Why Lifestyle is the BEST Medicine
Our (USA) budget though larger than other developed countries, does not accord health care proportional to the money spent.
The amount of money that we (USA) spend on health care every year is almost inconceivable. We (USA) spend about $316 billion on cardiovascular related costs, and then another $327 billion on costs associated with diabetes. Last year (2019), we (USA) spent over $11,000 per person on health care. 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 (USA) 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.
Choosing the path of a healer.
Growing up, I (Meagan L. Grega) 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 catalogues, so I decided to choose medicine instead. And I thought that becoming a family doc (doctor) would be the most modern path to serving my community as a healer, but I had no idea what I was getting myself into.
Lifestyle choices: The major determinants of health outcomes.
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 the nurses and the medical facilities we can access. The remaining 80% is directly related to our own health behaviors socio-economic factors, and the impact of our physical environments. So the chronic disease epidemic that has really emerged over the last 50 years including; cardiovascular disease, diabetes, cancer, dementia etc. 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. Unfortunately, all those pills and procedures that we use to try to combat them, 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 wellbeing.
Choosing my creed: "To cure sometimes, to relieve often, but to comfort, always".
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 life span? Well, I (Meagan L. Grega) 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 distil 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.
Going to medical school.
I (Meagan L. Grega) absorbed everything that I could from the late 20th century Western medical paradigm, I memorize things about pharmacology 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 “cure sometimes, relief often, but comfort always”.
Medical paradigm I had been trained in and practiced was not working.
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 the 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. 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, etc. This was completely ineffective, 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.
I became discontented, or in medical vernacular, I reached my puke point.
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 this stubbornly rising blood pressure and blood sugar and chest pain. The pills and procedures that I had been taught were 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 wellbeing and reverse disease.
I decided to take a deep dive into medical literature in hope of finding some answers.
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 evaluated four simple lifestyle factors.
- Does a person have a BMI less than 30, which means they're not classified as obese?
- Do they smoke?
- Do they participate in at least three and a half hours a week of physical activity? That's like 30 minutes a day, and we're 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.
- Do they eat a predominantly fat diet that has fruits, vegetables, and whole grains, with low red meat consumption? I'm not talking about a vegan diet here or not even a vegetarian diet, but in unprocessed predominantly plant diet.
What they found (study mentioned above) was shocking. 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, etc. all of that decreased risk, by 80%.
What I found was like a longevity jackpot.
For me as a doctor (Meagan L. Grega) 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 30. 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 (Meagan L. Grega), 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? I found 2.7%. Yes, we have documented evidence of therapeutic lifestyle behaviors that can change the trajectory of the chronic disease epidemic in our society, and less than 3% of Americans are benefiting from those habits. Inconceivable, right? But why is that?
Lifestyle choices can be contagious.
Well if we know that lifestyle choices have such a dramatic impact on our health outcomes, why do we have such a dismally low 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. 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 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.
Eating popcorns in a movie theatre as a default option.
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. 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. For example, there were theatre goers in a Chicago movie theatre 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, caused these people to eat significantly more popcorn, even though they didn't really like it.
Blue zones: The hotspots of longevity.
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 wellbeing? 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. In the Blue Zones, people not only live uncommonly long lives, but they remain healthy and active vital members of their community, while spending very little on health care.
Lifestyle choices, the key to longevity.
When the Blue Zones were first discovered, researchers travelled 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 rhythm of the inhabitants’ lives. And what they found is that the magic bullet is not something you can turn into a supplement or 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.
Decreased risk of disease and increase in habits of wellbeing is the default in blue zones.
Social nudges and choice architecture in these Blue Zones, add up to a sort of way of feeling like the default is to have decreased risk of disease and increase habits that are going to increase wellbeing. That's their default. So what would happen if we sort of follow 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. For example, eight out of the top 10 things that kill us are actually directly impacted by our lifestyle choices.
The number one killer, heart disease, can be tackeled with dietary lifestyle therapy.
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 (USA), so that's about one person every minute. We know that healthy diet, regular physical activity, stress management, restorative sleep, social connection, avoiding tobacco, etc. 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.
Using food as a medicine approach to type two diabetes shows similarly dramatic results.
How long does it take for this transformation to occur? Three weeks. That's right. People who have been told that they were out of options. Saw significant improvement in their symptoms and in Objective measurements of blood flow in just three weeks on a dietary lifestyle therapy.
How about diabetes? Turns out that using food as a medicine approach to type two diabetes shows similarly dramatic results. So they took a bunch of men who had type two 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. That meant they weighed them every day, and if they showed signs of losing weight they made them eat even more food. What happened to them?
No need to wait for a new study, we can tackle chronic disease through lifestyle choices.
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 for these astonishing results to happen? Do you think it was 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 process.
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, and 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.
Healthy eating, the easy choice.
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 emergent strategy”. 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 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.
By leveraging relationships, we hope to reach an effective therapeutic dose of beneficial lifestyle habits.
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. 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.
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 conversations about choices. And we can all be a part of that conversation, helping each other to shift our social norms and 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 lifespan 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.