Plant-Based Resources

[MikeyG]

Every so often I put together a collection of resources in discussions with others, and I wanted to share them in the event that the rest of you may benefit from the material. This will be a collection of those discussions.

Cancer
- Diet and Cancer: viewtopic.php?f=21&t=41997#p432908

BMI
- Diet, BMI and Health: viewtopic.php?f=21&t=41997#p432906

Getting Started on a Healthy Diet
- Implementing a Healthy Diet: viewtopic.php?p=434701#p434701

Diabetes
- Diet and Diabetes (w/ Spanish-Language Resources): viewtopic.php?p=432028#p432028

Policy
- White House Petition: Food Choice & Health: viewtopic.php?f=21&t=41997#p434702

[MikeyG]

Diet and Diabetes (w/ Spanish-Language Resources): (3/13/14)

It appears that there is an established and growing body of evidence to suggest that high carbohydrate, low-fat diets may be more beneficial in preventing and and effectively treating diabetes and insulin resistance than traditional approaches that limit carbohydrate intake. One recent study I saw reviewed, which I would be happy to dig up, has found that even patients with Type 1 Diabetes have been able to reduce their insulin doses following such a diet, as well as reducing their risk factors for many other chronic diseases. (Found it : http://pcrm.org/health/medNews/fat-matt ... 1-diabetes )

Also, from the linked study, an interesting comment from the study author on why high-fat diets may not be easily identified as harmful for diabetics:

"It is noteworthy that a recent study (3) demonstrated that higher-fat meals containing 35 g of fat (a quantity intermediate between that given in Wolever and Mullan [4] and our [2] study) cause late postprandial hyperglycemia in children with type 1 diabetes. This increase in the glucose excursions occurs approximately 3–5 h postmeal, also highlighting that meal-challenge tests need to be of sufficient duration to uncover the glycemic effect of dietary fat" (http://care.diabetesjournals.org/conten ... /e212.long)

Here's more on the high-carbohydrate approach, with peer-reviewed citations:
- http://www.drmcdougall.com/health/educa ... /diabetes/
- http://www.pcrm.org/health/healthcare-p ... r-diabetes
-- (Wow. Also available in Spanish: http://www.pcrm.org/health/health-topic ... y-diabetes )
-- Here are some more Spanish-language resources: http://www.pcrm.org/health/diabetes-res ... for-health

I hope you find the information at least as worthwhile as I have.

Unfortunately, it seems that high-carbohydrate, low-fat diets in the treatment of diabetes have not seen much widespread use in clinical practice.

For example, while the American Diabetes Association seems to recommend the inclusion of health-supporting, minimally processed starches [whole grains, starchy vegetables, and legumes], they seem to still advocate limiting portion sizes of these carbohydrates: http://www.diabetes.org/diabetes-basics/myths/.

How to construct an optimally healthy diet that follows these guidelines for the treatment of diabetes and other chronic illnesses: viewtopic.php?p=434701#p434701

More resources about the other conditions that can benefit: http://www.drmcdougall.com/health/educa ... ot-topics/

Please have a wonderful day.

---
Part 2, after receiving feedback: [3/14/14]

Thanks for the feedback. I really hope you do enjoy the information. Please feel free to share it with anyone you think it may benefit

Jeff Novick is an incredible RD I have encountered in researching lifestyle medicine, and he goes over how to apply many of the principles of an evidence-based, optimally healthy, minimally processed, high-carbohydrate diet here: viewtopic.php?p=430007#p430007

Dr. McDougall also has an extensive section of his website where he goes over "Hot Topics" in health and nutrition and his analysis of the peer-reviewed literature. It also outlines many of the health issues he believes can benefit from the diet that he and Novick both promote. That's here: http://www.drmcdougall.com/health/educa ... ot-topics/

Of all the health professionals prominent in lifestyle medicine that I have encountered, including Barnard (of PCRM), Esselstyn, Ornish, and Pritikin; Novick and McDougall seem to be the most evidence-based and the most generous in how they provide the vast majority of their information for free on their websites. (McDougall at drmcdougall.com , and Novick at jeffnovick.com ) PCRM definitely deserves some major credit though, I think, for providing Spanish-language materials.

Novick and McDougall have also both worked with underserved populations in California through the recent Meals for Health programs in Sacramento and Oakland. They have had great results so far, it appears: http://donforrestermd.com/?page_id=89

Novick and McDougall also estimate that their dietary recommendations can be followed and meet all our nutritional requirements for $3-5/day, depending on the region and the foods an individual includes. Novick also outlines some of the recipes used in the Meals for Health program that can achieve these targets here: viewtopic.php?t=7168

From Novick at that link: "[The recipes] consist of 5 basic ingredients and all meals can be cooked in around 5-15 minutes from start to end. All are prepared in a large pasta "style" pot. I think mine is [a] 7 or 8 qt." I have found microwaving also works just as well, although you can't quite fit the same amount of food in a microwave at one time, so preparing via microwave takes a bit more staging.

Most of the recipes that he employs use low-cost staples like dried legumes, brown rice, oats, and potatoes. These items should be readily available in most areas where food can be purchased. I believe Wendy's still sells plain baked potatoes and salads, in the event someone has to go the fast food route, which is normally much more expensive. Novick has found that steak houses and many Asian restaurants can easily provide plain baked potatoes, brown rice, and steamed vegetables as well. Novick has traveled quite a bit throughout his career, and has always managed to find food compliant with his guidelines wherever he is at any given time, although, as we discussed, eating out tends to be more expensive and less healthy.
(On finding healthy food:
- viewtopic.php?p=139668#p139668
On restaurants:
- viewtopic.php?p=50474#p50474
- viewtopic.php?p=50543#p50543)
Novick also reviewed a diet based on Wendy's baked potatoes and side salads. While it is expensive ($16.50/day), it is surprisingly adequate from a nutritional perspective: viewtopic.php?p=68927#p68927
Designing a potato/vegetable diet at home could be achieved with far better results, both from an economic and nutritional perspective.

For those of us who are healthcare professionals, PCRM is also responsible for this free, online CME program promoting lifestyle medicine:

"*Free Online Continuing Education Credits*
This site offers free online continuing education to health care professionals interested in using nutrition for health promotion and disease prevention." (http://www.nutritioncme.org/)

This appears to be an incredible opportunity, as Novick has found that the industry-influence in health education is extensive, and has prevented many health professionals from being exposed to lifestyle medicine and its potential impact: viewtopic.php?p=41239#p41239

Thanks so much for the feedback about your work with the communities in Santa Ana. The diabetes program seems to follow the holistic treatment model that Dr. Ornish has pioneered with great success. In addition to the lifestyle components, Ornish has demonstrated that the dietary recommendations that Novick/McDougall promote have been found to be effective in treating and reversing heart disease and prostate cancer. The other lifestyle medical professionals I mentioned have found similar results with their patients, and seem to believe the effect is largely attributable to the recommended diet, as some of the research has strongly indicated. Dietary treatment has been found to be effective in addressing heart disease, high blood pressure, diabetes, cancer, and many autoimmune diseases like multiple sclerosis; just to name a few.

Novick's review of the literature and the figures that many major health organizations put out has led him to believe that at least 70% of our chronic diseases can be prevented, treated, and potentially reversed with simple diet/lifestyle changes: http://www.jeffnovick.com/RD/Articles/E ... _Ugly.html

Unfortunately, very few people follow the optimal lifestyle recommendations, or fully understand what they are.

T Colin Campbell, a researcher well known for nutritional research, has also come to similar conclusions:

"To summarize, adoption of the WFPB [Whole Foods Plant Based] dietary lifestyle offers far more health benefits than the modern medical system. For those who comply, current evidence shows that at least 90% of all cardiovascular disease and type 2 diabetes, upwards of 70% of all cancers, and a broad spectrum of other illnesses can be prevented, even cured. Assuming that this message is effectively communicated, I estimate that at least 75% of contemporary health care costs could easily be saved. Sparing the side effects (often death) of the existing system would be a very large additional bonus." (from: http://www.independentsciencenews.org/h ... w-medicine)

McDougall would also agree, I think, and here is a recent presentation he has released on the topic of diet therapy: http://www.youtube.com/watch?v=kOfF_r2R8QM (McDougall has made many other videos available on that YouTube channel and on his website, for anyone interested.)

Here is one recent McDougall/Novick success story, from an individual who followed their recommendations solely by accessing their free online materials: http://drmcdougall.com/forums/viewtopic ... 81#p355981 (He mentions two of McDougall's books, but all of the information the books contain is freely available on McDougall's website.)

I find his story particularly notable because he tracked his biomarkers meticulously during his first year following the program, and he has shared their values with the rest of us at the link above. Here is what he found after a year on the program:

"But if you can’t be bothered by the numbers here’s what they show:

0. 106.2 lbs lost
1. No more obesity [BMI from 35.4 to 21.0]
2. No more high blood pressure
3. No more high pulse rate
4. No more diabetic blood sugars
5. No more chronic kidney deficiency
6. No more [abnormal] ALT levels
7. No more high Total cholesterol
8. No more high LDL
9. No more high VLDL
10. No more high cholesterol ratio
11. No more high trigylcerides
12. No more high CRP
13. Normal liver function
14. Normal kidney function
15. Normal electrolyte levels
16. Normal calcium levels
17. Normal protein levels"

What I find very valuable is that we can see many of his serum biomarkers improved to within normal levels in three months, and then continued to get better over the course of the year. He also achieved all this without medications.

McDougall holds 10-day residential programs for those who believe they are worth the expense, and in many cases he has found that once the individuals are following the program, many of their medications can be reduced or even eliminated within a few days. In many cases, blood pressure and diabetic medication *must* be stopped to prevent hypotension and hypoglycemia, due to the power of the diet in normalizing blood pressure and blood sugar. (http://www.drmcdougall.com/misc/2011nl/jun/promise.htm)

Many more success stories can be found here: http://www.drmcdougall.com/health/educa ... nce/stars/

While they are not peer-reviewed case reports, it seems that many individuals starting the program find significant encouragement in being able to identify actual people who have gone through the process and found amazing success. Additionally, as McDougall and Novick repeatedly emphasize, these results *are* typical, so long as the program guidelines are closely adhered to and adhered to for sufficient time. Results are also not all or none, so the more closely an individual is willing to follow the guidelines, the more benefits he/she will be able to enjoy.

Again, I hope you find the information at least as worthwhile as I have. Please let me know if I can be of any additional support, although I would highly recommend referring to the resources that McDougall and Novick have provided through their websites. Both Novick and McDougall also seem to be very responsive to questions, both by e-mail and on the McDougall discussion boards. Novick alone has made 5433 posts (as of this moment) on the McDougall message boards, including the forum there that he personally maintains. His posts can be easily searched from here: search.php?keywords=&terms=all&author=JeffN&sc=1&sf=all&sr=posts&sk=t&sd=d&st=0&ch=300&t=0&submit=Search . Should a question arise that he has not covered, Novick is normally very quick to respond.

(Also, Novick's forum is here, with many "sticky-ed" posts of frequently asked questions and common topics: http://drmcdougall.com/forums/viewforum.php?f=22 )

If I can further help sort through the information, especially due to my experience in doing so, please let me know. While it would be difficult for me to commute out to directly help your work, I am happy to do all that I can to support you remotely

Thank you again for all that you are doing on behalf of our community. Santa Ana and the community that you serve are very fortunate to have you, as are the rest of us I hope you and anyone else reading this are having an amazing day.

[MikeyG]

In a discussion of: http://www.huffingtonpost.com/2014/02/0 ... ertainment (Rachel Frederickson, the biggest loser winner, being criticized for becoming "far too thin," potentially endangering her health, and setting a terrible message for the biggest loser audience.)

Rachel Frederickson's statistics, from The Biggest Loser:
260 lbs starting; 105 ending weight
Height: 5'4"
BMI: 44.6 Starting; 18.0 Ending

The preponderance of scientific research to date strongly suggests that the optimal BMI range is on the low end of 18.5-22. Recent research, described below, also suggests that lower than 18.5 can still be optimally healthy, but this research has not been as conclusive, which is also described below. (Frederickson's final weight is approximately 3 lbs. below a BMI of 18.5, which could mean she was slightly dehydrated before weighing, had not eaten yet, or both.)
This recent discussion, featuring Jeff Novick, MS, RD, serves to put things in perspective regarding weight, BMI and other health biomarkers, I think: viewtopic.php?p=426450#p426450

BMI, like all other biomarkers, is just one health indicator, and the guidelines represent dynamic ranges in populations. Thus, the differences between the 18.0-19.0 range on BMI scale are probably not very meaningful. However, I think we can clearly state that a BMI of 18.0 reduces the risk of disease and disability far more than a BMI of 44.6.

However, as we have discussed here, for optimal health we need to emphasize optimally healthy lifestyles, not just the manipulation of a single biomarker, like BMI. Yet weight is still a major factor in the morbidity and mortality plaguing the United States and the globe, and diet has been found to be predominantly associated with excess weight:

- 68.8% of adults are overweight or obese; 35.7% are obese.
- 31.8% of children and adolescents are overweight or obese; 16.9% are obese.
(http://frac.org/initiatives/hunger-and- ... in-the-us/)

We also know, from the American Heart Association, that while 90% of people claim they consume a healthy diet and over 1/3 of those say they consume a very healthy diet, only 0.5% of individuals meet the minimum requirements for a healthy diet. (http://www.jeffnovick.com/RD/Articles/E ... ews!!.html)

Thus, while the weight of the recent Biggest Loser contestant is evidence-based as still within the healthy range, the excessive exercise portrayed in the Biggest Loser does not seem to be the best prescription for health, and it does little to address the many other biomarkers and lifestyle practices that support optimal health, which I hope Frederickson is aware of. For anyone else interested in that information, I have included it below.

Thanks for the incredible discussion, and please have a wonderful day.

---
Some recent studies on BMI and health care costs:
- Duke study finds healthcare costs increase starting at BMI of 19: http://www.dukehealth.org/health_librar ... -body-mass
-- Study did not go below BMI of 19, but provides evidence that higher BMI's are associated with poorer health outcomes
--- More discussion here: https://www.facebook.com/JeffNovickRD/p ... ream_ref=5
- "Energy efficiency as a unifying principle for human, environmental, and global health" http://f1000research.com/articles/2-101/v1
-- From the figure, we can see that healthcare costs are lowest at a BMI of 18. (http://cdn.f1000r.com.s3.amazonaws.com/ ... igure1.gif)
--- Research has indicated that BMI's below 18.5 are often associated with other negative health issues, which makes it unclear that a BMI lower than 18.5 may be optimally healthy. The consensus seems to be that more research is needed before we can make recommendations for maintaining a BMI lower than 18.5, as most research to date has not removed the confounding factors of low BMI that is associated with other negative health conditions. Cancer patients, for example, tend to be thin, but their healthcare issues are not due to their low BMI, but due to their cancer.

American Cancer Society 2009 recommendation:

"Be as lean as possible throughout life without being underweight."

It mirrors the one from the American Institute of Cancer Research, which came out in 2007 ...

"Be as lean as possible without becoming underweight. Maintaining a healthy weight is one of the most important things you can do to reduce your risk of cancer. Aim to be at the lower end of the healthy Body Mass Index (BMI) range.""

from: https://www.facebook.com/JeffNovickRD/p ... ream_ref=5

Also, since the Huffington Post article referenced eating disorders, there is a substantial difference between maintaining a low BMI for optimal health while following an optimally healthy diet, and an eating disorder. More on that, here: viewtopic.php?p=110988#p110988

"While the reality of eating disorders can be very serious with dire consequences, I believe there are many people who think they have a eating disorder, but do not really have the disease.
...
It is kind of like in the 80s when 12-step programs were in vogue. Anyone who had any run in with the law that involved any drug or alcohol, was mandated to go to a 12-step program for 6 mo to a year. Suddenly everyone was walking around claiming to be an addict of one type or another, when many of them may have had a single incident that got them in trouble or no real problem to begin with. Eventually, they stop going and realize they are not, and were never truly, an addict.

I have worked with several families who thought their adolescent or teenagers (usually female) had eating disorders, and over time, they seem to "grow out of them".

The difference today is people are overeating not because there is something wrong with them, but because there is something "right" with them. This is what humans do when they are put in an environment where there is an abundance of readily available high calorie dense foods. They over eat. In ancient times, it was called gorging. And if humans didn't gorge when there was "plenty", they would starve when there was "famine", which always followed. What we have know is an unnatural cycle of an incredible "plenty" with no natural cycles of "famine".

This is not to minimize the reality of the problem for those who do suffer. And, there may be serious emotional or psychological issues behind some of the eating disorders, which in that case, is the eating disorder a disease, or a symptom of an underlying issue? There is a very high percentage of those with eating disorders who have a "dual" diagnosis (depression, bi-polar,etc) and/or had childhood trauma (usually sexual in nature)."

viewtopic.php?p=46690#p46690

A common contention is that athletes can still be healthy at a higher BMI. However, research to date has suggested that is not the case, and athletes with higher than optimal BMI's suffer from many of the same health consequences as their sedentary peers. Thus, the belief that it is possible to be "fat and healthy" has not been supported by the evidence, which is well-presented in the following discussion on "Optimum BMI:" viewtopic.php?p=415473#p415473

In addition, the evidence indicates that the method that the Biggest Loser employs to achieve and maintain these low BMIs, extreme exercise, is probably not the healthiest method, as research on health and longevity has indicated that excess exercise can actually be harmful to health: ("Diet vs. Exercise:" viewtopic.php?p=415371#p415371 )

Thus, the science would indicate that our best option is to maintain an optimal BMI through optimally healthy dietary choices.

Here's some information on how to do that:

Healthy Eating Placemat, summarizing all the evidence-based lifestyle recommendations for optimal health: http://jeffnovick.com/RD/Q_%26_As/Entri ... ating.html
- More on how to manage weight successfully by making evidence-based food choices, emphasizing calorie density, which has found to be the most effective way to achieve and maintain a healthy weight: http://jeffnovick.com/RD/Articles/Entri ... u_Eat.html

While following a healthy diet and maintaining a healthy weight may be difficult in a society where pharmaceutical and food lobbyists would much rather we spend our money on drugs and unhealthy foods, the potential benefits are enormously encouraging:

"To summarize, adoption of the WFPB dietary lifestyle offers far more health benefits than the modern medical system. For those who comply, current evidence shows that at least 90% of all cardiovascular disease and type 2 diabetes, upwards of 70% of all cancers, and a broad spectrum of other illnesses can be prevented, even cured. Assuming that this message is effectively communicated, I estimate that at least 75% of contemporary health care costs could easily be saved. Sparing the side effects (often death) of the existing system would be a very large additional bonus." (from: http://www.independentsciencenews.org/h ... w-medicine)

The WFPB (Whole-Food-Plant-Based) dietary lifestyle, as supported by the evidence, is one where at least 95% of our calories are derived from minimally processed fruits, vegetables, starchy vegetables, whole grains, and legumes. The research has yet to indicate that more than 95% offers additional benefit, but the current trend does suggest that may be the case: http://www.jeffnovick.com/RD/Articles/E ... e_Way.html

For more on evidence-based health, I would highly recommend Jeff Novick's freely available materials, which can be found here: http://www.jeffnovick.com/RD/Articles/Archive.html

Jeff Novick, MS, RD is the most evidence-based health professional I have encountered in my review of the material, and he also provides that vast majority of his information for free.

I hope you find the information worthwhile. Please have an amazing day.

[MikeyG]

[I wrote this up for a friend struggling with the effects of cancer on his/her family.]

"I am very sorry to hear about the challenges you and your family have faced and are facing, and I hope being flooded with well-meaning people has not added too much of a burden. At least we know how many people out there care deeply about you and your family. As I said, thanks for being such an incredible person

I am happy to provide as much support as I can, and I am deeply honored to hear that you trust my sources and opinions. I am glad to hear that you and your mom are both skeptical, however, as I think it is important to evaluate all the health claims that float around the media and even among health professionals. I could potentially be just as susceptible, so please don't accept my conclusions without further scrutiny. However, I have found Novick and McDougall to hold themselves to the highest standard of evidence-based analysis, and I hope you find the same as you read through their recommendations and the sources they cite for these conclusions.

Novick has a great post about evaluating evidence, and I would highly recommend it. His recommendations have helped me a great deal in sorting through reasonable and unreasonable advice, especially on the subject of health:

"The Importance of Evidence"
http://www.drmcdougall.com/forums/viewt ... 47#p277347

As you may have noticed, Jeff Novick posts on the McDougall message board as "JeffN". We can also search the McDougall message boards by author and find all of the posts he has made to date: http://www.drmcdougall.com/forums/search.php
With 5407 posts as of this moment, Novick has covered a variety of topics. However, it does not appear that either he or McDougall have specifically covered [your cancer], but much of their information seems like it may be relevant, especially in light of what you have told me:

McDougall is not a fan of chemotherapy for general cancer treatment, if I recall. I believe, as indicated in many of his articles on the Breast Cancer hot topics page, that he continues to recommend surgical removal of any tumor, with clear margins, and then adherence to the diet he recommends, which has been found to be extremely effective at both fighting and preventing cancer.
Here's McDougall on his position for the treatment of breast cancer: http://www.drmcdougall.com/forums/viewt ... 66#p300966

"I do not recommend routine mammograms for screening for breast cancer in any age group. Furthermore, I do not teach or encourage breast self-examination. Both efforts cause real harms with questionable benefits. How does a woman find out she has cancer? By casual detection, such as when she is washing in the shower and finds a hard lump. That’s the time to get into the medical business, but not before. And my usual recommendation for that hard lump is surgical removal of the lump only (with clear margins): no radical surgery (mastectomy), and no routine radiation or chemotherapy."

For certain cancers, however, Dr. McDougall does seem to believe traditional cancer treatments, including chemotherapy, provide clear benefits that seem to outweigh the harms, based on the evidence: "Cancer is people’s greatest fear because it is thought of as an unstoppable disease. All hope is placed in medical treatments, such as surgery, followed by radiation and drug (chemo) therapy, even though four decades of scientific research has clearly established the ineffectiveness and harms of these treatments for common cancers, such as those of the breast. (There are exceptions: For a few cancers, such as leukemia, lymphomas, childhood and testicular cancer, the results are good and the patient’s life is unquestionably extended and benefited by traditional medical treatments.)" (http://www.drmcdougall.com/misc/2012stars/jessica.htm)

Here's McDougall's Hot Topics page, which covers a variety of issues, including Breast Cancer, as I stated: http://www.drmcdougall.com/health/educa ... ot-topics/

Here's one example of the power of the plant-based diet McDougall/Novick recommend on cancer: http://www.drmcdougall.com/forums/viewt ... 50#p310350

From the above: "The first study was actually done by both the Pritikin and Ornish groups, and, as he describes, was 8x better than the SAD [Standard American Diet] in fighting prostate cancer cells (9% vs 70%)
...
He then moves on to breast cancer to show the power of a plant based diet in just 2 weeks in its ability to both slow down the growth rate of several types of breast cancer cells and also to actually kill breast cancer cells.
...
In the third Pritikin study, he looks at the effect of exercise and a plant based diet on cancer cells. In this study, they compared the control group (sedentary SAD) to those on the SAD for 14 years who exercised heavily and to those who were on the plant based diet with moderate exercise for 14 years. The Pritikin diet was 2x as powerful. "

The Pritikin and Ornish programs, as indicated in the studies, fell closer to McDougall/Novick's current dietary recommendations at the time the studies were conducted. More recently, the Pritikin and Ornish diets have become more liberal, potentially in an attempt to attract more participants. Thus, I would still strongly recommend McDougall/Novick's guidelines, especially Novick's, as he worked for the Pritikin center as Director of Nutrition before the diet became more liberal.

McDougall/Novick's dietary recommendations tend to reduce the symptoms of GERD and acid reflux, so that may be very helpful: http://www.drmcdougall.com/health/educa ... -problems/

On meal planning for a cancer patient: http://www.drmcdougall.com/forums/viewt ... 603#p41603

(In the above discussion, Novick discusses how the food preferences of a cancer patient, especially during chemo, may actually make the Novick/McDougall diet more appealing and easier to transition into. Most of the foods also tend to be very easy on the digestive system, especially when one gets used to the increased amount of dietary fiber, and it seems they can be very palatable for many despite the appetite-reducing nature of chemotherapy.)

(In addition, here's my primer for implementing a healthy, evidence-based diet/lifestyle, which covers Novick/McDougall's resources: http://www.drmcdougall.com/forums/viewt ... 01#p434701 . I hope that helps make finding and reviewing the information easier.)

I am not sure how tall your [family member] is for the weight that you mentioned, as it may be somewhat beneficial for [him/her] to maintain a low BMI for optimal health. The health recommendations based on the evidence that I have seen, especially for cancer and chronic disease prevention, seem to suggest that the best health outcomes are associated with BMI's of around 18.5.

I wrote up this detailed discussion on BMI, which talks about the various health issues related to BMI; how the science indicates that a lower BMI tends to be more health-promoting; and how to go about achieving that BMI in an optimally healthy way, primarily by planning a diet according to the McDougall/Novick recommendations: http://www.drmcdougall.com/forums/viewt ... 06#p432906

Towards the end of the post on BMI, I also go into how to plan the most evidence-based and healthy meal plan, as recommended by Novick and McDougall. If you have trouble finding the information please let me know. I think it is valuable regardless of the perspective on BMI that I shared in the post.

(Novick also recently had a great overview of how to plan and implement the meal plan here, especially for someone who was concerned with portion sizes and how much to eat. I would highly recommend it: http://www.drmcdougall.com/forums/viewt ... 07#p430007 )

Maintaining a low BMI may also be beneficial to prevent further cancer and/or cancer progression: http://www.drmcdougall.com/forums/viewt ... 981#p77981

Novick also has an excellent section of Dr. McDougall's message boards, in addition to his website, where he goes through a variety of other subjects that you may find valuable. Here's a discussion he devoted to the questions he most frequently receives:

"Nutrition & Health FAQ: Answers To The Most Asked Questions"
(http://www.drmcdougall.com/forums/viewt ... 22&t=37233)

Novick is very responsive to questions posed on his message board, and both he and Dr. McDougall appear to be very responsive to e-mails. Thus, in the event you can't find anything in what they have already written that addresses a question or concern, I would highly recommend asking them directly. However, I am happy to help sift through their information with you, too, as I seem to have become somewhat proficient in doing so through my own review of the material.

Also, both Novick and McDougall have written about working with doctors while making evidence-based lifestyle changes like the ones we are discussing. Since research indicates that only 0.5% of the population, including health professionals, meet the minimum requirements of a healthy diet, McDougall and Novick's patients often have to learn to be a bit more cautious in working with health professionals who may not be supportive despite the evidence supporting their efforts. (On the 0.5%: http://www.jeffnovick.com/RD/Articles/E ... _Ugly.html)

Novick: http://www.jeffnovick.com/RD/Articles/E ... octor.html

McDougall: http://www.drmcdougall.com/health/educa ... opics/mds/

Novick's article outlines a variety of additional, recommended resources, most which need to be purchased. However, in my experience I have found that Novick and McDougall provide all the information present in their paid resources for free online. That is a major reason why I recommend their resources, although I do like to purchase their works when I can to help support their efforts. As I said though, I find that paying for the information is completely optional, since they are kind enough to provide all their evidence-based information to us for free.

That is all the relevant information I can come up with at the moment. However, as I said, please feel free to let me know if I can be of any additional support in sifting through these resources or helping examine any of the recommendations. I hope you and your family find incredible success in your health pursuits, and I hope that at least some of these resources help you to do that should you decide to use them.

Seeing the progress Novick and McDougall, as well as many of their peers, have made with their patients and communities is also very inspiring, and I hope my future career may be able to help continue their great work at improving global health.

Please have an amazing day, and I look forward to staying in touch.

Warmly,
Michael

[MikeyG]

Diet and lifestyle are often the first solutions recommended for many of our chronic health issues, although many people seem to have difficulty finding success in applying these solutions. In many cases, while the most effective, evidence-based guidelines are very simple, most individuals who attempt diet/lifestyle changes may not understand how these guidelines or how to implement them. Thus, these individuals often fail to see results without understanding why, and feel doomed to medications to attempt to manage their health problems. Unfortunately, these medications are found to be frequently less effective than diet/lifestyle changes, and often come with many negative side effects and significant costs.

Jeff Novick is a registered dietitian and is the most evidence-based health professional I have encountered in roughly eleven years of studying diet/lifestyle. He has written extensively about diet/lifestyle and how they can influence health, and he makes all of his information available to us for free. His website is http://www.jeffnovick.com . Between his website and Dr. McDougall's forums, Novick has covered the majority of health issues that we may have questions or concerns about.

Dr. McDougall, MD, (http://www.drmcdougall.com) is also a wonderful resource, who provides all of his information for free. I find his guidelines to be only slightly less effective and/or evidence-based than Novick's on a few, minor issues, which is why I tend to preferentially recommend Novick. However, they are both amazing resources for us, and I am incredibly grateful to both of them for their dedication and generosity.

I would recommend following Jeff Novick's guidelines, outlined below, to address any health issues you may have. In some rare circumstances, individuals may continue to have chronic health issues that require medical support, but in many cases, those following Novick's guidelines can recover completely from chronic diseases to the point where they no longer need further medical interventions like medications or surgery, so long as they continue to follow the guidelines.

""To summarize, adoption of the WFPB [Whole Foods Plant Based] dietary lifestyle offers far more health benefits than the modern medical system. For those who comply, current evidence shows that at least 90% of all cardiovascular disease and type 2 diabetes, upwards of 70% of all cancers, and a broad spectrum of other illnesses can be prevented, even cured. Assuming that this message is effectively communicated, I estimate that at least 75% of contemporary health care costs could easily be saved. Sparing the side effects (often death) of the existing system would be a very large additional bonus."" - T. Colin Campbell (viewtopic.php?p=434702#p434702)

"A diet that is (1) based predominately on a variety of
minimally processed fruits, vegetables, starchy vegetables,
roots/tubers, whole grains and legumes and (2) low in fat, saturated fat, calorie density, and (3) low in added sugars, oils and salt, has been documented to prevent and/or reverse disease - even for those who are seriously ill - in many published studies over the last 60 years. The results from these studies, which use differing specific diets in them, documents the importance and the effectiveness of this overall dietary pattern over any one specific version of this diet. This dietary pattern is commonly referred to as the Whole Food, Plant-Based Low/No SOS diet or simply the WFPB SOS or just WFPB." (http://www.jeffnovick.com/RD/Articles/E ... _Pt_1.html)

While change can be difficult, in this case the potential benefits we can enjoy from adopting a healthy, evidence-based diet/lifestyle are profound.

To see how simple these guidelines actually are, we can review the "Mary's Mini-McDougall Diet." Many seem to find it to be a very easy method to get started with the evidence-based guidelines that Dr. McDougall and Novick recommend for an optimally healthy diet.

"Have you ever tried Mary's Mini-McDougall Diet? In 2006, after working with thousands of people over 3 decades, my wife Mary introduced a trimmed-down, fast-acting modification of the McDougall program—referred to from now on as “Mary’s Mini-McDougall Diet.”

The principles are the same as with those of regular McDougall diet: it is starch-based with the addition of fruits and vegetables. The difference is the goal is to lose weight quickly with as little effort as possible. You know, a “diet”—not really a lifestyle change. This is a temporary “quick fix” to be used as a tool for people overwhelmed by the initial challenges of starting on the McDougall program and/or to boost their progress when they feel that changes are coming too slowly. Yet, this is a nutritionally sound program that you, too, may want to follow for a long time, if not a lifetime.

Part 1: http://www.drmcdougall.com/misc/2006nl/june/marys.htm
Part 2: http://www.drmcdougall.com/misc/2006nl/july/marys2.htm"

from: https://www.facebook.com/DrJohnMcDougal ... eam_ref=10

This is actually a very simple diet that can be followed long-term, if desired.

As we can see from Jeff Novick, MS, RD's guidelines, simple diets following the principles Novick/McDougall recommend can easily meet all of our daily nutritional requirements:
- Optimally healthy guidelines: viewtopic.php?p=430007#p430007
-- I would recommend following Novick's guidelines at the above link over the principles of the Mary's Mini-Diet, as Novick's approach appears to be nutritionally superior. Novick's approach also goes more into the basis of the guidelines and how to apply them.
- Nutritional Analysis of a Simple, Optimally Healthy Eating Plan, like the Mary's Mini Approach: viewtopic.php?p=82851#p82851
- Quick Recipes: viewtopic.php?t=7168

Jeff Novick, MS, RD also did the nutritional analysis using Wendy's Baked Potatoes and side salads. While far more expensive (~$16/day) than we can do by preparing the food at home (~$2-3/day), the diet was surprisingly nutritionally adequate: viewtopic.php?p=68927#p68927

Some of the evidence for our guidelines:
- viewtopic.php?p=39887#p39887
- viewtopic.php?p=393473#p393473

Novick also has an excellent Diet/Health FAQ, answering these and many other questions: viewtopic.php?p=378563&sid=a31176d6c3ff7ea285434d7c5cf15cf9#p378563

In addition, Dr. McDougall also has an extensive Education section of his website, where he provides a wealth of information to us for free such as medical/health hot topics, video lectures, an extensive newsletter archive, success stories from many of his patients, and a free program outlining his guidelines. In addition, there are countless free recipes available there that can be adapted to adhere to Novick's guidelines (as some recipes include more calorie dense foods; like nuts/seeds, liquid calories, and flour products; which many seem to find detrimental in their progress toward optimal health): http://www.drmcdougall.com/health/education/

Please have an amazing day.

Below, I cover some common issues that many people may encounter in following a plant-based diet.
- Simply being "vegan" is not enough for health.
- Nutrient comparison across fresh, frozen, and canned foods
- Organic vs. Conventional Produce
- "High quality Foods" or "Superfoods" for Health
---

(Simply being "vegan" is not enough for health.)

"Just what New Yorkers needed, a 24-hour cupcake vending machine.

http://www.cbc.ca/player/News/Must%20wa ... 444819403/"

from: https://www.facebook.com/JeffNovickRD/p ... eam_ref=10

Comments from Jeff Novick, MS, RD:

"That is not true at all and is a very misguided myth in the vegan world. We do ourselves no good at all, nor the ability for us to do any good for the planet, animals etc etc if we are sick and unhealthy and die before our time.

This site is about health and not about veganism, especially vegan junk food, though many of us (me included) choose not to eat any animal products.

Sadly, most Americans are not doing unhealthy things occasionally and giving them more and easier access to junk food, vegan or not, wont help our real health problems, which **is** what this site is about.

You are welcome to disagree, but if you do, you may be hanging out in the wrong place. I would recommend you read this...

[When Vegan is Not Enough:]
viewtopic.php?f=22&t=36550"

"Here is Dr McDougall's take on the issue...

"Obviously vegans are exceptional people. With this one simple shift to a starch-based diet the word “vegan” will become synonymous with terms like healthy, trim, active, young, strong, and energetic, and finally the most important adjective, earth-changing."

http://www.drmcdougall.com/misc/2008nl/dec/fat.htm"

"Right, and it has nothing to do with whether the junk food is vegan (or organic, or GMO-free, etc), but that in a world literally killing itself with the abundant availability of cheap junk food, we make access even easier. That, regardless of the exact minutia of the junk food, is a crime."

---

Nutrient comparison across fresh, frozen, and canned foods:

viewtopic.php?p=434687#p434687

The consensus seems to be that in many cases, frozen and canned produce items; when obtained without additives like salt, sugar, and oil; are just as nutritious and health-supporting, if not more so, than fresh produce items."

---
The guidelines can also be followed with incredible success using non-organic produce. As far as I know, the vast majority of the research done on these health benefits and clinical outcomes was done using conventional, non-organic produce.

""However, the overwhelming difference between benefit and risk estimates provides confidence that consumers should not be concerned about cancer risks from consuming conventionally-grown fruits and vegetables. PMID: 22981907"
...
[T]hey are saying that if the fruit and vegetables were not organic, there may be 10 more cancer deaths per year.
...
Or, since the increase of 10 deaths [to the 290,000 who will die per year from cancer, which is the number that could occur due to picking conventional produce over organic produce] is really coming out of the half of the population that is not already dying of cancer,

10/150,000,000 = .00000667% [This seems to represent the potential impact of conventional produce vs. organic produce on the number of deaths per year to the population, according to this study.]

Clearly, the first priority is to eat more fruits and veggies, no matter what, regardless of whether they are organic or not."

viewtopic.php?p=431052#p431052

---
There are also no "superfoods" that we need to include in the guidelines to obtain optimal benefit. Just stick to the super food groups of whole grains, legumes, fruits, non-starchy vegetables, and starchy vegetables; and we will reap all the benefits we have seen, without needing to go out and buy purple kale, rainbow rice, or the next sensationalized exotic food.

High Quality Foods:
viewtopic.php?p=283877#p283877
---
For these topics, and any others, I would refer to Jeff's extensive forum discussions, Hot Topics, and Nutrition FAQ.

Please have an amazing day

[MikeyG]

Dear Friends,

I hope that this message finds you all very well.

After being continuously inspired by a variety of activists, including our favorite evidence-based health professionals like Dr. McDougall and Jeff Novick, I decided to try to bring more attention to the evidence supporting our plant-based message for optimal health.

In addition to contacting my federal senators and representative, state officials, local news station, and the White House, I thought a petition could also be a great way to expand public awareness of the impact of food choice on global, climate, and economic health.

Here is what I came up with: http://wh.gov/lyFO8

"https://www.facebook.com/mmflint/posts/10102911805116013?stream_ref=10

"To summarize, adoption of the WFPB [Whole Foods Plant Based] dietary lifestyle offers far more health benefits than the modern medical system. For those who comply, current evidence shows that at least 90% of all cardiovascular disease and type 2 diabetes, upwards of 70% of all cancers, and a broad spectrum of other illnesses can be prevented, even cured. Assuming that this message is effectively communicated, I estimate that at least 75% of contemporary health care costs could easily be saved. Sparing the side effects (often death) of the existing system would be a very large additional bonus."

Livestock & Climate Change: http://www.worldwatch.org/files/pdf/Liv ... Change.pdf"

Unfortunately, the petition will not be publicly featured on the "We the People" website until it reaches 150 signatures. Thus, if you believe it is a message worth spreading in the form of the petition I created, please feel free to sign the petition and spread it widely. The petition will be active on the website for 30 days

The Facebook link included in the petition goes to a discussion thread that I posted to Michael Moore's Facebook page, as I would think he and his audience might be interested in the climate, health, and economic impacts of our food choices. The petition website had a character limit, so the link to the Facebook post allowed me to more thoroughly explain and source the message I was hoping to express. I would hope that the information I gathered together and the sources I cited may also be at least as valuable to others as I have found them. Please feel free to add to the Facebook discussion I linked, to help enhance the discussion I started.

Thanks so much for your consideration, and for fostering such an amazing community. I have learned a great deal from Dr. McDougall and Jeff Novick, especially through their interactions with this website and its forums, which would definitely not be nearly as enlightening without your contributions to them. Also, I doubt I would have had the opportunity to encounter Dr. McDougall and Jeff Novick, who have made a tremendously positive impact in my life, if you had not decided to support them due to their impact on your lives. I am sure your support has given them many more opportunities to continue their amazing work and spread their message further than they would have been able to without you. You all do and have done incredible things for our greater good, in whatever way you may choose and have chosen to do so. Please keep it up the great work

Please have an amazing day.

Warmly,
Michael

---

[From the linked Facebook discussion, for preservation purposes.]

""Human Health, Climate Health, and Economic Health; Same Solution"
(Title inspired by: "Human Health and Planet Health—Same Solution" (http://www.drmcdougall.com/misc/2007nl/jan/warming2.htm))

Thank you very much for your coverage of both public health and the economy. However, could you please help bring more attention to the overlap between these areas? For a brief summary of that connection:

"[In 2006] the World Health Organization released a groundbreaking study showing that raising livestock (cows, pigs, chickens, etc.) to feed people produces more greenhouse gases than all the transportation (cars, trains, airplanes, etc.) combined. [http://www.fao.org/docrep/010/a0701e/a0701e00.HTM] Since 2006 the estimated greenhouse gas contribution from people eating meat, poultry, dairy, and eggs has risen to over 50%. [http://www.worldwatch.org/files/pdf/Livestock%20and%20Climate%20Change.pdf]" (http://www.drmcdougall.com/2013/11/30/a ... ndividual/)

"If we can prevent 80% of heart disease, stroke and diabetes and 40% of the cancer, we can prevent about 928,000 of the 1,429,000 [US deaths per year]. That's over 65%.

(NOTE: The WHO believes their figures are underestimates of the impact and the real impact would be much higher than just 65% And, these are minimums. What if we looked at 9-12 servings of fruits & veggies, a BMI of 18.5-22, exercising 30-60 minutes 5-6 days per week, and being smoke free. Also, in 2011, the WHO raised the number of deaths from chronic disease from 35 million deaths to 51 million deaths per year.)" (http://www.jeffnovick.com/RD/Articles/E ... _Ugly.html)

Reducing the disease burden through dietary change in this way, with the potential to prevent/treat/reverse 75% of chronic diseases, could bring the current US Healthcare Costs from 18% of GDP to 5% of GDP. (http://www.youtube.com/watch?v=Btfhp-e1E1M)

"To summarize, adoption of the WFPB [Whole Foods Plant Based] dietary lifestyle offers far more health benefits than the modern medical system. For those who comply, current evidence shows that at least 90% of all cardiovascular disease and type 2 diabetes, upwards of 70% of all cancers, and a broad spectrum of other illnesses can be prevented, even cured. Assuming that this message is effectively communicated, I estimate that at least 75% of contemporary health care costs could easily be saved. Sparing the side effects (often death) of the existing system would be a very large additional bonus." (from: http://www.independentsciencenews.org/h ... w-medicine)

As the detractors of climate change and universal health care often complain about the costs, the potential benefits to addressing both issues through dietary change are profound.

While the food industries may resist encouragement for such a shift in dietary preferences in the United States, they food producers may stand to save quite a bit in agricultural costs: viewtopic.php?p=429123#p429123

"Beef vs. Potatoes. (CWT = 100 lbs)
Total Costs/cwt of product:
- 2004: Beef: $104
- 2006: Potatoes: $5.23"

Please let me know if I can do anything more to help in bringing awareness to this topic. I feel that your audience would significantly benefit from the information, and I think it would be wonderful to bring more attention to this potential solution to many of our current public policy issues.

Thank you for all of your efforts, which I find both educational and inspirational. Please have an amazing day."

[RE: "See what the diet has done for Al? It's destroyed what few brain cells he had!"]

"Actually, an optimally healthy plant-based diet has been found to be effective prevention and treatment for many mental illnesses, including multiple sclerosis. It has also been found to improve mood and reduce aggression. Additionally, vascular dementia is very common in many of those suffering from dementia, and an optimally healthy, plant-based diet has been found to improve vascular function in all areas of the body, including the brain (http://www.heartattackproof.com/olympic.htm).

I would hope that the version of a plant-based Al Gore is following will provide these same benefits. Esselstyn, McDougall, and Novick, to name a few of the plant-based health professionals, have found that the majority of their patients who follow the evidence-based diet recommendations they make experience profound health benefits. As Dr. McDougall has said, "results *are* typical" (McDougall's most recent presentation on Diet Therapy, its history, and its incredible promise: http://www.youtube.com/watch?v=kOfF_r2R8QM)

More here on diet/lifestyle, the health issues that can benefit from following the evidence-based recommendations, what those recommendations are, and how to implement them:
- http://www.drmcdougall.com/health/educa ... ot-topics/
- http://nutritionfacts.org/topics/
-- Please note: Dr. Greger has a tendency to report single studies, similar to how the media report them. This tends to lead to confusion about how to best implement the evidence-based practices. (More on that here: http://www.jeffnovick.com/RD/Articles/E ... ews!!.html). "Science is a process, not an event," as Novick has said. However, I think Dr. Greger does an excellent service in keeping us informed of the medical research. The research has repeatedly shown us, however, that overall diet is more important for health than individual food choices, and so I hope we do not get too distracted by his emphasis on single studies of isolated foods/substances.

On how to construct an evidence-based, optimally healthy, plant-based diet, for anyone interested: viewtopic.php?p=430007#p430007

While many health professionals have identified the benefits of plant-based diets throughout history, and many still work to promote their use for global health, I have found Dr. McDougall, MD, (www.drmcdougall.com) and Jeff Novick, RD, (www.jeffnovick.com), to be the most evidence-based and generous during my review of lifestyle medicine over the past 11 years.

Novick and McDougall provide all of their information freely to the public, with the option of purchasing books or DVDs if we want the information packaged in a different way than they offer for free through their websites, newsletters, video presentations, forum discussions, etc.. I have learned a great deal from their efforts, and I hope that you find their work at least as valuable as I have.

Thanks so much to Michael Moore for bringing awareness to this issue, in addition to all his other efforts to promote global health and wellness. Mike was one of the first progressive activists I was exposed to, and I appreciate the inspiration that he has continued to provide since I have first encountered him and his work.

I hope that you're all having an amazing day."

[MikeyG]

Diets in the Developed World: [From a conversation I had with someone I care deeply about.]

"Thanks for all the new info. I'll check it out later. About the Dutch eating habits. Believe me, the Dutch are very healthy. They have high requirements for what the supermarkets and restaurants offer. More and more people are also eating organic. Almost all restaurants have multiple options info for vegetarian dishes which I know often isn't the case in the US."

You're very welcome

As I said, I think it is great if your community is notably healthy, and that could be possible. However, the data for Dutch health in general does not suggest that the Dutch are much healthier than the rest of the Western world, despite your personal observations in your community.

Here is the World Health Organization (WHO) data on death rate per capita from cardiovascular disease/diabetes in 2008, by country: http://www.who.int/gho/ncd/mortality_morbidity/cvd/en/

The death rate is similar to what we see in Australia for 2008. However, Australia was not leading a very healthy diet then, or now, as we can see their obesity levels have reached epidemic proportions over that same period, with all the associated health risks/costs: http://en.wikipedia.org/wiki/Obesity_in_Australia

Australia's health status is thus very similar to the United States at this point, despite the minor difference in cardiovascular disease death rate in 2008. Thus, the data would suggest that the Netherlands is not much better, as we can see in the other study of Dutch women that I cited. (http://ajcn.nutrition.org/content/83/5/1170.full)

Also, you mentioned organic food. There have actually been numerous studies suggesting that consumption of organic foods, especially organic produce, is not a major factor in overall health: viewtopic.php?p=438488#p438488 .

We also know that vegetarian/vegan diets are not necessarily healthy, so those restaurant options may be no better for overall health. However, I think it is wonderful that the fact that they are offered seem to suggest a greater awareness of the potential health benefits of appropriately planned vegetarian/vegan diets, as well as the ethical and environmental benefits of consuming fewer animal products. (Veg*n diets and health: viewtopic.php?f=22&t=36550)

By comparison, there are few studies suggesting that organic produce is significantly better for overall health than conventional produce. Thus, as we can see, the research supports that the best thing we can do for overall health is to follow a low-fat, plant-based diet, as outlined by Novick/McDougall, along with a healthy lifestyle involving sufficient exercise, sun exposure, social interaction, etc. Everything else, according to the science, seems to be secondary. (viewtopic.php?p=434701#p434701)

Again, though, it is up to us to choose what we want to do. Smoking and alcohol consumption are both known contributors to morbidity and mortality, but many people still choose to participate in these activities despite the established evidence suggesting that the risks far outweigh any potential benefits. As not only the individual is harmed, but also the society that has to pay for their disease/disability costs, I believe that these unhealthy behaviors, including our dietary choices, should be priced appropriately to better cover their true cost to our communities. California, for example, passes increases to the cigarette tax periodically, but the tobacco companies lobby so hard against it that the last time the bill was proposed, it was voted down after the tobacco lobbies began throwing money to defeat the bill. We can see the same thing occurring with the food industries.

Evidence was published on the dangers of smoking as early as 1923. However, it took quite awhile for this evidence to mount to promote sufficient change. Fortunately, though, it did happen, and from 1965 to 2006, rates of smoking in the United States declined from 42% to 20.8%.
(http://en.wikipedia.org/wiki/Tobacco_sm ... lic_health)

Evidence on the link between cholesterol consumption and heart disease has been available since 1913. (http://en.wikipedia.org/wiki/Lipid_hypothesis)

Unfortunately, since we know that only about 0.5% of individuals meet the minimum criteria of a healthy diet, we have much farther to go, especially since the same tobacco companies have now transitioned to the animal/junk food industries, and know how much they stand to lose if they fail to lobby sufficiently to resist the evidence promoting dietary change. (http://en.wikipedia.org/wiki/Altria_Group#Holdings)

It is going to be quite the uphill struggle, I think, but the science has definitely allowed us to make notably progress, as have the clinical outcomes of those who follow the optimally healthy diet/lifestyle guidelines that Novick/McDougall recommend. Prevention and reversal of chronic disease through dietary change is almost miraculous, yet it is the expected outcome for those who follow the recommendations. I hope that our governments become more aware of the cost savings of these simple changes eventually, and that by sharing the information I come across I can at least help the people I interact with become informed and empowered with the knowledge of how to achieve and enjoy wonderful health for as long as possible.

"Life is not a race, but a relay," as has been said, and I hope that my efforts, even if they don't lead to dramatic differences in our world today, at least help progress toward better outcomes in the future. I think we all have tremendous power to help make the world a better place, and I try to do my best to aid in that effort

Thanks again for the discussion, and I hope you find the information at least as worthwhile as I have. Please have a wonderful day.

[MikeyG]

[Vitamin D, Nutrients for Bone Health, Working with Doctors, and Supplementation]

[This is an excerpt from long discussion of these issues that I had with someone I care deeply about. I wanted to share some of the information, however, especially if it could be helpful for anyone else interested in this material]

[Michael asked about the individuals serum Vit D, as the individual had said that since eliminating dairy/eggs s/he thought that could have been responsible for his/her low Vit D levels. Michael had said that while animal products are a source of Vit D; albeit an unhealthy, suboptimal source; and could have helped prevent a low serum Vit D, without measuring Vit D levels before the dietary change, we would have no way of knowing how much or how little these animal products contributed to the individual's serum Vit D.]

"Hi Michael,

Thank you again for your help. My vitamin D hadn't been measured before but I had also never ever experienced excruciating pain in joints/bones and or muscles that continued for so long so I knew something had to be wrong. I first thought it was muscle aches from working out but that always goes over within a few days.

My doctor has prescribed both the vitamin D serum for 9 months total (after this first month of 1 x per week I then take only 1 ml per month) plus the vitamin D/calcium tablet, one daily. She said I should take that for the rest of my life except if I diet changes a lot so I get a lot more calcium daily. I've read about food with the most calcium so I'm making sure I try to get enough but it's hard to always know if you're getting enough. I doubt that there's any danger that I take too much vit. D. I'm just following my doctor's instructions and we'll be checking my blood again in 1-1/2 month.

I've heard from more [] friends that a lot of people appear to now be getting a vitamin D shortage, probably due to the limited amount of sunshine.

Thanks again.

Btw, are you going to continue your medical studies again soon?

Hope your Sunday is grand.

[]

Btw, I don't know if they've ever checked my vitamin D before but if it was too low they would have said it. There also was no reason to check it. "

Michael's response:

Thanks for the message, [person I love.]

Regarding your pain: We do not know, and probably will never know, if it was related to your low Vit D levels.

Here is why: You presented to your doctor with unexplained pain, and your doctor ran a diagnostic panel to try to determine what may have been responsible for that pain. The doctor found that your Vit D levels were low, may know about the evidence suggesting certain pain symptoms tend to be present in those with low Vit D levels, and thus treated the low Vit D with supplementation. Our diagnostic tests, as far as I know, are not accurate enough at this point to determine without a doubt that your pain was a direct result of low Vit D levels. In addition, even if the pain goes away after you begin Vit D supplementation, we have no diagnostic tools that would allow us to definitively determine that your pain went away because of the Vit D supplementation. I would think your doctor is simply hoping that will work, and as I mentioned, there is some evidence that pain and low serum Vit D are associated, but we have no way of knowing that for sure at this point, based on the evidence that I have seen.

Routine supplementation with calcium has been shown to increase harm with very limited, if any, benefit. In my opinion, your doctor is making a horrible decision in providing you with that blanket recommendation, and it shows me that s/he has little knowledge of diet/lifestyle, in addition to little knowledge of appropriate supplementation. Routine calcium supplementation violates the evidence-based principles that Novick outlines, which is why I am so disappointed in your doctor's recommendation, which does not appear to be based in the peer-reviewed, scientific evidence.

Based on the evidence, I would strongly recommend that you attempt to limit all supplementation to only the supplements that you have been medically diagnosed as needing, based on an established deficiency and lack of dietary/lifestyle solution, and then to discontinue those supplements as soon as your levels improve. Based on the research I have reviewed, supplements and medications should always be considered a solution of last resort, since they are typically associated with significant harms.

As I stated, B-12 is the one example of a supplement being the best choice, because the two other methods of obtaining adequate B-12: consuming B-12 from bacteria, typically from fecal material (as animals do in nature); or from eating animal products, which for many omnivores is not a reliable source due to digestive problems; come with greater associated harms.

My conclusions/recommendations on supplementation correspond exactly with Novick's supplement guidelines: http://www.jeffnovick.com/RD/Q_%26_As/E ... ments.html

Underscoring this for calcium and Vitamin D supplementation, in addition to what Novick has already stated on the topic, is this recent scientific article that he featured on his Facebook wall:

""In conclusion, calcium supplements with or without vitamin D are associated with an increased risk for MI [myocardial infarction, or heart attack] and stroke, and this risk appears to apply across subgroups defined by important baseline characteristics. These findings suggest that targeted prescription of calcium supplements to specific population subgroups, such as younger people and those with low dietary calcium intake, should not be endorsed."
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3722731/

from: https://www.facebook.com/JeffNovickRD/p ... ream_ref=5

Thus, based on that comment and the wealth of scientific evidence on general supplementation, especially with calcium and Vit D, your doctor appears to be exposing you to very real and very unnecessary harm. I am concerned about this, but, again, it is ultimately up to you to decide if you are. Your doctor is basically your medical consultant. Should you choose not to listen to his/her advice on the routine supplementation I would think either s/he would be willing to work with you on finding a better, more evidence-based solution, or referring you to another doctor who would be better able to do so.

As with any service industry, if the service professional we are working with is not provide us with excellent customer service, I think we should go find a service professional who can. I think this is especially true in healthcare, and both Novick and McDougall cover how they recommend working with healthcare professionals extensively.

The study I mentioned about the harms of calcium supplementation is just one of many that address the harms of supplementation, especially with calcium and Vit D. Novick and McDougall do a great job presenting a large body of that evidence in a meaningful way, and so I would highly recommend reviewing their resources, as I have recommended before.

While I would love to continue to help you locate, analyze, and interpret the information, as you point out it unfortunately does not help me progress much in my professional medical pursuits. Thus, please let me know if you have problems in these areas, and I would be happy to help you through them. However, please be aware that by asking me to do so we are then delaying my medical pursuits by the amount of time it takes me to work through this information with you *smiles and winks*.

However, helping people to learn how to make informed, evidence-based decisions in their lives, especially in terms of their health, has really helped underscore how appropriate medical school is for me and how much I will enjoy being a physician. Thanks for helping me better identify that by allowing me to help you through this material. An added bonus when I am a doctor is that I will be able to actually get compensated for my time and effort, so that is going to be another great perk

Since you seem to be really concerned about dietary calcium, and you do not seem to have come across the information that is widely present in Novick/McDougall's resources to alleviate that concern, let's go over dietary calcium really quickly:

(Again, here's my primer for implementing a healthy, evidence-based diet/lifestyle, which covers Novick/McDougall's resources: viewtopic.php?p=434701#p434701 . I hope that helps make finding and reviewing the information easier.)

Novick recommends that we approach any nutrient we are concerned about by starting with two key questions: First, how much do we need, and second, how much are we getting?

from: viewtopic.php?p=397402#p397402

(Excerpt below, but please read the whole discussion at the link above, including all the links that Jeff Novick, posting as JeffN, references for the whole story. At the very least, please read all of the JeffN posts to get a better sense of the issue.)

"There are populations around the world that do no have osteoporisis yet have calcium intakes in the 300-500 range. Most of them also have total protein intakes about half of the USA and animal protein intakes of 1/4 to 1/7 of the USA.

... If you look at figure 18, you will see the impact of sodium and animal protein on calcium balance.

Quoting from the chart (Intercept value means where "balance" is reached)

Note: In a western-style diet, absorbed calcium matches urinary and skin calcium at an intake of 840 mg as in Figure 14. Reducing animal protein intakes by 40 g reduces the intercept value and requirement to 600 mg. Reducing both sodium and protein reduces the intercept value to 450 mg. "

So we know that on the Novick/McDougall diet, which limits both salt and animal protein, our needs for total dietary calcium are approximately 450 mg/day. For the general population on a western-style diet, it appears that 840 mg/day is the dietary calcium need, due to a much less health-supporting diet.

We can use the https://cronometer.com/ , a free nutritional tracking tool, to track our nutrient intake and see how we are doing. Novick goes into how to do this on his forum: search.php?st=0&sk=t&sd=d&sr=posts&keywords=cronometer&author=JeffN

Novick has already done that for us, using two generic daily meal plans that follow his guidelines 100%:

Here's one based on brown rice, tomatoes and vegetables: viewtopic.php?p=82851#p82851

The results, particularly for bone health:
Calories 1573
Protein / 59.4 g / 108%
Calcium | 1247.5 mg / 125%
Sodium | 609.6 mg 122%
Magnesium | 687.9 mg / 164%
Total Cost: $5.75

Here's another, based just on plain baked potatoes and garden salad, that he did using only food from the fast food restaurant "Wendy's." Novick did this to demonstrate that it is possible to eat a healthy diet regardless of our situation: viewtopic.php?f=22&t=9321

"...
- 6 Wendy's Baked Potato's and
- 6 Side Salads
...
Energy, 1836.0
Protein, 54.4 g (Novick mentions this is a little low, but has repeatedly said that as long as we hit at least 80% of the RDA for any nutrient on any particular day, we will probably be free of any issues of deficiency.)
Calcium, 486.4 mg 49% [Based on the higher, 1000 mg RDA for the general, western-diet. But still sufficient based on the calcium balance research]
Magnesium, 593.1 mg 141%
...
Wow. Not bad at all. I have to admit, even I was a little surprised at how adequate this is. It easily surpasses most all vitamins and minerals including protein, and has more Omega 3 than the recommended minimum with a 6/3 ratio of less than 2/1.

Calcium was a little low but within acceptable range based on worldwide intakes. The only other ones were Vit E, Selenium and Zinc, all of which I have discussed in other threads. Considering these prior discussions, the Zinc and Vit E are not far off at all, which leaves only the selenium, which if we wanted to make this "perfect by the numbers" we could easily fix. We just had a discussion on foods that were highest in Zinc and Selenium per calories. And, remember, all recommended numbers are for averages over time, and this is just one day.

Most important, remember, this whole diet was based on "white" potatoes and "iceberg" lettuce, 2 foods that are said to be "worthless." "

So as we can see, even a non-ideal, very limited diet based on white potatoes and iceberg lettuce meets our requirements for bone health, in addition to health in general.

I know you have expressed your dislike for potatoes and nightshade fruits/vegetables in large quantities, but we can easily substitute other starches and/or fruits/vegetables while fully meeting Novick's guidelines. Regardless, we can see that as long as we follow the guidelines, we easily meet, and in most cases surpass, all our nutrient requirements except for B-12 (which is best obtained from a supplement) and Vitamin D (which is best obtained from the sun.)

I hope that helps put your concerns to rest in terms of dietary calcium, other nutrients, and bone health.

Now, it is back to progress towards medical school for me, and funding that progress by helping my mom in her real estate business (www.melodygrandell.com , if you know of anyone we may be able to help *smiles*). Medicine is going to be a long road, but I am really looking forward to being able to have a successful career serving my community as a health professional, and hopefully carrying on the incredible, evidence-based message that those like Novick/McDougall promote.

Please have a wonderful day, and please let me know if I can be of additional support. As I said, though, the information is all there for you to review, and I would highly recommend it.

Love,
Michael

[MikeyG]

[RE: Medical education in the Netherlands, Osteoporosis Tests, Working with MDs, and food selections for an optimally healthy, starch-based diet.]

It appears that like the US, the Netherlands suffers from a severe shortage of diet/lifestyle education during medical training. If your doctor is the exception, that would be wonderful.

"In The Netherlands, the need for postgraduate nutrition education has re-emerged after recent research showed that patients' questions on nutrition and food tend to be addressed preferentially to GPs, who are seen by patients as the major and most reliable source of nutrition guidance.6 At the same time, however, it has been found that GPs, as well as GP trainees, feel impeded by a lack of training and education in nutrition.7,,8 GP trainees have also indicated the necessity of introducing disease-related nutrition topics in the vocational training curriculum.8" (http://fampra.oxfordjournals.org/content/21/4/425.full )

However, her recommendations that promote dairy and calcium supplements suggest to me that she is not as informed as she could be. Ultimately, though, I think it us up to us to be as informed as possible, as I think we are the ones responsible for our health and for deciding how to maintain and improve it.

Novick and McDougall both have recommendations for how to work with doctors while implementing an optimally healthy diet/lifestyle. The consensus opinion seems to be that we should use the doctor for their training in medicine, especially regarding urgent medical needs that the healthcare system is able to manage well, not in diet/lifestyle, where physician education is severely lacking.

On the subject of working with medical professionals:
- Novick: http://www.jeffnovick.com/RD/Articles/E ... octor.html
- McDougall: http://www.drmcdougall.com/health/educa ... opics/mds/

Osteoporosis is often analyzed using the DEXA test to determine bone density. However, McDougall and Novick are both very critical of the test.

Novick believes that fracture risk is far more important than an osteoporosis diagnosis, and goes into how we can best determine fracture risk here: viewtopic.php?p=428642#p428642

McDougall seems to believe that the evidence indicates that the bone density scans themselves were designed by the pharmaceutical industry to create a market for their medications: http://www.drmcdougall.com/health/educa ... eoporosis/

Staying out of the "medical business," by implementing and maintaining a healthy diet/lifestyle proven to reduce our risk of disease and disability, seems to be our best option, with the least amount of risks. The healthcare system seems to be very well suited to deal with acute issues, like broken bones, infections, or in your case, debilitating pain, but seems to do more harm than good with its treatment of more chronic issues like osteoporosis, diabetes, heart disease, cancer, hypertension, autoimmune diseases, etc.

It is nice to hear that you can identify some starches that you like. There are quite a few starches to choose from, including starchy vegetables and whole grains. (Wikipedia seems to have a nice list: http://en.wikipedia.org/wiki/Starches#Food )

No particular starches like potatoes, and even sweet potatoes, are required in any way to meet the guidelines for an optimally healthy diet, so it seems we can pick our favorites at any given time. Sweet potatoes are some of my favorite starches, but I love potatoes, too. *laughs* I actually can't think of a starch I have eaten that I don't like, although there are definitely many I have not tried, like taro. Brown rice, potatoes, and oats seem to be the cheapest starches available, and since medical school tuition is so expensive in the US, I am going to be doing everything I can to keep my costs down. However, most starches and legumes tend to be inexpensive, so I should do well cost-wise as long as I don't eat out frequently, I think. Taro, due to the exotic quality, is probably one of the more expensive starches, I would think, so I doubt I will be flocking to it anytime soon. I am happy with the budget starches, and I plan to remain that way.

There is also a wealth of evidence to suggest that if you wanted to follow an optimally healthy starch-based diet using only sweet potatoes as your starches, there would not be any issues: viewtopic.php?p=439451#p439451

There appears to be no need to make things more complicated, especially if complexity makes it more difficult to follow the optimally healthy guidelines.

I hope you find the information helpful. Please have an amazing day.

Love,
Michael

[MikeyG]

[RE: http://www.nature.com/nature/journal/v5 ... 8S66a.html ]

Thanks for sharing.

The article seems to suggest that protein is key to quelling our appetite, and the authors points to a single recent study (from 2014) suggesting that. However, it appears that the recent study may not correspond well with the research we have seen over a far greater period.

"One of the greatest distortions of the truth promoted by high-protein diet advocates is that protein causes little or no increase in production of insulin. However, research shows just the opposite. When fed in equal amounts (calories), beef raises insulin more than whole grain pasta, cheese more than white pasta, and fish more than porridge (Am J Clin Nutr 66:1264, 1997). Maybe as important is the fact that carbohydrates are very satisfying for our hunger drive. Potatoes produce twice the level of appetite satisfaction as beef or cheese (Eur J Clin Nutr 49:675, 1995)."

In addition, as we can see from the other articles McDougall has in the section of his website covering protein and fad diets (http://www.drmcdougall.com/health/educa ... fad-diets/), the suggestion in the article that many ancestral populations were optimally healthy on a high animal protein diet does not survive further scrutiny. In many cases, the longest-lived, most disease-free populations throughout history were those who followed low-protein, plant-based diets, such as the Tarahumara Indians (~85% of their calories from corn/beans/squash) and the Okinawans (~80% of their diet from sweet potatoes, and ~90% from sweet potatoes, grains, and legumes.)

Thus, the wealth of peer-reviewed, scientific evidence, in addition to clinical outcomes, suggests that low-fat, minimally processed, plant-based diets are the optimal choice for overall health, especially in preventing obesity: http://www.jeffnovick.com/RD/Articles/E ... _Pt_1.html

In terms of obesity and overeating, we also know that calorie density has been found to be the most important factor in maintaining a healthy weight. Our appetite regulation seems to be most strongly tied to the fiber and water content of foods, so the consumption of highly processed, refined, and/or high-fat foods all prevent this system from working properly. We are more satisfied with foods that are high in fiber, water, and overall bulk. In addition, whole, minimally-processed, low-fat plant foods also tend to be the most nutrient-dense, so we can fulfill all our nutrient needs with the lowest amount of calories, thus preventing excess weight gain. The research on calorie density suggests that people tend to eat the same weight of food each day, so adjusting calorie density is the best way to adjust total calories without having to go hungry or eat without satisfaction.

More on calorie density: http://www.jeffnovick.com/RD/Articles/E ... ories.html

... and on appetite/satiety: search.php?st=0&sk=t&sd=d&sr=posts&keywords=satiety&author=JeffN

Novick also had an amazing discussion recently, posting as "JeffN," where he emphasized the importance of getting the basics right for achieving optimal health. The research and our clinical experience both suggest that as we get more complex and focus more on the less important issues, we make ourselves less likely to succeed by distracting ourselves and our efforts from the basic, proven guidelines: viewtopic.php?f=22&t=8179&p=439451#p439451

Ultimately, it seems that the secret to overall health is the make sure we are getting the basics right. Everything else may just be "noise," but it's noise that many seem to try to take advantage of to make a profit, which we can see in all the advertising for magazines, books, supplements, and other gimmicks that claim to have discovered some "secret" to optimal health that no one else is telling us.

On "Breaking Health News," and the myths of how science works: viewtopic.php?p=304243#p304243

On the myth of "Superfoods" being necessary for health: viewtopic.php?p=283877#p283877

On how to evaluate evidence, and the importance of knowing how to do so:
- viewtopic.php?p=277347#p277347
-- As we can see from Novick's most recent comment in the thread, many published studies report results that cannot be repeatedly proven by subsequent studies, suggesting that it is important we do not get caught up the results of the newest, single study, but the overall picture that is painted by repeated studies over time: viewtopic.php?p=421908#p421908
- Using pubmed: viewtopic.php?p=45128#p45128

Thanks again for promoting awareness. I hope you find the information at least as worthwhile as I have. Please have an amazing day.

[MikeyG]

[RE: Diet, Changing Others, and Kidney Disease]

"Jeff Novick, MS, RD had a recent post on the McDougall forums about the importance of making sure we get the basics right, and then we can demonstrate the success of the program to others: viewtopic.php?p=439451#p439451

Novick seems to find that the best approach to helping others is to exemplify the success of following the guidelines and present the information to others only if they are interested in making the change themselves. Novick frequently brings up the quote, "A man convinced against his will is of the same opinion still."

You mentioned kidney problems, and it appears that the optimally healthy, plant-based guidelines may need to be adjusted for those with end-stage kidney disease. Dr. McDougall has a series of articles on kidney disease here: http://www.drmcdougall.com/health/educa ... y-disease/

In addition, one of Dr. McDougall's recent articles showcased Walter Kempner, who was successful in treating end-stage kidney disease patients with a low-fat, plant-based diet: http://www.drmcdougall.com/misc/2013nl/dec/kempner.htm

I would direct anyone facing end-stage kidney disease and looking for how to approach it with a plant-based diet to that article on Walter Kempner and the rice diet.

I hope you find the information worthwhile. Please have a wonderful day."

[nayasmom]

[quote="MikeyG"][RE: http://www.nature.com/nature/journal/v5 ... 8S66a.html ]

The article seems to suggest that protein is key to quelling our appetite, and the authors points to a single recent study (from 2014) suggesting that. However, it appears that the recent study may not correspond well with the research we have seen over a far greater period.

"One of the greatest distortions of the truth promoted by high-protein diet advocates is that protein causes little or no increase in production of insulin. However, research shows just the opposite. When fed in equal amounts (calories), beef raises insulin more than whole grain pasta, cheese more than white pasta, and fish more than porridge (Am J Clin Nutr 66:1264, 1997). Maybe as important is the fact that carbohydrates are very satisfying for our hunger drive. Potatoes produce twice the level of appetite satisfaction as beef or cheese (Eur J Clin Nutr 49:675, 1995)."

Regardless what the popular notion du juor may be, I have to live according to what works for me. Like just about every fat person on this planet, I have tried a wide variety of diets to lose weight. They all work... temporarily. The thing is, however, losing weight is not synonymous with losing fat or increasing health. Since I've adopted the McDougall diet, weight loss is slow but the body image is changing quickly, so I am convinced that I'm losing mostly fat. Watching television shows, female actors all look slim to underfed, but they all jiggle when they walk, too, even stick-people like fashion models.
On this diet, too, I have almost no cravings, and the thought of eating something cheesy now kind of makes me sick. My depression is much more manageable naturally, my palate has changed so I no longer need heavily spiced or sauced or salted or fat-filled rich food to feel satisfied.
Most of all, I knew that the myth of protein satisfying hunger was simply that, a myth, but there isn't a lot of easy access to the truth of hunger satiation, so a lot of people stay stuck in the protein rut. I did, even though I knew it wasn't right... I didn't know what WAS right.
The low-carbers have the big noise from Winnetka, and big noise always has the heaviest influence on the average person. I think this should be our motivation to speak up and speak out. People don't want to hear it, but that shouldn't be what decides us whether to remain silent or not.
Robyn

[MikeyG]

On an optimally healthy BMI:

"The evidence strongly suggests we all aim for a BMI range of 18.5-22, where the best health outcomes are found. The evidence has continued to grow that being on the lower end of this scale is optimal, so a BMI around 18.5-19 may actually be ideal. There's also growing evidence indicating a BMI below 18.5 may still be acceptable, so long as we get there through an optimally healthy diet/lifestyle, but that does not seem to be well-established enough yet to lower 18.5 threshold.

I did a write-up on the evidence on optimal BMI, too, if you were interested: http://www.drmcdougall.com/forums/viewt ... 06#p432906

Unfortunately, since most of our world is overweight, we have an inaccurate perspective of what a healthy weight actually is. In addition, in the past being heavy was associated with being wealthy, because only the rich could afford to obtain many calories from foods like animal products, high-fat foods, and highly-processed foods. Thus, many cultures developed to think being overweight was good, when in fact it was associated with some horrible health outcomes. This resulted in the "Mummy Paradox," where many people were surprised that many of our chronic diseases were present in history long before the junk foods we currently attribute these health problems to was available: http://www.drmcdougall.com/misc/2011nl/may/egyptian.htm

In truth, there was no paradox, as these individuals were simply eating the junk food available at the time, namely the animal products, high-fat plant-foods, and highly processed foods (like oil and sugar), and suffering from the health consequences that are associated with these items, which still persist today.

In some less developed countries, the erroneous perspective associating weight with wealth has continued, and parents in areas like Mauritania routinely "fatten up" their daughters despite the proven health risks: http://en.wikipedia.org/wiki/Leblouh

There's also an excellent video on the Mauritanian practice in the second segment, here: https://www.youtube.com/watch?v=8TMKyUdEEMo

Thankfully, these practices are becoming more rare, but the issue now is due to the increased availability of unhealthy foods, and the low cost of these items due to government subsidies for animal products and junk foods, we are seeing an epidemic of unhealthy weight, with 80% of people failing to maintain a healthy weight: http://www.drmcdougall.com/forums/viewt ... 65#p441365

In addition, advertising by food industries are not helping us either: http://www.drmcdougall.com/2013/07/31/s ... hooked-us/

Jeff Novick, MS, RD put it very eloquently here, too, on how we are simply not focused on the things that matter, and are distracted by the issues like organic foods, GMOs, and "superfoods," which have little, if any, proven impact on our overall health:

(https://www.facebook.com/JeffNovickRD/p ... omments=21)

[Q: Do people really fail to meet guidelines for optimal health because they are distracted by things like Organic food?]

"That is not the question or the point of the article. Organic was only used as an example. As I said in the article....

" it often seems that we have our priorities mixed up. I often see well-meaning and good intentioned people who are trying to do the right thing and put tremendous amount of time, energy and effort into avoiding things that may not have much of an impact on them at all while, at the same time and without realizing it, indulge in things that are very harmful to their health. "

So, yes, my experience over the last 2.5 decades says, yes, it is an issue. Just follow the boards and the discussions and you will see the many many distractions people find themselves caught up in and worrying about while not directing enough attention at those things that really matter. Remember, 90% if Americans say they eat healthy, 38% say they eat very healthy and about 18% say super healthy. Yet, less than 1% meet the basic requirements of even the AHA diet. That is the issue."

Diet-related illness is now the second-leading cause of death and disability worldwide, following very closely after tobacco: http://www.drmcdougall.com/forums/viewt ... 22&t=42831

We have a long way to go, but at least we have better access than ever before to evidence-based individuals like McDougall and Novick to help us interpret and apply the information. Unfortunately, the same increased access also allows us to more easily be misled by the Dr. Oz's and fad diets like the Paleo movement, which ultimately detract from our health efforts.

(http://www.drmcdougall.com/forums/viewt ... 61#p281261)

It's the overall dietary pattern that is important, and the evidence for such a pattern is significant and well-established over decades of scientific study: http://www.jeffnovick.com/RD/Articles/E ... _Pt_1.html

There is also this important discussion, on the ill-fated hope of "Superfoods" instead of the far more effective overall dietary pattern: http://www.drmcdougall.com/forums/viewt ... 50#p429750

I hope you find the information at least as worthwhile as I have. Please have a wonderful day."

[MikeyG]

Primer of Jeff Novick, MS, RD's Recommendations for a Healthy Diet/Lifestyle:

Please feel free to forward this to whomever you think may benefit from the information.

The primer of Jeff Novick, MS, RD's (http://www.jeffnovick.com) recommendations, which I find to be the most effective and the most evidence-based, is at the end of this message, after the "---".

Here are some additional points to consider:

John McDougall, MD (http://www.drmcdougall.com) fully endorses these recommendations, especially for those seeking optimal health, as do many other health professionals in diet/lifestyle medicine.

We can adopt these guidelines regardless of the type of doctor that we have, as our physician is fully capable of adjusting any medications we may be taking while our health rapidly improves on these guidelines (http://www.jeffnovick.com/RD/Articles/E ... octor.html .)

However, for anyone currently taking medication to treat hypertension and/or diabetes, it is normally very important to see our physicians within 1-3 days of starting the program. This is because the program is so powerful that it can reverse hypertension and diabetes very rapidly, and the medications, which were once prescribed to reduce our blood pressure and blood sugars to more normal ranges, now reduce them from their now-healthy ranges to ranges that are too low for optimal health. Without changing the dosage under our doctors' supervision, we can frequently suffer from low blood sugar and low blood pressure. Other medications, like statins, can typically be adjusted more gradually. However, a quick visit to the doctor can easily determine what needs to be adjusted.

Here is Dr. McDougall on his approach to different medications, especially in taking patients off them as they adopt the guidelines: https://www.drmcdougall.com/misc/2012nl/may/aword.htm

(I believe that since that newsletter, he no longer advocates for the long-term use of psychiatric medications, as the research indicates that for most people, the medications do far more harm than good:https://www.drmcdougall.com/health/education/videos/advanced-study-weekend-experts/peter-gotzsche-02/ )

While many seem to attempt plant-based diets for health reasons, not all plant-based diets are created equal. As we can see, the vast majority of plant-based diets, like the vast majority of diets in general, often are very unhealthy. This explains why some people may not see the benefits they expected when attempted to follow plant-based diets:

from: https://www.facebook.com/JeffNovickRD/p ... 2555900125
"When (& Why) Vegan is not Enough
viewtopic.php?f=22&t=36550"

Fortunately, the evidence for the effectiveness of these dietary guidelines has been clearly established in peer-reviewed, published scientific evidence for more than sixty years:

The Healthiest Eating Pattern:
"A diet that is (1) based predominantly on a variety of
minimally processed fruits, vegetables, starchy vegetables,
roots/tubers, whole grains and legumes and (2) low in fat, saturated fat, calorie density, and (3) low in added sugars, oils and salt, has been documented to prevent and/or reverse disease - even for those who are seriously ill - in many published studies over the last 60 years. The results from these studies, which use differing specific diets in them, documents the importance and the effectiveness of this overall dietary pattern over any one specific version of this diet. This dietary pattern is commonly referred to as the Whole Food, Plant-Based Low/No SOS diet or simply the WFPB SOS or just WFPB."
(http://jeffnovick.com/RD/Articles/Entri ... _Pt_1.html)

Unfortunately, as most health professionals are not familiar with the evidence or the incredible healing potential of the guidelines, most patients are not presented with these health-supporting principles. In addition, many health professionals, due to their lack of awareness of the simplicity and effectiveness of the program which Novick outlines below, erroneously believe that their patients would not want to invest the effort to attempt it, which is probably why it is not more widely implemented.

Apparently, the biggest obstacles for most people are long term compliance, and proper implementation of the principles and adherence to them.

It takes about 30 days for our taste-buds to adapt to a low-salt diet, allowing low-salt foods to taste good, and also about 90 days for our bodies to feel satisfied on a low-fat diet, according to Dr. Alan Goldhamer, DC, who fully supports the diet at his TrueNorth Health Center in Santa Rosa, CA. In addition, it may take some time to fully understand the principles of calorie density, and get used to the larger volumes of food that are typically consumed on a lower calorie density diet, as portion control is no longer and individuals can eat until fully satisfied, while simply adjusting calorie density to meet their caloric and satiation needs.

So the initial hurdles can be significant for people, but the evidence-based benefits are tremendous, especially when medical error, including adverse reactions to medications, is thought to be the third leading cause of death in the developed world. In addition, compliance can be tough for many people, even long-term, as those following the optimal dietary pattern are so rare, and our societies, especially in the developed world, simply do not cater to the pattern. Fast food restaurants don't serve minimally processed whole grains, legumes, starchy vegetables, fruits, and vegetables without added sodium, oils/fats, or sugars/sweeteners, because the demand simply isn't there.

Here's a wonderful discussion I had with Jeff Novick on compliance: viewtopic.php?f=22&t=44133

Novick on the Top Ten Reasons for Failure: viewtopic.php?p=75771#p75771

Fortunately, we have excellent advocates like Novick and McDougall who provide this amazing information to us for free, and generously donate their time and effort to help us understand and adhere to the principles.

I hope you find the information at least as worthwhile as I have. Please let me know if I can be of additional support.

Love,
Michael

---

"Diet/Lifestyle Guidelines:

For the quick-start guide to Jeff Novick, MS, RD's diet/lifestyle recommendations, which adhere to the MWL protocol, I recommend these three posts of his:

The Healthy Eating Placemat: A Visual Guide To Healthy Eating
[Included with the "The Ultimate Guide To Free Calorie Density Resources "]
viewtopic.php?p=500426#p500426
[Outlines the diet/lifestyle recommendations and their application]

The Real Dirty Dozen: The 12 Deadliest Dietary & Lifestyle Factors & What You Can Do About Them
viewtopic.php?p=441210#p441210
[Outlines the rationale for the diet/lifestyle recommendations]

A Day In The Life
viewtopic.php?p=445707#p445707
[An example of a sample day following the guidelines, showcasing the ease of implementation of the dietary principles to obtain all our dietary needs while minimizing all dietary risk factors.]
["As explained in the discussion on my SNAP meals, the above recipes take no more than 10 minutes, have 5 or less ingredients, are based on foods one can get anywhere, involve virtually no prep, clean up or waste and can be done for under $5/day per person. " - Novick]

For anyone with health issues, I would recommend trying Jeff Novick's recommendations to follow the Maximum Weight Loss Program, which he calls the "Maximum Health Program," very strictly for at least 60-90 days. Based on what I have read from him in the McDougall forums, he finds that the MWL Program eliminates many problems foods for individuals experiencing health problems, such as flour products, added sugars/sweeteners, added sodium, and higher fat plant foods (where nuts/seeds are strictly limited to no more than 1-2 Tablespoons a day for most people (approximately 1 oz/day)).

Here's my take on Novick:
"McDougall and Novick are at least 99% in step on most issues, but in some areas of stylistic deviation, such as added salt, calorie density, and nutrient adequacy, I feel that Novick comes out slightly ahead in his approach and presentation. I feel like everything on his website (http://www.jeffnovick.com) is worth its bandwidth in the most precious material I can imagine, and I would highly recommend it for anyone interested in diet/lifestyle, and evidence-based reasoning in general."

Novick seems to find that most of his clients following the MWL strictly for 60-90 days experience relief of their symptoms, even from "food sensitivities" like gluten or citrus that people were experiencing largely due to a less healthy dietary pattern or from including the less healthy foods that the MWL eliminates or strictly limits. However, should an individual still be experiencing problems, Novick then recommends adopting the elimination diet that McDougall outlines on his website (found at the bottom of this article: https://www.drmcdougall.com/misc/2014nl ... ncases.htm) while still modifying it to meet Novick's recommendations."

[MikeyG]

[On Privacy, Education, Career, Media Coverage, and a Healthy Diet/Lifestyle]

You're very welcome. Thanks for the message.

Facebook does have a bit of a learning curve, but it seems that once we get the privacy settings down, and are vigilant about changes that Facebook can make about how settings are handled for future posts, we can manage privacy relatively well. However, being on the more conservative side of the privacy-publicity spectrum seems like the safest bet. I would think this is especially true for those of us in the LGBT community, as our wider community does not seem to be as welcoming towards LGBT individuals as I would like, despite significant recent progress. My apologies on behalf of my straight peers.

Thanks for being such a wonderful and open member of the LGBT community, as it seems greater exposure to individuals like yourself is the key to promote community tolerance.

I had a lot of fun in high school, and would have loved to spend a fifth year there. Community college seems like a much more practical and economical option, though, especially as the schedule can be made to be more flexible to accommodate a job. Congratulations on making it through what seems like a very rigorous program, and for making such a great decision on your high school.

Thanks for the feedback on college prestige, especially coming from someone with practical experience. I would think it makes sense that there is some benefit to going to a "big name" school, but it seems to be more luck-based than anything. If we were to interview for a job with a pro-Yale boss, for example, s/he may look down on our Harvard degree because of the school rivalry. With that in mind, it seems the fickle nature of the prestige-boost may not warrant the significant additional costs to obtain a degree from a more "prestigious" institution. I would think that if a student is able to make the costs equivalent through scholarships/grants, however, that s/he should definitely go to the most prestigious school. Unfortunately, many schools seem to be realizing this, and provide short-term scholarships/grants to entice students to begin attendance, and then cut off the money shortly thereafter, relying on a student's inertia to keep them enrolled despite the higher prices.

The medical admissions perspective on major seems to be that performance in the required coursework for medical school is most important. I wonder if the same circumstance might exist for other fields too, like software engineering. If a basket-weaving major excels in all his/her software engineering courses, might they still be competitive applicants for jobs? From what I have read on career forums, this seems to be the case. Companies want software engineers who can perform well in the position, from what I have read, and the major and institution is likely to be less important as a result.

Thanks for your feedback.

Thanks for the clarification on the books. I just wanted to make sure that you were not hoping for a reading buddy, as with my medical school responsibilities I would find it pretty tough to keep up with your laudable non-fiction interests *smiles*. I do appreciate the recommendations, though, and the insight about what topics interest you. Thanks for sharing that. I agree that books, lectures, documentaries, and media articles are great ways to be introduced to a topic. Unfortunately, one important caveat I have found is that in many cases these sources merely scratch the surface of the subject, and may end up misleading their audience if we do not explore the subject further.

I had a recent discussion with Jeff Novick, MS, RD, about the greatest obstacle in promoting the diet/lifestyle changes necessary for optimal health, and he seemed to believe that it is a lack of community support. Our community simply is not catered toward a healthy diet/lifestyle, and until we see the same kind of community support that occurred with smoking-cessation, for example, where public and private spaces began to ban smoking, it is going to always be a more difficult path for those of us attempting to follow the diet/lifestyle recommendations. The food industry and restaurant industry realize that they can make more money by hijacking our evolutionary preferences for salt, sugar, and high-calorie-density, which would have allowed us to thrive on healthy, plant-based foods in nature but are now being taken advantage of by processed and refined foods like donuts, twinkies; animal products; and unhealthy restaurant-fare, which represents the majority of restaurant food

Here is my discussion with Novick: "Compliance on a Healthy Diet"
viewtopic.php?p=454637#p454637

The initial hurdles for most of us who have been following less healthy diets appear to be changing our habits and allowing our taste buds to change. Just like a smoker who may need to stop hanging out with friends who smoke, and who needs to allow his/her addiction withdrawal symptoms to pass, those of us following a less healthy diet will need to learn how to prepare and eat healthy foods, allow our addictions to unhealthy foods to fade, and stop putting ourselves in an environment that promotes the consumption of unhealthy foods. Fortunately, it seems that our taste buds change in around 4-6 weeks, and we fully enjoy the healthy foods. In addition, all of the withdrawal symptoms typically fade within the 4-6 week window.

Again, here is my primer for the diet/lifestyle recommendations that Novick recommends, which includes many simple and easy recipes that fully meet the dietary recommendations: "When (and Why) Vegan is not Enough. Also, what Is Enough, and Why": https://www.facebook.com/michael.govaer ... 2087728243

As Novick says, the recommendations are ideal for anyone once they are no longer breastfeeding (which typically occurs at the age of 2).

In addition, we find that the diet/lifestyle recommendations show significant benefits in preventing, treating, and potentially reversing many of our most common diseases and causes of disability.

For example, a study done in patients following Novick's recommendations found that their immune systems were eight times (8x) better at destroying cancerous cells than those following the Standard American Diet (and lifestyle) [SAD]: viewtopic.php?f=21&t=41997#p432908

However, the same diet/lifestyle also reduces our risk of autoimmune diseases, so we have a high-performing immune system that is also extremely discerning. This seems like it would also have important implications for those of us suffering from HIV/AIDs, as immune function seems to be a key factor in preserving quality of life in those conditions.

I eat most of my food steamed and boiled, with most of my vegetables microwaved plain. This seems to be an excellent and optimally healthy way of eating, and has been for me. I add a variety of salt-free spices right before I consume the foods, which Novick also recommends and outlines in his recipes, which definitely enhance the flavor. However, the spices are definitely not required.

I also usually lightly microwave iceberg lettuce when I eat it, as it tends to make the food more digestible, tastier (as the cooking begins the digestion/breakdown process and likely frees up carbohydrates and naturally-occurring sodium), and also kills any potentially harmful bacteria that may linger on the raw lettuce.

Novick seems to find that the key for his success in following these diet/lifestyle recommendations is that he has managed to keep his meal plan simple. While some of us may enjoy spending large amounts of time cooking and preparing our meals, it seems that without ways to obtain healthy food quickly, we can often run into trouble when we are pressed for time. Novick shared his strategy with me when I asked him about in back in 2008: viewtopic.php?p=50263#p50263 ("Healthy Eating and Time Management")

Also from Novick on simplicity: [https://www.drmcdougall.com/forums/viewtopic.php?p=133903#p133903]

"As I wrote about a year ago in this thread, on

viewtopic.php?t=8316

One of the main reasons for not being successful that I listed was ...

"Not understanding the difference between something that is "allowed" on occasion in small quantities, and something that is "recommended."

My personal and professional experience over the last 2 1/2 decades of helping people achieve their health goals is that the simpler and easier they keep the program and its definitions, the better.

Variety vs Simplicity: The Key to Success
viewtopic.php?t=8179"

Since then, he has shared all of his quick recipes with us for free: viewtopic.php?p=50367#p50367
and on Facebook (with pictures): https://www.facebook.com/media/set/?set ... 124&type=3

For those of us who want a more intensive introduction, he also has a line of DVDs that walk us through the entire preparation of these recipes: http://www.jeffnovick.com/RD/DVDs.html

I believe Novick's 4th DVD, "Beyond the Basics," goes into more exotic recipes, and he also shared a more complicated lasagna recipe in his Facebook album that many find popular: https://www.facebook.com/media/set/?set ... 124&type=3

I have found many of his "Fast Food" DVDs at my local library in Santa Clara County, and I have been urging El Paso's libraries to carry them. Here is to hoping they are available at your libraries if you would like to peruse them for free. If not, you may want to consider requesting them. A final option may be purchasing them and then donating them to the library, as I believe such a donation is tax deductible if the library has a charitable organization designed to receive such donations.

As you mentioned, the soundness of the science behind the recommendations is very clear, and has been clearly established in peer-reviewed, published, scientific evidence. Here is a sampling of that research:
"The Spectrum of Health: An Integrated Approach To Whole Food, Plant-Based Diets
; Pt 1 -The Evidence; Jeff Novick, MS, RD"
http://www.jeffnovick.com/RD/Articles/E ... _Pt_1.html

As Novick has repeatedly mentioned, restaurants and prepared foods can often be a minefield of hidden issues. Many individuals who tried to get healthier by eating salads, but poured fat-based dressings all over them, were instead eating added fats/oils with a tiny bit of salad, based on the caloric contribution to their overall diet. Similar issues arise with plant-based dieters who rely heavily on nuts/seeds, which are extremely calorie-dense (~2300 calories/lb) due to their high-fat content (~70% fat). Thus, I cannot comment on the benefits of that broccoli salad, though here is to hoping it only uses salt-free spices and/or a plain vinegar to enhance the flavors.

The food industries have been hijacking our taste buds for most of human history, which is why we see that the royalty of human history were frequently the ones plagued by these attempts, as they could afford the expensive foods prepared with the richest ingredients and added salt, sugars, fats, and oils: https://www.drmcdougall.com/misc/2011nl ... yptian.htm

Unfortunately, with agricultural subsidies and food industry lobbying, these same foods are now available cheaply to the general population, and we are seeing an epidemic of these previously "royal" health problems as a result. Thus, we should probably be very cautious about letting our taste buds deviate from a preferences for the healthiest, simply-prepared foods.

Personally, I stick to the optimal recommendations and the simplest meals, and have done so very happily since 2007. Learning how to tweak calorie density since then has allowed me to very easily manage my weight while being able to eat freely of the recommended foods until I am comfortably full. There was definitely a learning curve, and consistent tweaking since then to accommodate for changes in activity and the calorie densities of various foods, even among fruits, vegetables, starchy vegetables, intact whole grains and intact legumes, but I have found the effort and associated results to be extremely worthwhile. Both subjectively and objectively, I find myself healthier now than I have ever been.

I hope you find the information at least as worthwhile as I have. Please let me know if I can be of additional support. I look forward to staying in touch, and thanks for the excellent discussion. I am glad we have Facebook for a very convenient way to continue it and to stay connected in the future.

Please have an amazing day.

Love,
Michael