I have a carrot and a stent you pick

a hundred years ago

an average american died at the age of

during those days

not only were the life short but the

quality of life also went down very

rapidly

because they did not have access to all

the things that we take for granted in

today’s world

simple things like access to clean

drinking water

access to universal vaccination access

to a primary care doctor

over the past hundred years however we

have made enormous progress

an average person in 21st century

america as of last year or this year

is dying around 78 if you’re a male 82

or 83 if you’re a female so we are

living much much much longer compared to

literally two or three generations ago

however unfortunately while living

longer we are actually dying longer

because of enormous disease burden

imposed by very common chronic

preventable diseases

so what do i actually mean by dying

longer

right yes i am alive but i am unable to

get up and go for a walk with my dog

because i just got an amputation because

of diabetes which is preventable

i’m not even able to sleep properly

because of severe diabetic neuropathy

related pain

right i’m not able to go on a cruise

vacation because i’m hooked up to a

dialysis machine

so if you add all these things all this

burden that’s imposed by common chronic

preventable diseases while living longer

an average person in this country is

losing almost close to quarter of a

century of his or her life due to lack

of quality

that’s what i mean by dying longer

so how do i come into this picture

because i am an interventional

cardiologist i am not a preventive

public health official

right my entire training my entire

career my entire current day’s practice

is spent in the deep dungeons of a lead

shielded cardiac cath lab

so how did it come to be for me

personally to step outside the confines

of a cardiac cath lab and come in front

stage with my colleagues my family my

friends and now with the society at

large to make a humble play

to take prevention

and health promotion and health

maintenance into our hands

and this is where i would like to ask a

very simple question

what does health mean to all of us

and for discussions such as this

the very word healthy can be broken

apart into heal

thyself

meaning that majority of staying healthy

is in our hands

through practicing the pillars of

lifestyle medicine

however the words written in chicago

tribune in 1975

ring true today and that hurts me and

those words are the idea of preventive

medicine

or idea of prevention is faintly

unamerican

it begins with the idea of accepting

that the enemy is us

very powerful words but when i see these

words that the enemy is us i’m not

saying those words with the intent of

shifting the blame onto the society or

on to my patients but to discuss the

importance of personal responsibility

because so much of staying healthy is in

our hands

but as professionals and as society

collectively we have neglected these

simple pillars

and as a consequence we are paying a

dear price in the loss of quality of

life and suffering and dying due to

diseases that should not exist in 21st

century america

and

the next question i want to ask is

why do we actually want to be healthy

right and no matter how descriptive how

emotional and how detailed our answers

are

all of those answers will fall into only

two broad categories and those are the

only two reasons why we all want to be

healthy

and those two reasons are we want to be

healthy because we want to live a long

life and a life full of quality and if

you really think about it there’s no

third reason

yeah we may come across with the deep

emotions and deep values as to why and

how we connect with those two entities

but there’s really no third entity and

also i’m showing them as two separate

entities as we all know the quality of

life and the quantity of life are

inseparable like the two sides of a coin

and now

in 21st century america or for the most

part of the world we have the luxury

of not dying from infections and famine

two things lack of food and infection

were the leading causes of death across

recorded human history except for very

recent times so is it unreasonable for

someone like myself to ask or make a

humble play

can we take control of things that we

can and live

a happy

long and a healthy life

so again

we have ignored these very simple

pillars and how are we paying a price in

addition to the lack of quality of life

we have also paid a price in creating

this system that unfortunately we call

the health care system which is actually

a disease management system which is

standing upside down as a pyramid

where the entire emphasis at the very

highest level at the very expensive

level

is investing money in disease management

with very little on prevention

so the way i feel this and the way i see

this that every single one of us because

it takes five to make a fist

it also takes a drop and a drop and a

drop to make an ocean

so the onus is on all of us every single

one of us not just doctors not just

nurses because we are all part of a

single same society the onus is on all

of us to lend a forceful and a powerful

hand to flip this pyramid

of healthcare system back on its base

where the maintenance of health is the

primary focus

yes they’re always going to be people

people like myself and to be honest with

you i should not be the one putting out

this message

right i’m an interventional cardiologist

i should be the one waiting in a cardiac

cath lab to save your life when

everything else fails

but guess what folks we are failing

everything else and that’s why a guy

like me is stepping outside the

conference of the cardiac cath lab and

asking people don’t meet me there

so when i ask you and when i challenge

you to lend me and lend yourself most

importantly a forceful hand to flip the

pyramid back on its base what are the

tools that we can equip you with an

ordinary non-medical person in the

society and those are what we call the

pillars of lifestyle medicine

and these are very simple pillars except

for having to pay a little for our food

if you really look at it from a practice

and a practicality point of view all of

them are free

right the pillar number one i would like

to talk today about is social support

because if i’m going to step into your

life and your health and ask you or

challenge you to change 10 15 20

different things or to be very practical

six different things about your life

guess what folks i’ll give you an

example

right i work with a lot of vietnam era

veterans or veterans of many generations

and

it’s difficult right it’s easy for me to

come across and say hey do this this

this and differently but the first thing

that we need is social support and the

reason i think that social support or

the lack of it is now becoming a huge

burden is even long before covet we as a

society have

been rapidly becoming fragment

fragmented and disconnected

and it turns out after age 65 if you

self-report a life lived in isolation

the risk imposed by that is almost

identical to that of an individual

smoking 15 cigarettes

that’s the influence that’s a negative

influence of living in isolation so

first thing that we need to do is come

together as families come together as

professionals come together as small

towns large towns prioritize staying

healthy

and demand that of our ourselves and our

policy makers

and the second most important thing is

mindfulness be acutely aware of why

health matters to us because when i ask

that question why do you want to be

healthy you will come up with an answer

and that’s what i want you to be mindful

of about every decision that you make

throughout the day that i want to be

healthy because i want to see my child

graduate i want to see my granddaughter

walk down the aisle i don’t want to end

up with a heart attack or a stroke or

two

make those

answers count on a daily basis so that’s

the concept of mindfulness and stress

reduction

right it’s easy for me to stand here and

say hey reduce your stress it is

multifactorial stress comments comes to

us in many many different ways but

they’re a lot of help

especially now in the digital world

there are so many apps and so many help

you know within the realm of your health

care professional and also within the

realm of your own family support

so stress reduction and mindfulness are

extremely important

third one but seldom talked

is sleep

we cannot negotiate with sleep sleep is

an evolutionary must

right it’s negotiating with sleep is

like negotiated with time

once gone it’s gone so please prioritize

sleep there are many many resources

outside

right sleep is extent one of the central

pillars of lifestyle medicine

the next one i want to talk about is

regular physical activity

right

compared to a generation or two ago on

an average we as a country are

definitely moving more

but there is so much more to do

because there is such a huge gap in

terms of what the society is doing in

terms of physical activity

so

whatever you can move keep it moving

because the body in motion stays in

motion

right i literally tell my patients who

are even on a wheelchair are not able to

move if all that you can move is your

hands up and down few times a day please

do that

right if you don’t have time to go to

the gym park your car a little farther

out from from your office and take extra

few steps

right all of these things count

right and the next one is nutrition

right and this is where everybody wants

to argue about it but the science

is again the nutrition science is

complicated but agreement is is is is

universal

in the sense that almost all medical

organizations on the planet have a

singular message

eat more unprocessed plant-based food

eat more vegetables eat more lentils eat

more whole grains eat more beans eat

more fruits and drink more water

and you will be shocked if i told you as

of 2021

if we go out and look at the healthy

diet indexed

amongst american youth ages 12 to 19 the

signal is statistically undetectable the

percentage is listed as a zero

i can’t make this up even if i try these

are the 2021 statistics for healthy diet

amongst american youth ages 12 to 19 and

that’s where we are

completely losing focus because

prevention starts early and people ask

me what’s a good time to start it is

never too late

as early as possible and maintain it for

as long as possible and i often say when

i give these talks is prevention starts

from

womb to tomb or another way of saying is

from lust to dust it’s never too early

it’s never too late

and the next pillar of lifestyle

medicine is avoiding toxic substances

right

tobacco uh surprisingly up to 10 to 15

of american youth are still using some

form of a tobacco

and we are going to continue to pay the

price for it

and same thing with alcohol right if you

want to drink alcohol find many many

reasons other reasons than health don’t

drink alcohol thinking that it’s good

for you because i know people who drink

alcohol thinking that it’s good for them

right even the modest amount of alcohol

consumption has been shown to increase

many cardiovascular risks and event

rates

so once we take control of these very

simple things on a daily basis yes it’s

hard

i’m not saying it’s easy but it’s hard

as long as but we are mindful we chip at

it one little step at a time one lip

list at a time just imagine this way in

terms of behavior modification

right if i were to say you know what i

or myself or somebody is on the top of

being healthy but we want all of you to

meet us up there

but i’ll do you a favor i’ll throw you a

ladder

of course i’m going to throw you two

ladders

one with steps three feet apart one with

steps 10 feet apart

which one any one of us would pick the

one with baby steps

that’s all i am asking as an

interventional cardiologist take those

baby steps on a daily basis so you don’t

have to step into my cardiac cath lab

my message america is that i have a

two-pronged approach

one is i have a carrot and a stent you

pick

another way of saying my message is that

there are two places that you can meet

me at

kitchen table or a cardiac cath table

you pick

please don’t meet me in the cardiac cath

table

i’m begging you i’m imploring america

stay away from my cardiac cath lab

that’s my message and most of it

most of it can be done by practicing the

simple six pillars of healthy living and

lifestyle medicine

so i wish you all nothing but the best

of health best of joy and best of luck

in health

let there be health

thank you

you