Joey Wahler (Host): You can help prevent and reverse the most common diseases and live a longer, healthier life by maintaining a healthier lifestyle. So we're discussing an approach called Four For More. Our guest, Dr. David Drozek, he's Medical Director for Live Memorial Well, and the Department of Lifestyle Medicine. This is Memorial Health Radio, a podcast from Memorial Health System, Ohio.

Thanks for listening. I'm Joey Wahler. Hi, Dr. Drozek. Thanks for joining us.

David Drozek, D.O., FACLM: Hi, Joey.

Host: So we're going to get into this Four For More approach in just a moment. But first, you say you have found that less than 3% of Americans live a healthy lifestyle. Why do you think that is, based on your experience?

David Drozek, D.O., FACLM: There's multiple factors, cultural, political, socioeconomic. We could go on and on, but we have many pressures on us that keep us from eating that healthier diet.

Host: And oftentimes it's a matter of taking that first step right and then maintaining it from there. A lot of people have trouble just getting started changing their ways when it comes to eating and exercise, don't they?

David Drozek, D.O., FACLM: Yes, getting started is the toughest thing. Getting started against that inertia that we all have.

Host: Absolutely. So you say your Four For More lifestyle plan can significantly reduce diabetes, heart attacks, strokes, cancer and overall chronic disease in general, and that, as we mentioned, it can increase life expectancy. So let's talk about this Four For More philosophy, starting with the first of those four principles, which seems simple enough. Although for many people, it's far more difficult than that, which is don't smoke, right?

David Drozek, D.O., FACLM: Correct. Yeah, overall, our memory pegs are 0, less than 30, 30 by 5 or 10,000, 5, 2, 1, and almost none. And 0 stands for the tobacco.

Host: And so tell us about just how damaging tobacco and smoking are when we talk about warding off disease and living a longer, healthier life. We know it's bad. Why is it so adversarial to us accomplishing those things?

David Drozek, D.O., FACLM: One of the underlying factors is that tobacco causes inflammation in our bodies. And that's one of the root causes of cardiovascular disease, which is our number one killer, many of our cancers, which is our number two killer, and many other diseases as well.

Host: Second among your Four For More principles, a low body mass index known as BMI. Talk about the importance, please, of that.

David Drozek, D.O., FACLM: Yeah, the BMI is a calculation that accounts for height. So people who are taller can weigh a little bit more. So it's a combination of those two things together. And we know from multiple studies that the higher the BMI, the higher the weight the person's carrying, the higher the risk of many of these chronic diseases. Especially things like diabetes and cardiovascular disease.

Host: And so what kinds of numbers, again, it depends on height as well, of course, but what kinds of numbers are people typically shooting for in the healthy range when it comes to body mass index?

David Drozek, D.O., FACLM: Well when we look at the EPIC study, we found that if we just get people into the overweight range, there's significant advantage. So that's a BMI of less than 30. If we get them down into a healthier range of less than 25, they have even more benefits.

Host: Your third, Four For More guideline, be active, which means what exactly?

David Drozek, D.O., FACLM: We want people to be physically active. It doesn't have to necessarily be exercise. It just can be things that they normally would do in their life. It can be gardening. It can be dancing. Lots of different ways we can look at that. We just want people to move. So the way we measure that is we say 30 by 5 or 10,000.

So the 30 minutes a day, 5 days a week of physical activity, so it can be cut in half if the activity is more vigorous, like running. If somebody's interested in weight loss and weight maintenance, it probably needs to be double that, an hour a day, five days a week.

Host: I was just trimming my hedges and I can tell people, doc, if you do that a couple of times a month or so in the warm weather, that's about all the workout you need.

David Drozek, D.O., FACLM: That definitely counts in that category for physical activity. For many people who like to count numbers, a step counter is helpful. If we can get people up to 10,000 steps a day, there's some definite advantage to their health by doing that, and even more steps is even better.

Host: The fourth, Four For More principle, eat a healthy diet. And so what do we want to eat? What do we want to avoid?

David Drozek, D.O., FACLM: Yeah, so we try to get people to engrain the numbers 5, 2, 1, and almost none. And these are minimums to start. You can go well beyond this, but the 5 stands for those fruits and vegetables. We like people to eat whole foods, foods that are minimally processed. They can be cooked, but not processed out of recognition, like something like an Oreo cookie would be.

So five servings of fruits and vegetables. Two servings of whole grains, that can be oats, like for oatmeal, brown rice, many of the other grains that are out there, whole grain toast counts as well. Two servings of that a day, and one cup of legumes, which are beans, peas, or lentils. So if we get those added to the diet, then they help push off the things that are less healthy.

And that's the almost none. We want to avoid the things that are causing the cardiovascular disease, the cancers, the many things that we're trying to avoid. And those are the foods that contain high levels of salt, sugar, and fat, in particular, the saturated fat and cholesterol. So we try to get people to minimize the red meats and the processed meats, minimize the high fat dairy, and to go toward other options, ideally increasing their plant based intake.

Host: So five, two, and none, and we want to do that on a daily basis, ideally, right?

David Drozek, D.O., FACLM: No, five, two, and one.

Host: Five, two and one.

David Drozek, D.O., FACLM: So daily, five servings of fruits and vegetables, two servings of whole grains, and a cup of legumes. And almost none of those products that have the salt, sugar, and fats, particularly the animal fats.

Host: Gotcha. A couple of other things. So these things are of course, all approaches that have been discussed probably since the beginning of time. Tell us how you and yours at Live Memorial Well help patients to achieve these lifestyle changes.

David Drozek, D.O., FACLM: We have several methods that we can use with people. One is our individual appointments with one of our lifestyle medicine specialists. The other that is very popular and actually works very well because of the group dynamic, are our Fresh Start classes.

Host: And so what does that consist of?

David Drozek, D.O., FACLM: So the Fresh Start classes are a series of 90 minute classes. There are 10 of those. We usually offer those in the fall and again in the winter, early spring. And we'll enroll up to 30 35 people in a class. We do food samples and have one of our chefs come in and have a discussion with people who are there in the class. We go over materials for that session. So each session has a topic that we focus on, something like fiber or blue zones, different topics. It's all available on our website as well. People can look at that on their own. They don't need to come to the classes to get the same information. And then we end with setting some goals.

We have people share their goals to make them more accountable to other people in the group. And then when we come back the following session, we usually start with talking about how we did on our goals.

Host: So let me ask you a couple of things about what you just touched on. You mentioned food samples. Is that to let people know that some of these healthy foods that perhaps they're not as used to are more tasty than they could realize?

David Drozek, D.O., FACLM: Yes, we have a recipe of the week. So yes, we have them come in and taste the food, and most of the time they enjoy it. And then we give them that recipe as an assignment to go home and reproduce that for themselves and their families.

Host: And then you mentioned it's a group setting and tell us doctor, if you would, please, about how that group dynamic can be effective when coaching people for lack of a better term, in these areas that we're mentioning.

David Drozek, D.O., FACLM: Well, there's multiple studies out there that have shown that people do better in community, rather than being the Lone Ranger trying to make these changes on their own. They get that mutual support, a bunch of people doing it together. They come back and they share their successes and their struggles.

And oftentimes somebody else in the group can help give suggestions to people who are struggling in one area or another by sharing what they've done to overcome that. And then that accountability. People want to do well when they're in that group setting, they want other people to think well of them. So they work all the harder at achieving the goals and it seems to work very well.

Host: And when I mentioned a moment ago that some of the things we're talking about in a general sense have been talked about since the beginning of time, if you will, what's great here, of course, is that you've taken this Four For More approach, and you've really tried to kind of simplify things for people, right? So that they're not overwhelmed and they can make these changes more easily and take that first step and go from there, right?

David Drozek, D.O., FACLM: Yes. We've tried other things in the past. Many other programs have done things like calorie counting and things like that that are burdensome to many people. So we've tried to simplify that with the Four For More.

Host: You also stress that middle aged folks can start doing this even if they've not done any of these things we've just been talking about, and it's not too late, right?

David Drozek, D.O., FACLM: Right. Not just middle age, even people in that geriatric age range. We've seen several studies where people actually improve their health. People who were actually, on death's door, actually getting better and finding a renewed life, getting out there and being participants in life rather than spectators.

Host: So middle age and on then, and it's never too late.

David Drozek, D.O., FACLM: Correct.

Host: And finally, in summary here, Doctor, the word lifestyle is key here. Isn't it? Because you're not looking for people to just diet or change short term. You're looking for them to literally do this for a lifetime, right?

David Drozek, D.O., FACLM: Yes. It's a journey. So, what we focus on actually are these things we call modifiable risk factors. Those things that are under our control by the choices we make that can make a huge impact on what happens to our health. So, we get people to work on those lifestyle factors to improve their health, empower them with the knowledge so that they know what they can accomplish and help them do it.

Host: Sounds great. And folks, we trust you're now more familiar with Four For More. Dr. David Drozek, thanks so much again.

David Drozek, D.O., FACLM: Thank you, Joey.

Host: And for more information, as well as to connect with their providers, please visit nhsystem.org. Again, that's N-H-S-Y-S-T-E-M.org. Please remember to subscribe, rate, review this podcast and all the other Memorial Health System podcasts as well.

If you found this podcast helpful, please do share it on your social media. I'm Joey Wahler. And thanks again for listening to Memorial Health Radio, a podcast from Memorial Health System, Ohio.