Plant-based Nutrition for the Inpatient

Historical Overview and Application of the Science in

the Acute and Chronic Setting

Stephan Esser MD, USPTA

Tenets of Health•Plant Based Diet•Exercise•Sleep•Emotional Poise•Sunlight•Clean Water and Air

Tenets of Health•Plant Based Diet•Exercise•Sleep•Emotional Poise•Sunlight•Clean Water and Air

Disclosures

• I have no financial affiliation with any of the centers I am going to describe to you

• I am a strong advocate of plant based nutrition

• I grew up at an inpatient plant based facility

Goals

• Review the history of inpatient plant-based health programs

• Recognize and appraise challenges affecting application of plant-based nutrition to inpatient settings in the 21st century

• Develop strategies to facilitate application of plant-based nutrition in the inpatient setting thru case based examples

“Those who cannot remember the past are condemned to repeat it.”

The Life of Reason 1905

George Santaya

Challenges

• Knowledge/Awareness

• Cost/Reimbursement

• Patient Disinterest/Refusal

• Family/Social Cultural Norms

• Established System

• Habit

• Feelings/Fixed Beliefs/Emotions

The Past

Biblical

– Daniel 1:12-15

• “Please test your servants for ten days. Let us be given vegetables to eat and water to drink. Then see how we look in comparison with the other young men who eat from the royal table………..…..after ten days they looked healthier and better fed than any of the young men who ate from the royal table.”

Fr. Sebastian Kneipp 1821-1897

“The Waßer Cure”

Dr Henry Lindlahr  1862-1924• Nature Cure

• “No Surgery, No Drugs, No Serums.”

• Lindlahr Sanitorium: 1914-1928– Vegetarian diet, sunbaths, airbaths, exercise, hydrotherapy, and

manipulation.

Dr John Harvey Kellogg MD 1852-1943

• Battle Creek Sanitorium, MI

– 1866-1940’s– 30+ physicians on staff– Up to 1000 guests at a time– Based in Seventh Adventism

Dr. Herbert Shelton, N.D. 1895 –1985

Esser ’s Health Ranch

Dr William Esser ND, DC 1911-2003

Past• Incorporate “plant based” nutrition with

multiple other treatments:– Enemas– Hydrotherapy– Electrotherapy– Exercise– Herbs– Massage – Therapeutic Water Fasting

Past

• Leaders– Passionate– Iconoclasts– Eccentric– Varied levels of:• Training• Support• Science• “Product”/2ndary Gain

More Recent

A Quick View

• Hippocrates: Wheat Grass, Raw Food etc• Tree of Life: Raw Food, Kabalism etc• Gerson Clinics: Juice, Food, Coffee En., “other”• Total Health Institute: Juice, food, prayer etc• Optimum Health Institute: Food, juice, fasting• Others:– Many other small and large places with hosts of

option

Duke Rice Diet Program

• Walter Kempner MD: 1903-1997– German born physician– On Campus Duke Medical Center/Community– Advanced disease to aesthetics– Eventually Closed 2002/2013

Duke Rice Diet Program

Regression of Diabetic Neuropathy with Total Vegetarian (Vegan) Diet

• 21 pts with T2D and SDPN average age of 64• Low fat (10–15% of cats), high fiber, total vegetarian diet (TVD) of

unrefined foods and conditioning exercise

• 17/21 (81%) had complete relief of the DSPN pain in 4 to 16 days.

• Weight loss averaged 4-9 ± 2-6 kg during the 25 days. • By the 14th day, the fasting blood glucose level averaged 35% lower• 5 got off hypoglycemic agents• Serum triglyceride and total cholesterol had decreased by 25-0 ±

23% and 13 ± 15% respectively (p <0-01) in 2 weeks.• Follow-up studies of 17 of the 21 patients for 1-4 years indicated that

71% had remained on the diet and exercise program as advised in nearly every item.

Journal of Environmental and Nutritional Medicine 1994, Vol. 4, No. 4 , Pages 431-439

Diabetes• Does a vegetarian diet reduce the occurrence of

diabetes? American Journal of Public Health, Vol. 75, Issue 5 507-512

– 25,698 adult White Seventh-day Adventists identified in 1960 followed for 21 years– vegetarians had a substantially lower risk than non-vegetarians of diabetes as an

underlying or contributing cause of death

• Fruit and Vegetable Consumption and Diabetes Mellitus Incidence among U.S. Adults Preventive Medicine Vol 32 Iss 1 January 2001. Pages 33-39

– Appr. 10, 000 participants, highest fruit and vegetable consumption = lowest risk of T2D

• Dietary Patterns and the Incidence of Type 2 Diabetes Am. J. Epidemiol. (2005) 161 (3): 219-227.

– 4,000 Finnish en and women, followed 23 years– Highest consumption of fruits/vegetables in prudent diet resulted in decreased risk

Diet and Exercise in the Treatment of NIDDM: The need for early emphasis

• 652 with NIDDM • 3-week intensive dietary modification

program• 71% of 197 on oral hypoglycemic agents and

39% of 212 on insulin were able to discontinue their medication with normalized BS’s

Diabetes Care December 1994 vol. 17 no. 12 1469-1472

True North Health

• Santa Rosa, CA• Dr Alan Goldhamer and Staff• 30+ years• 10,000 + patients• Vegan/ SOS Diet and Therapeutic Water Fasting• Reversal of T2D, HTN, Inflammatory Conditions• Physician Offices on Site

Pritikin Institute

• Nathan Pritikin (August 29, 1915 – February 21, 1985)

– Inventor/Engineer turned Health Advocate– Founded the Pritikin Longevity Center in 1976 in CA– Now in South Florida

Nathan Pritikin

• Pritikin et al. Effects of a high-complex-carbohydrate, low-fat, low-cholesterol diet on levels of serum lipids and estradiol AJM 1985

– 26 day inpatient stay 15-20% in TC

• Pritikin et al Long-Term Use of a High-Complex-Carbohydrate, High-Fiber, Low-Fat Diet and Exercise in the Treatment of NIDDM Patients Diabetes Care 1983

– 26 day inpatient stay, 77% off Oral Hypoglycemics, 25% in TC

• Effect of Short-Term Pritikin Diet Therapy on the Metabolic Syndrome Journal of Cardio-Metabolic Disease 2006

– 12-15 day stays, BMI 3%, SBP, SG, LDL 10-15%– 37% no longer met criteria for Metabolic Syndrome

Challenges

• Dominant “worldview”• Feelings/Emotions• Inadequate Education• Lack of Insurance funding• Vested Interests entrenched• Personal beliefs of administration • Inertia• Energy required

ScienceScience

Cases and Application

Case #1

• 60 y/o AA male admitted to the ED and now up on the IM floor for:

Congestive Heart Failure• Stabilized with Medication• 3rd admission in 6 weeks• On Maximum Medical therapy

Why?

The What?

• Worsening Medical Condition

• Dietary Excesses: Na+ etc

• Medical “Non-Compliance”

The Why?

• Why……– Intrinsic Motivators• Personal Goals, Beliefs, Fears, Anxiety

– Extrinsic Factors• Living Situation/Support• Finances• Functional Abilities• Knowledge

Case #1 Cont’d

• Gather Information– What is your understanding of your health

condition?

– What have you been told?

– Has this ever happened before? How have you tried to prevent it?

– What has not worked? Is there anything else you can try?

Case #1 Cont’d

• The Pitch:– Are you interested in learning how you can

prevent repeat hospital visits?

– What would you be willing to do?

– Would you like to try some foods while in the hospital which can lower your blood pressure and may help you reduce the number of medicines you need?

Take Aways• Evaluate the scenario• Ask questions/Gather information• Listen/Empathize• Avoid projection/judgment/apathy• Look for Opportunities• “Sell” the product• Get “buy-in”• Develop Channel Factors

Case 2

Case 2

• 58 y/o female s/p Right CVA with mild residual left sided weakness in an IRF

– PMH:• Obesity• HTN/HLD• Depression• Chronic MSK Pain

Case 2 Cont’d

• Push Back– Establishment– Nutrition/Dietary Staff– Patient/Family

• Projection• Failure to Educate• Inadequate Options

Case 2 Cont’d

• Know the Science:

– Single HF meal• Alters Endothelial function up to 4 hours after

– Effect of a single high-fat meal on endothelial function in healthy subjects.Vogel RA, Corretti MC, Plotnick GDAm J Cardiol. 1997 Feb 1;

79(3):350-4.

BLOOD-PRESSURE-LOWERING EFFECT OF A VEGETARIAN DIET: CONTROLLED TRIAL IN NORMOTENSIVE SUBJECTS

The Lancet, Volume 321, Issue 8314, Pages 5-10I.Rouse

59 healthy, omnivorous subjects aged 25-63 years were randomly allocated to a control group, which ate an omnivorous diet for 14 weeks, or to one of two experimental groups, whose members ate an omnivorous diet for the first 2 weeks and a lacto-ovo-vegetarian diet for one of two 6-week experimental periods. Mean systolic and diastolic blood pressures did not change in the control group but fell significantly in both experimental groups

during the vegetarian diet and rose significantly in the experimental group which reverted to the omnivorous diet.

Adjustment of the blood-pressure changes for age, obesity, heart rate, weight change, and blood pressure before dietary change indicated a diet-related fall

of some 5-6 mm Hg systolic and 2-3 mm Hg diastolic. Although the nutrient(s) causing these blood-pressure changes are unknown, the effects were apparently not mediated by changes in sodium or potassium intake

Rapid reduction of serum cholesterol and blood pressure by a twelve-day, very low fat,

strictly vegetarian diet.J Am Coll Nutr. 1995 Oct;14(5):491-6.

During this short time period, cardiac risk factors improved: there was an average reduction of total

serum cholesterol of 11% (p < 0.001), of blood pressure of 6% (p < 0.001) and a weight loss of 2.5 kg

for men and 1 kg for women.

Case 2

• Know the Science

• Demonstrate the benefit

• Develop a sample menu

– Identify unique tastes of the individual

• Get patient and family interest/buy in

– “Marketing”

Case 3

• 48 y/o male s/p total knee replacement in Acute Hospital for 2 nights – PMH:• Obesity: BMI: 45• Type Two Diabetes: On Insulin• HTN/HLD• Gout• Osteoarthritis• Erectile Dysfunction• Excema

Case 3

• What are opportunities?

• Limitations?– Time– Reason for Adm

Stages of Change1: Pre-contemplation

2: Contemplation

3: Preparation

4: Action

5: Maintenance

Stages of Change1: Pre-contemplation

2: Contemplation

3: Preparation

4: Action

5: Maintenance

Case 3

• Assess readiness for change

• Determine knowledge/awareness

• Provide science in appropriate format

• Develop relationship: family/friends

• Encourage follow up

Plant a SeedPlant a Seed

Conclusion

• Assess need• Evaluate readiness for change• Help them GROW– Goals, Reality today, Obstacles, Will

• Gather and Publicize results• Promote change on an institution level after

personal change• Seek Sustainablity

Conclusion

• The science is clear

– Plant based nutrition is powerful medicine

• The history demonstrates

– Many versions have and do exist of integrating plant based foods in a healthcare setting

• The challenges are real

• The challenges are opportunities for change

Good Luck

Thank You!Thank You!