The Whole-Food Plant-Based Diet

The Whole-Food Plant-Based Diet— What Every Practitioner Should know Prepared for the CareVention HealthCare Clinical Advisory Panel Meeting 9/20/19 Lake Nona, Florida

Orsula V. Knowlton, PharmD, MBA Graduate of e-Cornell Certificate Course on Plant-Based Nutrition, August, 2019

Copyright © 2019, Tabula Rasa HealthCare, Inc., all rights reserved. These materials are confidential and proprietary information of Tabula RasaMedication Risk Identification and Mitigation HealthCare, Inc. and may not be reproduced in whole or in part withoutCopyright the written © 2019 consent Tabula of Rasa Tabula HealthCare, Rasa HealthCare, Inc., All RightsInc. | NASReserved.DAQ – MayTRHC. not be used without permission. | NASDAQ – TRHC. Goals and Objectives

+Explain the potential root cause of diet as it relates to cancer, cardiovascular disease, diabetes and obesity

+Identify the conflicts that exist in the U.S. as it relates to dietary recommendations

+Through case studies, describe the potential role for the prescribing of a whole-food plant-based diet in PACE

+List the food content of a whole-food plant-based diet

+I have no conflicts related to this presentation (the Whole Food Plant Based Diet can result disease reversal and fewer medications).

Fundamental #1—Do the right thing always.

+Most people consider various therapies (i.e., medication, surgery, PT, OT, etc…) as treatment for chronic disease. Yet, little time is spent on getting to the root cause for the disease. Thus, therapies are PALLIATIVE not CURATIVE.

+An example of this is that a house is on fire, and dousing it with fuel (animal fat and protein) instead of putting it out with a change in diet, the root cause (i.e., Whole food Plant Based Diet (WFPBD)).

+A WFPBD can minimize therapies, and health care related expenses, if adopted as a lifestyle.

+A WFPBD and prevent and even REVERSE these chronic disease, e.g., heart disease and diabetes.

Medication Risk Identification and Mitigation Copyright © 2019 Tabula Rasa HealthCare, Inc., All Rights Reserved. May not be used without permission. | NASDAQ – TRHC. Economic Impact of Heart Disease and Cancer

+According to the American College of Cardiology (Feb 19th, 2019) “By 2035, nearly half of the US +Cardiovascular disease is the leading cause of population will have some form of death in the US, since 1920. Cardiovascular disease.” -American Heart Association - Every 40 seconds, an American will have an MI, From AHA 2017 Report: Cardiovascular Disease: A costly with an average age of 65 years old for men and burden for American | Projections through 2035. 72 for women. Cardiovascular Current 2035 - Risks: obesity, smoking, LDL >130, hypertension, Disease diabetes, chronic kidney disease, lack of exercise. Direct cost $318 B $749 B Indirect cost $237 B $368 B +According to the American Cancer Society Total Cost $555 B $1.1 Trillion - Cost of Cancer Treatment $80 Billion in 2015, and 1700 people per day die of cancer.

Medication Risk Identification and Mitigation Copyright © 2019 Tabula Rasa HealthCare, Inc., All Rights Reserved. May not be used without permission. | NASDAQ – TRHC. Let’s look at Obesity In Countries with low rates of CV Disease

Medication Risk Identification and Mitigation Copyright © 2019 Tabula Rasa HealthCare, Inc., All Rights Reserved. May not be used without permission. | NASDAQ – TRHC. What about Fat? + Humans, unlike cats, get atherosclerosis from eating animal fat. + Nitric Oxide production is a key benefit of WFPBD.

Pinterest Medication Risk Identification and Mitigation Copyright © 2019 Tabula Rasa HealthCare, Inc., All Rights Reserved. May not be used without permission. | NASDAQ – TRHC. Evidence—The China Study and Others

Animal protein promotes the growth of cancer. Heart Disease can be Reversed with WFBPD + T. Colin Campbell, PhD • Caldwell B. Esselstyn, Jr., MD, The Cleveland + Multiple, peer-reviewed animal studies, Clinic, treated 18 patients with established researchers discovered that the growth of cancer coronary disease using a whole food, plant- cells can be turned on and off by raising and based diet. lowering doses of casein, the main protein found • Disease progression stopped of the WFPBD in cow’s milk. intervention group + Conclusion: Animal protein is a carcinogen. • 70 percent of the patients saw an opening of their clogged arteries. Eat plants for health. • People who ate the most animal-based foods had the most chronic disease. Dr. Dean Ornish, Harvard Medical School, • People who ate the most plant-based foods were the completed a similar study with consistent healthiest. results. Conclusion: Heart disease can be reversed. Plant-Based or not, put as many plants on your plate as possible at every meal. Medication Risk Identification and Mitigation Copyright © 2019 Tabula Rasa HealthCare, Inc., All Rights Reserved. May not be used without permission. | NASDAQ – TRHC. What is a Whole Food Plant Based Diet (and why is the US Dept of Agriculture providing nutrition guidelines over the NIH)? USDA Guidelines Compared to the WFPBD (‘Whole’ refers to minimally processed)

https://www.choosemyplate.gov/ https://i.pinimg.com/originals/df/64/e3/df64e35e219c375da0e57f69dfe9853f.jpg

No counting calories, or carbs. Medication Risk Identification and Mitigation Copyright © 2019 Tabula Rasa HealthCare, Inc., All Rights Reserved. May not be used without permission. | NASDAQ – TRHC. WFPBD—Guidelines A lifestyle change

+ WFPB diet– No meat, poultry, fish, dairy, or eggs. + Not the same as a vegan diet, defined only by what it eliminates. + Includes: - whole grains, fruits, vegetables, and legumes. - Moderation: nuts, seeds, avocados, natural sweeteners, and certain soy or wheat products that don’t contain added fat (e.g., tofu). + Not included: Heavily processed foods, avoiding - Highly refined grain products (e.g., white rice, white flour) - Foods containing added sugars or artificial sweeteners (e.g., confectioners sugar, high fructose corn syrup), and foods containing added fat, including olive oil). https://www.google.com/search?q=cns+food+guide&tbm=isch&source=iu&ictx=1&fir=UNOqofmYCQkL 4M%253A%252CsZSjUmb_Lo5btM%252C_&vet=1&usg=AI4_- kQaEkFsZoUGMt7n910QRyGWNnjxSQ&sa=X&ved=2ahUKEwjrjqKkxdrkAhVMm- AKHQ_uAf4Q9QEwA3oECAcQBg#imgrc=UNOqofmYCQkL4M:&vet=1 Medication Risk Identification and Mitigation Copyright © 2019 Tabula Rasa HealthCare, Inc., All Rights Reserved. May not be used without permission. | NASDAQ – TRHC. “From where do you get your protein?”

+ We have been conditioned to think that protein is the #1 most important nutrient. Why is that? + Protein--every cell, tissue and organ constantly broken down and replaced. Our bodies will use protein from all sources.

Protein Protein in Digested into replacement Food Amino Acids in our bodies

+ Most animals that we eat, eat plants for their protein. Eating plants takes out the ‘middle man’ to get our protein. Medication Risk Identification and Mitigation Copyright © 2019 Tabula Rasa HealthCare, Inc., All Rights Reserved. May not be used without permission. | NASDAQ – TRHC. What are the driving factors against the widespread adoption of WFPBD + Our own experiences, conditions and cultural beliefs + American Food Politics

E.g., Dairy--laden with sugar, fat, and salt Why is dairy still promoted in the American diet?

Government Checkoff programs • Developed and organized by the US government • Responsible for collecting funds from • certain sectors of agri-business • Funds used for research and advertisement on behalf of those businesses • food groups (dairy, beef, etc.).

https://www.google.com/search?biw=1920&bih=969&tbm=isch&sa=1&ei=MDqCXZOwFdCJggeegaSQBA&q= got+milk+ad+beef+it%27s+what%27s+for+dinner%2C+incredible+egg+pork+the+other+white+meat&oq=got +milk+ad+beef+it%27s+what%27s+for+dinner%2C+incredible+egg+pork+the+other+white+meat&gs_l=img.3 ...3341.13472..13634...2.0..2.187.4510.68j2...... 0....1..gws-wiz- img...... 0j0i8i30j0i24.nLMc9N6x1o4&ved=0ahUKEwiTiJHjxdrkAhXQhOAKHZ4ACUIQ4dUDCAc&uact=5#imgrc =pZXuHVx_z5LZZM: Medication Risk Identification and Mitigation Copyright © 2019 Tabula Rasa HealthCare, Inc., All Rights Reserved. May not be used without permission. | NASDAQ – TRHC. Want to Learn More?

Two books we have for you during this meeting on the topic: “A good diet is the most powerful weapon we have against disease and sickness.” T Colin Campbell, PhD

Documentary Movies to Watch: 1. Forks over Knives 2. What the Health Certificate in Plant-Based Nutrition (3 credits) 3. PlantNation 4. The Game Changer Medication Risk Identification and Mitigation Copyright © 2019 Tabula Rasa HealthCare, Inc., All Rights Reserved. May not be used without permission. | NASDAQ – TRHC. Thank you.

Enjoy the plant-based lunch.