#88: Dr. Saray Stancic - What's Missing from Medicine
Rip and Dr. Saray Stancic
Rip digs deep into the all-encompassing world of Lifestyle Medicine Physician, Dr. Saray Stancic. Her story has a little of everything that will have you on the edge of your seat -- personal trauma and transformation, redemption, discovery, and a passionate pursuit to change not just her health and the health of her patients, but of the healthcare field as a whole. Not a small task, but as you’ll hear, this plant-armored warrior is more than up to the task!
In 1995, as a third-year medical resident, Dr. Stancic was diagnosed with multiple sclerosis. At the time, it may as well have been a death sentence for this young doctor. This unforeseen health challenge changed the course of her life, both professionally and personally, and Rip and Saray talk about the impact that diagnosis had on her life as well as her “galileo” blueberry moment that ultimately changed the way she viewed her prognosis.
Today, over 25 years later, in addition to being a physician, you can also add marathon finisher, filmmaker, and author to her long list of credentials. Her film, “Code Blue” examines the healthcare industry and offers solutions featuring the practice of lifestyle medicine to prevent, treat, and manage disease. And, her new book, What’s Missing From Medicine offers six lifestyle changes to overcome chronic illness, including heart disease, diabetes, obesity, autoimmune diseases like lupus, multiple sclerosis, and many others.
Dr. Stancic received her M.D. degree from New Jersey Medical School in 1993. She completed an Internal Medicine residency and served an additional year as Chief Medical resident at University Hospital in Newark, NJ. In response to witnessing the height of the catastrophic HIV epidemic while in medical school in Newark, she became very interested in the field of Infectious Diseases. She wanted to be part of the solution to the AIDS health care crisis and went on to complete a fellowship in Infectious Diseases.
After completing her training, she was appointed Chief of Infectious Diseases at the Hudson Valley Veterans Administration Hospital in New York. During those years she treated hundreds of patients with viral hepatitis and HIV as well as other infectious diseases with a multidisciplinary approach to support her patients’ overall well-being.
Beyond her responsibilities as Chief of Infectious Diseases, clinical researcher, and Chief of Infection Control, she directed the MOVE program, a federal VA initiative to encourage healthy lifestyles in veterans.
She later joined the viral hepatology team at Roche Pharmaceuticals and conducted clinical studies for new, more efficacious treatments for hepatitis infections. During these research years, she continued to see patients at the Bronx Veterans Administration Hospital in New York City. She has authored several research papers in peer-reviewed medical journals.
Episode and PLANTSTRONG Resources:
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Links to Episode Music:
Full Transcript
Dr. Saray Stancic:
Every patient is a privilege to care for. But when I have a patient who's also a doctor, I know, in supporting that individual to optimize their lifestyle, that's going to pay it forward in great fashion because now, all of a sudden, the way that they practice medicine moving forward has changed. It's been modified and that's going to affect each and every one of their patients, and each and every one of their experiences with other peers. I think we have a responsibility to educate and act as mentors for interns and residents and medical students. So it's this beautiful ... all of a sudden, it flowers, and we can, by changing one life or by introducing these powerful aspects of lifestyle, it's infectious.
Rip Esselstyn:
Season Three of the PLANTSTRONG podcast explores those Galileo moments where you seek to understand the real truth around your health and dare to see the world through a different lens. This season, we honor those courageous seekers who are paving the way for you and me. So grab your telescope, point it towards your future, and let's get PLANTSTRONG together.
Rip Esselstyn:
Hello, everyone, I'm Rip Esselstyn, and this is the PLANTSTRONG podcast, where each and every week I bring a wide variety of guests to talk about the subject we all love, the power of plants to change the world, prevent and reverse disease, but also greatly enhance the quality of your life. You are in for a treat today as I dig in deep into the all-encompassing world of lifestyle medicine physician, Dr. Saray Stancic. Her story has a little of everything that will have you on the edge of your seat: personal trauma, transformation, redemption, discovery, and a passionate pursuit to change not just her health and the health of her patients but of the healthcare field as a whole. Not a small task, but as you'll hear, this plant-armored warrior is more than up to the task. It hasn't been an easy climb.
Rip Esselstyn:
In 1995, as a third year medical resident, Dr. Stancic was diagnosed with multiple sclerosis. At the time, it may as well have been a death sentence for this young doctor. This unforeseen health challenge changed the course of her life, both professionally and personally. Today, we talk about the impact that diagnosis had on her life as well as her Galileo blueberry moment that ultimately changed the way she viewed her prognosis. Today, over 25 years later, in addition to being a physician, you can also add marathon finisher, filmmaker, and author to her long list of credentials. Her film, Code Blue, examines the health care industry and offers solutions featuring the practice of lifestyle medicine to prevent, treat, and manage disease. Her new book, What's Missing From Medicine, offers six lifestyle changes to overcome chronic disease. We go deep into these six lifestyle habits, so let's not waste a single moment. Prepare to be empowered with the incomparable, Dr. Saray Stancic.
Rip Esselstyn:
Let me start by asking you this, because this is season three of the PLANTSTRONG podcast, and in season three, we're really trying to understand the person that I'm talking to, their Galileo moment, and what allowed you to look through the lens of that telescope and then see the truth that sets you free, and then also informed your path forward. With you, I think it's pretty powerful. So I'd love for you to share that.
Dr. Saray Stancic:
Sure. Well, my story really begins in 1995. At the time, I was a third year medical resident and I was in the midst of a call working in 24-hour shift and I woke up around 3:00 in the morning to find that I couldn't feel my legs, and that led to the emergency room and MRI that confirmed the diagnosis of multiple sclerosis. So there I was, 28 years old, abruptly learning that I had this chronic disease, incurable chronic disease, and I knew in that moment that my life had changed dramatically and irrevocably.
Rip Esselstyn:
Did you actually have lesions? Was that diagnosed then?
Dr. Saray Stancic:
Multiple lesions in my brain and spinal cord. In fact, the burden of disease was significant. I mean, when the neurologist saw me, he said, "Saray, you need to start planning for a future that may lead you to a wheelchair, nursing home setting." I mean, these were all of the terminology that he used at that time.
Rip Esselstyn:
That was 25 years ago.
Dr. Saray Stancic:
25 years ago, yeah, and he told me that I know this diagnosis is difficult, but here's the good news; a new drug, the first drug had just been approved for multiple sclerosis, a drug called Betaseron. He said, "This is a drug that is quite effective, but it's not going to be easy. It's a drug you're going to have to inject every day, has a significant side effect profile," which is numerous, but he said, "This is your best chance to reduce or slow down the disease. You can't cure the disease, but," he said, "this was the way in which we could slow it down." Buy more time. Meaning, buy more time where I wasn't disabled.
Dr. Saray Stancic:
So, of course, I was going to do whatever he asked me to do. I mean, he was a leading MS specialist and so I started the medication. The side effect profile was difficult to manage. I mean, I would wake up, I would inject the drug at 10:00 and at 2:00 in the morning, like clockwork, I would wake up, Rip, with violent shaking, chills, fever. Just I felt like I had the flu. I couldn't sleep. The injections were every day, and I would develop these really painful injection site reactions. I almost looked like a leopard because at some point I ran out of real estate, like, where do you inject? After doing this for some time, a month into this, I can't do this anymore. I mean, I'm ready to give this up. When I approached him about it, he said, "Are you crazy? You can't. This is your only chance. You have to remain compliant with this medication or you're going to be in a wheelchair within 10 years."
Dr. Saray Stancic:
So his solution to the problem was what we'll do is we'll treat the side effects of this drug with other drugs. So when I couldn't sleep, I was given an Ambien. When I couldn't wake up, I was given Provigil, an amphetamine-like drug. When I became depressed, I was given Prozac. So you can see the pattern here. By the time ... a few years into the diagnosis, I was taking about a dozen medications. I was a young woman walking around with a pill box. The disease progressed regardless, despite-
Rip Esselstyn:
A young woman physician.
Dr. Saray Stancic:
A young woman physician, yeah. Going through my residency, my chief resident year, my specialty as an infectious disease specialist, I mean, I fought my way through all of that with the pill box, with the cane, with the diaper, the humiliation of it all and I grew hopeless. Then my moment, the aha moment-
Rip Esselstyn:
And this aha moment, what year was that?
Dr. Saray Stancic:
2003.
Rip Esselstyn:
So you've been living with the MS and the meds and stuff for eight years?
Dr. Saray Stancic:
Eight years, yeah. And an exacerbation, probably, at least two, maybe three times a year where I would ... An exacerbation in MS is like ... it's an extraordinary disease in that you might feel well today and then the floor falls out from under you the next day, like if you develop something called optic neuritis, blindness; or you wake up and you can't feel your leg; or you wake up and you have a weak arm. It's unpredictable. Throughout all that, there is this fatigue that's hard to describe, but you feel like it's hard to just get up out of bed. Somehow I'm managing to get through this. I'm the Chief of Infectious Diseases at the VA in New York, and I'm sitting in my office one day, and my secretary drops off mail and on top of this big stack of mail, I see a journal. On the cover of the journal, I see multiple sclerosis and blueberries. I think, "What is that all about?"
Dr. Saray Stancic:
So curiosity, I picked it up. I turned, and it was a very small, poorly constructed, unscientific study that essentially took a group of MS patients and fed them a diet enriched in blueberries. These doctors or scientists suggested that it was the anthocyanin, the phytonutrient in the blueberry, that was playing a role in an anti-inflammatory fashion, and then it was somehow, the patients that were eating this blueberry-enriched diet, subjectively felt better.
Dr. Saray Stancic:
Now, as a physician and scientist, that's not an objective clinical endpoint and I thought this is wonky and not very serious. Had a lunch with a colleague of mine that afternoon. He was a neurologist. I told him about it, he laughed. But you know what, Rip, I couldn't get that silly study out of my head. I just kept thinking about those blueberries. And-
Rip Esselstyn:
Now your favorite fruit.
Dr. Saray Stancic:
Yes, and I said to myself, and an important question started to arise from that line of thinking as I thought more and more, and it wasn't that I thought eating the blueberries was going to resolve my issues, right? For the first time in my adult life as a practicing attending physician, dual board-certified, I considered the following question: could diet and disease, could there be a connection? Isn't that extraordinary? I was a physician and I knew nothing about nutrition and its role in the formation of disease. It's hard to fathom.
Rip Esselstyn:
Well, yeah, yeah. Well, it almost seems knowing what we know now, egregious, like, "Wow, what a miss. Huge miss.
Dr. Saray Stancic:
Huge miss. But in that moment, it catalyzed this insatiable appetite in me, like I want to learn as much as I can about these connections. So I delved into the literature. The first study that I came across, published in 1952, in the New England Journal of Medicine, Roy Swank, who was, back in the '50s, he hypothesized that saturated fat was playing a role in the pathogenesis of multiple sclerosis. Back then, he started treating patients with a low-fat, plant-based diet and people thought he was crazy, but he followed about 140 plus patients over 34 years, ultimately published data in the Lancet 1990, and he found and he reported then that 95% of his patients were disability free. I was like, "Oh my God, every time I see my doctor, he's talking about this wheelchair. Is there something to this?" and it wasn't just Swank. There were several other publications in literature that spoke similarly to the same and it wasn't just food. It was all these other aspects of lifestyle that play a role in the formation of disease.
Dr. Saray Stancic:
So anyway, I just consumed all of this literature. It excited me. Suddenly, there was hope. I made an appointment to visit my neurologist with all of these articles. Even made copies, highlighted sections that I wanted him to be aware of. I presented my thoughts and he was very surprised that I would consider that this could potentially change the course of my disease. He looked at me and he said, "Look ..." because he was one of my professors. He said to me, "You're a physician, I think you know, better. You know that this changing your diet and changing your lifestyle is not going to, in any important way, change the course of this chronic neurologic disabling autoimmune disease. What you need to do is remain compliant with the medications as prescribed," and then he said to me, "There's nothing you've done wrong and it's not your fault that you have MS. The reason you have MS is because of your genes, and there's nothing you can do about your genes."
Rip Esselstyn:
So how did you take what he had to say?
Dr. Saray Stancic:
Well, it certainly sent me back. I very much admired him and appreciated who he was and his expertise in the field, but it didn't take very long before I realized that, with all due respect, that I felt strongly that there was something here. I mean, I had read the evidence and I felt compelled to introduce these changes into my life. I was willing to take that risk because the alternative was my dependency on the many medications, I had no quality of life. So to me, it was "I'm willing to take this risk," but that was a personal decision for myself and one that I discussed with my husband. It was not a-
Rip Esselstyn:
So you were married at the time?
Dr. Saray Stancic:
I was married.
Rip Esselstyn:
How long have you been married?
Dr. Saray Stancic:
At the time, about five years.
Rip Esselstyn:
So he had met you maybe, or you guys had gotten married when you had MS.
Dr. Saray Stancic:
Yes. Well, he met me three weeks before I was diagnosed and he stuck around. He's a pretty fantastic guy.
Rip Esselstyn:
Well, you know what? Good for him because he has got to witness this insane recovery, hasn't he?
Dr. Saray Stancic:
Yes, he has.
Rip Esselstyn:
Right, and how you're just flourishing.
Dr. Saray Stancic:
Yeah, and he's part of my medicine, too. I mean, I have this amazing spouse who's just been with me through it all. Love is part of this quotient.
Rip Esselstyn:
Right, right, and I want to talk about that. Neurologist, who was a professor, who you admired and respected and basically said, "Saray, come on, you're a physician."
Dr. Saray Stancic:
Yes, stick with the meds.
Rip Esselstyn:
He says stick with the meds. Let's stick with the science, right? So have you gone back to him since? Has he come around at all?
Dr. Saray Stancic:
I did visit him around the time that I was filming Code Blue, because I actually wanted to interview him, but ...
Rip Esselstyn:
Yeah. No, he didn't want any part of it?
Dr. Saray Stancic:
No.
Rip Esselstyn:
Yeah.
Dr. Saray Stancic:
Mm-mm (negative).
Rip Esselstyn:
Yeah. Well, that's unfortunate, I suppose.
Dr. Saray Stancic:
He was very happy to see me though, and he was surprised to see me walking on two feet and looking well, but when-
Rip Esselstyn:
Did you hand him the stack of papers again and said, "I really think you should take a closer look at this"?
Dr. Saray Stancic:
Yeah, and I think, he still was very resistant. In fact, he thought that it could be ... Well, he thought I should be very careful about what ... I never tell, let me just make this point. I never tell MS patients not to take medicine or not to follow ... I'm not an MS specialist and they should have that conversation with their doctors. All I'm saying is if you have MS and all you do is take these disease-modifying therapies and you ignore everything else ... I mean, I've seen, in my practice, many young women with multiple sclerosis who are being managed by MS specialists and they come to see me because they've heard my story and they want to learn about lifestyle medicine and they want to introduce modifications into their own lives. So these women will come to see me and yes, they have MS, but guess what? They may also be obese, hypercholesterolemic, depressed, pre-diabetic, and that's being ignored by these MS specialists. We know all of those components are promoting the progression of this disease.
Dr. Saray Stancic:
So I think it's unethical for us to ignore all these other co-morbidities and just manage the MS. Because guess what happens? When you introduce these lifestyle modifications, the patient loses weight, the pre-diabetic state reverses, the fatty liver disease reverses, the hypercholesterolemia reverses, and guess what? Your MS gets better.
Rip Esselstyn:
Well, and I think the first chapter in your book, you basically talk about how these chronic western diseases, they're man-made diseases, right?
Dr. Saray Stancic:
They're man-made diseases, yeah. People don't like to hear that, man-made disease, but they are. They are.
Rip Esselstyn:
Yeah.
Dr. Saray Stancic:
And some people will feel like, "You're blaming people," and I'm not blaming. I'm empowering, I hope.
Rip Esselstyn:
Yeah, yeah, yeah. Yeah.
Dr. Saray Stancic:
It is to empower, not to blame. We're in trouble right now, Rip, in our country. The chronic disease epidemic is ever growing. We have a population that obesity rates are climbing every year. When I started the book, writing the book, in the section that I write about obesity, at the time ... So I'm doing my research, I go to the CDC to look at what is the obesity rate at the time. At the time, it was 39.8% of the population was obese in the United States. Last-
Rip Esselstyn:
What percent were considered overweight? 75?
Dr. Saray Stancic:
Right. If you consider overweight and obese, you're in the 70s, right?
Rip Esselstyn:
Yeah.
Dr. Saray Stancic:
But in one year, so now I'm at the final point of edits, sending in last edits to the publisher so I'm rechecking my facts. Go back to the CDC to check the obesity rate. Now-
Rip Esselstyn:
Is there a four? Does it start with a four?
Dr. Saray Stancic:
Yes. Now, it's 42.4%.
Rip Esselstyn:
Oh my gosh, so it goes up almost 3%.
Dr. Saray Stancic:
One year, yes, 2.6%. Isn't that amazing?
Rip Esselstyn:
It doesn't seem conceivable.
Dr. Saray Stancic:
It doesn't, but that's the state that we're in. Each year, there is no ... Just when you think it's going to plateau, like it can't get worse, it does, and we just continue to go about our way, like ... I'm an infectious disease physician. It was common for me to see an infected diabetic foot ulcer in a veteran. So the question to me would be, what antibiotic, Dr. Stancic, should this patient be on? So I would examine these patients and find often they had bone involvement. This is what we call osteomyelitis, and that buys them at least six weeks of antibiotics, maybe longer. We would debride the ... Despite the aggressive nature and the appropriate antibiotic regimen, often these patients wouldn't get better and so they end up with an amputation.
Dr. Saray Stancic:
So now, status post amputation, they become more sedentary. They gain more weight, blood pressure further out of control, blood glucose ... So what happens? Stroke or heart attack. So this is not unique to me. This happens every day in every hospital across our country and it's like normalized. Diabetics, they develop amputations. They lose their vision. But here's the thing: we have the knowledge and understanding today to prevent more than 90% of diabetes. This is a disease that is skyrocketing in our country. The CDC predicts that by 2050, 30% of Americans will be living with diabetes and, today, we know how to prevent it. How is this not the most important message that we're all delivering in the field of medicine?
Rip Esselstyn:
Number one. Let's just say it's 2003, you're eight years into your disease. You're walking with a cane.
Dr. Saray Stancic:
Walking with a cane.
Rip Esselstyn:
Walking with a cane, but you're now hitting the blueberries, right?
Dr. Saray Stancic:
Well, whole plant kingdom, I'm hitting. I'm hitting it really hard.
Rip Esselstyn:
The whole plant kingdom. Was there a book, or was there a person, or is there something-
Dr. Saray Stancic:
No.
Rip Esselstyn:
... That like inspired you besides some of the research you saw?
Dr. Saray Stancic:
No.
Rip Esselstyn:
No.
Dr. Saray Stancic:
I inspired myself.
Rip Esselstyn:
Okay, fantastic.
Dr. Saray Stancic:
Yeah. I read the literature, and the literature was pretty clear that it was about fiber and this microbiome, and these phytonutrients, and these phytochemicals, these antioxidants and their anti-inflammatory effects. I started to piece this together ...
PART 1 OF 4 ENDS [00:23:04]
Dr. Saray Stancic:
... antiinflammatory effects, and I started to piece this together and I just started with my diet, and then the exercise was really hard because I couldn't do much of anything. I mean, think about it, I couldn't feel my legs, they were heavy, I was walking with a cane or crutches. And so the best thing I could do was a stationary bike. And my husband would literally assist me to get on, and I could do a minute, that's it. And then I would get numb, and a shower of pins and needles when he would carry me off. Numbness, pain, shower of pins and needles, it would take about 15 to 20 minutes to recover from that, drinking water, getting my body temperature up. And multiple sclerosis, when your body temperature gets up, you get symptomatic, it's called Uhthoff's phenomenon.
Dr. Saray Stancic:
And so for many years it was felt MS patients were advised not to exercise, it was felt that potentially it was worsening the disease. And when that happened, it felt like it was worsening the disease, but I kept getting back on. And you know what I started to notice? That period of recovery started to lessen. And it sounds crazy that it was only a minute, but it started out as a minute. And over the months it went to five minutes and I started to get stronger and that recovery pain dissipated.
Rip Esselstyn:
Mm-hmm (affirmative)
Rip Esselstyn:
So as hard as it was to get yourself off the couch, and move, and exercise. It was so well worth it.
Dr. Saray Stancic:
Incredibly well worth it. And that fatigue, that heaviness, that was part of my life for the many years lifted. And I felt energized and I felt like, "Wow, this is a new beginning for me, an awakening. There's something to this."
Rip Esselstyn:
Yeah.
Dr. Saray Stancic:
And I just kept going.
Rip Esselstyn:
You kept going and then at some point, did you decide to take yourself off the meds?
Dr. Saray Stancic:
Yes. I tapered off very one of those medications. And-
Rip Esselstyn:
Over what period of time?
Dr. Saray Stancic:
... I think it probably took three to six months. The most difficult medication to come off of was Ambien, I was addicted to that drug. I didn't know how to sleep without it, because every time I went to the doctor, they gave me a prescription. It's a terrible drug.
Rip Esselstyn:
Right. Well, I'd love to talk about that because that's part of your wheel of the lifestyle medicine kind of, it's sleep hygiene. All right, so at some point you decide to throw away the cane and you decide to start run a marathon.
Dr. Saray Stancic:
Right. Running a marathon was not on my bucket list, it was not anything that I was into and yet you're a triathlete and an Ironman, yes?
Rip Esselstyn:
Yeah, I used to be.
Dr. Saray Stancic:
Yeah. But I mean, this was not part of me or anything that I was interested in. It just came by, my brother, in 2003 ran the Los Angeles marathon. And as this awakening came to me and he started to see me flourish and started to see this transition. He said to me, he lives in Los Angeles, came to visit me in New Jersey one summer and he looked at me and he said, "Oh, I think you should run a marathon. And I looked at him like I wanted to kill him, "Are you crazy? MS patients don't run marathons, I'm a mess."
Dr. Saray Stancic:
I was angry at him for even suggesting it, and that was another one of those moments like, "I have to drop that label." I was living my life as this woman with MS first and foremost.
Rip Esselstyn:
Yeah.
Dr. Saray Stancic:
I wasn't Saray, I wasn't Dr. Stancic. I wasn't Ralph's wife or Nick's mom, I was, "An MS patient," first.
Rip Esselstyn:
And did you let people know that?
Dr. Saray Stancic:
No, I was always very careful to share it, I didn't want people to... And one of the things that really bothered me when I was... That was very difficult for me, was being a physician with a cane, a young woman with a cane. The first thing they ask is like, "Why are you walking with a cane?"
Rip Esselstyn:
Yeah.
Dr. Saray Stancic:
And then you don't want... I'm there to serve that patient.
Dr. Saray Stancic:
I'm here to talk about you, not about me, but it was always this, so like, "What do you do?" And then if you tell them then like, "Oh, so sorry." Then you get that, I didn't like that at all.
Rip Esselstyn:
Yeah.
Dr. Saray Stancic:
It's brutal. And I have to say this, I'm not cured. I mean, I live with multiple sclerosis, I have a lot of respect for this disease. Today I feel great, I don't know what tomorrow will be, but I live in the moment and I'm joyful and grateful for today and to be here with you. But I do all I can each and every day to keep myself healthy and to care for myself. But I have a lot of respect for the disease and I don't know what tomorrow will bring. I'm certainly doing my best each day to keep it at bay.
Rip Esselstyn:
Yeah. And there are a whole host of autoimmune diseases that are out there, it feels like when I was growing up, I had never heard of lupus, I had never heard of, I mean-
Dr. Saray Stancic:
They're growing exponentially.
Rip Esselstyn:
... rheumatoid arthritis, although MS, there's a handful of them. Yeah, growing exponentially. Do you think that you think it's related? What do you think is the cause of that?
Dr. Saray Stancic:
Because there are some theories as to what that is, and I think I read about it in the book, but some of the leading theories are the hygiene theory is one of them. Do you know what the hygiene theory is?
Rip Esselstyn:
I know.
Dr. Saray Stancic:
When we were kids, we would play in the dirt and we were exposed to any more bugs. And so you're building your immune system, you're fortifying your immune system. So nowadays it's very different what we're in the midst of, we can talk about COVID. Nowadays we're readily, we have antibiotics and vaccines and we Purell our kids. It's not the same, we don't grow up the same way, kids don't grow up the same way as we did. So that's one of the theories, another theory is-
Rip Esselstyn:
Do you know who Robin Shaken is?
Dr. Saray Stancic:
No.
Rip Esselstyn:
Dr. Robinson, she's a gastroenterologist.
Dr. Saray Stancic:
Okay.
Rip Esselstyn:
And her whole motto is, "Eat clean, live dirty."
Dr. Saray Stancic:
Yes.
Rip Esselstyn:
Right. So that's the hygiene right there.
Dr. Saray Stancic:
Yeah, hygiene. Obesity is another theory, and then social like stress and alcohol and so those are all... I think it's the environment, the world that we live in today is likely contributing. But we've seen this over the past three or four decades, near exponential growth in these autoimmune diseases.
Rip Esselstyn:
Yeah. We'll get right back to Dr. Saray Stancic. But first, when we announced the return of our in-person retreat this year, we were bowled over by the response that we got from all of you. Suffice it to say that our team is more than ready to get back together, but we weren't sure if you guys were ready. Well, you absolutely were so much so that we filled up our Sedona experience super quickly. And we have a long wait list of folks that are interested in attending another Plant Strong retreat. So we called our friends in Black Mountain, North Carolina, just outside Asheville. And we found a week in late September from the 25th to the 30th to be precise. When we could bring the band back together and invite more people from around the globe to come together for an incredible week of learning, fellowship, And a whole lot of laughs.
Rip Esselstyn:
Our schedule as you can imagine, is jam packed with daily workouts, cooking demos, small group discussions talks by my father, Dr. Caldwell B Esselstyn Jr. My mother Ann Crile Esselstyn, the one only Dr. Michael Klaper, my sister Jane Esselstyn. Cardiologist and lifestyle medicine physician, Dr. Brian Asbill, and many more. So for all the details, click on the link in the show notes or visit plantstrong.com and then select the Black Mountain retreat. I really hope to see on the mountain side. Second, our first of the new Plant Strong products are on our truck heading to our fulfillment center in Plano, Texas, right this second. I cannot wait to unveil this first phase of delicious new foods for you guys. If you'd like to have early access, visit plantstrongfoods.com and enter your email to be on the list.
Rip Esselstyn:
Finally, I know that food is front and center for most of my listeners, it is for me as well. And whether I'm dishing on the latest food trends that show how the tides are turning or how we're discovering new products that are packed with nutritional integrity, we all love and connect over food. To that end, we are launching a new mini podcast called Plan Strong Snackables. It will run twice a month and we'll give you bite size nuggets, tasty meal ideas, and foods to get super jazzed over. Watch your inbox, I'll let you know when it's ready. Okay. Let's get back to Dr. Saray Stancic. When did you first open the Stancic Lifestyle Medical Clinic?
Dr. Saray Stancic:
It was, I think late 2012.
Rip Esselstyn:
And you did that because you were just so convinced that Lifestyle Medicine was where it was at, huh?
Dr. Saray Stancic:
Yeah, so I was in infectious diseases for nearly 20 years, I guess and it was good work, I'm proud of that work. I mean, I cared for patients with HIV and hepatitis and worked in research and developing better treatments. Very special career, but what always kept coming back to me was this Lifestyle Medicine plant-based nutrition piece. I mean, I was managing my patients and talking to them. Back in 2005, the VA started a program called the move program, which was sort of like Lifestyle Medicine light that they wanted to bring attention to lifestyle behaviors in veterans. Because like everyone else, veterans are also suffering from the chronic disease epidemic, very high rates of mental health issues. And so they introduced this idea, we're going to pay attention to diet, and exercise, and stress.
Dr. Saray Stancic:
And I'm the chief of infectious diseases and when this program comes to RVA, I volunteer to be the director like, "I want to do that." So I started walking with vets at lunchtime and we started to teach them how to eat a healthy diet. And I started to see these vets shedding pounds, shedding prescriptions, looking happier. And we had a multidisciplinary team, we had a physical therapist, we had a clinical psychologist, we had an RD, and we worked together to support these patients. And I saw that early, "Wow! This is powerful." And then I went on... I'm the infectious disease doc and I ended up moving into the research realm, and I worked in that capacity for a while. But even when I was working in research, I would give nutrition classes at lunchtime, volunteer and people would show up. And I saw that it was making a difference in my peers and then at some point I said to Ralph, "This is going to sound crazy to you, but I think I'm going to give this up and I'm going to start this practice.
Rip Esselstyn:
And when did you first have that idea?
Dr. Saray Stancic:
Probably early in 2009, but our everyone kept talking me out of it.
Rip Esselstyn:
Right, so it took almost three years for you to actually act upon it and make it happen.
Dr. Saray Stancic:
Yes. Because I was continuing to do the work that I was doing and I was doing it well, but I was sad. I knew there was something that I needed to put out into the world.
Rip Esselstyn:
Yeah.
Dr. Saray Stancic:
And it very likely was going to fail, and maybe it wouldn't make a difference, but I had to do I. So I told Ralph one day, because I would tell a friend, a colleague, "What do you think? I think I want to do this." And then they went, "Crazy, you're an infectious disease specialist, you're well known in that field. You're really good at it, look what you've accomplished. You're just going to give that up and start something called Lifestyle Medicine, what is that? You're a doctor." Yes. "You're crazy, you've lost your mind." So they would talk me out of it. And then one day I sat down with Ralph, I remember saying, "Honey, I have to do this." And it was a sacrifice, I knew I was giving up my salary, my benefits, everything. And we have two kids and he said to me, "I believe in you, if this is something you feel... You've been talking about this way too long, you have to do it."
Rip Esselstyn:
You did it.
Dr. Saray Stancic:
So I did it and I had zero patients when I opened the door, crickets. And how do you bring people in? Nobody knows what Lifestyle Medicine is, few people do. My peers know me as an infectious disease physician, so typically your peers are your stream of referral, but they don't know this thing called Lifestyle Medicine. They think Stancic lost her mind, she's crazy. So I just went out and I started to give lectures at the local free public library. That kind of thing, or go to a church and talk about plant-based nutrition, talk about Lifestyle Medicine, share my story. And people started to call and come in.
Rip Esselstyn:
And last year you had how many patients?
Dr. Saray Stancic:
I think more than a thousand.
Rip Esselstyn:
Wow!
Dr. Saray Stancic:
Yeah. And one of the really cool things about the practice that I could have never predicted is that I had several patients in my practice, at some point I just lost count, that were doctors. And that came to be, because at some point we had a patient in common, I had an endocrinologist. Who one of their patients had come to see me, a poorly controlled diabetic, 15 years of poorly controlled diabetes came in. We worked on their lifestyle, their diet, was able to come off of every one of those medications, hemoglobin A1C, went from 12 to 5.2.
Rip Esselstyn:
Wow!
Dr. Saray Stancic:
Loses all this weight, goes back to see the endocrinologist for their six month followup or whatever. And like, "What did you do?" And then the endocrinologist calls me, and what are you doing?
Dr. Saray Stancic:
And we have a conversation and I shared the literature. And then they say, "You know what? I'm really curious, I want to come see you." And I always think it's like a, "Let's sit down, we'll have a cup of tea." But no, "I want to come see you as a patient because I, the endocrinologist, I'm pre-diabetic, I'm hypertensive, I'm depressed." So then every patient is a privilege to care for. But when I have a patient, who's also a doctor, I know in supporting that individual to optimize their lifestyle, that's going to pay it forward in great fashion. Because now all of a sudden, the way that they practice medicine moving forward has changed.
Rip Esselstyn:
Yeah.
Dr. Saray Stancic:
It's been modified and that's going to affect each and every one of their patients, and each and every one of their experiences with other peers. I think we have a responsibility to educate and act as mentors for insurance, and residents, and medical students. And so it's this beautiful, all of a sudden it flowers. And we can by changing one life or by introducing these powerful aspects of lifestyle, it's infectious in a beautiful way.
Rip Esselstyn:
Listen, I have seen it firsthand for close to 35 years with my father's work. And what he's done with the heart patients and then cardiologists that have been so impressed with the results. And now they're coming and they're trying to learn the technique and follow up themselves.
Dr. Saray Stancic:
There's definitely a movement in the field of medicine that we need, this is information that needs to be integrated into the curricula of every medical school. And that we're recognizing that it is an important therapeutic intervention that needs to be added. And I think if we do that, it's going to be quite wonderful, period.
Rip Esselstyn:
Well, it absolutely a 100% needs to be added, it's like the foundation of everything.
Dr. Saray Stancic:
It is. Exactly.
Rip Esselstyn:
And as we were talking before this or maybe during, but 90% of these chronic Western diseases could basically evaporate, overnight practically if we could just get everybody to adopt this. So in your book, you have a... And I want to talk about the book. But in the book, you start out by saying how the Hippocratic Oath is 341 words.
Dr. Saray Stancic:
Yes.
Rip Esselstyn:
And you've kind of broken that up and you've taken what you think is the most important part of that Hippocratic Oath. Can you say it and if not? If you can, great, and if not, I can tell you what it is.
Dr. Saray Stancic:
Well, I always say to my medical students, it's 341 words, but the 13 that are most important to me is, "I will prevent disease because prevention is preferable over cure."
Rip Esselstyn:
That's exactly right.
Dr. Saray Stancic:
Yeah.
Rip Esselstyn:
I mean to me, and I want to repeat that again because I think it's so powerful. "I will prevent disease whenever I can for prevention is preferred to cure." And how many physicians are actually looking for the cure and they're not even looking at prevention? It seems to me the vast majority.
Dr. Saray Stancic:
Yeah. By no fault of their own, because that's the way they're trained. We're trained on, the foundation of medical school is pathogenesis. We learn the disease state, we become experts at recognizing pathology. So we collect data pieces, we take a thorough history and physical exam. And we do labs and imaging studies all in an effort to ultimately make a diagnosis. And once we have that diagnosis, what we're taught is the intervention is a pharmaceutical agent, a procedure or a surgical intervention. That's what we're taught, that's the world that we live in. What we don't learn in medical school is the mirror image of salutogenesis and that's...
Rip Esselstyn:
What was that word? Say it again.
Dr. Saray Stancic:
The mirror image of pathogenesis is salutogenesis.
Rip Esselstyn:
Salutogenesis?
Dr. Saray Stancic:
Salutogenesis.
Rip Esselstyn:
Oh!
Dr. Saray Stancic:
Salutogenesis is the study of health and wellbeing. So when you're in medical school, you only get half the story of the human health continuum. You learn the disease state, but you don't learn the health state.
Rip Esselstyn:
Why do you think that the most important half, this salutogenesis approach, has been missing from medicine?
Dr. Saray Stancic:
I don't know, Rip. I think that's the million dollar question. Why has that been missed? Why is there no emphasis placed on it? And I think that maybe early on the physician's role was really to treat the disease. I don't know, but I think that the chronic disease epidemic that we have today, and what we've learned through much literature, is that it is this manmade epidemic. So much of what we're dealing with today in clinical medicine is largely a result of the behaviors that we've adopted over the past several decades. And the solution to the problem is this idea of salutogenesis. And I think that it's catching on, I think that physicians are beginning to acknowledge that the solution to the diabetes epidemic is not to develop yet another drug to treat diabetes because we did keep developing them, and the diabetes epidemic continues to grow. I mean, 2% when I was a medical student, 10% diabetes rates today, and the CDC predicts by 2050 it'll be 30%. By the time my son is my age, think about that.
Rip Esselstyn:
This is 30%, this is not pre-diabetes.
Dr. Saray Stancic:
No.
Rip Esselstyn:
This is just that have diabetes.
Dr. Saray Stancic:
Diabetes, which is-
Rip Esselstyn:
Type 1 and type 2?
Dr. Saray Stancic:
Right, primarily-
Rip Esselstyn:
Primarily 2.
Dr. Saray Stancic:
2?
Rip Esselstyn:
Yeah.
Dr. Saray Stancic:
But this is a disease that we could prevent and it's ever growing. And currently what we're doing primarily is to address this diabetic population. We're continuously developing new drugs, new targets to treat the disease. Yet every endocrinologist who's a diabetologist or internist who... This should be the primary message that.
PART 2 OF 4 ENDS [00:46:04]
Dr. Saray Stancic:
This should be the primary message...
Rip Esselstyn:
I'm actually surprised that it's that low, that it's 30% by 2050 because you just talked about the obesity rates.
Dr. Saray Stancic:
Yeah.
Rip Esselstyn:
When you wrote the book it went from 39 to 41, I think it was?
Dr. Saray Stancic:
42.
Rip Esselstyn:
42 in just year, and I would imagine that the diabetes rates totally-
Dr. Saray Stancic:
Well, the CDC-
Rip Esselstyn:
Are right in line with that.
Dr. Saray Stancic:
Yeah, the CDC made those predictions a few years ago. They may have to recalculate. We can't continue on this path. The healthcare system will collapse.
Rip Esselstyn:
Yep. You started the Stancic medical practice in 2012. You've done a documentary "Code Blue." You wrote "What's Missing From Medicine?" You're going after it. You're trying to get this message out in a big wonderful, powerful way.
Dr. Saray Stancic:
Yeah, it's so important to me. This drives me. This gets me up in the morning because this problem is solvable.
Rip Esselstyn:
Yeah. Yeah, yeah, yeah.
Dr. Saray Stancic:
We just have to coalesce our voices and we just have to empower individuals. I think, and this is what I try to cover in the book and in the film. In the film, for me, it was about shedding light on this lapse in medical education because in order for us to do this, we need to change the way doctors think. We need to change the way that they're trained so that they ... because there's the thing. If I spend two hours with a patient talking to them about their diet and their lifestyle and then they go see their cardiologist next week and says, "Stancic's crazy. Ignore everything she just said." Then it doesn't work. We all need to speak to this unanimously and ubiquitously. Otherwise it falls through the cracks.
Dr. Saray Stancic:
Behavior modification is really hard, so all these touch points from different physicians and different healthcare professionals are necessary in order to get people over these difficult ... it's not easy to change your habits after you've been living a certain way for the first five decades of your life.
Rip Esselstyn:
Yeah. Yeah, need a united front.
Dr. Saray Stancic:
You need a united front. The wonderful news is that I see it. I see this movement washing over the country. I see it especially in medical students and in residents who get it. My peers are a little bit slower to warmup to it. They see something, but they're not quite there, but these young kids, they get it and they're excited. They want to make a difference.
Dr. Saray Stancic:
So when I see some of my medical students that are now residents and they're now educating medical students, you can see that ultimately these kids are going to be the Chair of Medicine. They're going to be the CMOs at different hospital and healthcare settings. They will demand these changes. That's exciting.
Rip Esselstyn:
I want to dive into the book.
Dr. Saray Stancic:
Okay.
Rip Esselstyn:
Okay? Because you have the lifestyle of medicine wheel and you have the six spokes of the wheel.
Dr. Saray Stancic:
Yeah.
Rip Esselstyn:
One of the things I love about the way you are, the way you speak, the way you write, is you're just a straight shooter.
Dr. Saray Stancic:
Yes.
Rip Esselstyn:
You keep it nice and simple, straight shooter, and you know exactly where you stand on things.
Dr. Saray Stancic:
Right.
Rip Esselstyn:
And I think it's served you really, really well. Before I ask you about the book, where do you think you got your spirit from, your ways? Is it from your mother, your father, somebody you grew up with, just the way you were born?
Dr. Saray Stancic:
Yeah, I think my parents. I'm an immigrant to this country. I was born in Cuba. My parents gave everything up to leave their country to bring us here to give us ... It was communism and they lost everything and they came here in the late 1960s and worked really hard, had to work in factories and didn't know the language. It urged hard work, ethics, your word meant everything. I just came from really strong family and lots of love in my family. This belief that you can do anything you want to do regardless. I grew up my early life in Oregon. We didn't have much, but we had a lot of love and we had ... My mother would set in me, "You can do anything you want to do. Don't let anyone ever tell you that you're not capable of achieving anything."
Rip Esselstyn:
For three years, and you let that neurologist tell, "Ah," but you stuck to your guns.
Dr. Saray Stancic:
I did.
Rip Esselstyn:
You did.
Dr. Saray Stancic:
Yeah, and at times it wasn't easy. I have to say this. It wasn't always perfect. There were setbacks. Of course, the minute something goes wrong everyone crowds around you and says, "See? We told you."
Rip Esselstyn:
Sure.
Dr. Saray Stancic:
And so, but I knew in my heart in my gut, that I was going in the right direction and I just needed to stay on the path and not get distracted.
Rip Esselstyn:
Yeah.
Dr. Saray Stancic:
And it ultimately, it bore fruit for me. I crossed that finish line in 2010. That was seven years after I started. Again, it was never a dream of mine to run a marathon, but that was symbolic, crossing that finish line. I did something that I didn't think was ever ... that I would ever be capable of doing and I was so proud of myself in that moment because every sacrifice I had made, every risk I had taken had paid off. Now I felt like I have to share this message with as many people as there are willing to hear it. This year, October 11th, 2020, was the 25th anniversary of my hospitalization, my diagnosis. That night when I woke up, age 28, numb legs, MS, wheelchair 10 years. That was 25 years. I walked 25 miles on that day.
Rip Esselstyn:
Let's dive into some of these spokes.
Dr. Saray Stancic:
The spokes, yeah.
Rip Esselstyn:
Go ahead.
Dr. Saray Stancic:
The wheel, I use that analogy because the spokes, they're interconnected, and so the point that I'm trying to make there is that every aspect of lifestyle is important. Some of us are really good at food, where some of us are really good at exercise and then we drink too much and we're super stressed. I think it's important that in order for us to achieve our best self and reduce our risk of developing chronic disease and live our optimal existence, we want to pay attention to all six spokes.
Dr. Saray Stancic:
The six spokes are nutrition, exercise, stress, sleep, addressing substance abuse issues, and then social interconnectedness. We know those of us who will have love and support in our lives are less likely to develop depression, anxiety, live longer. Social interconnections are also very, very important. Paying attention, the book gives a chapter to each one of these spokes, but I think it's so important that we understand that they sort of, in large part, are interconnected and rely on one another.
Dr. Saray Stancic:
We know, for example, if we exercise we're going to sleep better. When we do that, we live, I think, our optimal existence and that's really my hope for everyone of us. Imagine if every one of us lived to our greatest potential.
Rip Esselstyn:
Yeah.
Dr. Saray Stancic:
And accomplished our greatest potential. I say this all the time, but I'll say it one more time. My hope is that not only do we live to our optimal potential, but on that last day, be 92 or 102.
Rip Esselstyn:
Yeah.
Dr. Saray Stancic:
On that last day that we experience a beautiful, a happy, joyful day surrounded by our loved ones, and then at the end of that day we go to bed and we pass away peacefully. Right?
Rip Esselstyn:
Right.
Dr. Saray Stancic:
Isn't that the beautiful ending to a well lived life? Regrettably, as a physician, I have witnessed that pain and suffering that so many of us end our lives with, in the nursing home, demented, wearing a diaper, pressure ulcers, suffering. It's difficult to witness that for that individual patient, but also for the family who has to also see their loved one suffering. It shouldn't be that way. Again, that's another ... in our society, that's been normalized that that's the way life ends, that you must be in a nursing home and that's just part of it. That's part of the deal and it doesn't have to be that way.
Rip Esselstyn:
Yeah. I want to go through these one by one.
Dr. Saray Stancic:
Yeah.
Rip Esselstyn:
Whatever makes sense as far as how much you want to talk about it, but I'm going to kind of feed you.
Dr. Saray Stancic:
Okay.
Rip Esselstyn:
Some information.
Dr. Saray Stancic:
Okay.
Rip Esselstyn:
Then I want you to do with it what you want.
Dr. Saray Stancic:
Okay.
Rip Esselstyn:
But the first one really, it's the food. It's the food and you just say, "Eat more plants," right? What do you eat in a typical day?
Dr. Saray Stancic:
I only eat ... I don't eat any animal sources in my diet. Do you want me to give you a menu of what-
Rip Esselstyn:
I'd love to know what you typically eat for ... What's a typical breakfast, typical lunch, and typical dinner?
Dr. Saray Stancic:
Yeah, typical breakfast for me, right now I'm traveling so it's a little bit challenging, but it's typically oatmeal with blueberries or raspberries, or berries, lots of berries.
Rip Esselstyn:
Frozen or fresh? Does it not matter? What do you like?
Dr. Saray Stancic:
In May and June when berries are in peak season and they're readily accessible in New Jersey, I buy them fresh, but I always have frozen in my freezer to throw in, but there's always berries included in my oatmeal in the morning. I throw in some flax seed, little bit of cinnamon, and I'm happy with a cup of coffee. That's typically ... and often, maybe, I'll have another piece of fruit like an apple. I eat a lot of fruit.
Dr. Saray Stancic:
Lunchtime I will typically have a big salad, something like that, lots of color. I am a big chickpeas, beans. Black beans are my favorite. I'm Cuban, so black beans are one of my favorite, but I eat a lot of legumes. I eat probably a piece of fruit midmoring, midafternoon, just as fuel if I need it.
Rip Esselstyn:
Yeah.
Dr. Saray Stancic:
Then dinner, it varies.
Rip Esselstyn:
Do you usually have a dressing on that salad?
Dr. Saray Stancic:
I just add a little bit of balsamic vinegar. That's it.
Rip Esselstyn:
Okay.
Dr. Saray Stancic:
I keep it really simple or I might add some lime or even some orange, like I'll squeeze an orange over something. Because I'm Cuban, lime is big for me, a little lime and cilantro on a salad for me is awesome. I like to taste food. I don't add a lot to stuff. Very simple, very simple. I'm happy with some brown rice, some black beans, and some cucumbers, avocados.
Rip Esselstyn:
Yeah, well I'm glad you said that because I find that so many people, they smother their food with dressings and just things that prevent you from really tasting the real beautiful sublimeness that's in the red bell pepper or the mandarin orange or the chickpeas or whatever.
Dr. Saray Stancic:
Yeah, absolutely. I add a lot of herbs to things. I have one of those in my kitchen, it's growing basil and cilantro and parsley, so I'll throw something like that onto a dish and just opens it up. I just love it.
Rip Esselstyn:
How about dinner?
Dr. Saray Stancic:
I tend to be, again, my Cubanness, I'm a big rice and bean ... That's one of my favorite dishes, so any type of rice and bean dish is very popular. My husband's Italian American so we do a lot of pasta with zucchini, broccoli rub, dishes like that, a lot of veggie dishes and pasta.
Rip Esselstyn:
How about, do you have a dessert ever or is it just fruit?
Dr. Saray Stancic:
It's fruit for me. Yeah, on occasion I do like chocolate. I'll have it.
Rip Esselstyn:
Is Ralph also plant based?
Dr. Saray Stancic:
He's plant based, yeah, and he's a six time iron man.
Rip Esselstyn:
Oh.
Dr. Saray Stancic:
Yeah.
Rip Esselstyn:
Good, he's fit. How about your two children?
Dr. Saray Stancic:
My kids are also plant based. I'm not one of these moms that makes three different types of meals for everybody. You eat what I've prepared and if you don't eat that then you're not eating. We're very ... Yeah no, they're plant based. My daughter sometimes can be a little bit challenging, but she's 17. In our house we make what we make and they'll eat what I prepare. Now, I can't control what she does when she's in school, but yeah.
Rip Esselstyn:
Okay so, eat more plants, exercise. You say, "Play more." I love the fact that you're saying, "Let's try and figure out how this Californian be playful."
Dr. Saray Stancic:
Yeah.
Rip Esselstyn:
To make it fun.
Dr. Saray Stancic:
Because I think so many of us think that when you start an exercise regimen that it has to be all or none. Some of us who maybe have been sedentary for a long time and just feel like, "I'm scared to go to the gym. I don't feel right." Find something that you enjoy doing. Just start with a walk. The physical activity guidelines say that we should include at least 150 minutes of moderate physical activity per week and two sessions of resistance training. Yeah, absolutely, and we want to build to that, but the average patient that I see in the clinic setting is doing nothing. You can't throw that at them day one like, "Do this." We have to build. That's an important point that I want to raise is, in our country we want the quick fix, like the pill that's going to fix the problem.
Dr. Saray Stancic:
Lifestyle medicine and behavior modification is about investing and taking small steps in the right direction and not feeling like if you don't do everything in a week or in a month, then you're a failure. We're so hard on ourselves, Rip, that if we don't accomplish that thing, we don't lose those 10 pounds in the first month, oh well then I'm just going back to my old ways. I wish we would walk away from those because I think that sets us up for failure and it sets us up to sort of replay this. You know the whole scenario, "I'll start Monday, my diet." This whole idea of dieting and calorie counting and weighing food. I grew up in that generation. I call it the Oprah Winfrey generation where we were all fixated on losing weight and how did we do it? We drank Diet Coke and Tab and we ate 100 calorie bars that were just processed garbage just to keep the calorie count down.
Dr. Saray Stancic:
The wonderful thing about plant based nutrition is that you can eat ample food because you're eating these plates that are nutrient dense, but calorically deficient, and so we can eat so profoundly. Finally, I just want to tell every woman in America, eat. Fill your plate because you're not going to gain weight. Think about it, how much broccoli do you have to eat ... 100 calories of broccoli, what would that? That's-
Rip Esselstyn:
That would be about 40 pounds.
Dr. Saray Stancic:
Right. It's about our relationship with food, particularly women, we have this terrible relationship with food. We see it as this villain and when we eat it we feel guilty because then we're going to gain weight and we're not going to fit into that. I want to change that perspective. I want people to find the joy of the flavors of food and that you can eat and feel satiated both physically and emotionally and maintain a healthy weight. The weight is not the main outcome that we need to measure. It's about our health.
Rip Esselstyn:
Yeah. Yeah.
Dr. Saray Stancic:
It's our ability to live a disease free. It's about our quality of life, our ability to experience joy.
Rip Esselstyn:
Yeah, if you can past the superficiality of just trying to lose weight.
Dr. Saray Stancic:
Yes.
Rip Esselstyn:
And then make the end goal be just to get supremely healthy, the weight always takes care of itself.
Dr. Saray Stancic:
Exactly.
Rip Esselstyn:
It's just a byproduct of getting healthy. It's a beautiful thing. So number three is stress, and you say, "Stay present."
Dr. Saray Stancic:
Yeah.
Rip Esselstyn:
Which I think is perfect, especially with everything that we got going on right now. It seems like so many people are maxed out, they are stressed.
Dr. Saray Stancic:
For me, learning that practice of mindfulness and seeing the world differently, like sort of stepping out of myself and looking at the world with a new set of eyes, a new perspective. The day I was diagnosed, if we would have had an interview on that day I would have said to you, "This is the worst day of my life. My life is over." When I look back in retrospect, I can say it was probably one of the best days of my life because it put me on this path. That moment of suffering and that pain that I experienced subsequently, I needed to have that in order to evolved to who I am today. I think so many of us, whenever something doesn't work out in our favor or there's an obstacle that presents itself, we lose a job or we lose an opportunity or a friend, we needed to have that experience in order to get us to the next stage.
Dr. Saray Stancic:
When you have that perspective, then there's this release. Like anyone, like everyone else, I have to deal with challenges and at points sadness in my life, and things that seem unfair, but at the end of the day ... What was it when we were talking before, what you said about Anthony Hopkins?
Rip Esselstyn:
Oh yeah, basically how everything is important, but really in the reality, nothing is important.
Dr. Saray Stancic:
Exactly, and that's where I am. I see that. I believe that everything that presents itself to me was a necessary experience for me and so I accept it. Eckhart Tolle, I love his books. There's a particular book called A New Earth that has just been very important in my life. I think I've probably read this book more than a dozen times. Whenever I have a difficult moment in my life, I turn to it and his words just really bring me so much peace.
Rip Esselstyn:
What's the book?
Dr. Saray Stancic:
A New Earth by Eckhart Tolle. He's a mindfulness.
Rip Esselstyn:
Yeah, I've heard of him.
Dr. Saray Stancic:
He's written another book, Power of Now, you might know that one.
Rip Esselstyn:
Yeah.
Dr. Saray Stancic:
But New Earth is my favorite. He talks about suffering and he says we suffer when we resist what is. When you accept, and it's so true, when you accept whatever condition is presented before you, the suffering ends. The suffering is when you push against it, when you won't accept it. That was one of those moments like, "Wow. That's really profound. That really makes a lot of ..." and all of a sudden I started to apply this principle in my life and I found that there was a lot of peace that came from that.
Rip Esselstyn:
Well, I find that staying present and being in the moment.
Dr. Saray Stancic:
Yes.
Rip Esselstyn:
Is one of the hardest things to do, but if you can do it, it's one of the most beautiful things. Like with my kids, just being able to turn everything else off, get my mind focused, and just be in the moment with them whether it's playing corn hole or looking at something that they drew or playing a game around the dinner table, or whatever it is, but you just got to jump in both feet.
Rip Esselstyn:
Next thing, sleepy hygiene. You say, "Sleep, rest well." Obviously you had your own issues with the ambient and it seems like a lot of people with screen time and everything else are not sleeping well these days.
Dr. Saray Stancic:
No, it's a big problem. For me, personally, I think of all the spokes obviously were incredibly powerful for me, but sleep is one that I am most proud of because it was so difficult to overcome. It really was. Coming off of ambien and other sleep agents and anxiolytics like benzos that I was given, to come off of those medications and really learn sleep physiology and understand it, was so incredibly important for me, understanding the importance of the environment. The room should be cool, dark, and quiet. Again, these are not things that I learned in medical school. This is just going back and really understanding that what our-
PART 3 OF 4 ENDS [01:09:04]
Dr. Saray Stancic:
Well, this is just going back and really understanding that what are my pre-sleep rituals? What was I doing throughout the course of the day that could affect my sleep? Was that glass of wine or two glasses of wine affecting my sleep? Looking, particularly to nowadays-
Rip Esselstyn:
I've had more friends of mine tell me that if they have a glass of red wine, their sleep is short.
Dr. Saray Stancic:
Yes, it's short. You're not getting into those stages of sleep.
Rip Esselstyn:
Yeah.
Dr. Saray Stancic:
We need to get into those deep stages of sleep because that's where we recuperate and we regenerate. So really understanding that whole process and creating structure. One of the most important things is that we need to... In order to be a really good sleeper, you have to have structure. You really have to... People don't like to hear this. But, you really should set a bedtime and a wake up time, and in between those two, eight hours. Right? And be fixed. I go to bed... People laugh, this works for me. I go to bed at nine o'clock and I wake up at 5:00.
Rip Esselstyn:
Wow.
Dr. Saray Stancic:
And Rip, I call myself a professional sleeper. I'm so good at it. And I sleep so beautifully. I go to bed, I fall asleep within 10 minutes, and then I wake up. I don't have an alarm clock, like today I woke up five o'clock.
Rip Esselstyn:
Do you ever wake up in the middle of the night to like roll over or pee or anything like that?
Dr. Saray Stancic:
Yes. So, having lived with MS. MS does a lot of damage to the bladder. So yes, I probably have to get up two or three times at night to go to the bathroom. But, it's almost like I'm doing it sleepwalking. I can do it and go right back to bed. It doesn't really interfere or interrupt my sleep because I go right back. When I wake up in the morning, I feel so energized. I typically go for a run or a long walk or a hike, and I feel creative. So, five o'clock in the morning for me is like, "Wow, there's a lot of good stuff going on up here." I just feel my best.
Rip Esselstyn:
Do you wear a mask?
Dr. Saray Stancic:
I don't wear a mask.
Rip Esselstyn:
Ear plugs?
Dr. Saray Stancic:
No, I have blackout shades. There's no television in my room.
Rip Esselstyn:
Do you have white noise?
Dr. Saray Stancic:
No, I live in a really quiet environment. I'm not in the city or anything like that, but-
Rip Esselstyn:
Do you have a down pillow? What kind of pillow do you have?
Dr. Saray Stancic:
I have a down pillow, yeah. I mean, so the bedding is great. It used to be at one point that sleep was torture for me, because I would get into bed and I would worry about things. That's another part of the stress. I was the worst, as a young woman, medical student resident worrying about my boards and was I going to get into this fellowship or this residency? It was just constant... Am I going to pass that exam? It was always a lot of stress around sleep time. Sleep has just been for me... And before I go to bed, there's always a period of about five to 10 minutes of meditation or gratitude or prayer, whatever you want to call it. I think it's important. And I do this also in the morning. Offer my gratitude. Every morning I wake up and I feel everything and I'm in one piece, is joy.
Rip Esselstyn:
Yeah.
Dr. Saray Stancic:
Yeah.
Rip Esselstyn:
Good. So sleep, rest well, substance intake, it seems like a lot of Americans, whether it's drugs, whether it's nicotine, cigarettes, whether it's alcohol.
Dr. Saray Stancic:
It's a problem.
Rip Esselstyn:
Yeah. I love what you say. You say basically thrive without.
Dr. Saray Stancic:
Thrive, without, yeah.
Rip Esselstyn:
Thrive without.
Dr. Saray Stancic:
Thrive without. Yeah. Here's the thing. There's no safe amount of alcohol. There really isn't. I mean, even one glass of wine can-
Rip Esselstyn:
The safest amount is the least amount.
Dr. Saray Stancic:
Yeah. So with that said, I know that, I mean, I enjoy a glass of wine on occasion. It's not something I do every day. But, I think it's important that that's voiced. Because in our country, alcohol is again, very much normalized. It's part of everything we do. We go to a game, we have a drink, we go out to dinner, we have a couple of drinks, every gathering. So it's very much normalized. And I think that we need to understand that there is some risk there and that we need to become mindful about how much we're consuming.
Dr. Saray Stancic:
So if you go out to dinner, stop at that one glass, you don't have to have the second one. Because when you lose that attention or that mindfulness, then you're going to... Okay. I'll have another one. And think about it, what you're doing, and how you're using alcohol. Are you using alcohol to take the edge off? Are you using alcohol to deal with your stress from your job or are using alcohol because I went out with Rip, we had a beautiful dinner and we had a wonderful glass of wine, because we were celebrating. That's very different than using it to take the edge off. So those are questions that I want to have with patients, so that they become a bit more thoughtful. Now the substance abuse chapter for me too, was not just talking about all that we just listed, but I also included a little bit on supplements.
Rip Esselstyn:
I saw that. Vitamins and stuff. Interesting. I think it bears some explanation.
Dr. Saray Stancic:
Yeah well, the supplement industry is a multi-billion dollar industry and we turn to it as if, again, it's the magic pill that's going to solve the problem. It's not. And the evidence isn't there that it's really making any difference, and it can potentially do damage. And I don't know if you had a chance to read it, but I shared a personal story there. Back in 2005, when I was feeling really good, I read a book. It was a doctor who talked about supplements and how they were... If you take these supplements, your health is going to improve. So I'm thinking, wow, I feel pretty good right now with this lifestyle thing. If I add the supplements, maybe I'll feel even maybe, I don't know, I can run 10 marathons. So I started taking the supplements that this fine doctor was prescribing in his book. Two, three months into this. I found myself losing weight, developing nausea, and vomiting.
Dr. Saray Stancic:
Ultimately, I ended up in the hospital with something called drug induced liver injury. These supplements, people don't consider them medication. They are. They're metabolized with the liver and they can interact. They're not monitored by the FDA. They don't need to gain approval through the approach that we would for a pharmaceutical agent. So I took these supplements and they nearly killed me. I mean, there's a 10% chance of mortality with drug-induced liver injury. And even liver transplantation, I was in the hospital for two weeks, and it took six months to recover from it.
Rip Esselstyn:
Wow, so were you taking handfuls of supplements when you said that, I mean-
Dr. Saray Stancic:
Yes. I was taking, because this person... And there are many-
Rip Esselstyn:
Who shall remain unnamed. Which is just fine.
Dr. Saray Stancic:
Shall remain unnamed. The books are out there, and they sell the products under their name. And I was taking what the doctors said was necessary. And it was probably, I don't know, 12 pills.
Rip Esselstyn:
Well, I would imagine if somebody like you decided that this was a good idea and worth exploring, there's probably hundreds upon hundreds of people that are doing the same thing, and probably also having similar results. I would imagine that that would be a problem.
Dr. Saray Stancic:
This is not an uncommon phenomenon. Drug-induced liver injury. I actually went on to write a paper on that topic with a group of experts. At that time when I recovered from that, I was working for Roche Genentech as a scientist in developing treatments for hepatitis C. So I worked in this liver disease realm or space, and there was an opportunity to join a group that was looking at drug induced liver injury. And it was quite a learning experience for me to work with experts from across the world. And we wrote a paper on it. It's a real concern, and I think it's important for individuals who are just out there thinking, "I'm going to go to the supplement section of the store. I'm just going to buy all this stuff and think that it's..." I think a lot of people think, "Well, it can only do good. It could only help me."
Rip Esselstyn:
Safety net.
Dr. Saray Stancic:
Yeah, exactly. No. Be aware and be very, very careful. And always, if you're taking any supplement, tell your doctor. Because you'll ask a patient, "Are you taking anything?" And they'll give you the medications, but they ignore the supplements. And sometimes they can interact with medications. So always be fully transparent and share everything that you're taking.
Rip Esselstyn:
So would it be fair to say that outside of maybe B12 that if you're going to consider supplementing with anything else-
Dr. Saray Stancic:
You should have a conversation with your doctor. I mean, many of us-
Rip Esselstyn:
Make sure there's no deficiency?
Dr. Saray Stancic:
Yeah. I mean like vitamin D is something that might be something that you need to supplement. There was a paper just yesterday that actually Dean Ornish forwarded to me. And this has been recognized for-
Rip Esselstyn:
Who wrote the forward for your book.
Dr. Saray Stancic:
Yes. Yes. And this has been recognized for some time, that low vitamin D levels maybe playing a role in MS. So certainly vitamin D is something that I'm monitoring myself.
Rip Esselstyn:
It seems to me like the jury's still out on vitamin D.
Dr. Saray Stancic:
It is.
Rip Esselstyn:
And what are low levels and what are appropriate levels? Do you have an opinion on that?
Dr. Saray Stancic:
Yeah. I do have an opinion on that. I didn't speak to it directly in the book because it's a field that's always changing. And I think that the recommendation may vary for the individual. So I don't like to give recommendations. I think it's something that should be looked at. But you're right. The jury is out. I think at one point, and this happens every decade in the field of medicine, we get enthralled with some vitamin.
Rip Esselstyn:
Yeah.
Dr. Saray Stancic:
And then we over prescribe it, and then at the end of the day it does nothing, right? This happened with beta carotene. This happened with vitamin E. And so we end up writing these mega doses, and what you need to do is get those nutrients from food. But then the supplement industry doesn't-
Rip Esselstyn:
Would you say below 10 on your vitamin D is too low?
Dr. Saray Stancic:
Oh no. Definitely, that's deficient, for sure.
Rip Esselstyn:
And at that point, would you recommend supplementation?
Dr. Saray Stancic:
For sure. That person, 10 microgram, you definitely need to be supplemented. But the question is, how much do you need to be supplemented? And how often do you need to be monitored? I mean, vitamin D is a fat-soluble vitamin. You can accumulate too much.
Rip Esselstyn:
Yeah.
Dr. Saray Stancic:
In the field of MS, they ask patients to take very high doses and they want levels of as high as 60. I have some issues with that, because where the evidence is and what value might come of that. But I think it's a field that is ever evolving. I think most physicians would agree that vitamin D has... Many of the studies that we've done, and it's been looked at and heart disease and diabetes and Ms.
Dr. Saray Stancic:
Most of these studies have been null. They really haven't shown that if you supplement, that it makes a difference. But again, I think this is a trend in medicine that we, every decade are enthralled with some new vitamin or nutrient.
Rip Esselstyn:
Yeah. So let's be really careful with that.
Dr. Saray Stancic:
Yeah. To be careful. The most important thing we need to do. And the simplest approach to living that optimal existence is the things that we've just talked about. So simple. What could we do, Mr. Smith? What could we do to include more plants on your plate?
Rip Esselstyn:
So Saray, I'm Mr. Smith, I come to you, I am about 40 pounds overweight. I have a fasting glucose. That's about 120. I have elevated blood pressure and I have high cholesterol. So I'm on some statins for that as well. What would you tell me to do?
Dr. Saray Stancic:
The same thing I would tell Mrs. Wilson, who has M... It's the same prescription. It really is.
Rip Esselstyn:
Tell me what I should do?
Dr. Saray Stancic:
I mean, one of the first things I do when the patient comes in is they have some paperwork that they complete when they come in, right? So, there's going to be a couple of days of their diet, so I know where they are. I have to assess in that time, in that hour that I spend talking to him about who he is, because I take a really thorough history. I really want to understand everything about you. What is your willingness to change? Because we have to be respectful and we have to understand where that person is. What are you willing to do? Why did you come here today?
Rip Esselstyn:
I am willing to do whatever it takes to get me healthy.
Dr. Saray Stancic:
So we're looking at what you're consuming. So for breakfast, you had bacon, eggs, and a biscuit.
Rip Esselstyn:
I have that six mornings a week.
Dr. Saray Stancic:
Well, let me tell you what this is doing to you. And then we're going to talk about how that's promoting your pre... Because, you're pre-diabetic, and you're 40 pounds overweight. And if we do nothing, you're going to become diabetic. And so, we're going to be proactive here, and we're going to prevent that deleterious path. Because, suddenly today, Mr. Smith, you were going in this direction, and now this is a new beginning for you. We're going to introduce this change by modifying your diet. So let's talk about what your breakfast would look like. What do you like? Tell me things that you enjoy for breakfast? Could you see yourself eating a bowl of oatmeal?
Rip Esselstyn:
Love it.
Dr. Saray Stancic:
Could you see yourself... So these are the things that we're going to start to introduce. And we're going to talk about how it's really important to keep that plate colorful. Why is color important? When you walk into that grocer and that produce section, all those beautiful, bright colors that are staring back at you, what do they represent? That excites people, right?
Rip Esselstyn:
Mm-hmm (affirmative).
Dr. Saray Stancic:
So patients will call me, send me pictures. Look how colorful my plate is. They're excited about it. I have patients who have started an Instagram account. It's just me and them. And, I'm the only person who can see it, and they show all of their... So, it's about inspiring them, engaging them, but understanding what are you willing to do today? And it doesn't have to be all or none. Again, the same thing that we talked... The same rule that we apply to exercise. Because, I don't want you to do this for two weeks and then stop. I want this to be something that...
Dr. Saray Stancic:
And there are patients that come in and say, "Doc, I can do it all. I'm ready to do it now. I had that moment. I'll do moment. I'm doing it." Great. But the majority of individuals are not quite just there. And it's largely because I think culture, society, the rest of the healthcare setting is not fully on board. So again, I deal with that, where I have a patient and they're also seeing the cardiologist or the endocrinologist or whatever, the rheumatologist, and they're not on the same page. So there are obstacles that need to... There are hurdles that we constantly need to climb.
Rip Esselstyn:
Yeah. Yeah. So last is social connection. Basically, grow love, which I love.
Dr. Saray Stancic:
Right. So we know from a lot of work done by social scientists, Christakis and Fowler, that the more connections we have, the more favorable to outcomes. And it's also not just the number of connections that we have, but also the types of connections that we have. So, if your best friend is a sedentary alcoholic, that doesn't bode well for you. But if you have Rip Esselstyn as your best friend, what are you likely to do? You're going to go out hiking. We talked about that nice walk outside. So, it's important to surround ourselves with like-minded individuals, right? So, if you're in a community that maybe does plant based potlucks or engages in hiking events, very different than if we engage in a sedentary lifestyle, we're sitting in front of a television, eating and drinking beer and eating chips.
Rip Esselstyn:
So here's the book, What's Missing from Medicine. I just have the... I don't have the hard copy.
Dr. Saray Stancic:
I'm so sending you one tomorrow, I feel terrible that I didn't bring it.
Rip Esselstyn:
But Six Lifestyle Changes to Overcome Chronic Illness. It's a beautiful book. Congratulations on that.
Dr. Saray Stancic:
Thank you.
Rip Esselstyn:
What are you most excited about right now, going forward?
Dr. Saray Stancic:
Well, I think the future is about creating change on a global scale, and I'm, sort of, involved in an opportunity, and I'm not ready to talk about it prime time, but I will soon. Maybe I can come back and talk about it once we're out there.
Rip Esselstyn:
I would love that.
Dr. Saray Stancic:
There's a very exciting opportunity with really good people. And I've had the wonderful privilege of joining this team of Game Changers that really want to, not just create small things, but big things and change the world. And I'm so honored to be part of that team. And, largely that opportunity came to me through you. So you are a blessing to me.
Rip Esselstyn:
Well, it would be phenomenal if you could take what you've done with your clinic in New Jersey and figure out a way to replicate that all over the United States and the world.
Dr. Saray Stancic:
That's the hope.
Rip Esselstyn:
Hooray. Thanks so much for coming here this morning. I know it was super, super early, but I appreciate it. But you wake up at 5:00, so this is no issue for you.
Dr. Saray Stancic:
This is my prime time.
Rip Esselstyn:
Yeah. Yeah. With that, let me say, thank you for being such a trailblazer and everything you're doing to contribute to the health of this country and the world. It's not an easy path per se, but it's a worthwhile path, and you are between code blue, between the clinics, between what's missing in medicine, and your positive can-do attitude. I can't wait to see what the next decade brings for you.
Dr. Saray Stancic:
Thank you so much. Rip.
Rip Esselstyn:
Yeah. Thank you. Reflecting on this interview with Dr. Saray Stancic, so many things stood out. But, what I really loved was when she said that she had to be willing to take the risk, to treat her MS, in what was at the time, a super unpopular and unconventional way. She was willing to go against the grain and the opinions of some of her most trusted mentors to seek some semblance of a quality of life. And it all started with a picture of blueberries on the cover of a medical journal. I hope that this podcast empowers you to take some risks that you otherwise may not take. Don't worry though. We've got your back with tons of support and programs to assist you. Visit plantstrongpodcast.com, or plantstrong.com today for all of our resources. Thanks for listening, and keep it plant strong.
Rip Esselstyn:
Thank you for listening to the Plant Strong Podcast. You can support the show by taking a quick minute to follow us wherever you listen to your favorite podcast. Leaving us a positive review and sharing the show with your network is another great way to help us reach as many people as possible with the exciting news about plants. Thank you in advance for your support. It means everything. Have you had your own Galileo moment that you'd like to share? What happened when you stepped into the arena and shed the beliefs that you thought to be true? I'd love to hear about it. Visit plantstrongpodcast.com to submit your story and to learn more about today's guests and sponsors.
Rip Esselstyn:
The Plant Strong Podcast team includes Carrie Barrett, Laurie Kortowich, Ami Mackey, Patrick Gavin and Wade Clark. This season is dedicated to all of those courageous true 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.
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