Podcast Episode 209: Tackling Wellness One Step at a Time – Dr. David Sabgir

[MELISSA]: Hello and welcome back to the Sound Bites Podcast!

In today’s episode, I’ll be speaking with Ohio-based cardiologist Dr. David Sabgir about the national movement known as Walk with a Doc and how it all started with his grassroots efforts to address cardiovascular disease prevention.

Many of us are aware of the stark statistics around heart disease – it’s the leading cause of death in the U.S., and globally  for that matter. In the U.S., it’s responsible for 1 in 4 deaths.¹ Many deaths from heart disease are preventable with lifestyle changes and that’s where David has been focusing his efforts the past 18 years.

Dr. David Sabgir is a full-time cardiologist in Columbus, OH and the Founding CEO of Walk with a Doc, an international nonprofit with a mission to inspire communities around the world through movement and conversation.

I’m already intrigued and inspired by you, David, and can’t wait to dive in.

Before we do, I want to note that this episode is sponsored by Fresh Avocados – Love One Today® and we thank them for their continued sponsorship and support of the podcast. As many of you know, Love One Today is a leading source of the healthiest reasons and tastiest ways to enjoy fresh avocados. As a science-based resource, Love One Today provides turnkey solutions that make it easy for health professionals to stay on top of the latest research and confidently recommend avocados.

This podcast episode is also eligible for one free continuing education unit through the Commission on Dietetic Registration for registered dietitian nutritionists, dietetic technicians registered, and certified diabetes care and education specialists. You can visit the show notes for this episode or my CEU page at soundbitesrd.com for more information.

Dr. Sabgir, welcome to the show!

[DAVID]: Thank you for having me, Melissa. I am thrilled to be speaking with you.

[MELISSA]: Now can I call you David or do you prefer Dr. Sabgir?

[DAVID]: Please call me David

[MELISSA]: So, David, I’d love to hear about how you got into the field of cardiology. What was your inspiration initially for even becoming a doctor?

[DAVID]: I actually knew from a pretty early age that I wanted to be a doctor. I had an impressionable experience when I was nine years old my uncle was sick and his son was a cardiologist at the time in Houston and he guided me up to the room and the grace and dignity and compassion he showed – I was hooked on wanting to be a doctor. So moving forward through all the training with my cousin Mike being a cardiologist that was very important to me to see what I could do, if I could make that field. I love the field for the personalities that are there but also it’s a great combination of patient procedures and just spending time with patients, and I love that component of cardiology. As a physician in general we get to spend time with patients when they are at their most vulnerable moments and that is a gift for any of us as physicians and something that we don’t take lightly so now looking back I was so happy I was able to pursue medicine as a career.

[MELISSA]: Wonderful! And tell me a little bit about where you did your training.

[DAVID]: Sure! Undergrad I went to Miami of Ohio and for med school I went to a school called Medical College of Ohio in Northwest Ohio, Toledo, and for internship, residency and fellowship was all at Ohio State.

[MELISSA]: Well thank you, it’s always great to hear about how somebody got to where they are today and what an inspiring story! I’m glad that cardiology found you and you have made such a career out of it and you’re enjoying it. What would you say is one of the key things you’ve learned over the years that has made you a better clinician?

[DAVID]: I’ve learned a lot over years, and am still learning, but one of the main things is that there are many pieces to the wellness puzzle – exercise, sleep, nutrition, and even social connection – and that all are interconnected and need to be addressed in order to have a positive impact on overall health outcomes. Over the years, we’ve been fortunate to see a number of advancements when it comes to medications and surgeries that help in the treatment of heart disease. However, the thing that I believe has made me a better clinician is focusing on the lifestyle factors that can prevent this disease including recognizing where my patients have opportunities to improve. When I first started seeing patients, I quickly realized that a lot of them were leading sedentary lifestyles and not getting a lot of movement through the day. Taking the time to see these short falls and promote everyday inspiration that makes it simple and sustainable makes me a better doc.

[MELISSA]: Very good. The prevention and treatment of heart disease can feel complex at times but, as you said, it’s our job as health professionals to make it simple and sustainable – make it part of everyday and there lies the challenge. You mentioned nutrition being an important component. As a registered dietitian myself, and many of our listeners being RDs, can you talk about how you approach nutrition counseling with your patients? Do you work with dietitians in your practice?

[DAVID]: Of course! So these days, I’m 90 percent cardiologist and 10 percent Walk with a Doc CEO so I’m fortunate to have a lot of opportunities to bring nutrition into the conversation. Let me first strongly acknowledge I’m not certified in nutrition, like you, nor do I pretend to be. However, I do think it’s critically important that physicians, like me, keep up with nutrition research and integrate it into our practice in some way. Nutrition almost always comes up during my time with a patient and I try to keep it simple and meet them where they are. We all respond differently to various approaches and that’s something I try to sort out during the initial and follow up office visits. I often start by asking, “What are your thoughts on your nutrition?” That usually opens the floor and reveals some good information and then we can make a plan from there.

When I’m able to, I absolutely try to add a RD to the patient’s care team to be sure they’re getting the expert advice and counsel they need. Through my organization Walk with a Doc, we work with RDs to help share nutrition advice and tips to our walkers and volunteer physicians. And anytime we can get RDs to present at a walk, we jump on it.

[MELISSA]: Wonderful! I love your approach and certainly not everyone’s going to have the opportunity or the need necessarily to see a dietitian so I whole heartedly agree that all healthcare professionals need to be able to open that floor, like you said, and invite people to share their thoughts about nutrition.

[MELISSA]: So I understand you had a lightbulb moment years ago that changed the path of your career and approach as a cardiologist and I’d love to hear more about that.

[DAVID]: And I love talking about it, so that’s a good fit! As I mentioned, I was seeing patients who were mostly leading sedentary lifestyles, which unfortunately is all too frequent across the U.S. Frankly, I was almost 100% unsuccessful at motivating them to be physically active – no matter what I tried. One day, in a moment of frustration and desperation, I asked a patient to join me and my family for a walk in the park on a Saturday morning. I decided I wanted this patient to have to say “no” to my face, and to my surprise, the patient said “yes” immediately and enthusiastically. It was a really magical moment.

That was in 2004 (18 years ago) and based on the response I got, I thought I’d invite every single patient I had– just to see what would happen. So I collected over 1000 emails that winter and in the spring of 2005, we hosted our first walk with more than 100 people and that was when Walk with a Doc was born. It was rooted in this simple idea—walk the talk with your patients. There is something about the simplicity of it all – and the potential for impact – made sense and caught on. As a physician I can say with zero hesitation this needs to be a part of the practice of medicine.

[MELISSA]: What an inspiring story. So, tell us where Walk with a Doc is today, 18 years later.

[DAVID]: Today, we have over 630 chapters across the globe – 41 countries – prior to COVID we had 129,000 people participating in walks each year and with the numbers dipping we are getting back to that number much quicker than I had even hoped. We have an incredible network of about 2,000 doctors who volunteer to lead walks around the world. They share our vision to up-level care for our communities one step at a time and I feel really lucky to have found this group of people. The doctors give a brief, educational presentation at the beginning and then lead participants on a walk at their own pace. A lot of walks have healthy snacks, coffee, and blood pressure checks, those are an optional part of the walk. It’s really become a source of connection in communities and something that people, both the participants and the doctors, look forward to. The program started with exercise but has evolved to focus on other things like nutrition education.

[MELISSA]: That’s amazing. And 2,000 doctors – that is incredible! You know I think during COVID it seemed like everyone was walking everywhere so I’m glad your numbers are getting back up to precovid numbers. How has this program been received by the doctors?  How has this improved or changed their practice?

[DAVID]: It was rough for the first five years and now things have flipped. We’ve learned that for our volunteer doctors, this is really a labor of love and passion project – it gives us a purpose that we might not be getting as strongly in the office and it also really helps in making progress with our patients. You can imagine seeing them 50 times a year instead of once. Typically, patients get a very brief amount of time with their provider when they go in for appointments. They don’t love that—and trust me, as a doctor, we’re not thrilled about it either. It doesn’t leave much time to form a connection which is critical.

With our Saturday morning walks, suddenly there’s time to connect. You get to meet your patient’s family. They get to meet your family. There is time to talk about the bigger picture, health or otherwise. We form friendships very quickly and there’s something really special and really powerful about that.

Many doctors – and health professionals in general – go into their field to connect and help people. Walk with a Doc allows them to do this. It feels really good to be able to help your patients actually accomplish their goals and that’s what keeps the doctors coming back. I’m sure you can relate to this as a RD.

[MELISSA]: Absolutely! And just that connection factor, it’s the secret ingredient, and I can certainly relate to that as a dietitian and as a person. Over the past 18 years, you’ve had support from different, like-minded organizations that have helped Walk with a Doc grow. Can you talk about that a bit and your philosophy behind partnerships?

[DAVID]: In the early days of Walk with a Doc, when we didn’t even know what it could become, we were getting a lot of great advice from other experts and organizations with similar goals and that’s when we decided to become a nonprofit. Because our program is community-based and we’ve made it so simple to start a chapter, word of mouth has been a powerful marketing agent for us. We’re a group that’s rooted in really clear values and we’re led by doctors and other health experts. Who we decide to collaborate with is very important and it needs to align with those values.

For our recent virtual walks, we teamed up with Fresh Avocados – Love One Today. Working together just made sense. Many Americans are getting behind in the amount of fruits and vegetables, unsaturated fat, and fiber. With avocados being virtually the only fresh fruit with good, unsaturated fats, they’re a really easy way to meet these nutritional recommendations.

• More than 75% of the fat in avocados is unsaturated
• Avocados are a good source of fiber
• Additionally: as with most fruits and vegetables, avocados are cholesterol- and sodium-free

AND there are many published studies that support the growing body of evidence that avocados are heart-healthy.

[MELISSA]: My listeners know that I’m a big fan of avocados. I recently did an episode with Nikki Ford, the Senior Director of Nutrition at the Avocado Nutrition Center, and that interview really increased my awareness and appreciation for nutrition research. A lot of what we know about the nutrition and health benefits of avocados is because of the independent research funded by the Avocado Nutrition Center. Before they invested in research, there was only a handful of nutrition research studies looking at avocados. Now, within the past decade, the Avocado Nutrition Center has supported 16 studies exploring the consumption of avocados and cardiovascular health. 11 of those have been published and 5 are in progress. The same goes for other foods where there are organizations set up to invest in the research.

[DAVID]: With help from researchers around the world, health professionals like us continue to get more and more peer-reviewed findings and insights about the value of this fruit when it comes to health. I think that’s pretty cool!

For instance, there’s a neat study that I recently learned about which was funded by the Avocado Nutrition Center. It’s a systematic review and meta-analysis, that included over 200 participants and seven studies, when compared to an avocado-free diet, researchers found that including avocado in a diet increased good HDL-cholesterol and decreased total cholesterol to HDL and bad LDL to HDL- ratios. It’s important to note that when reported, the daily avocado intake ranged from one to 3.7 medium avocados and only studies of at least three weeks in length were included in the analysis.

[MELISSA]: We know – as with any nutrition research – that there are limitations to be aware of. Systematic reviews and meta-analyses, like this study, do not demonstrate cause and effect and this paper includes limitations such as a small number of subjects reporting data with a wide range of characteristics among participants. More research is needed to generalize the results to all people, but the findings certainly add to the growing body of evidence pointing to avocados as a heart-healthy fruit.

[MELISSA]: Building off of the topic of nutrition, you mentioned something really important earlier about how exercise, nutrition, sleep, and social connection are all important for cardiovascular health and overall wellness. Let’s dive into this a bit more. Can you briefly share why each of these is important?

[David]: Oh my gosh, I love talking about this stuff. There are many complementary approaches to improving heart health but an action plan that combines all of these pieces – physical activity, nutrition, sleep, and social connection – can address preventable risk factors. You know, the pandemic really brought to light the importance of all of these issues – and there wasn’t a lot positive about the pandemic but this was one thing that helped.

[DAVID]: So in regards to physical activity, a lack of movement is what inspired Walk with a Doc – it’s the foundation of our program.

The evidence is pretty clear that not getting enough physical activity is one thing that can lead to heart disease as well as other conditions that are risk factors, like obesity, high blood pressure, high cholesterol, and diabetes. Physical activity can help you feel better, function better, and even sleep better – again, emphasizing the interconnectedness of all of this.

It’s recommended that adults get at least 150 minutes of moderate-intensity physical activity or 75 minutes of vigorous-intensity physical activity, or an equivalent combination each week. And children and adolescents should be active for at least 60 minutes a day. I’m a huge fan of walking because it’s achievable. It doesn’t require any equipment, you can do it almost everywhere, and even our Surgeon General, Dr. Murthy, in 2015 recognized walking as one of the single most important things we can do for our health. So there is that, that’s physical activity and then also nutrition.

We also know that a quality diet makes a difference to our overall health. I know I’m preaching to the choir here to you, Melissa, and a lot of you who are listening. Nutrition science is complex, but the body of evidence strongly supports eating fruits and vegetables as well as sources of unsaturated fat and fiber as a way to support heart health and overall wellness.

[MELISSA]: Absolutely. Yes, we know that Americans are not meeting recommendations for fruit and vegetable intake, good unsaturated fats or fiber for sure. OK – let’s talk about the last 2 pieces – sleep and social connection.

[DAVID]: Not getting enough sleep, which the CDC defines as less than 7 hours for adults, has been linked to many chronic diseases and conditions—those include type 2 diabetes, heart disease, obesity, and depression. 1 in 3 adults don’t get enough sleep and kids don’t either and their sleep needs are even greater. Teenagers 13-18 years need about 8-10 hours and kids 6-12 years need 9-12 hours per night. 70 of teenagers and 60 percent of kids, aren’t getting enough sleep.¹³

Why does this matter? Research suggests that short sleep duration results in metabolic changes that may be linked to obesity. Epidemiologic studies have also shown an association between short sleep duration and excess body weight in all age groups but in particular, children. Health experts believe that since sleep in childhood and adolescence is important for brain development, insufficient sleep may adversely affect the function of a region of the brain known as the hypothalamus. The hypothalamus regulates appetite and the expenditure of energy.¹¹ Obesity is a known risk factor for heart disease and other conditions like high blood pressure and LDL cholesterol.

[MELISSA]: The sleep component is really interesting and I’m glad we know so much more about that connection these days. And I’m glad as a mom I was always very, I wouldn’t say strict, but made sleep a priority for my children and they’re really good sleepers and I’m really happy about that! I was looking at statistics from the CDC before our chat today and noticed that lack of sleep is more prevalent in some mid-west, mid-Atlantic, and southern states. What’s interesting about that is the correlation to heart disease prevalence in the US.

[DAVID]: It’s a valid point and is really eye-opening. OK – let’s talk about the last piece of the puzzle – social connection which has become more and more in the news recently.

[DAVID]: Many of us can relate to this after what we’ve been through during this pandemic. It has affected us in ways where we haven’t been able to interact and socially connect. A body of research, particularly looking at older adults, showing that social isolation and loneliness have a serious impact on physical and mental health, quality of life, and longevity. Based on the evidence, the effect of social isolation and loneliness on mortality can be comparable to that of other risk factors such as smoking, obesity, and physical inactivity. Think about it, when we were in lockdown, a lot of things changed for us – our exercise patterns changed because we couldn’t go to the gym or were afraid to go outside at times; our eating patterns changed because we were stuck at home; and for some, our sleep changed because we weren’t as engaged and active throughout the day. It’s all connected.

[MELISSA]: Absolutely. We’re still learning a lot about this virus, but can you speak to any associations with heart disease?

[DAVID]: You’re right – there’s still a lot to learn. Based on the data available to date, having heart conditions such as heart failure, coronary artery disease, cardiomyopathies (or weak heart muscle), and possibly high blood pressure can put us at higher risk for getting severely ill from COVID-19.

[MELISSA]: Back to the social connection, you talked about how social connection is integral to our health, and I 100% agree, I don’t think anyone could disagree with that. And to your point, it became very top of mind for us during the pandemic and still is. With that in mind, how have you pivoted your efforts during the pandemic?

[DAVID]: Oh boy – it’s been two years hasn’t it? Like many other organizations, we transitioned our walks to being virtual for a while. This was tough since social connection and talking with your friends is such an important part of what we do. One of our major pivots was going virtual for the Grand Canyon and Aloha Adventure walks. By bringing these virtual walks to life and creating this online community, we were able to still reach a significant number of people to educate and motivate. The Grand Canyon walk was in 2021 at the height of the pandemic and with help from Love One Today, we were able to offer this virtual walk free of charge which helped with access. And that has since evolved to now, we’re taping this on March 2, we just came off the best February we’ve had in our 18 years as far as requests so the momentum is returning.

[MELISSA]: That’s wonderful! I know the social connection piece has been tricky because we have been so isolated, but there have been some really interesting turn of events with the virtual options. You know we see this with conferences, like more people could attend because it was more accessible and things like that, so I’m glad to see you were able to use the virtual aspect albeit wasn’t your choice but to make that work for you. So let’s come back to these 4 pieces in a bit and talk about some ways to actually help people find success. Before that, I’d love to hear how you feel Walk with a Doc is helping to address some of these pieces. What success have you seen with the program?

[DAVID]: Based on surveys we’ve done with participants and volunteer physicians; I can tell you that:

• Majority of our guests join Walk with a Doc to increase their physical activity (understandable), meet and spend time with other people, and learn about topics related to health. Walk with a Doc is able to help them achieve these goals.
• 96% of respondents strongly agree that the program has helped them lead a healthier lifestyle.
• It has also had a positive impact on the volunteer doctors who often report having high levels of stress and burn-out with their careers.

These are a few of the powerful and positive changes we’re seeing. We’ve also done two of our largest walks the past couple of years, from a participation point. Although virtual, these walks have been centered around healthy movement and nutritious eating. In 2021, we did a virtual Grand Canyon-themed walk with Love One Today over the course of 14 days spanning nearly 70 miles. And a really cool thing is Dr. Tedros, Director General of the World Health Organization, who we’ve seen more throughout the last two years with COVID, gave us a shout out on Twitter that I just want to blow up and frame and put up in my office!

And in February, just a couple days ago, we wrapped up the next version of that, a  Hawaiian-themed Aloha Adventure walk. We’re still gathering the data, but I can tell you that in 2021, we exceeded our walker goal by 2.5x and our social engagement goal by 5x. I think it boils down to the fact that people enjoy and engage with creative challenges that include specific tasks and specific foods.

[MELISSA]: Very good, I bet some of the doctors also reported increased activity as well! So, let’s turn our focus to actionable tips and takeaways for patients: The S.M.A.R.T. goals philosophy is at work here. We know that all of this is important but what are some ways we can help our clients find success and help them set S.M.A.R.T. goals? As a RD, I know it’s nice to have some fresh ideas.

[DAVID]: It’s important for tips to be specific and attainable; people often respond better to specific recommendations that they know are achievable. That is what has made walking so successful for so many of my patients.

When it comes to movement, I like to push my patients to challenge themselves every day and we’re all coming from a different place. It’s like gamifying our life, right? Besides walking the extra few blocks to the park or choosing to take the stairs instead of the elevator, another fun approach I’ve used is ‘temptation bundling.’ For example, if you love a certain podcast, like this one, only allow yourself to listen when you go for a walk.

Another piece of advice is something I’ve witnessed personally. I am much more consistent when I’m wearing a pedometer or watch that records my steps. It makes it fun as I try and hit new goals. I’ve been doing it for years and now unfortunately I’ve gotten to a point where I hate taking my watch off to charge – I don’t want to miss any steps!

And of course, you can also join a Walk with a Doc group in your area.

[MELISSA]: Pairing an activity with something you love is very creative and effective. I really like that. I also believe that part of getting people to commit to changes is looking at how they are spending their time, what they are choosing to eat, and evaluating the value of those actions. For example, it’s important to consider the nutrient-density and thus, value, that something like avocado, nuts, or yogurt] provides versus other foods someone may be eating frequently.

[DAVID]: Exactly. One tip that has worked for my patients is to designate snack time as their daily opportunity to catch up on nutrition goals and get in more fruits and vegetables. It’s just one part of the day so it feels doable and is a great starting point for establishing solid eating behaviors.

There are lots of options when it comes to food – and it’s important to eat things we enjoy. There does need to be a level of planning ahead in order to have handy nutrient-dense foods for that energy boost between meals.

Snacks that rise to the top for me are those that satisfy your hunger, supply your body with energy, and provide those essential nutrients.

• Mashed avocado on toast is great. My wife, Kristin, will regularly add avocado to our smoothies – it makes them creamy like a milkshake. I’m a big fan. This is also a good non-dairy option for adding creaminess, if someone is looking for that.
• When you think of foods with fiber, avocados may not be the first food that comes to mind. But, avocados are actually a good source of fiber with 3 grams per third of a medium avocado. And thirty-five percent of the fiber in an avocado is soluble fiber, which prevents our digestive tract from absorbing cholesterol and therefore reducing the risk of heart disease.
• I noted some research earlier but one other example is a recent clinical trial where 45 adults with overweight or obesity added one avocado a day to their low-fat and moderate-fat oil diets. By adding the avocado, researchers noted increased blood antioxidant levels and decreased oxidation of small, dense LDL-cholesterol levels. During this five-week cross over study, researchers concluded that results from a single study could not be generalized to larger, more diverse populations. Still, the study supports the growing body of evidence demonstrating avocados as a heart-healthy fruit- and a great option for snacking.
• I also love chowing down on celery and hummus and I have a lot of patients that swear by a handful of nuts half an hour before dinner to fill them up.

[MELISSA]: I love that approach to snack time – it can be a really great opportunity to enjoy a snack that helps fill those nutrient gaps. My favorite way to enjoy avocados is simply cut into bite size pieces with a dash of salt or squeeze of lime, or of course my famous guacamole with red onions, tomatoes and plenty of lime and cilantro. Let’s also talk about sleep and social connection. Any specific tips for these aspects of wellness?

[DAVID]: I’m in the afternoon of an office day and I’ve already talked about it several times with patients. When it comes to sleep, I encourage my patients to:

• Be active during the day. This can help you fall asleep at night. Another reason to start walking!
• Get on a schedule, if you can. I know it’s difficult for some professions and certain circumstances but going to bed and getting up at about the same time each day can support a healthy sleep cycle.
• Avoid large meals, caffeine, and alcohol before bedtime.
• Remove electronic devices from your room or set your phone to do not disturb.

For social connection, I think this goes back to the idea of ‘temptation bundling.’ We can help our clients find social connection through the things they love. It’s also important to prioritize social connection, just as you would prioritize work meetings. It’s just as important.

• If you can do safely, schedule a weekly walk with a friend or family member. If you can’t be in person, walk and talk on the phone.
• Share things that encourage healthy living – maybe it’s a funny text that will make someone laugh or an easy recipe to inspire a healthy snack.
• It can also be as simple as saying hello to neighbors as you walk in your neighborhood. Connections can happen in so many ways.
• Of course, you can make so many friends at Walk with a Doc.
• I’m always looking for new tips and luckily, with the pandemic, it seems like a lot of people are sharing ideas. There are a lot of good resources out there.

[MELISSA]: Great ideas – I definitely find that I sleep better when I’ve been active that day, and I love the suggestions to make these social connections a priority – put them on the calendar, schedule them like a meeting – that definitely works for me. Like you said, bundling it up together with walking with a friend and if you can’t be there in person, put in your ear buds and walk together, separately. What is next for you and Walk with a Doc? What do you hope the future looks like?

[DAVID]: I’m very pleased with where are and what we’ve achieved, but not content.

We added 118 chapters last year, which was down from previous years. But it looks like we are back and we are coming back strong. I think there has been pent up demand that I am thrilled to be seeing as the days go on in 2022. Due to the simplicity of setting up a chapter and the passion that is in this community, I feel that we will strike out if we don’t hit 5,000 neighborhoods eventually.

So right now we have partnerships with 43 medical schools to integrate physical activity principles into their education. That’s part of our grand vision. Of course we want them all. We want to transform the way medicine is practiced, to make it more open, accessible, and rooted within a community. Despite the abundance of scientific evidence on the health benefits of physical activity and other lifestyle factors like nutrition, most physicians receive little to no formal training on how to talk with their patients about modifying these aspects of their life and the impact it can have on health and well-being. 

In response to this, we created Walk with a Future Doc in 2015. With this program, our future practitioners, under the direction of mentoring doctors, present discussions, check blood pressures, and walk with their local communities, in the same manner as Walk with a Doc. This provides opportunities for students to learn firsthand about the health benefits of physical activity generally and walking in particular, while providing a powerful opportunity for medical students to engage in their communities. There are currently 43 Walk with a Future Doc programs around the world and scholarships are now in place to take away the cost burdens of implementing and maintaining these programs.

[MELISSA]: It’s really remarkable to see what you’ve done so far. I have to say, I believe you are changing the world one step at a time!

[DAVID]: Thanks, Melissa, it takes a whole village to make it happen and I’m so happy to be a member of that village. I hope that there will be a time, within my lifetime, when people won’t remember when they didn’t take walks with their doctors. There are over 900,000 doctors in the U.S. and so many more nurses, nurse practitioners, and dietitians. If we cast this net broad enough, we can reach every community.

I look forward to seeing more research that helps our understanding of the connection between diet, lifestyle and disease – as we help to spread this news to others. Especially during these uncertain times, we see health professionals and consumers valuing updates on science and nutrition research and tools to help incorporate more heart healthy foods like avocados in their daily diet.

At Walk with a Doc, have a very big and very simple goal. We want to be an intact piece of the healthcare puzzle that doctors and patients can reliably depend on. To achieve this, we need to be respectful of the gift we’ve received and be true to it. If we do that, everything will work out in the end.

[MELISSA]: What is the most important thing you want our listeners to take away from today?

[DAVID]: I have said simplicity a few times – Don’t underestimate simplicity. Simple but specific changes like snacking on fruits and vegetables 3 times week – something as simple and delicious as guacamole with carrot sticks – or walking for 30 minutes 5 times a week to get the recommended 150 minutes of can have a significant impact on health.  No need to overcomplicate it.

A simple idea I had 18 years ago turned into an incredible, powerful thing that I never could have imagined.

[MELISSA]: Absolutely so true – simple is very key in this equation. Thank you so much for talking with me today and for all the great work that you have done and will continue to do.

As a reminder for our listeners: Links to research and resources that we have discussed, and more, will be available in the show notes. You can find those by going to soundbitesrd.com and also through any podcast app or platform you use to listen to podcasts.

This podcast episode is eligible for one free continuing education unit (CEU) through the Commission on Dietetic Registration for registered dietitian nutritionists, dietetic technicians registered and certified diabetes care and education specialists. Visit the show notes for this episode or my CEU page at soundbitesrd.com for more information.

For more information about Walk with a Doc, visit walkwithadoc.org. There, you can sign up for David’s weekly newsletter which is filled with funny stories, Walk with a Doc news, tips, and more. I highly recommend it.

David, are there any other resources you recommend to our listeners?

[DAVID]: I recommend checking out LoveOneToday.com/WWAD for heart-healthy recipes and educational materials including a handout we developed about how to create a heart health action plan that combines movement and nutrition – it’s called “Meaningful Steps Towards Heart Health.”

You can also check out the Health Professional tab at LoveOneToday.com for more about nutrition research, free educational materials, and easy recipes. I also recommend subscribing to their newsletter exclusively for health professionals. This newsletter provides the latest research, nutrition info, tips, as well as updates on continuing education opportunities like this podcast.

Thank you so much, David, for sharing all of the valuable information! And thank you to everybody tuning in, and thank you to Fresh Avocados – LoveOneToday® for sponsoring this podcast episode.

As always, enjoy your food with health in mind – and some delicious, nutrient-dense avocados! Till next time…

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