Life Style The Best Medicine

 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.                              we last year spent over $11,000 per person on healthcare and now the irony of this 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 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 make up a tribe, now you may not be surprised that the 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 serve 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 outcome here in the United States are directly related to the clinical care, that were ceive so that's like the quality of the doctors, and then nurses and medical facilities we can access to 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 can cerdementia. these things can really be attributed to the cumulative effect of the lifestyle choices, that we make everyday 

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, then it might slow down this impending train wreck 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 health span 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 come 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 patient's 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 my 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 has a BMI less than 30, which means they're not classified as obese do, they smoke 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 the diet that has fruits vegetables. and whole grains with low red meat consumption,

 so I'm not talking about the vegan diet here is 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, we rewarded with a decrease in the risk of disease, any chronic disease by 80% and we're talking about anything heart disease cancer diabetes stroke all of that decreases risk by 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 points 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 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 sorts 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 sorts 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 mean that most people in at he group will follow along with what the rest of the group is doing, and if you combine that with a predominant choice the 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 theatergoers in a Chicago movie theaters that were all given free buckets of stale popcorn, those that were given large buckets of stale popcorn. actually ate 50% more popcorn then 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 to 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 a healthier happier lives, that creates longevity and being well. it turns out that there are places in a 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 placed in the world that has 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 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 the rhythm of the inhabitant's lives and what they found 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, the fabric of these community's 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 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 shown 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, is the most likely thing to kill anyone sitting in this room, there are over 600,000 deaths from cardiovascular disease every year. in this country. so that's about one person every minute we know that a 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 portion of food as a medicine approach to type 2diabetes shows similarly dramatic results, so they took a bunch of men who had type 2 diabetes that was 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 maintenance, so that mean 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 by60% 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 to know for these astonishing results to happen. do you know is  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 the choice we call our healthy neighborhood immersion strategy. and it has things including a 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, the 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 on going relationships, with frequent contact. and remove the barriers to the healthy lifestyle choices that are the a most effective way to reach that optimal. the therapeutic dose that's required for positive change, and the relationship, the 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 are 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 in the community culture that we create, and the social nudges with which we surround ourselves. we can make the Healthy Choice is the easy choice both for us and for our children so the choice is ours, and the impact will be truly extraordinary thank you