The Power of Lifestyle medicine

in Managing and Reversing

Chronic Disease
Disclaimer
AHA Reccs at the time
6
Data from Centers for Disease Control
 Age-Adjusted Prevalence of Obesity and Diagnosed Diabetes Among
U.S. Adults Aged 18 Years or older
Obesity (BMI ≥30 kg/m2)
2000 2010
1994

No Data <14.0% 14.0-17.9% 18.0-21.9% 22.0-25.9% >26.0%

Diabetes
2000 2010
1994

No Data <4.5% 4.5-5.9% 6.0-7.4% 7.5-8.9% >9.0%

CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at
10/18/20 http://www.cdc.gov/diabetes/statistics
Heart Disease Facts (CDC)
Reversal Diet – Lifestyle Heart Trial
Dr. Dean Ornish
From: Intensive Lifestyle Changes for
Reversal of Coronary Heart Disease
From: Intensive Lifestyle Changes for
Reversal of Coronary Heart Disease
Updating a 12-Year Experience with Arrest and Reversal Therapy For Coronary Heart Disease
(An Overdue Requiem for Palliative Cardiology)

Esselstyn CB Jr. The American Journal of Cardiology 1999 Aug 1; 84:339-34

Diabetes Facts (CDC)
 99 People with Type 2 diabetes - 22 weeks
duration
49 followed a vegan diet low in fat with no
limits on carbohydrates

After 14 weeks - After meal calorie burn

was 16% higher (thermic effect of food)
Increased sensitivity to glucose
calories released as body heat rather than
stored as fat

Barnard ND, Cohen J, Jenkins DJ, et al. A low-fat vegan diet improves
glycemic control and cardiovascular risk factors in a randomized clinical
trial in individuals with type 2 diabetes. Diabetes Care. 2006;29:1777-
1783.
Barnard ND, Cohen J, Jenkins DJ, et al. A low-fat vegan diet improves glycemic control and
cardiovascular risk factors in a randomized clinical trial individuals with type 2 diabetes. Diabetes
Care. 2006;29:1777-1783.
 80% or more of all healthcare
spending in the U.S. is tied to the
treatment of conditions rooted in poor
lifestyle choices.
Chronic diseases and conditions—such as hypertension, heart
disease, stroke, type 2 diabetes, obesity, osteoporosis, multiple
types of cancer—are among the most common, costly and
preventable of all health conditions.
 Lifestyle Medicine
is the use of a whole food, plant-predominant dietary
lifestyle, regular physical activity, restorative sleep,
stress management, avoidance of risky substances
and positive social connection as a primary
therapeutic modality for treatment and reversal of
chronic disease.
What Lifestyle Medicine is not:
Alternative Medicine
Complementary Medicine
Integrated Medicine
Homeopathic Medicine
Herbal medicine
Functional Medicine
From SSVMS Medical
Museum
Focus on the root cause of disease.
Association Between Plant and Animal
Protein Intake and Overall and Cause-Specif ic
Mortality

Jiaqi Huang, PhD1 Linda M. Liao, PhD, MPH1 Stephanie J.Weinstein, PhD1

Prospective cohort study which included 237,036 men and 179, 068 women
(1995 -2011)
Comparative effectiveness of plant-based diets for weight loss: A
randomized controlled trial of five different diets.
Nutrition. 2015 Feb; 31 (2) 350-358
Permanente Journal - 2018

Balazs I Bodai 1 Therese E Nakata 2 William T Wong 3 Dawn R Clark 4 Steven

Lawenda 5 Christine Tsou 6 Raymond Liu 7 Linda Shiue 8 Neil Cooper 9 Michael
Rehbein 10 Benjamin P Ha 11 Anne Mckeirnan 12 Rajiv Misquitta 13 Pankaj
Vij 14 Andrew Klonecke 15 Carmelo S Mejia 16 Emil Dionysian 17 Sean
Hashmi 18 Michael Greger 19 Scott Stoll 20 Thomas M Campbell 21
Steps in the pathogenesis of inflammation leading to
progression of chronic diseases.

Bodai BI, Nakata TE, Wong WT, et al. Lifestyle Medicine: A Brief Review of Its
Dramatic Impact on Health and Survival. Perm J. 2018;22:17-025.
doi:10.7812/TPP/17-025
• “All disease begins in the gut.”

• - Hippocrates
Protein?
Calcium and vitamin D
Fiber Recommendation
Case Study #1
70-year-old diabetic man period of 8 months
South Sacramento Kaiser Permanente Medical Center
Department of Lifestyle Medicine
Participants will learn

• Cook heart-healthy meals that are • Manage stress

delicious and affordable
• Improve personal and professional
• Become smart grocery shoppers relationships

• Order intelligently in restaurants • Transform negative attitudes into

positive ones
• Lose weight utilizing science-based
skills
Measures of Success
1. Reach 6. Improvements in Mental Health
2. Retention • Addictive behaviors
3. Patient Satisfaction • Perceived confidence and health
4. Perceived Confidence and 7. Reduction of Prescription Medications
Sustainability
5. Improved Measures of Health
• Weight
• Blood Pressure
• Lipids
• HgA1C
Enrollment - Demographics

American Indian/Alaska Other

Native 1% Declined to state
1%
Native Hawaiian/Other Pacific1%
Islander
2%

Asian
15%
White
39%
Latin X
16%
African
American
25%
Participant Diagnosis

• 75% of Participants also

Both diagnosed with
9% Hypertension
CAD
11%

DM2
80%
HALT – Clinical Trial 2016

Health Achieved through Lifestyle Transformation

• Target Audience:

• Type 2 Diabetics

• Cardiac Patients

• Piloted 2016

• 39 Cohorts-940 Interventions

• Outcomes at 6 months

• 84% 6-month retention

• 7.5% Body Weight (BMI >25)

• 1.4 HgA1C reductions (HgA1C >8)

• 2.4 in Waist Circumference (All)

1 year – 14 patients reversed their diabetes

- Reversal of CAD
All Weight - BMI ≥ 25

Weight Reduction of Body Weight

225 222.9 6 months
7.6%
7.5% Max weight loss
219.6 7.5% 72 lbs

Reduction of Body Weight %

220
7.4% 92% lost weight
215 7.3%
(-16.3) (-15.1) 12 months
7.2% Max weight loss
lbs

210
206.6 7.1% 99 lbs
204.5 7.0% 83% lost weight
205
6.9%
6.9%
200
6.8%

195 6.7%
Initial to 6 mo Initial to 12 mo 6.6%
N = 155 N = 98 6 month 12 month
 African American: Weight - BMI ≥ 25

235 6 months
Reduction of Body Weight Max weight loss
231.2 6.0% 37.2 lbs
230.3 5.5%
230 91 % lost weight

Reduction of Body Weight %

(-8.4) 5.0%
4.3% 12 months
225 4.0% Max weight loss
(-11.9) 222.8
21.8 lbs
lbs

3.0% 86% lost weight

220 218.4
2.0%
215
1.0%

210
0.0%
Initial to 6 mo Initial to 12 mo
N=3 N=1 6 month 12 month
5 1
 Waist Circumference
6 months
45
44.6 89% decreased waist
Max reduction 9 inches.
44.1
44
12 months
(-2.4) 87% decreased waist
(-2.8)
43 Max reduction 9 inches.
Waist (in.)

42.2
42
41.3
41

40

39
Initial to 6 mo Initial to 12 mo
N=122 N=82
60
All DM2: Change in A1c and Insulin
A1c Insulin

8.4 8.3 100 6 months

87 89 75% reduced
90
8.2 insulin
80 (-21)
8 (-0.2) (-26) 11 no longer
8 70 68
using insulin
61
7.8 60
HgA1c%

7.8 (-0.8)

Insulin
12 months
50
7.6 68 % reduced
7.5 40 insulin
7.4 30 11 no longer
20 using insulin
7.2
10
7 0
Initial to 6 mo Initial to 12 mo Initial to 6 mo Initial to 12 mo
N = 133 N = 100 N=77 N=74
A1c ≥ 8 DM2: Change in A1c and
Insulin A1c ≥ 8 A1c ≥ 8: Insulin Change
10 6 months
9.8 120 5 (A1c) Dropped
9.5 100 Below 6.5
9.5 100 95 4 no longer using
(-23)
(-0.6) insulin
(-1.4) 80
9 8.9 72
HgA1c%

(-55) 12 months
Insulin
60 2 (A1c) Dropped
8.5 8.4 45 Below 6.5
40 3 no longer using
insulin
8
20

7.5 0
Initial to 6 mo Initial to 12 mo Initial to 6 mo Initial to 12 mo
N = 63 N = 40 N = 44 N = 41
SF-20 Survey: Mental Health
Mental Health Score: 6 month Mental Health Score: 12 month

25.2 25.5
25 25
25 25
24.8
24.5
24.6
24

Score
24.4
Score

24.2 23.5
24
24 23
23
23.8
23.6 22.5

23.4 22
Initial 6 mo Initial 12 mo
N=82 N=46
SF-20 Survey: Physical Health
Physical Health Score: 6 month Physical Health Score: 12 month

15.2 16.5
15
15 16
16
14.8
15.5
14.6
14.4 15
Score

Score
14.2 14.5
14
14 14
14
13.8
13.6 13.5

13.4 13
Initial 6 mo Initial 12 mo
N=82 N=46
Average Change in Resting Energy Expenditure

2000
1800 1729
1650
Resting Energy Expenditure

1600
1400
(calories/day)

1200
1000
800
600
400
200
0
Initial 6 Month
N = 68
DM2 Reversals

African American 3

Latin 1

White 7

Asian/Other Asian 3

Total 14
Images at 0, 6, 12 and 30 months

L: 70 lbs - 6 months 113 lbs - 1 yr 114 lbs -2 ½ yrs

J: 59 lbs - 6 months 92.2 lbs - 1 yr 80 lbs - 2 ½ yrs
RACe – Clinical Trial 2019
Resiliency After Cancer
• Target Audience:
• Breast Cancer Survivors
• Piloted 2019
• 5 Cohorts-50 Interventions
• Outcomes at 6 months
• 95% Retention
The role of visceral adiposity in the
severity of COVID-19: Highlights
from a unicenter cross-sectional
pilot study in Germany
Petersen A, Bressem K, Albrecht J, et al. The role of visceral adiposity in the severity of COVID-
19: Highlights from a unicenter cross-sectional pilot study in Germany [published online ahead of
print, 2020 Jul 14]. Metabolism. 2020;110:154317. doi:10.1016/j.metabol.2020.154317

An increase in visceral fat area by 19 square cms

was associated with a 1.37 fold higher likelihood of
ICU treatment and a 1.25 fold higher likelihood of
mechanical mechanical ventilation.
NEJM
May 21, 2020
 Health Care Disparity

Bancks MP, et al. Association of Modifiable Risk Factors in Young Adulthood With Racial Disparity in
Incident Type 2 Diabetes During Middle Adulthood. JAMA. 2017;318(24):2457-2465.
doi:10.1001/jama.2017.19546
The young physician starts life with twenty
drugs for each disease, and the old physician
ends life with one drug for twenty diseases.
- Sir William Osler
Image from the National Library of Medicine / Public
Domain
Three Phases of Truth

“All truth passes

through three stages.
First, it is ridiculed.
Second, it is violently
opposed. Third, it is
accepted as being self
evident.”
“Who are you gonna
believe, me or your
own eyes?”
-Groucho Marx
Image from the National Library of Medicine / Public Domain