[First, Dr. McDougall's introduction of Dr. Greger.
Captions of Dr. Greger's talk start shortly.] All right, welcome back. We have what I consider the McDougall
team, which is a group of associates, actually friends that I've
had for 20, 30 years. And our next presenter is one of those men who's worked
with us, worked in conjunction with the things that we've done, supported
each other, had similar crowds. And one thing really distinct about our next
presenter is his ability to communicate. I understand—I was just shocked that
he's given over a thousand lectures, and sometimes he's given four lectures a day—
amazing, what a dedicated person. So he also finally came out
with his first book. It's "How Not to Die"— what a title— and it has put him on the New York Times
Best Selling list for the last seven weeks.

So because of our long-time friendship
and my great respect for him, he's been a speaker for at least
one presentation every year for who knows how
far back it goes, and I know you're going
to enjoy Dr. Michael Greger. "How Not To Die: The Role of Diet in Preventing, Arresting,
and Reversing Our Top 15 Killers" I have taken so many great ideas
from Dr. John McDougall that it's only fair
that he take my beard. Allow me to begin
on a personal note. This is a picture of me, right around the time that my grandma
was diagnosed with end-stage heart disease and sent home to die. She had already had so
many bypass operations— basically run out of plumbing
at some point— confined to a wheelchair,
crushing chest pain. Nothing more they could do. Her life was over at age 65. But then she heard about
this guy, Nathan Pritikin, one of our early lifestyle
medicine pioneers. And what happened next is
chronicled in Pritikin's biography. My grandma was one of
the "death's door" people. Frances Greger arrived in one
of Pritikin's early sessions in a wheelchair.

"Mrs. Greger had heart disease,
angina, claudication; her condition was so bad
she could no longer walk without great pain
in her chest and legs. Within three weeks though, she
was not only out of her wheelchair but was walking ten miles a day." This is my grandma at
her grandson's wedding 15 years after she was given
her medical death sentence, and thanks to a healthy diet, she
was able to live another 31 years on this earth until 96, to enjoy
her six grandkids, including me. That is why I went into medicine. When Dr. Ornish published his
Lifestyle Heart trial years later, proving with quantitative
angiography that coronary heart disease
could be reversed— arteries opened up without drugs,
without surgery, just a plant-based diet and other healthy lifestyle changes,
I assumed it was going to be the game changer. I mean, my family had
seen it with their own eyes, but here it was
in black and white, in some of the most prestigious
medical journals on the planet.

But nothing happened, leaving
me to wonder if effectively the cure to our number 1 killer could get
lost down some rabbit hole and ignored, what else was there in the medical
literature that could help my patients? I've made it my life's
mission to find out. For those of you unfamiliar with my work,
every year I read through every issue of every English-language
nutrition journal in the world, so busy folks like you don't have to.

I then compile all the most interesting,
the most groundbreaking, the most practical findings, new videos and articles I upload every day
to my nonprofit site, Everything on the website is free. There are no ads, no
corporate sponsorships. It's strictly noncommercial,
not selling anything. Just put it up as a public
service, as a labor of love. New videos and articles every day
on the latest in evidence-based nutrition. What a concept! Where did Pritikin get his evidence from? Well, a network of missionary hospitals
set up throughout Sub-Saharan Africa uncovered what may be the most important
advance in health, according to one of the most famous medical figures
of the 20th century, Dr. Denis Burkitt. The fact that many of our most
common and major Western diseases were universally rare,
like heart disease.

"In the African population
of Uganda, coronary heart disease
is almost non-existent." Wait a second. Our number 1 cause
of death almost nonexistent? What were they eating? They were eating a lot of starchy
vegetables, starchy grains, and greens, and their protein almost
exclusively from plant sources, and they had the cholesterol
levels to prove it. Actually very similar to what
You see down here in the corner of those eating modern-day
plant-based diets. I said, wait a second. Maybe the Africans were just dying
early from some other kind of disease, never lived long enough
to get heart disease.

No. Here's age-matched heart attack
rates in Uganda versus St. Louis. Out of 632 autopsies in Uganda,
only one myocardial infarction. Out of 632 age and gender matched autopsies
in Missouri, 136 myocardial infarctions: more than 100 times
the rate of our #1 killer. They were so blown away they went back,
did another 800 autopsies in Uganda, and still just that one small healed infarct,
meaning it wasn't even the cause of death, out of 1,427 patients—less
than 1 in a thousand— whereas here heart
disease is an epidemic. This is a list of diseases commonly
found here in places that eat and live like the US, but were rare or even
nonexistent in populations centering their diets
around whole plant foods.

These are among our most common
diseases, like obesity, for example, or hiatal hernia: one of the most
common stomach problems. Varicose veins and hemorrhoids, two
of the most common venous problems, colorectal cancer, a leading
cause of cancer-related death, diverticulitis, the #1
disease of the intestine, appendicitis, the #1 cause of
emergency abdominal surgery, gallbladder disease, the #1 cause for
non-emergency abdominal surgery, as well as ischemic heart disease,
our commonest cause of death here, but a rarity among
plant-based populations. And so this suggests that heart disease
may be a choice, like cavities. If you look at the teeth of people
who lived over 10,000 years before the invention of the toothbrush,
pretty much no cavities. Didn't brush a day in their lives,
no flossing, yet no cavities. Why? Because candy bars
hadn't been invented yet. So why do people
continue to get cavities when we know they're
preventable through diet? Easy. Probably because, you
know, the pleasure of dessert basically outweighs the cost and discomfort
of the dentist chair for many people. Look, that's fine.

As long as people
understand the consequences of their actions, as a physician
what more can I do? If you think the benefits outweigh the risks
for you and your family, then go for it. I certainly enjoy the occasional indulgence. I've got a good dental plan. But what if instead of
the plaque in our teeth, we're talking about the plaque
building up inside of our arteries? All right, this is another disease that
can be prevented by changing our diet.

Now what are the consequences
for you and your family? Now we're not just talking
about scraping tarter anymore. Now we're talking life and death. The most likely reason that most of our loved
ones will die is because of heart disease. So being at a McDougall event is
the best Valentine's Day present ever. It's still up to each of us to make our own
decisions as to what to eat and how to live, but we should make these
choices consciously, educating ourselves about the
predictable consequences of our actions. Coronary heart disease, atherosclerosis,
hardening of the arteries begins in childhood. By age 10, the arteries of nearly all kids
raised on the standard American diet already have fatty streaks,
the first stage of the disease.

And then these plaques start
forming in our 20s, in our 30s, and then can start killing us off. In our hearts, it's called
a heart attack; in our brains, the same
disease is called a stroke. If there is anyone here in the room
today older than age 10, then the question isn't whether or not
to eat healthy to prevent heart disease; it's whether you want to reverse the
heart disease that you already have. Is that even possible? When researchers took people with
heart disease, put them on the kind of diet followed by populations that did
not get heart disease, their hope was to slow the disease
down, maybe even stop it, but instead something
miraculous happened.

The disease started to
reverse, to get better. As soon as patients stopped eating
an artery-clogging diet, their arteries started opening up. Their bodies were able to start
dissolving some of that plaque away, without drugs, without surgery. Even some cases severe triple-vessel
heart disease, arteries opening up, suggesting that their bodies
wanted to be healthy all along, but were just never
given the chance. This improvement in blood flow on
the left you see up here, if you can see, this is after just three
weeks of eating healthy. Let me share with you what's been called
the best kept secret in medicine. The best kept secret in medicine is that
sometimes, given the right conditions, our body can heal itself.

If you whack your shin really
hard on a coffee table, it can get all red, hot,
swollen, inflamed, right? But will heal naturally
if you just stand back and let your body's
magic take its place. But what if you kept whacking your
shin in the same place every day, in fact, three times a day:
breakfast, lunch, and dinner? It'd never heal. You'd go to your doctor and you'd be
like, "Oh, my shin hurts so bad." They'd be like, "No problem," whip out their pad and write you
a prescription for painkillers. You're still whacking your
shin three times a day, "Oh, it's still really bad—but feels so much better
with those pain pills on board. Oh, yeah." Thank heavens for
modern medicine. It's like taking nitroglycerine
for crushing chest pain: tremendous relief, but you're not actually
treating the underlying cause of the disease. Our body wants to come
back to health, if we let it.

But if we keep re-injuring it three
times a day, it may never heal. It's like smoking. One of the most amazing things
I learned in all of my medical training was that within 15 years
of stopping smoking, your lung cancer risk approaches
that of a lifelong nonsmoker. Isn't that amazing? Your lungs can
clear out all that tar, and eventually it's almost as if
you never started smoking at all. And every morning of our smoking life,
that healing process started until wham, our first cigarette of the day,
reinjuring our lungs with every puff, just like we can reinjure our arteries
with every bite, when all we had to do, the miracle cure, is to just
stand back, get out of the way, and let our bodies natural healing
processes bring us back towards health. Now sure, you could choose moderation,
and hit yourself with a smaller hammer, but why beat yourself up at all? We've known about this for decades.

American Heart Journal, 1977:
cases like Mr. F.W. here. Such severe angina, couldn't even
make it to the mailbox, then started eating healthier, and a few
months later: climbing mountains, no pain. Now there are some fancy new
anti-angina drugs on the market now, costs thousands of dollars a year. But at the highest dose, they can
successfully prolong exercise duration as long as 33 and a half seconds,
ladies and gentlemen. It does not look like those
choosing the drug route will be climbing mountains
anytime soon. See, plant-based diets aren't just safer
and cheaper, but can work better.

Heart disease is our number 1 killer. Killer number 2 is cancer. What happens if you put
cancer on a plant-based diet? Dr. Dean Ornish and colleagues found
that the progression of prostate cancer could be reversed with a plant-based diet
and other healthy lifestyle behaviors, and no wonder. If you drip the blood of those eating the
standard American diet onto cancer cells growing in a Petri dish, cancer
growth is cut down about 9%. But put people on a plant-based diet for
a year, though, and their blood can do this. The blood circulating throughout the
bodies of those eating plant-based diets has nearly 8 times the stopping power
when it comes to cancer cell growth. Now this was for prostate cancer, the
leading cancer killer specific to men.

In women, it's breast cancer. So they wanted to repeat this study using
women and breast cancer cells instead. But look, they didn't want to wait
a whole year to get the results. So they said, well, let's see what a
plant-based diet can do in just two weeks, against three lines of
human breast cancer cells. Here's the before: cancer cell
growth powering away at 100%. Here's after just two weeks,
eating healthy. Here's kind of a before picture: this is
a photograph taken under a microscope. What they did is they laid
down a confluent layer, like a carpet of human
breast cancer cells, and then they dripped
the blood of women eating the standard American
diet onto those cells, and as you can see, it kind
of breaks up the cancer, in these kind of cancer
continents here. So even women eating crappy
diets aren't totally defenseless.

But then they take these same women,
put them on a plant-based diet. Two weeks later, so they
act as their own controls. Same women, two weeks later
after a plant-based diet. They laid down another layer of breast
cancer, and then they dripped the blood of the same women two weeks later,
and their blood can do this. Just a few individual cancer cells left,
with their bodies cleaned up. Before and after, just two
weeks eating healthy. Their blood became that much
more hostile to cancer. Slowing down the growth of cancer cells
is nice; getting rid of it is even better. This is what's called apoptosis,
programmed cell death. Their bodies were able to somehow
kind of reprogram the cancer cells, forcing them into early retirement. This is what's called TUNEL imaging,
measuring DNA fragmentation or cell death.

So dying cancer cells show up
as little white spots. So as you can see in that little corner
there, there's a dying cancer cell. Again, this is after you drip
the blood of women eating the standard
American diet onto them. Then you take these same women,
two weeks later eating healthier, drip their blood again on
cancer and you see this. It's like you're an entirely
different person inside. The same blood now coursing
through these women's bodies gained the power to significantly slow
down and stop breast cancer growth, within just two weeks of
eating a plant-based diet. What kind of blood
do we want in our body? What kind of immune system? Do we want blood that just kind of rolls
over when new cancer cells pop up, or do we want blood circulating to
every nook and cranny in our body with the power to slow
down and stop it? Now, this dramatic strengthening
of cancer defenses was after 14 days of a plant-based diet and exercise.

They had these women out
walking 30 to 60 minutes a day. So, well, wait a second. If you do two things, I mean, how do
you know what role the diet played? So the researchers decided
to put it to the test. So this is measuring
cancer cell clearance. This is what we saw before,
the effect of blood taken from those eating a plant-based diet,
in this case for an average 14 years along with mild exercise, like
just out walking every day.

Plant-based diet and walking, that's
the kind of cancer cell clearance you get. Compare that to the cancer stopping power
of your average sedentary meat-eater— you see a little burger in there; I don't know if you can see that—
which is basically nonexistent. Now but this middle group is interesting. Instead of 14 years on a plant-based diet,
14 years of a standard American diet, but 14 years of daily, strenuous,
hour-long exercise, like calisthenics. They wanted to know if you exercise
long enough, if you exercise hard enough, can you rival some strolling
plant-eaters over here? And the answer is exercise
helped, no question, but literally 5,000 hours in the gym
was no match for a plant-based diet. Same thing as we saw before, even if you
are a couch potato eating fried potatoes, you're not totally defenseless.

You can kill off a few cancer cells. If you exercise for 5,000 hours, you can
knock off cancer cells left and right. But nothing appears to kick more
cancer tush than a plant-based diet. We think it's because of the animal
proteins—meat, egg white, and dairy proteins—increasing
the level of IGF-1 in our bodies; insulin-like growth factor-1,
a cancer-promoting growth hormone involved in the acquisition and
progression of malignant tumors. But if we lower animal
protein intake, if you put people on a plant-based
diet, their IGF-1 levels drop. This is the graph on the left. And if you put people on a plant-based
diet for years, it drops even further. And their IGF-1 binding
protein levels go up. IGF-1 binding protein, it's like
our body's emergency brake. It's one of the ways our body protects
itself from excessive growth. Sure, within two weeks, you can drop
your liver's production of IGF-1, but wait a second. What about all the IGF-1 you
have circulating in your body from the bacon and eggs you
had three weeks ago? Well, your body releases
this snatch squad of binding proteins
into the blood stream to tie up any excess IGF-1, As you can see, binding protein
levels go up within weeks, continue to get better the longer
one eats healthy.

Here's the experiment that really
nailed IGF-1 as the villain. Same as last time. Go on a plant-based diet, cancer cell
growth drops, cancer cell death shoots up. But then here's the
interesting column here. What if you add back to the cancer just the
amount of IGF-1 banished from your system because you were eating healthy
for two weeks? What happens? You erase the diet
and exercise effect.

It's almost as if you never
started eating healthy at all. So the reason the largest prospective
study on diet and cancer ever found that the incidence of all
cancers combined was lower among those eating vegetarian
than those eating meat, maybe because they're eating
less animal protein, so end up with less IGF-1, and
so end up with less cancer growth. How much less cancer
are we talking about? Middle-aged men and women
with high protein intakes: 75% increase in total mortality, 4-fold
increase in the risk of dying from cancer. But not all proteins. Specifically animal protein, which
makes sense, of course, given the higher IGF-1 levels. The academic institution sent out a press
release with a memorable opening line.

"That chicken wing you're eating
could be as deadly as a cigarette," explaining that eating a diet rich in
animal proteins during middle age makes you four times more
likely to die from cancer, which is comparable to what
you see with smoking. So what was the response
to this revelation that diets high in meat, eggs and dairy could
be as harmful to health as smoking? Well, one nutrition scientist replied
that it was potentially dangerous to compare the effects of smoking
to the effects of meat and cheese.

Why? Because a smoker might
think: "Well, wait a second. Why bother quitting smoking if my ham
and cheese sandwich is just as bad for me?" So we can't tell anyone about
this meat and cheese thing. Shh… This reminds me of a famous
Philip Morris cigarette ad which tried to downplay
the risks by saying, "You think second-hand smoke is bad,
increasing the risk of lung cancer 19%, drinking 1 or 2 glasses of milk
may be three times worse, 62% increased risk of lung cancer." Or doubling the risk by
frequently cooking with oil, or tripling your risk of heart disease
by eating by non-vegetarian, or multiplying your risk 6-fold
by eating lots of meat and dairy. So, they conclude, "Let's keep
some perspective here." The risk of lung cancer
from second-hand smoke, is well below the risk of
other everyday activities. So breathe deep. That's like saying: "Yeah, don't
worry about getting stabbed, because getting shot
is so much worse." How about neither? Two risks don't make a right.

Of course, you'll note Philip Morris
stopped throwing dairy under the bus once they purchased Kraft Foods. Just saying— All right, what about the
other 13 leading causes of death? Let's do it. The top three killers used to be
heart disease, cancer, and stroke. Oh, that is so 2007. Now it's heart disease, cancer, and COPD—chronic obstructive
pulmonary diseases like emphysema. Thankfully, COPD can be prevented
with the help of a plant-based diet, and even treated with plants,
improving lung function over time. Of course, the tobacco industry viewed
these landmark findings a little differently. If adding plants to one's diet
can help one's lung function, I mean wouldn't it be easier to just
add plants to cigarettes? And indeed, oh,
let's go back.

The addition of acai berries to cigarettes
evidently has a protective effect against emphysema
in smoking mice. Who would have thunk it? Next, they're going to start
putting berries in meat. And indeed, I couldn't make this
stuff up, ladies and gentlemen. The addition of fruit extracts to burger
patties was not without its glitches. For example, the blackberries dyed
burger patties with a distinct purplish color, kind of turned
people off a little. Evidently you can improve the
tenderness of lamb carcasses by infusing them before rigor mortis
sets in with kiwifruit juice.

You can even improve the
nutritional profile of frankfurters by adding powdered grape seeds. Though there were complaints
that grape seed particles became visible in the final product, And, look, I mean if there's one
thing we know about hot dog eaters, it's that they're picky about
what goes in their food. Pig anus?
OK But grape seeds?
Ew! Strokes are killer number 4. Preventing strokes may be all
about eating potassium rich foods, yet most Americans don't even reach the
recommended minimum daily intake, and by most, I mean
more than 98%. 98% of us eat
potassium deficient diets, because 98% of us
don't eat enough plants. Potassium comes from
the words pot ash. You take any plant, put it in a pot, reduce
it to ash, and you're left with pot-ash-ium, potassium, the so-called
vegetable alkali. True story. But who can name me one plant food
in particular high in potassium? Bananas, right? I don't know why; it's like the one thing
everybody knows about nutrition. I think like Chiquita must have had
this great PR firm or something. But it turns out that bananas don't even
make the top 50 sources, coming in, let me see, coming in at number 86,
right after fast food vanilla milk shakes.

It goes fast food vanilla milk
shakes, and then bananas. You know, it's funny.
When I was writing the book, I wanted to go back and make sure that
they didn't update their list, and they had. It turns out now bananas don't even
make the top 1,000 sources, coming in at 1,611, right
after Reese's Pieces. I kid you not. The most concentrated whole food
sources of potassium in the American diet are beans and greens and
dates, of all three things. But bananas don't even
make the top thousand. In fact, if you look at the next leading
cause of death (unintentional injuries), bananas could be
downright dangerous.

Alzheimer's disease, our
sixth leading killer, now striking a staggering
4 million Americans affected. Now 20 years ago it wasn't
even in the top 10. According to the latest dietary guidelines
for the prevention of Alzheimer's, the two most important things we
can do: cut down our consumption of meat, dairy, and junk, and replace those with vegetables,
beans, fruits, and whole grains. This is based, in part, on data
going back 20 years now. Those who eat meat—red meat,
white meat, it doesn't matter— between two to three times of the risk
of becoming demented later in life, And the longer one eats healthy, the
lower the risk of dementia drops. Next on the list is type 2 diabetes, which
we can prevent, arrest, and reverse with a plant-based diet—something
we've known since back in the 1930s. Within five years, about a quarter of the
diabetics were able to get off insulin. But, you know, plant-based diets
are relatively low calorie diets. Look, maybe their diabetes just got
better because they lost so much weight. To tease that out, what one would
have to do is design a study where you put people on a healthy
diet, but force them to eat so much food that they wouldn't lose weight
despite eating healthier.

Then we could see if a plant-based
diet had particular benefits, unique benefits beyond
just all the weight loss. Well, we'd have to wait
44 years, but here it is. Subjects were
weighed every day and if they started losing weight,
they were made to eat more food. In fact, so much food some of the
participants had problems eating it all. They're like "Oh, no,
not another tostada.

Oh, not another salad." But they eventually adapted. So no significant alterations
in body weight despite restricting meat,
dairy, eggs, and junk. So with zero weight loss
did a plant-based diet still help? Well, overall, insulin requirements
were cut about 60%, and half were able to get off insulin
altogether despite no change in weight. How many years did this take? No, 16 days! So we're talking diabetics who've
had diabetes as long as 20 years, injecting 20 units of insulin a day,
and then as few as 13 days later, off all insulin altogether, thanks to less
than two weeks on a plant-based diet. Diabetes for 20 years, off
all insulin in 2 weeks. Diabetes for 20 years because no one
had told them about a plant-based diet. Here's patient 15. 32 units of insulin on the control diet,
and then, 18 days later on none. Lower blood sugars
on 32 units less insulin. That's the power of plants. And as a bonus, their cholesterol dropped
like a rock to under 150, in just 16 days. Just like moderate changes in diet, you
only get moderate changes in cholesterol. How moderate do you
want your diabetes? Everything in moderation is a truer
statement than many people realize.

Moderate changes in diet can leave
diabetics with moderate vision loss, moderate kidney failure, moderate amputations—maybe
just a few toes or something. Moderation in all things is
not necessarily a good thing. You know that study that
purported to show that diets high in meat, eggs, and dairy could
be as harmful to health as smoking, supposedly suggested that people
who eat lots of animal protein are four times more likely
to die from cancer or diabetes. But if you look at the actual
study, you'll see that's not true. Those eating lots
of animal protein didn't have 4 times more likely
risk of dying from diabetes. They had 73 times higher risk
of dying from diabetes. Now those who chose moderation, eating
a moderate amount of animal protein, they only had 23 times
the risk of death from diabetes. Killer number 8 is kidney failure, which
can be both prevented and treated with a plant-based diet,
and no surprise. Kidneys are highly vascular organs. Harvard researchers found three dietary
risk factors for declining kidney function. Number one, animal protein;
number two, animal fat; and number three, cholesterol —
all of course only found in one kind of food.

Animal fat can alter the actual
structure of our kidneys, based on studies like this
showing plugs of fat literally clogging up the
works in autopsied kidneys. And the animal protein can have a
profound effect on normal kidney function, inducing what's called hyperfiltration,
increasing the workload on the kidney, but not plant protein. Eat some tuna fish and you can see
increased pressure on the kidneys: 1, 2, and 3 hours after
the meal, shoots right up. But, if instead of having a tuna
salad sandwich though, you had a tofu salad sandwich with the
exact same amount of protein: no effect. Kidneys can deal with plant protein
without even batting an eyelash.

So wait a second. Why does animal protein cause that
overload reaction, but not plant protein? It appears to be due to the inflammation
triggered by the animal protein. How do we know that?
It's because if you give a powerful anti-inflammatory
drug along with the tuna fish, you can actually abolish
that hyperfiltration effect, that protein leakage effect
in response to meat ingestion. Then, of course,
there's the acid load.

Animal protein induces the formation
of acid within the kidney, which can then lead to what's
called tubular toxicity: damage to the delicate urine-making
tubes within the kidney. Animal foods tend to be acid
forming, whereas plant foods tend to either be neutral
or actually alkaline, actually base forming to
counteract some of that acid. So the solution to stopping the
progression of chronic kidney disease may lie in the produce market, produce
aisle rather than the pharmacy aisle. No wonder plant-based diets have been
used to treat kidney failure for decades now. Here's protein leakage on
the traditional low sodium diet that physicians would normally
put these patients on, switched to a
supplemented vegan diet, a conventional, plant-based,
conventional, plant-based, turning on and off kidney
dysfunction like a light switch based on what's going
into their mouths. Killer number 9 is
respiratory infections. What possible role
could diet play? Well, you obviously haven't seen my
video "Kale and the Immune System," talking about the immunostimulatory
effects of kale. Is there anything kale cannot do? Boosting antibody production 7-fold,
but this is in a Petri dish. What about in people? Well, if you take two groups, older
men and women, split them up.

Half continue to eat
their regular diet; the other half, add just a few servings
of fruits and vegetables to their diet. After getting their pneumonia vaccination,
their Pneumovax vaccination, and you can see a
significant improvement in the protective antibody
immune response to just adding a few servings of
fruits and vegetables to their diet. That wasn't cutting out meat; just adding fruits and vegetables can
significantly improve immune function. Killer number 10 is suicide. We've known that those eating
healthier have healthier mood states. In fact, only about half the
depression, anxiety, stress scoring, compared to those that eat meat. Researchers suspect that
it's the arachidonic acid, this inflammatory long-chain
omega-6 fatty acid found predominantly in chicken and eggs; that's where
it's mostly found in the American diet. But you can't tell if it's cause and
effect until you put it to the test.

So they took people eating
the standard American diet, removed meat, removed fish, removed
poultry and eggs from their diets. Significant improvement in mood
scores within just two weeks, thanks, perhaps, to this removal
of arachidonic acid from their body, which they thought was
adversely impacting mental health via a cascade of neuroinflammation,
brain inflammation, but we could bring down that inflammation
in their brain within just two weeks by removing, you know, cutting out
eggs, chicken, and other meat.

Now am I just cherry picking though? What about all the other studies,
randomized controlled trials showing that other diets
have improved mood? There aren't any. A recent review concluded that
only that plant-based intervention fits the bill in terms of working. It's hard to cherry pick
when there's only one cherry. Works in a workplace setting too: significant increase in physical functioning,
general health, vitality, mental health, and not surprisingly translating into
improved worker productivity. The biggest such study, across 15 corporate
sites at Geico, found that plant-based diets— significant reported improvements
in depression, anxiety, stress, improvements in emotional
well-being, etc., etc. So lifestyle interventions like
exercise can help mental as well as physical health, and among the most effective
of these is this plant-based diet. Killer number 11, blood infections. Sure, foodborne bacteria can kind of burrow
through the intestine into the blood stream and in women can creep
up into their bladder. We've known for decades that it's
bacteria creeping up from the rectum that actually caused bladder infections,
but only recently did we figure out where this rectal reservoir of
UTI-causing bacteria was coming from, and we now know it's chicken.

We have DNA fingerprinting proof of
a direct link between farm animals, meat, and bladder infections, solid
evidence that urinary tract infections can be what's called a zoonosis,
an animal to human disease. Say, wait a second. Can't I just use a meat thermometer;
cook the meat through? No, because of cross-contamination. We've known for decades that if you
give someone a frozen chicken to prepare and cook in their own kitchens
as they normally would, and a multitude of antibiotic
resistant bacteria jump from the chicken into the gut of
the volunteer, before they even eat it! So you could incinerate
that thing to ash. You don't even have
to eat any of it. You're infected before it even
makes it into the oven. Just handling it is the problem. Within days, the drug resistant
chicken bacteria had multiplied to the point of becoming a
major part of the gut flora. The chicken bacteria was like
taking over their intestines. Now what about if you follow the
safe handling guidelines as well.

No one actually does this, but the
official USDA recommendation is you should disinfect all common
kitchen surfaces with a bleach solution. Then they spray the
bleach on all the— OK, what if you did this, and then came in later and
swabbed common kitchen surfaces? And when you do that, researchers
find pathogenic fecal bacteria: salmonella, campylobacter—serious human
pathogens—still left behind in the kitchen. The reason that most people
have more bacteria from feces in their kitchen sink
than on their toilet seat is because most people rinse
chickens in the sink, not the toilet. So unless our kitchen is like some
biohazard lab, the only way we're going to guarantee we're not
leaving infection around the kitchen is to not bring it into our
homes in the first place.

But the good news is it's not like you eat
chicken once and you're colonized for life. In this study, the chicken bacteria
only seemed to last about 10 days before your good bacteria can
kind muscle it out of the way. The problem is that many families eat
chicken more than once every ten days, so may be constantly re-introducing
these chicken bugs into their systems.

Say, wait a second. You can't sell unsafe cars;
you can't sell unsafe toys. How is it legal to sell unsafe meat? Well, they do it by blaming the consumer. As one USDA poultry microbiologist said,
"Look, raw meats are not idiot-proof. They can be mishandled, and when they
are, it's like handling a hand grenade. You pull the pin, somebody's
going to get hurt." While some may
question the wisdom of selling hand grenades in supermarkets
and we get sick, it's our fault. The USDA poultry expert
suggests that "it's the consumers responsibility,
but we just refuse to accept it." It's like a car company saying,
yeah, we installed faulty brakes, but it's your fault for not
putting your kid in a seat belt.

The head of the CDC's food
poisoning division famously responded to this kind of blame-the-victim
attitude coming from the meat industry. She asked, "Is it reasonable that if
a consumer undercooks a hamburger, their three-year-old dies?"
Is that reasonable? Not to worry though:
the meat industry is on it. They just got the FDA approval
for a bacteria-eating virus they can spray onto the meat. Now the industry is concerned
about the consumer acceptance of these so called bacteriophages
may present somewhat of a challenge
to the food industry, so of course they're not
going to label it or anything.

But if they think that's
going to be a challenge, check out their
other bright idea. "The Effect of Extracted Housefly
Pupae on Pork Preservation." This is a science-y way of saying they
want to smear a maggot mixture onto the meat. Now wait, it's a low cost
and simple method. Think about it. Look, maggots thrive
off of rotting meat. However, there have
been no reports of— Sorry, it's a new clicker for me.
We'll see if we can get through it. However there are no reports of maggots
having serious diseases, right? Have you ever seen
a maggot sneeze? I don't think so.

They must be filled with kind of
anti-bacteria, something right? So let's take some maggots, grow them
3 days old, wash them off, towel them, a little Vitamix action
there, and voila! Safer meats. We did kidney failure. What about liver failure? We've known for decades
that a plant-based diet could be used to
treat liver failure, significantly reducing the toxins
that would otherwise build up eating meat without a fully
functional liver to detoxify your blood. Well, I have to admit, though,
that some people, there are some people eating plant-based
diets with worsening liver function.

They're called alcoholics, living
off barley and corn and grapes. Strictly plant-based, but
not doing so good. It's not clear what— High blood pressure is next,
affecting nearly 78 million Americans; that's nearly one in three of us. And as we age, our pressures
get higher and higher, such that by age 60,
it strikes more than half. So wait a second. If it affects more than half of us,
then maybe it's less of a disease and more just kind of an
inevitable consequence of aging. No. We've known since the 1920's
that high blood pressure need not occur. Researchers measured the blood pressures
of a thousand people in rural Kenya who ate a diet centered
around what? Whole plant foods. Starchy vegetables, grains, vegetables,
fruit, and dark green leafies. Our pressures go up as we age;
their pressures actually go down.

And the lower the better. The whole 140 over 90
cut-off is arbitrary. Even people that start out with
blood pressure under 120 over 80— you went to your doctor, had 120
over 80, you would get a gold star. But even 120 over 80, people appear to
benefit from blood pressure reduction. So the ideal blood pressure, the no-benefit-from-reducing-it-further
blood pressure is actually 110 over 70. Say, wait a second. Is it even possible to get blood
pressures down to 110 over 70? It's not just possible, it's normal,
for those eating healthy enough diets. Over two years at a rural Kenyan
hospital, 1,800 patients were admitted. How many cases of high blood
pressure did they find? Zero.
Wow! So they must have had low
rates of heart disease, right? No, they had no rates
of heart disease.

Not a single case of arteriosclerosis
(our number 1 killer) was found. Rural China too, about 110 over 70
their entire lives. 70-year-olds: same average
blood pressure as 16 year olds. Now, of course, Africa, China:
vastly different diets, but they share this common theme
that they are plant-based day-to-day with meat only eaten
on special occasions. Now why do we think it's the plant-based
nature of their diets that was so protective? Because in the Western world,
the only group getting blood pressures down that low, according to
the American Heart Association, are those eating strictly
plant-based diets, coming in at an average
of 110 over 65.

Based on the largest study of those
eating plant-based diets to date— this is a study of
89,000 Californians— there appears to be this step-wise
drop in blood pressure rates the more and more plant-based
one's diet gets, as one goes from meat eater
to kind of flexitarian, to just fish, to just eggs and dairy,
to all the way plant-based. Same thing with obesity
and diabetes: the more and more healthy
we eat, the better. So of course, yes, we can eliminate
the vast majority of our risk, but what's important about this slide
as well is that it's not all or nothing. It's not black and white. Any steps we can make on the
spectrum towards eating healthier can accrue significant
health benefits, which just get better and better
the more you actually do it. Blood pressure-wise, you
can show this experimentally. You take vegetarians;
you give them meat and pay them enough to eat it,
and their blood pressures go up. Or you remove meat
from their diet and their blood pressures
go down after 7 days in this mysterious McDougall
program cohort, whatever that is.

And this is after the vast majority
had already stopped or reduced their blood pressure
medications completely. They had to reduce their
blood pressure medications, because you're treating
the cause of the disease. And so if you don't have high
blood pressure anymore and you're on blood pressure medications,
you can drop your pressures too low, fall over and crack your head open.
You have to reduce— So we've got lower pressures
on fewer drugs. That's the power of plants. So does the American Heart
Association recommend a no-meat diet? No, they recommend a low-meat
diet, the so-called DASH diet. Why not vegetarian? When the DASH diet was being
created, were they just not aware of this landmark research
done by Harvard's Frank Sacks? No, they were aware
of the landmark research. The Chair of the Design Committee
that came up with the DASH diet was Frank Sacks. See, the DASH diet was explicitly
designed with the number one goal of capturing the blood pressure
lowering benefits of a vegetarian diet, yet contain enough animal products to
make it palatable to the general public.

They didn't think the public
could handle the truth. Now in their defense, you can
see what they were thinking. Just like drugs never work
unless you actually take them, diets never work unless
you actually eat them. So they're like, OK, well, no one's going
to go on a strict vegetarian diet, right? So if we soft-peddled the truth
on the population scale, maybe we'll actually, you
know, help more people. Alright, tell that to the thousand
families a day that lose a family member
to high blood pressure. Maybe it's time to start telling
the American public the truth. Killer number 14
is Parkinson's disease. Does a plant-based diet reduce
the risk of Parkinson's disease? Well, most studies to date
suggest this link between dairy products
and Parkinson's, but why? Well, there's evidence that milk is
contaminated with neurotoxic chemicals.

High levels of pesticide residues have
been found both in the milk supply, and in the brains of people that
die from Parkinson's disease. These are compounds like
tetrahydro-isoquinoline, which is actually what they use to induce
Parkinson's in primates in a laboratory, found mostly in
cheese actually. And so there's been calls that we should
have toxin screenings of the milk supply. Yeah, good luck with that. Of course, you could just not drink it, but
then what would happen to your bones? That is a marketing ploy. If you look at the actual science,
milk does not appear to protect against hip fracture risk,
whether drinking in your adult years, or whether you're drinking
in your teen years. If anything, milk consumption was associated
with an increase in fracture risk. Maybe this is why hip
fracture risks are highest in populations where they
drink the most milk. So Swedish researchers
decided to put it to the test. A 100,000 men and women,
followed for up to 20 years, and milk drinking women had the higher
rates of death: more heart disease, significantly more cancer
for each daily glass of milk.

Three glasses a day was associated with
nearly twice the risk of premature death. And they had significantly more
bone and hip fractures, too. More milk, more fractures. Milk-drinking men also had higher
rates of death, but for some reason you never see milk ads like this.
I'm not clear why. And finally, aspiration pneumonia, which
is caused by swallowing difficulties due to a stroke or
Alzheimer's or Parkinson's, things we've already talked about. OK, so, where does this leave us? These are the top fifteen reasons
that Americans die, and a plant-based diet can
prevent nearly all of them, can help treat more than half of them,
and even prevent and even reverse the course of disease
in some of them, including in some cases
our top three killers. Now look, there are drugs that in
some circumstances can help, too. There's the cholesterol-lowering
statin drugs. There's usually a whole
bunch of different classes of blood pressure lowering
medications one has to be on. There's blood sugar pills
and insulin injections. But think about the diet. This same diet, though, does it all. It's not like there's a liver-healthy diet,
and then there's a heart-healthy diet, and a different brain-healthy diet.

No, a liver-healthy diet is a kidney-
healthy diet, is a body-healthy diet. One diet to rule them all. And what about drug side effects? I'm not talking a little
rash here or something. Prescription drugs kill more than
a 100,000 Americans every year. You say, wait a second, 100,000 American deaths every
year from adverse drug reactions? Well, wait a second. That means that the sixth leading cause
of death in the United States is actually doctors! The sixth leading cause
of death is me! Thankfully, I can be prevented
with a plant-based diet. Seriously, though, compared to 15,000
American vegetarians, meat eaters: about twice the odds of being on aspirin,
sleeping pills, tranquilizers, antacids, pain-killers, blood pressure medications,
laxatives (of course), as well as insulin.

So plant-based diets are great for
people that don't like taking drugs; for people that don't
like paying for drugs, and for people that don't
like risking drug side effects. Want to solve the healthcare crisis? I've got a suggestion. There is only one diet that's ever
been proven to reverse heart disease in the majority of patients,
a plant-based diet. So anytime, anyone tries to sell you
on some new diet they heard about, do me a favor.
Ask them a simple question. "Wait a second.

Has this new diet been
proven to reverse heart disease? You know, the most likely reason
me and all my loved ones will die?" If the answer is no, then why
would you even consider it? If that's all a plant-based diet could
do, reverse our number 1 killer, shouldn't that kind of be the default
diet until proven otherwise? And the fact that it can also be effective
in preventing, treating, and reversing other leading killers like
type 2 diabetes and hypertension, would seem to make
the case overwhelming. Most deaths in the United States are
preventable and related to nutrition. According to the most rigorous
analysis of risk factors ever published, the number 1 cause of death
in the United States, and the number one cause
of disability is our diet, which has since bumped
tobacco smoking to killer number 2. Cigarettes only kills about
a half million Americans every year, whereas our diet kills
hundreds of thousands more. So, let me end with
a thought experiment. Imagine yourself a
smoker in the 1950s. The average per capita cigarette
consumption was 4,000 cigarettes a year.

That means the average American
smoked a half a pack a day. The media was telling you to smoke;
famous athletes agreed. Even Santa Claus
wants you to smoke. I mean, look, you want to
keep fit and stay slim, stay slender, and keep yourself
trim by eating lots of hot dogs. So you smoke,
eat your hot dogs. And to stay slim and trim,
you eat a lot of sugar, too. A lot better than
that apple there. Can you see that?
I mean, sheesh… Although apples do "connote
goodness and freshness," according to one internal
tobacco industry memo, which they see many possibilities
for youth-oriented cigarettes. They wanted to make apple-flavored
cigarettes for kids. Shameless! "For digestion's sake,
you smoke." I mean no curative power
is claimed by Philip Morris, but look, an ounce of prevention
is worth a pound of cure, so better safe than sorry
and smoke.

"Blow in her face and
she'll follow you anywhere." "No woman ever says no." They're "so round, so firm,
so fully packed!" After all, John Wayne smoked them
until he got lung cancer and died. You know, back then, even the Paleo folks
were smoking, and so were the doctors. This is not to say there wasn't
controversy within the medical profession. Yes, some doctors smoked Camels,
but other physicians preferred Luckies, so there was a little conflict there. The leader of the U.S. Senate agreed. I mean, who wouldn't want
to give their throat a vacation? How could there be a single
case of throat irritation when "cigarettes are just as pure
as the water you drink?" Perhaps in Flint, Michigan. And if you do get irritated, no problem. Your doctor can always write you
a prescription for cigarettes.

This is an ad in the Journal
of the American Medical Association. So when mainstream medicine is saying
that smoking, on balance, is good for you, when the American Medical
Association is saying that, where could you turn back then
if you just wanted the facts? What's the new data
advanced by science? She was "too tired for fun, and
then she smoked a Camel." Babe Ruth spoke of proof
positive medical science, that is when he still could speak,
before he died of throat cancer.

Now, if by some miracle, there was a website back then that could deliver the
science directly, bypassing commercially
corruptible institutional filters, you would have become
aware of studies like this. This is an Adventist study in
California published in 1958. Showed that nonsmokers, have at least 90% lower
lung cancer risk than smokers. But this wasn't the first. When famed surgeon Michael DeBakey
was asked why his studies published back in the 30s linking
smoking and lung cancer were simply ignored, he had to remind people
what it was like back then.

We were a smoking society. It was in the movies;
it was everywhere. Medical meetings were
one heavy haze of smoke. Smoking was, in a word, normal. So back to our thought experiment. If you're a smoker in the 50s
in the know, what do you do? Do you change or do you wait? If you wait until your doctor
tells you, between puffs, to quit, you could have cancer by then. If you wait until the powers
that be officially recognize it, like the Surgeon General
did in the subsequent decade, you could be dead by then.

It took 25 years for the Surgeon
General's report to come out. It took more than 7,000 studies,
and the death of countless smokers, before the first Surgeon General's
report against smoking came out. You'd think maybe after the first
6,000 studies, they could have given a little heads up here or something? No. A powerful industry. So one wonders how many people
are currently suffering needlessly from dietary diseases? Maybe we should have stopped smoking
after the 700th study like this came out. So as a smoker in the 50's, on one hand
you had all of society, the government, the medical profession itself
telling you to smoke. And on the other hand, all
you had was the science, if you were even aware
of studies like this. Now let's fast forward 55 years.

There's a new Adventist study in California,
warning Americans about the risks of something else they may
be putting in their mouths. And it's not just one study. According to the latest review, the sum
total of evidence suggests mortality from all causes put together, many
of our dreaded diseases— stroke, cancer, diabetes, etc.— is significantly lower among
those eating plant-based. So instead of someone going along with
America's smoking habits in the 50s, imagine you or
someone you know going along with America's
eating habits today. What do you do? With access to the science, you realize that the best
available balance of evidence suggests that your eating
habits are not so good for you. So do you change or do you wait? If you wait until your doctor tells
you, between bites, to eat healthier, it could be too late. In fact, even after the Surgeon
General's report was released, the medical community
still dragged their feet. The AMA actually went on
record refusing to endorse the Surgeon General's report. Why?
Maybe it’s because they just got a $10 million check
from the tobacco industry.

Maybe not, maybe
it's coincidence. OK, so we know why the AMA may have been sucking up
to the tobacco industry, but why weren't, you know, just
individual doctors speaking out? Well, there were a few gallant souls
ahead of their time as there are now, writing in as there are
today, standing up against institutions killing
millions, but why not more? Well, maybe it's because the majority of physicians
themselves smoked cigarettes, just like the majority of physicians
today continue to eat foods that are contributing to our
epidemic of dietary diseases.

What was the AMA's
rallying cry back then? Everything in moderation. "Scientific studies have proved
that smoking in moderation—" Oh, that's fine.
Sound familiar? Today, the food industry uses
the same tobacco industry tactics, supplying misinformation,
twisting the science. The same scientists-for-hire
paid to downplay the risks of second hand
smoke and toxic chemicals are the same paid by the National
Confectioners Association to downplay the
risks of candy, and the same paid by the meat industry
to downplay the risks of meat. Consumption of animal products
and processed foods cause at least 14 million deaths
around the world each year. 14 million people dead. Plant-based diets can
now be considered kind of the nutritional equivalent
of quitting smoking. How many more people have
to die, though, before the CDC says, ah, don't wait for open-heart surgery
to start eating healthy as well? Until the system changes, we need
to take personal responsibility for our own health,
for our family's health.

We can't wait until society
catches up to the science because it's a matter
of life and death. Last year, Dr. Kim Williams was made President of the
American College of Cardiology. He was asked why he follows his
own advice that he gives to patients to eat a plant-based diet. "I don't mind dying,"
Dr. Williams replied. "I just don't want it
to be my own fault." Thank you very much. [Comments and Q&A session
follows after the applause.] Thank you so much. If you want to share the talk that I gave,
it's actually on a combination— it's kind of the best of my
last four annual DVD talks on The Leading Causes of Death,
The Leading Causes of Disability, The Most Common Diseases,
The Most Dreaded Diseases.

We have all those DVDs here,
as well as, I think, my latest DVD. I'm up to Volume 30
or something by now. All proceeds from the sale
of all my books, DVDs, and speaking engagements
all goes to charity. And I'm so excited,
for the first time here at McDougall to actually
have my book here, "How Not to Die." Remember back in September I was like,
"In three months my new book is out," and now finally I'm
so excited to be here. Of course, all my work is available
free at, yes! Michael, you're the master. Thank you, Dr. Greger. It was a wonderful presentation. I have a question for you since you
are the master of reading studies, disseminating them
to the general public.

Are you aware—I know that you cited the
research regarding the impact on cancer with a plant-based diet, Dr. Dean Ornish's
study on prostate cancer out of UCSF. Are you aware of any other clinical
human trials that are happening now that we can expect to see some results
that actually show the impact of a plant-based diet on the treatment of
cancer, as opposed to preventing cancer? Professor Campbell, wouldn't
that be an amazing study to do? Yes! All right. The only studies we have— so there are some studies on individual foods,
but in terms of a plant-based diet, no. We just have Ornish's study until we have
future studies coming out, hopefully soon. But currently we have,
for example, you know, I have videos about the effect
of strawberries, for example, on the progression of esophageal
cancer, where they just took people with these pre-cancerous lesions in their
esophagus and gave them basically— basically I think two pints
of strawberries a day for a month. That's a lot of strawberries,
but it was just strawberries. And found that in the
majority of patients— I think 80% of the patients,
the lesions got better, and I think half the patients they disappeared
completely, like they went away.

And then they did biopsies and saw all the
gene changes that took place, you know, onco genes go down, the tumor
suppressor genes go up. And there's been similar studies on black
raspberries painted onto oral cancer lesions, and given black raspberry suppositories
for rectal cancer lesions. Yeah, don't try it at home, folks. And then studies on flax seeds, and studies
on, you know, soy for breast cancer patients, and things like that, where
there's been individual foods. But when you say, wait a second: what if
your entire diet was filled with plant foods? And all we have to point to, I mean
in terms of clinical studies, is Dr.

Dean Ornish's landmark work,
beyond all the kind of ex-vivo work like we saw with the breast cancer patients
where, yes, we're using what happens in your body after eating healthy for
two weeks in terms of what happens to your blood stream's ability
to suppress cancer growth. But that's different from taking
people with cancer, changing their diets, and
actually seeing what happens. You say, well, wait a second. Why hasn't anyone done that study? Big broccoli doesn't quite have the same
kind of research budget, I'm afraid, that big pharma does. But wouldn't you—I mean, I certainly would
donate to have that kind of study done. Wouldn't you be like, "I want
to see that study done." And so if, for example, Dr.

put together such a research proposal and got some research institutions involved,
and said let's take cancer patients, let's put them on a plant-based
diet and see what happens, and put out like a Kickstarter
kind of program— I told him, we'll raise money
for him in a flash. I'll promote it on the site. We'll get it out there, and I think
it's going to be doable. So hopefully next year we'll get
back with some better news, right? Mike, forgive me for this
interjection on this topic, but something very profound
happened February 13, 2015, and that's [when] the American Cancer
Society came out and recommended that people with cancer follow a diet in
this direction because it improves survival.

And there are multiple studies that
have been done that show that people with breast cancer, prostate cancer,
colon cancer, even melanoma, when they eat a healthier diet,
they live longer. So the American Cancer Society
has come out and supported the treatment of cancer with diet. If you have cancer, you're to follow
this kind of diet, and up to date, which is often referred to, in February,
then they sent me the same conclusion. Part of the fundamental treatment
of all cancer patients should be a plant-food based diet. So there's a lot of information
to find out there about that. So there certainly have been studies
showing that, for example, women who eat more saturated
fat after breast cancer diagnosis live significantly shorter and
have greater recurrence. And so, absolutely, so more
plant food consumption. But in terms of actually randomizing people
to plant-based diets, unfortunately there's not enough of those studies,
but hopefully that will change. I was wondering if there's any correlation
between a good diet or a bad diet and joint replacements, because
everyone seems to be getting them.

Yeah, well, there is – I mean probably
the number one reason, so when you're talking
about knee replacements, why are people’s knees wearing out is
because they're carrying 200 pounds, not in their back
but in their waist. I mean that's kind of the primary cause where
we get this osteoarthritis in our knees. Our knees grind down and
they have to get replaced. And so, does diet have
anything to do with obesity? If you think there's some possible
mechanism there, then absolutely— kind of our most common
replacement surgeries. But it's not like you can be like, "Oh, I've got
to get my knees replaced next week. OK, well, let's do
some dietary reversal." No, it's got to start
decades before so you can prevent that kind
of response in one's joints. Thank you so much for this talk. I'm a nutrition educator and my question
is are there any studies done where the people make more drastic
changes if they're told the truth about eating a plant-based diet
versus when they are told, you know, make some changes, eat more plant foods
while you're still eating animal foods? Like what group of people make more
changes in their long-term diets? Like as an educator, should
I teach the PCRM programs or should I work for public health and teach
some classes but where I don't go fully out and say, "Get on a plant-based diet
because it can cure you of diabetes"? There's actually a study; there's
a rich psychology of literature on behavioral change, and it turns out
the more you ask for, the more you get.

So I think doctors are like, "Well, I'm going
to scare people off if I tell them the truth, so I'll be like: eat
an apple once in a while." But it turns out, no, I mean it's kind
of the old adage, you know, you shoot for the stars and end up
on the moon or something like that. I think it's the other way around, but it doesn't make sense astronomically,
so I have to flip it. Now it doesn't mean your patient
is ever going to follow it, but you say, look, we don't tell our patients:
cut down to a pack a day. We tell them to quit. I mean is smoking half a pack
a day better than two packs a day? Probably.

But no, it's not good for you. Ideally we should only put
healthy things in our mouths, and that's what we should
tell our patients. And so when we tell patients
"this is the ideal"— So like in my book, it's funny, out of all
the kind of radical ideas in my book I get all this push back about
my exercise recommendation. You know, I just review
the science on what's best— So I recommend 90 minutes
of exercise a day, like walking. And people are like, "90 minutes a day?" I'm just like, "Well, look.
The science shows—" "So wait a second.

Then why does the government
only recommend 22 minutes a day?" Because they're trying to make it palatable;
they're trying to make it doable. They don't want to scare people off,
instead of telling people the truth. But if you look at the
science, it's very clear: 30 minutes are better
than 22 minutes; 60 minutes is better than 45 minutes,
and then 90 better than 60. And then there's no studies where anyone's
ever exercised more than 90 minutes, so we don't even have
studies past that. So the best available balance of evidence
is just 90 minutes is better.

OK, so that's what—look, it doesn't
mean you have to do it every day, but you should just know that
that's kind of the— And then anything we
can do towards that is— And the same thing with diet. We should tell people
this is the ideal diet. "This is the diet that's actually
going to reverse disease. And then, look,
then it's up to you. You're an adult. You want
to smoke cigarettes? It's your body;
it's your choice, but you should know the predictable
consequences of your actions." As physicians, that's our role:
informed consent.

I'm going to go
shoot for the stars. All right! You know, Michael, without a doubt everyone
in the audience would agree with me, we could just sit here and listen
to you all afternoon. But the time has come, and
Michael, if you'll go outside because I know you're going to have a big
crowd, and we'll be back in six minutes. Thank you..



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