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]