Why Lifestyle is the BEST Medicine

[Music]

so the amount of money that we spend on

health care every year is almost

inconceivable we spend about 316 billion

dollars on cardiovascular related costs

and then another 327 billion on costs

associated with diabetes last year we

spent over $11,000 per person on health

care and now the irony of this is is

that most of that money is actually

going to sick care not to things that

help us with healthy behaviors or for

wellness so what are we buying with all

of that money is it good health is it

maybe a long life expectancy do we

actually have more vitality and

resilience and endurance than citizens

of other countries that spend

significantly less than we do on health

care every year unfortunately no

actually not only no but hell no now

growing up I actually didn’t want to be

a doctor what I actually wanted to be

was a shaman more specifically what I

wanted to be was a healer

I wanted to care for the physical and

the mental and the emotional and the

spiritual health of my community while

living my life ensconced in that web of

relationships that makes up a tribe now

you may not be surprised that shaman was

not a career path that was listed in my

high school guidance counselor’s college

catalogs so I decided to choose medicine

instead and I thought that becoming a

family doc would be the most modern path

to serving my community as a healer but

I had no idea what I was getting myself

into

now it might surprise you to know that

only about 20% of the health outcomes

here in the United States are directly

related to the clinical care that we

receive so that’s like the quality of

the doctors and then

nurses and medical facilities we can

access the remaining 80% is directly

related to our own health behaviors

socioeconomic factors and the impact of

our physical environment so the chronic

disease epidemic that has really emerged

over the last 50 years including

cardiovascular disease diabetes cancer

dementia these things can really be

attributed to the cumulative effect of

our lifestyle choices that we make every

day for the most part these diseases

happen by choice not by chance and

unfortunately all those pills and

procedures that we use to try to combat

them it might slow down this impending

trainwreck of disability and disease but

it rarely is able to bring us back to a

state of resilience and well-being but

what if we could change the game what if

we could create a new paradigm something

that actually brings us both along

healthspan and a long lifespan well I

studied hard in medical school and I

learned many things I met brilliant

clinicians I devoured cutting-edge

research studies I experienced the joy

of delivering babies and I also found

that peace and solace are possible even

for those that are dying if someone has

time to sit and breathe and just be

there for the experience with them so I

found a quote during medical school that

I felt distilled this essence of being a

healer and it said to cure sometimes to

relieve often but to comfort always and

so I chose that as my Creed and I

absorbed everything that I could from

the late 20th century Western medical

paradigm my memories for me and

physiology and pathology microbiology I

learned all these evidence-based

guidelines for treating hypertension and

heart disease and high cholesterol and

diabetes I eventually became a

practicing physician with my own panel

of wonderful patients forced by the

system to spend 15 minutes or less with

each of them

but still finding my purpose and trying

to live that Creed Cheers sometimes we

leave often but comfort always but

unfortunately I began to see that the

medical paradigm that I had been trained

in and practiced was not working I cared

for many children who struggled with

obesity and had very poor cardiovascular

fitness so much so that they could not

even run one lap around a gym without

getting out of breath and I could see

that they were already well on their way

to a lifetime of chronic disease just

because of the lifestyle choices and

social norms that were surrounding them

so coming to see me once a year for

their well child check and being told

drink less sweetened beverages eat more

fruits and vegetables participate in

active play for 60 minutes a day

oh this was completely ineffective I

mean especially compared to the tsunami

of competing messages that they were

exposed to every day in our society

asking them and urging them to eat more

sugary sweet salty foods to exercise

less and to consume as much digital

entertainment as possible I kind of felt

like I was trying to prevent an

avalanche from like burying them by

flicking cotton balls at it which is

basically an exercise in futility and

how about their parents well following

evidence-based guidelines on how to

treat my patients hypertension and

diabetes and heart disease did not

reverse these problems I frequently

found that I needed to either increase

their medications or maybe even add

additional new pills to try to combat

the stubbornly rising blood pressure and

blood sugar and chest pain the pills and

procedures that I had been taught we’re

the gold standard for maintaining and

improving health had failed so I became

discontented actually in the medical

vernacular I reached my puke point so I

felt like there had to be a better way

to nurture well-being and reverse

disease and being a science geek I

decided to take a deep dive into the

medical literature and hope that I could

find some answers there

so one of the most inspiring and

impactful studies that I have ever read

was done back in 2009 and it evaluated

four simple lifestyle factors one does a

person have a BMI less than 30 which

means they’re not classified as obese do

do they smoke three do they participate

in at least three and a half hours a

week of physical activity so that’s like

thirty minutes a day and we are not

talking about running marathons here

this is just getting your body moving

enough to get your heart rate up into

that light to moderate activity zone and

then four do they eat a predominantly

diet that has fruits vegetables and

whole grains with low red meat

consumption so I’m not talking about a

vegan diet here are not even a

vegetarian diet but an unprocessed

predominantly plant diet and what they

found was shocking so for the people

that actually could follow all four of

those lifestyle factors they were

rewarded with a decrease of risk of

disease any chronic disease by 80% and

we’re talking about anything heart

disease cancer diabetes stroke all of

that decrease risk 80% I mean for me as

a doctor that is mind blowing if we had

something like a pill that had that type

of efficacy I’d be prescribing it for

all of you guys by the time you were

thirty we have nothing in our

pharmaceutical or in our surgical

armamentarium that comes close to

decreasing the risk of chronic disease

by 80% so for me this was like finding

out that there is a longevity jackpot

out there with all of our names on it I

mean this is great news

so I quickly looked up how many

Americans can actually hit all four of

those lifestyle factors and I found you

guys ready for it two point seven

percent yes so we have documented

evidence of therapeutic lifestyle

behaviors that can change the trajectory

of the chronic disease epidemic in our

society and less than three percent of

Americans are benefiting from those

habits

inconceivable right I mean but why why

is that well if we know that lifestyle

choices have such a dramatic impact on

our health outcomes why do we have such

a dismal eloah percentage of people

actively engaged in those health habits

well it turns out that lifestyle choices

are contagious in a very similar way to

a virus so we are likely to pursue the

same types of habits and activities that

those who are around us are also engaged

in so for example if you hang out with

people that like to go for hikes on the

weekend and maybe they share plant-based

potlucks you are likely to be doing

those sort of activities too conversely

if you hang out with people that are

spending a whole lot of time in front of

screens and they’re having a lot of sort

of junky convenience food and sugary

snacks and maybe not prioritizing sleep

you are less likely to be focused on

exercise healthy food and sleep in your

life as well this is the power of social

nudges which means that most people in a

group will follow along with what the

rest of the group is doing and if you

combine that with a predominant choice

architecture of our environment you have

a one-two punch that really affects the

choices that are made so choice

architecture actually is more about what

is the default option in any particular

situation and it can have a huge impact

on the outcome of that situation so for

example there were theater goers in a

Chicago movie theater that were all

given free buckets of stale popcorn

those that were given large buckets of

stale popcorn actually ate 50% more

popcorn

than those who were given medium buckets

even though both groups said it did not

taste good so just having a large bucket

in front of you while you’re watching a

movie cause these people they eat

significantly more popcorn even though

they didn’t really like it unfortunately

having more of anything in front of us

makes us more likely to eat a lot of

that thing so how can we think about

crafting our community choice

architecture and our social nudges to be

able to create the healthier happier

lives

that create longevity and well-being

well it turns out that there are places

in the world where such social nudges

and choice architecture add up to a

phenomenon called the Blue Zones

so in the Blue Zones these are hotspots

of longevity they are places in the

world that have the highest percentage

of centenarians on the planet now in the

Blue Zones people not only live

uncommonly long lives but they remain

healthy and active and vital members of

their community while spending very

little on health care so when the Blue

Zones were first discovered

researchers traveled to those areas to

try to find out like what is going on

they were really kind of looking for

this Fountain of Youth you know

hopefully something that they could

replicate in other parts of the world so

they studied the people the food the

water sources and the kind of cultural

rhythm of the inhabitants lives and what

they found is that the magic bullet is

not something you can turn into a

supplement or to a pharmaceutical it

turns out it’s all about the lifestyle

choices that are part of the social

fabric of these communities lives and

these habits can be distilled down to

the way they move what they eat how they

handle stress and whether or not they

feel a sense of belonging or purpose so

social nudges and choice architecture in

these blue zones add up to a sort of way

of feeling like that the default is to

have decreased risk of disease and

increase habits that are going to

increase well-being that’s their default

so what would happen if we sort of

followed this lifestyle prescription

here in America could we become a blue

zone well luckily we have some really

amazing lifestyle medicine pioneers who

have showed us what is possible if we

choose to change our habits so for

example eight out of the top ten things

that kill us are actually directly

impacted by our lifestyle choices so

let’s talk about our number one killer

which is heart disease heart disease is

the most likely thing to kill anyone

sitting in this

room there’s over 600,000 deaths from

cardiovascular disease every year in

this country so that’s about one person

every minute we know that healthy diet

regular physical activity stress

management restorative sleep social

connection avoiding tobacco like all of

those things are really powerful

preventive strategies but what about if

you already have heart disease well it

turns out that patients who have severe

heart disease who have been put on a

low-fat whole food plant-based diet can

show increases in their blood flow that

makes their symptoms disappear how long

does it take for this transformation to

occur three weeks that’s right people

who had been told that they were out of

options so I had significant improvement

in their symptoms and in objective

measurements of blood flow in just three

weeks on a dietary lifestyle therapy so

how about diabetes turns out that using

as a food as medicine approach to type 2

diabetes shows similarly dramatic

results so they took a bunch of men who

had type 2 diabetes that were requiring

daily insulin injections and they

admitted them to the hospital they put

them on a low-fat whole food plant-based

diet and they fed them this diet so that

it was weight maintaining so that meant

they weighed them every day and if they

showed signs of losing weight they made

them eat even more food so what happened

to him turns out that the insulin

requirements of the group decreased by

60% and over half of the men were able

to stop their insulin injections

entirely their blood sugar normalized

despite losing no weight and having had

diabetes for years so how long did it

take you know for these astonishing

results to happen do you know is months

16 days it took only 16 days of having a

whole food plant-based diet for their

bodies to start to transform and to

begin that healing progress the process

so the good news is our community

doesn’t need

to wait for a new study or a new pill we

can start tackling our chronic epidemic

of chronic disease right now with tools

that we already know to be effective

food physical activity social connection

stress reduction restorative sleep we

can create our neighborhoods our schools

and our workplaces to nudge us into the

type of choices that will nourish us

instead of causing us damage I am the

co-founder of a foundation whose mission

is to make the Healthy Choice the easy

choice we call it our healthy

neighborhood immersion strategy and it

has things including healthy lifestyle

programs and garden as a classroom in

the schools

it also has hands-on plant-based cooking

classes and community settings helping

families to experience trying new

ingredients and the foods that will most

nourish their health we also have

improved access to the nutrient-dense

Pro produce that we all need through the

eat real food mobile market and our

local corner stores which also supports

local farmers and we also have intensive

therapeutic lifestyle change

interventions that support and encourage

patients to make those new habits that

will lead to better health so by

leveraging strong relationships in the

community to encourage change towards

healthier social nudges and choice

architecture we hope to see a shift

towards these beneficial lifestyle

habits that will reach what we call an

effective therapeutic dose so in the

same way that if you give somebody a

medication at too low of a dose to cure

if you’re just giving education and

advice and it’s only intermittent that’s

insufficient you need to nurture these

ongoing relationships with frequent

contact and removing the barriers to the

healthy lifestyle choices that is the

most effective way to reach that optimal

therapeutic dose that’s required for

positive change and the relationship

aspect of lifestyle change is crucial

becoming a part of the fabric of a

neighborhood or a family that’s what

builds trust and then trust opens the

door for conversation

about choices and we can all be a part

of that conversation helping each other

to shift our social norms in our

environment so we have the best choices

to achieve our long-term health the

power to achieve a long health span and

a long life span that is full of

vitality and purpose is really within

our own hands we don’t need to wait for

a new wonder drug or some sort of

high-tech medical procedure the power is

in the relationships that we nurture the

food that we eat the way that we move

and sleep the community culture that we

create and the social nudges with which

we surround ourselves we can make the

Healthy Choice the easy choice both for

us and for our children so the choice is

ours and the impact will be truly

extraordinary thank you

[Applause]