#149: Dr. Melissa Sundermann - This Doctor Googled Her Way to a Dream Job
Dr. Melissa Sundermann is living her dream so that you can live yours!
After practicing medicine for several years and raising two children who were officially off to college, Dr. Melissa Sundermann decided it was time to pursue her own passions and expand her knowledge and scope of practice.
While she loved being an internal medicine physician in Ann Arbor, Michigan, she wasn’t fulfilled by the revolving door aspect of the system - quick appointments, multiple patients, and prescription-based treatment.
So, Melissa did what we all do when we’re searching for an answer - she went to Google. Lo and behold, she discovered Lifestyle Medicine and knew instantly that she had found her calling - helping people treat and prevent diseases through the six pillars of lifestyle medicine: movement, restorative sleep, stress management, avoidance of risky behaviors, positive social connections, and of course a whole-foods plant predominant diet.
In this episode, she shares some of the advice and resources she gives to her patients who come in for lifestyle consultations and the great impact she is able to make in her patients’ lives. She also talks in-depth about the benefits of a whole food plant-based diet and the pillars of lifestyle medicine for women in perimenopause and menopause, and how she puts these pillars into practice in her own life.
Dr. Sundermann helps patients reach their health and longevity potential at any age and I know you’ll love her enthusiasm and zest for life.
About Melissa Sundermann
Dr. Melissa Sundermann is a plant-based physician double board-certified in both Internal Medicine and Lifestyle Medicine and has been practicing medicine for over 20 years. She also has training in Integrative Medicine through the University of Michigan and has completed a Professional Training Program in Mind Body Medicine through the Center for Mind Body Medicine based in Washington, DC. She has been featured in several Lifestyle Medicine articles and podcasts as well as an invited speaker for health/medical national conferences. She strongly believes in fostering a partnership with her patients and helping to guide them toward a healing pathway through self-care utilizing Lifestyle Medicine principles. Her 7 pillars of health include a whole food/plant-based diet, daily movement, restorative sleep, avoidance of risky behaviors (such as tobacco, excessive alcohol, and drug use), stress management, social connection, and daily exposure to nature and fresh air.
Dr. Sundermann currently practices medicine with IHA in Ann Arbor, Michigan where she is helping to launch the IHA Lifestyle Medicine Institute. She also leads IHA Staywell Committee which focuses on optimizing the health and well-being of 3000 employees of IHA. She does her best to practice what she preaches and enjoys running, biking, hiking, skiing and spending time outdoors, and creating adventures with her husband, two college-age children, and two dogs. She is a 10x Boston Marathon finisher, 3x Full Ironman Triathlon finisher, and currently training for several upcoming Ultramarathons. She truly believes that age is just a number and is passionate about spreading this word to all of her patients, family, and friends.
Episode Timestamps
3:20 Dr. Sundermann’s Introduction and a House Transitioning!
5:10 Dr. Sundermann’s inspiration for becoming a Doctor
8:30 What exactly does an Internal Medicine do?
13:45 Google to the Rescue!
22:20 The Pillars of Lifestyle Medicine - #1 Nutrition
23:05 #2 Movement
24:05 #3 Restorative Sleep
28:14 #4 Avoidance of Risky Behaviors - Smoking, Alcohol
29:10 #5 Stress Management - Managing Cortisol with Breathing Exercises
31:25 #6 Social Connection
32:40 Bonus #7 FRESH AIR
33:15 Promising research and advice for treating symptoms related to the perimenopause and menopause transition
Episode Resources
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Promo Music: Your Love by Atch License: Creative Commons License - Attribution 3.0
Full YouTube Transcript
Dr. Melissa Sundermann:
So we have six official pillars of lifestyle medicine from the American College of Lifestyle Medicine, the first is nutrition. And we do advocate for a plant strong as you like to call it, plant slant way of eating, really advocating for whole food, plant based. It's evidence based as the best diet pattern to prevent and possibly reverse chronic diseases.
Rip Esselstyn:
I'm Rip Esselstyn and welcome to The PLANTSTRONG Podcast. The mission at PLANTSTRONG is to further the advancement of all things within the plant-based movement. We advocate for the scientifically proven benefits of plant-based living and envision a world that universally understands, promotes, and prescribes plants as a solution to empowering your health, enhancing your performance, restoring the environment, and becoming better guardians to the animals we share this planet with. We welcome you wherever you are on your PLANTSTRONG journey and I hope that you enjoy this show. Hello, my PLANTSTRONG brothers and sisters. My guest today is Dr. Melissa Sundermann an internal medicine physician in Ann Arbor, Michigan, who was also recently board certified in lifestyle medicine. After practicing medicine for several years and raising two children who were officially headed off to college, Melissa decided that it was time to get back to herself and expand her own knowledge and scope of practice.
Rip Esselstyn:
While she absolutely loves being a doctor, she didn't love the revolving door aspect of the system, the quick appointments, multiple patients, prescription based treatment, et cetera. It just wasn't fulfilling. So Melissa did what we all do when we're searching for an answer, she went to Mr. Google and started searching different types of medicine and came across lifestyle medicine, very peculiar. She knew instantly that she had found her calling, which is helping people treat and prevent diseases through the six pillars of lifestyle medicine. They are movement, restorative sleep, stress management, avoidance of risky behaviors, positive social connections, and of course a whole food plant predominant diet.
Rip Esselstyn:
Today in our conversation, she shares some of the advice and resources that she gives her patients who come in for lifestyle consultations and the impressive impact she is able to make in her patients lives. We also talk in depth about the benefits of a whole food plant-based diet and the pillars of lifestyle medicine, specifically for women in perimenopause and menopause and how she puts these pillars into practice in her own life. Dr. Sundermann is a bright light for the future of medicine and I am thrilled for you to meet her. Please welcome, Dr. Melissa. Sundermann.
Rip Esselstyn:
Sundermann, that's a fun last name. Sundermann.
Dr. Melissa Sundermann:
Yeah, it gets confused with thunder men and yeah, a lot of different ways to pronounce it apparently.
Rip Esselstyn:
Yeah, but welcome. So tell me, where are you located right now?
Dr. Melissa Sundermann:
So I am located in Ann Arbor, Michigan, home of University of Michigan, Ann Arbor, Michigan. And yeah, I've been there since I went to undergrad there and went to medical school at Michigan State. So I was gone for a couple years, East Lansing area, but settled back down in Ann Arbor. That's where my husband is from. He's a true townie. And then we raised our kids here and now we've got a daughter, a junior at University of Michigan and a son who's a senior at Michigan State.
Rip Esselstyn:
Wow.
Dr. Melissa Sundermann:
So Big 10 sports and we're a house divided.
Rip Esselstyn:
Go blue.
Dr. Melissa Sundermann:
Go blue. For sure.
Rip Esselstyn:
So when you say you're a house divided, what exactly does that mean? In what way?
Dr. Melissa Sundermann:
Well, I guess a couple, so that's a big thing in Michigan when you've got the rivalry of Michigan State and University of Michigan. So my daughter is actually an athlete at the University of Michigan. She is on the women's swim and dive team. She's a diver, I know you were a swimmer. And then my son at Michigan State. And of course wherever you go to undergrad you cheer for, so I'm still a Wolverine, but I do support my son too. And I went to medical school there, so I do have some green blood in me. And I guess the other way we're divided is three fourths of our family are plant based, including our athlete daughter. And then our son we're slowly transitioning that way. So we're not a house divided, we're a house transitioning.
Rip Esselstyn:
Yes. Yes. That's a good way of putting it. Well, my brother and my sister both went to University of Michigan.
Dr. Melissa Sundermann:
Okay. Great.
Rip Esselstyn:
And swam there. So I got the opportunity to go visit University of Michigan and it's a great place. Great school. Ann Arbor is a fun town.
Dr. Melissa Sundermann:
It is. We love it.
Rip Esselstyn:
It really is. So you went to medical school there, why did you decide to get into medicine?
Dr. Melissa Sundermann:
So that is a good question because I didn't come from anyone in my family who was in medicine. I mean, we're talking like not even a nurse. So it is something that I just got interested in when I was little. I just remember visiting a relative at a hospital, probably I was like seven or eight years old, and just having this curiosity, this curiosity of what was going on at this hospital and I just wanted to explore. And I wasn't scared of it, I just wanted to learn more, and was just really fascinated by it, and medicine, and helping people, and healing people, and being around just the medical world. So that started at a very early age, and again, I didn't have any mentors to ask, family members, about their experience and just sort of did research on my own and during high school volunteered at a hospital.
Dr. Melissa Sundermann:
And just sort of had this calling, I'd say, of I want to be a doctor. I just want to be a doctor. And of course, it's an arduous process to get there. And I went to University of Michigan undergraduate and it was pre-med. And I also did research at that time, so I worked at a lab doing research all during undergrad just to get money and quite frankly, get money and then get some experience. And I actually took two years off in between undergrad and medical school because I thought, well, I've been working at this lab. I'm going to work for them full time, see what that's about. And I really found out that I'm a people person and I just wanted to interact with people rather than... And we need research and we need great researchers, but for me, I needed that connection.
Dr. Melissa Sundermann:
So I applied to medical school and the first time I didn't get in, but yet I was like, this is my calling. I'm not giving up on this dream. So I worked my butt off, retook the MCATs, just went in and interviewed to everywhere that I could get into and just conveyed to them this is my dream and I know I'm going to be a good doctor, so please consider me for admission. And I got into Michigan State, which was a perfect school for me. They really are focused on primary care, which I'm an internal medicine specialist, also lifestyle medicine now, but really the roots of my training are primary care. So I wasn't about to say no to a dream and sometimes that's what you have to do is just say, I really want this and it's worth fighting for.
Rip Esselstyn:
Oh yeah. I mean, I find typically when you don't get what you want the first time, it really makes you kind of well, reevaluate it, but then also decide, no, I really, really want this. And then when you get it, it's that much more satisfying and it means that much more to you.
Dr. Melissa Sundermann:
Right. And like I said, I didn't have family members who are in medicine, so it's not like I had this recommendation or these alumni that could help me, I did it all on my own. Right?
Rip Esselstyn:
Yeah.
Dr. Melissa Sundermann:
And that feels really good in life when you do things... We all like to network, right? And that helps us, but when you do it on your own, it feels that much more rewarding.
Rip Esselstyn:
Yeah. Okay. So you went into medical school, you came out in internal medicine. For people that have no idea, so what are some of the things that an internal medicine doc does?
Dr. Melissa Sundermann:
So basically, I'm a primary care physician. So when you get your insurance card, they say select a PCP. So your PCP is usually going to be a family medicine doctor or an internal medicine doctor. And then for females, an OB GYN, for kids at pediatrician. And I really chose internal medicine because I liked everything in medicine. I liked cardiology, and I liked pulmonary, and endocrinology, and all the specialties I thought were interesting and wanted to learn more. And the beauty of being internal medicine as a primary care doctor, I get to treat all of those. Now, not to the degree that a sub-specialist would, but I get to manage blood pressure, and cholesterol, and diabetes. And in primary care we develop long term relationships, right? And so a lot of times I will get the husband and wife, and I'll get their adult children, or I'll get their grandparents.
Dr. Melissa Sundermann:
So you really develop these long-term relationships and so much of primary care is really listening to your patients, listening to their story, getting to know their story. And that's where lifestyle medicine has been such a compliment, not even a compliment, it is the core of my career now, is that we need to really on a fundamental level get to know our patients and know how to educate and empower them and believe in them. And so primary care allows me that opportunity to do that every day.
Rip Esselstyn:
Yeah. So I want to know a couple things. Let me start by asking you this. So where do you work? What kind of hospital system are you working in right now?
Dr. Melissa Sundermann:
So I am part of IHA, which is based in Ann Arbor, Michigan. We are a multi-specialty group. We're very large. We have over 900 providers and we run every single specialty you can think of from primary care, to surgeons, to specialists. And we're located throughout Southeast Michigan. So I'm in an office with four other internists and then we have our medical staff. So we've got satellite clinics all over the place. So I'm part of a large organization, which works for me because we've got really great leadership. We have recently launched our IHA Lifestyle Medicine Institute, which is super exciting. And within those 900 providers, five of us are board certified and lifestyle medicine. So it's been a very exciting time for the growth in lifestyle medicine within our IHA and we have strong support from leadership, which is wonderful.
Rip Esselstyn:
Oh, that's really fantastic to hear. You're practicing medicine, you're seeing all these patients, I'm sure you were seeing all kinds of chronic Western disease, like you mentioned hypertension, high cholesterol, probably pre-diabetes, type two diabetes.
Dr. Melissa Sundermann:
Yeah.
Rip Esselstyn:
So at what point did you decide that okay, what I'm working with right now in my toolbox is not really making a dent?
Dr. Melissa Sundermann:
Yeah.
Rip Esselstyn:
So what was your eye opening moment where you're like, wow, I got to try something else?
Dr. Melissa Sundermann:
So I think a part of me has felt like that since the get go. So I'm a DO. At Michigan State they have an MD program and a DO program.
Rip Esselstyn:
Yeah.
Dr. Melissa Sundermann:
We take all of our core sciences together. Right? But then we're also trained in something called osteopathic manipulative, OMT, which really looks at the body as interconnected. Right? And so I always have thought of the body as a system and that wellness was more than just pills. And so I did integrative medicine training at the University of Michigan, which really opened my eyes to all of these complimentary and alternative ways of healing. And I went from then to do a professional training in mind, body medicine with James Gordon's program, the Center For Mind Body Medicine, being based out of Washington D.C., again saying, wow, this is not what I was taught in medical school.
Dr. Melissa Sundermann:
And I just... I was working in conventional medical practices, but I had this additional training and I'm going to say insight. And it's like, how do I... I have this deep belief system that there's something else out there. There's something that's keeping me healthy and it's not pills, right? It's how the foods that I eat, and how I move my body, and how I sleep, and how I manage stress, and that I get outdoors every day. So I'm plugging away in a conventional medical system and always feeling like an outlier per se, because I just approached wellness differently sometimes.
Rip Esselstyn:
Yeah.
Dr. Melissa Sundermann:
And so about 2018, my kids were heading off to college. I was becoming an empty nester, and for many years it was balancing family life with professional life. And my kids were super involved in their sports, my daughter, like I said, she's a diver. My son was a very high level soccer player. So every weekend I was traveling around the country with them, right? Staying in Hampton hotels. So I really felt like, okay, I love being a doctor, but right now is not the time for me to be completely selfish for my career. So 2018 comes around and I'm like, I'm about to become an empty nester, this is my time. So I went to the computer and I went to Google because that's what we all do when we just need professional insight, counseling, health coaching, and started combining words of things that I love.
Dr. Melissa Sundermann:
So it was wilderness medicine, it was wellness medicine, it was nature medicine, and then up popped lifestyle medicine, and this is about 2018. I'm like, well, what's lifestyle medicine? It brought me to the American College of Lifestyle Medicine homepage and I read their pillars and it felt like my Galileo moment-
Rip Esselstyn:
Yes.
Dr. Melissa Sundermann:
... of coming home. Right? It was like, wait a minute, this is what I've been doing for the past 20 years of my career. But now I have a body of medicine that actually believes in this and not only believes in it, but has the evidence and research to back it up. And for me, it was this aha, coming home, this is my place, these are my people. This is my true calling and I have been preparing for it this whole time.
Rip Esselstyn:
Yeah.
Dr. Melissa Sundermann:
And now I'm here. And I signed up for the board certification, and the training, and my modules, and I've been nonstop with passion ever since then.
Rip Esselstyn:
I mean, that's really fantastic. And the fact that where you're working now, IHA, you said you have a supportive leadership, which is fantastic. And then you said that there's five of you that basically-
Dr. Melissa Sundermann:
There's five of us, mm-hmm.
Rip Esselstyn:
... that have started this kind of lifestyle medicine institute. Is that fair to say?
Dr. Melissa Sundermann:
Right. Right. We're the ones who provide, we've started a consult service. So just before I got on with you, I was doing a lifestyle medicine consult. So patients that have chronic diseases such as blood high blood pressure, high cholesterol, type two diabetes, coronary artery disease, obesity, other practitioners, and then I can self refer to myself. I see a patient from the first visit, I'm like, come see me for a lifestyle medicine consult. And so we take a really deep dive into the six pillars and have a little bit longer time with the patient. In primary care, we're so rushed and it's like 15 minutes, 20 minutes. And as you know, lifestyle medicine, there's so much education and getting to know our patients that it takes longer than that. So our consults afford us more time with our patients to get to know them, to provide resources, to do the counseling that's really needed, so that's been really exciting.
Dr. Melissa Sundermann:
And to be on the forefront of this movement, I feel like as you know, you and your family, you guys have been in this world for much longer than many of us have, but to see the explosion that's been happening within lifestyle medicine is just so exciting. And I still feel like I'm on the cusp of the beginning of it and because of that, everyone is just so friendly. All of the lifestyle medicine physicians, professionals, that I have met have been so warm and always want to help. And we're collegial because we feel like we found something and we want to share it with the world.
Rip Esselstyn:
So I've done a lot of different sports in my life, from tennis, to swimming, to mountain biking, to triathlons, and I find that each sport a different type of personality gravitates to different sports. And so I think that's the really cool thing about lifestyle medicine is it takes a special personality and I think that's somebody that's open minded and willing to look outside the proverbial box and go, wow. I mean, there's something really significant here that can get to the root causation of all these issues. And actually, frankly, it's surprising to me that so many people that go into medicine, just because of all the research, all the data, and everything that's in abundance right now, that they... I mean, yes, you are part of the first wave. It is phenomenal. I don't want to take anything away from that. I'm just surprised that this isn't a tsunami.
Dr. Melissa Sundermann:
Right? And that's where we need to shift the training, right? So I didn't learn any of this in medical school. It's all about how do we manage diseases? It's not about preventing diseases. It's about once you have a disease process, this is how you'll go and treat it. And nutrition, I mean, throw that out the window. Right? And the average amount of time that medical school students, when I graduated in 1998, and even today, it's like 17 hours and that's medical school and residency. And guess what? That's not practical nutrition. That's let's memorize protein deficiency in the form of kwashiorkor that you'll never see in clinical practice, unless you maybe work in Africa, or let's talk about rickets. I mean, I've been practicing for almost quarter of a century, I've never seen that. Or memorize the Krebs Cycle, this biochemistry pathway, because that's nutrition, or let's learn about tube feedings in someone in the ICU.
Dr. Melissa Sundermann:
So I thought I knew a lot about nutrition because I'm an endurance athlete also, Ironmans, and marathons, and long mountain bike races. So I thought, hey, I'm an athlete. I'm going to fuel myself. And of course what my nutrition training quite frankly was Runner's World magazine, and magazines, and what I heard on the radio, or read a news clip. So I was convinced that chocolate milk was the best way to refuel my body after a hard workout and before every race I had to have protein, but that had to be animal protein, but it was lean protein. Right?
Rip Esselstyn:
Yeah.
Dr. Melissa Sundermann:
It was chicken or pork because that's the other white meat. So just a lot of these myths that I just believed and it wasn't that... I just didn't know. You know? You don't know what you don't know.
Rip Esselstyn:
Well, that's a good... No, that's a good point. I mean, yes, I will say that we need to get upstream, right?
Dr. Melissa Sundermann:
Mm-hmm.
Rip Esselstyn:
To the medical schools, get this so it is a substantial part of the education, and then we'll have probably more of that tsunami.
Dr. Melissa Sundermann:
Right. And what we're trying to do within our group, and like I said, we're very large, we're 900 providers across all the specialties, so we've actually launched a lifestyle medicine interest group. So once a month and this is where COVID's been great is that we're all virtual for these meetings. So we have a Zoom meeting once a month and we invite lifestyle medicine practitioners from all over the world to speak on different topics and usually we try to follow one of the pillars. And we invite all of our 900 providers to end staff, we also include staff, to jump in for these meetings and disseminate this information because a lot of physicians don't know this, a lot of our providers and our physician extenders, because I didn't know it either. And when I studied for my lifestyle medicine board exam, quite frankly, that nutrition module just blew me away. You know? And between that and How Not to Die with Dr. Michael Gregor, I was like, oh my God, the blinders are off and I can't go back.
Rip Esselstyn:
Yeah. Yeah. So how hard is that lifestyle medicine certification exam?
Dr. Melissa Sundermann:
The exam actually was really hard. I mean, part of me... You have to go through modules to prepare yourself and you have to do a certain amount of CME ahead of time and 30 hours online and then 10 hours live, and read case studies and write up a case study yourself. So I did the preparation and it was everything I was really interested in so I wanted to do the preparation. And the exam itself kicked my butt, but it wasn't just me. We basically all walked out of there. And I called my husband, because we took the exam in Orlando, Florida in 2019, and I said, "I am really confident I got 15 questions out of 200 right."
Dr. Melissa Sundermann:
And a part of me was like, well, this should be just like I should just know these answers. And it was a tough exam, I think they do that on purpose for like yeah, this is no joke. And lifestyle medicine is just not intuitive or like, well, duh, don't eat McDonald's and Cinnabons every day. So it was good and we all passed, all five of us passed the exam, but it really was a tough exam you got to take. And when people ask me like, "I'm studying, what should I expect?" I'm like, "It's going to kick your butt."
Rip Esselstyn:
Yeah. So a couple times you've mentioned the pillars of lifestyle medicine. I don't want to spend a lot of time on the pillars, but I'd love it if you could just give our listeners-
Dr. Melissa Sundermann:
Sure.
Rip Esselstyn:
... kind of an overview of what the pillars are.
Dr. Melissa Sundermann:
Sure. So we have six official pillars of lifestyle medicine from the American College of Lifestyle Medicine. The first is nutrition and we do advocate for a plant strong, as you like to call it, plant slant way of eating, really advocating for whole food plant based. It's evidence based as the best diet pattern to prevent and possibly reverse chronic diseases. So some of my patients when I'm counseling with them, I don't like to use the term vegan because I think that comes across some political connotations and oh... It's just is...
Rip Esselstyn:
A little polarizing.
Dr. Melissa Sundermann:
A little polarizing, yes. So if you say whole food plant based, I actually like plant strong because it just means moving in that direction, right?
Rip Esselstyn:
Yeah.
Dr. Melissa Sundermann:
So we do advocate for that. The second pillar is I like to call it movement rather than exercise. Again, exercise for some people seems like a chore and something they don't want to do. So when you reframe it as moving our bodies and that can be taking a walk to go look at birds, that can be dancing with your kids in your living room, that can be roller skating, that can be hula hooping, that can be mountain biking, running, so whatever you like to do, we need to move our bodies.
Rip Esselstyn:
I like movement as opposed to exercise, just like I like plant slant, plant strong as opposed to vegan. I think that's great.
Dr. Melissa Sundermann:
I totally agree. And then I always bring up the blue zones, right? And so when you look at the blue zones, movement is one of their nine pillars. They're not going to Planet Fitness, right? They're not going to the gym, they're learning, they're walking to go see their friends and interacting. So it's movement, it's not a gym and lifting barbells, but if you like that, that's fine.
Rip Esselstyn:
Yeah. Yeah. No, they're using the planet for their fitness.
Dr. Melissa Sundermann:
Right? Exactly. And so third would be sleep. And I think that for a long time, it's the busyness culture, and like, ugh, I cram so much into a day, sleep, that's just an afterthought, and that quote, I'll sleep when I'm dead. Well guess what? Research shows, that's not good. That's not good. And so much... Sleep is just not what you do at the end of your productive day, sleep is what you do to restore and heal yourself. And we're getting more and more research just about the real power and the importance of sleep. And that it has to be... You have to be intentional about this. As much as you make plans for exercise or my meal plan, you need to make plans for sleeping.
Dr. Melissa Sundermann:
And we could go further into kind of those hygienes, but knowing that healing processes happen and the lymphatic system that we're learning about that cleanses our brain and gets rid of amyloid protein as we sleep. And if you mention the word dementia, no one wants that. So if you say, if you get restorative sleep and the glymphatic is just cleansing this, people are like, oh, okay, I'll do it. And so we really do advocate for at least seven hours of restorative sleep for night.
Rip Esselstyn:
Well, like I asked you before we popped on here officially, what time you got to sleep last night, and you said 10:00 and you woke up, was it 5:00 or 5:30?
Dr. Melissa Sundermann:
5:00. Mm-hmm.
Rip Esselstyn:
Five o'clock.
Dr. Melissa Sundermann:
Yeah.
Dr. Melissa Sundermann:
And again, it's working backwards. It's like, my patients started at 8:00 AM this morning, I go for a run before work, so that means I start my run at this time, that means I go to sleep at this time. So it is, it's just like when I pack my lunch the night before, it's very intentional that I do the processes the night before, I'm preparing myself for success the next day. And there's things that you don't really like, like I don't like packing my lunch the night before, it's a pain in my butt.
Rip Esselstyn:
Yeah, yeah.
Dr. Melissa Sundermann:
I have to do it. But that ensures that all I have to do in the morning is grab my lunch bag that has healthy choices in it. So I make the healthy choice, the easy choice.
Rip Esselstyn:
Yeah.
Dr. Melissa Sundermann:
And then I'm not starving during my workday and then snacking on what someone's brought into my office. Right? And it's the same thing about sleep. Some days I'm like, oh man, I just want to watch another Netflix episode.
Rip Esselstyn:
I know.
Dr. Melissa Sundermann:
We're watching Ted Lasso right now. I'm like just one more episode, but I'm like, no, no, the Netflix will be there tomorrow, not going away. I'm going to bed. And I think that it's really being disciplined about that. And it's not like it's hard, it's not that... Well, maybe it is hard. I mean, but we just are developing routines that we know will serve ourself. And just being real with my patients like this isn't any easier for me. It's not any easier for me to do this than it is you, but you just have to know that this is going to benefit you.
Rip Esselstyn:
I was a firefighter for 12 years. I was up probably 24 hours a day for every other... Every 72 hours up 24 hours for almost 12 years, just the damage that did to my brain.
Dr. Melissa Sundermann:
Well, right, and similar with residency. And then actually during COVID, because I've been practicing for 23 years, so I've had several different jobs and one of them is I've been a hospitalist, so that means you're just taking care of acutely ill patients. Well, I got redeployed to the hospital during COVID for eight months. And I'm 51, so working midnight shifts at 51 is way different than being a resident at age 22. So I typically worked like... I did everything from like the 10P to like 4A, or no, maybe it was like... I can't remember. It was a 10 hour shift.
Rip Esselstyn:
Yeah.
Dr. Melissa Sundermann:
But some of them didn't end until four in the morning and oh my God, it was really difficult. And I did it because there was a need, and a calling, and I was going to step up into the front line to do it, but it really shook up so many of my habits. And how do you even eat when you're working all night and your meal times and my exercise times.
Rip Esselstyn:
Yep.
Dr. Melissa Sundermann:
So I did it because I was asked to step up to the plate and I'm glad I could contribute and be of service, but that's not good for me.
Rip Esselstyn:
Yeah. Yeah. Well, we could talk about sleep for a long time. So what's the next pillar?
Dr. Melissa Sundermann:
Okay, all right. So I'm sorry. Yes. I was supposed to be brief about these pillars.
Rip Esselstyn:
No, no, I was my fault. I'm diving in here too.
Dr. Melissa Sundermann:
Yeah, yeah. Yeah, no, great. Fourth would be avoiding some risky behaviors. So tobacco, most importantly and there's still lots of people that smoke. I mean, our rates of tobacco have definitely gone down, but the community that I practice in, there's still a large amount of smoking. And so really people know, they know what causes lung cancer, so you're not treating, you're not educating them that this is bad for you. So it's just, again, finding ways to quit. And then alcohol, again, that's a tough one because it's socially acceptable. It's part of a lot of cultures, but we know it's a class one carcinogen. So educating about, for men maximum two drinks, women just one and ideally none.
Rip Esselstyn:
Right.
Dr. Melissa Sundermann:
And then drug use and I know that marijuana is legal now, and so people have different thoughts about that. But in general, we just like to avoid risky substances. The fifth pillar is the role of stress management and we all have stress in our life. I mean, everyone does. Some people's stress at any given time is more than others, but our brains and our cortisol levels, stress reacts, they don't know, our brains don't know the difference between a bear about to attack us and me in the middle of the night freaking out that my teenager is out in the road right now and is going to get in a car accident.
Rip Esselstyn:
Yeah.
Dr. Melissa Sundermann:
You still fire up all of those neurotransmitters and those stress signals. And so really learning ways to manage our stress. And in my office, I will even go through deep breathing exercises with my patients. And so I'll teach them the square breathing method where you're inhaling, you draw imaginary square, inhaling, going up, holding your breath, exhale, coming down, holding it. And I have them do it with me. And I teach them, I'm like, your breath is always with you. So if you are feeling stressed, you could be in your car, stuck at an accident, you could be just whatever life situation it is, your breath is always with you.
Rip Esselstyn:
I like to square. I like that term.
Dr. Melissa Sundermann:
Yeah.
Rip Esselstyn:
And how many seconds do you try and do each one? Is it two, three?
Dr. Melissa Sundermann:
I don't even think about seconds. You're just drawing a square slowly. So you're not even counting seconds. You're just drawing an imaginary square or you can even use your finger if you want. So it's inhale, going up, holding the breath. And then for others, it's in the five finger breathing. So you can just trace your fingers, so inhale, exhale, inhale. So just giving that technique as a tool that the patient can walk out of my office with and that's a great way. And then of course, because I did training in mind body medicine and really learned about different mindfulness techniques and meditation doesn't have to be sitting like a pretzel on a ground saying mantras, right? There's many forms of mindfulness and Jon Kabat-Zinn has such wonderful books explaining that, so I will point to his books, and just finding ways to manage our stress. And then the sixth pillar, the sixth official pillar would be the role of social connection. And wow, has that been a challenge during our pandemic that we were forced to not connect, it was frowned on to connect.
Dr. Melissa Sundermann:
And I think we all felt that loss, right? And we did come up with Zoom and that helped us keep in touch, but that's different than hugging someone. And even in my office yesterday, I saw a patient I haven't seen forever. And we're all masked and we have to be vaccinated to be in our clinics, so I went to give her a hug. I haven't given her a hug. My medical assistant was like, I didn't think she was going to let go, dr. Sundermann, because she was just hugging me, and hugging me, and hugging me. And I think that we've all just been craving that connection. And when you, again, I'm going to point back to the Blue Zones, when Dan Buettner did all this research, and one of the power nine is that social connection and that need for your tribe and that we all need our tribe, whether it's our family, whether it's friends, whether you belong in the special interest club, or you belong to a church or a place of worship. So we all need our people.
Rip Esselstyn:
Yeah. No, thanks for that review of the pillars.
Dr. Melissa Sundermann:
I want to add on, I have one seventh unofficial pillar that I feel very strongly about and that is fresh air and exposure to nature every single day. Every single day you need to get outside and get fresh air. And I live in Michigan, we get four seasons. So my quote to my patients is there's no bad weather, just inappropriate clothing.
Rip Esselstyn:
That's right.
Dr. Melissa Sundermann:
So bundle up. I run outside all year round. It doesn't matter because I've got the equipment. I got my hand warmers, I got my balaclava, I got my headlamp, get outside, get fresh air, so that's my seventh pillar.
Rip Esselstyn:
Nice, nice, nice addition.
Dr. Melissa Sundermann:
Yeah.
Rip Esselstyn:
Let me ask you this. Before I went on today, I was talking to a member of the PLANTSTRONG team.
Dr. Melissa Sundermann:
Yeah.
Rip Esselstyn:
She's about 48, 49 years old and she knew I was going to be talking to you today. And she wanted me to ask you specifically about perimenopause and menopause.
Dr. Melissa Sundermann:
Yeah.
Rip Esselstyn:
And as someone who's 51, what are your thoughts on that? As a male that doesn't go through that, what exactly... What do you feel like, if you know?
Dr. Melissa Sundermann:
Yeah.
Rip Esselstyn:
And what can women listeners that are out there, is there anything that by embracing this lifestyle medicine type lifestyle, it will help them get through this?
Dr. Melissa Sundermann:
Absolutely, and you are exactly right. I'm 51. I'm in the thick of it and all of my close friends we're all going through this together. And I think for a long time perimenopause and menopause, we didn't talk about it much, you know? And so it's like, yeah, yeah, yeah, yeah, you're going to stop having periods. Maybe you'll sweat, you'll have a little hot flash. And it is so much more than that. I mean, I have patients coming to see me with symptoms ranging from heart palpitations, to of course the night sweats, body aches, weight gain, mood fluctuations. And for a long time, people are like, ah, you're just depressed because whatever your kids went off to college or you're gaining weight because you're just not as active. And really with these hormonal changes, the symptomology is vast and it can be really frustrating.
Dr. Melissa Sundermann:
And even though it's a normal thing we all go to, like as females, we all get our period. As females, we're all going to stop having periods. So it's important to legitimize that these are real symptoms you're having and not poo-poo it off like, oh, it's just in your head. These are real and it's scary, and it's frustrating, and a lot of times you're not expecting this to happen. So I really feel that the pillars that we have, maybe won't prevent all of the changes from happening, I mean, we're not going to change hormone levels, but the symptoms can really help. And a whole food plant based diet is huge in that with our estrogen levels. Neal Barnard and his PCRM group just came out with their Wave study, the woman's alleviation of vasomotor symptoms, which was awesome results. So they looked at hot flashes basically, and they asked their experimental group to go on a low fat, whole food plant based diet and one half cup of soybeans. They give them an Instapot, one half cup of soybeans every day. And at the end of their study, which I think was-
Rip Esselstyn:
For how long was it for, do you know?
Dr. Melissa Sundermann:
... I think it was 12 weeks.
Rip Esselstyn:
Uh-huh.
Dr. Melissa Sundermann:
They had an 84% reduction in hot flashes.
Rip Esselstyn:
Oh.
Dr. Melissa Sundermann:
Which I mean, that is a huge number, huge. And for women who have debilitating hot flashes, it's not like, oh, I'm just like feeling a little warm. It will wake people up at night and drench, and you'll have to change your clothes and your sheets, you're at like work and all of a sudden you're embarrassed because you're just sweating. So 84% reduction and really we're learning even more about... We're familiar with the gut microbiome and I know that's a whole nother conversation, but we're also learning about the estrobolome, which basically is the fiber and the health of the gut microbiome is also so key in hormonal regulation, but we can really stabilize those fluctuation of levels by keeping our gut microbiome healthy. And that's, as we know, the only way to fuel and nurture our gut microbiome is fiber in the diet. And fiber's only found in fruits, vegetable, beans, legumes, and whole grains. So I think that really getting my patients to adopt a whole food plant based diet, high in soy, soybeans, you could do tofu, tempeh, edamame, is really key with that.
Rip Esselstyn:
And when you say high in soy, what's your definition of high? Is it a half a cup a day, a cup a day?
Dr. Melissa Sundermann:
Well, his experiment was half a cup a day. So I think at minimum you want to do half a cup a day. And of course there's always the... I had a patient in yesterday, menopausal, but a history of breast cancer as well, and so I was talking to her about... She has debilitating hot flashes and doesn't want to go on hormones. So I told her about the study and she said, "Oh, Dr. Sundermann, remember I have a history of breast cancer." And I said, "Oh, that is a myth." And she said, "My oncologist told me I can never have soy." So it's a pervasive myth out there, right? And what we know is with soy is there's a 30% reduction in breast cancer and for those women, like my patient, who had breast cancers, a 30% reduction in recurrence. And then for men, it's 30% reduction in prostate.
Dr. Melissa Sundermann:
So emphasizing soy in the diet and that soy is beneficial and it's healthy for our bones because that's another thing with menopause is our bones are getting weaker. We're not building any more bone, we're just trying to prevent loss of bone and the receptors that the soy will target on the bones can actually help with bone preservation.
Rip Esselstyn:
We're fans of soy, but we're not fans of isolated soy proteins or concentrates.
Dr. Melissa Sundermann:
That's right. Yes. So we want the organic soy in the whole food form, right?
Rip Esselstyn:
Yeah.
Dr. Melissa Sundermann:
So I absolutely thank you for clarifying that. That's absolutely right. So that's the nutrition pillar. I'm just going to keep advocating for fiber in the diet, pushing that fiber up to 40, 50 grams per day. And what I've told patients is that everyone is still freaking out about protein, right? Because protein has glorified health food and if you're slap it on a label, we think it's healthy. I joke like Pop Tarts could have contains protein on them and people think that's healthy, it's got protein in it.
Rip Esselstyn:
Oh, yeah.
Dr. Melissa Sundermann:
Right? So I said, in quarter of a century of practicing I have yet to see a protein deficient patient, but about 95% of my patients are fiber deficient.
Rip Esselstyn:
Yes.
Dr. Melissa Sundermann:
So let's talk about the fiber. That should be the glorified nutrient, not a macro nutrient, but a nutrient in our diet. So I think that's really important with perimenopause and menopause is getting that shift to a plant strong way of eating. I think daily movement is really important because not only movement, exercise, but what all the other good vibes we get with it. We know it's good for our mental state. A lot of people, including myself, it's an act of meditation. A lot of times with my exercise in the mornings before work, it's just me or me and my husband, but on the weekends it's with my tribe, right? So it becomes this social dynamic too and a community that I've been able to connect with. So I think that's important is to keep moving our bodies. We talked about the emphasis of sleep and that sleep with helping us to not age and cleansing our brains of all those toxins. Stress is managing our stress.
Dr. Melissa Sundermann:
And we know that Elizabeth Blackburn did her her Nobel Prize with telomeres that shortened-
Rip Esselstyn:
Yes.
Dr. Melissa Sundermann:
... and telomeres in the end of chromosomes and with chronic stress that actually will shorten the telomere, which is about longevity. So it's not good for us to be stressed and worried all the time, so really actively working to manage our stress in our life. So those are some actionable items, take home items that I work with my perimenopause, menopause. And I think it helps to say I'm going through this too and I'm still trying to figure it out. And expectations, like running, right? I'm not going to be as fast as I used to be. The body takes a while to warm up I call it, I got to lube up the joints, get things oiled again and speed workout that will totally trash my high hamstrings.
Dr. Melissa Sundermann:
So it's adjusting expectations. I think there's a season for everything and my season right now is truly this passion for lifestyle medicine. I'm working my butt off and I love it. And my goal is lifestyle medicine, I want to be doing this full time. I want to connect on a broader audience and just bring this. And so that's my focus now. And I will always love to run, and mountain bike, and ski, and hike, and all those things, but right now I have the opportunity to really impact lives.
Rip Esselstyn:
Well, beautiful. And I want to thank you for coming on board PLANTSTRONG Podcast.
Dr. Melissa Sundermann:
Yes.
Rip Esselstyn:
I want to thank you for practicing what you preach and man, you're right. The season is upon us.
Dr. Melissa Sundermann:
Yes.
Rip Esselstyn:
When it comes to lifestyle medicine, and I think that there's a lot of blue skies ahead.
Dr. Melissa Sundermann:
Absolutely. And thank you to your whole family for being so instrumental in this movement. I'm in awe of what you guys have been able to accomplish. It's wonderful.
Rip Esselstyn:
Yeah. Well, our pleasure and it's going to take all of us working collectively to get where we want to be here. Let's do the sign off. Ready? Peace.
Dr. Melissa Sundermann:
Okay. Peace.
Rip Esselstyn:
Turn it around, engine two.
Dr. Melissa Sundermann:
Two.
Rip Esselstyn:
Live PLANTSTRONG.
Dr. Melissa Sundermann:
Yeah. Thanks so much for having me, Rip. This has been great.
Rip Esselstyn:
I think one of the best lessons from this episode is to keep learning and expanding your knowledge about whatever it is that interests you. Never stop learning and growing. Dr. Sundermann sought a different approach to helping patients and now gets to live her dream each and every day. What interests you? How can you use your skills to help not only yourself but others? And how can you employ some of these pillars of lifestyle medicine to increase your own health, wellbeing, and overall satisfaction? Most importantly, how can we at PLANTSTRONG help you? That's why we're here. Thanks so much for listening. And until next time, keep it PLANTSTRONG. The PLANTSTRONG Podcast team includes Carrie Barrett, Lori Kortowich, Ami Mackie, Patrick Gavin, and Wade Clark. This season is dedicated to all of those courageous truth seekers who weren't afraid to look through the lens with clear vision and hold firm to a higher truth. Most notably, my parents, Dr. Caldwell B. Esselstyn Jr. and Ann Crile-Esselstyn. Thanks for listening.
