Lifestyle Medicine

Prisma Health / Clemson School of Nursing

Up-To-Date APP
R. Daren Marionneaux, MD
Medical Director- Primary Care
BMW Associate Family Health Center

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 American College of Lifestyle Medicine Disclaimer

ACLM abides by strict professional and clinical standards with published evidence-based positions
and guidelines on the therapeutic approaches that make up Lifestyle Medicine. These standards
are posted for public review at www.lifestylemedicine.org/aclm-standards.
Members and certified professionals are authorized to use ACLM branding, presentations and
approved messaging for the enhancement of our stated mission and vision. ACLM is not
responsible nor accountable for individual deviations, misrepresentations and misinterpretations.
ACLM Vision:
A world wherein Lifestyle Medicine is the foundation of a transformed, sustainable system of health
care.
ACLM Mission:
Advancing evidenced-based Lifestyle Medicine as a value-based specialty that transforms,
redefines and sustains health and health care by treating, reversing and preventing
noncommunicable, chronic disease.

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 Disclosures
• No current or previous financial relationships with any commercial interests

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 Background / Practice Experience
• Board Certified in Family Medicine (since 1994)
• Fellow – American Academy of Family Physicians (AAFP)
• Member- American College of Lifestyle Medicine (ACLM)
• Practice Experience:
- Family Med Residency – US Army (EAMC, Ft Gordon GA)
- Military Troop Med Clinic Commander + Fam Med Faculty (3 years)- Ft Gordon GA
- Solo Private Practice (3 years) – Richmond, KY
- Small Group Private Practice- 7 providers (18 yrs) – Augusta, GA
- Veteran’s Administration- VAMC Primary Care (15 months)
- Premise Health (3 years) - BMW = employer-sponsored direct primary care

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 Premise Health
• The world’s leading direct healthcare provider (50 year history)
• Largest direct access (onsite) care network in the US
• Mainly Fortune 1000 companies (BMW, GE, Lockheed; Disney, Lowes, USAA)
• Onsite, nearsite and 24/7 virtual care
• Multiple lines of service: Primary Care, Dental, Vision, Behav Health, PT/OT,
Condition Mgmt / Wellness Coaching, Pharmacy, Occup Health, Fitness,
Nutrition, Lab / Radiology, Travel Med, Biometric Screening
• Top 5% (95th percentile) HEDIS ranking of all healthcare providers nationwide

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 Objectives
• Define ‘Lifestyle Medicine’
• Review the 6 core principals that lead to good health
• Identify why Lifestyle Medicine is relevant today
• Recognize the impact of lifestyle behaviors & attributable disease states
• Examine scientific research supporting the use of Lifestyle Medicine to prevent,
treat, and reverse disease
• Explore ways to impact patients in making lifestyle changes
• Discuss resources to help you on your journey as a medical provider

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 Lifestyle Medicine
Defined

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 Lifestyle Medicine is the use of evidence-based
lifestyle therapeutic approaches, such as a
whole-food, plant-predominant dietary lifestyle,
regular physical activity, adequate sleep, stress
management, avoiding use of risky substances
Lifestyle Medicine and pursuing other non-drug modalities, to treat,
reverse, and prevent chronic disease.

• Validated as highly effective

• Addresses the root-cause of disease
• Better outcomes and lower cost … value-based care
• Engaging / affordable / patient-centered / healing
 Simple, Powerful Therapy

Choose Lack of, or poor Regular and The well-documented Identify both positive Social connectedness
predominantly whole, quality sleep can consistent physical dangers of any and negative stress is essential to
plant-based foods lead to a strained activity is an essential addictive substance responses with coping emotional resiliency
that are fiber-filled, immune system. piece of an optimal use can increase risk mechanisms and and overall health
nutrient dense, health- Identify and alter health equation for many cancers and reduction techniques
promoting and dietary or heart disease for improved
disease-fighting environmental habits wellbeing
that may hinder
healthy sleep
 Lifestyle Medicine
Nutrition: Add more
vegetables, fruits, beans and
whole grains into your day

Outdoors: Enjoy Movement: Get active,

sunshine and fresh air sit less, move more

Hydrate: Make water Emotional Wellbeing / Stress:

your preferred beverage Focus on positivity, happiness,
and meaningful relationships

Substance Free: Live a life free of tobacco Sleep: Aim for 7 – 8 hours
products, illegal drugs, prescription drug restful sleep each day
abuse/misuse, and alcohol in excess

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 #RealHealthcareReform

• Team-Based Care
• Group Visits & Support Groups
• Value-Based Care “We have long known what behaviors
promote health and prevent disease.
• Proven Outcomes Lifestyle medicine embodies this idea of
• Improved Patient Satisfaction true 'health' care. Rather than pills and
procedures, the focus is on the lifestyle
• Renewed Physician Passion choices we make every day.”
- Jonathan Bonnet, MD

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 Systems of Change
Clinical guidelines state that diet changes are a critical first line treatment for many chronic
conditions
(e.g., diabetes, obesity, hypertension), often before any medication is prescribed.

This is reinforced by leading national and international organizations, and based on innumerable
evidence-based studies showing dietary change has an “A” rating on patient impact.

Lancet Commission

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 WHY NOW
Unsustainable Economics

• US Healthcare Spend = $3.3 trillion ($10,739 per person)

18% of US Gross Domestic Product
• 90% of this spend is on chronic disease - Nearly half of
all Americans live with one or more chronic disease
• Lifestyle Medicine is the cost- and life-saving foundation of
all healthcare - in clinical practice, as well as in worksite LMeconomicresearch.org
health promotion
• Launched in Nov 2018, LMERC Advisory Board Members:
economists, research physicians, health care consultants,
actuaries, data analysts and public health professionals

Source: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-
Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html
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 WHY NOW
Chronic Disease Epidemic:
• Healthcare in US costs $3.3 trillion annually
• 90% of these costs are attributed to the treatment of chronic conditions
• Lifestyle Medicine addresses the root cause to both improve health & reduce
costs

Source: https://www.cdc.gov/chronicdisease/about/costs/index.htm
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 Impact of Lifestyle
Behaviors

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 The World Health Organization estimates that by 2020,
2/3 of all diseases will be a result of lifestyle factors.

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 Did you know?

9 out of 10 people need to significantly improve their diet.

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 Did you know?

1 in 6 people smoke tobacco.

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 Did you know?

3 out of 4 people do not get enough physical activity.

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 Did you know?

90% of Americans do not consume adequate

amounts of fruits/vegetables in a day.

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 Only 3% of the U.S. Population meet the guidelines for healthy living.

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 Attributable
Diseases to
Lifestyle Behaviors

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 Lifestyle Related Diseases
• Heart Disease
- Hyperlipidemia
- Hypertension
• Cancer
- Breast cancer
- Prostate cancer
- Colon cancer
• Type 2 Diabetes
• Obesity
• Alzheimer’s Disease

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 Research
Supporting
Lifestyle Medicine

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 Dr. Dean Ornish’s Lifestyle Heart Trial Results

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 Heart Disease Treatment – Coronary Artery Disease

Lifestyle
Heart Trial:
Proved that
switching to a
WFPB diet can
actually open
arteries!

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 Heart Disease Treatment – Coronary Artery Disease

Treating the Cause – 3.75 Year Follow-Up

Lost to Follow up (1%) 2
Adherent (89%) 177
Non-Adherent (10%) 21
TOTAL 200

RECURRENT EVENTS (%)

Adherent Patients 0.6 %
Non-Adherent Patients 62 %

No mortality from the diet. No morbidity from the diet. Benefits improve over time!

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 Heart Disease - Hypertension

1940’s – Dr. Walter Kempner recognized the following:

• Low salt diet helped with blood pressure
• Low protein diet helped with kidney function
• Low fat/cholesterol diet helped the heart

Kempner Rice Diet was born – diet completely made up of rice and
fruit, which he used to treat those dying from malignant hypertension or
end stage renal disease, hoping to halt the progression of disease.

Instead, two thirds of the disease REVERSED!

Flash Forward D.A.S.H. Diet

Dietary Approaches to Stop Hypertension - 2001

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 Heart Disease - Hypertension

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 Heart Disease - Hypertension

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Adventist 2 Studyt 2 Study: The more animal food, the
more diabetes.

Nonvegetarian = higher BMI

Nonvegetarian = higher prevalence Diabetesimal
food, the.
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Dietary Fiber Affects.

Food Grams of
Fiber
1 cup of cooked white 19
beans
1 cup of raw raspberries 8
1 cup of cooked quinoa 5
1 cup of cooked collard 5
greens
1 cup of cooked broccoli 5
https://www.ncbi.nlm.nih.gov/pubmed/12963562 1 pear 6
https://www.ncbi.nlm.nih.gov/pubmed/26269366 Meat 0
https://www.ncbi.nlm.nih.gov/pubmed/24389767

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 Type 2 Diabetes
Diabetes is almost 100% preventable!

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 Type 2 Diabetes - Prevention

DPP Study Placebo Metformin Lifestyle

(control) Intervention
Incidence of Diabetes 11.0 7.8 4.8
(per 100 person-years)
Reduction in incidence -31% -58%
compared to placebo

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 Type 2 Diabetes - Treatment/Cure

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 Type 2 Diabetes - Diet
99 people with Type 2 Diabetes assigned to two diets for 22 weeks

Low Fat, Plant

ADA Diet
Based Diet
Reduction in Diabetic
Medications -43% -26%

Reduction in Body
-14.3 lbs -6.8 lbs
Weight (lbs)
Reduction in LDL
-21.2% -10.7%
Cholesterol
HbA1c (% points) -1.3 -0.4

Barnard, N.D. et al. A Low-Fat Vegan Diet Improves Glycemic Control and Cardiovascular Risk Factors in a Randomized Clinical Trial in Individuals with Type 2
Diabetes. Diabetes Care 2006.

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 Does Processed Meat Cause Cancer?
• 22 experts from 10 countries reviewed more than 800 studies to reach the
conclusion: “eating 50 grams of processed meat daily increased the risk of
colorectal cancer by 18%.”
• 50 grams of processed meat is equal to 4 strips of bacon or 1 hot dog

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 Breast Cancer

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 Breast Cancer
• Researchers followed about 30,000 post-menopausal women without a history
of breast cancer for 7 years and found that limiting alcohol, eating mostly plant
foods and maintaining a normal BMI (<25) was associated with a 62 percent
lower breast cancer risk.
• The Long Island Breast Cancer Study Project reported that women who eat
more grilled, BBQed or smoked meats over their lifetimes may have as much as
47% higher risk of breast cancer.
• In women actively fighting breast cancer, consuming less meat and more fruits,
vegetables and fiber, as well as flaxseed, soy foods, and cruciferous vegetables
improve survival chances.

Be as lean as Eat mostly foods Limit alcoholic

possible of plant origin drinks

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 Early-Stage Prostate Cancer Group @ 2 year Control Experimental
follow up (n=49) (n=43)
# that required 13 of 49 2 of 43 (5%)
conventional (27%)
intervention
PSA >10 3 of 49 (6%) 0 of 43 (0%)

Conclusion:
Patients with early-stage
prostate cancer choosing
active surveillance might
be able to avoid or delay
conventional treamtent
for at least 2 years by
making changes in their
diet and lifestyle!

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 Does Physical Activity Increase Life Expectancy?
A Review of the Literature- Journal of aging research 2012(11):243958
• Physical activity reduces many major mortality risk factors including arterial
hypertension, diabetes mellitus type 2, dyslipidemia, coronary heart disease,
stroke, and cancer. All-cause mortality is decreased by about 30% to 35% in
physically active as compared to inactive subjects
• Results of 13 studies describing eight different cohorts suggest that regular
physical activity is associated with an increase of life expectancy by 0.4 to 6.9
years.

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 Alzheimer's Disease

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 Beginning the
Journey

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 Lifestyle Change % Reduction in risk of Heart
Disease
1. 50% decrease in total 50%
cholesterol
Making these 6 2. 6mm/Hg decrease in diastolic 16% (42% reduction in stroke
changes can blood pressure risk)
reduce a person’s
risk of heart 3. Stop smoking 50% risk of sudden heart attack
disease by as
much as 90-95% 4. Maintain ideal body weight and 35 to 55%
waist size
5. ≥150 minutes per week of 35 to 55%
moderate exercise
6. ≥5 servings of fruits and 20 to 25%
vegetables a day

John, K., & Shull, J. (2018). Lifestyle Medicine Board Review Manual (2nd ed., p.22 ). ACLM.

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 Nutrition

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 Ensure Good Nutrition

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 Color Counts!

• Green
- Antioxidant potential to help promote
healthy vision and reduce cancer risks.
• Orange/Yellow
- Contain nutrients that promote healthy
vision, immunity, and reduce the risk of
some cancers.
• Purple/Blue
- Antioxidant and anti-aging benefits any
may help with memory, urinary tract
health and reduced cancer risks.
• Red
- May help maintain a healthy heart,
vision, immunity and may reduce
cancer risks.
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 Incorporate More Whole
Food/Plant Based Meals:

• Try new recipes!

• Add fruits to cereal, yogurt, salad, oatmeal.
• Have a supply on hand of frozen vegetables.
• Plan meals around dishes that contain
vegetables and then build the rest of the meal
from there.
• Look for ways to add more herbs/spices to
the recipes you already prepare.

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 Movement

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 Definition & Benefits
Any bodily movement by skeletal muscles that results in energy expenditure above resting levels.
Encompasses: exercise, sports, and physical activities done as part of daily living, occupation, and
leisure.
Physical activity health benefits:
• Control weight
• Reduce risk of cardiovascular disease
• Reduce risk for type 2 diabetes or metabolic disorder
• Reduce risk for some cancers
• Strengthen bones and muscles
• Improve mental health and mood
• Improve activities of daily living and prevent falls
• Increase chances of living longer

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 Frequency & Type

Physical activity guidelines

recommend that adults participate in
at least:
• 150 minutes per week of moderate-
intensity aerobic physical activity
Types of
• Two or more sessions per week of
Physical Activity
muscle-strengthening exercises
• Cardiovascular (aerobic)
and activities to increase flexibility
• Resistance (strengthening)
• Flexibility (stretching)

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 Sit Less, Move More
• With hectic schedules and the modern conveniences of daily life, many of us
spend a great deal of time in front of a computer, smart phone, behind the wheel
of a car or in front of the TV.
• Take a break from sitting every 30 minutes
• 20:8:2 Rule
- 20 minutes sitting
- 8 minutes standing
- 2 minutes moving around

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 Stepping Stones

BEST

BETTER Strive for 150

minutes of cardio
GOOD + 2 strength and
Move More
flexibility
sessions per
Sit Less week

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 Physical Activity Examples

Sit Less:
general movement Move More:
low intensity recreation
Meeting Movers Moderate to High
Take the Stairs Intensity: formal exercise
Active Work Station Wii Sports
Chair Stretches Ping Pong
Stretch Breaks Individual Exercise Prescription
Guided Meditation Classes
Bean Bag Toss Games Group Exercise Classes
Breathing drills
Hiking Strength Training
Tai Chi
Fishing Running/Jogging
Outdoor Cycling Sports Specific Training
Race Training
Competition
Endurance Sport and Interval
Training

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 Personalizing Your Plan
• Do what you love
• Variety of activities
• Fitness wearable tracker or app
• Accountability partner

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 Emotional
Wellbeing

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 Emotional Wellbeing
• Essential to our overall health Focus on positivity, happiness,
• Allows us to realize our full potential and meaningful relationships
• Helps us cope with the stresses of life
• Encourages us to work productively
• Supports us in making meaningful
contributions to our communities
• Is not the absence of emotions, but it is
our ability to understand the value of our
emotions and use them to move forward
in a positive direction

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 Deep Breathing

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 Positive Psychology

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 Gratitude

• Appreciating life's gifts,

including the challenges.
• Finding gratitude in your
everyday life can increase
your happiness and overall joy.

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 Form and maintain healthy relationships

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 Self-Compassion and Self Talk
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 Sleep

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 What Does Sleep Do?
• Cleanses our brain
• Encode memories and improves learning
• Promotes heart health
• Manages stress and improves mood
• Growth repair
• Regulates appetite, energy use and weight control
• Keeps you from getting sick

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 Sleep: Aim for 7 – 8 hours restful sleep each day

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 Disruptions to Our Sleep

• Blue light increases nighttime heart rate, blood

pressure and core body temperature
• Decreases sleepiness
• Suppresses melatonin
• Increase cortisol, increase body fat over time?
• May even alter our mood

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 Effects of Chronic Sleep Deficiency

High
Heart Kidney
Diabetes Stroke Blood Obesity Depression
Disease Disease
Pressure

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 Tips for a Good Night Sleep
• Review medications with your provider
- Cold medication and some blood pressure medications can interrupt sleep
• Relax before bedtime
- Unwind by reading or listening to relaxing music
- Guided meditations
- Restorative Yoga poses
• Take a warm bath or shower
- Lavender aromatherapy oil
• Bedroom setting- Tech free- No Cellphones
- Warm amber lighting to dark
- Cool lower temperature in bedroom by 5 degrees
- Quiet- Earbuds or white noise

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 Food Tips to Help You Sleep
• Pistachios are a great source of melatonin, eat a few (5-7) per day
• Dark cherries, bananas, pineapples, oranges also contain melatonin
• A cup of chamomile tea or “sleepytime” tea can help you relax before bed
• Avoid sweets or processed foods before bed, avoid alcohol and caffeine too

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 Hydration,
Getting
Outdoors &
Living
Substance Free

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 Hydrate, enjoy the outdoors, and live substance free!

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 Hydrate With Water
• Healthy skin
• Lubricates our joints (helps to reduce pain)
• Keeps blood flowing, delivers oxygen
• Avoid constipation, flush toxins
• Maintain blood pressure
• Prevent kidney issues and urinary tract infections
• Help to feel full and improve digestion

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 Be Substance Free

Live a life free of

tobacco products,
illegal drugs,
prescription drug
abuse/misuse, and
alcohol in excess

www.healthycures.org

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 Resources

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https://www.lifestylemedicine.org/ACLM/Tools_and_Resources/Web_Based_Resources_.aspx

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 Dr. Michael Greger – NutritionFacts.org

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 Film: Forks Over Knives
Websites:
• www.lifestylemedicine.org/Web-Based-Resources
• www.plantricianproject.org/quickstartguide
• www.nutritionfacts.org
American Journal of Lifestyle Medicine:
• www.journals.sagepub.com/home/ajl
Podcast: Dr. Michael Greger
Recipes: www.bluezones.com/recipes/

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Bluezones.com

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Forks Over Knives: Cherry Chip “Ice cream”

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 Questions

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 References
Intensive lifestyle changes for reversal of coronary heart disease. Ornish et al.
JAMA 1998:280(23):2001-7.
Changes in prostate gene expression in men undergoing an intensive nutrition
and lifestyle intervention. Ornish et al. Proc Natl Acad Sci USA. 2008 Jun
17;105(24):8369-74.
Clinical events in prostate cancer, lifestyle trial. Ornish et al. Urology 2008: Dec 72
(69): 1319-23.
Reduction in the incidence of type 2 diabetes with lifestyle intervention or
metformin. Knowler, W.C. et al. New Eng J Med 2002: 346(6): 393-403.
Vegetarian diets and incidence of diabetes in the Adventist Health Study-2.
Tonstad, S. et al. Nutr Metab Cardiovasc Dis, 2013:23 (4): 292-9.

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 References
Known and Probable Human Carcinogens. Oct 2, 2014. ACS.
https://www.cancer.org
Vegetarian dietary patterns and mortality in Adventist Health Study 2. Orlich, M.J. et
al. JAMA Int Med 2013. 173 (13): 1230-8.
A low-fat vegan diet and a conventional diabetes diet in the treatment of type 2
diabetes. Barnard, N.D., et al. Am J Clin Nutr 2009. 89 (5): 1588-1596.
The Long Island Breast Cancer Study. Nature Reviews Cancer 2005 Dec;5(12):986-
94.
Dietary fats and the risk of Alzheimer’s disease. Morris, C. et al. Arch Neuro 2003.
60(2):194-200.
Changing the treatment paradigm for coronary artery disease. Esselstyn, C.B., et al.
Am J Cardiol. 1998 Nov 26;82(10B):2T-4T.

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 References
Type of Vegetarian diet, body weight, prevalence of type 2 diabetes. Tonstad, S. et al.
Diabetes Care 2009. 32: 791-6.
Does Physical Activity Increase Life Expectancy? A Review of the Literature. Reimers,
C.D. Journal of Aging Research 2012: 243958.
Greater survival after breast cancer in physically active women with high vegetable-fruit
intake regardless of obesity. Pierce, J.P. et al. J Clin Oncol 2007: 25 (17): 2345-51.
Rapid reduction of serum cholesterol and blood pressure by a twelve-day, very low fat,
strictly vegetarian diet. McDougall, J. et al. J Amer Col Nutr 2013: 491-496.
World Health Organization says processed meat causes cancer Oct 2015.
https://www.cancer.org/latest-news/world-health-organization-says-processed-meat-
causes-cancer.html
Effects of a low fat, high fiber diet & exercise program on breast cancer risk factors in
vivo. Barnard R.J. et al. Nutr & Cancer 2006: 28-34.

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presentation is extremely confidential and is not for distribution.
 Thank you !!
Daren Marionneaux, MD
BMW Associate Family Health Center

Work: (864) 989-1432 Ext 344

Cell: (706) 833-7895

Email: [email protected]

© 2019 Premise Health. All material contained in this

presentation is extremely confidential and is not for distribution.