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