Plant Based nutrition has been show to be one of the most powerful methods to revers and prevent many of the most common cardiometabolic diseases today. In this talk learn about the long history of plant based nutrition in the inpatient setting and about clinics still functioning today. Also review some of the most common challenges keeping it from application in the inpatient setting in most health care settings.

1. Plant-based Nutrition for the
Inpatient
Historical Overview and Application of the Science in
the Acute and Chronic Setting
Stephan Esser MD, USPTA

2. Tenets of Health
Tenets of Health
•Plant Based Diet
•Exercise
•Sleep
•Emotional Poise
•Sunlight
•Clean Water and Air
•Plant Based Diet
•Exercise
•Sleep
•Emotional Poise
•Sunlight
•Clean Water and Air

4. Disclosures
• I have no financial affiliation with any of the
centers I am going to describe to you
• I am a strong advocate of plant based
nutrition
• I grew up at an inpatient plant based facility

5. Goals
• Review the history of inpatient plant-based health programs
• Recognize and appraise challenges affecting application
of plant-based nutrition to inpatient settings in the 21st century
• Develop strategies to facilitate application of plant-based nutrition in the
inpatient setting thru case based examples

6. “Those who cannot remember the past are
condemned to repeat it.”
The Life of Reason 1905
George Santaya

7. Challenges
• Knowledge/Awareness
• Cost/Reimbursement
• Patient Disinterest/Refusal
• Family/Social Cultural Norms
• Established System
• Habit
• Feelings/Fixed Beliefs/Emotions

8. The Past

9. Biblical
– Daniel 1:12-15
• “Please test your servants for ten days. Let us be given
vegetables to eat and water to drink. Then see how we
look in comparison with the other young men who eat
from the royal table………..…..after ten days they looked
healthier and better fed than any of the young men
who ate from the royal table.”

10. Fr. Sebastian Kneipp 1821-1897
“The Waßer Cure”

11. Dr Henry Lindlahr 1862-1924
• Nature Cure
• “No Surgery,
No Drugs,
No Serums.”
• Lindlahr Sanitorium: 1914-1928
– Vegetarian diet, sunbaths, airbaths, exercise, hydrotherapy, and
manipulation.

12. Dr John Harvey Kellogg MD 1852-1943
• Battle Creek Sanitorium, MI
– 1866-1940’s
– 30+ physicians on staff
– Up to 1000 guests at a time
– Based in Seventh Adventism

13. Dr. Herbert Shelton, N.D. 1895 –1985

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

15. Past
• Incorporate “plant based” nutrition with
multiple other treatments:
– Enemas
– Hydrotherapy
– Electrotherapy
– Exercise
– Herbs
– Massage
– Therapeutic Water Fasting

16. Past
• Leaders
– Passionate
– Iconoclasts
– Eccentric
– Varied levels of:
• Training
• Support
• Science
• “Product”/2ndary Gain

17. More Recent

18. A Quick View
• Hippocrates: Wheat Grass, Raw Food etc
• Tree of Life: Raw Food, Kabalism etc
• Gerson Clinics: Juice, Food, Coffee En., “other”
• Total Health Institute: Juice, food, prayer etc
• Optimum Health Institute: Food, juice, fasting
• Others:
– Many other small and large places with hosts of
option

19. Duke Rice Diet Program
• Walter Kempner MD: 1903-1997
– German born physician
– On Campus Duke Medical Center/Community
– Advanced disease to aesthetics
– Eventually Closed 2002/2013

20. Duke Rice Diet Program

22. Regression of Diabetic Neuropathy with Total
Vegetarian (Vegan) Diet
• 21 pts with T2D and SDPN average age of 64
• Low fat (10–15% of cats), high fiber, total vegetarian diet (TVD) of
unrefined foods and conditioning exercise
• 17/21 (81%) had complete relief of the DSPN pain in 4 to 16 days.
• Weight loss averaged 4-9 ± 2-6 kg during the 25 days.
• By the 14th day, the fasting blood glucose level averaged 35% lower
• 5 got off hypoglycemic agents
• Serum triglyceride and total cholesterol had decreased by 25-0 ±
23% and 13 ± 15% respectively (p <0-01) in 2 weeks.
• Follow-up studies of 17 of the 21 patients for 1-4 years indicated that
71% had remained on the diet and exercise program as advised in
nearly every item.
Journal of Environmental and Nutritional Medicine 1994, Vol. 4, No. 4 , Pages 431-439

23. Diabetes
• Does a vegetarian diet reduce the occurrence of
diabetes? American Journal of Public Health, Vol. 75, Issue 5 507-512
– 25,698 adult White Seventh-day Adventists identified in 1960 followed for 21 years
– vegetarians had a substantially lower risk than non-vegetarians of diabetes as an
underlying or contributing cause of death
• Fruit and Vegetable Consumption and Diabetes
Mellitus Incidence among U.S. Adults Preventive Medicine Vol 32 Iss
1 January 2001. Pages 33-39
– Appr. 10, 000 participants, highest fruit and vegetable consumption = lowest risk of
T2D
• Dietary Patterns and the Incidence of Type 2
Diabetes Am. J. Epidemiol. (2005) 161 (3): 219-227.
– 4,000 Finnish en and women, followed 23 years
– Highest consumption of fruits/vegetables in prudent diet resulted in decreased risk

24. Diet and Exercise in the Treatment of NIDDM: The
need for early emphasis
• 652 with NIDDM
• 3-week intensive dietary modification
program
• 71% of 197 on oral hypoglycemic agents and
39% of 212 on insulin were able to
discontinue their medication with normalized
BS’s
Diabetes Care December 1994 vol. 17 no. 12 1469-1472

25. True North Health
• Santa Rosa, CA
• Dr Alan Goldhamer and Staff
• 30+ years
• 10,000 + patients
• Vegan/ SOS Diet and Therapeutic Water Fasting
• Reversal of T2D, HTN, Inflammatory Conditions
• Physician Offices on Site

26. Pritikin Institute
• Nathan Pritikin (August 29, 1915 – February 21, 1985)
– Inventor/Engineer turned Health Advocate
– Founded the Pritikin Longevity Center in 1976 in CA
– Now in South Florida

27. Nathan Pritikin
• Pritikin et al. Effects of a high-complex-carbohydrate, low-fat, low-cholesterol
diet on levels of serum lipids and estradiol AJM 1985
– 26 day inpatient stay 15-20%  in TC
• 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

28. Challenges
• Dominant “worldview”
• Feelings/Emotions
• Inadequate Education
• Lack of Insurance funding
SScciieennccee
• Vested Interests entrenched
• Personal beliefs of administration
• Inertia
• Energy required

29. Cases and Application

30. Case #1
• 60 y/o AA male admitted to the ED and now
up on the IM floor for:
Congestive Heart Failure
• Stabilized with Medication
• 3rd admission in 6 weeks
• On Maximum Medical therapy

31. Why?

32. The What?
• Worsening Medical Condition
• Dietary Excesses: Na+ etc
• Medical “Non-Compliance”

33. The Why?
• Why……
– Intrinsic Motivators
• Personal Goals, Beliefs, Fears, Anxiety
– Extrinsic Factors
• Living Situation/Support
• Finances
• Functional Abilities
• Knowledge

34. Case #1 Cont’d
• Gather Information
– What is your understanding of your health
condition?
– What have you been told?
– Has this ever happened before? How have you
tried to prevent it?
– What has not worked? Is there anything else you
can try?

35. Case #1 Cont’d
• The Pitch:
– Are you interested in learning how you can
prevent repeat hospital visits?
– What would you be willing to do?
– Would you like to try some foods while in the
hospital which can lower your blood pressure and
may help you reduce the number of medicines
you need?

36. Take Aways
• Evaluate the scenario
• Ask questions/Gather information
• Listen/Empathize
• Avoid projection/judgment/apathy
• Look for Opportunities
• “Sell” the product
• Get “buy-in”
• Develop Channel Factors

37. Case 2

38. Case 2
• 58 y/o female s/p Right CVA with mild residual
left sided weakness in an IRF
– PMH:
• Obesity
• HTN/HLD
• Depression
• Chronic MSK Pain

40. Case 2 Cont’d
• Push Back
– Establishment
– Nutrition/Dietary Staff
– Patient/Family
• Projection
• Failure to Educate
• Inadequate Options

41. Case 2 Cont’d
• Know the Science:
– Single HF meal
• Alters Endothelial function up to 4 hours after
– Effect of a single high-fat meal on endothelial function in healthy subjects.Vogel RA, Corretti MC, Plotnick GDAm J Cardiol. 1997 Feb 1;
79(3):350-4.

42. BLOOD-PRESSURE-LOWERING EFFECT OF A VEGETARIAN DIET:
CONTROLLED TRIAL IN NORMOTENSIVE SUBJECTS
The Lancet, Volume 321, Issue 8314, Pages 5-10I.Rouse
59 healthy, omnivorous subjects aged 25-63 years were randomly allocated to a
control group, which ate an omnivorous diet for 14 weeks, or to one of two
experimental groups, whose members ate an omnivorous diet for the first 2
weeks and a lacto-ovo-vegetarian diet for one of two 6-week experimental
periods. Mean systolic and diastolic blood pressures did not change in the
control group but fell significantly in both experimental groups
during the vegetarian diet and rose significantly in the
experimental group which reverted to the omnivorous diet.
Adjustment of the blood-pressure changes for age, obesity, heart rate, weight
change, and blood pressure before dietary change indicated a diet-related fall
of some 5-6 mm Hg systolic and 2-3 mm Hg diastolic. Although the
nutrient(s) causing these blood-pressure changes are unknown, the effects
were apparently not mediated by changes in sodium or potassium intake

43. Rapid reduction of serum cholesterol and
blood pressure by a twelve-day, very low fat,
strictly vegetarian diet.
J Am Coll Nutr. 1995 Oct;14(5):491-6.
During this short time period, cardiac risk factors
improved: there was an average reduction of total
serum cholesterol of 11% (p < 0.001), of blood
pressure of 6% (p < 0.001) and a weight loss of 2.5 kg
for men and 1 kg for women.

44. Case 2
• Know the Science
• Demonstrate the benefit
• Develop a sample menu
– Identify unique tastes of the individual
• Get patient and family interest/buy in
– “Marketing”

45. Case 3
• 48 y/o male s/p total knee replacement in
Acute Hospital for 2 nights
– PMH:
• Obesity: BMI: 45
• Type Two Diabetes: On Insulin
• HTN/HLD
• Gout
• Osteoarthritis
• Erectile Dysfunction
• Excema

46. Case 3
• What are opportunities?
• Limitations?
– Time
– Reason for Adm
Stages of Change
Stages of Change
1: Pre-contemplation
2: Contemplation
3: Preparation
4: Action
5: Maintenance
1: Pre-contemplation
2: Contemplation
3: Preparation
4: Action
5: Maintenance

47. Case 3
PPllaanntt aa SSeeeedd
• Assess readiness for change
• Determine knowledge/awareness
• Provide science in appropriate format
• Develop relationship: family/friends
• Encourage follow up

48. Conclusion
• Assess need
• Evaluate readiness for change
• Help them GROW
– Goals, Reality today, Obstacles, Will
• Gather and Publicize results
• Promote change on an institution level after
personal change
• Seek Sustainablity

49. Conclusion
• The science is clear
– Plant based nutrition is powerful medicine
• The history demonstrates
– Many versions have and do exist of integrating
plant based foods in a healthcare setting
• The challenges are real
• The challenges are opportunities for change

50. Good Luck

51. TThhaannkk YYoouu!!