Let me take you into three rooms.
The first is an Aussie Rules football oval on the east coast of Australia. It's late afternoon, the air is thick with humidity, and a young strength and conditioning coach is standing on the boundary line watching a group of players he has spent all season preparing. It's his first season in the job, and by the end of the day his team have won the premiership.
The second is a birth suite in a rural Australian hospital at 3 in the morning. The nearest specialist backup is 30 minutes away, so a midwife and a doctor who used to be a strength coach are responsible for getting a woman and her baby safely through delivery.
The third is an Emergency Department in the United States. A man in his fifties has crushing chest pain, and his chart tells a slow story: years of high blood pressure, cholesterol creeping up, and the word prediabetes sitting in several clinic notes.
All three rooms belong to my career. And the same question followed me through each of them: why do we put so much effort into rescuing people at their worst moment, and so little into helping them avoid that moment in the first place?
Know your messenger
The health information space is crowded with people selling stacks, products, and protocols. Many of them win your trust by sowing distrust in everyone else, then sell you the cure for a problem they convinced you that you had. One of the best defenses against that is simple: know who is talking to you, what they've actually done, and what biases they bring.
So here are mine. I'm a former strength and conditioning coach, so I think exercise should be a mandatory prescription. I trained and practiced in Australia, a country with universal health coverage, so I see health care through a primary care lens. And I care a great deal about climate change, because it is a health issue. Weigh what follows accordingly.
What elite sport taught me about prevention
Before medicine, I studied exercise physiology and spent 5 seasons as the strength and conditioning coach for the Southport Sharks, an Australian Rules Football club on the Gold Coast, winning the premiership in my first season. I then spent 3 seasons as Head of Human Performance for Gold Coast United in the A-League, and owned the Gold Coast franchise of Acceleration Australia, a sports performance business. Three lessons from that time still shape how I practice medicine.
The fundamentals are the program. Professional athletes have access to every gadget imaginable, but the real program was sleep, nutrition, progressive training, and recovery, done consistently. The best athletes were the ones who never skipped the boring work.
Prevent the injury, don't just treat it. Clubs invest heavily in screening movement, managing training load, and strengthening weak links before they break. We called it prehab, and it was some of the best value work we did.
Athletes have a team. Most people don't. A professional footballer has a coach, a physiotherapist, a doctor, a dietitian, and someone watching their numbers every week. Most people have nobody doing that. That is a big part of why a primary care physician sits in the foundation of my framework. Your primary care physician is the closest thing most of us will ever have to a performance team.
A front door to the health system
Working alongside great physiotherapists and sports physicians, and a few who left something on the table, convinced me I could contribute as a clinician. So I went to medical school, and my first chapter in medicine was rural obstetrics in Australia.
Good prenatal care is prevention in its purest form. You check blood pressure at every visit, screen for gestational diabetes, and watch for early signs of preeclampsia. Most of that work is invisible when it succeeds, because the emergency never happens. And when one does happen, it's all hands on deck, a small high-performance team working toward one outcome. That's what drew me to obstetrics, and later to Emergency Medicine.
I also trained inside Medicare, Australia's universal health system. Almost every patient I looked after had a general practitioner. It wasn't perfect, and Australians will happily tell you about wait times, but there was a front door to the health system that almost everyone could use.
In 2020, I moved to the United States and into Emergency Medicine. Here, the Emergency Department is the safety net. It's open around the clock and takes everyone, and every shift I meet people whose first real contact with health care in years is me, at 2 in the morning, on their worst day. Americans live several years less on average than Australians on comparable OECD figures. That gap has many causes, including road deaths, opioids, firearms, and diet, and health system design is only one of them. But working in both systems, you notice how much easier prevention is when everyone has affordable access.
Where the Two-Tier Blueprint came from
Put those chapters together and you get the framework behind this show. The coach learned that fundamentals beat gadgets. The rural doctor watched prevention quietly working. The emergency physician sees what happens when it's missed. So the Two-Tier Blueprint starts with a non-negotiable foundation, Tier 1: diet, exercise, sleep, stress management, and a primary care physician. Tier 2, the evidence-based upgrades, comes only once that foundation is solid.
Why an ER doctor works on climate
Climate change isn't abstract in the Emergency Department. It arrives as heat illness during heat waves, as asthma and COPD flares on wildfire smoke days, and as patients who miss dialysis or run out of medications when extreme weather knocks out power and roads. That's why I chair the Climate Interest Group for the Society for Academic Emergency Medicine, serve on its Misinformation and Public Health consensus committee, and am building a climate and health curriculum for resident physicians.
Health care also has its own footprint. The 2019 Lancet Countdown estimated the health care sector produces about 4.6% of global greenhouse gas emissions. A 2020 Health Affairs analysis found US health care emissions reached 1,692 kg of carbon dioxide equivalents per person in 2018, the highest rate among industrialized nations, and estimated that the sector's greenhouse gas and toxic air emissions cost 388,000 disability-adjusted life years in a single year. An earlier analysis by the same team estimated that if US health care were a country, it would rank 13th in the world for greenhouse gas emissions.
None of this means anyone should skip care they need. It means the system should waste less, and one of the Health Affairs authors' own recommendations was to invest in preventive care. The greenest patient is the one who never needs the ambulance, the ICU bed, or a week of single-use plastics. Prevention isn't only good medicine. It's climate action.
The biggest lever is on your plate
In 2018, Poore and Nemecek published a meta-analysis in Science covering roughly 38,700 farms in 119 countries. They estimated the food supply chain produces about 13.7 billion metric tons of carbon dioxide equivalents a year, roughly 26% of human-caused greenhouse gas emissions.
Animal products stood out. Meat, aquaculture, eggs, and dairy used about 83% of the world's farmland while supplying only 37% of our protein and 18% of our calories. Even the lowest-impact animal products typically had higher impacts than plant protein substitutes: low-emission beef from dairy herds produced about 36 times the greenhouse gas emissions of peas for the same protein. This is life-cycle modeling rather than a trial, and impacts varied up to 50-fold between producers of the same food, but the direction held for greenhouse gases and nutrient pollution, and most of the time for land use.
The Planetary Health Diet: health first
In October 2025, the EAT-Lancet Commission published its updated report. It concluded that food is the single largest driver of humanity crossing the planet's safe boundaries, with food systems responsible for nearly 30% of greenhouse gas emissions, a figure in the same range as Poore and Nemecek's.
Here's what matters most to me as a doctor. The Commission states that its Planetary Health Diet is based entirely on the direct effects of diet on human health, not on environmental criteria. The pattern that's best for your arteries simply happens to be lighter on the planet. The Commission estimates that adopting it could prevent around 15 million premature deaths a year, about 27% of global deaths. That's a modeling estimate, not a guarantee, but it points the same way as decades of nutrition research.
In practice, half your plate is fruit and vegetables, with whole grains as the base, 2 to 3 servings of legumes a day, and 1 to 2 servings of nuts. Animal foods fit in modest amounts: about 2 servings of fish and 2 of poultry a week, a few eggs, and roughly 1 portion of beef, pork, or lamb a week. For context, reporting on the full Commission found that people in the US and Canada eat more than 7 times that red meat amount. This is what plant-forward means: plants at the center of the plate, celebrated rather than exclusive.
Full disclosure, since I started with my biases: I eat a fully plant-based diet. I don't ask my patients to do the same. The evidence supports a range of plant-forward patterns, and I would much rather someone make a change they can sustain for 30 years than one they abandon in 3 weeks.
Three objections, prebunked
"Doctors should stay out of climate politics." This is topic policing: declare an issue off-limits and the evidence never gets examined. Clinicians shouldn't use the white coat outside their expertise, but heat, smoke, and air pollution are exposures with measurable health effects. That's medicine.
"Plant-forward is just veganism, and you'll be protein deficient." This is a false dichotomy. Some people do need to plan carefully; the Commission notes that children and women of reproductive age on vegan or vegetarian diets should consider bioavailability and use fortified foods or supplements where appropriate. But the Planetary Health Diet includes animal foods, nearly two-thirds of the world's protein already comes from plants, and Poore and Nemecek found that halving each animal product, starting with the highest-emitting producers, achieved about 71% of the greenhouse gas reduction of removing animal products entirely.
"My dinner doesn't matter, it's the corporations." This is diffusion of responsibility with a large kernel of truth. The Commission assumes energy, transport, and industry do most of the heavy lifting on carbon dioxide, and argues the most effective food actions change food environments, not just individual choices. But food is still about a quarter of global emissions, and the health benefit to your own arteries doesn't depend on what any corporation does.
How should this modify your practice?
For clinicians and trainees.
1. Ask about dietary pattern, not just weight. A brief question about how often meals center on red and processed meat versus legumes, whole grains, and vegetables opens a Tier 1 conversation that serves cardiometabolic risk directly.
2. Frame plant-forward, not plant-only. Patients are more likely to sustain one or two swapped meals a week than an all-or-nothing switch. Meet them at a realistic first step.
3. Anticipate medication de-escalation. Meaningful dietary change can lower blood pressure and glucose. Review antihypertensives and glucose-lowering agents, especially insulin and sulfonylureas, and counsel patients on hypoglycemia and orthostatic symptoms.
4. Cover the nutrient basics. Patients choosing fully plant-based diets need a reliable vitamin B12 source, and pregnant patients and children warrant extra attention to bioavailability, as the Commission notes.
5. Treat prevention and low-value care as climate levers. Every avoided admission and unnecessary test is also avoided emissions. Advocate for plant-forward menus in your own institution's cafeteria and patient meals; Practice Greenhealth's Cool Food Pledge asks hospitals to cut food-related emissions 25% by 2030.
Your one thing this week
Swap one meal that would normally center on beef, pork, or lamb for one built around legumes: black bean and lentil chili, a chickpea curry, or lentil bolognese on whole-grain pasta. If it sticks, make it weekly, then add a second. And if you take medications for blood pressure or diabetes, loop in your primary care physician before making bigger changes. For a structured plan for the rest of your Tier 1 foundation, grab the free 16-week roadmap at DrCois.com.
Less bad days, more good decades.
About the author
Dr Adrian Cois is an Emergency Physician, former elite strength and conditioning coach, and host of Overheard in the Emergency Room. He chairs the Society for Academic Emergency Medicine Climate Interest Group and serves on its Misinformation and Public Health consensus committee.
Disclosure: Dr Cois has no financial relationships with any organization, product, or program mentioned in this post. He follows a plant-based diet, as disclosed in the episode. This post is educational and is not medical advice.
Related reading
• Overheard in the Emergency Room, Episode 2: Diet as a Tier 1 foundation (DrCois.com)
• Overheard in the Emergency Room, Episode 15: Your Longevity Playbook, and the free 16-week roadmap (DrCois.com)
• EAT-Lancet 2025 Summary Report: https://eatforum.org/wp-content/uploads/2025/09/EAT-Lancet_Commission_Summary_Report.pdf
• Practice Greenhealth, Why plant-forward: https://practicegreenhealth.org/topics/food/why-plant-forward
References
1. Poore J, Nemecek T. Reducing food's environmental impacts through producers and consumers. Science. 2018;360(6392):987-992. doi:10.1126/science.aaq0216
2. Rockström J, Thilsted SH, Willett WC, et al. The EAT-Lancet Commission on healthy, sustainable, and just food systems. Lancet. 2025;406(10512):1625-1700. doi:10.1016/S0140-6736(25)01201-2
3. EAT. The EAT-Lancet Commission on Healthy, Sustainable and Just Food Systems: Summary Report. EAT; 2025.
4. Willett W, Rockström J, Loken B, et al. Food in the Anthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems. Lancet. 2019;393(10170):447-492. doi:10.1016/S0140-6736(18)31788-4
5. Eckelman MJ, Huang K, Lagasse R, Senay E, Dubrow R, Sherman JD. Health care pollution and public health damage in the United States: an update. Health Aff (Millwood). 2020;39(12):2071-2079. doi:10.1377/hlthaff.2020.01247
6. Eckelman MJ, Sherman J. Environmental impacts of the U.S. health care system and effects on public health. PLoS One. 2016;11(6):e0157014. doi:10.1371/journal.pone.0157014
7. Watts N, Amann M, Arnell N, et al. The 2019 report of The Lancet Countdown on health and climate change: ensuring that the health of a child born today is not defined by a changing climate. Lancet. 2019;394(10211):1836-1878. doi:10.1016/S0140-6736(19)32596-6
8. Practice Greenhealth. Why plant-forward. Accessed October 3, 2026. https://practicegreenhealth.org/topics/food/why-plant-forward
