Original subtitles

[AMBULANCE SIREN WAILING]

SARAY STANCIC: A code blue is a medical emergency.

It's used in hospitals and institutions

to alert when a patient is in cardiopulmonary arrest.

A team of healthcare professionals

rushes to the patient's location

to administer resuscitative efforts

to revive them.

Today in many ways, it's our society and healthcare industries

that need to be brought back to life.

They need to be ushered into a new era of awareness,

one that prioritizes prevention and healthcare

over sick care.

Until then we're living a societal code blue epidemic.

Health care costs in this country $2.9 trillion per year,

and here's the scariest thing,

chronic illness accounts for 86 percent of that money.

Fifty percent of Americans live with at least one chronic disease.

Fifty percent.

Two thirds of Americans are obese or overweight.

Obesity is fueling chronic illness.

I'm talking about diabetes,

cardiovascular disease, heart attacks,

stroke, Alzheimer's disease.

We're really facing an epidemic,

really a crisis when it comes to a chronic disease.

Thirty percent of American adults

have either type 2 diabetes or pre-diabetes.

Autoimmune disease rates are skyrocketing.

Heart disease is the No. 1 cause of death.

What we're doing now

is largely treating symptoms of this epidemic.

Rarely are we getting to the root cause of illness.

STEVEN ADELMAN: I think the big problem in health care,

we don't think about behavior change at the right time.

We think about it when it's too late.

What if we spent as much time and energy

thinking about what makes people healthy

as we do thinking about illness?

We are struggling as a field.

We all drank medical Kool-Aid.

Consumers have, doctors have.

You have a symptom, you take a drug.

MICHELLE MCMACKEN: What I really think we need

is a complete paradigm shift.

Well, lifestyle medicine is, I think,

the most exciting trend in medicine today.

ANA NEGRON: Seventy to eighty percent of our chronic illnesses

really can be arrested and reversed.

Change our diets, change our approach, start exercising.

Every student that comes across lifestyle medicine,

they get so motivated. They're like, "This is what I want to do."

MAN 2: These simple changes can make such a powerful difference.

NEAL BARNARD: I'm hearing from a lot more medical students who say,

"We want to learn about this."

CALDWELL ESSELSTYN: Medicine is at the cusp

of what is truly a seismic revolution in health.

Imagine if the news were to break tomorrow.

There's a new drug available, just approved by the FDA.

It's available in bountiful supply.

It is shockingly inexpensive,

stunningly free of side effects,

safe enough for children and octogenarians alike.

And taken once daily for the rest of your life

will reduce your risk of ever getting

any major chronic disease by 80 percent.

Who would not want a prescription for this drug?

Lifestyle is exactly that medicine

and all too few are taking it.

[DRAMATIC MUSIC PLAYING]

[HEART RATE MONITOR FLATLINING]

[HEART RATE MONITOR BEEPING]

PILOT: [OVER PA SYSTEM] Make sure prior weather shift distance is appreciated.

Flight attendants at this time, prepare the cabin for landing.

-[PA SYSTEM BEEPS] -Now is a good time

to power down your larger electronic devices.

We will ask you to put away your devices in a few moments.

Small, handheld electronic devices may be used in airplane mode.

[SERENE MUSIC PLAYING]

STANCIC: I'm sort of at this stage in my life

that I don't feel like I have to prove anything

to myself or to anyone else.

I just do this because I love it,

and I think it's amazing that I can do it.

And the fact that I can climb

and make my way over these big boulders

and not fall,

I feel accomplished when I get to that summit.

Ten, fifteen years ago,

going on a hike was something that was so foreign

and so likely to be impossible.

And now, it's something that I enjoy.

I love being outdoors.

Uh, fresh air, the sunlight,

and it just feeds my soul.

My name is Dr. Saray Stancic.

Back in 1995,

the entire course of my life changed in an instant

when I went from doctor to patient.

For years, I struggled.

Desperately trying to manage

an unpredictable and disabling diagnosis.

Through my suffering as a patient,

I learned invaluable lessons that fundamentally changed

my perspective as a practicing physician.

I began my career in the 1990s

as an infectious disease specialist,

determined to combat the HIV epidemic.

But today, my professional focus is elsewhere.

I'm eager to bring change to our often misguided healthcare system

and antiquated medical education model,

which places little to no emphasis

on what we know today could save countless lives.

I was born in Cuba,

but my family immigrated to the United States

when I was only five months old.

My parents instilled in us

that they had made the sacrificeto come to this country,

and that we were gonna make something of ourselves.

For me, it was easy. I wanted to be a doctor.

I didn't know any physicians.

I guess I had seen doctors on TV,

and they looked pretty impressive and cool.

My first experience with a real physician

was when my grandmother was diagnosed with cancer.

When she passed, I was nine years old.

But going to the hospital and seeing physicians caring for her

solidified that for me that "I'm gonna become a doctor."

When I was accepted at New Jersey Medical School,

it was the happiest day of my life.

So now, I'm in my third year of my residency,

which is the last year.

I'd just turned 28.

I had just met Ralph in August.

RALPH: We were residents together.

A mutual friend introduced us,

and, um, we hit it off immediately.

STANCIC: Then comes October 11, 1995.

I'm on call and it was a really crazy, busy night.

There wasn't a break,

and I remember feeling really, really tired as the night progressed.

I remember getting to the call room,

literally almost crawling to the bed,

and I was gone.

[PAGER BEEPING]

Next thing I know my pager went off.

When I tried to get up, I couldn't feel my legs.

Then I stepped down to get help

and it suddenly felt like I was stepping on hot coals.

I'm brought to the Emergency Room,

and they said, "We need to do an MRI

"to see what's going on."

They tell you, "Don't move,"

and I'm in there for like two hours.

[MRI MACHINE WHIRRING LOUDLY]

And all I hear is the terrible sounds and the banging,

and then I start to feel this pain,

something like charley horse on steroids,

and I'm terrified.

They keep asking me, "Are you okay? Are you okay?"

And I keep saying, "Yes," and I'm thinking, "No."

And then as I'm wheeling out, I hear the Radiology attending say,

"Go get the medical students. Go get the interns.

"This is a classic case of MS."

And, um...

Like the floor fell out from under me.

You know, it was just like everything changed overnight.

RALPH: It was pretty frightening,

because we had only been dating for a couple months,

but I was fairly certain that this was a woman I was going to spend

[GULPS] the rest of my life with.

[SOMBER MUSIC PLAYING]

I knew it was an autoimmune disease,

but the things that were important to me at that moment,

I really had no idea.

When the neurologist came,

I remember him telling me that, uh,

"Multiple sclerosis is a chronic illness,

"and you just have to learn [SMACKS LIPS] to live with it."

DENNIS BOURDETTE: Multiple sclerosis is a disease that affects

the brain, the spinal cord, and the nerves to the back of the eye.

It's classified as an autoimmune disease.

In the early stages in the immune system,

it is episodically attacking

focal areas of the central nervous system.

A normal, healthy immune system is supposed to fight off

foreign invaders like bacteria or a virus, pathogens.

In MS, it attacks myelin,

the fatty sheath that protects the spinal cord and nerves.

The consequence of that is the development of these neurological issues,

and the progression of the illness would be

becoming dependent, for example,

on wheelchair or on other things.

It affects your bladder,

and it can cause optic neuritis even blindness.

I knew there was no cure for MS.

The best I could hope for was to slow its progression.

My doctors predicted I'd likely be in a wheelchair

within 20 years.

I can tell you those are difficult words to hear

when you're 28 years old.

RALPH: The imaging studies showed a great burden of disease,

so it was never a thought that she wasn't going to be on medication.

The first time I had to inject her, it was...

[SMACKS LIPS] It was... It was upsetting.

Here I was having to inflict pain on her,

and this is going to be her life moving forward.

These nightly injections, which gave her flu-like symptoms,

which lead to other medications to counteract

the side effects of the medication

that she was on for the MS.

STANCIC: By the time I was in my early 30s,

I was taking about 12 drugs.

I had no quality of life.

And then, one day I was sitting in my office

and, um, somebody dropped off a stack of mail,

and there was a journal, and on the cover

it said, "Multiple Sclerosis and Blueberries."

And I said, "What could that be?"

There was a study that looked at MS patients,

and they fed half of them a diet rich in blueberries.

And the patients who were eatingthis diet rich in blueberries

reported that they felt a little bit better.

Now, it wasn't a great scientific study,

but what it did, [SNAPS FINGERS]it was like that a-ha moment.

Like "Wow! Diet and disease? Could there be a connection."

I thought back to all that education that I had had.

Ten years, a decade of my life dedicated to medical education,

and I couldn't think of one example

in which any of my professors, mentors

ever discussed the connection between diet and disease.

I wanted to look into it myself and do a search,

and I put in words like "Multiple sclerosis and diet,

"chronic disease and diet,"

and what I found was extraordinary.

This idea of lifestyle medicine,it wasn't just powerful for me,

I knew that this was powerful for all of us.

And it was a message that I wanted to share

with as many as possible,

so I started to write articles, and I started to do public speaking

wherever anybody would invite me.

Such a great pleasure to be here

to speak on a topic that I'm immensely passionate about.

I've been practicing medicine for 22 years.

Today, I practice lifestyle medicine.

Has anyone ever heard of that?

It's a relatively new field in medicine.

Lifestyle medicine's focus is to educate and empower patients

on the importance of optimal nutrition,

a primarily plant-based diet,

physical activity,

stress management,

affective sleep hygiene,

the avoidance of tobacco,

the reduction or near elimination of alcohol,

and the importance of social interconnectedness.

DAVID KATZ: The evidence is absolutely overwhelming.

I don't think there's anything more consistently reported

in high-quality, peer-reviewed journals,

than the potential of lifestyle to improve the quality of life

for millions upon millions around the globe.

[CARS HONKING]

[INDISTINCT CHATTER]

One of the most powerful pieces of evidence,

2009, Earl Ford and colleagues

studied 23,000 adults in and around Potsdam, Germany,

and asked them about four factors.

They asked about weight.

They asked, "Do you smoke? Yes or no?

"Are you physically active? Yes or no?

"Do you eat well? Yes or no?"

And their definition of eating well was so simple.

It was habitual intake of vegetables, fruits and whole grains.

So, they compared the people who said,

"I don't smoke, I eat well, I'm active, my weight is fine,"

to people who said, "I smoke,

"eat badly, don't exercise,and my weight's out of control."

And these people

had an almost 80 percent lesser rate of developing

any major chronic disease.

Is he being a wise guy?

STANCIC: At some point, I had read enough.

And in 2003,

I adopted a whole food, plant-based diet,

because the evidence suggested

that this was the ideal diet for health maintenance.

I began to exercise.

Back in the 1990swhen you were diagnosed with MS,

you were told don't exercise.

MS patients struggle with fatigue.

You were told to conserve your energy.

So for eight years, I didn't exercise.

I was very deconditioned.

I could not get onto a stationary bike

without my husband's assistance.

And the first time, I could do a minute,

and I was in a lot of pain.

But the next day, I went back.

It didn't happen in a week,and it didn't happen in a month,

it happened over time but I started to feel better.

I came off all of those medications.

And on May 2, 2010,

I crossed the finish line at the New Jersey Marathon.

[AUDIENCE CHEERS]

-WOMAN 1: That's amazing. -WOMAN 2: That's incredible.

And you still have MS?

STANCIC: I still have MS and you know what?

If I stop doing all the things that I do every single day,

I would become symptomatic again.

There's tremendous power in our choices.

That's the message I wanted to get

to all students.

And that's a message that we need to get

to our communities, to our patients.

I know firsthand what lifestyle changes can do

for someone with chronic illness.

So, I've decided to embark on my most ambitious trek yet.

Now, nearly two decades

after personally adopting this lifestyle approach,

I'm setting out across the United States

to connect some dots.

From the most compelling science-based evidence

to the top practices around the country,

where physicians are helping their patients make lifestyle changes,

I wanted to hear their struggles and successes.

But most importantly, I wanted to uncover why

the field of medicine fails to emphasize prevention and lifestyle

despite the evidence that clearly supports its effectiveness.

The first stop on my journey is here, Ithaca, New York.

To revisit a 1980 study that remains

one of the touchstones of lifestyle medicine today.

Dr T. Colin Campbell's China Study.

T. COLIN CAMPBELL: 1980, I decided to go to China

and see what we could learn.

This is the real China Study.

We went into their homes and measured

exactly what they ate over a three-day period.

This is a total of 6,500 families,

130 villages, 65 counties across China.

We collected blood samples and urine samples.

We had all this information on a total 367,

I called them, "Items of information,"

which included about four dozendifferent kinds of disease rates

of different cancers, heart disease,

diabetes, all this kind of stuff.

STANCIC: Describe to me the dietthat you were using.

CAMPBELL: Yeah, rice, vegetables.

Lots of different kinds of vegetables, by the way.

It's what they were producing locally.

Overall, their consumption of animal protein

in China was only one-tenth an average of what we have here.

A huge difference.

And of course, heart disease is almost nonexistent,

in some places in China.

There's one county, there were something like

265,000 successive death certificates.

Not one was heart disease.

It seemed very clear

that our Western diet was too rich in animal foods.

STANCIC: This idea that animal foods

correlate with heart disease in particular

has actually been field tested.

In the 1960s, North Karelia, Finland,

had the world's highest rate of heart disease deaths.

The government decided to do something about it.

KATZ: It was an intervention called the North Karelia Project,

beginning nearly five decades ago

with a focus on preventing smoking,

reducing intake of saturated fat,

and shifting from animal foods like meat and processed dairy

to more vegetables, fruits, whole grains, beans, lentils,

nuts, seeds, fish and seafood.

And since the initiation of the North Karelia project,

an 82 percent reduction in coronary disease deaths,

and a ten-year average addition to life expectancy.

You show me anything in all of medicine

that has ever achieved anything remotely like that,

that has ever extended life expectancy routinely

for an entire population by ten years.

There is nothing.

RON WEISS: At the turn of the century,

the average American lived until they're 50 years old.

The government kept statistics.

If you looked at what people were dying of,

it was basically respiratory illnesses like pneumonia,

tuberculosis,

and the waterborne diseases like cholera and dysentery.

And then, we got antibiotics.

And so all of a sudden,

we saw people living beyond 50.

But that's when food causes the problem.

DEAN ORNISH: Every decade since 1950,

we've been eating more fat, more cholesterol,

more meat, more sugar, and more calories.

So not surprisingly, we're fatter,

because we're eating too much of everything.

When I was in medical school, I would walk in the hospital.

The gift shop sold cigarettes.

I bought my Merit menthols,

and my head of surgery would buy Marlboros,

and we would light up in the hallway,

walking down the doctor's lounge.

And when you got in there,

it was so smoky you could barely cut it with a knife.

We knew that cigarettes cause cancer,

but we also knew that it takes time to get cancer.

And if I quit, I'll be okay.

At some point, we realized now is the time

We gotta quit, and we've gotta get

the cigarettes out of the gift shop,

in fact get them out of the whole hospital.

This was a big decision.

Of course, after we made that decision

within two weeks everybody knew it was the right thing.

But that's where we are with food.

We know we got an issue. We know we've got to change.

STANCIC: When I started to learn about the importance

of nutrition and lifestyle,

I remember talking to colleagues that were in practice with me

and sharing this idea,

and I didn't get much support in that arena.

I started to think "Gosh,

"I can't be the only person who's thinking this way."

So, I started to look for other people.

That's when I found the American College of Lifestyle Medicine,

and I was like "Wow, this is home for me.

"These are my people."

There is a national conference that occurs once a year,

and it brings together like-minded physicians

and health professionals.

You make connections, you meet people

who understand this is important.

Sixty-five percent of our food is so highly processed,

it either... It's not even food.

STANCIC: When I came here, and I sat in a room full

of other physicians who understood this,

it was really empowering.

JAMES: This can be applied in the day-to-day clinical setting.

STANCIC: I was elated,

and I opened my practice a month after I got back from that.

I opened this practice in 2012,

and it was really very scary

because I had no patients,

and no one really knew what lifestyle medicine was.

I think a lot of my friends and family members thought

I had lost my mind.

Uh, I just knew it was the right thing for me.

There's no blueprint for this.

I've put this together in many ways also as a patient.

Like what would I want as a patient

when I go see a physician?

Take a nice deep breath, Mark.

With this idea of lifestyle medicine

when you're asking patients to change behaviors,

things that they've been doing for all their lives,

there has to be that trust between the patient and the doctor.

So, my first visit is two hours.

I'm going to do a really thorough history.

We're going to do a physical exam,

and then we're going to do education.

-And your your throat is, um... -MARK: That's better.

-It's better. -Great. Vastly improved.

When did you finish the Prednisone?

I think two days after Philadelphia.

So, you've been doing really well with your food.

Hummus, roasted red pepper, lettuce.

In general, you're making very, very good choices.

Mark came to see me in September of last year,

and he told me that he had been struggling

with his weight for many, many years,

and that he was a poorly-controlled diabetic,

and that he was sick of feeling sick.

Jack last night brought over Cuban pork chop for dad.

-A Cuban pork chop? -A Cuban pork chop.

Did he do that because he knows I'm Cuban?

[LAUGHS] No, no, no, he didn't.

I went and got a big salad.

One day at a time,

-one decision at a time. -Right.

-Okay? -Yeah, that'll work.

STANCIC: People will ask me is there a special diet for diabetes?

Is there a special diet for MS, and there isn't.

It's one diet for all of us.

We should all be eating a diet that is primarily plants.

SUSAN LEVIN: I hear all the time.

It's like "Well, there's no one diet for every body."

It's like, "Actually, there is."

MICHAEL GREGER: There is a remarkable consensus in the scientific literature

going back decades

suggests that the healthiest diet is one

that minimize the intake of meat, eggs, dairy and junk,

and maximize the intake of fruits, vegetables, whole grains, legumes.

Basically, real food that grows out of the ground,

these are healthiest choices.

I used to joke with my friends

that there are two types of cardiologists,

vegans and those who haven't read the data.

The science points toward eating more plant-based nutrition.

Vegan is the term that most people use,

but if you're eating a lot of refined sugar,

a lot of processed grains,

you may be a vegan, but you're not a healthy vegan.

And so, you'll see people who are struggling with their weight.

We really have to be very careful

about our food selections.

STANCIC: I'm not here to tell you, you need to be a vegan,

but I do believe that you need to cut down

on the amount of animal protein on your plate.

If you replace even just 3 percent

of the animal protein in your diet

with plant protein,

you can actually lower your death rates

by 34 percent when it comes to processed meat.

Nineteen percent for eggs.

Twelve percent for unprocessed red meat.

There's even benefits for replacing dairy, poultry and fish.

I quiz people a lot. "Which has more protein?

"Beef or peanuts?" Everybody picks beef,

but they're exactly the same.

CALDWELL ESSELSTYN: There is protein in grain.

There is protein in beans.

There is protein in red, yellow, green leafy vegetables.

It's almost impossible to be protein deficient.

On average, all Americans get

about twice the protein they need.

MICHELLE MCMACKEN: When you get excess protein from animal sources,

there's elevated heart disease risk.

There's elevated cholesterol, elevated diabetes risk,

elevated cancer risk.

Hello, yellow Mr. Horse.

-What's a horse say? -BOY: Neigh. Neigh!

Wow, good job. Neigh!

I was diagnosed in Septemberof 2016 with multiple sclerosis.

Um, on the day I got my diagnosis,

I was mindlessly scrolling through Facebook,

and I saw this article.

From Doctor to MS Patient and Back.

I knew I was waiting for my results,

and I said, "I don't need this. That's not going to be me,"

but I saved it.

And literally,

five minutes after that I got the phone call

that, yes, it was me. I have MS.

And in that moment, my whole world

came crashing down.

You know, I was thinking the worst,

and, um, I sobbed the whole way home.

I sobbed the whole next day.

Um, it was pretty devastating,

but I went back to the article that I had saved

that I thought I wouldn't need,

and I read about the incredible Dr. Stancic,

and I called her.

-The unpredictability of it. -KELLY: Mm-hmm.

I was having lots of twitching in my legs...

The day after I met with her,

I went cold turkey, gave up dairy and meat,

and I adopted the plant-based diet in October of 2016.

We're not gonna unravel, we're not gonna stop breathing.

-We're going to deal with it. -Mm-hmm, right.

Well, you know what, let me ask you...

STANCIC: Outside of Philadelphia, I met another physician

who has taken a unique approach to healthcare

in her community as well.

ANA NEGRON: I just couldn't write another prescription

for chronic disease.

I just couldn't really bear it,

so a lightbulb went on in my head.

"Maybe I could do something." [LAUGHS]

[ANA SPEAKING SPANISH]

I'm going to do a real quick review. [SNAPS FINGERS]

I started to bring some samples of food to the to the clinic

where I was volunteering.

As people said, "This is delicious, but what is it?"

I said, "You mean, you don't know oats and kale?"

I stepped back and said,

"I'd have to introduce people to food."

[SPEAKING SPANISH]

So for many years, I have been cooking with patients,

bringing the food.

Cauliflower. This is cauliflower.

We're doing six-week cycles.

[SPEAKING SPANISH]

So, it's made from soybeans.

They sample recipes which sometimes we assemble here,

sometimes I bring already made.

And they share their motivations, their obstacles.

In just two weeks,

people's triglycerides from 600 come down to 200.

Blood sugars come down without the use of medication.

Next week, we're making burritos.

[SPEAKING SPANISH]

NEGRON: The Chester County Food Bank

heard about what I was doing here

and devised a prescription for fruits and vegetables.

So let's say three people in the family,

they get $21 a week

that they can redeem in the truck.

They are parking here in Phoenix, though,

once a week from June to December.

They only have to present a prescription for food,

and they get the food for free.

Connecting services with people who need,

I think that's our work.

-[ELEVATOR DINGS] -This is us.

MCMACKEN: The challenges are very real

in a primary care situation

where you're given 15 or 20 minutes.

So, I try to keep it simple,

and we usually have to divide itup over quite a few visits.

ORLANDO: Being diagnosed with type 2 diabetes,

I was kind of afraid,

because I have heard stories about people

losing limbs or becoming blind.

I also was diagnosed with high cholesterol.

The plant-based diet, we started about a year ago.

I see the results.

So what about the exercise?

I do 15-20 minutes every day.

The cholesterol has dropped in a big way.

Okay, great.

Have a seat.

Lately, I have been trying

just to stay away from sweets as always.

-Mm-hmm. -[LAUGHS]

And the way you told me with the fruits,

like instead of a glass of orange juice,

-having a whole orange. -Exactly.

BARNARD: The old-fashioned idea of type 2 diabetes

was "I've got too much sugar in my blood," which is true.

And so, "That must mean I ate too much sugar,"

or "I ate carbohydrates that release trigger and that's the whole problem."

That doesn't hold up very well

because looking inside the cells,

you see the buildup of tiny fat particles

inside the muscles and the liver,

'cause the insulin in the body to not work anymore,

and that leads to insulin resistance.

Suddenly, the blood sugar rises up,

because insulin can't get into the cell.

That's the disease process.

The problem in diabetes isn't that you're getting sugar in your body.

You should be.

The problem is it's not getting into the cells

working to do some work.

It's the fatty foodscontributing fat to those cells,

and that's what's keeping the sugar up.

And it's one medication after another, after another, after another,

and you guarantee your patient will not reverse their diabetes.

They are going to beV pill taker

for the rest of their life.

GREGER: I wasn't taught this in medical school.

There is a severe nutrition deficiency

in education for our physicians.

STANCIC: Most doctors are solely trained

on an outdated medical education model.

We learn how to detect disease,

and then treat with pharmaceuticals,

procedures or surgical interventions.

All these are important

but what we don't learn is how to keep patients healthy.

We are receiving an incomplete education,

leaving us ill-prepared to care for a country

drowning in chronic disease.

Lifestyle medicine was not emphasized

when I went to medical school.

I had to learn this on my own.

And in large part, our schools continue to fail us.

DAVID EISENBERG: One in four medical schools

have a dedicated nutrition course,

and fewer than a third of medical schools

meet the suggested minimum

of time spent studying nutrition,

which is recommended at 25 hours over four years.

Medical school, I got one lecture.

One lecture on nutrition,

which I remember the lecturer,

she had baked homemade banana bread.

She said, "Here. Here's the healthy fat to put on your bread,"

and it was some mayonnaise, you know,

chemical shit storm [LAUGHS] that was served up.

STANCIC: Seventy percent of medical students when they come in

think that nutrition is important.

That it's relevant.

By the time they finish, it's less than half.

So, it's like medical school washes away

the importance of nutrition.

SAUL BAUTISTA: Growing up here in Newark, you know,

there isn't really anyone telling you,

"Hey, you can be a doctor."

So I never really thought it was something I could do.

I joined the Army as a medical lab tech,

and I saw how doctors gave

wounded troops a chance at life.

I wanted to be able to do that for someone.

Last year,I discovered lifestyle medicine.

But no one at my school,

no one ever heard or talked about this.

So, I went to Google, and I found Dr. Stancic,

and I said to myself, "I need to meet her."

[KNOCK ON DOOR]

-Hi. -Hey. How are you?

-It's so good to see you. -BAUTISTA: Long story short,

she became my mentor.

Actually, we we did a nutritional lecture,

and it was like this big eye-opener.

No one at Rutgers New Jersey Medical School

talked about lifestyle medicine.

So, we started the Lifestyle Medicine Interest Group, August 2015,

with a paper sign and a table.

We held a couple of lectures.

Dr. Stancic delivered our first talk,

and it really inspired a lot of students.

STANCIC: The scientific literature tells us

that we can prevent nearly 80 percent of the chronic illnesses

we see today in clinical practice.

What if we had identified this patient

early on before that endpoint occurred?

What if we had given him the tools

to understand the importance of his nutrition?

The importance of his physical activity?

Could this path have taken a different course?

BAUTISTA: I just hope I can advocate for lifestyle,

change the lives of patients the way she's changing her patients' lives.

STANCIC: My practice is really unusual.

It's atypical in that beyond what I do in the office setting,

I do other things.

Uh, I do house calls.

I cook with my patients.

I go food shopping with patients.

It's all about eating whole foods, whole.

You take an apple,

you pick it off the tree and you eat it, that's perfect.

As soon as we press it,

we turn into apple sauce or apple juice, it's processed.

So, less and less processing,

eating food in its natural state.

Choose foods that are in season.

They're gonna be nutrient dense,

-they're gonna be cost-effective. -MARK: Okay.

-So, like corn. Look, three for a dollar. -Wow.

That's a great veggie for you to pick up now,

end of August.

MARK: So, we'll do one, dos...

Pumpkin.

You see that orange color? What is that?

-That is... -Vital nutrient.

That is a vital nutrient.Color, beta-carotene, vitamin A.

This is really good, powerful stuff.

That dill smells amazing.

-Oh. -Yeah.

Uh, make sure we haven't missed anything.

Cannellini beans. Have you ever tried cannellini beans?

I don't think so.

-Beans are a great source of fiber. -Okay.

So, we're gonna take a look at the label here.

Red kidney beans, water, salt and ascorbic acid.

Ascorbic acid is vitamin C.

STANCIC: How you read the label,

simple things like that are very empowering for patients.

They often go, "Oh, my gosh. I never saw that."

LEVIN: What's important, of course, is that the ingredient list

is as few ingredients as possible

and that you can pronounce those ingredients.

Of course, when you read ingredients,

you have to know all the tricks words, too.

It might say something like cane juice.

You just gotta know that "Oh, that's sugar."

Do you really want in your spaghetti sauce or whatever?

STANCIC: How do we know something's a whole grain?

The labeling laws are pretty loose

about what you can call a whole grain.

So, the front of a box of Lucky Charms

says whole grain.

[GROANS] That is not... You know, like, come on.

A whole grain has one ingredient.

Oats, rice,

quinoa, barley, that's a whole grain.

STANCIC: This chronic illness epidemic,

how do we turn this tide?

There are so many variables that play a role here,

but I believe physicians have to take the lead on this.

LEVIN: At the physicians committee,

the mission is to advocate and promote

plant-based eating for disease prevention.

Treatment as well.

-A small apple. Did you eat the skin, too? -Yeah.

We are one of the few places

that do randomized controlled trials

with a plant-based diet.

HANA KAHLEOVA: Who is the dietician here?

We're conducting a new study

that's testing the effect of a plant-based diet on metabolism.

So, the participants typically come

early in the morning in the fasting state,

and we measure their metabolism.

Then, they get a standard breakfast,

and we're measuring their metabolism

for three hours after the breakfast.

STANCIC: And what do you expect to see?

Uh, we're expecting to see an increase

in the ability to burn calories in response to the meal intake

after the 16 weeks of plant-based diet.

Cheddar, approximately one tablespoon.

White rotisserie chicken...

LEVIN: PCRM does do some work around legislation with food.

So, sometimes, it does involve

bills and acts and talking to Congress.

BARNARD: Congress is a difficult animal.

In the House, they have to get elected every two years.

That means they're fundraising all the time.

So if you're from Iowa,

and you're gonna speak out against pork

and say that it's linked to colorectal cancer?

You might be out of a job in two years' time.

MARION NESTLE: You would hope that the federal agencies

would put public health first.

But in fact, right now,

corporations run a lot of American society,

and they are extremely influential in government.

PAM POPPER: The United States Department of Agriculture

was formed under Abraham Lincoln's administration.

And it's an agricultural advocacy organization,

which I think is a good idea.

Taking care of farmers and... All good.

The problem is that some place along the line,

the USDA decided it was going to issue

dietary guidelines to the American public.

These dietary guidelines

infiltrate the curriculum that teaches dieticians

what our military eats,

hospital food.

It is the blueprint for all federal food programs,

school lunch, and the Supplemental Nutrition Assistance Program,

otherwise known as Food Stamps.

So, it's incredibly important that it be accurate.

BARNARD: The dietary guidelines right now

still say you should have dairy products every day.

Despite the fact that dairy products

are the No. 1 source of bad fat and saturated fat,

they're still too friendly to meat.

Especially the processed meats like bacon or ham

that are clearly linked to colon cancer.

We gotta be tough on those foods

and stop pushing them.

[INTENSE MUSIC PLAYING]

POPPER: The USDA actually operates in partnership

to promote the consumption of animal food.

For example, there's a Dairy Checkoff Program,

where dairy farmers in the United States,

pay a certain number of pennies per pound.

It goes into a fund, and then the USDA administers it

and goes out and forms partnerships

to help promote dairy.

They partnered with Pizza Hut,

uh, Taco Bell.

They come up with new items on the menu

that have cheese or to add more cheese

to various items.

This is an institutional conflict of interest

that can never be resolved.

Over here, you're helping farmers.

Then over here, if you really did the right thing,

you might tell people not to buy so much of something

that these people who you're advocating for produce.

It can never be reconciled.

LEVIN: It takes years to move government.

So, now we're trying to move that conversation,

which is long overdue,

but this is gonna be hard.

We got ourselves into quite a bind here,

and it's gonna take a lot of work and effort

to get us out of it.

ESSELSTYN: Forty years ago,

medicine recognized that cardiovascular disease

was the leading cause of death in this country.

Today, 40 years later, it's still the same.

So, we look at that and we say to ourselves,

"Can't we do better?"

I do this five-and-a-half-hour intensive seminar

where people become aware

that food is their salvation

or it can also be their destiny to an early grave.

When you have a pizza or a cheeseburger,

the first thing that happens in your bloodstream...

A chronic illness doesn't occur when you have a cheeseburger,

but you do take a hit.

Of that hit, your body recovers, let's say 90 percent,

but you're left with a little 10 percent injury.

Does it make any difference in your blood pressure? Probably not.

But you do that over five years,

you blood pressure goes up just a few points.

You do it another five years,

now your doctor says, "You know..."[SMACKS LIPS]

I think we ought to start a little pill

for this blood pressure.

And I've also noticed

your blood sugar is a little high.

So, this is chronic illness.

Well, you gotta become good strippers,

so you take the left hand here and you pull.

ESSELSTYN: There's a marvelous presentation

preparing plant-based foods,

dealing with reading ingredients,

travel and restaurants.

...led me to a vascular surgeon.

ESSELSTYN: We've always have participants

who've had a previous successful experience.

Cholesterol medication was cut in half,

then cut in half again.

ESSELSTYN: We answer questions.

WOMAN: So, Diet Coke...

No, no, no. Let's be sure.

-The thing you drink is water. -[AUDIENCE LAUGHS]

-Water is what you drink. -WOMAN: Yes, got it.

I show them exactly how they created their disease.

This little dark area,

that is the life jacket and guardian of your blood vessels.

The endothelium.

The endothelial cells manufacture nitric oxide,

which prevents the wall of the artery

from becoming thick and stiff or inflamed.

Keeps all the cellular elements

flowing smoothly in our bloodstream

like Teflon rather than Velcro.

Keep things from getting sticky.

If you eat foods that are gonna injure the endothelium,

now cholesterol can find a pathway

through the endothelium.

We begin this cascade of LDL oxidation,

formation of the foam cell.

The foam cell makes metalloproteinases

that erode the plaque till it ruptures,

then we have the heart attack.

BAXTER MONTGOMERY: We have a lot of heart failure here in Texas

all within 250 miles

of what seven heart transplant centers.

Right here in Houston, Texas Medical Center has its own zip code.

It's the largest medical center in the world.

STANCIC: So when you first started coming here,

how long ago was that?

MONTGOMERY: Well, I've been here since '64.

-'64? -Mm-hmm.

-You were born here? -Right.

[SARAY LAUGHS]

MONTGOMERY: We have patients coming in

with multivessel coronary disease

that have had bypass surgery once or twice.

It's not enough to say eat healthy,

to the extent that patients need some type of intervention,

medically, surgically, etc.

We also include the lifestyle intervention.

STANCIC: This subject has become very personal for me.

Last year, my brother-in-law, Glenn,

had triple bypass surgery.

It was a shock.

Glenn was an active runner, and he wasn't overweight,

but he did have a terrible diet.

After the surgery,

he admitted to me he routinely ate

chocolate chip cookies for breakfast.

GIOVANNI CAMPANILE: Bypass surgery or stenting

alleviates the immediate problem

of the blocked arteries.

It doesn't alleviate the underlying problem,

and the Ornish Program addresses that part of it.

It's very effective.

How many sessions have you done so far?

GLENN: First to fourth week, so about eight.

STANCIC: Following his doctor's advice,

Glenn started an intensive lifestyle intervention.

I sat down with the program's founder,

Dr. Dean Ornish.

ORNISH: When I was in medical school

and learning how to do bypass surgery,

we cut people open, they go home, we'd tell them they were cured.

And more often than not, they would eat the same food,

the same junk foods, not manage stress well,

not exercise.

The bypasses would clog up.

We'd cut them up again. Bypass the bypass.

Sometimes two or three times.

And so for me, bypass surgery became a metaphor

of an incomplete approach.

We were literally bypassing the problem.

We weren't treating the cause.

I wondered what would happen if we treated the cause.

NURSE: Okay, what'd you get, Bill?

ORNISH: Our lifestyle medicine program

is 18 four-hour sessions.

So, we have supervised exercise...

-Stop at 45. -Okay.

ORNISH: ...stress management, which is yoga and meditation.

A support group, which is really key to getting adherence,

and a group meal with a lecture.

I'm starving.

-WOMAN: Okay. -Wow.

I'd leave the tofu out.

Would you do something else to put a different protein in?

He said, "Steak."

-[LAUGHING] -WOMAN: I heard him. Wise guy.

GLENN: The Ornish Program, when I started,

I was a little, maybe skeptical is the word,

'cause I was like, "Okay."

When I was his age, you didn't hear any of this.

You're basically, you know,"Don't smoke 'cause that's bad."

That was coming out. That was being bad for you

and then that was kinda it,

and exercise and watch your weight.

ANTHONY: My grandfather had an open-heart surgery.

My dad had open-heart surgery.

Genes kinda make it seem like, "Oh, it's gonna happen.

"There's nothing I can do about it.

"So then, why do I care?"

Whereas this, the Ornish thing,

it kinda returns some power to yourself.

It's like if you make these different choices every day,

you can kinda control what happens to you.

STANCIC: Just because you have a gene for a particular illness

doesn't mean that you're going to get that illness.

Genes are like a light torch.

We can turn them on, and we can turn them off.

This concept is the foundation for the science of epigenetics.

SHELLEY BERGER: We can't discount

what we inherit from our parents,

but the genes themselves aren't enough.

They have to be regulated or turned on and off.

So, epigenetics is the regulatory system

that's on top of genes.

All of our cells have exactly the same genes,

but they're differently used.

So, you have 200 major cell types.

Same genes.

In different cells,

some genes have to be on and other genes have to be off.

That's accomplished with these epigenetic marks.

Two identical twins at birth

have exactly the same epigenetic marks.

However, as twins age,

the genes can differ from one another.

So, a great example are these two sisters,

Dear Abby and Ann Landers

They were both advice columnistswhen I was young.

They're identical twins,

but one died of cancer,

the other died as a result of Alzheimer's disease.

So in spite of the fact that they're monozygotic twins,

exactly the same genetics at birth.

As they aged, they became so different

that they actually died11 years apart from one another.

CAMPBELL: Look at the website of the National Cancer Institute,

they'll say, "Cancer is a genetic disease."

Full stop. I say, "No, it's not."

I was interested in knowing what protein did to cancer.

Does high protein feeding increase cancer formation?

I learned more protein really turned that cancer on.

Animal protein did that. Plant proteins did not.

Because we're eating the whole food,

you're also eating complex carbohydrates

as well as the antioxidants,

which tend to repress

some of the activities that proteins otherwise might have.

STANCIC: Cancer is one of the leading causes of death worldwide.

By 2030, the number of new cases

is expected to reach more than 20 million per year.

KATZ: The good news is

the lifestyle medicine prescription defends against cancer.

Now, we probably can't prevent cancer

quite as consistently

as we can prevent heart disease and diabetes,

but cancer is also preventable.

More than a 30 percent risk reduction

through lifestyle practices.

That's pretty darn good.

STANCIC: Lifestyle won't help every kind of cancer.

But lifestyle changes can reduce your risk

for some of the most prevalent,

such as colon, prostate and breast cancer.

Hi, Charlene.

They found a small lump.

It is a breast cancer. It started...

JOVITA ORUWARI: I've been doing breast cancer surgery for about 15 years.

I don't think that women realize

that diet, exercise, obesity

actually have an impacton the developing breast cancer.

Most women, when I talk to them about that,

is the first time they've heard it.

And it's frankly, a big surprise to them

to hear that those life choices

made an impact into their breast cancer.

One in four cancers diagnosed in women

in the world is breast cancer

Um, so this is, in fact, a global problem.

And so, we've looked at a numbers lifestyle factors

such as physical activity

protective for particularly premenopausal breast cancer.

Alcohol, clearly increasing risk.

And high fruits and vegetables, high fiber,

protective against breast cancer.

Avoiding weight gain through premenopausal years

reduces risk of breast cancer.

STANCIC: How much of a reduction in risk

do you think potentially we could reap

from adopting these behaviors.

Part of the answer is when do we start?

If we start with our daughters

or our nieces or our grandchildren,

we could have a really big impact

on premenopausal breast cancer.

With that healthy diet from, let's say age ten or twelve,

on high physical activity, limited alcohol,

where over 50 percent, over half,

of premenopausal breast cancer could be avoided.

The factors outside that affect the epigenome

are diet, alcohol is a big one,

air pollution, water pollution,

too much sunlight can lead to mutations.

So really almost everything that's coming in.

Now, when we get into stress, it gets a little complicated.

A little bit of stress

is protective to the epigenome.

So that's actually what exercise does.

It stresses our cells a little bit,

and that brings in repair mechanisms

that keep our genomes pristine.

But too much stress can lead to the mutational errors.

Um, too much stress is bad.

STANCIC: Let's talk about inflammation.

When we live in a pro-inflammatory environment,

we turn on the bad genes.

Inflammation is a common denominator

among many of my patients with autoimmune diseases.

AMY: I am a general surgeon,

and I had been dealing with ulcerative colitis

ever since I was, um, at the end of my residency.

Every single colonoscopy I had,

there was always an element of inflammation on the scope.

Last year, my ankles were swelling.

So, I had my heart checked out and everything was fine.

And I had no explanation as to why my ankles were swelling.

I just knew something had to change,

so I went to see Dr. Stancic last June,

and for two hours we sat down,

and we talked about what my life is like

and how to change it.

I went on a plant-based diet.

I exercise more, lost some weight,

and then I had a colonoscopy.

Six months into it,

and there was absolutely no inflammation at all.

I am feeling so much better than I did a year ago,

and I even cut my medicine in half.

STANCIC: The idea that diet and lifestyle

can affect an autoimmune diseaseis relatively new,

but there is evidence in inflammatory bowel diseases

like ulcerative colitis and Crohn's disease.

There is evidence in the lupus literature.

There's evidence in the rheumatoid arthritis literature.

And we're looking at the microbiome,

the microbiome is connected to this immune system of ours.

And what affects our microbiome?

Our diet.

The microbiome refers to a whole host of organisms

that live on, in and around us.

Fungi, bacteria, protozoa, yeast.

We used to think they were pretty insignificant,

but they dictate our overall health.

When you eat an unhealthy diet, your microbiome gets altered.

You enter a state called dysbiosis

where you have bacteria that may not be so healthy for you

that are overgrown in relation to the healthy bacteria.

They produce chemicals and often times

these chemicals are carcinogenic

and really mess with our immune system.

So, an unhealthy gut microbiome

corresponds with many autoimmune diseases.

If you were to ask me to summarize

how to get a healthy microbiome in one word, it would be fiber.

Americans are so fiber deplete.

LEVIN: That should be the headline in the paper.

There should be a fiber diet

because most people are getting about 15 grams a day,

but they need anywhere from 26 to 30 grams a day.

Fiber only exists in plant foods,

and there's a lot of research out there now.

People on plant-based diets tend to have better gut flora.

STANCIC: Lifestyle and plant-based eating

is an important aspect of not only preventing disease

but it's going to be very important

in managing the spectrum of autoimmunity.

Because think about how we treat autoimmunity now.

We treat autoimmune disease with a drug

that knocks out your immune system.

And when we do that, yep,

maybe we cool off that autoimmune disease,

but we're also doing collateral damage.

Our immune system is important.

There's a lot of little bits of light

that we're starting to see.

We now just have to connect these dots.

Almost as important as what we eat

is how we move.

It's a key part of the lifestyle medicine approach

to overall health.

EDWARD PHILLIPS: We're here at the Boston VA.

I often see people with osteoarthritis

of the knees and the hips,

and I will say to them,

"Let me explain the physics of what's going on.

"Your leg muscles are relatively weak.

"I've just determined that.

"You're carrying around more weight,

"which has a multiplier effect

"because of the physics of how we walk."

And by then, the person's saying,

"So if I were to lose a few pounds

"and get my legs stronger,

"my knees would hurt less."

They've just written themselves a lifestyle prescription.

If they take my exercise prescription,

I'm actually obligated to warn them...

-That your blood sugar...-That your blood sugars may drop

if you're on a medication for, you know, a little bit.

Facetiously, I'll start to list the side effects.

"You're going to live longer so save your money.

"You're going to reduce your incidence

"of several dozen cancers."

It goes on and on.

The federal guidelines

based on lots of research

are simply a 150 minutes per week.

And then, the only other thing is twice a week

of resistance training,

something where you're stressing your muscles.

DAVID SABGIR: Walking will reduce

your risk of heart attack by 50 percent.

If you can do 150 minutes a week, so...

Better than any drug that we know.

On the flip side, I'm having 5 percent of my patients

reach these 150 minutes a week.

Hi, David.

-How are you, sir? -Good.

So, I would spend a lot of time talking with patients

about how they can be active,

and it turned out when the patients came back

I wasn't moving the needle at all.

One day I said, "How about if my family and I were at the park?

"Would you like to walk with a doc?"

You guys are crazy. It's freezing out here.

Our first Walk with a Doc event was April 9th of 2005.

We had 101, our first day,

and it's only grown since then.

-Good morning. -MAN: Hi, how are you doing?

-SABGIR: Good. How are you? -MAN: My daughter...

It's so cold. I just need hugs.

So, I expect a lot more people for 23 degrees.

-[ALL LAUGH] -Let's walk!

[ALL TALKING INDISTINCTLY]

SABGIR: Everyone walks at their own pace.

-We have 278 chapters. -Two hundred and seventy eight.

And we have nine countries.

There are many more in development.

-Nice to meet you! -[BOTH LAUGH]

-You came! -Hi.

STANCIC: It was an extraordinary surprise

to see this couple at the Walk with a Doc.

-You look great. -Oh, you do, too.

-I have to take a pic. We have to take a picture. -We gotta take a picture.

STANCIC: This young lady whose husband

was diagnosed with multiple sclerosis

sent me an email in March 2015.

I was...

She was in tears every single day.

The motivation that you gave...

STANCIC: They were very frightened,

and I called her, and I described

what a plant-based diet was,

and why I thoughtit was important in managing MS.

Every doctor, we just heard negative things

that you know, he would be in the wheelchair

-right the next moment. -You're one of the very few

who actually told that that's not gonna happen.

-WOMAN: Yeah, his last MRI came out clean. -MAN: Came out clean.

No lesions at all.

It started out with 16, I got zero now.

-All gone. -You keep at this.

-You keep at this. -MAN: Yes.

-Continue this lifestyle. -MAN: Because this gives me motivation.

-Now I see the results. -WOMAN: Yeah.

-MAN: I see the results. -And you share this with other patients.

MAN: Yes, I will.

You have no idea the gift you've given me today. [LAUGHS]

I walk with my patients. I hike with my patients.

I do yoga with my patients.

We practice meditation.

Does anybody want to dance?

STANCIC: When Kelly first came to see me,

she was very scared, very tearful.

2016, I had the second episode,

[VOICE SHAKING] and it was so traumatic.

I really can't even talk about it.

Thank you.

And I literally get as basic as saying, "In, out."

Dr. Stancic recommended daily meditation

and that has made a huge difference.

STANCIC: Gently bring your palmstogether in prayer,

close at heart's center.

ORNISH: Lifestyle medicine, people often go straight to diet.

Of course, diets important,

but at least as important

are the psychosocial, emotional and spiritual dimensions.

STANCIC: Breath in, breath out.

KIM WILLIAMS: I remember Dean Ornish saying

that we really need to include meditation and mindfulness,

and I said, "Dean, is there really any data?"

I should have done that search engine thing first.

[LAUGHS] So, massive amount of data.

Reducing heart attacks, stroke, blood pressure,

uh, variety of endpoints.

Stress-management techniques are really important.

MAN: The three weeks that I've been on this program with the yoga

brought more love into my family.

So that's beautiful to hear.

Studies are showing that six months after a heart attack,

those that are depressed are four times more likely

to be dead than those that aren't.

Independent of their diet, their smoking,

any other kinds of behaviors. Fourfold.

It's so easy to make fun of this.

"Oh, it's so touchy-feely."

When people say that, I get defensive.

I say, "No, no, look at our quantitative arteriograms,

"and cardiac positron emission tomography," and blah, blah, blah.

One day I said, "You know, it is touchy feely."

That's what makes it work so well.

We are touchy feely creatures.

That's how we've survived as a species

by learning to nurture and love and care for each other.

They have a place where people can let down their emotional defenses,

and talk openly and authentically

about what's really going on in their lives.

It's incredibly meaningful, and if it's meaningful then it's sustainable.

Having a heart attack six weeks ago...

Wow.

Everything came into full focus.

I wanted very much to stay alive.

MARK: Between the commercials on the radio

and the golden arches that you see when you're driving,

it's so easy to medicate yourself with fast food

or whatever the case may be.

Then some left turns here and there along the way...

I'm not perfect and, uh, my heart's in the right place,

and I'm looking to take it to the next level.

You're right. The world is sort of, um, out there

to get us to purchase these foods,

so we have to be extraordinary in the world as it is today.

MARK: You're shifting your thought processes

and just keep driving by the fast food places without turning in.

Atta boy.

Good boy, Griffo.

Sometimes I wish I could get into a time machine

and go back to Dr. Stancic's office.

I wish I had made better choices.

Sup, partner?

Back in December, I suffered a stroke.

Uh...

They said it was a small, but acute stroke,

that's left me with numbness in my left foot and my left hand.

Like pins and needles and stiffness in the arm in general.

And also in my foot.

It's worse on some days than others

where it feels like you're walking

on a piece of wood or something.

I believe more and more that plant-based is the way to go.

It's just very hard,

even having been through what I've been through.

STANCIC: You know, this idea of lifestyle medicine

and behavioral change is a challenging one.

Sometimes even though patients

are well intended and they'll say, "I'm ready."

You're not quite there.

Mark is a great example that lifestyle medicine

is exactly that.

It's a lifestyle that requires commitment.

[SIZZLING]

But in today's fast-paced world,

it's not always easy to stay on track.

KATZ: Everything about our culture

conspires against the lifestyle medicine prescription.

This is fairly obvious.

Here's the part that really worries me.

All too often you see fast foods in the hospital,

so let's serve food on one floor of the hospital

that causes the coronary disease,

and then the treatment on another floor of the same building.

We're basically profiting

from both causing disease and treating disease.

You know what the leading sourceof revenue for any hospital

in the United States of America is bypass surgery.

I hate to sound like a pessimist,

but there's too much money in the status quo.

And the resistance from institutional standpoint,

hospitals, the drug companies, the medical schools,

it's gonna be very, very strong.

STANCIC: You guys, you wanna watch TV?

Even now, nearly a decade

after founding my own lifestyle medicine practice,

I never stopped being amazed

by how much confusion there is about what to eat.

Of course, I can see why that's the case

every time I turn on the TV.

MAN 1: [ON TV] Get ready to tip the scales.

A trendy new weight loss method...

My biggest weight loss program to date.

MAN 2: Energize your weight loss with more...

STANCIC: While doctors have contributed to the conversation,

they haven't always helped.

I have written a weight loss book.

Anybody can write a book and say anything,

and it can be a New York Timesbestseller

even if there'sno scientific foundation for it.

Sometimes the crazier the idea, the more attraction in gets.

GREGER: Putting butter on the cover ofTime or something

sells a lot of magazines, but it really sells the public short.

MCMACKEN: There are messages all over

that take scientific information

and either broadcast a study

that's very small and not that important

or change the findings of a study

such that it's something that people want to read about,

and it really contributes to people's misunderstandings around food.

Physicians know so little about nutrition,

and we're susceptible to the same societal messages

that everyone else gets.

So, physicians are equally confused

as everyone else out there.

STANCIC: These students represent the future.

BAUTISTA: Every student that comes across lifestyle medicine

they get so motivated. They're like, "This is what I want to do."

-Thank you. -[AUDIENCE APPLAUDING]

This chronic illness epidemic,

how do we turn this tide?

MCMACKEN: For every one serving a day

of a fruit or a vegetable,

studies show that you can decrease your risk

of coronary heart disease by 4 percent, just think about that.

BAUTISTA: Over the past year, the Lifestyle Medicine Interest Group

made so many connections with physicians

that are coming not only to speak at our lectures,

but they're bringing us to their practices

and showing us how they practice lifestyle medicine.

Showing us techniques and methodologies.

How to exercise, proper lifts.

MAN: Arms are long, bend your knees...

So that way you can teach your patients how to do it.

WOMAN: Let's try it out. The other person can row.

We even have a culinary medicine workshop.

No, we don't have a teaching kitchen,

so we sort of made our own.

[INDISTINCT CONVERSATION]

-MAN 1: Keep it down. -MAN 2: Yeah, I know, but cover your fingers.

RICH WOLFERZ JR.: I got into medicine

because I want to keep people healthy.

If you wanna really help sick people,

you prevent them from ever becoming sick.

That looks beautiful.

BAUTISTA: We were just in class,

and we just memorized 50 different drugs.

And that was to say, "Oh, this patient's hypertensive,

"these are the drugs you prescribe."

Not once did we talk about,

"Hey, let's modify that patient's diet.

"Let's try to get them on an exercise program."

We never talked about that for treatment,

but we did talk about the 50 drugs that we had to learn.

ADELMAN: If you're going to medical school,

and you know you're going to come out with $400,000 of debt,

what specialties are you gonna think about?

You're gonna think about big-ticket-item specialties

that allow you to pay that debt back.

It's a rational economic decision.

Those are the procedural specialties.

That's where the financial rewards are in medicine.

The financial aspect is a hugely important one.

If I spend 25 minutes

counseling someone about plant-based nutrition,

the hospital will get reimbursed the same

as if I spend three minutes and wrote them a prescription.

So right now, the system is not geared

to make it financially viable.

Big pharma plays a role

in medical education and practice.

Uh, you know, when's the last time,

uh, you know, your doctor was taken out to dinner by big broccoli.

It's probably been a while.

POPPER: The pharmaceutical industry

absolutely runs the healthcare industry.

It's incredibly insidious.

The American Academy of Pediatrics,

American College of Cardiology,

they're all supported by the drug companies.

Appearing at the conferences

and supporting these organizations,

gets their drugs sold.

Take a look at any medical school,

it's part of a complex.

You got hospitals and research and all that sort of thing.

Who funds all that?

Let's be honest. Medical schools are run by Pharmageddon.

ESSELSTYN: It's really a national embarrassment

that our medical schools are totally missing out

on the strongest tool in our toolbox.

I hope every administrator at every medical school

-just heard you. -[BOTH LAUGHING]

EISENBERG: As long as physicians and hospitals

make money or save money

by having more and better diagnostic tests,

surgical procedures,

if money is made by the more they do,

then what's the incentive of helping people prevent disease

or alter the course of their disease

through enhanced diet, exercise,

mindfulness, and behavior change.

So in order for us to change

the curriculum in medical schools,

we're gonna have to change the financial incentives, it's essentially...

I think that's part of the solution.

Sadly.

STANCIC: I mean, it's money.

I mean, everybody has to make a living. I get it, but...

Physicians, that doesn't apply to us

that finances, that shouldn't be part

of the decision-making process.

That we don't... That we always act

in the best interest of our patients.

It has nothing to do with money,

that was my naive thinking when I started this film.

Uh...

I've been trying to figure out why

I got a little bit emotional.

Maybe it's because we're gettingtowards the end of this journey.

You know, the questions that I wanted answered,

or have they been answered?

And maybe the answer is not the one I wanted to get.

I think that it's much more complicated

than just financial incentives, you know?

There's no physician in this country

that's sitting around going, "Yes, another diabetic."

What I do believe isthat physicians don't know this,

because they're not taught it,

and I lay the blame completely on the medical school.

Finances shouldn't be the incentive

to teach the right thing, to teach the truth,

to teach what is best for communities

and for health, and for well-being

for the entire country, the globe.

How about we change 'cause it's the right thing to do?

How about we change because the evidence is overwhelming?

How about we change because we're scientists and we're physicians,

and we want to... we want to deliver the best care.

When we know better, we do better.

Yes, maybe we didn't know things in the past, but we know today.

Okay, so maybe I'm pissed.

PILOT: [OVER PA SYSTEM] Glad to have you on board with us.

We're currently up to 33,000 feet,

expecting a mostly smooth ride here.

We're gonna turn off that seatbelt sign.

Please feel free to move about as necessary,

however, while you are seated, we do ask that you...

STANCIC: I knew there were some medical schools out there

like Stanford University

offering a lifestyle medicine non-credit elective.

But when I heard about a medical school

that includes lifestyle medicine from day one,

I had to see it for myself.

JENNIFER TRILK: We teach lifestyle medicine

across all four years of the curriculum.

I think we're one of the only schools

that incorporates it as a core curriculum

so as a requirement for all of the students to go through.

What are some pro-inflammatory foods?

-FEMALE STUDENT: Sugar. -TRILK: Sugar. Excellent.

We have 49 teaching hours of lifestyle medicine

in the first two years,

and I work with my partners in their third and fourth year

on how to practice it in the clinics

when they get over to the delivery system.

There are more studies coming out showing

that sugar is addictive in the prefrontal cortex,

and they're actually comparing it to cocaine in some...

PAUL CATALANA: We have a lot of interest.

We have just this past year over 4,200 applications.

I think a lot of that has been driven

by the uniqueness of our curriculum.

NATALIE: When I learned about the school

and heard that lifestyle medicine

was such a huge component,

that was a really big draw for me.

Personally, that was one of my deciding factors.

TRILK: The teaching kitchen gives students

the hands-on ability to take what they've learned

from the classroom and apply it.

CHEF SCOTT: Hi, guys, welcome.

We're gonna teach you how to cook.

We're gonna teach you how to deal with nutrition.

STANCIC: Chef Scott eats a plant-based diet.

He also is a tri-athlete.

CHEF SCOTT: All your pots and grains are on top

as well as most of your tongs and spoons.

BIANCA: Currently, I'm on a lifestyle medicine rotation,

and the entire rotation is showing people

how to eat, what to eat, when to eat, how much to eat.

Really to help impact their overall health.

If only you could smell this right now. Unreal.

[BOTH LAUGHING]

TAYLOR LUCAS: Success.

If medical school doesn't work out,

-I guess we kind of have a backup plan. -FEMALE STUDENT: Yeah, you do.

Mm, wow.

-[LAUGHING] Yeah. -It's very good.

ALISON LEHANE: You wanna try some, Dr. Trilk?

I'll tell a friend, she's at a different medical school,

and they'll be like "Oh.

"Well, why don't we do that? That makes so much sense."

Um, and I think for us it's kind of like

we can't imagine school without it.

It's just so much a part of our curriculum that I mean...

It wouldn't make sense not to do it.

Hopefully, other schoolswill start doing the same thing.

UMA RAMAN: The garden got started two years ago

by two, now, third years,

because they realized the access

to fruits and vegetables in this community

was very scarce.

It's cool because it's food access,

but it's also a way of building that relationship

between physician and community.

How do you guys eat vegetables?

-[SPEAKING SPANISH] -Roasted.

My mother won't do that, though.

What makes it hard to, like, avoid certain fatty foods?

-MAN: It's so cheap. -WOMAN: Maybe price.

-It's everywhere, too. -It's so cheap.

It's not like you can go to the corner store and just get vegetables.

-Right. -We could get like, five things for $2 at least.

RAMAN: It's really frustrating how easy it is to get terrible food

and how hard it is to just get a tomato.

[ALL LAUGHING]

BAUTISTA: The Lifestyle Medicine Interest Group,

it's wonderful,

but it's all student-driven.

We do everything. The marketing, the research.

We designed the curriculum.

All this is funded through the students own money.

They don't get any funding from the school.

This is something that's great.

This is something that helps everyone.

Why aren't you supporting us?

THOMAS PACE: The Medical Roots Garden

came together shortly after the school was formed.

The school has funding to support gardening equipment,

plants, tools, composting.

And the students get together with faculty

and plant in the fall, plant again in the spring,

and prepare the beds each year.

STANCIC: We still have a ways to go

educating our next generation of healthcare professionals.

But some of our hard work is already bearing fruit.

MONTGOMERY: We've been practicing culinary medicine

for about 12 years. It evolved to a point

where now, we're a full-fledged restaurant,

we do shopping rounds and so on.

The restaurant is available to the general public.

We are on UberEATS.

During lunch time, we may have a full house,

especially when we visit a clinic.

[WOMAN SPEAKING SPANISH]

STANCIC: Your mom's very proud of you, I'm sure,

because you're making a difference

-in so many patients' lives. -MONTGOMERY: Yeah. Mm-hmm.

And that's a beautiful thing.

Folks will ask me,

"When was the first time you felt better?"

And I can't really say when,

but there is one day that I remember well,

and it was a really special day.

July 2, 2005.

And my husband and I attended a wedding.

And I did two things on this day

that I hadn't done in more than a decade.

I wore heels, and I danced with my husband.

You can tell by my smile that I was pretty happy.

I was just pulling up MRIs from the past.

This is the second one I had in 1996,

and here I have ten deep white matter lesions.

This was 1999.

You know, I had forgotten I had all these films.

This one's 20 years old. This is 1996.

The more recent ones are on the desk,

but this just goes to show how old I am.

The one I remember most, of course, is the first one.

In the winter of 2014,

this is the national MS magazinethat came out,

and I saw this Diet and MS on the cover.

So, wow, I turned to the page,

and I read about this physician in Oregon, Vijay Yadav,

and, um, she had done a clinical study

looking at a whole-food, plant-based diet essentially.

This is really the first neurologist I've come across

that is a legitimate neurologist,

mainstream,

but also understands

that this lifestyle thing is important, too.

My last MRI was over five years ago.

Today, I'm going to have another

before my trip to Oregon in a couple of weeks

to meet Dr. Yadav.

Oh, my God. What am I doing?

I feel like I'm driving off to my execution.

[CHUCKLES]

Oh, my gosh.

My first MRI in 1995

was physically and emotionally traumatic.

So, it's never easy for me to return for another one.

Have a good day. Good luck.

Love you. Bye.

One more blueberry for the road.

I had one final stop on my journey.

My consultation with Dr. Vijay Yadav.

A neurologist who recognizes the potential

of lifestyle in managing multiple sclerosis.

I was looking forward to what she had to say,

but also nervous about what my latest MRI would show.

-VIJAYSHREE YADAV: Oh, my God. Hi. -STANCIC: Oh, my God.

It's so nice to meet you.

-So nice to see you. -Oh, my gosh. I brought you some films.

Oh, very nice.

This is 1996.

[SOMBER MUSIC PLAYING]

YADAV: I'm looking at...Maybe you had someenhance adhesion there actually.

Let me just pull up this image here.

This is a brain MRI that I just had done a couple of weeks ago.

Mm-hmm.

These white spots, they're not normal.

STANCIC: So that's a lesion there?

YADAV: That's right. So, this one and this one.

It's just like a residual...

STANCIC: There is evidence of old scars and lesions from my past.

YADAV: It's not causing any damage,

-but nothing to be worried about. -Okay.

STANCIC: I was relieved to learn there were no new lesions.

YADAV: So, 21 years into your disease process,

I would say you've done very well.

-I think it looks very positive. -Okay.

I mean, again, it's all about the unpredictability in MS that we see,

-you know, nobody can say... -We don't know.

I think you're fine based upon this MRI,

plus how you've done.

There's a huge component of what we do to ourselves.

Lifestyle medicine, plant-based medicine.

You can continue what you're doing

as long as you're being monitored.

STANCIC: It was amazing to hear a neurologist tell me

to continue what I was doing.

I'm not cured. I mean, I live with MS,

but I manage it by taking really good care of myself.

Every single day I meditate.

Every single day I exercise.

Every single day I eat optimally.

I am so grateful to be here.

Now more than 20 years since my diagnosis,

and I am medication-free, disability-free,

and empowered more than ever before

to share my healing message with the world.

This is something that has been talked about since the inception,

I think, of ACLM back in 2004.

The long awaited, long anticipated

certification in the field of lifestyle medicine.

[AUDIENCE APPLAUDING]

STANCIC: For me, Amy is an extraordinary story.

She's not only applied these things to herself,

but now, she is sharing this with her patients.

AMY: Patients who come in with gallbladder disease,

with constipation.

I treat a lot of hemorrhoids,

and so I have always said

to use an over-the-counter fiber supplement.

And, I'm never gonna say that ever again.

I'm gonna say you can.

However, I'm gonna show them

how to get fiber into their diet,

so I have a lot more to say to my patients now.

I joined the American College of Lifestyle Medicine,

and this coming fall I plan on sitting

and becoming board certified in lifestyle medicine.

WOLFERZ JR.: I wanna welcome everyone to our kickoff event

for a Walk with a Doc, Newark.

It took a long time, a good year that we were working on this.

We knew this was such a great program.

We need this in Newark.

WOMAN: We need to think about prevention

starting in our communities.

Your persistence is inspiring,

and I'm getting emotional.

With leaders like you guys, the future's so bright.

BAUTISTA: My dream is to come back to Rutgers Medical School

and be a professor in a lifestyle medicine department,

training the next generation of physicians to do this.

-[BOTH LAUGH] -They don't know it yet

but that's my little secret goal.

KELLY: I have a ten-year-old son,

and I would do anything to stay healthy for him.

Hi, I'm Charles, and I'm making vegan crepes.

Really it would be eggs,

but we're using flaxseed instead.

She has MS, and she's doing that,

that way she can stay healthy and have a good life.

KELLY: That's good enough. That's good.

STANCIC: Family support is crucial to patients

who are making changes to their lifestyle.

Because if they don't have the buy in

from the people around them, it can become very challenging.

But often the patient's family

also makes changes in their diet and activity.

They benefit, too.

Good.

STANCIC: I've seen Kelly evolve

to where she is today.

Um, confident.

Um, positive.

Uh, empowered.

And I want that for all of my patients.

KELLY: I felt very powerless with this diagnosis,

and Dr. Stancic has given me power.

All right.

I have power over my life,

over my health, over my MS.

STANCIC: Oddly enough,

I am grateful to my MS

as it served to awaken something within me

that I now hope will serve others.

I am grateful every day

for Dr. Stancic sharing her story.

Because if she hadn't shared it,

I don't know where I would be today.

I am happy and healthy which is ironic

that it took the diagnosis of MS

to get me to where I am today.

STANCIC: Our mission to change the medical culture

of our doctors, patients and academia

is still far from over, but we are well on our way.

I'm proud of the strides our field has already made.

It's illustrated by the work of the many experts

we visited on my journey.

-And then, put in good soil on top. -Okay.

Every day, I witnessed examples

of this growing movement on full display.

-Start right up, I'll try to do it. -What a smart guy.

STANCIC: Undeniable mounting evidence

that progress and awareness

is spreading across our country and beyond.

We have this huge lapse in medical education,

and we believe the solution is lifestyle medicine.

It should be the foundation

on which we build everything else.

Medicine as we know it today is going to become extinct.

The conversation has shifted.

Changes are seen in society now.

More plant-based options, more information out there.

We're reaching a tipping point.

MAN: Tomorrow morning,

we have yoga by the lake at 7:00 a.m.

BARNARD: It's our time.

I think it's our time

because we have more tools than ever before.

I think it's our time because young people are getting excited.

I think it's our time because we have no choice.

It is up to each of us to make our own decisions

as to what to eat and how to live.

We should make these choices consciously educating ourselves

about the predictable consequences of our actions.

MCMACKEN: You have the power.

You actually have the power. It's in your hands

to prevent diabetes, to prevent heart disease, to prevent cancer.

ESSELSTYN: I want to end the day with a Tibetan proverb.

Eat half, walk double,

laugh triple,

and love without measure. Thank you.

[AUDIENCE APPLAUDING]

STANCIC: I'm not saying changing your diet

is going to cure all your ailments.

Or that we need to throw away all the medications,

and all the proce...

all those amazing advances that we have in medicine.

That's not what I'm saying.

Lifestyle is important for anybody

whether you're healthy,

whether you're old, whether you're young.

We should all be eating in a healthful way.

We shouldall be incorporating physical...

No matter where you are on that spectrum or where you...

It's going to benefit you in some way.

It was more than 20 years ago when doctors predicted

that I'd likely be in a wheelchair by now.

I'm glad I found it within myself

to prove them wrong.

STANCIC: Diet, nutrition, exercise, stress,

all the things that we talk about

in lifestyle medicine are relevant,

and that's what all the experts have told us, right?

But what I believe to be true is that

if physicians change,

then we all change.

Healthcare professionals, because we are

the representatives of health in the community.

That catalyst, that first domino...

is medicine, physicians,

because that's what... that's what we're here for.

We have to be expert

in diagnosing disease and treating it,

and we have all this technology and advances, that's wonderful.

But my goodness, if we could potentially...

We know that we could potentially prevent

80 percent of chronic disease,

that has to be our primary initiative.

We can all do this. We can do this in our little offices.

We can do in our communities.

We can give a little lecture in the local library

but spread this message.

You don't have to be vegan.

You don't have to, like, run a marathon.

Just do this.

Eat more plants.

Move. Breathe.

Slow down. Simple things, right?

We're addressing our diet.

We're addressing our physical activity.

We're addressing our stress.

Breathe. Slow down.

We can start a movement by just small things.