Cleaned Up Transcript - Blue Ridge Mountain Rotary Club Presentation, 10/1/25

Lifestyle Medicine: The Most Important Talk of Your Life

Opening

Today I'm going to give a presentation that may just be one of the most important talks of your life. I know that's a bold claim. The email said this was a talk about healthcare and medicine, and most of y'all look healthy enough. It's so easy to look at a topic like this and think that it doesn't really apply to me.

I want to paint a picture. Fast forward 20, 30 years from now. Maybe if you're lucky enough, you'll have grandchildren. And one day your grandchild is going to say, "Grandma, Grandpa, I want you to come play with me." And you won't be able to. You won't have the physical strength and stability to do so. That might when it starts to sink in. That you're no longer able to do the things you love to do. That might be hiking the beautiful Shenandoah valley, or maybe you won't be able to go shopping with your friends. If you're like most people in this country, you're decline won't be linear. You'll spend the last years of your life sitting in a chair, fading away until you die.

Now, that sounds depressing. Unless we do something about it, this will happen to every single one of us, myself included. But here's the point: it doesn't have to be this way. That's the frame I want you to hold on to during this talk. Lifestyle medicine isn't just about how you feel this month or this year. This is about the rest of your life—whether you'll be able to show up for your loved ones, your friends, and your family.

So how are we actually going to even approach this topic? First, we'll break down the structure of our current healthcare system and why it's not designed to help with chronic disease. Second, explain the training of physicians so you can understand why you can't outsource all of this to your doctor. And finally, give you practical tips you can start using the moment you leave this room to live a healthier and happier life. Across this talk there will be 5 major takehome points I want everyone to walk away with.

Introduction

Before we jump in, I should probably give an introduction. My name is Paul Clancy, and I'm a fifth-year medical and business student here at the University of Virginia. I was invited by my friend Matt Crane. So, if you don't like the presentation, you know who to go complain to.

This is a topic that's very near and dear to our heart. My parents are both in their 70s and I've seen their health start to decline. The same time as I went through the quotations, I realized that our system does a big disservice to patients. And we need to have more education about how big of a problem this is and what patients can do. Because it's such a passion of mine, I have ideas for projects on how we can help increased education about this topic. On the website there's a quick form, and I'd love to hear from any and all of you. I welcome feedback and mentorship.

I really want everyone to be able to be fully present for this presentation and the conversation we have afterwards. I've actually recorded this presentation and made a website for all y'all. So I'm going to post a link to this after, but this contains a recording of the talk, all of the resources I mentioned—books, podcasts—along with some tip sheets for some of those actual things I talked about at the end. I'm also going to send a follow-up email with this information. So don't feel like you have to take a bunch of notes and just sit back and enjoy the show.

In case you're interested, I also founded a medical education nonprofit called AdmissionsAcademy, where we're helping pre-medical and pre-health students navigate the undergrad admissions process and trying to increase equity and accessibility This is what I'm working on full time until graduation.

I also should give a disclosure that I'm not actually a physician yet. I have completed all my exams and all my elective credits, but I do have to wait until May for UVA to give me my MD. So I know this talk is not official medical advice and no patient-provider relationship is formed. My views are my own and do not represent the University of Virginia School of Medicine or the Darden School of Business.

I do have one request - get some pics for my mom please!

Health Care System Primer

Let's take a trip back a couple thousand years to the time of Hippocrates. You get sick, you come down with a fever, you go to a local healer. They really didn't have a clue what was going on. This is what we call Medicine 1.0—based on superstition, observation, and guesswork. Some of it was accurate, like the idea that walking is good for you or that food can be medicine. Some of it was not, like the theory of bodily humors. But for almost 2,000 years, this was the best we had.

Then came Medicine 2.0. With the scientific method, light microscope, germ theory, and antibiotics, everything changed. We made staggering progress. We doubled life expectancy—not so much because of medicine itself, but because of public health advances like sanitation, clean water, and safer childbirth. People stopped dying in droves from infections and trauma.

Back then most problems were a "fast death." If you got an infection, you either lived or died quickly. Today, the major causes of suffering and death look completely different. Attia calls them the Four Horsemen: atherosclerosis, cancer, neurodegenerative disease, and metabolic disease. These are slow, grinding killers. They develop over decades, they rob people of function year by year, and they don't have quick fixes. While medicine 2.0 has been extremely successful at fighting what used to kill us, it's not equipped to manage slow death from chronic disease.

And that brings us to another important point. Medicine 2.0 and our current healthcare system today is focused on improving lifespan. Seeking out a couple extra years of living. For most people, you're not truly living. You're not alive. You're just bars beating your brain for you. And that has a big effect on your feeling. So I told everyone that you could live in another 50 years. That 50 years would be spent sitting in a chair the whole time. Who's going to jump at that opportunity, right? The point of living is not just to be alive, it's to actually enjoy a good life.

Summary of Medicine 3.0

So what are we supposed to do? Well there's this idea of Medicine 3.0, which shifts the focus from reactive, symptom-based care to proactive, preventative care. It's not about waiting until a heart attack or diabetes diagnosis to act—it's about identifying risks and root causes decades earlier, while there's still time to change the trajectory.

And by identifying things or really treating them, we may improve your amount of years you live a little bit more. Most importantly, we improve what's called your health span or your quality of life in those final years. So you see here that without intervention in the current medical system, you get old and then the last few years of your life, you're not doing that well. Point of Medicine 3.0 is that maybe not only the last couple of years of your life, you're still going to have the inevitable decline, but we can really prolong that and help you do the things that matter most.

Take Home Point #1
That's the lens I want you to carry through the rest of this talk. We've conquered most of the acute killers. But the system we live in today is not built to keep you healthy against the chronic diseases that will define the last decades of your life.

How Training Works

So the idea of preventative root cause medicine, right? Yeah, most people are going to acknowledge that way to go, So why isn't it more common? Why isn't this the type of medicine that you get to experience when you go to the doctor's office? Well, there's a few barriers. First, we're going to talk about the training system of physicians in the United States.

The path to becoming a physician is long. You do four years of college, then four years of medical school. After that comes anywhere from 3-7 years of residency, depending on the specialty. Then you may do a fellowship, which adds another one to three years of highly specialized training. If you go straight through, you're in your mid-thirties by the time you're finally practicing independently.

And at each step, the training pushes you toward more and more specialization. You start broad, with a foundation in science and medicine. But by the end, you might spend your career focused on something as specific as the inner ear or the electrical system of the heart. That's what the system rewards—getting narrower, getting more technical, stacking up research papers, test scores, and prestige.

On top of that, everything we do learn is framed in silos. The heart is taught separately from the lungs, which are taught separately from the kidneys, as though they don't interact. But your body is not a machine with separate compartments—it's a complex system.

But what doesn't get rewarded is just as important. We don't do a good job acknowledging how everything is connected and works together. What doesn't get taught are the things that really determine whether people live or die over decades. That brings us to point 2

Take Home #2
There are around five or six things that really impact your health, but in the medical education system, physicians are only taught less than two of those.

  • Nutrition
  • Activity
  • Sleep
  • Mental Health
  • Drugs/Supplements
  • Surgery

Your physician is not primed with the education to actually know about the stuff.

Structural Barriers

Now let's say you somehow you've taken time to educaiton yourself on your own and make it through this gauntlet of training with your passion intact. . You're fired up about prevention, about lifestyle medicine, about actually helping patients avoid disease. What happens when you get into the real world?

Here's what I saw on my family medicine rotation in Roanoke. The doctor I worked with was one of the most exceptional physicians I've ever met. He worked 14 hour days, and saw about 40-60 patients a day. Our visit was on average about 7 minutes.

Physicians aren't trained to chase dollars, but if they don't, their practices can't survive. Their appointment slots often don't have enough physical time to cover prevention.

And it's not that doctors don't care. They do. They went into this field because they care deeply about patients. If we could wave a magic wand I imagine that the majority of them would love ot practice medicine 3.0. But they're drowning in a system that makes prevention almost impossible.

Take Home #3
Nobody can do this for you. Even if doctors mean best, we don't have the systems to teach. If you want to be involved in preventive medicine, you want to get the care, your options are either your option to really to become educated, to become your own advocate.

Instead of being an active, passive passenger, passive participant in your health, you need to be the captain and you need to educate yourself, be in charge. It takes work, but if you don't do it, nobody, including a physician, can do it for you.

Example of Medicine 2.0 vs 3.0

I know I've been really hammering prevention. Let's give an example of what that actually would look like in practice. Now an acute injury, let's say I didn't go to bed early and I went to that Friday football game, I was part of the field rush and got trampled and broke my leg. I could go to the UVA emergency room, they'd patch me up and do a really good job at that.

But the chronic diseases that kill most of us—heart disease, cancer, Alzheimer's, metabolic disease—don't happen overnight. They unfold slowly, over decades. Let's look at an example of a chronic disease like type 2 diabetes.

Take type 2 diabetes. For years, your pancreas works overtime trying to keep your blood sugar stable. Slowly, it burns out. Blood sugar creeps up, but you feel fine. Then one day you cross an arbitrary line—an A1c of 6.5—and you're suddenly labeled diabetic. Out come the pills. But in reality, you've been on that path for a decade.

And here's the cruel irony: in medicine, we act like it's binary. Not diabetic, then diabetic. But life doesn't work that way. It's a spectrum.

Prevention would look like monitoring over years, realizing the trend that is happening. As you get older, we'd focus on treating the root causes and keeping you in good health for longer

The principle is simple: almost any problem in the body is easier to treat if you catch it early. But our system is not designed to do that. It's designed to patch up the sickest people and move on to the next patient.

Lifestyle Medicine Interventions

And honestly, most of it sounds pretty obvious. Everyone knows they should eat healthier. Everyone knows they should exercise. Everyone knows they probably need more sleep.

The problem is not knowledge—it's emphasis. Our system doesn't prioritize this. To a hammer, everything looks like a nail. And in medicine, the hammer is prescriptions and procedures. When patients come in, that's what doctors are trained to use. Not because they don't care, but because that's what the system rewards, and that's what their training covered.

That doesn't mean drugs and surgeries aren't incredible. They are. As a future anesthesiologist, most of my work will be drugs. And surgeries save countless lives. But it's not always the answer. And when it comes to the chronic diseases that kill most of us, lifestyle change is the only way forward.

There is an old two-part rule that often works wonders in business, science, and elsewhere:

1. Take a simple, basic idea and
2. Take it very seriously.

— Charlie Munger

Take Home #4
The problem isn't that we don't have a clue what to do - in many cases, it's that we just don't to it, we don't take it seriously, and when we do act, we focus on the wrong things.

Don't major in the minors. Focus on the low-hanging fruit and you'll get 90% of the way there.

So what are the majors? Let's walk through six big levers: sleep, exercise, nutrition, mental health, drugs and supplements, and surgery.

The Six Big Levers

Sleep

Start with sleep. Most people need more of it, and it's the foundation of everything else.

Make your room cool and dark. Buy blackout shades. Don't sleep with your phone in the room—get a cheap alarm clock instead. Try to go to bed at the same time each night. Follow the 3-2-1 rule: three hours before bed, stop eating. Two hours before bed, stop drinking. One hour before bed, stop looking at your phone.

Even small changes here can pay huge dividends in energy, mood, and long-term health.

Activity

Next is exercise. Think about three categories: strength, endurance, and stability.

Strength training is essential, especially as you age. Every year you lose one to two percent of your muscle mass. If you want to be able to lift a suitcase overhead when you're 80, you need to be lifting 40 pounds now. Women in particular have often been told strength training is just for bodybuilders. That's wrong. Strength is what lets you play with grandkids, carry groceries, and stay independent.

Endurance comes down to cardiovascular fitness—your VO₂ max. And here's the mind-blowing stat from the bottom percentile of VO₂ max to the top reduces your risk of death from any cause by nearly 400%. For reference, smoking incresaes your all cause mortality by 200%. If exercise were a pill, it would be the most valuable drug ever created. NorvoNordisc tried this with ozempic, and it's working pretty well!

Stability is about mobility and balance—being able to squat, bend, reach, and move without injury. You don't need to overcomplicate it. Stretch in the shower. Practice a deep squat. Work your balance. Anything is better than nothing.

Nutrition

Nutrition is trickier because it's a religion. But the principle is simple: minimize ultra-processed, hyper-palatable foods. You know them when you see them—long shelf life, boxes in the middle aisles of the store, ingredient lists full of things you can't pronounce.

Cook at home when you can. If you only ate whole foods you cooked yourself, it would be very hard to gain weight. Meal prep on Sundays if you're busy. Try new ingredients. Make it sustainable.

Protein deserves a quick highlight. Aim for about one gram per pound of body weight. That sounds extreme, but it's very filling, supports strength, and makes it harder to overeat junk.

At the end of the day, the best diet is the one you can stick to that emphasizes whole, minimally processed foods.

Mental Health

You could be physically perfect, but if your mental health is broken, your life will still feel miserable.

Sleep, nutrition, and exercise all feed into mental health. But for many people, professional support is essential. Medication has its place. Therapy has its place. Don't ignore this. Lifestyle change helps, but it's not a cure-all.

Drugs & Supplements

Supplements are the classic example of majoring in the minor. The industry is unregulated, and profit-driven. That doesn't mean everything is useless. A few are well supported by evidence: creatine, vitamin D if you're deficient, and high-dose fish oil. But if you're obsessing about supplements before you're exercising, sleeping, and eating decently, you're wasting your time.

Surgery

Finally, surgery. I'm not a surgeon, but here's the point: surgery always comes with risks. And recovery often hinges on physical therapy, which too many people treat as an afterthought. If you're not willing to commit to PT, think twice about surgery.

The Hard Part

Take Home #5
Now here's the last major point I want to leave you with: this is hard. It's not supposed to be easy. You're fighting against millions of years of evolution designed to make you conserve energy. You're fighting against companies spending billions to keep you addicted to food, technology, and comfort.

Now, here's where it gets tricky. Behavioral change is hard. Really hard. And doctors get zero training in it. But if you want to live a healthier, longer life, you need to start somewhere.

Almost everyone will fail at some point. That's okay. Failure is part of the process. What matters is designing habits and environments that make success easier. Willpower alone isn't enough.

Conclusion & Next Steps

So let's step back. Show of hands, who learned something?

We've covered a lot. We've talked about how the system isn't built for prevention. We've talked about the gaps in physician training and the structural barriers that keep doctors reactive instead of proactive. We've talked about Medicine 3.0, about the lifestyle factors that actually move the needle, and about how hard it is to change.

If you remember nothing else, remember 5 points:

  1. The system is not designed to handle chronic diseases
  2. There are 6 things that have a large impact on your health, and our medical education system does not cover itdon't receive the education for it
  3. You have to take ownership of your health. Nobody will do it for you.
  4. With any interventions, focus on the important things. Don't major in the minors
  5. This is hard. That's normal

I've recorded this talk, made a website with resources, and included tip sheets for workouts, meal plans, and reading. If you want one place to start, I recommend Peter Attia's book Outlive. It lays out these ideas beautifully and was the spark that set me down this path.

I'd love your feedback. Fill out the form I'll share, and let me know what questions you have or what you're struggling with. That helps me figure out where to focus next.