All language subtitles for Code.Blue.2020.1080p.AMZN.WEBRip.AAC.x264-NOGRP_Track03

[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]

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Make sure prior weather shift
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Flight attendants at this time, prepare the cabin for landing.

-[PA SYSTEM BEEPS]
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We will ask you to put away your devices in a few moments.

Small, handheld
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[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.