David Ferriss, MD, MPH is Medical Executive for Lifestyle Medicine with CIGNA HealthCare, where he tracks research on the beneﬁts of good nutrition, exercise and stress relief, to create eﬀective programs for improving clinical outcomes and reducing medical costs. We ﬁrst met David at an Oldways Mediterranean Diet conference in 2003, and recently checked in with him to see how he’s been able to weave the information he garnered there into his passions and his work.
Oldways: You work in the emerging specialty of lifestyle medicine. Can you explain what that is?
David: Lifestyle medicine involves the use of lifestyle interventions such as nutrition, physical activity, and mind-body interventions to prevent and treat chronic conditions such as type 2 diabetes, coronary artery disease, and hypertension.
Oldways: Getting people to change the way they eat can be a hard sell, since many people feel that they’ll have to give up all their favorite foods for years in order to see a small reduction, years later, in their risk for some disease they’ve never heard of. How soon is it realistic to expect positive results from changing the way you eat?
David: People think of prevention and treatment with lifestyle interventions as having only a long-term payoﬀ – so why invest the eﬀort? But payoﬀ can be very quick. The vast majority of people with type 2 diabetes, for example, can most likely normalize their blood sugar in a few months or less if they really change to something like the Mediterranean Diet. It’s also not unusual to have patients’ total cholesterol drop signiﬁcantly in six weeks just from dietary changes.
Oldways: How well documented are results like these?
David: The research is more and more conclusive – not only from epidemiological studies but also from clinical trials. Amazing things happen when people undertake serious lifestyle change, especially with respect to what they eat. Some people get oﬀ their medications entirely, while others are able to reduce them signiﬁcantly.
Oldways: Then why isn’t nutrition emphasized more in the medical community?
David: I think there are multiple reasons. National clinical guidelines for elevated cholesterol and hypertension certainly recognize that healthy nutrition as well as regular exercise should be considered ﬁrst-line therapy, but doctor appointments are short, changing habits can often be diﬃcult, and so people leave the doctor’s oﬃce with another prescription instead. In addition, most physicians have received little to no formal training as part of their medical education in the use of lifestyle interventions, especially nutrition, to prevent and treat chronic disease. Most physicians don’t understand that food is powerful medicine and exercise is powerful medicine.
Oldways: Do you think this will change anytime soon?
David: I think new discoveries about the expression of genes are shedding new light on the importance of nutrition and other lifestyle factors. Dean Ornish, for example, has demonstrated that lifestyle change can up-regulate and down-regulate genes. We’re all born with a certain genetic make-up, but some 80% of the determination of our genes to turn on or oﬀ most likely comes down to lifestyle – the food we eat, whether we smoke, the amount of exercise we get, and how we handle stress.
As I looked at the research, the key “light bulb” for me was the idea that food is medicine, exercise is medicine. Food is not just a source of energy or enjoyment. I keep thinking of food as information, washing over one’s inherited genetic code every time one eats. We need to make connections between foods – the phytochemicals, antioxidants, and ﬁber they contain — and their biochemical eﬀects.
Oldways: So what kind of diet do you recommend in your programs?
David: We need to encourage people toward more of a plant-based diet, with lots of fruits and vegetables, whole grains, legumes – all of which provide ﬁber and lots of good phytochemicals and antioxidants. Go sparingly on meat; most Americans eat far too much meat. In the traditional Mediterranean Diet, meat was generally just for feast days. Whether it’s Mediterranean or based in other cultures, fundamentally it’s the same plant-based diet.
The ﬁrst time I attended an Oldways Mediterranean Diet conference was a wonderful experience. I remember the banquet you held. It was an amazing dinner with all kinds of colors and textures and tastes, and I didn’t realize at ﬁrst that there wasn’t any meat, or even any ﬁsh – which I love! That’s why the work you’re doing is so important – you show people just how much you can do with plants.
Oldways: What will be the next chapter in your life?
David: I’ve cut back at CIGNA from full-time to three days a week, in part so that I can open a part-time lifestyle medicine clinical practice. We see the results of unhealthy diet everywhere, in a tsunami of chronic disease. I want to help people connect the dots, get those light bulbs to turn on, get them interacting with food in profound ways that will dramatically impact their health and enjoyment of life.