First of all, thank you, Andrew, for inviting me here.
And I feel very honored to be here today, like all of us.
I'm going to try to cover more than 30 years of work in a relatively short period of time.
But I'm passionate about it because, you know, we tend to think of advances in medicine as
being a new drug, a new laser, something really high-tech and expensive.
And we often have a hard time believing that the simple choices that we make in our lives
each day, like what we eat and how we respond to stress and how much exercise we get and
whether or not we smoke and how much love and intimacy we have, that these simple choices
can make such a powerful difference, but they really do.
And in our studies, we've used these very high-tech, expensive state-of-the-art measures
to prove the power of these very low-tech and low-cost and often ancient interventions.
But I want to start by saying, since this particular session is on healthy desserts,
is what is it that enables people to make and maintain changes in their lifestyles and
to sustain them?
You know, there are a lot of people who think it's about fear, but it's really about joy
and freedom and pleasure are really what enable us to make sustainable changes.
It's not, you know, these false choices that people have, you know, is it fun for me or
is it good for me?
You know, I have to choose.
You know, am I going to live longer?
Is it just going to seem longer if I live healthily?
You know, those aren't the choices.
But what we're finding is that even the language of behavioral change has these, you know,
it's hard for me to go out to dinner with someone without, you know, they're either
apologizing for what they're eating or commenting what I'm eating and then, you know, I say,
I don't care what you eat, you know, it's your business.
But the language of behavioral change has this moralistic quality, you know, I eat bad
food, so it's a very small step to saying I'm a bad person and then you might as well
finish the pint of ice cream.
Even the language that we use to talk about behavioral change of patient compliance is
such a manipulative word.
It's very fascist.
It's about forcing people to change and manipulating.
That's not sustainable either.
What's sustainable, again, is freedom and pleasure and joy.
And so the spectrum approach says there are no good foods or bad foods, but some foods
are healthier for you than others.
And to the degree that you move in a healthy direction, there's a corresponding benefit.
Whereas if it's a diet you're on, it's a diet you're going to get off.
The whole concept of diet is about what you can't have and what you must do.
And that's not sustainable.
This factor reduction just sounds boring to people.
They say, you know, I don't care if I live longer, I just want to enjoy my life.
And I say, you want me too.
That's why I make these changes.
Because when you make these changes, you feel so much better so quickly, it reframes the
reason for making these changes from fear of dying to joy of living.
And it's joy of living that's really sustainable as opposed to the cartoon where she says I
give smokers a discount because there's not as much to tell.
That doesn't work very well.
Because there's no point in giving up something that you enjoy unless you get something back
that's better and quickly.
And people often say, oh, people can't change.
You know, it's too hard.
But you know what?
People change all the time.
I mean, you probably change all the time.
How many of you have at least one child?
I'm just curious.
Raise your hand.
Was that a big change in your lifestyle?
Yeah.
Was it harder than you thought?
How many of you have more than one kid?
Did you forget?
Or were you just careless?
This is my wife, Ann, and my son, Lucas, who's been here the whole conference.
And it's the hardest thing I've ever done.
And it's the most wonderful thing ever.
We have a new four-month-old baby jasmine now because of that.
And that's the point, is that people aren't afraid to make big changes if we can help
them connect the dots between what they do and how they feel.
And so the spectrum is that idea is that all foods are included, but some foods are healthier
for you than others.
They're not good or bad.
So I've categorized foods from the most helpful to the least helpful and say, you can personalize
this.
And to the degree that you move in a healthy direction, there's a corresponding benefit.
What matters most is your overall way of eating and living.
So if you indulge yourself one day, eat healthier than next.
It's not all or nothing.
And there's a nutrition spectrum.
There's an exercise spectrum.
The more you exercise, the more you do stress management, and the more love and intimacy
you have, then the better you're off.
It's not all or nothing.
Everything is included.
And because of that, it's sustainable because it's all about freedom and joy and pleasure.
But the more you change, the more you move in a healthy direction, and the more different
things you change, the better you feel and the more objective measures we can show.
And this is what we found over and over again.
And that surprised me because I thought the younger people who had less severe disease
would be more likely to show improvement, but I was wrong.
The more you change, the better you get.
Now I've been in a lot of the diet wars over the years, but there's an emerging consensus
about what really constitutes a healthy way of eating and living.
And what I find really encouraging is that it's not just what you exclude from your diet
that's harmful, but also what you include that's beneficial.
There are hundreds of thousands of protective substances like phytochemicals and bioflavonoids
and carotenoids and retinols and isoflavones and genocene and on and on and on.
Where do you find them?
You generally find them in fruits and vegetables, whole grains, legumes, soy products, the
usual suspects.
You want to eat more of the good carbs, the unrefined carbs like whole wheat and things
in their natural forms, and avoid fewer, more of the harmful carbs.
I don't like using the bad carbs because, again, it applies to moral judgment, but the
ones that aren't as healthy for you like sugar and white flour and white rice.
You want to avoid red meat for lots of reasons.
You want to avoid the processed foods the way that Michael Pollan and others were talking
about earlier today.
You want to avoid the bad fats, the trans fats, the saturated fats and the partially hydrogenated
fats and eat more of the good fats, the omega-3 fatty acids that you find in fish oil and flaxseed
oil.
3 grams a day can reduce sudden cardiac death by up to 80 percent, can reduce prostate and
breast cancer.
If you take them when you're pregnant, it can make your kids smarter by 7 to 10 IQ points.
So if you don't remember anything else today, take 3 grams a day of fish oil, it's a really
good thing.
You want to eat fewer calories overall and especially of the simple carbs, and you want
to eat quality over quantity.
When you do, because if you pay attention to what you're eating, it's not just what
you eat, it's also how you eat.
If you can eat mindfully, if you go through a bag of popcorn while watching a movie, you
can look down the bag of popcorn's empties like, who ate this, you get all the calories
and none of the pleasure.
If you really focus on what you're eating, people like to talk about the French paradox.
To me, it's because in France, besides the fact that you're eating with a loving group
of community, and more often than not, but you're really savoring the food and really
enjoying each bite.
And then you get much more pleasure with many fewer calories if you really focus on what
you're eating.
I also want to talk about how dynamic these changes are, and part of what was really encouraging
to me is that your body has a remarkable capacity to begin healing itself, and much more quickly
if you stop doing what's causing the problem.
Your body can often begin to heal, and everything that we've been doing for the 30 years we've
been doing this work was thought impossible at the time, and we're able to show how quickly
and how dynamic these processes are and how fast your body can begin to heal.
So when you eat healthier, when you manage stress, when you exercise, when you love more,
your brain gets more blood and more oxygen, so you think more clearly, you have more energy,
you need less sleep, so you feel better very quickly.
It happens within hours, everyone's had the opposite experience, you have a big Thanksgiving
feast, you want to take a nap an hour or two later because your brain's getting less blood
flow.
Now, just 10 years ago, it was thought impossible that you only had a certain number of brain
cells, and if you went out and had a drinking binge or had a good party, you know, you're
just a few hundred thousand cells gone, you'll never get them back.
The good news is that your brain can regenerate itself, it's called neuroplasticity.
In the latest studies, we're showing that in just a few months, you can grow so many
new brain cells that your brain gets measurably bigger.
I mean, that was thought, you know, a wild idea just a decade ago.
And what's nice also is, again, what you include is as important what you exclude.
Some of my favorite foods, like chocolate and tea and blueberries, can increase neurogenesis,
whereas saturated fat and sugar are not only bad for your heart, they're bad for your brain
as well.
Modern alcohol increases neurogenesis, excessive, kills your brain cells.
Stress management can increase your brain size, chronic stress can decrease it.
Modern exercise increases neurogenesis, sedentary lifestyle decreases it.
Now, I showed this slide at the TED Talk a year ago, and I got more correspondence and
more articles about this one comment that cannabinoids can actually increase neurogenesis
than anything I've ever talked about.
I'm just a messenger here, but anyway, there it is.
What were we just talking about?
Never mind.
And just walking for three hours a week, not even all that fast, can cause so many new
brain cells to grow that your brain can get measurably bigger.
Tango, this is my wife and I, when we found out we were pregnant, or she was pregnant,
to be honest, went to Buenos Aires and danced the tango.
That increases neurogenesis as well.
So some of the most fun things in life, again, are the healthiest.
So you don't have these false choices, is it fun for me or is it good for me?
It can be both.
Chronic stress, the more stressed you are, the more it decreases your brain size, particularly
in the hippocampus, which controls memory, which is why under a lot of chronic stress
it's often hard to remember things.
When you change your lifestyle, your skin gets more blood, so you don't age as quickly.
You look better.
You feel better.
Your heart gets more blood.
We've shown that you can actually reverse even severe heart disease when you change
your lifestyle.
And much more quickly, just in a month, you can show improved blood flow to the heart.
The chest pain goes away.
This is a slide where we looked at angiograms showing the amount of blockage in the arteries
in the upper left became wider, less clogged after just a year.
In the lower left is a cardiac PET skin.
Blue and black is no blood flow.
In the lower left, at the beginning, the lower right you can see is almost normal, orange
and white is maximal blood flow.
So you don't have to wait that long, even if you've had a lifetime of damage, to show
the benefits.
And overall, the blockages from beginning to one year to five years got worse and worse
in the group that made only moderate changes in lifestyle who had heart disease, and they
got better and better in the group who made more intensive changes.
Now, I want to just show you a three-minute video.
This is like the worst graphics and the least imaginative shooting.
But the content, I think, is so inspiring.
This was at a hospital that we've trained about 50 hospitals through our nonprofit institute.
We trained hospitals at no cost, and we licensed them at no cost because we just want to get
it out there because we're so passionate about what a difference this can make.
And I just want to show you this little three-minute clip because it makes it real about how much
difference this can make in someone's life.
And this is not our best case.
This is representative of the kinds of changes that we see that most doctors, unfortunately,
don't have that experience.
So if you could show the video, we'll do that.
I began to see some real transforming physical things happening to me.
The first thing is I've lost 50 pounds.
If anybody is looking for an inexpensive wardrobe, let me know.
The seventh week that I was in the program, my angina disappeared just seven weeks in.
I thought that was a little bit too good to be true.
But it was, and things like that have been happening ever since.
I'll just give you my vital statistics here.
My ejection fraction has increased from 45 percent to 61 percent.
I lost 50 pounds.
My triglycerides are down from 819 to 93.
My cholesterol is down from 243 to 110.
My HDL is up from 27 to 38.
My PSA even went down.
I'm no longer using a cane or a wheelchair.
In November of 2001, I was using a cane to walk with, and I had to have the humiliating
experience of riding a wheelchair around Walmart.
Now, I didn't like that.
I wasn't going to settle for that.
I knew there must be a better way, and thank God I found a better way.
I no longer have to take my diabetes medication.
In fact, my total medication has been reduced by 75 percent.
I had trouble getting to my mailbox without having chest pain.
But now I'm walking at least two miles a day.
I ride my stationary bike anywhere from eight to 10 miles a day at our American Heart Association
Health Walk here a few months ago.
I walked two miles in that, and felt like the energizer bunny I still wanted to keep
going.
Now, what sustains that is feeling good.
If you were to the point where you literally couldn't walk across the street without getting
chest pain, and you change your diet and lifestyle, and essentially you're pain-free, and you
can do pretty much whatever you want, people say things like, yeah, I like eating cheese
burgers, but not that much, because you feel so much better.
You can connect the dots between what you do and how you feel for better and for worse.
We published these findings in JAMA, circulation, Lancet, New England Journal, and so on.
We found even more of Versyl after five years than after one year.
The more you do it, the better you get, and the longer you do it, generally, the better
you get.
Here again, this is a correlation between the degree of change in lifestyle and the degree
of change in blockages.
I got this as a Christmas card a couple of years ago from two of the men in one of the
hospitals we trained in New York, Beth Israel.
The younger brother on the left is 88, and the one on the right is 92.
They wanted to show me how much more flexible they were after doing their yoga, and the
next year they sent me this one, which I thought was pretty funny.
You just never know.
This is an unretouched photo, how much better people can get.
We also found there was a 40% reduction in the cholesterol level.
This is comparable to what you can get with statins, but without the cost.
We spent $20 billion last year just on Lipitor in this country.
Your sexual organs get more blood flow, works the same way that Viagra does.
This was one of the most effective anti-smoking ads.
It doesn't say emphysema, heart attack, lung cancer.
It says impotence, because half of guys who smoke are impotent.
How sexy is that?
See Turlington, the supermodel, has this wonderful website called smokingisugly.com, because
the nicotine makes your arteries and your face, your arterioles, and the capillaries
constrict so you age 10 or 20 years faster.
So instead of making you sexy and beautiful, it makes you ugly and impotent.
That's a much more powerful message to give teenagers and say, you're going to live to
be 86 instead of 85, which really doesn't motivate most people, you know, often even
when they're 85, but particularly when they're teenagers.
We also found that you can stop or reverse the progression of prostate cancer and bi-extension
breast cancer.
In a study we did in a collaboration with the chair of urology at UCSF, Peter Carroll,
and the then chair, who unfortunately has died of colon cancer since then, Dr. Bill
Fair at Memorial Sun Kettering Cancer Center in New York.
And we found that PSA levels went down in the group that changed.
They went up or got worse in the group that made more conventional changes.
And again, we found the same relationship.
The more people change, the lower their PSA went.
And their prostate tumor in vitro was inhibited 70%, whereas in the comparison group, it didn't
make such intensive changes hardly at all.
So again, that's just in the space of a year.
You don't have to wait that long to see that.
And the latest randomized trials have shown that for most men who have prostate cancer,
they're more likely to die with it than from it.
And the treatments leave most men either impotent or incontinent or both.
So these lifestyle changes turned out to be not only as effective, but in some cases even
better than drugs and surgery.
And we have found again, the more people change their lifestyle, the more directly inhibited
their tumor growth.
And we did MRI and MRI spectroscopy in some of the patients.
The tumor activity is shown in red here.
And you can see that not only did the PSA go down, but the tumor activity diminished
as well.
So again, just by changing lifestyle, people have a hard time saying, you mean that's just
changing my diet and lifestyle can cause all these things to happen?
But it does.
And it's not like there's one diet for heart disease and another one for prostate cancer
and another one for diabetes.
It's the same one.
It's just a healthy way of eating and living.
Now I want to focus on, again, the primary department of improvement was how much people
change.
And that's the scientific basis of the spectrum.
The more you change, the better you get.
How much you change, how many things you want to change are really up to you.
But again, the more you change, the better you get.
It's a very powerful, very empowering, very hopeful message to give people.
Now we published a study last year in the Proceedings of the National Academy of Sciences
where we found that when you change your lifestyle, it actually changes your genes.
And so often I hear people say, oh, I've got bad genes.
What can I do?
Well, it turns out you can do a lot.
I found over 500 genes were changed in just three months.
Three months.
Again, that was not thought possible before.
And the genes that we change are the ones you want to change.
We turn on the good genes that protect you.
We turn off the genes, the oncogenes that promote prostate cancer, breast cancer.
The genes that promote oxidative stress and chronic inflammation that in turn promote
heart disease.
In every case where we could identify the gene, it went in the good direction.
Now this is what's called a heat map, which is just a way of displaying a lot of data.
And on the left is before, and it's mostly green.
Green is turned on, excuse me, turned off, and, excuse me, red is turned on and green
is turned off.
And you can see how after three months it went from mostly red to mostly green.
And again, all the genes, these are all oncogenes that control breast and prostate cancer.
Another study that was done by a different group of investigators, Jeff Dusek, found
that just meditation alone caused changes in gene expression.
And it was that same dose response effect.
The more people, the eight weeks of meditators, if you can see the down regular, went from
on the top from red to kind of green to green, and at the bottom from green to kind of red
to red.
That's the beginning.
The non-meditators, the people who've been meditating for eight weeks, and the advanced
meditators who've been doing it for years.
Again, meditation can affect your genes in just three months, in this case, in just eight
weeks.
So powerful changes from, outcomes from simple changes.
We published a study in the Lancet Oncology last year with Dr. Elizabeth Blackburn, who
won the Nobel Prize in Medicine a couple of weeks ago for her discovery of telomerase.
Telomerase is an enzyme that lengthens our telomeres, which are the ends of our chromosomes
that control how long we live, that control aging.
And she did a study a few years ago where she found with Dr. Alyssa Eppel that women
who are under chronic emotional stress had lower telomerase and shorter telomeres.
So it was the first evidence showing that chronic emotional stress may actually shorten
your lifespan and give a mechanism for that.
And so we were at a conference together.
I said, you know, most things in biology go both ways.
If bad things are caused by, you know, to telomeres by chronic stress, what if we do
good things?
And what we found was that, again, after just three months, we found that telomerase and
thus telomer length increased by almost a third by 30%.
And even pharma drugs have not been shown to do that.
So here again, lifestyle can only be as good, but in this case, even better than drugs.
So our genes are a predisposition, but our genes are not our fate.
And I think that's, again, a very motivating message to give people.
Because again, lifestyle changes can only be as good, but even better than drugs.
This was a study in the New England Journal of Medicine comparing lifestyle with a diabetes
drug called Medformin or with placebo.
And they found that the lifestyle changes actually worked even better at a fraction
of the cost.
And in fact, the side effects, I mean, the potential reduction of the complications
of diabetes, the eye nerve, kidney damage, heart disease, works even better with lifestyle
than with drugs because you can control your blood sugar much more closely by lifestyle
changes.
Lifestyle changes can be synergistic with drugs.
This is a study by John Kabat-Zim who found that lifestyle, that meditation plus a drug
caused psoriasis to clear much faster than the drug alone.
So it's not one or the other.
Meditation increases antibody titers to influenza vaccines.
So here again, it's synergistic.
You don't have to say is it one versus the other.
It can often be both.
Now moving into health reform, because these have a lot of implications, my concern about
health reform has been we've been focusing on the 46 million people who don't have health
insurance, which we clearly need to get into the system.
But if we don't also change what we're doing, what we're covering, not just who we're covering,
then if we just do more bypasses and angioplasties and so on, on 46 million more people than
cost to go up exponentially, and then we have these painful choices, do we ration or raise
taxes or let the deficit go up?
None of them are very good.
It's threatening the viability of health reform.
But if we can change lifestyle as treatment, not just as prevention, then we can actually
make better care available at lower costs.
Now many people are surprised to find that three quarters of the $2.1 trillion in health
care costs, which Senator Harkin Paul sick care costs, are from just chronic diseases
like heart disease, diabetes, prostate or breast cancer, and obesity, all of which can
not only be prevented, but even reversed simply by changing lifestyle.
Now in this sense, lifestyle can be prevention, but it's also treatment.
And people have a hard time thinking about lifestyle as treatment.
And so most of the health reform bill, when it talks about prevention, is really early
detection, like mammograms and PSAs.
It's good to find cancer earlier.
It's even better to prevent it.
And that's what really, early detection is not the same as prevention.
Now heart disease, as I mentioned, is not only preventable in most cases, but it's even
reversible.
But many people don't know that heart and blood vessel diseases kill more people each
year than everything else combine.
And yet because we're so busily mopping up the floor rather than turning off the faucet,
literally or figuratively bypassing the problem, we're not really addressing the underlying
cause.
Now that's important because heart disease, although it kills more people than everything
else combined, is almost completely preventable for 95% of people.
It's a staggering statistic.
The disease that kills more people than everything else combined is almost completely preventable.
We don't need to wait for a new breakthrough or a new drug.
We just need to put into practice what we already know.
Now another study came out just this year and they found that just exercising, not smoking,
eating a healthy diet prevented most diabetes as well as heart attacks, strokes, and many
cancers as well.
Powerful effects from these simple changes.
Now how do we treat heart disease in this country?
We mainly do it with drugs and surgery.
Last year we spent $60 billion on angioplasties and stents where you blow up a balloon and
squish the blockage or put a stent in to keep the artery open.
Now that might be worth it if they worked.
But many people are really shocked, I was shocked, to find that in the New England Journal
of Medicine a year and a half ago, in a very carefully done $40 million randomized trial
of several thousand people, angioplasties did not prevent heart attacks and did not prolong
life compared to just people who got drugs, not even compared to people who made lifestyle
changes.
Now you would think if we're really practicing evidence-based medicine, people would stop
doing them.
Unless you're in the middle of having a heart attack, which only 2% or 3% of people are,
but the other 95% they don't.
And they say, you see this blockage, we can fix it, we can go die, what do you want us
to do?
And generally people say fix it, but it doesn't really do much and that's been the problem.
So it's really not so much evidence-based medicine, but more often reimbursement driven.
Now we've done a series of demonstration projects where we found that changing lifestyle was
not only medically effective, but it was also cost-effective.
We've done three demonstration projects and we've shown that these really work.
The first was with Mutual Vomit, where they found that most patients who were told they
needed a bypass range of plastic were able to safely avoid it.
And they saved almost $30,000 per patient in the first year.
The second study was done with Blue Cross Blue Shield of Pennsylvania.
They found they cut their costs in half in the first year and by an additional 20%-30%
in subsequent years.
And finally after 16 years, Medicare is now paying for programs like this, which again,
we're open sourcing because we want to get out there.
We worked at the work site with Safeway.
We found that we could lower the cost there.
Healthcare costs are reaching a tipping point.
Starbucks finds they spend more money for healthcare than for coffee beans.
Mars for more for healthcare than for candy.
So there's a convergence of forces that make the receptivity to these ideas more than they
had been.
I worked with President Clinton and the Heart Association and the soft drink bottleers to
get the soft drinks out of schools and to put healthier snacks in the vending machines.
I was looking for leverage points.
And what we found in the Medicare demonstration project is weight fell strikingly, angina fell
strikingly, ability to exercise increase, depression fell, and quality of life improved.
Blood pressure fell both systolic and by diastolic to the point where most people could get off
their medications.
People could get off their diabetes medications as well.
And as Michael Pollan said, this may be the first generation which our kids live a shorter
lifespan than their parents.
The time is now to begin making these changes because they work.
Everything is reaching a tipping point, whether it's the cost or whether it's other factors.
And as he talked about, what's personally sustainable is also globally sustainable because so much
of global warming is caused by livestock and it takes so much more energy as well as being
a major cause of deforestation.
There's also this globalization of illness that's occurring as other countries are starting
to eat like us and live like us and die like us.
And so there's an opportunity to make a difference.
The other epidemic that I want to close with is depression and loneliness.
The number one prescription drug last year and for the last several years has been antidepressants.
And that's important because if information were enough to cause people to change their
lifestyle, nobody would smoke.
It's not like people don't know any better.
But I'd ask people, why do you smoke and why do you overeat and drink too much and work
too hard and abuse substances?
And they'd say, because they help me get through the day.
I've got 20 friends in this pack of cigarettes, one patient told me.
They're always there for me and nobody else is.
You're going to take away my 20 friends?
Or food fills the void?
Or alcohol numbs the pain?
Or video games numb the pain?
Or working too hard numbs the pain?
And so we need to work at a deeper level, not just on the information, but also these
deeper issues.
And when we do, we find that we can help people use the experience of suffering as a doorway
for transforming their lives.
And they often say things like having a heart attack was the best thing that ever happened
to me.
You say, what, are you nuts?
And they say, no, that's what it took to get my attention that's made such a meaningful
difference in my life.
Anything that promotes intimacy is healing.
And all of us here are here because we're trying to make a difference in the world.
And the kinds of things that we all do in our own ways of bringing people together,
this conference that Andrew is doing, bringing people together, is healing, just being here
is healing.
The kinds of things that you do with technology to connect people are healing.
And the need for connection to community is the unmet need.
And you don't even have to do it that well to create a multi-billion dollar business.
Look at the AOL chat rooms initially, or Facebook, or Twitter.
Most people's Facebook friends are not necessarily the most intimate of life experiences.
And yet, even if you can meet that just a little bit, you can make a huge difference.
And the last slide I'm going to show you is I was on a panel years ago doing grand rounds
at the University of Virginia Medical School with Swami Satya Dhananda, who I'd studied
with for many years, an eminent spiritual teacher.
And someone said, hey, Swami, what's in between illness and wellness?
And he went up on the board, he wrote the word illness, and circled the first letter,
and then wrote the word wellness, and circled the second two.
And to me, it's just a beautiful shorthand that anything that we can do together to bring
ourselves together, to heal the isolation that separates us, is not only makes us feel
good, it's actually healing.
People who are lonely and depressed are many times more likely to get sick and die prematurely.
And so I just want to end by saying, we're all here today because we were finding ways
to connect with each other.
I've been so inspired by the presentations that I've heard, and I salute each of you
for the work that you're doing to help bring this together, because it's really healing
from the root to make whole, even the word yoga is to unite, to bring together.
And so thank you for the chance to be here today, I'm really grateful.
