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Vital Gathering IV – Oct 4‐6, 201910/2/2019Grazing Iffasting is our best way to heal, how is eating everytwo hours not considered the worst way to eat? Poor blood sugar control (adrenals, liver, pancreas) Migrating motor complex and SIBO risk Endless digestive energy vs. energy spent elsewherein the body Life is tied to eating Low protein intake Poor appetite control Sweet/CHO cravingMona Morstein, ND 201943Organic Vs. Conventional Organic:more nutrients, less chemicals, supportinghealthier earth Con: may be more expensiveEWG card Conventional: IfCheaperAffordable and available—buy organicMona Morstein, ND 201944Fast/Junk Foods Agri‐industrymeat: proinflammatory, low nutrients,higher calories, saturated fat, no EFA Added hormones and pesticides Inhumane High salt Refined flour, refined sugar GMO Lack EFA Trans fat (fries and fried foods) High calories Food additives, preservatives, colorings, flavorings .Mona Morstein, ND 201945Morstein15

Vital Gathering IV – Oct 4‐6, 201910/2/2019Eating Out Difficultto control ingredients, calories, quality offood. More refined, agri‐industry foods Suggest:Simple mealsThink outside the typical American box for meals Give healthier restaurants Money saving Mona Morstein, ND 201946DIET DIARY AND CONDITIONS:KNOW YOUR PATHOPHYSIOLOGY Howcan white sugar aggravate a woman’s PMS?can low EFA intake affect a man withhypertension? How can eating a lot of Agri‐industry meat aggravateosteoarthritis? HowMona Morstein, ND 201947WHITE SUGAR AND PMS1. Liver Detoxification of Estrogens2. Proinflammatory cramps3. Dysbiosis—candida4. Associated with depression and anxiety5. Reduce nutrients6. Reactive hypoglycemia7. Loss of appetite controlMona Morstein, ND 201948Morstein16

Vital Gathering IV – Oct 4‐6, 201910/2/2019LOW EFAS AND HYPERTENSIONLower blood pressureReduce TG’s3. Decrease plaque development4. Decrease arrhythmias5. Anti‐inflammatory6. Reduces risk of CVD7. Reduce insulin resistance/metabolic syndrome8. Reduce Depression/Anxiety eating poorly1.2.Mona Morstein, ND 201949AGRI‐INDUSTRY MEAT ANDOSTEOARTHRITISHigh proinflammatory fatLess Omega‐33. Acidic diet4. Increase Toxins: GMOs, Hormones, Antibiotics.1.2.Mona Morstein, ND 201950CONDITIONS AND PHYSIOLOGY Howdoes low veggie intake increase risk of skincancers? How does having a fruit smoothie in themorning with banana, berries, and somesweetened soy milk weaken adrenals? How does eating fewer fruits and vegetablesincrease risk for dementia? How does a Snickers bar aggravate diverticulitis? How can eating white rice cause “brain fog”?Mona Morstein, ND 201951Morstein17

Vital Gathering IV – Oct 4‐6, 201910/2/2019DIET DIARY AND CONDITIONS Howdoes drinking pop increase risk of osteoporosis?can grazing work against having good bowelmovements? How does eating a Pop Tart for breakfast increase a child’sADD/ADHD? How does eating high refined carbs worsen subclinicalhypothyroidism? How can drinking beer, coffee and processed foods,increase risk for hemorrhoids? Why is fiber good for a patient who has estrogendominance? Why are eating oils helpful to increase our antioxidantstatus?Mona Morstein, ND 2019 How52#1 Key Need ForNutritionally Based Physician KNOWwhat is in a great deal of common foodspatients eat Read labels of common foods in the supermarket Getgood info from Diet Diarywhat nutrients associated with that condition. Know how nutrition can help/hurt that condition. Have computer handy KNOW Your prediabetic patient eats Omega 3 our‐fats/interesterificationMona Morstein, ND 201953#1 Key Need ForNutritionally Based PhysicianIngredients:MADE FROM PEANUT BUTTER (ROASTED PEANUTS,SUGAR, CONTAINS 2% OR LESS OF: MOLASSES, FULLYHYDROGENATED VEGETABLE OILS [RAPESEED AND SOYBEAN],MONO AND DIGLYCERIDES, SALT), ANCHOVY* AND SARDINEOIL*, TILAPIA GELATIN, TOCOPHEROLS AND CITRIC ACID(ANTIOXIDANTS). *A TASTELESS, ODORLESS SOURCE OFOMEGA‐3 DHA ANDProduct Claim Information:Excellent Source of Omega‐3 EPAand DHA ‐ Contains 32mg of EPA and DHA combined perserving, which is 20% of the 160mg Daily Value for acombination of EPA and /interesterificationMona Morstein, ND 201954Morstein18

Vital Gathering IV – Oct 4‐6, 201910/2/2019EXPANDING THE DIET DIARY Breakfast: Oatmeal, coffee with sugar and cream, appleLunch: Turkey sandwich with popSupper: Salmon, rice, saladBreakfast: Oatmeal, coffee with sugar and cream, apple What type of and how much oatmeal—instant flavored or just plainoatmeal? Coffee—decaf, fully caffeinated? What kind of cream—real cream, coconut cream, Coffeemate?Lunch: Turkey sandwich with pop What type of pop—diet or regular? Caffeine? What type of bread? Any mayo or other condiments? Turkey—name of processed, cooked, how much? Any vegetable(s) on the sandwich?Mona Morstein, ND 201955EXPANDING THE DIET DIARYSupper: Salmon, rice, salad What type of salmon and ounces? White, brown, wild rice, and amount? What was in the salad—type of lettuce, veggies,dressing?What did you drink the rest of the day?Mona Morstein, ND 201956DIVERTICULITIS 65 Y/O MALE:Dairy AllergyMona Morstein, ND 201957Morstein19

Vital Gathering IV – Oct 4‐6, 201910/2/2019DIET DIARY EXAMPLE 1 60year old female has Osteoporosiswould be problematic in her diet? What would be helpful in her diet? WhatProblematic:White sugar in any formWhite flourAcidic foods: pop, coffeeExcess caloriesHigh saturated fat—low EFAFood sensitivitiesHelpful:EFA: fatty fish, green leafies, good oilsin home, walnuts, eggsGood fiberMore plant based proteinsGF/GF Organic meatsProper portionsMona Morstein, ND 201958DIET DIARY EXAMPLE #2 33year old male has IBS (SIBO negative)would be problematic things in his diet? What would be helpful things in his diet? WhatProblematic:White flourWhite sugarLack of produceFried/Processed/fast foodsLiver irritants: coffee, pop,alcoholRushed eatingOver‐eatingHelpful:High fiber: beans, veggies, wholegrainsNo SAD type processed foods withcolors/flavorings/etc.No GMOsNo over‐eatingRemove food sensitivitiesMona Morstein, ND 201959KEY NEED FOR PHYSICIANS #2 Handouts: EXTREMELY USEFULGathering data:Diet DiaryGlucograph Candida Questionnaire Giving DataFood Allergy Handouts—Dairy, Egg, Gluten, Wheat, Soy, Corn General Diet Plan: Can be adapted for many conditions Insulin Resistance Diet Plan Diabetic Diet Plan Special Carbohydrate Diet/SIBO Candida Diet Mona Morstein, ND 201960Morstein20

Vital Gathering IV – Oct 4‐6, 201910/2/2019VALUE OF HANDOUTS Docere Professional Expertise EducationOf PatientOf Treatment Compliance Take home information Ever changing—continue to improve them OrganizationMona Morstein, ND 201961KEY POINTS TO USING HANDOUTSDO NOT READ OFF HANDOUT—know the form well so you candiscuss it regarding patient’s illness and diet diary.High lighter on important points to patient Use high‐lighter Constantly relate handout to patients condition Ask patient to let you do handout section before askingquestions—most of questions will be answered. Keep patient as equal—let them choose what they cancommit to do BUT only if will be helpful. Remember the Vis—everything doesn’t have to happen THISvisit. Update the handout—they can always be better. Mona Morstein, ND 201962KEY POINTS TO USING HANDOUTS Yes,it’s repetitive—all jobs have repetition: it’snew to each patient. Allergen handouts—5 minutes Diet handout—30‐40 minutesMona Morstein, ND 201963Morstein21

Vital Gathering IV – Oct 4‐6, 201910/2/2019FOLLOW‐UP Emaildiet diary to patient to have on filepatients to always do diet diary for 3 days beforefollow‐up office visits Ask Alarm on phoneAlarm on computer Haveoffice person call patients and mention bringingin diet diary. Patients get trained! Compliment and praise patient for positive steps Motivational interview for problem areasMona Morstein, ND 201964Individual Analyzations:A BAKED POTATO Your patient has Type 2 diabetes and is on Metformin. A1C of 7.0.He is 40 pounds overweight. Should he have a baked potato withdinner? Your patient is a 30 year old female asthmatic on daily inhalers.You found she is allergic to dairy and are now going over her dietdiary. Is it okay for her to have eaten a baked potato with dinner? Your 26 year old lean, athletic patient has psoriasis and is allergic toeggs and corn. She is willing to remove those. She likes eatinghealthy, baked potato chips from s/bops‐sea‐salt/Can she still eat them 1‐2 times a week?Mona Morstein, ND 201965ANALYZING: A CUP OF COFFEE Your 40 year old patient with eczema is tidying up his dietand removing his egg allergy; his lesions are clearing nicely.He still wants a cup of coffee in the morning as he loves thetaste. Do you let him keep drinking the coffee? Your 30 year old male patient takes Benadryl every night tofall asleep. He only has one cup of coffee around 6 am everymorning and then is caffeine free the rest of the day. Shouldhe keep drinking his coffee? Your 55 year old female patient has osteoporosis, anddoesn’t want to end up with a broken hip like her mom had.She is changing her diet, exercising, and taking hersupplements. Do you want her to have two cups of decaf aday?Mona Morstein, ND 201966Morstein22

Vital Gathering IV – Oct 4‐6, 201910/2/2019ANALYZING: CORN CHIPS Yourpatient is a lean 40 year old male with IBSand many food allergies, although corn is not oneof them. He loves Mexican food and makingfajitas, which he eats with Tostito corn chips. Canhe eat them? Yourpatient is a slightly obese woman, BMI 31,who is trying to avoid becoming a diabetic patientlike her mother. Can she snack on organic cornchips?Mona Morstein, ND 201967ANALYZING: A PIECE OF CHOCOLATE Your patient has gotten her diet on track from having reactivehypoglycemia. One day a week she allows herself to havesomething sweet. That day how would it be okay for her to havesome chocolate without a reaction? Your lean, athletic patient has a soy allergy which causeseczema. Is it okay for him to grab a Snickers bar for a quickburst of energy when hiking? Your patient has migraines. It’s Valentine’s Day and her partnerhas given her a box of chocolates. What’s your opinion on hereating them? Your lean marathoner, with some depression, has 1 bite of 83%dark chocolate once a day. Is that okay?Mona Morstein, ND 201968ANALYZING: A GLASS OF WINE Your patient with hypertension has had a terrible, intenseweek at work, and has a teenage child also acting out. Fridaynight she wants to drink 1‐2 glasses of red wine. Is that okay? Your patient is overweight and has pre‐diabetes. Her ferritinand ALT was elevated on labwork and you did an abdominalultrasound and found she has NAFLD. Can she continue herone glass of red wine with dinner? Your patient is getting over an ulcer. She just finished thetriple therapy to kill her h.pylori, and is taking yoursupplements. Can she have just 1 glass of red wine 2‐3 timesa week?Mona Morstein, ND 201969Morstein23

Vital Gathering IV – Oct 4‐6, 201910/2/2019DIET DIARY #3:LOW IMMUNE SYSTEM and WHEAT ALLERGEN 24year old woman gets sick all the timeFiber One Chocolate Peanut Butter Bar,and Starbucks Caramel Latte Lunch: Dannon Strawberry Yoghurt, Triscuits withDiet Coke Snack: Some random muffin in office lunch room Supper: Sushi and Saki Breakfast:Mona Morstein, ND 201970DIET DIARY #3:LOW IMMUNE SYSTEM and WHEAT ALLERGENChange to:Quick smoothie for breakfastor wheat free toast andtopping or hard‐boiledegg/fruitRawma or Lara Bar—makeown trail mixQuick home‐made sandwichFruit for snackDiscuss beverages (water!):Non‐sweetened coffeeWhole grainsProblematic:Refined Sugar: Fiber One,Caramel Latte, Muffin,sweetened sushi riceGMO: Fiber OneLow Vit D foodsLow ProduceLow fiber foodsWheat: Muffin, TriscutsMona Morstein, ND 201971PATIENT WITH OSTEOARTHRITIS &GLUTEN ALLERGY: BREAKFASTBreakfast: Oatmeal with brown sugar, coffee with sugar andcream, orange juiceWhat type of and how much oatmeal—instant flavored or just plain oatmeal?INSTANT SWEETENEDFLAVORED OATMEALCoffee—decaf, fully caffeinated?FULLY CAFFEINATEDWhat kind of cream—real cream,coconut cream, Coffeemate?FRENCH VANILLACOFFEEMATEGluten: OatmealOsteoarthritis:1. Brown sugar2. weetened instant oatmeal3. Coffeemate4. Coffee—loss of boneMona Morstein, ND 201972Morstein24

Vital Gathering IV – Oct 4‐6, 201910/2/2019PATIENT WITH OSTEOARTHRITIS ANDGLUTEN ALLERGY Shopat Whole Foods, Trader Joe’s, Sprouts, Frye’s.Handout—what grains to eat/avoid Gluten Breakfast alternatives: rice/quinoa cereal, plain GF oatmeal (Bob’s RedMill)Draw for Celiac Disease GeneralDiet Handout—how to stop inflammation,bone loss, pain/stiffness of O/A Add fruit instead of brown sugarUse regular cream, unsweetened coconut creamChange fruit juice and coffee: herbal tea, veggie juice, unsweeteneddairy alternative, coffee substitutes (Pero, Roma, Cafix)Discuss rest of GDP for omega‐3, less meat, etc.Mona Morstein, ND 201973Patient with Psoriasis Allergic To Soy Lunch: Turkey sandwich with pop Diet PepsiSara Lee Whole Wheat BreadHellman’s MayoBoarshead Turkey breastIceberg lettuce and tomato slicesCookieAnalysis: Soy: Sara Lee Bread, Hellman’s mayo, supermarket cookie Inflammation: Cookie, Pop Liver irritant: Cookie, PopMona Morstein, ND 2019 Low antioxidants74Patient with Psoriasis Allergic To SoyANALYSISAllergy:Soy free handout: Soy free mayo (Olive oils, Safflower oil,Veganaise), Soy Free whole grain bread.General Diet Handout:Increase EFA: whole greens on sandwich (Kale—O‐3 and liverdetox help)Remove inflammation/liver irritants (no pop/cookie): water,herbal tea, veggie juice, fruit for dessertIncrease antioxidants: tomatoes, onions, sprouts on sandwich;fruit for dessertMona Morstein, ND 201975Morstein25

Vital Gathering IV – Oct 4‐6, 201910/2/2019DIET DIARY SUMMARYExcellent way to get dietary informationFocus of Nutritional Based Practice Examine based on patient, condition, pathophysiology Educate patient with handouts (Remove/Replace) Have patient agree to protocol If too much, reduce: If they are allergic to dairy, gluten, soy andcorn and cannot remove all of them, choose the 1‐2 which arehighest on diet diaryIf diet is terrible, perhaps just ask patient to reduce sugar intaketo two days a week and add one salad a day.Follow‐up with diet diaryAlways praise and be supportive!Mona Morstein, ND 201976Morstein26

Vital Gathering IV -Oct 4‐6, 2019 10/2/2019 Morstein 7 DON'T WORK BLINDLY: Please Do Not . Give nutritional advice without Diet Diary These foods are bad and don't eat (patient—I don't eat those) (patient—I do eat those, but what else can I eat) (patient—partially hydrogenated what? .