IamA doc who studied people who live extremely long lives in places called Blue Zones. The human body is incredibly resilient which is why I specialize in chronic disease prevention and reversal. AMA!

I enjoy a great deal of homecooking, cheese with fruit, hookah, beer, wine, sex, sun, being at work, gardening, arguing on the internet and dungeons&dragons.

Which one should I get twice as much of, which one should I get half as much of and why?

If you were my patient I would want to give you the most bang for your buck so let me comment on your entire routine.

Overall: The good thing is you are hitting several keys of longevity found in Blue Zones.

Homecooking- Love this, eating whole foods one of the keys to longevity. Do this for every meal if you can.

Cheese with fruit- One of my guilty pleasures, but cheese can have high levels of saturated fat. I'd say do this in moderation.

Hookah- Hookah is just as bad as smoking (sorry everyone) so cut this to zero.

Beer- In moderation, unless you are gluten sensitive, then sorry to say its only gluten free beer for you… They really do make this stuff!!

Wine- Daily mild-moderate alcohol consumption is one of the things observed in many of the blue zones. Although its clearly not necessary as most Adventists abstain. A wine called cannonau is consumed in Sardinia that has a high concentration of flavonoids (A powerful category of antioxidant).

Sex- Great workout and a key to long lasting health.

Sun- Use proper sun protection, but many people are vitamin D deficient.

Being at work- If you are doing something that fulfills you and makes you feel good and accomplished this is great.

Gardening- Great to do with beer and sun. Arguing on the internet- Stress detracts from well-being so why seek conflict?

Dungeons & dragons- Social connection and community are huge drivers of having a long life.

Hope this helps!! Smile and have fun, it will add years to your life and life to your years as they say!

Hi Doc,

When blue zone people leave their zone, do they continue the long-life trend? When people move into the blue zone do they pick up the long-life tendency?

I do not know the answer off hand, but I suspect it depends on what they decide to do next! I actually did undergrad studying in Hawaii and I was fascinated by the amount of times I would hear people tell me of there relatives who were healthy in Japan or Southeast Asia, then came to Hawaii and they themselves and their kids were getting fatter and sicker. Their is a lot of evidence showing healthy people in healthy cultures that adopt our "western ways" start to accumulate the same illnesses, diabetes, obesity, heart disease, etc... I can tell you, that my hope in moving here in part was to learn to live better and I believe I have been transformed for the better having come to this blue zone nestled in SoCal!

What are the common characteristics that these blue zones share that might correlate to longer lives of inhabitants? Or I guess what I'm really getting at is "What can I do to mimic them to extend my lifespan?"

Thanks for a great question, I believe much of the common characteristics are around dietary habits, movement patterns, stress resilience and social and spiritual practices. They smoke less, eat more vegetables and whole foods, they practice gratitude, the move more, they connect more! If you want to expand your lifespan I would love for you to get connected with like-minded people either in person or online and make some goals. Goodluck!

A great TED talk from Dan Buettner really shows the point well...

http://www.ted.com/talks/dan_buettner_how_to_live_to_be_100?language=en

Are there any characteristics of these Blue Zones which are less social and more environmental? Temperature averages and ranges? Elevation? Humidity? Rainfall patterns? Soil pH? Flora and fauna?

I think this is a great question. I really don't think so. I would have to defer to other experts who might know if there is a specific link that I am unaware of, and would be happy to learn of the evidence.

Worth knowing many of the blue zones are on or near water, but Loma Linda is land locked in a heavy smog zone. It has a heavy industrial chemical exposure close by with major railways in San Bernardino. It is dry and desert climate vs the tropical climates and mediterranean. Yet other unique factors connected to lifestyle seem to be important.

Would you say that Loma Linda is a blue zone because of Adventists and their dietary restrictions? A large portion of the population follows strict religious and mostly vegetarian dietary restrictions, and I don't see it mentioned anywhere yet in this post.

Do other blue zones have similarly obvious correlations?

Great question. Thanks for bringing this up. What many people don't realize is that Loma Linda is centered in San Bernardino county which actually as a county has some the worst health outcomes in the country. It is known for being a fast food capital where McDonalds and Del Taco were started. The stark contrast in health outcomes is also apparent as I see patients from multiple communities in the area. The Adventist culture definitely plays a major role in the disparities. Many Adventists here do not see their lives as or diets as restrictive. Some eat eggs, some have dairy, some have fish. The Adventist health studies actually compare the population against itself in many ways to discover which areas of their lifestyle has the biggest impact.

My simple understanding is that eating more whole foods that are plant based has a huge role on health. The ability to attend to spiritual needs in community, avoiding toxic substances, take time out to practice gratitude, and focus on being physically active also plays a major role.

You advocate, based on your findings, a plant based diet. I've read research regarding the low amounts of DHA-EPA found those who practice a plant based diet and vegans who don't supplement with either micro algae oil or fish oil. Because the DHA-EPA is needed for the brain there has been a lot of talk about lowered brain functions of those deficient in it. Any thoughts on this?

Thanks for your comment. I advocate for helping people reach their individual potentials, not everyone will be a vegan or even a vegetarian. Not everyone will follow a strict Mediterrean, Paleo, Raw food, Atkins, or any other type of "diet". I actually do not advocate for diet, I focus on the people in front of me and help them understand their personal risks and we create a plan to optimize their health according to their values.

That said, we are learning more and more about the need for essential fats for brain health. I personally am not a vegan or a vegetarian. However I recognize the benefits of nutrient dense foods when compared with nutrient poor and calorie dense foods. What most people need is more whole foods (More vegetables and fruits often) then is supplied in the SAD (Standard American Diet). Your point about the need for good oils, I agree with! And for patients that do not get DHA/EPA naturally in their diet in sufficient quantities, I recommend supplementation. One of my concerns with having people eat toxic diets and then coupling a cholesterol lowering medicine like a statin, is the effects on brain health. Thanks for the comment.

What have you found works best for lowering high cholesterol? Does this work if it's a genetic issue? Does lowering and sustaining at low levels remove plaque build up?

This is a great question, in short the answer is Lifestyle change!! However, to really understand this, lets ask the more important question which is, "Why lower high cholesterol?" Your second question regarding plaque build-up in blood vessels gets us closer to heart of the question. We want to know if lowering cholesterol can protect us from illness. If we lower cholesterol will that help protect us from a heart attack? From stroke?

In essence we need to start with the right story to make sense of the lowering. My goal is not to lower cholesterol into a normal range, my goal is to help people reverse, treat and prevent disease and improve well being. I want to share a story that Dr. Kenneth Browning shared with me, which I think is an interesting illustration.

He tells it better, but he starts the cholesterol story, "If you came home and your neighbor’s house was on fire and saw a ton of fireman with the water and the hoses putting out the fire, then you saw on the news a large forest fire and again fireman were on the scene putting out the fire… Then on your drive to work again another fire in the neighborhood… And as you got closer sure enough the fireman were there… If you knew nothing about fires, you could draw the conclusion that firemen might be a big problem, we might even want to eliminate them if we wanted to stop all these fires!!!” As the story goes we know that fireman don’t cause fires and LDL cholesterol (bad cholesterol) doesn’t cause the damage in blood vessels. It is part of a response of the body trying to protect itself. The story of plaque build up and plaque rupture is complex, but a useful oversimplification is to understand that inflammation and disruption to endothelial (blood vessel) function is detrimental. The solution starts with shutting off the leaky sink (attacking the root causes of inflammation and endothelial dysfunction) and not just mopping up the floors (medications to lower cholesterol).

Genetic or familial hypercholesterolemias require even more lifestyle change to help protect the blood vessels. This means more whole foods and less pro-inflammatory foods, more stress resilience, better regular exercise routines as well as the use of medications to support the individual in many cases.

However we are learning more and more that particle size and particle number can be more important to understand the risk of high cholesterol then just the cholesterol number. So its an ever changing story. I hope this helps.

Depression seems to be a recurring problem with a lot of redditors. Can you provide a few tips big or small to reverse depression in our day to day lives?

Depression is a major concern in today's world of partial attention, multiple distractions, increased stress, poor nutrition and sedentary lifestyles. Much of the time we really need to just start somewhere. I love the power of vulnerability TED talk from Brene Brown which she talks about how healthy that vulnerability can be... That is step one. Realize its okay to feel depressed and know that you deserve to feel better. Ask for help... Medicines can help, exercise helps, dietary change helps, and a thorough work up to make sure we aren't missing a clear cause is important...

How do you think the continuing trend against vaccinations effect people in the long term?

As a secondary question if that one proves overly controversial, do you believe a reduction in the use of antimicrobial soaps/hygiene products will help reduce the amount of resistant diseases that are emerging, or have we already struck the tipping point?

My general answer from a family doctor perspective is that vaccines act like training wheels for the immune system and help protect not only individuals but communities and populations against potential would be pathogens. The conversation has gotten unfortunately very divisive, I think because the stakes are high (the health of our children is clearly of upmost importance!) also people have had very real experiences both good and bad after vaccines have been given to a population. To answer your first point, I think each vaccine must be looked at individually, but if we trend against certain vaccines out of fear on unintended consequences or side effects, we will likely lose our "herd immunity" and the pathogens that cause disease may very well return (As we have seen with measles in Southern California recently).

Your second question I love! When I was a young kid, we had a dishwasher and I remember being convinced that dishes needed to go through that cycle in order to be clean. Then we moved and no longer had a dishwasher when I was around 8. You could imagine my dilemma. My paradigm had to shift, or I was going to be in a world of stress. I soon realized, I wasn't getting sick, my food still tasted the same, and everything was okay when I ate from dishes we cleaned by hand.

To answer you more directly, sanitation has been critical to our society and civilization to help lower infectious pathogens. However, we are learning more and more about good bacteria not only on the skin but in the gut as well, and why they are so important for health. I think the pendulum will swing back somewhere closer to the middle soon as we learn to value good bacteria and find better ways to lower the risk of infectious/pathogenic bacteria and viruses without using toxic chemicals. My hope is we will see autoimmune and allergic syndromes decrease in the years to come.

I've been a smoker for 15 years. Mid 30's, male.

What can I do to: 1: Stop smoking 2: Once I've stopped smoking, help my body recover from the harm I've done it?

Thank you so much for the question. Helping people quit smoking is an absolute passion of mine. I have seen much of the detrimental effects of long term smoking and yet have heard the stories of close relatives who beat the odds and smoked unfiltered cigarettes long into their 90s.

5% of the population of smokers just stop smoking, they put them down and don't feel the need to have another. If this is you congratulations you are an anomaly, but you are done. You will have a 50% reduction in the likelihood of dropping dead of a heart attack within 24 hrs. Truthfully its not that simple for most people. It can be one of the hardest things you will do in your life. But getting support and the right tools and treatments can make it way way way easier.

I have worked with an incredible mentor, Dr. Linda Ferry at the VA in Loma Linda who is an incredible doctor and expert in the field of helping people quit smoking. She has taught me that if you want to quit, we have the right combination of tools to help you be successful. Find an expert in your area and get started. If you don't know an expert you can call 1-800 NO-BUTTS and they will get you started on creating a plan for free.

Much of the negative morbidity from smoking is actually prevented if you quit when you are still this young according to the data. Smoking can have a cumulative effect, so the best time to get started is always now.

To get started list important reasons to quit. Money, relationships, health etc... 1. Increase your smoke-free space 2. Take a 2 minute timeout before having a cigarette. 3. Plan for a quit date....

Medications and nicotine replacement products can help a lot with withdrawal symptoms, craving and will-power... I wish you so much success!!!

What are 5 foods everyone should add to their diet?

What are 5 foods everyone should drop/avoid in their diet?

I've recently incorporated more Olive Oil, and dropped Ketchup with High Fructose Corn Syrup for example.

I love questions like this! Thanks A great guide to finding really great foods that have incredible health benefits can be found here.

http://www.fullplateliving.org/sites/default/files/fpl-fiber-guide.pdf

The foods highlighted in blue, I recommend for the following reasons: 1. They are natural and whole. 2. They have water and fiber in generous quantities to keep the calorie index low 3. They do not have added sweeteners, artificial sweeteners, oils

Foods to avoid are highly processed and refined foods Corn is better then corn oil, corn starch and corn syrup. Olives are alot better then olive oil, using your example.

However to say everyone should have the same 5 things, isn't fair... Or avoid the same 5 also isn't fair.

But what the heck

5 great food: 1. Avocado 2. Broccoli 3. Spinach 4. Raspberries/Blackberries 5. Pears

5 Foods to Drop 1. Flaming hot cheetoes (So many kids in our community are hooked on these things) 2. Donuts 3. Any product that still didn't get the memo on trans fats! 4. The Xtra large fountain drink ... (Drink your water people, as Tony Horton would say!) 5. Chili cheese dog - All of the bad and none of the good!

What should I do now to live a longer healthier life like those people in the blue zones?

~25 M Vegetarian, doesn't smoke nor drink.

This is a great question, one many of us aspire to answer and then live. The approach to better living is as important as the behavior. In happiness literature we describe happiness on a continuum from pleasure to passion to purpose. Eating more plant-based, whole foods and eliminating processed foods from your vegetarian diet may support health. Physical activity in moderation and stress resiliency and social connection are all important. I would suggest a simple exercise could be a fun start. Try to write down the things that you find pleasurable and are passionate about then connect them to the things that bring you meaning. Try to focus on the overlap. We are finding more and more that its not just what you do, but also your belief about what you do which can change how your body responds. The mind-body connection is very real.

Are you for Obamacare?

This is definitely a charged question. People have strong opinions about this complex piece of legislation which has far reaching effects. I have a master's degree in health services administration and the complexities are still daunting. I believe that for primary care delivery we need to simplify the administrative burdens and help primary care teams get back to caring for patients. I am currently working to create a clinical model that focuses on changing the practice of primary care medicine by combining a model of "direct primary care" reimbursement with lifestyle medicine expertise. You can see what I am up to at lifestylemedpc.com.

To answer your question more directly, I am hopeful that the affordable care act can help more people to access healthcare, but skeptical and concerned with its application and complexity. In the meanwhile, my hope is that patients, employers and great primary care clinicians will work together to bypass a complex and confusing system and get back to basics. I am betting my early career on it! My practice is mostly outside of the world of insurance and I have no contracts with any of the plans on the exchange. See http://www.dpcare.org/ for more information on a movement of medicine that is happening which is counter current!

Have you done any work with Chronic Fatigue Syndrome patients? Any recommendations for things we should talk to our own doctors about? (Not looking for medical advice, except avenues to explore with my own medical professional.)

Yes, I have had several patients who meet the criteria for diagnosis or have been previously diagnosed. The best kept secret in chronic fatigue syndrome is the link to metabolic disturbances and inflammatory processed within the body. This is an area where I am building my clinical skillset in functional medicine and appreciate my functional medicine colleagues who take the time to explore potential links from heavy metal toxicity, to other environmental pollutants in the foundation of the syndrome.

It is worth talking to your doctor about these potential areas that could be affecting your symptoms. Under the circumstances where traditional therapies aren't working, then sometimes it may make sense to seek out a specialist in this area.

Do you have any advice for chronic pain suffers such as myself? I have osteoarthritis in my upper spine and have been living with chronic pain since the age of 19. I'm getting tired and frustrated more often, and my only 26. I'm worried what my life will be like in the future.

I am really sorry to hear about your chronic pain... This is an area that I really like to work on, because often a lot can be done using nutrition and lifestyle and medical therapy outside the traditional, "Here is a pill for your pain" or "I don't want to give you any pills for your pain cause I don't believe you"

Moderating the amplitude of the pain response can come from multiple modalities. Treating stress, reducing inflammation, and changing the pain paradigm can be very effective.

My advice is to stay optimistic and find a doctor that you like and trust to help support you.

Hi,

What's your opinion on how reversible pre-diabetes is? I've added a lot of exercise and changed my diet to be lower carb / less grains and sugar, and while I do so my blood glucose stays in check.

However, despite these changes, bad food (wheat, rice, etc) will still spike me to the 160-170 range.

Do you think I'm just not doing enough to improve insulin sensitivity, or do pancreatic beta cells already start dying in the pre-diabetic stage?

I know most ancient civilizations never saw any metabolic disease at all, and I imagine that some combination of genetics (or epigenetics) and poor diet in my youth lead to this.

I've maintained an A1C of 5.5 for around 7-8 years now, but 1 hour post-prandial spikes are still in an unacceptable range for any food that I want to cheat on once in a while!

Obviously feel free to answer in a general sense and not as a diagnosis for me.

Thank you for a great question! I want to encourage you to continue to remain hopeful that you can change your destiny and the work you are doing matters! Also thank you for allowing me to answer more generally as this questioning can likely help others too! This is actually a very hot topic and also very debated topic in the clinical literature and among specialists. There are still a lot of my colleagues who would say that there is no such thing as reversing diabetes; once you have it you always have it. However it's become clear that individuals who make lifestyle changes sometimes with the support of medications, nutraceuticals, and professionals are able to reverse the very numbers with which we used to diagnose diabetes. So if you're interested in truly changing your diagnosis, which in this case is actually pre-diabetes I would first suggest laying out the reasons why it's important for you. Time and time again we find that recognizing the purpose and meaning for the changes that you're going to need to make will allow you to sustain sometimes difficult changes. I would also suggest getting a group of supporters and connecting with people that you can depend on. Also connecting with an expert in the field to help design a specific plan for you can be instrumental to helping you succeed.

To be fair, I don't know if any doctor can be sure that diabetes will be reversed even in the most dedicated patient with a ton of social support. But more and more colleagues have had incredible success helping patients lose weight, feel better and reverse diabetic markers with a focused approach. I would love to say there's a one-size-fits-all approach but it's just not the case. Although common things being common decreasing processed foods, refined carbohydrates and many other pro-inflammatory components of your diet is a great place to start. Another important tool which can be instrumental in getting better blood sugar control and reducing some of the metabolic dysfunction that leads to diabetes is to get regular exercise at opportune times throughout the day. Regular sleep, finding ways of becoming resilient to stress and reducing/controlling other risk factors and contributing factors can all have profound effects. I wish you so much success on your path... Have faith that you can do it!!

Also to be more specific on the physiology, I find it hard to believe that the pancreatic islet cells cannot respond to lifestyle change for most people when in pre-diabetic ranges which is why we have much success helping people avoid becoming diabetic. Studies have actually compared placebo alone to both metformin and to therapeutic lifestyle change (TLC) on decreasing the risk of becoming diabetic. The result was TLC using healthy diet change and physical activity beat both metformin and placebo. Although metformin also beat placebo which is in part why some clinicians will use metformin for pre-diabetes.

In terms of climate and geography, where are blue zones located the most?

Edit: spelling

The five regions identified as the Blue Zones are Sardinia, Italy, Okinawa, Japan, Loma Linda, California, Nicoya Peninsula, Costa Rica, and Icaria Greece.

I am not a climate expert, but they are spread across the world... This is what I find so fascinating because it leads me to think that our lifestyle and not just where we live or what our genetic predisposition can play a huge role on our overall health and longevity. This is what brought me to Southern California to Loma Linda to study for 4 years as a physician.

Hi Dr. Badalamenti,

What is your opinion on the link between the immune system and the health of the GI tract?

What is the optimal way to get pro- and/or pre-biotics?

I have heard that drinking raw organic Apple Cider Vinegar has health benefits, is this true?

I work an office job where a standing desk is not in the budget, so I got an exercise ball to sit on. Is this actually helping or am I still prone to all of the various health conditions associated with excessive sitting?

As for sitting disease... Its real and linked to morbidity and mortality, whenever you can... Get up, stand, walk around, take short exercise breaks... As I just did now!

Proper posture can help a lot though, so if you are going to sit, improving your posture (this often happens naturally when on an exercise ball with your feet on the ground) can still prove beneficial and decrease the problems such as pain associated with poor sitting posture for extended periods of time

This is a great question. I am learning more and more of incredible links of the immune system and digestion. The "Microbiome" is of great interest to researchers and clinicians. We are finding evidence that links the bacteria of your gut to most chronic illnesses.

This could be a 6 month course to delve into the complexities here, but my favorite understanding is that much of the gut flora will change to match the foods that you eat. This is not univeral and certain pre/probiotics can be helpful in certain conditions and when you are taking antibiotics that can harm your natural gut flora. However changing your diet to include a rich supply of fiber rich, nutrient dense foods is probably the most important way to positively affect your gut bacteria.

What do you think of life extension medicine? Can we expect to see telomorase treatments come to market in the next decade or two?

In Russia, they have a long running (50+ years) experiment to breed tame foxes. They recently started doing genetic profiling on the now-somewhat tame foxes, and found noticeable genetic changes. (Specifically, big decreases in genes that promote adrenaline production, which had the very cool side effect of lowering melanin production and making them change color from red to silver) Has anyone tried doing an experiment like that with longevity? E.g, breed mice for longevity and then monitor genetic changes?

I am not sure about the experiment you describe. I have spent a lot of my time becoming an expert in the evidence that does exist and helping people optimize their health through lifestyle and medicine. So I would have to do some research to know who is working on age-defying experiments on lengthening telomeres and down regulating genes that are linked to aging.

That said Lifestyle change we are learning can be a telomere treatment! This blew me away in my training, because this was not something that I was taught did not naturally occur when I was studying molecular biology... Learning more everyday! http://www.ucsf.edu/news/2013/09/108886/lifestyle-changes-may-lengthen-telomeres-measure-cell-aging

What was the most interesting case you had?

Also, what was the biggest improvement you've seen?

Thank you for the opportunity to reflect! I have had many incredible patients teach me so much. It is from patients that doctors can truly learn the profession of medicine. Quietly listening has been my most treasured gift. One of the most interesting cases that I had was a woman with terminal cancer who had come to the hospital and was very sick, she had hx of heart disease, previous strokes and many other ailments. She had signed a DNI/DNR form and had clear goals for no aggressive treatment with plans to get home with hospice care. I met her and her family and she just had a spark about her. I genuinely immediately felt like she had more to give me then I had to give her. I was the night doctor covering the shift. By morning I went to check in on her and let her know I was leaving for the day but she was completely unresponsive. She couldn't communicate and didn't even respond to pain. I rushed her to CT scan and considered our limited options and felt grateful that I would not be doing CPR in a situation that would likely break ribs, cause pain, but not provide a likely improvement if her heart was to stop. Needless to stay she woke up spontaneously about 30 minutes later as if nothing had ever happened. I later had a simple question I asked her, I said I am interested in increasing my influence and ability to help people. What can I do? Her response has stuck with me, she looked at me straight without hesitation and a twinkle in her eye... She said, "Be pure, have pure thoughts"... Beautiful words from a beautiful person

Hiya doc! I signed up to hopefully be a part of a PeerWell pilot program, but when I got an email to claim my spot I realized that a requirement is that I have an iPhone with iOS9 installed.

So I guess my question for you is: any chance of an Android version for this pilot program?

Thanks!

Believe me, I want and Android version as much as you do. PeerWell tells me that an Android version is coming soon but for now it is iOS only. They will let everyone who signed up and has Android as soon as something is available.

Hello doctor, thanks for the AMA.

I've heard that fasting can also cure chronic diseases and improve the immune response of the body. Is that true? In visiting the Blue Zones, have you ever came across fasting as a habit?

Also, when your book about your work is going to be available? ;)

Cheers from Brazil!

As a physician I approach fasting very closely. Some people can have medical risks when making drastic changes to the body, so they should be monitored by their personal physician. That said, I am a strong advocate for many patients to "fast" This can come in many different varieties. Giving up television could be a form of fast, but the fasting you are referring to might be more wet/dry fasting (Not eating only water/no food no water?)

What are your thoughts on "new" chronic diseases such as fibromyalgia and chronic lyme disease? I'm specifically interested in chronic lyme disease, which (I think) has been gaining broader acceptance in the medical profession.

I am born and raised in Massachusetts and trained in New England before moving to Loma Linda for residency. I have visited Lyme, CT on multiple occasions, so Lyme disease is a subject that is close to home in more then one way. I have met and talked with Lyme experts and am fascinated with infectious etiology of spirochetes in general.

That said, I believe many of the "new" chronic diseases are multifactorial. I will give you an example of a middle-aged patient I saw in medical school, who had multiple poor lifestyle choices with resulting obesity, hypertension, metabolic syndrome and non-specific neurological symptoms. She had seen multiple specialists and primary care providers. She had racked up multiple diagnoses, the neurologist who was a multiple sclerosis specialist said she likely had an atypical version of MS, the infectious disease, Lyme expert said she likely could have chronic lyme, she also was told she had both fibromyalgia and chronic fatigue syndrome. She felt hopeless and confused. After refocusing on her actual symptoms and not the naming of diseases, we focused on what she could do... She made incredible progress in a short time. She lost weight and her symptoms improves and some disappeared. Many illnesses will still be affected by positive and negative lifestyle changes regardless of the underlying complexities of the original cause of the condition. We need to focus on engagement and empowerment!

To what extent do research diet and its impact on aging chronic health conditions? Nearly every major health organization recommends a vegan or plant based diet as they tend to live longer and healthier lives.

I have been studying diet and nutrition for the past 5 years in depth and you can find a study or two it seems to support just about anything. Now the validity and generalization of each study can be debated. What is mostly not debated at this stage is that most of the intake in the diet should come from vegetables and fruits and other plant based sources because of the high nutrient/calorie density ratio. Telling people that they must only eat plants can be confusing and miss the point. This is because processed and refined plant products can be more inflammation provoking then the animal protein/saturated fat counterparts that we are trying to decrease in the diet. I start with common sense truths and help my patients move the needle in ways which make sense based on their current ailments. It will look a little different for everyone. That said, most people in the US are currently eating in ways that are leading to the chronic illnesses we are facing. 84% of the healthcare spend in this country is on people with chronic illness according to my latest read from a CDC article! My point is we can do better

What would you suggest for reversing male Lichen Sclerosus?

Thanks for a great question, I wish I had an easy answer for you, but my suggestion starts with a general approach more than a specific treatment modality which is successful for reversing Lichen Sclerosis is a condition which can be difficult to treat through traditional medical modalities.

The approach starts with identifying a timeline of symptoms, understanding the context of all potential risk factors within a thorough clinical history. We do an Integrated Lifestyle Medicine Health Review. Collecting the data includes a survey, a physical exam, and collection of pertinent laboratory, imaging and special test data. Depending on the results an approach from detox, to dietary change to specific nutriceuticals and medications might be tried.

So, I am huge Zombie fan and based on your medical background, how likely is a "zombie apocalypse" (doesnt have to be traditional living dead, but even a virus that makes people rabid or anything) and how likely is it that you would survive?

I am highly entertained by this surprisingly! I really do not foresee a zombie apocalypse, but there are some incredibly scary infectious diseases and pathogens. It is incredible the amount of time and dedication is put towards enviromental health, decreasing the risk of communicable diseases and emergency preparedness planning. I like to have faith in humanity to pull through and come together when disaster strikes.

What kind of exercise is required to keep diabetes under control if the person is not physically capable to run? And other what other things can be done to keep it in control?

Good question, diabetic control really starts from nutrition and dietary change for most type 2 diabetics. That said consistent activity is really helpful. Even walking can have a profound effect on blood sugar control for many individuals. The best time would be right after a meal to help decrease the post-meal spike. You can even try this and see the difference pre and post meals.

If a person is overweight for decades but then becomes healthy (normal numbers in most metrics), is there a residual "unhealthiness" that will persist? Or is that person just as likely to live a long, happy life as a peer who was always healthy?

This is a great question, my belief in short is that if you make healthy lifestyle changes to improve your weight, you can reverse some of the disease risk. We have studies that support the concept that if you lose weight your risk profile changes. That said, some structural damage that has already occured may remain. Not all things are completely reversible, but the body is often more dynamic then we give it credit for. The way you lose weight definitely matters too though.

I have DSRCT, what's the best advice you can give me regarding things like my health, fitness, diet, etc? Are there any things you recommend I do or think are a must for me?

I am really sorry to hear that. However I think it's important for you and anyone who receives a diagnosis of cancer to find hope and maintain hope. I have heard on more than one occasion from colleagues that you shouldn't give a patient false hope. My response has been "please define false hope" because from my understanding there's no such thing. You can rely on faulty facts, you can have unrealistic expectations, however hope it's something universally powerful and worthwhile regardless of the outcome.

See this first hand experience from my mentor and partner, Wayne Dysinger, to appreciate a powerful perspective... https://vimeo.com/98492880

Now to get to your specific question. DSRCT is a rare form of cancer that isn't well understood and I am not an expert in this area. I would ask your doctor about your specific prognosis and the likelihood of successful treatment and options given your unique circumstance and diagnosis.

The US is lifting limits on dietary cholesterol. Is this a smart move? In your opinion, is it important to avoid high cholesterol foods?

Yes, I think the war on cholesterol was a bit mislead in its approach, as is true of many "war on {fill in the blank}". Although its worth recognizing that many foods that are high in cholesterol are also high in saturated fat, animal protein, have low nutrient density, poor water content, and generally can be unhealthy for many other reasons. Cholesterol is not the likely scapegoat though.

Can you explain a bit more about inflammatory foods?

Yes, great questions. An inflammatory response is surprisingly a part of the process of digesting foods in general... Common macronutrients that make up a lot of our food generate an inflammatory response... Some culprits of inflammation: Sugar. Saturated Fats, Trans Fats, Omega 6 Fatty Acids, Refined Carbohydrates, Gluten and Casein.

This is why having anti-inflammatory packaging to the food is so important to balance the natural digestion of these foods. There are unique differences in individuals which make certain foods more inflammatory for individuals, but in general this is why increasing anti-oxidant rich foods and nutrient dense foods is so important.

What is your opinion on Homeopathic medicine? I've always assumed they could work for their holistic approach as well as for being extracted from natural components. However, I've seen several articles protesting against them lately, and I would like to know your take on that debate.

I am a physician and a scientist, but also a natural explorer of life. I keep an open mind to approaches that differ from my understanding. Many people use the word homeopathy to mean different things. I am all for taking a whole person approach to an individual and support that aspect.

However, if we are talking specifically about the approach of dilution to strengthen the medicinal effects of a compound, this does not make any sense to me. I do not believe in the general approach and more likely assume the power of belief of the individual ingesting such a compound is helping to create a benefit for those who receive benefit from such compounds. Although I am open to data suggesting otherwise.

What do you think about Google Calico and other biotech companies looking to create drugs to do life extension? Is it feasible / worthwhile to use pharmaceuticals for radical life extension?

Good question, I have been watching the progress of the human genome and advances in science and technology with bated breath to see if we get closer to unlocking the full mystery of aging and eventually reverse cellular dysfunction. I am in general an optimistic skeptic or a skeptical optimistic. I was a biology major with a focus on molecular biology before becoming a physician and I am fascinated with genetic expression and gene focusing. Everything from RNAi technologies to the epigenetic expression changes with nutriceuticals, I am optimistic for us to continue to make progress. However, the more I have learned the more complexities of mother nature always seem to arise. So I am skeptical that we will create a wonder drug formula to solve aging. That said I think we are learning alot from the evidence that has already been collected that we can accelerate or decelerate the aging process with our choices and environment. Nurture changes nature!!!

What is your opinion of once-daily multi-vitamins, and do you think they have any long-term effect?

I don't want to open a can of worms here, but I can't help myself... We just don't have great evidence that says, "Hey healthy general population, you should be taking a multivitamin" If anything we have large studies (albeit quite flawed) which says a multivitamin a day may be linked to mortality not longevity.

I use this example to illustrate a very important point, that pills do not substitute for lifestyle change... I want to say that twice... Pills do not substitute for lifestyle change...

All that said, I think many Americans probably will have some risk reduction by taking a "good" vitamin supplement, it is best to actually use vitamins in targeted ways... Like some vegans should be ensuring adequate B12 and omega 3 oils. Many people run low in Vit D, especially in the Northeast where I grew up... The problem is everyone is trying to sell their supplements and the misinformation can be hard to sift through... It can be hard to know what you are getting even when you are picking up the vitamins and supplements that might be beneficial. I use nutriceutical at times with my patients. But, I really focus on the synergy with lifestyle

A little late to the party, but here goes.

During medical school, how did you think about your future career path? I think that I am getting caught-up in how ridiculously busy they keep us. I guess I am just not accustomed to the "do what makes you happy" idea. I also have no idea how different specialties interest me and what kind of lifestyle they have to offer.

Do you have any recommendations for a first year medical student?

Thanks doc!

Hey thanks for joining the party! I love talking with medical students... You will be the future of where this profession will go. I recommend you keep an open mind and learn as much from each subject and each specialty. However, do things to continue to connect you to people. Things outside of the traditional training, take care of your personal needs too. Burnout in medicine is a very real threat to the profession... Some of the best advice I ever got was to realize that healing is as important as curing, and take time to be present in the moment. Sometimes the best thing for the soul is not to get home after a long day, but instead dropping in on a patient to let them know you were thinking of them. I wish you all the best in your journey... Look into the world of lifestyle medicine. Feel free to check out what we are up to... All primary care is not the same... www.lifestylemedpc.com

Can you describe what the actual steps and time taken up of being a doctor? I know it's college, medical school, residency.. Etc. but what is it actually like? Thank you!!!

Thanks for the question... It is an incredible journey... I can tell you it is a long process and probably not for everyone. I got a lot of advice along the way, "Just stay with it... It will be worth the sacrifice when you are done..." I do believe that discipline is a virtue. Foregoing a pleasure for something that will bring you value or meaning later is often worthwhile. But I never saw the road as a sacrifice to a better destination. I loved the science, the exploration, the people and the challenges. There are hard days and long days, but find something you love to do, that adds to your purpose and turn this into your profession!

The road is 4 years of college, 4 years of medical school training. Then you are technically a doctor. You then decide on a path for residency training which can be anywhere from 3 to 7 years depending on specialty. I did 4 years of training in Preventive Medicine and also Family Medicine.

I've suddenly heard so much about Blue Zones in the past month and there's been authors releasing books about them coming on here to do AMA's.

Are Blue Zones and talking about them just another trend or fad?

What is the cool thing about the blue zones, is actually the projects. This is where they take the concepts of healthy living learned from the extreme longevity and practices in the 5 blue zone populations and then bring those changes in a systematic way to study a different community. They have been doing projects throughout the beach cities in Southern California, in Minnesota and other locations. The results are cool so far http://www.bluezones.com/community/minnesota/

From my studying and first hand experiences, I would say there is definitely something to this!

Is it true that many people try to push their bodies into survival mode in order to live longer?

My understanding of your question is regarding the concept of fasting on a cellular level... People will do all sorts of things to push themselves sometimes for the better sometimes for the worse. What I do know is that mitochondria need a break from food. So ideally fasting for at least 12 hours (ideal example dinner at 6 then not eating breakfast till 6AM) can have benefits. More extended fasting in animal models is still one of the only consistently linked connections to increased lifespan. That said, fasting without guidance from your physician can be dangerous.

What do you recommend for seasonal allergies? Mine have gotten worse over the years and I take a nasal steroid every day, Allegra when I start to feel triggered in the spring and fall, and Singulair when Allegra isn't cutting it. I've encased my bedding, too, which makes a huge difference. Are there other environmental or dietary things I could be doing? I'd love to take fewer drugs.

Seasonal allergies can really be so bursensome. I wish I knew the quick fix. You are using products that for some really do the trick... Sometimes its worth a deeper exploration. I will sometimes check allergy panels (both respiratory and food and sometimes patch) and other metabolic and inflammatory markers. Everything from an elimination diet to nutriceutical support to allergy injections can help. Sometimes making good use of saline rinses and Neti-Pot can make a big difference. I hope you get to the bottom of it!

What are the BMI profiles of people in these zones? If I were to conjecture, i'd expect rates of obesity to be lower and a large proportion to be BMI normal to underweight.

Great question, I honestly do not know the answer off hand for all of the blue zones, but the Adventist health trials which has data describing the population in Loma Linda for over 40 years definitely has your conjecturing right on target. The BMI profiles tend to be in healthier ranges then the general population. Here in US almost 2/3 of American adults are overweight or obese.

Hello, i am big fan of healthy lifestyle etc. :) What do you think about imminent fasting? :) Do you think that healthy fats may also play important role? :) As far as i am concerned, Greeks and Italians are using "excessive amounts of olive oil", while Japanese love fish (one of the healthiest fat source). And at least, what do you think about role of stress? Greeks and Italians are known for some kind of i dont care mentality. I mean, for example, Italians like to say smth like: There is always Sunday in Italy. :D Is your study taking mortality as the whole, or just from the diseases? Japan got some of the highest suicude rates in the world. And at last, are those communities eating Soy? :P Thank you for your answers :)

Wow there is a lot to this question. Thanks for getting involved. First I will start by saying healthy fats are super important for cellular function and for our health in general. Mediterranean type diets have been shown to help people in large studies when we look to long term health and disease prevention. So there is likely something to getting good oils in the diet. That being said, excess calories in high amounts of oil, like you said "excess" can sabotage weight loss plans for those who aren't at a healthy weight and are trying to reverse the metabolic dysfunction that they already may have. So I am careful to not recommend people replace calorically dense processed carbs with calorically dense healthy oils. Balance is key. When it comes to mental health. We find that community and relationships can be really important, see a great talk by Brene Brown here http://www.ted.com/talks/brene_brown_on_vulnerability?language=en. Stress is a huge component, but the way we look at stress is valuable too. Kelly McGonigal does an incredible job of describing stress here http://www.ted.com/talks/kelly_mcgonigal_how_to_make_stress_your_friend?language=en

As far as soy, not sure if your question is regarding the amount of soy in the diet being the reason for longevity and the link between the 5 blue zones. I highly doubt its the soy that links the community. Soy can be good for some and too much for others can effect hormonal regulation. It is another moderation food in my book.