Introduction to Lifestyle as Medicine
The evidence supporting this approach to medical care, which addresses the underlying causes of medical diseases, is overwhelming. When Dr. Evans started this journey to find a better approach, he was both overwhelmed by the volume of literature and disappointed that it was unknown to those who did not actively seek it out.
The literature dates back all the way to the 1600’s. Presently, there are over two million patient years of data to support the FACT that most chronic illnesses are predominantly preventable, and some are can even be reversible. The first large studies published in this regard are “The Nurses’ Health Study” for women and the “US Health Professionals Study” for men along with hundreds, if not thousands, of randomized controlled studies showing that if people adopt a cluster of positive practices including keeping a healthy body weight with regular exercise, avoiding tobacco, and eating a diet consisting predominantly of whole grains, fruits and vegetables, this Lifestyle Medicine Approach can make some very bold claims including more than 80% reduction and reversal of Coronary Heart Disease (CAD) and vascular disease in general, 90% reduction in Type 2 Diabetes Mellitus, 90% of Alzheimer’s disease, and 60% of all causes of cancer.
It has been estimated from these data that eight million lives would be saved worldwide every day just from changing from the Standard American Diet (meat and fat based) to a whole-foods, plant-based diet, and becoming less sedentary. The evidence is so overwhelming that Medicare and commercial health insurances are now paying for “intensive lifestyle intervention” (see below) in select patients. For those sceptics who have not read the data, these same insurance carriers do not recognize meat-based diets as promoting good health.
We live in an era where our children are exposed to an estimated 10,000 hours of TV time between the ages of 5 and 15. During this time, they are the target for market for unhealthy products such as pizza, sodas, burgers and countless other unhealthy foods, which seem to be balanced by ads for drugs to combat the diseases caused by these foods. The healthcare industry is driven by the almighty dollar and is not apt to change from its disease control stance using pharmaceuticals and interventional procedures any time soon. There is no incentive to put fewer patients in the hospital or to perform fewer cardiac interventions until insurance stops paying large fees for these services. This whole new lifestyle paradigm will not come without some pushback from both industry and patients.
To put some perspective on this conversation, the healthcare industry represents 20% of the total US gross domestic product (2-3 trillion dollars yearly), and these kind of dollars carries a lot of political influence. This current system is not sustainable when treating childhood obesity, diabetes and heart disease, which double in numbers every two decades. Our attitude at The Institute is that we cannot fix the world all at once, but we can focus on our patients one at a time, and eventually the masses will shift.
What foods are we designed to eat?
The consensus from paleoanthropologists to nutritional experts around the world is that we are not genetically designed to be carnivores. We do not have large canine teeth to tear into flesh, and, for most of us, we do not have the desire to do so. Also, most carnivores are small, sleek and fast. Additionally, we are ill equipped with other essentials for hunting like a sensitive nose to catch a scent, and the acute vision and hearing to detect prey. We do not have good sharp claws and teeth, speed or the senses to be a good predator. Let’s face it, the average American would never be able to chase prey and kill them without modernized weaponry.
Homo sapiens (humans) began eating meat two-million years ago in the Stone Age by scavenging. However, all the evidence shows that Homo sapiens have been around for 200 million years. As a result, 99% of our genes and our ability to metabolize foods are from the pre-stone age era. When we eat plant foods, our arteries begin to open, plaque starts to disappear, and blood flow is restored; diabetes starts to improve; weight starts to come off; and health recovers. Americans eat more than a million chickens alone every hour – and every American eats 190 lbs. of meat per year. On television, we are blasted with propaganda ads from the animal-based industry, and the other half of the ads are for drugs that treat the diseases that animal-based foods cause. Interestingly, when herbivore animals are forced to eat animal products, they developed diabetes and arterial disease. However, these diseases are virtually unheard of in carnivores.
Recently, Dr. Joel Kahn (a popular integrative cardiologist) has outlined the 6 pillars that support a plant-based diet over an animal-based diet.
- The 2015-2020 Dietary Guidelines are published every 5 years from the Federal government and the USDA. This agency translates the latest science into a pattern to help people choose foods for healthy diets that reduce chronic diseases. Although vegetarian dietary patterns were mentioned in the 2010 Guidelines, the 2015-2020 edition placed this eating pattern free from all animal products on a lofty pedestal for health promotion. In the Federal guidelines, soy, legumes, nuts, seeds and whole grains were increased, while meat, poultry, and seafood were eliminated.
- The Academy of Nutrition and Dietetics Position paper incorporates the consensus of over 100,000 nutritional professionals and serves as a strong endorsement for the use of plant-based diets for our health and the health of our planet. They reported that these diets were healthy for the prevention and treatment of certain diseases and were appropriate for the young and old alike (including pregnancy). They also report that plant-based diets are more environmentally sustainable than diets rich in animal products because they use fewer natural resources and were associated with much less environmental damage.
- The US Government: The Center for Medicare and Medicaid Services (CMS) has analyzed all the available scientific literature and after exhaustive consensus, now reimburses medical practitioners for “Intensive Cardiac Rehabilitation” under the condition that they use plant-based diet programs (the Ornish Diet preferred) in conjunction with exercise for cardiac patients. No other diet patterns were endorsed for this population.
- “US News and World Report” prints a yearly publication that ranks various diets for health using various dietitian experts. Year-after-year, the best heart diet selected is the Ornish Diet based on plant selections. This diet can also be tailored for losing weight, preventing and reversing diabetes, lowering blood pressure and cholesterol and preventing and treating prostate and breast cancer.
- Kaiser Permanente, one of the largest not-for–profit health and hospital system in the world with 11 million members and 17,000 physicians are recommending a whole-food, plant-based diet to all their patients with a guide to get started. They strongly discourage dairy, meats, eggs and processed foods.
- Oxford University pooled 95 studies involving 2 million study subjects finding that a diet rich in fruits and vegetables was associated with a 24% drop in heart disease, 33% drop in stroke, 14% drop in cancer and an impressive 31% drop in death from all causes. They estimated that up to 8 million people a year would avoid death worldwide if they adopted this habit.
- EAT Lancet is a 47-page document which has just been published. It was developed over 2 years by 37 experts from 16 countries addressing food, health and the planet, specifically addressing how to feed the expected 10 billion people expected to be living in this world by 2050. Their headlines state that “for the first time in human history, we are severely out of synchronization with the planet and nature.” It reports that the diets that the world has been eating for the last 50 years are not only not nutritionally optimal but are accelerating erosion and natural biodiversity. They recommended an urgent, dramatic dietary shift with reduction in the consumption of unhealthy foods, such as red meats, by at least 50% in the next 30 years.
- Canadian 2019 Food Guidelines has just been published and describes a food plate with a glass of water (instead of milk). Half the plate has vegetables and fruit, one quarter of the plate has protein foods (mostly plant-based), and one quarter of the plate has whole grain food. Overall the guideline called for a shift away from dairy and more plant proteins like beans, soy and lentils in place of meats. They went on to mention that a) Healthy eating is more than the food you eat. b) Being mindful of your eating habits and choice. c) Cooking more often. d) Enjoying your food. e) Eating meals with others. f) Reading and using food labels. g) Limiting foods high in sodium, sugars and saturated fats, and h) Becoming aware of unhealthy food marketing.