Steve Lawenda, MD -

A Doctor’s journey to better health with a Plant-based Diet

Dr. Steven Lawenda is a board-certified Family Medicine physician in Southern California who transformed his own health and influenced the health of countless patients suffering from diabetes, heart disease, and other chronic illnesses. Dr. Lawenda has co-created and leads Lifestyle Medicine programs in his practice. He is a speaker on the benefits of plant-based diets at conferences around the country. In 2018, Dr. Lawenda co-authored a review of Lifestyle Medicine with several esteemed colleagues that was published in The Permanente Journal.

Interview Transcript

Sean Hashmi, MD

We have an awesome person here today. He is a great friend, and I’ve known him for a long time. He’s a pioneer in the field of lifestyle medicine, and his journey is remarkable. I can’t wait to talk to you, Steve, about your own personal journey and what you’re doing these days. So I’m delighted to introduce Dr. Steve Lawenda. Steve, let me start by asking you if you don’t mind just seeing a bit of who you are, what you do, and more importantly, what got you into this concept of eating healthier.

Steve Lawenda, MD

Sure, and I want to, first of all, I want to thank you, Sean. I appreciate so much what you’ve done in the field of lifestyle, medicine, and nutrition. And I just want to say to I may have shared this with you before, but I want to compliment you when you give presentations. When you explain nutrition and explain studies, you do it in such a brilliant way. You make it all sound so simple.

I think so many people appreciate that. Now because, you know, studies can be complex, especially for those medical people who don’t typically read a lot of studies. Especially nutrition studies. And so nutrition studies are a little challenging to interpret sometimes because of so many limitations. And you do an excellent job. I want to thank you for that and for all you do in this field. And for doing this. And I’m honored to be speaking with you today and honored to call you a friend as well.

And so I just appreciate you, and I’m very grateful. So I’m Sean; as you know, I’m a primary care physician. So, you know, I mainly treat adults most in family medicine. And we don’t see many kids these days because they generally go to pediatrics.

But I do see people for the most part across most of the lifespan. And I, of course, have seen a lot of suffering in my patients. That has made me wonder if there’s a better way if all this suffering is quote-unquote, “normal and expected,” or whether it can be prevented; whether it can be reversed to an extent. You know, but my journey and the reason I got interested in lifestyle, medicine, and nutrition are mainly personal ones, at least at the core.

If you don’t mind, I can share that personal journey. You know, Sean, I was born to a mother who grew up in a family where the family business was a mom-and-pop fast food restaurant.  My mother’s side of that.

I mean, I love my family. Don’t get me wrong. I’m not trying to criticize them. I love them with all my heart. But in terms of food, you know, I grew up again, my mother’s side just had a love for sugary, greasy, salty food, fast food and food was everything. When I say everything, when we were celebrating something, when we were sad, when we were every time we got together, it’s food, food, food, and it’s always rich food. And then on my father’s side, you won’t believe this. Honestly, this story is kind of like, I don’t know what the odds of this are, but my father, when he grew up, his family business was a family bakery.

When I say bakery, I don’t mean whole grain. One hundred percent organic, you know, earthy bread, I mean pastries and everything. Cake and donuts and all kinds of sugary greasy pastries, and you name it; they made it. That side of the family especially loves pastries and all that kind of thing, that genre. And so I was you can imagine growing up with both of these parents. I mean, again, they’re the most loving parents.

But I just didn’t grow up with much knowledge around healthy eating. And I didn’t grow up with parents who were examples of that. And my father, well, I’ll say more about him in a moment, but I want to. I guess I’ll reflect on my own sort of health. So growing up, I struggled with my weight.

Junk Food |

You can probably imagine why, given what I just shared with you. I struggled with my weight. And I remember my mom took me to a nutritionist when I was young. The nutritionist would tell me that, you know, kind of like moderation and portion control. Because I love Mexican food, my family would often go to Mexican restaurants. The dietitian and nutritionist would tell me, you know, Steve, why don’t you when you eat the chips at the Mexican restaurant, count ten chips and stop there. I remember how hard that was, Sean, because and looking back, I realize now that, you know, these ultra-processed foods are so addictive and, you know, the foods are made with a certain amount of sugar, fat, and salt. They are made to be a specific texture. All of this is down to a science to get us hooked and addicted because the more we’re addicted, the more we buy. It’s better business. And so it’s a good business model.

It makes a lot of sense. I don’t think there these companies are out there to cause harm. They’re in this to make money, and they realize, hey, it’s our responsibility. Nonetheless, I was misguided early on in life by this message of portion control and moderation. And I struggle. They did a lot of yoyos, going up and down with my weight. And it affected me. It affected my self-esteem growing up.

I was able to get my weight down at times, but it was through pretty extreme measures, Sean. There were times where I did skip meals because I just knew that, oh my gosh, if I eat this meal, I’m going to take in so many calories, I’ll just skip. And I was doing a lot of I tried to. I’ve always loved the game of basketball. And in high school, I wanted to be on the basketball team.

I would do an extreme amount, honestly. I want to say extreme.  I don’t mean to the point of clinically excessive. Still, I would exercise probably two or three hours every day and be extra careful with eating. I was able to get my weight down to a pretty healthy weight. But it didn’t last long, Sean, because these were not sustainable two or three hours a day of exercise. I mean, even though it sounds great, it’s not practical to sustain.

A lot of people struggle to get half an hour. So I wasn’t able to continue that. And in my eating habits, I loved all this rich food growing up, and I knew it was moderation and portion control. I struggled. I gained weight in college. I gained weight and in medical school, and I just continued to gain. I would have times where there was one period of time, not it was about nine, 10 years ago, where I had an app on my smartphone, and I was tracking everything, everything I was eating.

But it was very tedious, and it drove me crazy. Even though it was helping in the short term, I was losing weight. It drove me insane to be tracking everything, to be measuring. And the other thing that drove me insane was that there would be times where at the end of the day go. Oh, my gosh, I’ve already eaten all my daily calorie allotment.

I’m hungry, and there’s something in front of me.  My family’s eating, and I see things I want to eat. And I have these cravings because I never know when you are still eating all these ultra-processed foods. Even though you’re tracking them, it does nothing to monitoring them. It doesn’t help with the cravings. So, boy, did I struggle.  I can show you a picture. I don’t think you knew me back then. But if you don’t mind, I can share my screen and show you a picture of what I looked like.

So there I was about this is about ten years ago, Sean.

And the other thing I wanted to share, let me I guess I’ll stay on this for a moment because I want to show you something else.  As I was struggling with my weight, my father had Type 2 diabetes. He had a heart attack when I was only thirteen. He survived, but I had the fear that I would lose my father. And he went on to have heart bypass surgery cabbage a few years after that, even though he quit smoking.

Obviously, it wasn’t only the smoking. It was the food as well. He went on to be diagnosed with Type 2 diabetes, and he suffered multiple complications of diabetes. But there was one complication that he suffered from that changed my whole family’s outlook and trajectory of really, I mean, just our entire quality of life and everything to do with our family.

To be honest, it hadn’t had a ripple effect. And it deeply affected me. And that was that my father ended up getting diabetic gangrene and losing one of his legs. And I’m going to show a picture.  But I’m just warning people it’s a graphic image. I’ll give you that warning. Here is this was his foot, Sean, before they had to amputate. It is, excuses the French. It’s nasty.

You can imagine here I am when I saw my dad going through this. I didn’t know much about nutrition. I was struggling with my weight. Seeing him suffer from this affected me because this is my father, and I’m a doctor, by the way, and I’m thinking. Oh my gosh, how is this happening to my father?

I’m a doctor. He shouldn’t. You know, I should protect him. I’m a doctor. But I realized those, Sean, that it was even though my dad was taking all the medications prescribed to him, and he was, I would say, a pretty good patient. Was he perfect? No. But he followed all the directions he was given. These things still happen to him, and they happen to him really because of his lifestyle. He’s my father. Unfortunately, in many patients, as a primary care doctor, I see this all the time.

Many patients feel that their medications will take care of their problems and don’t address them. In fact, to some extent, I would say that the medications in some cases, even though, of course, I prescribed medications, Sean, and I believe that they help. Of course, they help.

But sometimes there can be when I say adverse effects, we know about side effects, but there’s one negative effect.

In the case of my father, for example, he would be sitting with a pastry. Remember, he grew up in the family business, was a bakery. He never really gave up his parties. He’d be sitting with the pastry, and we would say Dad, what are you doing? You’re eating this pastry; You have diabetes; You have all these complications.  He said, don’t worry, I can increase my insulin if I need to. He always felt that his medications would cover him and almost that the medications justified his continuing this lifestyle, the poor lifestyle choices, anyway.

My dad lost his leg, and as he was recovering. By the way, before my dad lost his leg, Sean. He was he was functional. He has many medical issues, but he was functional to the point of walking, driving. He had a job that he enjoyed. His career was happy.  He just became a grandfather. Our daughter, my wife, and I had a daughter.  Our daughter Gabby was his first grandchild.

Gabby was just a baby when this was happening. My dad was looking forward to becoming a grandpa and enjoying many, many years of quality time as a grandfather. And this is the way that this chapter of his life begins, tragically. And as my father is learning to recover with one leg. And they gave him, of course, the prosthesis for the B.K.A, the below the knee. Unfortunately, he develops gangrene in the good foot, the remaining foot.  And my father had to lose the other leg. My father lost both of his legs in less than one year.

My daughter, his first grandchild, was learning to walk. My father lost the ability to walk, so he could never actually do hardly anything that typical grandparents do with their grandchildren, couldn’t watch, or couldn’t take her anywhere. Couldn’t. So. The other thing is that our daughter grew up scared of him because she was like, why’s grandpa has no legs and what’s going on with him.

And but eventually, they developed a very strong and close-knit bond, and they were very close. My father survived eight years after this happened.  He passed away a couple of years ago. But I can tell you, Sean, that what I learned from this are so many things I learned from this, and it affected me greatly because illness is not just illness. It has tremendous ripple effects across not only the individual. I mean, my father became very severely depressed.

It affected him financially; He lost his job; He lost his income. But the depression and everything to do with the quality of life. It impacts the whole family negatively. And so we all kind of became depressed together, collectively. It altered the future trajectory of our family again, and it affected our grandchildren. And so anyway, I think I’m preaching to the choir. I’m sure you understand this, but I think a lot of times, as clinicians, we don’t always see illness as an illness.

We look at numbers here today. When we see, here’s your blood pressure. We look at medications, and we don’t realize what illness does to people. We don’t. As clinicians, too, we have a relative lack of nutrition education in our training. We don’t realize that medications do a great job of slowing, reduce risk, and slow down the disease. For the most part, they don’t completely prevent illness, obviously, and they don’t reverse disease.

So the disease process continues. In the case of my father, his habits never really improved. His lifestyle never really improved. So this had a tremendous effect on me. But even though it had a tremendous impact on me. I still didn’t know much about nutrition. I feared for my own life, too, because I was following his footsteps. More or less when you see this picture here, Sean, I already was about 255 pounds, which is a B.M.I. of about thirty-three.

I had pre-diabetes; I had daily acid reflux (GERD); I had fatty liver. I was worried that I was following in his footsteps and that I was a ticking time bomb. And my father, I mentioned, had a heart attack at age 45. So I was approaching that age.

In any case, I kind of by coincidence. It wasn’t a coincidence. Well, one hundred percent, but not through medicine, not through my medical training, not through, you know, my workplace, but through friends and family. A book was recommended, a book on plant-based nutrition. And my wife was the one who started reading it. And she introduced it to me. I was very hesitant in the beginning because I had always thought that when people make claims, I don’t know how reversed disease. I go, oh, this sounds like quack medicine.

Sean Hashmi, MD

What was the book?

Steve Lawenda, MD

It was Dr. Fuhrman’s book, Eat to Live.  And you know, I was so intrigued, though, even though, again, as I mentioned, my first initial reaction was a knee-jerk reaction, like, oh, this doctor sounds like a quack. But the more he spoke and spoke because we listen first and listen to it as an audiobook driving home one day from a trip, I started hearing things.  The more greens you eat, the more weight you lose, the healthier you get. The first time in my entire life, Sean, where I heard that the more something you eat, the healthier you get. The less. The more weight you lose. We always listen to you have to restrict. You have to eat less, eat less food, eat fewer calories. So I was intrigued by this message, and it made a lot of sense to me.

It made a lot of common sense greens. I mean, of course. Yeah. I mean, the more greens you eat, they’re less calorie-dense, and they’re very nutritious. I learned this concept that it’s not really how much we eat. It’s what we eat.  And I started to realize that; actually, we can eat more food, or at least we don’t have to count and measure and restrict.  By eating the right foods, we can lose weight pretty quickly once we have the correct information.  He claimed in the book that you can lose a significant amount of weight even if you don’t exercise.  I said no way. You have to exercise to lose weight.

That’s what I’ve always you have to eat less, and you have to exercise to lose weight.  I challenge myself to start adopting a plant-based diet based on what I learned from this book, initially, not one hundred percent plant-based. First of all, I didn’t. In the book, for those of you who may have read it or curious, Dr. Fuhrman doesn’t recommend or quote-unquote “require people to go.” He says you don’t need to be one hundred percent to get benefits to reach your goals. It’s kind of like the more you go in this direction, the better your results will be. It’s up to you to decide how far you want to go. So I initially kind of was starting maybe 80, 90 percent plant-based.

I couldn’t believe myself, Sean. I intentionally wanted to disprove his theory that you could lose weight without exercising.  So for the first month, I did not exercise. I continued that I mean, I lost 17 pounds in the first month, to be honest with you.  Now I know some of it is maybe water weight, but I don’t think it was seventeen pounds of water weight. Over the months that followed, I lost 75 pounds in eight months, and I did the minimal exercise to see how far this goes.  Eventually, I started exercising towards the very end, but this was after I’d lost the majority of the weight.

It blew my mind because, again, I was not counting, not measuring anything, not tracking anything short, not literally nothing eating until I was full. Many times I couldn’t believe how stuffed I was and how satisfied I was. The only thing I will mention, I’m probably making it sound too good to be true. Perhaps if I’m guilty of that, yeah, so be it.

But I’ll be honest, the challenge there’s always a catch to everything. The challenge was that when you’re so used to these ultra-processed foods, and I was, you don’t realize how addictive they are until you try to give them up. For the first few weeks, I had I did have some cravings. I did feel kind of like it. I don’t know how to explain it, but I didn’t quite feel right, and I didn’t realize that probably what I was going through is kind of like a withdrawal and cravings kind of situation, probably analogous to what people I don’t know what it’s like to give up smoking.

I’ve never been a smoker, but I can imagine, you know, when people go through substance withdrawal, what for whatever it may be, they don’t quite feel right in the beginning. You know, there are all kinds of symptoms that people describe.  I didn’t feel quite right. But I was losing weight, and I realized that I started as the weeks went by, I felt better and better, stronger and stronger, lighter, and more energetic. And again, it was and the cravings that I had because, you know, initially, I would have all these cravings for the things that I was giving up initially. Eventually, most of those cravings subsided, and I couldn’t believe that.

Plant-based diet | SELF Principle

Wow. I said, you know, I’ve always heard people say before that, you know when you eat healthily, your taste buds change, and you can get. I don’t buy that because I didn’t try to eat something healthy in the past. The thing is, I didn’t give it enough time. That’s when people eat healthy for a couple of days and might not like it, but they don’t realize that sometimes it takes a few weeks.

I also learned a lot of tricks to make healthy food taste delicious.  I always say this to share this joke that I love hot sauce. I love spicy food. I don’t know about you, Sean. I make this joke that you sometimes don’t even know what you’re eating because you can mask the more hot sauce you put on something.

I put so many spices and seasonings in my food, and I love it. The thing is, too, is that I realize that as you make this change, you start to appreciate the subtle flavors of foods that you didn’t maybe appreciate before because I think all that sugar, fat, and salt dulls your senses.

You just get used to that. You get used to the sugar, so you don’t realize that there’s cilantro in something or ginger and something. There’s basil. Once you kind of take away the mask of all that sugar, fat, and salt, you know, those herbs and spices are potent and start to appreciate them.

I couldn’t believe what I was going through, Sean. I was like, wow, this is like a spiritual awakening. I just realized that my whole life, Sean.  I believed that genetically because I had so much chronic disease in my family on both sides, I was led to believe that we were genetically weak or inferior and had genetic defects. Because it wasn’t good, quote-unquote, “good at portion control and moderation,” that there was something wrong with me. That I was broken; that I was weak; I had little willpower.

And so I had this low self-esteem for many years, not realizing that. I should mention I lost weight, but I also lost pre-diabetes. The fatty liver went away, the acid reflux. I became, quote-unquote, a “healthy, normal person.” I mean, whatever that means to you. But the point is, I didn’t have all these conditions anymore, and I didn’t have the extra weight.

And so what I realized is that I’m not weak. I’m not broken. It’s I don’t have weak willpower. It’s that I was given the wrong information. I mean, I don’t think there was any malintent in those giving me this information. When we eat healthy foods, natural foods, especially plant whole plant foods, they’re not. They don’t need to be restricted. Restricting is not. We look at the animal kingdom, all the wild animals. They don’t count. They don’t measure; they don’t starve themselves. They have a healthy weight, and they eat, eat freely from the land.

There’s an expression. I’m sure you’ve heard this before, Sean. That “genetics loads the gun, lifestyle pulls the trigger.” I believe that. And I know obviously, genetics can be for some people. It can be more of a factor than for others. We’re all different, of course.  I realize that in most cases, genetics can be overcome, at least to a significant degree. And I and I’ve seen that with my patients, too. So it’s kind of a long-winded story.

Sean Hashmi, MD

Right.  Interestingly, you bring up genetics. So when twin studies are done and looked at how long people live, what they’ve found repeatedly in different populations, there’s a Swedish study, there’s a Finnish study. What they showed was genetics is about 20 to 30 percent of your longevity. That’s where it ends. The other portion that’s about 70 to 80 percent is what you’re describing in this environment. What’s interesting about the book, Eat to Live. When the book was written, I read the book, and I love the book. There weren’t randomized clinical trials to show the benefits you were alluding to when it was published.

What’s interesting is we have those randomized clinical trials now. So what you’re describing with a Whole Foods plant-based diet is the sense you came out of New Barnard’s group and what they showed was if you follow a Whole Foods plant-based diet, number one, you don’t have to restrict calories. No two found that the people who were following that diet and were allowed to eat anything they wanted eating on average 500 to 700 calories less per day.

That alone wasn’t enough to account for the weight loss. Those whole grains, legumes, fruits, and veggies in there, the rich and fibers, and the thermic effect of food were also revved up significantly. So your experience without exercise, eating the whole food plant-based diet, which is essentially nutrient-dense, calorie poor, allows you to be able to cut your calories down and not have a change in hunger. So there’s an entire scientific explanation of what you experience where we now have randomized studies.

Steve Lawenda, MD

Yes, absolutely. The way I explained it to my patients, I appreciate that. And you’re right. I explained to my patients is that whole plant foods are rich in fiber and water. You mentioned the fiber and the water, too. And actually, people might think so. What water? I mean, but the thing is, are you know, our stomachs are only a specific size in terms of like the volumetrics concept. When you fill up with a lot of fiber and a lot of water, as you mentioned, that’s the fiber and water.

Well, they have no calories. They take up space. They’re bulky; they’re heavy, so essentially. You’re filling up your stomach with these whole foods with fewer calories because of all the fiber and water. There’s only so much room in there. I find it is a helpful way for people to understand this.  I explain to people, you know, it’s better to have whole natural foods instead of crackers, cookies, and chips because they’re dry.

Not only that, they’re highly processed and higher in fat and sugar, which make them more calorie-dense as well, but especially the fat because fats more calorically dense than carbohydrates, as you know. But so, yeah, it’s there’s so much science that to me, a lot of it in hindsight, it’s common sense. I mean, some of this is common sense. It’s fantastic to have all the science behind it.

A stomach that’s full of whole plant foods, and it’s four hundred calories of whole plant foods versus a stomach that has maybe oil in it or perhaps beef in it. And it’s because they’re so calorically dense, it doesn’t fill up as much of the stomach nearly as whole plant food.

As a primary care physician, I just realized that eighty percent, give or take of what I see in my daily practice, are the very conditions that can be prevented and or reversed with this kind of lifestyle change. And so, most of the suffering I see day in and day out, all day long, is preventable, reversible with simple modifications.

I mean, granted, I’m not trying to downplay the fact that this can be very challenging for people to adopt. However, I mean, on paper, it’s straightforward. I just see people suffering for years. And you’re just like my dad for so many years. I can only imagine my dad’s life known all these years and years ago and how much better his life would have been and how it would have.

So the trajectory of our lives has altered so much. I started implementing this in my practice but teaching this to my patients. Initially, I became very frustrated at the same time because, as you know, as in medicine, we don’t have a lot of time with patients generally have about 20 minutes per patient depending on where we practice and so forth. And I realize it’s just not enough time to counsel patients, really give them all the education and tools they need.

Often, I would refer patients to read a book to maybe watch something, a documentary or something, to get them started. And some patients would take that advice, and they’d run with it. And they do well. But for the most part, I realize that so many patients were not either. I was limited with the time or weren’t following through and what I was recommending. I realized that you know what I can.

And the other thing that was happening was I was spending in some cases, I was spending an hour with some patients and finding myself so behind schedule that I was getting patients upset with me as a doctor. I’ve been waiting almost two hours, and this is not sustainable. On the one hand, I don’t think that obesity and chronic disease are sustainable. I call obesity and chronic illness the real pandemic, not to get off-topic, not to minimize the Covid pandemic.

As we all know, first of all, obesity and chronic disease, 1.8M, approximately one point eight million Americans die every year from those conditions, which is about five thousand per day, far more than Covid deaths. But when it comes to covid deaths, 90 percent of covid deaths are in people with the same chronic conditions. Obesity and chronic disease are the main underlying pandemic, which is mostly lifestyle. The point is, is that I knew that I didn’t understand what Covid was years ago.  None of us did. But I knew that this was the main problem that people were having. It was driving me crazy. What can I do? That’s when I, along with the nurse practitioner, became inspired. Her name is Maureen. She became inspired by what I was doing in my transformation. Some other colleagues in my medical center were becoming inspired by my transformation and what I was sharing with the information I was sharing with them.

I got the support to start a group program to teach this information to make sense to us. Because, you know, we realized that obviously science, as you know, Sean, can be overwhelming to people. People don’t like too much statistics and numbers. They want it practical. We taught them what we know from our perspective.

The nurse practitioner had her transformation. So we tried to be good examples to these patients and help them. And we said, look, we’re all in this together. We sort of started as a small group kind of project. And I was very fortunate that I was given time to do this. Rather than having 20 minutes only with one patient, I now had two hours with 20 patients. And so it was much more optimal for this kind of endeavor.

We got excellent results from it. I’ve never seen patients before getting off insulin. The only patients I’ve seen get off insulin in the past were people who had bariatric surgery. Now all of a sudden, I’m seeing patients get off insulin, off blood pressure medications. When you hear that heart disease can be reversed, you go; that can’t be true. It sounds like, again, quackery, but I’ve seen that as well.

I can share some of these incredible, true stories.

Janet, as you can see, Sean is in a scooter here. She has an oxygen tubing here; she had COPD, a former smoker. She could barely walk across a room, kind of poor quality of life, but had a great outlet, which means she had a great personality. She’s you can see her smiling in the picture. She was not a negative person. She tried to remain positive, but she wasn’t very happy with this quality of life. I think most people, when they see somebody like this, see somebody like Janet, they think, oh, poor Janet. But I think we all believe that she’s kind of stuck this way for the most part. Most of us probably think that, well, the only way she could get out of a situation like this is maybe bariatric surgery.  Of course, there are risks involved. And she’s older, and she’s a former smoker.  Would she be a good candidate for that? But she started to eat this way.

And by the way, I didn’t mention this earlier, but I prefer I know this sounds like a little corny, but I refer to this way of sometimes eating as the magical buffet. In a buffet, it’s all you can eat. We love buffets, but when you eat in a buffet, you tend to gain weight, at least in the typical buffet in the United States, you tend to gain weight. You tend to get sicker and sicker, whereas this way, with these whole plant foods, you lose weight, and you get healthier and healthier.

So ate from the magical buffet and she can’t exercise much. You can see. So it was this not from exercise, but she lost a lot of weight. And you could see her standing here.  In less than a year, she lost, I think it was eighty-four pounds. The most impressive thing to me was about not only weight loss but also the quality of life. She no longer needed her oxygen. She no longer needed her walker or her scooter.

She walks, she says, all over the place. She also was quoted telling us that she feels twenty-five years younger. She got the benefit of weight loss surgery without having had the surgery.  She feels fantastic and free. She can eat as much as she wants, and she can live such a better, higher quality of life. She was dancing in a karaoke bar like a teenager. And she couldn’t do that before.

That’s her story. I don’t know whether I usually continue with this because there’s one more chapter to this. She has a daughter named Kim. Kim had weight loss surgery and gained most of the weight back. And this is her after having gained most of the weight back. But this is her daughter, Kim. Often, what’s beautiful about nutrition and lifestyle is that, unlike medications, again, nothing against medications. But in this sense, I know I’m preaching to the choir, Sean. But when we prescribe pills, let’s say a blood pressure pill that helps lower the blood pressure of that individual patient does absolutely nothing to their family.

So but when we teach lifestyle and promote it, that can spread. It can be contagious. The benefits can be transferable. So this is Janet’s daughter Kim. Anyway, Kim ended up gaining most of the weight back from the bariatric surgery. A lot of it, not all of it, to be honest.

But she had a lot of fatigue issues with fatigue, sciatica, and high blood pressure. Essentially all those problems went away. Here she is after going plant-based eating from the magical buffet.

The idea is that many patients have so many patients who have either, first of all, not want maybe they felt that weight loss surgery was the only option for them, or they’ve had weight loss surgery. Still, they felt frustrated that they’d gained a lot of the weight back, and they might feel like, oh, there’s nothing else I can do. I love the fact that there is this option.

And we’ve had many patients in our program either avoid weight loss surgery or have had it and have gained the weight. And they’ve had success with this. And I know you said one story, and that’s fine, but I’ve had so many we had a patient who was going to have heart bypass surgery because of angina, and then angina went away. We’ve had we had one patient two years ago who was diagnosed with diabetes. His A1C was 12.4, and he was put on insulin.

Two months later, he’s off the insulin, and his A1C comes down eventually to 5.1 with no medications.  But he essentially put his diabetes into complete remission. And these are stories I would have never dreamed of before, Sean. Again, I would hear these stories in Eat to Live. I said, there’s this is too good to be true. This guy’s a quack.

I can’t believe that these things actually can happen now.  I share this with my patients. None of us can guarantee that these will be. Everybody’s going to be cured of every disease that everybody is going to lose. One hundred pounds, of course not. But and I think, for the most part, the longer people have the disease, the harder it is to reverse. So the earlier you intervene, the better. But the other thing, too, I think, and this is an unfortunate reality, is that some patients struggle with making these changes. We’re living in a society that makes it very challenging. There’s so much temptation. There’s so much, and we’re social creatures.

We’re tribal. We don’t to be different. We want to eat like our family, and we want to eat like our friends.

I found that if we build supportive patients, it is easier to get support within their families. I was fortunate to have support from my wife, which made all the difference in the world. But we try to, with our program, Sean. As much as possible, try to create a family-type environment where people get to know each other a little bit, so they don’t feel alone.

I think that’s so important is the social aspect of lifestyle change because, again, I think I have seen many patients relapse. I’m honest because the relapse typically started as something social. They go to a party or hang out with their friends or go out to eat with their friends, Pre-Covid. They want to eat like them. They don’t want to be different.

I hope what I’m sharing is helpful. I probably am too long-winded. I’m not giving you much of a chance to ask me questions. So let me turn back to you. Let me ask you, Steve.

Sean Hashmi, MD

A lot of people, when they’re watching what these interviews or others are, they’re wondering. There are so many things that make it hard for them to take that first step. So I always ask any guest that I have is where do people start? If somebody is watching this, they don’t have access to a health care team that understands this philosophy or their social determinants of health or cost or an issue, whatever. Where do you tell people the first steps they can take to get started in this journey?

Steve Lawenda, MD

Absolutely.  Well, I think the first step is getting the knowledge, the information. Because without the proper knowledge and information, I mean, that’s you’re not going to be you need that to guide you. So obviously, that’s number one. And there are many ways to get the correct information. And that’s that was the impetus, you know, for us to start our classes to our program is to give them information from our perspective that we felt was most important. That’s number one.

Number two, I think the and I say I share this with my patients. It’s vital to clean out your kitchen. When I say clean it out, I don’t mean, like, dust it.

I mean, get rid of all the quote-unquote junk because there’s an expression. Chef A.J., who, you know, Sean. She has an indication. I’m going to give her credit, “If it’s in your house, it’s in your mouth.”

I think our brain, the pleasure centers in our brain, the dopamine, rewards us so. So clean it out.

I make a joke. I’m not trying to be too sarcastic to donate or give it to somebody else. Let them be sick. I mean, that’s obviously. I’m sarcastic.  We don’t want other people to get sick. But the point is not to waste food. If you’re going to donate, it OK.

Plant-based diet | SELF Principle

If it’s out of your house, then the next step is to fill up your home, your kitchen with only healthy food, natural whole plant foods, you know, whatever you decide to do. I always share with people. If you’re on an island where there’s only healthy food, you can’t die. You cannot fail unless you escape the island.  Create that island around you in your own home. And then socially, you have to be very aware.

You always have to be one step ahead. What I mean by that is if you know you’re going to a party or a social function and you’re not quite sure what they’re going to be serving, what you don’t want to do is show up there on an empty stomach because you’re more tempted. I’ve done that before. I made a mistake, but you learn from my mistakes. There are times when I will eat a full meal before I go somewhere so that I won’t get tempted.

Even going to the grocery store on a full stomach is because if you’re prone to cravings. I want this one. You’re going to grab things and regret them later. The other thing that I think is very important psychologically, because that’s a significant factor, is my advice to people is make a list of three things.

One is your why. That’s your emotional reason for why and your why is not. “I want to lose weight,” that’s a goal. That’s not your why. You’re why it might be, for example, your children, your grandchildren, maybe your love of life, your passions, joy out of life, emotional reason. Your why is the thing that makes you cry. We have to know what that is and remind ourselves. Especially in our modern society, because there’s going to be so much temptation.

We need to have that drive. Then a list of your goals as specific as possible. Maybe it’s I want to have a good A1C. I want to have an A1C less than seven, whatever it is, specific goals. I want to get off this minute. Granted, we may not always achieve them, but we’ll be more motivated if we know what they are.

Then the final one is a list of action steps.  Often, we might say I want to eat healthily, and I want to lose this much weight. I want to get my A1C down. But what are the steps you’re going to take? For example, clean out your kitchen shopping? That very. So the more specific we are across all three of these categories and the more we remind ourselves, I recommend people make these three things very visible in their life.

Some people talk about what’s called a vision board. Maybe you’ve heard of that, Sean. Maybe make a board at home that you have that you can see or put on your smartphone or something, make a habit of looking at it, maybe put it in your bathroom, look at it every day.

Those are some tips to get started and get and finally get support. However, it may be whether it’s a group program through your wherever you’re getting your medical care, whether it’s online. There are so so many programs, so much support online through social media.

Sean Hashmi, MD

I love it. When you talk about support, what are some things that you do? You talked about, in your particular case, your wife is very supportive. How do you get other people in your family to sort of buy into this or, you know, even if they can’t meet you at one hundred percent, maybe they can meet you at 10 percent? What are some guides you tell your patients?

Steve Lawenda, MD

Oh, that’s such a great question because, honestly, Sean. I would say this is probably the number one obstacle people have.  I mean, first, obviously getting the correct information and getting those three things. I mentioned the why this the goals, the action steps. But the big problem biggest obstacle is family, I think.  My joke, and again, it’s not a joke, is that families are harder to get to change than patients, in other words.

I haven’t had as much success with the family getting them to change. However, as you said, it doesn’t have to be perfect.  It doesn’t have to be one hundred percent. I have been successful at getting a lot of respect from my family and support when we get together in our family. First of all, they understand so.  I think your question was like, how do you get patients to so when there are so many steps? I recommend people start very gently. Start gently and gradually build up a little bit.

So gentle could be let’s read a book together, let’s watch a documentary together. Let’s look at this website together. Let’s, you know, let’s share information and let’s try some foods together. Sometimes there are some people, if the food tastes good, that’s all they care. So they don’t want to hear any science. They don’t want to hear anything medical, but they just care.  We have to know the audience, understand our audience, speak, and know what works for them. So there’s that.

Then I would say to that sometimes negotiating. I think you mentioned that. Are you maybe you’re not willing to go all the way like I am, but are we willing to give up soda in the house? Are we willing to give up chips in the house? Or are you? Maybe we don’t have them in the house.  If you want to eat them outside, go for it. For example, you smokers, you can smoke outside, don’t smoke in the house. And that can so. We can negotiate.

I’ve also told people that if you feel genuinely feel that you’ve tried everything and you’re desperate. Then I say, you might want to pull out kind of like an emotional plea to them and say, look, I feel for me that this is potentially life or death for me, that this because I’ve seen it. I’ve seen people where I’ve had conversations with them about this.  And two weeks later, they’re dead, and they’re dead because they had a heart attack or a fatal stroke.  I feel so terrible because, in hindsight, I know that we had had these conversations and that there were some obstacles.

Sometimes that works for some families, you know, an emotional plea or maybe somebody as you’re a nephrologist or somebody has chronic kidney disease and say, I don’t want to go on dialysis.  Do you want mommy to go on dialysis? Do you want your dad to go on dialysis? Whatever it is, this is so important to me. Or do you want your father to lose his leg? I’ve already had neuropathy in my feet. I’ve shared with my patients said, look, if you’re going to take my dad’s foot or feet and put those pictures, share them with your family, you know, do that because sometimes that.  I hope that answers the question.

Sean Hashmi, MD

It does. The next question, which is a natural sort of follow-up to the first one, is. So what happens when people fall? How do you help them through it? Because part of nutrition and part of obesity and part of chronic diseases is a shame. It’s one of those topics we never talk about. I’ve never met somebody who had an extra weight that they didn’t realize they had actually. All those things they’ve gone through already, and yet we shame them for it.  When they fail, they’re so afraid to bring it up, especially to their health care provider. So how do you help people to deal with the falls?

Steve Lawenda, MD

Excellent question, because that, again, you know where the money is. First of all, it happens a lot.

You’re right. And people do feel shame. And I think what I try and share with patients is they say, look, you’re human. We’re living in a society where this is very hard and making them feel like they’re not alone.

You’re not alone. This happens to a lot of people, just like with smoking. For the person who’s a smoker, it takes several attempts to quit. Normalizing it, instead says, hey, look, this is normal. People fall, it’s OK. Don’t feel bad. You know, give them a pat on the back or whatever it is.

Maybe we don’t do that anymore with Covid, but give them an elbow or something and say, it’s OK. You’re going to get through this and try to make it a learning experience and a healing experience and kind of like reflect. OK, what was working when things were going well? Why were things going well? And then how did this happen? How did this evolve? And if we were to kind of go back in time, how can we replay all this?

Would we have changed? How can we?  You know what? Our bodies are amazing. They forgive us most of the time. If you didn’t die from this relapse, you could start fresh. For people with diabetes, we see that their A1C shoots up because they weren’t doing so well. But we can see that a few months later, it’s back down.  Our bodies are forgiving. You take a fresh start and try and learn. I think I shared with you just a moment ago that this is just a tiny thing, but I share this with my patients. Hey, look, I’m human, too.

I also think that empathy, I’m human, too. These things have happened to me. And but I always share with my patients that I went to a kid’s birthday. I went to a kid’s birthday party on an empty stomach. Kids’ birthday parties are notorious for serving junk food. I gave in to some of it, and I felt awful. I felt shameful. I felt guilty.

I’ve had other times where it was more than just one day where I was having a string of, like, what am I doing? Even during the pandemic, I’ve had some days where I haven’t been at my best. I may have even put a few pounds on. But I realized that, OK, why is this happening? What’s going on? How can I learn from this going forward?  What can I change and normalizing?

Empathy and support. How can I, as a provider, can I support you going forward? What resources are you connecting people with?

We’ve had people in our program, Sean, who have shared with Alcoholics Anonymous, a lifeline for many people. The reason it’s lifelong is it’s we’re never finished.  This is a journey trying to help.  Initially, our program was for three months. You’re done with the three-month program. But what we found was that because the relapse rate was much higher than we anticipated.

We end because people were demanding, like, why did you stop this program?  You cut us off, and it’s your fault.  We decided we’re going to leave it open. We’re going to have new people come in. But if the old-timers or graduated want to stay, you can stay. We realized that that was a significant benefit because of those who stayed.  It helped them remain accountable and continue to get support, but they started to act as mentors to the new people.  We created this sense of community, much like A.A. You have sponsors and kind of a sense of community. We realize that community and support are so important.

Sean Hashmi, MD

In that regard, I think one of the things that we all go through and we all suffer from, and I’m probably in that boat with everybody, is we are our harshest critics. When we talk to ourselves internally, we don’t do many, “hey, you know, Sean, you’re awesome.” You did such a great job this morning. It’s about, “Wow, you didn’t work out this morning. That’s terrible. Why did you give in and eat that? All of those things that we end up doing at negative self-talk. It’s so crazy, and you bring up the word empathy.

We learn to show empathy towards others. The idea of loving ourselves, accepting ourselves, showing compassion to ourselves, and realizing that we as humans are bound to make mistakes are such an interesting concept. I tell you, there are very few people I’ve met and have truly mastered this concept. Me, I have not mastered it. One of the beauties of interviewing guys like yourself is I learn from every interview, and it’s almost like I’m able to take that and make myself better from it.

Steve Lawenda, MD

That’s beautiful. I, I feel the same way. The other thing I realized, too, Sean, in terms of the sense of community, I mean, you’re familiar, of course. With the blue zones and, you know, in the blue zones. I think, you know, I’ve not lived in one, of course. But I can imagine that when your culture is very healthy, there’s no such thing as a relapse because you’re just living. It’s a lifestyle. It’s a culture, I think.

One of the biggest challenges is that we’re not living in that healthy culture here. We’re trying to motivate people, inspire people to live a blue zone life in a non-blue zone culture. This is very difficult because there’s no struggle in the blues on culture; there’s no relapse because it’s just the norm.

Culture | SELF Principle

I think the more that we can, the more that we can start on a grassroots level to change the culture, you know, one individual, because, you know, what I’ve realized Sean, this is so rewarding as a physician is that when I see one patient change their lifestyle, it’s so rewarding. But when I see that, they then share it with other friends and family. I realized, oh my gosh, this is incredible because I feel like this is contagious.

It makes me feel that you know, again, there’s no greater joy I’ve had. I mean, don’t get me wrong, I love our profession, but there’s no greater joy and reward than life than helping people with their lifestyle. Especially when you see that you’re not only influencing one person in the family but sometimes several in friends. And so that’s how we’re going to change the world. We have to start with individuals and families, and communities.

I’ve been, you know, the other thing again, I’m preaching to the choir.  When you turn on the T.V., which I try not, I try to minimize my T.V. watching, but I’m so disgusted.  I’m just being honest. I’m disgusted by commercial after commercial, and T.V. is either fast food or medication. That’s become a mainstream American culture because we eat this way, and we get sick and need pills.

Sean Hashmi, MD

Final question. The most complex question I always ask. Everybody is so bringing it all together. What are Doctor Lawenda’s top three or four tips that you want to leave the audience with that they can do?

Steve Lawenda, MD

Would you and just to be clear in this question, which is a tough question. You put me on the spot, but that’s good. I like that. Should I gear this towards more like clinical people or patients?

Sean Hashmi, MD

You like whatever you like. You have a diverse audience, so you pick.

Steve Lawenda, MD

I may have already shared them, but maybe it’s OK if it’s all right with you. I’ll just kind of highlight. And you said three, so let me count.

Sean Hashmi, MD

 Three or four is fine.

Steve Lawenda, MD

I already shared the one about your “why” your goals and just being specific, specific, and reminding yourself, especially in our culture, because of your why, goals, and action steps.

Many people say I want to live better. I want to be healthier. That’s too vague. We need specifics, and it’s not going to work. I mean, don’t get me wrong, some people may work for them, but so be specific. So that’s number one. I like number and number two, you know, educate yourself as well as you can because it’s tough, of course, as we’ve talked about this all the time.

Diet is such a passionate topic. The point is that prepare yourself. You know, if it’s a Whole Foods plant-based diet, which, of course, we both agree is a very healthy way to go. If it’s something modified or something else, whatever it is, know. And then I mentioned this one also earlier, is your environment, prepare your environment. Pretend that I call that the island is magical. It’s not magic, but if you’re on an island where there’s only healthy food, you’re not going to fail.

To create that environment, create a very healthy environment as much as possible. Of course, the family can be an obstacle. We talked about that, but that’s a whole separate issue. But do it the best you can of a creator.

Your environment not only includes your home, but it includes your social environment, which means a lot of times. My final maybe I can do this could be my fourth would always be to plan as much as possible.

There’s an expression for failing to plan, planning to fail something like that, failure to it. The point is that we live in a society where the default culture is an unhealthy one. If you don’t plan, you will often encounter yourself in a situation where you’re tempted or surrounded by unhealthy food. And so that planning ahead could be bad cooking, preparing meals ahead of time so that if you eat, so that when it comes to when it’s a busy day like today. I don’t have to worry about where is my where’s my healthy food going to come from? Because I’ve prepared something earlier. Maybe I made a big batch of soup and I’ve put that away in the freezer. Right. So it’s ready to go. That’s when you batch cook. That becomes fast food as the week goes on, you know, so you so. The other thing just real quick on fast food, a lot of people think about fast food.  So convenient. I mean, that’s why I go to the drive-thru. That’s I always should look at the animals. Everything they eat is fast food. I mean, it’s all fast.

The healthiest foods are fast. When you pick up our fast food, when you pick up an apple, that’s fast food. Most of the foods we’re talking about, whole plant foods, are very fast to prepare or eat, most of them raw, even a little bit of light cooking, steaming.  Saute is fast. So anyway. But I think the reason people eat fast food is more than convenience. Planning and, like I said, with social situations, if you need to eat ahead or even call ahead, ask what will be served or if it’s a friend’s house. Again, Covid aside, can I bring something? Ask them if you can bring something, and if and if you’re plant-based and bring something, always bring double the amount because chances are people will love it.  Then if they eat all your food, you have nothing left. So those are my tips.

Sean Hashmi, MD

Well, those are fantastic.  Dr. Lawenda, I want to thank you. You are a friend. You are a scholar. You’re doing amazing work for everybody. This has truly been an honor to have you on. We will have links to how to contact Dr. Lawenda and his program information.  We will be back with another interview. And we look forward to seeing you.  Thank you.

Steve Lawenda, MD

Thanks so much, Sean

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Sean Hashmi MD
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