THE SCIENCE OF LIFESTYLE MEDICINE

Corey Howard, MD, FACP, FMNM

Internal Medicine, Gastroenterology, Anti-Aging, Functional and Regenerative Medicine, Lifestyle Medicine

ABOUT: COREY HOWARD, MD, FACP, FMNM

• Internship, Psychiatry, Einstein Campus at Long Island Jewish Medical Center

• Residency, Internal Medicine, University of South Florida

• Chief Resident, Internal Medicine

• Fellowship, Digestive Diseases and Nutrition

• Private Practice Gastroenterology (Board Certified)

• Private Practice Internal Medicine (Board Certified)

• Board Certified Anti-Aging and Regenerative Medicine

• Professional Certification, Plant Based Cooking

• Past Chair, Department of Internal Medicine NCH Healthcare

• Past President, Collier County Medical Society

• Speaker, Florida Medical Association

• Community Involvement

• Ironman Triathlete

• Musician

• Writer

• Public Speaker

• Dad, Husband, Friend

80% of Chronic Disease Can Be Attributed to

Lifestyle Choices

Each lifestyle factor was associated with

a reduction in risk.

The more factors you had the lower

the risk.

Diet/Nutrients

Physical Activity

Stress Response

Sleep

Environmental Factors

Community and Purpose

ADAPTED FROM THE ORIGINAL PRESCRIPTION BY THOMAS GUILLIAMS PHD

HEALTH

OBESITY FACTS

• 34.9% (78.6 million) US adults are obese

• Increases risks of diseases

• Leading cause of preventable death

• $147 billion annual medical cost of obesity

• Obesity rate in black population 47.8%

• Rate highest in middle age (39.5%)

2000

Obesity Trends* Among U.S. AdultsBRFSS, 1990, 2000, 2010

(*BMI 30, or about 30 lbs. overweight for 5’4” person)

2010

1990

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

15%–<20% 20%–<25% 25%–<30% 30%–<35% ≥35%

Prevalence* of Self-Reported Obesity Among U.S. Adults by State and Territory, BRFSS, 2013

*Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be compared to prevalence estimates before 2011.

CA

MT

ID

NV

UT

AZNM

WY

WA

OR

CO

NE

ND

SD

TX

OK

KS

IA

MN

AR

MO

LA

MI

IN

KY

ILOH

TN

MS AL

WI

PA

WV

SC

VA

NC

GA

FL

NY

VT

ME

HI

AK

NH

MA

RI

CTNJ

DE

MD

DC

PRGUAM

HEALTH CONSEQUENCES OF OBESITY

• Coronary heart disease

• Stroke

• High blood pressure

• Type 2 diabetes

• Elevated lipids

• Sleep apnea

• Osteoarthritis

• Reproductive issues

• Mental health issues

• Cancer (uterus, cervix, endometrium, liver breast, ovaries, colon, prostate…)

POTENTIAL CANCER CAUSING FOODS YOU MAY EAT RIGHT NOW

• Microwave popcorn

• Non-organic fruits

• Processed meats

• Farmed salmon

• Potato chips (fried foods) acrylamides

• Hydrogenated oils

• White flour

• GMO

• Sugars (HFCS)

• Artificial sweeteners

• Red meats

• Soda

GOOGLE: DIET COMPARISON

136,000,000 RESULTS IN 0.27 SECONDS!

DASH

TLC DIET

MAYO CLINIC DIET

MEDITERRANEAN DIET

WEIGHT WATCHERS DIET

FLEXITARIAN DIET

VOLUMETRICS

JENNY CRAIG

BIGGEST LOSER DIET

ORNISH DIET

TRADITIONAL ASIAN DIET

VEGETARIAN DIET

ANTI-INFLAMMATORY DIET

SLIM FAST DIET

SPARK SOLUTION DIET

FLAT BELLY DIET

HMR DIET

NUTRISYSTEMS

ABS DIET

ENGINE 2 DIET

SOUTH BEACH DIET

VEGAN DIET

ZONE DIET

GLYCEMIC INDEX DIET

MACROBIOTIC DIET

MEDIFAST

SUPERCHARGED HORMONE DIET

BODY RESET DIET

THE FAST DIET

ATKINS

RAW FOOD DIET

DUKAN DIET

PALEO DIET

3-HOUR DIET

8-MINUTES DIET

BECK DIET SOLUTION

THE BEST LIFE DIET

THE BLOOD TYPE DIET

BODY FOR LIFE DIET

CABBAGE SOUP DIET

CURVES

DR. PHIL

E-DIETS

EAT CLEAN DIET

FAT FLUSH PLAN

FAT SMASH DIET

FLAT BELLY DIET

THE FLAVOR POINT DIET

FRENCH WOMEN DON’T GET FAT DIET

THE GI DIET

GRAPEFRUIT DIET

THE PERFECT BODY DIET

PICTURE PERFECT DIET

PRITIKIN DIET

SCARSDALE DIET

SKINNY BITCH DIET

SNACK FACTOR DIET

THE STEP DIET

STRUCTURE HOUSE DIET

SUGAR BUSTERS DIET

SUZANNE SOMERS DIET

THE SOLUTION

TEN YEARS THINNER

THE THRIVE DIET

YOU ON A DIET

US per capita red meat, poultry, and fish availability (kg/y).

Barnard N D Am J Clin Nutr 2010;91:1530S-1536S

©2010 by American Society for Nutrition

US per capita use of added fats and oils (kg/y).

Barnard N D Am J Clin Nutr 2010;91:1530S-1536S

©2010 by American Society for Nutrition

US per capita cheese consumption(kg/y).

Barnard N D Am J Clin Nutr 2010;91:1530S-1536S

©2010 by American Society for Nutrition

Vitamin C

Vitamin A Anti Cancer

Carotenoids,

Vitamin C,

Manganese and

Selenium (SOD)

Copper, nasunin,

Lycopene

Anthocyanins

Polyphenols/Lignans

Vitamin C

Lycopene

Vitamin K, Folate,

antioxidants

Sulforaphanes

Zeaxanthin, polyphenols,

Potassium, floride, iron,

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Men Women

Fruits Veg

CDC MMWR 59(35);2010.

% OF ADULTS ACHIEVING THE RECOMMENDED DIETARY

INTAKES OF FRUITS AND VEGETABLES

Diet/Nutrients

Physical Activity

Stress Response

Sleep

Environmental Factors

Community and Purpose

ADAPTED FROM THE ORIGINAL PRESCRIPTION BY THOMAS GUILLIAMS

PHD

HEALTH

WHY IS EXERCISE IMPORTANT?

80% of all chronic illness is

related to lifestyle behaviors

SITTING VERSUS EVERYTHING ELSE

• Sleeping 48 calories

• Sitting 55 calories

• Standing 65 calories

• Walking 138 calories

• Cooking 138 calories

• Sex 221 calories

• Jogging 524 calories

• Based on 60 minutes of activity in a woman (5’5, 115 lbs)

I-Min Lee et. al. Lancet Vol 380 July 21, 2012

Inactivity causes 9% (range 5.1–12.5)

of premature mortality, or more than 5.3 million of the 57 million

deaths that occurred worldwide in 2008.

If inactivity were not eliminated, but decreased instead by 10% or 25%,

more than 533 000 and more than 1.3 million deaths, respectively, could

be averted every year. We estimated that elimination of physical

inactivity would increase the life expectancy of the world’s population

by 0.68 (range 0.41–0.95) years

Effect of physical inactivity on major non-communicable

diseases worldwide: an analysis of burden of disease

and life expectancy

Copyright © The American College of Cardiology.

All rights reserved.

From: Low-Risk Diet and Lifestyle Habits in the Primary Prevention of Myocardial Infarction in Men: A

Population-Based Prospective Cohort Study

J Am Coll Cardiol. 2014;64(13):1299-1306. doi:10.1016/j.jacc.2014.06.1190

The combination of healthy behaviors (found in only 1%) could prevent 79% of MI

events on the basis of the study population

Photo credit: Flicker.com/photos/compfight

What is mindfulness?

The skill of being deliberately attentive to one’s

experience as it unfolds-without the superimposition of

our usual commentary and conceptualizing.

*Practicing Mindfulness: An Introduction to Meditation

Professor Mark W. Muesse

Rhodes College

Photo Credit: <a href="https://www.flickr.com/photos/70140013@N07/7416282758/">ShotHotspot.com</a> via <a href="http://compfight.com">Compfight</a> <a href="https://creativecommons.org/licenses/by/2.0/">cc</a>

November

2014

Scientific American

November 2014

Conclusion: There is emerging evidence that certain areas of the brain actually grow more connections in those who meditate compared to those who do not.

HEALTHY LIFESTYLES ARE ASSOCIATED WITH HIGHER NATURAL KILLER CELL ACTIVITY

• Kusaka et al.

• Looked at: smoking, alcohol, sleep, exercise, breakfast, balanced nutrition, hours of work, and mental stress

• Conclusion: Higher NK activity with healthy lifestyle practices may reflect an increase in the cytolytic potential of NK cell activity within the CD16 and CD57 subset

• CD16-Fc receptor of IgG Ab activates Ab dependent cell mediated toxicity

• CD57-distinct mature NK cell=more potent lytic activity

Preventive medicine: volume 21, issue 5, september1992, pages 602-615

GREATEST DISCOVERY OF OUR TIME

The new science of epigenetics reveals how the choices you make can change your genes …

by John Cloud

NUTRIGENOMICS

• How nutrients in your diet affect the expression of your genes

FOOD CHOICES AFFECT YOUR LIFE

DNA METHYLATION• One way to control gene expression

METHYLATION REVIEW

• Addition of CH3 (methyl) group to DNA/RNA, neurotransmitters, hormones, immune cells, nerves, environmental toxins

• This modification in DNA alters gene expression

• Methylation of DNA helps to “lock” genes in an off position

• Methylation cycle involved with: detoxification, immune function, Maintaining DNA, energy production, mood balancing, controlling inflammation

• Basic nutrients needed: B12, glycine, serine, B6, selenium, cysteine, methionine and folic acid

HOW FOODS INTERACT WITH YOUR DNA

FOODS AND HABITS THAT DEPLETE METHYLATION

• Tobacco

• Caffeine

• Alcohol

• Sugar

• Processed and canned foods

• Animal protein increases homocysteine

• Saturated fats

• Metal toxicity

WHAT CAN LIFESTYLE CHANGE?

• Reduce and reverse coronary disease

• Reduce prostate cancer: Ornish D et al. Journal of Urology. 2005;174:1065

• Affects gene expression in a short time

• Down regulate different oncogenes that promote prostate and breast cancer

• Decrease aging process through telomeres

Conclusions.— More regression of coronary atherosclerosis

occurred after 5 years than after 1 year in the experimental

group. In contrast, in the control group, coronary

atherosclerosis continued to progress and more than twice as

many cardiac events occurred.

DIABETES

• 29.1 million people or 9.3% of the population

• Cost in 2014 is $245 billion

• 43% hospital inpatient care

• Costs expected to rise exponentially

• Lifestyle trumps medications:

• NEJM 2002;346:393-403

DIETS HIGH IN ANIMAL PROTEINS

• 75% increase mortality

• 400% increase in cancer risk

• 500% increase in diabetes

• Higher levels of IGF-1 (some cancers grow more easily)

Levine ME et al. Cell Metabolism 19, 407-417, March 2014

Winter 2014

Food is information for our genes.

Bland, J. What role has nutrition been playing in our health?

The xenohormesis connection. Integrative Medicine 6(3);

Jun/Jul 2007.

Surh Y-J, (2003) Nature Reviews Cancer. 2003;3:768-780.

Bioactive

Phytochemicals

• Indole-3 carbinol

reduced

cervical

neoplasia in

women

• Other foods

containing

isoflavones may

improve

outcomes as

well

EFFECTS OF HERBS AND SPICES

• Healing properties

• Anti-inflammatory

• Antioxidants

• Antimicrobial

• Antifungal

• Aid in digestion

• Ginger

• Peppermint

• Turmeric

• Black pepper

The Atlantic

March 24, 2014

Adherence to a

Mediterranean diet and

healthful lifestyle is

associated with a more

than 50% lower rate of all-

cause mortality and cause-

specific mortality.

CONCLUSION OF ALL DIETS REVIEWED

“A diet of minimally processed foods close to nature,

predominately plants, is decisively associated with health

promotion and disease prevention”

Katz and Meller. Annu Rev. Public Health 2014. 35:83-103

INHIBITORS

Busy Practice OBAMACARE AND REGULATIONS

Meaningful Use

Requirements Time

Training/Education

Limited Referral Sources

Treatments:MedicalSurgical, Alternative

Disease/Illness

Toxic exposures

Lifestyle behaviors

Fitness

Nutrition

Avoid

This

By

Improving

This

SUMMARY

• Only able to scratch the surface

• Obesity can cause many chronic diseases-PREVENTABLE

• Inactivity can cause many chronic diseases-PREVENTABLE

• We need to rethink our definition of health

• We need to emphasize nutrition as a health habit

• Empower patients to help themselves

THANK YOU