How Healthy Lifestyles Increase Lifespan

Transcript Generated by AI.

Announcer: 0:00

Welcome to MedEvidence, where we help you navigate the truth behind medical research with unbiased, evidence-proven facts Hosted by cardiologist and top medical researcher, Dr. Michael Koren.

Dr. Michael Koren: 0:11

Hello, I'm Dr. Michael Koren, the executive editor of MedEvidence! And I'm really excited about the conversation I'm about to have with Dr. Michael Greger, who is the founder of NutritionFacts. org and he and I are going to talk about his path to becoming a guru on nutrition, a medical guru with his background as a physician, and also talk about how evidence-based medicine impacts nutritional research and science. So, Dr. Greger, welcome to MedEvidence! Thank you for coming on.

Dr. Michael Greger: 0:45

Thanks so much. I'm honored to be here.

Dr. Michael Koren: 0:53

Well, I'm excited about this conversation. So, as you know, we have a lot of physicians who look into our podcast and other people in the healthcare industry, and there's a lot of interest on the career path of physicians. So tell us a little bit about your background where'd you grow up, how you got involved in being focused on nutritional issues and, ultimately, how you developed this very important website.

Dr. Michael Greger: 1:11

You know it all started actually with my grandmother. I was just a kid when my grandma was sent home in a wheelchair to die, essentially. She had end-stage heart disease, already had so many bypass surgeries, basically, you know, get so scarred up inside there's nothing more they could do, confined in a wheelchair, crushing chest pain. Her life was over at age 65. But then she heard about this guy, Nathan Pritikin, one of our early lifestyle medicine pioneers, and what happened next is actually detailed in Pritikin's biography Talks about Francis Gregor, my grandmother.

Dr. Michael Koren: 1:44

Really, oh wow,

Dr. Michael Greger: 1:45

They wheeled her in and she walked out.

Dr. Michael Greger: 1:48

She was given a medical death sentence at age 65, thanks to a healthy diet, was able to enjoy another 31 years on this planet

Dr. Michael Koren: 1:56

Wow

Dr. Michael Greger: 1:57

To age 96, to continue to enjoy her six grandkids including me

Dr. Michael Koren: 2:02

Wow

Dr. Michael Greger: 2:03

That's why I went into medicine. That's why I went to lifestyle medicine, why I started nutritionfacts. org, why I wrote the book How Not to Die, why all the proceeds from all my books are all donated directly to charity. I just want to do for everyone's family what Pritikin did for my family.

Dr. Michael Koren: 2:23

Wow. Well, that's a very compelling story. Thank you for sharing that. So tell me about your medical training. What path did you choose for medical training?

Dr. Michael Greger: 2:34

So I actually started agriculture undergrad, then went to Tufts Med and just did a transitional year at the Lemuel Shattuck Hospital, which is a public health hospital Tufts affiliated in Boston, before starting general practice and then very quickly realized I could actually reach you know how many people can you reach in a day? So started a I was going to say DVD series, series, but actually back then it VHS tapes. Then then, video series and then, finally started traveling around the country to kind of to teach the teachers. My goal was to hit every single medical school every two years to reach all the pre-clinical students. So spent years on the road talking about lifestyle medicine, um, before realizing that that was an unsustainable lifestyle. I was living on my car, I was, you know, so then, uh, finally, thanks to the Internet, I was able to put my work online and so you know reach, you know, eventually, millions of people with this life changing, life saving information.

Dr. Michael Koren: 3:55

So that's super interesting. So let me make sure I understand. Did you do a traditional residency or you just skipped all that residency, or you just skipped all that?

Dr. Michael Greger: 4:02

just a transitional year.

Dr. Michael Greger: 4:03

So in 28 states. You can practice as a general practitioner, just with the transitional year. I was originally actually going to do a public health residency at UMass but realized that I didn't think that would give me the skills I needed to spread the message that I really wanted to, which is that we have tremendous power over our health destiny and longevity, and that the vast majority of premature death and disability is preventable with a healthy enough diet and lifestyle Interesting.

Dr. Michael Koren: 4:37

Do you see patients now or are you just

Dr. Michael Greger: 4:39

no, no.

Dr. Michael Greger: 4:40

So I give up my clinical practice. Oh God, decades ago now. So it's all writing, research, speaking, trying to reach as many people as possible

Dr. Michael Koren: 4:50

Fabulous.

Dr. Michael Koren: 4:51

So interesting. So Pritikin was certainly an interesting person and certainly a pioneer on developing programs to help people really change their trajectory through better lifestyle. As I recall, he was an engineer.

Dr. Michael Koren: 5:08

He wasn't a medical person initially.

Dr. Michael Greger: 5:10

Exactly.

Dr. Michael Koren: 5:11

and kind of self-taught person but certainly evangelical in his beliefs of getting the word out. And this gets into a discussion of evidence-based medicine. And the fact is that there have been some conflicting signals when you actually try to do randomized trials in diet, but the epidemiology is so clear that people and cultures that eat better live longer. It's pretty straightforward. My favorite fact to quote is why do Italians live three years longer than Germans, even though Germans make more money than Italians and have more health care resources? And it's got to be lifestyle, wouldn't you agree?

Dr. Michael Greger: 5:58

Yeah, Well, that's where Pritikin, the evidence-based Pritikin, worked off of to come up with his heart disease reversal program was based on studies by Dr. Dennis Burkitt, one of our leading luminatries in medicine, who early in the last century was part of a group of evangelical doctors. he went to subsaharan Africa and opened up hospitals, kind of like the Albert Schweitzer's of the world.

Dr. Michael Greger: 6:30

And what really struck him is that many of the diseases, the epidemic diseases we were dying from, in the Western world practically didn't exist. So epidemics of heart disease and type 2 diabetes and obesity and colorectal cancer and diverticulosis. And so they actually started these African medical journals to kind of compare notes and what is going on. Why is there a hundredfold difference in some of these disease rates around the world? And you can follow that up with migration studies where you know it's not just kind of genetic differences but when people migrate to new areas they acquire the diseases of people who live and eat in that new area. And that's really what led Pritikin to be like well, what if we put people on the diet, followed by populations that don't get epidemic heart disease, in hopes of maybe slowing the disease down, when in fact you realize that you can even halt the progression, even perhaps reverse the progression of heart disease, which later demonstrated in a randomized control trial by Dr. Dean Ornish in the famous Lifestyle Heart Trial published in 1980 in the Lancet.

Dr. Michael Koren: 7:46

Yeah, yeah, yeah. The Ornish study is super fascinating Again a randomized trial that showed actual disease regression in coronary disease patients. Now it wasn't a huge number it was like 4% as I remember but it's really the first time that anybody was able to show any regression, so that was certainly a breakthrough trial, really really neat. The other trial I'm really curious about your perspective on this. So I still practice cardiology and I like to tell my patients that the diet is extremely important.

Dr. Michael Koren: 8:19

Sometimes it's hard to get simple, impactful advice to patients, but one of the things I do like to tell them is that there is pretty strong evidence that eating fish multiple times per week has some benefits. And some of the fish oil studies have had results that are at first glance in discrepancy with one another, but I think there's an overall again epidemiological trend that fish eating is good. And then there's the DART study, which is a randomized trial of giving people the advice to eat fish. That actually showed a 29% reduction in mortality in patients after a myocardial infarction. On the other hand, the follow-up study that was looking at-

Dr. Michael Greger: 9:00

-DART 2!

Dr. Michael Koren: 9:05

Yeah, DART 2 didn't show the same thing. So I was really curious about your comments on that. And how do you contextualize all that information? That can be really really complicated for people.

Dr. Michael Greger: 9:13

Yeah, people seem to forget about DART2, but certainly DART1 launched this billion dollar fish oil industry. If you look at the latest Cochrane review, we don't have good evidence that either advice to eat fish or fish oil substantially affects cardiovascular disease rates. So it may be more confounding. I mean, who eats fish?

Dr. Michael Koren: 9:39

I love it.

Dr. Michael Greger: 9:56

People who are. You know it's like when you're on an airplane you want chicken or fish. Well what are people not eating instead? And so they may be eating less red meat, processed meat, if they are eating more fish. And may have other confounding lifestyle factors that they just may be generally more healthy.

Dr. Michael Koren: 10:03

So you would argue that the eat fish advice may have been beneficial in certain randomized trials because you're taking away things that are toxic. Is that what you're saying?

Dr. Michael Greger: 10:15

Well, certainly, yeah. I mean, the fundamental question in nutrition is really compared to what? So if you ask the question, you know, is fish healthy? So well, what would you be having instead? Right, food is a zero-sum game, right? Every time we put something in our mouth, there's an opportunity cost a lost opportunity to put something even healthier in our mouth. And so is fish healthy? Well, I mean, is a tuna fish sandwich healthy? Well, compared to a bologna sandwich? Absolutely. But compared to something like hummus, for example, I would argue that not necessarily. So Same thing, look, eggs. Are eggs healthy compared to a breakfast sausage? Absolutely. Compared to oatmeal no. So we can always kind of ratchet up the healthiness on a day-to-day basis. Of course, it doesn't matter what you eat on your holidays, birthdays, special occasions, but on a day-to-day basis, you really should try to eat healthy, which means centering our diets around whole foods from fields, not factories, unprocessed plant foods really probably are healthiest choices.

Dr. Michael Koren: 11:17

Got it Very interesting perspective. So patient comes in and they're ready to make some changes in their diet, but they have a typical American diet, so break down your approach on how you would help that person. Those people, by the way, are listening as we speak, so talk to those people out there that are ready to go to their fast food joint and get their burger with bacon which I get the willies when I think about that, but that's what people do. But they're ready. They're ready to roll, they're ready to do something different. How do you advise them?

Dr. Michael Greger: 11:56

I think it really depends on the psychology of the various individuals. Some people have a very kind of black and white thinking all or nothing and it's actually easier for them to make more kind of dramatic changes. But I think for most people it's a matter of, you know, slowly edging out some of the least healthy choices and kind of crowding out by adding healthy foods to your diet. I mean, I think people, you know, when I was practicing, people had the sense that I was, you know, ready to take away some of their favorite foods and are surprised when I say no, no, I want you to add healthy foods to your diet in hopes, by the end of the day, they just don't have enough room for some of the less healthy choices. So encourage people.

Dr. Michael Greger: 12:34

Eat, you know, berries every day, the healthiest fruits, greens every day, the healthiest vegetables, legumes, beans, split peas, chickpeas and lentils. That is the kind of protein centerpiece of all the blue zones around the world, these areas of exceptional longevity. According to the Global Burden of Disease Study, the largest study of risk factors in human history for death and disease, legumes appear to be associated with the greatest life expectancy gains, and that may be a combination of what they would the protein sources they would be eating instead. But so if I could just have people eat those three things, I think that would go a long way towards people eating healthy. And if there were just three things I would first remove from someone's diet. It'd be trans fats anything with partially hydrogenated vegetable oils removed from the US food supply but still contributing to hundreds of thousands of deaths around the rest of the world.

Dr. Michael Greger: 13:24

Number two processed meat bacon, ham, hot dogs, lunch meat sausage. We know these foods cause cancer, colorectal cancer, the number one cancer killer of non-smokers. And number three sugar sweetened beverages. You know, liquid candy. We really shouldn't be consuming our calories in that way.

Dr. Michael Koren: 13:42

Yeah, and that's super helpful.

Dr. Michael Koren: 13:43

Repeat the three things that we should eat, just to be clear for the audience.

Dr. Michael Greger: 13:48

Beans, greens and berries. And removing trans fats, processed meat and soda.

Dr. Michael Koren: 13:53

Perfect. That's very succinct advice. It's terrific. So tell us a little bit about your website and how's it going. Are you getting the traction that you're looking for? What are the reactions? How does it help people?

Dr. Michael Greger: 14:09

So Nutrition Facts is a free, nonprofit, science-based public service providing daily updates on the latest in nutrition research via bite-sized videos. Now over 2,000 videos on nearly every aspect of healthy eating, with new videos and articles uploaded every day. The latest in evidence-based nutrition what a concept at Nutrition Facts. org. It's interesting. The traffic's actually down and it's because we're getting less organic searches thanks to the Google AI technology um blurb. So normally when someone looks you know what can I eat for migraines, or how do I cook a sweet potato or anything like that, you know we, um, you know we've been around for so long that you know we often you know uh, are in that first page of results. But now we have this little AI blurb which kind of goes directly, so no one has to keep clicking and watching videos, and so I think that's actually kind of undermined our ability to reach people. But having said that, sometimes the AI blurb actually quotes something on our website, so that helps as well.

Dr. Michael Koren: 15:18

Well, that's super interesting. I think there's a lot of insight to that is, with these kind of AI descriptions, some of the work is taken away, but there may be unintended consequences of that, in fact directing you to certain places for whatever reasons, and that can certainly impact your reach and business model. So interesting. So I have a question for you what study would you design or what do you have in mind for looking at an issue that you're very passionate about? If you could design a clinical trial and get it funded, what would that look like?

Dr. Michael Koren: 15:59

I'm curious about how you're thinking and for our audience as well.

Dr. Michael Greger: 16:04

You know, when it comes to nutrition, I think the controversy is less about science and more about the compliance I mean people. Just, you know, too often you know, we physicians have this kind of patronizing attitude that our patients aren't, you know, willing to make changes in diet and lifestyle. But I think what can be most motivating is are these kind of disease reversal, you know, when you're looking at, you know, high blood pressure, type 2 diabetes the fact that you can put someone in a healthy enough diet and actually, um, reverse the course of the disease. I think that excites people more than prevention, unfortunately. I mean prevention the best, but prevention is not sexy. Prevention works. Nothing happens. It's very difficult to motivate people. So I mean the disease reversal studies I'd love to see there was just this Plants for Joints trial on both osteoarthritis and rheumatoid arthritis in Europe Really exciting results.

Dr. Michael Greger: 17:04

You know these are some of the, you know, osteoarthritis leading cause of physical disability among older adults and you see significant improvements in, you know, number of tender and swollen joints. You know quality of life, a significant improvement in pain, just by switching someone's diet and so-.

Dr. Michael Koren: 17:24

-was that randomized, controlled or?

Dr. Michael Greger: 17:26

Randomized controlled trial.

Dr. Michael Koren: 17:31

Wow

Dr. Michael Greger: 17:32

So I mean. So those are the most kind of exciting. So yeah, RCTs on disease reversal, I'd love to see so there's. There's been such studies on, you know, migraines and PMS, and-

Dr. Michael Koren: 17:51

-so for migraines that's a common complaint

Dr. Michael Koren: 17:55

What is the dietary solution for that? We talk about caffeine and things like that as a dietary solution, but educate us a little bit more on that.

Dr. Michael Greger: 18:04

Yeah, so certainly there's. Many people with migraines do have dietary triggers. So one can do kind of an exclusion diet and then slowly add back some of the foods that are more common triggers to see if they're indeed are lucky enough that there is indeed some kind of food sensitivity that they can then eliminate. In terms of treatment, though, ground ginger, 1/4 teaspoon of ground ginger that you can buy at any store compares well to some of the abortive migraine treatments that we would normally prescribe for reducing pain duration and so something like that, where it's just like you know you never there's no, there's no, you know big ginger isn't out there, it can't put ads on TV, but these kind of safe, simple, side effect free solutions can sometimes be quite potent and compare favorably to you know, something an NSAID, NSAID um, ibuprofen which is uh lots uh of- potentially be uh um rare cases.

Dr. Michael Koren: 19:21

That's great. Well, Michael, this has been a fabulous conversation. Any, any parting words for our audience or anything, um anything you think is important for people to hear as a take-home lesson.

Dr. Michael Greger: 19:32

I think it's important that one need not make drastic changes. It's not all or nothing. Even basic common-sense lifestyle behaviors can mean living a decade longer not smoking, not being obese, regular exercise, more fruits and vegetables. You know, it's never too late to stop smoking, never too late to start moving, never too late to start eating healthier. We really do have the power.

Dr. Michael Koren: 19:55

So, Michael, I'm really curious to ask you do you feel like people need a strict vegetarian diet to get their maximum health benefits?

Dr. Michael Greger: 20:04

We should try to eat primarily plants, not necessarily exclusively plants. A plant-based diet is really more just about maximizing the intake of the healthiest foods. Right as a physician labels like vegetarian, vegan, that just tells us what people don't eat. I mean, do you actually eat vegetables?

Dr. Michael Greger: 20:21

If you look at the Blue Zones food guidelines, for example, which is based on more than 150 dietary surveys of the world's longest living populations. They recommend eating at least 95% plant-based, but that could include 100 calories of animal products a day. So like a tablespoon of butter every day, a container of Greek yogurt, a third of a lamb chop or something. So really meat seen more as a condiment or flavoring rather than a big chunk at the center of the plate.

Dr. Michael Koren: 20:47

That makes sense. My other question is what are your views about the use of less than high levels of alcohol? There's some controversy about whether or not people who are light to moderate drinkers are at health risk, balancing cancer risk versus potential cardiovascular benefits.

Dr. Michael Greger: 21:05

Yeah well, everyone agrees that heavy drinking, drinking during pregnancy and binge drinking bad ideas. But there's been this controversy about moderate drinking, not with regards to cancer, but since cancer is killer number two, heart disease killer number one, and we thought there might be some benefit. That's why there hasn't been a stronger public health message against drinking. Those who live the longest tend to not be abstainers, but those who imbibe a few drinks a week. Unfortunately, this appears to be an artifact of the so-called sick-quitter effect arising from the systematic misclassification of former drinkers as lifelong abstainers. It's the same reason. You can find studies that find higher mortality rates among those who quit smoking compared to those who continue to smoke. It's not that abstention led to poor health, but rather poor health led to abstention. So you know, according to the Global Burden of Disease Study of the World Health Organization, the World Heart Federation, the safest level of drinking is none. You know, grapes, barley and potatoes best eaten in their non-distilled form, and Johnny Walker, no substitute for actual walking.

Dr. Michael Koren: 22:08

Michael, thank you for your insights. I truly enjoyed it. Thank you for educating me and thank you for being a guest on MedEvidence.

Dr. Michael Greger: 22:16

I'm honored. Keep up the great work.

Dr. Michael Koren: 22:18

Thank you. MedEvidence.

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