Brenda Davis – Plant-Based Diets and Disease: The Current State of The Evidence

Thank you so much, Steve, and thank you all for being here. And thank you for putting this amazing conference on. And thank you for my cheering section over there. you know how to make me feel very welcome. Um, I’m actually really excited about this presentation because I think it shares some of my favorite moments. I’m going to talk a little bit about the Marshall Islands and a lot about the research, what we know about the connection between plant-based diets and our risk of chronic disease.

So just a quick outline. I’m going to talk about longevity, cardiovascular disease, cancer, diabetes, and that’s where I’ll tell you about the Marshall Islands, and then just a little overview of other diseases, and then the practical implications of these findings.

So what we know right now is that the number one killer globally is chronic disease. About 70% of all deaths in the Western world are due to chronic diseases that are essentially lifestyle induced. They’re induced by what we consider lifestyle norms within our culture. It’s about 63% worldwide. an estimated 90% of type 2 diabetes, 80 to 90% of heart disease, and about 50 to 70% of all cancers are considered entirely preventable. Think about that for a moment, if you will. It’s really unbelievable that the diseases that are killing us and the people we love are mostly entirely preventable by very simple lifestyle changes.

The four big lifestyle culprits according to the global status report from the World Health Organization are number one an unhealthy diet, number two a sedentary lifestyle, number three alcohol and number four tobacco.

The World Health Organization makes specific recommendations for a healthy diet. And they are, this is the World Health Organization. This is not a vegetarian organization. Eat more fruits, vegetables, legumes, nuts, and seeds. Cut down on salt, sugar, and fat. Choose unsaturated fat instead of saturated fat. And eliminate trans fatty acids. the 2010 and I’m I’m going to apologize right now because we had problems with getting my presentation on the screen. So, the uh pictures are totally messed up. As you can see, there’s things over top of the writing and so forth. So, I apologize for that. But the 2010 dietary guidelines advisory committee report had four main action points and they were eat fewer calories, shift to a more plant-based diet, significantly reduce intake of foods containing solid fats and added sugars, and increase physical activity. The 2015 dietary guidelines advisory committee report added the following. For the first time ever, eat less meat. It’s the first time they’ve ever said eat less meat. They’ve said eat less saturated fat. They’ve said eat less cholesterol, but they’ve never before come out and said eat less meat. especially red and processed meat as its consumption is associated with increased disease risk. And they also stated for the first time ever, emphasize plant foods and deemphasize animal products to improve environmental sustainability. Can you imagine? It’s really quite remarkable.

So, how strong is the evidence plant-based diets confer a health advantage? Well, here’s what we know about dietary patterns and disease risk. And a lot of it comes predominantly from two large studies. And you know what’s really neat about these studies is these studies, they’re so valuable because they are comparing people who consume different dietary patterns, non-vegetarians, semi-vearians, pesco vegetarians, lactoovo vegetarians, and vegans, but they’re all healthconscious. So they’re trying to select for people that are similar health conscious in their daily practices, in their lifestyle practices.

So the first is the Adventist Health Study 2 96,000 individuals and it began in 2002 and is ongoing and this is an American, Canadian, North American study and then Epic Oxford with over 65,000 participants and it is um out of the UK. It began in 1993 and is ongoing. So we’ve got a lot of information and a lot of this information has come out just in the last two three four years.

So let’s talk first about longevity and we can’t talk about longevity with talking about the blue zones because there are places in the world where people commonly live to be 90 or 100 and even when they reach those advanced ages they are still very productive. They feel good. They’re out gardening. They’re walking and so on.

There are five recognized blue zones. Okinawa, Sardinia, Italy, the 7th Day Adventist, the Vegetarian 7th Day Adventist of Lomolinda, California, Iicaria, Greece, and the NCOA Peninsula of Costa Rica. And I talked a little bit yesterday, but I’m just going to go over it again to remind you and for the for the benefit of those that didn’t hear yesterday’s presentations, there are two there are actually six common lifestyle practices that that are sort of the things that we weave through all the blue zones. Strong families, they’re socially engaged. They do constant moderate physical activity. They tend not to smoke. And where diet is concerned, there are two things that they tend to do. They all consume plant-based diets and they all consume legumes.

And the the researchers involved with the blue zones put together sort of the best from all of these blue zones and came up with what they call the blue zones longevity diet. And here are the six principles. Number one, eat less. Harry Hatchy Boo it’s called in in uh Okinawa. Stop eating when you’re 80% full. Number two, move more. Be as active as possible in your daily activities. Number three, eat primarily unprocessed foods. So you want to minimize your intake of packaged foods, fast foods, fried foods. Eat more plants. Load up on vegetables, fruits, beans, whole grains, nuts, and seeds. And finally, eat less. or number five, eat less meat and avoid processed meat. And number six, eat at home.

So what do we know about vegetarians? Do vegetarians actually live longer? And in a word, yes, they do. The Adventist Health Study 2 found that vegetarians, including vegans, live on average about 9.1 9.5 years longer for men and about 6.1 years longer for women. And what’s really interesting is when you look at the percent of people in this population living to age 85, nearly half of men live to age 85 in this Adventist population compared to only 15 to 20% of men in the general population and over 60% of the women compared to about 30 to 40% of the women in the general population.

Now when we look at vegetarian mortality and the adventist health study too compared to similar this is not compared to the average western eater but compared to similar healthconscious non-vegetarians mortality rates are reduced by about 28% for vegan men about 19% for pesco vegetarians 15% for vegans and 9% for lacto oval vegetarians And when I say vegans, I’m talking about as a whole, including women. And the thing was is the women didn’t do as well as the men. And the reason that I think that is, and this is just a hypothesis, I don’t really know for sure. I think it’s because within the Adventist community, even the non-vegetarian women eat really well. They tend not to eat much meat. They tend to eat a lot of fruits and vegetables. Even if they’re not vegetarian, they’re very healthconscious. whereas there may be a greater discrepancy in the men. So the vegan men have, you know, an even greater difference than the non-vegetarian men and so they would have that extra advantage.

Have have any of you ever watched the uh videos with Dr. Ellsworth aware? If you haven’t, please look this guy up on the internet. He is absolutely amazing. He was a practicing cardiothoracic surgeon till he was 95 years old. He was doing surgeries. And he said, “The only reason I retired was because I promised my family I would spend more time with them.” He said, “At 100, I could still be doing this.” at 100, he’s still, you know, mowing his lawn and driving everywhere and still speaking eloquently and very intelligently. It’s really fun to listen to him. So, he’s one of the blue zone Adventists.

And there was also a metaanalysis in 2012 looking at seven prospective studies and this included about 125,000 participants from the UK, Germany, the US, the Netherlands and Japan. And they found compared to non-vegetarians, vegetarians had a lower overall mortality of about 9% and that included vegetarians and vegans.

So what do we know about red meat and mortality? Well, there was a study that came out of Harvard looking at over 120,000 participants and people consuming one serving of red meat per day increased their total mortality. And before I tell you how much, I want to tell you how much a serving equals. A serving was 3 oz of unprocessed red meat. How many people do you know eat a 3 oz steak? Yeah, right. Not very many. It was a half an ounce of bacon. Actually, less than an half an ounce of bacon. It was, you know, just under 13 grams is under a half an ounce. Then it was an ounce of sausage, salami, or bologna and an ounce and a half or one wiener. So that was a serving, not a very big amount of meat. One serving of unprocessed meat increased total mortality by 13%. And one serving of processed red meat increased total mortality by 20%. So triple the numbers if people are eating a 9 oz steak or 3 oz of sausage or salami. The authors estimated that 0.5 fewer servings of red meat per day would have reduced deaths by 9.3% in men and 7.6% in women.

There was also a very interesting study that was released in 2014 on high protein intake and mortality. And what it looked at was it looked at people who were consuming over 20% of calories from protein. And what they found was participants who were 50 to 65 years of age who were followed for 18 years had a 74% increase in overall mortality and a 400% or so four-fold increase in cancer and diabetes mortality. with intakes of protein of over 20% of calories. But what was really interesting is the associations were abolished or greatly attenuated, which means there was very little association if the protein came from plant foods as opposed to animal foods. Now what’s the other interesting thing in this study is that those that were 66 years of age plus actually experienced benefits from higher protein except they had about 10 times increased risk of diabetes but they had less mortality and they had less cancer and they had less uh heart disease I believe. So why you know does it make any sense? Well, actually, it makes a lot of sense when you consider that somebody who’s 50 to 65, a man especially, would be eating maybe 2800 calories, which is 140 gram of protein. But a senior, an older person might only be eating 1,600 calories, which would be about 80 g of protein. And as you get older, your ability to actually absorb protein decreases. So many people, many countries recommend now a 25% increase in protein intake for seniors because they’re not digesting and absorbing it as well. So that probably explains So a lot of seniors actually aren’t getting quite enough protein. They need to up their protein intakes a little bit. So that’s probably why the seniors did all right because they weren’t eating as much total protein even with 20% of calories from protein as compared to the younger people.

So one thing that we know and I think this is absolutely fascinating uh research is that genes are responsible for an estimated 5 to 10% only of disease risk. Lifestyle changes can actually alter our genes. They can turn off diseasepromoting genes and turn on diseasepreventing genes. they can increase talomeorase by about 30% and talomeorase is the enzyme that lengthens telomeres. These are the ends of the chromosomes, these red things on this picture that actually influence longevity. And I don’t know if you’re familiar with Dean Ornish’s work on on uh well, of course with heart disease, but also with prostate cancer. It’s unbelievable. We found that diet and lifestyle changes turned off about 500 disease-promoting genes, turned on about 50 diseasepreventing genes in fairly short order. They actually looked at what was happening to the genes. So what you eat not only can change your own destiny, but it can change the destiny of your children as well. And I thought this was an interesting Time magazine. why your gene DNA or why your DNA isn’t your destiny.

The take-home message here is plant-based diets are very positively linked to longevity. The healthiest, longest living people on the planet consume largely plant-based diets.

So, what about cardiovascular disease? Cardiovascular disease is the number one cause of death globally. It’s responsible for about 30% of all deaths, or at least it was in 2008.

What we know about dietary patterns in cardiovascular disease? Well, the Institute of Medicine says the following. The western dietary pattern characterized by high intakes of red and processed meat, refined grains, sweets, and desserts and French fries is associated with an increased risk of cardiovascular disease in all regions of the world. But a prudent dietary pattern characterized by a higher consumption of plant-based foods such as fruits and vegetables, nuts and whole grains is associated with a significantly lower risk of cardiovascular disease. And one of the reasons I want to I wanted to show you this slide is simply because I want you to be aware of the stance of mainstream organizations like the Institute of Medicine, the American Heart Association. They know this is the information they’re providing people with. For some reason, people still aren’t quite getting it.

The World Heart Federation says a person eating a low a diet low in saturated fats with plenty of fruits and vegetables has a 73% risk reduction for new major cardiac events compared to someone eating a western style diet.

So what about rates in vegetarian and vegan populations? Well, epic Oxford 45,000 participants followed for 12 years found that vegetarians were less likely to develop heart disease than cons healthconscious meat or fish eaters. This was really interesting. they actually h were 32% less likely when and this was vegetarians plus vegans lumped into one when all the variables were adjusted for except BMI which is body fatness and then 28% less likely when they also factored in body fatness. So how overweight somebody was. Now this fish eater thing I thought this was the strangest finding because normally fish in most of the epidemiological studies have found to be somewhat cardiorive relative to meat. So when fish eaters are compared to meate eaters they tend to do better. So I actually this was um I I called one of the uh lead researchers on this on this study and I said what the heck? how come the fish eaters didn’t do any better than the meateers? And he said, “I don’t know.” And I said, “Could it be because in the UK you tend to dip your fish in fat before you eat it, as in fish and chips?” He said, “Oh, yeah, maybe that’s it.” So, so it’s a possibility.

The Adventist Health Study again over 73,000 participants and with men the vegans had 42% less cardiovascular disease and 55% less eskeemic heart disease. Lactoova vegetarians were 23% less cardiovascular disease, 24% less eskeemic heart disease. And the the numbers that are bolded are significant. The ones that aren’t bolded are non-significant. um pescco vegetarians had 34% less cardiovascular disease and 23% less eskeemic heart disease in the women there were no significant differences among the different dietary groups except the pesco the fish eating women had a 49% lower risk of eskeemic heart disease and again I phoned Dr. Orlick, who was the author on this, and I said, “What’s up? Why are the women not doing as well as the men? It doesn’t make sense.” And I um he said, “I don’t know.” And I said, “Could it be possible, just what I told you before, that the women have smaller differences, the meat eatating Adventist versus the vegetarian Adventists than the men?” And he said, “That really is a possibility.” So, but they’re not, we really don’t know for sure.

So, why do vegetarians and vegans tend to do better where heart disease is concerned? Well, they have more favorable risk factors. So, when we look at major modifiable risk factors like overweight and obesity, elevated total and LDL cholesterol, elevated triglycerides, and high blood pressure, vegetarians and vegans at a group are at lower risk for all of these things. when we look at emerging risk factors like oxidized cholesterol, inflammation, poor antioxidant status, greater IMT, uh you know, elevated TMAO. I’m going to talk about all of these things, but but again, vegetarians are have a benefit for all of those emerging risk factors.

So, let’s first talk a little bit about the major modifiable risk factors. Well, here we’ve got Epic Oxford. If you look at overweight and obesity, the lowest BMI is in vegans. You can see then lacto ovoarians about the same as fish eaters and both less than meat eaters. But what’s really interesting here is if you look at the BMIs, they’re all within the healthy BMI zone. Even the meateers, this is a European study, but the vegans have the healthiest BMIs. This is Adventist Health Study 2. Here’s the vegans, lactoovo, pesco, semi, and non-vegetarian. You can see the, you know, numbers, the BMIs going up. And a healthy BMI is is between 18.5 and 24.9, right? And so here within the United States, the Adventist Health Study, the only group that was in a healthy weight zone were the vegans. Everybody else was above the healthy weight uh numbers.

Elevated blood lipids. Again, as you go from vegan to lactoovo to non-vegetarian, blood cholesterols go up, LDLs go up. HDLs are not much different. They’re a little lower in the vegans, but not a lot. Triglycerides are lowest in vegans are actually highest in the lactoovo vegetarians. And this is based on about 20 studies and uh somewhere in between in non-vegetarians. And that would you know triglycerides tend to go up as your intake of carbohydrates especially refined carbohydrates goes up. So these people may have been eating too many refined carbohydrates.

What about hypertensions? Epic Oxford shows lowest rates of hypertension among vegans like 5.8% 8% among men, 7.7% among women, and then going up um and and 15% among uh meat eatating men and 12% among mediating women. So really a very significant difference. In the Adventist health study too, hypertension was 75% lower among vegans and it was 55% lower among lacto oval vegetarians than it was among healthconscious meateers. So very very significant finding.

So what about the emerging risk factors? Inflammation. Chronic lowgrade inflammation increases metabolic abnormalities that are associated with cardiovascular disease and it makes arterial plaque vulnerable to rupture and thrombosis. So this is a serious issue in uh risk. So vegetarians what we know is four out of five studies assessing CRP levels and CRP is your indicator for inflammation. It’s a blood test you can do to test your levels of inflammation. Uh, vegetarians showed significantly lower levels of inflammation compared to omnivores. And there was only one study on vegans. And this was actually on raw vegans, but the vegans had a um CRP of 0.57 compared to endurance athletes 75. Compared to people eating a western diet, 2.6. 61 and a really healthy level is one or less. So the vegans had the best level by far.

What about oxidative stress? Well, hyper lipidmia, which is, you know, high cholesterol and high triglycerides causes oxidative stress and reduces our antioxidant defense system, elevating levels of the of sort of damaged fats in our bodies. high intakes of dietary heem iron. That’s blood iron, the iron from meat and fish. And not all of the iron in meat and fish fish is hem iron, but a you know probably 40 or 50% of it is. And from saturated animal fats are associated with increased oxidative stress. And dietary cholesterol actually increases the susceptibility of LDL to oxidation by nearly 40%. Limited evidence suggests that vegan and vegetarian diets decrease the oxidation of lipids, probably owing to the high antioxidant and low well no hem iron content in these diets. And also vegetarians tend to have more favorable antioxidant status. And and uh this is important to know. Food sources of antioxidants are protective. Supplement sources of antioxidants have not been shown to be protective. Okay. So very important to know that uh corateed IMT and here we’re looking at this kind of um uh layer uh where plaque develops within the blood vessels sort of the outer layer and when you have a high IMT or corateed IMT it increases dramatically your risk of heart disease and diets high in meat and low in fiber can increase this corateed IMT. tea. Well, vegan diets and nearvegan diets tend to reduce it.

So, what about this high TMAO which vegetarians tend to be protected against? Well, high TMAO accelerates atherosclerosis, especially in heart failure patients. The highest TMAO levels increase their risk of dying by 3.4 times. So, this is really significant. Omnivores who regularly consume red meat are ideal hosts for the bacteria in the intestines that produce TMA. And vegans have none of the TMA producing bacteria. Zero. So even Exactly. Even if you take carnitine from a supplement, you won’t produce TMA because you don’t have the bacteria to make it. So we don’t have those bad bacteria. And then the TMA gets sent to the liver and it gets converted to TMAO which causes the damage. And in fact it can also be produced from choline which is very high in eggs as well. But we get choline from some plant foods but again we don’t have the bacteria to produce the TMA from it. So this is good news.

uh and then but there are some factors that are potentially unfavorable uh for vegans and we and vegetarians. So we need to be aware of those. So what are they? Number one, elevated homocyine. If you ignore vitamin B12, you are shooting yourself in the foot because your homocyine shoots up, your risk of heart disease, potential risk of of Alzheimer’s, birth defects, and so on will also shoot up. Okay? So, it’s really important to recognize that low omega-3 fatty acid status may also cause increased platelet aggregation or the stickiness of your blood cells. It can elevate triglyceride levels and many vegetarians and vegans tend to have a lower omega-3 status. So, we need to take care of that. It’s not difficult to take care of it, but we need to take care of it.

So, plant sources of omega-3s or taking microalgae, which is the original source of DHA and EPA in the ocean, which you can buy in a supplement form. And um oh this um uh I won’t I won’t go into that.

High refined carbohydrate intakes are another problem uh potentially with vegetarian and vegan diets. Refined carbohydrate diets boost triglyceride levels and they increase the bad small dense LDL levels and this is the low density lipoprotein which elevates your risk of heart disease. So we what we don’t want to do is rely on refined carbohydrates as staples in our diet. We should be eating unrefined carbohydrates instead. Low carbohydrates are not the answer. And uh replacing saturated fat with refined carbohydrates does very little to alter our risk for cardiovascular disease. Replacing saturated fat, however, with unrefined carbohydrate is protective.

The Nurses Health Study in 2014 reported that long-term use of low carb diets rich in animal protein, not in vegetable protein, increase cardiovascular disease risk by 51% and all cause mortality by 33%. So the high protein plant-based diets did not increase risk at all.

So the question is often asked, how much red meat is safe? And this question was posed to Dr. Walter Willlet from Harvard. If you’re aware of Dr. Willlet’s work, he’s one of the leading epidemiologists in the world and has been involved with the nurses health study and the health physician study and so forth. And here’s what he had to say. Like almost everything, it’s frequency and amount that influence our risk. There’s no sharp cut off. It’s like radiation. We can’t say there’s any safe amount.

Harvard study found that red meat increased risk of cardiovascular dis disease by 18% for every serving of unprocessed red meat and 21% for every serving of processed red meat. Why? Saturated fat, hem iron, new 5GC, carnitine, uh hormones and antibiotics and so on and so on and so on.

There have been three recent metaanalyses on uh uh red meat intake and cardiovascular disease and they all showed for unprocessed red meat an increase of 10 to 15% in risk and for processed red meat an intake of more like 20 to 40% uh increase in risk.

So I want to address this really quickly because a lot of people say but wasn’t saturated fat vindicated? Did anybody see the headlines that saturated fat has been vindicated? Butter is back. You don’t have to worry about saturated fat at all anymore.

Well, there were two studies that suggested we don’t have to worry about saturated fat. And one was an analysis by Siri Torino and the other was an analysis by uh Chowuri. And I’ve highlighted in yellow here a few names that were involved with these trials. Frank, who uh Francesca Crowe, Dr. Mosspherian, Dr. uh Angel I think Angelino or something. Anyway, we’ll see it in bigger and then I’ll be able to say it, so I can’t read it so well there. But here’s the headlines we saw. Saturated fat isn’t bad for your heart. You know, saturated fat may not cause heart disease, not so bad after all, etc., etc., etc.

Well, the people at Harvard said the media misrepresented and sensationalized these study results, contributing to a haze of confusion among consumers. And they brought together a group of nutrition experts to do a teachin. And in that were Frank who was an author of the first study uh Dr. Mosspherian who is an author of the second study, Frank Saxs, Alice Lickenstein who wrote the position paper for the American Heart Association and Walter Willlet again.

And here’s what the panel consensus was. Cutting back on saturated fat is good for health if the saturated fat is replaced with good fats, especially polyunsaturated fats. If you replace saturated fats with refined carbohydrates like sugar, there will be a detrimental effect. Food quality matters. We’ve got to focus on food sources and dietary patterns rather than nutrients alone. And they basically determined that saturated fat increases LDL and HDL but with an overall negative effect on cardioabolic risk. So they’re saying it’s not good. Replacing saturated fat with polyunsaturated fat lowers risk. Trans fat increases risk significantly. Refined carbs adverse effects. Monounsaturated fat uncertain effects. And unrefined carbohydrates favorable effects.

And Dr. Walter Willlet did this little diagram. You replace saturated fat with trans fat, the worst possible outcome. with refined carbs, the next worst. With monounsaturated fat, not so bad. With unrefined carbohydrates, much better. And with polyunsaturated vegetable fat, uh, much better as well.

Here’s what Doctor Who said, and remember, he was an author of the first study that vindicated saturated fat. Dietary recommendation should be food-based. Replacing high saturated fat foods such as red and processed meats with and butter with vegetable oils high in monos and pufas or polyunsaturated fats, nuts, seeds, legumes, and whole grains.

There’s a world-renowned expert who was interviewed about this whole saturated fat fiasco and he says the fact that saturated fat raises cholesterol is beyond doubt. That has been shown in hundreds of trials that fed people different types of fat. The observational studies he’s talking about these two studies sometimes do not show a link for two main reasons. Reason number one, the differences in saturated fat intake within populations are too small to produce an effect. So if you compare someone eating 12% of calories from saturated fat with someone eating 14% of calories from saturated fat, you won’t see huge differences. The dietary data is inaccurate in a lot of these studies. You know what they do? They often do one 24-hour recall. What did you eat yesterday? And then follow the people for 10 years. and do no other dietary assessments. None. Zero. That’s shocking. It’s shocking.

The metaanalysis, and again, the metaanalysis included in the second trial, the SHA Chowuri trial, gave people margarine that was high in trans fats. When the authors omitted that trial, they found that people who replace saturated fat with polyunsaturated fat actually had a 19% lower risk of heart disease. But the metaanalysis buried that finding in a supplement after they were challenged that didn’t make the headlines. 19 out of the 20 studies compared populations with almost no variation in saturated fat intake.

And this is very interesting. The rate of cardiovascular disease in Finland where there’s very high saturated fat intake was 4 point time 4.4 four times higher than that of Japan, which was in this study in the same metaanalysis. But they didn’t show that because they only looked at differences within each population. So the Japanese people that some of were eating 6% of calories from saturated fat and some ate, they didn’t see any difference. In Finland, 15 versus 17, they didn’t see any difference. If they would have compared between the different populations, they would have seen a huge difference. Okay? And Epic Oxford was the only study in that trial, the only meta anal the only study used in the meta analysis that included a wide range, you know, the wide range, the non-vegetarians, the vegetarians, the vegans, etc. They found a 2.77 times greater risk in those with the lowest uh or the highest saturated fat intake versus the lowest saturated fat intake. So that tells you something as well.

Now this is very interesting because I I actually emailed one of the authors of the Chow Hurry study and I said, “What’s with this study? There’s it just doesn’t make sense based on what we know.” She wrote me back and she explained to me that she had been very involved with the study when it was first done and she said they found a big difference in people eating the most saturated fat versus the least saturated fat. But when they submitted it to a journal, it was not accepted. There was nothing new. So the lead author took and reworked the data taking out some of the studies like the one you saw on the last slide, resubmitted it with a little different finding and it got accepted. And she said when it was sent back to her, she said it was within a week of being published and there was nothing she could do.

And here’s what she said. The best available evidence from randomized control trials shows that saturated fat intake affects blood cholesterol levels, which is an important risk factor for heart disease. Therefore, current guidelines should still recommend that people minimize their intakes of saturated fat.

And what do people recommend? Well, the American College of Cardiology and the American Heart Association recommend that people aim for a dietary pattern that achieves 5 to 6% of calories from saturated fat. You’re basically talking a plant-based diet. You cannot get down to 5 to 6% of calories from saturated fat. If you’re not eating a plant-based diet, and their level of evidence was the strongest level of evidence that exists. Okay? And that’s you know that’s our conservative organizations.

So what about heart disease reversal? Well we know and I won’t go into detail but you know Dr. Caldwell Esleston has shown heart disease reversal using a low-fat plant-based diet as has Dr. Dean Ornish. Both of Dr. Esleston showing 72% of those tested getting reversal and and Dr. Ornish finding 82% with reversal.

And it Dr. Esleston just put out a study in 2014 that was quite interesting. 198 patients with cardio severe cardiovascular disease. 177 adhered to his program. 21 were nonadherent. The recurrence rate was6% among the adherent people and it was 62% among the nonadherent. And you know this study wasn’t a good study. It wasn’t it was a self- selected group. There was no control. It wasn’t randomized. All of that stuff. But nonetheless, it’s very interesting and very powerful findings.

This uh cartoon says heads you get a quadruple bypass. Tails you eat your veggies. And I think the point here is you have a choice, you know, on in your treatment for cardiovascular disease and you have a choice in avoiding cardiovascular disease altogether.

The take-home message is whole food plant-based diets protect against cardiovascular disease. And well-designed plant-based diets can provide more effective treatment than our most powerful medications and surgeries.

cancer. The World Cancer Research Fund and the American Institute for Cancer Research uh probably put out the most comprehensive documents ever written on diet and cancer. And in 2007, they put out this food, nutrition, physical activity, and the prevention of cancer, a global perspective. And it involved over a hundred scientists from 30 different countries around the world. And what’s really interesting is they have an independent group of scientists that updates recommendations on an ongoing basis. This is called the continuous update project. So we’re getting, you know, they keep looking at the research and updating us on diet and cancer. And they have a series of goals and recommendations. And they basically say that they believe that populations and people who achieve these recommendations will not only reduce the risk of cancer but reduce the risk of many other diseases as well.

And there are two recommendations that have anything to do with our plant intake and our animal our intake of animal foods and plant foods. and they are under plant foods. Eat mostly foods of plant origin. Eat at least five servings or 400 grams of a variety of non-starchy vegetables and fruits every day. Eat relatively unprocessed cereal grains and/or pulses or legumes with every meal. And limit refined starchy foods. And people who consume starchy roots and tubers like potatoes make sure that they have sufficient non-starchy vegetables, fruits and pulses or legumes as well.

The justification for this recommendation, most diets that are protective against cancer are made up of foods of plant origin. And if you look at this list, this is inside the book. They list vegetables, fruits, pulses, nuts, seeds, herbs, spices, and the risk of cancer. You can see the decreases risk column and the increases risk column. There is nothing in the increases risk column. These foods don’t increase risk based on the studies we have, but they seriously reduce risk. And there was a one finding that was upgraded. Foods with fiber reduce risk of colon cancer or colurectal cancer went from probable to convincing in 2011.

Animal foods, what do they say? Limit intake of red meat and avoid avoid processed meat. People who eat red meat to consume less than 500 grams a week very little if any to be processed. Justification. Red and processed meats are convincing or probable causes of some cancers. And here’s meat, poultry, fish, eggs, and the risk of cancer. You can see in the decreases risk column, the only thing there is fish for colarctal cancer. You can see in the increases risk convincing evidence for red and processed meat and colarctal cancer and probable or limited or suggestive evidence for several other cancers.

There have been several about seven metaanalyses that have looked at unprocessed red meat and cancer in 2012 to 2014. And you can see basically this is unprocessed red meat increasing risk of a variety of cancers between about 10 and about 20 or 30%. Total red meat increasing risk about 45%. Here’s processed red meat in cancer increasing risk about 15 to 25% per serving.

The American Institute of Cancer Research estimated that about 45% of colorctyl cases could be prevented if we all ate more fiber richch plant foods and less meat, drank less alcohol, moved more and stayed lean.

So what are the rates among veg populations, vegetarians and vegans? Well, Epic Oxford compared to similar healthconscious non-vegetarians, cancer rates were 19% lower among vegans, 12% lower among pesco vegetarians, and 11% lower among lacto vegetarians. So you can imagine this is compared to healthconscious meateers. Imagine what it would be if it were compared to nonhealthconscious meateers, the average western diet eaters. It would probably be 50 or 60% lower.

The Adventist Health Study 2 again uh almost 70,000 participants compared to non-vegetarians. cancer risk was 16% lower among vegans, 12% lower among pesco vegetarians, and 8% lower among lactoovo vegetarians.

2012 meta analysis, the same 12 uh seven studies that I talked about before. The result showed cancer incidents and mortality rates were 18% lower among vegetarians compared with non-vegetarians.

So, why the veg advantage? Well, plant-based diets have been shown to inhibit cancer cell growth, reduce DNA damage, improve DNA repair, lower IGF-1 levels or insulin like growth factor uh one levels, favorably alter fecal enzymes and gut microfllora and reduce levels of v of a variety of toxic metabolites.

So, what about soy? And we talked a little bit about soy yesterday, but I want to talk about the weight of the evidence for soy and cancer. The American Institute of Cancer Research had a press release in 2012. And this is what the press release said release said for all cancers. Human studies show soy foods do not increase cancer risk and in some cases may even lower it. Breast cancer patients and survivors need no longer worry about eating moderate amounts of soy foods.

So, here’s what we know about soy and breast cancer. In a 2014 metaanalysis, soy consumers in Asia had a 41% risk reduction. No association was noted in Western countries in this meta analysis.

In 2012 there was a pulled analysis of Chinese and American women. Those with the highest intakes of isoflavones and that is the phytoestrogen in soy were 17% less likely to die from breast cancer and 25% less likely to have a recurrence of breast cancer.

I think this study is one of the most interesting. This is a study from Korea 2013. People with the highest quartortile of soy intake had a 61% lower risk if they were BA 1 or BA 2 carriers. And the people with the highest quartortile of meat intake had 197% higher risk regardless of their BA status whether or not they were BA positive. So very very interesting. So soy was very protective and the highest quartortile of soy was actually four to five servings a day.

Soy intake in childhood moderate soy consumption in childhood adolescence and throughout puberty actually reduces lifetime breast cancer risk.

So what about soy and prostate cancer? Well, a 2014 system systematic review and metaanalysis report reported that high soy that high-risk men in high-risisk men intake of soy or soy isoflavones reduced risk of prostate cancer by 51%. Preliminary evidence suggests that soy actually reduces prostate cancer metastasiz, slows rise in PA, reduces side effects also from radiation therapy.

The take-home message here is populations eating plant-based diets have lower cancer rates and plant-based diets have several lower or people eating plant-based diets lower several metabolic risk factors for cancer.

So moving on to type 2 diabetes. There was a study that looked at all kinds of dietary patterns and diabetes risk. And the authors said in their summary, together with maintenance of ideal body weight, the promotion of a so-called prudent diet characterized by a high higher intake of plant-based foods, and a lower intake of red meat, meat products, sweets, highfat dairy, and refined grains, or a Mediterranean dietary pattern appear to be the best strategies for decreasing diabetes risk.

So what are the rates among vegetarian or vegan populations? Well, the Adventist Health Study 2 found that in healthconscious meateers, semi-vearians, pesco vegetarians, lactoovo, vegetarians, and vegans, as people consume less meat, their their risk for diabetes decreased. And so the rates were about 7.6% 6% among the healthconscious non-vegetarians, 6.1 amongst the semi-vegetarians, 4.8 among pesco vegetarians. And this is lacto ovo vegetarians plus fish. Uh about 3.2% among lacto vegetarians and about 2.9% among vegans. And taking the same cohort and following them for another two years who develop diabetes. Well, the risk was 62% lower for developing diabetes for vegans than for non-vegetarians. Was about 32% lower among lactoovo vegetarians. And this was adjusted for everything for age, gender, education, income, television, watching, physical activity, smoking, and body mass index. So they actually adjusted for body weight. So this is very interesting.

There was a study looking at diabetes rates in Taiwanese Buddhists and for similar healthconscious nearvegan and they looked at rates in similar healthconscious nearvegan and omnivorous volunteers diabetes risk fully adjusted for all of these variables was 51% lower among nearvegan men and about 75% lower um for nearvegan women. And I want to tell you the pictures on this slide are very interesting because I was speaking at uh the Suchi International Medical Association conference in Taiwan and there are seven of the most highly regarded hospitals in Taiwan. Uh they are all Buddhist hospitals and they are all completely vegetarian. This meal at the bottom was your typical cafeteria meal. whole grain rice and it’s just a whole huge buffet of vegetables and tofu dishes and so forth. I went I was taken into the kitchen and do you see that the garbage bags in that corner? They’re all filled with greens for the patients. Fresh greens from the organic gardens that the Buddhist nuns were growing. Yeah. I mean, unbelievable. Can you imagine this concept of actually feeding sick people healthy food? It’s just unbelievable. I I I you know, and we have so much to learn from others around the world. I was stunned when I saw those bags of greens. You would never see that in a hospital here.

What about the diabetes rates among East Indians? Well, over 150,000 adults 20 to 49 years of age comparing non-vegetarians and this again is fully adjusted including BMIs. Lactoovo vegetarians were 33% less likely to develop diabetes. Lactoovo vegetarian or lacto vegetarians 31% less likely. So they didn’t consume uh the lacto vegetarians were consuming milk but no eggs. the lacto oval consuming both milk and eggs. They didn’t have a vegan population, but semi-vegetarians were 24% less likely to develop diabetes.

So, what do we know about red meat and diabetes risk? Again, from the Harvard uh studies, health professional follow-up study and the nurses health study, almost 150,000 participants participants adding just half a serving, 1 and a half ounces of meat a day increased risk of diabetes by 48%. Unbelievable.

So we also have a study, this is another arm of EPIC, not not EPIC Oxford but Epic Norfolk and they did a study looking at fruit and vegetable intake and diabetes risk. And what they found was that um that that basically there was a strong inverse association between fruit and vegetable intake and diabetes incidents compared with people eating the in the lowest quartortile of vegetable intake. risk was reduced 30% for the second quartile, 66% for the third quartile and 81% for the highest quartortile of vegetable intake. So the the quarter of the group that were consuming the most uh vegetables, 81% lower risk. And remember, we learned yesterday that only 2% of men and 3.5% of women actually get even the minimal amounts of fruits and vegetables recommended by the US government. Just unbelievable. This is how much it would help if they improve their intakes.

So, we also know about treatment using plant-based diets from PCRM. They’ve had a number of studies comparing low-fat vegan diets to an American Dietetic Association or sorry an American Diabetic Association diet for the treatment of diabetes. And those eating vegan diets lost more weight and had greater blood glucose reductions than those eating the American diet diabetic association diets. We also have research from a Czech team that found near vegan diets more effective than calorierestricted conventional diets in increasing insulin sensitivity and reducing medications and body fat.

So, and there are also a lot of books that have been published on using plant-based diets to actually reverse diabetes or at least improve the, you know, the the risks of of complications of diabetes. And the one on the left, defeating diabetes, is a book that I wrote back in 2004. And this book was responsible for getting me invited to the Marshall Islands. And that’s where we are now at the Marshall Islands story.

So, where are the Marshall Islands? Well, you know where Hawaii is. You know where New Zealand is. The Marshall Islands are about 2300 miles southwest of Hawaii and about 3,500 miles directly north of New Zealand. They are about 5 to 7° north of the equator. And uh they are it’s really interesting. As you can imagine, it’s summer year round. Uh, and it’s 82° on average, uh, at midnight, at 6:00 in the morning, in the middle of the day, 100 ft below the surface of the water in the ocean. And when and the coldest it ever gets is 77°. And the first week I was there, it hit 77 cuz it was raining outside. And people were shaking. They were sh I’m not kidding you. They were just shaking. and they were putting coats on and and and I have to tell you this story cuz it’s so funny. A doctor in the Marshall Islands, his daughter was going to come to Canada. They were 7th Day Adventists and she was going to go to an Adventist college in Alberta. And he said to me, and this is in Lome, Alberta, it’s like minus30 there in the winter time, minus 40. And he said to me, he said, “You know, I’ve heard it’s cold in your country.” He said, “Do you think she might need a sweater?” I told him to go into the kitchen, enter the refrigerator, stay there for a few hours. That’ help him decide if she needed a sweater. I told him, “Please do not send her to send her to California. Send her to California. She won’t like Canada.” Um, but in the Marshall Islands, diabetes is a state of emergency. They have the highest death rates from diabetes on the planet. The estimated prevalence is about 50% in those 35 plus. Pre-diabetes or type 2 diabetes. Almost all adults, at least 90% of adults have either pre-diabetes or diabetes. About half of all surgeries on the islands are amputations due to diabetes.

So, was diabetes a problem in the past? Not at all. It was practically unheard of 70 or 80 years ago. The people were slim. They were physically active and they lived off the land. So what was the traditional diet? Well, they ate they ate plants. 50 to 60% of their calories came from coconut. They ate breadf fruit, bananas, they ate pandanas, green leaves, and of course, whatever they could catch out of the ocean. Period. That’s all they ate. They didn’t have anything in a box or a bag.

today. What do they eat? Well, the little girl on the far left is eating breakfast. And I’m not kidding. This was 7:00 in the morning. Children eat whatever they want because parents have the still think that if they have a full belly, they’re wellnourished. That’s the way it was for generations. They didn’t understand that any food wouldn’t be nourishing. Uh they eat for lunch and dinner uh white rice, sticky white rice, and uh meat. It’s often spam or some sort of canned meat or chicken. Uh they eat all the parts of the animals that we don’t want like turkey tails or any cheap animal parts. Uh you can see in the left hand corner, it’s all bins of meat for a celebration. And it’s bins of processed meat mostly. Uh the children’s favorite snack. Oh, and I should say it’s all washed down with luau. The number one ingredient for lua luau is high fructose corn syrup. Uh the meal on the right is a a celebration meal. And so you can see it’s white rice, chicken, uh ham sandwich, a donut, and some white soda biscuits. So that’s the food they’re living on. The favorite snack of the children is you know what ramen noodles are in those crinkly packages. They’re deep fried noodles, salted noodles. Well, that’s the favorite snack. And what they do is crack open a package. They don’t cook it. They uh pour a bag of or a a package of Kool-Aid powder on top. So, all the artificial colors and preservatives. And one day I was watching a kid, they poured their Kool-Aid powder on top, and then they took something out of their pocket, a package of white stuff, and they started sprinkling the white stuff. And I thought, they can’t be putting salt. There’s, you know, there’s 1,800 mg of sodium in one of those packages. They can’t be putting. So, so I said to the person next to me, I said, “What are they putting on their ramen noodles?” And they said, “Oh, that’s a cinamoto.” You know what a cenamoto is? Pure MSG. Yeah.

So, the top sources of calories in the Marshall diet are white rice, white bread and rolls, donuts and white flour, baked goods, spam and other canned meat, chicken, ramen noodles with Kool-Aid powder sprinkled on top, sweetened beverages, fish, other meat, salty snacks, and that’s about it. It would be difficult for me to design a diet to induce diabetes any better than the diet these people have adopted. And that’s why they have such huge diabetes rates and that’s why they have the highest highest death rates from diabetes on the planet.

So in 2006 uh we began the diabetes wellness project in the Marshall Islands. And the founder of this project was Canvasback Missions, a 7th Day Adventist medical mission group that had been providing um medical teams to the Marshall Islands for 20 years plus, bringing in teams of oncologists, teams of ENT doctors, teams of dentists to try to help the people. And they watched the diabetes epidemic really unfold and they were determined to do something.

So they got they uh applied for and were granted um a grant uh got a grant a research grant from the US Department of Defense. Why? Because the US government uh the Marshall Islands were atomic bomb testing grounds after the Second World War. And so there’s some sort of relation, you know, sort of a relationship between the Marshall Islands and the United States. in the United States does give a lot back to the Marshall Islands now and so wanted to do this as another giving back and the partners were the Marshall Islands Ministry of Health and Lomol Linda University and I was brought on because the doctor that was hired to be the sort of director the medical director of the project had just been to a conference that I was speaking at on diabetes and he said I think I think you know we could used the program from her book as our program to try in the Marshall Islands. So that’s how I ended up getting involved.

So what we did was we basically did a proper study where we were con we were comparing very aggressive lifestyle intervention with the usual care and we had 169 participants with A1C’s over eight. So they were diabetic or they were taking diabetes medications. And we used a random randomized parallel design with five overlapping cohorts and they were with us for 24 uh four weeks. And what that means this overlapping design means before one group has stopped we’re already starting another group. Okay. So we did five groups and we did many others but only five were part of the actual research. Our goal was really simple. Our goal was to reverse the diabetes epidemic. Step one, to prove that diabetes can be successfully treated with diet and lifestyle in the Marshall Islands. And step two, to get the government to adopt the program as standard treatment for all Marshall people.

So here’s what we did. Weeks 1, 2, 4, and six, they were with us four weekdays for 6 hours a day. Weeks 3, five, 7, and 8, they were with us twice weekly for about 5 hours. Weeks 9 to 12, they were with us weekly for about 5 hours. In weeks 12 to 24, they were on their own, but they would come for exercise and measure blood sugars and all of that sort of thing. And the guys you see here, all of these men are ministers of health or senators. So, we put through the leaders of the communities. We had the president. We had you know all of the the the the um you know princes and kings and all of those uh leaders because we wanted to educate the leaders. It’s a it’s a quite um a society where where this it’s a bit of a nepotistic society. Just say that. And uh and it’s and and I should also say it’s a beautiful society. Uh the people are absolutely incredible. I have never heard people laugh as loud or you know sing as beautifully. I one story I just have to tell you. This doctor told me this story. he first arrived to the Marshall Islands and he took a side road home to our hotel and uh and he said the first thing he saw was this gang of teenagers coming towards him and he got scared and he said it was a gang of teenage boys and as they approached and got closer he realized that they all had their arms around one another and they were all singing and as they got close to him they were so friendly and they were saying yakay yak and and the witches Hello and love and all of that stuff. And he knew he was in a very special place. It’s a very special place.

Um so they people would do a walk, a blood glucose and breakfast on their own, but we would provide their food. This is in the intensive phase. They’d come to the clinic for lunch and then they would be working during the day. And then they would come at 3:00 and be with us till about 8:15. And in that time they would do an exercise class, a cooking class, they’d have dinner, they’d have an you know an education session in the evening. It was very intense.

And our diet goal was very simple. To restore insulin sensitivity and to accomplish that task, we must produce weight loss in the overweight participants. We’ve got to improve blood glucose control. We’ve got to reduce oxidation and inflammation. and we have to restore their nutritional health because they are, as you can imagine, extraordinarily malnourished.

So, the diet design, well, it was a plant-based diet, high in fiber. It was a very low glycemic load. I have to tell you this before I go on the high fiber thing. The average fiber intake in the Marshall people was about 5 grams a day. Okay? We got them to 40 to 50 grams a day. So you can imagine what happened. We had people that on average were going to the bathroom once every week or two. Yeah. And so when they started going to the bathroom every day, it scared them. It it it scared them. It was just so unusual for them. And so it was really quite quite interesting. So it very low glycemic load, minimal refined carbohydrates if any, minimal ground grains. We didn’t use flour products. We used intact whole grains, moderate fat, so we used some nuts and seeds, uh, low saturated fat, zero trans fatty acids. Most of the saturated fat, coconut that we used, and we did use coconut. It’s a really important traditional food for them. And um, sufficient essential fatty acids using flax seeds because they’re cheap. We did allow them to eat some fish at home. We’d never served any animal products at the clinic at all, but they were allowed after the first few weeks if they wanted to have boiled fish, not fried fish, that was permitted because it’s a very important part of their cultural diet as well. The diet was anti-inflammatory, high in phytochemicals, high in antioxidants, low in proxidants, contained moderate levels of sodium. A lot of people say, “Well, and these girls at the bottom, these are these ladies are our cooks, and they’re eating pandanis.” And pandanis is a really important source of vitamin A for these people. And pandanis is so fibrous that you can’t really eat it. You can only suck the juice out of it. It’s like you need to have dental floss if you can go near it. But they love it. It’s quite flowery tasting.

So, so why not just return them to their local foods? Well, of course it would be a great idea. You know, it would make sense from a health perspective and from a cultural perspective, but from a practical perspective, it’s impossible because the island might sustain like Maduro, the main island that we worked on might sustain 500 or a,000 people. There are 30,000 people there. So, there’s no way you have to import food. So the answer is to get them to import healthy foods and to eat as many local foods as they can. So it’s just so important. So the best choices are cheap imported foods but healthful ones like beans, legumes, barley, lowcost vegetables like cabbage and squash.

So what else did we do in the program? Well, they did daily exercise. Their favorite was dancing. men and women, they love to dance. So, there were cardio and you can see the women, none of them have exercise clothes on because pants in their culture, they’re starting a little bit now, but when we arrived, if you wore pants as a woman, you were a prostitute. And it was only people from Asia that would ever wear pants, and they were prostitutes. So, women wore long dresses, period. And we had to abide by that, of course, as well. Uh, and so they exercised in their long dresses and every this if you take nothing away from this for diabetes, if you know of family or friends, walking after meals is one of the most potent things that you can do to keep your blood sugar down, even if it’s only five minutes. We had them walking about 20 or 30 minutes after meals.

Uh we did cooking classes, we did shopping tours, we did education sessions. And this man right here, Dr. Kamal, was known as the butcher. This is the man that cut the people’s legs off. And everybody was scared of him. And he was the sweetest man on the planet. He was a vegetarian himself. And I absolutely loved him. He was just such a dear person. And he said, “If only I could convince people to come in before they have gang green going up their body and I have to cut their legs off to save their lives.” But what they would do in their culture, if they got sores on their feet, they would try to treat it with local medicine because they were scared if they went to the doctor he’d cut their leg off. So they would wait until they, you know, their leg was everything was black and they had gang green going and that’s the only thing he could do. So we brought him in to teach people about, you know, how to care for their feet and that he was he didn’t want to cut their legs off.

So you know, and we would teach people about lifestyle and chronic disease, food and nutrition, exercise, stress management, dental health, feet and eye care, and and and gardening. We tried to help people plant gardens even if only in buckets because the soil there you can imagine the a the atole that they lived on is uh 30 mi long and 3.7 square miles in area. It’s this long strip of coral reef and there’s not good soil there at all. So it’s very difficult.

So I’ll tell you a little bit about the results. In the first two weeks, pain in the joints, arms and legs was reduced or eliminated in almost everybody. Some of these people had intermittent claudication, terrible pain in their legs. It would disappear in the first week. It was unbelievable. They couldn’t believe it. They’d be able to sleep through the night. They had increased energy. They of course were no longer constipated. They could think more clearly. And 90% of the participants were able to stop taking their medications in the first two weeks was unbelievable.

So, and changes at 2 weeks and 12 weeks. Well, you can see fasting blood sugar dropping 71 points in the first two weeks, 48 in the first 12 because they were eating foods at home. Again, A1C dropped about two points by 12 weeks. uh the uh insulin production went down which is wonderful because they were hyperinsulinemic uh BMIs went down systolic blood pressure total cholesterol and the CRP the measure of inflammation went down about 1.2 two points. So this was all good and the com committed participants, the ones that really stuck to the program had the greatest success, many of whom were able to uh reverse their disease completely.

The man on the top right, this is Lorac Lorac. His name is Lorac Lorac. And uh he was a pilot. And a lot of people in the Marshall Islands don’t get well educated, but he was actually able to um to become a pilot and and you know fly planes, which was really quite remarkable. He lost his pilot’s license because of diabetes and uh he came to the program and he completely reversed his disease. He’s now flying again. So it was really exciting for him. You know these people are really pioneers of the Pacific. The participants of this program provided hope amid a very deep sense of hopelessness. They overcame insurmountable mountains of spam, donuts, ramen noodles, and cola. They put together lowcost healthful meals despite the high cost and poor quality of their produce and their lack of resources. They don’t have money. They managed with little education and marginal English skills. They succeeded with few gyms, one to be exact, no trails, and a cultural taboo against women wearing exercise clothing.

The challenge in the Marshall Islands, however, is that even the best education program in the world is not enough because the Marshall culture is very grouporiented. Everything’s shared. There’s very few people with independent living units. So community ownership is really key and until changes are embraced by the entire culture, it’s very difficult for people to succeed long term.

So what are we doing now? Our funding has run out. Uh so we are there doing what we can and we’ve shifted away from research to community efforts. So, we gave these little children, this came from PCRM. Carolyn trap came with me for a couple of weeks and handed these choose smart foods uh I choose smart foods bracelets to the children. We we partnered with the Ministry of Health and the RMI government. This is World Diabetes Day and the president and the Minister of Health and so forth are all there and we’re educating people. We planted gardens in every single square inch of the hospital grounds. Um, we are teaching the children in the schools and getting them exercising as much as possible. We’re educating community groups and church congregations. We’ve partnered with restaurants and grocery stores and we’re still offering free lifestyle interventions, free exercise classes, and even and we keep going there every year.

In 2014, we went also to Ebby. And Ebby has an area of.14 square miles. It’s also part of the Marshall Islands. The population is 15,000 people on 14 square miles. It’s unbelievable. We couldn’t do what we could do in Madro. We had a very small space. We had to use little cooktop stoves, but we did our best. And uh we taught people to garden. We brought 177 earth boxes so people could could garden. And of course, things grow very, very well. We taught people to sprout. We brought the hempseed sprouting bags from the Sprout Man. Uh we got people walking. We got people dancing. And they had a lot of fun. We did grocery store tours.

And here’s the results. In our Madro intervention last year, fasting glucose average drop was 119 points. After exercise, 68 points. And in Ebby, it was the opposite. The average fasting glucose drop was 50 and after exercise 116 milligrams per deciliter.

And people ask me, could this program work at home? And I say, if there is hope in the Marshall Islands, given the enormous barriers they face, what is our excuse? What is our excuse? But the hope rests on demand from those affected and the integration of lifestyle medicine into our health care system. It has got to be offered as a treatment option. And so often physicians say to me, “Oh, but my patients wouldn’t do that.” And I always say, “How do you know if you don’t offer it to them?

And I quickly want to introduce you to the Vallejo family. The Vallejo family, Andreas right here, was diagnosed with cancer at 36 years of age. And uh he actually went to Hypocrates. He came to uh a few conferences, one of which I was speaking at, and he asked me if I could help him to design a diet that would give him the best chance of survival. He had a sal salivary gland tumor and it was not good, put it that way. And we put him on a very high raw, very nutrient-dense diet. But what just amazes me is everyone on his family said, “Andreas,” and he was a lawyer in San, he is a lawyer in San Francisco. And he his favorite pastime was going to the best restaurant in whatever city he was, buying the bea best steak and the best bottle of wine. He wants he and his wife flew to Paris and spent $3,000 on one meal. So they were really foodies, okay? And his whole family was like that. But what really shocked me is his entire foodie family said, “Andreas, whatever diet you’re put on, we’re doing with you.” Just amazing.

And his father, Carlos, uh, here’s what he was dealing with. Type 2 diabetic, coronary heart disease. He had just had a major heart attack. He had uncontrollable high blood pressure, high cholesterol, peripheral artery disease. His kidneys were failing and he had recurring gout. He was on 40 units of insulin and 17 pills a day. He was told by his phys physician that he probably had less than two years to live. He never expected that the diet would do anything for him. You know why? because his doctor told him he had a progressive irreversible disease and that nothing that he did would change anything.

After less than a year on a whole foods plant-based diet, Carlos took zero insulin and zero pills. His fasting glucose was 4.4 to 4.8. His A1C 4.9, his blood pressure 115 over 70s. His arteries opened up up based on a PET scan he did without surgical intervention. The scar tissue is disappearing. There is no longer any sign of peripheral artery disease. His kidney function is now perfectly normal. And he has not had a single recurrence of gout since he became vegetarian. After four years, his numbers are still the same and his health continues to improve. Carlos said, “I used to spend my days in pain and suffering. I took my insulin. I was dizzy from my pills and I just knew I was going to die.” He said, “Now I don’t even know what to do with all my time.” He said, “I spend two hours a day at the gym.” And he said, “I feel like I’m 25 years old.” He’s in his 70s.

Yeah. The take-home message, whole foods plant-based diets reduce risk of type 2 diabetes and provide the most effective therapeutic treatment for people with type 2 diabetes. Plant-based diets also protect against cataracts. Vegans have a 40% reduced risk. Kidney stones, they have a 31% lower risk among lacto vegetarians and vegans. Diverticular disease, 31% lower risk. Renal disease, 52% lower risk.

Why the advantage? Very simple. Because well planned plant-based diets maximize protective dietary components and minimize pathogenic dietary components. They maximize fiber, phyitochemicals, enzymes, antioxidants, anti-inflammatories, plant steriles and stanels, pre and probiotics. And they provide adequate micro nutrients and healthy macronutrients. They minimize pathogenic factors, the trans fats, the excessive saturated fats, the refined carbs, the sodium and artificial food additives in new 5GC and chemical contaminants and all the products of high temperature cooking in the TMAO.

And when we look at what Americans are eating, 63% of the calories come from processed foods and 25% of the calories come from animal products. Only 12% from plant foods. People get it. This is, you know, you’ve heard of this heart attack grill. Anyone over 350 pounds eats for free all day every day, every day. They even flaunt it. Oh my god. you know, here double bypass burger, triple bypass burger, quadruple bypass burger. He was their um mascot until he died at 29.

And the bottom line is if you do not change directions, you may end up where you’re headed. And a 5% change in direction will not change anything. You need to make an about face. Lifestyle medicine is one powerful treatment option. Medications and surgeries cannot reverse lifestyle induced diseases because they do not address the root causes of those diseases. Only profound lifestyle changes have ever proven effective in reversing lifestyle induced diseases. And the bottom line is the more we change, the more we heal.

And I would like to make a call to action because it is time for food and nutrition policies to become a national priority. And it is time that governments recognize that policies that ma make healthy choices easier for people bring significant health, economic, social, ecological and ethical advantages. And with that, I will close and say thank you so very much for your attention. and I’m promoting my books which have all of this information in them. But thank you so much. Thank you. Thank you very much. Thank you.