The #WFPB Nutrition Paradigm Shift Is Under Way in the Bronx

On Friday October 27th, I attended the first annual Montefiore Preventive Cardiology Conference, which was an amazing experience.

Many of the heavyweights in the field were there, and it was a truly amazing experience. While the material was meaty, since the conference offers educational credits for medical professionals, it was accessible to the general public as well, and people had come from all over the country. There was even a delegation from the Brooklyn Borough President's office, as well as from the Mayor's office, in this week when it had just been announced that Brooklyn was launching Meatless Mondays in 15 public schools.

The speakers included the following:

• Opening remarks by Dr. Robert Ostfeld, cardiologist at Montefiore, who was the conference organizer.
• He was followed by Dr. Paul M. Ridker, Director of the Center for Cardiovascular Disease Prevention at the Brigham and Women's Hospital, who spoke on the issue of inflammation in cardiovascular disease. The bottom line is that cholesterol levels and inflammation are equally important in cardiovascular disease (CVD).
• Next came Dr. Neal Barnard (he of PCRM fame), who spoke on the role of nutrition in the prevention and treatment of diabetes. The bottom line is that the ADA approach (low carb), does not work nearly as well as a Whole Foods Plant-Based diet without added sugar, oil or salt, and that this is now fully scientifically proven. It is notable that fruit is healthy for diabetics because the sugar in the context of fruit is not a problem, it's the refined sugar we add to food that is the problem. Carbs are also essential, and sugar in and of itself does not cause diabetes, fat does. So, the avoidance of added oils and fats is critical. Most importantly, once a patient starts on the diet, the changes can happen so fast that medical supervision is critical since otherwise people can become hypoglycemic if their medications are not adjusted in a timely fashion. Not in all cases, but for probably two thirds of diabetics it seems realistically possible to get off of medicine and insulin altogether within weeks or months.
  Dr. Barnard's graphical illustrations of the diabetes mechanism were extremely helpful.
  Barnard also brought up a fascinating report on Geico, where he was involved in lowering health care costs with a Whole Foods Plant Based diet, for a company that is self-insured for health. This type of development could point the way towards a better solution for our healthcare crisis. Whole Foods operates along similar lines.
• Next was Dr. Kim Williams of Rush University Medical Center in Chicago and former president of the American College of Cardiology, who spoke on "Describing My Evolution Toward Advocating for a Lifestyle Oriented Approach for the Prevention and Treatment of Cardiovascular Disease. A very engaging speech - you can get a little taste here.
• Next up was Dr. Caldwell Esselstyn, Jr. and it is always a delight to hear him state his core position, that heart disease is a toothless paper tiger that does not even exist, not to mention how amazing it is that this has become a multi-billion dollar medical specialty in the Western world, without anybody wondering why large parts of the world do not even have this problem. In short, coronary heart disease is entirely preventable and in most cases (except when it is totally critical) reversible with diet and exercise.
• Finally, Dr. Robert Ostfeld spoke specifically on the challenges of the Bronx, the borough that steadily always comes in at #62 of 62 counties in NY in the Robert Woods Johnson survey of health outcomes for the state. With his customary sense of humor he described the challenges of working in a poor community and focusing on teaching people to make the transition to a WFPB diet on a budget.
• Next, there was a panel discussion, which also included Dr. Michelle McMacken, Assistant Professor of Medicine at NYU School of Medicine and Director of the Adult Weight Management Program at Bellevue Hospital.

One of the more hilarious moments of the day (and there were many) was in the presentation by Dr. Kim Williams about a study where the relationship of dietary intake to premature death from heart disease was analyzed. At first it seemed the study indicated that red meat was worse than eggs, until it became clear that consumption of eggs causes cancer, and the patients in the study died from cancer before they died from heart disease. Conclusion: eggs are the incredible, edible carcinogen.

Another salient point that came out during the day was the difference between a "vegan" diet, defined in the negative (no animal products), but not observing the whole foods paradigm, which often produces worse health outcomes than a meat-based diet. This confirms again that "vegan" is not a useful category from a nutritional standpoint, for a whole foods plant-based diet, without added Sugar, Oil and Salt is really the issue. Potato chips, Coca Cola and chocolate may make a "vegan" diet, they do not add up to a healthy lifestyle.

Overall, it is increasingly clear that the Whole Foods, Plant-Based nutritional model is slowly becoming main stream and in fact that the adoption is picking up speed as evidenced by the developments in Brooklyn, which now are getting the support from the mayor's office, as well as the adoption in hospitals, such as the Montefiore health system, which includes five hospitals. Both AMA and the American College of Cardiology now recommend that hospitals offer plant-based menu options at every meal.

Throughout the day the food was excellent and a worthwhile demonstration of the variations that are possible within the #WFPB paradigm. The sky is the limit. Literally - as was also emphasized by various speakers - #WFPB is more bulky but you lose weight automatically and end up returning to a homeostatic, healthy weight. Overeating is never a problem because the diet is rich in fiber and nutritionally abundant as long as people eat enough different foods. There is no such thing as a protein deficiency if people eat a reasonably varied plant-based diet, and likewise the notion of supplements is completely moot, with the sole exception of B12. It was not discussed in detail, but there was mention of the fact that supplements from bottles can indeed easily be counter productive - everything is more easily absorbed from food, and the plant based diet will provide abundant nutrients.

Another simple way of looking at the problem is this: your body produces all the cholesterol it really needs, you need no dietary cholesterol ever. Plant-based nutrition has zero cholesterol and all animal-based nutrition has cholesterol, hence you should not eat it. 

As to added sugar, oil and salt: 

• sugar is harmless in fruit, but adding refined sugar in any form is bad news
• added oil is always bad, it damages the endothelium immediately, preventing your bloodvessels from dilating normally with exercise. You'll get about 10% of your calories from naturally occurring oil if you include small amounts of nuts, avocado or coconut in your diet, but, generally speaking, all plants contain small amounts of oil naturally, so it is easy to go over.
• as to salt, 2,000 micro grams per day is all you need which is easy to meet if you eat all plants, and sometimes you can even add a sprinkle, but generally you want to use herbs and spices for seasoning, not salt. All vegetables and grains contain sodium naturally.

Meanwhile, it is clear that different doctors have slightly different attitudes in practice, but they all focus on helping patients with at least a half-day of intensive nutrition counseling that includes the significant other, in order to help people get on track about their diet and stay on track. In Dr. Ostfeld's program at the Montefiore Cardiac Wellness program, this is typically a half-day program on a Saturday, that includes food so people leave inspired about the many options that exist within the plant-based paradigm.

Ostfeld tends to be rather mild and focuses on not letting the perfect get in the way of the merely good: progress is progress. The other side of that coin is that, as reported above, a sloppy and only nominally "vegan" diet is really counter productive, and in practice is often the reason why would-be vegans fail. Esselstyn typically does not allow his patients any wiggle room for that reason, for he knows that once you are on the right track, you will feel so much better, you will not want to get off it. One thing sums up the difference perhaps. Esselstyn recommends 6 fist-sized green leafies per day, typically cooked kale with balsamic vinegar, which taken together is great for nitrous oxide production. Ostfeld, more modestly, ask for four. Personally I find that cooked kale, drizzled with balsamic vinegar is an absolute delight, and I miss it when I don't have it.

Post Script:
In other news, the movie Code Blue is being announced, which is going to be a next chapter in the adoption of the Plant-based nutritional program in clinical practice. It reminds us of the fact that 86% of our healthcare spending is on treating the degenerative chronic diseases, which by and large are the result of bad diet and conversely are preventable and most often reversible with a Whole Foods Plant-Based diet. If we can eliminate 75% of the 86%, we will have largely solved the healthcare crisis. In this conference only heart disease and diabetes were being discussed at length, though the more general application was mentioned. The movie Code Blue is going to add MS to the discussion. The implications are truly staggering.

Health and Well-being Comes First

Health means more than physical health, it must first mean spiritual and psychological health and well-being, the example of which is perhaps best seen in Victor Frankl's book Man's Search for Meaning, about spiritual health and how it helped him survive the Nazi death camps. Cindy Lora-Renard, in her book A Course in Health and Well-being, frames the issue in a modern way, with practical advice on how to put inner health, inner peace central in your life.

During my visit at Plantstock in August of 2017, I listened to many of the personal stories of people who were finding health through the Whole Foods Plant-Based nutritional paradigm, and two in particular really drove the message home to me of how much this transition is part of a spiritual growth process for many.

Health and Well-being is First Spiritual

Eric Adams, the Brooklyn Borough President, spoke about this dimension explicitly. He was well aware of the fundamental change in his life of going from abusing food, almost like a drug, to enjoying the empowerment of taking control of your health with the Whole Foods Plant-Based lifestyle.

Another presenter who stood out for me was Tim Kaufman from Atlanta, who blew me away by his realization that as a trial lawyer all of his life his business had been to catch people in a lie, but that his unhealthy relationship with food had made his own life a lie. His description of his turnaround was truly a cathartic moment.


I have encountered many who at some point in their spiritual journeys actively pursued a change in their relationship to food as part of that journey. There is something about becoming conscious about all of your relationships, with people as well as things, including food. Around us, the awareness of the health problems resulting from the Standard American Diet is growing to the point that the fast food industry, and really the whole food industry is fast finding itself in the place of the tobacco industry. Particularly the recent book by Dr. Neal Barnard, The Cheese Trap, makes it very clear how junk food is not just psychologically addictive, but in some cases - cheese obviously - may be physically addictive as well. No wonder people abuse food as a pacifier.

Before anything else, psychological and spiritual well-being means an equanimity with the physical, for we know it is not the be-all and end-all of who we are, but certainly the body is our vehicle in this world and being reasonable about the upkeep makes sense. In the end the old saying holds:

Before enlightenment, chop wood, carry water. After enlightenment, chop wood, carry water.

Or, just be normal, but being normal in this case includes stopping self-destructive behaviors. One thing I know from experience now and that is that, since I consciously committed myself to the Whole Foods Plant-Based paradigm, this has opened up a whole new level of enjoyment of food. This does not mean in any sense that you would never get sick, but still it produces a tremendous new level of empowerment to feel how you can take responsibility for your own health.

Particularly important is the message from the work of T. Colin Caldwell, which says that never mind the genetic predispositions (or other challenges) you may have, it always holds that, all else being equal, the Whole Foods, Plant-Based nutritional approach produces superior results. In short, you can take responsibility by doing your part, and if you do have to deal with disease of any sort, you will deal with it that much better if you've taken care of your body as best you can.

Let food be thy medicine

Hippocrates said that. The whole Whole Foods Plant-Based revolution falls in line with this notion. The truth is that 75% of healthcare spending is in fact sick-care, related to the growing list of chronic, degenerative diseases that all result from the Western diet. The economic incentives in our system are to provide ever more sick care, for that's where the money is. On the ground, people are feeling sicker and sicker as they get more sick care, until they finally realize that they can take charge, and growing numbers of people are dumping hands full of medications almost as soon as they get on a #WFPB diet. In fact, for diabetics the results are often so dramatic that they need regular medical attention to adjust their insulin doses, and often their insulin needs can be drastically reduced, or even eliminated altogether within weeks or months. In cardiology the results tend to be equally dramatic.
Here are some interesting videos:

• T.Colin Campbell, PhD. suggests an alternative approach to the health care crisis in a TEDx talk, based on WFPB, pointing out that 75% of health care dollars is spent on caring for degenerative diseases caused by diet, and that since the 70's till now our healthcare costs have risen from 5% of GDP to 18% of GDP, and are still rising, while we are in 37th place in terms of health outcomes.
• Irminne van Dyken, MD proposes that many surgeries can be avoided in the same way. She focuses on surgeries, because she is a surgeon, but she says, she would rather not be.
• And an interesting presentation about the health cost of our fast food culture from the Food Revolution Network.

Here is a brief list of some of the best literature in this area. It is rapidly growing.

• Ivan Illich, Limits to Medicine: Medical Nemesis: the expropriation of health. The updated edition of his 1975 paper. This remains one of the seminal papers on the health threat posed by our modern Western medical model.
  The results cited by T. Colin Campbell (above) merely confirm it: with growing "healthcare" expenditure from 5 to 18% of GDP we have fallen to 37th on the global list of health outcomes. As we now understand, the fact that doctors do not learn anything about nutrition has something to do with this outcome. The currently proposed solutions to our healthcare crisis are counterproductive for making dysfunctional care cheaper makes the dysfunction worse, not better.
  Illich's frame of reference may seem "too Roman Catholic" for some, but once you adjust to that, and put his findings in your own words, you know that he has nailed the problem better than almost anybody has to this day.
• E. Richard Brown, Rockefeller Medicine Men: Medicine and Capitalism in America, which is the perfect corollary to Ivan Illich's points.
• Caldwell B. Esselstyn, Jr. MD, Prevent and Reverse Heart Disease: The Revolutionary, Scientifically Proven, Nutrition-based Cure.
• Neal Barnard and Bryanna Clark Grogan, Dr. Neal Barnard's Program for Reversing Diabetes: The Scientifically Proven Program for Reversing Diabetes without Drugs.
• Dr. Joel Fuhrman, The End of Diabetes.

I could go on, but this is a blog post, not a book. The gist of it is that we are in a dysfunctional medical model, which is perfectly characterized by Illich with the words "expropriation of health." Recently, we seem to be regaining an understanding of the role of nutrition in health, as per the work of Campbell, Esselstyn, Barnard, Fuhrman, McDougall, Greger, Ornish and many other leaders in this field. 

The gist of it is the new sense of liberation that goes with the realization that the Whole Foods Plant-Based nutritional paradigm empowers us to take responsibility for our health in a major way. And, while it is definitely a transition that takes some effort, once you are used to it, it turns out it all is simplicity itself, you just eat mostly whole foods plant based nutrition, cooked or raw, and watch your SOS: No added Sugar, Oil or Salt. Staying within that paradigm, you can eat as much as you want since this diet burns more calories than it gives you, and you will automatically arrive at a homeostatic weight and a BMI below 25.

In short if the majority of the leading causes of death can be prevented or reversed with diet, the implication also is that the 3rd leading cause of death, iatrogernic illness, can also be massively reduced with the Whole Foods Plant-Based diet, because prevention over pills is the sound version of the old saw that an apple a day keeps the doctor away... we just need to add some kale, whole grains, and legumes to the list - an apple alone won't do.

Our first #WFPB/Suppers meeting at St. Helena

Today was our first #WFPB Suppers meeting at St Helena's

The idea of The Suppers Program is a communal meal preparation and meal, usually at someone's home, in which there is room for people's personal dietary needs, whatever they are. Our meeting in particular was focused mostly on learning more about the Whole Foods Plant-Based lifestyle. But some of us were selective because of their specific needs and none of that is a problem.

We had a group of 8 people, from eleven to seventy years of age and lots of fun was had by all.

The feedback was generally good and several people want to do it again, and the date will be announced soon on our Meetup site for this program.

The program was rich, for we wanted to emulate a whole day of living with a Whole Foods Plant-Based diet. Lots of people learned new things and folks were excited to discover different ways of preparing food they thought they knew and did not like but suddenly they liked it.

Note: Berries with breakfast are particularly emphasized, and 4-6 "fist sized" portions of green leafy vegetables during the day. It can be cooked kale, collard greens, swiss chard, spinach etc. or salads, but leafy greens are particularly beneficial for epithelial health. Dr. Robert Ostfeld tends to recommend "at least four" portions per day, but Dr. Esselstyn would recommend six.

Recipes: A Day of #WFPB food

For reference the recipes are provided here in order.

Breakfast:

Note: We had Bob's Red Mill Steel Cut Oats.
We cooked some steel-cut oats, and added some finely shredded apple (with a mandolin), some blueberries, some cinnamon, and some raisins. Let it simmer a few more minutes till the apple gets soft and the raisins absorb some of the cooking liquid as well.
We served it topped with extra cinnamon and balsamic vinegar.

A side of cooked kale, dressed with balsamic vinegar.

Notice that the cooking water from kale or any vegetable can be used as is for e.g. cooking grains, or to create a more elaborate vegetable bouillon.

Lunch:

• Red leaf lettuce
• Green leaf lettuce
• Some spinach leaves
• Tomatoes
• Peppers in three colors (red, yellow, green)
• some Chia seeds, some ground flax seed (good for those Omega-3's)
• some cooked Quinoa (cooked in some home made vegetable bouillon, made of cooking water from kale with some Marmite or some Braggs Liquid Aminos
• Jane Esselstyn's 3/2/1 dressing: 3 measures of balsamic vinegar, 2 measures of dijon mustard, and 1 measure of maple syrup.
• some olives, some capers, some artichoke hearts in water.

Take Out: Collard Green Roti's

Take a boiled leaf of Collard Green and put a bit of hummus along the stem, add in some rice, add some vegetables, which can be boiled, or sometimes raw.
Today we used some grated carrots, some chopped scallions, some cilantro and parsley, a bit of kimchi. For our rice we used Lundberg's Sprouted Brown Basmati. Roll it up, and I prefer to roll it in a half sheet of paper towel and put it in a sandwhich bag, so I come prepared to every meal.
We also used some nutritional yeast for seasoning.

Oil-free hummus is easy to make. Leave out the tahini, use a little liquid from the can of chick peas, the juice of one lemon, 2 garlic cloves minced, and add a splash of Braggs liquid aminos. Obviously, you can make hummus with various spices, parsley, cilantro, jalapeno, pimento... as you wish the number of variations is endless. A Nutribullet or similar food processor makes it all easy as pie.

Dinner: 

Note: We fudged it a little bit, but the meal plan for the dinner was Rice (Lundberg Sprouted Brown Basmati), with Lentil Stew, and Side dishes of cooked spinach, and Citrus Berry Salsa. In this case, we did not quite make the spinach.

Suppers Breakfast Challenge Lentil Stew
See the full recipe on the link above.

Suppers Citrus Berry Salsa
Again, see the full recipe at that link.

We forgot to make the spinach with the dinner, but it should be noted that generally the #WFPB recommendation is to have green leafy vegetables 4-6 times a day, so normally you would always have a salad with every meal or some green leafy vegetable as a side dish.

In all, with the massive amount of food we had, the bill was only $11.50 per person, good for an $3.50 refund and there were plenty of leftovers.

Interestingly, two of us go to Dr. Robert Ostfeld, the cardiologist at Montefiore who teaches this diet, but one other person had already heard about the diet from a friend in New Jersey, who in turn got it from their cardiologist.

WE had a visit from a journalism student from NYU, and we eagerly await her report as well.

Summary of #WFPB Principles:

The Whole Foods, Plant-Based lifestyle is a new nutritional paradigm, as defined by T. Colin Campbell in his book Whole, and based on the research that was published in The China Study. The principles are simplicity itself:

• Eat only plant-based, whole foods (cooked or raw is fine)
• Do not worry about proteins (protein deficiency does not exist if you follow this program). You need only 5-10% of calories from protein, and even plant-based many get closer to 15%. Overall, circa 10% of calories should come from protein and 10% from fat.
• Do not use added oils or sugar, go light on salt or even oily fruit (avocado, nuts, coconut). Serious heart patient may have to avoid all oily fruits. 
• The only supplement you ever need is B12, which nobody gets in sufficient quantity, usually one every other day is all you will need. All other supplements are good only for expensive urine, unless specifically medically indicated. The #WFPB lifestyle provides an abundance of nutrients, anti-oxidants, vitamins, and aside from B12, supplementation is moot.
• Dieting does not exist in #WFPB. Dieting means tinkering within a dysfunctional nutritional paradigm. #WFPB provides whole nutrition automatically, so eat to your heart's content and you will revert to your optimal weight by default. Start eating garbage and the weight will come back. Of course there are exceptions like food allergies, or simply preferences, but within the paradigm there is no dieting, such as portion control, etc.
• It is recommended you get some berries every day (blueberries, blackberries, raspberries, strawberries) preferably with breakfast, work some chia seeds and or fresh-milled flax seed into salads, etc. for Omega-3s and 4-6 fist-sized portions of green leafy vegetables, such as kale, spinach, swiss chard, etc. for epithelial health.

Bonus: here is the account of an FDNY firefighter on a plant-based diet: https://www.forksoverknives.com/rethinking-my-health-after-september-11-exposure/?utm_medium=social&utm_source=twitter&utm_content=vegan&utm_term=plant-based#gs.4aqcY_g