The Third Annual Montefiore-Einstein Preventive Cardiology Conference.

You can easily get your own report on the conference by searching #MEPCC19 on Twitter.

  There was once again a stellar group of presenters there, starting with Dr. Ostfeld himself, who opened the conference, followed by

• Dr. Caldwell Esselstyn, Jr. on his favorite topic: why Heart disease is a paper tiger that need not exist, and if it does can be reversed with diet. I never get tired of hearing him and I had a chance to speak with him briefly.
• Dr. Philip Gordts, on a fascinating (relatively) new evolutionary theory on why red meat is such a trigger for heart disease in humans. Understanding the "why" is always helpful. See also this newspaper article Red meat triggers toxic immune reaction which causes cancer, scientists find. Bottom line: we always knew from the research of Dr. Colin Campbell that animal proteins tend to stimulate tumor growth and now this mechanism that Dr. Gordts discussed may be the evolutionary reason why our bodies reject meat - it contains a sugar which occurs in many mammals, but not humans, called Neu5Gc and the body rejects it and treats it as a foreign invader.
• Dr. Walter Willett, on achieving an optimal diet.
• Dr. Wilson Tang, on Diet, Intestinal Biota and Cardio-renal Disease Risk. This area is ever so important. The first shocker always is that it takes only three days on a #WFPB diet for your gut to stop making TMAO, which is a leading cause of CVD.
• Dr. Andrew Freeman on why 2019 is the year of the Plant-based diets.
• Dr. Michelle McMacken, who runs the Lifestyle Medicine program at Bellevue gave the Daniel and Michael Ostfeld Memorial Lecture
• Dr. Ostfeld himself presenting on the practical issues in implementing the diet in your clinical practice (Answer: leverage outsourced support mechanisms as much as possible).
• Then a series of presentations by interns who are active in the Lifestyle Medicine field, which was brilliant. Speakers were Drs. Danielle Belardo, on a Cardiac case, Sasha deJesus, again on Cardiac issues, Clark Yarber, on an outlier case of Cardiac Syndrome X, and Timothy A. Zaki on Type 2 Diabetes.

All followed by a panel discussion of questions from the public.

There's too much information that comes out of an event like this, but here are a few highlights that stood out for me:

• Esselstyn: Focusing on the green leafies for the nitrates that convert to nitric oxide in the body, which keeps your arteries limber, combined with the high ORAC value of various fruits, particularly berries, for that is what repairs cell damage. Those are just two simple concepts that makes the whole logic of the whole foods, plant-based diet understandable.
  Complete reversals, even without statins, are typically possible in three to four weeks, but certainly within 3 months. Angina usually is much reduced within 1-2 weeks. His conclusion was that he "... felt more excited about medicine today, 20 years after retiring as a surgeon," because of the increasing uptake of these new ideas in the medical field. A comment from Dr. Joel Kahn emphasized again that stents or bypass surgery only correct for the effects of heart disease, but do not heal the disease itself - only diet will.
• Dr. Walter Willett commented on the general fact that 5-10 years life extension is a reasonable expectation from changing to a whole foods, plant-based diet. He focused on the big picture of planetary health and the EAT/Lancet study. He cautioned against becoming overly simplistic about lowering medical costs, as people will live longer. So they might spend less on medical services per year, but live more years. Time will tell.
• Dr. Wilson Tang took us through the whole TMAO issue and how choline is converted to TMA by the enzymes in the intestinal tract and subsequently oxidized in the liver to result in TMAO. It is a big cause of inflammation and implicated in heart disease (CVD/CAD), type 2 diabetes (T2D), and chronic kidney disease (CKD). Evidently, the point is that a plant-based diet will stop this immediately.
• Dr. Walter Willett's take away points were that even the Economist labeled 2019 the year of the vegan and the fact that Medicare and most major insurers now cover either the Dean Ornish program or the Pritikin protocol for reversing heart disease. Equally obvious, it is still cheaper to change to a #WFPB diet now, rather than wait until you have heart disease.
• Dr. Michelle McMacken injected a dose of reality with a beautiful case history of a 42-year-old with undiagnosed T2D and an A1C at 12.7%, who was no longer a diabetic after 4 months (A1C below 6) after throwing out his metformin at 2 months in. She also cautioned that "unhealthy vegan" is as bad or worse as the SAD.

Here is a summary on YouTube by Dr. Joel Kahn.

The whole thing was brilliant as always and an enormous asset of our community in the Bronx. Meanwhile, once again no one from the Bronx officialdom was present, but Eric Adams' office was represented, even if he could not make it. Otherwise, people came from all over. At lunch, I talked with a lovely doctor from Montgomery, Al.

How to deal with doctors

My qualifications on this particular topic are based mostly on my own experience with doctor visits, which are a relatively rare occurrence in my life. My outlook is heavily informed by the the fact that my father was a doctor and our mealtimes were often mini conferences of him and various colleagues, often focused on their resistance to the formation of what we now call Pharmageddon, or the medical-industrial complex and the de-humanization of medicine. Even then, in the early sixties some doctors were seeing how the new developments in pharmaceuticals made doctors into drug pushers fighting symptoms and not helping patients heal and be healthy. My father had scathing criticism for the pharmacological inroads into psychiatry and eventually evolved into a sort of Jungian psychotherapist more than a psychiatrist because he categorically declined to get involved with psychopharmaca. He also would at times serve patients for free or on a sliding scale whenever insurance stopped covering them, he simply would not accept administrative interference in patient relationships.

The Lifestyle Medicine revolution

Lifestyle Medicine is the new form of medicine that is rooted in the Whole Foods, Plant-Based diet and the insight that nutrition is 80% of the work. In other words, acute issues aside, the first order of business is to make sure you are getting the whole benefit of the whole foods, plant-based diet, for it provides an abundance of nutrients, which puts your body in optimal shape to deal with all of the real life challenges, including preventing or reversing the chronic diseases that kill people who follow a modern, industrial Western diet. So, diet should be your first concern, but that does not mean doctors are an unnecessary luxury.

The slow evolution of lifestyle medicine means we have to be innovative in dealing with doctors. The central point is that you are now taking responsibility for your health, for you decide what goes down the gullet. How far you want to go with that is your business, but besides my wide reading in this area, I went and took the certificate in Plant-Based Nutrition from Nutrition Studies. The new relationship with your doctor, assuming he is a plant-based doctor is a partner in wellness, where he/she should be very much your personal subject matter expert, particularly if there are any challenges and together you can figure out any adjustments that may be needed along the way.

Not necessary, but it helps

In most cases, your regular doctor is in a system that pushes him one way and one way only a consultation and a treatment. Even the ones that do sympathize with the premises of lifestyle medicine and the whole foods, plant-based diet are still in that system. So when this year I had some anomalies in my regular annual physical exam, I decided it was time for some extracurricular consultation, and as it was, I went and visited Dr. Robert Graham at www.freshmednyc.com. He went and took some more extensive tests and together we figured out what was right and what was wrong and some prudent adjustments to make. We are talking about tweaking now, but sometimes it helps to not be guessing and get very specific feedback from a trusted expert who cares.

I learned a lot. Without discussing all the details here, I will highlight one element... just to illustrate why I got concerned with my physical this year.

2015: Spring physical, Total Cholesterol (TC) was 185. My diet was still fairly mixed, although for the most part I did not eat a lot of meat, probably a chicken a week and a hamburger 3 times a year. But lots of eggs, yoghurt, cheese, cheese and more cheese. Still, I always ate plenty of fruit, vegetables and whole grains. I never ate white bread or white rice in my life. I considered that rat food, or window caulking in a pinch. So I probably ate a bit above average. And 185 is not really all that concerning. I just recently read a book about heart disease, "Know Your Real Risk of Heart Disease" by the Australian physician Dr. Warwick Bishop. The book is very well organized, and offers good explanations about how the heart works and what various diagnostics do or don't mean. To him, TC level below 193 would be just fine. In America, regular doctors consider 200-239 the range for borderline concern, so 185 would be of no concern.

And then there is Dr. Caldwell Esselstyn, who says below 150 is heart attack proof. Is he nuts or what? The same Dr. Esselstyn also says again and again that Cardiovascular Disease (CVD) is a paper tiger that need not exist and unless it is absolutely acute and critical, the only intervention we ever need is a whole foods, plant-based diet. He will also point out that anyone eating a Western diet and aged 60 ish will have some level of CVD. And recently, we learned that for our Southeast Asian friends, we could say above 40, for the average age of heart attack victims in e.g. Bangladesh is 43 years of age, because genetically, they have smaller veins.

Here is my personal experience (I wrote about this before when I turned 65):

2015: physical (spring) TC=185
2015: May, re-read Esselstyn's Prevent and Reverse Heart Disease. I decided to quit fooling around and jumped in with both feet.
2016: physical in spring: TC=151
2017: physical in spring: TC=146
2018: no physical
2019: physical in spring: TC=168???
2019: retested three months after my physical, with a more elaborated test (June) TC=145

That was one of a few things that seemed off, and I could not explain except I was probably more religious about going to the gym in 2016 than recently, so time to step up my game, but still.
With further testing and consultation as indicated above, this time TC came back at 145, just two months later. That simply makes more sense given the history, and what I know I am doing with my diet. By the way there was absolutely NO sign of inflammation. Nice to know the diet works, but with the information at hand we figured out I could add another scoop of chia seeds, hemp seeds, (milled) flax seed, or walnuts, to slightly increase my Omega-3 intake. This becomes one of those areas where we're all different, and some may need a bit more than others, but it is important to know that more is not always bettter. It is about the ratio between Omega-6 and Omega-3.

In short, I learned a lot from a very specific consultation that allows me to tweak my lifestyle. It pays not to become complacent. As to diagnostics, initially, here is the only diagnostic you need:

https://4leafsurvey.com

It is a simple self-test for how well you eat based on whole foods, plant-based nutrition criteria. It give you a rating from 1-leaf (slightly above average already) to 4-leaves (you are doing a Whole Food, Plant-Based diet completely) and it is excellent for handholding so you can gradually improve your diet.

Conclusion

If you are doing a Whole Foods, Plant-Based diet, talk about it with your physician. If they ignore it, it may be worth looking for another doctor. That is what happened with me in 2018. I switched away from my old doctor, because he did not know or understand enough about lifestyle medicine and the whole foods, plant-based diet. Of course as soon as I switched my new doctor moved to another state, and I changed doctors again this year.
In terms of doing this diet, for yourself, or for others: don't try to practice medicine without a license, but you can confidently rely on the fact that if you are following the #WFPB diet properly, minus Sugar, Oil and Salt, and plus some natural Omega-3 sources, and your B12 supplement, you are giving your body the optimal chances to heal itself, and many common issues will pass you by unnoticed. Against that background your medical requirements should be extremely modest, and if anything comes up, at least you know you are helping yourself to the maximum.
That latter point is really the theme of the movie The Game Changers, which premieres on Sept 16th (don't miss it!!!). The lead character is a martial arts trainer for the military and he found the whole foods plant-based diet because he wanted to help himself recover from a very serious injury and in his research he stumbled on the fact that the gladiators in Rome ate mostly barley and veggies. That is where his journey started.

NoorieBoorie's Spicy Bangladeshi Mashed Potatoes

Ok, this inspiration started with the discovery of an excellent Bangladeshi food blog on NoorieBoorie.com

Now I want to take some of the recipes and create #WFPB variants that are as authentic as possible.

Spicy Bangladeshi Mashed Potatoes

Here is the link:
https://www.noorieboorie.com/recipes/bangladeshi-spicy-mashed-potatoes/
First of all enjoy the read, the author's love for food is infectious.
Second of all, please realize how easy it is to change this recipe into a completely perfect Whole Foods Plant-Based (#WFPB) variant.

Ingredients

• 2-3 medium potatoes, peeled
• 1-2 tsp mustard oil
• 1 small shallot or 1/3rd small red onion, finely chopped
• 1 fresh green chili or 1/2 tsp crushed dried red chili
• cilantro, finely chopped (optional, for color)
• salt to taste 

Instructions

1. Boil the potatoes in a pot of salted water until tender.
2. Remove potatoes from water, drain completely and let it cool.
3. Add mustard oil, chilies, onions, cilantro (if using) and salt into a mixing bowl and mash everything together with your hands.
4. Add the cooled potatoes to the mixing bowl and mash them (by hand or with a potato masher), making sure to mix well with the other ingredients.
5. Adjust salt and any other seasoning as desired and serve with rice, lentils and curries. 

 I will call my variant Spicy Bangla #WFPB Mashed Potatoes and here is how it goes:

Spicy Bangla #WFPB Mashed Potatoes

Ingredients

• 2-3 medium potatoes, peeled
• 1 tsp mustard seeds ( or 1/4 tsp of mustard powder) soaked in 1 tbsp veggie broth, "mustard broth"
• 1 small shallot or 1/3rd small red onion, finely chopped
• 1 fresh green chili or 1/2 tsp crushed dried red chili
• cilantro, finely chopped (mandatory, for nutrition)
• some liquid aminos if you absolutely have to ;-) 

 Instructions

1. Boil the potatoes until tender.
2. Remove potatoes from water, drain completely and let it cool.
3. Add mustard broth, chilies, onions, cilantro (if using) and liquid aminos into a mixing bowl and mash everything together with your hands.
4. Add the cooled potatoes to the mixing bowl and mash them (by hand or with a potato masher), making sure to mix well with the other ingredients.
5. Adjust seasoning as desired and serve with rice, lentils and curries.

Notes

To assemble daal bhaat & bhortas (as shown in photograph above):
1. Start by discarding any large whole spices like bay leaves and green chillies from daal.
2. Spoon the daal into a slightly inverted plate. A shallow plate-bowl works well.
3. Take a small greased bowl and press the rice inside it. Jasmine rice or other rice that is slightly stickier than basmati will work well here.
4. Release the rice onto a separate plate and carefully transfer on top of the plated lentils.
5. Spread a layer of chutney, achar or a bhorta like tomato or eggplant bhorta on top of the rice.
6. Place your aloo bhorta sphere on top.
7. Garnish the plate. (I've used onion sprouts in this photo, but anything green like cilantro, scallion, etc would add a good contrasting pop of color.)

 Now, that could not be easier, and it is absolutely delicious.

The therapeutic value of cooking, especially #WFPB

(Note: An expanded version of this note can be found here: https://hippocratessays.com/let-your-hands-do-the-talking/)

Before enlightenment, chop wood, carry water. After enlightenment, chop wood, carry water. (Zen saying)

One thing I have noticed in the transition to #WFPB is that food preparation becomes more important if you're eating more plants. Interestingly, when my girlfriend and I compared notes about our favorite moments of 2017, they were both in the kitchen. Hers was when we cut up a 60 lb jackfruit together and froze most of it, spontaneously working in perfect sync. Mine was when we were peeling some fresh beans together spontaneously after I brought them home from the local green market. I had been sitting in the kitchen peeling the beans and she saw me and joined in the fun.

How busy hands can alter our brain chemistry

Even at the busiest times in my life, cooking was always a favorite activity, and for twenty years I was married to a woman who could barely boil water, so that was a great motivation. I ran the kitchen, while she volunteered for clean-up detail.

Presently, however, my food preparation is becoming both more professional and more fun. For one thing, my current kitchen is probably 1/3rd the size of what I was used to and space efficiency counts. But, I also teach classes now.

Lately, I have been on a tour of new appreciation of simple kitchen tools. For one thing, lots of gadgets are unnecessary if you keep a good set of knives.
Also, I am finding out that sharpening knives is particularly satisfying if you learn to do it properly with whetstones. These days I am finding out that cutting up veggies with a super sharp knife is immensely satisfying, beginning with cutting up an onion without tearing. It becomes a really enjoyable craft.

And then CBS Sunday Morning recently aired a piece on how that satisfaction in manual work can work wonders for you: How busy hands can alter our brain chemistry. Suddenly, it all made sense.

Food addiction and conditioning

We are starting to understand a lot about food addiction and how we are conditioning even young kids with dairy and sugar to become addicts later in life. We now know from Dr. Neal Barnard's book The Cheese Trap, how cheese is naturally addictive. But in the packaged food and fast food business, foods are routinely engineered consciously or sometimes unwittingly for addictive properties, all in the pursuit of higher sales. It all results in a permanent state of nutritional deprivation which is the perfect setup for addictions of all sorts later in life. Often times the addictions start via the medical route. Fortunately these days there is growing awareness in the nutritional field that nutrition has a lot to do with breaking addiction. One program that is working in this area is Dr. Keith Kantor's N.A.M.E.D. program, which boast vastly improved recovery and significantly lower relapse rates in treatment of many addictions.

Medical Collusion

Sometimes consciously and sometimes unwittingly, the industrial medical complex is the perfect enabler of this type of malnutrition and nutritional deprivation, for it will sell you the drugs that allow you NOT to ever address your bad nutritional condition you are in. Thus starts the vicious circle that leads to drugs and ever more drugs, and eventually to chronic illnesses which makes you the drug industry's favorite milking cow. The diabetes pandemic is pharmageddon's best friend, and so is the cardiovascular disease complex, starting with baby aspirin, viagra, blood pressure medicines and cholesterol-lowering drugs. Each and every step gets you deeper into drug dependency and allows the disease to progress in the meantime, thus insuring that you will keep coming back.

Nutritional uprising: Whole Foods, Plant-Based diets

Currently, the Whole Foods, Plant-Based nutritional revolution is becoming almost a popular uprising against the industrialization of food, which sacrificed convenience for nutrition. In one fell swoop it is also eliminating the use of supplements and prescription drugs, as well as over the counter drugs. Plus on the whole, this new enjoyment restores the natural high that comes from great food, and from simply feeling healthy - which beats the alternative.
I recently wrote about the iThrive program, which is organized by a lay person, Jon McMahon, who is himself recovering from food addiction, diabetes and morbid obesity.
The stories abound. In a way it all started with Dr. Esselstyn and his original group of heart patients who had all been given less than a year to live by their 'expert cardiologists,' as Esselstyn refers to them, all the while taking plenty of medications. Of the eighteen, one strayed and died, but the other seventeen were still alive twenty years later, having dropped their meds, and adopted a healthy diet instead. Of course, as Esselstyn and others have pointed out, ED is just the canary in the coal mine of Cardio Vascular Disease (CVD), and prescribing Viagra is a way of suppressing the symptoms, and allowing the disease to progress unfettered, because the cause, bad diet, is never addressed. The same can be said for baby aspirin, statins, and blood pressure medications. Suppressing the symptoms in the short run makes for repeat customers later on. The population is now starting to rebel, however. Better food is something you can do yourself.


With Jon McMahon and iThrive it is the turn of the diabetics. The standard medical protocol means an average life expectancy of ten years less than of non-diabetics, and a living hell of medications and medical interventions at tremendous. Of course there had been many doctors active in this area, such as Dr. John McDougall, Dr. Neal Barnard and others. But iThrive is making it into a popular movement, and again the stories abound of people dropping hands full of medicines. If you look at the FaceBook group for iThrive, there are regular stories of diabetics getting off of insulin sometimes in a month or less, and in other cases it may take a little longer, and many drop all medicines soon after that. These were the drug industry's best customers, who are now getting their get out of jail free card, courtesy of the Whole Foods, Plant-Based diet.

Dr. Saray Stancic is adding Multiple Sclerosis (MS) to the #WFPB vocabulary as well and again, patient are dropping hands full of meds and reversing an incurable disease.

Well-being, being well and Healthy Living

It is all coming together now that health and well-being are a decision one must make. On the one hand, it is true that seven out of ten out of the leading causes of death can be prevented or reversed by changing to a Whole Foods, Plant-Based diet. This change will tend to increase life expectancy, but more importantly a better overall health will make us more resilient. A better functioning immune system will help us resist a lot of diseases, or if we do have an illness, recover faster. Sports figures are reporting in growing numbers that the Plant-Based, Whole Foods diet helps them recover from injuries quicker.

Chop wood, carry water

In the end, cooking and food prep becomes an almost meditative practice and a welcome balance to all the running around we do in our lives. In and of itself the act of cooking is therapeutic, and specifically focusing on the Whole Foods, Plant-Based diet becomes a wonderful example of day to day handiwork that becomes an almost meditative practice and in and of itself a healing process.

The pharmaceutical industry has succeeded beyond its wildest dreams in making legal drug dealers out of doctors, but the patients are now rebelling to the disguised death sentence of this type of medicine and choosing a healthy lifestyle instead. The answer to the healthcare crisis lies here.

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.

Madras Lentils - an oil-free variant

I always love Madras lentils, but the point here is an oil-free variant, since I have adopted Dr. Caldwell Esselstyn's oil-free vegan lifestyle. Actually, this is a very easy recipe.
It is amazing how cooking with oil now tastes dull to me...

Pulses are plentiful on Starling Avenue, so any lentils and such are easy to find.

Ingredients:

3-4 cups of water (or you can also use some cooking water from green leafies, like spinach, etc.)
2 cups of red split lentils (Masoor Dal)
1 large onion, finely diced
1 large potato, peeled and cubed [1 russet or a few yukon gold]
1 Qt pack of tomato sauce/puree
1 15 Oz Can of Diced Tomatoes
1 15 Oz can of unsweetened coconut milk
3 cloves of garlic, minced
1/2 tsp Himalayan salt, Real Salt, or Sea Salt
1 tsp dried oregano
1 tsp cumin seeds, ground
freshly ground black pepper, to taste
red pepper flakes, to taste

Watch it with the red pepper - the above may be too hot for some palates, so you may want to start with 1 tablespoon of red pepper the first time you try if you have a sensitive palate.

Preparation:

• bring 2 cups of water to a boil with the chopped onion, garlic, 
• add lentils and potato and simmer for about 45 mins,
• add in ground cumin, dried oregano, salt
• add in 1Qt of tomato puree, 1 15 Oz can of diced tomatoes
• add in 2 Tablespoons (to taste) of Indian Red Chili Powder, or Dried Crushed Red Peppers, or Cayenne pepper
• mix in a can of unsweetened coconut milk
• keep stirring with a wooden spoon all the time
• let it simmer until if feels "done."
• You can puree it, if you want it smooth.

This is excellent to freeze portions so you have this ready in a flash during the week. Over rice, with some fresh veggies, and you're done. A very healthy meal.

About the Stores

All the stores in my Starling Avenue food triangle are now posted on Nextdoor. You can get everything you need for the above recipe in one quick shopping excursion up and down Starling Avenue. SWAD lentils are everywhere. The Pioneer at 1345 has my favorite, Pomi Tomato Sauce. And the Key Food on Unionport usually has Muir Glen canned organic tomatoes.

WHY VEGAN DOCTORS ARE SUING THE GOVERNMENT: Dr Neal Barnard

It helps to realize how much the food and agricultural industry has dictated nutritional information in this country and around the world. I know, for I grew up in that dairy country, Holland, and while I was raised vegetarian, my parents were deeply convinced that dairy, including milk, eggs, cheese and yoghurt was actually healthy for you. Not until a few years ago did I discover that the complete vegan diet is simply the way to go, healthy, delicious and nutritious.

What also helps is to remember how skewed our information stream has really become, for the recent obsession with deaths from opioid addiction and heroin overdoses puts this in perspective:

• 78 deaths a day from heroin overdoses is a national health crisis, and we send in the marines,
• 1671 deaths a day from cardiovascular illness is business as usual, and the USDA blithely continues to recommend animal proteins and dairy, even in its latest version of "MyPlate." 

An objective reader might conclude that cardiovascular disease should be the bigger priority, and the government should stop promoting more of it, i.e. animal protein, fats and dairy. Sugar, white flour and whipped cream are a more dangerous addiction than opioids. Time to tune in to Dr. Neil Barnard, Dr. Caldwell Esselstyn, and others who are focused on the right priorities.

Meanwhile, John Oliver recently put the whole mess with opioid addictions in perspective beautifully: 

Meaning again that iatrogenic disease, disease caused by doctors and the side effects of medicine continue to be a serious issue. A recent piece on Nutrition Facts makes the same point all over again: Medical Care: The Third Leading Cause of Death.

Taking responsibility for your own health and nutrition is really up to you, and it pays to do your own research and to scrutinize the validity of the government's assertions. The USDA is in the business of supporting the food industry, and the health and well-being of consumers is an after thought. What PCRM is doing is of critical importance, and we all need to pay attention and come to our own conclusions.