3rd annual international plant-based nutrition healthcare
TRANSCRIPT
3rd Annual International
Plant-Based Nutrition Healthcare Conference
Hyatt Regency Orange County Garden Grove, CA Sept 30-Oct 3,2015
Elements and Dynamics in a Community-based
Intensive Therapeutic Lifestyle Change (ITLC) Program
Hans Diehl, DrHSc, MPH, FACN
Clin. Professor of Preventive Medicine Loma Linda University, School of Medicine
Loma Linda CA 92354
Mortality changes in N. Karelia
Decrease in Mortality rates by condition, 1970-1995
CHD
Lung CA
All CVD
73%
71%
68%
Int J Epidemiol 2000; 29(1):49-56
Changes in life expectancy in N. Karelia
Men
Women
64.8 yrs
74.7 yrs
80.5 yrs
72.5 yrs
1974 1999
Life Expectancy changes by gender, 1974-1999
Int J Epidemiol 2000; 29(1):49-56
An increase in GDP effects a change in: 1) the distribution of the dietary energy sources (macro-nutrients) expressed in % of total calories consumed; 2) starch-rich foods, like whole grains and potatoes, become replaced by processed white flour products, or fries and chips
US Diet Western
Pritikin Diet
Fats, Oils 80-120 gm 20-30 gm
Cholesterol 400 mg <25 mg
Sugars 35 tsp <10 tsp
Salt 10 gm <5 gm
Fiber 10 gm >40 gm
Water Minimal 8-10 gl.
ITLC: The Pritikin Longevity Center (PLC)
44% of patients with type 2 diabetes could stop their insulin within four weeks. 74% of patients with type 2 diabetes on oral drugs were able to leave the center drug-free within 4 weeks.
Diabetes Care 6:268, 1983 JAppl Physiol 98:3, 2005 (874 pts, meta-analysis)
ITLC: PLC
17%
83%
No longer on Meds (n=180)
Maintained on Meds n=36)
The absence of developed atherosclerosis and the
complete absence of its effects are remarkable.”
Nathan Pritikin
N Engl J Med, July 4, 1985
major arteries and coronaries were found to be soft and pliable without evidence of atherosclerotic plaques or
vascular disease.
“Diagnosed with CAD 22 years earlier, at autopsy all
ITLC: Lessons learned
#1 We need to go beyond symptomatic management
Treating Chronic Diseases
Symptoms or Causes? Treating
1960 1980 2000 2020
28 75
255 717
1,359
2,887
5,010 Medical Spending (in $ Billions). Of this, 84% on Chronic Diseases
in % of GDP
5% 7
9
12
14
18
20% US Medical Cost Trends
Centers for Medicare & Medicaid Office of the Actuary (2010)
Anderson G R.Wood Johnson Found 2010 www.rwjf.org/pr/product.jsp?id=50968
ITLC: Lessons learned
#1 We need to go beyond symptomatic management
Treating Chronic Diseases
#5 Patients need to hear, see and understand information that is transformative
#4 Disease reversal can best facilitated in a group
#2 Treat one, treat many
#3 Disease reversal can be documented
ITLC: Lessons learned
#1 We need to go beyond symptomatic management
Treating Chronic Diseases
#2 Treat one, treat many
#3 Disease reversal can be documented
Nov. 27, 1996
ITLC: Reversal of Coronary Disease July 22, 1999
Distal
LAD
ITLC: Lessons learned
#1 We need to go beyond symptomatic management
Treating Chronic Diseases
#4 Disease reversal can best facilitated in a group*
#2 Treat one, treat many
#3 Disease reversal can be documented
*J Consult Clin Psych 2001:69:71
ITLC: Lessons learned
#1 We need to go beyond symptomatic management
Treating Chronic Diseases
#5 Patients need to hear, see and understand information that is transformative
#4 Disease reversal can best facilitated in a group
#2 Treat one, treat many
#3 Disease reversal can be documented
ITLC: PLC Program Behavioral Underpinnings
Intensive Education in a Group Setting*
Objective Biometric Feedback
Health Belief Model**
Social Cognitive Theory of Bandura***
Financial Investment
Transtheoretical Change Model ****
Exclusive Club and “Guru” Mentality
*J Consul Clin Psychol 2001;69:717-21 **Health Commun 2010;25:661-9 ***Ann Rev Psych 2001;52:1-26 ****J Clin Psych 2011,67:143-54
Transtheoretical Model of Change
Preparation
Termination
J Clin Psych 2011, 67:143-54
ITLC: Ornish Program
ITLC: Esselstyn Program
Trans-theoretical Model of Change
Prochaska, 1983
ITLC: CHIP
Meats Dairy Eggs Processed Foods Alcohol & Caffeine
Fruits Vegetables
Legumes Whole Grains Water
Worst Health Outcomes Best Health Outcomes
ITLC: The Complete Health Improvement Program (CHIP) 12 wk Intensive Educational lifestyle change program. Rx: diet: whole food, plant based & on daily exercise & resilience
Creston, BC 400 Vernon, BC 1,500
Kelowna, BC 2,000 Ottawa, Ont 250
Bangalore, India 1,500 Kalamazoo, MI MC 500*
Rockford, IL MC 3,000
CHIP 1988-2000
*Filmed
CHIP transcends cultures
Canada Australia, New Zealand
Solomon Islands, Fiji United Kingdom
Germany Philippines, Egypt
CHIP “works” in
Corporations
Hospitals
Faith communities
Clinical practices
Communities
Clinical outcomes of an ITLC program presented by Dr. Salvatore Lacagnina of Lee Memorial, FL 10 – 15 min.
What’s the magic?
What are the elements to heighten and help maintain behavioral change?
Intensive Education in a Group Setting
Objective Biometric Feedback
Health Belief Model
Social Cognitive Theory of Bandura
Trans-theoretical Model of Change
Financial Investment and “Guru” Mentality
Elements and Dynamics
Behavioral Cognitive Therapy
Emotional Intelligence
Supportive , Caring Environment Facilitator=role model: caring, supportive, gentle, affirming, authentic, transparent, reliable, dependable, fair, objective, fun!
Planned Action setting goals, contracting, journaling, homework
Elements and Dynamics
The Why? Content presented in 18 DVD sessions. Progressive disclosure. The Lifestyle-- chronic disease connection, ecological impact, ethical aspects, emotional health, resilience; the cerebral part of taste
Meats Dairy Eggs Processed Foods Alcohol & Caffeine
Fruits Vegetables
Legumes Whole Grains Water
Worst Health Outcomes Best Health Outcomes
The Eating Continuum
Elements and Dynamics
The Why? Content presented in 18 DVD sessions. Progressive disclosure. The Lifestyle-chronic disease connection, ecological impact, ethical aspects, emotional health, resilience. the cerebral part of taste
The How To? Adult learning, engagement. Use of a table host. Success & failure stories. Skill Development: Food demos. Exercise drills. Competing groups/tables distance walked.
Elements and Dynamics
Family Involvement
Align Community Support Restaurants, food outlets, City council School system, CME for MDs, RDs , Clergy, Public Health
Sustaining and Maintenance of new behaviors
Re-entry into the program
Monthly Alumni meetings
Elements and Dynamics
Unique opportunities in changing the environment Social reinforcement, financial incentives (wellness points), bragging sessions, vouchers for the gym, dietary reinforcement: healthy options in cafeteria and vending machines.
Changing behaviors in Corporation and hospitals
Summary
When it comes to the practice of medicine and public health, there are few opportunities greater to find meaningful satisfaction and greater joy in seeing the health of people turning around than through the practice of Lifestyle Medicine . It is here with a plant-based whole-food diet at the center and accompanied by daily exercise, emotional and spiritual health principles that
And this is best facilitated through education, motivation and inspiration and ideally delivered through group processes. The challenges of changing our current practice of medicine and public health are not few. It will take a new paradigm. It will take a new attitude. It will take creativity. It will take new tools.
we can attack the causes of our current epidemic of chronic diseases leading to effective prevention, arrest and often reversal and cure .
But the rewards will be priceless!
