Our Heart to Yours by Cardiovascular Institute

The information contained in this book is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified healthcare provider before starting any new treatment or discontinuing existing treatment. Talk with your healthcare provider about any questions you may have regarding a medical condition. Nothing contained in this book is intended to be used for purposes of medical diagnosis or treatment. The Paulette Tashnek-Wagner Cardiovascular Institute of Greater Los Angeles Copyright ÂŠ 2016. All rights reserved 2

ABOUT THE BOOK This book was written with my patients in mind who struggle every day with the complications of their lifestyle choices, such as hypertension, diabetes, smoking, and obesity. It is based on a simple, but powerful (and proven) concept: proper nutrition and exercise are critical factors in controlling your cardiac risk factors. I understand that changing your lifestyle can be difficult when you are used to eating certain foods or maintaining the same level of activity for most of your life. However, with small, consistent changes every day, the healthy benefits you reap for your heart and wellbeing can prove invaluable! I hope you use this book as a way to support and guide your progress toward a healthier lifestyle for yourself, your family, and friends. I have trained thousands of students, who have each gone on to treat hundreds, even thousands, of their own patients. It is a beautiful thing to see the importance of diet and exercise being carried with them as they become the fine physicians of tomorrow. As of the date of publication of this book we are amidst retrospective and prospective clinical trials on the effect of diet and exercise on blood pressure, diabetes, weight, and other modern ailments that plague Western society. These are the very topics discussed in these pages.

ACKNOWLEDGEMENTS This book would not have been possible without the hard work of my students and wonderful editors. I and the staff of The Cardiovascular Institute of Greater Los Angeles would like to thank the following for their contributions to “Our Heart to Yours”: Contributing Author: Dr. Richard Pietras, M.D., Ph.D., Professor of Medicine, UCLA Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine, UCLA; Director, Stiles Program in Integrative Oncology, UCLA-Jonsson Comprehensive Cancer Center. Contributing Editors: Karen Binkow, Anne E. Feldman, Azita Shalom, Michael Moline, Ron Goldfarb, and the students rotating at the Institute (see back of book). Exercise Models: Marissa Gaytan, Ramiro Reyes Contributing Students: Anna Adamczyk, Chay Bae, Rita Balyan, John Daliva, Dina Bedwani, Clayton Chiapuzio, Daniel Leininger, Trevor Graif-man, Sarah Hassman, Erika Kamish, Nate Kan, Kelli Lem, Julia Kim, Susan Lee, Saul Miller, Diana Moers, Menachem Nagar, Mario Rofael, Chris Rosse, Allison Sarmiento, Haley von Haven, Shawn Whelan, Michelle Yim, Nikesh Patel, Benjamin Pugsley, Imran Masood, Kyaw Lin, Nhan Pham, Meghan Tanner, Frank M. Choe, Tina Xu I especially thank my dad, Naim Ben-Zur, for being the inspiration of this book.

URI BEN-ZUR, M.D., F.A.C.C. Uri M. Ben-Zur, M.D.,F.A.C.C., completed his internal medicine residency at the prestigious Albert Einstein College of Medicine before pursuing his training in the field of cardiology. During his tenure at the esteemed Montefiore Medical Center of the Albert Einstein College of Medicine, New York City (site of implantation of the world’s first transvenouspacemaker), he completed separate fellowships in cardiology, electrophysiology and cardiac pacing. There, Dr. Ben-Zur worked under the guidance of doctors Seymour Furman and John Fisher, pioneers in the field of cardiac pacing and electrophysiology. After training, he was privileged to be appointed as an assistant professor of medicine at the Albert Einstein College of Medicine. Dr. Ben-Zur then went on to complete his interventional cardiology fellowship at the Scripps Clinic and Research Foundation in La Jolla, California. His training was under the auspices of doctors Richard Schatz and Paul Teirstein, recognized authorities in interventional cardiology. As a result of years spent in academia, Dr. Ben-Zur has been published in a number of prestigious journals, including The New England Journal of Medicine, Circulation, The Journal of The American College of Cardiology, The American Heart Journal, as well as a number of other medical journals and textbooks. Academic Associations:

FOREWORD Twelve years ago, almost to the day, my dad Naim Ben-Zur nearly lost his life because of several uncaring physicians. The suffering that he endured over the following few years cannot be described. My father has always been an extremely energetic, positive and compassionate human being. "Worry about your neighbor more than you care about yourself and that will be the key to your happiness in life!" I heard that phrase from him countless times growing up. As a result of what he endured in that hospital, he strengthened us all. "Make something positive of this," he keeps saying, "I'd like you to write a book on diet and exercise and hand it to the entire world. People don't realize what this will do for them!" He motivated me to write this book. And every day for the past several years as the book was being written he asked me about its progress. He printed each page and reviewed and studied every detail. "It has to be a book that will motivate people to understand the importance of diet and exercise. It really needs to be better than anything else that has ever been written on the topic. The cover must be the greatest cover ever. We must give it to people without charge." These were the lofty goals he set in front of me.

And his response to those uncaring physicians? He says, "You can't be upset at them. You can't blame them for anything; they didn't have the proper training and tools. The way we have to fight back is to take many more students, hundreds of students, and teach them the proper way, proper ethics, proper medical techniques. That's the way you fight back: one student at a time, one patient at a time." To that end, I've significantly extended my teaching responsibilities over the past 12 years. So far in my career I've taught thousands of medical students, residents, fellows and attending physicians. And they in turn have taught thousands of students, and cared for hundreds of thousands of patients. In this way, one by one, I hope we can eventually do enough to make every physician a caring one and every patient safe from thoughtless and neglectful treatment. If not for my dad's inspiration this book would never have been written. He is the fuel to my ever-burning desire to mend others. If not for my mother and father's inspiration my career would never have happened. I am forever grateful. Respectfully, and with a lot of love from all of us, Uri Ben-Zur, M.D. F.A.C.C.

The eternal providence has appointed me to watch over the life and health of Thy creatures. May the love for my art actuate me at all time; may neither avarice nor miserliness, nor thirst for glory or for a great reputation engage my mind; for the enemies of truth and philanthropy could easily deceive me and make me forgetful of my lofty aim of doing good to Thy children.

TABLE OF CONTENTS

HIGH BLOOD PRESSURE

High blood pressure, also known as “hypertension,” is increased pressure inside your arteries and veins. This increased pressure causes your heart to work harder to supply blood to the rest of the body, even while resting. This increased stress on the heart causes increased risk for heart attack, stroke, heart failure, and sudden death. Time and time again, lifestyle modifications have been proven to be the most powerful treatments before medication.1 Think of these changes as a “lifestyle prescription,” and make every effort to comply with them. We will help, too!

Black bean burgers from the freezer section sound like a good vegan option, but some brands have upwards of 700 mg of sodium per patty! This is about 1/3 of the recommended allowed daily sodium intake. Some more surprising high sodium foods: - Tomato juice: 480 mg sodium (20% of daily salt intake) - 1/2 Cup of canned soup: 1,000 mg of sodium – half of the recommended daily intake - 1/2 Cup cottage cheese: 400 mg of sodium. - Ketchup, barbecue sauces, marinades, and salad dressings can set you back 1,000 mg of sodium in only a few tablespoons

On average, Americans consume 1/3 of their diet from restaurants. This can be a very unhealthy diet for the following reasons: - You’re unable to control how food is prepared. It can easily be cooked with high amounts of fat and salt. - According to the FDA, patrons who regularly eat out at restaurants consume, on average, an extra 2.5 g of trans fats per day and 200 calories per day. - The USDA found that, on average, lunch and dinner at a restaurant add an additional 156 and 144 calories, respectively (as opposed to the meal being made at home) b,c - Eating out is associated with a higher Body Mass Index (BMI). See Body Mass Index page for more on BMI. Calories consumed at restaurants can cause more weight gain due to metabolic and hormonal reasons.

It is my view that the vegetarian manner of living, by its purely physical effect on the human temperament, would most beneficially influence the lot of mankind. -Albert Einstein, letter to Vegetarian Watch-Tower

Your health matters. This is the only body you will have, so take care of yourself. Learn to say “no” to foods that are killing you! Just because it is your best friend’s birthday, your sister’s wedding, or your company picnic, it does not mean that you have to eat anything and everything. Your diet is always a choice! You want to do this, and you need to do this. Stop thinking and start doing! We are here to help you succeed!

CHOLESTEROL

During his two terms, former President Clinton2 regularly ate hamburgers, French fries, donuts, barbecue, etc. He did not take into account his strong family history of heart disease in planning his diet. In 2004, he felt a s ensation of chest tightness; fast-forward several days, and he was recovering from quadruple bypass surgery. After his surgery, he started a strict, plant- based diet and lost more than 20 pounds

Moral of the story:

"You Can Do It Too!"

A key to having a healthy heart is making sure that the heart is receiving all of the nutrients and oxygen it needs to properly function. When the blood vessels that supply the heart become clogged with fat and cholesterol, the process of atherosclerosis is taking place. This process can result in damage to the heart, leading to a heart attack and possibly death. Smoking and consumption of toxic chemicals3 only accelerate this process because it creates the initial damage that gives the fats a place to stick. Once the pathway to the heart is completely blocked, a heart attack occurs. Limiting dietary consumption of saturated fats and cholesterol will help to prevent the â&#x20AC;&#x153;pipesâ&#x20AC;? that provide the blood to the heart muscle from narrowing and clogging. Consuming a high-fiber, plantbased diet and engaging in moderate amounts of exercise will ensure the blood reaches its required destination.3 Components of the food that is eaten is absorbed and transported through the blood system.

Imagine the excess fat and cholesterol from foods like cookies, ice cream, and red meat creating a cement-like sludge in your blood vessels that clogs them. The blood in the image below is so full of fat and cholesterol that one cannot see through it: a heart attack in the making. Through dietary and lifestyle changes, thick, greasy blood can be transformed to be free and clear of these harmful fats.3 Removing the unhealthy sweets and meats from the diet and living an active lifestyle3 will allow blood to flow freely and provide the heart with the nutrition it needs. With diet and exercise, the dense, sludgelike blood can become fluid and clear again, allowing your heart to receive the nutrients it needs.

Meat doesn’t only affect your heart, it can lead to many other problems as well. On October 26, 2015, the World Health Organization (WHO) concluded that processed meats are linked to cancer. These include salted, cured, smoked, or fermented meat like hot dogs, sausages, corned beef, and jerky. The WHO based its conclusion on the results of over 800 scientific studies. Most of the studies showed a link between processed meat and colorectal cancer, but many others found that meat may cause other types of cancer as well, including prostate, pancreatic, and stomach cancer. Based on sufficient evidence regarding the association between consumption of processed meat4 and colorectal cancer, processed meat was classified as a Group 1 carcinogen. This “Group 1” means that there is sufficient evidence of a causal relationship with cancer. So, perhaps think twice about that weekend barbecue. 20

HEART DISEASE & DEMENTIA When people think of cardiovascular disease, they often think of heart attacks from clogged arteries in the heart. New research, however, shows that cardiovascular disease is not just a heart disease — it’s a whole body disease that can affect multiple body organs, including the brain. When cholesterol and fat lead to plaque buildup along the sides of blood vessel walls, the plaque doesn’t stop at the vessels of the heart. It is a systemic disease affecting blood vessels throughout the body, including the small blood vessels in the brain. When these vessels get clogged, small areas of the brain begin to die, causing what doctors call “Lacunar lesions.”

Everyone knows smoking can affect your lungs. However, did you know it can affect your blood’s ability to carry oxygen13? In the photos below you can see the contrast between a blood sample taken from a smoker and one taken from non-smoker. The darker color means more waste products like carbon dioxide that build up due to smoking. Smoking also increases your risk of developing high blood pressure and forming plaques that can block your blood flow.

These damaged areas can play a key role in causing cognitive deficits and dementia. In fact, the same risk factors that predispose people to heart disease — things like obesity,5 smoking, and sedentary lifestyle — are now being shown to predispose people to degenerative brain diseases like Alzheimer’s disease. As small areas of the brain die, the brain shrinks (or “atrophies”) and the ability to think clearly, remember new information, and make good judgments fades away. This process starts early in life. Uncontrolled, variable blood pressure in young adults in their 20s are linked with worse memory and slower thinking speeds many years later, when they are in their 40s or 50s. Thus, it is important to start a healthy lifestyle early on in life. By the time the problems start, it might be too late. 5

Smoker's blood

Non-smoker's blood

OBESITY Smoking can damage any part of the body. Start taking steps toward reversing some of the negative effects of smoking15. Kingman P, Strohl, M.D.8

Credit: Häggström, Mikael. "Medical gallery of Mikael Häggström 2014". Wikiversity Journal of Medicine 1 (2). DOI:10.15347/wjm/2014.008. ISSN 20018762.

blood pressure, pulmonary hypertension, stroke, coronary vascular disease, arrhythmias, and heart failure. 24

There is a high association blood pressure, pulmonary hypertension, stroke, coronary vascular disease, arrhythmias, and heart failure. There is a high association of OSA and diabetes. In research studies, OSA has been suggested as a risk factor for diabetes. Finally, OSA can contribute to liver disease by decreasing the amount of oxygen that your body needs. Your body responds by being in a state of inflammation. This can lead to liver disease.

Drinking too much alcohol can put more fat into the blood circulation in your body, raising your triglyceride levels.10 It can also lead to high blood pressure, heart failure, and an increased calorie intake. Consuming too many calories can lead to obesity and a higher risk of developing diabetes. Excessive drinking and binge drinking can lead to stroke. Other serious complications include fetal alcohol syndrome, cardiomyopathy, cardiac arrhythmia, and sudden cardiac death. While numerous studies suggest that moderate alcohol consumption helps protect against heart disease by raising HDL (good) cholesterol and reducing plaque accumulations in your arteries, having more than three drinks a day has a direct toxic effect on the heart.11 That is why doctors will tell you â&#x20AC;&#x153;If you don't drink, don't start.â&#x20AC;? There are other, healthier ways to reduce your risk of heart disease like eating right, getting regular exercise, and maintaining a healthy weight.

The treatment for obstructive sleep apnea is usually long-term with the results of better quality of sleep, improved function during the day, and decreases in cardiovascular disease risk. Two treatments include weight loss and continuous positive airway pressure (CPAP).9 CPAP is a mask that patients use at night to sleep. The link between excess weight and sleep apnea is well established. People who are overweight have in the back of their throat extra tissue that can cause obstruction during expiration and inspiration. Not only will weight loss contribute to the resolution of obstructive sleep apnea, but it will also contribute to the improvement of other comorbid conditions such as hypertension, diabetes, and osteoarthritis.

BMI is a personâ&#x20AC;&#x2122;s weight in relationship to height and is a good measure to screen for obesity.12 A high BMI is strongly correlated with unhealthy levels of fat and various diseases such as diabetes and heart disease. If you have a high BMI, then following the diet and exercise outlined in this book will help bring you back to the healthy range and lower your chances of life-threatening diseases.

http://drbenzur.com/heartrisk/

https://www.heart.org/gglRisk/ main_en_US.html

Underweight

<18.5

Normal Weight

18.5 - 24.99

Overweight

25-29.99

Obesity

>30

CANCER Another problem is that fat tissue makes hormones and growth factors that increase the growth of local cells, which can turn some into cancers. Therefore, the risk of many cancers increase as body weight and amount of fatty tissue increase. In fact, cancer patients who are obese have a worse prognosis than those who are of a lower Body Mass Index (BMI). Read more about BMI on the next page. Obesity is associated with an increased risk of cancer in many organs6:

Several mechanisms have been suggested to explain the associationbetween obesity and cancer6. Most notable is the chronic low-level inflammatory state in which obese patients exist. A body in an inflammatory state tries to regenerate new cells that are not inflamed. Being in a chronic state of inflammation puts the body at a higher risk of these continually regenerating cells becoming cancerous6. Imagine photocopying a page from a book, then making a photocopy of the photocopy. If you keep repeating this, eventually the photocopy may become distorted and appear substantially different from the original. Similarly, if the body has to regenerate new cells over and over again, the odds of a â&#x20AC;&#x153;distortedâ&#x20AC;? (cancerous) cell being made increase. 30

“Suddenly it felt like I was hit in the head. I started slurring my speech and I couldn’t move part of my face. One side of my body became weak and I had shooting pains.”

• “I felt like I was hit by a truck.” • “It was like an elephant sitting on my chest.”

*A heart attack or stroke may be the first and last symptom of heart disease. Some people do not get a second chance.

DIET AND RECIPES Nature has provided an incredible bounty of food that contains every substance we could ever need in order to have healthy and active bodies. In the process of industrialization we have taken such perfect, complete foods, stripped them of their valuable nutrients, and repackaged them to be sold as food that is, in reality, a toxic, addictive substance.

“Clean eating” at its essence is to love food for its natural state. It involves understanding where your food came from and how it was handled, from the time it was growing in the ground to the moment it meets your lips. Join the clean eating revolution. Try growing your own vegetables and herbs, buy fresh produce, visit your farmers market, consume whole grains, enjoy nuts and seeds, and choose foods in their most pure untampered form whenever possible.

Eating “clean” means eating food in its most pure form. Clean food is free from antibiotics, preservatives, and added chemicals or flavors. It is free from added salt that contributes to high blood pressure and free from added sugars that contribute to diabetes.16 It is minimally processed so that the vitamins, minerals, and fiber are present in their original form.

When you “eat clean” from a variety of sources, you will find that a good diet and excerise will provide better health than a laundry list of medications ever could. Not only does “clean food” taste better, fresher, and more satisfying, but it is part of a diet and lifestyle that will promote optimal heart health and total wellbeing.

Once one begins to “eat clean,” it is easy to become disgusted by the poor excuses for food that are sold in packages in vending machines, convenience stores, and fast-food restaurants These “dirty” foods are high in the sugar and fat that are responsible for the high rates of diabetes and heart disease that we are seeing, not only in our country17,18,19 but increasingly world-wide, as our nation’s fast food chains arise in previously healthy societies.

When it comes to maintaining a healthy diet, you can’t go wrong with filling up on vegetables, whether raw or cooked. These are natures most compatible-with-life foods. Other great natural sources which are replete with nutrients and vitamins will also contribute to your wellbeing but are most effective when consumed in moderation. These include grains, starchy vegetables, seeds, nuts, avocado, beans, legumes, and fresh fruits. It is critical to stay away from all animal products, including dairy and eggs. Also, avoid dried fruit, juice, processed foods, oil, and salt. 24,25 Following this recommendation will help you reduce your risk of cardiovascular disease risk. 26

For many who are living on one side of the extreme of a healthy diet, the best way to adopt healthier eating habits is to go “all in.” In this way, you can experience the most immediate benefits of an all-plant-based diet: weight loss and increased energy. Other benefits will follow. The new possibilities of health and vitality become clear when you commit to a new diet. Yet for some this approach may seem too drastic and intimidating. Another option to quitting harmful foods is to take a stepwise approach.27 For some individuals, this is a more accessible and realistic way to achieve meaningful nutritional changes. Which route is taken is a personal option, akin to the decision about quitting cigarettes “cold-turkey” or slowly cutting back over time. Taking the stepwise approach might involve taking the first step to avoid eating meat during the week while simultaneously including new vegetables and plant-based protein in the diet. Here is a sample stepwise approach; talk to your doctor to create a plan that is best for you:

Week 1

Week 2

Week 3

Week 4

Week 5

Cut out all red meat. Increase plant- based protein

Cut out unhealthy sweets and soda. Eat more fruits and vegetables and drink more water.

Cut back on salt. Use more fresh herbs.

Eliminate dairy. Use unsweetened soy or almond milk

Eliminate pre-made dressings. Use vinegar or lemon.

Keep your appetite for junk-food at bay. Carrying a smoothie of blended nutrition with you all day will force you to sip on nutritional yum and not cave in to munching on junk food. 27, 28 36

Whatever approach is chosen, the important point is that one be honest with his or her own progress and be truly making strides in the right direction. It is important to constantly reassess where a current diet is and where it optimally could be. Falling back on bad habits is hard to avoid; having clear goals and a strong support network will help. Getting the entire family involved and stating one’s new lifestyle choice to friends and colleagues help to build the needed support. The seed for one’s new diet may be planted in the doctor's office or in this book, but it is up to the individual to make sure that it grows more fully every day. Remember, every single choice adds to create a healthy heart and body. Whatever strategy is employed, one must stick with it in order to win.

We live in a society in which we have been told more protein is better, and the only sources of protein worthy of consumption come from meat and dairy products. Protein is an essential nutrient, absolutely critical, not just in building and repairing muscle tissue, but in the maintenance of a wide array of important bodily functions.29 But does it really matter if our protein comes from plants rather than animals? Protein is made up of twenty different amino acids. Our bodies are able to make eleven of them, but the other nine are ones we must consume from our food, the so-called “essential” amino acids. So it is not the protein, but actually these nine essential amino acids that we need.29 The argument against plant proteins is that not all plant-based proteins are “complete,” meaning they do not contain all nine amino acids. However, a well-rounded whole plant-based diet can easily include all nine essential amino acids. A diet that rotates healthy plant-based protein sources like black, kidney, and pinto beans, almonds, lentils, hemp seeds, spirulina, quinoa, spinach, and broccoli will more than satisfy an individual’s protein needs. It does so without the saturated fat linked to heart disease. Despite popular belief, more protein is not better; no scientific study has shown the benefits of protein consumption beyond the recommended 10-15 percent of daily calories.30 Still not convinced? Consider this: Some of the fiercest animals in the world are plant powered. The rhino, hippo, elephant, and gorilla all share one thing—they get 100 percent of their protein from plants. It’s time to ditch that steak, put away the cheese, and join us for a bowl of quinoa, lentils, and vegetables!

Plant-based diets can be rich in fiber and low in calories. The high fiber content can cause some people to feel too full, leading them to eat fewer calories.

The amount of calories you need each day depends on your age, gender, size, and activity level. Talk with a nutritionist or your doctor to learn how many calories you should consume daily. (This is especially important in those who are most at risk for getting too few calories on a plant -based diet, like pregnant women. Your daily caloric needs will likely fall in the range of 1,500 to 2,500 calories. Use your daily caloric needs to help you make decisions about what you eat. Several calculators are available online, where you can get a rough estimate of the required amount of caloric intake. Mayo Clinicâ&#x20AC;&#x2122;s Calorie Calculator is one example.31 Those who are on a plant-based diet are often challenged with questions about where they should get their protein, and the concern about protein is often misplaced. Although protein is certainly an essential nutrient which plays many key roles in the way our bodies function, we do not need huge quantities of it. 29 Only about one calorie out of every ten we take in needs to come from protein. The recommended daily allowance (RDA) is that we take in 0.8 grams of protein for every kilogram that we weigh (or about 0.36 grams of protein per pound that we weigh).32 This recommendation includes a generous safety factor for most people. 40

When we make a few adjustments to account for some plant proteins being digested somewhat differently from animal proteins and for the amino acid mix in some plant proteins, we arrive at a level of 0.9 gram of protein per kilogram body weight (0.41 grams of protein per pound). If we do a few calculations we see that the protein recommendation for a plant-based diet amounts to about 10 percent of calories coming from protein. For example, a person weighing 172 pounds could have a calorie requirement of 2,400 calories. His or her protein needs are calculated as 172 pounds times 0.41 grams per pound equals 70 grams of protein; 70 grams of protein times 4 calories per gram of protein equals 280 calories from protein; 280 divided by 2,400 calories equals 11% of calories from protein. If we look at what a plant-based diet consists of, we find that, typically, between 10 to 12 percent of calories come from protein.33 This contrasts with the protein balance of a non-plant-based diet, which is close to 14 to 18 percent of calories. In the United States it appears that plant-based diets are commonly lower in protein than standard American diets. However, remember that there do not appear to be health advantages to consuming a high protein diet. Diets that are high in protein may even increase the risk of osteoporosis34 and kidney disease.35 In summary, it is easy for a plant-based diet to meet recommendations for protein, as long as caloric intake is adequate. trict protein combining is not necessary; it is more important to eat a balanced diet throughout the day. Warning: High calorie junk foods and highly processed foods are not a healthy way to add calories to a plant-based diet. These foods contain lots of sugar and lack nutrients. Incorporating these foods into your diet may cause you to skip out on the nutritional foods, and you will miss necessary vitamins and minerals. Those who consume a plant-based diet are at risk for developing a vitamin B-12 deficiency because it is found mainly in animal-based foods. Talk with you doctor about taking a B-12 supplement if you eat a plant-based diet.36

VEGETABLES 75% Spinach, kale, lettuce, cucumber, beets, tomatoes, watercress, cabbage, celery, edamame, scallions, seaweed, onions, carrots, eggplant, mushrooms, bok choy, asparagus, arugula, corn, squashes, brussel sprouts, chard.

VEGETABLES 70% Spinach, kale, lettuce, cucumber, tomatoes, beets, watercress, cabbage, celery, edamame, scallions, seaweed, onions, carrots, eggplant, mushrooms, bok choy, asparagus, arugula, corn, squashes, brussel sprouts, chard

PROTEIN 15% Tofu, quinoa, peas, chia seeds, edamame, black beans, white beans, kidney beans, chick peas, almonds, cashews, pistachios, lentils, sunflower seeds, hemp seeds, spirulina, plain soy milk.

PROTEIN 15% Tofu, quinoa, peas, chia seeds, edamame, black beans, white beans, kidney beans, chick peas, almonds, cashews, pistachios, lentils, spirulina sunflower seeds, hemp seeds, , plain soy milk, Greek yogurt, cottage cheese, egg whites

FRUITS 10% Oranges, apples, kiwi, blueberries, strawberries, blackberries, raspberries, figs, melon, grapefruit, pears.

FRUITS 10% Oranges, bananas, grapes, apples, kiwi, blueberries, strawberries, blackberries, raspberries, figs, melon, grapefruit, pears.

AVOID Red meat, poultry, fish, sodium, sugars, fats, oils, dairy.

LOW fish, fats including avocados, oils

AVOID Red meat, poultry, no sodium, no sugars.

How Can a Plant-Based Diet Change My Life?

PROTEIN 40% Red meats, poultry, eggs

MEDIUM TO HIGH 35% Breads, pasta, sodium, fats, oils, dairy, sugars

FRUITS 20% Apples

VEGETABLES Lettuce

The Positive Effects of a Vegan Lifestyle:

Show Me the Science

Dr. Joel Fuhrman: I Love Nutritional Science:

Cholesterol and the Plant-Based Diet

Dr. Joel Fuhrman: Cooking Up Great Health

Animal Neighbors

Flour

Black Beans

Bread, Pasta, Rice

Quinoa

Sugar

Unsweetened Apple Sauce

Pasta

Zucchini Ribbons

Butter

Water

Mashed Potatoes

Mashed Cauliflower

Eggs

Chia Seeds

Tortillas

Lettuce Wraps

Potato Chips

Kale Chips

Canned Foods

Fresh Produce

Ice Cream

Frozen Berries

Fruit Juice

Real Fruit Smoothies

Croutons

Nuts, Seeds

Soda

Water with a Splash of Lemon, Mint, or Cucumbers

Meats

Tofu and Tempeh 48

HEALTHY EATING FOR CHILDREN

Children learn from watching you.24 Eat fruits and vegetables and your children will, too! Children should be reminded that what they eat is important!

Food is energy and helps you grow big and strong

There is growing evidence that lifestyle changes such as eating a healthier diet and exercising more may be enough to prevent and even treat conditions ranging from diabetes to cancer. A review of studies published in the Annals of Internal Medicine analyzed the effects of a combination of behaviors that reduced the rate of Type 2 diabetes among those at high risk of developing the disease. Improving their diets and boosting their amount of daily exercise, as well as quitting smoking and managing their stress, were enough to help the participants, all of whom had high blood-sugar levels that precede diabetes.22 These interventions helped lower their blood glucose and prevented them from being diagnosed with the disease. In another study published in the journal Cancer, Epidemiology, Biomarkers & Prevention, researchers credit vigorous exercise with lowering risk for the disease by 25 percent. These are just two of several studies that hint at the power of a pharmaceutical-free approach. Treating ailments with prescription medications can address the symptoms, but does nothing to change the forces that drive these diseases. In many cases, the drugs may cause even more problems in the form of side effects. As such, the simple strategy of making exercise and diet changes should be sought out with as much vigor as medications.

An analogy that Dr. Ben-Zur likes to use for conveying the importance of diet and exercise in health management is that of driving a car. We all know that driving down the boulevard at speeds of 200 mph is reckless and dangerous. Of course, one can use a seatbelt to help prevent terrible outcomes, but nothing is as safe as reducing the risk of a crash by driving carefully and staying within the speed limit. Controlling high blood pressure with medications is like wearing a seatbelt while speeding. While you may affect the outcome, your risk for heart disease remains higher than if you modified your lifestyle. The best approach to controlling high blood pressure is to avoid getting there in the first place or controlling it with proper diet and exercise.23 This will not only help you reduce the medication and toxin load, but you will also regain your health and decrease your chances of a negative outcome in the future. The pill-free route is not for everyone, however, so it is important for physicians and patients to understand when it is appropriate and when it is not. More and more doctors are putting away their prescription pads when they see certain patients, particularly those who demonstrate an interest and discipline to improve their health.

The first test of Man was put to, is his ability to withstand the temptation to partake of a forbidden food. Adam in the Garden of Eden is told not to eat from a fruit that the Bible describes as “desirous to the eye.” He is told that eating of that forbidden fruit will bring about his demise.

To get on his nutrition and exercise program requires you to make a decision that you want to take responsibility for your life. The initial effort of self-control and difficulty of abstinence is far outweighed by the long-term benefits. You will be fulfilling the mitzvah of , the commandment of safeguarding and maintaining your wellbeing. May G-d, the source of goodness, bless you with good health.

The temptation to eat what would be detrimental to one’s wellbeing is a continuing test of hu- manity throughout the ages. What logic and reason dictate is often overlooked to satisfy a desirous greed, a craving, self-indulgent gluttony, or just irresponsible consumption. It took several generations after Adam before Noah and his descendants would be allowed to eat meat. Generations later, the Jewish people were nourished in the desert with the heavenly manna. Unfortunately, some clamored for a pot of meat; their desire was satisfied with s’lav birds and many died, which gave that geographical location a sadly meaningful name, Kivrot Hata’ava, the tombs of temptation as they buried the people who clamored for meat. King Solomon, the wisest of all men, said in Kohelet All the labor of a person is for his mouth and his soul (appetite) is not filled. Our sages explain that the effort of a person should be on how well he is able to have self-control of what comes out of his mouth in terms of proper speech and what goes into his mouth in terms of his nutrition. The Torah commands us to be act responsibly for our health and wellbeing and to avoid any activity or consumption that may put one at risk. The nutrition advice of Dr. Ben Zur is price- less in that it can help not only those who are at risk but most importantly to maintain and even improve the health of those who are, thank G-d, healthy. 54

Top 10 Positive Effects of a Plant-Based Diet

20,21

1. Lowers cholesterol by avoiding LDL (“bad”) cholesterol in meats 2. Raises magnesium levels with dark, leafy greens 3. Improves cardiovascular health from nuts and whole grains 4. Provides adequate fiber intake which is protective against colon cancer 5. Ensures adequate vitamin C intake, an important antioxidant and booster of the immune system 6. Will automatically be a low-salt diet 7. Lowers blood pressure 8. Reduces migraine headache 9. Reduces costs—meat and dairy products are typically more expensive than vegetables 10. Reduces carbon “footprint”; raising animals for consumption takes land and uses water12

• Animal products including Meat, Dairy, Eggs

• Dried fruit, Juice • Processed foods • Oil • Salt

• Grains and starchy vegetables (max 1 cup per day) • Seeds and nuts (max 1 oz per day) • Avocado (max 2 oz per day) • Beans & legumes (max 1 cup per day) • Fresh Fruit (4-6 daily)

• Raw and cooked vegetables, especially green vegetables (Eat to your heart’s desire)

Let your head guide you, not your stomach.

As your body becomes cleared of junk food, it will desire less and less of it.

When you look at junk food, remind yourself of the damage it can cause to your body.

Things will get easier with time - everyone goes through an adjustment period when starting a plant-based diet.

Enjoying a healthy body for your entire life is much more satisfying than the taste of any junk food.

Once you have been on the plant-based diet for some time, you will no longer miss the high-fat or high-sodium foods of your past!

2 Tbsp Chia Seeds ½ cup Rolled Oats ¾ cup Unsweetened Almond or Coconut Milk ¼ tsp Pure Vanilla Extract ¼ tsp Cinnamon

¾ cup Plain, unsweetened, dairy-free yogurt (Coconut is a good option) ½ cup Blueberries (or pomegranate seeds) ¼ cup Slivered almonds 1 Tbsp Hemp heart seeds

1. In a bowl or tall glass, layer a scoop of yogurt with ber ries and almonds and seeds. Continue layering until there are no more ingredients left.

¼ cup Nuts and seeds ¼ cup Fresh berries A dash of cinnamon or cocoa powder 2 Tbsp Unsweetened Coconut Flakes

2. Top parfait with a dash of cinnamon or cocoa.

1. The night before, mix ingredients (except toppings) in a medium sized bowl. Cover and place in refrigerator overnight (or for at least 2 hours).

1-2 cup Spinach and/or kale ½ cup Strawberries 1 cup Chopped cucumber ½ cup Chopped celery 2-3 Tbsp Hemp hearts A few mint leaves

2. In the morning, the oats and chia seeds will soften for you to enjoy. Top with your favorite, healthy toppings! 3. Note: you can double or triple this recipe and have left overs throughout the week. Save the toppings until you are ready to eat.

1. Add ingredients to a blender and blend until smooth (not a juicer) 2. Note: a splash or two of water may be necessary depend ing on how thick you prefer your smoothie

½ cup Rolled Oats 1 cup Water or unsweetened Almond Milk 1 Tbsp Flax Seed ¼ tsp Pure Vanilla Extract ¼ tsp Cinnamon

¼ cup Nuts and seeds ¼ cup Fresh berries A dash of cinnamon or cocoa powder 2 Tbsp Unsweetened Coconut Flakes 2 Tbsp Peanut Butter (all natural, no added ingredients— just peanuts!)

1. Heat water/almond milk in a saucepan. Add oats, flax seed, cinnamon and vanilla and cook until desired consistency. 2. Top with any of the suggested toppings or enjoy plain!

1 Package Extra-firm tofu, drained and crumbled 1 Bell pepper sliced ¼ Onion sliced 2 cup Kale chopped

½ tsp garlic powder ½ tsp cumin powder ¼ tsp chili powder ¼ tsp turmeric

1. Sauté peppers, onions and kale in a medium saucepan with non-stick spray until soft 2. In a small bowl, add seasonings with about 1-2 table spoons of water (enough to make a sauce consistency). 3. Once tofu has been drained and patted down, crumble and add to the veggie pan. Sauté with the veggies for a few minutes and then add the sauce. Stir until tofu is slightly browned. 4. This makes 4 servings and will keep well in the refrig erator for leftovers. You may top with ¼ avocado or a dollop of dairy-free yogurt.

Note: Lunch salads can easily be packed for busy work days. Toss your ingredients in a container, leaving the lemon juice/vegetable broth on the side. Dress the salad when you are ready to eat. Or, leftover dinners heat well for quick lunch options! The green power smoothie can be made into a more filling lunch option by adding ½ cup rolled oats. Blend until smooth and enjoy its heart-healthy effects!

4 cups spinach or arugula 1 small zucchini ⅔ cup pecan halves ⅓ cup unsalted salted, roasted sunflower seeds Juice from 1 lemon 2 Tbsp freshly grated orange zest

1. To make zucchini ribbons, shave zucchini using a vegetable peeler. 2. Add spinach to a large bowl and top with ribbons. 4 cup Arugula 1 cup Cooked quinoa, cooled 1 Tomato, chopped 1 cup Cucumber, chopped Juice & zest from 1 lemon 2 teaspoon raspberry vinegar/red wine vinegar/apple cider vinegar + ¼ cup vegetable broth + 1 teaspoon honey/pomegranate molasses ½ cup Slivered almonds or walnuts 1-2 Tbsp pomegranate seeds

3. Sprinkle with pecans and sunflower seeds. 4. Squeeze lemon over salad. Sprinkle with zest. 5. Add ingredients and lightly mix.

1. In a large bowl, mix arugula, quinoa, tomato and cucumber. Dress with lemon juice, lemon zest and 2 teaspoon raspberry vinegar/red wine vinegar/apple ci der vinegar + ¼ cup vegetable broth + 1 teaspoon honey/ pomegranate molasses 2. Top with pomegranate seeds and almonds or walnuts. 64

2 Leaves of butter lettuce (or romaine) 1 Can chickpeas, drained and rinsed 1 cup Celery, chopped fine 3 green onions, thinly sliced ¼ cup finely chopped red bell pepper 3 Tbsp Non-dairy yogurt, plain 1 Clove garlic, minced 1 ½t yellow mustard 2 tsp fresh dill, minced Juice from ½ lemon Ground black pepper

1. Mash the chickpeas with a fork or potato masher in a large bowl. 2. Add the remaining ingredients, except the lettuce, and stir to combine 3. Top each lettuce leaf with ½ cup of chickpea.

1 Medium onion, chopped 1 Tbsp fresh ginger, minced 1 Tbsp lemongrass, minced 2 Cloves garlic, minced 1 Package extra-firm tofu, drained and crumbled 2 Tbsp Bragg liquid aminos 2 Tbsp hoisin sauce 1-2 tsp low sodium chile sauce 4 Butter lettuce or iceberg lettuce leaves Toppings: 1 large carrot, grated ½ cup bean sprouts ½ cup edamame 1 Green onion, chopped ½ cup fresh mint, chopped ½ cup peanuts, finely chopped Sprinkle of red pepper flakes

1. Use a cast iron skillet to cook. Heat the skillet for a few minutes until hot and then add onion. Sautee on low heat until golden brown. Stir onions to keep from burning and sticking to the pan since no oil is being used. Then add ginger, lemongrass, and garlic, and cook until flavors from ingredients blend. 2. Add tofu and cook 5 minutes, or until heated through. Stir in soy sauce, hoisin sauce, and chili sauce. 3. Add a scoop of the tofu mixture to each lettuce leaf. Top with carrots, sprouts, edamame, green onions, peanuts, mint and red pepper flakes.

1 Can low sodium black beans, rinsed and drained 1 cup Cooked quinoa1 2 cup Kale, chopped 1 Tbsp vegetable broth ½ Onion, diced 2 Cloves garlic, minced 1 Tomato, chopped 1 Avocado sliced 2 Green onions, chopped 3 Tbsp Non-dairy, unsweetened plain yogurt 3 Tbsp low sodium salsa 1 Head of romaine lettuce, shredded Juice from 1 lime

Use a cast iron skillet to cook. Heat the skillet for a few minutes until hot and then add onion. Sautee on low heat until golden brown. Stir onions to keep from burning and sticking to the pan since no oil is being used.

1 Head of romaine lettuce, chopped 1 Tomato, chopped ½ cup Cucumber, chopped ¼ Red onion, sliced thin 1 Carrot, peeled and grated ½ cup Low sodium chickpeas, rinsed and drained Juice & zest from ½ lemon

Combine ingredients in a big bowl. Top with lemon juice, and zest.

2-3 sweet potatoes 2 eggplants 1 onion 1 parsley Whole Tahini

Add garlic when onions are cooked. Add black beans and kale and stir until heated through. Remove from heat.

Cut 4 big slices (include skin). Place in oven along with 1 chopped onion.

On the bottom of the plate add a scoop of quinoa. Top with black bean and kale mixture. Stack on a big handful of lettuce. Top with tomatoes, green onions, avocado, salsa and yogurt.

Once soft, add 1 bunch of chopped parsley on veggies. Return to oven for 10-15 minutes.

Squeeze a wedge of lime over your haystack.

Take 2 Tbsp of whole Tahini (brown) mixed with water and pour on veggies before serving.

Power Bowl

1 Large sweet potato, chopped into small cubes 1 (15oz) can of low sodium chickpeas, drained, rinsed and dry 2 cups cooked quinoa (1C dry, cooked in water) 1 large carrot, julienned 1 small head purple cabbage, shredded 3 cups arugula (or other greens like spinach or kale) 1-2 Tbsp hummus per power bowl 1-2 Tbsp hemp seeds per bowl

4. Place the sweet potatoes and chickpeas in the 400*F oven and roast for 15 minutes, then flip the sweet potatoes and roll around the chickpeas. Roast for another 15 minutes. The potatoes will be done when they are fork tender and lightly browned. The chick peas are ready when they are golden. Be careful not to burn them. 5. Cook the quinoa according to package directions (usu ally 1.5-2 cups water to every 1 cup of quinoa). When the quinoa, sweet potatoes and chickpeas are done, you can assemble the bowl. 6. For assembly: add a cup of greens to the bottom of your bowl. Top with ½ cup sweet potatoes, ½ cup cooked quinoa, shredded vegetables, hemp seeds and hummus. Serve as is or squeeze a wedge of lime over the top.

¼ tsp each: garlic powder, onion powder, chili powder, cumin, cayenne

1. Roast the sweet potato and chickpeas. Preheat oven to 400*F. Line two baking sheets with parchment paper. 2. Spread out the chopped sweet potato on one sheet. Toss with black pepper. 3. In a bowl, combine the dry chickpeas with ½ Tbsp vegetable broth and seasonings. Spread out evenly on the other sheet.

2 cups Cooked quinoa (1cup dried, cooked in water) 1 8oz package of tempeh, diced into bite-sized pieces 1 Tbsp water ½ Onion, chopped 1 Bell pepper, chopped ½ cup Cherry tomatoes, halved Juice from 1 lime 1 can of low sodium organic black beans, drained and rinsed 2 Tbsp fresh cilantro 1 Avocado, diced

1 tsp cumin ¼ tsp each: cayenne pepper, chili powder, garlic powder, black pepper

1. While the quinoa cooks, prepare the tempeh: heat vegetable broth in a skillet on medium heat and add onions. Cook until soft. 2. Add the bell pepper, tempeh, lime juice and season ings and cook the mixture for about 15 minutes (stir ring occasionally) 3. Pour the cooked quinoa and tempeh mixture into a bowl and add the black beans, cilantro and tomatoes 4. Serve with sliced avocado, a dollop of non- dairy yogurt or hummus

1 large head of cauliflower, cut into florets 1 red onion sliced (separated into 2 piles) 4 cloves garlic minced (separated into 2 piles) 1 Tbsp fresh ginger, minced 1 small red chili, thinly sliced 2 cups fresh broccoli florets 1 Carrot, sliced thin 3 Cups fresh spinach ½ Bell pepper sliced Juice from ½ lemon ½ C edamame 2T shelled pumpkin seeds & fresh cilantro

1. Place cauliflower in food processor and pulse until finely chopped 2. Heat 1 Tbsp water in a large pan on medium heat. Add ½ of the onions and garlic to the pan and sauté for 5 minutes. 3. Add cauliflower to the pan along with ¼ cup of water. Steam the mixture for about 6 minutes, or until the water has evaporated and cauliflower is tender. Transfer to a bowl and cover to keep warm. 4. Sauté the remaining garlic and onions until tender. Add the ginger and chili and cook another minute. 5. Add the broccoli, carrot, bell pepper to the pan and cook 5 minutes or until tender. Turn off the heat and add the spinach and lemon juice, stirring to combine. For each serving, top cauliflower with vegetables and garnish with edamame, pumpkin seeds and cilantro. 73

Quinoa: 1 cup dried quinoa 2 cups of water 2 carrots, peeled & diced 1 can of low sodium black beans, rinsed & drained Lentils: 1 Tbsp vegetable broth 1 onion, chopped 1 clove garlic, chopped 4 tomatoes, chopped 1 cup dried green lentils 1 quart low sodium vegetable broth 6 stalks of celery, chopped 4 carrots, peeled & diced ¼ tsp ground coriander ¼ tsp ground cumin ¼ tsp black pepper

1. Heat vegetable broth in a pan and sauté onions and garlic for 5 minutes. Then add the tomatoes, lentils, cel ery, carrots, vegetable broth and spices. Cover and cook on medium heat for 1 hour or until the lentils are soft. 2. While the lentils cook, make the quinoa. Add dry qui noa and 2 cups of water to a pot and heat on high. Once it comes to a boil lower heat to a simmer and cook. After 10 minutes, add beans and carrots and cook for another 10-15 minutes or until the quinoa is cooked.

1 package extra-firm tofu Non-stick spray Dressing: 1 clove of garlic Juice from 2 lemons 1 Tbsp tahini 1 Tbsp water 1 tsp extra virgin vegetable broth 3/4 cup fresh dill (stems removed) Black pepper

1. Rinse the tofu and wrap in a few paper towels. Place a heavy object (like a saucepan) on top of the tofu for 25 minutes to remove the moisture. 2. While the tofu is straining, make the lemon dill sauce. Add all dressing ingredients to a food processor and pulse until well incorporated. 3. When the tofu is ready, slice into four large steaks. Heat a skillet over high heat and add non-stick spray to the pan and add the tofu. Let brown on one side for 6 minutes and then flip. Reduce heat if necessary to avoid burning. 4. When tofu is golden on each side, transfer to a bowl and pour on the dressing, stirring to coat. 5. Serve immediately with steamed vegetables and/or quinoa.

3. To serve: place quinoa mixture in the bottom of the bowl and top with lentil stew.

1 and ½ cups of wheat groats (burghul or bulgur) A bowl with hot water Bunch of parsley ½ bunch of mint 2-3 tomatoes A bunch of green onions ½ Tbsp vegetable broth 1 lemon

Preheat oven to 325 F. Separate the florets from the Cauliflower. Put them in a bowl with the garlic, chile powder, crushed chile, cumin, salt & vegetable broth and toss gently to mix together and coat well.

Put the wheat in the hot water bowl and let the water cover it. Soak it for 15-20 minutes Take off the water that’s left. Chop the parsley mint tomatoes and onions and mix with the west. Add the lemon and vegetable broth. May add black pepper.

1 large head Cauliflower 3 cloves garlic, minced 1 Tbsp Red New Mexico Chile Powder (substitute Ancho Chile Powder if you don’t have Red New Mexico) ½ tsp crushed dried Red Childe ½ tsp crushed dried Red Chile 1 tsp Cumin seeds toasted and ground 4 Tbsp vegetable broth ¼ cup Cilantro leaves, chopped ½ Lime, juiced Salt to taste 76

3.75-ounce package cellophane (bean thread) or thin rice noodles 8 ounces shiitake or other mushrooms, stems discarded and caps thinly sliced 6 cups vegetable broth 3 Tablespoons low-sodium soy sauce (Optional) 2 tablespoons grated fresh ginger 1 teaspoon chili sauce or hot pepper sauce to taste (optional) 4 scallions (green and white parts), thinly sliced 4 carrots, thinly sliced 8 ounces green beans, trimmed and cut into 2-inch pieces

1. Heat large saucepan over medium-high heat. Add the mushrooms and cook, stirring occasionally, for 2 minutes. 2. Add the broth, optional soy sauce, ginger, and chili sauce (if desired) and combine. Bring to a boil. 3. Add the scallions, carrots, and green beans. Simmer until the vegetables are tender, 5 to 6 minutes 77

Vegetables - cauliflower, carrots, celery root, celery, parsley root, bell paper, squash, sweet potato-optional, onion, shredded cabbage, leek, and fennel. (Whatever you have at home - not necessary all these veggies). Beet leaves, dill, parsley

Preparation takes more time than cooking. Because you are using many vegetables, youâ&#x20AC;&#x2122;ll be getting a large soup. You can freeze some of it for a few days later. 1. Cut vegetables into small pieces.

2 large carrots, scrubbed and cut into 1-inch pieces 1 medium red bell pepper, cored and cut into thin strips 2 Â˝ cups non fat vegetable stock 1 teaspoon turmeric 1 small cinnamon stick 1 teaspoon curry powder 1 teaspoon cumin 1 large zucchini, cut into 1-inch pieces 1 medium eggplant, cut into 1-inch pieces 1/4 cup golden raisins 3 tablespoons chopped fresh cilantro 1 cup instant couscous 2 tablespoons sliced almonds (optional)

2. Place in pot, cover with water, and cook for 15-20 minutes. 3. Cut some beet leaves, dill, parsley 4. After turning off fire, add spinach, kale, and small pieces beet leaves, dill, parsley, tomato sauce (organic tomato basil marinara), lemon juice and a piece of cooked shredded beet. 5. Mix everything together

1. In a large, high-sided skillet, heat with medium-high heat. Add the onion and cook until softened, about 5 minutes. Add the garlic, carrots, bell pepper, stock, and spices and bring to a boil. Reduce to a simmer and cook for 10 minutes. 2. Add the zucchini, eggplant, raisins, and half the cilan tro and continue cooking until tender, about 25 to 30 minutes. Season to taste with salt.

6. Add some garlic or green onions - if you like them. 3. Prepare the veggie spaghetti or couscous for 4 servings. Serve with the tagging garnished with the remaining cilantro and optional sliced almonds. 1 medium onion, chopped 2 medium garlic cloves, minced 78

A classic. Try almond butter as a healthier alternative to peanut butter.

Feeling hungry and low in blood sugar between meals? A good place to start is making sure you are eating complete meals, especially a good breakfast with long-lasting energy provided from whole grains and/or nuts and seeds. If you still find yourself craving a quick bite, here are some healthy snacking suggestions: A classic. Try almond butter as a healthier alternative to peanut butter.

Hummus is high in protein, beware of high salt content. Try making your own with chickpeas, tahini, lemon, and garlic all blended together. Whole grain pita is recommended.

Fruit is a great source of fiber and vitamins, but it is high in sugar, so keep that in mind. A piece of fruit before meals is a good way to help avoid over-eating.

The best trail mixes are free from sugary yogurt bites and chocolate. Beware of the high calorie content and to not overdo consumption. Try to mix your own.

Not just for the Japanese restaurant. Great high protein snack idea. Avoid salted edamame. Other Ideas: Broccoli, Bell Pepper, jicama. 80

1. Design an exercise program that works for you. You may need to get a professional trainer in order to do this. Everyone’s body is unique and has been through different experiences. What may work well for a 25-year-old (e.g., weight training) might not work well for an 80- year-old. 2. Regardless of age, start slowly, making sure that you are exercising with the correct techniques. 3. Reduce your risk of injury—if you have bad knees, then try wa ter sports; if you have never lifted weights before, then work with a trainer; if you know you get short of breath while walking uphill, then walk on a flat surface. 4. Be adventurous! Try planning a vacation in the great outdoors. 5. Listen to music while you work out. 6. Don’t be afraid to go outside of your comfort zone—try paddle-boarding, Pilates, yoga, etc.

1. Join a walking group in your neighborhood or local shopping mall. 2. Get the whole family involved—enjoy an afternoon bike ride or nature hike with your kids. 3. Walk the dog—don't just watch the dog walk. 4. Clean the house or wash the car. 5. Do stretches, exercises, or stationary bike while watching television. 6. Plant and care for a vegetable or flower garden. 7. Exercise to a workout video. 8. Get off the bus one stop earlier and walk the rest of the way to your workplace.

For most people, the hardest part of exercising is just getting started. We often hear people with good intentions stating, “Oh, I’ll start tomorrow!” Hectic schedules and lack of time certainly contribute to the excuses. But for many people, the lack of basic workout knowledge may intimidate and prevent them from even getting started. Ask your doctor for tips on beginning an exercise routine so you can lose the excuse and start today.

9. Use stairs instead of the elevator or intentionally park further away from the entrance. 10. Replace a coffee break with a brisk 10-minute walk. Ask a friend to go with you.

The Frequency Intensity Time Type Principle is a set of guidelines to help you get started with a workout routine that “FITTs” your goals and current fitness level. Aerobic Exercise

Strength Training

Flexibility

Frequency

EVERY DAY

2-3 nonconsecutive days per week

3-5 days per week

Intensity

Exercise at 60-80% of maximum heart rate

Train at your maximum capability

Stretch 15-45 seconds per movement

30-60 minutes per day

60 minutes per day

Any activity that maintains target heart rate (e.g. running, walking, swimming, cycling, sports, etc.)

Resistance exercise (e.g. bands, dumbbells, bodyweight, etc.)

Stretching exercise (e.g. yoga, Tai Chi, Pilates, etc.)

Time

Type

REMEMBER: Maximum Heart Rate = 220 – (your age) Target Heart Rate = 60% to 80% of maximum heart rate

• STOP if you become overly fatigued or short of breath; discuss the symptoms with your doctor • STOP if you develop a rapid or irregular heartbeat or have heart palpitations. Check your pulse after you have rested for 15 min utes. If it’s above 120 beats per minute at rest, call your doctor. • STOP if you experience chest pain and visit your doctor. 84

Stretchingis the best way to decrease muscle tension and improve flexibility.40 It also helps to relieve stress. It is a simple exercise that requires only a few minutes every day! Here are a few exercises to get you started.

Raise your left arm to the right shoulder and pull your elbow towards your chest until you feel a light stretch. Hold for 30 seconds and release. Repeat those steps with your right arm.

Hold onto a chair with your right hand for balance. Use your left hand to grab your left foot. Feel the stretch in your left leg. Hold for 30 seconds. Lean forward slightly for a deeper stretch. Now repeat with opposite leg and hand.

Interlock your fingers behind your body. Roll your shoulders back. Stretch the muscles in your chest by moving your hands further from your body. Hold for 30 seconds.

Use your hand to pull your head down. Hold for 15 seconds. Pull your head to the right side. Hold for 15 seconds. Pull your head to the left side. Hold for 15 seconds.

Lie down on your back. Use your hands to grab your shins. Relax your head and pull your shins toward you. Try to make the arch in your lower back touch the ground. Hold for 30 seconds.

Always start with a warm-up. Walking at a slow pace for 5-10 minutes is a great way to start. It will get your muscles ready for exercise. Use the stretches on the previous page. From there you can build your own stretching routine. Focus on stretching for about 5-10 minutes to prevent injury. From here you can choose an exercise for the day. Try to alternate them over 6 days each week; then take a day off: Tai Chi is proven by the New England Journal of Medicine to decrease falls and improve balance. You can sign up for a class or do it at home with online videos. Aim for 20 minutes or longer.

Get a chair without wheels. Put your arms out in front for balance. Slowly sit on the chair then come back up to standing.

Grab a pair of 5 pound dumbbells. Hold them at your sides. Shrug both shoulders up and hold for 2 seconds. Slowly lower your shoulders.

Stand arms-length from the wall. Put palms on the wall. Bend your elbows until your face is an inch from the wall. Push against the wall until arms are straight.

Grab two 5 pound dumbbells. Have both arms by your sides. Bend one elbow to raise the dumbbell; then extend your elbow. Repeat with the other arm.

â&#x20AC;&#x153;Cardioâ&#x20AC;? is an important exercise that helps with heart health and function. In order to make your heart stronger and prevent or heal disease, get about 30 minutes or longer. For low intensity exercise, try a light walk; use the elliptical, rowing machine, or stationary bicycle; or walk in the pool. 41, 42 Resistance training not only helps burn fat and build muscle, it protects against osteoporosis. On the next page, we have four resistance exercises to help guide you. Try doing 2 sets of 20 repetitions. Take a break in between each set. You deserve it!

Always start with a warm-up. Moderate Intensity

High Intensity

Walking at a brisk pace of 4 miles per hour for 5-10 minutes will get your muscles primed for your work out.

Jogging for 5-10 minutes is a great way to start. It will get your muscles ready for exercise.

Use the stretches on the previous page. From there you can build your own stretching routine. Focus on stretching for about 5-10 minutes to prevent injury. From here you can choose an exercise for the day. Try to alternate them over 6 days each week; then take a day off:

Moderate Intensity

High Intensity

Beginner yoga is a great way to improve balance and flexibility. You can sign up for a class or do it at home with online videos. Aim for 20 minutes or longer.

Pilates is an exercise that builds muscle and burns fat. It also helps with balance. There are classes you can join or find an online video! Try doing 20 minutes or longer.

â&#x20AC;&#x153;Cardioâ&#x20AC;? is an important exercise that helps with heart health and function. In order to make your heart stronger and prevent or heal disease get about 30 minutes or longer.

Moderate Intensity

High Intensity

Moderate intensity cardio for a longer period of time is the best way to decrease body fat. For moderate intensity cardio try jogging, water aerobics, doubles tennis, ballroom dancing, or riding a bike at 10 miles per hour.

For high intensity try running, swimming laps, spin class, or singles tennis.

Resistance training not only helps burn fat and build muscle, it protects against osteoporosis. On the next page, we have four resistance exercises to help guide you. Try doing 2 sets of 20 repetitions. Take a break in between each set. You deserve it! Moderate Intensity

High Intensity

Resistance training not only helps burn fat and build muscle, it protects against osteoporosis. We have five resistance exercises to help guide you. Try doing 3 sets of 12-15 repetitions. Take a break in between each set. You deserve it!

Resistance training not only helps burn fat and build muscle, it protects against osteoporosis. We have five resistance exercises to help guide you. Try doing 3 sets of 8-12 repetitions at a higher weight. Take a break in between each set. You deserve it!

Grab two dumbbells and hold them with your elbows straight at your sides. Extend your arms straight out in front of you. Slowly lower them back down by your sides.

For moderate exercise, do not use weights. For more intensity, grab a 5 pound dumbbell for each hand. Start with your feet together; then take a large step with your right foot. Slowly bend your knees to touch your left knee to the ground. Make sure your left knee is at 90 degrees. Straighten out your knees; then step your right foot back to standing; then repeat with your left foot.

Grab two 5 pound dumbbells. Have both arms by your sides. Bend one elbow to raise the dumbbell; then extend your elbow. Repeat with the other arm.

Lie face down on the floor with arms slightly more than shoulder-width apart. Extend your arms while keeping your body straight. Lower your body back to the floor by slowly bending your elbows. For moderate exercise, pivot on your knees. For more intensity, pivot on your feet.

Lie on you back and bend your knees. Put both arms behind your head or crossed on your chest. Stare at a fixed point on the ceiling. Tighten your abdominal muscles and lift your head up while staring at the same fixed point. Only lift your upper back a few inches off of the ground, then return your back to the ground. For moderate exercise, do 15 sit-ups. For more intensity, do 25 sit-ups.

Falls are a big deal! One in every three adults over the age of 65 will fall and get taken to the emergency room, and the adults who develop fractures have a very high mortality rate! There are many exercises and routines that one can do on a daily basis to improve strength and balance and reduce the risk for falls. Here are some examples:

Stand behind a stable chair just in case you need to hold it for balance. 1. Place left hand on back of chair. 2. Place right hand on your right hip or on chair for more balance and lift right leg up (bending at the knee and slightly at the hip). 3. Place right foot back on the floor and repeat. 4. Repeat leg raise for 15 repetitions. 5. Repeat steps 1-4 with the other leg (try to repeat 3 times on each side). 1. Plant left leg on the floor and lift right leg. 2. Walk forward placing the heel of the right leg so it touches the toes of the left foot. 3. Take next step by lifting left leg and placing left heel so it touches the toes of the right foot. 4. Repeat for 10-20 steps

1. Place both hands on a sturdy non-mobile chair for balance. 2. Stand with legs shoulder width apart and keep back and body in straight line. 3. Lift left leg to the side to achieve a 30 degree angle between legs then place leg back on ground. 4. Repeat 10-20 times with one leg and then switch legs. 5. Try to complete 2 sets of leg raises in each leg.

1. Place both hands on a sturdy non-mobile chair for balance. 2. Stand with both legs shoulder width apart. 3. Lift both to stand on your toes and hold for 1-2 seconds. 4. Lower heels to the ground and repeat 10-20 times.

IMPORTANT: Before beginning any exercise program, remember you must get medical clearance from your physician! 95

EXERCISE ON THE GO! With a busy schedule, how is it possible to keep an active lifestyle, especially when working from a desk or a couch? You can't go wrong with this simple workout. It only takes a couple of minutes throughout the day, and you can do the exercises from where you are sitting. You can do this anywhere. It will also boost your energy level and productivity. This is the best way to utilize your breaks and get your heart pumping and gain nextra energy. You are probably sitting as you read this. Just stand up, then sit back down! Start by doing 15 squats from your workstation. You can do them throughout the day. Try to aim for 200 per day. This is another great exercise to get your blood pumping. Not only is there more blood circulating in your body, there is more blood going to your brain! Make sur eyou have enough room for jumping jacks. Start off with 20 and them during your work day. Our final recommendation is push-ups. This will engage your upper body. All you need is a piece of floor. So set up and get active! Do these exercies anywhere. You have nothing to lose except those extra pounds!

1. Strengthens your heart, allowing it to pump effectively 2. Decreases oxygen demands on the heart 3. Decreases blood sugar 4. Decreases body mass 5. Decreases need for medications 6. Improves sleep 7. Reduces stress and tension, and increase one's self-confidence and wellbeing 8. Reduces anxiety 9. Maintains cognitive ability, decreases risk for cancer & improves overall immune system's function 10. Allows for opportunities to socialize (e.g., joining the office softball team) IMPORTANT: Before beginning any exercise program, remember that you must get medical clearance from your physician!

For many, a morning cup of coffee is an essential part of starting the day. But what are the effects of coffee on your health? Large amounts of caffeine may be detrimental to the heart.43 Caffeine may precipitate palpitations, or irregular heartbeats.44 If you are experiencing palpitations, it is best to stop caffeine ingestion altogether. Tea is an excellent alternative to coffee. It is high in antioxidants which can protect against atherosclerosis.45 Drink herbal teas that are free of caffeine for the optimal effect in relaxation and heart health. Mint tea or any other variety is a great drink to enjoy.

•Do not drink coffee, tea, and other foods that have caffeine in the afternoon or evening. Avoid alcohol. •Avoid heavy late-night meals. •Avoid smoking, especially in the evening. •Keep your bedroom dark, cool, quiet, and free of reminders of work or other things that cause you stress. •Solve problems you have before you go to bed. •Exercise several days a week, but not right before bed.

SLEEP

•Avoid looking at phones or tablets before bed. This can make it harder to fall asleep. Reading a book is okay.

Sleeping difficulty is very common, especially with aging. Poor sleep can cause numerous negative effects including poor concentration, forgetfulness, irritability, daytime fatigue, anxiety, and depression.46 Sleep deprivation is a proven risk factor for cardiovascular disease.47,48 While there are several types of sleep aid medications, in many cases these may actually disturb the sleep cycle and can worsen a patient’s insomnia in the long run. So what can you do to improve your sleep? The answer is to improve sleep hygiene by taking the following steps: •The bed is only for sleep; avoid eating and watching TV in bed. •Sleep only long enough to feel rested. •Go to bed and get up at the same time every day; routine is very important. •Do not try to force yourself to sleep. If you can't sleep, get out of bed and try again in 15 100

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CASES OF THE CARDIOVASCULAR INSTITUE As an advocate for lifestyle optimization, I have seen that for many patients, changes are often not made until the heart disease has progressed to a life- threatening level. My hope is that through sharing these patients’ stories, others may learn and avoid the need to put their own lives on the line. It is my great privilege and joy in life to practice medicine and bring health to my patients. Yet through my years of training and experience, I have come to realize the limitations of our medical tool box. I have come to see time and time again that the lasting changes I’ve helped bring to patients’ lives were achieved through diet and exercise.

I was a person who considered French fries my daily vegetable in-take. I figured if it couldn’t run or fly and be doused with barbecue sauce, it wasn’t worth eating. My exercise consisted of picking up the remote control from the counter and sitting back down on the couch to watch TV. My high-intake, low-output lifestyle was taking its toll on my heart. I began to experience shortness of breath with any activity over 10 minutes, I was waking up from sleep with a cough at night, I was feeling occasional chest pains, and I noticed increased swelling in my legs. These were all signs that my heart was not pumping well, also known as congestive heart failure. After years of doctors visits and medications, my heart was so diseased that the only possible solution would be a heart transplant. It was a dangerous procedure with long-term complications. However, it was the only way to save my life. Yet there was one problem. I had become so obese that the surgeons could not operate on me unless I lost some weight. 102

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This is the point that I began to see Dr. Ben-Zur. The counseling he provided me began to trans- form my life. I realized that I had passed a point of no return and could allow life to keep hap- pening to me, or I could take a stand to make some positive changes in my lifestyle. I took responsibility for myself and started to cultivate a new outlook and self-discipline. By adopting a plant-based diet and starting to get real forms of exercise, I was able to lose the weight I needed to undergo my surgery. Diet and exercise allowed me to undergo the operation that saved my life. I was able to prolong my life past the age of 50. Had I implemented the lifestyle changes I made just a few years earlier, I might have avoided the risky and complicated procedure altogether. I hope others will listen to their hearts and give themselves the nutrition and activity they need long before their body’s most important muscle dies of neglect.

Driving for the basket, I spun, evading the defender as I set up for the shot and prepared to sink the game-winning shot. Suddenly my vision started to turn black and the next thing I knew, I was lying on the ground with a group of sweaty players looking down at me. This was the third time I had suddenly passed out while playing sports. I knew something must be wrong with me, but I was afraid to find out what it was, and I didn’t know who to see. Luckily for me, I was referred to The Cardiovascular Institute, where my life would be saved and forever changed for the better through the diagnosis and treatment of my rare heart condition.

heart pumping, Dr. Ben-Zur was able to explain my diagnosis to me: “Based on your history and the results of your test, we have determined that you have a condition known as hypertrophic cardiomyopathy (HCM). HCM is a ge- netic condition, meaning it is passed on to you from one of your parents at birth. A mutation in one of your heart’s proteins has caused your heart to become enlarged. When your heart is pumping blood, the enlarged portion in the center, the interventricular septum, creates a blockage in the flow of blood into your body’s circulation. As a result, when you are playing sports, not enough blood and oxygen is reaching your brain and you are passing out. While there is no cure, through a combination of medication and lifestyle modifications it will still be possible for you to maintain a healthy and active lifestyle.” I learned that I had a serious condition and that I was fortunate to discover it a young age, while life-threatening complications could still be prevented. People with HCM who do not receive proper treatment and take the necessary precautions may go on to develop arrhythmias, or ab- normal heartbeats that can be fatal. It would be important for me to listen to my body and not push myself too hard while playing basketball and working out. Likewise, I also learned about the importance of staying well hydrated. Not only did the doctor prescribe a medication called a beta-blocker, which decreased the stress and blockage of blood flow from my heart, but he provided me with valuable lifestyle coaching. I hadn’t realized it at the time, but I was eating a diet that was high in fat and salt. By switching to a vegan diet, I was able to lower the stress on my already sensitive heart. My blood sugars were high, and through my new diet, I was able to bring these down as well, preventing the need for diabetes medications. The treatment and guidance provided to me by Dr. Ben-Zur has allowed me to learn about and manage my condition with diet and moderate exercise before it was too late.

The first thing I noticed at Dr. Ben-Zur’s office was that I didn’t have to wait, I was brought directly into the room and was soon feeling more at ease by the comforting and friendly staff. By asking me questions about my symptoms, performing an EKG to see my heart’s electrical activity, and using echocardiography to visualize my 104

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that he does not always eat on time.)

In June 2012 my husband developed chest pain. We went to the local emergency room, where a doctor told me my husband was having a major heart attack. A cardiologist had been called. Fear and panic overwhelmed me. My husband was 47 years old at the time. We have three children. Thoughts began taking root in my head: What will happen to him, my life-long friend? What will happen to our children? Amazingly within minutes, a tall gentleman arrived. He said, “Hi my name is Dr. Ben-Zur, and I’ll be taking care of your husband.” He was obviously hurried and intensely focused on the problem, but his gentle eyes were calming. Within seconds I felt at ease. It was as if an older brother had come to save us while we were drowning. Almost immediately Dr. Ben-Zur rushed my husband to the operating room. This was at about 1:30 AM. At about 4:30 AM Dr. BenZur emerged and came out to the waiting area. He had a glowing look, a big smile, and two thumbs up. His clothing was damp from perspiration. It was obvious that he had worked very hard. My husband was fine, and he would be going home in a few days. My husband was then seen in Dr. Ben-Zur’s office over the next several months. Dr. Ben-Zur and his amazing staff completely changed our lifestyle. My husband is now eating healthy food and is in the best shape he has been in for a very long time. After meeting with many of Dr. Ben-Zur’s patients, I realized that our story was not unique. Hundreds of them have similar ones. Dr. Ben-Zur has been a tremendous addition to our lives. My youngest son said it best: “Our doctor is special.”

My name is Azita and I look forward to meeting you at Dr. BenZur’s. –Azita Shalom (Ms. Shalom was nice enough to plant roses for us so that every morning we are reminded of the new life we gave to her and her husband).

CASE 4: NO INDICATION ANYTHING WAS WRONG The following is an excerpt from the book, “Straight from the Heart,” by Uri Ben-Zur. On August 2, 2008, I was playing basketball in Balboa Park with some friends when I began to feel a little tired. I motioned to one of the other players to take my place on the basketball court and then sat down to rest. The next thing I remember, I was at the hospital. Dr. Uri Ben-Zur met me there and told me I was having a heart attack. He performed an angiogram and inserted stents into my heart. I later found out that Dr. Ben-Zur was a distance away when he received the call, but somehow he got to the hospital before the ambulance. Little did I know that, at age 52, my life was about to change forever. I thought I was a healthy man up to that point. I had no physical indication that anything was wrong with me. I played basketball several times a week, was pretty active—a little overweight, maybe, but that had never stopped me from playing ball with my friends. I felt pretty good.

Even though I’m busy with my husband and raising three children, I take two cups of green juice to Dr. Ben-Zur every morning. (I worry

Only, I wasn’t fine. I discovered that I suffered from a 100 percent blockage in one of my arteries, which explained why my heart had given up on me in the park. Luckily for me, Dr. Robert Feinfield, an ophthalmologist who happened to be on his way to see his son coach a basketball game, performed CPR, keeping me alive until

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paramedics arrived and rushed me to Providence Tarzana Medical Center. I think my heart stopped working for about 15 minutes. I was very lucky to survive; I had a lot of angels around me that day. Chief of those angels was Dr. Ben-Zur, who performed the surgery that saved my life—but that’s not all he did. He changed my outlook on everything I did. I don’t drink anymore, I eat much healthier than I used to, and I exercise daily. On weekends I go on hikes up in the mountains for three to four hours. I have lost 40 pounds and have more energy than ever before, I feel like a new person.... If something good can come from my heart attack, then this is it. Dr. Ben-Zur introduced me to a new way of life, and thanks to him, I feel much healthier and more energized than ever before. My wife and children would have had their lives changed forever if it weren’t for Dr. Ben-Zur and the other angels that watched over me. –Howard Abravanel

I want to preface this by saying that this is not a miraculous success story. I wish it were, but the truth is that this is my “work-in-progress” story. Food has always been my weakness. My parents love to tell a story about me from my toddler days: my whole family was gathered in the synagogue for my uncle’s wedding, which had started about 15 minutes prior, when I managed to wriggle my way out of my mother’s grasp and took off speed-crawling down the aisle. My parents were frozen in horror. I was 10 seconds from reaching the altar when my grandmother in the front row managed to whip out a bag of M&M’s and dangle them in front of me. At the first sight of the chocolate, I forgot all about reaching the altar and, instead, I made a beeline for the candy. Cri- sis averted. I laugh every time I think about that story, but the sad truth is that I have lived my entire life being captivated, distracted, and drawn towards unhealthy foods. As I approached my teen years, I was always very active in sports, but I was never able to lose weight (or at least not for any meaningful and sustained period of time) because working out couldn’t possibly compensate for my regular sessions of ice cream and cookie binge-eating. I obsessed over junk food. I would lie in bed and be unable to sleep because I was craving chocolate. I wish I were joking when I say that there were times that I would sleep with a pack of cookies in my bed, so that I could have them close by and ready to stuff in my mouth when I woke up in the middle of the night with another craving. It’s awful– truly, truly awful– the amount of power I allowed food to have over me. By the time I showed up for my first day of medical school, I had a BMI of 39.9. I was literally half a pound shy of being classified as morbidly obese at 23 years old.

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I would sit there in class and cringe as our professors would lecture to us about the importance of encouraging healthy lifestyles in our future patients because I could only imagine how hypocritical it would look to preach a healthy lifestyle when mine was so blatantly unhealthy. I had known for a long time that I needed to change, but realizing that I could potentially jeopardize an opportunity for my patients to invest in their health motivated me to commit to a new and healthier lifestyle. I am not going to lie and say it was easy. It wasn’t. I had several setbacks. One thing that I eventually realized was setting me up for failure was the idea that I could still eat my chocolate, cookies and ice cream as long as it was in moderation. I had to come to terms with the fact that, at least in my world, I don’t have the self-control for moderation. And in retrospect, it makes sense. I had a true addiction to food, and you would never hear anyone tell an alcoholic to go ahead and have some wine as long as it’s in moderation. I would try to limit myself to one cookie, and all it would do was torture me. That one cookie was such a tease. How could I possibly eat just one cookie when there were another 30 waiting for me in the package? Without fail, that one cookie quickly became the entire package, and then I would spend the next few days fighting the cravings and, more often than not, falling off the wagon again, so to speak. So, once I realized that eating tiny amounts of unhealthy food was harder for me than not eating it at all, it became much easier to make the decision to pass up on that one cookie or a small sliver of cake. Another thing that I believe contributed to my success-in-progress has been reprogramming how I think about meals, especially meals out at restaurants. In my family, we always used to throw around the phrase “you don’t want to spoil your meal!” as in, we shouldn’t eat now because dinner is soon, and we don’t want to be full for dinner. To this day, my dad (who, I might add, has had two massive heart attacks) will fast all day in preparation to an all-you-can-eat buffet for dinner, to ensure that he gets his “money’s worth” of food. Now, if I’m going to go out to eat (which I try to avoid as much as possible, because it’s just better to avoid the temptation), I make 110

sure to eat some bell peppers or a cucumber beforehand so that I’m not starving as I’m looking at the menu. Hungry Diana makes very poor decisions. Along the same lines, I stopped buying unhealthy snacks that masquerade as healthy snacks (for example, those 100 calorie packs–they’re a lot less healthy when you scarf down all 600 calories contained in those boxes in one sitting). Again, it comes down to me recognizing my limitations with my self-control and avoiding those situations. I also started paying attention to which foods cause me to be hungry five minutes later. Breads and cheese do nothing except make me hungrier, so I try to stay clear of them. The biggest thing that has contributed to my success so far, however, has been how good I feel. The difference in my life has been incredible since I’ve stopped eating junk food. My energy has tripled, my mind is clearer, my memory is improved, I sleep better at night, and overall I feel so much better in my day-to-day life. It has been two years since I started this journey. I have lost 75 pounds so far and am no longer classified as obese; however, I have another 20 pounds to go before my BMI is in the normal weight category. Although I can’t say that this entire process has been easy, I will say that the bulk of the weight loss was extremely easy once I started improving my diet. And that’s the amazing thing about the diet contained in these pages–you do not have to be 100 percent vegan to benefit from the information in this book. Obviously the more you can adhere to this diet, the better results you’ll have. But if you’re not willing to commit to a completely vegan lifestyle, that’s okay! I am not completely vegan either. At least not yet. It’s okay to start small. Based on my own personal experience with this, I believe that any amount of change that you are willing to commit to will have beneficial results for you. The most important thing is that you start doing something. Please remember that even the smallest step in the right direction is still the right direction. I spent 15 or so years of my life trying to justify my poor eating habits, or making comments such as, “I know this is so bad for me, but it’s worth it. It’s so delicious.” I look back now, and I can’t believe I ever thought that way. I can’t believe I ever thought that a slice of 111

cake was worth sacrificing my health. There is no food that is worth dying for, having a heart attack for, or severely diminishing my quality of life. It really is that simple.

THANK YOU, DR. BEN-ZUR Through rotating with Dr. Ben-Zur we’ve not only expanded our knowledge on the science behind cardiology, but he’s shown us the art of patient care. His dedication, compassion, and commitment to each patient is inspirational.

–Diana Moers, OMS III

In addition to molding us into future physicians and physician assistants, he influenced us to make healthy modifications in our personal lives. It was eye-opening to watch the effect of diet and exercise on each patient’s health. Many of the patients we followed were able to decrease their medications or discontinue them all together through exercise and a vegan lifestyle. Being in an atmosphere that advocated for healthy diets and exercise has had profound effects on our lives. For some of us, it was our first time eating vegetables on a daily basis. For others, we have adopted a complete plant-based lifestyle and could not be happier. Some of us have even returned to the gym after years of no exercise, while others committed to increasing our exercise habits. Thank you, Dr. Ben-Zur, for shaping our futures in the field of medicine and for motivating us to reflect on our personal habits. You have inspired us to lead by example and to become role models for our patients.

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TESTIMONIALS Dr. Ben-Zur is a pure and simple life saver! When I met Dr. Ben-Zur, I was on seven different prescription medications (three for hypertension, three for diabetes, and one for cholesterol). I also was severely obese with a history of heart problems in my family. I had not had a heart attack, but I felt I needed to be examined. After regular visits with Dr. Ben-Zur and only a few months, I am off all medications, and have lost 50 pounds! I have never felt better, and never had more energy. He is a miracle worker. He will motivate you to lose weight and design a nutrition plan for you that really works. He is more than a doctor, but a life coach.” “I went on the program ... No meat. No sugar. No salt. No more alcohol. If I couldn’t walk or run, I was to find another way to get an hour of cardiovascular exercise every day. My blood pressure is normal, even though I am off all medication. I have not been in such good health in 15 years.” – Dr. Mordecai Finley, Ph.D. Who exercises every day? It’s crazy.” I have never exercised before, so it seemed unheard of to do it on a daily basis. Dr. Ben- Zur advised me to purchase a treadmill and start walking on its highest incline. I told him that I had no room for it in my home, and I’ll never forget his response: “If you need to take out the dining room table, do it! It will be the most important furniture in your home.” Exercise became part of my daily life. It’s like brushing my teeth. I became vegetarian and not all, but most, of my symptoms subsided.” - Katie Lefevre

After my heart attack, my first priority was to survive and recover, but once past the immediate emergency, I knew I needed to make more permanent lifestyle changes. I lost 30 pounds, and I’m about to turn 62. I’m in better shape than I was before my heart attack.” – Dr. William Toutant, Ph.D. Before the heart attack, I weighed 210 pounds. With Dr. Ben-Zur’s health plan, I lost all the fat on my body and now weigh 168 pounds, which was my high-school weight. At 6 feet 3 inches, I’m in better shape today than when I was a college hockey player.” – Michael Moline I was diagnosed with type II diabetes six years ago and I used to take five different medications every day. When Dr. BenZur spoke with me he recommended a plant- based diet. I cut out all breads, sugars, meat and after 10 days I feel I have gained more life than the last five years. I am now off my blood pressure and diabetes medications and my labs show normal levels. I am so thankful and happy, and I highly recommend that everyone follow the same. I also lost 12 lbs. I am never starving, and I enjoy the food I make, contrary to what many people believe about a vegan diet.” – Shlomo Rushinek I was placed on a strict diet that enabled me to lose 30 pounds. My medications were eventually reduced from 15 pills per day to only six.” – HarveyTurell

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Our clinic is dedicated to honoring the memory of Paulette Tashnek-Wagner, who embodied many of my own philosophies: treating everyone as if they were part of the family, putting others before oneself, and greeting each person with open arms. She was suddenly diagnosed with, and succumbed to, cancer. Her family, friends, and community constantly stood by her side and exemplified the values that guide our clinicâ&#x20AC;&#x2122;s work. We named the clinic after Paulette, our patient, to honor her strength and courage throughout the devastation caused by her illness. Her loss brought back vivid memories of the loss of my grandfather, which traumatized my family indescribably. This, more than anything else, motivated me to become the physician I am today. I have and will always stand beside each and every person who puts trust in me. I will always put their needs before my own. I will stand ready and willing to teach anyone who would like to learn from me, so that others will continue with my conviction. I will fight, with all my might, to find cures for diseases and prevent disease whenever possible. I will fight, with all my might, to try to prevent these tragedies from afflicting other families. Though our departed loved ones are now beyond our touch, their candles still burn, their hands still guide, and their voices still answer, forever within us.

In Loving Memory of Paulette Tashnek-Wagner 116

In loving memory: Paulette Tashnek-Wagner. Uri Ben-Zur, M.D., F.A.C.C.

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BIBLIOGRAPHY 1. The American Heart Association's Diet and Lifestyle Recommendations. Heartorg. 2016. Available at: http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/ Nutrition/The-American-Heart- Associations-Diet-and-Lifestyle-Recommendations_UCM_305855_Article.jsp#.V4pH2KJ5LAo. 2. The Dietary Education of Bill Clinton. Courtesy of CNN. http://www.cnn.com/2011/HEALTH/08/18/ bill.clinton.diet.vegan/ 3. Falk E. Pathogenesis of Atherosclerosis. Journal of the American College of Cardiology. 2006;47(8):C7-C12. doi:10.1016/j. jacc.2005.09.068. 4. World Health Organization Says Processed Meat Causes Cancer. Cancerorg. 2016. Available at: http:// www.cancer.org/cancer/news/ world-health-organization-says-processed-meat-causes-cancer. 5. Society A. Risk factors for dementia - Alzheimer's Society. Alzheimersorguk. 2016. Available at: https:// www.alzheimers.org. uk/site/scripts/documents_info.php?documentID=102. 6. Obesity and Cancer Risk. http://www.cancer.gov/about-cancer/ causes-prevention/risk/obesity/obesity- factsheet# 7. Obesity and Cancer. http://www.asco.org/practice-research/obesity-and-cancer 8. Overview of obstructive sleep apnea in adults. Uptodatecom. 2016. Available at: http://www.uptodate.com/contents/overview-of-obstructive-sleep-apnea-in-adults.

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9. Chirinos J, Gurubhagavatula I, Teff K et al. CPAP, Weight Loss, or Both for Obstructive Sleep Apnea. New England Journal of Medicine. 2014;370(24):2265-2275. doi:10.1056/nejmoa1306187 10. Triglycerides and High Cholesterol | Cleveland Clinic. Myclevelandclinicorg. 2016. Available at: http://my.clevelandclinic.org/health/diseases_conditions/hic_what_ you_need_to_know_about_triglyceri des 11. Does Alcohol Consumption Affect Your Cholesterol Levels?. Cholesterolmenucom. 2016. Available at: http://www.cholesterolmenu.com/alcohol-and-cholesterol/. 12. Measurement of Obesity :: Public Health England Obesity Knowledge and Intelligence team. Nooorguk. 2016. Available at: http://www.noo.org.uk/NOO_about_obesity/measurement. 13. How does smoking affect the heart and blood vessels? http:// www.nhlbi.nih.gov/health/health- topics/topics/ smo 14. Smoking and Cardiovascular Disease. 1st ed. CDC Available at: https://www.cdc.gov/tobacco/data_statistics/sgr/50th-anniversary/ pdfs/fs_smoking_CVD_508.pdf 15. The Ultimate Guide to Quitting Smoking. http://greatist.com/ health/ultimate-guide-quitting-smoking 16. Healthy diet. World Health Organization. 2016. Available at: http://www.who.int/mediacentre/factsheets/fs394/en/. 17. 10 Reasons to Stop Eating Out. http://www.healthguidance.org/ entry/16153/1/10-Reasons-to-Stop- Eating-Out.html 18. Restaurant Meals. http://www.cbsnews.com/news/restaurantmeals-can-be-as-bad-for-you-as-fast-food/

19. Ornish Lifestyle Medicine. 'Ornish Lifestyle Medicine | Ornish Lifestyle Medicine'. N.p., 2015. Web. 7 Aug.2015. 20. Nutritional Update for Physicians: Plant-Based Diets. The Permanente Journal. 2016. Available at: http://dx.doi.org/10.7812%2FTPP%2F12-085. 21. M.D. M. plant-based diets | Health Topics | NutritionFacts.org. Nutritionfactsorg. 2016. Available at: http://nutritionfacts.org/topics/plant-based-diets/. 22. Schellenberg E, Dryden D, Vandermeer B, Ha C, Korownyk C. Lifestyle Interventions for Patients With and at Risk for Type 2 Diabetes. Annals of Internal Medicine. 2013;159(8):543. doi:10.7326/0003-4819-8-201310150-00007. 23. Controlling Blood Pressure | cdc.gov. Cdcgov. 2016. Available at: https://www.cdc.gov/bloodpressure/control.htm 24. Eating Out, Weight and Weight Gain. http://www.ncbi.nlm.nih. gov/pubmed/20661252 25. Eating Out At Restaurants Boosts Risk of Obesity. http://articles.orlandosentinel.com/2011-07-04/health/osrestaurants-obesity-20110704_1_restaurant-foods-eating-obesity-experts 26. Sacks, Frank M. (2013, November 11). Guidelines of the American College of Cardiology/American Heart Association Task Force on Practice 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk: A Report.Retrieved October 10, 2014 from http://circ.ahajournals.org/ content/early/2013/11/11/01.cir.0000437740.48606.d1.full.pdf 27. Becoming a Vegetarian. http://www.webmd.com/diet/ss/slideshow-vegetarian-diet 28. The Benefits of Going Vegan. https://www.scripps.org/news_ items/4521-the-benefits-of-going-vegan

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29. Protein | Nutrient Reference Values. Nrvgovau. 2014. Available at: https://www.nrv.gov.au/nutrients/protein. 30. St. Michael’s Hospital. (2014, May 22). Low-carb vegan diet may reduce heart disease risk, weight. Science-Daily. Retrieved October 10, 2014 from www.sciencedaily.com/releases/2014/05/140522105136.htm 31. Tool: Calorie calculator - Mayo Clinic. Mayoclinicorg. 2016. Available at: http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/calorie-calculator/ itt-20084939. 32. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington, DC: National Academy Press, 2002. 33. Mangels R, Messina V, Messina M. The Dietitian’s Guide to Vegetar-ian Diets, 3rd ed. Sudbury, MA: Jones and Bartlett Learning, 2011. 34. Sellmeyer DE, Stone KL, Sebastian A, et al. A high ratio of dietary animal to vegetable protein increases the rate of bone loss and the risk of fracture in postmenopausal women. Am J Clin Nutr 2001;73:118-22. 35. Knight EL, Stampfer MJ, Hankinson SE, et al. The impact of protein intake on renal function decline in women with normal renal function or mild insufficiency. Ann Intern Med 2003;138:460-7.

37. 10 of the Best Reasons to Exercise – University Health Services. Nichollsedu. 2016. Available at: https://www.nicholls.edu/health/ forms-and-more-information/10-of-the-best-reasons-to-exercise/ 38. Adsett JMullins R. Evidence Based Guidelines For Exercise And Chronic Heart Failure. 1st ed.; 2007. Available at: https://www. health.qld.gov.au/heart_failure/pdf/guide_exercise_chf.pdf. 39. Cleveland Clinic – Heart Failure Exercise/Activity Guidelines (Cleveland Clinic http://my.clevelandclinic.org/ disorders/heart_failure/hic_heart_failure_exercise-activity_guidelines.aspx 40. Current Concepts in Muscle Stretching for Exercise and Rehabilitation. The International Journal of Sports Physical Therapy. 2012;7(9):109. 41. Aerobic interval training reduces blood pressure and improves myocardial function in hypertensive patients.European Journal of Preventive Cardiology. 2012 19 April: 151-160. 42. Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study. Naci H, Ioannidis JP. BMJ. 2013 Oct 1;347:f5577. doi: 10.1136/bmj.f5577. Review. PMID: 24473061 43. Fabrizio C, Desiderio M, Coyne R. Electrocardiogram Abnormalities of Caffeine Overdose. Circulation: Arrhythmia and Electrophysiology. 2016;9(7):e003088. doi:10.1161/circep.115.003088. 44. Caffeine arrhythmia. Paediatric Nursing. 1989;1(2):25-25. doi:10.7748/paed.1.2.25.s27.

36. M.D. M. The Vitamin Everyone on a Plant-Based Diet Needs | NutritionFacts.org. NutritionFactsorg. 2015. Available at: http:// nutritionfacts.org/2014/12/18/the-vitamin-everyone-on-a-plant-baseddiet- needs/

45. Bøhn S, Ward N, Hodgson J, Croft K. Effects of tea and coffee on cardiovascular disease risk. Food & Function. 2012;3(6):575. doi:10.1039/c2fo10288a.

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46. How Sleep Deprivation Affects Your Heart. Sleepfoundationorg. 2016. Available at:https://sleepfoundation.org/sleep-news/howsleep-deprivation-affects-your-heart. 48. Mullington J, Haack M, Toth M, Serrador J, Meier-Ewert H. Cardiovascular, Inflammatory, and Metabolic Consequences of Sleep Deprivation. Progress in Cardiovascular Diseases. 2009;51(4):294-doi:10.1016/j.pcad.2008.10.003.

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