#260: Beth Motley, MD - Make These 1% Changes to Create Long-Lasting Health
Learn more about Beth Motley, MD
Beth Motley, MD grew up an athlete and always had an interest in nutrition. Once she went into medical school, however, she realized that good nutrition is about way more than just athletic performance. It’s about longevity, disease prevention, and disease reversal. It’s about human health.
This inspired her to train under the greats like Dr. John McDougall, Dr. Ron Weiss, Dr. Neal Barnard, Dr. Caldwell B. Esselstyn and pursue family and lifestyle medicine as a career. What a resume of training, right?
Today, Dr. Motley and Rip Esselstyn dive into the importance of meeting patients where they are in their journeys and focusing on small “atomic habits” to create lasting change.
They also chat about the perks of a plant-based diet for cancer prevention and managing diabetes with personalized approaches, emphasizing the power of patient education and understanding the science behind dietary choices to effectively reverse insulin resistance.
Finally, Dr. Motley shares how she navigates her hectic life with five children, four of whom are under the age of five!
Episode Resources
Watch Dr. Motley’s Talks on Diabetes and Heart Disease Reversal on a Plant-Based Diet
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[1:48] Beth Motley grew up as an athlete and always had a peaked interest in nutrition for peak performance. Once she went into medical school, she quickly realized that nutrition is about way more than just athletic performance. It's about longevity, disease prevention, and even disease reversal. It's about human health. Today, as a family medicine physician who is also board certified in lifestyle medicine, she combines her passion for nutrition with primary care in order to meet her patients where they are and guide them to better health.
[2:42] Great to have you. Thank you so much. Thank you for inviting me. Absolutely. Well, you came highly recommended by Melissa and Doug Sturgis, who came to our Black Mountain retreat a couple months ago. And they're like, this woman is incredible. And so, you know, in doing some research into you, you do seem incredible. And so we're going to find out just how incredible here over the next hour or so. But Beth, tell me, where am I talking to you from? Well, I'm actually at my neighbor's house in Greenville, South Carolina, because I've got an infant and construction going on at my house. But yep, Greenville. I'm from Massachusetts, but I have made my way down south a bit. Wow. How do you get from Massachusetts to Greenville, South Carolina? You know, that's just kind of how medical training works. It's very linear. You hop from one place to the next. And I had done undergrad in medical school in Virginia, and I googled best places to live for young people. And part of the reason I chose Greenville was for sports medicine, thinking I would go into sports medicine. But I went to a sports medicine conference. And, you know, I am a former athlete. I'm still an athlete, still an athlete.
[4:03] I went to a sports medicine conference and I found myself the whole time, like not paying attention and instead just like reviewing information about plant-based nutrition and how can I help my patients? And that was my sign that I had to go instead from sports medicine, you know, to lifestyle medicine where I am today. Right. And so what are you, what is your current medical practice, your family life or your family medicine? Is that correct? Yep. So I'm family medicine, subspecialty lifestyle medicine. I was lucky that I completed my training in 2017, which was the first year that that lifestyle medicine certification exam became available. So I went ahead and took that and I was in the first class of lifestyle medicine physicians.
[4:46] So I work in a general family medicine practice for a large medical group. I am a busy mom. So the idea of running my own practice is very daunting. And I like to be able just to show up to work, do what I am good at and leave and not worry about, you know, anything else that is involved in running a medical practice. So when I signed on, you know, I assumed I would just be doing general family medicine and, you know, maybe someday I'd open an amazing lifestyle medicine practice, but little did I realize just due to my interest in lifestyle medicine, that was becoming my practice. So now while I do full scope primary care, I tend to work with patients who are interested in a lifestyle medicine approach. So I always say I'm not anti-medicine, but I am pro-lifestyle. Before we jump into medications, we always talk about what we can do in our lifestyle. Right.
[5:42] So before we went live here, you and I, we both were talking about how John McDougall, who was absolutely one of the pioneers and heroes of the whole food plant-based movement, passed away a few days ago. I'm wearing black. I just found out. I literally just found out like an hour ago. And I'm just kind of like, just kind of like heavy hearted and just dumbstruck thinking that at, you know, 77, John is, is gone. You know, we all know that it, I think it was age 21. He had that stroke. And, and so his, his health, you know, was maybe always a little bit subpar. I mean, I hate to think if he hadn't found whole food plant-based what it would have been like, but I know that you said that he's one of the people that inspired you to go into lifestyle medicine. Can you explain that? Absolutely. Right. So I grew up figure skating and as a figure skater, I first became interested in nutrition as a means towards performance.
[6:56] There were a lot of good figure skaters out there and I was just one of the pack. I was a little on the scrawny side. So I was trying to figure out, you know, what could I do in my power to stand out? And I just assumed, you know, why not focus on nutrition? That's something that a lot of my peers at that young age were not focusing on. And so, you know, as an adolescent, my interest in nutrition really just meant reading whatever was popular. I didn't really understand nutrition from a medical perspective, from a chronic disease prevention and longevity perspective. But I always carried that interest with me. And even in medical school, I considered it a side interest. And I had done an away rotation at Duke, and I met a resident there who had worked with John McDougall, and just chatted with him. And he, you know, heard about my interest in nutrition and sports and athleticism. And he's like, you've really got to go work with John McDougall. So I worked with McDougall, I was there for the 10 day program in January of 2014. And as a medical student at the time, I was in charge of doing all the blood pressures in the morning and, you know, checking in with patients. And it was an absolute incredible experience. 10 days just to see, just by day two and three, people's complexion improving, their mood improving.
[8:14] Seeing, I just remember on day one, 15 out of 60 patients, I had to report the blood pressures to John McDougall because they were in the alarming range. And by the last day, there was only one guy who probably had some underlying kidney disease or something, you know, that was not reversible with diet, but only one guy still had high blood pressure by the end of those 10 days. So that was just, it was comprehensive, um, live in program. They'd go there, you'd eat all the food, you know, there's the proof of concept right there in the 10 day program. It was absolutely, totally inspiring. And that's why I was like, Oh, you know, someday I want to run something like this, but for now I'll just do primary care. But yeah, absolute inspiration. And after that, actually, you know, I asked John McDougall, who should I work with next? And he pointed me to Neil Barnard. So I did a rotation with him and also to your father, Caldwell Esselstyn. So I stopped by and did his heart disease reversal program. And then I worked with Ron Weiss, who's a physician farmer in Long Valley, New Jersey. So it was just an incredible experience.
[9:19] Wow. You really made the rotation there. So McDougall, Weiss, Esselstyn, and Barnard. Yep. Yep. And then I also challenged myself to look at some different perspectives working with people in like integrative medicine, functional medicine, maybe not exactly what speaks to me, but similar areas. I even did two weeks of bariatric surgery. I really wanted to see what my future patients are going to be exposed to and really get like a broad knowledge base there. Wow. I'm impressed with your open mind. What do you think has allowed you to have such an open mind?
[10:06] Mind to bring in kind of new philosophies and new ways of looking at things? Well, I think there's a lot of rejection of the unknown in medicine. We're comfortable with what we know and what we learn in medical school. And when people introduce new information, it's inconvenient as a provider. First of all, we have to go look it up and figure it out if it's right or not. And, you know, we're pressed for time. I think a lot of providers reject things that they don't know and they have their own protocols.
[10:44] And if you think about it, you know, anything that is alternative medicine today, meaning something that we don't have the scientific evidence base to support its use to treat whatever condition, right? It's alternative medicine until we have the science and the data that support it. And then it becomes, you know, classic medicine. For example, Tai Chi, that would have been considered alternative medicine many years ago, but now we have all sorts of research studies that talk about the benefits of Tai Chi, you know, for older adults who may be debilitated or who have chronic back pain, something like that. So especially with my interest in primary care, I know my patients are just going to have questions about all of these things. And in primary care, we're going going to have patients, you know, asking for advice on new things and what they hear in the media. So I just, I feel like that's part of my role in primary care is, is to have that broad knowledge base. Yeah. Well, what's interesting to me is, so you also have a background as a, you said a figure skater from what ages did you figure skate from?
[11:51] So I started at four years old. I grew up with three sisters and a brother. And so figure skating was something that was available in town. And my parents could bring all four of us sisters at the same time, which was convenient for a few years until we got more serious up until I completed high school. So in my final year of high school, I was lucky to make Team USA, which was such an incredible experience. But I knew deep down I was not going to be a professional figure skater for the rest of my life. So I gave it up when I went to college. And I still dabble once a year, but I'm not very good anymore. Wow. So could you do, what's it, a double axel or whatever? Most people ask triple axel. You know, I did team figure skating, so synchronized skating. I was on the Hayden Nets. If anyone out in cyberspace knows the Hayden Nets out of Lexington, Massachusetts. So I was lucky that where I grew up in Massachusetts, I just lived 22 minutes away from where Team USA practiced. So I was the closest one to the rink pretty much all around. Wow. You were probably training, would you say, what, two to three hours a day? Oh, a lot. Yeah, a lot of training.
[13:15] Yeah, four days a week was just the team practice and then individual practice outside of that. Sundays, we would practice three hours in the morning, we'd have a three-hour break and three hours again in the afternoon. So yes, definitely a lot of practice. Oh my goodness gracious. Do you look at a pair of figure skates and you get PTSD or you get a little... No, no, no. It was great. It was a great experience. And not just from the athletic perspective, but, you know, to be a part of a community and just growing up together with other figure skaters as a team. So, yeah, it was it was great. Yeah. Well, I'm glad to hear that. You know, it's interesting. I'm just kind of thinking about, you know, in the kind of plant-based community, some, like my father who, you know, won a gold medal in crew. Scott Stoll, who made the U.S. team, the Olympic team in the bobsled.
[14:19] Furman, Joel Furman, who won, you know, some national championships in figure skating. Figure skating. Yeah. He's my buddy. Yeah. So I think that there might be something to kind of, being a high level athlete and always looking for ways to improve your performance, which, which then carries over into medicine where you're kind of always looking for something that might be a little bit better, a little bit smarter, a little simpler. You know what I mean?
[14:49] Yes. Yes, of course. I really enjoyed the recent New York Times bestseller, Atomic Habits, and I'm sure you've read it, but something that really resonated with me is how just simple 1% changes in your life can really compound over time. And even though you may not see it immediately within a year, you will. Um, so I, as in my role in primary care, I tend to simplify things for my patients. So like the simplified way I would talk about this, um, is that if you can eat well, right? More plant-based equals more anti-inflammatory. That will help with muscle repair and perhaps allow you to train more frequently. And in a lot of young athletes, we're not dealing with things necessarily like high blood pressure and hypertension. A lot of times we'll see that in our 30s and 40s. But it does make sense from that atomic habits, it's 1% improvement perspective. If you can make those simple improvements, like eating better, even though you may not see it, they do add up over time. Yeah. Yeah. Well, give me, so give me an example of, um, what is, what is a way with your patients that come in where you're trying to get them? And I know one of your philosophy is you kind of like to meet your patients where they are.
[16:18] But give me an example of maybe a small improvement that will add up over the course of a year.
[16:26] Sure. I was just chatting with a patient earlier. She has high cholesterol. And in my world, everyone has high cholesterol until proven otherwise. That is pretty much the softball in lifestyle medicine. She's similar to me, you know, stage of life, female, similar in age.
[16:45] And, you know, she's not plant-based, but she's open-minded. And anytime I get lab work back, i say hey it looks like your ldl your bad cholesterol is a bit high you know cholesterol is only found in plants uh sorry let me try that again uh cholesterol is only comes from animal based foods animal based foods are also our number one source of saturated fat which turns into cholesterol in our bodies on the other hand fiber is only found in plants fiber helps to escort that cholesterol out of our bodies so i just ask her you know do you have any ideas about what kind of changes you can make. She's a well, you know, I do have eggs every morning. So the plan we came up with today is that we're gonna do a six week trial, she's gonna swap out her morning eggs for oatmeal, and we'll check her lipids at the end of six weeks. So I really like to use lab work as leverage, in particular cholesterol, because that is one that almost everyone has high cholesterol, and it responds very quickly to dietary changes. And that was something huge that I saw when I worked with John McDougall, you know, within 10 days, huge changes. I have an album of lipid panels that I just, I stopped adding to it because it's just absurd how quickly your cholesterol can improve on a plant-based diet. And I love to hear people arguing otherwise, oh, dietary cholesterol doesn't matter. I'm like, yes, it does. Absolutely does.
[18:06] So, you know, it's important with patients to hear the words come out of their mouth, right? So what ideas as do you have?
[18:16] It's my role to educate them, right? For example, like we need to move more plant-based. And then my question to them is like, what do you think you can do to work towards that goal? Yeah. Why, let me ask you this. So if you know, as well as I do, that we can make some significant changes in total cholesterol, LDL, you know, triglycerides in really like six to 10 days, is why six weeks? Why not two weeks? I mean, why, why give her... We can do that. Well, we're also adjusting a little thyroid medicine on her. So six weeks is convenient. Yeah. Yeah. I mean, I'd say six weeks, you know, when I have a new patient in the office, I do a lot of, you know, deep dive in lifestyle medicine. And also there's just a convenient standpoint where sometimes people just don't want to be coming in every two weeks. So, you know, it can be any amount of time. It can be two weeks. It can be whatever they want, But yeah, you don't really need more than a week to see those cholesterol numbers come way down. What, in your opinion, is, what do you consider to be elevated cholesterol?
[19:21] So you will see different guidelines out there. As Caldwell Esselstyn would say, you know, LDL less than 70 is essentially heart attack proof. We just don't tend to see heart attacks in people with an LDL below 70. And also, if you look at data, we see communities that have LDL less than 70 have the lowest risk of heart disease. And if you consider a total cholesterol up to 200 as normal, there's still about 25% of people who have heart attacks have a cholesterol, a total cholesterol within that range. I forget the exact statistics. I'm going to look it up. I do. I saw it on your website. Oh, 180 to 210. Was that it? 180 to 200 is where 25% of heart attacks happen where the American heart attack association. Right. Exactly. Would say that's an acceptable range. Yeah, exactly.
[20:20] So patients have a hard time with that because, you know, the EMR will only flag it as abnormal if it's above 200 or if LDL is above 100. But, you know, I definitely push them towards less than 70 as a goal. Yeah. Yeah. So in your medical practice, you, and again, I learned a lot about you from your website, which is very informative, but you say you have this classic medical model where you've also flipped. Right. Right. Like a flipped class. Yeah. Practice style. What does that mean? Flipped? Yeah. So let me give you a little background. So in my practice, I am employed within a standard insurance-based medical practice within a large medical group. And part of the reason I like to practice in this setting is I like to be accessible to the whole community. Private practice has its pros and cons, but I felt if I did private practice, I would not be accessible to a lot of people in the community who prefer an insurance-based model.
[21:33] And when you are in an insurance-based model, of course, time is of the essence, right? And so that's always the complaint. People say, oh, my doctor's so rushed. My doctor doesn't have enough time. So I think you can do a good job being efficient without being rushed. So I like to sit down with the patient, really figure out what are your goals, right? That's something that not everyone has even thought about, but opening the discussion with what are your goals allows that person to verbalize, oh, what are my goals? Maybe it is to lose some weight. Maybe it is to get control of my high blood pressure. And then I really assess where they are. Are they pre contemplative? Do they not even know they have high cholesterol? Are they contemplative? They know they have high cholesterol, but don't really have any thought about how to address it. Are they in that preparation stage of change where they're starting to think about doing something? Or the action stage, they're taking action or maintenance, someone who's maybe already on a plant based diet, we're just working on maintenance and tinkering. So have a good assessment of where they are, and then I will provide resources to maybe move them up a ladder on that trans-theoretical model of change. So, for example, I often refer people to documentaries.
[22:46] Forks Over Knives is a huge one. I also really enjoy The Game Changers, just depending on who my patient is. So I'll give them some homework to do on their own time. I also often refer to books. Like I mentioned, Atomic Habits is great. your book often goes hand in hand with the game changers, you know, for my, for my men, for my athletes, people who I think those messages would resonate with. For those who have heart attacks, particularly a lot of my older men, I might refer them to your father's book.
[23:17] And then for diabetes, I'm often referring people to Neil Barnard's program for reversing diabetes or Mastering Diabetes, which is a book or a program. So I really like to sort of take a snapshot, figure out where they are and what they need to move towards success, and then give them some resources to start working on that. I also have some health coaches I use, or there's some people who, you know, their main problem maybe is not dietary. Maybe it's we need to work on sleep and stress management. So there are six pillars of lifestyle medicine. Of course, my focus tends to be most on diet, because I see that to be a big area of confusion and an area where people can make a lot of change. You're right. You say that your favorite diagnosis is diabetes i love diabetes.
[24:07] So well you know explain to our listeners today why you love diabetes there's a lot of confusion with diabetes there's a lot of confusion and you know if your goal is to lower blood sugar, lower blood sugar if that is your goal there's two ways you can achieve that you can do the standard approach of a more low-carb eating style. The problem with that is that pushes you towards more high-fat foods. A lot of people who are eating low-carb may be doing meat, they may be doing dairy, and probably some vegetables, but they're missing out on the whole grains and the beans. And you can do that, and you can make your numbers look better, at least somewhat, at least in the short term. However, you're not addressing the underlying problem, which is the the fat in our muscle cells, the intramyocellular lipids that are underlying insulin resistance. And so it's very backwards thinking, right? People think about diabetes and they think about blood sugar. High blood sugar is not the, or high sugar is not the cause of diabetes. Diabetes causes high blood sugar, right? So the solution is not...
[25:22] A low carb eating style if you want to reverse that fat build up in the muscle cells so i have a youtube i made if you just google beth motley diabetes that really explains that concept of how if we move to a more plant-based diet sure in the next few days your blood sugar might look a little bit higher but very quickly you will start to remove and discard those intramyocellular lipids that are causing the insulin resistance. So it's, it's a total new way of thinking. And it's wonderful that the American College of Lifestyle Medicine has put out some resources.
[26:00] Not just for physicians who want to be trained in that approach, but also for patients who want to learn more about that approach to treating diabetes. And also with diabetes, the A1Cs you you get every 90 days can really show someone how much they change. So I've had patients, I mean, A1C up at 11 or 12, able to change their diet and get it way down, you know, six or seven. I mean, I have a patient who's been off insulin now. He's been my patient for, I don't know, eight years or so. And he was on 30 units of insulin when he came to me. And he had been doing Neil Barnard's program, which is all the same. It's a, you know, a whole foods plant-based, a little more focused on low fat, which in general whole foods plant-based is lower fat, but, you know, one step further by removing things like, like nuts and, and high fat plant foods. Um, and he's, he's been off insulin for, you know, six or seven years now. I mean, it's, it's amazing to see. I think I think patients are so thankful to be able to get off those medicines, be able to avoid or greatly reduce insulin and like.
[27:14] The proof is right there. The proof is in the numbers. If I can get people to make the change, they can see the numbers. They really understand that it works. Yeah. How do your patients usually respond when they come in and let's say they have an elevated A1C that's in the sixes, sevens, or 11s, or 12s, or they have a fasting blood sugar, what, above 125? I think that also is indicative of maybe having some diabetes going on. And you You say, you know, let's try this whole food plant-based diet. It's not the sugar that's causing the diabetes. It's the fat. And they're a carbophobe. I mean, how hard do you have to convince them?
[27:57] Because as you just said, this is kind of a new way of thinking. Unfortunately, it's really, I mean, technically it's not. I mean, you know, some of my very, very good friends are Cyrus Kambada and Robbie Barbaro. Of course. Yes, I know. They show the research going back to 1918, showing that this is something that works really, really well. In the medical field, it seems like, you know, this is this new way, this new age way of looking at diabetes. But anyway, I'm digressing. So, yeah. So how do they respond when you say, hey, let's try this method? Well, I don't necessarily even tell them, like, let's try a whole foods plant-based diet. I typically start by, I just want to, I want to nudge, you know, and they're usually overwhelmed, right? I mean, if it's a new diagnosis of diabetes, or they don't realize they have it, or, you know, they're thinking through a lot. So that is why I refer them to my YouTube, because I think it's a very confusing concept about using a plant-based diet to reverse the insulin resistance. And I do feel like patients need to understand why they're doing what they're doing, you know, for them to effectively do it. I've not always been the greatest rule follower in my life, but I like to say, you know, I follow the philosophy behind the rules. So for me, if I don't understand why a rule is in place, I have a hard time following it.
[29:21] So yes, for my patients, I really want them to understand the science. So I put together that YouTube, tried to really simplify it. And depending on whether they have a science or medical background, you know, Neil Barnard, I find that to be more 101 for someone who's a new introduction to the concept, or the Mastering Diabetes book is more 201 for someone who's on the road and is doing a little more detail work. I also have a handout I go through. And all this is available on my website under my provider tools there. It's called Understanding Carbohydrates. And this is something Jeff Novick helped me with many years ago, back after I had worked at the McDougall program. But just explaining carbohydrates instead of, you know, complex and simple and all these words that can get confusing, talking about carbohydrates as, you know, either a, unprocessed, minimally processed on one end, and on the other end, we have processed. I don't like to villainize an entire macronutrient, right? The goal is not to avoid all carbohydrates. We want to avoid the highly processed carbohydrates.
[30:29] So that's another concept I try to review with patients is, you know, what are the right kind of carbohydrates that we should be consuming? Because that is definitely difficult. Carbophobia, I didn't even know other people use use that term, but yes, that's something I talk about. You know, a lot of my patients are carbophobic. They're afraid of carbohydrates, especially if they've had that diagnosis for years, it's just, it's ingrained in them. And then you tell them that we're going to eat more plant-based and then they don't know what to eat. And then they, you know, a failure would be for them to go home and just eat lettuce and tomatoes for two days and say, I can't do it and give up. So I've really tried to give them the resources to be successful. Yeah. Well, on your website, when you click on, I think it might be carbs or one of them, you have a great graphic chart that shows from unprocessed all the way to highly processed and what it looks like. Right. Exactly. For different food types. Yep. Yeah. And I do have to give you a great, big, wonderful shout out because, You make everything available, just kind of all these resources. You're very open with them. You have a link to basically your, I think it's your G drive.
[31:41] All my patient handouts. All your handouts and documents. It's just there for anybody. It's really wonderful. I have made several of them, but I have also curated that collection because there are lots of good ones available for free online. line. So that's what I have tried to come together, or tried to bring together. But what's funny is, you know, I feel like I'm locally known for my handouts and, you know, office style. But when I started out after residency, I completed residency in 2017, I only had one or two handouts, but then you get patients who come in, they have the same question, same question, same question. Like calorie density is a big one. That's another concept I find myself going through a lot. And so So I have a few different handouts that really focus on calorie density and what is that concept and like what foods should we be focusing on or even like your dad's book, you know, my patients who have heart disease who are doing this, you know, really strictly to try to reverse their coronary artery disease. I refer them to Caldwell Esselstyn's book. But at the same time, I have a handout that's just a one page summary of the book. It's like a quick start, you know, OK, here's the book that'll help you learn the science behind it. And here's the quick start guide. So you can go ahead and get started tomorrow. Yeah.
[33:00] So you said a bunch there. Let me just reflect on a couple of things. One, you say you love talking about calorie density. Calorie density is such an, to me, an important pillar of really understanding whole food plant-based. And I too learned the vast majority of calorie density from Jeff Novick, just absolutely brilliant, brilliant presenter, calorie density, and so many other things, how to read a, how to read a food label. Um.
[33:31] How, just for the audience, because I think it, you know, it bears repeating and my father loves to say repetition is the mother of learning. What would, what would be your one, two minute summary of calorie density? Right. So a lot of times when I'm, I'm working on a lot of times when I'm working with a patient on calorie density, it's because they have expressed that their goal is weight loss or perhaps they have high blood pressure they're maybe eating plant based already and doing a little bit better but they still haven't lost all the weight and they still haven't really gotten off those blood pressure medicines that they hope to so i really bring back the discussion to what are our goals our goal is to you know optimize our blood pressure we know that having an optimal bmi will help us to optimize our blood pressure um and so there's a lot of confusion. People are like, oh, you know, nuts are good. Nuts are healthy. Avocados, those are healthy fats. Oh, I do olive oil. You know, I don't do other oils. I have to bring them back to what is our goal? If our goal is weight loss, we need to focus on choosing those foods that fill us up without costing us too many calories, right?
[34:46] Oils, no matter what kind of oil, olive oil, you know, coconut oil, avocado oil, whatever oil you choose, it is going to be 120 calories per tablespoon. So if your goal is weight loss, adding oils to your, you know, salad, adding oils to whatever you're sauteing on the stove, even if it's a preferable oil, like olive oil, it's not going to help you to achieve that goal. Yeah. Yeah. I used to love peanut butter and, you know, I just had to give it up because I'm like, it's just not worth it. Just not worth the calories. Um, but like nut butters are a common one nuts, like, you know, and for my normal weight patients, kids, whatever, you know, I'm okay with some nuts, but if someone's goal is weight loss, nuts are not going to help you to achieve that because calorically, they're very expensive. So I do often refer to McDougall's Maximum Weight Loss book, that that's a great one. And then I have an infographic of his 5050 plate, which basically means, you know, fill half your plate with the least calorie dense foods, the fruits, the vegetables, the mushrooms, berries, and the other half with those plant-based foods that may actually provide you some more calories, you know, the whole grains and beans. So Beth, I love what you said about calorie density.
[36:08] What is going to fill us up without costing us too many calories, especially if the goal is to find that BMI or achieve weight loss? My question to you is, I mean, how many patients is it about that you have? Is it about weight loss and how many is it about optimizing their overall health with a wonderful byproduct being the weight loss? I find it's a tricky mentality. And when it's purely weight loss, it seems to be kind of rooted in a little bit of, I don't know, unhealthiness.
[36:49] Yeah. Yeah. You know, it's, it's actually a package deal. I mean, you eat better, every, everything improves. So from my end, it's like, what is going to motivate the patient or what is going to capture the patient? Um, a lot of times I have patients with, 10 different diagnoses and i know the answer is going to be a plant-based diet but you know maybe i'll focus on cholesterol or maybe if i think you know they're they're fairly new to this area this could sound intimidating we'll just focus on cholesterol today and see where we get in general, i wouldn't introduce calorie density until we get someone eating more plant-based to start with, um so i try to figure out you know what diagnosis most motivates them another one we'll see is arthritis. I mean, that's an easy one. If someone's in pain, we can work on a more anti-inflammatory diet, AKA plant-based diet. You know, if, if they're in pain every day, that's, what's going to motivate them. So I may present information about plant-based diets and arthritis to guide them down that path, knowing full well that we're moving plant-based and that's going to help all of their diagnoses. So usually I try to, I move them plant-based and then once we're there, then And for most of my patients who do need to lose weight, then calorie density is, you know, one of my later steps that we take. How do you feel about the latest, you know, craze going on with Ozempic and Wegovia? And I'm sure your patients are asking about it. They are, yes. Love to know what you do.
[38:18] Yeah, well, so I always say I am pro-lifestyle. I'm not anti-medicine. I would say that former me used to be like completely against any of that under the assumption that I'd be enabling patients, you know, just like they say with high blood pressure, like, oh, you just treat their blood pressure, then they're going to lose their motivation to address it on their own. So I would say that used to be my philosophy, thinking that if we use these medicines, you know, people are not going to learn to eat well. But I have found naturally that that is not necessarily the case. And like what I experienced with the McDougal program and seeing people make the change and 10 days later, they felt so much better and it was positively reinforcing and they would just, they would never go back to their old selves. I have found that using the GLP-1 medicines can actually help people to really hit the reset button, help them to get the weight off, give them a little more motivation. A lot of times for people, if they're overweight, that's wrapped up into mental health. Possibly depression, they're not sleeping well, they're not exercising.
[39:31] I ideally would see this as a tool when it comes to weight loss for someone to help them lose the weight along their lifestyle medicine journey with the goal to be to use that time while they're on the medicine to develop skills. I really focus on fiber. Sometimes I refer people to the Full Plate Living program. It's fullplateliving.org. Just some great free information about, you know, moving towards a more plant-based diet. it. So if we are using those medicines, I really like to use that time to focus on lifestyle medicine with the hopes that once we get them to their goal, that they have the skills to maintain it off them. So I do use that medicine plenty, of course, in my patients with diabetes. And it's really incredible because once we are able to get the weight off, a lot of times we don't even have diabetes anymore. So, um, as an MD, I do, I do use some medicines, but my, my goal is always lifestyle, right? What can we do in our lifestyle? Right. So, but in, but in, in, in many cases, it seems to be a effective one, two punch. So the medicine, the Wagovia or the Ozempic with, uh, let's say whole food plant-based And what is your understanding? Like how much does it cost a patient to be on these drugs?
[40:55] Very expensive. So right now we are primarily seeing insurance companies cover these medicines for people who have diabetes, who are already on or have failed to oral medicines or to other medicines. So those are primarily the patients that I have on it are people who have diabetes.
[41:19] There are a few insurance companies that are paying for it for weight loss, and we are seeing some of them cover it for weight loss in people who also have some documented heart disease. Outside of that, they're very expensive, like $1,600 a month, I believe, is the going rate for name brand semaglutide. So it is expensive, and that's obviously not affordable and sustainable for a lot of people. What are you seeing with your patients?
[41:47] As far as any potential side effects with these drugs. Right, right. So you have to weigh the pros and cons. So part of the way the medicine works is by slowing down your GI system. That has the desired effect of making you feel more full. But of course, at the same time, if things are slowed down, that can present as nausea on one end or possibly constipation on the other end.
[42:14] So if we are using those medicines, that is all the more reason why I'm working with a patient to focus on fiber, right? Because not only is fiber, I explained to them, a dietary appetite suppressant. The more fiber we can consume earlier in the day, the fewer calories we tend to consume overall. Michael Greger's done a lot of great videos about fiber and exactly that, how we tend to consume fewer calories when we focus on more fiber. Um, so I, if, if we are using those medicines, that is all the more reason to focus on fiber. And really a lot of these people who are seeking these medicines are people who are discouraged. They have tried a lot of things. They've tried a lot of different diets. Um, you know, they're, they're really looking for help. Um, and so I do find a lot of people who are on those medicines are also motivated to make the changes. Yeah. When you, so when you, uh, when you, Give me a rough estimate. How many patients are you seeing a week? Are you seeing 50? Are you seeing 20? I have none. I work part-time, so I'm seeing 40 patients a week. Okay. Okay. 40 patients a week.
[43:23] And how many of these, let's say on average, 40 patients a week that you're seeing, would you say are inactive, meaning they're not moving, they're not exercising?
[43:36] Yeah. Yeah. Yeah. A good amount. I really try to ask about physical activity instead of exercise because there are a lot of people who are naturally active throughout the day who may not be doing what we label as exercise. There's a good amount that are inactive. And again, this is another case where former me would have been very blaming of the person who doesn't exercise. I think a lot of people want to exercise and they want to be active, but there's only so many hours in the day and maybe they haven't thought through strategies for incorporating that. Or there's a lot of people who work 40 hours a week and they have stressors at home or they have parents who are sick and it can can be really hard to fit that in. So it's important to talk with patients about.
[44:35] Strategies for how can you fit that in? So I have a bunch of kids and I'm very busy. And despite working part-time on my other days, what do I do? I work. I mean, I'm very busy. And so for me, one of the ways I can incorporate physical activity is by walking to the grocery store. And it's only, I don't know, a mile away. And I take my stroller and I get all sorts of terrible jokes from people about where'd your baby go? I know, I just bring the empty stroller, you know, fill up my groceries and walk home because it almost takes the same amount of time, you know, if it's a mile away to like walk there and park and get in and then, you know, load up your grocery cart, load up your car. So that that's one strategy I have used to incorporate more physical activity into my own life. So that is really what I like to work with, or, work on with patients is figuring out how we can integrate more physical activity into their daily lives. If they have time to do, you know, formal exercise, you know, that's awesome. Weightlifting, especially for my postmenopausal patients, or for anyone who might be on a GLP-1, you know, weightlifting, I think is, is wonderful.
[45:40] And we do have an amazing program called Exercises Medicine down here that Jennifer Trilk, who is one of the professors at the medical school, she really helped to pioneer that where I can make a referral to the YMCA for my patient and they get enrolled in this exercises medicine program. They meet with a trainer twice a week for 12 weeks to help them. It's basically like just helping people get into the gym. Like even me personally, I mean, I have a good exercise resume from my past experiences, but a lot of people like don't really know what to do in a gym. I mean, even I feel like if you just put me in a weight room, I would be like, Oh, I need some I need some structure. So that's a really great program that gets people in the door at the gym. And also, while they are enrolled in that program, they have full access to the local network of YMCA is here. So for me, group fitness has always been a big part of my past, because all I have to do is show up. And then you know, someone else tells me what to do and, and keeps me motivated. So I that's a really wonderful program to get someone in the gym to give them some structure, some accountability, and also allow them an opportunity to maybe explore some of the other programs that the YMCA offers. So I'm also a board member for the YMCA because I love the Y and I love what they do for the community.
[47:00] Yeah, so exercise, you can't just tell a person to exercise. Oh, you need to exercise. You need to do your 150 minutes a week. That doesn't work. You need to let the patient express what might work for them or how they can integrate it into their life. Yeah. Has the pickleball craze hit Greenville? Oh, I love pickleball. Yes, it definitely has hit Greenville. There's all these extra courts opening up. We're about to build some at the Y also. Good. Yeah. I played a few times while pregnant, and I think I was scaring everyone. So I haven't picked it back up since I had my baby, but love pickleball. So speaking of babies, I'd love to talk about – so my understanding is you have five children. Is that right? Yes, I do have a lot of kids. I only birthed four of them. So my 10-year-old I have through marriage, and I am her full-time mom. So her mother passed away at 29. She had colon cancer. So that was part of, you know, when I met my husband, you know, that was something I sort of brought to the table is he didn't know much about cancer and diet. And as you know, within classic medicine, it's something that's often not talked about. However, you know, colon cancer is multifactorial, but a big part of it, you know, may be diet.
[48:20] So that's yet another motivation for our family to, to eat more plant-based. And then we have four other kids ages four, three, two, and five months. So it's, it's very, it's very hectic. But But it's a lot of fun. Um and uh i would say we i've had to come up with a good strategy you know i would like to raise kids who can make good decisions on their own when i was growing up uh my parent i grew up you know in a catholic family in massachusetts and i would say church was something that was forced upon us and i did not have a good experience with church growing up right and i don't want that for my kids so same thing with you know diet our our philosophy is this is the way we eat at home and you know when we go out to restaurants as a family of course this is the way we eat but when my kids go to friends houses when they go to birthday parties that's their time to make their own decisions.
[49:28] Because I do want to ultimately raise kids who are going to make their own good decisions and it's a tricky thing to navigate in this very non-plant-based world.
[49:40] Yeah. Good for you. That's incredible. All those kids, 10 and under. And what did you say, a five-month-old? Yeah, yeah. Wow. Good on you. Four, three, two, and five months. So it's- Holy. Wow. I mean, that is as close as me and my siblings.
[50:02] There's four of us and we're four and a half years apart. Oh, like within a four-year, four and a half year window? Yeah, that's how my little ones are. Yeah, they're all within four and a half years. Wow. Were any of them birthed within 12 months of each other? No, no, no Irish twins in there. So the four little ones are all 18 months apart. Okay. I have a brother who's 11 months younger than I am. So we're Irish twins. Oh, wow. That is pretty cool. That is pretty cool. Yeah, I grew up in a large family myself. I have three sisters and a brother. So I'm not new to the chaos. Now, so with all these kids and your husband, who's doing the cooking in the house? Yeah. So my husband and I are different. He's the foodie, right? He's the super chef. And I'm more of the functional eater. I'm like, I'm busy. I'm just going to microwave a sweet potato at work. If you open my cabinet, that should include lots of textbooks and medical references. It just includes a bunch of beans. And I just like open a can and just put a spoon in. And you know, for me, it's more function. So I think we've found a good balance where he's sort of the dinner chef. He likes to do fancy dinner stuff. And I'm more of the.
[51:20] You know the the lunches the desserts that that sort of thing the snacks you know that's that's more me so we made peach ice cream last night and luckily my kids don't really know what real ice cream is and so we just froze a bunch of peaches from the farmer's market and just blended them with some cashews and you know ice cream ice cream kids go crazy um so that's more my role and i like simple stuff if i'm going to make something for the family it's it's probably Probably going to be, you know, in the crock pot or the instant pot or, you know, some sort of easy blender dessert like that.
[51:57] So for kids that you birthed, and I am assuming that you were whole food plant-based through every pregnancy. Yep, I definitely was. us. And so any tips or advice that you would give for mothers out there that are pregnant or wanting to get pregnant and are a little bit maybe gun-shy about doing it on a whole food plant-based diet because they're afraid they're not getting all the nutrients they need? Well, it's a common misconception that they would be nutrient deficient, but really it's just the opposite. A plant-based diet is the most nutrient-dense eating style. I have a nice handout I use to explain that concept. Obviously, you're going to want to take some B12. The safest package to get B12 is in a supplement rather than animal-based foods. And, You'll want to take a prenatal too. With my first pregnancy, I was like, oh, I don't need a prenatal. I'm just going to double down on beans and greens and get lots of iron and lots of folate. I still became anemic. So just take your prenatal vitamin.
[53:09] Yeah. I mean, it's really not that difficult. And eating plant-based, I think, helped me to avoid some of the common complaints with pregnancy, right? So a lot of women experience constipation. Not only does that progesterone potentially slow you down, but also if you're taking an iron supplement that can constipate you. So we see a lot of pregnant women who are backed up and they've got hemorrhoids and all sorts of terrible stuff that nobody talks about, you know, by eating a more plant-based diet, really focusing on fiber, that should not be as much of an issue. And another common thing we see and pregnancy, well, first of all, if we are not healthy prior to pregnancy, that puts you in a higher risk category. So if you can optimize your BMI prior to pregnancy, that is a wonderful thing to do. You will have a lower risk pregnancy if so. But also hypertension is a big deal in pregnancy. We don't want our patients to have preeclampsia. You know, we want to avoid that at all costs. So we know eating a more plant-based diet absolutely is going to help from the blood pressure perspective.
[54:19] So I can't think of a reason not to eat more plant-based while pregnant. And what about gestational diabetes? Yes, that is another one. Gestational diabetes is something that pops up in a lot of people who are totally not anticipating it. And having gestational diabetes is a risk factor for having diabetes later in life. Really, I think when women get pregnant, we are able to figure out, you know, which women, assuming they follow their same lifestyle going forward, are going to pass that threshold into diabetes. So all the more reason to eat more plant-based in patients who do have gestational diabetes. To start with, you know, I am not their OB, so they will work under their OB, but in general, I will refer them to the Mastering Diabetes Program to really help them start to make some dietary changes. Yeah. So you mentioned earlier as a athlete, as a skater, and I think to some of these athletes that you're seeing, you recommend a kind of whole food plant-based diet because it's the most anti-inflammatory eating style out there. Um.
[55:33] Would you recommend the same for somebody if they want to prevent cancer? And can you kind of explain a little bit about the whole food plant-based and how this anti-inflammatory eating style is helpful in maybe preventing major cancers? Yeah. So cancer is interesting. It's a little bit of a harder diagnosis for me to work with patients on because I don't necessarily have lab work that I can follow. It's also something that's often multifactorial, and we have like lots of different cancers, you know, with lots of different factors at play.
[56:12] So when it comes to cancer, we see a few things. Number one, people who have an optimal BMI have a much lower risk of cancer, right? Obesity is a risk factor for almost every sort of cancer. So just from a simple weight perspective, we know that will massively help. I love T. Colin Campbell, a name we haven't mentioned yet. His China study is often a resource that I refer patients with cancer to, or Michael Greger's book, How Not to Die. He's got several good chapters on common cancers and the science behind them. So cancer is not quite as intuitive. It is intuitive that we eat junk food and we gain weight you know people people tend to see those sorts of things but eating well and how that may affect our breast cancer risk is a little bit harder to understand um and this is another area i think where we bring up the discussion of alcohol which um.
[57:13] You know, the USDA. The USDA is a dietary advocacy group, right? They have many factors at play. They have many groups that they're speaking to. They are not primarily a nutrition group. And every five years, the USDA will take all of the latest research, consider it, and put out dietary guidelines based on it, but also with some other parties' influences at play.
[57:46] So we know from a cancer perspective, and if you look at the American Cancer Society, the American Institute for Cancer Research, we know that, you know, as close as you can get to no alcohol will reduce your risk of, you know, most every cancer. However, the USDA is, oh, you know, I don't think people can handle that. And they'll say, okay, so you, you know, women, you guys can have up to seven drinks a week. Men, you can have up to 14. Um, but yeah, that, that's another area that I think a lot of people don't even realize, or they may be drinking alcohol. They don't even think about how that can contribute to poor sleep, which then, you know, can, can lead to fatigue the next day. They don't want to exercise. They don't want to eat well, et cetera. Um, anyway, so yeah, so cancer, uh, for sure a more plant-based diet is unanimously recommended by our cancer authorities. And if you look at their websites, they may recommend it to different levels, right? Some will say, oh, you know, more Mediterranean, which, you know, more Mediterranean is more plant-based. I still think you can go a step further than that.
[58:57] The American College of Lifestyle Medicine, of course, will recommend, recommend you know a more plant predominant diet than just a Mediterranean diet um but yeah in general more plant-based is what the research shows it's just a little bit harder to convey that to patients because these concepts are harder to grasp but in general I will show a chart um.
[59:21] Of nutrient density and just use that to talk to them about how if we choose more nutrient-dense foods, those tend to be more anti-inflammatory. Most cancers are inflammatory in nature, and that will help minimize our risk of cancer or cancer recurrence down the road. I always find, you know, and you mentioned T. Colin Campbell in his research at Cornell with casein and the number of Americans that are consuming probably two to four to five servings of dairy a day and all that casein that's accelerating tumor and cancer. Prostate cancer, especially. Yeah. Yeah. I mean, I drank milk all through medical school because I thought it was healthy. You know, I, I was always interested in nutrition from a young age, but I didn't really understand plant-based diets until I worked with John McDougall. But, you know, I, I was like the only one of my roommates who drank milk in undergrad. Yeah, I guess it was 2014. So it was my final year of medical school that I worked with John McDougall. But yeah, I consumed dairy because I thought it was healthful. And it just totally blew my mind to learn that perhaps it was not.
[1:00:32] That was eye opening. I almost, when McDougall brought up those concepts, I was like, oh, come on. It just went against everything I knew and believed. And as a kid who went to public school, I had all those posters up from the USDA about getting two to three servings a day. So yeah, that was huge. And I see it in the office. I mean, dairy, of course, is a cancer risk factor, although that's not as intuitive to people. But acne, that's a really easy one for an adolescent who has acne. That's a great way. Usually when my patients do have acne, I also check their cholesterol because, again, everyone has high cholesterol until proven otherwise. And then I can get them, you know, moving to a plant-based diet, we can see the lipids improve. We can also see their face clear up a lot of times. Yeah. Yeah. You know, it was interesting. I had, um.
[1:01:20] Dr. Alan Goldhammer from True North on the podcast not too long ago. And he was talking about, if you're 20 pounds overweight, you're essentially, you've got all this visceral fat on your organs. And he said, if you're 20 pounds overweight, essentially you've got, you're carrying around a two pound tumor, 30 pounds, three, 40 pounds, four. And, And, you know, what that is kind of omitting, secreting. And I just, I never heard it put that way before. And just how being overweight really is such a, it's like inflammation. And it puts you just at that much higher risk factor for all these chronic Western diseases.
[1:02:09] Right. Yeah. Visceral fat for sure is hormonally active. One of the simplest ways that someone can assess their visceral fat is with a bioimpedance scanner, and that will, you know, tell you how much you have. You definitely want less than 4% visceral fat, less than 3% or 3% or less would be ideal. But yeah, that's a huge thing that people don't, you know, really think about. out. So you mentioned, so you got out of medical school in 2014? Yep. Did my residency down here in Greenville, 14 to 17. You are young. You are so young. I caught the wave of lifestyle medicine. I caught the wave. You really did. I'm wondering, where did you go to medical school? Eastern Virginia Medical School. I did my undergrad at University of Virginia. And how many people were in your class? Can you remember? 120. 120 were in your graduating class. Yep. And let me ask you this. Of those 120, how many do you think are also enthusiastic about lifestyle medicine?
[1:03:23] One, one. I ran into one at our medical conference. Seriously? You know, total just like hadn't seen him in forever. And I did a talk at ACLM a few years back and he was in the audience and he came up after, you know, say hi. But one that I know is enthusiastic about lifestyle medicine.
[1:03:41] I know, I know, I know. Well, I also haven't touched base with them in a long time, but you know, in our connections on social media, I don't know that anyone else has pursued that road. No, I get it. But that, I mean, you know, let's just say it was, you know, 12, I mean, 12 would be 10%. Um, so it looks like it's more like 1%, maybe 2%. I know. I know. I know. We do have a good, a good group in Greenville though. I mean, we've got, um, you know, our oncology department, there's a lot who are lifestyle medicine certified within cardiology for sure. Uh, I've got a smattering in different specialties that will they'll refer to me. Whenever I get a doctor that refers to me, I'm like, good, okay, they get it, you know, they really value, you know, what I'm doing in lifestyle medicine. So it's always nice to get new referrals. You know, when I have new providers referring to me, I'm like, good, all right, they get it. So I think we are starting to see more and more people. And, you know, I think all of us enter medical school, because we do want to help people. That is what we want but you know like if you haven't been introduced to lifestyle medicine.
[1:04:52] You know I just can't blame them I mean it was my experience with McDougal that really opened my eyes because even in medical school I just thought nutrition was like a side interest you know I didn't think it was like relevant, to what I was learning in medical school and to my future career unfortunately yeah but isn't that like.
[1:05:16] Isn't that super frustrating? And doesn't that somehow need to be rectified where we got to go upstream to the medical schools where, hey, you know what? The most powerful tool in your medical toolbox when you get out of here is going to be the food.
[1:05:32] And even the fact that these medical schools, you know, I've heard about this since I wrote my first book in 2009, that you're just not teaching nutrition in medical schools. And they're still not like 15 years later for the most part. Yeah. Yeah. We're, we're getting there. It's all wrapped up in politics and society and we're getting there. I like your optimism. I love your optimism. Absolutely. And we got to get there. I mean, this, this is the solution. And I don't know if it would be five years or 40 years, but we're going to get there. Well, I don't, you know, a lot of us doctors are frustrated when patients don't listen to us or when they look elsewhere. But in part, I don't blame them because in a lot of ways, the medical community has not solved their problems. And that is part of the reason why patients are looking to social media. They're looking at all sorts of, you know, alternative practitioners. They have not found the answer within allopathic medicine, and so they're looking elsewhere. So I don't blame people. As frustrating as it is as a primary care provider to deal with people who come in who have all sorts of misinformation that they want to discuss with me, I mean, that is very frustrating.
[1:06:52] But at the same time, I don't blame them because they are ultimately looking for a solution. Mm And he has lost a hundred pounds in a year and his doctor is just flabbergasted. He said, he's never seen anything like this. And he said, the gentleman that lost a hundred pounds and reversed all of his chronic Western diseases said, well.
[1:07:23] I think that you should tell your other patients about whole food plant-based. And he's like, I can't even get my patients to take their meds. How am I going to get them to go whole food plant-based? And that's the thing that I think is so frustrating to me is that if these physicians were doing it themselves, like you are, right, then it would be a completely different conversation they're having with their patients. But, but when they're not doing themselves and their patients aren't doing their meds, it's like, they don't, they're not able to see it. Right. Yeah. I mean, we're, we're up against culture and that's why in my patients who are pre-contemplative, um, you know, that's why I just refer them to the Forks Over Knives documentary. Like that's a great place to start. Um, so it is, it is difficult. And then of course that thought, you know, patients aren't willing to do it. Well, I think patients would be willing to do it if they had the information. I do find a lot of my patients are really motivated, right? We as providers always say, oh, you know, they're not going to do it. They're not motivated. My patients are motivated, but a lot of times they have the wrong information, right? And so that's a lot of the reason why I will challenge people for six weeks or whatever time period to make those changes.
[1:08:40] And then once they see the result at the end of six weeks, they're positively reinforced to continue on that path. Yeah. So you said some of your patients or some of these patients have the wrong information. And you and I both know there's so much noise, so much distraction that's going on out there. What to you is one of the most...
[1:09:05] Obnoxious types of wrong information that you are hearing or seeing about right now? Oh, there's so much. But one example I always bring up is like bulletproof coffee. Like, how could we be so confused that we are putting butter in our coffee? I mean, that is one. Um, there's always something trendy. I mean, the lectins, the don't eat beans, or, you know, If you eat beans, you got to pressure cook them. I mean, beans are like the ultimate health food. They're the ultimate health food. Every study tells us that beans are healthful. So that's another frustration. What else?
[1:09:49] What about, have you heard about this latest diet? And it's maybe eight months old, 10 months old. It's called the lion diet, where you actually eat like a lion. You know it's just meat and no actually i don't know that one it's meat and salt and butter period yeah even just a simple paleo diet you know if you are going to eat like the paleo people it's probably going to be heavier on gathering and not quite as heavy on hunting and also you should be burning you know many many many calories a day with all of your work that you are doing as opposed to us being generally sedentary in our current lives. I mean, and then there's, you know, the blood type diet, you know, those sorts of things where patients come in. Well, and.
[1:10:41] You have to show respect for your patients. And again, you know, everyone is looking for a solution, but patients come in with this misinformation. I have to sort of talk them out of what they're doing. And then I need to sort of educate them in the direction that they need to move, which of course is going to be more, more plant-based. So I would say social media and the internet have made our jobs harder as physicians for sure. Because there's just a lot more that patients are getting into and getting interested in and trying to like make sure they steer in the right direction. And sometimes I get patients and they do amazing and they're awesome. And then all of a sudden they, you know, discover something and they, oh, okay. Okay. Fell off a bit, but that's why on that.
[1:11:23] That's a bright, shiny object that I need to chase. I know, I know it's, it's difficult, but we're, we're up against society in primary care. And so I like to think we are doing a good job within, you know, lifestyle medicine training practitioners to motivate their patients to make changes, but also we need things that like PCRM is doing and ACLM, that's the Physicians Committee for Responsible Medicine in DC and the American College of Lifestyle Medicine. We need to also work on the advocacy level. In looking at your website, it looks like you've done a really nice job of showing several of the restaurants in the area that are whole food plant-based friendly. You might be able to get minimal or no added oils there.
[1:12:14] I was very, very intrigued by one called the Sun Belly Cafe that is close to the Swamp Rabbit Trail. What in the world is the Swamp Rabbit Trail? How do I get there? I know, right? Swamp rabbits are like a Greenville thing. So I guess there was a railroad road called the swamp rabbit railroad which is no longer a railroad and they've turned it into a huge walking trail so greenville is actually really an incredible community it's um been very thoughtfully designed and there is a lot of infrastructure for walking and biking um which is wonderful i love to go on the trail take my bike out it's just it's refreshing to go out there and just see hundreds of people who are also being active um so i do i do love that we have that in our community and our community has put a lot of money towards not only maintaining it but expanding it i feel like every nine months we get another you know news release that we're expanding the trail to go to this area so greenville is a fairly new city which has been um.
[1:13:21] You know a really great opportunity for me completing my residency here in 2017 again i just feel like i'm catching it on the upswing you know greenville's really grown a lot in the past decade um has been just a great area to practice lifestyle medicine um and yes sun belly cafe is has got to be my go-to restaurant um deb bouts owns it and she is just she is wonderful And I feel like she's been doing plant-based since before plant-based was a thing. As you know, 10 years ago, back when I worked with McDougal, plant-based was not a term anyone knew. But now, today, you are seeing many more restaurants embracing that. Unfortunately, we're also seeing more of the Impossible Burger, Beyond Meat, the Sham Burgers out there.
[1:14:12] We really want to focus on whole foods plant-based so that that's been a little tough lately as plant-based has become popular the food industry using that term how they want to not actually to mean whole foods plant-based as it was originally intended but you know part of the reason I put that resource together for my patients is because like you said at the beginning you have to meet people where they are if if these are people who are going to go out to lunch no matter what you know, you can't, Oh no, you got to start doing all your meal prep and home cooking. Like, okay. If they are going to go out to lunch, you know, what are some better options? Yeah. What about, uh, what's dirty girl? Like I like their logo. Clean food, dirty girl. Yeah. Clean food, dirty girl. Um, uh, meal prep. Um, and you'll have to check that they're still active. Cause I haven't had a patient mentioned clean food, dirty girl lately. Um, but I have had a lot of patients who've done really well with either happy herbivore or Clean Food Dirty Girl or using one of these meal prep type resources where basically they give you a grocery list. You know, once a week you go to the grocery store, pick everything up, and then it has a variety of recipes using those ingredients for the week. Yeah. On your home page of your website, you have a Virgil quote that is the greatest wealth is health.
[1:15:36] That's right. Yes. I was listening to just the radio this morning and, you know, just some silly, I don't even know what station it was, but they were talking about, you know, what do rich people want? And ultimately, they said, on their list, top of their list is health, we spend all this time, you know, working and now I'm going through all these busy years. Trying to earn money for my family, trying to raise kids, you know, so, so focused on living life right now. But in the end, you know, what are we working towards? Ultimately, I want to enjoy my decades ahead. And that can, can be a hard concept for young people to wrap their mind around. It's hard to motivate a young person to eat well, because generally, they, they feel good.
[1:16:33] And then maybe all their labs look good. Maybe I don't have any leverage over them. But ultimately, our health is wealth, right? I mean, that is what we want in our years ahead. And I always say I prefer to work with like the 40 and up crowd because those people tend to have more medical problems, which gives me more leverage. I'm able to motivate them using that leverage. But yes, I mean, this is the time when we are young, this is the time to be investing in our health. And all those 1% changes, they sure will add up over the decades. Yeah. Bravo. So as we sign off here, Beth, I'd like to just give a shout out to Dr. John McDougall, who had such a strong influence uh with you was absolutely one of my heroes and i know was the man that really influenced my father to go to go whole food plant plant-based after he won after he read the mcdougall medicine back in the early 1980s and um you know he you talk about somebody that was fighting and was such a fighter literally till till the day he died for this this lifestyle.
[1:17:51] And so I think that, you know, the best thing that we can do is to continue to carry that torch. On behalf of John and all these amazing, amazing pilots. I learned so much from him. Still like memorable is his, you know, the truth doesn't change. And in residency, I did a presentation to my co-residents and attendings about using a plant-based diet to overcome diabetes and, you know, the intramyocellular lipids. And one of my attendings who just didn't buy it, he's like, oh, yeah, you know, find me a study that shows that. I pulled one up. It was like from the 80s or something like that. I just pulled up, you know, the first one I could find. He's like, oh, well, you know, this is from the 80s. I was like, yeah, well, the truth doesn't change. This is a primary study, so it's valid. That and also just to any other practitioners who are out there, McDougall gave me some great advice. He said, in your training, just, you know, keep your head down, go through your training, learn the medicine. When you get out on your own, you can practice however you want, which I think is great advice. Because as providers, I mean, I do need to know primary care. I wouldn't be very useful to my patients if I didn't know full scope primary care.
[1:19:04] But yeah, really, really focusing and keeping your head down, getting your studies done. When you go out there, you know, you practice how you walk. Yeah, yeah. So he was an amazing mentor and inspiration. And yeah, I mean, I can't believe he's not with us anymore. more, but for sure he has influenced a lot of people who will carry his legacy forward. Absolutely. Beth, it was such a pleasure meeting you. Thank you for all you're doing in Greenville, South Carolina to make people healthier. It's great. Yeah. Thank you so much. It's been wonderful to be on your podcast and to meet you virtually, and I'll have to catch you at one of these Black Mountain retreats sometime in the future. I would love that.
[1:19:53] So can you give me a virtual plant strong fist bump on the way out?
[1:21:33] Music.
