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10/12/2016Antitrust Notice The Casualty Actuarial Society is committed to adhering strictlyto the letter and spirit of the antitrust laws. Seminars conductedunder the auspices of the CAS are designed solely to provide aforum for the expression of various points of view on topicsdescribed in the programs or agendas for such meetings. Under no circumstances shall CAS seminars be used as ameans for competing companies or firms to reach anyunderstanding – expressed or implied – that restrictscompetition or in any way impairs the ability of members toexercise independent business judgment regarding mattersaffecting competition. It is the responsibility of all seminar participants to be aware ofantitrust regulations, to prevent any written or verbaldiscussions that appear to violate these laws, and to adhere inevery respect to the CAS antitrust compliance policy.1Food as MedicineCIA and CAS In Focus SeminarOctober 28, 2016Betty-Jo WalkeKen BeckmanCaterina LindmanNote: The information presented is based on research and personal experience, and does notconstitute medical advice.2Workshop Agenda How can Food be our Medicine? - Caterina Personal Stories - Caterina, Ken Obesity - Ken Heart Disease - Caterina Cancer - Ken Diabetes - Caterina Insurance Aspects - Ken Small group work - All31

10/12/20164Whole-foods, Plant-based Diethttps://www.youtube.com/watch?v wpmp5NmZ4aw5Plant based, whole foodswww.humanefacts.org62

10/12/2016Our Personal Stories7ObesityCause: consuming more calories than are burnedOnly Three Possible Solutions:(1) Eat less of the same foods(2) Exercise moreDouble Cheeseburger2 slices Pepperoni Pizza8 oz Potato Chips1 cup Chocolate Ice CreamHours Needed to BurnCalories by1:WalkingJogging3.01.02.51.05.01.752.0.75(3) Eat the same or more of certain seburger.html893

10/12/2016Controlled Study of Overweight Women1Weight LossAfter:Plant-Based Diet(PBD)Cholesterol Education Diet(included animal products)1 year2 years4.9 kg3.1 kg1.8 kg0.8 kg No restrictions on caloriesFor 14 weeks all met with physician/dieticianPBD group -- consumed fewer calories than before studyPBD group -- not aware they were eating fewer calories –greater volume of food compared to Cholesterol Educationgroup1GabrielleM. Turner-McGrievy et al., "A Two-Year Randomized Weight Loss Trial Comparing a Vegan Diet to a More ModerateLow-Fat Diet," Obesity 15 (September 2007).Neal Barnard, 21-Day Weight Loss Kickstart: Boost Metabolism, Lower Cholesterol and Dramatically Improve Your Health,10(New York: Grand Central Life & Style, 2011), 24.Studies of BMI by Diet TypeBody Mass Index (BMI)UK Study of 38,0001US Study of 60,0002(controlled for age/lifestyle) (not controlled for .425.7Vegans22.523.6Diet Type BMI 25 is overweight, BMI 30 is obese Many vegans do not follow a whole food plant-based diet. Thosewho do would expect to have a lower BMI than shown.1EASpencer et al., "Diet and body mass index in 38,000 EPIC-Oxford meat-eaters, fish-eaters, vegetarians and vegans, " InternationalJournal of Obesity 27 (2003).2Serena Tonstad et al., "Type of Vegetarian Diet, Body Weight, and Prevalence of Type 2 Diabetes," Diabetes Care 32, (May 2009).11Whole Food Plant-Based Diet and Obesity Weight loss can and does occur by eating thesame or even greater volume of food Does not require extreme exercise to burn offcalories Avoids feelings of deprivation or starvation—ifyou are hungry just eat Focus is on the types of food rather than limitson the amount of food124

10/12/2016The progression of atherosclerosisHeart Diseasewww.nhlbi.nhi.gov13Angiograms after 32 months with a plant-based diet without cholesterol-loweringmedication, showing profound improvement. Source: Prevent and Reverse HeartDisease by Dr. Esselstyn155

10/12/201616CancerWorld Health Organization (WHO) in 20151: processed meat "carcinogenic to humans" same classification as tobacco smoke andasbestos red meat "probably carcinogenic to /pdfs/pr240 t/en/17Laboratory Animal Research – T. Colin Campbell1 Able to turn on/off cancer by varying amounts of animal protein Foci cells initially determined by carcinogen exposure but controlled bydietary protein Initiation stage of cancer less important than promotion stage1T. Colin Campbell and Thomas M. Campbell, The China Study: The Most Comprehensive Study of Nutrition Ever Conducted and18the Startling Implications for Diet, Weight Loss and Long-term Health, (Dallas: BenBella Books, Inc., 2004).6

10/12/2016Campbell: In animal subjects "nutrients from animal based foods increasedtumor development while nutrients from plant-based foods decreased tumordevelopment."19China Study (1980s) – Campbell & Chen 6,500 adult subjects across non-urban China Cancer rates varied widely among areas inChina "Animal protein intake was convincinglyassociated in the China study with theprevalence of cancer in families." U.S. had 5x breast cancer rates of rural ChinaCalories (kcal/kg)BMIProtein (g)Animal protein (% of total cal.)China study(least active)40.620640.8%U.S. average30.6259110%20Recent data – Deaths per 100,000 (WHO-2012)1Type of CancerBreastProstateNorth orld-Cancer-Report-2014217

10/12/2016Men with Early Stage Prostate Cancer1PSA (Year 1)Reduced growth of cancer cells (Year 1)Required traditional treatments (Year 2)2Plant-Based Diet-4%70%5%Control 6%9%27%1DeanOrnish et al., "Intensive Lifestyle Changes May Affect the Progression of Prostate Cancer," The Journal ofUrology 174 (September 2005).2Joanne Frattaroli et al., “Clinical Events in Prostate Cancer Lifestyle Trial: Results from Two Years of Follow-Up,”Urology 72 (December 2008).2223Study Results74 people - plant based whole foods vs ‘diabetes /PMC3427880/8

10/12/2016Whole Food Plant-Based Diet:A Disruptor of the Health Care/Health Insurance IndustryFee-for-Service:Health care providers/facilities receive payment fortheir services based on number and complexity ofprocedures performed regardless of healthoutcomesResulting in 25Non Sequitur by Wiley Miller1 Wiley - All Rights Reserved.November 19, 2014 from ur/2014/11/1926Insurers (Private Companies and Government Plans):transfer rising costs of care in the form of higher premiums andtaxesDr. Dean Ornish observed in his work1: There was no "shortage of motivated patients" that werereceptive to lifestyle changes as an alternative to drugs orsurgery "The primary limiting factor has been the lack of widespreadinsurance coverage." "No matter how good a program is clinically, if it's notreimbursable, it's not sustainable.“Resulting in 1AmyLynn Sorrel, "Medicare's new approach to familiar diseases," American Medical News, (May 14, ernment/305149956/4/.279

loads/wizard-of-id.jpg28Trends Favoring Adoption of Plant-Based Diet by Insurers/Health ProvidersHealth Care Costs as % of GDP1Canada10.4%U.S.17.1% Movement away from fee-for-service towards value-based modelsDr. Dean Ornish program approved by U.S. Medicare in 2010 as a coveredservice for beneficiaries with certain heart conditions; evidence from privateplans showed savings of about 30,000 per patient.2Kaiser Permanente—Large integrated health care company employingphysicians, owning medical facilities and providing health insurance in 2013endorsed a policy that "[p]hysicians should consider recommending a plantbased diet to all their patients, especially those with high blood pressure,diabetes, cardiovascular disease, or obesity.”3ZOOM Prime—Small Integrated Health Care Company operating inNorthwestern U.S. launched in 2015 for “people who want to prevent orreverse chronic illness such as diabetes, autoimmune disease and heartdisease using food, movement and relationships as medicine.”41 Dean Ornish, "Avoiding Revascularization with Lifestyle Changes: The Multicenter Lifestyle Demonstration Project," American Journal of Cardiology 82 (1998). Decision Memo for IntensiveCardiac Rehabilitation (ICR) Program - Dr. Ornish's Program for Reversing Heart Disease (CAG-00419N)," August 12, 2010, Centers for Medicare & Medicaid Services, http://www.cms.gov/.23 Philip J. Tuso et al., "Nutritional Update for Physicians: Plant-Based Diets," Permanente Journal 17 (Spring 2013): 61-66. "The Plant-Based Diet: A Healthier Way to Eat," Kaiser t.pdf.4 u-your-meds"29Disruption Example:#1 Reason for visiting the Doctor:Hypertension (HBP) - 36 million PCP visits annually in U.S.170% of U.S. Adults age 65 have HBP2Vegetarians 55% lower and Vegans 75% lowerrisk of HBP than non-vegetarians31http://www.cdc.gov/nchs/ahcd/web tables.htm"Table 1. Annual number and percent distribution of ambulatory care visitsby setting type according to diagnosis 0913-blood-pressure.html3Lap Tai Le and Joan Sabate, "Beyond Meatless, the Health Effects of Vegan Diets: Findings from the Adventist Cohorts,"30Nutrients 6 (2014).10

10/12/2016T. Colin Campbell1:“should not be ignoring ideas just because weperceive that the public does not want to hearthem. Consumers have the ultimate choice ofwhether to integrate our findings into theirlifestyles, but we owe it to them to give them thebest information possible with which to makethat decision and not decide for them."1T.Colin Campbell and Thomas M. Campbell, The China Study: The Most Comprehensive Study of Nutrition Ever Conducted and31the Startling Implications for Diet, Weight Loss and Long-term Health, (Dallas: BenBella Books, Inc., 2004), 287.Discussion Group Format1. Watch a video about Alzheimer’s Disease.2. Take 5 minutes alone to answer thequestions.3. Appoint a facilitator, scribe andspokesperson.4. Discuss for 15 minutes, including about 2-3minutes to summarize. You don’t need todiscuss all the questions.5. Spokesperson reports back to the main group.1 minute for each group.32Discussion Questions1. Are you surprised you have not heard this informationbefore? Do you believe this information?2. Would you have concerns about you and your familyadopting this diet?3. Are there legitimate reasons not to have physiciansand insurers recommend this approach to all theirpatients/insureds?4. Barriers for individuals/physicians adopting.5. Ways for insurance organizations to promote amonginsureds6. Do you believe this can be adopted on a widespreadbasis?3311

10/12/2016Find Plant-based Diet resources tresources.html3412

Neal Barnard, 21-Day Weight Loss Kickstart: Boost Metabolism, Lower Cholesterol and Dramatically Improve Your Health, (New York: Grand Central Life & Style, 2011), 24. 1 year No restrictions on calories For 14 weeks all met with physician/dietician PBD group -- consumed fewer calories than before study PBD group -- not aware they were eating fewer calories – greater volume