This week we have the pleasure of hearing from David Katz. In his own words:
“DAVID L. KATZ MD, MPH, FACPM, FACP, is the founding (1998) director ofYale University’s Prevention Research Center. He received his BA from Dartmouth College (1984; Magna Cum Laude); his MD from the Albert Einstein College of Medicine (1988); and his MPH from the Yale University School of Public Health (1993). He is a two-time diplomate of the American Board of Internal Medicine, a board-certified specialist in Preventive Medicine/Public Health, and a clinical instructor in medicine at the Yale School of Medicine. Katz is known internationally for expertise in nutrition, weight management, and chronic disease prevention. He has published roughly 150 scientific articles; innumerable blogs and columns; nearly 1,000 newspaper articles; and twelve books to date, with 3 more currently in production. He is the Editor-in-Chief of the journal Childhood Obesity, President-Elect of the American College of Lifestyle Medicine, founder and President of the non-profit Turn the Tide Foundation, and a blogger/medical review board member for the Huffington Post. Dr. Katz remains active in patient care, and directs the Integrative Medicine Center at Griffin Hospital in Derby, CT. He helped establish, and formerly directed, one of the nation’s first combined training program in Internal Medicine and Preventive Medicine, and served as Director of Medical Studies In Public Health at the Yale School of Medicine for 8 years (1996-2004). Programming Katz and colleagues have developed- such as Nutrition Detectives™ and ABC for Fitness™ -has been adopted by thousands of public schools throughout the U.S., and abroad, and is reaching many tens of thousands of children. Katz has five U.S. patents, several patents pending, and is the principal inventor of the Overall Nutritional Quality Index (patents pending) utilized in the NuVal® nutrition guidance program (www.nuval.com), currently offered in over 1,600 supermarkets throughout the United States, from coast to coast, reaching some 30 million consumers. He has been recognized three times by theConsumers Research Council of America as one of the nation’s top physicians in Preventive Medicine. He was nominated for the position of US Surgeon General in 2009 by the American College of Physicians, the American College of Preventive Medicine, the Association of Yale Alumni in Public Health, and the Center for Science in the Public Interest, among others. He was the 2011 recipient of the Katharine Boucot Sturgis award from the American College of Preventive Medicine, the most prestigious award the College confers, awarded for illustrious career contributions to the field of Preventive Medicine. Also in 2011, Dr. Katz received the Lenna Frances Cooper Award from the American Dietetic Association (now known as the Academy of Nutrition and Dietetics) for illustrious contributions to the field of nutrition. In 2012, he was the first inductee into the Marketing Disease Prevention in America hall of fame for efforts related to childhood obesity control. Also in 2012, Katz received the annual J. Warren Perry Award and Lectureship at the University at Buffalo and was the Stanley P. Mayers Endowed Lecturer at Penn State University. Dr. Katz is a leading voice in medical media, is quoted almost daily in major news publications, and appears routinely on national TV. He speaks routinely at conferences and meetings throughout the United States, and the world, and has delivered addresses in at least 7 countries. Widely recognized as a gifted public speaker, Katz has been acclaimed by peers as the “poet laureate of health promotion.”
The Slim Is Simple.org Non-Profit Nutrition Education Effort
Jonathan: Hey, everyone! Jonathan Bailor back with another bonus Smarter Science of Slim podcast. Very, very excited about today’s show because we have a wonderful man. Personally been a wonderful person to work with over email and a wonderful supporter and collaborator. Also, just a man who is certainly very busy. He is an internationally renowned expert in chronic disease prevention and weight management. Recognized in 2012 as “One of the Most Influential Figures in Health Promotion”.
He is a specialist in preventative medicine and the founding director of Yale University’s prevention research center. He is the author of 12 books. Twelve! The most recent of which is called Disease Proof: The Remarkable Truth About What Makes Us Well. He is Dr. David Katz. Dr. Katz, welcome to the show!
David: Well, Jonathan, that energy level is going to be hard to match. Thank you. I’ll try to keep up with you, my friend. Thanks so much.
Jonathan: Well, I am excited because I am holding in my hands a book by you sir that says that I can slash my risk of chronic disease by 80%. So how can I not be excited?
David: I agree with you. I think it’s an incredibly exciting opportunity. The tragic thing is its accessible to everybody and almost no one is taking advantage of it. We’re really hoping, with this book, to put that power in peoples’ hands so we start getting real use of it. Because knowledge is only power when you do put it to use. That’s the potential. We really could eliminate 80% of all chronic disease. I agree with you. Its incredible exciting, Jonathan. Partly so because of how intimate it is. I am a public health guy. I know you’re very interested in making contributions to the public health as well.
But there’s a problem in efforts to advance public health. That problem is pretty big. It’s the fact that there is no public. There is you. There is me. There is everybody else. When we talk about the public, it’s everybody but it’s also nobody. One of the things we want to fix with Disease Proof is that mistake. To think that when we talk about the strategies that will prevent heart disease, cancer, stroke, diabetes, that it’s about some anonymous public. It’s about you and me. For example, do you love somebody who’s been affected by heart disease?
Jonathan: Heart disease does not run in my family but diabetes does. So definitely, it’s diabetes.
David: Okay, diabetes or cancer or stroke. If you list just those top four disease killers in the United States to almost any audience anywhere, and I do this as a matter of routine, and you ask audience members, “Do you love somebody who’s been affected by heart disease, cancer, stroke, diabetes?” By the time you get through that list of just the top four chronic diseases, almost every hand in almost every auditorium in almost every venue in the country is up.
An 80% reduction in the rate of chronic disease means 8 out of 10 of those hands in a given room would not have been raised in the first place. When those hands go up, they are testimony to terrible days. Days when you get a phone call about somebody you love who is in an ambulance on their way to the hospital or in the ICU or in the CCU or in the emergency department. Sometimes, they get better and come home. Sometimes, they don’t. But either way, those are anxious, dreadful days. Almost all of us have lived through them. Most of us, more than once.
When you think about someone you love affected by heart disease, cancer, stroke, diabetes, dementia, for many of us, it’s more than 1 person. 8 out of 10 of those bad days don’t need to happen. We look ahead to a future where we either bequeath to our kids a world in which those days happen ever more often at every younger age and those hands go up in the air that much more routinely. Or 8 times in 10 of those, they simply don’t happen at all. That’s the power of Disease Proofing. It is incredible power. It is incredibly intimate. So yes, I am excited too about this message.
Jonathan: David, I am so happy that you brought up that point of intimacy. It’s a brilliant point. I’m curious. You’ve been all over the world. You were one of the most, let’s call it, active voices in this community on many levels. It seems quite clear what we need to do. We need to take in more nutritious food. We need to stop eating things that are not really food. We need to move our bodies. We need to get proper sleep. We know these things. Yet, the motivation seems not strong enough.
Let me give a concrete example. So becoming a vegetarian, which is certainly not the point or topic of this show, but becoming a vegetarian is a very significant lifestyle change. But a lot of people are able to do it. Actually, the people who do it, they don’t… at least from my experience, they are not “Oh, this is so hard.” Actually, they love it. They love being a vegetarian because they believe doing so will enable them to manifest a higher purpose. They believe in something.
The reason I get so excited about your point about it being intimate is believing that you can set an example where your children can avoid these terrible days, where you can avoid these terrible days, when those who rely on you can avoid these terrible days. You can manifest all the glory that you were put on this world to manifest. That seems inspirational and aspirational enough to get us to make these changes. What do you think?
David: I think that’s a great point. I agree with you. So I just want to dial it back a little bit, kind of run through what you just said, Jonathan. Because there is a lot there. First, you hit a point that I wanted to get to. That is we do need know what behavioral factors will eliminate 80% of chronic disease. There’s a literature in Peer Reviewed Journals going back at least 20 years to what is widely recognized in preventive medicine circles as… it’s almost scripture at this point. It’s really the seminal study entitled Actual Causes of Death in the United States.
The authors were Will Foege and Mike McGinnis, two leading epidemiologists. Essentially, what they reported in The Journal of The American Medical Association in 1993 is that the leading causes of premature death. We can characterize that as years lost from life. But because these are chronic diseases also, life lost from years. The leading causes of premature death weren’t really diseases because diseases are effects. The question was what was causing the diseases that were in turn causing premature deaths?
The answer was the list of 10 factors which overwhelmingly we control in our daily lives. As you just suggested on the shortlist is diet. But essentially, the first three items on the list, tobacco, dietary patterns and physical activity accounted for 80% of all the premature deaths in United States every year. In other words, if we didn’t smoke, ate optimally and we’re routinely physically active and that led in turn to weight control. Those four things would result in an 80% reduction in the lifetime risk of any major chronic disease, heart disease, cancer, stroke, diabetes, dementia. All the bad stuff we don’t want to have happened.
So the first part of my response to your very insightful comment is feet, forks and fingers are the master lovers of medical destiny. What we do with our feet? Physical activity. What we do with our forks? How we eat. What we do with our fingers? Namely, not holding cigarettes. That’s the power center right there. The power center is great enough to actually alter gene expression. We point all of this out in Disease Proof. There’s study showing that lifestyle interventions can alter gene expressions. They can increase the production of cancer prevention proteins and reduce the production by our genes of cancer promoting proteins.
So the question about which is the more important influence; nature or nurture is almost a false question because we can nurture nature. We can change the expression of our genes with lifestyle. Your comment then went on to the issue of motivation. I would say, motivation falls within the realm of willpower. So the will to be healthy. Yes, I think you are right. I think having inspiration, having aspiration, this is part of something bigger. It’s about my health but it’s also about other things, making the world a better place. I think people do buy into that. I agree with you. Many of my friends and colleagues who were vegetarian or vegan, it’s partly about health. But it’s also partly about planetary stewardship and how other species are treated and their ethical implications. It’s part of a bigger mission.
But there’s another equally important component to all of this. You might want to climb Mount Everest. You might be highly motivated. You might think, “Gee, the most fantastic thing in the world would be to see the roof of the world.” To see the view of the planet earth from as high up you can get and still stand on your own two feet on solid ground. But no matter how badly you wanted to climb Everest, the fact would remain that it’s an enormous mountain with lots of ice and snow on it. Unless you got mountaineering skills, you are probably not going to get up there. The average Joe just can’t get to the top of Everest. That’s all there is to it. You got to know what you are doing.
So with lifestyle change, a big part of the story that is routinely neglected is the analogue to willpower. You speak, I think, very insightfully about the motivation side and we address motivation and will power in Disease Proof. We then, move on and say “But what about the skill power? What if you want it really bad? What if you really care about your health and the health of your children and the health of your grandchildren?” But you really just don’t have the skill set to get there from here. You really don’t know what the more nutritious foods are. You really are duped by the medicine avenue. You really don’t know how to figure out, how to prepare family, friendly nutritious meals everyday given your crazy schedule.
You are really not confident about how to work physical activity into the hectic demands of your daily routine. All of that then becomes a metaphor. A skill set that most people don’t have but skills can be acquired. In Disease Proof, we emphasize the motivation, the inspiration, the aspiration, the things that you just referred to. We then say, “Given that.” The job is still too hard for most people and we can overcome that one or two ways. We can either change the whole world. We advocate for that. Making the food environment a better food environment. Making physical activity a routine part of the school day and a work day.
But we can’t just keep on waiting for the world to change while our health goes to hell in a hand basket. So between here and there, we need to take matters into our own hands. The way to do that is skillfully and that requires skill power. So most of the book is actually devoted to a systematic delivery of the skill set. For example, I have and share with my wife and my kids and my patients and that my co-author Stacey Colino has and shares with her family. What are the skills that people who manage to be healthy in spite of it all have that can be shared with everybody? What are all the ways to make good use of your feet and your fork?
Obviously, tobacco is a relatively simple one. But we do briefly address the issue of smoking cessation for those who need that help. But mostly the challenge is “Yes, I know that physical activity is good for me but here’s my daily routine. How do I make it happen?” and “Yes, I know that supposedly eating well is good for me but I am not sure I even know what eating well is because there are so many competing opinions.” You just mentioned vegetarianism, Jonathan.
But you could be doing a podcast with Loren Cordain, who would make an impassion plea for a Paleo diet with a very strong emphasis on meat intake. So the average person listening in says “I’m confused.” So we have to sort that out. What do we really know? Which part of this is science? Which part of this is opinion? How do we reconcile the competing opinions? Show people that there really is a clear destination. Then, most importantly empower them so they feel as if they can get there from here.
Jonathan: David, you used the analogy of climbing Mount Everest and empowering people with various tools and skill sets and giving them the ability to wade through what seems to be a complex train of mixed messages and food marketing and such and such. What is your take on…so while certainly their debates rage between this group of people that advocates this set of whole foods and that set of people which advocates that set of whole foods.
It does seem like there is a bit of common sense in historical backing for saying, “If we were to simply eat things found directly in nature, aka what we did up until let’s say 40 years ago for all intents and purposes.” Obviously, there was canning and some level of preservation of food. But you understand my point that I don’t know how close we could get to that 80% but we’d be pretty that on close. So could it be simplified to at least that level? If you can’t find it directly in nature, chances are it’s not helping you to become disease proof.
David: In many ways I agree completely, Jonathan. In fact, my own advice about simplifying messages. I like Michael Pollan’s Eat Food. Not Too Much, Mostly Plants. I often point out the opportunity. Trade up your choices, eat close to nature, learn to love foods that love you back. We are all saying this same thing in different ways. Essentially, its real food. It’s natural food. It’s minimally processed food. The concept is sound. The problem is the application. Because we are not getting our food directly from nature. We are getting our food in restaurants. There they are mixed into dishes. We are not in control of what goes into those dishes.
So in nature there are no restaurants. In nature, there are no cafeterias. In nature, frankly, there are no plastic bags. There’s no Styrofoam. There is nothing that’s pre-fabricated and put together. So you could say, “Well, then don’t buy anything that comes in a package.” I have arguments with the likes of Mary Nessel and Michael Pollan about these kinds of things. Because frankly, dried lentils come in a package with their nutrition facts panel and an ingredient list and steel-cut oats do as well. I know almost no one who would argue against eating lentils or chick peas or steel-cut oats.
But they are part of the same display on a supermarket shelf as a lot of other stuff that is more highly processed. So the trouble is you quickly get into shades of gray. If it were black and white, you would go out of your front door with bow and arrow in your hand and really get your food direct from nature. Pick stuff off trees and shoot stuff that is running away that you want to catch and cook for dinner. That would be pretty simple story. But the reality is the opposite ends of the spectrum. There’s organic spinach and there’s fluffernutter.
But there’s an awful lot of stuff in the middle where, “Okay, it’s a lentil soup. The ingredients are all pretty much direct from nature but it’s still a prepackaged soup. It does have salt added. Do we call that a food from nature? Do we call that a processed food? What about those lentils which were dried and put in the bag?” Each time you think you’ve made a decision there is some other ‘what if’ product that’s very close to that one but maybe a little different. My insights about this, Jonathan, other than having worked in this space for 20 years. Right now, I am writing with colleagues, the third edition of my nutrition textbook for health care professionals, nutrition and clinical practice that provides a bird’s eye view.
But as you know, I’m the principal inventor of the overall nutritional quality index algorithm, which powers the NuVal nutrition profiling system. We covered that pretty extensively in Disease Proof as well. NuVal is a nutrition guiding system 1 to a 100. The higher the number, the more nutritious the food. The company has scored over a hundred thousand foods and the system is on display in over 1,700 supermarkets around the country reaching about 30 million people. We’ve had an enormous opportunity to look at the subtle challenges of the food supply.
There are a lot of these foods that are mostly natural but not quite exactly. Not even meats for the people who do eat meat. Some are entirely pure. Some seem like they should be but actually they have been infused with a saline solution. Sometimes that solution contains sugar and the consumer may not even know it. So there are a lot of challenges because you are not going out of your front door with a bow and arrow or a scythe. You really are dependent on what stands between you and foods from nature. That’s the entire food industry. There are supermarkets there. Cafeterias is there. Bodegas is there. Restaurants is there.
So we need to be able to navigate that space. Until we reshape the food supply so all of it is more natural and more reliable and more honest and true, we have to be able to navigate successfully through that space where many of our choices come in shades of gray. It’s not direct from nature. But is it or isn’t it close enough? Like those steel-cut oats. It’s not the same as picking the grain out of a field and chewing on it. Somebody has done something to those. So they have been processed. Extra virgin olive oil is put into a bottle. There is a nutrition facts panel on the bottle. Sitting next to that bottle are all sorts of other bottles. All of the bottles and all of the bags and all of the boxes have health claims on the front.
So for example, you may have a very humble cereal made from nothing but some whole grain. Actually, the nutrition facts panel will be less impressive than a cereal sitting right next to it that’s been made from some highly processed grain but was then highly fortified. I think, the typical consumer is vulnerable to those distortions. Total cereal. The cereal itself is not highly nutritious but they throw a multivitamin in at the end. Well, it gives up the appearance of being the most nutritious thing in the whole damn food supply, right? You need a certain level of knowledge to get past that. So yes, I totally agree with you in principle that what we really want to do is simply want to eat close to nature.
If it wasn’t a food 100 years ago, it’s not a food now. But we have to be able to get there from here. Again, I am a public health pragmatist. I want to help everybody. In particular, I want to help the people who mostly need the help and the people who are in a position to eat closest to nature right now. It might be you. It might be me. It might be Mary Nessel. It might be Michael Pollan. It might be Alice Waters with her restaurant in Berkeley, Chez Panisse.
All the elite foodies, maybe, they’ll be all set right now. But they are ones who least need the help anyway. It’s the average person who is shopping in a big supermarket, maybe Wal-Mart and trying to figure out what’s what. They need help to navigating the general direction of closer to nature. We have got miles to go.
Jonathan: David, you hit on two key points there, which is making ourselves disease proof seems like there is at least two routes. One is the individual empowerment and education that allows us to climb the, what has become a Mount Everest of complexity out there. There is another approach we touched on a bit, which is blowing up Mt. Everest. So that you have flat terrain that everyone could just walk across very easily, especially speaking to the people who need the help the most. It’s very easy for us and even the listeners of this podcast who are likely are already very, very healthy. To be, “Yup, we’re going to be even healthier now.”
David, the issue to me is we have so clearly… you outlined this in your book, Disease Proof so well. We have so clearly linked putting certain substances into our body with the disease. It seems the link is as clear as if you smoke… to the extent that you smoke, you are going to get lung cancer or you predispose yourself to lung cancer, a.k.a if you don’t want lung cancer, don’t smoke. Because we understand there’s that clear relationship, even though 60 years ago the whole economy depended on tobacco and everyone smoked everywhere. There were second hand smoke and blah, blah, blah, blah, blah. Because we saw such a tight relationship between that activity and disease, we blew up Mt. Everest.
Jonathan: We made it much easier for people to avoid second hand smoke. We made it… No one smokes with any uncertainty about what it’s going to do to them. How… at this point, how can we even excuse the fact that it isn’t happening, with say, soda? Things that nobody would say is good for you. We still hear messages of moderation yet no one says smoking moderation. Where is the disconnect there?
David: Well, you raised an excellent point. Again, in the book we have whole section devoted to the essentially what would constitute the blowing up of Mt. Everest. Or actually, as we described it in building a levy to turn the obesogenic flood tide, to make the world a place where eating well is the norm and being physically active is the norm. Where you don’t have to swim against the current to make that happen. It’s what your culture does. The problem in blowing up Mt. Everest or changing the world. Now, why don’t we just do that with regard to food even though we seem to have done it with regard to tobacco is that, actually in comparison to changing the food supply, tobacco was a molehill.
If we want eating right to be the Mt. Everest to help promotion, tobacco was a molehill. I’ll tell you why. Tobacco was never necessary. It’s a modern part of human culture. We didn’t have tobacco in the Stone Age. We didn’t have tobacco when we were Homoerectus. We’ve had food since before Homosapiens were sapiens. It’s always been part of our experience. It shaped our physiology. We actually have an innate craving for sugar. We were not born craving tobacco. There’s an aspect of food we are born craving. It’s part of our hardwiring. The relationship is so much more powerful and so much more intimate.
Second, tobacco is an either or choice. You can’t tell people, “Just don’t eat.” If we could tell people “Just don’t eat.”, if the choice were be “I eat or I don’t eat.” Not eating might be hard but it certainly wouldn’t be complicated. It wouldn’t be subject to all sorts of competing theories. There are lots of competing theories about how not to smoke. Maybe, a few competing theories about the best ways to quit but fundamentally not smoking is not smoking. There’s very little debate about what that means. But eating well, there’s enormous debate about what that means. Whenever you got enormous debate, you got enormous opportunity for hoaxers and charlatans to get in on the act and distort perspective.
You’ve got opportunity for Medicine Avenue and marketers to get in on the act and say, “Okay, people know that certain nutrients are good for them. We’ll throw those nutrients into a vat of glue. We’ll know that it’s putting lipstick on a pig but the public doesn’t need to know that. We’ll pretend it’s really a good product.” So the next thing you know, you’ve got people who would be willing to quit smoking and are willing to eat better. But they know what quitting smoking means and they really don’t know what eating better means.
So it’s a vastly more complicated issue. It’s never to go away because we have to eat. So we are in this area where we do need to be informed to make better choices. There’re many more ways to get it wrong than with tobacco. Tobacco, give up entirely and you’re getting it right. Or you can smoke and you’re getting it wrong. Everybody eats. Those were getting it right eat or those getting it wrong eat and those in between eat. So we got all of these subtle challenges to deal with. There’s also the fact, Jonathan, that there are culture really is built around the importance of food.
Every important human interaction and virtually every culture uses food as a centerpiece. We show generosity with food. We show love with food. Food has even infiltrated the vernacular. In fact, the modern use of currency, money, really is just a surrogate for food. That’s the reason why we talk about things being the breadwinner, bringing home the bacon, making dough, putting bread on the table. Actually, that what’s food really was about. It was the security that you could keep your belly full and keep the bellies of those you love reliably full because starvation was a constant threat.
Just think about how deep and profound and far-reaching and intimate and ultimately complicated that relationship is. So there you have Mt. Everest and in comparison, frankly, tobacco was a molehill. Now, we should do some things to dramatically improve the food environment. But one of the things we need to do first is empower the public to know what we reliably know about good eating. So let’s cut through the clutter and competing theories. Which part of this is reliable? How do we really make practical use not to Eat Food, Not Too Much, Mostly Plants, for example? But we address all of that in Disease Proof.
I think the theme of healthful eating is extremely well and robustly established. I also think there’s plenty of room for variation on the theme. I actually think you could have an optimal diet that’s pretty Paleo. I think you have an optimal diet that is Vegan. Both are close to nature but they are very different. Yet, I think they both are variations on the theme of optimal eating. I think you could have an optimal diet that is Mediterranean or an optimal diet that is Asian low-fat. I think by allowing for that variation on the theme and our science, the current state of the science, does allow for that variation of the theme.
It puts you in the driver seat that says, “You really can get pleasure in the pursuit of health and health in the pursuit of pleasure. You can love food that loves you back.” I think that’s important, too. Because ultimately the value of health isn’t health itself, the value of health is living. Health is itself a currency that you can spend on days doing what you want to do. You have the energy, the vitality to do what you want to do. When we remember that health is for something, you don’t want to spend your life eating in a way that’s unpleasant.
You do want to love food that loves you back. I think there’s an enormous opportunity there. But it’s a huge challenge. I think it’s a much bigger challenge than tobacco. I think it is qualitatively different because tobacco was never necessary. Tobacco was not part of that fundamental group of exposures that actually shaped the development of human physiology. Food was here before human physiology existed. We invented tobacco.
Jonathan: David, therein I think lies the key. Maybe, the issue is not… because as you said, and certainly I would agree, that there are myriad food. Let’s define food as things found in nature. There are myriad assortments of food diets that could allow someone to thrive. Certainly, eating food has always been with us. Certainly, we need to eat lots of food. In fact, many argue that eating more of the right kinds of food is critical to maintaining health. But are we creating? Could the problem be overcomplicated in a sense?
We haven’t always had soda. Soda doesn’t have to be embedded in every human interaction nor do Twinkies. Yet, those are sold in schools whereas we don’t even allow tobacco to be advertised. I think… Let’s agree that saying, “Let’s get meat, vegetables, fruits, nuts and seeds to all be organic and local. Blah, blah, blah.” That may never happen just from an economic viability perspective. But can’t we just… for example, there are cigarettes. Okay, there’s soda. We don’t have to have soda. It’s very easy to target that thing individually. Why aren’t we doing it?
Dave: Well, a couple of reasons. One, people don’t like being told what to do. So you look at the struggles there Bloomberg is having in New York with banning large sodas. It don’t feels heavy-handed. I think that ought to happen. The question is, how do we make it happen? Do we make it happen with supply side regulation? Or can we make it happen by informing the consumer and generating a change in the demand. I think we have to carefully orchestrate the best ways to get there from here.
But the other issue is, and again it’s a slippery slope, on what basis do you say that soda is the single thing we should be regulating as opposed to… I don’t know. Pick something – pop tarts or toaster pastries in general or donuts. There are many batted items in the food supply that really provide almost no nutrition of any value. You could argue well some of the basis of sugar content. But then, you could identify things that have at least that much sugar content. Then, it gets very insidious, very slippery slope, very fast.
For example, there are pasta sauces that have more concentrated additions of sugar than ice cream topping. So then, we had to focus on pasta sauce. Forget about the dessert aisle. So in principle, I agree with you, Jonathan again. One of the things that the NuVal experience has shown me is how very quickly, unless you get some objective standard, how quickly you get into the realm of slippery slope. The problem isn’t so much that we couldn’t just sort of throw up our hands and say, “You know what, let’s just go ahead and do it anyway. Let’s just ban. Soda is liquid candy. Let’s get rid of it.” Let’s start somewhere.
The problem then is that we have sort of four arms that the beverage association to say, “Why are you singling us out? Is it on the basis of sugar? Well, look at these other items that have this much or more added sugar. Is on the basis of calories? Look at these items that have as much or more added calories. Is on the basis of missing nutrients? Look at these other items that have as much or more missing nutrients. Is on the basis of contributions to obesity?” On and on and on it goes. I think we have a much more reliable basis for policy change when we invoke some generalizable standard.
Now frankly, and to some extent, of course this is when you got a hammer you look out and see nails. But the NuVal system is the only nutritional profiling system ever devised to date that has been shown to correlate directly without health outcomes. In the Harvard study of a hundred thousand people, the higher the average NuVal scores of their food, the lower the rate of cardiovascular disease, the lower the rate of diabetes, the lower their body mass index, the lower the rate of premature death from any cause. Well, when you got a system like that and it applies to all foods, I think you could potentially invoke a more universal standard. You are talking about schools and I feel passionately as well that schools should be in the vanguard of healthy living.
So why not put food in categories? We’d have the beverage category. For example, we look at the range of scores there and say, “Anything scoring in the bottom core tile of beverage scores, can’t get on to school grounds.” We draw a line on the sand and nothing crosses. You do the same for every food category. You basically say, “Every item on the kid’s menus in public schools nationally has to clear a certain objective threshold.” That threshold is relative to the foods available. It’s not an arbitrary threshold. We basically stratify the scores of overall nutrition category by category.
Now, and frankly, we could flip it around as well. So that’s sort of using the stick approach. I think there is enormous opportunity. Use objective nutrition guidance for a carrot approach. I proposed, for example, that we could take a metric like NuVal applied to hundred thousand foods and use to incentivize purchases through the SNAP program. Right now, we, the American tax payers send a hundred billion dollars a year to the federal authorities to underwrite SNAP to help poor people choose poor food to get to poor health. We then pay a ton more money through Medicaid, to cover the cost of all that poor health and pay for things like bariatric surgery and coronary bypass.
How much more economical it would be if we scored all the foods available to SNAP beneficiaries, put them into categories, put them into core tiles and said, “If you buy a food in the bottom core tile of those scores, your dollars’ worth a dollar. But if you buy a food in the next core tile up, your dollars’ worth your a dollar twenty-five. In the next core tile, a dollar fifty. In the top core tile, two dollars. The more nutritious the food you buy in any given category, the less it will cost you, the more rewards you get.” Then, potentially we could help poor people choose better food and get to better health and save a ton of money doing it. Everybody wins.
So again, I think it’s really just a question of what works? How do we best get there from here? Efforts to tax soda. Yeah, I think they make perfectly good sense but the beverage industry has fought them very effectively. Efforts to ban big soda and it seems to be bogged down, again because it’s an inconsistent application of policy, people get riled up because it’s heavy handed. I don’t object it. I haven’t had a soda in thirty-five years. My kids essentially don’t know what soda is. They never see it in the refrigerator. Except my son brought them home recently to conduct science experiments. But yeah, I kid you not… Nobody in the house drinks them.
I think we need these fundamental changes in how we perceive food. I think the First Lady did a very nice job of pointing out you would never water your garden with Coca-Cola. You wouldn’t pour it on a plant. You want it to grow well. You can pour it into the body of your children. Hello!!! Are we really paying any attention to what we are doing here? So yes, honestly, I don’t see any reason why anybody needs to drink liquid candy. But it really is a small part of a very big problem. The food industry is very agile, very nimble. So if we say the problem is soda, we know how readily they can invent a new category. It will some highly sweetened green tea beverage. The other problem with these blunt top-down approaches is they are particularly incapable of new ones. I had a colleague who was involved in founding the Honest Tea Company. Are you familiar with Honest Tea?
Jonathan: I am. Yes.
David: Yeah. So it means a great product line. These are minimally sweetened beverages that the main ingredient is some natural source typically of green tea. They are fairly nutrient rich. They are claim to fame was for people who are currently drinking sugar sweetened beverages. These have vanishingly less sugar in them. But they are sugar sweetened beverages. I think they are standard bottle size was 16.9 ounces. As you may recall the Bloomberg soda ban for example, was focused on 16 ounces as a cutoff. Well, it turned out that anybody that coming under the Bloomberg ban would be unable to sell Honest Tea.
Now, clearly the ban didn’t have Honest Tea in its crosshairs but there you go. So that’s actually Barry Nalebuff, who’s a colleague at Yale involved in establishing the Honest Tea Company, wrote an editorial piece in the Wall Street Journal about the fact that there are some unintended consequences here. So you and I agree about what needs to happen. I think where there’s room for a useful constructive debate is, what do we really know about how best to get there from here? But in Disease Proof, what we focus on is the fact that no matter what the best way to change the world, changing the world is slow.
There are going to be lots of arguments and counter-arguments between here and there. You’ve got skin in the game today. You’ve got skin in the game today if you are living today. You’ve got skin in the game today if you have got kids today because their skin is in the game. You can’t wait on the world to change. So we know we talk about the importance of that ultimately, we do want to put health on a path of lesser resistance. We don’t want everybody to have to work against the prevailing occurrence in our culture. But today, you can learn to get to health in spite of it all if you got the right skill power. The book is mostly devoted to imparting that because that’s something you can use right now.
Jonathan. It seems like while we are waiting to destroy Mt. Everest or at least shrink it down to be a more surmountable hill we can all walk over, it seems David we are beginning to talk almost in terms of a spectrum. Where on one end of the spectrum, you have disease proof or as close to someone can be to disease proof and when it comes to food, it seems like the closer the thing can be to nature, the fewer ingredients it has, things like that. Those gone that side of the spectrum. On the other end of the spectrum which is disease prone seems like it is further away from nature. It has multiple ingredients. All things being considered equal if we use those two things as a guide. How close to disease proof do you think we could become?
David: Well, that’s the beauty of it, Jonathan. Again, you look at modern epidemiology and we can say with extreme confidence that 80% of all the chronic disease we currently see affecting the world at large and the people we know and love could disappear. Eventually, our parts are going to wear out. We are going to die of old age. But really the aspiration for human kind is to live robustly. Then, get old in a very short period of time, just short of wear out and pass on. We are mortal. We going to check out at some point. But you want to have robust good health for as much of the time it comes before then as possible.
It’s chronic disease that steals that from you. Almost all the chronic disease could go away. It is pretty much a matter of universal agreement that at least 80% of heart disease could be eliminated. At least 90% of diabetes could be eliminated. Cancers are a little more controversial but as much as 60% of all cancer could be eliminated. Most dementia could be eliminated. Almost all respiratory diseases could be eliminated with better control of exposure to tobacco around the world. So you do the math across the spectrum of chronic diseases. Those diseases that are most responsible in the modern world for years lost from life and life lost from years. 80% of that could go away.
Then, in terms of what remains, frankly, we probably could get rid of a lot of that, if we went beyond just taking basically good care of ourselves to really optimizing the care we take of ourselves. That would include then good medical care, appropriate screening, finding things early because some stuff will sneak through even if you take good care of yourself. Then, we are talking about a reduction even beyond the 80%. We also have very good evidence that lifestyle intervention, eating optimally, avoiding tobacco, physical activity, weight control can modify gene expression.
So I think we can establish an 80% elimination of all the chronic disease; the slings an hours of outrageous fortune that really bedevil modern living. The bad stuff heart disease, cancer, stroke, diabetes, dementia, the stuff that we all dread and hope never happens to us or anybody we love. At least 8 times in 10 that could go away. That’s the floor, not the ceiling. How high is the ceiling? I don’t think we know. I don’t think we will ever be able to 100% avoid disease. Because that requires a crystal ball. That sort of… human beings coming with a guarantee of future health and stuff can happen. Stuff can always happen.
I tell people… every now and then, I hear story about some “I was vegan and physically active and this happened or that happened.” Then, I point out “Well, you can control ship and sail, but you never get to control wind and wave.” Let’s face it. A wild unpredictable tempest at sea can cause even the best captain ship to founder. So there will always be stuff that can happen. You don’t get a guarantee. But it’s absolutely stunning, how close we can get to a guarantee. I will take 80% any day.
The other important thing to realize about an 80% reduction in all chronic disease, compare that to any medical advance in history, it’s bigger. Compare that to any Nobel Prize ever awarded in medicine. This is bigger. There really is has never been a medical advance to rival the power we now have and are squandering every day to use lifestyle as medicine. So you are asking me how high is up? I am telling you its way up.
Jonathan: Folks, his name is Dr. David L. Katz. Hopefully, if you been listening to this you’ve got goose bumps just like I do right now. The good news about Dr. Katz is that there is absolutely no shortage of information out there. David, you must not ever sleep because the amount of work you do… we will follow up on that once we hang up the phone. Because I just need to learn how you do that. It’s pretty impressive.
Folks, if you want to see all of David’s work, please check out David Katz, that’s with a Z. So D-A-V-I-D-K-A-T-Z-M-D.com. There is just an absurd… I am actually scrolling through your list of articles. That’s in addition to 12 books and all the other things you do. Lots of free information. So go check it out DavidKatzMD.com. The book we have been talking about is called Disease-Proof and the subtitle is The Remarkable Truth About What Makes Us Well. Dr. Katz, thank you so much for joining us today. Obviously, a wonderful conversation.
David: Jonathan, I couldn’t agree more. You really raise wonderful, insightful points. It’s been a pleasure. Thank you so much.
Jonathan: Well, we only scratched surface sir so I do hope you will come back.
David: I look forward to that.
Jonathan: Well, folks, I hope you enjoyed today’s conversation as much as I did. Please remember this week and every week after. Eat smarter, exercise smarter and live better. Talk with you soon.
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