1. A Healthy Diet – Whole Foods Plant Based (WFPB)

The health of the American public is deteriorating in an alarming fashion. The rates of obesity, diabetes, heart disease, stroke, dementia, male impotence, autoimmune disease, osteoporosis, and cancer of all sorts are staggering. We continue to develop more expensive medicines and procedures to keep people living a short while longer in misery with these conditions.

For years, the cause has been eluding us, but certain researchers have done some pioneering work and have fearlessly spoken out. But, since their evidence strongly conflicts with established wisdom, they have been ridiculed and marginalized by all of us. The single most effective thing you can do to improve your health is to convert to a WFPB diet.

The US government agencies that are charged to provide us with official health advice have failed in their duty to objectively evaluate scientific evidence and give us unbiased information. This is because people who make up these agencies have strong financial ties with the dairy and meat industry and desire any information about the deleterious effects of animal products in our diet to be suppressed. The processed food industry is also very powerful and spends enormous amounts of money on misinformation.

Scientific evidence is substantial that indicates consuming animal protein is the primary underlying cause of the degenerative conditions that I previously listed. This includes low-fat milk, cheese, eggs, and fish! Well-recognized risk factors for cardiovascular disease are smoking, high blood pressure, diabetes, elevated cholesterol, and family history. A far more potent risk factor than all of these is the consumption of animal protein. Animal protein has also been shown to be a strong carcinogen.

Most commonly, people choose a specific diet to lose weight. Maintaining a healthy weight is critical. There are serious negative health consequences to carrying excess weight as fat. A Body Mass Index (BMI = [weight in lbs.] x 703/ [height in inches]2) is a simple and reasonably accurate way to determine if a person’s weight is healthy. A lean but very muscular man would have a BMI suggesting obesity. But most men who claim muscles are the cause for their elevated BMI are kidding themselves. They should get a DEXA body composition scan which is the most accurate way to determine body fat (< 15% is considered normal).

BMI Scores

Calculate the target weight you need to reach to achieve a certain BMI by rearranging the formula: Target weight = Target BMI x [height in inches]2/703

Any BMI over 25 increases your risk for surgery. The higher the BMI, the higher the risk. Any amount dropped is beneficial. If you want to decrease your risk, lose weight. It will make the surgery technically easier for the surgeon, increasing the chances that the outcome will be optimal. Also, it will decrease the chance of infection, blood clots, fractures, and many other complications that are inherent in hip and knee replacement surgery.

Unrelated to surgery, elevated BMI is associated with a higher mortality at any age. For every 5 points of increased BMI above the normal 25, your annual risk of premature death increases by 31%. That means if your BMI is over 40 you have almost double the risk of dying every year than a normal weight individual of your same age has.

The WFPB diet is the healthiest way to lose weight. We are inundated with too numerous to count diet gimmicks and fads, even pills and weight loss surgery. Basically, fat is an energy storage battery. We must consume less than we burn off by basal metabolic rate (BMR, energy it takes our body to run its basic functions) and activity. Some people are fortunate to have high BMR and can eat more without gaining weight.

BMR can be increased by exercising and eating a WFPB diet. But anyone can become slim by consuming a healthy diet and exercising regularly. If you have severe enough arthritis limiting vigorous exercise capacity, you can still lose weight by adopting a healthy diet. Diet typically accounts for 80% of weight loss.

Types of diet include:

• Ketogenic (High fat/ low carb) diets like Keto, Adkins, or paleo are effective ways to lose weight, but are very unhealthy, raising your cholesterol and promoting vascular disease and cancer.
• Calorie restriction diets like Weight Watchers are also effective, but starving yourself long term to burn off fat reserves is mentally very challenging and most people cannot maintain this and then they feel like failures.
• WFPB diet: allows eating until you are full and has numerous health benefits discussed previously.
• Diet Pills: Really? Eat unhealthy food and try to negate the bad effects of drugs. This is the typical modern delusion that drives poor health.

In the United States, vegan diets are the only dietary patterns associated with a healthy weight. This may be a result of several factors. Firstly, plant-based diets naturally increase your metabolism (BMR); individuals on a plant-based diet average an 11% higher resting metabolic rate than those on a conventional American diet. Additionally, vegetarians typically consume 364 - 464 fewer daily calories than meat eaters without consciously calorie counting. There is also accumulating evidence demonstrating that not all calories are created/processed equally. When comparing groups of people who consume the same amount of daily calories, those who consume meat gain significantly more weight.

Defining a Whole Foods Plant-Based (WFPB) Diet

Whole foods means un-processed food. If the fiber is removed, it is processed.

Examples

• Fruit vs. fruit juice: Eat all the fruit you want. Drink whole fruit smoothies, but not juice. Blood sugar is reduced in diabetics if they eat whole fruit. It is elevated by fruit juice.
• Brown rice vs. white rice: Only whole grains, no white rice, white flour, or regular pasta. Pasta made from whole wheat, beans or other unprocessed foods is good. Alternative unprocessed grains such as quinoa, amaranth, etc. are good. Potatoes and corn are good. Potatoes fried in oil – not so good. Sweeteners made from corn – terrible.
• Olives vs. olive oil: Eat all the olives you like, but minimize olive oil. Olives contain fiber, oil does not. Vegetable oil is better than animal fat, but try to minimize this processed food. Saturated plant fats such as coconut and palm oil are worse than other plant oils, they are nearly as bad as animal fats. Because they are plants, they do not contain cholesterol, but they will still cause a rise in your cholesterol level. Purchase an air fryer to fry your foods with minimal canola oil. Limit fried foods.
• No sugar or artificial sweeteners: If you want something sweet eat whole fruit or cooked sweet potatoes. The more the better! Do not add any sweeteners to your coffee, tea, or other drinks.

Plant-based (or Vegan) means avoiding all animal products. Dairy products and eggs may even be worse than meat because they contain hormones and growth factors meant to boost the growth of infant animals. They are not suitable for adults. Fish and chicken are just as bad as pork and cow. Minimize any consumption of these.

Benefits of WFPB Diet

• Promotes normal weight.
• Prevents Acne.
• Prevents all types of cardiovascular disease such as heart attacks, stroke, dementia, impotence (men who are obese (BMI>30) have impotence rates similar to normal weight (BMI<25) men 20 years older than they are), and peripheral vascular disease.
• Prevents cancer.
• Prevents autoimmune diseases such as juvenile diabetes, MS, rheumatoid arthritis, psoriasis, lupus, and many others.
• Improves bone density.

Basically, most of the chronic health conditions that people in wealthy countries suffer from are directly related to our poor diet. We eat poorly, don’t exercise and then engage in wishful delusional behavior with the encouragement of our doctors that taking a few pills can solve these problems. The evidence suggests that this is not effective.

Osteoporosis

Weakening of the bones as we age is a major health problem that is underappreciated. We obtain our peak bone strength between 25-30 and then there is a steady decline. Men start out with stronger bone at age 25 and women often suffer a steeper rate of decline after they enter menopause at age around 50.

The most common way to check bone strength is by the Dual Energy X-ray Absorptiometry (DEXA) study which uses a low X-ray dose to measure bone density. Bone density gives a reasonable approximation of bone strength. The T-score compares your density to a normal range for 25-year-olds of your sex and race. A T-score of 1 to -1 is considered normal. If the T-score is below -1, you are described as osteopenic (somewhat weak bone) and if you are below -2.5, then you have osteoporosis (very weak bone). These cutoffs are arbitrary, the lower the number, the higher your fracture risk. The standard recommendation is to begin treatment below -2.5. Most people don’t even know what their bone density is.

In my opinion everyone should have a DEXA scan at age 50 and should consider measures to strengthen their bone (drugs as a last resort) as soon as it shows any sign of weakness. Women over 50 should have regular scans every 1-2 years because they are at particularly high risk of losing bone mass after they lose their estrogen (menopause). Shockingly, most primary care providers completely ignore this problem. Osteoporosis increases the risk of all fractures, and they can occur with minor or no trauma. Vertebral compression fractures lead to a hunched-over appearance in the elderly and cause chronic back pain. Hip fractures are even worse. They usually require surgery and often result in residual shortening of the leg, persistent pain, and a 30% chance of death within one year. Really this a more serious condition than a heart attack or cancer.

There are many factors that affect bone density:

• Genetics: Men have stronger bones than women. Density among racial groups ranks Blacks > Whites (redheads are lowest) > Latinos> Asians.
• Lack of exercise: Particularly impact exercise (running and jumping)
• Diet: WFPB is best. Meat and especially dairy depletes your bone (despite claims to the contrary by the dairy industry).
• Vitamin D deficiency: 40% of the population is deficient. Sun exposure increases Vitamin D, Sunscreen prevents it. Normal is 30-100. I would shoot for 50. Supplements are not as good as sunlight, but better than being low. If you are below 30, add 2000-3000IU daily intake and remeasure in 3 months. Adjust dosage and repeat. Repeat levels annually at the end of winter when levels are lowest.
• Hormones: Women lose testosterone at age 40 and estrogen at age 50. Both of these cause bone loss. Hormones should be restored to normal using bioidentical pellets every 3 months. Men lose testosterone more gradually at 1% per year after age 30. Normal levels are falsely reported as 200-800. But below 500 is actually low. Testosterone should be supplemented with bioidentical pellets every 3 months.
• Drugs: Corticosteroids are the worst. Reflux medicines such as proton pump inhibitors are also bad.
• Excess alcohol consumption: Alcohol increases parathyroid secretion causing bone erosion.
• Smoking: Just another reason that this is a bad habit.

The best way to address bone density is by modifying the risk factors above such as eating healthier, exercising, and replacing lost hormones. We now have many effective drugs to reverse osteoporosis and decrease the risk of further fractures. Drugs have side effects, but on balance, these drugs do more good than harm. Unfortunately, increased calcium consumption has never correlated with the prevention or reversal of osteoporosis. For decades, physicians, osteoporotic foundations, industries, and governments have advocated for calcium consumption to prevent osteoporosis, often emphasizing the essentiality of dairy consumption to meet dietary recommendations for musculoskeletal health (Weaver et al., 1999; Langsetmo et al., 2015).

Following this logic, countries with the lowest consumption of dairy products should suffer the greatest burden of fractures (indicative of osteoporosis). However, the opposite holds true (Hegsted, 1986). While the per capita consumption of dairy in the United States, Australia, New Zealand, and Western Europe exceeds 300 kg per year, the rate of hip fractures is significantly greater in these countries than in Asian and African countries, where consumption ranges between 10 and 30 kg per year (Hegsted, 1986). On a global scale, dairy consumption and hip fracture rates are inversely related (Hegsted, 1986). The same trend exists with calcium consumption and hip fracture rates (Hegsted, 1986). Also, the greater the ratio of animal protein to plant protein consumption, the greater the incidence of fractures (Frassetto et al., 2000).

Migration studies further illustrate this “calcium paradox” (FAA and WHO, 2004), where communities consuming more calcium also suffer from more osteoporosis. African Bantu women consume on average approximately 1/3 of the United States Recommended Daily Allowance of calcium, without dairy and/or supplementation. Osteoporosis, however, is virtually nonexistent in the Bantu population. When Bantu women migrate to Western countries and adopt Western diets, rich in calcium and animal protein, osteoporosis simultaneously emerges (Walker, 1965).

Human and other animal studies have shown that the rate of urinary calcium excretion is directly related to the amount of animal protein consumed. It’s hard to believe, but drinking milk actually leaches calcium out of our bones! We all believed the common-sense recommendation that milk made our bones strong, but when confronted with the facts that milk consumption has never been shown to improve bone density and that it causes higher calcium loss, we would expect that the USDA would alert the public to this fact and put a warning label on dairy products just like they do on cigarettes. Dairy products are actually carcinogens and likely cause osteoporosis. The USDA has totally lost my trust.

The myth that consuming more dairy products is important to maintain healthy bones has been promoted by the dairy industry for obvious reasons without a bit of scientific evidence to support it. The highly dubious supplement industry promotes calcium pills in the same fashion, again without any evidence to back it up. Furthermore, evidence exists that correlates increased calcium consumption with heart disease. The USDA should protect us from this nonsense, but they have deep financial ties to these industries and are ethically too compromised to objectively analyze the scientific information. The fact is that a Whole Foods Plant Based (WFPB) diet prevents osteoporosis. To date, I know of no evidence that indicates that this diet can reverse osteoporosis, but this study should be done.

To prevent and attempt to reverse osteoporosis, I would now advise a WFPB diet. As well as a program of regular impact exercises as well as measuring and replacing vitamin D and hormone deficiencies in both men and women. I would still recommend bone-strengthening medications temporarily in all patients who have certain DEXA scores (bone density values), and have hip surgery to prevent fractures in the high-risk period of 6 months after surgery (I have demonstrated this in my studies). In patients who have osteoporosis, I would recommend several years of bone-strengthening medication if hormone replacement is declined or not effective.

Medicines to increase bone density:

• Bisphosphonates: Many different versions. I use alendronate 70 mg orally once weekly. This works by inhibiting osteoclasts which are cells that break down bone in the normal bone turnover process. This is very cheap, will increase bone density by about 1% per year and has been shown to dramatically increase fracture risk in large population studies. Side effects are reflux (rarely esophagitis), rarely osteonecrosis of the jaw (1/10,000), and after five years a slightly higher risk for atypical femur fractures. They can also cause a low calcium blood level; therefore, calcium supplements should be taken concurrently.
• Prolia: This is an expensive biological injectable drug that works in a similar way and has similar side effects as bisphosphonates, but is 5x as effective. An additional unique side effect is lower infection resistance. Subcutaneous injections are given twice a year. The cost is about $1400 per dose if you get it at the cheapest pharmacy (use the GoodRx app). Medicare will cover it if you have osteoporosis. Most other insurance companies won’t until you fail cheaper bisphosphonates. Please do not ask me to fill out forms for insurance companies to help you get this drug. It wastes my staff's time and doesn’t work. This is simply a disingenuous strategy of insurance companies to hassle us. But if your insurance doesn’t cover it, you can directly apply to AMGEN, the manufacturer, they will often sell it to you at a discount. If this doesn’t work, you have to decide if it is worth the extra money.
• Tymlos and Forteo: The most effective bone-building drugs available. Forteo is a copy of parathyroid hormone (PTH) and Tymlos is a drug that is similar and mimics PTH action They are daily injectable biologicals that cost in excess of $20,000 per year. There is a small risk of osteosarcoma (bone cancer). Insurance will only cover these in limited circumstances. I will not prescribe them. If you want these you need to convince your PCP or an endocrinologist.

Degenerative arthritis

As an Orthopedic surgeon specializing in joint replacement, I enjoy returning people back to maximum function. My professional reputation and income are directly related to how good a job I do surgically correcting end-stage degenerative hip and knee disease. I have pioneered hip resurfacing as a more functional and durable type of hip replacement. I am working on techniques to improve the outcome of total knee replacement as well. There is no evidence that diet can prevent cartilage loss or that it can be restored by diet.

On the other hand, obesity is a major cause of cartilage destruction (severe knee arthritis) and to a much lesser degree hip arthritis. Knee replacement rates in the US are skyrocketing as a direct result of the American obesity epidemic. Knee and hip replacements in the obese have a higher failure rate. If we could eliminate obesity by consuming a healthy diet, health costs and mortality rates would plummet.

Unfortunately, once your cartilage is gone (severe osteoarthritis) nothing can bring it back (including expensive stem cell injections). You need a joint replacement operation. However, losing weight will decrease your risks of a complication from surgery and increase your chances of a good outcome. It will also increase the lifespan of total hip and total knee replacements.

WFPB Resources

If you are interested in exploring the health benefits of a WFPB diet, I suggest the following sources:

The China Study – T. Colin Campbell Ph.D.
The best scientific evidence that is available on the subject. It is very readable; you don’t have to be a scientist to understand it. This book provides strong scientific evidence for the connection between animal protein consumption and many of the chronic degenerative conditions that people living in wealthy nations suffer from.

A good friend, who is not a scientist, asked me to read this in September 2015 and give him my opinion. It completely changed my view on nutrition. I was very grateful to him and was somewhat embarrassed that as a doctor I had not been the one to give him the book to read.

Previous to reading the evidence, I was a proponent of a healthy diet of organic lean meats and fish, vegetables, whole grains and healthy plant oils and avoidance of processed foods and all sweeteners including artificial ones. Basically, this is the “Mediterranean diet”. This is better than the Standard American Diet (SAD), but is clearly not good enough.

In October 2015 my wife and I took the plunge into a WFPB diet. One of our four grown children has already been a Vegan for 1 year, 2 others have also converted.

Dan Buettner – The Blue Zones: Lessons for Living Longer from the People Who've Lived the Longest
Describes the healthiest known naturally occurring populations in the world and analyzes their healthy lifestyle choices.

Forks over Knives – Documentary available on Netflix
This gives an excellent overview of the subject, and features Drs. Campbell and Esselstyn.

John Mackey CEO of Whole Foods
A good basic overview of the whole food plant-based diet and its rationale are given in his book “The Whole Food Diet”. Recipes are included as are references for more reading. I suggest this for your first introductory book on this topic. Also, you can watch Mr. Mackey's lecture on this topic online: "John Mackey: Discusses His New Book: The Whole Foods Diet"

Mr. Mackey is an inspiring business leader who is the co-founder of Whole Foods Market, a very successful chain that is growing rapidly in the US. More and more Americans are convinced that eating better will improve their health. The problem is that much nutritional information from the media and the government is conflicting and inaccurate. At Whole Foods, they provide healthier food and try to educate people about their choices. Mr. Mackey, who maintains a Vegan diet himself, admits that most foods sold at his Market are not healthy enough. His goal is to sell people what they want but to also educate them and gradually move them to healthier choices.

His one-and-a-quarter-hour lecture gives a good overview of what a healthy diet should be. Whole Foods for years has been sending employees who are interested to weeklong clinics to learn WFPB diet. These are now available to the public through Whole Foods Market.

John McDougal MD Health Clinics – https://www.drmcdougall.com
Book: The Starch Solution: Eat the Foods You Love, Regain Your Health and Lose the Weight for Good!
A dietary pioneer who offers extensive educational programs to learn the WFPB diet. You can access all his educational opportunities through his website, visit his clinic in Northern California, or order his book on the topic listed above.

Dr. Caldwell Esselstyn and Dean Ornish
Book: Prevent and Reverse Heart Disease: The Revolutionary, Scientifically Proven, Nutrition-Based Cure Book: Dr. Dean Ornish's Program for Reversing Heart Disease: The Only System Scientifically Proven to Reverse Heart Disease Without Drugs or Surgery
Leading experts in using a stricter low-fat WFPB diet to arrest and even reverse end-stage heart disease. Drugs and cardiac procedures can only control emergencies and temporarily relieve symptoms. Cardiac disease continues to advance despite any known medical treatment. Drs. Esselstyn and Ornish are two doctors who have been able to demonstrate arrest of progression and even reversal of heart disease. Please read their books if you have heart disease or want to avoid getting it as you age.

Dr. Michael Greger (nutritionfacts.org) maintains a free searchable website on the health benefits of a whole food plant-based diet. For example, if you search the debilitating autoimmune disease Multiple Sclerosis (MS) you will find scientific evidence that consuming a WFPB diet is more effective than new powerful, expensive and dangerous “biologics” that target and knockout parts of our immune system. These drugs certainly work, but the side effects can be very dangerous and the long-term consequences are not known. Our immune system prevents cancer from developing, and crippling the immune system with these drugs may have devastating late consequences that we may not discover for many years. Also, I recommend Dr. Greger’s book “How Not To Die."

Doctors Wellness Center – 2005 Beltline Blvd. Columbia SC 29204 – 803.782.4440
If you live in the Columbia area and have come to understand the importance of a WFPB Diet, but don’t know how to get there on your own, consider contacting this group who may be able to help.

Popular Cookbooks

• Veganomicon by Isa Chandra Moskowitz
• The Minimalist Baker’s Everyday Cooking by Dana Schultz
• The Oh She Glows Cookbook by Angela Liddon
• Search Amazon for many others

Food Blog – FROMMYBOWL.com
Easy vegan recipes using minimal oil

Nutritionist Nikola Hamilton, MSc. – www.beatifylife.com | This email address is being protected from spambots. You need JavaScript enabled to view it.
My daughter is an expert in WFPB diet and has been one of the chief reasons that I converted to this diet. My wife and I have been fortunate to have access to her vast knowledge in this area for frequent consultation. Even after 4 years of embarking on this healthy eating project, we are still learning new pearls from Nikola and when she visits we are treated to amazing vegan feasts.

If you need a personal coach to help you in navigating a transition to a healthier diet, please consult her online. In my opinion, most nutritionists give poor advice because they are trained in traditional dietary dogma which is tainted by USDA misinformation. To achieve remarkable and sustainable health goals, access an expert who remains critical of food industry propaganda and up-to-date on the scientific literature.