As clinicians and public health leaders, we falsely believe that we are in a crisis of education when it comes to nutrition. In other words, the world hasn’t become plant-based because they don’t know about it or know very little. While this may be true for some, the real issue remains in our failure to provide a roadmap and the resources necessary for implementation. The world should follow a plant-based lifestyle, but what does this actually look like in the day-to-day life of the average family or person or population even? We know that the key to good health lies in our ability to manage several risk factors, most of which are lifestyle-based, yet despite our desires for our patient’s to achieve a healthy eating lifestyle, we continue to be overwhelmed with an alarming increase in chronic illnesses such as Alzheimer’s, high blood pressure, diabetes, etc. We have the answers and it should be simple. Change your eating habits and increase your chances of healthy longevity. But this isn’t happening. We have 23 million adults living with diabetes. Over 100 million people have high blood pressure (that’s nearly half of the population)^[1] and 38% of the population are suffering from obesity. From 1953 to now, the prevalence of smoking among adults has decreased by more than 70%, in contrast the American Heart Association estimates that less than 1% of Americans are consuming a healthy diet.^[2] Why are we winning the battle on smoking but losing the war on healthy eating? Somewhere between what we know we need to do and what the numbers tell us, we are not getting a consistent message out, nor are we teaching people how to implement these changes into their lives for good.

As researchers and physicians in preventive and behavioral neurology, we see the critical need to not stop with just treating existing patients suffering from neurological diseases such as dementia and stroke. In order to make big gains in decreasing the prevalence of these diseases, we knew we needed to focus on prevention. Through this integrated approach that focuses on prevention education and feasible implementation, we believe we can make lasting changes to large populations that will drastically reduce the prevalence of some of the most devastating and costly diseases in history.

Nutrition as prevention is one of the mightiest weapons we have against chronic diseases and cognitive decline.

Food is at the core of our chronic disease epidemic, and yet we are failing miserably at affecting change in this area for the general population. There is a huge misconception that doctors hold the key to proper nutrition. Many would be surprised to find out that doctors do not receive focused nor adequate education on proper nutrition in all their years of school. They focus on treating existing illnesses with pills and scalpels. Additionally, they receive zero tools on how to partner with their patients to achieve their health goals. Physicians are also the most cynical with regards to lifestyle change because they just don’t believe people can change behavior — not because it is true – but rather because they have never seen it in a disease-based model (hospital and clinic) and, for lack of time and knowledge, have never been part of it. This is a big problem since nutrition as prevention is one of the mightiest weapons we have against chronic diseases and cognitive decline. If we look at the “Simple 7” reported by the American Heart Associated every year (seven cardiovascular health metrics, AHA Life’s Simple 7 – four health behaviors: smoking, weight, physical activity, and diet and three health risk factors: total cholesterol, blood pressure, and fasting blood glucose],^[3] we see that we continue to struggle in properly addressing healthy eating.

Why is this the case?

In our extensive experience both working directly with patients, families and populations, we have learned that there are two main reasons for this failure to create change. First, there is profound chaos and often conflicting information about what constitutes a healthy diet. People are inundated with a plethora of “new takes” or fad diets promising to give them their health back. In the steady drum of information on all the latest and greatest eating plans, often with no research to back the claims, the scientific case for a whole food, plant-based diet gets lost in the noise. Second, we fail individuals, families and communities when we create false expectations at the end of unclear paths to change. This reason is probably more detrimental than the first. Physicians can actually make the problem worse. We perpetuate the all-or-nothing myth with our New Year’s resolution mentality and deprivation techniques. In other words, we set our patients up to fail before they even get started.

The key to making lasting dietary changes is to build healthy habits, but the public perception on this terminology itself holds a lot of misconceptions. We should be guiding patients to pursue a whole food, plant-based diet and teach them how to do this through a systematic habit building process.

Habit building is more than just a series of motivational steps that keep us consciously inspired so that we can continue to “white knuckle” our way through our new promises to ourselves. There are actual neurologic changes that take place which profoundly enhance our ability to create lasting change. Through instruments such as the Magnetic Resonance Imaging, PET scans and other amazing tools, we have been able to identify specific areas in the brain that are enhanced through habit building. The basal ganglia and prefrontal lobe are centrally involved in the neurology of building habits.^[4] So changing your life is not a completely conscious process. It’s not solely about maintaining your resolve. It’s about strengthening your neurocircuitry to aid in the process. The very steps you choose to take to build any single habit creates pathways in your brain that makes future habit building even more likely.

If we truly want to win this battle we need to teach the art and science of behavior modification, which is centered on clear goal setting and creating a clear path of successes towards the said goal.

The very concept of motivation is often thought of as a magical heightened sense of inspiration that creates habits. Many don’t realize the motivation comes from the brain’s ability to give emotions to anything. When we make goals (the more specific the better) and make small successful steps towards that goal, our basal ganglia is busy creating real pathways (neural connections), literally laying down the permanent habit tracks. Good habit building is not an emotional process, it’s a mechanical one. Emotions are the aftermath of the process happening underneath. We are actually conditioning our brains to do a more efficient job of creating healthy steps. This is why simply looking at health outcomes as binary (all or none) can profoundly undermine the brain’s intrinsic capacity to build habits through simple linear successes. Today, in the academic world, it is fairly well established that a whole food, plant-based lifestyle can significantly reduce burden of disease, especially those related to the brain, yet our greatest failure in transferring this remarkable fact to the general public has been empowering individuals, families, and communities with the tools to transform at the level of habits and core structure of the brain. If we truly want to win this battle we need to teach the art and science of behavior modification, which is centered on clear goal setting and creating a clear path of successes towards the said goal. Our remarkable brain will do the rest of the work for us by assigning it positive emotions which we call motivation. Thus we need to focus more on empowerment and less on the battle of ideas as the latter is already won.

People willing to take their brain and body health back into their own hands can sign up for a free 25 day “Brain and Body Boost Challenge” with Drs. Sherzai: http://teamsherzai.com/brain-and-body-boost-waiting-list.
Follow their hashtag #brainandbodyboost for tips and to connect with others making the transition to health.

References

1. https://news.heart.org/nearly-half-u-s-adults-now-classified-high-blood-pressure-new-definitions/
2. Heart Disease and Stroke Statistics – 2018 Update. A Report From the American Heart Association. Circulation. 2018;137:e67–e492. DOI: 10.1161/CIR.0000000000000558.
3. http://www.acc.org/latest-in-cardiology/articles/2016/05/27/01/55/ahas-lifes-simple-7
4. The role of the basal ganglia in habit formation. Nature Reviews Neuroscience volume 7, pages 464–476 (2006).