positive
than negative and to see the world in a
flourishing way and to act in a flourishing way,
instead of essentially kneecapping yourself
with unproductive, cynical, pessimistic, self-
defeating behavior.
ISSUE 1 • SPRING 2019
That’s a really good example. Then,
your work was on, as you described,
goal-setting. You actually looked at the
evidence and you were the first one to do
that. Can you explain your work and how
you’ve seen it benefit people and what
exactly does grit mean?
hopeful, zestful, able to be
curious about other people
and the world around you, but
generally to be more positive
than negative and to see the
world in a flourishing way and
to act in a flourishing way.”
Sure. I’ll start with goal-setting because one
of the things that really struck me for the
first time was when I was exposed to goal-
setting theory at Penn. That’s Locke and
Latham’s work. The reason that it hit me in
the right place at the right time is that I am
a credentialed Executive Coach and I work
with people and organizations on goal-
setting. That’s always been an interest of
mine that dates way back to my childhood
and to other things that I had overcome, so
when I found out there was a science to goal-
setting, that smart goals are not a science,
that the law of attraction is what a lot of
people use to set and pursue and try to
achieve goals. When I found out that you
could maximize your chances of success by
pursuing goals in the right way with all of
these theories – self-determination theory,
priming, contagion – all these things that
were in academia that no one in the mass
market had heart of, I made that my
capstone, the connection between
flourishing/happiness and goal-setting.
That book, Creating Your Best Life, came out
in early 2009 and it was the very first book
every published on goal-setting that had
research or footnotes or facts. The other
31
 books that I think a lot of that little nondescript club, in the 80s and
people could quote, from 90s. Not only that, but they had been world
very popular authors, were champions and Olympic gold medalists and
all filled with urban legends NCAA winners. My husband and I very
and anecdotes, but no innocently asked if we could see the record
science, so I then took it to board. You know, where’s the record board?
a deeper level with my most Usually, a record board is on a wall. We were
recent book, Getting Grit, told that the record board had been hidden
because one of the things because if you had those kinds of high standards
that we learned by studying where the impressionable young children could
flourishing is that half of see them, they would then become very
these people wake up every discouraged and would choose not to work
day to hard goals, not easy very hard.
goals, and that this quality
This was all in the middle of the parenting
of grit, passion, and
movement where you’re supposed to praise your
persistence in pursuit of long-term goals is really
children and trophy your children and tell them
the X factor. It’s that ingredient you need to
they’re great, even when they don’t do anything,
pursue and achieve meaningful, hard goals that
so I got a little hot under the collar about that.
really are the game-changers in our lives.
I thought, if these three men are worth telling
I worked with Angela Duckworth as I wrote stories about to new members who just joined,
Getting Grit because what I did that was different I’m going to celebrate them, so I got a record
from her work, which she is very supportive of, board made. I got the biggest one ever made
is that I unpacked grit to try to understand for summer swimming, a little team, I heard,
and teach how do you cultivate the characters, and I embedded pictures of these three scary
strengths, and behaviors that undergird grit, men and I invited them back and we had a big
because I think we all agree that grit is a quality breakfast of champions. What I learned, and
that has gone missing in our society and in our I think what everyone learned, by watching this
world, and there’s a real race to get back to being record board going up and seeing opposing teams
able to focus, being able to have patience, being cluster around it and our kids cluster around it is
able to do hard things without whining. So, that’s we suddenly had transparent high standards for
really where my work has been focused in the excellence. It wasn’t winners for all. It wasn’t that
last, say, 15 years. it’s good enough to be good enough. It’s like, if
you want to really be elite in this sport, here’s
Which is fascinating because you have – your
what it takes.
book is amazing, by the way. I love Getting Grit.
You have some really cool stories. One that Records began to be broken and I’ll never forget
really resonated with me was when your children the moment a young man named Ben Gordon
were swimming and there was the board. Maybe beat one of the oldest records on the board, by
that’s a good example of what you mean? Could one of these three men. He swam out of his
you share that story? mind. He never swam that fast ever again, but
he got his name on the record board and he
Sure. I love that story. I just got back from New
beat this old record by 1/10th of a second and it
Zealand and I was telling the story in New
electrified the crowd who was there, witnessing
Zealand. It really resonates with people. That’s
it. It made one of those marks; I call it the awe-
because when we joined a very small swim team
thentic effect. When we witness somebody doing
just outside of Washington, DC, a summer league
something very hard that’s meaningful to them, I
team, we were told almost immediately that
find that we’re uplifted by that behavior, that we
three amazing men had come through that club,
can’t help but ask ourselves what would happen if

32 DISEASE REVERSAL AND PREVENTION DIGEST

I went for something that big, that powerful?
What if I was willing to put it all on the line and
take those risks? I think we really long to be that
person, but we have to witness it often so that
it becomes real to us.
Ben Gordon gave this audience, that day, that
gift by being so willing to say, “I don’t know if I
can do it, but my god, I’m going to die trying.”
Darned if he didn’t get it by 1/10th of a second.
I love to tell that story because it started a
domino effect of other records being broken.
Suddenly, people realized, wow, if that guy over
there, who I had breakfast with and swim with
and I’ve seen him grow up, if he can get a record,
maybe I can too. Self-efficacy theory.
Anyway, the record board story encapsulates
everything about what has gone wrong in this
world with goal-setting and grit and resilience
and taking challenges away from children. We
know that, in order to have a flourishing life, you
have to overcome setbacks. You have to find out
who you are, what you’re made of. That’s the
only way we begin to build self-esteem. All of
this is part and parcel of positive psychology
and that’s the area I’m most focused on is post-
traumatic growth, grit, goal-setting, and how it
all pertains to flourishing.
What do you mean by post-traumatic growth?
There’s a field of positive psychology that
focuses on not what’s wrong after you have a
huge setback. We often hear it used for people
in the military who come back after seeing
combat, post-traumatic stress disorder. In
positive psychology, often what we do is flip
the questions upside down. The question that
was asked was what goes right after people
experience combat? Not always let’s look at
what went wrong, but what went right?
There’s this fascinating field that’s been growing
for the last 10-15 years, studying the impact of
adversity on people’s ability to flourish. What’s
been found is that we all need at least 3-7 very
significant setbacks in life in order to flourish, in
order to find out who we are, in order to
ISSUE 1 • SPRING 2019
challenge ourselves and say, “Are we on the right
track? Is this still our purpose? Does this still feel
meaningful? Do I need to change things up?”
That’s post-traumatic growth, when you grow in
spite of adversity and somehow become bolder
bigger, stronger, and even happier.
What are the traits or what would set someone
up to have post-traumatic growth versus
having someone that would not flourish after
a traumatic experience?
That’s a really good question. I’m not a
researcher, so I can only report on what I know,
but that’s a really good question that it might be
appropriate to find an expert in that and
interview them because it is so important.
“We know that, in order to have
a flourishing life, you have to
overcome setbacks. You have
to find out who you are, what
you’re made of.”
One of the things that we find is that people who
are stress-hardy often have the ability to find
humor, to diffuse difficult situations by lightening
the mood. They also have the ability to connect
with other people. They’re able to build
relationships, which then become their soft
place to fall. So, there’s optimism, there’s
persistence, there’s zest, there’s curiosity, but
more than anything, there’s hope. People who
have hope change the way their brains are
organized. It’s called pathways thinking. Quite
often, hope is triggered by having just one role
model, which is what we saw with the record
board. Role models change the way we think
about what is possible for us. When you have
hope, a lot of different things can change in
terms of what you believe you’re capable of.
33
“ I think, in the 21st century,
what we need to get away from
is this me-me-me and, instead,
talk about we-we-we. How do
we flourish as a group, a couple,
a community, an organization?”
Which is remarkable. Honestly, every time I
talk to you, I tell you I could talk to you for
hours, and we have. I think that’s a really
great way to show that hope abounds – we
just have to look for it – and to be the hope
for someone because we all have those
people in our lives that we can be that
person for. I think that’s probably why,
when you were talking about the grit in the
example, we love to rally around our
country with the Olympics and get excited
and you see people who have grit and really
worked hard, and you always dream of
being that person. That’s really cool.
Yes. I like the way you tied this back to
what can you do for other people, because
I really believe that one of the most
important things is not just flourishing
yourself, but how do you impact other
people’s flourishing, which is why my
definition for grit is really about authentic
grit. I think in order for grit to be good, not
stupid grit or selfie grit or faux grit, in order
for it to be good grit or authentic grit, it
has to, in some way, uplift, awe, and inspire
other people who witness that goal pursuit.
34
I think, in the 21st century, what we need
to get away from is this me-me-me and,
instead, talk about we-we-we. How do we
flourish as a group, a couple, a community,
an organization? I’m really happy that
positive psychology is going into not just
what can I get, but how do I spread and
make it contagious?
That’s awesome. There are so many things
we can unpack. We could go for hours and
hours. Social contagion and everything.
Caroline, can you tell us all your books? You
have some really different types of books
from a wide assortment of things in your
life. You have a lot to teach. Can you share
with us so everyone will know what to look
for from you?
Sure. My website is a great clearinghouse for
all of this. My first book came out, believe it
or not, 30 years ago. That book, My Name is
Caroline, really changed the course of my life
because I was the first person to overcome
bulimia and write a book about it, and write
an autobiography where I laid out how I got
better. I gave people hope. It wasn’t to say T
DISEASE REVERSAL AND PREVENTION DIGEST
here’s the only way, but it was an important
book and discussion at this time because
nobody was getting better. Nobody knew
anyone who was even willing to talk about
it. I was willing to talk about it because once
I got into recovery, and really,it was also the
beginning of my interest in what I now know
as grit because I had been very successful in
other things in life, the Harvard University
degree and other things. I had bumper
sticker virtues, but what I didn’t have
was grit.
When I decided that I was going to recover
from bulimia at all costs, My Name is
Caroline became the result. That was
book #1. I’ve got two books in that area.
Positively Caroline is about how I reached
30 years of unbroken recovery, because
now I think the important thing is to give
hope to people, not just that you can get
into recovery, because that was the holy
grail 30 years ago, but it’s that you can stay
in recovery, which we now know is harder.
It’s harder to stay in recovery.
I’ve also written several spiritual meditation
books, like Bright Words for Dark Days.
Then, Creating Your Best Life is the first
goal-setting book with research and
evidence in it. Getting Grit, my seventh
book, came out last year and was named
one of the 10 books that will change your
life. There’s a real thread from book 1 to
book 7, I promise you, and now I’m trying
to finish book 8, which is about straight
goal-setting.
I find that, if you come right down to it,
what I’m most interested in is how do I give
people hope and tools to accomplish big,
meaningful goals so that they can live their
very best lives? I keep coming at it from
different directions, but I would say that
that’s my ikigai. That’s my reason for waking
up in the morning. That’s my purpose. It’s
reflected in everything I do, everything I
talk about, and everything I write about.
ISSUE 1 • SPRING 2019
Your books are well-written. They’re
humorous. They’re engaging. I agree, they
are life-changing because when you give
hope to someone, and that’s what I enjoy
doing in medicine with lifestyle changes, is
giving hope that they don’t have to remain
ill, so I think you’re right on to something.
You’re getting a little dopamine hit, too,
when you do that.
Yeah. It’s wonderful to be a giver. I think
you’re a giver. I try to be a giver because
when you give information, hope, and tools,
you really are what Adam Grant talks about
in Give and Take. You’re somebody who’s not
just keeping things, but giving away so that
you can actually continue to pay things
forward, so giving is very satisfying and it’s
contagious.
It is highly contagious. Thank you so much
for your time and sharing that with us.
Like I said, I hate to cut it short, but I know
you’re busy and we want to make sure that
we get all the information for everyone, but
thank you so much for sharing your time
with us.
I appreciate it. Thank you, Laurie.
You’re welcome.
Caroline Adams Miller, MAPP is one of the world’s
leading experts on the science behind successful
goal setting and the use of ‘good grit’ to achieve hard
things. For more than 30 years, she’s been sharing her
research-backed strategies to help people cultivate
more grit and dig deeper to clarify and achieve their
toughest goals. A Harvard graduate with a Masters in
Applied Positive Psychology from the University of
Pennsylvania, she has authored six books including
Creating Your Best Life and Getting Grit, and teaches
at Wharton Business School’s Executive Education
program. Her work has been featured in The New York
Times, The Washington Post, BBC, NPR, and CNN.
35
 Healthy Living • 7

How to Improve
Your Sleep
Wouldn’t it make sense to optimize an activity that
you spend about one-third of your life doing?
Yes, of course it would! So let’s discuss sleep and review some tips for
improving it. Ultimately, sleep quality impacts our whole quality of life.
Millions of people do not obtain good sleep. Some complain about
sleep quality; others complain about quantity. The amount of money
spent on sleeping pills around the world is huge and continues to grow.
Experts continue to recommend seven to nine hours of sleep per night
as ideal for adults. Less than seven hours of sleep is associated with
decreased productivity, performance, alertness, judgment, memory,
and ability to fight infections. Inadequate sleep time is also associated
with increased irritability, accidents, weight, blood pressure, and risk of
diabetes or heart disease. More than nine hours of sleep per night is
associated with depression or medical illnesses.

By Sheila Hautbois, PA-C, MPH

Sheila Hautbois, PA-C, MPH is a Board-Certified Physician Assistant
with a Masters in Public Health and many years experience providing
screenings, seminars, and health coaching for chronic disease
prevention and reversal. She has helped thousands of people improve
blood pressure, cholesterol, weight, diabetes, heart disease, energy
level, and other health issues.

36 DISEASE REVERSAL AND PREVENTION DIGEST

What happens during sleep? Cells divide,
muscles rebuild, and injuries experience more
rapid healing. Liver function accelerates.
Short-term memories transfer to long-term
storage. Growth hormone is released. Our
brain and nerves get recharged. Sleep for a
person is like what plugging in and recharging
is for a cell phone. Our body rests during
dreaming sleep, and our mind rests during the
other phases of sleep. Everyone dreams, even
those who do not remember the dreams.
If you have trouble sleeping, you should
speak with your healthcare providers.
Some medications or health conditions
may interfere with sleep quality or quantity.
Additionally, they can further assess any sleep
issues and recommend personalized tips,
behavior therapy, or short-term medications
that might help.
Good sleep hygiene is very important and is
often sufficient to fix sleep complaints.
Review the following sleep tips, and begin
working on any that you should improve.
• Stick to a consistent wake schedule
throughout the week, ideally waking
within an hour or so of the same time
each day.
• Try to get a few minutes of sunlight
every day.
• Get some regular exercise during the day.
• Limit caffeine (tea, coffee, soda, energy
drinks, chocolate, and some
medications).
• Avoid heavy or spicy evening meals.
• Avoid nicotine in the evening; better yet, good sleep hygiene is not enough. Stress
quit altogether.
• Don’t use naps to substitute for nighttime helpful. Professional counseling can teach
sleeping; limit most naps to 30 minutes
and only in the first half of your day.
• Be sure you have a good mattress and
pillow, plus bedding that helps you stay at be able to recommend some medical
a comfortable temperature throughout
the night.
• Keep the room temperature slightly cool
but not too cold.
ISSUE 1 • SPRING 2019
• Sleep positioned on your side or back.
• If you snore and experience daytime
sleepiness, get evaluated for sleep apnea.
• Limit alcohol; it interrupts the normal
sleep cycle and causes early waking.
• Try establishing a regular bedtime
routine.
• Keep a small notebook and pen by your
bed to jot down any thoughts you want
to remember the next day.
• Soak in a warm Epsom salt bath in the
evening.
• Get into bed when you feel tired. If you
don’t fall asleep within 20-30 minutes,
go do something relaxing and come back
and try again a bit later.
• Try reading before bed instead of using
electronics or watching television.
• Ensure your bedroom is dark, without
ambient light.
• Block out bothersome noise with
earplugs, “white noise”, relaxing music
or nature sounds, and double-pane
windows.
• Do deep breathing or progressive
relaxation exercises while lying in bed.
• Try meditation or prayer right before bed.
• Associate your bed only with sleep and
intimacy; don’t work or watch TV in bed.
• Close your eyes while trying to fall asleep.
Professional help can be useful if practicing
management and relaxation training are often
positive thoughts and realistic expectations
about sleep. Your pharmacist can review your
medications to ensure none are interfering
with sleep. Your primary care provider should
treatments if more help is needed after all
of the above have been tried.
37
 Healthy Living • 8

My Health
Transformation
Story
My story initially started when I was just 12 years
old. I had a very bad relationship with food and was
already starting to go on diets.
My unhealthy relationship with food and fad diets would continue up to
my freshman year of high school. I was always tired and suffered from
migraines and a mystery problem with my thyroid that the doctors
could not figure out. It was during this year I gave the
“paleo diet” a try.
I had a love for reading at this time and decided to start reading for
science and health books, when searching for new books to come
across The China Study, a book by T. Colin Campbell. I began reading it
and was instantly hooked. The book introduced me to a whole-food
plant-based diet.

By Mia Taylor
Mia is currently a senior in high school in Omaha, Nebraska.
She will be pursuing a degree in human biology at the College
of Saint Mary’s in the fall. Mia hopes to follow her dreams of
one day becoming a doctor.

38 DISEASE REVERSAL AND PREVENTION DIGEST

plant-based diet. It was the first thing
regarding nutrition that truly made sense to
me. I began researching and discovered the
“vegan diet,” which was something that I had
not heard of. Doctors were talking about how
diseases could be prevented and reversed
with diet. It was confusing to me that I was
just now hearing about all of this and why
more people didn't know about this. All sorts
of chronic diseases that were killing people
and changing their lives for the worse were
being treated with diet and not medication.
I decided to tell my family about my new
discoveries and how I was going to go vegan
myself. I was not expecting the backfire I
would receive from my entire family; not one
person wanted to support my decision. They
expressed concern for my health, worried that
I would not be getting enough protein and
other nutrients. They also though all my
claims about how I would be preventing
myself from chronic diseases was all crazy talk.
I assured them I would be getting plenty, and
that this was the best thing I could do for my
health. My mom tried to bribe me with money
to get me to eat at least some meat or fish,
but I would not budge. My palate began to
evolve, and my parents were shocked at the
number of veggies I was eating that I never
touched before.
My body and mind felt great, and I was
addicted to learning more about plant-based
nutrition and all the benefits that came along
with it. I had some thyroid issues that even a
thyroid specialist could not figure out, after
going vegan the thyroid issues disappeared
completely. Some other health benefits I
personally noticed was healthier hair, better
skin, improved fitness, and a decrease in
anxiety over time.
After learning about all the health benefits,
I started learning about animal agriculture and
the toll our planet is taking because of it. One
of the hardest things was learning about the
horrible treatment the animals go through,
as someone who loves animals this was just
another reason why I knew I was doing the
right thing. It felt amazing to know I was
making a difference and impact to the animals
ISSUE 1 • SPRING 2019
and planet. It initially started for health but
now the ethics is another huge reason I stand
behind a vegan diet. I was becoming well-
resourced, so when I would receive criticism
and worry about my diet, I had science to
back up my claims. Some very powerful tools
for me in learning more about plant-based
nutrition have been books, documentaries,
and podcasts. There are also many plant-
based and vegan influencers on YouTube and
Instagram so it is very easy to find inspiration
and motivation.
My family and those around me began to
welcome my new diet choice, but still made
comments about how they did not think it
would last, and that I would be back to eating
hamburgers in no time. After time, my family
realized that this was not just a fad diet I was
doing but that it was a lifestyle. After some
time of still including vegan processed foods
in my diet, I decided I wanted to improve my
eating even more by trying to adopt a whole-
food plant-based diet and only eat vegan
processed foods for special occasions.
I am now 18 years old, and to this day,
switching the way I ate to a whole-food plant-
based diet was the best decision I ever made.
My family now accepts the way I eat, and
some of them are trying to transition
eating a more whole-food plant-based
diet themselves.
If I could give advice to someone going
through a similar situation, it would be to stick
with it and become knowledgeable, so that
when people do question their choice (in
going vegan or fully plant-based) they are able
to defend their position with facts. It can be
hard going out to eat with friends and not
being able to eat what they are eating. At first
the transition can be hard especially if you
don’t have those around you supporting you,
but you must think back to the reason you are
doing it and stick with it. It can be helpful to
find people on social media who are vegan or
plant-based themselves or transitioning so
you do not feel so alone. If you stick with it
you will not regret it! Make sure to give
yourself credit for what you are doing;
you should be proud!
39
 Healthy Living • 9

Creating a Safe,
Efficient, and
Effective Aerobic
Exercise Program
The positive effects of aerobic exercise on
cardiovascular, metabolic, and mental health
are well-documented.
A recent article in the Journal of the American Medical
Association concluded, “Cardiorespiratory fitness is inversely
associated with long-term mortality with no observed upper
limit of benefit. Extremely high aerobic fitness was associated
with the greatest survival and was associated with benefit in
older patients and those with hypertension.

By Jeff Young, Kinesiologist, CSCS, ACSM-EIM

Jeff is a Kinesiologist, Certified Strength and Conditioning Specialist
(CSCS), American College of Sports Medicine Exercise is Medicine
credentialed (ACSM-EIM), and previously held the USA Weightlifting
Sports Performance Coach certification (USAW).

40 DISEASE REVERSAL AND PREVENTION DIGEST

Cardiorespiratory fitness is a modifiable
indicator of long-term mortality, and health
care professionals should encourage patients to
achieve and maintain high levels of fitness.”(1)
Despite this, only about 20% of adults meet
the minimum recommended aerobic exercise
guidelines.
Lack of perceived time, motivation, or
confidence to participate safely are commonly
cited reasons as barriers to exercise
participation.(2) To address those perceived
barriers, this article will describe the
components of aerobic exercise prescription
and how to safely design an individualized
program.
Before beginning any exercise program, the
individual should be screened and cleared for
exercise. In 2016 the American College of
Sports Medicine issued new and simplified
preparticipation health screening
recommendations. The following is a summary
from an article in the American College of
Sports Medicine’s Health and Fitness Journal:(3) the reader create a safe, efficient, effective,
“After the determination of the physical activity and individualized aerobic program.
participation (defined as performing planned
structured physical activity for at least 30
minutes at moderate intensity on at least 3
days/week for at least the last 3 months), a
participant is placed into the “no” branch (left) blanks” for each variable:
or the “yes” branch (right).
For individuals who are currently active:
1. If asymptomatic without known
cardiovascular, metabolic, or renal diseases,
one may continue the exercise program and
may progress gradually using published ACSM
guidelines.(4)
2. If asymptomatic with known cardiovascular,
metabolic, or renal diseases, one may continue
the exercise program as long as one remains
symptom free and as long as medical clearance
was given within the last 12 months.
3. If symptomatic with or without known
cardiovascular, metabolic, or renal diseases,
one should discontinue the exercise program
and seek medical clearance.
ISSUE 1 • SPRING 2019
For individuals who are currently inactive:
1. If asymptomatic without known
cardiovascular, metabolic, or renal diseases,
one may engage in a light- to moderate-
intensity exercise program and may progress
gradually using published ACSM guidelines.(4)
2. If asymptomatic with known cardiovascular,
metabolic, or renal diseases, one should
discontinue the exercise program and seek
medical clearance.
3. If symptomatic with or without known
cardiovascular, metabolic, or renal diseases,
one should discontinue the exercise program
and seek medical clearance.”
Please refer to this downloadable screening
checklist the ACSM created to simplify the
screening process.
Once screened and cleared for exercise,
designing a program is as simple as following a
concept known as the “F.I.T.T. Principle.”
Below is a detailed description which will help
The acronym “F.I.T.T.” stands for each variable
involved in designing a program — frequency,
intensity, time (or duration), and type.
Creating a program is as easy as “filling in the
1. FREQUENCY
The governing body guidelines recommend
engaging in at least 30 minutes of moderate-
intensity aerobic exercise a minimum of five
days each week, at least 20 minutes of vigorous
exercise a minimum of three days each week,
or a combination of the two.(5)
Having said that, for most people, time and
desire are what will determine weekly
frequency. Some people can be overwhelmed
at the thought of having an absolute standard
they need to adhere to, may have an "all or
nothing" mind-frame, and may decide that
since they can't meet those standards they
aren't going to perform aerobic exercise at all.
41
“ Many times, as a person sees their fitness
level improving, and activities of daily
living becoming easier, the motivation
and confidence to increase in frequency
will naturally follow.”

Since getting started is most important, another
approach, which may be more realistic for
some, is to determine what frequency the
person can realistically fit into their life at that
moment and use that as the start point or
baseline. The individual can progress from that
baseline, using the above-mentioned standards
as a goal to strive to meet or exceed. There is
nothing wrong with beginning with two days per
week, for example. Many times, as a person
sees their fitness level improving, and activities
of daily living becoming easier, the motivation
and confidence to increase in frequency will
naturally follow.
2. INTENSITY
There are two types of intensity, objective and
subjective:
Karvonen formula) to determine their aerobic
training zone. Below is an example using the
Karvonen formula:
This method of calculating your target training
zone is based on your maximal heart rate and
resting pulse. The individual can calculate their
own training heart rate using the this formula,
but first they’ll have to determine their resting
heart rate, maximum heart rate and heart rate
reserve:
• Resting Heart Rate (RHR) = pulse at rest
(the best time to get a true resting heart
rate is first thing in the morning before you
get out of bed).
• Maximum Heart Rate (MHR) = 220 minus
your age (this is your predicted maximum
heart rate)

Objective intensity means we are taking internal • Heart Rate Reserve (HRR) = Maximum
feelings/emotions and rate of perceived Heart Rate minus Resting Heart Rate
exertion (i.e. perceived effort) out of the
To determine target training zone with HRR,
equation, and only focusing on heart rate. Since
take resting pulse just after waking up
it can be difficult to measure heart rate
(preferable) or after sitting quietly for five
manually while exercising (e.g. taking individual
minutes in a low-stress environment. Then
pulse at the wrist with the index finger) it is
determine MHR (220 minus age) and subtract
more accurate and easier to invest in a heart
RHR from MHR – this is the HRR. Once HRR is
rate monitor. The individual can then use either
determined, multiply that number by 60% and
the results from a recent cardiovascular stress
80% and then add RHR back in to determine
test; a sub-maximal aerobic capacity test (e.g. a
the aerobic training zone. This is the “zone” that
6-minute walk test), or a formula (e.g. the

42 DISEASE REVERSAL AND PREVENTION DIGEST

your heart rate should be in, in order to train at
an intensity high enough to have a positive
effect on your cardiovascular and respiratory
systems, and therefore your aerobic capacity
and overall health. For example:
Age = 50 and resting heart rate = 70 beats
per minute.
220 – 50 = 170 (predicted maximum
heart rate)
170 (predicted maximum heart rate) – 70
(resting heart rate) = 100 (heart rate
reserve)
100 (heart rate reserve) x .6 (60%) = 60
100 (heart rate reserve) x .8 (80%) = 80
Add resting heart rate to each number to
determine aerobic training zone:
60 + 70 = 130 (lower end of aerobic
training zone)
80 + 70 = 150 (upper end of aerobic
training zone)
In this example, the target training zone,
monitored with a heart rate monitor during
aerobic exercise, is 130 to 150 beats per
minute. It is important to understand that
there is a window of error of plus or minute
approximately 10 beats per minute. This means
ISSUE 1 • SPRING 2019
that the lower end of the training zone could
actually be as low as 120 beats per minute, and
the upper end could be as high as 160 beats per
minute. Therefore, while monitoring heart rate
is important during aerobic exercise, since there
is a window of error, it is equally if not more
important to monitor aerobic exercise
subjectively.
Subjectively, use the Omni scale (1 to 10
intensity) or the Borg scale can be used
(6 to 20 intensity) to determine rate of
perceived exertion (RPE), or perceived
effort. (The scales are shown above.)
An example would be to choose the mode of
exercise, such as a stationary bicycle or walking
on a treadmill, start with an easy intensity —
one that feels like a “3” on the 1 to 10 Omni
scale. Remain at that subjective intensity for
three minutes while monitoring heart rate, and
then increase the intensity slightly. Repeat this
procedure incrementally (slightly increasing the
intensity every three minutes) until the rate of
perceived exertion feels like a “6.” If the person
begins to feel anything other-than-the-norm
prior to an RPE of 6, such as feeling light-
headed, dizzy, chest pain, cramping in the
calves, or unusual fatigue, the exercise should
be terminated and the person should consult
their physician. Otherwise they should note the
43
 intensity achieved at an RPE of 6 and the
corresponding heart rate, and this can serve as
their baseline intensity to exercise. For more
clarity, an RPE of 6 feels somewhat hard but it
does not feel hard.
If the person feels more comfortable both
mentally and physically to stop at an RPE
below 6, that is fine. The most important thing
is to find a realistic and safe starting point.
3. TIME/DURATION
The initial duration of aerobic exercise may be
dependent upon starting fitness level,
motivation/desire, and time constraints within
a busy lifestyle. If possible, ten minutes should
be a minimum exercise session length. But this
also depends on if the session is continuous,
steady-state exercise (e.g. walking) or
discontinuous high-intensity interval training,
which is typically shorter in length.
Having said that, a person should always begin
with continuous aerobic exercise to establish a
baseline of aerobic fitness before progressing
to high-intensity interval training. Once the
starting RPE is determined as described above,
determine the duration that the RPE can be
sustained and use that as the baseline to
progress from.
44
4. TYPE
“Type” can be broken down into two categories:
1. Impact (e.g. walking, jogging, running,
sprinting) vs. non-impact (e.g. swimming,
biking, elliptical).
2. Long slow duration, moderate-intensity
continuous, high-intensity interval training,
sprint interval training, and tempo training.
It is outside of the scope of this article to
describe high intensity interval training, sprint
interval training, or tempo training. These will
be discussed in a future article.
A general rule of thumb is to switch back and
forth between impact and non-impact —
sometimes putting stress on the joints via
impact, and sometimes giving the joints a
break via non-impact.
In summary, once the individual has been
cleared for exercise, designing an individualized
aerobic exercise program is as simple as
determining the frequency, intensity, duration,
and type of exercise. To ensure safety, begin
with the type of exercise that is most
comfortable and enjoyable (e.g. walking on a
treadmill) and primarily use RPE scales to
determine a baseline intensity and duration.
RPE scales can then be used to guide
progression over the course of time.
Lastly, always ensure that prior to each exercise
session the individual has eaten a healthy meal
(approximately 1-2 hours prior) or snack
(approximately 30-60 minutes prior), is
hydrated, has taken their medications (if
applicable), and feels both physically and
mentally ready to exercise.
HERE’S TO YOUR HEALTH!
DISEASE REVERSAL AND PREVENTION DIGEST
REFERENCES:

1. Mandsager K, Harb S, Cremer P, Phelan D, Nissen SE, Jaber W. Association of Cardiorespiratory Fitness With
Long-term Mortality Among Adults Undergoing Exercise Treadmill Testing. JAMA Netw Open.2018;1(6):e183605.
doi:10.1001/jamanetworkopen.2018.3605

2. Center for Disease Control and Prevention: Overcoming Barriers to Physical Activity, 2011.https://www.cdc.gov/
cancer/dcpc/prevention/policies_practices/physical_activity/barriers.htm
3. Magal, M. et al, NEW PREPARTICIPATION HEALTH SCREENING RECOMMENDATIONS: What Exercise
Professionals Need to Know, ACSMs Health and Fitness Journal, May/June 2016, 20:3, pages 22-27. doi: 10.1249/
FIT.0000000000000202

4. Garber, CE et al, Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory,
Musculoskeletal, and Neuromotor Fitness in Apparently Healthy Adults: Guidance for Prescribing Exercise,
Medicine and Science in Sport and Exercise, July 2011, 43:7, pages 1334-1359. doi: 10.1249/MSS.0b013e318213fefb
5. Piercy KL, Troiano RP, Ballard RM, et al. The Physical Activity Guidelines for Americans. JAMA.2018;320(19):
2020–2028. doi:10.1001/jama.2018.14854

ISSUE 1 • SPRING 2019 45

 Healthy Living Interview • 10
A CONVERSATION WITH DR. PADMAJA PATEL & MARCY MADRID

Lifestyle Medicine
at Midland Health
Reversing disease and saving lives

At Midland Health, embracing lifestyle medicine and plant-based

nutrition is bringing dramatic results, reversing everything from
diabetes and obesity to heart disease and multiple sclerosis.
The approach has given people their lives back and saved the
west Texas health system millions. Dr. Laurie Marbas speaks with
Dr. Padmaja Patel, an internal medicine doctor at Midland Health,
and Marcy Madrid, vice president of planning and marketing at
Midland Health, about how they’ve pulled it off.

DR. PADMAJA PATEL MARCY MADRID

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46 DISEASE REVERSAL AND PREVENTION DIGEST

Dr. Laurie Marbas (LM): I’m honored to
welcome you both. You are doing some
remarkable things in your community with
nutrition and health at your hospital. Could
you tell us how it got started and what’s
going on there now?
Marcy Madrid (MM): A pioneering spirit is
alive and well in our community. Our health
system and our hospital are really in the
center of that. We redefined our mission,
our vision, and our core values in 2014 around
that idea that we are going to have a pioneer’s
spirit. We’re not going to be stuck in doing
the same thing that we’ve always done just
because it’s the thing we’ve always done.
If there’s a new way, a better way or a new
approach, we’re going to look at that.
We’re going to move forward.
Our vision was to make Midland the healthiest
community in Texas. That really clarified what
are we here for. If we truly want to make the
community healthier, we really have to look
at the nuances of what creates health and
wellness and what deteriorates health and
wellness.
I think that mentality and philosophy
positioned us well in 2015 when a handful
of doctors had a new idea of focusing on
plant-based nutrition.
Dr. Staton Awtrey (a cardiothoracic surgeon
at Midland Health), and his wife, Blythe
Awtrey, R.N., had attended a Plantrician
Project conference where they learned a lot
about plant-based nutrition. They began
sharing information with their peers, including
Dr. Patel. They started building up a really
interesting business case for why this should
be an important aspect of our healthcare
delivery model and the information we’re
providing to our patients.
They joined together and presented our
hospital administration with this idea, and
I was part of the group. At first, it’s hard to
really grasp because it doesn’t fit into a
standard business model and there aren’t
ISSUE 1 • SPRING 2019
very clear-cut reimbursement models—
especially not in 2015. It was uncharted
territory. But because of the passion and
respect Dr. Awtrey and Dr. Patel and others
had, and because of personal first-hand
experiences—including my own experience
reversing multiple sclerosis—the conversation
continued on.
LM: Tell us about your experience, Marcy.
(MM): I was diagnosed with MS almost the
same month that we were having these
meetings about plant-based nutrition—it was
the summer and fall of 2015. I feel like it was
divine intervention, really.
“ Our vision was to make Midland
the healthiest community in Texas.”
I remember just getting my diagnosis and
being on all kinds of steroids and having these
flare-ups and sitting in these meetings about
plant-based nutrition and how food is
medicine. I heard all about how it could
reverse diabetes and improve heart disease,
and eventually I made the connection with
how eating this way could help autoimmune
diseases like MS.
I made a complex switchover to eating a
plant-based diet, and six months later the
lesions in my brain were shrinking. I was a
believer at that point, and it made me even
more passionate. I wanted to do everything
we could to make this information available
to our patients and our community.
We’re not going to be the food police, but
we’re going to make sure as many people
know about this as possible. I think that’s the
approach that Dr. Patel and Dr. Awtrey had
taken that allowed them to progress so far in
their practices. You can’t force this on people,
obviously. It’s a huge cultural change. It’s like
dropping a bomb in someone’s life when you
tell them, “Everything you’ve always known
about food and the way that you’re eating and
47
 carrying on with your lifestyle could be killing
you.” So you have to have a lot of grace with that
message, and patience and the understanding
that people take it differently and at a different
pace.
(LM): Absolutely. Dr. Patel, can you tell us a
little bit about these conversations you were
having with the other physicians when you
approached the administration?
Dr. Padmaja Patel (PP): Dr. Awtrey invited me to
this all-day seminar on plant-based nutrition that
was led by Dr. Scott Stoll and the Plantrician
Project. My husband and I both attended, and I
was very impressed with the data that was
presented. It was pretty compelling
“Patients are willing to
make dramatic changes
if you educate them and
give them the tools.”
The first sense that I got was I kind of felt guilty.
Gosh, I didn’t talk to my patients about this all
along. I went to more conferences to learn more,
and then I did start talking to my patients.
What really impressed me was that patients
actually do listen to you. They are willing to make
dramatic changes if you educate them and give
them the tools. I thought this was such a personal
space that you’d never want to get into, but
patients are hungry to learn more.
This is how Dr. Awtrey and I, after a couple of
conferences, came back and had a conversation
with our CMO (Chief Medical Officer). Initially,
we started a wellness committee, which was
meeting every month at the hospital. As we
learned more about lifestyle medicine, I
suggested that we should start a lifestyle
medicine clinic. Early on, we wondered how we
could get the hospital interested. We had to
show some sort of return for the money.
48
We thought the first thing we should do is talk
about employee wellness. If we made hospital
employees healthier, the hospital would save
money, because our hospital is self-insured.
That’s where we got the idea to bring in the
CHIP program (which stands for Community
Health Improvement Program, a 9-week lifestyle
medicine program that emphasizes plant-based
nutrition).
(MM): I remember thinking maybe we should
do our own research project. We knew all this
information about food was a bombshell we
were dropping on our employees and on
administrators. We wanted to have proof that
that this was really going to impact the health
and healthcare costs of our employees in a
meaningful way in order to justify the
investment.
Our administration approved the research, so
we took a handful of our employees who were
suffering from several different disease processes,
including hypertension, hyperlipidemia, diabetes
and obesity. We had some of our sickest
employees.
We had a control group and a test group. The
control group was to follow the standard ADA
dietary and exercise guidelines. The test group
was using strictly plant-based nutrition and
lifestyle medicine.
We ran those groups side-by-side and noted
significant differences. In our test group, we saw
a significant decline in cholesterol and weight—
everyone dropped at least 20 pounds. In
addition, cholesterol, A1Cs, blood sugars and
blood pressure improved. We had several people
who were already able to adjust their medications
within those first two weeks. But our control
group—who were following the standard
guidelines we typically tell them—showed the
same results we historically see, which is maybe a
little up or a little down but not a significant
change. It was obvious what a difference our test
program had.
DISEASE REVERSAL AND PREVENTION DIGEST
That was a good launching point of discussions
for our board members, our administrative teams
and also our employees. When our employees
see their peers they work next to, say Susie Q., a
nurse everyone’s known for years, and they know
she went through this two-week program and it
had a dramatic impact on her weight and
cholesterol, and well, if Susie got that in two
weeks maybe it can work for me too.
People needed that data, but they also needed
the personal connection, the real life example.
The employees who went through that initial
program and experienced remarkable change are
still our cheerleaders today because they had
such incredible life changes and their quality of
life was improved. I think that has been an
unintended secret to this whole movement.
The data, the studies, the research and the
presentations are great, but once you have
people actually engage with the information and
make the lifestyle changes, that grassroots effort
and word of mouth marketing is very powerful.
(LM): Absolutely. Do you recall your numbers
or savings?
(MM): Yes. Within the CHIP program we
monitored participants for that three-month
period and we had a lot of reduction in
prescription costs.
We’re looking to do some more long-term studies
over the healthcare costs and prescription drug
impact on the group of employees who were in
the initial test group. We want to look at year-
over-year prescription drug and healthcare cost
impact from pre-intervention to post-
intervention. Several of the employees who went
through the initial study are still living like this and
improving their health. We really want to see that
long-term impact.
What we’ve found is that when people really go
all in, they have such a remarkable lifestyle
change that they do stick with it.
(LM): It would be cool, too, if you guys looked
at the ripple effect, like on family members of
those who do it.
ISSUE 1 • SPRING 2019
(PP): We were just discussing the other day that
there’s going to be, in 2018, at the end of the
data, a several million dollar cost savings when
it comes to healthcare spending.
Once we were a couple years into this we’d had
a new group of CHIP participants every three
months and we were still focusing on employee
wellness. We’d also made a lot of changes in our
cafeteria and inpatient menu by offering a lot of
plant-based foods.
But I still had this idea in mind that we have to
have a lifestyle medicine clinic, so I sat down with
our CEO and CMO. The model I had in mind was
a clinic where we could provide more support to
patients.
In my own private practice, in internal medicine,
I was already talking to patients. But I realized,
this is hard just having the conversation in your
average office visit and providing them resources
and then the patients are pretty much on their
own. We needed to have a more comprehensive
approach to lifestyle medicine to really have
some meaningful outcomes.
The lifestyle medicine clinic is a regular office
with a clinic, but we focus mainly on lifestyle
interventions as a first line of treatment, using
medications on an as-needed basis. Patients
have the option to go to our weekly educational
classes. And they can do grocery tours to learn
how to buy, what to buy and how to look at the
nutritional label. We also do cooking
demonstrations, so they learn a lot of practical
applications. We offer the CHIP program to the
community, and we brought in the Ornish
program (a 9-week program that emphasizes
plant-based nutrition as part of cardiac
rehabilitation), which reimburses at about
$7,200 per patient.
(LM): That’s awesome. When did the lifestyle
medicine clinic open?
(PP): The center opened last year, in August. One
of the keys to our success is that a lot of things
we are doing are connected with Healthy City,
which is a local nonprofit that both of us are
49
 affiliated with. Healthy City does a lot with
community education and awareness, and
they organize the annual Food As Medicine
event. The community effort is very valuable.
(LM): That makes it less scary.
(MM): Dr. Patel is so right about the
community aspect. One of the reasons we
formed Healthy City, which does a lot of
community-based events, is because this
kind of approach isn’t directly aligned with
healthcare reimbursement—yet. I feel like
with population health management, that’s
the direction we’re all going to have to head,
but it’s not that way today.
There are so many other community needs
that really go beyond what we can do within
the hospital walls or clinic walls because we
just don’t have the resources to put toward it.
This local nonprofit can dedicate the time and
resources and raise the money to support
everything from working with restaurants,
working with schools, gardening and doing
big conferences.
(LM): Who actually started the nonprofit?
The hospital? Or a group of individuals?
50
(MM): We did.
(LM): Oh, wow. Okay. That’s really cool. So,
you guys have taken it upon yourselves, as
advocates in your community, because you
see that’s where the real change will affect,
all together. It’s the synergistic effect. That’s
brilliant.
(MM): It was really the realization that there’s
so much more we need to do. We needed to
pull together all those passionate people in our
community. The nonprofit was formed in 2016,
and it’s really been an important part of this.
I think having all these resources available now
is very helpful because when people want to
make changes, we have a place to plug them
in at whatever level they’re able to engage.
(LM): I appreciate you taking the time and
sharing your message, and I think you may be
inspiring others to take their communities to
the next level, like you guys are, and they’ll
look to you as leaders, so I’m excited to see
where you go.
DISEASE REVERSAL AND PREVENTION DIGEST
“ Once you have people actually engage
with the information and make the
lifestyle changes, that grassroots
effort and word of mouth marketing
is very powerful.”
Padmaja Patel, MD has been a
practicing internist in Midland for the
last two decades. She is certified in
Plant Based Nutrition through the
eCornell T. Colin Campbell Center
for Nutrition Studies. Dr. Patel is a
Diplomate of the American Board
of Lifestyle Medicine and American
Board of Internal Medicine.
Being a lifelong vegetarian, Dr. Patel
and her husband embarked on a
whole-food, plant-based diet about
three years ago after looking at the
compelling medical evidence in
regards to prevention, treatment
and reversal of some chronic health
conditions. Dr. Patel’s passion and
enthusiasm fueled her desire to take
this movement to another level by
joining the Healthy City Board, as well
as becoming the Medical Director for
the Midland Health Lifestyle Medicine
Center which provides patients with a
medically supervised comprehensive
lifestyle program.
ISSUE 1 • SPRING 2019
Marcy Madrid is the Vice President of
Planning and Marketing for Midland
Health. She oversees strategic
planning, community health outreach,
marketing and public relations, sales
as well as employee engagement and
patient experience. Marcy is a member
of the American College of Lifestyle
Medicine.
In September 2015, Marcy was
diagnosed with Multiple Sclerosis and
began taking medication for about a
month while experiencing many side
effects. Around this same time, she
was learning about plant-based
nutrition from a few local physicians
who were interested in starting a
movement in Midland. Marcy
consulted with her doctor, stopped
taking her medications, adopted a
plant-based lifestyle and began using
food as medicine. Six months later,
Marcy’s MRI scans of her spine and
brain showed that her lesions had
shrank and nearly disappeared entirely.
51
 Disease Reversal Success Story

A CONVERSATION WITH
DR. BROOKE GOLDNER

Healing Autoimmune
Disease with
Plant-Based
Nutrition

DR. LAURIE MARBAS: We want DR. BROOKE GOLDNER:

to bring you amazing interviews
with some amazing people, like
Dr. Goldner. Dr. Goldner has
recovered from lupus, and she
has an amazing inspirational
story. You can find her at
GoodbyeLupus.com.
We want to know what is
autoimmune disease, what is
lupus, how did you find your way
to recovery, what is your
experience working with patients,
and how have you helped others
recover from some very serious
autoimmune diseases?
I’m a board-certified medical
doctor, but before I was a
doctor I was a patient for
much of my life. When I was
diagnosed with lupus, at age
16, I had no idea what it was.
Lupus is a type of autoimmune
disease. Autoimmune diseases
are diseases where your
immune system starts to
malfunction. Normally, your
immune system is what
protects you from illness.
It protects you if you get
an injury. The other way is
if you get an infection.

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OF INTERVIEW OF INTERVIEW

52 DISEASE REVERSAL AND PREVENTION DIGEST

If you get bacteria or a virus you develop
antibodies, and the antibodies kill that
offender so it doesn’t hurt you. In
autoimmune disease, you start to develop
antibodies against parts of your own body
and your immune system is very effective
at killing things that are not supposed to be
there. Unfortunately, with autoimmune
disease, it starts attacking and killing parts
of your own body.
Lupus is a type of autoimmune disease where
it really can attack any part of your body.
Nephritis, or kidney involvement, is very
common. It’s one of the most common
manifestations besides arthritis and rashes.
There are lots of people who end up getting
kidney transplants. Selena Gomez is a very
famous person who just got a kidney
transplant because of lupus. It can also affect
the brain. I had someone with lupus in her
brain who was getting seizures multiple times
a day. It can be in your heart, your lungs.
It’s a very devastating autoimmune disease
because it really can manifest in any part of
your body and can progress as you get older.
At the time of my diagnosis, I was in stage IV
kidney failure, so I had about six months
before my kidneys would completely shut
down. Here I am, 16 years old. I’ve got some
arthritis, rashes and headaches, and the
next thing I’m being told is if we don’t do
aggressive treatment, you’re going to be
on dialysis or dead in six months.
It completely changed my life, in so many
ways, dealing with that diagnosis. #1, figuring
out how to live and prosper with a disease
that offered a death or a disability sentence
was really over my head. I give my family
a lot of credit for that. My mother, my
grandmother, they all were just amazing at
helping me stay focused on the fact that
lupus was something I had, but it didn’t define
who I was and it wasn’t going to take away
who I would become.
At the time, using chemotherapy for lupus
was very new. They used chemotherapy
because a side effect of chemotherapy is that
ISSUE 1 • SPRING 2019
it shuts off your immune system. I took 60 mg
of steroids a day, plus seven other pills, plus
chemotherapy for two years of my life, from
16 to 18. I just stayed focused on, okay, there’s
so much good in my life- my family, my brain’s
pretty good, I have all these things that I can
do, I love to sing. I just focused on what I had
and I was able to graduate on time, in the
top 10 of my class, and get a scholarship to
Carnegie Mellon, which was my first choice of
college, all while getting chemotherapy and
everything else. When I help patients of my
own who are fighting these horrible diseases,
that’s one of the things I help them with
because I know what it’s like. When you can
focus on your passion and you can focus on
the gratitude for what you have, then the
illness becomes part of what you have in
your life. It doesn’t take over your life.
“ When you can focus on your passion
and you can focus on the gratitude
for what you have, then the illness
becomes part of what you have in your
life. It doesn’t take over your life.”
I had my last chemotherapy a week before
I started college, which was wild in itself.
It’s like a new chapter starting immediately.
I was in remission at that point, so they tried
to stop the chemo multiple times, but my
antibodies would just go right back up and
kidney function would go down, so it took
two years, exactly, to get me into a remission
state. I still had lupus. I had positive ANA,
and positive DS-DNA antibodies. Those are
markers for lupus. I was able to maintain that
through college, which is pretty good. I made
sure I got enough sleep. If I didn’t get enough
sleep, I’d get arthritis the next day, take my
medicine for the arthritis and fix that, so
I was very careful. That’s one of the gifts that
chronic disease taught me was listen to your
body, get enough rest, avoid stress. That
was a mantra that kept me alive, that many
people ignore in their lives until they get sick.
53
“ This year, in October, it’ll be 14 years that
I’ve been completely lupus-free, all because
I changed what I ate. I’m never looking back.”

I did well all the way through my decision to
go to medical school. I, at one point, thought
maybe I could cure lupus. How many people
choose careers where they try to fix
themselves? I did three years of genetic
research at Carnegie Mellon in leukemia and
neural development. I found that I hate doing
genetic research! I’m a really social person, and
I’d just be sitting in the lab by myself. You do
so much work and most of your tests don’t
work, and then I was like, oh, this is not my path.
I had this revelation that my path was I’m a
master at helping people have more happiness
and purpose in their lives, in spite of being sick,
so what if I became a doctor who helped people
overcome illnesses and find passion and
happiness in their lives? If I can’t cure a disease,
I can help people not be burdened so much by
disease that they don’t live. I decided to go
into medicine and ultimately into psychiatry.
I became an expert in helping people overcome
trauma and obstacles, and find happiness,
which brought more health, right?
But, I did get sick again in medical school. I got
diagnosed with anticardiolipin antibody that was
causing TIAs, transient ischemic attacks, or what
we call mini-strokes. I actually passed out in one
of the clinics. I was getting double vision, and it
was from blood clots passing. Thankfully, I didn’t
have a permanent condition from it. I didn’t
have a full stroke but it was very dangerous, so
I was put on blood thinners. That’s really where
I came to another big moment in my life, where
I thought I had it under control, which is life
with autoimmune disease. You try to get it under
control, so I was like, “Oh, wow, I’ve been in
remission. I haven’t needed as much medication.
I’m going to graduate medical school and
become a doctor. It’s this close.” Then, I’m
sending blood clots into my brain and I’m
being told that you have to be on blood thinners
forever and you can never get pregnant because,
if it’s not kidney failure, you’re going to have a
major stroke and shorten your life expectancy.
I became super-grateful and felt lucky again,
like, “How lucky am I that every time something
terrible happens, there’s a medicine that can help
me and I still get to live? I’m the luckiest person
on the planet.” I truly felt that. People with lupus
often tell me they feel they’re so unlucky. I felt
really lucky, like, “Oh my god, I almost died
from a stroke, but I didn’t! And I can take blood
thinners, and I don’t have to have that again.
I can’t hit my head or I’ll bleed out, but, like,
cool, I’m still here! I’m still lucky!” That’s when it
all changed for me. I had full acceptance in my
heart that my life’s not like anyone else’s, but
I’m still damn lucky, like I’m living my dream.
How many people don’t have physical illness
and they don’t live their dream, right?
I was just a super-happy person and that’s when
I met the man who became my husband, Thomas
Tadlock. He wanted to marry me, in spite of my
illness. I tried to ward him off, like, “You’re going
to have to take care of me. I can’t have your
children. This isn’t really something most 28 year
olds want to sign up for, that they’re going to
have a wife that will die early, that’s going to
become handicapped. I understand if that’s not
what you want.” He said, “I just want to be with
you. I’ll take a short life with you over a long life
with anybody else.” I said, “Well, then, let’s do
this marriage thing. Let’s do it.”
That’s what changed everything because, #1, the
fact that I took good care of myself, emotionally
especially, and that I was in that place to be able
to receive all the changes that happened and to
let somebody love me — even though I might not
have all the working parts that other people

54 DISEASE REVERSAL AND PREVENTION DIGEST

might have. He was in the perfect place in his
life, too, where he actually ended up saving my
life. I wanted to look good for our wedding. I was
living in Pittsburgh, eating Pittsburgh food. In
Pittsburgh, if you order a salad, they put French
fries on it, so I was overweight and had illness.
I got my residency at UCLA Harbor, so I’m
moving to LA and we’re getting married in Hawaii
and I wanted to look good. He’s a celebrity
trainer who was training people who were going
on MTV at the time. I was like, “I want to look like
MTV. I want to be LA-hot.” So, he trained me.
He has a best-selling book now, Miracle
Metabolism. It’s about how, by changing how you
eat, you can create a fast metabolism. He was
doing high amounts of raw vegetables, omega-3s
and hydration, all the stuff I teach people to do
now for autoimmune. But he was telling people
to eat free-range meat for protein, which is the
healthiest version of paleo there could ever be,
over a decade ago before paleo existed. People
were shedding tons of weight, getting six-packs,
but no one was reversing diseases.
I had been a vegetarian since I was a kid, because
I was an animal lover, but I ate dairy and eggs
every single day. He said dairy is the most
insulinemic food on the planet, so you’re going to
get fatter on that than anything else. Cut out the
saturated fats. He took me off eggs and cheese,
but I wouldn’t eat meat, so he was like, “I don’t
know. We’ll just use some tofu. I’ve never trained
a vegetarian before.” Within a couple of weeks
I felt the best I had ever felt in my life.
Right before our wedding, it was about 3 ½
months later, I got my blood tests drawn and,
for the first time since I was 16, all of those labs
were negative. After 12 years of positive labs and
symptoms, it just wasn’t there. My doctor said,
“Maybe it’s a lab error? Because I’m looking at
your chart from Pennsylvania, and it says you
have all this stuff.” Came back from the wedding,
retested, still negative, plus my cholesterol came
down, which I was told was genetically high
and had nothing to do with all the dairy I ate.
Go figure.
This year, in October, it’ll be 14 years that I’ve
been completely lupus-free, all because I
changed what I ate. I’m never looking back.
ISSUE 1 • SPRING 2019
Four years after I got healthy, I finally decided
I was going to try to have kids because I was a
healthy person. I had my first son. Zero lupus
came back. I had my second son four years later.
I’m 42 years old and was recently on the cover of
Fit Over 40, so now I’m an example of being fit
and healthy over 40, which still blows my mind
because I always figured I’d be handicapped by
my 40s and here I am.
We took at least a year after I had my first son —
that’s when it clicked that I was actually healed,
because I’m a doctor, so I really didn’t believe
that nutrition had anything to do with disease,
right? Because they would have told me that in
those 12 freaking years of training. So, when
people get mad at their doctors for not believing
this, I’m like, I am a doctor and I didn’t believe
it in my own body for four years. I just thought
oh, it must be a remission, until I had my first son
and I was like, it was supposed to come back. It
didn’t come back. I lost all the weight from the
pregnancy within a week. That had to happen
for me to really, truly understand that I wasn’t
sick anymore. So, don’t be mad at your doctors
if they don’t get it yet. If I couldn’t see it and
it was my own body, give them a break. Show
them by healing.
For the past decade, I’ve been giving that gift
back. My husband and I spent a year reverse
engineering everything I ate and everything I
stopped eating, and we learned, on a cellular
level, the foods that trigger cellular repair
and an optimal immune system and eliminate
inflammation. We realized we had accidentally
created basically the most anti-inflammatory diet
a human could be on. We kept testing it, so over
the past decade we have reversed diseases in
thousands of people. If you count all the people
who have read Goodbye Lupus who comment on
Amazon that they’re pain-free and I never even
met them, thousands of people all over the world
have been able to reverse RA, lupus, scleroderma,
Sjogren’s, multiple sclerosis, mixed connective
tissue disease, and also non-autoimmune diseases
like diabetes and heart disease. All because of
this experience I had and this really simple way
of eating that has the power to reverse damage
from even a decade of illness and get you your
health and life back.
55
 Wow. That’s phenomenal. What is it that you
are consuming that has such a remarkable
recovery? Really explain to people what it is that
you have your patients eat.
I break my program down into six steps because
I like things to be easy. The first three steps are
how to stop getting sicker. Stop eating animal
products — meat, dairy, butter, ghee. Stop eating
all those different types of oils. Don’t believe that
sunflower oil and safflower oil are somehow good
for you. They’re not. Coconut oil, we know
that’s not good for you. Processed foods tend
to have a lot of oils in them. They create their
own inflammatory reaction. All of those are
super-inflammatory.
“Leafy greens and
cruciferous vegetables…
are the most powerful foods
you can eat, when you look
at nutrient density.”
What’s missing a lot of times in even the plant-
based eating world is what are the best foods to
eat to reverse disease? How do I do it the fastest?
There’s a huge array of plant foods, so my
specialty is rapid recovery. When I did my
research on foods on the cellular level, I had
never heard of anyone else doing that. I found
out afterwards there were people like T. Colin
Campbell or Esselstyn or Fuhrman. I had never
heard of them because I went to medical school,
and they told us not to listen to anything besides
what’s in the New England Journal of Medicine.
I’m actually really happy we created it on our own
because the things we came up with were, in
some ways, unique. What we found was that
there are foods that accelerate healing faster
than other ones. What are they? The first one is
getting the majority of your nutrients from leafy
greens and cruciferous vegetables. Those are the
most powerful foods you can eat, when you look
56
at nutrient density. I suggest you eat them in
the raw form. When you look at all the different
fruits and vegetables, cruciferous vegetables
have more nutrients — I’m talking about vitamins,
minerals, phytonutrients, and just everything
in there. They have more than any other type
of food.
When I have people in rapid recovery, which
means you’re coming to me to get better as fast
as you can — you’re trying to get to the Olympics
level of healing, so you’re going to have to do
things way more extreme. I’ll have them do a
pound of greens a day, raw greens. That’s a new
habit to get into, so for lots of folks, I’m like, if
you’re not ready for the Olympics yet, just start
adding that to your diet.
The other thing people are really missing is
omega-3 fatty acids. There has, unfortunately,
been a trend in the plant-based world to think
of all fats as bad for you and it’s not the case.
Thankfully, the newer research coming out is
supporting what I have been telling people for
a decade, that avocados are great for you. Flax
and chia seeds are great for you. I have a rapid
recovery group where I put 30 people at a time
through these programs, so I know it works.
That’s all I do is heal people, all day, every day,
so I love to see that that’s supporting that now.
Omega-3s are what creates your anti-
inflammatory immune system, and they
need to become a part of your cells in order
for your cells to function optimally. Anyone who
is starved of those nutrients is not going to get
the best form of cellular function, and they’re
not going to be able to eliminate inflammation
properly. That’s why a lot of people with a plant-
based diet who don’t have omega-3s, they’ll tell
me, “As long as I don’t eat anything that’s bad
for me – no meat, no dairy, no processed foods –
I feel fine, but if I eat one thing, have one bite of
cheese pizza, one cheat meal,” and I tell them
there’s no cheating, there’s just hurting, but
they have one bad meal and, “I’m in pain again.”
That means you don’t have a functioning anti-
inflammatory immune system that can eliminate
the damage fast enough. When I add omega-3s,
all of a sudden, that goes away.
DISEASE REVERSAL AND PREVENTION DIGEST
That’s also the difference between remission and
healing, in my opinion. I’ve been in remission for
many years before. Remission means I can
maintain where I am if I’m careful. Right? I did
that in college. Versus I’m healed. I have not had
lupus for 14 years. If I want to go to a Chinese
restaurant and eat fried tofu and broccoli with
oil in it, yes, I will have a stomach ache, but I do
not get lupus back. I wake up in the morning
back to normal again.

Your body, which is healthy, can tolerate injury

and heal it like a paper cut. It hurts and then
you’re fine the next day. When you’re sick, you
don’t have the ability to do that because you’re
already sick. It’s like having an open wound and
you keep scratching the scab off. If you’re
missing omega-3s, you can’t get that complete
healing. I usually really load up people on
omega-3s because omega-6 is what creates your
inflammatory immune system and you get
omega-6 from oils, nuts and any animal products
people are eating. I usually tell people, at
minimum, if you’re sick, ½ cup of chia or flax
seeds a day. If you’re healthy, a handful.
Some people’s guts are so weak they can’t
tolerate all the fiber, between the greens and
the seeds. They get constipated because their
bodies are like, “What’s this fiber stuff? I don’t
know what to do.” In those cases, I’ll tell them to
get cold pressed flax oil, keep it in the fridge. It’ll
work just as well without the fiber. Yes, it’s in oil
and, yes, people heal on it because it’s purely
omega-3s. Omega-3s are super-important for
healing.
Then, hydration. People totally ignore water. I
see what works and 96 ounces seems to be the
cutoff for where people start to get rapid
recovery. For general health, eight glasses a day,
you’re probably fine. We do know that water is
used for all the cellular functions that are
involved in eliminating inflammation. So it makes
sense that if you drink just enough water, you’re
going to use that to support your blood pressure,
to keep your kidneys working, and for general
health functions, but if you want extra repair
work to happen that requires water, if you don’t
have any left over, it won’t happen.
I can give you a trick for people who are like,
“How the heck am I supposed to eat all that?
That just seems overwhelming.” The trick to
getting all that in is green smoothies. They have
been the most powerful tool I have used to help
people reverse diseases in all these years. The
specific recipe is that you take the kale, spinach,
whatever greens you want, and stuff it in there
until it fills ¾ of your blender. Then, you take
your ½ cup of omega-3s, put that in there. Then,
you take water and fill it up to the level of the
greens. Now you’re getting hydrated too. Then
put some fruit in there for flavor and blend it.
You just sit there and – look, I practice what I
preach – all day long, you just sip on that and
you’re getting nourished with the best foods on
the planet for reversing illness and, if you’re not
sick, it gives you tons of energy and makes you
superpowered. I’m not sick anymore, but the
reason I can talk like this for 12 hours straight is
because of this. I’m not actually manic; I’m just
supercharged healthy.
My husband and I created a website called
www.SmoothieShred.com that contains free
recipes for some of our favorite smoothies,
and the easiest ones to make. We show exactly
how to do it, and we have tons of videos to help
people. There is a link on there for people who
want to join our Facebook group that has
thousands of people from all over the world who
are just making smoothies and getting support.
We do free Q&As in there and help them.

ISSUE 1 • SPRING 2019 57

 For me, I want you to get your life back. My
husband always says, “I want you to get your
wife back,” because he married me thinking he
wasn’t going to have me for long and now he’s
stuck with me forever, like we get to grow old
together, which is just the coolest thing in
the world.
You talked about rapid recovery is a pound of
greens/cruciferous a day; ½ cup of chia or
ground flax, so that’s where you’re getting your
omega-3s; and then hydration. Was that three
of the six pillars?
Yes. The second half is the hyper-nourishment.
There’s the stop getting sicker, the foods to
stop. Hyper-nourishment is the other half. If
someone’s in my rapid recovery group, where
I’m going to help you every day for six weeks,
my husband and I do it together. We just love
people until they’re healthy for six weeks. A lot
of what I do, too, is help people understand how
they stop themselves from healing. I’m sure
everybody listening understands that it’s very
difficult to change your diet and this is one of the
strictest ones. It’s not forever. I don’t live only
on kale and omega-3s and water. That is not my
lifestyle, but it is how you change your body as
fast as possible. In rapid recovery, every bite you
take, if I only have six weeks with you and we’re
going to try to reverse a disease, every bite you
take better be healing you.
I teach people how to overcome cravings,
mental blocks, suffering and all the things they
come up with. At the same time that I teach
them how to eat, I teach them how to embrace
happiness and forgiveness and gratitude, and I
give them all the love that helped me live with
lupus and overcome lupus. That’s why, when
people graduate, they tell me, “I’m not the same
anymore. I have the same level of stress in my
life, but it doesn’t affect me anymore. I have
eliminated my anxiety in six weeks because I
finally am full of gratitude.”
When you can embrace love, happiness and
amazing self-care emotionally at the same time
you change your diet, there’s an amazing
transformation that happens in people’s health.
58
The food can do its job because they’re in a state
of love. When someone’s super high anxiety or
super high stress or very depressed, that’s
inflammatory, so the food is fighting the
inflammation and their moods are raising the
inflammation and it’s like “argh!” If I’m actually
going to take care of you every day, I’m there in
every way. I’m there for the emotional health.
We do live meetings in the group, and today we
were helping people solve their marriage issues
because there are multiple people whose fights
with their husbands are causing them stress
that’s going to make them crave other foods.
My husband and I are relationship experts.
We’ve taught this at retreats, so we’re teaching
them how to communicate with their spouses as
part of their healing program from autoimmune
disease.
Basically, whatever people need for six weeks,
that’s what we do. We basically give them a life
reboot. Everything about your life has to be
geared in. When I changed my diet, I was already
happy. I was good at happy. That was a gift I got
from my family. My grandmother is a Holocaust
survivor, and my grandparents taught me that
every day you wake up you’re lucky. I grew up
feeling lucky no matter what happened to me
because if they could feel lucky when their
family was murdered, when they almost died,
when all of these things happened to them in
camps, if they could feel lucky, then growing
up in America, I am lucky.
Is there any last thing you feel is important to
let people know who are reading this or know
someone, because autoimmune disease is
certainly on the rise. I think people don’t realize
that allergies are an autoimmune issue and
thyroid problems are often autoimmune, so
there are multiple factors involved. Do you
have anything in particular you feel like we’re
missing in this conversation that will spur
someone to do more investigation?
Yes, hypothyroidism, one of the issues I have
with that illness is it’s treated by endocrinology
and not rheumatology. We treat it as you have
this autoimmune disease that’s attacking the
DISEASE REVERSAL AND PREVENTION DIGEST
thyroid, but once the thyroid is dead, we just body is not your enemy. Your body is desperately
replace the thyroid hormone. I have a lot of fighting for you every single day. I thought my
people with Hashimoto’s and other thyroid body was my enemy and I was this spiritual being,
conditions who reverse their illnesses very well being assaulted by my immune system, that my
in my program because — here’s the thing — body was trying to kill me. My body was fighting
just because you don’t have anymore thyroid to keep me alive. I was assaulting my body with all
doesn’t mean you don’t have raging the wrong things. When you realize there’s hope,
inflammation autoimmune disease still going on. that your body wants you to live and it wants you
So what happens is a lot of people take their to be pain-free and it wants you to be healthy,
thyroid hormone, but still feel horrible. They then it’s easier to take action.
have no energy. They’re still overweight. They
don’t feel well. In my rapid recovery group, I’ve
had people with hypothyroid, within two weeks,
“The next thing is to just focus
they’re like, “Oh my god, I have so much energy. on not the food, but on your
I’ve lost all the weight. I feel good.” They just
needed the nourishment, not just the purpose in this life. I call it
replacement hormone, so you’re absolutely
right, thyroid. your why.… Why do I want to
Allergies too. If you weren’t born with that allergy be alive? What is my reason
and it happened later in life, that’s inflammation
that’s causing your immune system to for being on this Earth?”
malfunction. Some people get an allergy before
they develop autoimmune (issues). Sometimes
they get it together. That’s a lot of what I do in
my group as well. I’m looking at, if someone’s
The next thing is to just focus on not the food,
having a food reaction, switching that up. I’ve
but on your purpose in this life. I call it your why
diagnosed food sensitivities in that group as well.
and I teach this in my group as well. Like I said, it’s
If I’m watching you every day, I can always figure
an emotional thing. You have to be focused on
out what’s going on. I’ve had people completely
your why because, to me, your why is, “Why do
reverse their food allergies in a very short period
I want to be alive? What is my reason for being
of time by doing this, which is great.
on this Earth?” I usually lead people through an
So, yes, it’s all related, but I think the most exercise in the group that you can do here on
important thing to realize is that healing is a your own, where I ask you to tell yourself, now
natural state. If you look at every cell in our body, that I’m healthy, what am I doing? Who do I
there’s a mechanism for cellular repair. The only inspire? How do I feel?
reason you’re not healthy is because there’s
I have people say it as if it already happened,
repeated damage happening on a daily basis.
even though they’re terrified to imagine it. Now
When we stop damaging and we start giving
that I’m healthy, I’m on stage, teaching people
ourselves the tools we need to recover, we have
how to heal, I have a bestselling book, and I’m
an extraordinary ability to heal. Every part of our
growing old with the person I love and I’m raising
body wants to recover, so an extraordinary
healthy kids. That’s mine. That’s what I’m doing.
amount of hope comes from that, that I can
What is yours? What is your gift? Because
make the choice today to stop the damage and
everyone on this Earth was born with a gift to
start healing, and I don’t have to feel hopeless
give. I believe that with my heart and soul. We
that because I’ve been sick I can’t get better.
all have different gifts we were born to give and
One of the biggest lessons I teach in my group, you have to embrace that gift because if you’re
and this is one that causes a lot of tears, is your focused on your why, your reason for being,

ISSUE 1 • SPRING 2019 59

 if you’re not functioning under why power,
you’re only relying on willpower and will-
power fails every single time. Why power
doesn’t fail you, though.
If you meditate in your bed imagining yourself
giving your gift, whether it’s creating beautiful
art or writing books or being on stage or just
being a great mother who has the energy to
take care of her kids, if you’re
in that zone of feeling and experiencing all
the things you’re meant to do in this lifetime, don’t have to be weird if you’re vegan, but
then get out of bed and go into the kitchen,
you’re going to want the smoothie because
the smoothie is going to give you that. Then
you don’t have to have willpower.
You’ve got to focus on your passion and your
purpose, then the rest of it becomes easy.
Always, always remember that there is hope
and there is healing, that none of us were
born to be sick and suffer. All of us have the
ability to live better and to feel better, and
we’re the only ones who can take action to
make that happen.
Absolutely. I agree 100%. People are
accustomed now that it’s normal to
be sick. It is not normal to be sick.
I am fully weird and everyone knows it. I will
hug a tree. I don’t care. I’m weird. I drink
green stuff all day long. I drink tons of water.
You know what else is weird? I reversed
lupus and kidney failure and blood clots,
and I’m vibrantly healthy in my 40s and I feel
amazing. That’s weird and I will take that over
being normal any day of the week. We’ve just
got to all be weird.
I made a video about that years ago, like you
you probably will be. You are, right? Being
different means being different than the
norm and the norm is sickness and disease
and unhappiness, so don’t be normal. Be
weird and be healthy.
I think that’s an awesome way to say it. It is
good. Let’s be weird.
Let’s just be weird. We’re all weird, right? Of
course we’re weird. It’s great. Gotta embrace
it. Otherwise, it’s all peer pressure, right?
If you’re like, “Oh, I want to fit in,” you’re
not going to be able to fit in and heal.
It doesn’t work.
Right, and we’re on this Earth for a purpose.
To find it, that’s your hope.

It is normal in that it’s common. Thank you, Dr. Goldner. We so appreciate

your story and your enthusiasm is
It’s normal in that it’s common, but it’s not contagious, as always. We so appreciate
normal in the sense of how we were made. you. Thank you.
I was talking about this with a client the other
day. I do Skype sessions with people all over
the world and I get to talk about all these fun
issues with people. One of the issues that just
came up as they were saying, “Everyone
thinks I’m weird, and they’re all questioning
why I’m drinking green stuff and why I won’t
eat French fries.” I said, “Listen, in order to be
really wildly, ridiculously healthy or successful
at anything, you have to be weird.” It’s normal
to be unfulfilled and it’s normal to be sick. It’s
normal to have all of these negative things in
your life, so you have to be willing to be weird
to have an abnormal experience.

60 DISEASE REVERSAL AND PREVENTION DIGEST

“Being different means being
different than the norm and the
norm is sickness and disease and
unhappiness, so don’t be normal.
Be weird and be healthy.”

Brooke Goldner, MD is a best-selling author, the founder of

VeganMedicalDoctor.com, GoodbyeLupus.com. creator of
the Hyper-nourishing Nutrition Protocol for Lupus Recovery,
and is the author of 2 best-selling books, Goodbye Lupus and
Green Smoothie Recipes to Kick-Start Your Health and Healing.

Dr. Goldner graduated with honors from Carnegie Mellon

University for her genetic research in Leukemia and
neurobiology. She received her M.D. from Temple University
School of Medicine, and was Chief Resident at UCLA-Harbor
Residency in Psychiatry. She also holds a certification in
Plant-Based Nutrition from Cornell University.

ISSUE 1 • SPRING 2019 61

 Research From The International
Journal of Disease Reversal and Prevention

A CONVERSATION WITH
DR. NEAL BARNARD AND SUSAN LEVIN

The Use of
Plant-Based
Diets for Obesity
Treatment
DR. LAURIE MARBAS (LM): Today, I’m so honored to
interview. Dr. Neal Barnard and Susan Levin. We’re
here to speak to you about the article that we are
publishing in the IJDRP, called “The Use of Plant-
Based Diets for Obesity Treatment.” We really
want to understand what this article is about and
DR. NEAL BARNARD
what message does it convey. Can you give us a big
picture idea of what the article is about?

LISTEN TO AUDIO
OF INTERVIEW

WATCH VIDEO OF INTERVIEW SUSAN LEVIN

62 DISEASE REVERSAL AND PREVENTION DIGEST

Susan Levin (SL): There’s been so much good
research published about plant-based eating
and maintaining a healthy weight, and this was
a really great opportunity to compile a lot of
that research into one review, to gather the
information in one place and to convey to
medical professionals why this way of eating
really works.
(LM): Absolutely. I think that’s really important
because weight loss is the #1 thing that people
come to us about when they speak to
physicians about nutrition, so I think you’re
definitely right on.
Can you give us a little bit of knowledge,
because you mentioned here as well the current
state of knowledge. What do we actually know
about weight loss in different types of dietary
patterns?
Dr. Neal Barnard (NB): Some of the beginning
data really come from observational studies,
where the researchers aren’t changing anything;
they’re just looking at how people are within the
dietary patterns that they have selected on their
own. So, when we look both in Europe and in the
United States, very large observational studies
show a really clear pattern. This is, if you
compare people who are eating meat every day
to people who eat meat less often to people
who eat no meat at all (except for fish) to people
who eat not even that (maybe some dairy) and
then you compare those to people who don’t
eat animal products at all, a total vegan diet,
you see this downward stepwise trend toward
healthier and healthier body weight.
When we compare, in the United States,
in the Adventist Health Study, which brought in
people who are following the Adventist church
teachings that say you ought to be health
conscious, and for many of these people that
means a lot of attention to nutrition, the meat-
eaters in this sample of 61,000 people had a
body mass index that was not under 25, which
is where we’d like to see it. Their average body
mass index was 28.8. Among the vegans in that
group, it was more than five points lower. It was
23.6. In fact, the people following a vegan diet
were the only group that actually was smack in
the middle of the healthy weight range.
ISSUE 1 • SPRING 2019
Then, when we go from observational studies
to clinical trials, where you bring in people who
never thought about doing a diet like this before
and you, in a randomized fashion, assign them to
a plant-based diet or a control diet, plant-based
diets very predictably cause weight loss, even for
people who aren’t counting calories or changing
their exercise.
(LM): I think that’s a very important point, that
it doesn’t necessarily require exercise. For those
who can’t, it’s a really great solution.
Then we go into the mechanisms of weight loss.
I think that’s really important because there’s so
much confusion about how do you actually lose
weight. Even physicians don’t know what
they’re talking about much of the time. Can you
explain what you mentioned in the paper about
the mechanisms of weight loss?
(SL): We can start with one big one. That is
the reduced calorie density of the diet. It just
comes naturally with eating more plants and
getting rid of the meat, dairy, and other animal
products. You’ve already eliminated most of
the fat that you might naturally consume on an
omnivorous diet. Then, you go to plant-based
and not only are you not eating all those high fat
sources, and fat is way more energy dense than
carbohydrate, but you’re eating so much fiber.
I love to put pictures in front of my patients
where I show what a stomach full of fiber looks
like versus a stomach with the same amount of
calories, but in fat form or mixed diet form. The
fibrous, plant-filled gut is packed. It’s math, but
it just sends a signal to the brain that you’re full.
The bulk is enormous. You’re literally full. You
feel heavy. You’re done eating, but you’ve
eaten not that many calories. Then, one of my
favorite fun facts is that fiber, only found in
plants, what makes up all that bulk, doesn’t
even digest, so those calories are coming right
back out. Not for nothing, they come back out
doing lots of good stuff, too.
That’s one huge mechanism, I think.
(NB): I think that’s the most important one,
actually, is that people are eating high fiber,
low fat foods, so the number of calories they’re
eating, even though they swear they’re eating
as much as before, they’re eating less.
63
 The other one is that we’ve tested what’s called
the thermic effect of food or the after-meal
calorie burn. The patient comes in. You lie them
on an exam table and you cover their face and
shoulders with this big plastic bubble. What we’re
doing is sampling how much oxygen they’re taking
in minute by minute and how much carbon
dioxide they’re putting out. With some fairly
simple arithmetic, that will show their metabolic
rate. They’re fasting. It’s 6:00 in the morning.
Then, we give them breakfast and their
metabolism rises for maybe three hours
or more after the meal. That’s normal.
“Then, we put them on a
completely plant-based diet,
a vegan diet, also low in fat.
In our study that made
waves in this regard.”
Then, we put them on a completely plant-based
diet, a vegan diet, also low in fat. In our study
that made waves in this regard, we did it for 14
weeks. They come back and you do the exact
same test again, but you discover that, after they
have a meal, their metabolism rises much more
than it would have before, maybe about 16%
more, so you’re burning calories faster in the
after-meal period. There’s something about a low
fat, plant-based diet that allows the metabolism
to be faster. Basically, what we think is going on is
that the mitochondria inside the cells burn fuel
and produce energy much more efficiently when
that fat has gotten out of the diet.
You can do it the other way. You can go into a
laboratory and eat a really high fat diet for 3-5
days and your mitochondria will be impaired and
your energy burn will be impaired that quickly.
So, vegans are skinny because they’re eating
fewer calories, as Susan said, and their after-meal
metabolism is higher for maybe three hours or so
after each meal.
64
(LM): You’re eating less calories, but you feel full
and you’re burning more calories at rest.
(NB): Exactly.
(LM): Okay. Makes complete sense. Then, the
mitochondria, can you explain, for those who
aren’t aware, what those are in the cells? It’s
important when you mentioned that they are
creating energy.
(NB): Sure. Inside every one of your cells are
these little tiny dots called mitochondria and
they’re burners. In other words, fuel comes in,
like sugar, and your mitochondria’s job is to burn
them and turn that fuel, that sugar, into energy
that the cell can use. However, if I go on a really
high fat diet, a grilled cheese sandwich with extra
mayo, followed by French fries dripping in grease,
and at dinner I’m going to have pepperoni pizza,
also dripping in grease, that fat actually enters
the cell and it appears that it interferes with the
mitochondria’s ability to work.
Even worse, many people imagine that you
might be born with a certain complement of
mitochondria and you’ll have the same number
for the rest of your life. Not true. They can come
and they can go. In other words, if your body
has need for more energy, it’ll make more
mitochondria. If it needs less energy or wants to
metabolize less, the mitochondria can coalesce.
So, high fat diets cause a reduction in
mitochondrial action. High fat diets slow your
metabolism, so to speak. That person who says,
“Wow, when I was 16, I could eat anything. Never
gained a pound. Now, I just look at food and I gain
weight,” it’s true. We can measure it. But it’s still
dynamic. You can change that later in life by
getting – on a vegan diet, there’s no animal fat in
your diet at all. If we keep the oils low, there’s not
much of any kind of fat. The mitochondria say
thank you and they can come back and start
doing their work again. It’s not huge, but a 16%
extra calorie burn after each meal is a significant
contribution to why vegans are the skinniest
person on the block.
(LM): I think that’s fabulous. I’m going to start
talking to my patients about their mitochondria.
DISEASE REVERSAL AND PREVENTION DIGEST
(NB): They may be abusing their mitochondria “You don’t have to watch portions.” They say,
on their current diet. The other thing I want to “How much when I weigh it on the scale? How
say quickly is it’s very, very fast. Researchers many points is that?” We say, “No, no, no. These
have looked at this and found that if you go on a aren’t numbers anymore. This is a qualitative shift
high fat diet, within 3-5 days your mitochondria in what you’re eating, a lifestyle shift in your diet.”
are impaired. It’s not as if we can fool around
As daunting as it might sound, once they get
with this and half the time do a healthy diet and
into it and realize how much they can eat, and if
the other half of the time not. The mitochondria
they’re eating really healthy foods, they can eat
are very sensitive to it.
as much as they want, they love it. They love
What we think is going on is when they get a high being told to eat as much as you want, as long as
fat load, we are guessing that this is nature’s way it’s of these good, healthy foods. That really wins
of preserving that fat as a fuel for future use, in the acceptability of this diet, versus when you
case there is a famine. Of course, you can tell have diabetes and you’re told to count carbs,
your body there is no famine, at least not here portion control, eat so much fat, deficit of 500
right now. You don’t have to store everything that calories a day — all that math, but just be told no
I’m eating, but the mitochondria shut down the more math. This is really about a quality shift in
metabolism, we believe, to preserve that fat. your lifestyle.

(SL): What’s striking about that is we talk about (LM): Very good. How does that compare
3-5 days, but most of us in this country have to if someone says the Mediterranean diet,
been eating this way for thousands of days. This that they’ve been shown that’s helpful?
is just our normal high fat diet, every meal, every How would that compare, would you say,
day, for our whole lives. between a vegan low fat to something like
the Mediterranean diet?
(NB): The great thing is that when people change
that, the body doesn’t lose its memory of how to (NB): I would argue that a Mediterranean diet,
get the mitochondria back. In the same way as at least as it was traditionally used — when I say
arteries will heal and your skin will heal and your traditionally, the term was coined in the 1960s
bones will heal, to an extent, your metabolism and at that time a Mediterranean diet was better
can rebound as well, at least to a degree. Age than a typical American diet. It was less meat, a
does not seem to be a factor. lot less dairy, more fruit, more vegetables. Even
though the Mediterranean diet is known for using
(LM): We need a meme that says Stop Abusing
olive oil, instead of butter, at least at that time
Your Mitochondria. That would be a good one.
they weren’t using a huge amount of olive oil. In
Now, how does this compare to other diet the village of Nicotera, which was Ancel Keys’
approaches, because you also talk about that? favorite village in Italy, the fat content of the diet
was 23% of calories, compared to 30% or more
(SL): Well, one of the best things about this diet here in the United States, so they weren’t using
is what Dr. Barnard mentioned earlier, which is it’s a lot of any kind of oil, not eating much meat or
ad libitum, which means all you can eat. When much dairy.
we see, whether it’s in a clinical trial or patients in
our clinic who are overweight, they’re not coming However, there have been some quite good
in with a really strong skill set for eating in studies, but frightening studies, of the
moderation. It’s not really anybody’s skill set, Mediterranean diet. The PREDIMED Study,
I would argue, but to come in and be told, “We which got headlines everywhere, did reduce the
don’t care how much you eat if you’re eating risk of cardiac events a little bit, which is good,
fruits, vegetables, beans, and grains. You can eat not hugely, but it did have that effect and it was
as much as you want,” they say, “How many significant. However, when you looked at people
calories?” We say, “No counting calories.” They following this diet, they lost virtually no weight
say, “Well, how big are my portions?” We say, at all, just a minuscule amount, and I believe it’s

ISSUE 1 • SPRING 2019 65

 because of the way they did it. First of all, they where if you’re following a 100% plant-based
didn’t get the meat and cheese out completely. diet, you need to take a B12 supplement. I
Secondly, their use of olive oil or nuts was so always add to that, if you’re over the age of 50,
calorie dense that they were defeating the you need a B12 supplement anyway. If you’re
effects of the vegetables and fruits that would taking certain medications, you need a B12
otherwise cause weight loss. supplement. So there’s a good chance that
anyone needs to be taking a B12 supplement,
(LM): Wow. Okay. That is fantastic. Then, you
regardless, but certainly on a plant-based diet,
mention here, as well, effects on cardiovascular
that’s a good idea.
risk factors. That’s the #1 killer of Americans
and many places as well. What’s the benefit of (LM): I would definitely echo that because
a whole food, plant-based, low fat, vegan diet even in my own patients, when we measure
on cardiovascular risk? B12, those who are eating an omnivorous diet
are B12 deficient and actually more of them,
(SL): For starters, it’s by getting the animal because those who are eating a plant-based
products out of your diet and you’re getting the diet are conscious of that B12 need, so I agree.
major sources of saturated fat out of your diet
by doing that, dairy being the #1 source of As a conclusion, what should someone who’s
saturated fat in our diets. That’s gone, so that’s reading this actually take away? What is the
going to help reduce the internal production of truth of your research and your review that you
cholesterol. It’s going to then give your arteries really feel is an important take-home message
for anyone who is reading it?
a bit of a rest in terms of what they’re being
bombarded with every day, whether it’s your (NB): I think perhaps the most important
own body being triggered to make more thing is that plant-based diets, and by that I
cholesterol because of the amount of fat mean a vegan diet, without animal products,
you’re eating or even just consuming dietary prescribed in a healthy way, so it’s low in fat
cholesterol and adding to the problem. So, and high in vegetables, fruits, whole grains,
you’re getting rid of that and then just other and beans, that, first of all, it’s a tremendous
issues that Dr. Barnard mentioned, such as the prescription for a healthy weight. All of the side
viscosity of your blood is going to be lower, so effects are good ones. As Susan mentioned, it
that’s going to be better for heart health. Blood will bring down your cholesterol, bring down
pressure is going to go down. That’s better for your blood glucose, bring down your blood
heart health. Stroke risk reduction. I mean, you pressure, probably improve your digestion a
could check off every point of cardiovascular whole lot too. It’s quite easy to do. The
disease and see that there’s a reduced risk for acceptability of it has been quantified in heart
that when you consume plant-based diets. patients, young healthy people, overweight
people, people with diabetes, and it stacks up
(LM): Absolutely. One question I often get, as a
favorably compared to any other therapeutic
physician, is, “Will I get all of the nutrients that
diet. In other words, patients are not going to
I need?” So, complete nutrition, can you
run screaming. They’re going to say, “Give this
explain, if that’s true, how is that possible?
to me and let me stick with it because I don’t
(NB): Let me give this one to you, Susan. You’ve have to count. I don’t ever have to go hungry.”
written more on this than anybody. And, perhaps the most important thing is that
caregivers, healthcare providers, clinicians,
(SL): Completely possible. I always start with
should do it themselves, in the same way as,
the Academy of Nutrition and Dietetics, which
a generation ago, the doctor who had a pack
said that a completely vegan diet provides all
of cigarettes in his or her shirt pocket really
the nutrients that you need, adequate in all the
completely lost all credibility in talking to
nutrients, and they go on to say plus benefits for
patients. The same is true if the clinician can’t
things like heart disease, diabetes, cancer, but
answer simple nutrition questions, like, “What’s
in terms of all the nutrients, yeah, you get
a vegan meal that I can get at a fast food
everything you need. The only exception is B12,

66 DISEASE REVERSAL AND PREVENTION DIGEST

restaurant?” If you walk the walk and have done
this in your own life, you know the answers to
“ I just love all the win-win-wins
those questions and you can be a really credible
advocate for your patients. So, prescribe it to
your patients and do it yourself.
(LM): Absolutely. Susan, did you have anything
else to add?
(SL): I just love all the win-win-wins that you get
from eating this way, like yes, weight loss; yes,
lower heart disease risk; yes, less risk for diabetes. whole list and beyond is more
Just the whole list and beyond is more than
enough motivation for me, as a dietitian, to
promote this way of eating.
(NB): One last thing, if I can also jump in, because as a dietitian, to promote this
it might sound like a daunting prospect to go to a
vegan diet, I should, first of all, caution everyone
that it doesn’t mean you have to have a taste for
folk music or be a philosopher or work in a library,
but it does mean that you’re going to get away
from animal products.
The way we do it with our patients is we break it
into two steps. The first step is to take a week
and, during that week, don’t take anything out
of your diet. Just explore your options. So, for
breakfast, I could have oatmeal with cinnamon
and raisins. For lunch, instead of meat chili, I
could have bean chili. So, they’re just exploring.
That maybe takes a week to find out what you
like for each meal.
Then, after you know what you like, the next step
is to take three weeks and do it all vegan, all the
time, but it’s only three weeks, that’s easy and
you’ve already picked out all the foods you like, so
at the end of three weeks, patients feel physically
a lot better and they’re losing weight and their
tastes are changing. At that point, the idea of
doing it longer term is a much more welcome
prospect to them.
(LM): Absolutely. I like that stepwise approach
because that works very well. It’s not too
daunting.
(NB): Exactly.
(LM): Fabulous. Thank you both so much for
your time. We certainly hope everyone enjoys
the paper and that it will bring some new
information to those who had some questions,
and we so appreciate that. Thank you for your
research and everything that you do.
(NB): Thank you, Dr. Marbas.
ISSUE 1 • SPRING 2019
that you get from eating this
way, like yes, weight loss; yes,
lower heart disease risk; yes,
less risk for diabetes. Just the
than enough motivation for me,
way of eating.”
Neal D. Barnard, MD, FACC, is a physician, clinical
researcher, author, and an adjunct associate
professor of medicine at the George Washington
University School of Medicine and Health Sciences.
In 1985, Dr. Barnard established the Physicians
Committee for Responsible Medicine to promote
preventive medicine, conduct clinical research, and
advocate for higher ethical standards in research.
The Physicians Committee also provides direct
medical care through its subsidiary, Barnard Medical
Center. Dr. Barnard works with patients with
diabetes, obesity, and other chronic conditions in
clinical research studies aiming to improve the
prevention and treatment of these health problems.
Susan Levin, MS, RD, CSSD, is director of nutrition
education for the Physicians Committee for
Responsible Medicine, a Washington, D.C.-based
nonprofit organization dedicated to promoting
preventive medicine, especially better nutrition,
and higher standards in research. She studies the
connection between plant-based diets and a
reduced risk of chronic diseases. Through her work,
she also addresses the need for nutrition guidelines
that reflect the Physicians Committee’s Power
Plate (fruits, vegetables, legumes, and whole
grains).Ms. Levin received her Master of Science in
Nutrition from Bastyr University in Seattle. There
she focused on clinical counseling for a variety of
nutrition-related issues.
67
 Research From The International
Journal of Disease Reversal and Prevention

A CONVERSATION WITH
DR. THEMIS YIASLAS AND DR. SAUL SCHAEFER

Reverse Heart
Disease With A
Plant-Based
Diet

DR. LAURIE MARBAS (LM): We’d like to welcome

Dr. Themis Yiaslas and Dr. Saul Schaefer from the
Sacramento VA Medical Center to talk about an DR. THEMIS YIASLAS
article that they submitted to the International
Journal of Disease Reversal and Prevention
regarding a gentleman that they worked with.

LISTEN TO AUDIO
OF INTERVIEW

WATCH VIDEO OF INTERVIEW DR. SAUL SCHAEFER

68 DISEASE REVERSAL AND PREVENTION DIGEST

(LM): The title of your paper is “Elimination of
Angina, Comprehensive Cardiometabolic Risk
Reduction, and 50-Pound Weight Loss in U.S.
Navy Veteran with Myasthenia Gravis.” Wow,
that is a very complicated patient and some
very interesting things that happened.
Can you tell us a little bit about the
background? First of all, the program that the
gentleman participated in and how you chose
this particular case to submit to the journal?
Dr. Themis Yiaslas (TY): The program is called
the Heart Disease Reversal program. Actually, at
the very beginning, I had the idea and I reached
out to Dr. Schaeffer at a time when I didn’t really
recognize his background in this area, being one
of a small number of people in the world who
have actually shown regression of atherosclerotic
plaques through a plant-based comprehensive
lifestyle program. He was very supportive.
The program itself consists of three components,
the whole foods, plant-based diet being the
centerpiece, but also including safe, home-
based, moderate intensity physical activity
and stress management training. It’s an
interdisciplinary crew. We’ve got myself, as a
psychologist with behavioral medicine expertise;
a registered dietitian; and a clinical pharmacist.
The program is available to anyone who has
atherosclerotic heart disease here at our medical
center. We actually did some outreach, sent
some letters to folks who had the diagnosis and
had care at our hospital. This patient actually
reached out to me, directly, in response to a
letter that said, hey, there’s this program that
you can participate in. That’s how it began.
As the article states, he had just come off of two
heart attacks within a two-month period and was One of the things we detailed in the article
quite down and out. He was pretty much ready
to do what he could to improve his health.
The results were pretty substantial.
(LM): Amazing.
(TY): Yeah. We chose him in particular, too,
because of how vocal he was. Within the first
month, he really became someone that was
very outspoken, helpful to other people in the
program, sort of like an ambassador, of sorts,
ISSUE 1 • SPRING 2019
and has joined us at our seminars, giving his
experience. You know, I learned a few things
about him at those seminars and it struck me
that he had that mixture of a remarkable story
and almost the desire, maybe even the need
to tell it to help others, so we asked him and
he was all in.
(LM): Wonderful. Can you give us a little bit of
background on exactly how severe his illness was
and what type of changes did you see? How long
did it take? What was he eating? What did he
do, exactly?
(TY): He actually had quite a variety of different
conditions, not all of them fully represented in
our article, the key being atherosclerotic heart
disease and type 2 diabetes. He had a significant
amount of excess body weight, being obese,
with this myasthenia gravis complicating things
in the sense that any time he did any significant
exercise, he’d have these neurological symptoms
that would actually interfere and worsen. So,
he was kind of stuck. He wasn’t really able to
exercise or be as active as maybe he would
have chosen to, based on his heart health.
The heart attacks gave him the message that
I am a chip off the old block. He had a very
significant family history, as he detailed in his
story. This led him to conclude, “I’m going to die
very soon.” He described even being afraid to
leave his room and not really being able to feel
the confidence to just be as active as he had
been. He had begun making arrangements
with his wife and really making plans with the
expectation that he was probably going to
have another heart attack and die pretty much
any day.
is this distinction between depression and
demoralization. I think the key is that he didn’t
present to me in a very depressed way. He didn’t
score very highly on a screening measure that
asks about depression symptoms, but when you
got to ask him about it, there was this sense of
lost purpose. It’s possible that you can be
demoralized and have given up, in a way, about
your fate, despite not being sad and down and
those more obvious symptoms of depression.
69
“Pretty much everything we measured improved in
terms of his cardiovascular risk factors. Combined
with the angina and weight loss, he was just overjoyed.
It’s very rewarding to work with someone like that,
who puts everything into it and really gets rewarded.”

How did he respond? He went all in. He was very
aggressive in his approach and that’s what we ask
people to do, do it all at once, in particular to
have a rapid resolution of symptoms, but also
so they can really feel the difference. What was I
feeling before and how do I feel now? Within the
first month, I think he essentially had almost
total resolution of his angina pain. He described
this chest pain as being so severe and affecting
him every single day that he was afraid to move
because of it. Without much exercise, just
very simple calisthenics, really emphasizing the
diet component, he was able to reduce that
chest pain. That can be so frightening. In my
experience, it’s those people who have that
symptom resolve that it’s not really much more
effort at that point. The benefit to quality of life
is so obvious and so clear, it’s so rewarding to
just keep doing it.
From there, he branched out, became more of a
culinary expert, learning about different ways of
cooking and trying to increase the variety. He
was very aggressively managed in cardiology. His
baseline LDL cholesterol was 38 and it definitely
wasn’t down there just because of lifestyle
beforehand, so to have his LDL cholesterol, for
example, go down 42% in a month, it’s really just
getting down to the basement. That was big
for him.
The significant weight loss was big for him. The
slow, steady improvement in blood pressure was
huge. His fasting glucose, hemoglobin A1c was
dropping and dropping, eventually prompting his
physician to cut down his medicine. Pretty much
everything we measured improved in terms of his
cardiovascular risk factors. Combined with the
angina and weight loss, he was just overjoyed.
It’s very rewarding to work with someone like
that, who puts everything into it and really
gets rewarded.
It really prompted this idea that this isn’t just a
boosted mood. There’s something qualitatively
different about him, which I thought needed
further focus and attention. How do you feel
when you go this way? Yeah, you feel better, you
have more energy, you lose weight, but the shift
from a dead man walking to someone who feels
like they’re in command of life, who’s out living
life to the fullest, that, to me, seemed like a mini-
resurrection, of sorts, which is what I’m proposing
in the article, that maybe we should call this
something to differentiate it from just feeling
better, what happens with plant-based nutrition.
Dr. Schaefer (SS): One of the things that struck
me over the years – I’ve been involved for
decades, actually, in the concept of using diet
and things like meditation, stress reduction to
improved cardiovascular health, starting at UCSF
and then we have a coronary artery disease
reversal program at UC Davis and we published
the results. For the scientific literature, it was
important that we showed that you could both
reduce atherosclerotic plaque and, in a greater
way, reduce cardiovascular events, which has
been a common finding in these sorts of trials.
That’s well accepted now, but I think the
remarkable thing that’s really exemplified by this
patient and by the reversal program here are the
psychological benefits of being on a plant-based
diet and being part of a group. I think being part
of a group, having a sense of a common enemy
and a common mission and a common way of

70 DISEASE REVERSAL AND PREVENTION DIGEST

dealing with these issues brings people together,
brings a sense of community, and I think that has
a significant, profound psychological effect on
their well-being.
We have found previously in our studies that
people that remain in the program really
become proselytizers, enthusiasts. They become
committed and they do really well, both on
the medical side and the psychological side,
the well-being side. People that, for whatever
reason, don’t stay in the program don’t get these
benefits. Even though they may initially get some
of the chemical, biochemical benefits, they don’t
get the psychological benefits and they wind up
having more events and having more disease.
I think a couple of key points. One is the intensity
of the program, the commitment of the people
running the program, like Themis; and of the
patients putting their heart, literally, and soul into
the program; and then the benefits that they reap
and the sense of community they gain from being
there. So, I think people have become more
accepting of this intervention. Where it was
radical 30 years ago, it’s now, I think, accepted
among many physicians, among nutritionists,
biologists, and the public at large. I think one of
the key issues is implementing this in people that
are at risk or have severe heart disease.
(LM): Wow. What time period are we talking
about? How long is the program? How long was
t before the gentleman entered the program
and had this tremendous 50-pound weight loss,
reversal of his metabolic disease, relief from his
angina? How long are we talking here?
(TY): As far as the timeline for that, January 2018,
we met first. Within one month, I think there
might have an instance or two of some angina,
but it was more or less resolved between the
one-month mark and before the program ended.
As he went through it, the core group that met
every week, that was 12 sessions, so we had a
period of 3-3½ months where he had experienced
these benefits. We do labs after one month,
so we actually could see improvements in all
his cholesterol numbers and body weight and
all of that within the first month, which is
pretty significant.
ISSUE 1 • SPRING 2019
As far as the 50 pounds, which we are describing
him accomplishing that, was all the way into,
I think, October 2018. So, about a 10-month
period to reach that 50-pound weight loss mark.
The way he described it was that he was losing 1-2
pounds a week, just on the regular. We actually
don’t talk about weight loss in the program, as a
goal. We mention it happens, for example, but we
don’t encourage the typical weight management
behaviors, like calorie counting or watching how
much you eat, other than encouraging people
to eat until they’re full. It was a benefit that he
enjoyed, but it wasn’t necessarily something that
he was specifically striving for. He was just trying
to follow a whole foods, plant-based diet.
(SS): I think our diets in America and largely the
Western world are so bad, when you compare it
to what a good diet would be, that getting off
that bad diet and getting onto a plant-based
diet really reduces calories, provides satiety with
fewer calories, and is a lot healthier. A lot lower
saturated fat, sugar, salt, all the things that we
encourage our patients not to eat.
The thing is it’s persistent because, in the
conventional dietary plan, you buy in and you’re
forced to eat smaller portions or whatever. This is
really a much broader conversion in terms of a
thought process and style of living, so I think it’s
easier to maintain that over the long haul.
(TY): I was thinking, too, you had asked about his
background and other conditions. That was one
of the things that stuck out to us, too, was that
routinely we’re seeing folks that have more than
just atherosclerotic heart disease, so what are
you supposed to do? What often comes up are
things like, “Well, I was told I needed to watch
these carbohydrates, and I have to do this for my
diabetes, and I have to watch my salt, and I have
to…” There’s actually so many tailor-made
nutritional approaches for different conditions,
what do you do? One of the benefits for this
particular patient, but also for other people that
we work with, is that we really simplify things.
There are some requirements, like if you have
gout, we have to look for those high purine foods.
If you have heart failure, we focus on, in some
cases, fluid restriction. We have this core
71
 approach, with some modifications that we
can do for the individual, but really it’s been
described as easier. We’ve had folks finish a
diabetes program, for example, a behavioral
lifestyle program, and they come to us and
say that it’s easier. It takes less work.
I think that’s an important factor. It’s one of the
things that makes somebody feel less confident
that they have any control over their health,
when the chips are stacked so high. “What
do I do? If I eat this way, it’s going to hurt this
diagnosis.” For him, he could just do one way
and it made it easier.
(LM): I see the benefit for him. I think that’s
a very important point, that the mechanisms
that are in play here with the whole foods,
plant-based diet will see benefit across many
chronic diseases – diabetes, heart disease,
hypertension, high cholesterol, all of those
different things. Absolutely.
When you have such a wonderful story, people
are going, “Oh, that’s just that patient,” but
we all know, because we work with these
patients, this is routine. This is a very common
occurrence. What can someone who resists,
maybe a physician who a patient brought this
story to them or a person who is reading this
and identifies himself as someone similar to this
gentleman, what is the takeaway? What should
be their first steps? What should they do? What
would you encourage someone like that to
actually do? Is there anything that they need
to be monitored for, like if they’re on insulin for
diabetes, hypertension meds, all those things
can improve very rapidly. What do you guys
typically recommend?
(TY): You just brought up a couple of keys. One
big takeaway is to go all in for a short period. If
you’re a patient, sometimes just putting a toe
in the water, trying one plant-based meal, you
think, “What does this taste like?” It’s difficult
to dabble. You can dabble if you want. That’s
definitely one way, but our way is to go all in,
dive in 100%, do so over a three-week period or
a week period and get all the support that you
can. There are people that are going to be allies
in your circle. Who can help you? Is it a spouse,
72
a friend, someone else who can maybe do it
with you or be a helpful supporter?
There are lots of great online resources. The
Plantrician Project has great materials. There’s
also a great many out there, these so-called
quick start guides. They’re totally free. You can
explore them at your leisure and say, “Hey, could
I do this? What’s the right time to start?”
If you have a lot of these conditions, like you
were mentioning diabetes and high blood
pressure, we’re actually really aggressive about
that. We have people that are either getting
dose reductions or discontinuing meds within
the first few weeks, so it’s actually kind of really
important, hey, you know that blood pressure
cuff in your closet? You might want to pull that
out and use it every morning, just to monitor
things. Those are the keys, and blood sugar,
monitoring those regularly.
I think that’s a big takeaway, that it may be quite
surprising how quickly this works. Don’t sleep on
it. Don’t think it’s going to be a two-, three-, six-
month endeavor. You will see results rapidly.
(SS): It’s interesting because there’s a parallel
to gastric bypass where, with just getting
the bypass, your weight doesn’t change
immediately, but your diabetes does and your
glucose control does, so there’s something
about changing the microbiome or metabolism
that can affect, especially, diabetic control
very rapidly, without weight loss.
(LM): I would have to say, as a physician that
works with these patients daily, absolutely.
Insulin is oftentimes cut in half within the first
week. That is not an uncommon experience
with me. The blood pressure will depend on
the patient, but that is wonderful.
Are there any final suggestions? Let’s say
someone comes across this video or article and
they’re thinking about this. What would you
like to say, the one- or two-sentence summary
that you would like to highlight about your
entire article that you submitted?
(TY): If you’re looking for something that’s
going to give you a chance to dramatically
change the status quo, if you’re ready to
DISEASE REVERSAL AND PREVENTION DIGEST
“ Lifestyle is much better and more important
than pills. Even though I prescribe them all
the time and they have a role, really, lifestyle
is key.”

challenge your own assumptions about what

you’re capable of, and you want to be more in Themis Yiaslas, PsyD is a Behavioral Medicine
control of your health and not have it delegated Psychologist at the Sacramento VA Medical Center.
to healthcare providers or other people, if you He also works as a trainer and consultant for the
want to take that control back, if you have National VA Motivational Interviewing Training
oppressive symptoms, like angina, and you want Program, and is an Assistant Clinical Professor,
at UC Davis School of Medicine. He received his
some relief, make the decision to go all in for a
PsyD, Clinical Psychology from PGSP–Stanford
period and let your experience help you decide
PsyD Consortium, at Palo Alto University.
whether this is right for you.
You might be surprised. It might be the beginning
of the rest of your life, one that’s imbued with a
sense of gratitude and joy and health, and you Saul Schaefer, MD Is Chief of Cardiology Section
might never look back, so give it a try. at the VA Northern California Health Care System,
and Director of Medical Student Research and
(SS): I’ll summarize it. Lifestyle is much better Physician Scientist Training Program at the UC,
and more important than pills. Even though Davis, School of Medicine. Dr. Schaefer focuses
I prescribe them all the time and they have his clinical research on the utilization of non-
a role, really, lifestyle is key. nvasive cardiac testing to diagnosis ischemic
heart disease and pulmonary embolism. He
(LM): Absolutely. Plants over pills and pills received his medical degree from the UC,
when needed. Davis, School of Medicine in 1981.
I think what you’re describing here is a
gentleman
who found hope when he had no hope and was
written off as medical management only, and
he probably saw the demise of his life coming
rapidly and said even the best medical care
can’t help me, but literally what was on the
end of his fork was his salvation. I think that is
a resurrection of a new individual, so I think
you’re right on when you say that.

Thank you both so much for this information.

It’s such an inspiring case and I’m sure it will
inspire others to take some changes into their
own hands and their own plates and do well.
Thank you again. I so appreciate your time.

(SS): Thank you.

(TY): Thank you so much. Our pleasure.

ISSUE 1 • SPRING 2019 73

 Research From The International
Journal of Disease Reversal and Prevention

A CONVERSATION WITH
DR. SIREEN KASSAM

Does Diet
Impact the Risk
of Non-Hodgkin
Lymphoma?
DR. LAURIE MARBAS: We’d like to welcome
Dr. Shireen Kassam. How are you today?
Dr. SHIREEN KASSAM: I’m well, thank you.
Thank you for taking the time.
DR. LAURIE MARBAS: Thank you for spending
your time with us today. We’re very excited to
discuss your article, Does Diet Impact the Risk
of Non-Hodgkin Lymphoma? Can you give us a
little background about yourself and why you DR. SHIREEN KASSAM
those to write this article?

LISTEN TO AUDIO WATCH VIDEO

OF INTERVIEW OF INTERVIEW

74 DISEASE REVERSAL AND PREVENTION DIGEST

Sure. I work at Kings College Hospital in
London, in the UK. It’s one of the largest
tertiary referral centers for hematological
cancers, cancers of the blood system. I
particularly focus on caring for patients with
lymphoma, so cancer of the lymphatic system.
Up until now, my focus has been on writing
papers and reporting research based on clinical
outcomes to patients and seeing how they do.
In the clinic room, it’s quite clear that patients
and their families want to know whether there’s
something specific they can do to impact their
chances of improving their outcomes and their
survival, and how they can prevent lymphoma,
in general, for themselves and for their family
members. Of course, everyone asks about diet.
It’s not been something I’ve really focused on.
Therefore, I thought it would be good to look
into what the impact of diet is on the risk of
non-Hodgkin lymphoma.
Wonderful. Can you give us the statistics of
non-Hodgkin lymphoma? Has there been any
indication of the cause?
We know a little bit. It varies around the world.
The difficulty, talking about lymphoma, is that it
describes probably over 40 different sub-types
of cancer. So, in general, we’re talking about the
commonest sub-types, which are diffuse large
B cell lymphoma and follicular lymphoma, that
make up 50% of all cases.
But, going back to your question, in general, the
risk of getting non-Hodgkin lymphoma is about
2% in somebody’s lifetime, which is around 19-20
cases per 100,000 of the population. As I say, it
varies around the world as to what type, but
those are general US stats, where we’ve got
good data.
Although over the last few decades there has
been an increase in the reported incidence, over
the last few years this has leveled off and maybe
starting to decrease. It’s difficult to know what is
the cause of those trends, but what we know
about the causes of lymphoma are general
conditions that lead to inflammation and also
there’s association with infections, so things that
increase your risk of non-Hodgkin lymphoma are
infections, such as HIV infection, Epstein-Barr
virus, hepatitis B, hepatitis C; and if you have an
ISSUE 1 • SPRING 2019
underlying autoimmune condition, your risk of
non-Hodgkin lymphoma is increased. There are
various workplace and environmental exposures
that increase the risk.
When it comes to thinking about diet, it’s
interesting that people working in the meat
industry, so slaughter houses, butchers, they
have an increased risk of non-Hodgkin
lymphoma. We don’t really know why, but it’s
suggested that it could be transmission of a
virus, which makes sense because human viruses
cause lymphoma and we know that animal
viruses can be transmitted to humans, so there
could be transmission of a poultry virus or, in
the case of beef, bovine leukemia virus, which
causes leukemia in cows, so it makes sense that
it could cause lymphoma and hematological
cancers in humans.
“The risk of getting non-Hodgkin
lymphoma is about 2% in somebody’s
lifetime, which is around 19-20 cases
per 100,000 of the population.”
Exposure to radiation and also the drugs we
use to treat lymphoma can also then increase
your risk of getting a second lymphoma, so
chemotherapies, in general, if you’ve been
exposed to chemotherapy, toxic agents, that
can also increase your risk of then later getting
a lymphoma.
Wow. That’s fascinating. Those things affecting
our immune response, our ability to respond
immunologically to something, seem to be the
common thread.
Yes. Absolutely. I think things that activate
the immune system, whether it’s infection or
inflammation, and maybe we’ll come to this,
but just this week there’s been a paper published
from the World Cancer Research Fund that
produces much of these data that we’ll talk
about, showing that obesity is really a risk factor
for developing non-Hodgkin lymphoma and
when you look at what obesity does in the body,
it’s generally causing some sort of inflammation
and increase in various growth hormones in the
75
“We know that fruits and vegetables
have antioxidants and phytonutrients
and vitamins and minerals that have
anti-cancer properties.”
the body, so it sort of fits that picture of non-Hodgkin lymphoma. The studies suggest
infection and inflammation. anywhere between 10 to 30% relative increase
in risk of getting non-Hodgkin lymphoma.
Wow. Okay. That is very good. Thank you so
much for sharing that. Can you give us a little Then, you have to think back to what that
bit of an idea of, when you did your review, means for people as an individual. The
what did your article come to, conclusion- absolute risks are going to be small, of course,
wise? Were there any risk factors that were but maybe it would contribute to an extra half
identified? a case per 100,000 population. Nonetheless,
it seems that there is an association. The
When it comes to looking at the role of diet in
association seems strongest in case control
causing non-Hodgkin lymphoma, it seems at
studies. As the audience probably knows,
the moment the evidence is not as compelling
these types of studies can have issues with
as for other cancer sub-types. For example,
bias, such as selection and recall bias, so the
we know that there’s very strong evidence that
conclusions aren’t as strong as if they were
processed meat causes or can cause a
related to people and populations for large
proportion of colorectal cancers, but we can’t
amounts of time, then reporting cases that
come to those same strong conclusions for
occur during that follow-up period.
non-Hodgkin lymphoma. When I was doing my
literature search and research, the data were So, there are some associations with
certainly compelling and support the dietary processed meat and red meat, but I think
recommendations that we already know are we have to be guarded in our interpretation.
effective for other cancer sub-types. Then, the same can be said for dairy
consumption, so there seems to be a ghost
I think, partly, the reason is that there haven’t
response in that the more dairy products
been large cohort studies looking at lymphoma
that are consumed, the higher the risk of
and the role of diet, partly because the
non-Hodgkin lymphoma. Again, you can
number of cases is much lower when you
hypothesize why that may be the case. We
compare it to the number of cases of breast,
know that the saturated fat in dairy can
lung, or colon cancer, so it’s always going to
contribute to weight gain and then that can
take a larger sample size to really see the
lead to obesity and a state of inflammation.
effects of diet on non-Hodgkin lymphoma.
We know that dairy, because of its fat
Also, as I mentioned before, there are over
content, concentrates these persistent organic
40 different sub-types, so to then give broad
pollutants that are present in the environment
brush recommendations that cover all these
and they particularly concentrate high up the
sub-types is unlikely to be possible, but there
food chain, and these can contribute to
are some clear themes coming out of the
cancer development.
meta-analyses that I write about in the article.
That is that there does seem to be an As I’ve said, there is evidence that bovine
association between eating processed red leukemia virus can be transmitted through
meat and red meat, and the increased risks of the drinking of milk. Bovine leukemia virus

76 DISEASE REVERSAL AND PREVENTION DIGEST

has been detected in the serum and samples
of patients with cancer. There are a lot of
hypothetical reasons why this would be the case,
but again, it’s in case control studies that you see
the stronger association with dairy and the risk
for non-Hodgkin lymphoma, and it hasn’t yet
been firmly confirmed in cohort studies.
Then, the other thing that we write about in
the article is the potential protective effects
of fruits and vegetables. Again, you can
extrapolate from other cancer types. We know
that fruits and vegetables have antioxidants and
phytonutrients and vitamins and minerals that
have anti-cancer properties. The evidence that
I presented is most strong for cruciferous
vegetables and citrus fruits.
Overall, eating more fruits and vegetables, in
general, seems to be protective. It's always
difficult to know whether that’s being protective
or it’s just crowding out the less good foods in
the diet, so people who eat more fruits and
vegetables are likely to eat less processed and
red meat. It’s difficult to tease those apart, but
again, general recommendations can be made to
say eat more fruits and vegetables, and eat less
red and processed meat, when it comes to trying
to prevent non-Hodgkin lymphoma.
Wonderful. The takeaway from your article,
for the general person who may be reading
this or listening to the interview, would be what,
would you say? Is it what you just said, avoid red
and processed meats and eat more fruits and
vegetables to be protective of any type of
cancer, it sounds like, but in particular, for this
article, non-Hodgkin lymphoma?
Yes. I think it adds weight and support to the
current recommendations from the World
Cancer Research Fund for how we should,
in general, be preventing cancer with diet
emphasizing fruits, vegetables, whole grains,
and legumes, and minimizing red and processed
meats. I would say avoid red and processed
meats and also limit processed foods, in
general, and sugar-sweetened beverages.
Then, of course, obesity is a risk factor, in
general, probably, for lymphoma, so physical
activity is also important, not only to boost
the immune system, but to maintain a
healthful weight.
ISSUE 1 • SPRING 2019
Finally, I’ll mention, from the article, that there’s
emerging evidence that exposure to pesticides
and herbicides in our diet is potentially harmful.
I refer to one particular cohort study of more
than 7,000 people followed in France, where
consumption of organic food, in general, versus
non-organic produce seems to reduce your risk
of non-Hodgkin lymphoma. This was also found
in a large study conducted in British women as
well. Again, it makes sense. The World Health
Organization has classified certain pesticides as
probable carcinogens that have been shown in
animal models to cause cancer, so it makes sense
that, in humans, they will be potentially
carcinogenic. That’s not to say that one should
limit the eating of fruits and vegetables because
of worry about eating pesticides and herbicides.
We know that consuming more fruits and
vegetables, despite the fact that they may have
some pesticide residue, is certainly better than
not eating that. I think evidence will continue to
emerge in that area.
So, buy organic if possible, but certainly don’t
let that inhibit your ability to consume more
fruits and vegetables.
Absolutely.
Okay. That sounds wonderful. Thank you again
so much for your time. We really appreciate
everything that you discussed with us today.
Shireen Kassam MBBS, FRCPath, PhD is is a
Consultant Haematologist and Honorary Senior
Lecturer at King’s College Hospital, London with
a specialist interest in the treatment of patients
with lymphoma. She is also passionate about
promoting plant-based nutrition for the
prevention and reversal of chronic diseases and
or maintaining optimal health after treatment
for cancer.
She qualified as a medical doctor in 2000,
initially training in general medicine, and gaining
Membership of the Royal College of Physicians
(MRCP; 2003). She then specialized in
Haematology and achieved Fellowship of the
Royal College of Pathologists (FRCPath; 2008).
During training, she took time out to undertake
a PhD (University of London, 2011).
77
 Research From The International
Journal of Disease Reversal and Prevention

A CONVERSATION WITH
DR. JOEL FUHRMAN

Efficacy of
a Plant-Based
Anti-
Inflammatory
DR. LAURIE MARBAS: I’m so honored
to have Dr. Joel Fuhrman with us today.
We really are honored that you would
spend some time with us and share your
expertise because you’ve done so much
research in working with patients. The
first case is Efficacy of a Plant-Based
Anti-Inflammatory Diet as Monotherapy
in Psoriasis. Could you give us a little DR. JOEL FUHRMAN
background and explain what psoriasis is?

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OF INTERVIEW OF INTERVIEW

78 DISEASE REVERSAL AND PREVENTION DIGEST

There are more than 100 autoimmune diseases,
where your own immune system is attacking
your body in some way. In general, it’s related
to a degree of heightened inflammation. An
autoimmune disease that attacks your skin and
you develop skin plaques is called psoriasis, but
it can be associated with a disease like
rheumatoid arthritis.
In this case, this person had joint pain and
psoriasis, so she really had psoriatic arthritis. She
also had Sjogren’s syndrome, an autoimmune
disease that gives you dry mouth and dry eyes.
She almost had a lupus-type syndrome. In my
30 years of practice, I’ve had rewarding and
remarkable successes in all those cases — with
multiple sclerosis, lupus, ulcerative colitis,
rheumatoid arthritis, psoriasis, and psoriatic
arthritis — inducing complete remissions where
people did not have to be sick and have those
autoimmune diseases the rest of their lives.
We’re using this psoriatic arthritis case as an
example because I’ve kept in contact with some
of my patients, and here’s a person who came
to me in 2005 or 2006. It was a remarkable case
because she was so ill and could hardly move,
in bed for so long, and taking drugs for her
psoriatic arthritis. She had such a limited life.
That year when she got well and got rid of her
psoriatic arthritis, she played volleyball and
tennis. She climbed mountains. She went to one
of our getaways at the Red Mountain Spa and
put her arms in the air and said, “Look at me.
I’m a miracle!” I said, “You’re not a miracle. This
is just what nutritional excellence can do for
people.” These are inflammatory conditions
and it seems like a miracle because the
conventional medical approach is to give people
chemotherapeutic agents to suppress the
immune system, instead of excellent nutrition
to remove the inflammation and allow the body
to resolve these conditions.
I’m excited to contribute some of these cases to
the journal because I feel people are suffering
greatly, and they’re not being told there’s an
option for them to get well.
ISSUE 1 • SPRING 2019
So what is it about a nutrient-dense,
plant-rich diet that decreases inflammation?
What mechanisms can people focus in on
to understand why this works so well and
so rapidly?
The American diet is about 60% of calories
from processed foods and about 35% from
animal products. Processed foods and animal
products do not contain phytochemicals and
antioxidants. They just contain what people call
macronutrients — fat, carbohydrates, protein,
some vitamins, some minerals, but no significant
antioxidant load.
The small amount of produce Americans eat —
only 2% of calories from vegetables — is not
sufficient to remove free radicals that develop.
Normal living, metabolism, and digestion
produces free radicals when we metabolize
calories, but it’s okay to produce free radicals
and toxic metabolites because colorful plant
food contains antioxidants that eliminate free
radicals.
When you put fat on your body, because fat is
tissue that’s low oxygenated — in other words,
fat supply doesn’t have a heavy blood supply —
the fat supply produces more free radicals and
therefore produces more cytokines and
inflammatory compounds. Gaining weight
increases aromatase enzymes that produce
more estrogen, so there’s an increased risk of
breast cancer in people who are overweight and
have autoimmune conditions.
You have a higher risk of autoimmune conditions
in the overweight, but you also have higher risk
of psoriasis in people who are not overweight
but are eating poorly, whose genetic
predisposition makes them produce more pro-
inflammatory cytokines, like osteopontin and
other markers of inflammation, that we can
measure in today’s laboratories. With this anti-
inflammatory diet, osteopontin and leukotrienes
go down. HSCRPs, the inflammatory markers,
go down and people’s pain goes away.
Eventually, their psoriasis clears.
79
“That extra weight, in conjunction with their
low-nutrient and low-phytonutrient diet, makes
certain people prone to produce more inflammatory
compounds and have their immune system not
function normally.”
Our whole population is overweight. Even
people who are 10-20 pounds overweight could
have increased inflammation as a result of extra
body weight. That extra weight, in conjunction
with their low-nutrient and low-phytonutrient
diet, makes certain people prone to produce
more inflammatory compounds and have their
immune system not function normally. Then we
have the T suppressor cells that control the
activity of the immune system so it doesn’t
hyper-react.
In a pro-inflammatory state, you have a lack of
nutrients fueling the immune system, and you’re
not activating your Nrf2 transcription proteins
from phytochemical activation. The Nrf2
transcription proteins activate those parts of the
DNA that reduce free radicals, remove irritated
compounds, and fix breaks and damage. The part
of the DNA that’s doing the repair isn’t activated
unless you’re activating the Nrf2 transcription
proteins with enough phytochemicals and
antioxidants. Because of all these things, it
interferes with the function of the T suppressor
cells, so when the immune system overreacts you
can’t shut it down and it starts to attack itself.
A significant number of people have gotten well
from lupus. One individual was waiting for a new
kidney. Because she was young — I think 17 or 18
— her body was able to fix it, and her kidneys
returned to normal. This case of psoriatic arthritis
is not an independent case. There are others with
advanced autoimmune diseases that have had
reversal using the same protocol.
Amazing. Can you give us an idea of what a
nutrient-dense, plant-rich diet is?
80
Plant foods, especially carbohydrate-rich plant
foods, can be scored on a hierarchical scale of
quality — the ones that have the most fiber, the
ones that are lower glycemic and have more
phytochemicals — so we can rate something like
cauliflower and beans over something like brown
rice or white potato. Flour and sugar could be
even lower than that.
We’re trying to eat more green vegetables,
non-starchy vegetables that have more
phytochemicals in them, particularly onions and
mushrooms. We’re eating a variety of foods to
get the full symphonic effect from the increased
absorption of the lipophilic phytochemicals by
having about half an ounce of nuts and seeds
with each meal. Then, we’re telling people how
to not destroy the nutrients in the preparation
process. That involves, perhaps, taking the green
cruciferous vegetables and blending them before
they’re heated in a soup base so they maintain
the activity of the myrosinase enzyme to form all
those isothiocyanates. These ITCs are important
for activation of the Nrf2 transcription proteins
and for anti-cancer effects.
It’s essentially a diet rich in G-bombs, which are
greens, beans, onions, mushrooms, berries and
seeds. Have a salad every day. Have soup, maybe
with carrot, celery and onion in the base, and put
green vegetables and beans into that. Have flax
seeds, chia seeds and wild berries with your
morning steel cut oats. Have a wok vegetable
dinner with broccoli, Chinese cabbage and
mushrooms, with Thai curry, turmeric, peanut
sauce. In other words, make these recipes
taste good, but have the full orchestra of
phytochemicals that maximally activate
DISEASE REVERSAL AND PREVENTION DIGEST
human immune function while at the same time
not eating a diet that’s high-glycemic or going
to promote too much IGF-1 (insulin-like growth
factor 1). Avoid high-glycemic, refined
carbohydrates and animal products, or at least
keep them to a level that’s so low to maintain
IGF-1 in a favorable range that’s not going to
drive growth or promote excessive immune
reactivity.
This diet is similar to what we’re going to talk
about with your next case series. Is there
anything else you’d like to say about this
psoriasis case?
I’d just like to say that I know this person
personally. 15 years later, and she’s active and
doing things she could never do when younger.
She’s in her later 60s and looks about 45 years old.
She’s in phenomenally good health, so it wasn’t
that she got well, then gained weight back or got
sick again. This is years later and she’s in superb
health, enjoying life to the fullest.
That’s really what we all strive for, to get our
patients to the thriving level.
Then we have your three other cases. We have
Treatment and Remission of Symptoms in Type 1
Diabetes with Nutrient-Dense, Plant-Rich Diet
Case Studies. Before we dive into those cases,
can you tell us a bit about the difference
between a type 1 diabetic and a type 2 diabetic?
And then about insulin resistance and how that
can actually affect a type 1 diabetic as well?
Most people think type 1 diabetics’ beta cells
in the pancreas have been destroyed by an
autoimmune attack when they were younger,
so they have no insulin production and require
exogenous insulin. Whereas a type 2 diabetic,
they become overweight and poor diet has made
their body insulin-resistant, causing beta cells
in the pancreas to overwork to produce excess
insulin. Over the years, the overwork of the
pancreas makes those beta cells only able to
produce a normal amount of insulin. That amount
of insulin produced by the beta cells might be
enough for a person of a normal weight, but it’s
not enough for this overweight person, so their
ISSUE 1 • SPRING 2019
glucose levels rise and they get a diagnosis of type
2 diabetes. Doctors give them medications to get
the failing beta cells to push out more insulin, or
they give them insulin- a growth-promoting and
fat storage hormone. It makes you gain weight. It
promotes angiogenesis, which means the growth
of blood vessels to fuel the growth of fat. Insulin’s
angiogenesis promotion can permit or accelerate
the growth of tumors and cancers. Excess insulin
accelerates aging of the brain, increases risk of
cancer, and can increase the deposition of
atherosclerosis in the body.
In the type 2 diabetic, giving them more insulin
or drugs to make them produce insulin to lower
their blood sugar is not always favorable. It’s
most favorable if we can give them an anti-
inflammatory, low-glycemic diet and have them
lose weight. We’ve seen beta cell recovery
in some of my type 2 diabetics who have lost
weight on a high-nutrient diet. Some of those
hibernating beta cells that are not dead yet
recover, and their C-peptides and measurement
of their insulin production went up as the glucose
and weight went down.
I think it’s more generally accepted that it’s
possible to cure a type 2 diabetic, or get them
in remission, because we know of people where
gastric bypass or lap bands helped them lose
weight and their diabetes went away. Doctors are
starting to accept that these cases are possible,
so I wanted to submit these cases on type 1
diabetics to show how important it is to do this
with a type 1, not just a type 2. Almost all type 1s
across America, their doctors are giving them as
much insulin as they need to control their glucose
levels, letting them eat an American diet, letting
them require almost any amount of insulin —
which causes the type 1 to become overweight,
increasing their insulin requirements. Heightened
insulin requirements in the type 1 dramatically
shorten their lifespan, causing increased
morbidity, blindness, kidney failure, aging of
the brain, depression, high rates of cancer, early
heart attack deaths, and peripheral neuropathies
through the build-up of advanced glycation
end products.
81
 The bottom line is that the conventional
treatment for type 1 is not safe because they’re
not having their diet controlled adequately, and
doctors are over-prescribing insulin thinking
that’s okay as long as their glucose is okay. It’s
not okay. You have to keep a high level of
phytochemicals in your tissues, keep a favorable
weight, and use a moderate amount of insulin
when you’re type 1.
Going back to beta cell function recovery, I
always tell patients those are the beta cells in
the ICU, so we’re trying to get them out of the
ICU. They may not be working right now, but
maybe we can. That’s a visual for those who
may be questioning what that means, exactly.
So, you had these three cases. The three-year-
old was started on the diet and within a month
of diagnosis started having decreased antibody
production. The six-year-old had the diagnosis
for a bit, but I want to focus on the older
gentleman who had a diagnosis of type 2
diabetes, but also was found to have type 1.
I think this is an increasing number of diabetics
— type 1½ diabetics. There are some physicians
who are not fully educated on understanding
that you can develop an autoimmune
component like a type 1, even if you start
out as a type 2.
Can you give us a little insight into how that
works and what you’re measuring?
This gentleman, who was really a fully type 1
diabetic — it developed a little older than most
type 1s develop, had antibodies. He had the
autoimmune attack on his pancreas. We were
discussing earlier that an autoimmune disease
can develop from bad health and nutrition.
The risk of developing lupus, psoriasis and even
type 1 diabetes can be influenced by the quality
of your diet and, in regard to these children,
perhaps the quality of the parents’ diet before
conception and during pregnancy, even, can
increase risk of autoimmune disease.
Parents who eat poorly have children who have a
higher rate of developing autoimmune disease.
There are a lot of factors involved, but even with
genetic predispositions, with optimal nutrition
the body still has the ability to repair broken DNA — hamburgers, pizza, mac and cheese — we do
crosslinks or suppress the expression of genetic
82
defects. Nutrition can do things to overwhelm
genetic tendencies.
In this case, this gentleman was an anesthes-
iologist at the local hospital consulting me
because he was concerned about his career. He
couldn’t focus on surgeries anymore because he
would get fatigued and fall asleep while trying to
control a person’s anesthesia when they were
undergoing a surgical procedure. He was thinking
he would have to quit his career because he was
having highs and lows, requiring too much insulin.
He had the foresight to come to me, as the
nutritional specialist in the community at the
local hospital. Over the time I cared for him as a
patient, he lost about 40 pounds. He’d pick his
shirt up and show me he now had a six-pack, he’s
lean, and how physically fit he became, but the
bottom line is that he was able to go back to his
job again as an anesthesiologist and physician.
I teach my type 1 patients that we don’t want to
moderate the insulin to the diet. We want to give
you a regimented amount of insulin each day and
keep you on that same amount of insulin. He had
to control his sugars with diet, so he loses weight,
gets fit, and his body stops requiring so much
insulin. Now he can go and exercise. Now he can
do a surgical procedure where he’s stuck in the
OR for 4-5 hours, not eating, and he’s not going
to bottom out his blood sugar because he’s not
over-taking insulin. It gives him his life back
because he’s requiring the amount of insulin
normal people use, not a person who is insulin-
resistant requiring a huge amount.
Even though the pancreas is not producing
insulin, type 1s are still becoming insulin-resistant
and now require more exogenous insulin because
fat blocks the uptake of insulin. Saturated fat
penetrates into the caveolins, caves in the sides
of your cell membranes, and blocks the lock and
key mechanism. When you have more butter,
coconut oil, and meat in your diet, you need
more insulin to cover the high-glycemic
carbohydrates because now you’ve hurt the lock
and key mechanism where insulin isn’t allowing
the glucose to go out of the bloodstream.
It’s the whole dietary model that Americans eat
everything wrong. We have too many animal
DISEASE REVERSAL AND PREVENTION DIGEST
“We have too many animal products, and we have
processed foods that don’t contain nutrients and
are high-glycemic. We have a too low amount of
the colorful plant foods that contain antioxidants.
Vegetables are the key to successful health.”
products, and we have processed foods that
don’t contain nutrients that are high-glycemic.
We have a too low amount of the colorful plant
foods that contain antioxidants. Vegetables are
the key to successful health. No matter what
you have wrong with you, you have to eat a lot
of vegetables so we get these people to like
vegetables.
Many of them say they hate vegetables. I say to
them, “We’re not asking you what you like right
now, because eating what you liked is what got you
into this problem to begin with. You’re going to eat
what you have to eat to get well, but I will prove to
you that I can teach you and make you like it by
changing your taste buds over time. Right now you
just have to eat what’s going to get you well and
don’t evaluate whether you like it or not. We’re
going to test this out scientifically. The only way it
can work is if you do 100% what I’m asking you to
do.” Over time, they get well and start to like it
more and more. They don’t just learn the recipes,
their taste buds get stronger and taste preferences
change. Then, we’ve solved the problem.
That’s actually the approach parents need to
take with their children, right? It doesn’t really
matter. This is what you can eat. You either eat
or you don’t.
Is there any last little bit you’d like to share about
these cases before we close?
Oh, I have to share something, yes. It’s that you
wouldn’t believe how enthusiastic and excited
these children are with type 1 diabetes. You’d think
it would be hard to get them to eat a healthy diet.
They are so into it. When they start this diet when
they’re young, they start learning recipes. They
know how to make hummus with real sesame
ISSUE 1 • SPRING 2019
seeds. They know the nuances of eating beans.
They know they have better sugar readings from it.
They like eating this way. It’s easier for kids to eat
healthy than it is sometimes for people who have
heart disease and diabetes when they’re 60 years
old and 40-80 pounds overweight. I tell them,
“You have to get your parents to eat healthier.
They have to eat what you’re eating because you
want them to be healthy too.” I just have to say
how cooperative and enthusiastic the children are
to eat healthy, control their illness, and get well.
That’s fantastic. Thank you, Dr. Fuhrman, for your
time and sharing your insight and wisdom with our
folks and sharing your cases with us today.
Thank you so much. Thanks for the work you’re
doing, too.
Joel Fuhrman, MD is a board-certified family
physician, six-time NY Times best-selling author,
and nutritional researcher — who specializes
in preventing and reversing disease through
nutritional methods. Dr. Fuhrman presently
serves as the President of the Nutritional
Research Foundation. He has published
multiple scientific articles on human nutrition
and is involved with multiple ongoing studies
addressing heart disease, diabetes and cancer.
His foundational discoveries on food addiction
and human hunger were published in the
scientific journal, Nutrition Journal, in 2010.
He is also serves on the Nutritional Science
faculty of Northern Arizona University.
Dr. Fuhrman is a graduate of the University
of Pennsylvania School of Medicine (1988).
83

Curry Kale Chips
4 SERVINGS
INGREDIENTS
12 ounces kale
1/3-cup nutritional yeast
1–2 tablespoons lemon juice
1 tablespoon coconut aminos
1 tablespoon curry powder,
or more to taste
Pinch of cayenne pepper (optional)
VARIATIONS
To make Spicy Southwestern-Style
Kale Chips, substitute 2 teaspoons
smoked paprika, 1 teaspoon dried
basil, 1 teaspoon ground cumin, and
1/4-teaspoon or more of ground
chipotle for the curry powder.
To make Italian-Style Kale Chips,
substitute 2 teaspoons of Italian
seasoning, 3 to 6 cloves of pressed
garlic, and freshly ground black
pepper to taste for the curry and
cayenne. Replace the lemon juice
with balsamic vinegar.
84
Recipes
RECIPE FROM DR. SCOTT STOLL
DIRECTIONS
Preheat oven to 350°F.
Wash the kale, strip it from its thick stems (discard
stems), and lightly dry in a salad spinner. It should
retain a bit of moisture, but not be dripping wet.
Place the prepared kale in a large bowl. Add the
nutritional yeast, lemon juice, coconut aminos,
curry powder and, if desired, cayenne. Mix well,
using your hands to coat the leaves as evenly as
possible.
Spray two 13-by-18-inch baking sheets lightly with
nonstick cooking spray. Arrange the kale in an even
layer over the baking sheets, keeping larger pieces
near the edges of the pans.
Bake for about 8 minutes, watching carefully to
make sure it doesn’t get overcooked. Then remove
the baking sheets from the oven and carefully turn
the leaves over, again arranging them in a single
layer and placing the larger pieces toward the edges
of the pans.
Alternatively, use a dehydrator on low temperature
for 4 hours.
Return the sheets to the oven and bake for another
7 or 8 minutes, or until the leaves are crisp and
brittle. Turn the oven off. If any leaves are not
done, return to the oven and allow them to stay
there until crisp, checking every 5 minutes. Even
though the oven is off, theremaining heat will
continue to cook and crisp the kale.
Cool before serving, or transfer to a covered
container and store for 3 or 4 days.
DISEASE REVERSAL AND PREVENTION DIGEST
Spuds, Veggies,
and Greens
RECIPE FROM DR. SCOTT STOLL
4 SERVINGS
INGREDIENTS
2 tablespoons lower-sodium
vegetable broth or water
2 medium yellow onions, chopped
4 medium Yukon gold or purple
potatoes (unpeeled), cut into
bite-sized pieces
1 clove garlic, minced
1/2-teaspoon ground black pepper
1 red bell pepper, thinly sliced
1 yellow bell pepper, thinly sliced
2 cups lightly packed chopped kale,
add more kale for greater nutrient
density
1 cup chopped broccoli
ISSUE 1 • SPRING 2019
If you love a hot and savory breakfast,
this is the dish for you! An inspired
combination of potatoes, veggies, and
greens, it will awaken your morning taste
buds and prepare you for the day ahead.
DIRECTIONS
Place a large nonstick skillet over high heat, and add
broth or water and onions. Cook, stirring often, for
about 5 minutes, or until the onions are
transparent.
Stir in the potatoes, garlic, and black pepper, and
cook for 3 to 4 minutes.
Layer the remaining vegetables over the potato
mixture. Turn the heat to low, cover, and cook for
10 to 15 minutes, or until the potatoes are soft.
Carefully mix the potatoes and other veggies
together and serve hot.
85
 Southwestern
Black Bean Salad
RECIPE FROM DR. SCOTT STOLL

4 SERVINGS This salad is a huge hit at every party,

INGREDIENTS witnessed by the empty bowl at the end
of the event and numerous requests for
Black Bean Salad
the recipe. Colorful and delicious, it is
1 cup cooked or canned black beans, also so nutritious that it can serve as an
rinsed and drained
entire meal.
1 cup corn kernels, fresh or frozen
(thawed)
1 cup finely chopped kale DIRECTIONS

1 cup peas, fresh or frozen (thawed)
1 cup chopped orange or red bell
pepper
1 cup sliced plum tomatoes
1 avocado, diced
1/2 red onion, finely chopped
1/2-cup chopped fresh cilantro
To make the dressing, place all of the dressing
ingredients in a small bowl, and whisk until well
mixed. Set aside.
To assemble the salad, place all of the salad
ingredients in a large bowl, and stir to mix well.
Add the dressing, and mix until the ingredients
are well coated. Serve immediately or chill until
ready to serve.

Lime-Chili Dressing
Juice of 2 limes
2 cloves garlic, minced
1/2-teaspoon pink Himalayan
sea salt
1/4-teaspoon chili powder
1 teaspoon of smoked paprika
to add smoky flavor

86 DISEASE REVERSAL AND PREVENTION DIGEST

Minestrone Soup
with Vegan Pesto
RECIPE FROM DAN PURJES

4 SERVINGS DIRECTIONS

INGREDIENTS In nonstick skillet stir in onion. Add salt & pepper.

Minestrone Soup
1 large red onion, diced
Salt & pepper
6 garlic cloves, minced
2 bay leaves
2 tablespoons organic tomato paste
Pinch of crushed red pepper
2 cups chopped sweet tomato
(any color)
2 zucchini, chopped into
1/2-inch cubes
1 summer squash, chopped into
1/2-inch cubes
1/2-pound Romano beans,
cut into one-inch pieces
1/2-pound green beans,
cut into one-inch pieces
2 cups small whole wheat
orchetta or penne pasta
Stir until beginning to color & soften. Add garlic,
bay leaf, crushed red pepper, tomato paste &
tomatoes. Bring to brisk simmer.
Set a large soup pot on stove. Add mixture from
skillet. Add 8 cups of water and a pinch of salt.
Bring to a brisk simmer. Cook for 10 minutes.
Add seasoning to broth before vegetables go in.
MAKE PESTO: As broth simmers, pound the garlic
& salt in a large bowl or food processor. Add basil
and pound to paste. Then add parsley & a little
salt.
Continue to pound into a coarse green paste. Stir
in
nutritional yeast & olive oil. Cover with plastic to
avoid oxidation.
Add zucchini, squash, Romano beans & pasta to
broth. Cook pasta until al dente. Add green beans
for a minute or two.
Ladle soup into bowls, topping each with a dollop
of pesto.

Vegan Pesto
2 medium garlic cloves, chopped
Salt & pepper
2 cups basil leaves
1 cup parsley leaves
3/4-cup extra virgin olive oil
1/4-cup nutritional yeast

ISSUE 1 • SPRING 2019 87

 Spring Salad
INGREDIENTS
Salad
One container multi-colored
cherry tomatoes
One red, yellow & orange bell
pepper. 3 peppers total.
3 cups of triple-washed spring
mix lettuce
1/2-cup sliced black olives
1/2-cup organic canned black
beans
1/2-cup pine nuts
2 ripe avocado
1 large cucumber
1/2-cup of glass-contained,
organic sun-dried tomato
Salad Dressing
One lemon
Sea salt
1/2-cup Dijon mustard
Tablespoon balsamic vinegar
88
RECIPE FROM DAN PURJES
DIRECTIONS
Put pine nuts in a small dry skillet over
moderate heat. Toast.
Shake the pan until nuts are lightly browned.
Set aside.
Rinse olives with cold water. Set aside.
Rinse black beans with cold water. Set aside.
Rinse sun-dried tomatoes with cold water.
Chop. Set aside.
Chop into small pieces: spring mix, cherry
tomatoes, cucumbers,peppers and avocado.
Put in large bowl.
Add black beans, sun dried tomato, olives &
pine nuts.
Whisk in a separate bowl: mustard, squeezed
lemon juice, balsamic vinegar and sea salt.
Pour dressing over salad. Mix.
DISEASE REVERSAL AND PREVENTION DIGEST
Quinoa & Chickpea
Tabbouleh Salad
RECIPE FROM JULIEANNA HEVER – The Vegiterranean Diet

4 SERVINGS Light and herb-infused, this salad is

INGREDIENTS
3 to 4 tablespoons freshly
squeezed lemon juice with zest
1⁄2-teaspoon freshly ground
black pepper
1⁄2-teaspoon salt (optional)
1 garlic clove, minced (optional)
2 cups cooked quinoa
1 (15-ounce) can chickpeas,
rinsed and drained
1 large unpeeled cucumber,
seeded and diced
3⁄4-cup halved grape or
cherry tomatoes
3⁄4-cup finely chopped Italian
flat-leaf parsley
3⁄4-cup finely chopped fresh
mint leaves
1⁄4-cup chopped finely scallions
refreshing and extremely nutritious.
Traditionally made with bulgur wheat,
this gluten-free version boasts similar
flavors, but it’s friendly for those
eschewing gluten and more substantial
because of the added chickpeas.
DIRECTIONS
In a medium bowl, whisk together the lemon juice
and zest, pepper, salt, and garlic. Fold in the
quinoa, chickpeas, cucumber, tomatoes, parsley,
mint and scallions, and combine well.
Serve immediately, or cover and refrigerate.
Serve cold or at room temperature. Store
leftovers in an airtight container in the
refrigerator for up to 4 days.

ISSUE 1 • SPRING 2019 89

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