Dasha: Welcome to the Biomedical Frontiers Podcast, where we explore pivotal research projects and disruptive innovations aimed at translating scientific advancements into tangible healthcare solutions. I'm your host, Dasha Tyshlek.
Meagan: I think that lifestyle should always be our first intervention for diabetes, for hypertension, for heart disease, high cholesterol, because it gets at the root cause of the problem. Everybody who makes changes sees benefit. It's just where are you on the spectrum? But I would never recommend jumping just to medication and not doing the lifestyle part at all.
I think that's the crux of this whole lifestyle medicine and getting to the root A cause of the chronic disease epidemic issue is how do we help support people with behavior change? It takes real work to change those patterns, but luckily, once you change the patterns, you start to feel better. And then once you start to feel better, you wanna do it, not because you're afraid of your diabetes or your hypertension, but because you're like, I feel better when I do this.
And then it becomes self-reinforcing. We have to help people to get to that point. 
Dasha: Welcome back to biomedical Frontiers, and today we're tackling one topic that's been voted on by you, our listeners, diabetes. And our guest today is Dr. Meagan Grega. Her TEDx presentation on lifestyle medicine has been watched over 250,000 times.
She is a family medicine doctor who is co-authoring the first clinical practice guidelines on lifestyle interventions for treatment and remission of type two diabetes.
Dr. Grega, welcome to the show. 
Meagan: Thank you. It's my pleasure. I'm really looking forward to this conversation. 
Dasha: While you have helped patients reverse type two diabetes through lifestyle change, can you tell us a story of a patient journey and what that reversal actually look like? 
Meagan: Well, thank you for that question because this is absolutely one of my favorite parts about being a doctor is when patients are able to actually change their lifestyle and be able to make a big difference in their health, but most importantly, feel so much better while they're doing it.
So it's not just that they have a good outcome as far as their numbers that we talk about, but that they're actually having so much more energy and they feel so much better in their day-to-day life. So one of my favorite stories that kind of exemplifies that type of a, of a transformation is a patient that we had that I, I actually should probably call her a participant because I was not her primary care doctor, but she was a participant in one of our Kellen Foundation Therapeutic Lifestyle Change Intervention Cohorts.
And we can talk a little bit more later about what, what that entails. But basically it's a year long program that has a three month intensive period where we're meeting weekly in group visit formats with participants to really kind of kickstart their lifestyle change journey. And then for the remaining nine months, there's like a maintenance part where we, we meet less frequently, but we still get together.
There's still that contact and the goal for people that are joining our therapeutic lifestyle change intervention cohorts can be multiple different things. You know, some of them already have chronic diseases that they're aware of. Others are just feeling like they're not feeling as well, or they are concerned about risks for chronic disease that they may have seen in their family or they're worried about for themselves.
So it's, what I'm trying to say is it's a mixed bag of people, you know, it's not like they come in necessarily all the same as far as their medical histories. So this particular participant. She actually didn't have any medical problems that she was aware of. She just knew that she wasn't feeling well, like she was feeling tired and you know, kind of feeling like her digestion wasn't the way it used to be.
And she kind of feeling blah. And so she. Wanted to make some changes so that she would have more energy and, and enjoy activities more so she came to the participation in our program without any specific goals other than to improve her lifestyle and to feel better. Now, part of this program we do fasting labs as a right before you start the program, and then we do 'em again at three months, six months and 12 months.
So people can see what their trajectory is in the program as far as their lifestyle changes and how it's affecting their, their metabolism. So in this particular, patient and the, the fasting labs that we do are a fasting lipid panel that looks at cholesterol and L-D-L, H-D-L triglycerides. We do a fasting hemoglobin A1C.
So that's a measure of what your blood sugar has been over the last three months, and it's one of the diagnostic criteria you can use for diagnosing type two diabetes. We do a high sensitivity CRP, which is a blood test that is pretty non-specific, but it basically looks at levels of inflammation in the body.
And then we also do blood pressure and height and weight so we can get an idea of people's BMI. So for this particular patient or participant when she joined us after getting her labs and her biometrics, which are the blood pressure and the weight and height I had to sit down and chat with her and say, you know, I, I think this may come as a surprise to you, but what we have found on your blood work is that you have a, a high hemoglobin, A1C, it's 9.5, which is, is diagnostic basically for type two diabetes.
You have very, very high cholesterol. So much so that her triglycerides were, almost off the chart. And so was her. LDL unfortunately. You have very high inflammation with your high sensitivity CRP, and you have hypertension based on your blood pressure. And so that's a lot for somebody to get that type of information all at once.
You know, going from feeling that they were just kind of tired and not feeling great to having all these multiple issues to deal with. At first she was like, well, what do I do? And, I said, well, there's medications that would be useful to kind of manage this in the beginning, but you can make a big difference in all of these issues with changes in your lifestyle, and that's what this intervention program is gonna be about.
And so we talked to her regular physician and between the two of them, they actually decided not to start medications. And, you know, that's a, that's a patient choice, with, consultation of their primary care doctor. And she really jumped into the program with changing her diet, sleeping more getting regular physical activity and managing her stress in different ways and really just kind of putting her whole heart and soul into it.
And over the course of three months, she had one of the most amazing transformations that I've ever seen. Now I have seen patients do really, really well and improve their blood pressure, improve their blood sugar. But for her in three months, she actually managed to drop her hemoglobin A1C from 9.5 to 6.1.
6.1 is what would be considered in the pre-diabetes range. So in just three months, she made a massive change as far as what her average blood sugar was. She also dropped her blood pressure so much so that she, was basically in what we would call the, like just stage one hypertension, just barely when she had been in stage two hypertension.
So significant improvement in her blood pressure. She lost over 30 pounds. Her cholesterol levels came down significantly. So she just really kind of made an entire transformation from the inside out during this time. But I think what was most important is how she felt. She felt like she was sleeping better.
She felt like she had more energy. She actually was doing walks with her husband after work instead of kind of plopping down on the couch because she used to be so exhausted when she came home. And one of the things that she said on our graduation day, 'cause we, we have a graduation from the, the intensive time before we go into the kind of maintenance period.
She said, thank you for letting me know that this was possible. I would never have realized that I could make these much changes and that it would have this much of an effect. So that's one of my favorite stories. The other piece of that story that I love so much though is that her husband joined the, the program with her.
And that's one of the things I know that we might wanna talk a little bit about group support and, and how behavior change happens. But in her case, the two of them joined together. Therefore they were able to support each other as they were making these changes. He also improved, he lost about 30 pounds also along with her.
He improved his blood pressure. He improved his blood sugar and his cholesterol, even though he didn't have as high of a readings as she did when they entered the program. So I find the two of them to be like one of my most inspiring stories of what is possible if you make, if you're able to put these changes into practice into your life, you can see dramatic, dramatic improvements.
Now, does everybody see dramatic, dramatic improvements? No, because it depends on how much change you make, and it also depends on how long maybe you've had some of these chronic diseases and how long it might take for your body to kind of bounce back or to to heal. But I can say that everybody who makes changes sees benefit.
It's just where are you on the spectrum? So I love to tell people the best stories, but I also want people to know that, everybody's individual and perfect is the enemy of good. So the more that you can make, changes in your life that work for you and keep moving forward, you're gonna see results.
Dasha: That's a beautiful story and I love that component of a family doing it together too, and that support.
But I wanna get in a little bit first into kind of the nitty gritty of the clinical aspect of it. Insulin treatment, that's been around for a really long time.
But you're saying that actually, you can treat with lifestyle. And for me, the question is why isn't that the standard treatment? Can we talk a little bit about treating lifestyle, what it means for the patient, what it means for the doctor, and what does it mean clinically?
Meagan: Those are great questions. So let's see if we can unpack and if I miss any of those pieces we'll circle back to 'em. So let's start first, like, what does insulin do for the body? And type two diabetes is really a disease of insulin resistance. In the beginning, it's not that you don't have insulin that your pancreas is making, that's type one diabetes.
So type one diabetes is where the beta cells and the pancreas, they stop making insulin because of either an autoimmune issue or, or something happens that they shut down. So type one diabetes, your body's not making insulin, so you're gonna need insulin from somewhere.
That's where a lot of the for in type one diabetes is where that medication is like a lifesaver because you're not making insulin yourself. Whereas type two diabetes is a different type of a situation. It's not that the body doesn't make insulin, it's that you've become insulin resistance in your peripheral tissues, especially in your muscle cells.
So when you eat something. You digest it and then you get some blood sugar 'cause the, the carbohydrates and turn into simple sugars go, you get glucose into your bloodstream and that's your easiest form of energy. So it's great for your muscles if you gotta go out and do a run or something. It's great for your brain, for all the things you're thinking, but we have, we, we don't eat like continuously at a same level all the time so that we can have this like level of glucose that's the same all the time.
So our body has to figure out where am I gonna put this blood sugar when I eat it, until I need it. And there's a couple of different places that it goes, but one of the main, what we call like glucose sinks or sugar sinks is your muscle. And in your muscle you've got these insulin receptors. So the insulin receptors basically are hanging out on the muscle cells and when there's sugar outside, blood sugar in the bloodstream, the insulin receptors hanging out on the muscle cell and it needs insulin itself, the hormone, to be kind of like the key that opens the lock of that insulin receptor.
So if everything's going well, you have some food, your blood sugar goes up, your pancreas says, oh, I need to get that blood sugar to go into the muscle cells. I'm gonna put some insulin out. It puts out the insulin. The insulin hangs out in the, in the bloodstream. It finds the insulin receptor on the muscle cells.
It opens the lock. The lock means that the glucose transport molecule allows sugar into your muscle cell. That means the glucose goes into your muscle cell and out of your bloodstream. Life is good. Like that is the way it's supposed to work. That's kind of an oversimplification, but it's basically the way it's supposed to work with, with insulin.
What happens with type two diabetes is you become insulin resistant in that your insulin receptor on your tissues throughout your body is not as receptive or as sensitive to the insulin that your pancreas is producing. So if you can imagine your house key and your house lock on your front door, if life is good, you come home, you put your key in the lock, you open it up and you walk through the door and everything's great.
But if you came home and someone had stuck a big glob of like chewing gum in your lock in your door and you tried to open it, it probably wouldn't open. And so if you think of yourself as the blood sugar, you're stuck outside. Like you can't get into the place where you're supposed to get into.
And the way our body reacts to that is to go, oh, it doesn't seem like I have a key for this. I better make more keys. I better make more insulin so that I can open that door and so it actually makes more insulin even though your body is resistant to that insulin. And so your blood sugar's still going up.
So the big question in type two diabetes really was. What's gumming up the lock? Like what is it that's making that insulin resistance happen? And it turns out that it is basically fat and there's this stuff called intramyocellular lipid, which is basically fat in your muscle cells. If you have a high level of intracellular lipid in your muscle cells, it is gumming up the lock of the insulin receptor.
And so what happens is that insulin that your body makes is not able to open that insulin receptor. The blood sugar stays outside, which means that your blood sugar levels raise, and then you have type two diabetes that goes along with, there's a whole lot of other things that that blood sugar does that causes the problem.
So that's kind of how insulin works in the body. When we talk about why isn't lifestyle first, I think there's a couple of reasons. 
So when, what I hear you say is something causes this lipid that's in the muscle cells mm-hmm. To now block insulin, is this created somehow through the process of diabetes, like this extra lipid is generated and that's the problem.
Is this lipid, like almost the cause of diabetes? Is it like a kind of concurrent with it? Like the lipid is like, Hey, I'm just here because I've been told to do a job and it's actually something that's causing me to do this. Like maybe there's only, maybe the muscle is saturated with sugar or something like that.
Like what's, what's going on behind that that relates it to lifestyle that is, is causing that?
That's great. No, that's an excellent question. So the, the extra fat in your muscle basically comes from extra fat in your diet and in your body. So let's think of ourselves as we would any other animal. Like if you think about a steak.
A steak that has a lot of marbling in it has a lot of fat within the muscle. One of the ways that our current system gets animals ready for slaughter is they, they feed them a lot of, of calories and types, sort of bulk 'em up so that they get fatter and they get that like, sort of marbling within the, the muscle tissue.
Whereas if you think of grass fed animals that are out on pasture and they don't get as bulked up before slaughter, they don't have as much marbling in their muscle tissue.
Okay. So that happens to us too. So when we have more fat in our body, especially when we're eating more fat, saturated fat, especially in our diet. One of the places it ends up is in our muscles. So they've done studies where they've done calf biopsies on, so the muscle of your, of your calf, basically your Gastrocnemius down there, where they've done biopsies and compared omnivores, which are people that are eating kind of like whatever, everything, you know, kind of eating all sorts of different types of foods to vegetarians.
And even if they are of similar BMIs, the omnivores have more fat in their Gastrocnemius muscle than the vegetarians do. And especially if you are somebody who's overweight, you may have more marbling or fat in your muscle tissues.
You can also see it from more of a population standpoint, as far as the diabetes piece. If you look at what type of dietary pattern people have, and this is coming directly from the Adventist Health Studies, where they looked at if a, a participant said that they were either an omnivore, somebody Who was a pescatarian, somebody who was a lacto ovo vegetarian or versus somebody who was a what they would call vegan, but I would say a low a whole food plant predominant or whole food plant-based person.
And they looked at the percentage risk of them having type two diabetes. And it steps down with each of those categories. So you are at a higher risk if you're eating kind of a, an omnivore everything diet, then it steps down as you're going into like the different types of vegetarian. And then the very lowest risk, which in that study was only 2.7% of the population were found developed diabetes if they were on a plant-based or a vegan diet.
So if you think about it, we currently have in the United States, about 12% of our population has diabetes. In that population only 2.7% of the people had diabetes. 
Dasha: What, what I think is striking me and a lot, you know, I've, I've read about this topic, but you know, it's hard to digest all the information out there, but I've seen, I've associated diabetes with a, like a sugar carbohydrate intake problem, right?
You taking in too much 'cause you have high blood sugar. And so that means you should eat less sugar and carbohydrates. But you are also describing that it's not just that, it's a saturated fats, and maybe other fats as well, but primarily saturated fat intake as well is contributing to this.
Is sugar also contributing in other ways? And how does that relate with the fat as well? 
Meagan: That's a really good thought process because it's sort of like, well, what should we, what should we be focusing on?
And I would say in a lot of ways you still need to focus on both when you're talking about a health promoting diet that a very high sugar, high simple carbohydrate, high refined grain diet is not going to be the healthiest choice either. But if you look at a chicken and an egg sort of scenario, 
David: yeah, no 
Meagan: pun intended.
Considering we're talking about plant-based stuff. But if you look at a chicken and an egg, what really seems to kick off type two diabetes and insulin resistance is the fat. Because that's gumming up the lock. And what I would encourage people to look at is there's, there's studies that if you look at Dr.
Michael Gregor's nutrition facts.org website and type in insulin resistance into the, into the search bar, there, he, he has all the sources cited. And you can look at some of the actual studies themselves. But if you look at people who are, do not currently have insulin resistance, and they, they have a kind of normal metabolism and you give them high loads of sugar, you know, have 'em drink a whole lot of sugar, for example, or, or have them eat something that is very, very high in sugar, their blood sugar goes up but very quickly comes back down.
The body is able to kind of get rid of that sugar and put it into the muscles. Whereas if you take those people and you put them on a very high fat diet and then give them sugar. They have a lot harder time clearing the sugar from their blood, from their bloodstream. So the fat seems to be the first step that it interferes with the ability of your body to clear that sugar from your blood.
But if you have that problem already with insulin resistance, definitely eating a high sugar load of food is going to just exacerbate how high your blood sugar's going to get. So if you think about, there's like a fire and so the fire is what's happening and you can sort of make the fire lower by kind of dampening it down by not giving it the fuel that it needs.
Or you can make the fire explode and be like really, really, really kind of a roaring fire because you've given it more of the type of fuel that it needs. I sort of think of type two diabetes that way that the fire is the fact that there's all this glommed up stuff in your, in your insulin receptor.
So the fat is what started the fire to begin with, but when you put a lot of sugar into your body by eating a lot of sugar, that's the kind of fuel that makes your blood sugar go way high. Whereas if you're not eating as much sugar, even though you've got this fire going on because the the fat is in your muscle tissues, your blood sugar is gonna stay lower.
So I think these are very complimentary issues as far as managing blood sugar. But one of the best strategies to at least reverse insulin resistance is to eat a predominantly whole food plant based diet that is lower in fat so that your body can kind of get that fat out of some of the fat, out of your muscle cells, and it's gonna make your insulin sensitivity better.
It's still good to eat lower sugar though. 
Dasha: Well, I was gonna say, and it sounds like maybe pound cake is probably the worst. 
Meagan: Oh, yeah. Or, or I don't wanna say a specific type of donut, but donut, 
Dasha: yes. Donuts and pound cakes. Yeah. Okay. So, so we've kind of dove in a little bit about the mechanics. So now it does appear that lifestyle has a huge contribution contributing factor.
So going to that second part of the question, why, why wouldn't lifestyle be our first intervention? Should it be our first intervention for diabetes? And when should, you know, how do you make that trade off or decision? 
Meagan: Well, I think that lifestyle should always be our first intervention for diabetes, for hypertension, for heart disease, high cholesterol, because it gets at the root cause of the problem.
So, and for diabetes, one of the problems that we see that's like a symptom is the blood sugar, but the higher blood sugar is not the root cause of the problem. That's the symptom of what is happening in the body that isn't working well, which is the fact that now you have insulin resistance and you're not able to utilize and metabolize your sugar the way that it would be most helpful.
So I think lifestyle first is always important because it looks at what caused the problem to begin with and starts to address those issues. But I think lifestyle plus medication is often necessary, especially in the very beginning when somebody comes in. For example, if they've got a hemoglobin, A1C of 10 or 11, you know, normal is less than 5.7.
Or if we would consider, you know, not having diabetes is less than 5.7. You know, they're like double that, that we don't want 'em to hang around with really high blood sugar while their body is healing from the, the issues as far as the insulin resistance and they get some weight loss and start to do some more physical activity and eat differently.
So it's not an either or. The problem is we often skip lifestyle entirely in our current medical system and jump right to the medications. So I'm definitely not anti-medication. I think medications have their place and are very, very useful and could potentially be something that you start somebody on and then maybe you're able to wean them off and de-prescribe those medications as the lifestyle changes. 
So I think we should be working together with lifestyle and medications. And it's also a, a, a spectrum because. If you, for example, are somebody who has pre-diabetes, that means your hemoglobin A1C is between 5.7 and, and 6.4. 'cause 6.5 is where we say that flips over to type two diabetes.
Well then maybe you don't really need medication because you're at an early phase where things could be turned around completely by your lifestyle and you're not at a danger zone that I feel as a physician, like, oh, we have to get your blood sugar down really, really quickly. So each individual person, we have to assess two things.
We have to assess how much risk are you at right now today based on what's going on in your body? You know, how high is your blood pressure or how high is your blood sugar? Are you having chest pain? You know, things like that. So figure out, okay, does something need to be done immediately or do we have a little bit of time here?
And then the second thing we have to assess is how willing are you to engage on a lifestyle change journey? Is this something that you're interested in doing? How do you feel about medications? How likely is it that you feel like you can engage in changing your, your diet and your physical activity and your sleep, and then make a decision based on that patient's responses to decide, do we just do lifestyle or do we do lifestyle and medication?
But I would never recommend jumping just to medication and not doing the lifestyle part at all. 
Dasha: How willing are people to really change their lifestyle? Is there is there kind of a myth versus reality? Are, are people more willing or less willing? Or is it about, you know, what do they need to know about it to become willing?
 How does work?
Meagan: I think that's the crux of this whole lifestyle medicine and, and getting to the root a cause of the chronic disease epidemic issue is how do we help support people with behavior change? A lot of times doctors in the healthcare system in general have often in the past been like, ah, patients are never gonna do that, so let's just jump right to the medications.
That's the safest thing for them because now they're not, they're not ever gonna do this, change their diet that much, or exercise that much, or, you know, get more sleep. And when you actually talk with patients about it, that's, that really couldn't be further from the truth. What's confusing for patients is to understand how, how to implement this into their life, like how to integrate it into their, their day-to-day.
And then a lot of times they don't get the information about how impactful it could be. So most people have known either themselves or a loved one or a friend who have had that yo-yo dieting thing and they're like it never works. Or, you know, they start a physical activity program in January and by Valentine's Day they're done, they're not doing it anymore.
You know, so the people are more used to that type of stop start sort of thing. Like, oh, I'm on a diet, or I am, I'm, you know, starting this exercise thing because I want to, you know, go to my high school reunion and, and look a certain way or something like that. As opposed to, how can I change things either slowly or quickly, depending. On, on what their interest is.
But, so that this is now just the way my life is. This is just how I do things. It's not a short term fix. It's, it's like, this is how I eat now, or this is the way I integrate physical activity now. This is the way I try to get adequate sleep. And when patients learn how impactful it can be, they're much more likely to engage.
But even more important than that, they need time, and relationship building and support to really integrate it into their own lives. Because just telling people like, Hey, you gotta eat more fruits and vegetables and whole grains, that's not really helpful. I mean, it's helpful 'cause you're, you're giving them some information, but it doesn't tell them, well, yeah, what am I gonna eat for breakfast tomorrow?
Like, what, what am I supposed to eat for dinner? What am I gonna do when I go out with my friends? And if you say, you know, you really need to exercise more and you don't give much other information, people are like, oh, sure, I'm gonna exercise more. But that's not really measurable. There's these things called smart goals, which is specific, measurable, achievable, relevant, and time bound.
That's the way to help people change their lifestyle, or at least it's one good way. There's, I'm sure there's, there's others as well, but to really make a goal that you can say, these are the specific steps I'm going to take to meet my goal. And then we're gonna follow up again. Two weeks, a month, whatever, or next week if we're doing it at an intensive thing to see how things went with that goal.
So when I think about lifestyle, I think that we have to, when we're helping patients change their lifestyle and change their health behaviors, we need to provide that support at what I call the appropriate therapeutic dose. And in the same way when we're talking about a medication, if you give somebody 10 milligrams of penicillin when they have pneumonia, that's not gonna work.
It's not that penicillin doesn't work for pneumonia as long as it's not drug resistant to penicillin. I mean, penicillin does work for pneumonia, but you have to give it at the appropriate dose and frequently enough, as long as you need to fix the problem. And that you need to be able to give it the correct route.
You know, like whether it's IV or that kind, or I am, if we, nobody expects penicillin to fix pneumonia with a one time 10 milligram dose. Yet somehow we seem to think that if we give somebody a handout in our office about healthier eating, that that's gonna like fix it and it doesn't. We need to be able to have supportive, wraparound, comprehensive programming that helps patients walk their way into a different lifestyle and then helps them maintain it moving forward because their environment around them is what pushed them into this whatever situation they are with their health to begin with.
Because it's just, we all do what most people around us are doing, or what's the most convenient thing around us. It takes real work to change those patterns. But luckily, once you change the patterns, you start to feel better. And then once you start to feel better, you wanna do it, not because you're afraid of your diabetes or your hypertension, but because you're like, I feel better when I do this.
And then it becomes self-reinforcing. But you have to help people to get to that point. That in a nutshell, I think is the reason why, lifestyle interventions are not appropriately dosed or appropriately given or offered to patients because our system isn't set up now to provide that type of longitudinal support.
Like the things that we do with Kellen Foundation for our Therapeutic Lifestyle change program cohorts for a year. It's very rare in this country. It's becoming more common, but it's not the way I, I went to medical school back in the last century, back in the 1990s, and this is not the way healthcare has been set up in general.
So, shifting the way we provide care to patients is going to be what makes the biggest difference in them being able to truly change their lifestyle, to be able to, to hit that therapeutic dose that they need to make impactful change. 
Dasha: Well, you brought up the Kellen Foundation and so I wanna jump into that.
What is it, and then can you tell us the story of how you went from being practicing doctor to running a nonprofit that does these at this point, unusual long-term intervention programs, group coachings, and actually delivers food. To people in different areas. It's a very, very interesting approach.
Meagan: Well, thank you.
So Kellen Foundation is a 5 0 1 C3 nonprofit that I co-founded with my awesome co-founder, Eric Ruth, back in 2007. And really the goal is what we now call our Healthy Neighborhood Immersion Strategy. We didn't start with that, we kind of got to that, but let me tell you what that means now, and maybe I can then back up a little bit like how we got started.
So when we talk about our Healthy Neighborhood Immersion Strategy, it has four main pillars in it. And the reason that we think about it as a neighborhood immersion is going back to that therapeutic dose that I talked to you about as far as for participants changing their lifestyle, but also to really try to shift the culture and the social norms of the entirely Lehigh Valley of Pennsylvania, which is, which is where we are located. Because we know that
the default choice around you is what you are usually going to, to pick. Whether it has to do with what you do after work or what you do with your kid on the weekend. If everybody else is going out in your neighborhood and they're outside playing and people are, you know, going on hikes or you're probably gonna do that too.
But if everybody else is inside on video games or sedentary, you know, bingeing on Netflix or something like that, that's probably what you're gonna do as well. It doesn't mean that you definitely will, but you have a definite tug towards that direction. Same thing when you think about how people manage stress.
If people manage dress through social connections and, you know, going out for a walk together or playing a game, you know, playing an in-person game that, or, or maybe having a conversation with a friend. It's easier for you to access that for yourself if your social group around you is doing that.
Whereas if you manage stress by, you know, using substances or completely kind of disengaging and just going into your virtual world and not interacting in the real world, you're more likely to do that too. So we thought, Eric and I, that the most effective way to help everybody in the Lehigh Valley live their longest, healthiest, most vital, happiest lives was to look at it as a community based solution as opposed to just an individual based solution.
So individuals are very important. Individuals are what make up the community, but if you can look at it in a more community based way, you have a better chance of really shifting the situation for a whole lot of people. So the Healthy Neighborhood Immersion Strategy has these four pillars. One is Kellen Schools, and that has to do with going into elementary schools and teaching about: what's real food, nutrition label reading, eating out survival skills, things with physical activity and screen time and sleep. And also things that we call actually a program that we call the garden as a classroom where we build raised beds at the elementary schools and then the students get to do some planting inside where then they get to take like a tomato plant or a zucchini plant home to their own house to be able to, to plant in a pot or outside.
But then we also plant outside in the school gardens with them, all sorts of different crops that then they get a chance to taste later in the season or over the summertime. We try to encourage family members or community members to help maintain the gardens over the summertime so that they can harvest the produce and distribute it to everybody.
And it just really helps the students learn about, you know, where does food come from and, and how, how delicious it is when you take a cherry tomato right off the vine outside and eat that. Or at the, I mean, they eat kale and their parents are like, I can't believe they ate kale. But if you take like baby kale right outta the garden, it's delicious.
Or if you, even if you take 'cause we often will make a kale salad with like a citrus dressing and have them eat that. They love it. So it's and dragon tongue beans are our favorite too. Those are purple. So if, if you give a, a child a purple vegetable, they're very much more likely to try it and then be like, oh, this is really good.
So the, the Kellen schools programs basically use the elementary school as a hub, as a way to engage the whole community in nutrition education, lifestyle change, education and definitely gardening, and, and rowing education. At this point, we're in nine different school districts. Actually, I take that back.
We're in 10 different school districts now and we see well over 10,000 students a year in third, fourth, and fifth grade. And the good part about it too is that it's longitudinal. So we see them over several years and reinforce the concepts year after year. So that has been a really huge impact for our community and for Kellen's ability to, to interact and engage with so many people is we're engaging with the students, but also the parents, the principals, the teachers,
the bus drivers, all sorts of people at, at the, the schools. And so that's a big piece that is part of our Healthy Neighborhood Immersion Strategy. 
Dasha: Have you been able to observe any population impact either before the foundation's involvement in the schools or maybe compared to other districts in the area in terms of, you know, even just obesity rates or just even like interests in food?
Yeah. Or anything 
Meagan: like that? So definitely interest in food. Obesity rates are very difficult to kind of assess in these types of situations without a massive research study because students come into the district, leave the district go from one school to another school. And also there's so many other influences around them.
So if you look at socioeconomic, influences for somebody in a suburban school district versus a rural versus a inner city. You know, like to try to compare all those. We don't have it set up in such a way that we have a control group because we're trying to do the entirely High Valley and get as many students this education as possible. But,
separately, we do pre and post test surveys for them as far as knowledge gain, and we see big increases in things like being able to identify how many servings of fruits and vegetables they should have a day. And being able to choose if you give them three different options, what would be the healthiest choice from those three different options?
And definitely better as far as their label reading skills, being able to look at the, the sugar content and the fat content, and being able to use the red, yellow, green classification system. So we, we have good data on those aspects, but what I think is the most fun data and it's, it's not, you know, it's not hardcore like statistical analysis.
It's the testimonials we get back from the parents, from the kids, from the teachers, how much they love their plants, they love it. They like come in, it's like their plants are their pets. They come in every day and take a look at seeing them growing on the window sill or seeing them outside. We get emails from parents saying, where did you get that salad that you fed my child?
I want to go buy it. And we say, it's in your school garden. You know, go harvest it. It's the, because parents aren't thinking that their kids would eat that. So when their kids come home and they're like, I had this great salad. And it's, it's sort of is like getting, a lot of times I think that parents, understandably, and grandparents too, they don't wanna buy food that they don't think their kids are going to eat because that's like a waste.
And, and understandably they only have so much time and so much money and you know that if they know their kid will eat it, that's what they're gonna buy. But when they get a chance to see that their children or their grandchildren are actually loving cherry tomatoes and loving dragon tongue beans and salad.
So I think the key is that it's giving students and then also families, some tools to make sense out of the nutrition chaos and confusion that's around them. And it's, it, it's encouraging them to try growing some of their own food or having them participate in the garden at the school and having them realize that this stuff actually tastes really good.
And that just starts to shift the behaviors. 
Dasha: Megan, could we get a mini lesson the red, yellow, green, and what is healthy? Because I think nutritional, I mean, I think some of us kind of know what's healthy and what's not, but there's also so much confusion and some of it is just normal confusion because there's like interesting diets that people come up with and people swear by it, and everybody's body's different.
There's also some intentional confusion. I looked at like the ultra processed food industry spent $1.2 billion lobbying in the last 20 years, which doub was double the amount of the tobacco industry more than double like alcohol. So it's like you, you also have like intentional misrepresentation these companies trying to put out research that sort of confuses things a little bit and, and leads to erroneous conclusions and things like that.
What is like the basic framework that could work for anybody? 
Meagan: I agree with you that nutrition often is portrayed as being confusing, and I think a lot of that has to do with that confusion as profitable for the food industry. So if you're not really sure. Yeah, you're more likely to go along with whatever the most recent fad is, like you mentioned, or kind of be swayed by the advertising budgets or possibly just be exhausted and be like, whatever.
Can I just grab some food to eat because I need something. So I'd like to kinda level set. I'll, I'll tell you about the red, yellow green, which is a specific classification for things that are more like packaged goods in bags, bottles and boxes. And it's something that's relatively simple that we can teach fourth and fifth graders.
That is not as complex as getting into the whole like, oh, well, how much sodium, how much protein, how much fiber, how much that stuff. But let's just level set for a second as far as what are our healthiest options. And I know a lot of times when I talk to college students, medical students and residents, they're like, it's so confusing.
You know, it changes all the time. Nobody seems to have a, a consistent message about this and, you know, butter's back or paleo or keto or vegan or all these like words, 30 day, 30 day cleanse. Like, what, what are we supposed to do? And so what I teach is there's a lot of confusion out there in the media, but there is not confusion in the literature, in the evidence-based peer reviewed literature.
There's not confusion. So if you look at the American College of Cardiology's Clinical Practice Guidelines, the World Health Organization the American Heart Association, the International Society for Hypertension, the American Stroke Association, like all these very large, very well respected organizations have put out guidelines about what is the most health promoting.
Nutritional pattern. And if you look at that, they all overlap at this, at these topics or at these recommendations, which is we should all be following a low sodium, high potassium dietary pattern. And that includes the consumption of ample servings, of fruits, vegetables, whole grains, and beans, legumes, and that we should be limiting saturated fat, red meat, processed red meat, processed foods containing added sugars, sodium and refined grains and sugar sweetened beverages as the preferred nutritional approach.
So if we take that as what we are eating the most of, let's just say 85%, then the other 15% or so can be some things with sugar, some things with animal products, some things that are like the refined grains higher in fat. And your body's gonna probably do just fine, especially if you don't already have heart disease or already have diabetes.
And we can get into the Eat Lancet report a little bit too, about like, what's the most health promoting diet that is also within the planetary boundaries of, of the planet Earth. So if you look at the recommendations of experts who have looked at nutrition for decades, if not longer, it all comes down to saying we should be eating a predominantly whole food, which means minimally processed.
'Cause you mentioned the ultra processed industry is very, very strong and has, has had a lot of sway. So minimally processed whole grains, fruits, vegetables, nuts, seeds, beans, throw in a bunch of spices. Mushrooms are good too. That though is kind of like big picture. So if you wanna get down into some like real nitty gritty stuff that we teach the fourth grade and fifth graders, we use the red, yellow, green classification system that was not devised by Len Foundation.
That's an a dietician sort of framework. But if you're looking at foods that come in, boxes, bags, bottles, so you don't use it at looking at an avocado or, or a, you know some peanuts or an apple. You look at it for a cereal that's like apple flavored cereal, something like that. And the way the classification system goes is you need to know how many grams of fat per serving and you need to know what percentage of calories come from sugar.
That's all. So it's, it's small, it's, it's only looking at those two pieces. So it doesn't look at the salt and it doesn't look at the fiber and the protein, but we do talk to the students about it as we're going through the labels. Like, oh, look how much salt's on this, or, oh, look at how much protein, but it's harder to give those like kind of classifications for all those different things.
So for fat, to be in the green zone, we tell the students, raise your hand and just put out your five fingers and wiggle your fingers. And they do, they wiggle their fingers and we say, if you can count the grams of fat in a serving of what you are about to eat, on one hand that is going to be a green food, a "Go" food, like the food that you can eat on a regular basis, at least as far as fat is concerned.
Okay. Then we have 'em put two hands up and we say, okay, wiggle all those fingers. And if you have two hands up, if what you are about to eat has between five and 10 grams of fat. So you need two hands to be able to count it, that's gonna put you into the yellow zone as far as the vet's concerned. Then I tell them, okay, put both hands up.
All right, put up one foot. If you have to start counting fat grams on your toes because you have more than 10 grams of fat, that puts you into the red zone. That's as far as the fat is concerned. Now, as far as sugar, it's a little harder because it's percentage, which means percentage of calories. So we have to teach the kids the magic number.
And the magic number is that when you look at one gram of sugar, it is four calories per gram. Most adults do not know this either. Actually, most doctors do not know this. There's actually research studies that show that doctors also, and I'm not, I don't wanna pick on my fellow colleagues, I wasn't taught at medical school either.
So it, it's not common knowledge. How many grams of, I'm sorry, how many calories per gram of sugar? But the answer is four. So the magic number is four. So if you look at your nutrition label. You see that there are 10 grams of sugar, we teach them that, then they have to multiply it by four to say there's 40 calories of sugar.
And then you need to do some divisions, some math here, fractions to figure out what percentage. So we say how, how much total calories are there? So calories from sugar over how many calories total? And then we get that percentage. So the rules as far as where you are with red, yellow, green, is if what you are about to eat is comprised of less than 25% of the calories are from sugar, that puts it into the green zone.
If it's between 25% and 50% calories are from sugar, that puts it in the yellow zone. And if what you are about to eat is more than half sugar, that is going to put you into the red zone. And when you decide if a snack or a, you know, frozen meal or a, a a, a power bar, like some sort of energy bar or whatever, if you just, if you're looking at it and you're like which, which way is it?
Red, yellow, green? For it to be green, which would be a go food to eat, as you know, frequently it needs to be, it needs to be green for both fat and both sugar. So, so you can't be like, well it's green for the, for the fat, but it has 50% sugar. No. So to be green, you have to be the, within the, the categories for both fat and sugar.
And to be red, it's whatever the highest either fat or sugar is. So like, say you have no fat, but it's 70% sugar, that's still gonna be a red food. So we explain that the classification system, that to be green, you have to be green for both. And then after that, it's whatever's the highest, either yellow or red, whether it's fat or sugar.
And kids really get the hang of it. You know, we go through actual real examples and we do a game and a detective game. They're food detectives, and we talk about, okay, here's the thing. Here's the information. How many people think it's green? How many people think it's yellow? How many people think it's red?
So they actually get to work through it, and then we go through the actual answers. So that would be one way to start. 
Dasha: I love that you're also applying math. It, this is actually such a helpful framework. I'm a big nutrition label reader at the store, but I've never had a framework. I just sort of look at it and I'm like, this looks like too much sugar.
Or I'll just read and I'll be like, why is there sugar in pesto? I don't get it. Yeah.
Meagan: Barbecue sauce. Sauce for sure. Sauce. And for adults we often go a couple steps further.
So let me give you just a couple more. Yeah. For your listeners, things like little tips. So if you are looking at something and trying to decide whether it's a whole grain or it's made of enough, like to classify as whole grain because. You know, they put like made with whole grains on the front of things, and then it turns out that when you actually turn it around, there's almost no fiber in it.
You're like, how is that made with whole grains? Well, maybe it has a little bit of whole grains, but that's not the main thing. So one of the rules that we teach people is the five to one rule. So if you're looking for things that could be classified as whole grain, you should have at least one gram of fiber for every five grams of carbohydrate.
So when you look at that label, look at how much fiber in relation to how much carbohydrate, because there's gonna be carbohydrates in your fruit, for example, or in your carrots. But if you look at, or even in your whole grain, Triscuits, or I, I shouldn't say what type of thing, crackers, one of those types of things.
But that helps you look and see how close are you? Are you above the five to one rule that you have more than one gram of fiber for every five grams of carbohydrates? That's a pretty whole food. Not totally, you know, it might still be somewhat processed, but it's definitely not ultra processed at that point.
If you are in a situation like I was recently looking at excuse me, looking at a quinoa pasta, which I thought, gosh, that's gonna have to be great. I mean, 'cause it's quinoa pasta, but when I looked at the actual fiber versus carbohydrates, it was something like 30 grams of carbohydrates and like two grams of fiber.
I was like, how in the, what did they do? They must have like taken all the fiber out to make this pasta. So that'll help you also look at your your labels and if you use the red yellow green classification and then plus throw in the fiber, that helps. 
Dasha: And I just wanna put a point on it. This is for packaged food, but when you're looking at an avocado, watermelon, an apple, yes.
A salad. That is not what it's for. You don't need to read the labels, you just go ahead and eat it.
Meagan: Exactly, exactly. This is for the stuff that comes in a box bag or bottle that you're like, what exactly is in this? And you mentioned something about just looking at the number of ingredients and looking at the ingredient list.
That's something else that we do teach the kids, is we say, look at the ingredients and then figure out what the first three ingredients are, because that's going to be what the majority of the food is usually. And if sugar is and different types of sugar are in within those first three ingredients, that gives you a heads up that this is gonna be a high sugar food, basically.
And then we teach them that there's all sorts of different names for sugar. 'cause they're sugar, but then there's also. Maltose and malted barley and corn syrup and high fructose corn syrup and honey and molasses and like, there's so many different names and one of the things that's so kind of sneaky that processed food vendors do is they use multiple types of sweetener.
And because of the way the rules are written, you don't then put that all as one type of sweetener. It's different types. So if you have like five different types of sweetener, it looks like there's less of those ingredients in your, in your list. Because the way the ingredient list is set up, it's the first, the first thing on the list is whatever is the most or the, the greatest volume in that food.
So it's sneaky. If you see different labels that have maybe five different types of sweetener, if they had all been classified together, that would've been the first ingredient. But because they are different types, they get to be lower down the list. 
Dasha: Yeah. Well, I wanna turn to something else that you're working on.
Mm-hmm. Because I think this is gonna be extremely relevant. It's gonna, it's coming out very soon, maybe even at the same time that this podcast is coming out. You're involved with American College of Lifestyle Medicine, you're a certified lifestyle medicine doctor, and recently you published a paper called American College of Lifestyle Medicine, Expert Consensus Statement, lifestyle Medicine for Optimal Outcomes in Primary Care.
Mm-hmm. So you have an expert statement that just came out and then also about to come out is a set of clinical guidelines for lifestyle and interventions for diabetes. And so I was wondering if you could tell us, number one, what are these two documents? What goes into creating them and what can people learn from these documents if they're medical professionals or maybe they're patients or, or even scientists who might be thinking about researching things in this area.
Meagan: So, expert consensus statements are when you bring together a group of experts, you know, and those are people that are working actively in the field. And you use something called, at least in our case something called a, a Delphi Method where people write statements, people, these experts get together and, and create statements about the topic, whatever the topic is.
And in our case it was integrating lifestyle medicine into primary care. And then you vote on them in a very specific kind of. Not every basically anonymous way, and you have to come to consensus. We had well over a hundred statements and they did not all come to consensus that all the experts agreed that that applied in this situation as far as lifestyle medicine and primary care.
But what's valuable about an expert consensus statement is in areas where you maybe don't have a whole lot of evidence-based research in the literature yet. You know, for example, one of our expert consensus statements has to do with what type of assessments do you do for people as far as their lifestyle when they're in your office and you're trying to engage with them on behavior change?
Well, there's some literature on that, but there's, there's not a huge amount that you could necessarily pull from to do a clinical practice guideline, which we're gonna talk about. 'Cause that's more pulling from the literature, more evidence-based of what's been published. Whereas an expert consensus statement is saying, for experts that are practicing in the field, this is what they say is applicable as far as these particular statements.
And we had statements for that expert consensus statement relating to lifestyle medicine in education. Like, how do we train the workforce to be able to provide lifestyle medicine interventions, and how does that, how does that integrate with social determinants of health? And how are we doing this as far as, integrating it into the healthcare system from a clinical model or a, or a payment model. So we had a bunch of different lenses that we looked at and had a large group of experts that voted and came out with these statements that we can basically say we all agree on. And the reason that that helps, besides for individual clinicians who are trying to say like, yeah, what should I be doing about this?
I'm, you know, I'm not sure, is you can also take that type of a publication to your, your administrators in a hospital system or to a insurance company or to an employer based system and say, "Hey, this is what the kind of standard of the field is. So we should be trying to implement or integrate these concepts into the type of patient care that we're doing."
So that's the expert consensus statement, and we, we started with that particular one because we feel that lifestyle medicine is such a critical component of primary care, and that that's really the, the kind of point of the sphere place to start getting it into the rest of the healthcare system.
It's very applicable to lots of other specialty care too, like cardiology and endocrinology and GI and so it's very applicable across multiple specialties. But primary care is a place where you already are trying to build these longitudinal relationships. You're working on prevention, you're, you're trying to look at chronic disease management over a lifetime.
It's a great place for us to be able to really get that up and scaled across the country. So I recommend, and a, I invite people to take a look at it and look at what those statements were. There's too many of them for me to list for you right now, but if you're interested in how could you actually integrate lifestyle medicine into primary care, check it out.
And there's a, a bunch of statements to kinda get you off and off and running. And it's linked in the show notes! Excellent. Okay. And now a clinical practice guideline is something where a group of clinicians usually are getting together and reviewing the evidence-based literature on a specific topic.
And then one of the things that I think that's critical, critical about a clinical practice guideline is: it's actionable. It's trying to give you key action statements that say if you are engaged in, in this case for us. Taking care of patients with type two diabetes, pre-diabetes, or women who have previously had gestational diabetes.
These are recommendations of things that you do. And in our case, we were a multidisciplinary team of clinicians coming together. In some clinical practice guidelines it may be all the same type of clinician. Like if the American College of Cardiology comes out with one, it's probably mostly, if not completely, cardiologists that are, that are contributing.
But for, for lifestyle medicine, it's really a team-based sport. So there's doctors that are a part of it, but not just primary care doctors. Definitely endocrinologists in the case of diabetes, definitely sleep medicine. Maybe physical medicine and rehab or physical therapists, dieticians, health coaches, nurses, psychologists.
So there's just a very, very wide range of clinicians that participate in that team-based care that lifestyle medicine really brings to the table. So we had we had representation or representatives from multiple different societies in medicine like the American Academy of Family Practice and Nutrition and Dietetics and the we had from the Endocrinology Society.
So it in this way is a broad look at across the kind of house of medicine or across the, the healthcare sectors. How can we, in our case, integrate lifestyle medicine as the primary modality? Not the only modality, but the primary modality for the prevention, treatment and reversal of type two diabetes, prediabetes, and the trying to keep people who'd had gestational diabetes from developing diabetes in the future.
This is a multi-year process, or at least at least two years for us and for sometimes clinical practice guidelines go on for three to four years because you gather the group of experts. You do a literature search on the topics that you think are gonna be relevant. Everybody reviews that stuff. You get together in person and virtually at different times for hours and hours or sometimes days to actually hash out what our recommendations are for these key actions statements.
Then there's a process of it's not exactly voting, but basically a, a process to come to agreement on which statements we all feel are accurate and are also going to be, there's like different grades of evidence, whether it's, you know, grade A, grade B evidence. So that we can really lay out for people who are reading the guideline, what's the current
kind of status of the field or what's the lay of the land, of what the literature currently shows and, and what this can do for your clinical practice. So why I think that this particular one, the, the Clinical Practice Guideline from the American College of Lifestyle Medicine on Diabetes, which is our first one for the American College of Lifestyle Medicine, the thing that I think it really brings to the table is it focuses on the lifestyle behavior changes and the longitudinal nature of health behavior change, and ongoing relationships as the key part to, to really leverage first in your care.
Doesn't mean that we wouldn't also recommend continuing to do different medications or, and it's not about trying to talk about what's the diagnosis of type two diabetes. There's other clinical practice guidelines out there that have done an excellent job at those types of topics. What we, we really wanted to do.
Was shine the light on how impactful lifestyle change can be, and then specifically how do you on a practical, strategic level, implement that into the care that you're giving to patients. 
Dasha: So you also got a chance to really see the whole landscape of research and and then work on translating that research into clinical practice.
But what are sort of your kind of big picture conclusions about where the research and the sciences for lifestyle interventions in, in diabetes, but also generally, and then what's really important for the next five to 10 years to really advance our society's ability to treat and cure or, or bring into remission some of these chronic diseases.
I would say 
Meagan: that the field of research related to lifestyle medicine is exploding compared to where it was 30 years ago or, or four years ago. And we had a few lifestyle medicine pioneers back in the, the eighties and the nineties that were, were publishing on things like, so Dean Ornish was one of them.
Dr. Caldwell Esselstyn would be another T. Colin Campbell, Neil Barnard, they've been publishing for a long time to kind of start the evidence base of how impactful lifestyle medicine changes can be. But over the course of the last, even just 10 years, when you do a literature search on something like food as medicine or lifestyle medicine or health behavior change or physical activity in, in any chronic disease, like the amount of
of citations you get back now is just overwhelming in some ways. When we were doing the clinical practice guideline, we were getting back thousands of thousands of different citations for our queries, which is great because that means that there's a huge interest in this and lots of people are doing research, which is going to contribute to all of our knowledge base as to what's the best way to help patients and ourselves really live our longest, healthiest, happiest lives.
So I'm really excited to see how this has become a kind of hot area of research or a, a place that more people are putting their energy and, and their wisdom and expertise and passion into. As far as some of the things that we really kind of need to figure out or where research could focus on. I feel like we have a lot of good research now on the, on the why.
And what I mean by that, the why is. Why does lifestyle medicine work? Why is it important? For example, does food really impact our outcomes? Obviously we've got a lot of research on that now. Does physical activity, again, a lot of research on that. Mm-hmm. Social connection is one of the ones, one of our pillars that I think there's getting to be more and more research on.
But if you look at the Harvard Study on adult development that Dr. Robert Waldinger is the current executive director of that study, there's great research in that already too. So we, we know social connection is a incredibly important determinant of how long and how well we live. So I could also say for the stress management and for the avoidance of toxic exposures or risky substances pillars. We have a lot of data that says these are the basic components that when you leverage or optimize them, people have longer, healthier, happier lives.
Now what we have to try to work on more is. How do we integrate this actually into the healthcare system that we currently have or our communities that we currently have? And what is the appropriate therapeutic dose? Like I was saying about before, as far as how much or what type of programs will get us the outcomes that we are hopeful for, for our patients.
Food as medicine is a great example of that. Like we know that medically tailored meals or produce prescriptions help patients with chronic disease improve their biometrics, improve their mood, improve their quality of life. We know that, but it's all small, mostly, mostly small pilot studies or computer modeling studies based off of those small pilot studies because it costs a chunk of money to be able to do food as medicine research and you don't have the same deep pockets of pharmaceuticals trying to, to put this, like to actually fund this research. So it's usually funded more by the government or by philanthropic grants or academic institutions. So it hasn't expanded out as far as would be helpful. And the reason I think it'd be really helpful is because we haven't really been able to nail down yet exactly what components are the most critical for food as medicine, including how long does the intervention need to last?
Do you need to have follow up interventions where it's like you reintroduce people to the medically tailored meals? Or like, what, how much nutrition education do they need with this? Does group better? Is individual better? You know, there's so there's a lot of questions that we know in general, food as medicine is a powerful strategy.
Now figuring out how can we integrate it into our clinical care more effectively and what is the appropriate therapeutic dose for different patients. Because if you are really, really kind of having a lot of challenges with chronic disease, you need a different therapeutic dose than somebody who's maybe has pre-diabetes but has not had a lot of these other complications yet.
So same way with medications, need different doses for different people. I think lifestyle medicine interventions need different doses for different people. And that's where a lot of the research could go. Same with things like how do we best help people with behavior change, not just the food part, but overall.
So, you know, how, what about group visits? What about in their community where they already are anyway, which is kind of what Kellen Foundation is doing. So you're not asking them to come to the healthcare world. The healthcare world is going to them into their schools or their employers or their places of worship or whatever.
That's a very exciting area of research because it takes us out of the current medical paradigm, which is one patient, one visit, one, one code, that you get paid for this one thing that you just did. And starts to look more at a population health lens.
And a how do you make this as convenient and accessible for patients lens? And that's something that lifestyle medicine can really thrive in because I have people in my intervention program that are of all varying levels of health. You know, some of them have many chronic diseases, others not as many, or they're just worried about potentially contracting that as they get older and we can really kind of do the intervention or, or, or experience the education and the, and the goal setting and the health behavior changes together in a way that you could never do a
visit about a specific medical problem in that same way. So we can do it out in a community. Everybody eats together. Everybody starts to form relationships together. They get to support each other by talking about what their own obstacles are and how they're overcoming them. They're giving each other group support when they, when somebody walks in and they, you know, had something really great happen.
Or when somebody walks in and, you know, something really unfortunate happened. They have that connection of people like that are just either cheering 'em on or cheering 'em up one, or I think one or the other. So that's where I think that's only some examples. There's, there's so much research that could be done, but those are some of the examples that I'm most interested in is the food as medicine and the how do you actually help support patients in this behavior change journey with the appropriate therapeutic dose, and how do we actually get that,
reimbursable or paid for in our systems. So that the people who want, the people being the, the clinicians as well as the patients, who want to experience this type of healthcare, are able to actually do it. 
Dasha: I think there's so much appetite among the people, the individuals wanting to, to have more lifestyle interventions and better education about nutrition and sleep and health and prioritizing that.
I think there's also I love that there's a growing amount of scientifically backed research to actually tell us these things, that there's clarity actually on the nutrition side. For our listeners I just wanna say first of all, there's a Lifestyle Medicine and Food as Medicine essentials course that already has over 60,000 registered clinicians.
It's free and it's available until September 14th. So we'll link that. We'll link the paper the, the guidelines and the consensus and please check out the American College of Lifestyle Medicine website for a whole variety of papers, resources and clinicians like Dr.
Grega who are leading these efforts. If you're really interested in learning about how community lifestyle change is implemented, the Kellen Foundation has a variety of papers on all the different things that they're doing. We talked about kind of two pillars of what you're doing. We didn't even get to the other two, but there's so much to learn from Megan's work here.
And of course, just wanna say, check out Dr. Grega herself and her amazing TEDx talk. It's not very long. It's very inspirational. And she goes in further on the pillars of lifestyle medicine and, and how big changes can be made in a community. So for both inspiration and education, we'll link that for your benefit.
Dr. Grega, thank you so much for coming on the show. I feel like we could have spent another hour or two diving into things. So maybe we'll have to have some longer episodes or have you back on the show in the future. 
Meagan: Oh, thank you Dasha. I have really enjoyed our conversation and I would love to come back
'cause like as you mentioned, we only got to two of the pillars of the Kellen Foundation, the schools and the intervention program. There's still the food access, eat real food, mobile market. And then there's also the culinary medicine that has to do with, like you said, how can we help everybody actually know how, know what's the healthier options, but how to cook it so that it tastes delicious.
So, so many more exciting things that we could talk about. And I know we I'm sure once we get some more research going on as well, there would be some interesting things to talk about with the American College of Lifestyle Medicine and the kind of focus of how American College of Lifestyle Medicine is really trying to make lifestyle medicine the foundation of all healthcare integrated into whole person health and have it be something that is not just a nice to have, but need to have, in all of our healthcare worlds.
Dasha: I love that. Now, if you're listening to this show and you want to learn about similar topics, we really recommend our first episode of Dr. Nathan Price, CSO of Thorn Health Tech. He wrote a book on the Age of Scientific Wellness, talks a lot about chronic diseases, long-term longevity, and health management.
We cover some of these topics, but from perspective of how AI will be involved. And also I would recommend a previous episode in this season with Dr. Bethany Teachman and her free resources for anxiety and stress and depression management. So very related to one of the pillars of lifestyle medicine, if you're trying to make those changes in your life.
Or you want your patients to have those resources, please check out those two episodes for further information. Thank you everybody, and we'll see you back next month.
David: Thank you for listening to Biomedical Frontiers Stories with Innovators in Healthcare. My name is David Chen and I'm the managing director of the Walls H Culture Center for Translational Research at the University of Virginia. Our mission is to help bring promising new biomedical research and technology into the hands of the provider and the patient.
If you found this episode valuable, please let us know by subscribing, following board sharing, you can learn more about our promising translational research projects on our website. See links in the show notes.