Understanding Lifestyle Medicine From the Heart

Convincing Doctors to Embrace Lifestyle Medicine

I talk a lot about numbers and statistics, but as the Director of Yale’s Prevention Research Center Dr. David Katz put it in an editorial in the American Journal of Health Promotion, to reach doctors, our fellow colleagues, maybe we need to “put a human face on it all.”

We have known, for at least a decade that the “leading causes of both premature death and persistent misery in our society are chronic diseases that are, in turn, attributable to the use of our feet (exercise), forks (diet), and fingers (cigarette smoking). Feet, forks, and fingers are the master levels of medical destiny for not just thousands of people on any one occasion but the medical destiny of millions upon millions year after year.”

We as doctors, as a medical profession have known—Ornish published his landmark study 25 years ago (See Our Number One Killer Can Be Stopped). “We have known, but we have not managed to care,” writes Dr. Katz. At least not care deeply enough to turn what we know into what we routinely do.” Were we to do so, we might be able to eliminate most heart disease, strokes, diabetes, and cancer.

But saving millions of lives is just a number. He asks doctors to:

“forget the bland statistics of public health, and ask yourself if you love someone who has suffered a heart attack, stroke, cancer, or diabetes….Now imagine their faces, whisper their names. Recall what it felt like to get the news. And while at it, imagine the faces of others like you and me imagining beloved faces. Now imagine if eight out of ten of us wistfully reflecting on intimate love and loss, on personal anguish, never got that dreadful news because it never happened. Mom did not get cancer; dad did not have a heart attack; grandpa did not have a stroke; sister, brother, aunt, and uncle did not lose a limb or kidney or eyes to diabetes. We are all intimately linked, in a network of personal tragedy that need never have occurred.”

Which leads to what he is asking doctors to do about it: put a face on public health every chance you get. “When talking about heart disease and its prevention—or cancer or diabetes—ask your audience to see in their mind’s eye the face of a loved one affected by that condition. Then imagine that loved one among the 80% who need never have succumbed if what we knew as doctors were what we do.”

“Invoke the mind’s eye,” he advises, and “then bring a tear to it.” (See Convincing Doctors to Embrace Lifestyle Medicine).

I think I’ve only profiled one other editorial (Ornish’s Convergence of Evidence), but this one really struck me, so much so I used it to close out my live presentation, More Than an Apple a Day: Combating Common Diseases.

Why don’t more doctors practice lifestyle medicine? Two theories are offered in The Tomato Effect and Lifestyle Medicine: Treating the Causes of Disease.

For more on the power of our day-to-day choices, see:

-Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my videos for free by clicking here and watch my full 2012 – 2015 presentations Uprooting the Leading Causes of Death, More than an Apple a Day, From Table to Able, and Food as Medicine.

Image Credit: Maia Weinstock / Flickr

  • I feel this way of educating people will get more people to listen because they want to take action. I’m no doctor, but I wish I could spread awareness easier without coming off as preachy.
    I also I like the photos you pick.

    • It is hard to advocate for change in others. I mostly get away with it as a physician when patients or others open the door with questions about disease or disability. You can lead by example… a good form of teaching. Another thought is to direct others to this website or other commercial free websites such as Physicians Committee for Responsible Medicine or Dr. John McDougall.

      • Dr. Forrester,
        Thank you for your feedback! I have shied away from directing others to the hard facts (in thought they might not read anything) but I think it’ll be super beneficial to share with them, these two sites.

  • Brigitte

    Thanks Dr Greger for sharing this so useful idea: put a face on a problem, so it triggers the emotion that has a chance to lead to action! Beliefs and habits are so hard to change. We need a good strategy to lead our patients to change instead of resistance.

  • Sylvia

    Although this idea is excellent, I’ve frequently wanted to write to remind you that there are many of us, myself included, who despite being a vegetarian for most of my 53 years, exercising regularly, never smoke or drank alcohol or used drugs, still have been diagnosed with cancer multiple times.
    My belief is that we must look more closely at the environment and how all of our collective actions to harm it only harms ourselves. “No man is an island, entire of itself” . Nutrition is one small piece of the health puzzle.

    • Rita

      Sylvia, when you say you have been a vegetarian for most of your life does that mean you eat some animal protein?

      • sylvia

        None, no dairy, no animal products at all. I ate animal products as a child because I had no choice.

        • tkramer

          Hi Sylvia,

          Cancer does seem to be a ‘great mystery’. My therory on it is that people with a ‘higher metabolic rate’ tend to be less prone to promoting cancer cell growth. My observation is younger people on ‘junk-food diets’ can be less suseptible, and older people on ‘healthy diets’ can have problems even though they may appear to be doing everything right.

          A high VO2Max and a very low fitness age, coupled with a 100% ‘live’ plant=based-diet (no processed vegan food) as a solution is just my therory that I am testing on myself. Time will tell.


      • Alan

        You can eat a vegan diet without eating a healthy diet. I am not saying you eat a unhealthy diet. If not doing so already try a starch based diet with fruits and veggies and just a few nuts and seeds. And if you use any added oils use them very sparingly.

    • jj

      I believe you are right about cancer and environmental factors. There are certain areas of the world that are more cancer prone than others. There are so many known carcinogens that are allowed in our food, water, air, soil, etc. Synthetic everything.

    • HeartHealthy


      It is a good thing that you have had cancer multiple times and are still with us. I hope your cancer stays under control or in remission and that you stay healthy. Can you tell us more about your diet like what you eat on weekends? Would you consider your diet to be a high fat/low carb or a high carb/low fat? Do you eat much refined grains, sweet drinks or sodas, processed foods? This is very interesting to me as I also walk your road. What would you be willing to share on your cancers and their treatments while being a vegetarian? Any info would be appreciated without getting too detailed.

    • I’m not sure nutrition is a small piece of the puzzle. I would agree we are exposed to many carcinogens. You might enjoy watching Dr. Greger’s 2009 presentation… http://www.turnx.info/Stopping_Cancer_Before_It_Starts_Flash/
      It gives a good overview of cancer and the way we can minimize our risk for getting cancer or at least slowing it down so it isn’t clinically significant in our life time. Sorry to read about multiple diagnoses of CA. Good luck.

  • Enthusiast

    I’m with Janessa. When I told my wife and kids that I wasn’t bringing processed foods into the house anymore, they just rolled their eyes. When I told them I wasn’t bringing milk or juice home, my kids stopped talking to me for a week. My oldest is morbidly obese and will binge on candy, cookies and ice cream while lamenting her weight problem. My wife tries to lose weight with low carb even though she says that her heart health scares her and she knows it’s not good for her. I cook healthy dinners and they make something else (or go out to eat).

    How do I convey to them the seriousness of their decisions? How do I convert them to a healthy lifestyle? My wife’s sister died of breast cancer 3 years ago at age 40… how much of a wake-up call do people need??

    • Thea

      Enthusiast: You are in a difficult position because your wife is not on board. I don’t know if this will help or not, but here is a recorded audio interview between Chef AJ and a woman who at one point brought her family “over”, including three children who were *very* not happy at first. You have a different situation, but maybe you can get some ideas from this talk???


      Would showing Forks Over Knives to your family help???

      My heart goes out to you. I hope you are able to make some progress.

      • Enthusiast

        Thanks, I’ll watch that. Not sure I could get them to sit thru FOK ;)

        • Charzie

          I know it’s no help at all, but your problem is universal, and how we got into this situation in the first place. I know because I was “one of them”. For me it took a diabetes diagnosis to wake me up, sad but true, and still I know others who just take their meds and go on as always, making no changes, losing limbs and life. Why? What is the trigger to make that connection? Sure wish I knew! I really think that if doctors like our beloved Dr G started presenting a stronger case for nutrition and emphasized that pills are TEMPORARY measures to help, not fix the problems. Almost everyone I know panders to their tastebuds with hardly a thought of the consequences, besides fleeting guilt sometimes. It’s a problem with so many layers! I think with all the different ideas about diet, people just tune out to all of it because it gets so confusing! If somehow we could present the truth in a united and universal way, and stop all the stupid conflict, it would help greatly! I vote we make Dr Greger president, and let him take care of it! LOL!!!

          • Matthew Smith

            Hello. There is a discussion about diabetes at this link at this site: http://nutritionfacts.org/video/amla-versus-diabetes/

            This site makes some recommendations for diabetes:
            hibiscus tea, cinnamon (one teaspoon a day of the “toxic” variety can bring blood sugar to normal), flax seed meal, amla, and beans are recommended here for high blood sugar.

            Thule has produced another list of recommendations from this site:

            Indian gooseberries (amla), .coffee, soy, flaxseeds, green tea, pulses (dried beans), chamomile tea, purple potatoes, sprouts, whole grains, vinegar, and beans.

            Some of these food can work as well as the leading prescription without the side effects.

  • stuart614

    Unfortunately the main reason doctors treat chronic diseases instead of prevent them is the same reason Willie Sutton robbed banks, because that’s where the money is. We do not have a health care system but instead have a disease management system that creates more sickness than it treats. Drugs are given which create side effects which are treated with still more drugs which create still more side effects in an endless loop. As Dr. Greger and others have pointed out, disease can be both prevented and treated with food, but that is not profitable for doctors, hospitals, drug companies, etc and the entire medical-pharmaceutical complex. What we really need is a dramatic change in the way medical schools and our medical system operate, that is, for people and not for profits. And unfortunately that would put many doctors out of business.

    • Dommy

      Well summed up.
      In other words, the ‘system’ is broken.
      Or perhaps more to the point, the people are broken.

    • Psych MD

      With all due respect, this notion that the medical establishment has an underlying, ulterior motive to perpetuate illness in order to profit is ridiculous. I have been a physician for 25 years and I assure you there is absolutely no need to drum up business. Sunday night I drove home four hours in a torrential downpour after seeing Dr. Greger in person in Camarillo, CA. (It was a thrill). The following day I was on call and accepted 21 patients to our 56 bed psych hospital, with another 10 waiting in the ER for their turn. Of the five new patients that I personally admitted, one was a pleasant, 187 lb. 55 y/o lady on 24 different medications for problems ranging from diabetes to hypertension to hyperlipidemia to coagulopathy, etc. As I reviewed with her her list of meds she knew exactly what each one was for and was adamant they all be continued. Strict adherence to an Ornish-style diet would probably eventually allow her to discontinue 90% of them. However, she had been clean and sober for 13 years and as far as she was concerned that was as much lifestyle sacrifice as she was willing to accept. There is no “big medicine” conspiracy to keep healthy life choices a secret. Is there an American alive who doesn’t know what the term “junk food” means? Yet millions choose to consume it every day. Who doesn’t understand that sugar makes you fat and smoking causes cancer?

      • John

        Psych MD,
        I agree with you that way too many eat junk food. That does not mean that much of the medical system aims for money rather than health. Why would they send people to jail who don’t use chemo and radiation when chemo is horribly expensive and 3% expensive? Just because many eat junk food doesn’t rule out ill will among the greedy. I think it’s mostly not doctors but salesmen and corporate types.
        John S
        PDX OR

        • Psych MD

          I’m having trouble understanding your sentence re: sending people to jail for not using chemo. My specialty is not particularly lucrative compared to most others, but I have never found it necessary, nor has the thought ever occurred to me to render suboptimal care to insure a continuous stream of business. We have patients literally lined up at the door waiting to get in. Years ago I knew an internist who would not accept smokers into his practice. As a result he had fewer but healthier patients. Greed obviously exists but I believe that the vast majority of physicians have their patients’ best interests in mind. For a substantial portion of our society instant gratification is a primary driving force which, unfortunately, often leads to delayed deleterious outcomes.

          • Eric Woods

            Issues regarding consent issues with minors with respect to chemotherapy (e.g. the case in Connecticut) are very much outliers. Minors are the only population [aside from those judged incompetent by a court of law, involved in the criminal justice system, or unconscious (e.g. coma)] that a court can either compel or restrict medical treatment. That is a red herring

      • There are obviously many factors that go into how broken our medical industry is in the US. I do think that physicians are contributing significantly to the problem. I think most of us aren’t aware of how we contribute to the problem. I speak to physicians regularly about chronic conditions and lifestyle interventions, over treatment and over testing. They are generally appreciative of the information. Unfortunately there is alot of momentum in the systems we work in to support the status quo. I think each physician needs to work in their own specialty to avoid over treatment and over diagnosis as well as reinforce their colleagues working in other specialties. They need to keep up with the most current science. Currently I’m going through the experience of studying to take my Family Medicine Boards for the sixth time. The only disadvantage I have is that the “correct” answers in lifestyle medicine has not caught up to the boards yet. No mention of the Nordic Cochrane Collaboration Report on the problems with routine mammogram screening for populations as opposed to indicated diagnostic mammography. No mention of the value of diet and exercise to prevent, stabilize and often cure chronic conditions. No mention of the long term adverse consequences to prescribing psychiatric medications… read Robert Whitaker’s Anatomy of an Epidemic or Peter Breggin’s Psychiatric Drug Withdrawal: A Guide for Prescribers, Therapists, Patients and Their Families. It is important for us that work in treating diabetes, arterial disease and weight issues to give the correct information to our patients and their families. We know about advising to stop smoking to minimize the risks of developing cancer. We should know that the issue with sugar is that it has a calorie density of 1800 cal/pound and understand the physiology enough to explain to patients the difference between starches (i.e.. calorie density 500), breads(i.e. 1400) and oils(i.e. 4000). Physicians need to lead the way to better population health one patient at a time. It will take a team effort. We have too many patients on too many drugs and every drug prescription requires the signature of a health care provider. We need to begin to “detox” our patients off medications through skillful counseling and the foundation for that is the best science. I encourage all physicians to subscribe to NutrtionFacts.org to keep current so they can give patients the best information and also improve their own health.

        • Dommy

          Hear, hear, Dr. Don!

  • Anna

    I really appreciate the point being made here, but the problem is that the issue is presented in a way that makes it sound as if almost no one would ever die if these lifestyle changes were made. People would still get cancer or some other disease eventually—just not as soon. It’s unhelpful and inaccurate to talk about eliminating most cancers and other lifestyle diseases, rather than increasing the number of good-quality years in people’s lives.

    I often want to share material from this site with friends, especially with regards to meat-eating, but whenever I do, this is the main criticism I get, and it leads to the core message being ignored, because the “We can eliminate most cancer!” claim comes across as zealotry, and it’s inaccuracy obscures the scientific basis for the recommendations.

    • How would you increase the number of good quality years in people’s lives if no change to the standard Western diet was made?

      If people’s bodies are “breaking down” / aging faster than they should due to a standard Western diet for example, then the quality of life will be degraded earlier.

      • Eric Woods

        That’s a tough one. One battle is making the public understand that “healthspan” is really the more relevant term rather than “lifespan.” Another is that, although up until now there haven’t been *effective* pharmaceutical interventions against aging and/or age related diseases, there are emerging interventions such as Basis by Elysium (that has 5 Nobel Prize winners on its board) that have very promising results in rodent models (their specific trick is high doses of pterostilbene and nicotinamide riboside). Basis is currently being marketed as a supplement, but their board and CEO want to start human trials very soon (at least, that’s their publicly stated intent).

        While I’m not convinced enough to drop $50/month on that product, I do eat various types of wild berries (e.g. wild (low-bush) blueberries and various others) that have among the highest concentrations of pterostilbene available in natural fruits (ug vs 10^5 more in Basis) that are just as, if not more, expensive to procure. I’m not convinced yet that nicotinamide riboside is the panacea they’re claiming it is. Mouse models have shown that it’s effective at preventing hearing loss (and/or regenerating hair cells) when administered into the middle ear (and / or systemically available for uptake into the blood supply for the cochlea). But the argument that it supplements NAD+ has not yet been borne out, even in rodent models, and even then there are no standards or baseline on what NAD+ deficiency is, how to measure it, or whether systemic administration will increase mitochondrial uptake.

        The only supplement backed by significant, real science that has demonstrated uptake by mitochondria is MitoQ. Even then, I’m skeptical that it provides the long-term benefits in humans. They are doing longitudinal studies, but that takes years.

  • tkramer

    At best, regarding health and longevity..diet is 50% of the equation.

    What every centurian has in common…

    is a large degree of daily (rural) physical activity (Okinawan’s in the 50’s & 60’s). Something that can not be achieved in the USA without…

  • Vonda Mayfield

    Janess hits a key word “preachy”. In the medical field, we come across as having all the information, “listen to me, I can help you.” Patients should feel comfortable looking at us and saying “listen to me, this is my problem and this is what I need for you to help me.” Our current stimulus for action is the experience of pain. To successfully grow lifestyle changes, make patients warriors in the battle instead of making them church members in the pew.

  • VeganVagon

    I’ve been vegan for about one year. Certainly a sacrifice but there is a lot of good food to eat. The one food I don’t eat now but consider eating is nuts. After having 2 stents I went vegan soon after I read Dr Esselstyn book “Preventing and Reversing Heart Disease”. In the book he does not endorse nuts yet I see a lot of positive research about eating nuts. I think the rational around Dr Esselstyn’s advice is to try to avoid the high fat found in nuts. So I guess the question in a nutshell, should I eat nuts?