The document emphasizes the significant impact of personal lifestyle choices on health, highlighting the epidemic of overnutrition and its link to chronic non-communicable diseases such as obesity, diabetes, and heart disease. A multi-sectoral approach involving policy, education, and lifestyle changes is necessary to combat these health issues. It advocates for healthy living through better nutrition, physical activity, and reducing toxic exposures as key strategies for achieving improved health outcomes.

2. Healthy, Wealthy and Wise
Achieving your best Health in 2018
Stephan Esser MD, USPTA

3. “Early to bed and early to rise,
makes a man healthy and
wealthy and wise; wise, healthy
and wealthy!”

4. Esser’s Health
Ranch
Dr William Esser ND, DC 1911-2003

6. • Your Personal Choices may just be the most
powerful influences of your health, today,
tomorrow and for years to come

7. Goals
• Explore the Health of America Today
• Learn why what you do matters
• Develop a plan of health for your life

8. A Paradigm Shift

9. “A global response to a
global problem: the epidemic
of overnutrition.” WHO
It is estimated that by 2020 2/3rds
of the global
burden of disease will be attributable to chronic
non-communicable diseases, most of them
strongly associated with diet. The nutrition
transition towards refined foods, foods of animal
origin, and increased fats plays a major role in
the current global epidemics of obesity, diabetes
and cardiovascular diseases, among other non-
communicable conditions. Sedentary lifestyles and the
use of tobacco are also significant risk factors. …….. A
concerted multi-sectoral approach, involving the use of
policy, education and trade mechanisms, is necessary
to address these matters.

10. Mortality Statistics

11. Leading Causes of Death in US

12. Top Ten Causes of Death for Men in the United States

13. “A global response to a
global problem: the epidemic
of overnutrition.” WHO
It is estimated that by 2020 2/3rds
of the global
burden of disease will be attributable to chronic
non-communicable diseases, most of them
strongly associated with diet. The nutrition
transition towards refined foods, foods of animal
origin, and increased fats plays a major role in
the current global epidemics of obesity, diabetes
and cardiovascular diseases, among other non-
communicable conditions. Sedentary lifestyles and the
use of tobacco are also significant risk factors. …….. A
concerted multi-sectoral approach, involving the use of
policy, education and trade mechanisms, is necessary
to address these matters.
DiabetesDiabetes
High Blood PressureHigh Blood Pressure
High CholesterolHigh Cholesterol
Heart DiseaseHeart Disease
ObesityObesity

14. 2 of 32 of 3

15. Associated Pathology
• CVD:
– Hypertension
– Congestive Heart Failure
– PVD
– Impotence
– Claudication
• Endocrine:
– Diabetes
– PCOS
– Hypothyroidism
– Infertility
• Orthopedics:
– Osteoarthritis
– AVN
• Hepatic:
– #1 cause of liver dz in US
• Obstetrics:
– Gestational DM
– Macrosomia
– Inc. C Section rate
– Inc. Perinatal Morbidity
– Inc. Pre/Eclampsia
• Cancer:
– Prostate
– Colon
– Breast
– Endometrial
– Renal Cell
– Gallbladder
– Esophageal Adeno.
• Other:
• Hyperuricemia, Pancreatitis,
Gallstones, Sleep Apnea, Alzheimer’s,
Dyslipidemia, Metabolic Syndrome

17. Overweight ↑ risk of DM2 by 3 fold
Obesity ↑ risk by 9 fold

21. The Problem
1:9 adults1:9 adults

22. The Problem
• High Blood Pressure:
– 1 in 3 adults
1:3 adults1:3 adults

23. 1:6 adults1:6 adults

25. How did this Happen?

27. ↑39%
Av. of 52 tsp added sugar/person/day

28. •IOM:
(UL) for salt is 5.8 g/day
> 95 percent US Males 31 - 50
> 75 percent of US females 31- 50
regularly in excess of the UL.
< 2 g/day< 2 g/day

29. Sodium < 2000 mg
Cholesterol < 200mg
Sodium < 2000 mg
Cholesterol < 200mg

30. Sodium < 2000 mg
Cholesterol < 200mg
Sodium < 2000 mg
Cholesterol < 200mg

33. Food Portion Cholesterol/mg
Vegetables Unlimited 0
Fruits “ “ 0
Nuts “ “ 0
Seed “ “ 0
Grains “ “ 0
Milk (non-fat) 100g 2
Milk (whole) 100g 10
Butter 1 Tbs 31
Beef 100g 61
Salmon 100g 55
Chicken 100g 65
Shrimp 100g 126
Lobster 100g 127
Egg 100g 372
http://www.nal.usda.gov/fnic/foodcomp/search/

34. 83.9 lbs/person/year83.9 lbs/person/year
↑88%↑88%
20122012

35. US Meat Consumption
↑57 lb/capita

36. Year Bee
f
Pork Total
Red
Meat
Total
Chicken
Turkey Total
Poultry
Total
Red
meat
and
Poultry
Commerci
al Fish and
Shellfish
1965 74.7 51.5 133.9 36.9 7.6 44.4 178.4 10.9
2000 67.5 50.8 120.2 77.4 17.3 94.7 214.8 15.2
2016
Prj.
55.0 49.2 105.3 91.4 16.2 107.6
213
NA
As of 9/6/15

37. ↑300%
33.533.5
20122012

38. 8% from Fruits
and Vegetables
8% from Fruits
and Vegetables
≈ 50% from Added
fat/oil and
processed flour
≈ 50% from Added
fat/oil and
processed flour

39. Perspective
• We eat more
– Sugar, Salt, Fat, Meat, Dairy
– 1970-2018:
• ↑ 24.5 % C/day ≈
504K/day
• We get less then ideal Physical Activity
– 18.8% of adults achieved CDC reccs on
Exercise
– 10% of adults >65 y/o

40. Michelangelo’s David:
12 month 20 city tour of the US

41. What we Know
• Americans
– Eat More
– Exercise Less
• 2018:
– Obesity
– Diabetes
– Metabolic Syndrome
– CV Disease

42. HealthCare Spending = $2.7 trillion = 17.7% GDPHealthCare Spending = $2.7 trillion = 17.7% GDP

44. Associated Pathology
• CVD:
– Hypertension
– Congestive Heart Failure
– PVD
– Impotence
– Claudication
• Endocrine:
– Diabetes
– PCOS
– Hypothyroidism
– Infertility
• Orthopedics:
– Osteoarthritis
– AVN
• Hepatic:
– #1 cause of liver dz in US
• Obstetrics:
– Gestational DM
– Macrosomia
– Inc. C Section rate
– Inc. Perinatal Morbidity
– Inc. Pre/Eclampsia
• Cancer:
– Prostate
– Colon
– Breast
– Endometrial
– Renal Cell
– Gallbladder
– Esophageal Adeno.
• Other:
• Hyperuricemia, Pancreatitis,
Gallstones, Sleep Apnea, Alzheimer’s,
Dyslipidemia, Metabolic Syndrome

46. 1: Essential Hypertension
7: Diabetes Mellitus
15/17: Heart Disease
1: Essential Hypertension
7: Diabetes Mellitus
15/17: Heart Disease
Top 35 leading diagnosis groups at ambulatory care clinicsTop 35 leading diagnosis groups at ambulatory care clinics

47. Number and rate of discharges from short stay hospitals 2009Number and rate of discharges from short stay hospitals 2009
2: Heart Disease
8: Strokes
11: Diabetes Mellitus
17: Essential Hypertension
2: Heart Disease
8: Strokes
11: Diabetes Mellitus
17: Essential Hypertension

48. Admission Diagnosis to Nursing Homes 2009Admission Diagnosis to Nursing Homes 2009
1: Disease of Circulatory System1: Disease of Circulatory System

49. Can WEChange this?

50. Can we Change Health through Lifestyle
Or are Genetics the end of the story?

51. They did not display their parent’s susceptibility to cancer and diabetes….
……..the effects of the agouti gene had been virtually erased.

52. Pima Indians

54. “A global response to a global
problem: the epidemic of
overnutrition.” WHO
It is estimated that by 2020 2/3rds
of the global burden
of disease will be attributable to chronic
noncommunicable diseases, most of them strongly
associated with diet. The nutrition transition towards
refined foods, foods of animal origin, and increased fats
plays a major role in the current global epidemics of
obesity, diabetes and cardiovascular diseases, among
other noncommunicable conditions. Sedentary
lifestyles and the use of tobacco are also significant
risk factors. …….. A concerted multi-sectoral approach,
involving the use of policy, education and trade
mechanisms, is necessary to address these matters.
……if…….Lifestyle is the
Problem
……if…….Lifestyle is the
Problem
What is the answer……..?What is the answer……..?

55. Lifestyle Medicine
Physical Modalities
Pharmaceuticals
Surgery

56. What HAS worked?

57. • What if……..
– You ate MOREfruits, vegetables,
unprocessed whole grains, nuts, seeds and beans?
– You ate LESS foods of animal origin (meat, dairy,
fish) and processed foods
– You reduced Toxic exposures
– You exercised daily

59. 12 year Cohort Study
1507 men 832 Women
Ages 70-90 years
Outcomes: 10 yr all cause mortality
4 Factors: More plants, Moderate EtOH, physical exercise
and non-smoking were ass. w ↓ in ACM
50% ↓ in all-cause
and cause specific
mortality

60. “Not only do persons with better health habits
survive longer, but in such persons, disability is
postponed and compressed into fewer years
at the end of life.”
Vita, AJ et al. NEJM 1998; 338:1035-1041

61. Finnish Diabetes Prevention Trial
Total 522: 172M 350W
Av. age 55
Av. BMI 31
Randomized to standard of care or
individualized lifestyle counseling
Av. f/u 3.2 yrs
Risk of
Diabetes ↓ 58 %
(P<0.001)
N Engl J Med 2001;344:1343-50
“The reduction in the incidence of diabetes was
directly associated with changes in lifestyle”

63. The calorically restricted low-fat nutrient-dense diet in Biosphere 2
significantly lowers blood glucose, total leukocyte count, cholesterol,
and blood pressure in humans
PNAS December 1, 1992 vol. 89 no. 23 11533-11537
• Biosphere 2 is a 3.15-acre space containing an ecosystem that is energetically open (sunlight, electric
power, and heat) but materially closed, with air, water, and organic material being recycled. Since
September 1991, eight subjects (four women and four men) have been sealed inside, living on food crops
grown within. Their diet, low in calories (average, 1780 kcal/day; 1 kcal = 4.184 kJ), low in fat
(10% of calories), and nutrient-dense, conforms to that which in numerous animal experiments has
promoted health, retarded aging, and extended maximum life span. We report here medical data on the
eight subjects, comparing preclosure data with data through 6 months of closure. Significant changes
included: (i) weight, 74 to 62 kg (men) and 61 to 54 kg (women); (ii) mean
systolic/diastolic blood pressure (eight subjects), 109/74 to 89/58 mmHg (1 mmHg
= 133 Pa); (iii) total serum cholesterol, from 191 +/- 11 to 123 +/- 9 mg/dl (mean +/- SD;
36% mean reduction), and high density lipoprotein, from 62 +/- 8 to 38 +/- 5 (risk ratio
unchanged); (iv) triglyceride, 139 to 96 mg/dl (men) and 114 to 78 mg/dl (women); (v)
fasting glucose, 92 to 74 mg/dl; (vi) leukocyte count, 6.7 to 4.7 x 10(9) cells per liter. We
conclude that drastic reductions in cholesterol and blood pressure may be
instituted in normal individuals in Western countries by application of a
carefully chosen diet and that a low-calorie nutrient-dense regime shows
physiologic features in humans similar to those in other animal species.

64. Healthy living is the best revenge: findings from
the European Prospective Investigation Into
Cancer and Nutrition-Potsdam study 2009
• 23,153 participants (35 to 65yr) for about 8 years
• Rates of type 2 diabetes mellitus, myocardial
infarction, stroke, and cancer
• 4 Variables:
– Never smoking
– BMI<30
– 3.5 h/wk or more of physical activity
– healthy dietary principles (high intake of fruits,
vegetables, and whole-grain bread and low meat
consumption).
If you had all 4 factors at baseline you had
• 78% lower risk of developing a chronic disease
•
• 93% lower risk of diabetes
•81% lower risk of myocardial infarction
•50% lower risk of stroke, and
•36% lower risk of cancer
If you had all 4 factors at baseline you had
• 78% lower risk of developing a chronic disease
•
• 93% lower risk of diabetes
•81% lower risk of myocardial infarction
•50% lower risk of stroke, and
•36% lower risk of cancer
Sign Me Up!Sign Me Up!

65. Pritikin Program
• Effects of a High-Complex-Carbohydrate Diet
and Daily Walking on Blood Pressure and
Medication Status of Hypertensive Patients
Journal of Cardiac Rehabilitation, 3: 839, 1983
• 216 adults on 3 week program
• 83% were able to discontinue BP medx and
had normal BP’s
• 17% had their pill dosages substantially
reduced

66. Pritikin Program
• Pritikin et al Long-Term Use of a High-Complex-Carbohydrate,
High-Fiber, Low-Fat Diet and Exercise in the Treatment of NIDDM
Patients Diabetes Care 1983
– 26 day inpatient stay, 77% off Oral Hypoglycemics, 25%  in TC
• Effect of Short-Term Pritikin Diet Therapy on the Metabolic
Syndrome Journal of Cardio-Metabolic Disease 2006
– 12-15 day stays, BMI 3%, SBP, SG, LDL  10-15%
– 37% no longer met criteria for Metabolic Syndrome

67. Duke Rice Diet Program

68. What we Know
Health Comes from
Healthy Living
Health Comes from
Healthy Living

69. We know
• Health Comes from Healthy Living
–MORE Color
–MORE Movement
– Reduce/Eliminate Toxins
– Spiritual/Emotional Well-Being

70. Stages of Change
(Prochaska and DiClemente)
1: Pre-contemplation
2: Contemplation
3: Preparation/planning
4: Action
5: Maintenance
6: Permanent Maintenance (Termination)

71. GROW
• Goals
• Reality today
• Options
• Will
Disease Prevention
Disease Reversal
Medication Reduction
Functional Improvements
Pain Reduction
Feeling Good
Weight Loss
Improved Energy
Longevity
Sexual Performance
Aesthetics
Disease Prevention
Disease Reversal
Medication Reduction
Functional Improvements
Pain Reduction
Feeling Good
Weight Loss
Improved Energy
Longevity
Sexual Performance
Aesthetics

72. Setting Goals
•Specific
•Measureable
•Achievable
•Realistic
•Timely

73. Conclusion
• Personal Choices are powerful Medicine
• Assess YOUR Health Today
• Identify your health goals
• Develop a support team
• Take charge of your health today!

74. Profound Simplicity

75. Thank You!
Stephan Esser MD, USPTA

76. Conclusion
You are the most powerful influence
in your health today, tomorrow and
for years to come!

77. Fingers
Feet
Forks
the
Master Levers of Health Destiny

78. Feet

79. Exercise and Physical Health
• Reduces risk of
– Heart Disease ≈ 40%
– Obesity: ≈ 30-100%
– Stroke ≈ 50%
– Type 2 Diabetes ≈ 50%
– Hypertension ≈ 50%
– Disability delayed ≈15 years
– Colon Cancer ≈ 25-40%
– Breast Cancer ≈ 20%-44%
– Osteoporosis ≈ 20+%
• As many as 250,000 deaths per year in the United States
areattributable to a lack of regular physical activity

80. Exercise and Mental Health
• Regular Exercise:
– Reduces risk/severity of:
• Depression
• Anxiety
• ADD/ADHD
• Alzheimers Dementia
– Improves:
• Mental Clarity, test scores, focus

81. Exercise and Emotional Health
• Regular Exercise:
– Increases Self Confidence
– Teaches skills to manage adversity
– Enhances Self Esteem
– Develops Discipline
– Encourages Goal setting and self awareness

82. Exercise means pink spandex, going to a
gym, sweating with a bunch of people I
don’t even know or like!

84. Categories
• Leisure time Exercise: organized sports,
running, gym activities, rehabilitation etc.
• Lifestyle Exercise: activity incorporated into our
daily pattern of life
– eg: parking in the distant portion of the parking lot rather then the first
bumper, taking the stairs instead of the elevator etc.

85. Present Recommendations
• Cardiovascular:
– 150 minutes of moderate-intensity exercise per
week.
– 30-60 minutes of moderate-intensity exercise (five
days per week) or 20-60 minutes of vigorous-
intensity exercise (three days per week).

86. Present Recommendations
• Resistance Training:
– 2-3 days per week
– All major muscle groups
– 2-4 sets of each exercise
– 48 hours in between sessions
http://www.acsm.org/about-acsm/media-room/news-releases/2011/08/01/acsm-issues-new-recommendations-on-
quantity-and-quality-of-exercise

87. Present Recommendations
• Flexibility:
– 2-3 days/week to improve range of motion
• Balance:
– 2-3 days/week
– Eg: Tai Chi, Yoga

88. All Kinds
• People
• Programs
• Locations
• Products: Pedometers, Accelerometers etc

89. Intensity of Exercise
Maximal Heart Rate:
220-Age or 206.9-(0.67x age)
Heart Rate Reserve (HRR):
Max. HR- Resting HR = HRR
Target HR=HRR x % intensity + HR @ rest
Maximal Heart Rate:
220-Age or 206.9-(0.67x age)
Heart Rate Reserve (HRR):
Max. HR- Resting HR = HRR
Target HR=HRR x % intensity + HR @ rest
Talk Test:
-Easy: Can Talk and Sing
-Moderate: Can Talk but not sing
-Intense: Can’t talk or sing
Talk Test:
-Easy: Can Talk and Sing
-Moderate: Can Talk but not sing
-Intense: Can’t talk or sing

90. Nutrition
• Up to 50% of Americans are on a Diet
DIEtDIEt
LifestyleLifestyle

91. Nutrition
• Health Promoting Nutrition:
• Majority of Calories derived from Plant-Based
Sources
• Limited Calories from Refined Foods and
Foods of Animal Origins

92. Nutrition
Think more about Health and
less about Weight Loss

93. GoodGood
BadBad
Health
Promoting
Health
Promoting
Health CompromisingHealth Compromising

94. Nutrition
Think about Calorie Density
and less about individual
Calories

95. Toxins
• Get em’ out
• Get help if you need it
• You can do it
• You deserve it

96. Basics
• Physical Activity:
– Achieve 150 min of aerobic exercise and 2 sessions of
strength training per week
• Nutrition:
– Eat a high nutrient density program
– Limit/moderate lean meats, limit refined foods, fat,
sodium and cholesterol
• Eliminate Smoking and Limit Alcohol
Consumption

97. Now What?

98. Stages of Change
(Prochaska and DiClemente)
1: Pre-contemplation
2: Contemplation
3: Preparation/planning
4: Action
5: Maintenance
6: Permanent Maintenance (Termination)

99. GROW
• Goals
• Reality today
• Options
• Will

100. Setting Goals
•Specific
•Measureable
•Achievable
•Realistic
•Timely

101. Break Out: 4 minutes
• Set YOURSELF a SMART Goal for 1 Lifestyle
Measure and share it with your neighbor!
• Specific
• Measureable
• Achievable
• Realistic
• Timely
Exercise
Nutrition
Toxins
Sleep
Emotional
Poise(Stress)
Exercise
Nutrition
Toxins
Sleep
Emotional
Poise(Stress)

102. Conclusion
• Personal Choices are powerful Medicine
• Assess YOUR Health Today
• Identify your health goals
• Develop a support team
• Take charge of your health today!