27: WIN-WIN Medicine with Dr. Dave Donohue

Ever feel like your doctor doesn’t listen to you - not really listen, anyway? And just keeps pushing medication down your throat (pun intended), or send you for yet another lab, test, or scan? 

Want to break out of the hamster wheel of pills and procedures, but don’t know how? Or maybe you're a medical provider that’s sick and tired of being a pill pusher but when you look in your medical bag, there aren't many tools, so you grab the prescription pad, stack on yet another med and be on your way to see the next victim, I mean patient!

The thought of having to talk to someone about diet or exercise seems futile - you don’t actually know what to tell them, they won’t do it anyway, and you already have hours of work to do tonight . . . and you already feel spent.

The burnout is on both sides of the desk. Patients AND medical providers alike feel the burn of the SICKcare model in the US.

Speaking of burning - how bout the planet? Most of us now accept the fact that the health of our planet is threatened, but what can YOU do about it? You . . . just one person among billions? Well, you can start with your diet. That's right! An action you take at least 3 (often more) times a day is more powerful than you may know - both for your body AND our planet.

Today Dr. David Donohue & I talk to you about a few antidotes - things we can all do to slow the burn  - ways you (patient and medical provider) can break out of the sick care matrix and break new ground into true HEALTHcare. Dr. Donohue is a leader in Lifestyle Medicine, with a thriving medical practice called Progressive Health of Delaware and founder of the first and only LM accountable care organization network called Poplar Care.

He drops knowledge about his LM medical practice that addresses ROOT causes of the many chronic conditions we face today, how you can eat to help eat Mother Earth back to life, big picture ideas like reforming health education for kids, shines a light on health disparities, and provides plenty of practical tips and resources to get started asap including his beloved purple potatoes with walnut date icing! It's a good one, folks!  Check out Dr. Donohue's practice here: https://www.progressivehealthproject.com American College of Lifestyle Medicine's HEAL Initiative: https://lifestylemedicine.org/heal-initiative and here: https://www.lmhealthequity.org ACLM: https://lifestylemedicine.org Nutrition Facts: https://nutritionfacts.org Nutrition Facts video mentioned in episode related to African Americans and food culture: https://nutritionfacts.org/video/the-harms-associated-with-eating-more-southern-style-food

You can find me at www.vitaltransformationsllc.com

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Susie: Hello and welcome to the Return to Vibrant Health Podcast, a show highlighting the power of lifestyle instead of pills and procedures to prevent, stop, and even reverse many of today's chronic illnesses. I'm your host Susie Spell. I'm a nurse practitioner and a health coach trained in lifestyle medicine as well as holistic and mind body practices. I am on a mission to spread hope and healing, and in doing so, empower you to take control of your health destiny.

Welcome back to the podcast. Today's guest is Dr. David Donahue. He's been practicing primary care internal medicine for over 20 years, and he is co-owner and chief medical officer of Progressive Healthcare of Delaware. Which is arguably one of the most successful lifestyle medicine clinics in the U.S. He's passionate about lots of things, most notably adding or using a plant-based diet and nutrition and sustainability medicine to improve patient and planetary health.

Additionally, he continues to blaze the trail for other lifestyle medicine providers, crafting a way that helps all of us be clinically and financially successful, which also includes, and maybe even more importantly, helps alleviate provider burnout, which is a really big issue I think, and as we both know, lifestyle medicine can really be the antidote to burnout and provide some much needed rejuvenation for our practices.

As such, in 2021, he co-founded Poplar Care, the nation's lifestyle medicine network, and he's active in the American College of Lifestyle Medicine, where since 2018, he's chaired the provider network member interest group, where he really does lead the way for others with the same passion and perseverance that he has.

I want to quickly just share how I came to know Dr. Donahue first. I work in one of the clinics that is part of the Popular Care Network. It's called Headwaters Health in Jacksonville in Northeast Florida. And then second, I attended his presentation at the recent ACLM conference, and man was I blown away!

He covered tons of information, but he presented it in a way that was really fun and engaging and nobody was bored at all. It was a great session, and I was really thankful that I got to see that. So I can't wait to have this conversation with him. I know you're going to find him funny and smart and articulate and so very passionate.

Welcome Dr. Donahue. What did I miss?

Dr. Donohue: Wow. Geez. You didn't miss anything Susie. Yeah, how can I top that? I mean, thanks for that introduction is like, you're welcome. Maybe the most glowing introduction I've ever had. So little over the top, but we'll go with it.

Susie: Hmm. Yeah. Why not?

Dr. Donohue: why not?

Susie: Can you tell us a little bit about your origin story? How did you even get to what you're doing right now?

Dr. Donohue: Well, I began, let's see, in Wilmington, Delaware, I was born and, that's where I come back to. I live like a quarter mile from where I was born. But, uh, yeah, we basically, uh, went through the whole medical thing and along the way started to learn little glimmerings that the science says, oh, by the way, almost everything we've taught you is somewhat inconsequential.

And this is one of the things you learn, uh, as you start to study sort of the evidence behind what we do in medicine. And a whole lot of what we do in medicine is not really supported by evidence. A good bit is for sure, but a lot is not, I don't mean to throw out the entire baby in the bathwater. There's lots of good stuff we do for sure.

And I embrace medicine. I'm an internal medicine physician, so I, you know, got through med school, went through residency as a primary care internal medicine resident at George Washington University. I'm an internist. I prescribe medicines and use procedures. And they very much can cure and be lifesaving for people in the right setting.

But what we find is there's huge limitations. So especially for chronic diseases, , especially for a long list of conditions that most of the things we're familiar with, like high blood pressure, high cholesterol, heart disease, kidney disease, liver disease, gastrointestinal diseases, list goes on and on and on, arthritis . . ..

These diseases are mostly not that well treated by the medications and the procedures we have because, and I think this is lifestyle medicine's big secret, is to treat the root cause of conditions and the medicines that we have and the procedures, most of the procedures, don't really treat the root cause.

You can bypass an artery with a bypass graft. you've sort of solved one root cause like the blocked artery, but you haven't solved the broader cause of the vascular disease, which is plaguing their entire body. And that's just one example of so many. The medicines we take for blood pressure for the most part don't treat the underlying cause, which is relates to too much pressure in the system, which often relates to dietary factors and other lifestyle factors and when we treat the lifestyle, it's a big win-win.

I think the other big exciting secret of lifestyle medicine is it's like win-win medicine. Traditional medicine's win-lose, like I'm going to give you this pill, it's going to be a win cause it's going to lower your blood pressure, but it's a lose because you're going to have to take it the rest of your life and it's a lose because you're going to have side effects and it's a lose cuz it costs money. So it's like a win lose, lose, lose.

Whereas lifestyle medicine's, it's like 20 wins. Like there's no end to the, in fact, it can be 101 of these days. I need to give a lecture where the title of the talk is win, win, win, win, win, win. And I'm just going to say that a hundred times and because it's a win-win. I'm a firm believer in the win-win. I'll stop there.

[00:05:41] Susie: That's great. I really do think it's all win-win, win and I think the more people recognize that and know that, the more medical providers will be interested and want to engage in lifestyle medicine and patients will want to seek people out who know this information.

[00:05:58] Dr. Donohue: I agree.

[00:05:59] Susie: Can you touch on why lifestyle medicine is important? Why do you think from a provider standpoint that we should be interested in lifestyle medicine?

[00:06:11] Dr. Donohue: Well, again, it's a win-win. From a selfless perspective, it's really good for you to be a lifestyle medicine practitioner because you are going to walk the talk and, and there's research that supports that when we live the healthier lifestyle, we the provider, we the clinician, it rubs off on other people and we're not as effective at helping people achieve their best if we're not living that lifestyle ourselves.

The other reasons are really I think evidence based. You look at a patient with hypertension, we want that person to live as long as possible. We want to prevent that stroke or that heart attack as effectively as possible. And if you go the lifestyle medicine route, you actually can almost drop some of these risks close to zero. It's been described that our leading killer cardiovascular disease is, as Dr. Caldwell Esselstyn calls it, a toothless paper tiger that need not exist. But really to paraphrase, it's preventable in the vast majority of cases, and some of the research has been done, estimates about 90% of cardiovascular death could be averted if we just had a healthier lifestyle. So there's, there's such a value proposition. And again, it's a win-win for your personal life.

It's, it's satisfying to practice lifestyle medicine. There's less burnout because you're, you're actually helping people get better. I mean, I could go on and on.

Susie: Mm-hmm. And I love all that. And the way I think about it sometimes too is that at the turn of the century, well, 1900s, it was trauma kind of care. And then antibiotics came about and we're patching things up and curing things. But now we have these chronic conditions that are different than what we had 50 or a hundred years ago, and we're trying to use the same methods from before and it just doesn't work.

Dr. Donohue: Right. The system is kind of geared up around that whole model too, which is part of the problem. We have a sick care system, not a healthcare system.

[00:08:07] Susie: Right. And so when did you start your practice and how has it grown?

[00:08:11] Dr. Donohue: Well, we started about 2000 and I was in New Jersey for the first few years, and then we started here in Delaware in about 2003, 2004. But, it's grown really well, it's been a funny journey, um, because we happened to hang our shingle in a market that one of the worst markets to practice primary care, maybe ever. Reimbursement in the state of Delaware has traditionally been 69% to 84% of Medicare. So we got paid significantly less than Medicare rates, which is almost unheard of on a, a nationwide basis, like almost every other market that the private insurers pay more than Medicare.

So we were kind of chronically starved of cash, but we were popular cuz our model was always to spend like half hour with patients. And the reason we did that is because we just couldn't bring ourselves to do the 10 minute visit. I know that that's really how the financial rewards come in with fee for service.

You see as many patients as you can in a day. But when you're doing that, you're trying to walk out the room as soon as you walk in and you're not trying to address all the problems and really get at, the root causes of people's conditions.

So we've always done the half hour thing even before I discovered lifestyle medicine. And patients love that, because you can get a bunch of things taken care of in one visit and you're just getting more thorough care. So we've always been popular that a lot of people wanna see us, but we're not hardly making any money, but we kept growing over the years and we're now up to, I guess we have about 18 providers, so we're definitely one of the larger lifestyle medicine practices.

If there's another one out there that's even half as big, I would love to learn that you exist because we would love to collaborate and help you if we can help each other. in more recent years, we've had a little bit of relief in the reimbursement side and there's also been value-based contracts that have come along that have helped so we're finally finding ways of being paid for the quality that we've been delivering all these years, which is fueled more growth, which is why we're up to about 18 providers now.

[00:10:08] Susie: Wow, that's really big. I didn't realize it was that big. That's awesome. Could explore with us a little bit about the planetary side? Cause I don't know that a lot of people are talking about that, but the first part of your presentation during the conference was all about climate change, how we can make a difference in our lives every day with what we eat. Could you touch on that a little bit? Kind of help people understand that relationship?

[00:10:34] Dr. Donohue: I would be honored to talk about that. The reason I talked about that is because the American College of Lifestyle of Medicine is such a great institution. I really love these guys. They talked about it very aggressively in my first year that I went to the conference, which was 2016, I was so impressed. I mean, there's a lot of science around how important the healthcare industry is for determining our environmental footprint and how dire the situation is. We really need to change. What I shared was, you know, kind of an update on what the science is showing us about what's going on with climate change right now.

One of the things I talked about is the, well, we can get to the six aims in a little bit, but, we're starting with aim number six: ENVIRONMENTAL STEWARDSHIP. One of the broader goals here is to get healthcare to be environmentally responsible. Most other industries have some sense that they have an environmental footprint, and it's even baked into their, their corporate mission oftentimes is to have proper environmental stewardship. A lot of companies will get sued for environmental degradation and damage if, if they're not doing that. But healthcare ignores it. Healthcare is always, we've always had our triple aim: improved QUALITY, reduced total COST of care, and improved PATIENT SATISFACTION.

We never really, even as we added on other aims, we never talked about the environment. So I think it's important that we recognize healthcare worldwide accounts for 8.5% of our carbon emissions. And we account for a much larger share of our broader waste generation.

But one of the things that a lot of people aren't aware of is that the food we eat plays such a big role in our carbon footprint and nobody else seems to be talking about this besides lifestyle medicine that, Hey guys, you know, we really need to stop eating beef or drastically reduce the amount of beef we're eating. We, need to drastically reduce the amount of processed foods we're eating, and not only for health reasons, but also because it is damaging the planet so drastically. 91% of Amazon rainforest deforestation is to either to make room for grains and cattle or to grow crops for those cattle.

That's one of the most important systems in our global environment, that we really need to preserve it. It, it's estimated we're going to lose the Amazon rainforest in it's entirety if we don't really reverse the trend. So that would be one example of the many reasons why plant-based nutrition can be healthy for the planet.

Bottom line is as we move away from the red beef, as we move to the legumes and the five food groups that we recommend in plant-based nutrition, we're drastically reducing our footprint on this planet. And this is just what the world needs. We're approaching 8 billion people on the planet and, we've gotta modernize. I see the key step there is to move away from red meat and meat more broadly and processed meats and processed foods and move toward whole food, plant-based nutrition for the sake of our health and for the sake of the livability of our planet for our children and grandchildren.

[00:13:36] Susie: Right, which requires a little bit more foresight. And, I just think compassion for those that are coming after us. It's interesting the last couple weeks I've been querying people. I see the lady at TJ Maxx and the grocery store and I've queried them with two questions: how much does the, the climate crisis keep you up at night? You know, zero, none, 10 the worst ever. And a lot of young people say between seven and nine, you know, they're pretty worried about it. And then my follow-up question is: how powerful do you think you are to do something about it every day as a single person? And they say anywhere between zero and five. They don't feel that powerful. And so I throw in a little plug, well, hey, you know what you eat can help with that, so people just, I think young people especially, but a lot of people have concern over the climate. But even just researching an electric vehicle or something like that seems a little daunting or the cost of it, but you make decisions at least three times a day, if not more about what to put in your mouth.

[00:14:39] Dr. Donohue: Yeah, absolutely and that's one of the great things about lifestyle medicine. It's so empowering to the individual, not only for the environment like you just mentioned, but clearly for taking control of one's own health.

I think a mistake that a lot of people make, even environmental activists make is to equate, climate change with the burning of fuel. And if it relates to burning of fuel, then it relates to climate change. But if it's something else, it doesn't, but it turns out that we have a burning machine. Basically, you look at our industry as something that burns a lot of stuff and outputs a lot And then, we have a killing machine, an industry that, causes depopulation of wild animals and land usage.

About half of the world's habitable land is used for agriculture, and the vast majority of that 78% is used for animal agriculture and it's, sorry, 82%. It's the only thing remaining 18% that's used to grow crops for people. that 82% of the land that we use for animal agriculture, only produces 18% of our calories.

So it's, sorry, it's 22%. I'm tripping over my numbers, but the vast minority of the calories coming from the vast majority of the land, very inefficient system. And that deforesting, that land usage that comes hand in hand with animal-based agriculture is driving arguably to a larger extent of the climate devastation that we see, globally even more than potentially even carbon emissions. There's definitely a school of thought in the climate science community that holds that land usage is the key. But it's certainly a huge.

[00:16:13] Susie: Right. I was reading this very good book called The Great Healing, and it talks about land in one of the chapters. It's really pretty cool. But you had touched on the six aims, so could you circle back to that and tell us what the six aims are?

[00:16:27] Dr. Donohue: Well, yeah, I would be delighted. Thanks. we've talked about the triple aim of healthcare for years. So people in the healthcare industry, the hospital system, the healthcare system will talk at their board meetings. we're all pursuing the triple aim, and that's: improved OUTCOMES, reduced total COST of care, and improved PATIENT SATISFACTION. We want to achieve all three of those things in one fell swoop. This in a sense, summarizes our corporate mission as a hospital, as a health plan, right? And these words have been repeated so many times by so many institutions, and then they realized, oops, we're burning out people who work for us.

So it's becoming unsustainable. They're working so hard on this triple aim that they're burning out. And that threatens our mission, so let's make it the quadruple aim. Let's add the wellbeing of, uh, members of our care team as a fourth aim. And then they realize, oops, we're also excluding the medically underserved, those who are economically disadvantage are being excluded from our healthcare system. and this is a fascinating area of science where it turns out there's a lot, Of research that's been done to find that almost no matter what health intervention, it's, it's delivered much more readily and frequently to more affluent people, more whiter skinned people than people of color, people of economic disadvantage.

They pretty much name an intervention and we, we tend to offer it more to the more privileged. And so we think that that's part of all of racial implicit bias that exists. So we added HEALTH EQUITY as a fifth aim, and that was a very admirable step. And so now, healthcare has these five aims, which are marvelous. But again, we've ignored the environment.

I think that all of healthcare needs to add ENVIRONMENTAL STEWARDSHIP as the sixth aim. I love to talk about this in lifestyle medicine circles because we are really, in my opinion, ideally suited to address all six of these aims. It's not like it's hard. It's like doing lifestyle medicine you're almost automatically addressing all six of these aims. So when I talk about the biggest win-win ever, I'm referring partially to the ability to meet this "sextuple" aim that we should all have in healthcare. And apologies in advance, somebody listening to this in a few years, probably there's a seventh aim that I'm neglecting. I'm sorry, I'm this Luddite from 2023 who doesn't get it, but we'll add that on when we, when we become aware of it.

[00:18:56] Susie: Right. Well, and the group HEAL within ACLM, I think has really done a lot within our community to shine a spotlight on that medically underserved or disadvantaged group, and we have some nice positive energy around that.

[00:19:14] Dr. Donohue: Yeah. What, what an organization, I mean, this speaks to how powerful ACLM is, American College of Lifestyle Medicine. They spun up HEAL in, I think 2019 or even 2020, and it didn't even exist before then and now it's this, hybrid subgroup within ACLM, that's causing real change. And that's been so inspiring to watch.

[00:19:38] Susie: I agree. I've loved it. They had a really nice panel. I don't know if you got a chance to see it, but it was really good during the conference. And that was one of my questions for you, was a racial bias in healthcare and what we can do to address it, but we already talked a little bit about how lifestyle medicine is perfectly suited to do just that.

[00:19:56] Dr. Donohue: Yeah. Could I add a plug for (yes) my favorite website, which is www.nutritionfacts.org. Today's video from Dr. Michael Gregor talks about the health disparities based on race, especially around outcomes. He starts talking about stroke, but he talks about cardiovascular disease and congestive heart failure and certain cancers, it's disease after disease, as we know from public health research, that they afflict people of color at a higher rate than they do, whiter populations.

What he shares is, there's a fair bit of science that says that a large percentage of that disparity is attributable to the diet. I don't want to oversimplify cuz I know this is a, a very complex problem that's not going to be solved with one pillar. But suffice it to say that one of our key pillars of lifestyle medicine, according to some research that's out there now is, and that's eating more plant-based diet, has the power of making good on some of these health disparities that plague our healthcare system. So I would recommend watching that video. It's very well done.

[00:21:05] Susie: I'll link it in the show notes.

[00:21:06] Dr. Donohue: Oh, thank you.

[00:21:06] Susie: I do feel like those populations can be so much more disadvantaged because of our processed food and the "Frankenfood" that , I've heard it called, that people buy at dollar stores versus having access to fresh, whole food. A lot of people don't even have access to that in their own neighborhood.

[00:21:27] Dr. Donohue: Yeah. and a lot of the science says it's relatable to the southern eating style, which is more prevalent in the African American population. I'm sure it relates also to processed foods. And I think that there's a lot of systemic things in place that make that population more vulnerable to being introduced to these less healthy foods.

[00:21:46] Susie: I know about the southern eating style cuz I married into a North Carolina family and there was a lot of fried foods When I first started dating my husband we had gone to the beach one time with some other family and they were eating so much grease and fried food. I said to him, I can't handle any anymore, my stomach… This was way long ago. I said, I just need to go to Subway, I just need a subway (before I knew any of this information).

[00:22:15] Dr. Donohue: You know you're in trouble when subway is the healthy alternative.

[00:22:19] Susie: Right. So what can you share with us that is your big picture thinking? How would you challenge the rest of us? What is your imagined state for healthcare in the U.S?

[00:22:33] Dr. Donohue: Well, some of this is just basics. Like other countries do it so much better than we do. We spend a lot of percentage of our total social spend on healthcare, and we spend a relatively small percentage on social services and most European countries, most western countries have those flipped. So they spend a higher percentage on social, on a social safety net and smaller percentage on healthcare and what gets spent on healthcare is, is more prevention. So some of this is just like, be like most of the rest of the Western world, cuz it's just more economically efficient to do it that way. There's no secret there. This is just obvious stuff.

I would say though that uh, there's an opportunity in my opinion to address again, trying to treat the root cause of our healthcare system. The root cause of a lot of our diseases is a lack of education, what I would say the proper education, lack of good health education. So this is a point I made in my talk at ACLM.

[00:23:34] Susie: Yes, I remember

[00:23:36] Dr. Donohue: Our education system needs to be reformed. As a primary care physician, over the years, I've felt like a first-grade educator because I'm teaching people stuff about their body or their diseases or about food that they should have learned. there's so much widespread ignorance of topics like what is fiber and, and what are the healthy things that are in fruits and vegetables or knowledge about just how important food is. You know, and I think I mentioned www.nutritionfacts.org. I think that's really a testament to how incredibly important food is.

One of the huge lessons of going this route into lifestyle medicine is to open my mind into this vast body of research that's been done. There's a hundred thousand research articles come out every year in nutrition science on average. And there's so much in there that has like direct implications on whether we're going develop these deadly diseases or not.

[00:24:32] Dr. Donohue: So what I want to do is get the world educated on the importance of this stuff. In my opinion, nutrition and health education and sustainability should be a K through 12 course. It should be every bit is important in the curriculum as math and reading and english and ELA and social studies.

You know, because we all have a body and healthcare is potentially so much more important than studying trigonometry, right? Cosigns and signs. How often does anybody use that? It's information is so much waste and there's so much important stuff that we need to be teaching, including lessons around sustainability. So I, I'm actually, um, in the process of trying to put something together around what I call a SMILE curriculum. You've heard of STEM? STEM education: science, technology, engineering, and math. Well, I think we need a SMILE curriculum that would be Social health, Mental health, Immunologic or Infectious disease to health around vaccines or other approaches to infectious disease, Lifestyle, including nutrition and Environmental health and Environmental sustainability.

I think to be resilient as a population to avoid the ravages of chronic disease, which we're experiencing in higher and higher numbers each passing year, to curb the childhood obesity, childhood diabetes epidemic, I think to fix all these problems and to build a more sustainable world. We ideally would have a SMILE health curriculum that everybody is studying.

[00:26:07] Susie: I think that would be wonderful. Who can we get to do that? Are you doing that?

[00:26:11] Dr. Donohue: I thought you were going to do it. I just suggested it.

[00:26:14] Susie: It sounds really great! It sounds really great.

[00:26:17] Dr. Donohue: Let's do it together.

[00:26:19] Susie: Yeah. And you know, I worked in pediatrics for a long time before I was a nurse practitioner, so I have a heart for families and young children. Cause you know, they can't, decide themselves when they're young and they can't protect themselves, so it's up to us to help do that with them.

[00:26:34] Dr. Donohue: Absolutely. I really feel like we have a responsibility to kids to teach them the right stuff. (Yes). It kind of breaks my heart when I see kids being trained to eat a certain way, like a really unhealthy way, which is so widespread as to be completely commonplace to feed your kids hot dogs, which is a processed food meat, which is known cancer causer, and known to reduce life expectancy. Just a one example of so many, we just get nutrition so wrong with our kids and every time we feed them these unhealthy meals, we're training them a skill, an unhealthy skill that they're going to have for the rest of their lives. And I feel like we're not empowering the kids with the knowledge that, that fruits and vegetables are, are so important.

[00:27:15] Susie: Right. You know, I have one in high school and one's launched to college now, but especially those middle school years, like they were all eating talkies. You know what those are? (Mm-hmm) those corn chips that are real spicy (saltiest thing ever) and drinking Gatorade. Salt and sugar. And if my son would bring something healthy, he would get made fun of, it's this culture (right) of eating crappy food is the cool thing to do.

[00:27:40] Dr. Donohue: Yeah, well, TV ads. You know, they've seen how many hundreds of hours of ads for unhealthy food and that probably accounts for 90 plus percent of the education they've gotten around nutrition. And there's topics on Beyond nutrition. So, so many more topics we should be, cover what's coming now.

[00:27:59] Susie: I reached out to my daughter's school a couple of times asking to come talk about lifestyle medicine or nutrition, whatever pillar they want. And it's always radio silence, nothing. You have to be the squeaky wheel, know what I mean? I know school systems are a whole thing in and of themselves, but I had offered up the info and the willingness to do it, just because.

[00:28:29] Dr. Donohue: well, good on you, Susie.

[00:28:30] Susie: But I didn’t get very far.

[00:28:31] Dr. Donohue: You have so much wisdom to share. You would have the perfect message for these kids, and I encourage you to squeak as loud as you can until these people fall in line and start letting you come in and talk about all six pillars. And ideally you would be doing this or somebody, somebody like you would be doing this all day, every day in the school.

[00:28:53] Susie: That would be great. My daughter told me about a day where she was standing there in the cafeteria and the principal came in and kind of looked to see what was on deck for the menu. And she went, “oh God, so gross”, and that's what the kids eat if they didn't bring their lunch.

[00:29:08] Dr. Donohue: Yeah, one of the slides I like to share is the cafeteria menu for our local school district, which is probably more forward thinking than most anybody else. And it's all fast food. It's all junk food almost every day is what most kids eat. It's a shame.

[00:29:20] Susie: And so can you tell us on that note real quick and then I'm going to let you go so you can go grab some lunch also. Tell me what your favorite, just pick breakfast or lunch or dinner or plant-based meal. What's your favorite? Your absolute favorite?

[00:29:34] Dr. Donohue: Oh my gosh. It's like picking your favorite child. I mean, how could I pick a favorite? Oh my God.

[00:29:39] Susie: We all have a favorite! I'm just kidding.

[00:29:41] Dr. Donohue: I guess I'll give a nod to purple sweet potato. I just love, love my purple sweet potatoes. They're a little more pricey, so I really hope the price comes down. They're like two bucks a pound right now, which is cheaper than chicken, but they're so filling, chewy, gooey, sweet, dark purple anthocyanin pigment rich antioxidant. So satisfying. I love to eat them. You asked for one, but I'm gonna add a bonus.

I blend walnuts and dates together. It's like icing. It's like a healthy icing and I love to eat 'em with that. I feel like I'm having like a sweet potato pie. I'm like, sinning every time I have that stuff. But anyway, it's so good.

[00:30:27] Susie: That sounds really good. (Yeah.) Okay, great. And what if somebody, if they think, you know, I could do a day or a meal or my whole life, plant-based, what is the first thing that you think somebody should do to get started?

[00:30:41] Dr. Donohue: I would say I like substituting. So take the meals you like to eat now and substitute. So, uh, instead of chicken fajitas make chickpea fajitas. Instead of beef chili make just bean chili instead of beef burgers. I recommend the older school veggie burgers. , not the impossible or beyond because those are richer, like the, the tropical oils and saturated fat but something with fiber, ideally everything that hits your palate has a lot of fiber in it.

And then, your best snacks are gonna be fruit. Eat as much fruit as you can substitute for those, uh, those main meals.

And the other thing I like to do is think about having ingredients around. if I get home and I'm ravenous, I always got it purples or, or a sweet regular sweet potato to munch on and it's so filling. So find things like that, that are healthy, that are go-to bananas, whatever's going to keep you satisfied because the goal is to don't let yourself get ravenously hungry.

Some people say, “I switched to healthy eating and I was so hungry, I couldn't do it.” You gotta eat more food. You gotta eat a lot of food, eat a lot of healthy food, have it prepared and ready to eat at all times.

[00:31:46] Susie: Those are great tips. Yep. And I think that prepping ahead, having a little bit of a plan is nice because that way you can have the stuff on hand and you can just grab it, throw it in a bowl. I just like putting everything in a bowl. That's my tip, I guess! I make bowls of everything. Rice, quinoa, greens, whatever. Just put it in the bowl. Little drizzle. And you're full by the end.

[00:32:07] Dr. Donohue: That's so great. We're doing a bowl potluck in January. We're doing the exact same thing. Everybody bring one ingredient. I love bowls. Yeah, good, good stuff.

[00:32:16] Susie: Yeah, that's great. Well, listen, I really appreciate you spending this time with us and sharing your wisdom and your knowledge, and I would love to chat with you again about the business part of the lifestyle medicine.

[00:32:29] Dr. Donohue: Let me just thank you, Susie, for all you're doing. I love your podcast. Since I've learned about your podcast, I've been a regular listener. I love your interviews. I love the questions you ask. I think you have so much to offer in the world, so keep it up.

[00:32:42] Susie: Oh, thank you. I appreciate that. Have a good day.